Beyond resistance: social factors in the general public response to pandemic influenza

Background: Influencing the general public response to pandemics is a public health priority. There is a prevailing view, however, that the general public is resistant to communications on pandemic influenza and that behavioural responses to the 2009/10 H1N1 pandemic were not sufficient. Using qualitative methods, this paper investigates how members of the general public respond to pandemic influenza and the hygiene, social isolation and other measures proposed by public health. Going beyond the commonly deployed notion that the general public is resistant to public health communications, this paper examines how health individualism, gender and real world constraints enable and limit individual action. Methods: In-depth interviews (n = 57) and focus groups (ten focus groups; 59 individuals) were conducted with community samples in Melbourne, Sydney and Glasgow. Participants were selected according to maximum variation sampling using purposive criteria, including: 1) pregnancy in 2009/2010; 2) chronic illness; 3) aged 70 years and over; 4) no disclosed health problems. Verbatim transcripts were subjected to inductive, thematic analysis. Results: Respondents did not express resistance to public health communications, but gave insight into how they interpreted and implemented guidance. An individualistic approach to pandemic risk predominated. The uptake of hygiene, social isolation and vaccine strategies was constrained by seeing oneself 'at risk' but not 'a risk' to others. Gender norms shape how members of the general public enact hygiene and social isolation. Other challenges pertained to over-reliance on perceived remoteness from risk, expectation of recovery from infection and practical constraints on the uptake of vaccination. Conclusions: Overall, respondents were engaged with public health advice regarding pandemic influenza, indicating that the idea of public resistance has limited explanatory power. Public communications are endorsed, but challenges persist. Individualistic approaches to pandemic risk inhibit acting for the benefit of others and may deepen divisions in the community according to health status. Public communications on pandemics are mediated by gender norms that may overburden women and limit the action of men. Social research on the public response to pandemics needs to focus on the social structures and real world settings and relationships that shape the action of individuals

What factors shape doctors’ trustworthiness? Patients’ perspectives in the context of hypertension care in rural Tanzania

Introduction: There is increasing evidence that improving patient trust in doctors can improve patients’ use of healthcare services, compliance and continuing engagement with care –particularly for chronic diseases. Consequently, much of the current literature on trust in therapeutic relationships focuses on factors shaping doctors’ trustworthiness. However, few studies on this issue have been conducted among rural populations in low-income Africa, where health service delivery, cultural norms and patient expectations differ from those in high-income countries. This study examined patients’ perspectives of factors that shape doctors’ trustworthiness in rural Tanzania in the context of hypertension care. Methods: A qualitative inquiry using in-depth interviews was conducted between 2015 and 2016 in two characteristically rural districts of Tanzania. Data were analysed thematically. Results: The accounts of 34 patients from a Western-based care setting were examined. There was broad consensus about factors shaping doctors’ trustworthiness along the care trajectory (before, during and after a therapeutic encounter). Two major themes emerged: doctors’ interpersonal behaviours and doctors’ technical competence. Good interpersonal behaviour and technical skills in healthcare settings were factors that constructed a positive reputation in the community and shaped patients’ initial trust before a physical encounter. Doctors’ interpersonal behaviours that portrayed good customer care, understanding and sympathy shaped trustworthiness during a physical encounter. Finally, doctors’ technical competence shaped trustworthiness during and after an encounter. Participants used these factors to differentiate a trustworthy (‘good’) doctor from an untrustworthy (‘bad’) doctor. Conclusion: Good interpersonal behaviours and good technical skills are important in shaping patients’ judgements of doctors’ trustworthiness in rural Tanzania. The present findings provide useful insights for designing interventions to improve patient trust in doctors to address challenges associated with non-communicable diseases in rural low-income Africa

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

ACKNOWLEDGEMENTS Review and editing: S.R. Brown, Professor of Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. Email [email protected]. Patient summary: R.G. Arnott, Retired Professor, Patient Liaison Group, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK. Email [email protected]. Delphi review: C.P. Macklin. BMedSci BM BS FRCS DM, Consultant Colorectal Surgeon, Mid Yorkshire Hospitals, UK. Email [email protected] reviewedPublisher PD

Thinking through Errance: Journeying and Waiting among African Travelers in Quito and Dakar

RESUMEN: A partir del cambio de milenio, Ecuador se ha convertido en un lugar de paso, pero también de residencia para migrantes de diferentes países del mundo. Mientras que la fuerza de atracción de este país proviene de requisitos migratorios flexibles como resultado de una política de ciudadanía universal, las condiciones económicas no estimulan la posibilidad de quedarse. Este artículo tiene como punto de partida una reflexión previa sobre el concepto errancia que surgió de un acercamiento a las historias de africanos que esperaban en Dakar (Senegal) para continuar el viaje fuera de su continente. Contrastamos esta experiencia con la de otros africanos que han atravesado el Atlántico y han llegado a Quito. Dos opciones se presentan a estos últimos: continuar el viaje hacia Estados Unidos o quedarse. En ambos casos, las políticas migratorias, el valor de los papeles (pasaportes y visas) y las formas de socialidad influyen en su experiencia como viajeros. En el caso de quienes continúan el viaje hacia Estados Unidos,los riesgos de la travesía se convierten en pruebas de aptitud para recibir asilo.ABSTRACT: Since the beginning of the 21st century, Ecuador has been a point of transit but also of residence for migrants from around the world. While the attraction of this country resides in the flexible regulations of migration which stem from its policy of universal citizenship, the economic conditions there do not encourage migrants to stay. The starting point of this article is a previous study of the concept of errance which emerged from listening to the stories of Africans who were waiting in Dakar, Senegal, as they sought a way to leave from the continent from Africa. The article contrasts their experiences with those of other Africans who manage to cross the Atlantic and land in Quito. There are two options available for them: to either continue the journey toward the United States or remain in Ecuador. In both cases, migration policies, immigration papers and socialities are factors which shape their experience as travelers. For those who continue on their journey to the United States, the risks they run become a proof of their worthiness to be granted asylum

“Speaking as a woman” : agency in intersubjective communication

There is a tension in social-constructionist psychological accounts of the subject. On the one hand, the notion of the originary, substantive “I” is critiqued through an emphasis on the intersubjective constitution of subjects. On the other, the agency of this socially constituted subject is taken as a given. I analyse this tension as it is played out in attempts to understand the often-fraught position of “speaking as a woman”. In order to understand the difficulties entailed in any specific attempt to exercise agency, we need to avoid accounts of speaking positions that inadvertently split subjects into effective agents or communicators and failed agents or communicators. Drawing on Butler's antifoundationalist approach to the question of identity, I argue that the capacity to effect change can be better approached as emerging from the instability of subjectivity, intersubjectivity, and communication. That is, any agency entailed in speaking as a woman needs to be understood in terms of the instability of that speaking position

Being clichéd : women's talk and feminine subjectivities

In this chapter, I discuss ways of theorising the relationship between women's subjectivities and social practices of talk. I draw on sexual difference feminism (eg. Irigaray, 1977; Irigaray 1985a; Irigaray 1985b; Irigaray 1993) to argue for the need to move beyond phallocentric accounts of women's subjectivities, and to theorise power relations as intrinsic to social practices of talk (rather than describing the operation of power as disruptive of ordinary conversation). This approach to power offers a critique of many claims to equality between the sexes, on the basis that such claims perpetuate phallocentric verions of subjectivity. But here, I draw on a notion of 'fictional equality' (Sennett, 1976), arguing that particular conventions which involve acting as if equality existed can be thought to result in the subversion of phallocentric subjectivities. This is because conventions of talk in which the subject is constituted as self-distanced might undermine the unitary, self-knowing attributes of phallocentric subjectivity. My argument begins with, and progresses through a discussion of one particular account of a young woman talking to a man on a bus

The Reach and Limits of the US President’s Emergency Plan for Aids Relief (PEPFAR) Funding of Prevention of Mother-to-Child Transmission (PMTCT) of HIV in Nigeria

WHO advocates the use of comprehensive 4-pronged strategy for PMTCT of HIV. It includes HIV prevention, preventing unintended pregnancies in HIV positive women and follows up treatment and support as well as therapeutic interventions around delivery. This study examines PEPFAR’s funding of Nigerian PMTCT, via an analysis of the funded activities of 396 agencies PEPFAR funds to do PMTCT. PEPFAR Sub-partners selected for this study were included because they were funded to do therapeutic intervention around delivery, but significant gaps were identified regarding the other 3 prongs advocated by WHO. Up to 70% were not funded to do any primary prevention. PEPFAR’s own reporting does not allow assessment of Sub-partner involvement in preventing unintended pregnancies. Regarding follow up treatment and care, some Sub-partners were not funded at all. PEPFAR is not supporting a comprehensive approach to PMTCT in the way it funds PMTCT in Nigeria Keywords: HIV, PMTCT, Prevention, PEPFAR, Nigeria Afr J Reprod Health 2012; 16[1]:23-3

Securitising health : Australian newspaper coverage of pandemic influenza

This paper analyses contemporary Australian newspaper coverage of the threat of pandemic influenza in humans, specifically in the light of recent transformations in biomedical and public health understandings of infectious disease as continuously emerging. Our analysis suggests that the spectre of pandemic influenza is characterised, in newspaper accounts, as invoking a specific form of nation building. The Australian nation is depicted as successfully securing itself in the face of a threat from Asia (and in the absence of an effective international health body). What is described in newspaper accounts reflects a shift in the public health response to infectious disease. This response does not entail a direct focus on protecting either the population or national territory. Instead, it involves the continuous rehearsal of readiness to react to disasters through the networking of government and private agencies responsible for maintaining critical infrastructure. In this way, coverage of pandemic influenza positions health as central to national security, with little reporting of the reasons for or the potential implications of this alliance. Thus, the imperative to ‘be prepared’ is presented as self-evident.15 page(s

La portée et les limites du plan d’urgence du Président américain à l’égard du financement des secours au SIDA (PUPFSS) pour la prévention de la Transmission du VIH de la mère à l’enfant (PTME) au Nigéria

WHO advocates the use of comprehensive 4-pronged strategy for PMTCT of HIV. It includes HIV prevention, preventing unintended pregnancies in HIV positive women and follows up treatment and support as well as therapeutic interventions around delivery. This study examines PEPFAR’s funding of Nigerian PMTCT, via an analysis of the funded activities of 396 agencies PEPFAR funds to do PMTCT. PEPFAR Sub-partners selected for this study were included because they were funded to do therapeutic intervention around delivery, but significant gaps were identified regarding the other 3 prongs advocated by WHO. Up to 70% were not funded to do any primary prevention. PEPFAR’s own reporting does not allow assessment of Sub-partner involvement in preventing unintended pregnancies. Regarding follow up treatment and care, some Sub-partners were not funded at all. PEPFAR is not supporting a comprehensive approach to PMTCT in the way it funds PMTCT in Nigeria (Afr J Reprod Health 2012; 16[1]:23-34).L’OMS préconise l’utilisation d’une stratégie compréhensive à quatre fronts pour la PTME du VIH. Elle comprend la prévention du VIH, la prévention des grossesses non-voulues chez les femmes séropositives, le traitement en postcure et d’appui aussi bien que les interventions thérapeutiques autour de l’accouchement. Cette étude examine le financement de la PTME du Nigéria par le PUPFSS à travers une analyse des activités financées auprès des agences financées, elles aussi, par PUPFSS pour réaliser la PTME. Les sous-partenaires du PUPFSS sélectionnés pour cette étude, ont été inclus parce qu’ils étaient financés pour réaliser des interventions thérapeutiques autour de l’accouchement, mais on a identifié d’importants trous à propos des trois autres fronts préconisés par l’OMS. Jusqu’à 70% n’ont pas été financés pour réaliser une prévention primaire. Le reportage par le PUPFSS ne permet pas d’évaluer la participation des sous-partenaires dans la prévention des grossesses non-voulues. En ce qui concerne le traitement en postcure et au soin, certains sous-partenaires n’ont pas été du tout financés. Le PUPFSS ne soutient pas une approche compréhensive à la PTME dans la manière dont il finance la PTME au Nigéria (Afr J Reprod Health 2012; 16[1]:23-34)