Eric Mykhalovskiy

The social context of smoking: the next frontier in tobacco control?

A better understanding of the social context of smoking may help to enhance tobacco control research and practice

Hegemonic Masculinity and the Experience of Prostate Cancer: A Narrative Approach

Prostate cancer is a major health problem—one that inevitably challenges mens notions about themselves and their expressions of masculinity. As part of a larger study investigating linkages between masculinity and prostate cancer, this article focuses on the narratives of three men with prostate cancer—all of whom shed light on contemporary forms of hegemonic masculinity. Multiple interviews were conducted with study participants, capturing experiencesboth prior to and following cancer diagnosis. Analysis of individual narratives showed how social factors such as work and family influenced (and were influenced by) mens experiences with illness. All three men were forced to renegotiate their performances of masculinity—with this renegotiation mostly occurring within the parameters of performance consistent with hegemonic masculinity. However, there was also some evidence of shifts into new socialterritory and new expressions of masculinity. In contrast to more traditional, trait-based approaches to studying mens experiences, a narrative approach allows social scientists to do justice to the temporal realities and contextual complexities of mens lives. Men will be better understood as more attention is paid to the actual shape of individual lives.

Reconsidering table talk: Critical thoughts on the relationship between sociology, autobiography and self-indulgence

Those who use autobiographical perspectives in the practice of sociology and related disciplines have noted, with concern, the association of their work with self-indulgence (Devault, 1994; Jackson, 1990; Okely, 1992; Kreiger, 1991). This paper elaborates this concern by directing analytic attention to the nature of the charge of self-indulgence. The paper reads as an autobiographical defense of autobiographical sociology. It uses the naming of my own work as self-involved as a point of departure for explicating the implications of this regulatory practice. The device of irony is used to expose how self-indulgence, as a critique invoking highly insular relations of readership, authorship and subject/object distinction, relies on the conventions of a traditional masculine academic discourse.

Toward Population-based Indicators of Quality End-of-Life Care: Testing Stakeholder Agreement

Quality indicators (QIs) are tools designed to measure and improve quality of care. The objective of this study was to assess stakeholder acceptability of QIs of end‐of‐life (EOL) care that potentially were measurable from population‐based administrative health databases.

Population Health in Canada: A Brief Critique

An internationally influential model of population health was developed in Canada in the 1990s, shifting the research agenda beyond health care to the social and economic determinants of health. While agreeing that health has important social determinants, the authors believe that this model has serious shortcomings; they critique the model by focusing on its hidden assumptions. Assumptions about how knowledge is produced and an implicit interest group perspective exclude the sociopolitical and class contexts that shape interest group power and citizen health. Overly rationalist assumptions about change understate the role of agency. The authors review the policy and practice implications of the Canadian population health model and point to alternative ways of viewing the determinants of health.

Symptoms and related severity experienced by women with breast hypertrophy.

Background: Breast hypertrophy is a common condition that can be associated with significant morbidity. Symptoms emphasized in the literature include physical problems such as pain, intertrigo, and exercise restrictions. The purpose of this study was to explore the suffering experienced by women with breast hypertrophy and to evaluate the importance of different symptoms. Methods: Twenty-one women with breast hypertrophy were divided into five focus groups guided by a facilitator. Open discussion was encouraged to generate a comprehensive list of symptoms experienced by women with breast hypertrophy. Subjects then completed an iterative process to determine the relative importance of each symptom. Conversations were recorded, transcribed, and analyzed using Nvivo software. Results: A weighted list of 45 dominant symptoms was created from an initial pool of 128. Physical pain symptoms predominated in the older age group, whereas younger women expressed more psychological symptoms. Difficulties experienced by these women transcended all aspects of their lives. Back, neck, and shoulder pain were considered most troublesome, followed by exercise difficulties, poor posture, and low self-esteem. Conclusions: This study provides insight into the burden of breast hypertrophy and has implications for the objective assessment of this condition in the clinical setting.

Tobacco control and the inequitable socio-economic distribution of smoking: smokers’ discourses and implications for tobacco control

Warning: this article contains strong language. This paper focuses on the ways in which social context structures smokers’ views of, and reactions to, tobacco control. This exploratory study examined the interactions between tobacco control and smokers’ social contexts and how this may be contributing to inequalities in smoking. We found in our sample that higher socio-economic status (SES) smokers are more likely to positively respond and adapt to tobacco control messages and policies, viewing them for their future health betterment. Lower SES smokers in our study, on the other hand, are in conflict with tobacco control and feel intransigent with regard to the effects that tobacco control is having on their smoking. A better understanding of how social context structures peoples perceptions of tobacco control may help us to understand why social inequalities in smoking are deepening, and potentially what can be done better in tobacco control to decrease them.

Troubled hearts, care pathways and hospital restructuring: Exploring health services research as active knowledge

This paper explores the socially active character of contemporary forms of expertise through an institutional ethnographic analysis of health services research. The paper draws primarily on interview research to investigate how health services research helps shape text-mediated relations linking government health-care policy with local reform initiatives. In the paper, I focus on the use of a particular research report by managers, physicians, and others at a community hospital in Toronto, Canada as part of their efforts to standardize and reduce the duration of care provided to heart attack patients. I discuss how, through its intertextual presence, health services research helps to co-ordinate medical and managerial practices and rationalities into medico-administrative relations. I offer two examples of this process. The first focuses on the relations co-ordinated through the textual observance of inefficiency. The second addresses how the report helped resolve the problem of physicians’ resistance to reforming cardiac care. My analysis contributes to current perspectives on the relationship between discourse and action.

Beyond Decision Making: Class, Community Organizations, and the Healthwork of People Living with HIV/AIDS. Contributions from Institutional Ethnographic Research

The consolidation of antiretroviral therapy as the primary biomedical response to HIV infection in the global North has occasioned a growing interest in the health decision making of people living with HIV (PHAs). This interest is burdened by the weight of a behaviorist theoretical orientation that limits decision making to individual acts of rational choice. This article offers an alternative way to understand how PHAs come to take (or not take) biomedical treatments. Drawing on institutional ethnographic research conducted in Toronto, Canada, it explores how the “healthwork” of coming to take (or not take) treatments is organized by extended relations of biomedical knowledge. The article focuses on two aspects of the knowledge relations of coming to take pharmaceutical medications that transcend the conceptual and relational terrain of rational decision-making perspectives. First, it explores disjunctures between the everyday healthwork of poor, socially marginalized PHAs and the terms of biomedical decision making. Second, it investigates the knowledge-mediating activities of community-based organizations that help mitigate those disjunctures.

Mouth care for orally intubated patients: A critical ethnographic review of the nursing literature

OBJECTIVES The aim of this critical ethnographic literature review was to explore the evolution of nursing discourse in oral hygiene for intubated and mechanically ventilated patients. METHODS The online databases CINAHL and MEDLINE were searched for nurse-authored English language articles published between 1960 and 2011 in peer-reviewed journals. Articles that did not discuss oral problems or related care for intubated adult patients were excluded. Articles that met the inclusion criteria were chronologically reviewed to trace changes in language and focus over time. RESULTS A total of 469 articles were identified, and 84 papers met all of the inclusion criteria. These articles presented an increasingly scientific and evaluative nursing discourse. Oral care originally focused on patient comfort within the literature; now it is emphasized as an infection control practice for the prevention of ventilator-associated pneumonia (VAP). Despite concern for its neglected application, the literature does not sufficiently address mouth cares practical accomplishment. CONCLUSIONS Mouth care for orally intubated patients is both a science and practice. However, the nursing literature now emphasises a scientific discourse of infection prevention. Inattention to the social and technical complexities of practice may inhibit how nurses learn, discuss and effectively perform this critical aspect of patient care.