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Coexisting cancer regimes: Transformations of breast and lung cancer in the United Kingdom. 并存的癌症制度:英国乳腺癌和肺癌的转变。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 Epub Date: 2023-05-22 DOI: 10.1177/13634593231176979
Cinzia Greco

Using in-depth interviews with medical professionals working in the UK, I explore the coexistence of two different cancer regimes in which the different innovations for breast and lung cancer can be located. Breast cancer treatment has seen a protracted series of significant innovations in the context of an emphasis on screening that coexists with a segmentation in subtypes that has allowed targeted therapies for most patients. Lung cancer has also seen the introduction of targeted therapies; however, these can only be used for small groups of patients. Consequently, some interviewees working on lung cancer have expressed a stronger focus on increasing the number of patients undergoing surgery, as well as introducing screening also for lung cancer. As a result, a cancer regime based on the promises of targeted therapies coexists with a more traditional approach that focuses on diagnosing and treating cancers in their early stages.

通过对在英国工作的医疗专业人员进行深入访谈,我探索了两种不同癌症治疗体系的共存情况,并将乳腺癌和肺癌的不同创新归结于此。乳腺癌治疗经历了一系列旷日持久的重大创新,在强调筛查的同时,还对亚型进行了细分,使大多数患者都能接受靶向治疗。肺癌也引入了靶向疗法,但这些疗法只能用于小部分患者。因此,一些从事肺癌研究的受访者表示,应更加重视增加接受手术治疗的患者人数,并同时开展肺癌筛查。因此,建立在靶向治疗承诺基础上的癌症治疗体系与注重早期诊断和治疗癌症的传统方法并存。
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引用次数: 0
Good care and adverse effects: Exploring the use of social alarms in care for older people in Sweden. 良好护理与不良影响:探索瑞典老年人护理中社会警报器的使用。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 Epub Date: 2023-06-30 DOI: 10.1177/13634593231185260
Doris Lydahl

In Nordic countries, 'welfare technology' is a concept used increasingly by policymakers when discussing the promise of digitalisation in care for older people. In this paper, I draw on data from 14 qualitative ethnographic interviews with employees in municipal eldercare in Sweden, as well as observations carried out at a nursing home, to suggest the importance of studying how good care is enacted through welfare technology, whilst simultaneously attending to the adverse effects sometimes consequent from these practices. In this article, I explore what values are supported when doing care with welfare technology, and what values are neglected in this process. The theoretical starting point for this article takes its inspiration from recent discussions of care within Science and Technology Studies (STS). Employing a double vision of care, the article argues for the importance of understanding how good care is enacted with technology, while also attending to what these care practices exclude and neglect. Focusing on the use of social alarms, the article shows that when doing care with such technology, values such as independence, safety and some forms of togetherness and availability were enhanced; while other values such as other forms togetherness and availability, a stress-free working environment and functionality were neglected.

在北欧国家,"福利技术 "这一概念越来越多地被政策制定者在讨论老年人护理数字化的前景时使用。在本文中,我通过对瑞典市级老年人护理机构员工的 14 次定性人种学访谈以及在一家养老院的观察,提出了研究如何通过福利技术实现良好护理的重要性,同时也关注了这些做法有时会带来的负面影响。在本文中,我将探讨在利用福利技术进行护理时,哪些价值观得到了支持,哪些价值观在这一过程中被忽视了。本文的理论出发点来自近期科技研究(STS)中关于关爱的讨论。文章采用双重视角来看待关爱问题,认为理解如何利用技术实现良好关爱非常重要,同时也要关注这些关爱实践排除和忽视了什么。文章以社交警报器的使用为重点,说明在使用此类技术进行护理时,独立、安全以及某些形式的团结和可用性等价值观得到了提升;而其他价值观,如其他形式的团结和可用性、无压力的工作环境和功能性则受到了忽视。
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引用次数: 0
Reflections of a white healthcare professional researching ethnicized and racialized minorities: Autoethnographically explored emotions revealing implicit advantages and consequences. 一名白人医疗保健专业人员对少数族裔和种族化少数群体的研究反思:通过自编民族志探索情感,揭示隐含的优势和后果。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 Epub Date: 2023-06-30 DOI: 10.1177/13634593231185261
Nina Halberg

Health research is often embedded in biomedicine in which the goal is to remove all bias. However, this is problematic in research on social issues such as social and health inequities. Therefore, there is growing criticism of health researchers' positions as neutral and invisible. I explore research-based advantages and consequences following my positionings within whiteness, nursing and healthcare professionality. Drawing on two ethnographic studies conducted in Denmark, one among black Nigerian women working in the streets of Copenhagen, the other following patients, defined in Danish healthcare as 'ethnic minorities', in two hospitals in the greater Copenhagen area, I take the point of departure from autoethnographic emotions of 'doing good', 'discomfort' and 'denial'. As I analyse these emotions as a production in the contexts, I show the advantages and consequences of leaving my marked body unmarked. With an intersectional lens, I discuss how health researchers' risk (re)producing social inequalities in health based on for example, avoiding topics of skin colour and experiences of discrimination. Ultimately, what legitimized my access to the people in the field paradoxically also risked delegitimizing their experiences of racialized and ethnicized inequalities. This is not only consequential for the interlocutors but also for the knowledge production, since we as health researchers' risk implicitly avoiding important knowledge if we do not see our own research positionings as a racialized, ethnicized and culturalized matter. Therefore, the need for educational curriculum on racialization and anti-discrimination is imperative within the health professions and as health researchers regardless of profession or research area.

健康研究通常以生物医学为基础,其目标是消除一切偏见。然而,这在社会和健康不平等等社会问题的研究中却存在问题。因此,越来越多的人批评健康研究人员的立场是中立和无形的。我将根据自己在白人、护理和医疗保健专业性方面的立场,探讨基于研究的优势和后果。根据在丹麦进行的两项人种学研究,一项是在哥本哈根街头工作的尼日利亚黑人妇女,另一项是在大哥本哈根地区两家医院工作的被丹麦医疗界定义为 "少数民族 "的病人,我从 "做好事"、"不舒服 "和 "否认 "的自我人种学情绪出发。当我分析这些情绪作为情境中的产物时,我展示了让我有标记的身体没有标记的好处和后果。通过交叉视角,我讨论了健康研究人员如何在回避肤色和歧视经历等话题的基础上,冒着(重新)制造社会健康不平等的风险。最终,使我与实地人员接触合法化的同时,也有可能使他们在种族化和民族化不平等中的经历失去合法性。这不仅对对话者有影响,对知识的产生也有影响,因为作为健康研究人员,如果我们不把自己的研究立场看作是种族化、民族化和文化化的问题,就有可能暗中回避重要的知识。因此,无论在哪个专业或研究领域,作为卫生专业和卫生研究人员,都必须开设有关种族化和反歧视的教育课程。
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引用次数: 0
Experiences and management of urinary incontinence following treatment for prostate cancer: Disrupted embodied practices and adapting to maintain masculinity. 前列腺癌治疗后尿失禁的经历和处理:被打乱的体现实践和适应以保持男子气概。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 Epub Date: 2023-06-30 DOI: 10.1177/13634593231185266
Richard Green

This article explores men's experiences of and management strategies for urinary incontinence (UI) following treatment for prostate cancer. Qualitative interviews with 29 men, recruited from two prostate cancer support groups, explored their post-treatment experiences. Drawing on a conceptual toolkit connecting theories of masculinities, embodiment, and chronic illness, this paper identifies older men's experiences and strategies for managing UI and explores how these are shaped by their masculinities. This article identifies interdependence between managing stigma for UI and maintaining masculinity. Men's embodied practices for engaging in activities in public, crucial to masculine identity, were disrupted. In response, they adopted new reflexive body techniques to manage and resolve their UI, and thereby address the threat to their masculine identities, characterised in three strategies: monitoring, planning, and disciplining. The new embodied practices men described suggest three factors as important components for adopting new reflexive body techniques: routine, desire, and unruliness.

本文探讨了男性在接受前列腺癌治疗后的尿失禁(UI)经历和处理策略。对从两个前列腺癌支持小组招募的 29 名男性进行了定性访谈,探讨了他们的治疗后经历。本文利用一个概念工具包,将男性气质、体现和慢性疾病理论联系起来,确定了老年男性在尿失禁管理方面的经验和策略,并探讨了这些经验和策略是如何由他们的男性气质所塑造的。本文指出了处理对尿毒症的成见与保持男性气质之间的相互依存关系。男性在公共场合参与活动的具体做法对其男性身份至关重要,但却遭到了破坏。作为回应,他们采用了新的反思性肢体技巧来管理和解决他们的尿失禁问题,从而应对男性身份所面临的威胁,这体现在三种策略中:监控、计划和约束。男性所描述的新的身体实践表明,有三个因素是采用新的反身性身体技巧的重要组成部分:常规、欲望和不羁。
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引用次数: 0
How workplaces produce or reduce disability along the career paths of young people with cystic fibrosis. 工作场所如何在囊性纤维化青年的职业道路上产生或减少残疾。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 Epub Date: 2023-07-06 DOI: 10.1177/13634593231185265
Laura Silvestri, Damien Issanchou, Laura Schuft, Sylvain Ferez

Using the theoretical perspective of "social participation" as considered in the Human Development-Disability Creation Process, this article examines certain obstacles and facilitators to sustainable access to work among young French adults with cystic fibrosis. Drawing from the analyses of 29 qualitative interviews, the results show how such obstacles do not depend solely on their health status or on the medical management of the illness, but also on the work environments that these young professionals have recently entered or are trying to access. In these contexts, managing information about the illness can represent a means of obtaining cooperation from colleagues and superiors to reduce material or organizational obstacles (e.g. adapted work schedules), as well as a means of preventing socially uncomfortable or disabling situations. In this light, the social participation model can complement Corbin and Strauss' illness trajectory model, by setting the multi-factorial disabling or participatory situations along illness or medical trajectories. This enables dynamic consideration of how workplaces contribute to producing or reducing disability, in interaction with the actions taken by young people with cystic fibrosis to manage their career paths but also the evolution of illness, symptoms, or medical requirements.

本文从 "人类发展-残疾创造过程 "中的 "社会参与 "这一理论视角出发,对患有囊性纤维化的法国年轻成年人持续获得工作的某些障碍和促进因素进行了研究。通过对 29 个定性访谈的分析,结果表明这些障碍不仅取决于他们的健康状况或对疾病的医疗管理,还取决于这些年轻专业人士最近进入或正在尝试进入的工作环境。在这种情况下,对疾病信息的管理可以是一种获得同事和上司合作的手段,以减少物质或组织上的障碍(如调整工作时间安排),也可以是一种防止出现社会不适或失能情况的手段。有鉴于此,社会参与模式可以补充科尔宾和斯特劳斯的疾病轨迹模式,将多因素致残或参与情况设定为疾病或医疗轨迹。这样就可以动态地考虑工作场所是如何与囊性纤维化青年管理其职业道路的行动以及疾病、症状或医疗要求的演变相互作用,从而产生或减少残疾的。
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引用次数: 0
Navigating ambivalence: A qualitative study of young fitness self-trackers' engagement with body ideals through social media. 矛盾的导航:对年轻健身自我追踪者通过社交媒体参与身体理想的定性研究。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 Epub Date: 2023-05-16 DOI: 10.1177/13634593231175277
Carsten Stage, Stinne Bach Nielsen

This article explores how social media are involved in imagining and sensing body ideals among young fitness self-trackers in Denmark (age 15-24). The analysis is based on 20 interviews and contributes to existing research on social media, body image and self-tracking by showing that social media are central for the fitness practices of the participants, but also that gaining access to practical knowledge, motivational material and visual goals seem to be more important motivations for social media use than personal sharing and interaction. Social media are furthermore understood by the participants as unavoidable, but ambivalent terrains in the sense that cognitive and affective benefits, like knowledge or motivation, can only be accessed and felt by handling the risk of also encountering misinformation and demotivating images of idealised or deceptive bodies. The informants legitimise their engagement with social media by positioning themselves as mature media users able to navigate social media through practices of content dis/engagement. The ambivalence of social media is in other words experienced as both 'elemental' and 'curatable' by the informants; an experience that stresses the need to question the traditional conceptualisation of ambivalence as an inhibition of personal agency and will formation.

本文探讨了社交媒体如何参与丹麦年轻健身自我追踪者(15-24 岁)对身体理想的想象和感知。文章基于 20 个访谈进行分析,表明社交媒体是参与者健身实践的核心,但与个人分享和互动相比,获取实用知识、激励材料和视觉目标似乎是使用社交媒体的更重要动机,从而为现有关于社交媒体、身体形象和自我追踪的研究做出了贡献。此外,社交媒体还被参与者理解为不可避免但又矛盾的领域,因为只有在处理好遇到错误信息和理想化或欺骗性身体的负面形象的风险时,才能获得和感受到认知和情感上的益处,如知识或动力。受访者将自己定位为成熟的媒体用户,能够通过 "取消/参与 "内容的做法来驾驭社交媒体,从而使他们参与社交媒体的行为合法化。换句话说,信息提供者将社交媒体的矛盾体验视为 "元素 "和 "可策划的";这种体验强调有必要质疑将矛盾体验视为抑制个人能动性和意志形成的传统概念。
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引用次数: 0
Introducing Point-of-Care PCR technology in general practice: Ambiguities, experiences, and perceptions among health care professionals. 在全科医疗中引入护理点 PCR 技术:医疗保健专业人员的模糊认识、经验和看法。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-31 DOI: 10.1177/13634593241254988
Line Maria Simonsen, Natasja Eilerskov, Rikke Sand Andersen, Jens Soendergaard, Jesper Bo Nielsen, Dorte Ejg Jarbøl, Trine Thilsing, Kirubakaran Balasubramaniam, Elisabeth Assing Hvidt

In this paper we present findings from a qualitative ethnographic study investigating the experiences and perceptions of general practitioners and other practice staff when introducing a new point of care diagnostic test technology (point of care polymerase chain reaction (POC PCR)) in general practice in Denmark. The ethnographic study was conducted in five general practice clinics, involving observations in four of the clinics and interviews with general practitioners and practice staff in all five clinics. Following an initial analytic phase in which barriers and facilitators in the implementation process of the Point-of-Care test were identified, we developed theoretically informed themes, drawing upon Hartmut Rosa's social theory of technological acceleration. These themes included ambiguous experiences and perceptions of: (i) diagnostic specification and inflation embedded in diagnostic practices; (ii) empowerment and erosion of professional judgment; (iii) strategies of security and insecurity in communication; (iv) the interdependence between professional autonomy and economic structures associated with organizational power; and (v) subjective and organizational time. We discuss how diagnostic technologies simultaneously contribute to and disrupt treatment safety, efficiency, and medical decision-making. Using Rosa's sociological concepts of alienation and resonance, this article furthermore explores how these ambiguous dynamics are experienced in general practice settings. It also examines the implications of navigating a heterogeneous socio-technical and medical landscape and what it means to be a health professional in a contemporary general practice environment that is increasingly shaped by diagnostic technologies.

本文介绍了一项定性人种学研究的结果,该研究调查了丹麦全科医生和其他医务人员在全科诊所引入新的护理点诊断检测技术(护理点聚合酶链反应(POC PCR))时的经验和看法。这项人种学研究在五家全科诊所进行,包括对其中四家诊所的观察以及对所有五家诊所的全科医生和医务人员的访谈。在最初的分析阶段,我们确定了护理点检测实施过程中的障碍和促进因素,之后我们借鉴哈特穆特-罗萨的技术加速社会理论,提出了具有理论依据的主题。这些主题包括对以下方面的模糊体验和看法(i) 诊断实践中的诊断规范和通货膨胀;(ii) 专业判断的授权和侵蚀;(iii) 沟通中的安全和不安全策略;(iv) 专业自主和与组织权力相关的经济结构之间的相互依存关系;以及 (v) 主观时间和组织时间。我们讨论了诊断技术如何同时促进和破坏治疗安全、效率和医疗决策。本文利用罗莎的社会学概念 "异化 "和 "共鸣",进一步探讨了在全科医疗环境中如何体验这些模棱两可的动态。文章还探讨了驾驭异质社会技术和医疗环境的意义,以及在诊断技术日益影响的当代全科医疗环境中,作为一名医疗专业人员意味着什么。
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引用次数: 0
The normativist-naturalist puzzle: Functions and assumptions of health assessment tools. 规范主义者-自然主义者之谜:健康评估工具的功能和假设。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-27 DOI: 10.1177/13634593241255006
Thor Hennelund Nielsen, Lasse Nielsen, Søren Harnow Klausen

While there is no shortage in discussions of health assessment tools, little is known about health professionals' experience of their practical uses. However, these tools rely on assumptions that have significant impacts on the practice of health assessment. In this study, we explore health professionals' experiences with health assessment tools, that is, how they define, use, and understand these tools, and whether they take them to measure health and wellbeing. We combine a qualitative, interview-based study of the uses and understandings of health assessment tools among Danish health professionals with a philosophical analysis of these applications and perceptions. Our study shows that contrary assumptions are involved in the use of the tools, to the extent that one can speak of a normativist-naturalist puzzle: health professionals generally apply a normativist conception of health, find health assessment useful and valuable for their clinical practice, but believe that what the tools measure is basically not health proper but some proximal entity of a more naturalist kind. This result demonstrates the complexity of health assessment tools and suggests that they are used with care to ensure both that particular tools are used for the kinds of tasks they are most apt for, and that they are put to use in awareness of their limitations.

虽然关于健康评估工具的讨论并不缺乏,但对卫生专业人员实际使用这些工具的经验却知之甚少。然而,这些工具依赖于对健康评估实践有重大影响的假设。在本研究中,我们探讨了卫生专业人员使用健康评估工具的经验,即他们如何定义、使用和理解这些工具,以及他们是否使用这些工具来衡量健康和福祉。我们对丹麦卫生专业人员使用和理解健康评估工具的情况进行了定性访谈研究,并对这些应用和看法进行了哲学分析。我们的研究表明,在工具的使用过程中存在着相反的假设,甚至可以说是规范主义-自然主义之谜:医疗专业人员普遍采用规范主义的健康概念,认为健康评估对他们的临床实践有用且有价值,但又认为这些工具所测量的基本上不是健康本身,而是某种更自然主义的近似实体。这一结果表明了健康评估工具的复杂性,并建议在使用这些工具时要小心谨慎,既要确保将特定工具用于最适合的任务,又要确保在使用这些工具时认识到它们的局限性。
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引用次数: 0
Void and narrative in the clinic of addictions: A theoretical proposal. 成瘾诊所中的虚无与叙事:理论建议。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2023-04-12 DOI: 10.1177/13634593231167064
Clément Cimolaï, Vincent Bréjard

We propose a connection between the void and addiction via psychoanalysis and current developments in narration in the context of the psychoanalytic clinic. We maintain that the addicted subject is shaped in particular by a relationship to the void evolving from the disruptive effects of the narrative. Our modern era is marked by a parallel evolution towards an unbearable void, to be filled at all costs. The neo-liberal promise of 'filling' the void with consumer objects in turn feeds the illusion of a so-called freedom, based on alienation to the inseparable duos of growth/jouissance and productivism/consumerism. The void has a multidisciplinary heritage (philosophy, physics, art, psychology) underlining certain aspects of a dialectic of the void that fluctuates between nothing at all and everything as potential. Taking this dialectic into account allows us to construct a concept of the void centred around two types of void: a narrative void and an a-narrative void. We maintain that the toxic in addiction can be interpreted as a narco-narrative that is constructed upon an a-narrative void. The clinical implications and technical proposals are briefly explored as openings to a clinical consideration of the void in the field of addictology.

我们通过精神分析和当前精神分析诊所的叙事发展,提出了空虚与成瘾之间的联系。我们认为,上瘾的主体尤其是由叙事的破坏性影响演变而来的空虚关系所塑造的。现代社会的特点是,人们不惜一切代价填补无法忍受的空虚。新自由主义承诺用消费品来 "填补 "空虚,这反过来又助长了所谓自由的幻觉,而这种自由是建立在与增长/享乐和生产/消费主义这不可分割的二元对立的异化基础之上的。虚无 "具有多学科的遗产(哲学、物理学、艺术、心理学),强调了 "虚无 "辩证法的某些方面。考虑到这一辩证法,我们可以围绕两种类型的虚空构建一个虚空概念:叙事性虚空和非叙事性虚空。我们认为,毒瘾中的毒可以被解释为一种叙事性空洞,而这种叙事性空洞是建立在一种叙事性空洞之上的。我们将简要探讨其临床影响和技术建议,作为成瘾学领域对空洞进行临床思考的开端。
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引用次数: 0
Quantitative Textual Analysis as a means to explore corporate interests in food safety. 以定量文本分析为手段,探讨食品安全中的企业利益。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-01 Epub Date: 2023-06-13 DOI: 10.1177/13634593231173807
Corina L Vasilescu, Martin McKee, Aaron Reeves

The growing body of scholarship on the commercial determinants of health has, so far, mostly employed qualitative methods but this is now being complemented by a small, yet growing, corpus of quantitative studies. We illustrate the use of one such method, quantitative text analysis (QTA), in a case study of submissions to a public consultation on a draft scientific opinion by the European Food Safety Authority on the chemical acrylamide, demonstrating how this method can be used and insights that might be drawn from it. We use Wordscores as one example of QTA to illuminate the diverse positions taken by actors submitting comments and then assess whether the final policy documents moved towards or away from the positions taken by different stakeholders. We find a broadly uniform position among the public health community, opposed to acrylamide, contrasting with industry positions that were not monolithic. Some firms recommended major amendments to the guidance, largely reflecting the impact on their practices, while policy innovators seeking ways to reduce acrylamide in foods aligned with the public health community. We also find no clear movement in the policy guidance, likely because most submissions supported the draft document. Many governments are required to conduct public consultations, some attracting enormous numbers of responses, with little guidance on how best to synthesise the responses so the default position is often a count of those for and against. We argue that QTA, primarily a research tool, might usefully be applied in analysing public consultation responses to understand better the positions taken by different actors.

迄今为止,有关健康的商业决定因素的学术研究日益增多,其中大部分采用的是定性方法,但现在又有了数量虽少但却日益增多的定量研究作为补充。我们通过对欧洲食品安全局关于化学物质丙烯酰胺的科学意见草案的公众咨询意见的案例研究,说明了定量文本分析(QTA)这一方法的使用情况,并展示了如何使用这一方法以及从中可能获得的启示。我们使用 Wordscores 作为 QTA 的一个示例,来阐明提交意见的参与者所持的不同立场,然后评估最终政策文件是趋向于还是偏离了不同利益相关者所持的立场。我们发现,公共健康界的立场大体一致,反对丙烯酰胺,与之形成鲜明对比的是,工业界的立场也并非铁板一块。一些公司建议对指南进行重大修订,这主要反映了对其业务的影响,而寻求减少食品中丙烯酰胺的政策创新者则与公共卫生界保持一致。我们还发现政策指南没有明显的变化,这可能是因为大多数意见都支持文件草案。许多国家的政府都需要进行公众咨询,有些咨询会吸引大量回复,但却没有关于如何最好地综合这些回复的指导,因此默认的立场往往是对支持和反对意见进行统计。我们认为,QTA 主要是一种研究工具,可用于分析公众咨询答复,以便更好地了解不同参与者的立场。
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引用次数: 0
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