本文以貫時性的描述，探討日治時期（前）至今台灣哺育知識變遷。研究者根據官方對於母乳哺育率的調查資料以及田野研究，將台灣哺育型態分為三個時期：母乳哺育期（~1970）、配方奶粉哺育期（1971~1990）和混合哺育期（1991~）。本文企圖分析哺育型態的轉折，以社會學的角度，將哺育知識的變遷帶入歷史時空架構和社會文化脈絡之中詮釋，並突顯行動者的角色及位置，描繪行動者與結構之間互相形塑的樣態。 　　從歷史的意義考察，本研究發現哺育型態的轉變和產程的質變聯結在一起。傳統時期的哺育知識（或母職建構）與生命歷程密不可分，存在於女性的「私相授受」之中，與女性的生活經驗交織在一塊，本文以「母性互助系統」稱之。然而隨著醫院生產成為主流，在產後病房中，則是應用兒科醫學的科學知識作為哺育指導方針。定時定量的哺育知識與配方奶粉的瓶餵實作，成為此時期的主流哺育知識，形成歷史上前所未有的人工哺育時代。而在當今的混合哺育期，則由於母乳哺育訴求與固有產科結構之間的矛盾和衝突，引導出哺育者對「新哺育專家」的需求，並詳細介紹國際認證泌乳顧問（IBCLC）目前在台灣的發展和執業狀況。 / This study explores the historical process whereby knowledge and practice about infant feeding have changed in Taiwan from the Japan-ruled period to recent years. By analyzing how the transition occurred in patterns, it highlights the role of the cultural context within which the structure of feeding knowledge, along with construction of motherhood, has shaped and been shaped by social actors in different positions. Focusing on the historical significance, we find that feeding knowledge has varied with the qualitative transformation of the process of birth-giving. Traditional knowledge of feeding, is closely related to the course of life of females, and under the influence of the private life, interwoven with their life experience. As in-hospital birth-giving becomes the mainstream, the “medicalized” and therefore “scientific” parenting authorities serve as guidelines for feeding and nurturing. Nevertheless, the idea that mothers should breastfeed their children remains unchallenged nowadays. It brings about the conflict between appeals for breastfeeding practices and obstetrics structure. Under this trend, new expert systems in feeding teaching, such as International Board Certified Lactation Consultant (IBCLC), emerge.

Although Talcott Parsons’s sick role theory, as described in 1951 in The Social System, has been severely criticized for its inapplicability to chronic illnesses, a portion of the theory is still a relevant and necessary factor in terms of understanding and treating chronic illness today. Using data from the 2012 National Health Interview Survey, this study looks at the individual effects of sex, age, race, cohabitation, education and region of residence on the likelihood of chronically ill patients considering themselves limited in their amount or kind of work as an indicator of sick role adaptation. Results show statistically significant relationships between work limitation and sex, age, cohabitation, education and region of residence, when controlling for the duration of the respondents’ condition. Further evaluation of these results is provided.

No description available.

Iatrogenic injury resulting from psychiatric treatment represents a critical concern within the healthcare system and causes great harm to the afflicted individuals. This study delves into the multifaceted dimensions of iatrogenic harm attributed to psychiatric treatment, with a focus on the interplay between trust, accountability and recognition, and the social and relational experience of receiving treatment that ends up causing harm. The erosion of trust in psychiatric medicine on part of the individual, stemming from instances of iatrogenic injury where professional and systemic accountability was perceived as inadequate, challenges the foundation of the relationship between individual and treatment provider as well as the relationship between the individual and the psychiatric system. To mitigate this erosion, it is imperative to understand the factors that contribute to the individual’s lack of trust, in order to promote open communication and informed decision-making in psychiatric treatment. In that sense, being afflicted with iatrogenic injury is an inherently social experience. Furthermore, central to this study is the emphasis on recognizing the individual narratives of those who have experienced iatrogenic injury, as each individual’s unique circumstances and personal stories offer valuable insights into the human impact of medical maltreatment, and centering their experiences can contribute to a broader discourse on psychiatric care reform. This study underscores the need for a holistic re-evaluation of psychiatric treatment practices, where recognition of the individual’s experiences and open discussions on the limitations of psychiatric treatment are at the forefront. Ultimately, this study aims to contribute to the ongoing dialogue surrounding iatrogenic harm and the need for different pathways that improve the safety and quality of psychiatric care by focusing on the individual’s inherent right to control the process of undergoing psychiatric treatment and the right to not be harmed.

Medical tourism is a relatively recent global economic and political phenomenon which has assumed increasing importance for developing countries, particularly in Asia. It has been slower to develop within the context of the tourism industry in English-speaking Caribbean countries but there is evidence that the tourism policy makers in the region perceive medical tourism as a potentially lucrative niche market. However, while the potential of medical tourism has seemingly been embraced by the region's political directorate, there has been limited discussion of the extent to which this market niche can realistically provide competitive advantage for the region. The argument of this conceptual paper is that the English-speaking Caribbean cannot hope to compete successfully in the global medical tourism market with many developing world destinations in Asia, or even with other Caribbean countries such as Cuba, on factors such as low cost, staff expertise, medical technological capability, investment in healthcare facilities or even in terms of the natural resources of sun, sea and sand. Rather, in order to achieve competitive advantage the countries of the region should, on the one hand, identify and develop their unique resources and competences as they relate to medical tourism, while, on the other hand, they should exploit the demand of the postmodern tourist for authentic experiences. Both these supply and demand side issues, it is argued, can be addressed through the development of a medical tourism product that utilises the region's indigenous herbal remedies. [PUBLICATION ABSTRACT]; Medical tourism is a relatively recent global economic and political phenomenon which has assumed increasing importance for developing countries, particularly in Asia. It has been slower to develop within the context of the tourism industry in English-speaking Caribbean countries but there is evidence that the tourism policy makers in the region perceive medical tourism as a potentially lucrative niche market. However, while the potential of medical tourism has seemingly been embraced by the region's political directorate, there has been limited discussion of the extent to which this market niche can realistically provide competitive advantage for the region. The argument of this conceptual paper is that the English-speaking Caribbean cannot hope to compete successfully in the global medical tourism market with many developing world destinations in Asia, or even with other Caribbean countries such as Cuba, on factors such as low cost, staff expertise, medical technological capability, investment in healthcare facilities or even in terms of the natural resources of sun, sea and sand. Rather, in order to achieve competitive advantage the countries of the region should, on the one hand, identify and develop their unique resources and competences as they relate to medical tourism, while, on the other hand, they should exploit the demand of the postmodern tourist for authentic experiences. Both these supply and demand side issues, it is argued, can be addressed through the development of a medical tourism product that utilises the region's indigenous herbal remedies. Reprinted by permission of Carfax Publishing, Taylor & Francis Ltd.

<p>This dissertation, broadly, examines how power dynamics manifest during clinical interactions related to vague and gendered medical symptoms, such as pelvic pain. To examine this issue, I approach my research questions through multiple methods including a critical discourse analysis of the medical discourse on pelvic pain, a survey experiment administered to healthcare workers in the US, and a narrative analysis of pelvic pain patient experiences. While the focus of this research is on pelvic pain, the analyses presented here reach far beyond ideas of power dynamics and pelvic pain. Rather, the findings from this research speak to theoretical discussions medical sociologists have been having for decades. Specifically, findings provide new insight on: 1) the limits of evidence-based medicine as a biomedical paradigm, 2) how fundamental causes of health inequality intersect with each other as well as other factors, such as gender, important in predicting health outcomes and 3) how discussions of metamechanisms in fundamental cause theory can inform our understanding of the accumulation of cultural health capital. In providing such insight, this dissertation uses the case of pelvic pain to integrate multiple perspectives and theories in medical sociology to drive the field forward in a way that acknowledges the many ways power is simultaneously constituted in the clinical interaction. From the role of gender, race, and class in power relations, to the ways medical knowledge, discourse, and authority dictate the clinical interaction, this research covers a wide range of sociological theories and concepts. In doing so, this dissertation sheds new light on current understandings of power in the clinical interaction and its relationship to inequitable health outcomes in the US.</p>

No description available.

Hospital admissions for patients close to the end of life are considered ‘inappropriate’ in contemporary English health policy. Hospitals are supposedly unable to offer a ‘good’ death for patients, and dying there is thought to contradict patient choice, since patients are assumed to want to die at home. However, almost half of all deaths in England in 2015 occurred in hospital, and of these, nearly a third died within three days of admission. This thesis seeks to explore why these admissions are considered to be a problem and how they occur. Through a systematic review of UK literature I found that it cannot be stated that most patients want to die at home, because of the extent of missing data (preferences not asked, expressed, reported or absent). This finding challenges the justification that admissions are inappropriate because they contravene patient choice. Similarly inconclusive evidence about the undesirability, cost, and lack of need for patients to be in hospital were also found in a review of policy. Together with analysis of historical trends in hospital and hospice provision, it is apparent that attitudes towards end-of-life admissions reflect existing tensions about the role of hospital as an acute provider, and as a place of death. An analysis of interviews conducted with healthcare staff and next-of-kin involved in the admission of patients (case-patients) who died shortly after being admitted to Meadowbridge, a large English hospital explored these tensions further. I found that whilst hospital was not recognised as a place where ‘good’ deaths typically occurred, it was acknowledged as an emergency place of care. In this context, patients without obvious need for hospital care were nevertheless admitted to the hospital and the environment was subsequently recognised to offer distinct benefits. The need for emergency care reflected the difficulties of providing end-of-life care in the community. For dying to occur appropriately, home had to be adapted and care organised by healthcare staff. Both tasks were complicated by the unpredictability of dying, and family carers helped to absorb much of the uncertainty and support patients to die at home. Ambulance staff became involved when patients had care needs that exceeded care quickly and easily available in the community. When called to the case-patients, ambulance staff instituted familiar practices in transferring them to hospital. Hospital was recognised as a default place of care because ambulance staff struggled to facilitate alternative care and lacked sufficient professional authority to keep patients at home. The admissions of the case-patients represent the best attempts of staff to navigate the tangled practices of end-of-life care. These practices are the result of the actions of the staff, which in turn both constrained and enabled their action in providing care to patients. The term ‘inappropriate’ to describe admissions does not encompass these attempts, and moreover, devalued the significant care provided by healthcare staff in the community and hospital.

No description available.