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PubMed2002

Negotiating care: reproductive tract infections in Vietnam.

Through case studies of two women, this paper uses a taskonomy approach to analyze rural Vietnamese women's narratives of prevention, treatment and management of vaginal discharge to illustrate care seeking, health practice and the pragmatism of their action. The research is based upon ethnographic research undertaken by the author between 1995 and 1997 in a rural district in northern Vietnam. This exploration illustrates the complexities of women's rationalities and the web of influences upon their choices-the health seeking culture as practiced. The women's narratives are also placed within the broader context of gender, power and health systems that structure their decision making. The author discusses how social and economic resource factors influence the choices women make regarding when to begin treatment for vaginal discharge and where to seek care. She concludes that women use their understanding of the relationships between health, living conditions and diseases on a day-to-day basis and that the practice of managing vaginal discharge is mediated by concepts of body, self and the body politic in Vietnam.

Adult↗
PubMed2005

Negotiating relationship contexts in gerontological social work practice.

OBJECTIVES: The objective of this study was to demonstrate the role of social workers in addressing the complex relationship and problem solving contexts typical of practice in multi-service geriatric care settings. METHODS: We conducted a thematic analysis of the work of five social workers with five clients, their families, and the professional healthcare team, and extracted common themes across cases that illustrate the nature and timing of the interventions depending on the relationship context addressed. RESULTS: While there were problems and issues common across relationship contexts, intervention strategies that were essential for optimizing client care and wellbeing were specific to resolving relationship conflicts in one or more of the identified relationship contexts.

Aged↗
PubMed2006

'It's good to be different': parent and child negotiations of 'twin' identity.

Research on twins has tended to focus around the question of heredity/environment. As part of this, attention has been paid to how twins' family environments impact upon them. By examining twinship as a social identity, this article considers the social experience of twinship as it is framed by parent-child relations and also actively shaped by twins themselves. Sameness constitutes one central defining component of 'twin' identity within Western societies. In preparing their twins' bodies for public presentation, parents play a key role in communicating twin identity on their children's behalf. However, children also construct and convey their own identities through presenting their bodies in certain ways. Drawing on findings from a small-scale qualitative study of twinship, this article examines how twin identity is created, modified and reproduced by parents and child twins. It highlights the active role that twins take in constructing their own identities and in shaping the 'twin situation'.

Adolescent↗
PubMedDate not supplied

Hospital consolidation and negotiated PPO prices.

We examine the effects of hospital consolidation on the actual prices paid by preferred provider organizations. We find that price increases following consolidations among nearby hospitals invariably equaled or exceeded median price increases among other hospitals in the same market. Using multivariate regression analysis, we find that consolidation enables hospitals to increase prices in three of the four markets studied; these increases are generally statistically significant. In the remaining market, the measured effect was zero. Our results suggest that some, but not all, consolidations of competing hospitals facilitate price increases. We conclude that antitrust scrutiny of hospital consolidation is warranted.

Economic Competition↗
PubMedDate not supplied

[Cyberspace and the negotiation of meaning: the social aspects of implementing digital communications networks in public health academic institutions].

This article analyzes social aspects in the incorporation of new information and communications technologies in public health academic institutions. To demarcate the study of these processes and demonstrate the close relationship between their social and technical aspects, the study employs concepts pertaining to "intellectual technologies" and a "critical theory of technology". Theoretical and methodological elements are identified to approach the implementation dynamics of electronic networks in public health institutions, through a discourse analysis of their social actors and the various meanings they attribute to such dynamics Considering discourse as an expression of the relations created during these implementation dynamics, the study seeks a proposal for the ways by which these relations might influence the social and technical dimensions of digital networks.

Computer Communication Networks↗
PubMed2002

Between parent and child: negotiating cancer treatment in adolescents.

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital, founded the Kenneth B. Schwartz Center. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and sustenance to the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. Cancer in adolescents presents an extra dynamic of psychosocial complexity. The case of a 19-year-old woman with acute myelocytic leukemia is discussed. Her disease was refractory to allogeneic transplantation, and she died with severe graft-versus-host disease. Ms. P and her mother established very different relationships with the team which supported them through the transitions in her care, and Ms. P was able to die at home, with hospice care. The personal connection with the team enabled a degree of positive adjustment through the nightmare of loss. The epidemiology of cancer in adolescents and paradigms of care are reviewed. Psychosocial aspects of adolescence, opportunities for personal growth and support, and the challenge of end-of-life care are discussed.

Acute Disease↗