Briefing Paper 3: The social determinants of health inequalities: implications for research and practice

https://stars.library.ucf.edu/cfm-ch-register-vol26/1216/thumbnail.jp

Negotiating identities of ‘responsible drinking’: Exploring accounts of alcohol consumption of working mothers in their early parenting period

Mothers’ alcohol consumption has often been portrayed as problematic: firstly, because of the effects of alcohol on the foetus, and secondly, because of the association between motherhood and morality. Refracted through the disciplinary lens of public health, mothers’ alcohol consumption has been the target of numerous messages and discourses designed to monitor and regulate women's bodies and reproductive health. This study explores how mothers negotiated this dilemmatic terrain, drawing on accounts of drinking practices of women in paid work in the early parenting period living in Northern England in 2017–2018. Almost all of the participants reported alcohol abstention during pregnancy and the postpartum period and referred to low-risk drinking practices. A feature of their accounts was appearing knowledgeable and familiar with public health messages, with participants often deploying ‘othering’, and linguistic expressions seen in public health advice. Here, we conceptualise these as Assumed Shared Alcohol Narratives (ASANs). ASANs, we argue, allowed participants to present themselves as morally legitimate parents and drinkers, with a strong awareness of risk discourses which protected the self from potential attacks of irresponsible behaviour. As such, these narratives can be viewed as neoliberal narratives, contributing to the shaping of highly responsible and self-regulating subjectivities

Non-epileptic attack disorder: the importance of diagnosis and treatment

A 50-year-old woman was taken to hospital by emergency ambulance during her first seizure. She was admitted to hospital, treated with intravenous diazepam, diagnosed with epilepsy and started on antiepileptic drug (AED) therapy. This was ineffective so she was referred to a tertiary centre where she underwent video EEG and was diagnosed with non-epileptic attack disorder. Her experience of the diagnosis was positive; it allowed her to understand what was happening to her and to understand the link between her seizures, adverse childhood experiences and the death of her mother. She stopped taking AEDs and she was referred to a psychologist which led to a significant improvement in her functioning and quality of life. We present this case as a good example of the benefits of accurate diagnosis, clear explanation and access to specialist car

Optimal capture of non-Gaussianity in weak lensing surveys: power spectrum, bispectrum and halo counts

We compare the efficiency of weak lensing-selected galaxy clusters counts and of the weak lensing bispectrum at capturing non-Gaussian features in the dark matter distribution. We use the halo model to compute the weak lensing power spectrum, the bispectrum and the expected number of detected clusters, and derive constraints on cosmological parameters for a large, low systematic weak lensing survey, by focusing on the $\Omega_m$-$\sigma_8$ plane and on the dark energy equation of state. We separate the power spectrum into the resolved and the unresolved parts of the data, the resolved part being defined as detected clusters, and the unresolved part as the rest of the field. We consider four kinds of clusters counts, taking into account different amount of information : signal-to-noise ratio peak counts; counts as a function of clusters' mass; counts as a function of clusters' redshift; and counts as a function of clusters' mass and redshift. We show that when combined with the power spectrum, those four kinds of counts provide similar constraints, thus allowing one to perform the most direct counts, signal-to-noise peaks counts, and get percent level constraints on cosmological parameters. We show that the weak lensing bispectrum gives constraints comparable to those given by the power spectrum and captures non-Gaussian features as well as clusters counts, its combination with the power spectrum giving errors on cosmological parameters that are similar to, if not marginally smaller than, those obtained when combining the power spectrum with cluster counts. We finally note that in order to reach its potential, the weak lensing bispectrum must be computed using all triangle configurations, as equilateral triangles alone do not provide useful information.Comment: Matches ApJ-accepted versio

'I just need to know what they are and if you can help me': Medicalization and the search for legitimacy in people diagnosed with non-epileptic attack disorder

This paper focuses on the struggles for legitimacy expressed by people with non-epileptic attack disorder (NEAD), one of the most common manifestations of functional neurological disorder presenting to emergency and secondary care services. Nonepileptic attacks are episodes of altered experience, awareness, and reduced self-control that superficially resemble epileptic seizures or other paroxysmal disorders but are not associated with physiological abnormalities sufficient to explain the semiological features. "Organic" or medicalized explanations are frequently sought by patients as the only legitimate explanation for symptoms, and consequently, a diagnosis of NEAD is often contested. Drawing on narrative interviews with patients from a small exploratory study and using a sociological perspective, we propose that a psychological account of NEAD does not provide a sufficiently legitimate path into a socially sanctioned sick role. This is a reflection of the dominance of biomedicine and the associated processes of medicalization. These processes are, we argue, the sole route to achieving legitimacy. The stress-based or psychologically oriented explanations offered to patients in contemporary medical models of the etiology of NEAD engender an uncertain identity and social position and fail to provide many patients with an account of the nature or origin of their symptoms that they find satisfactory or convincing. These struggles for legitimacy (shared by others with functional or somatoform conditions) are sharpened by key features of the contemporary healthcare landscape, such as the increasing framing of health through a lens of 'responsibilization'. [Abstract copyright: Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.