Under the carpet : the politics and trauma of patient harm

Few studies have investigated iatrogenic outcomes from the viewpoint of patient experience. To address this anomaly, the broad aim of this research is to explore the lived experience of patient harm. Patient harm is defined as major harm to the patient, either psychosocial or physical in nature, resulting from any aspect of health care. Utilising the method of Consensual Qualitative Research (CQR), in-depth interviews are conducted with twenty-four volunteer research participants who self-report having been severely harmed by an invasive medical procedure. A standardised measure of emotional distress, the Impact of Event Scale (IES), is additionally employed for purposes of triangulation. Thematic analysis of transcript data indicate numerous findings including: (i) difficulties regarding patients‘ prior understanding of risks involved with their medical procedure; (ii) the problematic response of the health system post-procedure; (iii) multiple adverse effects upon life functioning; (iv) limited recourse options for patients; and (v) the approach desired in terms of how patient harm should be systemically handled. In addition, IES results indicate a clinically significant level of distress in the sample as a whole. To discuss findings, a cross-disciplinary approach is adopted that draws upon sociology, medicine, medical anthropology, psychology, philosophy, history, ethics, law, and political theory. Furthermore, an overall explanatory framework is proposed in terms of the master themes of power and trauma. In terms of the theme of power, a postmodernist analysis explores the politics of patient harm, particularly the dynamics surrounding the politics of knowledge (e.g., notions of subjective versus objective knowledge, informed consent, and open disclosure). This analysis suggests that patient care is not the prime function of the health system, which appears more focussed upon serving the interests of those in the upper levels of its hierarchy. In terms of the master theme of trauma, current understandings of posttraumatic stress disorder (PTSD) are critiqued, and based on data from this research as well as the international literature, a new model of trauma is proposed. This model is based upon the principle of homeostasis observed in biology, whereby within every cell or organism a state of equilibrium is sought and maintained. The proposed model identifies several bio-psychosocial markers of trauma across its three main phases. These trauma markers include: (i) a profound sense of loss; (ii) a lack of perceived control; (iii) passive trauma processing responses; (iv) an identity crisis; (v) a quest to fully understand the trauma event; (vi) a need for social validation of the traumatic experience; and (vii) posttraumatic adaption with the possibility of positive change. To further explore the master themes of power and trauma, a natural group interview is carried out at a meeting of a patient support group for arachnoiditis. Observations at this meeting and members‘ stories in general support the homeostatic model of trauma, particularly the quest to find answers in the face of distressing experience, as well as the need for social recognition of that experience. In addition, the sociopolitical response to arachnoiditis highlights how public domains of knowledge are largely constructed and controlled by vested interests. Implications of the data overall are discussed in terms of a cultural revolution being needed in health care to position core values around a prime focus upon patients as human beings.

Mediating cultural politics : a dialogue with Georgina Born

The following dialogue is based on an interview conducted as part of Professor Born’s visit to Brisbane in 2006, which included three public seminars at the University of Queensland (UQ) and Queensland University of Technology (QUT). The following dialogue provides a counterpoint to these events and to Born’s work as a whole, drawing together and extending key themes in the cultural politics of both public service broadcasting and new media technologies. It begins by discussing the possibilities of public sphere theory to provide useful models of institutional design. The discussion moves from there to SBS Television – an example of Public Service Broadcasting that provides an interesting contrast to the BBC, especially by virtue of SBS’s relationship with the politics of multiculturalism in Australia. The second half of the interview draws out the issues around cultural value, cultural power and the politics of technology in relation to new media, and concludes by focusing especially on the problems and potentialities of ‘user-generated content’.

Sacred cows and crashing boars : ethno-religious minorities and the politics of online representation in Malaysia

Starting with the incident now known as the Cow’s Head Protest, this article traces and unpacks the events, techniques, and conditions surrounding the representation of ethno-religious minorities in Malaysia. The author suggests that the Malaysian Indians’ struggle to correct the dominant reading of their community as an impoverished and humbled underclass is a disruption of the dominant cultural order in Malaysia. It is also among the key events to have has set in motion a set of dynamics—the visual turn—introduced by new media into the politics of ethno-communal representation in Malaysia. Believing that this situation requires urgent examination the author attempts to outline the problematics of the task.

Enlightenment out of chaos : power, politics and The Chaser’s War on Everything

This paper focuses on the satirical Australian television show The Chaser’s War on Everything, and uses it to critically explore the potential ramifications of what McNair (2006) has called ‘cultural chaos’. Through an analysis of several examples from this particular program, alongside interviews with its production team and qualitative audience research, this paper argues that this TV show’s engagement with political issues in a creative, entertaining way that departs from the conventions of traditional journalism, allows it to present a perhaps more authentic image of political agents than is often cultivated in the mainstream news media. This paper therefore provides clear evidence that the shift from homogeneity to heterogeneity in the news media presents a significant challenge to those who wish to heavily control public opinion. It also provides further support for an optimistic re-appraisal of entertainment which emphasises its central (not merely periphery) role in political discourse.

'In the hands of the Receivers': The Politics of Literacy in The Savage by David Almond and Dave McKean

David Almond and Dave McKean's The Savage is a hybrid prose and graphic novel which tells the story of one young man’s maturation through literacy. The protagonist learns to deal with the death of his father and his own 'savage' self by writing a graphic novel. This article reads The Savage in the context of earlier, 'Northern' literacy narrative - particularly Tony Harrison's poem "Them & [uz]" and Barry Hines' Kes — through the discourse of neoliberalism and the notion of the reluctant boy reader. It is suggested that Almond and McKean are influenced by currently dominant ideologies of gender and literacy.

Deviant knowledge : criminology, politics and policy

The “political” dynamics and the details of conducting criminological research on a day-to-day basis are examined. The role of government and commercial contracts in contemporary criminological scholarship are explored, as well as the various obstacles that criminologists must negotiate during the completion of a research project. The criminological implications of the ways in which academic environments are changing under new managerialist philosophies are examined. The ways in which notions of “critique” have become subordinate to the politics of existing governing rationalities are also examined. Chapter 1 details the questions, contours, and methods of “deviant knowledge.” Chapter 2 discusses the contours of criminological knowledge, including early criminological developments, international reconstruction and developments in criminological research following World War II, the United Nations, and the rise of critical genres. Chapter 3 explores criminology, government, and public policy, including the policies of the Home Office of England and Wales; the National Institute of Justice in Washington, DC; and the Australian Institute of Criminology in Canberra. The politics and control of criminological knowledge are discussed in chapter 4, along with ethical and legal issues, gathering and accessing data, and publishing results of research. Chapter 5 describes the “War on Terror” and government intolerance and suppression of free speech. Chapter 6 examines the new modes of governance and the commercialization of criminological knowledge. Chapter 7 discusses intellectual independence and collective concern, and the value of critique. 3 appendices, 546 references, index

Locally oriented crime prevention and the “partnership approach” : politics, practices and prospects

Why have multi-agency or "partnership" approaches to crime prevention and community safety been reported internationally with unfavorable results? Can groups and individuals from disparate government and non-government sectors work together to reduce or prevent crime? This article will address these and other questions by using developments in Belgium as its case study. In 1992, Belgium launched its "safety and crime prevention contracts", a series of locally based crime prevention initiatives which have attempted to contract federal, regional and local governments to a range of social and police oriented crime prevention endeavors. Traces the development of the Belgian crime prevention contracts and examines the difficulties experienced with "multi-agency crime prevention" and suggests that much of the political rhetoric in Belgium calling for local, community and intersectorial "partnerships" has, like several other countries including England and Wales, Canada, Australia and New Zealand, lacked clear practical expression. However, some promising initiatives indicate that this prevention approach may be capable of producing effective crime prevention and community safety outcomes. Further research is needed to describe these initiatives and analyze the conditions under which they are developed.

The perils and politics of criminological research and the threat to academic freedom

This article focuses on government acts of intimidation or the "policing of knowledge". It is more concerned with the suppression of academic freedom, the contractual ambiguities of contemporary criminological research and the ways in which independent scholarship is controlled or influenced by funding bodies than with the specifics of the original crime prevention research which forms the basis of the case study.

Timing of births and endometrial cancer risk in Swedish women

While a protective long-term effect of parity on endometrial cancer risk is well established, the impact of timing of births is not fully understood. We examined the relationship between endometrial cancer risk and reproductive characteristics in a population-based cohort of 2,674,465 Swedish women, 20–72 years of age. During follow-up from 1973 through 2004, 7,386 endometrial cancers were observed. Compared to uniparous women, nulliparous women had a significantly elevated endometrial cancer risk (hazard ratio [HR] = 1.32, 95% confidence interval [CI], 1.22–1.42). Endometrial cancer risk decreased with increasing parity; compared to uniparous women, women with ≥4 births had a HR=0.66 (95% CI, 0.59–0.74); p-trend < 0.001. Among multiparous women, we observed no relationship of risk with age at first birth after adjustment for other reproductive factors. While we initially observed a decreased risk with later ages at last birth, this appeared to reflect a stronger relationship with time since last birth, with women with shorter times being at lowest risk. In models for multiparous women that included number of births, age at first and last birth, and time since last birth, age at last birth was not associated with endometrial cancer risk, while shorter time since last birth and increased parity were associated with statistically significantly reduced endometrial cancer risks. The HR was 3.95 (95%CI; 2.17–7.20; p-trend=<0.0001) for women with ≥25 years since a last birth compared to women having given birth within 4 years. Our findings support that clearance of initiated cells during delivery may be important in endometrial carcinogenesis. Keywords: endometrial carcinoma, parity, registry, reproductive factors