Belief, Knowledge and Expertise. The emergence of the lay expert in medical sociology

The paper has three main aims. First, to trace – through the pages of the Journal – the changing ways in which lay understandings of health and illness have been represented during the 1979-2002 period. Second, to say something about the limits of lay knowledge (and particularly lay expertise) in matters of health and medicine. Third, to call for a re-assessment of what lay people can offer to a democratised and customer sensitive system of health care and to attempt to draw a boundary around the domain of expertise. In following through on those aims, the author calls upon data derived from three current projects. These latter concern the diagnosis of Alzheimer’s disease in people with Down’s syndrome; the development of an outcome measure for people who have suffered a traumatic brain injury; and a study of why older people might reject annual influenza vaccinations. Key words: Lay health beliefs, lay expertise, Alzheimer’s, Traumatic Brain Injury, Vaccinations

Dispossessing bare life: Towards a theoretical framework for examining power relations through economic development at the 2010 FIFA World Cup in South Africa

In the past twenty years an increasing number of Global South nations have vied for the rights to host prestigious and expensive sport mega events. This trend requires significant reflection given the enormous economic costs of these events, which often produce little capital gain for the host nation (Whitson & Horne, 2006). Furthermore, sport mega events are often utilized for their symbolic capital (Belanger, 2009), which sometimes manifests through forcing people from their land for the sake of “beautification” (Davis, 2006). In this project, then, I asked how technologies of power were utilized by FIFA, corporate stakeholders, and the South African government to control people who were marginal to, or impeded the success of, the World Cup in Nelspruit, South Africa. This project consisted of two parts: the first involved constructing a theoretical framework for better understanding power as it operates through sport mega events in general. To this end I employed Marxian notions of the ordering of physical space, Foucauldian conceptions of sovereignty and governmentality, and Agamben’s (1998) state of exception to determine how particular bodies are constituted and controlled through sport mega events. In the second part, I applied this theoretical framework to the events in South Africa to better elucidate how people became displaced and killed because of the 2010 FIFA World Cup. I used South African popular news and documentaries as empirical evidence and conducted a discursive analysis of said news media. Through this coverage it became apparent that the mega event created the conditions in which new forms of rogue sovereign partnerships could arise through a historically and spatially contingent process of capitalism. The rogue sovereigns’ para-juridico-political orders, the discourses and practices of accumulation by dispossession as a tactic and effect of govermentality, and other historical non-capital subjectivities such as racial identity, all contributed to constituting Agamben’s state of exception in which people could be displaced, killed or left to die in the events surrounding the World Cup.

The origins of the Irish hospitals' sweepstake

This article examines the two main reasons for the setting up of the Irish sweepstakes in 1930; the financial crisis facing voluntary hospitals and the tradition of using sweepstake gambling to raise funds for charitable purposes. Such gambling, although technically illegal, was prevalent and widely tolerated during the late 19th and early 20th centuries. The change of government that accompanied Irish independence in 1921 led to much confusion surrounding the law on gambling and large-scale sweepstakes proliferated during the early 1920s, many of them selling tickets illegally in Britain. At the same time the Irish voluntary hospitals faced a financial crisis that threatened their future, brought about by the adverse impact of war-time inflation on the value of their endowments, the emigration of supporters of the Protestant voluntary hospitals after independence, the political upheaval of the revolutionary period, the decline in fees from medical students and the increasing cost of and demand for hospital treatment. This article provides a detailed account of the enactment of the sweepstake legislation and of the first sweepstake on the 1930 Manchester November Handicap.

Extracting Policy Positions from Political Texts Using words as Data

We present a new way of extracting policy positions from political texts that treats texts not as discourses to be understood and interpreted but rather, as data in the form of words. We compare this approach to previous methods of text analysis and use it to replicate published estimates of the policy positions of political parties in Britain and Ireland, on both economic and social policy dimensions. We “export” the method to a non-English-language environment, analyzing the policy positions of German parties, including the PDS as it entered the former West German party system. Finally, we extend its application beyond the analysis of party manifestos, to the estimation of political positions from legislative speeches. Our “language-blind” word scoring technique successfully replicates published policy estimates without the substantial costs of time and labor that these require. Furthermore, unlike in any previous method for extracting policy positions from political texts, we provide uncertainty measures for our estimates, allowing analysts to make informed judgments of the extent to which differences between two estimated policy positions can be viewed as significant or merely as products of measurement error.

The SPHERE Study: Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses. [ISRCTN24081411]

Background: The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease (CHD) in general practice across two different health systems on the island of Ireland.CHD is a common cause of death and a significant cause of morbidity in Ireland. Secondary prevention has been recommended as a key strategy for reducing levels of CHD mortality and general practice has been highlighted as an ideal setting for secondary prevention initiatives. Current indications suggest that there is considerable room for improvement in the provision of secondary prevention for patients with established heart disease on the island of Ireland. The review literature recommends structured programmes with continued support and follow-up of patients; the provision of training, tailored to practice needs of access to evidence of effectiveness of secondary prevention; structured recall programmes that also take account of individual practice needs; and patient-centred consultations accompanied by attention to disease management guidelines.

Methods: SPHERE is a cluster randomised controlled trial, with practice-level randomisation to intervention and control groups, recruiting 960 patients from 48 practices in three study centres (Belfast, Dublin and Galway). Primary outcomes are blood pressure, total cholesterol, physical and mental health status (SF-12) and hospital re-admissions. The intervention takes place over two years and data is collected at baseline, one-year and two-year follow-up. Data is obtained from medical charts, consultations with practitioners, and patient postal questionnaires. The SPHERE intervention involves the implementation of a structured systematic programme of care for patients with CHD attending general practice. It is a multi-faceted intervention that has been developed to respond to barriers and solutions to optimal secondary prevention identified in preliminary qualitative research with practitioners and patients. General practitioners and practice nurses attend training sessions in facilitating behaviour change and medication prescribing guidelines for secondary prevention of CHD. Patients are invited to attend regular four-monthly consultations over two years, during which targets and goals for secondary prevention are set and reviewed. The analysis will be strengthened by economic, policy and qualitative components.

Economic modelling of antenatal screening and ultrasound scanning programmes for identification of fetal abnormalities

Objective Within the framework of a health technology assessment and using an economic model, to determine the most clinically and cost effective policy of scanning and screening for fetal abnormalities in early pregnancy. Design A discrete event simulation model of 50,000 singleton pregnancies. Setting Maternity services in Scotland. Population Women during the first 24 weeks of their pregnancy. Methods The mathematical model was populated with data on uptake of screening, prevalence, detection and false positive rates for eight fetal abnormalities and with costs for ultrasound scanning and serum screening. Inclusion of abnormalities was based on the relative prevalence and clinical importance of conditions and the availability of data. Six strategies for the identification of abnormalities prenatally including combinations of first and second trimester ultrasound scanning and first and second trimester screening for chromosomal abnormalities were compared. Main outcome measures The number of abnormalities detected and missed, the number of iatrogenic losses resulting from invasive tests, the total cost of strategies and the cost per abnormality detected were compared between strategies. Results First trimester screening for chromosomal abnormalities costs more than second trimester screening but results in fewer iatrogenic losses. Strategies which include a second trimester ultrasound scan result in more abnormalities being detected and have lower costs per anomaly detected. Conclusions The preferred strategy includes both first and second trimester ultrasound scans and a first trimester screening test for chromosomal abnormalities. It has been recommended that this policy is offered to all women in Scotland.