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Malawi is one of the world''s most AIDS-afflicted countries. In order to cope with the AIDS pandemic, we must know what the people most at risk think about it, how they evaluate their situation and that of their community, and what actions they would consider adopting to lower their risk. However, the main research methods in studying attitudes—surveys and questionnaires—have only a limited ability to capture what people think about AIDS. In order to get a more naturalistic perspective on attitudes towards AIDS from 1999 to 2001 six Malawian research assistants who lived in rural villages were asked to keep journals in which they wrote down information about all the conversations they participated in or witnessed in which the topic of AIDS surfaced in any way. The conversations ranged from graveside condolences following a funeral to stories told during men—only beer—drinking sessions, to women chatting on the bus. In this paper, I analyse these journals in order to see how men talk about AIDS in naturalistic settings, what they perceive as the impact of the AIDS epidemic, and how they understand AIDS risk. [Copyright &y& Elsevier]

The hormonal treatment of advanced prostate cancer involves life disruptive side-effects, such as impotence, libido loss and bodily feminisation. Conflicting views on the weight of the disruption they cause as against the therapy''s survival benefits currently underlie debates over its appropriate mode of administration and its optimal timing in cases that do not necessitate immediate intervention. On the basis of a study of the disruptions caused to various life domains of 15 Israeli patients receiving such treatment, the present paper illustrates an integrated approach to their analysis that sheds new light on their intensity. The study was conducted by means of in-depth interviews and its data were processed according to the constant comparative analysis method. Its findings indicate that the therapy allowed the patients to regain their strength, to retain their need of love, basic masculine self-identification and spousal ties, and to renew their past social contacts. On the other hand they could no longer define themselves as healthy, sexually competent and ‘male’ in all respects, and their pre-treatment relationships with partners and friends lost the sense of closeness. Further psychosocial costs that were detected include patients’ deprivation of their sense of continuity, excitements, hopes and coping capabilities. An integrated analysis of the concurrent normalisation and deviantisation processes undergone by them yielded the conclusion that the therapy subjects them to a liminal state, that is, the inability to classify themselves into culturally available categories. The difficulties entailed in this state highlight the need to take them into consideration when patients’ condition allows a choice between alternative forms of hormonal therapy and between its early or deferred commencement. The interpretation of the disruption to their lives in terms of liminality also clarifies former studies’ confusing reference to this subject and points to issues that still await investigation. [Copyright &y& Elsevier]

This research comes in the wake of increasing interest in men''s roles in childbearing decisions in sub-Saharan Africa. While some of the findings indicate that men tend to hinder fertility decline, we aimed to identify which men desire fewer children, under what circumstances, and why. The research was done in a Pare community in Northern Tanzania. It is our hypothesis that differences in men''s fertility desires and decisions are to be sought in the context of their conjugal union. This paper, based on data from a case study from two Pare villages, attempts to examine the relationship between male attitudes toward reproduction and marital relations. The methodology consisted of a combination of an ethnographic study and in-depth interviews. A subsequent survey, the questions for which were derived from the qualitative work, was administered in order to verify the generalisability of the findings of the qualitative work. Findings show that those men who desire fewer children are younger, educated at least to the primary and often to the secondary level, their wives have also completed at least primary school, they are more affluent, and they are likely to be Christian. They are in a marital relationship where the partners chose each other, they communicate with their wives about important issues, and make joint decisions, including the number of children they should have. The discussion relates the differences in the marital patterns and fertility preferences to differences in the life plans of Christians and Muslims in this community. [Copyright &y& Elsevier]

Views about correct ways of obtaining knowledge develop from socially constructed tenets and beliefs. The dominant beliefs about how health research should be conducted are derived from the biomedical model of human health. The beliefs are maintained by traditions developed in support of the orthodox model and by power relationships. This paper examines the impact of the orthodox views of the biomedical model on the research methods used to investigate population health issues. Experimental design is the “gold standard” for research in the biomedical model. Beliefs about the superiority of experimental research have affected most types of health research. The role that methods assume in maintaining the orthodoxy is examined. Acceptance in other health disciplines of the attitudes of the dominant paradigm and limited options for research and training in alternatives to the orthodoxy became major influences reinforcing orthodox beliefs about health research. [Copyright &y& Elsevier]

The past few decades have witnessed the increasingly active participation of patient organisations in research activities concerning them. They contribute substantially to the funding of scientific and clinical research. More importantly, certain patient organisations take strategic decisions concerning that research, and contribute to the production of knowledge on their diseases. In France, the AFM (Association Franc¸aise contre les Myopathies—French Muscular Dystrophy Organisation), is a striking illustration. The paper argues that the model of the AFM's engagement in research—the “partnership model”—is original insofar as it renews the power relations between patients and professionals found in two classic models: the “auxiliary model” and the “emancipatory model”. Based on a long-term study of the French Muscular Dystrophy Organisation, this “partnership model” is characterised and its implications discussed in three respects: the possible generalisation of the mode of relations it establishes between patients and professionals; its effects on the steering of research; and its consequences for the dynamics of patient organisations movements. [Copyright &y& Elsevier]

The International Pilot Study of Schizophrenia has had a major influence on mental health and research practice since its inception in the 1960s. It is most famous for demonstrating superior outcomes for people living with schizophrenia in developing countries over those living with schizophrenia in developed countries. Like other international research initiatives, it has been shaped by social, political and economic circumstances that contribute to positive and negative outcomes for participating nations. This paper evaluates the contribution of the pilot study by analyzing the discourse surrounding the dissemination of its results. The discussion of long-term outcomes across cultures is used to scrutinize the process of long-term research collaborations across nations. Discourse analysis of the research records indicates that, in various ways, the discourse was constructed to preserve an image of Western superiority and Third World inferiority. As the international research context shifts in psychiatry, it is hoped that inequitable practices that affect this and other studies will be challenged to benefit knowledge-building and mental health care across the world. [Copyright &y& Elsevier]

Involving children in their healthcare encounter is a national and international priority. While existing research has examined the ways in which children are recruited to participate in the consultation, no work has examined whether and how children instigate talk, and the extent to which their contributions are successful. This paper presents a conversation analysis of a selection of 10 out of 30 video recordings in which children aged 4–10 years instigate talk during consultations they attend with their parents/carers at a UK pediatric clinic. The analysis reveals for the first time that children do successfully instigate talk without being asked or selected in 22 episodes during their consultation with the doctor. Children most frequently address their parent/carer (16/22). They capitalize on specific contexts within the consultation to instigate talk, for example: history-taking questions about what they ate or how they reacted (10/22); or discussions surrounding the child's feelings or sensations following the skin-prick testing (7/22) - aspects of experience to which they have access. Children's non-solicited talk necessarily occurs when they are not currently active participators and children engage in extra interactional work including various verbal strategies (summons and prosodic variations) and non-verbal resources (tapping and gaze) to break into the interaction. The benefits of their contributions include the opportunity to affirm the child's role as a legitimate contributor, and the potential for additional medically-relevant information to arise which could enrich the clinical process. Our analysis shows that the previously overlooked phenomenon of children instigating talk, although not common, can play a crucial role in the consultation. We suggest that strategies to increase such involvement have the potential to augment the healthcare process. Our findings offer a critical baseline for the introduction of new consultations models, such as digital appointments, which may exclude some children completely. • Child contributions are valuable: do children instigate talk in consultations? • Meticulous conversation analysis of 10 videoed UK pediatric consultations. • Children instigated talk in 22 episodes, including crucial medical information. • Children drew on extra verbal and non-verbal resources to break into adult talk. • Understanding how children contribute is important when developing e-consultations. [ABSTRACT FROM AUTHOR]

Existing sociological research documents patient and physician reticence to discuss death in the context of a patient's end of life. This study offers a new approach to analyzing how death gets discussed in medical interaction. Using a corpus of 90 video-recorded oncology visits and conversation analytic (CA) methods, this analysis reveals that when existing parameters are expanded to look at mentions of death outside of the end-of-life context, physicians do discuss death with their patients. Specifically, the most frequent way physicians invoke death is in a persuasive context during treatment recommendation discussions. When patients demonstrate active or passive resistance to a recommendation, physicians invoke the possibility of the patient's death to push back against this resistance and lobby for treatment. Occasionally, physicians invoke death in instances where resistance is anticipated but never actualized. Similarly, death invocations function for treatment advocacy. Ultimately, this study concludes that physicians in these data invoke death to leverage their professional authority for particular treatment outcomes. • Historically, talk of death has been studied in an end-of-life (EOL) context. • This paper finds that death can be discussed outside of the EOL context. • One primary place death gets invoked in these data is in recommending treatment. • The primary function of death invocations is to advocate for treatment in a persuasive context. • Death can be involved in instances of both active or passive resistance to cancer treatment. [ABSTRACT FROM AUTHOR]

Misoprostol has during the past few years become an important obstetric drug used for different purposes both within and outside hospitals in Tanzania. In this paper, we analyze how misoprostol is perceived, accessed and used off-label as an abortion drug in the city and region of Dar es Salaam. The study took place in Dar es Salaam's three districts from July to November 2015, and had a qualitative explorative approach. We carried out in-depth interviews (42) with the following main categories of informants: women having undergone medical abortion (15), health care workers with experiences from post abortion care (16) and drug vendors (11). Focus group discussions (10) were carried out with young women. A client simulation study was carried out in 64 drugstores across Dar es Salaam assessing the availability of misoprostol and the advice given concerning its use. In addition, shorter qualitative interviews were carried out with representatives of NGOs and public agencies working with sexual and reproductive health issues (17). Our findings reveal that in Dar es Salaam, misoprostol is well known, available and accessed for abortion purposes through drugstores and health providers. Women tend to prefer misoprostol over other abortion methods since it allows for a private, low-cost, safer and less uncomfortable abortion experience. But, while misoprostol facilitates women's agency in the process of seeking abortion, a series of obstacles shaped by a restrictive abortion law and an unregulated pharmaceutical market hinder its safe use. Central obstacles are profit-seeking providers, suboptimal user instructions and poor provider follow-up. In the discussion of the material we draw upon Van der Geest, Hardon and Whyte's concept of the 'social life of pharmaceuticals' and indicate the ways in which misoprostol acts as an agent of change in the social relations connected to abortion. • Misoprostol is commonly used off-label for medical abortion in Dar es Salaam. • Misoprostol changes who controls access to abortion in restrictive settings. • Access to medical abortion enhances women's abortion related agency. • Access to safe medical abortion is context dependent. • Misoprostol and medical abortion may be studied as a social and cultural phenomenon. [ABSTRACT FROM AUTHOR]