Lay perceptions of type 2 diabetes in Scotland:bringing health services back in

The growing prevalence of type 2 diabetes is placing Scottish health services under considerable strain. Consequently, diabetes services are undergoing a major process of reorganisation, including the devolvement of routine diabetes care/diabetic review from secondary to primary healthcare settings. This qualitative study was devised to explore newly diagnosed type 2 diabetes patients' perceptions of their disease and the health services they receive at a time when this restructuring of services is taking place. The sample comprised 40 patients resident in Lothian, Scotland, who had diverse experiences of services, some receiving GP-based care only, others having varying contact with hospital diabetes clinics. In-depth interviews were undertaken with patients, three times at six monthly intervals over 1 year, enabling their experiences to be tracked at critical junctures during the post-diagnostic period. Disease perceptions and health service delivery were found to be mutually informing and effecting. Not only did (different types of) health service delivery influence the ways in which patients thought about and self-managed their disease, over time patients' disease perceptions also informed their expectations of, and preferences for, diabetes services. We thus argue that there is a need for a reconceptualisation within the medical social sciences to take into account the context of healthcare and the economic/policy factors that inform health service delivery when looking at patients' disease perceptions. We also discuss the logistical and ethical challenges of drawing upon patients' perspectives, preferences and views in the design and delivery of future health services. © 2004 Elsevier Ltd. All rights reserved.

Early visual detection of oriented line targets: spatial characteristics,and reference frames of early visual orientation-processing

The orientations of lines and edges are important in defining the structure of the visual environment, and observers can detect differences in line orientation within the first few hundred milliseconds of scene viewing. The present work is a psychophysical investigation of the mechanisms of early visual orientation-processing. In experiments with briefly presented displays of line elements, observers indicated whether all the elements were uniformly oriented or whether a uniquely oriented target was present among uniformly oriented nontargets. The minimum difference between nontarget and target orientations that was required for effective target-detection (the orientation increment threshold) varied little with the number of elements and their spatial density, but the percentage of correct responses in detection of a large orientation-difference increased with increasing element density. The differing variations with element density of thresholds and percent-correct scores may indicate the operation of more than one mechanism in early visual orientation-processIng. Reducing element length caused threshold to increase with increasing number of elements, showing that the effectiveness of rapid, spatially parallel orientation-processing depends on element length. Orientational anisotropy in line-target detection has been reported previously: a coarse periodic variation and some finer variations in orientation increment threshold with nontarget orientation have been found. In the present work, the prominence of the coarse variation in relation to finer variations decreased with increasing effective viewing duration, as if the operation of coarse orientation-processing mechanisms precedes the operation of finer ones. Orientational anisotropy was prominent even when observers lay horizontally and viewed displays by looking upwards through a black cylinder that excluded all possible visual references for orientation. So, gravitational and visual cues are not essential to the definition of an orientational reference frame for early vision, and such a reference can be well defined by retinocentric neural coding, awareness of body-axis orientation, or both.

Subjective indicators of health held by the lay population:eudaimanistic model

DUE TO COPYRIGHT RESTRICTIONS ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY AND INFORMATION SERVICES WITH PRIOR ARRANGEMENT