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Complementary and alternative medicine (CAM) degrees in Australian and British universities have come under attack from sceptics who argue that such courses teach only 'pseudoscience'. Moreover, CAM academics have themselves been publicly labelled 'quacks'. Comparatively little is known about this group of health professionals who span the two worlds of CAM practice and academia. How do they navigate between these domains, and how are their collective and individual professional identities constructed? Drawing on 47 semi-structured interviews, this paper explores the professional identities of academics working in three university-based CAM disciplines in Australia and the UK: osteopathy, chiropractic and Chinese medicine. By analysing these individuals' accounts, and building on prior research on health professions in the academy, the paper contributes to understanding how contests about professionalism and professional knowledge take place against the academic-practice divide. By focussing on a domain where knowledge claims are conspicuously contested, it highlights the salience of navigating 'epistemic stress' for both group and individual professional identity. [ABSTRACT FROM AUTHOR]

This qualitative study investigates health care practitioners’ approaches to early childhood obesity in Denmark and their view on their own ability to initiate processes of change in affected families, and it asks the overall question of whether perceived barriers become real through practitioners’ reluctance to intervene in families labelled as ´problematic’. The paper identifies three approaches in the practitioners’ narratives: the socially oriented, the individually oriented, and the mixed. The individually oriented approach was based on a logic resembling individualistic explanatory models of behaviour change, and was related to a positive perspective on their own ability to move families towards healthier habits by health care practitioners. The socially oriented approach borrowed elements from a sociological perspective, which seemed to lead to resigned pessimism in the face of the complexity of the problem of childhood overweight and a reluctance to address early childhood overweight in some families. In practitioners of all three types, widespread cultural essentialism was found. Non-western, ethnic minority background was seen as determining family habits and making preventive action especially difficult. Based on this, the current paper discusses whether individual actions and choices are being ascribed too much explanatory power, and the health system's biased perceptions too little. [ABSTRACT FROM AUTHOR]

While recognition of transgender people has increased in Vietnam, this population continues to face significant stigma and discrimination within their families and in public, including in medical settings. Understanding of transgender health is limited, especially regarding the provision of care to transgender people. This paper explores providers' preparedness for delivering transgender care using data from qualitative interviews with twelve healthcare professionals in Hanoi and Ho Chi Minh City. Drawing on the socio-ecological model, we illustrated multi-level factors that influenced the provision of medical services to transgender people, including restrictive legislation (policy level); shortage of transgender-specific services, and lack of training and guidelines (organisational level); and ambiguous perceptions, inappropriate provider-patient communication, and medical knowledge gaps (individual level). Overall, our study has identified a healthcare environment that is under-prepared to meet the complex health needs of transgender individuals. With this study, we call for intervention strategies beyond individual-level support and emphasise the urgency of allowing medical institutions to provide transgender-specific health services including gender-affirming surgery and hormonal treatments. [ABSTRACT FROM AUTHOR]

This paper, based on data taken from in-depth interviews with senior midwives and obstetricians and conducted as part of a critical ethnographic study, argues for a greater appreciation of person-centred, value-led midwifery practice. The paper begins with a discussion of the way midwifery practice is shaped by encoded and embodied knowledge. The paper subsequently focuses on an emergent practice-based leadership using an adapted Aristotelian conceptual framework derived from MacIntyre [(2007). After virtue (3rd ed.). London: Duckworth]. Professional dissonance is highlighted as a difficulty experienced by repositioned managers who are also expected to be leaders in their field. Using data gathered from indepth interviews it is contended that establishing person-centred care might be better achieved through the development of practice-based leadership (rather than solely by adherence to organisational requirements). This type of leadership could potentially nurture a professional environment that promotes qualities such as agency, commitment and high levels of competence among midwives. Such leadership is central to UK government priorities and is applicable to a global practice development agenda. [ABSTRACT FROM AUTHOR]

There is increasing pressure on complementary and alternative medicine (CAM) to follow the evidence-based approach promoted in allied health and medicine, in which the randomised control trial represents the evidence gold standard. However, many CAM advocates see these methods as undermining the holism of CAM practice. This paper explores how such tensions are managed in CAM university departments – settings in which particular forms of knowledge and evidence are given 'official' imprimatur by CAM educators and researchers. By comparing two types of CAM, the paper also unpacks differences within this broad category, asking whether CAM academic disciplines comprise different 'epistemic cultures' (Knorr-Cetina, K. (1999). Epistemic cultures: How the sciences make knowledge. Cambridge, MA: Harvard University Press). Interviews were conducted with 20 lecturers in Chinese medicine and osteopathy, across five Australian universities, and augmented with observation in two degree programs. Findings reveal contrasting ontological and epistemological perspectives between the two academic fields. Chinese medicine lecturers had largely adopted bioscientific models of research, typically conducting laboratory work and trials, although teaching included traditional theories. Osteopathy academics were more critical of dominant approaches and were focused on reframing notions of evidence to account for experiences, with some advocating qualitative research. The study illustrates CAM's 'epistemic disunity' while also highlighting the particular challenges facing academic CAM. [ABSTRACT FROM AUTHOR]

Health promotion, as one tool of hospital managers to reorient hospitals towards more client-oriented healthcare services, has been emphasized for almost three decades. Yet, it is recognized that change in hospitals is challenging and is more desired than substantially enacted. To overcome organizational challenges, health promotion has, so far, adapted organizational change strategies primarily applied in business organizations. However, in this paper, it is argued that such strategies do not adequately reflect the nature of hospitals as 'professional organizations'. To gain a better understanding of the challenges for health promotion reorientation, this paper combines well-established theories from the sociology of professions and organizational science. These theories provide a useful framework that advances the role of professionals as powerful agents within any reorientation efforts in hospitals. This framework guided the narrative review of empirical literature on critical dimensions along which professionals engage with reorientation efforts in hospitals. Accordingly, specific managerial strategies to facilitate health promotion reorientation are formulated. With its theoretical underpinnings and related empirical studies, the paper offers a new perspective on the challenges of implementing health promotion and proposes strategies that may help hospital managers to push forward health promotion reorientation in their organizations. [ABSTRACT FROM AUTHOR]

The branding of ayurveda as a market strategy for the health consumer has become an important factor in the creation of 'New Age orientalist desire'. Using Vedic Village as a case, this paper shows how new age orientalism has been spread in modern India to middle class professionals, entrepreneurs and overseas health tourists. With this representation, ayurveda has become a wellness therapy instead of a means to restore health, and affluent people can now buy a package of 'ayurvedic healthy life' without changing their lifestyles. In addition to Euro-American health tourists, emerging middle class professionals and entrepreneurs in modern India have also become an integral part of the process of 'new age orientalization'. This paper concludes that the commodijied version of ayurveda, which has been developed in the West as part of 'wellness and spa culture', has become popular among the affluent middle class in India and abroad today, and through this the West has claimed and justifies authority over Eastern medicine. [ABSTRACT FROM AUTHOR]

This concluding paper draws together the dominant themes across the papers published in this issue. The majority of the papers clearly point to disparities between the aims of policy-makers and mental health workers. Using a variety of perspectives and methods, the authors of these insightful papers argue that modernist, rational approaches to structuring and evaluating services are at odds with the professional needs of mental health workers. At one level this critique is self-evident given the messiness and uncertainties inherent in working with service users whose individual problems require flexible approaches tailored from a broad and evolving practice-base. For some authors, the focus is epistemological and methodological; they offer much needed examples of analysing policy construction, interpreting statistics and the concurrent application of the widely used concepts of medicalisation and structural inequality. Together, the papers indicate that the progress of mental health reform in many western countries remains inconsistent and, in some cases, obstructive to effective professional practice. [ABSTRACT FROM AUTHOR]

There has been a tendency for researchers and practitioners to overlook the needs and experiences of children and young people in relation to disasters. In this paper, we report on our exploration of the question of whether to involve children and young people in post-bushfire research, and if so how? In considering children's rights in this context we were guided by a number of conceptions of the child (reflecting research debates within the Sociology of Childhood): The citizen child; the child at risk; and the developing child. We engaged in formal, progressive consultations with experts internationally and with bushfire affected community partners. This study determined that research with children post-bushfires was an important, ethical and appropriate activity, provided the methodology was sensitive and allowed children to provide informed consent and to have a sense of control over the issues being discussed. We conclude that carefully considering a rights approach materially changed the final methodology that includes the perspectives of children and young people in research about recovery from traumatic disasters, while still respecting their right to be safe and supported. [ABSTRACT FROM AUTHOR]

Scientific-bureaucratic medicine (SBM) has been the dominant discourse on evidence-based medicine in the English National Health System (NHS). It has being claimed that SBM has led to new forms of medical professionalism with an emphasis on organisational values and the control of autonomy. This paper explores the medical professions' response to SBM, where SBM is manifested in the form of National Institute of Health and Clinical Excellence (NICE) guidelines. Seventy-four face-to-face informal interviews were carried out with clinicians and managers between 2007 and 2009. Three major themes emerged from the analysis each of which was linked to doctors' receptiveness to NICE guidelines implementation. The first emphasised organisational values, which accounted for conditional acceptance of NICE guidelines. The second was proactive professionalism or entrepreneurial professionalism, which was linked to the rejection of NICE guidelines and the emergence of alternative forms of introducing new ideas for the expansion of their clinical practice. The third was related to the prominence of clinical autonomy linked with doctors' resistance to the use of NICE guidelines. It is argued that this evidence does not reflect a significant emergence of new forms of professionalism but the development of multiple occupational identities. [ABSTRACT FROM AUTHOR]

Despite almost two decades of reform under Australia's National Mental Health Strategy, the life circumstances of many people with mental illness seem little improved. While lack of rehabilitation, housing and community support services have been blamed for policy shortfalls, there is also concern that mental health services may impede rather than facilitate recovery from mental illness. To explore this particular concern, this paper reports data from a project which evaluated a group mentorship programme for new graduate nurses working in an Australian public mental health service. Prominent among the problems raised in mentorship group discussions were: the arduous nature of mental health work; the uncaring attitudes and practices of many veteran nursing staff; and the maltreatment and neglect of service users. These participants characterised mental health facilities as tough security-minded places, where staff act more as risk-managers rather than therapists, and all service users are treated as if they might be dangerous. They also perceived a connection between the dismissive ways in which they were often treated by veteran colleagues and the widespread mistreatment of service users. [ABSTRACT FROM AUTHOR]

This paper reports on a qualitative study of UK mental health practitioners' experiences of working with the contested condition, dangerous and severe personality disorder (DSPD). Our interviews focused on the issues of treatability, risk assessment and decision-making in multi-disciplinary teams. We discuss the approach of values-based medicine (VBM) as a useful framework for interpreting the data: respondents cited both explicit values (based on occupational training) and implicit values (based on personal beliefs and subjective perceptions). There was evidence of conflicting values -- within individuals, between occupational groups, and between individuals in occupational groups -- which led to widespread uncertainty and caution about whether and how those with 'dangerous' personality disorders could be treated. These disputes were resolved by a 'slide to pragmatism', whereby practitioners, reluctantly acknowledging their own empowerment in the process, sought to make whichever choice was least risky for their own professional reputation, and most pragmatic, given the resources available. [ABSTRACT FROM AUTHOR]

The aim of this paper is to explore how the avoidance of death preoccupies the focus of most health professionals, including policy makers, in the western world, and the implications of this for the lives of people with chronic diseases. Avoiding death has become the ultimate challenge in the provision of contemporary healthcare. An implication of this way of thinking for people with chronic diseases is that their chronic disease is then positioned as something which will produce a death which could have been avoided. Such a death is then viewed as failure, not only biological, but also social. However, such failure is also position [ABSTRACT FROM AUTHOR]