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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]

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]

In this article the concepts of statist medicine and subaltern therapeutics are used to provide insight into the debates over the therapeutic use of marijuana in cases of serious or terminal illness. In 2015 medical marijuana gained public attention in Aotearoa New Zealand as cases of people facing life-threatening conditions who wished to use marijuana for therapeutic purposes were given voice in the popular media. In Aotearoa New Zealand marijuana use is illegal for recreational purposes, but theoretically patients with particular conditions could gain access to medicinal forms of marijuana if health professionals, the Ministry of Health and the relevant government minister approved. This approval process is embedded within statist medicine's regulatory regimes, where access can be provided on condition that the medication meets standards of safety and efficacy. Patients faced with the difficulty of negotiating the processes of statist medicine to access medical marijuana often reverted to illegal means of accessing the plant. Access to illegal forms of marijuana for medical purposes could be through 'green fairies', people who provided the plant for therapeutic purposes in a way that was distant from the criminalised recreational use of the drug obtained through 'dealers'. The process of the state, patients and marijuana providers negotiating the regulation of therapeutic uses of marijuana provides insights into the role of statist medicine and subaltern therapeutics. The case of medical marijuana alerts us to the possibilities of other subaltern therapeutic practices that operate beyond the gaze of the state. [ABSTRACT FROM AUTHOR]

Patient-centred care requires patients to be active participants in decision-making in consultations. Decision-making participation requires patients to understand their condition and to be able to convey their health literacy to medical specialists they encounter. Based on conversation analysis of 18 audio-recorded consultations between cancer patients and a range of cancer care specialists, this article analyses the ways cancer specialists attempt to ascertain their patient's understanding of their disease. Cancer specialists routinely enquire about their patient's understanding. In doing so, they phrase enquiries in different ways, resulting in different patient responses. How questions are phrased can require patients to deal with contradictory norms in the consultation, such as the patient being competent but not assuming medical expertise, and potentially hinder patient participation. Alternatively, questions can allow patients to draw on their own experience and so facilitate greater patient involvement. Questions aimed directly at the patient's medical understanding result in minimal or negative responses. In contrast, questions directed at what the patient has been told or has experienced, elicit longer and more in-depth responses from the patient. This analysis illuminates the co-construction of cancer specialist consultations and suggests simple ways in which patient involvement in the consultation can be facilitated. [ABSTRACT FROM AUTHOR]

This study identified ways in which patients and medical specialists negotiated decisions about cancer treatment by observing decision-making discussion in situ. Audio-recordings of cancer care consultations with 18 patients, their support people, and their medical specialists, including medical oncologists, radiation oncologists and surgeons were collected in different regions of New Zealand. Patients were followed up with interviews and specialists provided consultation debriefings. The interpretation of the data drew on the concepts of epistemic and deontic rights to argue that in complex consultations, such as occur in cancer care, we need to reconsider the simple dichotomy of preferred consultations styles as paternalistic or based on shared decision-making. Decision-making is a dynamic process with specialists and patients linked into networks that impact on decision-making and where rights to knowledge and rights to decision-making are interactionally negotiated. The level of information and understanding that patients desire to exercise rights needs to be reconsidered. [ABSTRACT FROM AUTHOR]

The article discusses the relation of mass media and public reactions to adverse drug reactions (ADR) to the medication Eltroxin (levothyroxine) in New Zealand from June 2008 to August 2009. Topics include statements by New Zealand government agencies related to public health, the importation of alternative drugs to treat hypothyroidism, and reforms related to drug safety and reporting.

An editorial is presented on vaccines, policies, and the role of public health. Topics include McCoy's report on the characteristics of Americans who may be opposed to vaccination which explains respondent's views regarding vaccines' safety and unimportance of compulsory vaccinations; and concerns of public about vaccines portrayal in public and social media.

This study uses conversation analysis to explore 'candidate obstacles', a practice observed in sequences of patient resistance to lifestyle advice within health professional consultations. This article presents illustrative analyses of selected data excerpts drawn from audio-visual recordings of 116 tracked consultations between health professionals and 34 patients newly diagnosed with type 2 diabetes mellitus in New Zealand. The analysis shows that in consultations where health promotion activities are central, patient resistance can provide space for patients to identify obstacles to their compliance with lifestyle advice. Identifying candidate obstacles provides opportunities for health professionals to align advice with concerns of patients and potentially improve patient outcomes. [ABSTRACT FROM AUTHOR]

This article explores processes of legitimising health knowledge in three different spaces: the clinic, the home and the multidisciplinary meeting. It considers the ways in which categorisation work, health understandings and therapeutic actions are intertwined. The analysis draws on ethnomethodology and actor-network theory to suggest that in the clinic consultation room, a number of interactional elements in talk about side effects and talk about unorthodox interventions attempt to stabilise the categories used by health experts. In contrast, the household is a centre of knowledge production that may subvert, manipulate or align with expert systems. Fixed and stable expert knowledge becomes flexible and hybridised inside the home. In the multidisciplinary team meeting different forms of authority are called upon in hospital-based cancer care meetings, where health professionals mix scientific understandings with other ways of knowing in determining treatment options. From these empirical observations it is argued that therapeutic actions are not subject in any simplistic way to a dominant mode of understanding, but there are many means of understanding that selectively come into play in relation to the specifics of the interaction that is occurring between patients, health professionals and therapeutic spaces. [ABSTRACT FROM AUTHOR]

Indigenous peoples have poorer health outcomes than their non-indigenous counterparts and this applies to cancer outcomes for Māori in Aotearoa/New Zealand. Differential access to and quality of healthcare contributes to poorer survival rates for Māori. This research provides insight into some of the mechanisms that hinder and facilitate care access. Thirty four people who had undergone cancer treatment (19 Māori and 15 non-Māori) were interviewed by two Māori researchers. The analysis of the interview transcripts was informed by membership categorization analysis. This form of analysis attends to the categories that are used and the activities and characteristics associated with those categories. From this analysis it is argued that the classical patient role, or sick role, inadequately captures the kind of role that some Māori take in relation to their healthcare. Māori can also have culturally specific family (whānau) influences and a greater draw towards alternative approaches to healthcare. Dissonant roles contribute to a different experience for Māori. A better understanding of the categories and roles that are relevant to those who have cancer provides opportunities to attenuate the monocultural impacts of healthcare. [ABSTRACT FROM AUTHOR]

This article extends our understanding of the everyday practices of pharmaceuticalisation through an examination of moral concerns over medication practices in the household. Moral concerns of responsibility and discipline in relation to pharmaceutical consumption have been identified, such as passive or active medication practices, and adherence to orthodox or unorthodox accounts. This paper further delineates dimensions of the moral evaluations of pharmaceuticals. In 2010 and 2011 data were collected from 55 households across New Zealand and data collection techniques, such as photo- and diary-elicitation interviews, allowed the participants to develop and articulate reflective stories of the moral meaning of pharmaceuticals. Four repertoires were identified: a disordering society repertoire where pharmaceuticals evoke a society in an unnatural state; a disordering self repertoire where pharmaceuticals signify a moral failing of the individual; a disordering substances repertoire where pharmaceuticals signify a threat to one's physical or mental equilibrium; a re-ordering substances repertoire where pharmaceuticals signify the restoration of function. The research demonstrated that the dichotomies of orthodox/unorthodox and compliance/resistance do not adequately capture how medications are used and understood in everyday practice. Attitudes change according to why pharmaceuticals are taken and who is taking them, their impacts on social relationships, and different views on the social or natural production of disease, the power of the pharmaceutical industry, and the role of health experts. Pharmaceuticals are tied to our identity, what we want to show of ourselves, and what sort of world we see ourselves living in. The ordering and disordering understandings of pharmaceuticals intersect with forms of pharmaceuticalised governance, where conduct is governed through pharmaceutical routines, and where self-responsibility entails following the prescription of other agents. Pharmaceuticals symbolise forms of governance with different sets of roles and responsibilities. [ABSTRACT FROM AUTHOR]

Abstract: Using a material semiotics methodology, this paper explores the link between diagnostic practices, patient awareness of the body, and biopolitical governance. We collected video and audio recordings of a patient with chest pain involved in three medical interactions (a general practitioner [GP] consultation, an electrocardiogram stress test and a consultation with a cardiologist) in Wellington, New Zealand. Following the work of Annemarie Mol, we argue that each of these diagnostics interactions bring together a range of material and non-material entities that enact the body and disease. Consequently, we note how the diagnostic practices associated with cardiovascular medicine enable and prompt an awareness of the body based on uncertainty, and thus promotes the self-management of cardiac health and risk. This paper illustrates that a material semiotics methodology makes important contributions to the sociology of diagnosis. Firstly, it draws attention to the relationship between humans and material entities in rendering the body intelligible. Secondly, it illustrates that different diagnostic procedures can produce multiple, potentially conflicting, forms of self-awareness. Alongside these practices generating multiplicity, however, are those that presuppose and produce singularity and coherence. We illustrate how the cardiologist “patches” two potentially conflicting diagnoses together in order to provide a sense of coherence to the interactions. Thirdly, material semiotics illustrates how various diagnostic practices can reify risk, and produce bodies that lend themselves to particular forms of governance. [Copyright &y& Elsevier]

In the ongoing discourses around housing and health, the voices of those on the margins are largely absent. This article describes the use of poetry to capture “realities” of marginal housing in Aotearoa/New Zealand from the perspectives of 40 people living in informal dwellings such as sheds, vans, buses, garages, tents, and caravans. The poems combine participants’ words with descriptions of their living situations and complement thematic analysis of in-depth interviews. Feedback from participants has been that their poems accurately represent them and their living situations—and in a form which has meaning for them. Taken as a whole, the poems reveal the diversity of people, perspectives, housing histories, and living situations among the informally housed, emphasizing the complexity of the phenomenon. Presenting findings poetically has allowed voices from the margins to be heard in a wider range of academic, general public, public health, and policy settings. [ABSTRACT FROM PUBLISHER]

In 2007, a new formulation of Eltroxin, a medicine used to treat hypothyroidism, was introduced into New Zealand. By the end of September 2008, there were just over 800 reports linking the new formulation to a range of adverse reactions: joint and muscle pain, weight gain and depression, conjunctivitis, skin rash, and visual disturbances. In response to the prevalence of reports of adverse reactions, an alternative medication, Goldshield, was approved and offered to the public at a subsidised rate. This was despite assurances that the new Eltroxin formulation was safe for use: Medsafe, the government agency responsible for regulating therapeutic products in New Zealand, and an independent medicines monitoring group, stated there was no medical or physiological basis for the supposed adverse reactions. Using media coverage, agency press releases, and meeting minutes of the agencies involved, the paper employs an Actor-Network Theory-based (ANT) approach to understand how the controversy arose, how it took the form it did, and how it was ultimately settled. We explored how, during the controversy, actors emerged, delineated themselves, and concurrently prompted other actors to do the same, as they defined and debated the nature of the risk of Eltroxin. By using an ANT approach, it is possible to illustrate how various actors, including the lay-public, collectively shape the activities of apparatuses that regulate and provide medicines. Thus, we believe such an analysis demonstrates the importance of using public controversies about health risk as an analytical focal point for understanding how various forces shape contemporary society. [ABSTRACT FROM AUTHOR]

Using grounded theory methodology, members of nine families with 'young carers' were interviewed to explore their experiences of caring. A dynamic theory of change and adaptation emerged in relation to changes in who cares within families, in external support and in the attitudes of young carers towards caring. Adaptations included becoming used to the way life is, knowing how to care, balancing and trading off, rewarding care, and anticipating future adaptations. A model has been developed to offer an explanation of factors which influence young caring in families. These include family expectations about caring; who is available to care; the willingness and capability of young carers to help; and the degree of choice or obligation they experience. Formal and informal support services from outside the family, and environmental adaptations, can reduce the amount of family caregiving required, increase choice and contribute to balancing life for carers. [ABSTRACT FROM AUTHOR]

Reducing health inequalities has been part of the New Zealand government's agenda since the early 1990s. As a result, interventions have been implemented nationally with the explicit goal of reducing health inequalities. This paper describes findings from a comparative case study of two community-based interventions -- carried out in different New Zealand communities. Complexity theory was used as an analytic tool to examine the case data, and provided a systematic way in which to explore 'local' issues by taking a 'whole system' perspective. The findings showed that two important influences on the successful implementation of the interventions were the existence and capacity of local organisations and their relationships with government agencies. The analysis provided a dynamic picture of shared influences on the interventions in different communities and in doing so offered insight into intervention effectiveness. It is argued in this article that, for examining intervention effectiveness, it is essential to have a theoretical understanding of the behaviour of the complex system in which they are implemented. This theoretical understanding has implications for the appropriate design of interventions to reduce health inequalities, and in turn should lead to more meaningful ways to evaluate them. [ABSTRACT FROM AUTHOR]

New Zealand research suggests that CAM use by GPs has decreased, while referral to CAM practitioners by GPs has increased, and that patients often do not tell their health practitioners when they are using CAM. The New Zealand Medical Council has developed guidelines for GPs who use CAM. However, there is no research in New Zealand that looks at how patients and GPs respond to CAM issues in the consultation. This paper uses data collected for two research projects on doctor-patient interaction. For this research, consultations between 105 patients and nine GPs were video-recorded. In this data set, all doctors but one were 'orthodox' and to some degree reserved judgement on CAM, albeit remaining cautious in how they made this evident. Patients on the other hand demonstrated a variety of strategies to get CAM on the agenda, and GPs were careful to couch any criticism in such a way as to protect the 'face' of patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Public health researchers have used a number of concepts derived from the work of Durkheim, such as anomie and social capital. One concept that has not been deployed in public health discourses is that of the cult of humanity-Durkheim's religion in a society organised around organic solidarity. This paper discusses Durkheim's views on religion and science, and the cult of humanity. The cult of humanity is characterised as having humanity at the centre of worship and combining elements of religion and science. Medicine and complementary therapies are identified as possible candidates to fulfil the role of the cult of humanity, but the institution of public health seems to be a particularly apt candidate. The paper concludes by discussing the way in which this analysis provides insight into the dual advocacy and academic functions of public health, the tension between individual choice and constraint and the buffering role of public health in relation to other social institutions. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: To explore factors potentially influencing equitable access to elective surgery in New Zealand by describing clinicians' perceptions of equity and the factors they consider when prioritising patients for elective surgery. Methods: A qualitative study in selected New Zealand localities. A purposive sample of 49 general practitioners, specialists and registrars were interviewed. Data were analysed thematically. Results: General practitioners described unequal opportunities for patients to access primary and secondary care and, in particular, private sector elective surgery. They felt that socio-economically disadvantaged patients were less able to advocate for themselves and were more vulnerable to being lost to the elective surgical booking system as well as being less able to access private care. Both GPs and secondary care clinicians described situations where they would personally advocate for individual patients to improve their access. Advocacy was related to clinicians' perceptions of the 'value' that patients would receive from the surgery and patients' needs for public sector funding. Conclusions: The structure of the health system contributes to inequities in access to elective care in New Zealand. Subjective decision making by clinicians has the potential to advantage or disadvantage patients through the weighting clinicians place on socio-demographic factors when making rationing decisions. Review of the potential structural barriers to equitable access, further public debate and guidance for clinicians on the relative importance of socio-demographic factors in deciding access to rationed services are required for allocation of services to be fair. [ABSTRACT FROM AUTHOR]

Increasingly, patients are asserting their rights through complaints procedures. In this article, New Zealand's approach to consumer rights regarding health and disability will be contrasted with mechanisms in Australia and England, to reveal the common and distinct approaches. As a basis of comparison, a recent opinion of New Zealand's Health and Disability Commissioner will be examined to demonstrate a system that resolves patient disputes without resort to litigation. The consistent theme of the critical analysis is whether the systems achieve patient and consumer satisfaction and how that approach might inform best practice. INSETS: A case study;KEY POINTS;COMMENTARY. [ABSTRACT FROM AUTHOR]

The medical profession in many industrialized nations has increasingly been subjected to accountability measures, most notably through the development of quality assurance programmes for practitioners. In New Zealand this development has been enshrined in law under the Medical Practitioners Act 1995. This article looks at some of the concerns raised by these developments, particularly focusing on the ways this might affect practitioners using alternative therapies. From an examination of the debates around accountability in medical practice, and interviews with practitioners who use alternative therapy, three models of medical practice are proposed. These models suggest that medical practices reflect worldviews that revolve around the way relationships between the medical profession, the practitioner, the patient and the patient's condition are perceived. [ABSTRACT FROM AUTHOR]

Examines ways in which acupuncture has been represented in different medical forums in New Zealand. Need for awareness of the changing nature of representations to better understand the relationships between biomedicine and alternative medicine; Presence of pluralities of medical and healing worldwide.

This paper examines the arguments presented at the Royal Commission of Inquiry into chiropractic, which took place in New Zealand in 1978. Drawing on the work of Potter, it suggests that the protagonists in the debate, the medical profession and its allies on one side and the chiropractic profession on the other, developed rhetorical strategies to counter competing versions of the world. An unusual feature of this debate was that it took place before 'impartial' judges. The paper demonstrates the delicate process of negotiation performed by chiropractic groups when confronting medicine in an open forum. The paper concludes that in order to resolve the competing rhetorics, the Commissioners sought for a compromise, which at once embedded chiropractic within the public health service in New Zealand and 'de-radicalised' its claims. [ABSTRACT FROM AUTHOR]

In anglophone countries, there have been increasing efforts to vaccinate the total population. A number of strategies have been employed in order to achieve this goal, including compulsory vaccination before children can attend school (USA); financial incentives to general practitioners and other vaccinators to achieve vaccination targets (UK); and, in New Zealand, a system known as mandatory choice. The New Zealand system involves education centres being co-opted into the medical domain to encourage parents to vaccinate their children. In order to promulgate such strategies, 'vaccinepreventable' diseases, vaccines, parents of unvaccinated children, and the children themselves are represented in particular ways. This paper examines the last three 'epidemics' of measles in New Zealand and the way in which the campaigns to prevent these epidemics represented the disease and other agents. Drawing on Foucault's concepts of governmentality and bio-power, the paper explores the linkages between disease representations and the state. In anglophone countries, there have been increasing efforts to vaccinate the total population. A number of strategies have been employed in order to achieve this goal, including compulsory vaccination before children can attend school (USA); financial incentives to general practitioners and other vaccinators to achieve vaccination targets (UK); and, in New Zealand, a system known as mandatory choice. The New Zealand system involves education centres being co-opted into the medical domain to encourage parents to vaccinate their children. In order to promulgate such strategies, 'vaccinepreventable' diseases, vaccines, parents of unvaccinated children, and the children themselves are represented in particular ways. This paper examines the last three 'epidemics' of measles in New Zealand and the way in which the campaigns to prevent these epidemics represented the disease and other agents. Drawing on Foucault's concepts of governmentality and... [ABSTRACT FROM AUTHOR]

This paper uses two case studies to examine the scope for medical practitioners to utilize alternative forms of diagnosis and treatment The first is a specific study of a medical practitioner who was deemed to have transgressed the boundaries of orthodox medicine. The second is a general case study which examines the possible effects of a new medical practitioners bill and the New Zealand health reforms. it is suggested that when the medical profession is faced with external threats it attempts to strengthen itself at the cost of limiting the autonomy of its membership. [ABSTRACT FROM AUTHOR]

Background: Barriers to accessing hospice and palliative care have been well studied. An important yet less researched area is why people approaching the end-of-life decline a referral when they are offered services. This review focused on synthesising literature on patients in the last months of life due to a cancer diagnosis who have declined a referral to end-of-life care. Methods: Six academic databases were systematically searched for qualitative literature published between 2007 and 2021. Two researchers independently reviewed and critically appraised the studies. Using meta-ethnographic methods of translation and synthesis, we set out to identify and develop a new overarching model of the reasons patients decline end-of-life care and the factors contributing to this decision. Results: The search yielded 2060 articles, and nine articles were identified that met the review inclusion criteria. The included studies can be reconceptualised with the key concept of 'embodied decisions unfolding over time'. It emphasises the iterative, dynamic, situational, contextual and relational nature of decisions about end-of-life care that are grounded in people's physical experiences. The primary influences on how that decision unfolded for patients were (1) the communication they received about end-of-life care; (2) uncertainty around their prognosis, and (3) the evolving situations in which the patient and family found themselves. Our review identified contextual, person and medical factors that helped to shape the decision-making process. Conclusions: Decisions about when (and for some, whether at all) to accept end-of-life care are made in a complex system with preferences shifting over time, in relation to the embodied experience of life-limiting cancer. Time is central to patients' end-of-life care decision-making, in particular estimating how much time one has left and patients' embodied knowing about when the right time for end-of-life care is. The multiple and intersecting domains of health that inform decision-making, namely physical, mental, social, and existential/spiritual as well as emotions/affect need further exploration. The integration of palliative care across the cancer care trajectory and earlier introduction of end-of-life care highlight the importance of these findings for improving access whilst recognising that accessing end-of-life care will not be desired by all patients. [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.

Background: Effective clinical handover has always been integral to delivering safe, high‐quality care in medical wards. Aim: As handover activity increases in importance we wanted to explore the experience of physicians and trainee doctors. There is little research on internal medicine handover with even less based on direct observational research. Methods: Data collection over 4 months by two general medicine physicians included participant observation of 37 meetings and 52 audio‐recorded individual interviews. Inductive thematic analysis of the transcribed interviews proceeded iteratively in parallel with data collection. Results: There was an excellent response rate from 27 of 28 invited trainees and 25 of 26 invited physicians. Overall the experience was positive. Acute medicine handover is a complex human endeavour, occurring daily with an unpredictable workload and areas of tension. Themes were grouped as structural (leadership role, start time, sequence, checklist, handbacks and efficiency) and relational (sensitivity, collegiality, acknowledgement, performance anxiety, tension, responsibility and leadership style). The physician leader needs to be skilled to follow the agreed and evolving process as well as being prepared, authoritative, flexible, equitable, aware and sensitive to the needs of senior colleagues and trainees. There was a tension between efficiency and teaching opportunities. Conclusion: This paper adds to a contextually sensitive understanding of the social dynamics of handover in acute medicine. Addressing the structural aspects is important to provide the necessary consistency and efficiency in what is an extremely complex and time‐sensitive environment. As we continue to work on the evolution of the handover process in acute internal medicine, we must also attend to the relational aspects which are dynamic and central to its sustainability. [ABSTRACT FROM AUTHOR]

In this article, the author discusses a study on the effect of presenteeism, working in long term without taking sick leave, on the working capacity of professionals. The author states that the in certain occupations, particularly involving caring and teaching, have high rate of presenteeism. The author opines that for occupational health or workplace productivity serious consideration should be given to presenteeism.

Background There is an assumption that there is a similarity between surgeon-patient and primary care consultations. Yet, surgeon communication has had far less analytic attention than its primary care counterparts. Therefore, this assumption of similarity (and the proposition here of dissimilarity) has yet to be evidenced through detailed interactional analysis. Methods Conversation analysis ( CA) is a methodology used to understand both mundane and institutional interactions. Using CA, we have developed an understanding of surgeon-patient interactions in outpatient clinic settings in New Zealand. Rather than attempting to determine what 'bad' communication is, we describe and analyse what occurs routinely in surgeon-patient consultations, particularly how these interactions are built up by both patient and doctor. Results This research shows that while surgeon-patient consultations share some similarities to the overall structure of primary care consultations, there are two unique structures that occur in surgical consultations. These structures follow a logical progression of activities and are influenced by the type of visit (referred versus follow-up). Discussion This article summarizes the first comprehensive description of the overall interactional structure of surgeon-patient consultations. It demonstrates that surgeon-patient consultations are structurally distinct from primary care consultations. This key finding has implications for surgeon-specific research and education, highlighting the need to question current assumptions in communication training and in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: We undertook a study to observe in detail the primary care interactions and communications of patients with newly diagnosed diabetes over time. In addition, we sought to identify key points in the process where miscommunication might occur.Methods: All health interactions of 32 patients with newly diagnosed type 2 diabetes were recorded and tracked as they moved through the New Zealand health care system for a period of approximately 6 months. Data included video recordings of patient interactions with the health professionals involved in their care (eg, general practitioners, nurses, dietitians). We analyzed data with ethnography and interaction analysis.Results: Challenges to effective communication in diabetes care were identified. Although clinicians showed high levels of technical knowledge and general communication skill, initial consultations were often driven by biomedical explanations out of context from patient experience. There was a perception of time pressure, but considerable time was spent with patients by health professionals repeating information that may not be relevant to patient need. Health professionals had little knowledge of what disciplines other than their own do and how their contributions to patient care may differ.Conclusions: Despite current high skill levels of primary care professionals, opportunities exist to increase the effectiveness of communication and consultation in diabetes care. The various health professionals involved in patient care should agree on the length and focus of each consultation. [ABSTRACT FROM AUTHOR]

Cityscapes comprise intense repositories for socio-economic interactions, including those surrounding medicinal products. This raises issues of pharmaceuticalisation, involving the construction of a range of human conditions as targets for pharmaceutical interventions. Employing the metaphoric figure of the flâneur, we traverse the New Zealand cityscape, interrogating the mediation and emplacement of various medicinal products within thoroughfares, commercial sites and domestic dwellings. We demonstrate the pharmaceuticalised commodification of the city and interpolation of urbanites as citizen-consumers. [ABSTRACT FROM AUTHOR]

This study examines New Zealand GPs' interaction with computers in routine consultations. Twenty-eight video-recorded consultations from 10 GPs were analysed in micro-detail to explore: (i) how doctors divide their time and attention between computer and patient; (ii) the different roles ascribed to the computer; and (iii) how computer use influences the interactional flow of the consultation. All GPs engaged with the computer in some way for at least 20% of each consultation, and on average spent 12% of time totally focussed on the computer. Patterns of use varied; most GPs inputted all or most notes during the consultation, but a few set aside dedicated time afterwards. The computer acted as an additional participant enacting roles like information repository and legitimiser of decisions. Computer use also altered some of the normal 'rules of engagement' between doctor and patient. Long silences and turning away interrupted the smooth flow of conversation, but various 'multitasking' strategies allowed GPs to remain engaged with patients during episodes of computer use (e.g. signposting, online commentary, verbalising while typing, social chat). Conclusions were that use of computers has many benefits but also significantly influences the fine detail of the GP consultation. Doctors must consciously develop strategies to manage this impact. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a major health issue for individuals and for health services. There is a considerable literature on the management of diabetes and also on communication in primary care consultations. However, few studies combine these two topics and specifically in relation to nurse communication. This paper describes the nature of nurse-patient communication in diabetes management. Methods: Thirty-five primary health care consultations involving 18 patients and 10 nurses were video-recorded as part of a larger multi-site study tracking health care interactions between health professionals and patients who were newly diagnosed with Type 2 diabetes. Patients and nurses were interviewed separately at the end of the 6-month study period and asked to describe their experience of managing diabetes. The analysis used ethnography and interaction analysis. In addition to analysis of the recorded consultations and interviews, the number of consultations for each patient and total time spent with nurses and other health professionals were quantified and compared. Results: This study showed that initial consultations with nurses often incorporated completion of extensive checklists, physical examination, referral to other health professionals and distribution of written material, and were typically longer than consultations with other health professionals. The consultations were driven more by the nurses' clinical agenda than by what the patient already knew or wanted to know. Interactional analysis showed that protocols and checklists both help and hinder the communication process. This contradictory outcome was also evident at a health systems level: although organisational targets may have been met, the patient did not always feel that their priorities were attended to. Both nurses and patients reported a sense of being overwhelmed arising from the sheer volume of information exchanged along with a mismatch in expectations. Conclusions: Conscientious nursing work was evident but at times misdirected in terms of optimal use of time. The misalignment of patient expectations and clinical protocols highlights a common dilemma in clinical practice and raises questions about the best ways to balance the needs of individuals with the needs of a health system. Video- recording can be a powerful tool for reflection and peer review. [ABSTRACT FROM AUTHOR]

Abstract: In December 2008 the newly elected Prime Minister of New Zealand bypassed the agency that negotiates with manufacturers about the cost of medicines and agreed to fund Herceptin for women with early stage breast cancer for a twelve months course of treatment. This paper describes the unfolding of this decision and seeks to explain it in terms of the theory of countervailing powers, which has recently been applied to understand the rapid growth of medicines and the governance of the pharmaceutical industry. We explore the role of various actors in this debate about Herceptin funding, drawing on documentary analysis based on a systematic search of journals, websites and media databases. The case of Herceptin both confirms and questions the propositions of countervailing powers theory. On the one hand the manufacturers of the drug proved to be highly influential in their attempts to get Herceptin funded and were generally supported by consumer groups. On the other hand some scientists and regulators attempted to challenge the power of the manufacturers, with the regulators not showing signs of corporate bias as one might expect. Groups did not, as has been proposed, exert power monolithically, with several groups exhibiting opposing factions. The media, ignored in this literature, are considered as a potential countervailing force in the debate. In the end the government bypassed the recommendation of its regulators, thereby undermining the latter''s efforts to act as a countervailing power. [ABSTRACT FROM AUTHOR]

Abstract: In December 2008 the newly elected Prime Minister of New Zealand bypassed the agency that negotiates with manufacturers about the cost of medicines and agreed to fund Herceptin for women with early stage breast cancer for a twelve months course of treatment. This paper describes the unfolding of this decision and seeks to explain it in terms of the theory of countervailing powers, which has recently been applied to understand the rapid growth of medicines and the governance of the pharmaceutical industry. We explore the role of various actors in this debate about Herceptin funding, drawing on documentary analysis based on a systematic search of journals, websites and media databases. The case of Herceptin both confirms and questions the propositions of countervailing powers theory. On the one hand the manufacturers of the drug proved to be highly influential in their attempts to get Herceptin funded and were generally supported by consumer groups. On the other hand some scientists and regulators attempted to challenge the power of the manufacturers, with the regulators not showing signs of corporate bias as one might expect. Groups did not, as has been proposed, exert power monolithically, with several groups exhibiting opposing factions. The media, ignored in this literature, are considered as a potential countervailing force in the debate. In the end the government bypassed the recommendation of its regulators, thereby undermining the latter''s efforts to act as a countervailing power. [Copyright &y& Elsevier]

Background: There is a widely held expectation that GPs will routinely use opportunities to provide opportunistic screening and brief intervention for alcohol and other drug (AOD) abuse, a major cause of preventable death and morbidity.Aim: To explore how opportunities arise for AOD discussion in GP consultations and how that advice is delivered.Design: Analysis of video-recorded primary care consultations.Setting: New Zealand General Practice.Methods: Interactional content analysis of AOD consultations between 15 GP's and 56 patients identified by keyword search from a bank of digital video consultation recordings.Results: AOD-related words were found in almost one-third (56/171) of the GP consultation transcripts (22 female and 34 male patients). The AOD dialogue varied from brief mention to pertinent advice. Tobacco and alcohol discussion featured more often than misuse of anxiolytics, night sedation, analgesics and caffeine, with only one direct enquiry about other (unspecified) recreational drug use. Discussion was associated with interactional delicacy on the part of both doctor and patient, manifested by verbal and non-verbal discomfort, use of closed statements, understatement, wry humour and sudden topic change.Conclusions: Mindful prioritization of competing demands, time pressures, topic delicacy and the acuteness of the presenting complaint can impede use of AOD discussion opportunities. Guidelines and tools for routine screening and brief intervention in primary care do not accommodate this reality. Possible responses to enhance AOD conversations within general practice settings are discussed. [ABSTRACT FROM AUTHOR]

Background. There is a widely held expectation that GPs will routinely use opportunities to provide opportunistic screening and brief intervention for alcohol and other drug (AOD) abuse, a major cause of preventable death and morbidity.Aim. To explore how opportunities arise for AOD discussion in GP consultations and how that advice is delivered.Design. Analysis of video-recorded primary care consultationsSetting. New Zealand General Practice.Methods. Interactional content analysis of AOD consultations between 15 GP’s and 56 patients identified by keyword search from a bank of digital video consultation recordings.Results. AOD-related words were found in almost one-third (56/171) of the GP consultation transcripts (22 female and 34 male patients). The AOD dialogue varied from brief mention to pertinent advice. Tobacco and alcohol discussion featured more often than misuse of anxiolytics, night sedation, analgesics and caffeine, with only one direct enquiry about other (unspecified) recreational drug use. Discussion was associated with interactional delicacy on the part of both doctor and patient, manifested by verbal and non-verbal discomfort, use of closed statements, understatement, wry humour and sudden topic change.Conclusions. Mindful prioritization of competing demands, time pressures, topic delicacy and the acuteness of the presenting complaint can impede use of AOD discussion opportunities. Guidelines and tools for routine screening and brief intervention in primary care do not accommodate this reality. Possible responses to enhance AOD conversations within general practice settings are discussed. [ABSTRACT FROM PUBLISHER]

Abstract: Studies investigating relationships between mental health and residential areas suggest that certain characteristics of neighbourhood environments matter. After developing a conceptual model of neighbourhood social fragmentation and health we examine this relationship (using the New Zealand Index of Neighbourhood Social Fragmentation (NeighFrag)) with self-reported mental health (using SF-36). We used the nationally representative 2002/3 New Zealand Health Survey dataset of urban adults, employing multilevel methods. Results suggest that increasing neighbourhood-level social fragmentation is associated with poorer mental health, when simultaneously accounting for individual-level confounding factors and neighbourhood-level deprivation. The association was modified by sex (stronger association seen for women) and labour force status (unemployed women more sensitive to NeighFrag than those employed or not in labour force). There was limited evidence of any association of fragmentation with non-mental health outcomes, suggesting specificity for mental health. Social fragmentation as a property of neighbourhoods appears to have a specific association with mental health among women, and particularly unemployed women, in our study. [Copyright &y& Elsevier]

Abstract: To extend knowledge of relationships between people and domestic settings in the context of medication use, we conducted fieldwork in twenty households in New Zealand. These households contained a range of ‘medicative’ forms, including prescription drugs, traditional remedies, dietary supplements and enhanced foods. The location and use of these substances within domestic dwellings speaks to processes of emplacement and identity in the creation of spaces for care. Our analysis contributes to current understandings of the ways in which objects from ‘outside’ the home come to be woven into relationships, identities and meanings ‘inside’ the home. We demonstrate that, as well as being pharmacological objects, medications are complex, socially embedded objects with histories and memories that are ingrained within contemporary relationships of care and home-making practices. [ABSTRACT FROM AUTHOR]

The article focuses on a study which compared the cancer treatment approaches applied to a nationally representative cohort of Maori (indigenous) and non-Maori New Zealanders with colon cancer. The study included 301 Maori patients and 329 randomly selected non-Maori patients who were diagnosed with colon cancer between 1996 and 2003. It examined the medical notes and surgical and oncology treatments received by the patients. It found that Maori New Zealenders with colon cancer were less likely to receive adjuvant chemotherapy.

Reducing health inequalities has been part of the New Zealand government's agenda since the early 1990s. As a result, interventions have been implemented nationally with the explicit goal of reducing health inequalities. This paper describes findings from a comparative case study of two community-based interventions - carried out in different New Zealand communities. Complexity theory was used as an analytic tool to examine the case data, and provided a systematic way in which to explore 'local' issues by taking a 'whole system' perspective. The findings showed that two important influences on the successful implementation of the interventions were the existence and capacity of local organisations and their relationships with government agencies. The analysis provided a dynamic picture of shared influences on the interventions in different communities and in doing so offered insight into intervention effectiveness. It is argued in this article that, for examining intervention effectiveness, it is essential to have a theoretical understanding of the behaviour of the complex system in which they are implemented. This theoretical understanding has implications for the appropriate design of interventions to reduce health inequalities, and in turn should lead to more meaningful ways to evaluate them. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]