This qualitative study tests the hypothesis that doctors who provide Dl in Britain make non-medical decisions about the suitability of both who should receive Dl and those who should donate sperm and that these decisions show an allegiance to an ideal family model. Some supplementary questions are also asked: how and why doctors have sought to attain professional authority in the provision of Dl. This is a case study of Dl practitioners. The collection of data was informed by grounded theory techniques and the fieldwork was conducted using semi structured interviews. Of the sampling universe (58) a non-random sample of 31 Dl practitioners were approached and 21 were interviewed (67.7&37 response rate). A strength of the study lies in the size of the sample which is over half of the sampling universe. The first chapter identifies some of the categories which emerged from the literature and were used to inform the interview schedule and data analysis: non-medical criteria applied to potential recipients and donors; non-medical professionals' arguments for inclusion in the Dl process; some factors implicated in a medicalisation process. The second chapter outlines the methodology. The third and fourth chapters examine aspects of how Dl practitioners have established professional authority in the provision of Dl: in the third the medicalisation process is discussed; and in the fourth the exclusion of non-medical professionals. In the fifth and sixth chapters the different elements of how the family is constructed by Dl practitioners are examined, first by analysing the selection criteria applied to potential recipients and then discussing what constitutes an acceptable genetic father. In conclusion the results are discussed in the light of the Human Fertilisation and Embryology Act (1990). The routine allegiance of Dl practitioners to an idealised family - an idealised heterosexual nuclear one - is reflected in the broader public debates which have put 'the family' on the Party Political agenda.

This is an anthropological study of a rural Maternal-Child Health and Family Planning (MCH-FP) project and the community in which it worked, in Bangladesh. It analyses the Non-Government Organisation's (NGO's) approach to rural community-based health care and integrated development, using the health programme as a framework. Beginning with an examination of the NGO's relationships with its donor-funding and technical support organisations, it moves on to a critique of population policy from a socio-cultural perspective, focusing on issues of gender and poverty. The main conclusions call for an expansion of the MCH agenda to adopt a more holistic perspective on the social context of women's health. This involves recognising the role of men in women's health care and actively including them in programmes. It also necessitates recognising the heterogeneity of female needs, beyond those of the conventional MCH reproductory focus, and the recognition of domestic violence as a significant cause of female morbidity and mortality. The principal conclusion is, therefore, the need for a gender perspective in the formulation of health policy and the design and implementation of health programmes, and more active participation in these processes, not only of women, but all members of the community, particularly men and influential leaders. Finally, a comparison is made between the ethnography of this and other anthropological works on Bangladesh, placing the study in the context of existing literature.

Family and other social support is increasingly being recognised as a necessary component for comprehensive rehabilitation of the head injured. This study investigates the potentially constructive roles for relatives as co-therapists in ameliorating problems that persist after discharge from hospital and in-patient rehabilitation, if available. These are:- (a) As a source of information to help delineate the patient's problems. (b) As co-therapists, taking part in the planning and process of treatment. Four memory aids/mnemonics were devised and adapted from the literature on cognitive remediation aimed at reducing day-to-day memory problems. A multiple baseline design was used. The results suggest that relatives have a potential value in helping to achieve generalisation of memory techniques to real life environments. Single case studies highlight, the principles and practicalities of intervention, and the issues of family dynamics that arise during the course of treatment.

Health promotion is investigated as a concept which has intruded into debates about nursing practice. Review of the literature on health promotion reveals two major problems with the way in which the relationship between theory and practice is conceptualized in nursing literature. A critical review reveals that 'power' has received inadequate treatment and an absence of critical debate regarding the conceptualization of action as a social accomplishment in accounts of nursing practice. The argument is advanced that much research into nursing practice is currently based on functionalist frameworks influencing not only decisions made regarding changes in practice but, more importantly, the way in which the field of practice is conceptualized as a research 'site'. The thesis advances a theoretical position which addresses these problems by keeping action as a social accomplishment and power in the foreground of a study of nursing practice. The position draws on Giddens' structuration theory (1976, 1984), which offers an explanatory locus for an analysis of social action. Foucault's writings on 'procedures of power' (1963/1973, 1975/1977, 1978/1991) are used to situate the study as an investigation of how knowledge of action has implications for constituting viable interests in practice settings. Ethnographic methods are employed, generating contextualized accounts of nursing practice in one setting: a community health clinic. Transcribed interactions between nurses and clients were drawn on as the primary source for interpretation. Interpretations were cross-checked first with observational fieldnotes and secondly with interviews conducted with nurses and clients after the clinic interactions. 'Conversation' is excavated as a strategy-in-use by nurses conducting immunization clinic visits. The analysis demonstrates that nurses are presently in the process of instituting a new 'nstitution' (Lyotard, 1979/1984) in their accomplishment of work in this setting. This has the effect of moving parents out of the home and into the clinic, a move which has implications for the 'fracturing' of the parent-child life-world.

No description available.

Consideration was given to the likelihood of earlier experiences influencing attitudes in old age, and for the purpose of examining such associations, a structured interview schedule was devised to collect data, related to the youth, maturity and old age of the respondents. An open-ended schedule of questions was adopted to avoid certain limitations thought to "be inherent in the multi-choice form of questionnaire. The sample was balanced for age within each sex and other social criteria such as civil state followed randomly after these divisions. The sample was randomly selected from the medical records of six practices in the City of Aberdeen. Records were extracted at regular intervals according to the size of the practice and the names, and addresses were noted of all who qualified by age, The final list from each practice was then classified by age and sex and a balanced sample approximating to one-sixth of the sample was obtained from each practice, The sample from each subsequent practice was adjusted to make good any deficiencies through refusals or withdrawals which, may have occurred in the preceding sample. In order to albw this procedure to be carried out, the overall sample was not drawn before the commencement of the field work. Once a practice batch had been drawn, field work was started and when the interviews were nearing their end and sample losses were known, work was started on the next practice sample * Socio-economic standards in the family of origin Respondents gave their impressions of living standards in their families of origin and these impressions were then associated with certain objective criteria. Occupation was one such criterion and an operational classification of occupations was employed to avoid anomalies which might arise from the application of the E.G. social class index to late nineteenth century occupational status. Each respondent was classified by- the occupational level he or she had attained at the end of training or by the late 'teens. When this classification was related to that of the opinions given ahout early living standards the association was significant. Those who had thought that their living standards had been satisfactory were associated with the higher occupational levels and low level occupations were associated with low living standards. Educational level was another objective criterion by which impressions of living standards were assessed, and the association between these two sets of data was also significant. Judgements of living standards were further inspected by a weighting system based on the objective criteria of the occupation of the head of the household in the respondent* s family of origin and the number of persons per room in the household. The combination of these two factors gives a more effective measurement of living standards than could be given by either factor on its own. Weights for the tv/o factors were combined into a single index and the rang(c) was classified in upper, middle and lower socio-economic levels. The association between these data was also significant. Finally, two sets of subjeotive data on living standards were associated and found to be significant. These were the impressions of living standards already referred to and impressions of how often the needs of the respondents had "been met in their early years. It was thought that tests of validation such as have been described were of importance insofar as they established a level of integrity on the parts of respondents participating in a study based lax'gely on subjective information. Changes in economic conditions during life Attitudes to living standards in the different stages of life were examined* Opinions about living standards in childhood were already known and further questions sought to discover reactions to living conditions in the subsequent stages of middle age, beyond middle age and retirement. Most of the respondents had been satisfied with their living standards in middle age. More were satisfied among those whose early living conditions had been satisfactory and this was particularly true of retired men in that group. keast satisfaction was found among retired respondents who had started life in unsatisfactory economic circumstances. The period of the last working years prior to retirement was described as "Beyond middle age"t some respondents were in that stage at the time of interview, and most of these were satisfied with their income. Retired respondents looked back on the economic circumstances of their working years just prior to retirement and returned a much lower proportion of those who had been satisfied.

No description available.

1. This thesis describes a statistical-genetical approach to the problem of aetiology in schizophrenia and affective psychosis. 2. The study can be seen to have three aims: (1) To establish population parameters for schizophrenia and affective psychosis specific to the North-East of Scotland; (2) To investigate the familial nature of schizophrenia and affective psychosis using linked family records; (3) To present a preliminary analysis of the heritability of liability to schizophrenia and affective psychosis, using the polygenic threshold model described by Falconer (1965). 3. The results of previous genetic studies of schizophrenia and affective psychosis are briefly outlined and critical consideration is given to a number of studies relevant to this investigation. 4. It is suggested that, on the basis of the results of previous studies, polygenic transmission is likely with respect to both schizophrenia and affective psychosis. 5. It is observed that there are sources of bias in some previous studies, as follows: (i) inappropriate population parameters, (ii) age corrections, and (iii) ascertainment of diagnoses. 6. Characteristics of the study area and its population are described. 7. The case register concept is explained and the principal features of the North-East Scottish psychiatric case register, from which data was derived for this study, are outlined. 8. Age and sex specific expectancy risks were derived for schizophrenia and affective psychosis in the North-East region of Scotland. 9. The method described is new to British studies and is based upon a Scandinavian study by Hagnell (1966). 10. Modifications were made to the method for the size of the population and the availability of data and these are described. 11. The cumulated lifetime expectancy risks for diagnosed cases of schizophrenia and affective psychosis, in the North-East of Scotland, are 1.9 per cent and 6.2 per cent respectively. 12. These estimates are higher than those previously reported by other British studies. 13. When the sexes are considered separately the overall risk is not very different - 1.8 per cent in males and 1.7 per cent in females for schizophrenia, and 5.8 per cent in males and 6.3 per cent in females for affective psychosis. 14. This finding is in contrast to earlier studies where a large excess of female affectives has generally been reported (e.g. Adelstein et al., 1968; Slater and Cowie, 1971) and a similar though smaller excess of males amongst schizophrenics (e.g. Adelstein et al., 1968). 15. The results suggested a possible reason for the changing sex ratio amongst affectives in an increase amongst males. 16. The expectancy risks also show that the elderly of both sexes still have a high risk of becoming schizophrenic or affective thus providing no support for the upper limits of the characteristic risk periods for schizophrenia and affective psychosis. 17. The expectancy risks and the annual incidence rates show no bimodality and therefore provide no support for separating early and late onset affective disorders into distinct genetic entities. 18. Some sources of bias affecting the population parameters of this study are outlined. 19. Reasons for the differences between the results of this and previous studies are suggested and discussed. 20. It is concluded that the sources of bias affecting the population parameters are unlikely to detract from their usefulness to planners, clinicians and researchers. The cumulated expectancy risks are an estimate of potential prevalence and are likely to be of use in forward planning. 21. An investigation of diagnostic resemblance amongst four types of relatives is described. The relatives are: husbands and wives, parents and children, siblings, and second degree blood relatives. 22. Significant concordance was found amongst married pairs with respect to schizophrenia and further investigation suggested that assortative mating might be of importance amongst schizophrenics. 23. Amongst blood relatives the diagnostic concordance was significant for both schizophrenia and affective psychosis. 24. Concordance was greater amongst first degree relatives than amongst those of the second degree type. 25. It is concluded that the results regarding diagnostic resemblance do not refute the importance of hereditary factors, neither are they felt to be inconsistent with polygenic inheritance. 26. Schizophrenia and affective psychosis were found to occur in significant numbers in the same families. 27. Whilst affective parents produced significant numbers of affective and schizophrenic offspring, schizophrenic parents produce only schizophrenic offspring. 28. A comparison of the consistency of diagnostic histories in mixed schizophrenia x affective families with that in concordant schizophrenic x schizophrenic and affective x affective families is described. 29. The results suggest that the presence of both disorders in the same family may qualitatively alter the symptoms of some members producing either atypical features or persons who manifest, at different times, the symptoms of both disorders. 30. Some deficiencies in the analysis are discussed and further research is suggested to clarify the relationship between schizophrenia and affective psychosis. 31. Using the method described by Falconer (1965), estimates of heritability of the liability to schizophrenia and affective psychosis were derived for two classes of relative: children and siblings. The heritability for schizophrenia was estimated to be 49 per cent ± 0.07 and 20 per cent ± 0.04 for children and siblings respectively. For affective psychosis the values were 19 per cent ± 0.05 for children, and -2 per cent ± 0.02 for siblings. 33. The estimated heritability values in his study are lower than those reported in previous studies. 34. It is pointed out that the present study is rather different from previous studies in the source of data and the methodology; much of the discrepancy between this study and previous studies can be attributed to these differences. 35. The genetic correlation in liability (Falconer, 1960) was used to determine whether a genetic associction exists between schizophrenia and affective psychosis. 36. A value, for the genetic correlation, of + 0.26 was obtained which was inconclusive in suggesting a genetic association. 37. In the light of the genetic analysis it is suggested that modifications are necessary to render psychiatric case register data more suitable for further genetic study, and some recommendations are made.

In this study a discourse analytic approach was used to explore the views expressed about community care for people with mental health problems in a 'hot situation'. Specifically, people's views were explored by examining the ways in which they were expressed when arguing for or against a supported accommodation project for mentally ill people in their community. Three main data sources were used. These were; written texts, comprising letters written to the local press by objectors and supporters of the project, and a written statement compiled by objectors; group discussions held with the writers of these documents; and interviews with representatives of the organisation setting up the project. The analysis was concerned with both the topics and form of argumentation. Objectors to the supported accommodation project constructed their views around a number of argumentative topics which they characterised as issues of public concern. These were: the lack of prior consultation with local people and the secrecy they claimed surrounded the plans for the supported accommodation project; the claimed unsuitability of the project's location; and the type of tenants who would take up residence there. Supporters criticised objectors for their oppositional stance and expressed their views on the issues raised by objectors in formulating their case against the project. Supporters also constructed arguments around broader issues such as human rights. It was noteworthy however that there was no specific argument in favour of community care in this particular community. In the course of arguing either for or against the supported accommodation project, participants constructed a number of different versions of people with mental health problems. In addition they formulated their arguments in such a way as to attend to various issues of accountability and to protect their arguments from potential rebuttal.

Each year approximately 26,000 British women develop breast cancer and 16,000 die from their disease. Breast cancer is the most common cancer in women in the United Kingdom. Previously, most studies have focused on the needs of women following surgery for the treatment of primary breast cancer. However, few systematic studies have monitored the needs of women with metastatic disease. The median survival of women with metastatic breast cancer is 19 months and therefore it would seem appropriate to monitor the rehabilitation needs of these women. This study examines the physical, psychological, and social rehabilitation needs of a consecutive series of 80 patients following definitive diagnosis of metastatic breast cancer. These patients were interviewed every eight weeks at home on eight separate occasions and were asked to complete the following standardised questionnaires: The Cancer Rehabilitation Evaluation System (CARES); The Hospital Anxiety and Depression Scale (HAD); and The Rotterdam Symptom Checklist (RSCL). In addition, the researcher completed an interview schedule to detail demographic details, current treatment, and which members of the medical team the patient had seen in the previsou month. The researcher also completed the Edinburgh Rehabilitation Status Scale (ERSS) which gives a total score of disability. The results of the descriptive component demonstrated that patients had a range of different rehabilitation needs throughout the course of their illness as defined by the CARES and the ERSS. These needs do not change throughout the course of the metastatic phase of the disease but detection of these problems is extremely low and, as a result, referral to appropriate services does not usually occur. Demographic factors such as age, marital status, social class, and number and age of children were not found to be associated with rehabilitation status. A significant problem in this group of patients was found to be that of mood disturbance and a complex inter-relationship was found to exist between rehabilitation status, age, physical symptomatology and mood using multiple stepwise regression analyses and factor analysis.