The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK

This paper examines UK and US primary care doctors' decision-making about older (aged 75 years) and midlife (aged 55 years) patients presenting with coronary heart disease (CHD). Using an analytic approach based on conceptualising clinical decision-making as a classification process, it explores the ways in which doctors' cognitive processes contribute to ageism in health-care at three key decision points during consultations. In each country, 56 randomly selected doctors were shown videotaped vignettes of actors portraying patients with CHD. The patients' ages (55 or 75 years), gender, ethnicity and social class were varied systematically. During the interviews, doctors gave free-recall accounts of their decision-making. The results do not establish that there was substantial ageism in the doctors' decisions, but rather suggest that diagnostic processes pay insufficient attention to the significance of older patients' age and its association with the likelihood of co-morbidity and atypical disease presentations. The doctors also demonstrated more limited use of 'knowledge structures' when diagnosing older than midlife patients. With respect to interventions, differences in the national health-care systems rather than patients' age accounted for the differences in doctors' decisions. US doctors were significantly more concerned about the potential for adverse outcomes if important diagnoses were untreated, while UK general practitioners cited greater difficulty in accessing diagnostic tests.

From the medicalisation of dementia to the politics of memory and identity in three Spanish documentary films:Bicicleta, cullera, poma, Las voces de la memoria and Bucarest: la memòria perduda

This paper explores how the concept of Alzheimer’s disease (AD) is constructed through Spanish media and documentary films and how it is represented. The article analyses three documentary films and the cultural and social contexts in and from which they emerged: Solé´s Bucarest: la memòria perduda [Bucharest: Memory Lost] (2007), Bosch´s Bicicleta, cullera, poma [Bicycle, Spoon, Apple] (2010) , and Frabra’s Las voces de la memoria [Memory´s Voices] (2011). The three documentary films approach AD from different perspectives, creating well-structured discourses of what AD represents for contemporary Spanish society, from medicalisation of AD to issues of personhood and citizenship. These three films are studied from an interdisciplinary perspective, in an effort to strengthen the links between ageing and dementia studies and cultural studies. Examining documentary film representations of AD from these perspectives enables semiotic analyses beyond the aesthetic perspectives of film studies, and the exploration of the articulation of knowledge and power in discourses about AD in contemporary Spain

Health inequalities and user involvement?

This chapter examines the theory and practice of user involvement and evaluates its impact on health inequalities in Great Britain. It describes different types of user involvement and highlights the problems in trying to define ‘hard to reach’ groups and the importance of user involvement for such groups. It concludes that user involvement is everyone's business that requires radical shifts in both theory and practice to succeed. It also suggests that creating and promoting greater exchange between those who provide and manage health services and communities and individuals who seek and receive services will create better tailoring of services to demand.

Culture and the psychological impacts of natural disasters: Implications for disaster management and disaster mental health

In recent decades, natural disasters have caused extensive losses and damages to human psychological wellbeing, economy, and society. It has been argued that cultural factors such as social values, traditions, and attachment to a location influence communities facing and responding to natural disasters. However, the issue of culture in disaster mental health seems to have received limited attention in policy and practice. This review highlights the importance of cultural background in the assessment of vulnerability to the psychological impacts of disasters, disaster preparedness, and provision of disaster mental health services. In particular, this paper suggests the importance of cultural competence in the planning and delivery of effective disaster mental health services. In order to address the varying circumstances of people with different cultural backgrounds, disaster mental health services must be developed in a culturally sensitive manner. Development of culturally competent disaster mental health services requires significant changes in policy making, administration, and direct service provision

THOMAS NIEHR AND KARIN BÖKE (eds), Einwanderungsdiskurse. Vergleichende diskurslinguistische Studien. [Immigration Discourses: Comparative Discourse Studies.] Opladen: Westdeutscher Verlag, 2000. 241 pp. DM 56.00 (pbk). ISBN 3–5311–3307–1

Book review

Who is really in charge of contemporary education? People and technologies in, against and beyond the neoliberal university

This article reflects on the position of people in, against and beyond information and communication technologies. Firstly, using Jandrić and Kuzmanić’s work on digital postcolonialism, Raymond Williams's work on residual and emergent cultures, and Deleuze and Guattari's insights into the dynamics between territorialization, de-territorialization and re-territorialization, it develops a theoretical framework for inquiry into the hybrid identity of the contemporary university. Then, through critical discourse analysis (CDA), the article moves on to analyse the ways in which technology discourse resides in the dominating ideology of technological determinism and co-opts with neoliberal agendas by omitting humans from explicit mention in UK policy documents. It shows that true counter-hegemonic practice against dominating social practices is possible only through reinvigorating the central position of human beings in regards to information and communication technologies. Within the developed theoretical framework, it seeks openings to intervene subversively into current relationships between technologies, people, and (higher) education, and to identify opportunities for building a non-determinist identity of the contemporary university that reaches beyond the single-minded logic of techno-scientific development. In the process, it situates Paulo Freire's insights into critical pedagogy in the context of the network society, and places the relationships between human beings, language and information and communication technologies amongst central questions of today's (higher) education and society at large.

Growing better brains? Pregnancy and neuroscience discourses in English social and welfare policies

In recent years, English welfare and health policy has started to include pregnancy within the foundation stage of child development. The foetus is also increasingly designated as ‘at risk’ from pregnant women. In this article, we draw on an analysis of a purposive sample of English social and welfare policies and closely related advocacy documents to trace the emergence of neuroscientific claims-making in relation to the family. In this article, we show that a specific deterministic understanding of the developing brain that only has a loose relationship with current scientific evidence is an important component in these changes. We examine the ways in which pregnancy is situated in these debates. In these debates, maternal stress is identified as a risk to the foetus; however, the selective concern with women living in disadvantage undermines biological claims. The policy claim of neurological ‘critical windows’ also seems to be influenced by social concerns. Hence, these emerging concerns over the foetus’ developing brain seem to be situated within the gendered history of policing women’s pregnant bodies rather than acting on new insights from scientific discoveries. By situating these developments within the broader framework of risk consciousness, we can link these changes to wider understandings of the ‘at risk’ child and intensified surveillance over family life.

Soccer, South Africa and celebrity status:Mark Fish, popular culture and the post-apartheid state

The rise of celebrity culture is a theme that has attracted a significant amount of attention within both mainstream sociology and cultural studies in more recent times. Ensuing debate has identified contemporary sports figures as an important facet of the celebrity‐media nexus and as possible signifiers of cultural change. In this paper we take one particular sports celebrity, South African soccer star Mark Fish, and evaluate his image in relation to debates surrounding sport, politics and the post‐apartheid state. We argue that because Fish appears to enjoy all the benefits of celebrity status (within his home country at least), an analysis of his career and identity provide a useful means by which to think about the changing political and nationalistic values within South African society.

‘Death talk’, ‘loss talk’ and identification in the process of ageing

In this paper, we examine the injunction issued by the prominent politician, broadcaster and older people's advocate, Baroness Joan Bakewell, to engage in ‘death talk’. We see positive ethical potential in this injunction, insofar as it serves as a call to confront more directly the prospects of death and dying, thereby releasing creative energies with which to change our outlook on life and ageing more generally. However, when set against a culture that valorises choice, independence and control, the positive ethical potential of such injunctions is invariably thwarted. We illustrate this with reference to one of Bakewell's interventions in a debate on scientific innovation and population ageing. In examining the context of her intervention, we affirm her intuition about its positive ethical potential, but we also point to an ambivalence that accompanies the formulation of the injunction – one that ultimately blunts the force and significance of her intuition. We suggest that Gilleard and Higgs' idea of the third age/fourth age dialectic, combined with the psycho-analytic concepts of fantasy and mourning, allow us to express this intuition better. In particular, we argue that the expression ‘loss talk’ (rather than ‘death talk’) better captures the ethical negotiations that should ultimately underpin the transformation processes associated with ageing, and that our theoretical contextualisation of her remarks can help us see this more clearly. In this view, deteriorations in our physical and mental capacities are best understood as involving changes in how we see ourselves, i.e. in our identifications, and so what is at stake are losses of identity and the conditions under which we can engage in new processes of identification.

Hungarian international development cooperation:context, stakeholders and performance

This paper explores the domestic and international context of Hungary's emerging international development policy. Specifically, it looks at three factors that may influence how this policy operates: membership in the European Union (EU) and potential ‘Europeanization’, Hungary's wider foreign policy strategy, and the influence of domestic stakeholders. In order to uncover how these factors affect the country's international development policy, semi-structured interviews were carried out with the main stakeholders. The main conclusions are: (1) While accession to the EU did play a crucial role in restarting Hungary's international development policy, the integration has had little effect since then; (2) international development policy seems to serve mainly Hungary's regional strategic foreign policy and economic interests, and not its global development goals; and (3) although all the domestic development stakeholders are rather weak, the Ministry of Foreign Affairs (MFA) still seems to play a dominating role. Convergence with European requirements and best practices is, therefore, clearly hindered by foreign policy interests and also by the weakness of non- governmental stakeholders.

On the F word:a corpus-based analysis of the media representation of feminism in British and German press discourse, 1990-2009

Research in social psychology has shown that public attitudes towards feminism are mostly based on stereotypical views linking feminism with leftist politics and lesbian orientation. It is claimed that such attitudes are due to the negative and sexualised media construction of feminism. Studies concerned with the media representation of feminism seem to confirm this tendency. While most of this research provides significant insights into the representation of feminism, the findings are often based on a small sample of texts. Also, most of the research was conducted in an Anglo-American setting. This study attempts to address some of the shortcomings of previous work by examining the discourse of feminism in a large corpus of German and British newspaper data. It does so by employing the tools of Corpus Linguistics. By investigating the collocation profiles of the search term feminism, we provide evidence of salient discourse patterns surrounding feminism in two different cultural contexts. © The Author(s) 2012.

Manufacturing reshoring and its limits:the UK automotive case

This paper explores the meaning of reshoring and its drivers in the case of UK manufacturing and in particular its automotive sector. Drawing on interviews, policy reviews and a range of recent surveys, the paper finds that while reshoring is a discernable trend in UK manufacturing, it is less pronounced than many have claimed and that – in the UK case at least - there are severe limits as to how far this reshoring trend can go, particularly in relation to the availability of skills and finance in the supply chain. This is in turn raises questions over the stance of British policy and whether more could be done, with comparisons made to US experience.

Phoenix industries and open innovation? The Midlands advanced automotive manufacturing and engineering industry

This paper explores the links between open innovation and the emergence of a ‘phoenix industry’ centred on the UK’s traditional automotive heartland, the West Midlands, which has developed a significant presence in automotive design and engineering, particularly among small and niche firms. Drawing on case study research, the paper investigates whether this can be considered as a phoenix industry, and to what extent open innovation has been important in the industry’s development. The paper considers relationships between firms and impacts in terms of changing economic and labour market conditions. The paper concludes by examining the role that public policy has played to date and might play in the future in supporting an emerging phoenix industry with open innovation features.

High growth firms, jobs and peripheral regions:the case of Scotland

Enterprise policy is increasingly favouring support for high growth firms (HGFs). However, this may be less effective in promoting new jobs and economic development in peripheral regions. This issue is addressed by a study of HGFs in Scotland. Scottish HGFs differ in a number of respects from the stylised facts in the literature. They create less employment than their counterparts elsewhere in the UK. Most have a significant physical presence outside of Scotland, thereby reducing their Scottish 'footprint' and domestic job creation. Scottish HGFs appear to have a high propensity to be acquired, increasing the susceptibility of the head office to closure. The evidence suggests that the tendency towards 'policy universalism' in the sphere of entrepreneurship policy is problematic.