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Although a diagnosis of a life‐limiting cancer is likely to evoke emotions, such as fear, panic and anxiety, for some people it can also provide an opportunity to live life differently. This article is based on research undertaken in Aotearoa New Zealand on the topic of exceptional cancer trajectories. Eighty‐one participants who had been identified as living with a cancer diagnosis longer than clinically expected were interviewed, along with 25 people identified by some of the participants as supporters in their journey. For some participants the diagnosis provided the opportunity to rethink their lives, to undertake lifestyle and consumption changes, to be culturally adventurous, to take up new skills, to quit work and to change relationships with others. The concepts of biographical disruption and posttraumatic growth are considered in relation to these accounts, and it is argued that the event of a cancer diagnosis can give license for people to breach social norms. [ABSTRACT FROM AUTHOR]

The article focuses on the challenges faced by scholarly journals, particularly the financial and academic unsustainability of the current publishing system, leading to the mass resignation of the Editorial Board of Critical Public Health. Topics discussed include the impact of rising costs, overproduction of research papers, and the need for new models of publishing to address the crisis in academic publishing.

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2009.01229.x Byline: Kevin Dew (1), Maria Stubbe (2), Lindsay Macdonald (2), Anthony Dowell (2), Elizabeth Plumridge (2) Keywords: elective surgery; prioritisation tools; doctor-patient interaction Abstract: Abstract Priority setting and rationing is a dominant feature of contemporary health policy. In New Zealand, clinical priority assessment criteria (CPAC) tools have been developed to make access to elective surgery more equitable and efficient. Research was undertaken to identify how surgeons used these tools in the consultation. Forty-seven consultations with 15 different surgeons have to date been video- and audio-recorded. There were no instances where CPAC tools were explicitly used in the consultation. Drawing on the methodology of conversation analysis and the concept of news delivery as developed by Maynard, this paper argues that the delivery of diagnoses and treatment plans can usefully be seen in part as the delivery of bad or good news. Using three case studies to illustrate the argument, it is suggested that the interactional work required in the delivery of such news challenges the ability of clinicians to use protocols such as CPAC. The analysis sheds light on important consultation processes that need to be more carefully considered when designing interventions to influence clinician behaviour. In order to influence the behaviour of clinicians to achieve policy goals, greater attention needs to be paid to the interactional demands of the consultation process. Author Affiliation: (1)Sociology Programme, Victoria University of Wellington, New Zealand (2)Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand Article note: Address for correspondence: Kevin Dew, Sociology Programme, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand, e-mail: Kevin.dew@vuw.ac.nz

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2009.01169.x Byline: Kevin Dew, Trina Taupo Keywords: New Zealand; Durkheim; public health; anomie; workplace; presenteeism Abstract: Abstract This paper draws on Durkheimian concepts of moral forces, particularly anomie and fatalism, and the forced division of labour, to argue that the current institutional arrangements to protect and compensate workers in hazardous workplaces are insufficient. This argument is illustrated with interview data from workers at a meatworks in New Zealand which examined workers' responses to illness and injury in the workplace. It is suggested that an imbalance in moral forces leads to pathological outcomes for workers - seen in presenteeism - the phenomenon of staying at work when injured or ill - and workplace injustice. There are state institutions such as worker compensation schemes and occupational safely and health regulations, and other intermediary groups such as unions, that can act as a buffer against anomic and fatalistic forces in the workplace, but at present these countervailing regulatory and advocacy forces are not sufficiently protective of vulnerable workers. Public health advocacy and research could fill the current void. Article note: Address for correspondence: Kevin Dew, Sociology Programme, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand e-mail: Kevin.dew@vuw.ac.nz

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2007.01022.x Byline: Kevin Dew (1), Sonya Morgan (2), Anthony Dowell (2), Deborah McLeod (2), John Bushnell (3), Sunny Collings (4) Keywords: mental health; general practice; doctor-patient relationship; fear; trust Abstract: Abstract Research indicates that there is a high level of trust in health professionals but also a high level of non-disclosure of mental health issues to general practitioners (GPs). This paper explores the issue of patients' willingness to disclose mental health problems to GPs through interviews with 33 patients from the lower half of the North Island of New Zealand. Patients' willingness to disclose related to a range of factors but this paper focuses on fear and sense of control as these issues have received little attention in the extant literature and provide important discussion points for the conduct of consultations. Fear of the consequences of consultation warrants attention if general practice is to be promoted as the preferred point of contact for mental health consultations. The research reported here suggests that trust in a range of institutions and agencies, not just in the individual practitioner, would need to be achieved for the GP to be the preferred point of contact. Author Affiliation: (1)Public Health, University of Otago, Wellington, New Zealand (2)Primary Care and General Practice, University of Otago, Wellington, New Zealand (3)Graduate School of Medicine, University of Wollongong, Australia (4)Psychological Medicine, University of Otago, Wellington, New Zealand Article note: Address for correspondence: Kevin Dew, Public Health, University of Otago, PO Box 7343, Wellington South, Wellington 6002, New Zealand, e-mail: kevin.dew@otago.ac.nz

Objective: To provide an overview of qualitative methodologies for health researchers in order to inform better research practices. Approach: Different possible goals in health research are outlined: quantifying relationships between variables, identifying associations, exploring experience, understanding process, distinguishing representations, comprehending social practices and achieving change. Three important issues in understanding qualitative approaches to research are discussed: the partiality of our view of the world, deductive and inductive approaches to research, and the role of the researcher in the research process. The methodologies of phenomenology, grounded theory, discourse analysis, ethnography, ethnomethodology and action research are illustrated. Conclusion: In order to undertake high-quality qualitative research, it is important for researchers to consider their analytic focus and methodological position. Key words: Qualitative research; health services research.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ctim.2005.08.005 Byline: Kevin Dew Abstract: The analysis of documents can provide insights into important social and political issues related to complementary and alternative medicine (CAM). This paper identifies some important sources of documents and outlines some of the advantages and disadvantages of using documents in social research. A number of analytic strategies are illustrated with examples to demonstrate the potential for documentary analysis to answer particular CAM-related research questions. These strategies are described as quantitative content analysis, qualitative descriptive analysis, qualitative interpretive analysis and semiotic analysis. It is argued that documents are a convenient source of data and that their analysis can enrich our understanding of CAM. Part 1 covered quantitative and qualitative strategies. Part 2 focuses on semiotic analysis and the methodological strengths and weaknesses of the different strategies. Author Affiliation: Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, P.O. Box 7343, Wellington South, New Zealand

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ctim.2005.08.006 Byline: Kevin Dew Abstract: The analysis of documents can provide insights into important social and political issues related to complementary and alternative medicine (CAM). This paper identifies some important sources of documents and outlines some of the advantages and disadvantages of using documents in social research. A number of analytic strategies are illustrated with examples to demonstrate the potential for documentary analysis to answer particular CAM-related research questions. These strategies are described as quantitative content analysis, qualitative descriptive analysis, qualitative interpretive analysis and semiotic analysis. It is argued that documents are a convenient source of data and that their analysis can enrich our understanding of CAM. Part 1 covers quantitative and qualitative strategies and Part 2 focuses on semiotic analysis. Author Affiliation: Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington South, New Zealand

Abstract The current policy trend to have the reduction of health inequalities as a desired outcome indicates a serious attempt to deal with the complexity of social interactions. In New [...]

General practitioners provide treatment for the majority of people diagnosed as having a mental disorder in New Zealand, but much research suggests that they fail to diagnose many common mental disorders. This paper explores the issue of GP recognition of mental health problems through four discussion groups with GPs from the lower half of the North Island of New Zealand. GPs were asked to consider what they thought their role was in relation to mental health, what facilitated discussion of mental health issues in consultations and what could influence patients to disclose mental health problems. The analysis of the data collected drew on thematic and discourse analysis. Four key domains that had an impact on the consultation were identified, which were categorised as practice pressures, socio-cultural factors, the medico-legal framework and the consultation process. GPs employ a number of strategies to respond to the systemic and social issues influencing the consultation. This research suggests that GPs do recognise mental health problems in patients, but that a number of important factors result in the consultations not being labeled as mental health ones. The paper concludes by offering a framework for the mental health consultation that illustrates the systemic issues that GPs consider when making decisions about mental health consultations. Keywords: New Zealand; General practice; Mental health; Doctor-patient relationship

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2004.10.022 Byline: Kevin Dew (a), Vera Keefe (b), Keitha Small (b) Keywords: Presenteeism; Absenteeism; Sickness absence; Occupational health; New Zealand Abstract: Presenteeism is a concept used to describe the phenomenon of working through illness and injury. This paper is based on interviews and focus groups undertaken at three different work sites in New Zealand: a small private hospital, a large public hospital and a small factory. The research suggests that presenteeism is a prominent phenomenon in the lives of workers at these different sites, but the way in which it is rationalised and the factors that foster presenteeism are quite distinct. Exploring the way in which presenteeism links to economic and social constraints and workplace cultures provides insights into these rationalisations. The powerful forces promoting presenteeism tempers the research community's concern with absenteeism. A presenteeism discourse needs to be more prominently articulated to oppose both the absenteeism discourse, and to moderate the views taken by some postmodernist theorists on choice in relation to health practices in workplace settings. Author Affiliation: (a) Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, P.O. Box 7343, Wellington South, New Zealand (b) Te RApA' Rangahau Hauora a Eru PAmare, Wellington School of Medicine and Health Sciences, University of Otago, New Zealand

Homeopathy, along with many other alternative therapies, has come under severe attack from apologists for orthodox medicine. Given the cultural authority of medicine, what then provides the impetus for people to take up homeopathy as a clinical practice? This article addresses this question in the context of homeopathic practice in New Zealand. Five focus groups were conducted with 22 homeopaths in five cities. The study found that it was common to be drawn to homeopathy through witnessing in themselves, their family, friends or animals, the positive effects of homeopathy, commonly after negligible success from conventional medicine. For many participants, all of whom were women, the opportunity to study homeopathy occurred when they were the primary carers of children, with homeopathy providing a possibility for a change in work trajectories. Many participants had previous occupations inside the conventional health system. Central to the appeal of homeopathy as a subaltern practice in New Zealand is the often dramatic impact of witnessing the effects of the therapeutic modality, which is conceptualised as analogous to an 'event' that tears at the fabric of the everyday. [ABSTRACT FROM AUTHOR]

Acupuncture gained considerable attention in anglophone countries in the 1970s. As part of that popularity many medical practitioners became interested in the therapy and learned acupuncture techniques. A number of studies have indicated that medical practitioners were able to take up the practice of acupuncture without threatening the cultural authority of medicine so long as they limited the scope of its practice and redefined acupuncture concepts in Western biomedical terms. These analyses tend to present the medical profession as monolithic and emphasize a dichotomous relationship between biomedicine and alternative therapies such as acupuncture. This study examines the ways in which acupuncture has been represented in different medical forums, suggesting that in order to understand the relationships between biomedicine and alternative medicine we need to be more aware of the changing nature of these representations and their dependency upon the context of the representation. Rather than emphasizing a duality between orthodox medicine and alternative medicine, it is argued here that there are pluralities of medical and healing worldviews.

The Royal Commission of Inquiry assessment of chiropractic in New Zealand in 1978 is discussed, and revealed a tension between the medical debate and the chiropractic one. A compromise gave chiropractic a place in the public health service in New Zealand and 'de-radicalized' its claims.

The 1984 ICI chemical fire was a major occupational health and safety incident that involved various disputes between lay and expert factions. The term 'partial connections' emphasizes how lay or expert knowledge is a socially constructed and precarious element of actor-networks. The hard facts of the incident did not favor the lay actors or their knowledge.

Abstract Background Comorbidity has a well documented detrimental effect on cancer survival. However it is difficult to disentangle the direct effects of comorbidity on survival from indirect effects via the influence of comorbidity on treatment choice. This study aimed to assess the impact of comorbidity on colon cancer patient survival, the effect of comorbidity on treatment choices for these patients, and the impact of this on survival among those with comorbidity. Methods This retrospective cohort study reviewed 589 New Zealanders diagnosed with colon cancer in 1996–2003, followed until the end of 2005. Clinical and outcome data were obtained from clinical records and the national mortality database. Cox proportional hazards and logistic regression models were used to assess the impact of comorbidity on cancer specific and all-cause survival, the effect of comorbidity on chemotherapy recommendations for stage III patients, and the impact of this on survival among those with comorbidity. Results After adjusting for age, sex, ethnicity, area deprivation, smoking, stage, grade and site of disease, higher Charlson comorbidity score was associated with poorer all-cause survival (HR = 2.63 95%CI:1.82–3.81 for Charlson score ≥ 3 compared with 0). Comorbidity count and several individual conditions were significantly related to poorer all-cause survival. A similar, but less marked effect was seen for cancer specific survival. Among patients with stage III colon cancer, those with a Charlson score ≥ 3 compared with 0 were less likely to be offered chemotherapy (19% compared with 84%) despite such therapy being associated with around a 60% reduction in excess mortality for both all-cause and cancer specific survival in these patients. Conclusion Comorbidity impacts on colon cancer survival thorough both physiological burden of disease and its impact on treatment choices. Some patients with comorbidity may forego chemotherapy unnecessarily, increasing avoidable cancer mortality.