全科医生的社会性及医学社会学素养

发展社区卫生服务的关键是要大力培养全科医生,合格的全科医生必须具备一定的医学社会学素养。本文分析了全科医生的社会性、医学的社会化特征及医学社会学的内涵、研究对象和研究方法,探讨了培养全科医生医学社会学素养的意义和途径。     

Investigation of the ways in which patients' reports of their satisfaction with healthcare are constructed

A characteristic feature of patient satisfaction research is the consistently high level of satisfaction recorded. More reliable and relevant inquiry tools are constantly being developed, but underlying psychological and social pressures that could promote such a consistent and undiscriminating response have been little investigated. Williams et al. (1998) explored the phenomenon and concluded that, by considering issues of duty and culpability, patients could make allowances for poor care, and avoid evaluating it negatively. Their study was in community mental health. This study follows up their work within elective orthopaedic surgery, and investigates the pressures promoting such apparent transformation of opinion. Using a longitudinal design, and in-depth qualitative interviews, the patient's process of reflection was explored. Three psycho-social pressures were identified that appear to work together to make the transformation of opinion almost the default process. They are: the relative dependency of patients within the healthcare system; their need to maintain constructive working relationships with those providing their care; and their general preference for holding a positive outlook. It is suggested that, while it is the patient's prerogative to re-interpret the quality of their care positively, it is not the prerogative of the inquirer to accept this re-interpretation as representative of the patient's experience. Methods of inquiry are needed which access something of patients' development of opinion, and thereby something of their initial, often more negative, untransformed responses to their healthcare experiences.     

‘You know that we are not able to go to McDonald’s’: processes of doing participation in Swedish leisure time centres

ABSTRACT

This study aims to answer the question of how pupils’ participation is acted within the context of Swedish leisure time centres (LTCs) through the analysis of ethnographic material from five different LTCs. The analysis took a grounded theory approach, and the results show that pupils’ participation in LTCs can be seen as an ongoing negotiation and that participation is something that needs to be worked with in everyday interactions. We identify three important processes for doing participation in LTCs – participation by negotiating, participation by initiating, and participation by choosing. Different aspects of formal and informal ways of doing participation are also of importance, and while pupils can have a greater influence in informal negotiations, this requires certain negotiating skills that not all children possess.     

‘Plausible uncertainty’: The negotiated indeterminacy of pandemic influenza in the UK

Policymakers in the UK (and worldwide) are preparing for what is said to be an inevitable and imminent influenza pandemic. However, aside from its inevitability, there is a considerable amount of uncertainty surrounding the pandemic. Public health policy is flexible and ad hoc, and this, the public is told, is a direct result of the natural unpredictability of the influenza virus, This article argues that we should not uncritically accept policymakers’ assertion that the uncertainty surrounding pandemic influenza public health is simply a result of this natural unpredictability. Uncertainty in public health policy must be understood in terms of its socio-political, as well as its scientific, context. Uncertainty is seen to occupy two separate but related levels: basic scientific uncertainty and public health policy uncertainty. This study shows how the former, which to an extent is real uncertainty, is translated into the latter which is (re)constructed and politicised as ‘plausible uncertainty’. The actors are seen to displace accountability onto the influenza virus through a naturalistic account of uncertainty which fails to include a public discussion of those socio-political factors, such as funding and licensing, which also help to shape both scientific research and policy formulation, and which subsequently have an impact on how well prepared we are for coping with a pandemic. The danger, it is suggested, is that the existence of a ‘culture of precaution’ too easily allows for a naturalistic account of uncertainty to be seen as a justifiable solution to a difficult policy problem, in instances where the full social and political context of the issue may not have been openly discussed.     

刍议护理语言的应用及作用

从临床护理语言在疾病康复中的作用出发 ,探讨了护士的社会角色、融洽护患关系等问题。提出临床护理语言是一个广义的概念 ,护患沟通中语言交流与非语言交流同等重要 ,是影响病人身体康复的重要社会因素。     

The sociology of risk and uncertainty: A response to Judith Green's ‘Is it time for the sociology of health to abandon “risk”?’

This article responds to Judith Green's (2009 Green, J. 2009. Is it time for the sociology of health to abandon ‘risk’?. Health, Risk & Society, 11(6): 493–508. [Taylor & Francis Online], [Web of Science ®] [Google Scholar], p. 493–508, this issue) contribution ‘Is it time for the sociology of health to abandon “risk”?’ It agrees with some of Green's criticisms of risk studies, but argues that rather than abandoning the concept of risk it should be refined and developed. Even though Green is right to have concerns about narrow approaches to social reality she follows a narrow perspective herself, which is atypical for sociological approaches to risk. She starts with criticism of the overemphasis on risk in research on the sociology of health but seem to shift to a general critique of risk research and focuses on one particular approach. Sociological risk research, I would argue, provides a critique of precisely those reductionist approaches to risk which Green sees as narrowing the focus of risk to concepts of rational decision making, technical calculation and risk assessment. Her examples, however, indicate a range of problems, but less with the concept of risk but rather methodological weaknesses, issues of operationalisation of macro theory and a technical understanding of risk which are altogether problematic not only in the realm of risk but for sociological approach to social reality in general. Instead of questioning risk I point to ways in which sociological risk research can be systematised. I show that Green's analysis has weaknesses that are conceptually important. In particular, she does not clearly distinguish between several levels of analysis such as institutional self representation and everyday practice, the risk society as a specific theory and the sociology of risk and uncertainty as an area of research and risk as an analytical approach and a research object. I argue that sociological approaches to risk already work with other distinctions than rational/subjective and some research even shows how such distinctions can be overcome to open further perspectives for risk research.     

道德教育生态的社会学探讨

通过对当前我国道德教育的审视,从社会学角度分析道德教育缺失的生态困境,中国道德教育要建构科学的道德教育生态系,必须树立道德教育生态理念,并致力于道德教育生态的理论建构与现实建设?     

Community correlates of outcomes in subjects with panic attacks.

The purpose of this study was to document the association between community factors and mental health outcomes in subjects with panic attacks. Randomly selected adults from 18 census tracts were screened for the presence of panic attacks. A structured interview was used to assess health care utilization, psychiatric morbidity, quality of life, and sense of control over panic. Community measures were obtained from census data. Regression analyses found that each community measure was associated with at least one outcome even when adjusted for individual socioeconomic status and barriers to access. Research concerning mental health outcomes in subjects with panic attacks should include community-level data.     

Sport as a vehicle for health promotion – an analysis of Norwegian policy documents

In contemporary western society, there has been an increasing focus on physical activity as a vehicle for promoting health. How physical activity is promoted and organized varies across countries. This article focuses on the Norwegian system, which is characterized by voluntary sport being organized during leisure time, and all being federated under the Norwegian Olympic Committee and Confederation of Sports (NOC). Guided by the field concept of Bourdieu, historical works and contemporary sport policy documents are analyzed in order to explore how health is considered within the sport context. The conclusion is that health is both facilitated and constrained in the sport field. The voluntary dominance of the sport field makes it sustainable in relation to providing physical activity. However, the voluntary dominance of the sport field also makes it vulnerable and unpredictable in relation to implementing state sport and/or health policy. The state cannot in any way be assured to achieve its health objectives through the sport field.