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This paper considers matters of time in online mental health peer support. Significant evidence of the value of peer support exists, with new digital platforms emerging as part of the digitisation of mental health support. This paper draws from a project exploring the impact of digital platforms on peer support through interviews with users of a major UK-based online peer support platform. Drawing on Gilles Deleuze's concept of the 'living present', the paper highlights how notions of past, present and future operate as co-existing dimensions of the present. The analysis highlights how the immediacy of digital platforms elicits expectations of peer support being 'on tap', which creates challenges when support is not received synchronously. Unlike in-person support, digital platforms facilitate the archiving of support, which can (re)enter the present at any moment through asynchronous communication. Anticipations of the future feature as dimensions of the present in terms of feelings regarding when support may no longer be needed. The paper offers potential implications for social scientific understanding of digital peer support, which include valuable insight for mental health services designing and delivering digital peer support. [ABSTRACT FROM AUTHOR]

This paper uses a drama-based method to illustrate the responses of healthcare and legal systems to women experiencing coercive control. This approach involved writing a play using the first-person narrative voice of a victim-survivor. We presented the play at the Stop Domestic Violence Conference (Gold Coast, Australia) in 2021. The central character, 'Kate', provided an embodied performance that enabled the conference participants to see, feel and understand experiences of coercive control from a personal perspective. We followed the trajectory of coercive control from the beginning of an intimate relationship to the time of separation. We showed how the process of coercive control escalates from love bombing, reproductive coercion, isolation, and technology-facilitated abuse until a point of police intervention. As Kate told her story, the conference audience witnessed the barriers and challenges faced by survivors of coercive control, and the emotional, financial, and psychological impacts that are intensified in geographically remote environments. They watched Kate navigate health and other systems meant to help women experiencing domestic and family violence, but that ultimately failed to deliver. Finally, the drama-based approach allowed us to present a feminist embodiment of coercive control and an innovative method for communicating inter-disciplinary research findings on domestic abuse. [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]

The production of sociological knowledge in Australian universities is explored through an empirical study of research papers published in a selection of academic outlets between 1960 and 2011. Drawing on theories concerning scholarly practices, institutional formation and the sociology of knowledge, questions are posed about the factors that shape and structure the production of sociological knowledge about health and medicine. The concept of intellectual schools is examined, with evidence sought for the presence of these 'knowledge networks' in the Australian context. The study suggests the formation and maintenance of schools are subject to structural factors within the university sector, specifically the relative wealth and prestige of the university and the dictates of the higher education market. [ABSTRACT FROM AUTHOR]

Over the past decade ‘social egg freezing’ has emerged as a technology of hope that purports to empower women by enabling them to continue their careers or find the right partner without the fear of jeopardising their fertility. This technology has been promoted and celebrated by fertility companies, bioethicists, clinicians, and multi-national corporations such as Apple and Facebook. While critical questions have been raised, they tend to focus on ethical and legal issues, such as informed consent and patient autonomy. This paper uses Foucault’s notion ofdispositifas analytic lens to examine the entanglement of the commercial arrangements of fertility companies, the discursive use of hope in promoting these services, and effects on professional medical care. Drawing on socio-political analyses of hope, this paper examines the potential financial conflicts of interest facing clinicians and the way discourses of hope might mask problematic financial relations and lack of evidence of effectiveness. [ABSTRACT FROM AUTHOR]

This paper presents findings from a UK mixed-method study that aimed to understand parents/carers' views and experiences of support received from health services for primary school age (4–11) gender diverse children and their families. Data was collected via an e-survey including 10 open-ended questions with 75 parents/carers addressing experiences with (i) primary health services, including general practice (GP) clinics and child and adolescent mental health services (CAMHS) (ii) specialist gender identity development services (GIDS) (iii) non-health related support including transgender groups and online resources. Findings are organised into four themes: 'journey to health service provision', 'view on health services used', 'waiting' and 'isolation'. Discourses about gender diversity, childhood and the validity of trans healthcare shape parental experiences, including their desire for better information, more certainty in healthcare pathways and more expedient access to support services to reduce anxiety, distress and isolation. The emotional costs of waiting are compounded by the material costs of accessing the limited number of specialist services. Experiences could be improved through ensuring GPs and CAMHS are better prepared, expanding access to trans-specific support groups for those caring for children and young people, and exploring the provision of school-based support for gender diverse primary-age children. [ABSTRACT FROM AUTHOR]

Poor health and disease and the nature of interventions to ameliorate them typically generate opportunities and costs. What diseases are prevalent, which interventions are favoured and what factors fuel the nature of health interventions are recurrent concerns for political economists. This paper examines the prevailing viewpoints about what health policy works and what does not. Drawing on evidence from developing countries, it shows that there are many deficiencies in the prevailing orthodoxy which emphasises state, market, and civil society solutions. The paper suggests that health policy debate must be refrained around poverty and social inequality, constructs which are often subordinated to attaining grand ideological goals. [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]

More than 20 years have elapsed since the book that is the subject of this special edition was published. The aim in this scene-setting introductory paper is to undertake a stock-taking of status of doctors, doctoring and professionalism as we head into the 21st century. It considers the various challenges to medical dominance of health systems including neo-liberalism and economic rationalism, a growth in consumerism and associated litigiousness, the change from a cottage industry basis to mass markets as medicine has been industrialised, the rise of complementary and alternative medicine (CAM) and changing roles of other health care professionals. [ABSTRACT FROM AUTHOR]

This paper discusses the role of video-based research methods in social research. The paper situates these methods in the context of rising levels of visibility of professionals in government-funded organisations. The paper argues that while visual research may appear to play an ambiguous role in these organisations, it can also enable practitioners to confront the encroaching demands of post-bureaucratic work. To ground its argument, the paper presents an account of a video-ethnographic project currently underway in a local metropolitan hospital. This project focuses on negotiating understandings about existing care practices among a team of multi-disciplinary clinicians. Visual data gathered as part of that project are presented to specify issues which have thus far arisen during the project. Against this empirical background, the paper turns to considering the ambiguous potential of video-based research. The argument developed here is that, besides potentially exacerbating the pressure already imposed on clinicians - thanks to audit, surveillance and risk minimisation - video-based research may provide staff with new resources and opportunities for shaping their increasingly public and visible work practices. [ABSTRACT FROM AUTHOR]

In England there has been substantial policy development and an academic drive to promote the goal of 'living well' for people with dementia and their family members. This article critically evaluates the feasibility of this intention, with reference to the experience of those caring for people with the condition. Qualitative data are utilised from a study which explored how couples negotiate relationships and care. The focus of this paper is the perspectives of spousal carers and the challenges they encounter within their caring role. Views were obtained via semi-structured joint interviews where the carer participated alongside the person with dementia. The extent to which living well with dementia is a credible aspiration for carers is examined via three themes: identity subsumed under care responsibilities; the couple as an isolated family unit; and barriers to professional support. The findings highlight that experience of caring is highly complex and fraught with multiple practical, emotional and moral pressures. It is asserted that research into dementia and care relationships must avoid a zero sum situation, prompted by living well discourses, where attempts to bolster the position of people with dementia compound the marginalisation and stigmatisation of informal carers. [ABSTRACT FROM AUTHOR]

In Australia we have become preoccupied with the potential adverse impact of our ageing population on our health and social systems. The projected cost of having increasing proportions of our population in the over 70s, retired, chronically ill category of the demographic profile is emerging as a major challenge for governments and private insurers: so much so in fact that the government is now urging older people to stay at work longer. In America, new approaches to the management and self-management of chronic diseases have been invoked to encourage and support older people to improve their quality of life and reduce their recourse to and dependence upon health care technologies, clinical interventions and health care management systems. Unless this is achieved, it is argued, the cost of looking after this emerging ‘bubble’ of elderly people will become increasingly unsustainable as fewer and fewer (proportionately) younger people work to pay the taxes that support ageing, retired, sick and dependent populations. This paper argues that we are at real risk of having our economic wealth and productivity impeded and truncated by the financial burden of looking after high demand and high cost dependants at the aged end of the social demographic. This paper offers an alternative view of our ageing population, as well as highlighting some of the assets we have in our elderly populations, and providing suggestions as to an alternative view of the phenomenon of ageing that incorporates elements such as flexible working arrangements and the application of new, enabling technologies. This approach to our ageing population dilemma is predicated on a concept of lifelong learning and social participation along with better preventive and early intervention systems of health care. [ABSTRACT FROM AUTHOR]

Health researchers in a number of settings are expressing concern about the 'gap' between what we 'know' about the social determinants of health and of health inequalities, and the lack of action based upon this 'knowledge'. Indeed, the 'know-do gap' has become almost a mantra echoed across international and some national institutional sites. This paper examines how the 'problem' of the 'gap' is understood and represented in dominant and sub-dominant conceptualisations. It highlights what is missing from these representations: adequate reflection on changing modes of governance of research management. Where once there was a degree of separation between research production and government policy, increasingly there is congruence between these governmental functions. This congruence means that the problem we face today is not a 'gap' but rather a 'fit' between what we 'know' and what we (don't) do regarding SDH. [ABSTRACT FROM AUTHOR]

The question we raise in this paper is whether the educational gradient in avoidable mortality differs from overall and non-avoidable mortality among men and women in Norway. By avoidable deaths we refer to deaths caused by diseases that are either treatable if given appropriate medical care, or preventable if available preventive measures were implemented. The data set is derived from official administrative registers and includes all Norwegian men (1 107 427) and women (1 087 842) aged 25-67 years with information about status alive/dead during the period 1994-1999. Adjusted for sociodemographic and socioeconomic factors, education forms a marked and independent gradient in overall and non-avoidable mortality and an even steeper gradient in avoidable mortality - in particular in ischemic heart disease and preventable deaths. The educational gradient is shallower for deaths considered treatable by health care, but is still present. These patterns apply to men and women alike. The findings of our study suggest that health care and health policies may play a role in reducing inequalities in deaths that are 'avoidable, unnecessary and unjust'. [ABSTRACT FROM AUTHOR]

This article deals with the social democratic aspiration of equitable access to health care in Bulgaria, a country in transition since 1989 from communism and a command economy to democracy and a free market. The focus is on access to health services and resources after the introduction of a universal health insurance system, with particular reference to formal and informal out-of-pocket payments for health care. The paper reports empirical results from a national household expenditure survey, supplemented with a semi-structured interview, conducted at the end of the survey period (April-May 2002). The results bring to light the groups in society who suffer most in this scenario: the poor, Roma, older persons and those living in towns and villages. The study reveals that the stated aim of the National Health Insurance Fund, to provide equitable access to health care, is a mirage rather than a reality, as the vast bulk of health care is self funded. This paper has particular significance for understanding the challenges faced by post-communist states in their attempts to achieve social democratic health care reforms. [ABSTRACT FROM AUTHOR]

With the commodification of healthcare in general and of private health in particular, it is difficult not to acknowledge the growing influence of competition and 'the market' in shaping the way that nurses' work is managed by private hospitals and by nurses themselves. This paper explores the discourses shaping nurses' work in private healthcare, drawing upon data from an ethnographic study conducted in one Australian acute care private hospital. The framework for analysis relies on an exploration of the mentalities and governance of nurses' work in such a setting. The study shows how marketing and performance measures are believed to ensure the viability of the enterprise while simultaneously commodifying nurses' caring work. It is this work that remains invisible to the healthcare system and the hospitals where they work. [ABSTRACT FROM AUTHOR]

The 21st century will be characterised by aged and ageing nations, making eldercare a growing concern. Most eldercare in most nations will be provided informally, primarily by female family members. Helping these people understand the dimensions of eldercare is a key to effective and cost-effective caregiving. The Person-Environment Model (Lawton and Nahemow 1973) is proposed as a theoretical framework for understanding, assessing, and optimising family-based caregiving. This paper presents findings from a qualitative study of informal rehabilitation caregiving provided to elderly stroke survivors in Thailand. Four main rehabilitation dimensions (biological, psychological, social, spiritual) are identified, as are three main caregiver needs (information, assistance, and support). We suggest that while the Person-Environment Model is useful in developed nations, it is perhaps more valuable in societies where fewer options to family-based eldercare exist, and thus where effective informal eldercare is more critical. Implications for education and training of health care providers are also discussed. [ABSTRACT FROM AUTHOR]

This paper examines the extent to which US citizenship status affects the probability of a person's having a usual source of care and the predictors associated with access to health care among non-citizens. The research is founded on the analysis of data from the 2005 California Health Interview Survey (CHIS) (n = 33,187 adults, ages 18–64). Guided by a modified Andersen model of access to health care, the researchers conducted a series of logistic regression analyses using the survey data to compare native-born citizens with non-citizens who were 1.6 times less likely to access a usual source of care. Among non-citizens, insurance status, shorter duration of residence in the United States, and lower levels of English proficiency were related to a lower probability of having a usual source of care. Based on this research it is argued that affordable health care and health insurance options and access to culturally and linguistically sensitive services are needed to increase access to health care among these identified subgroups of non-citizens. [ABSTRACT FROM AUTHOR]

The increase of chronic illness as a leading cause of death has given rise to self-care and expert patient initiatives. Caring for chronically ill people places a tremendous economic burden on the health care system, informal carers, the labour market and benefit system (Department of Health 2001, 2004, 2005). Thus, in many countries health policy encourages patients to become ‘experts’ in the self-management of their conditions in the belief that it will help save money and improve health and well-being (Wanless 2002). For example, the notion of ‘expert patients’ has emerged in UK policy and is pivotal to government plans to modernise the National Health Service (NHS) by linking patient expertise to ideas of empowerment, a better quality of life, self-esteem and a user-driven NHS (Department of Health 2001; Fox et al 2005). Self-management and expert patient initiatives aim to encourage chronically ill patients to become more actively involved in decisions concerning their care and well-being (Lorig and Holman 2003; Lorig et al 1985, 1999, 2001). [ABSTRACT FROM AUTHOR]

This paper reports on a recent population-based study of the last months of life of 1071 people in Western Australia who died from a chronic condition. Data was collected from death certificates and telephone interviews of primary carers who acted as proxies providing second hand accounts of the severity of the deceased person's symptoms and sources of concerns, their awareness and acceptance of dying, and experiences of the health care system. We present descriptive statistics and quotes supporting our premise that dying in Australia is largely mismanaged. We base our assertions on three themes: dying with multiple conditions and symptoms; awareness and acceptance of dying; and support during the dying process. Each theme illustrates the difficulty of self-managing complex conditions, the failure of the health care system to acknowledge this complexity, and the need for a more radical and social approach to the management of dying. [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]

This paper examines the governance of the medical profession in the UK. As in many other countries, external and internal pressures have brought a shift in relations between the state and medicine. From a relatively protected position within the British NHS, where clinical autonomy, social status and involvement in a corporatist politics, the context in which doctors practise has undergone radical change. In common with many countries, the UK has turned to competitive markets, and state-sponsored regulatory measures to boost performance. As a consequence, state domination of the health policy agenda has increased replacing a corporatist politics and doctors' individual clinical autonomy has been reduced. Moreover, the existing system of self-governance is in question. It is argued that, nevertheless, there is evidence of different forms of accommodation. The medical profession continues to control a valued knowledge base, retains its social standing and is able to reap economic rewards. A more plural form of medical leadership may emerge better suited to assuring quality in patient care. [ABSTRACT FROM AUTHOR]

There has been a renewed interest in collaborative models of health care delivered by 'interdisciplinary teams' of providers across several health care systems. This growing phenomenon raises a host of issues related to the management of professional boundaries and the contemporary state of medical dominance. In this paper, we undertake a critical analysis of the factors both promoting and impeding collaborative care models of primary and mental health care in Canada and the U.S. The data our arguments are based upon include a combination of documentary and interview data from key stakeholders influential in various collaborative care initiatives. Based on these data, we develop a conceptual model of the various levels of influence, focusing in particular on the macro (regulatory/funding) and meso (institutional) factors. Our comparative policy and institutional analysis reveals the similarities and differences in the influences of the broader contexts in Canada and the U.S., and by extension the different ways that the structural embeddedness of medical dominance impinges upon and reacts to recent policy changes regarding collaborative health care teams. [ABSTRACT FROM AUTHOR]

This paper deals with the dynamics of medical dominance and patient choice, primarily within the Britain, with reference to a range of other European countries too (including Germany, France and Greece) for comparative purposes. It will draw upon two concepts in particular: 'responsibilisation' and 'proto-professionalism', the first undermining medical dominance the latter reinforcing it. The ongoing influence of a neo-liberal and managerialist agenda has eroded the certainties of the welfare state and the assumptions underpinning the dominant role of the medical profession, which has been subjected to increasing external state regulation and control (Dent 2003a). These reforms, which are associated with New Public Management, have been aimed at bringing the cost and quality of health care more effectively under the control of the state. This has involved redefining the compact or contract between the medical profession, public and the state. In this project greater emphasis is being formally given to the wishes of patients. Rather than the physician claiming to be the patient's voice it is now the state administration's assertion to have provided the patient with their own voice(s) - and choices. [ABSTRACT FROM AUTHOR]

Alcohol consumption is a significant public health concern in Australia, with men disproportionately represented in treatment for health issues related to heavy drinking. Despite this, little is known about the experiences of these men or the gender dynamics that may shape heavy drinking. Increasingly, the treatment of alcohol and other drug-related issues, including those related to heavy drinking, is based on a biopsychosocial approach. Within this framework, heavy drinking is understood as a symptom of individual pathology in the context of various social 'factors' that influence individual capacity to exercise agency. Following the work of Karen Barad, this article employs a feminist science studies account of agency to formulate heavy drinking as a gendered 'phenomenon': enacted and sustained through the 'intra-action' of other phenomena. Drawing on interviews with men who drink heavily, our analysis explores how the phenomenon of men's heavy drinking materialises through the intra-actions of gender, isolation and healthcare. We argue that heavy drinking is not a sign of failed individual agency but an expression of entangled agencies. In concluding, we suggest it is possible to enhance the well-being of men who drink heavily by addressing specific gendered intra-actions in the making of heavy drinking. [ABSTRACT FROM AUTHOR]

In this article, we examine the ways transitions are constructed and represented within healthcare settings vis-à-vis lived experiences. Drawing on in-depth interviews with transgender people and data from a document analysis, we examine how transgender peoples' experiences fit within conceptualisations of transition(s) in healthcare guidance documents used in England. We take up Pearce's ([2018]. Understanding trans health. Bristol: Policy Press) suggestion to (re)think trans beyond 'condition', and rather as 'movement', to view being trans as a social identity rather than a defect. Our findings show how trans people and transitions are imagined through often linear narratives of movement in/out of transition. Through this framing, fluidity and gender liminal spaces are made invisible, where health care is imagined for certain transitions but not others. Our analysis attends to tensions that emerge in the complexity of transition(s) as well as the intricate ways in which transgender people are responding to often restrictive ontologies of medical transition. As a conceptual tool, 'trans as movement' can be used to create space for more expansive ontologies of gender that confront the harms and restrictions imposed by the gender binary, and offer alternative ways of (re)imagining multiplicity in transition trajectories and futures for both those in healthcare delivery, and for trans patients. [ABSTRACT FROM AUTHOR]

Access to medical care is significant for many transgender young people and their families, which involves interactions with healthcare professionals. While a trans affirming model is used across Australian paediatric gender clinics, this does not automatically mean that all transgender young people and their parents experience the care they receive as affirming. This article considers the experiences and views of transgender young people (aged 11–17) and their parents in relation to healthcare professionals inside and outside of gender clinics in Australia. Ten qualitative interviews were conducted with parent–child dyads in two Australian states. Key themes relating to healthcare professionals were: differing levels of healthcare professional knowledge and affirmation, quality of service is dependent on individual healthcare professionals, and lack of connected services and referral pathways. The discussion explores specific issues arising from the findings that suggest implications for training for healthcare professionals so as to be better equipped to provide trans affirming clinical care. [ABSTRACT FROM AUTHOR]

In the context of persisting health inequities within many multicultural and socially diverse countries like Australia, there is a call for health services to implement culturally inclusive systems and practices. Nowhere is this more important than in regional, rural and remote Australia where consumers are diverse, health services are scarce, and services designed for particular groups of the population are lacking. Drawing on interviews with 20 staff of a rurally-based, mainstream community health service, this article examines the role of discourse in the transition to a culturally inclusive health centre. In doing so, the power struggles inherent in such a process are highlighted. The article contends that improvements in the health outcomes of First Nation and culturally Other groups within the Australian population is contingent upon systematic resistances that disrupt and re-arrange existing dominant discourses. This calls for a disruption of current race relations in both broader social fields as well as those supporting biomedical assumptions about the delivery of healthcare in the mainstream health sector. Alternative discourses must be promoted in both these fields. [ABSTRACT FROM AUTHOR]

South Africa's long and arduous journey from colonial and apartheid-era care for people with mental illness to more comprehensive, equitable mental health care is well-described. Deeper engagement with the structural power dynamics involved in providing collaborative mental health services are less-well described, especially in its post-apartheid era. This conceptual article positions state and non-state mental health service providers - along with their relationships and conflicts - within Bourdieu's bureaucratic field. It is suggested that key internecine struggles in South Africa's post-apartheid socio-political arena have influenced the ways in which collaborative mental health care is provided. Drawing from two recent examples of conflict within the bureaucratic field, the article illustrates the ways in which neoliberal forces play out in contemporary South Africa's mental health service delivery. Struggles between the state and private healthcare in the Life Esidimeni tragedy receive focus, as well as the shifting of responsibility onto civil society. A court case between the state and a coalition of non-profit organisations provides further evidence that neoliberal rationalities significantly influences the position and power of non-state service providers. Unless serious consideration is given to these dynamics, collaborative mental health care in South Africa will remain out of reach. [ABSTRACT FROM AUTHOR]

Despite an increasingly pathologised discourse on overweight and obesity, the clinical experiences of large bodied individuals remain relatively unexplored. In addition, interventions targeting overweight and obesity have generally failed to recognise the role that weight related discrimination and stigma play in both the uptake of interventions and the experience of healthcare consumers. This Australian research used a grounded theory approach, informed by constructivism, to further understanding and generate dialogue about the experiences of large bodied female healthcare consumers. Participants included 22 women, who were purposively sampled, all of whom identified as overweight or obese. Data was collected from two major sources: intensive interviews with participants and literature. For the participants in this study, being overweight or obese created a significant barrier to positive clinical interactions with their medical professionals. Women described their interactions with medical professionals, particularly general practitioners (GPs) as the most challenging to manage. Participants believed that when they became patients, they were defined by their body size, which worked to create a one-dimensional identity – that of a fat patient. These findings suggest that weight-related discrimination and stigma has a significant impact on both the clinical interaction, and the health and wellbeing of large bodied, female healthcare consumers. [ABSTRACT FROM AUTHOR]

Few studies have examined the relationship between religiosity and health-seeking belief outcomes in Ghana. Drawing on in-depth interviews and group discussions with informal prayer group members and leaders in Accra, Ghana, the study explores participants' conceptions of illnesses and the significance of the forest as a place of gathering and healing. There are several reasons why prayer group members in this study make their way to the forest, including finding a serene sacred space in a crowded city to confront the vicissitudes of life. Disease, for the prayer group members, is seen to hold both spiritual and physical origins, inspiring them to seek both biomedical and spiritual forms of care. Interviewees believed hospitals could help with physical diseases, but saw spiritual diseases as requiring spiritual solutions. There was a salient differentiation expressed between treatment and healing, however: doctors can treat certain conditions, but only God heals. While there is a need for public health practitioners to better engage spiritual/religious leaders and their followers with mainstream biomedicine, and to challenge some of their misconceptions and mistrust, attending to and understanding the role of religious beliefs, and religious spaces, in everyday conceptions of health, would strengthen the promotion of both men's and women's health in this context. [ABSTRACT FROM AUTHOR]

In this article we approach socioeconomic inequities in cancer by examining a particular dimension of health care: how health services attending patients with cancer set priorities for their daily activities. By using qualitative ethnographic data, we explore logics underlying how practitioners make priority-setting decisions regarding cancer prevention and care. We found four main types of accounts: accounts based on macro social inequalities, accounts based on patients' social and cultural features, accounts based on characteristics of health services, and accounts based on personal voluntarism. These blurred logics shape the everyday decisions which have an impact not only on the quality of health care in general but on the increasing socioeconomic inequities in cancer care attention. [ABSTRACT FROM AUTHOR]

Informal payments are prevalent in the health care systems in the post-communist economies. Some scholars attribute the emergence of the phenomenon to the tension between patients' rising expectations for quality and the shortages due to government failure, and accuse it of exacerbating inequality in health care. However, existing literature does not identify which part of medical services is affected by poor quality. Drawing on evidence from interviews with Chinese doctors, this research shows that the informal payment system has only limited impact on the technical core of medical procedures but can considerably improve the quality of the peripheral components of medical practice. It further argues that the influence of informal payments on inequality is also limited because evidence indicates that Chinese doctors maintain their professionalism. [ABSTRACT FROM AUTHOR]

The implementation of interprofessional practice (IPP) within healthcare appears to be fraught with difficulties, despite the attention it has received in the literature. Although there are examples where IPP has reaped significant benefits, it has also been shown to impede team performance. We demonstrate that a key cause of failure in IPP can be attributed to interprofessional conflicts based on threats to professional identity, and provide insight into how professional identity faultlines have the potential to be activated and conflict induced when there is differential treatment of professional groups, different values between professions, assimilation, insult or humiliating action and simple contact within the team. This has significant implications for the management of interprofessional healthcare teams and provides information for team leaders and health managers. [ABSTRACT FROM AUTHOR]

Our aim is to examine a series of systems-level challenges to the continuity of care of a newborn (i.e. a particular case) in the rural–urban context. These challenges include the state-wide system whereby inadequate bed numbers relative to demand are monitored on a daily basis (bed management), specialist medical expertise as a resource, and the flow of information between hospitals in a rural–urban divide. Whether quality of care is maintained in light of these challenges is dependent on the relationships and ‘invisible’ work of a number of clinicians. Of critical importance are issues involving affective or invisible work and the solidary networks and relationships of clinicians. Ethnographic participant-observations were made of clinical teams and their networks in an Australian rural–urban health care service involving the multiple hospital admissions of a seriously-ill infant. The findings demonstrate that the system works because of clinicians' willingness to enact their practice knowledge, the networking they undertake, their resilience and the affective labour they perform to attend to patients' and families' needs. Ultimately the continuity of care is embedded in the quality of relationships as much as in specialist knowledge or professional expertise. [ABSTRACT FROM AUTHOR]

While anti-ageing medicine may be defined by efforts to control human aging, individual motivation to utilise anti-ageing medicine proves to be multifaceted. Qualitative, in-depth interviews with 15 people who have used anti-ageing medicine reveal that the turn to anti-ageing medicine may be more about disillusionment with allopathic medicine than it is about controlling bodily aging. By contextualising people's use of anti-ageing medicine within their lifelong body regimen ‘careers’, and looking closely at the first career sequence, which is characterised by a questioning of tradition – the tradition of allopathic medicine – new perspectives behind the rise of anti-ageing medicine are offered. Shared grievances with mainstream medicine tend to be situated around both the medical delivery and the medical treatment. Rather than reject the values associated with biomedicine, as is often the case with alternative health enthusiasts (Siahpush 1998), those using anti-ageing medicine seek out an ‘alternative’ biomedicine that they perceive to offer more satisfactory solutions to their problems. [ABSTRACT FROM AUTHOR]

Population ageing and increasing life expectancy are triumphs of modern times. However, advances in healthy ageing and longevity are not inevitable. Recent data suggest that future generations may not age in as good health as those who are currently over 65 years of age, particularly because of the rising prevalence of obesity. Obesity is a worldwide phenomenon associated with urbanisation and global changes to food availability, eating habits, and increasing sedentary activities. The current and future global impacts of this condition on health, health care expenditure, and human life expectancy are momentous. [ABSTRACT FROM AUTHOR]

The patients' ability to perform healthcare measurements by themselves using the information communication technologies (ICT) is a valuable variable. But are there ‘expert patients’ out there? The objective of the present study is to address this question. In Scenario A, participants performed measurements themselves using a portable biosignal device (PBD) in ‘bedside settings’. The data collected were validated against the measurements that were performed simultaneously via the routine hospital process. In Scenario B, five participants located at their homes performed measurements by themselves and without surveillance in ‘real world e-health settings’. Under surveillance (Scenario A), patients succeeded in obtaining many measurements accurately. In ‘real-world e-health settings’ (Scenario B) several measurements were not complete and accurate. Although there are not many expert patients out there yet, e-health outcomes may be improved by balancing three issues, namely surveillance, current patient status, and ICT difficulty level. [ABSTRACT FROM AUTHOR]

Interprofessional Education (IPE) has the potential to create and sustain the type of vibrant environments needed for Integrative Medicine (IM) to thrive. IPE strategies and initiatives are conducive to the goals of integrative medicine in that both seek to bring together diverse professionals. This makes the application of IPE towards advancing integrative medicine timely. Bringing together varied disciplines which represent biomedicine and complementary and alternative medicine (CAM), while maintaining each of their unique attributes, is what IPE can accomplish. Their synergy has the potential to improve holistic and patient-centered care, as well as bolster chronic disease management. That biomedical and CAM driven practice domains could work more collaboratively, by implementing IPE, for their own enhanced legitimisation as well as for the benefit of the people they serve, speaks of the importance of this emerging topic. [ABSTRACT FROM AUTHOR]

A United States sample of 166 transgender adults including 50 male-to-females (MTFs), 52 female-to-males (FTMs), and 64 genderqueers (neither completely female nor completely male), were surveyed about identity development, levels of disclosure of transgender status, and relationship to community. There was no difference among transgender groups in age of first experiencing oneself differently from assigned birth sex. MTFs first identified as other than their assigned sex earlier than FTMs. However, they did not present themselves to others in a gender-congruent way until much later than FTMs. MTFs were less likely to disclose their gender identity to their parents than were FTMs. Disclosure of assigned birth sex was more common among younger participants. There was no difference in the extent to which individuals felt connected to the transgender community. Genderqueers felt more connected to the lesbian, gay, and bisexual community than did MTFs or FTMs. Implications for health care professionals and transgender communities are discussed. [ABSTRACT FROM AUTHOR]

The primary aim of this study is the exploration of the views of physicians in Barbados on the provision of a patient-focused health service. Qualitative interviews were conducted with fifteen physicians based at a teaching hospital in Barbados. The data was analysed in relation to literature on the physicianpatient relationship with particular reference to 'patient-focused' versus 'provider-focused' approaches to health care delivery. Results were first, that while the concept of patient-focused care has gained some recognition in Barbados over the last five years, several respondents considered health care delivery was in general not patient-focused. Secondly, with regard to the sample of physicians interviewed, there were different approaches to health care delivery and varying extents to which physicians were 'patient-focused' in relation to different issues. Three broad approaches were identified: 'patient-focused', 'provider-focused' and 'intermediate'. Thirdly, physicians could also be grouped into three 'types' consistent with these three broad approaches; that is, patientfocused, provider-focused, and intermediate. [ABSTRACT FROM AUTHOR]

Many countries, including Australia, are currently experiencing severe shortages of professional, para-professional, and semi-professional workers in their health care systems. This is generally conceived as a problem stemming from rising demand in health care services or the production of inadequate numbers of health related graduates. A qualitative study of health care workers in the Australian context challenges the adequacy of this supply-demand approach to the health care system; and demonstrates that solutions lie in the conceptualisation of the health sector as a socio-cultural system. Findings indicate the extent to which policies independently formulated for the health, education, finance, and industry sectors have, in combination, inadvertently impacted on the functioning of the health care system, and some policy mechanisms, such as privatisation and marketisation, have fundamentally eroded its structural framework. Conclusions can therefore be drawn about the relationship between workforce shortages and the neo-liberal orientation of recent governments. [ABSTRACT FROM AUTHOR]

The publication of Evan Willis's notable book on medical dominance coincided with the appearance of similar Anglo-American accounts. Now, there are retrospectives on medical power. Why then and why now? Professional power was central because health care was the focus of political discussion at the time but is now less important vis-a-vis political struggles over neo-liberalism. Freidson played a key role in bringing medical power into focus. Medicine is also less sociologically prominent now because, it is in fact less powerful than it was. There is a convergence between the power of the traditional professions and that of numerous other expert occupations. Despite assumptions to the contrary it is noted that neither the linkages of knowledge/expertise/power nor the existence of putatively self-regulatory organizations is sufficient to ensure professional dominance or control. Closure theory, the pre-eminent approach in the area of the professions cannot adequately explain these changes in medical power. Rather, both challenges to medical power and the changing salience of medical dominance within sociology can be illuminated using the type of political economy approach which Evan Willis helped to pioneer. [ABSTRACT FROM AUTHOR]

This article analyses the concept of productivity underpinning the implementation of an information-technology-driven virage ambulatoire, or shift to outpatient care, as a solution to the productivity 'crisis' in Quebec's health care system. This 'crisis' was diagnosed in the 1970s and based on expenditure trends. These trends were regarded by the State as an 'obstacle' to balanced budgets and more generally, economic growth. Into this situation stepped the IT-driven virage ambulatoire with a structural reorganisation following a productivist logic. Unrolled in the 1980s, this connected health care to the economistic discourses of the 1960s which were developed to boost productivity in a service- or information-based economy. The State thus came to draw on analytic categories, developed for a very particular mode of economic analysis, to produce a hospital restructuring program oriented around IT-based ambulatory care. The result was the reduction of health care's principles of clinical and therapeutic efficiency to the administrative imperatives of time, quantum, cost, and optimisation, all of which became variables to be controlled, and the placement of economic logics ahead of clinical imperatives. Quebec has thus moved to a neoliberal productivist system in which clinical and therapeutic effectiveness are subordinate to economic need. [ABSTRACT FROM AUTHOR]