Healthcare choice: Discourses, perceptions, experiences and practices

Policy discourse shaped by neoliberal ideology, with its emphasis on marketisation and competition, has highlighted the importance of choice in the context of healthcare and health systems globally. Yet, evidence about how so-called consumers perceive and experience healthcare choice is in short supply and limited to specific healthcare systems, primarily in the Global North. This special issue aims to explore how choice is perceived and utilised in the context of different systems of healthcare throughout the world, where choice, at least in policy and organisational terms, has been embedded for some time. The articles are divided into those emphasising: embodiment and the meaning of choice; social processes associated with choice; the uncertainties, risks and trust involved in making choices; and issues of access and inequality associated with enacting choice. These sociological studies reveal complexities not always captured in policy discourse and suggest that the commodification of healthcare is particularly problematic

Trust, regulatory processes and NICE decision-making: Appraising cost-effectiveness models through appraising people and systems.

This article presents an ethnographic study of regulatory decision-making regarding the cost-effectiveness of expensive medicines at the National Institute for Health and Care Excellence (NICE) in England. We explored trust as one important mechanism by which problems of complexity and uncertainty were resolved. Existing studies note the salience of trust for regulatory decisions, by which the appraisal of people becomes a proxy for appraising technologies themselves. Although such (dis)trust in manufacturers was one important influence, we describe a more intricate web of (dis)trust relations also involving various expert advisors, fellow committee members and committee Chairs. Within these complex chains of relations, we found examples of both more blind-acquiescent and more critical-investigative forms of trust as well as, at times, pronounced distrust. Difficulties in overcoming uncertainty through other means obliged trust in some contexts, although not in others. (Dis)trust was constructed through inferences involving abstract systems alongside actors’ oral and written presentations-of-self. Systemic features and ‘forced options’ to trust indicate potential insidious processes of regulatory capture

Sedimentation and historical changes in fluvial-deltaic wetlands along the Texas Gulf Coast with emphasis on the Colorado and Trinity River deltas

158 pagesThe objective of this study was to determine from published and unpublished researches the effects of brine effluents on marine organisms, and on the natural ecological balance in estuarial waters, and included a literature search of papers on sessile, benthic, pelagic, and planktonic organisms from the standpoint of the effect of oils and waste brines.http://gbic.tamug.edu/request.ht

Status and Trends of Inland Wetland and Aquatic Habitats in the Corpus Christi Area

Wetland and aquatic habitats are essential components of estuarine systems along the Texas coast. These valuable resources are highly productive biologically and chemically and are part of an ecosystem on which a variety of flora and fauna depend. Scientific investigations of wetland distribution and abundance through time are prerequisites to effective habitat management, thereby ensuring their protection and preservation and directly promoting long-term biological productivity and public use. This report presents results of an investigation to determine the current status and historical trends of wetlands and associated aquatic habitats in the Corpus Christi area from Lamar Peninsula to Encinal Peninsula. The study area encompasses most of the mainland between the Gulf Intracoastal Waterway (GIWW) and the Texas General Land Office Coastal Management Program boundary, an area located within Refugio, Aransas, San Patricio, and Nueces Counties (Fig. 1). Natural environments include wetlands, wind-tidal flats, riparian woodlands, and bay shorelines. The methods and classification system used in this report follow those found in the Texas coastal barrier-island report for the Coastal Bend (White et al., 2002).Bureau of Economic Geolog

Communication between family carers and health professionals about end-of-life care for older people in the acute hospital setting: a qualitative study

This paper focuses on communication between hospital staff and family carers of patients dying on acute hospital wards, with an emphasis on the family carers’ perspective. The age at which people in the UK die is increasing and many continue to die in the acute hospital setting. Concerns have been expressed about poor quality end of life care in hospitals, in particular regarding communication between staff and relatives. This research aimed to understand the factors and processes which affect the quality of care provided to frail older people who are dying in hospital and their family carers

Lung cancer diagnosed following an emergency admission: exploring patient and carer perspectives on delay in seeking help

Purpose Compared to others, patients diagnosed with lung cancer following an emergency, unplanned admission to hospital (DFEA) have more advanced disease and poorer prognosis. Little is known about DFEA patients’ beliefs about cancer and its symptoms or about their help-seeking behaviours prior to admission. Methods As part of a larger single-centre, prospective mixed-methods study conducted in one University hospital, we undertook qualitative interviews with patients DFEA and their carers to obtain their understanding of symptoms and experiences of trying to access healthcare services before admission to hospital. Interviews were recorded and transcribed. Framework analysis was employed. Results Thirteen patients and 10 carers plus 3 bereaved carers took part in interviews. Three patient/carer dyads were interviewed together. Participants spoke about their symptoms and why they did not seek help sooner. They described complex and nuanced experiences. Some (n = 12) had what they recalled as the wrong symptoms for lung cancer and attributed them either to a pre-existing condition or to ageing. In other cases (n = 9), patients or carers realised with hindsight that their symptoms were signs of lung cancer, but at the time had made other attributions to account for them. In some cases (n = 3), a sudden onset of symptoms was reported. Some GPs (n = 6) were also reported to have made incorrect attributions about cause. Conclusion Late diagnosis meant that patients DFEA needed palliative support sooner after diagnosis than patients not DFEA. Professionals and lay people interpret health and illness experiences differently

Submerged Lands of Texas, Brownsville-Harlingen Area: Sediments, Geochemistry, Benthic Macroinvertebrates..

Surface sediment textures, sediment geochemistry, and benthic fauna of the State-owned submerged lands were mapped and described using bottom samples collected at 1-mi (1.6-km) intervals from bays, estuaries, and lagoons, and the inner continental shelf. In one area of Laguna Madre samples were collected at 0.5-mi (0.8-km) intervals. In addition, the distribution of wetlands in adjacent areas was mapped using color infrared photographs taken primarily in 1979. Textural maps of the Brownsville-Harlingen area show that sand and muddy sand, having a mean grain size of between 2.5 and 5, are the dominant sediment types in bay-estuary-lagoon and inner-shelf areas. Generally, in Laguna Madre sands occur on the barrier island side of the lagoon, whereas muddier sediments are more abundant along the mainland side and in deeper areas. Muddy sand is dominant in the relatively wide southern end of Laguna Madre, and sand is dominant along the narrower, northern two-thirds of the lagoon where broad sandy wind-tidal flats on Padre Island grade into shallow subaqueous lagoon sands. Dominantly sand-sized sediments blanket most of the inner shelf and extend about 10 mi (16 km) offshore from Padre Island. The greatest extent of sand is associated with marine reworked late Pleistocene fluvial-deltaic deposits that underlie much of the inner shelf. Water depths average about 90 ft (30 m) at the outer limits of this sand-rich area. A nearshore patch of mud occurs near the mouth of the Rio Grande and represents the most recent deposition of the river. To the east and north the mud grades into muddy sand that represents a mixture of relict shelf sands and more modern fluvial muds.Bureau of Economic Geolog