Compassionate containment? Balancing technical safety and therapy in the design of psychiatric wards

This paper contributes to the international literature examining design of inpatient settings for mental health care. Theoretically, it elaborates the connections between conceptual frameworks from different strands of literature relating to therapeutic landscapes, social control and the social construction of risk. It does so through a discussion of the substantive example of research to evaluate the design of a purpose built inpatient psychiatric health care facility, opened in 2010 as part of the National Health Service (NHS) in England. Findings are reported from interviews or discussion groups with staff, patients and their family and friends. This paper demonstrates a strong, and often critical awareness among members of staff and other participants about how responsibilities for risk governance of ‘persons’ are exercised through ‘technical safety’ measures and the implications for therapeutic settings. Our participants often emphasised how responsibility for technical safety was being invested in the physical infrastructure of certain ‘places’ within the hospital where risks are seen to be ‘located’. This illuminates how the spatial dimensions of social constructions of risk are incorporated into understandings about therapeutic landscapes. There were also more subtle implications, partly relating to ‘Panopticist’ theories about how the institution uses technical safety to supervise its own mechanisms, through the observation of staff behaviour as well as patients and visitors. Furthermore, staff seemed to feel that in relying on technical safety measures they were, to a degree, divesting themselves of human responsibility for risks they are required to manage. However, their critical assessment showed their concerns about how this might conflict with a more therapeutic approach and they contemplated ways that they might be able to engage more effectively with patients without the imposition of technical safety measures. These findings advance our thinking about the construction of therapeutic landscapes in theory and in practice.     

Discourses of risk in lay accounts of microbiological safety and BSE: a qualitative interview study

This paper reports on a qualitative study of lay understandings of food risks, focusing on discourses of risk in lay accounts of microbiological safety and BSE. The research was conducted using interpretive sociological methods. In-depth interviews were conducted with 32 lay participants from a range of social backgrounds and perspectives on food issues. The qualitative data were analysed thematically, drawing on principles and techniques derived from Grounded Theory approaches. Several key themes relating to risk emerged: these included, the role of experience in interpreting vulnerability to food risks, the time-scale of foods risks, the severity of the consequences of food risks, the incidence of food risks (and comparative risk), personal risk management strategies (and the ‘salience’ of food risks), risk and trusted food sources, responsibility for regulating food risks and the ‘politics’ of food risks. This paper presents an interpretive account of these themes and discusses the implications of the findings for a sociological analysis of food risks.     

动物冠状病毒感染特征与跨种传播研究进展

目的 总结动物冠状病毒感染特征及其跨种传播机制,为防治动物源性冠状病毒导致的新发传染性疾病提供参考。 方法 以“冠状病毒”、“动物”、“感染”、“跨种传播”为主题词检索中国知网、万方数据库、PubMed数据库,检索日期截至2020年6月30日,共检索到中文文献910篇,英文文献1374篇,排除重复文献与非相关研究后对156篇文献进行归纳。 结果 总结发现,动物冠状病毒宿主范围广泛,感染特征多样,突变和重组在其跨种传播的过程中发挥了重要作用。 结论 应加强对动物冠状病毒的监测,重点关注发生于棘突蛋白的变异,完善跨种传播机制等相关研究。     

Re-assessing vulnerability to foodborne illness: pathways and practices

Foodborne illness is a major public health concern, often approached by focusing on socio-demographic groups who are considered most ‘vulnerable’ to foodborne disease such as elderly people or pregnant women. Based on a review of existing literature and original research with UK consumers, this paper proposes an alternative approach to analysing vulnerability to foodborne illness. Challenging conventional approaches that focus on the inherent vulnerability of particular socio-demographic groups, the paper emphasises the context-specific and situational nature of vulnerability and the practices and pathways through which people negotiate specific threats which may, in turn, affect their future vulnerabilities. The paper also addresses the gap between lay and expert knowledge that may increase exposure to particular food-related risks. Evidence is provided from research on the food safety and health implications of consumers’ everyday domestic practices including behaviours that do not comply with current ‘best practice’ advice. The evidence supports a turn from notions of inherent vulnerability, based on the membership of certain socio-demographic groups, towards a more nuanced understanding of situational vulnerability, based on the context and logic informing specific social practices.     

Personalised risk: new risk encounters facing migrant care workers

Many long-term care systems are seeking to address problems of growing demand, increasing expense, and higher user expectations. For many of them fostering care at home and private care arrangements are attractive options. The long-term care sector in England is typical of these systems. Over the last 2 decades, government policy in England has placed stronger emphasis on people’s choice and control when receiving care services. People with care and support needs may be eligible for public funds to employ care workers or to use them in other ways promote their well-being. These financial transactions are a major part of the policy of personalisation in adult social care, as confirmed by the Care Act 2014. Drawing on findings from life story interviews with 31 migrant care workers who had worked for disabled or older people in England, conducted 2011–2013, we note the potential for expanding the sociologically inspired concept ‘personalised risk’. This necessitates an appreciation of risks potentially faced by the multiple parties in the care relationship and a differentiated set of structural risks. Applying a multilevel analysis we highlight the potential risks of ‘informality’ of employment conditions experienced by directly employed care workers, the ‘emotional’ content of care worker-employer relationships, and ‘intimacy’ of employer/employee roles. In this article, we offer an empirical based contribution to the wider discussion of risks and risk theory derived from policy changes being adopted by many developed countries that increasingly emphasise individual responsibility for personal welfare within an uncertain and mobile social world.     

Lay epidemiology and the prevention paradox: the implications of coronary candidacy for health education

This paper is concerned with the appropriateness of current attempts to prevent chronic disease through behavioural change. Based on extensive ethnographic research in South Wales, the paper suggests that, within contemporary British health culture, there exists a well developed lay epidemiology which has a significant bearing on the public plausibility of modern health promotion messages. The paper describes the notion of the coronary candidate (the ‘kind of person who gets heart trouble’) and discusses the operation of the idea in everyday life. The manner by which lay epidemiology and the population approach to health promotion construct the ‘prevention paradox’ within the social world is outlined. In conclusion it is suggested that lay epidemiology readily accommodates official messages concerning behavioural risks within the important cultural fields of luck, fate and destiny. This simultaneously constitutes a rational way of incorporating potentially troublesome information, and a potential barrier to the aims of health education.     

„Subjektiver sozialer Status“

Background

Social status is just about always assessed by ‘objective’ measures such as educational level, income or occupational status. In recent years, some studies have also included the assessment of ‘subjective social status’ (SSS). This new variable could be important for health promotion and prevention. In Germany, though, this discussion has hardly been recognized yet.

Methods

Based on different databases, we conducted a systematic review of empirical studies which include an assessment of SSS. As far as we know, a similar review has not been published in German yet. We looked for associations with morbidity, mortality and health risks such as smoking or obesity. We finish with recommendations for further research and practice.

Results

We were able to find 53 empirical studies. Most of them are from the USA; no study has been published from Germany, Austria or Switzerland. Most studies (46 of 53) were published in the last 5 years, clearly indicating that this discussion is still rather new. ‘Subjective social status’ is mostly assessed by the MacArthur Scale, i.e. a ladder where the respondents can mark their position between ‘low’ (low social status) and ‘high’ (high social status). The results of the studies often show increased health risks for people with low SSS, even if ‘objective’ measures such as educational level or income are controlled for statistically.

Conclusion

“Subjective social status” should also be included in German studies, in addition to ‘objective’ measures such as educational level or income. If people are to be reached in programmes for health promotion or prevention, it is important to know what social position they believe they have; and this subjective perception does not just depend on ‘objective’ measures such as educational level or income. We would recommend that ‘subjective social status’ be assessed with a German version of the MacArthur Scale. The picture of a ladder is apparently able to capture the meaning of ‘social status’ very well and it is very easy to understand.     

GPs and the social amplification of BSE-related risk: An empirical study

Social studies of risk have consistently shown that physicians and health professionals are viewed by the general public as a trustworthy source of information and communication regarding risks. However, few if any empirical investigations have focused on the role physicians, particularly general practitioners (GPs), may play as a ‘social station’ in the processes of amplification or attenuation of risks to health that Kasperson et al described in their framework. The purpose of the present study is to investigate whether French GPs acted as amplifiers or attenuators in the BSE (‘mad cow disease’) crisis. A sample of 602 general practitioners completed a questionnaire aimed at assessing in a variety of ways their cognitive, affective and behavioural responses to BSE. Results show that, (1) GPs expressed moderate concern about BSE-related risks: Mad cow disease only ranked tenth in averaged ratings of 14 current risks to health. (2) However, about 90% of respondents reported having recommended one or several modifications in their patients' food habits. Remarkably, only 44% did the same at home. (3) By far the most common recommendation was to avoid organ meats from cattle, even though specified risk materials (which included some of those cuts) had been withdrawn from the market as early as April 1996. Such results point to potentially complex—perhaps even contradictory—responses to BSE from the GPs, with a clear dichotomy between reported private and professional behaviour. Our data suggest that social agents may act simultaneously as risk amplifiers and risk attenuators depending on the public towards which their communication was directed.     

Notes on the concepts of ‘serodiscordance’ and ‘risk’ in couples with mixed HIV status

Abstract

Serodiscordant primary relationships, in which one partner is HIV-positive and the other is HIV-negative, are increasingly recognised as a key context for the transmission of HIV globally. Yet insights into the dynamics of serodiscordance remain relatively limited. I argue that to understand what makes serodiscordant couples engage in sexual practices that increase the chance of transmission, we need to examine what HIV ‘risk’ actually means in different cultures and contexts. A ‘socially situated’ approach to HIV risk moves beyond its scientific conceptualisation as an objective ‘fact’, revealing a diversity of perceptions and competing risks. It also reveals that couples do not necessarily perceive their mixed HIV status in terms of ‘difference’, a common assumption that predetermines serodiscordance and thereby obscures its many and complex enactments. I draw on examples from the social research literature to illustrate how serodiscordance is shaped in different ways by local practices, priorities, and meanings. I argue that it is within these lived contexts that perceptions and negotiations of ‘risk’ arise and, thus, where couples’ sexual practices need to be situated and understood. Such insights are timely as HIV research and prevention grapple with emerging scientific data that challenge traditional understandings about HIV transmission risk.