Views on primary prevention of cardiovascular disease - an interview study with Swedish GPs

Background: General practitioners (GPs) have gradually become more involved in the prevention of cardiovascular disease (CVD), both through more frequent prescribing of pharmaceuticals and by giving advice regarding lifestyle factors. Most general practitioners are now faced with decisions about pharmaceutical or non-pharmaceutical treatment for primary prevention every day. The aim of this study was to explore, structure and describe the views on primary prevention of cardiovascular disease in clinical practice among Swedish GPs. Methods: Individual interviews were conducted with 21 GPs in southern Sweden. The interview transcripts were analysed using a qualitative approach, inspired by phenomenography. Results: Two main categories of description emerged during the analysis. One was the degree of reliance on research data regarding the predictability of real risk and the opportunities for primary prevention of CVD. The other was the allocation of responsibility between the patient and the doctor. The GPs showed different views, from being convinced of an actual and predictable risk for the individual to strongly doubting it; from relying firmly on protection from disease by pharmaceutical treatment to strongly questioning its effectiveness in individual cases; and from reliance on prevention of disease by non-pharmaceutical interventions to a total lack of reliance on such measures. Conclusions: The GPs' different views, regarding the rationale for and practical management of primary prevention of CVD, can be interpreted as a reflection of the complexity of patient counselling in primary prevention in clinical practice. The findings have implications for development and implementation of standard treatment guidelines, regarding long-time primary preventive treatment

Intercultural moments in translating and humanising the socio-legal system

This paper seeks to address the question how people go about intercultural differences in an institutional setting which aims to mediate between the socio-legal system and the ‘outsiders’ of the system, i.e. ordinary citizens, through an investigation of professional interactions between a legal advisor and her clients of Eastern European backgrounds in London. Drawing data from a linguistic ethnography, the analysis foregrounds the practice of resemiotisation and calibration. The second aim is to extend the notion of ‘intercultural moments’ and to explore its analytical benefits in understanding fleeting and seemingly mundane moments in encounters

Constructing the identity of an advice-giver in an American internet advice column.

This paper is a contribution to research on the expression of expert advice-giving (e.g., Heritage and Sefi 1992; Silverman et al. 1992). We present a linguistic analysis of the ways in which the identity of the fictional expert advisor Lucy emerges in an Internet advice column run by professional health educators as part of a university health service. In discourse-analytical close readings of 280 question–answer records, we identify and discuss seven recurring strategies (the advisor's name, self-reference and use of address terms; expert information-giving; giving options and making readers think; the choice of vocabulary; offering opinions; the use of empathy; the display of humor), which together contribute to Lucy's voice as an expert advice-giver if the readers repeatedly access the question–answer exchanges. This emerging identity is in line with the site's mission to provide information designed to facilitate independent and responsible decision processes and corresponds to an ideal of nondirectiveness, as also identified in the literature on other advisory settings (He 1994; Sarangi and Clarke 2002; Vehviläinen 2003). The constructed identity of Lucy thus makes ‘Lucy Answers’ an attractive site to (re)turn to for advice and complements the other services provided by the health educators