Edgework, institutions and enhanced interrogation

The Enhanced Interrogation programme was a medicalised interrogation programme that was designed by the United States in the wake of 9/11. It is now widely recognized that the Enhanced Interrogation programme engaged in some activities that were, at the least, tantamount to torture. The programme was designed by Psychologists and overseen by other professionals, including medical professionals. This article argues that the Enhanced Interrogation programme displayed many of the features of what Sociologists refer to as Edgework. It demonstrated voluntary risk-taking by health and other professionals; this risk-taking pressed up against catastrophic outcomes across multiple dimensions; risks were taken for the purposes of escaping a death-saturated macrosocial context; and the health professionals in the programme were highly skilled. The article argues that a new form of Edgework can be detected by studying the programme, which the article refers to as 'Institutional Edgework'.

Experiences of Young People with Harmful Sexual Behaviors in Services: A Qualitative Study

Young people are responsible for a significant number of the sexual offenses that are committed every year. These young people are generally referred to specialist services for treatment. This article explores the health characteristics and service experiences of 117 young people with sexual behavior problems, and the issues that services face when working with them. The study is based on analysis of 117 case files, identified from nine specialist services in the UK. The case files were thematically analyzed. Case files provided information on the following topics: the reasons why the young people were referred to harmful sexual behavior services; the young people's personal characteristics; their medical and mental health problems; the young people's interests and aspirations; their attitudes toward services and interventions; continued problematic sexual incidents in services; progress in services; and post-service experiences. Overall, the findings of the study indicate that these young people have a number of strengths, but often have problems across a range of personal and health domains. A number of them continue to remain sexually and generally violent in services, particularly in residential settings, which has risk management implications for staff.

Posttraumatic growth in head and neck cancer survivors: Is it possible and what are the correlates?

OBJECTIVES

Posttraumatic growth (PTG) is a possible positive consequence of a traumatic event, such as cancer. Head and neck cancer (HNC) may be particularly traumatic, given its adverse effects on functional, psychological, and social wellbeing. We investigated the extent of PTG, factors associated with PTG, and associations between PTG and health-related quality-of-life (HRQoL) in HNC survivors.

METHODS

HNC survivors (ICD10 C00-C14, C32), identified from the population-based National Cancer Registry Ireland, completed a postal survey. PTG was assessed using the Posttraumatic Growth Inventory (PTG-I) and HRQoL with FACT-G and FACT-H&N. Associations between socio-economic characteristics, social support, and clinical variables and PTG were examined using multivariable linear regression. Total HRQoL scores were compared in those with none-low PTG vs moderate-high PTG.

RESULTS

A total of 583 survivors participated (response rate = 59%). The mean PTG score was 55.74 (95%CI 53.15-58.33); 60% had moderate-high PTG. Survivors scored highest in the PTG-I domain appreciation of life. In multivariable analysis, being female, being younger, having more social support, and having cancer-related financial stress were significantly associated with more PTG. HRQoL was significantly higher in those with moderate-high than no-little PTG (P < .01).

CONCLUSIONS

A notable proportion of HNC survivors report PTG but growth is, on average, lower than reported for other cancers. Nonetheless, higher PTG appears related to better HRQoL. Further research would be valuable to understand the pathways by which HNC may lead to PTG and inform development of strategies to support and encourage PTG in this survivor population.

The Nun Study and Alzheimer's disease: Quality of vocation as a potential protective factor?

Data from the Nun Study, the most famous longitudinal epidemiology of Alzheimer’s disease to date, are analyzed and reformulated in terms of Max Weber’s discussion of the centrality of beruf – “calling” – fulfilling a life task in pursuit of a vocation. Qualitative differences in the Nuns’ vocations are uncovered, which are correlated to their resilience to dementia. Extrapolating, we argue that Alzheimer’s disease and the dementia reputed to it should be understood as a social pathology of contemporary civilization related to the loss of moral foundations from which coherent, meaningful life-projects can be conducted.

Making Implicit Assumptions Explicit in the Costing of Informal Care: The Case of Head and Neck Cancer in Ireland

BACKGROUND

From a health service perspective, informal care is often viewed as a potentially cost-effective way of transferring costs out of the formal healthcare sector. However, informal care is not a free resource.

OBJECTIVE

Our objective was to assess the impact of alternative valuation methods and key assumptions on the cost of informal care.

METHODS

Informal carers who assisted in the care of a head and neck cancer survivor for at least 1 year were sent a postal questionnaire during January-June 2014 requesting information on time spent on caring tasks in the month prior to the survey. Time was costed using the opportunity cost approach (OCA; base-case) and the generalist (GRCA) and specialist (SRCA) replacement cost approaches. The impact on results of how household work and informal carers not in paid employment are treated were investigated.

RESULTS

We estimated a cost of €20,613 annually in the base case (OCA - mean wage) for informal care. The GRCA and SRCA equivalent costs were 36% (€13,196) and 31% (€14,196) lower, respectively. In the extreme scenario of applying a 'zero' opportunity cost to carers not in paid employment, costs fell by 67% below the base case.

CONCLUSION

While the choice of costing method is important for monetary valuation, the sociodemographic and economic characteristics of the underlying population can be equally so. This is especially important given the heterogeneous treatment of older carers, female carers and carers not in paid employment in the OCA. To limit this, we would suggest using the SRCA to value informal care across heterogeneous carer populations.

Social networks, social support and social negativity: A qualitative study of head and neck cancer caregivers' experiences

Head and neck cancer is a serious form of cancer that can generate substantial physical and psychosocial morbidity. Informal caregivers can help patients to manage head and neck cancer and its emotional impacts, both during and after treatment. Caregivers, however, can experience considerable stress as a result of their caring activities. Supportive relationships can protect caregivers from psychosocial strain. Thirty-one head and neck cancer caregivers were interviewed about their experiences of accessing social support from their social networks; difficulties that they experienced accessing this support; and strategies that they used to address these difficulties. Results suggest that head and neck cancer caregivers strongly value social support, but can find it difficult to obtain, and a number of them experience socially negative responses from their networks. Some carers attempt to answer or supplement support deficiencies by turning to non-human coping supports, such as pets, spiritual figures or medication. Implications for theory and practice are discussed.

Why Did U.S. Healthcare Professionals Become Involved in Torture During the War on Terror?

This article examines why U.S. healthcare professionals became involved in "enhanced interrogation," or torture, during the War on Terror. A number of factors are identified including a desire on the part of these professionals to defend their country and fellow citizens from future attack; having their activities approved and authorized by legitimate command structures; financial incentives; and wanting to prevent serious harm from occurring to prisoners/detainees. The factors outlined here suggest that psychosocial factors can influence health professionals' ethical decision-making.

Dealing with the devil: weight loss concerns in young adult women with type 1 diabetes

AIMS AND OBJECTIVES

To examine the weight loss concerns of young adults with type 1 diabetes.

BACKGROUND

Eating disorders are prevalent in young women with type 1 diabetes.

DESIGN

Qualitative.

METHODS

Interviews with 35 young adults (23-30 years of age) with type 1 diabetes and 13 healthcare professionals.

RESULTS

Most female interviewees were concerned about the difficulties of losing weight when having diabetes. Six female interviewees developed severe eating disturbances when they were younger. These women initially regarded their disturbed eating behaviour positively and engaged in weight loss activities intermittently. However, over time, they lost control of their behaviour, and it came to dominate their lives. Family conflict often intensified disordered eating behaviours. Eventually all of these women managed to transition away from their behaviour, although this process took, for some of them, several years. Several of them (now in their early to late twenties), however, continued to struggle with weight loss impulses. Healthcare professionals felt that eating- and weight-related issues often went undiagnosed and undocumented in young adult women with type 1 diabetes.

CONCLUSION

Many young women with type 1 diabetes are worried about their weight, but will not engage in risky weight loss activities because of concerns about their health. A minority of young adult women will develop more severe eating-related disturbances. These eating disturbances may last a significant amount of time before clinicians become aware of them. These women may also experience disordered weight loss impulses for sometime after clinical interventions.

RELEVANCE TO CLINICAL PRACTICE

Clinicians should screen young adult women with type 1 diabetes for eating disorders and monitor young adult women who have developed eating disorders over the longer term. There may be a need to provide asymptomatic young women with diabetes with information about the potential risks of insulin omission.

Considering quality of care for young adults with diabetes in Ireland

BACKGROUND

Research on the quality of diabetes care provided to young adults with Type 1 diabetes is lacking. This study investigates perceptions of quality of care for young adults with Type 1 diabetes (23-30 years old) living in the Republic of Ireland.

METHODS

Thirty-five young adults with Type 1 diabetes (twenty-nine women, six men) and thirteen healthcare professionals (ten diabetes nurse specialists, three consultant Endocrinologists) were recruited. All study participants completed semi-structured interviews that explored their perspectives on the quality of diabetes services in Ireland. Interviews were analyzed using standard qualitative thematic analysis techniques.

RESULTS

Most interviewees identified problems with Irish diabetes services for young adults. Healthcare services were often characterised by long waiting times, inadequate continuity of care, overreliance on junior doctors and inadequate professional-patient interaction times. Many rural and non-specialist services lacked funding for diabetes education programmes, diabetes nurse specialists, insulin pumps or for psychological support, though these services are important components of quality Type 1 diabetes healthcare. Allied health services such as psychology, podiatry and dietician services appeared to be underfunded in many parts of the country. While Irish diabetes services lacked funding prior to the recession, the economic decline in Ireland, and the subsequent austerity imposed on the Irish health service as a result of that decline, appears to have additional negative consequences. Despite these difficulties, a number of specialist healthcare services for young adults with diabetes seemed to be providing excellent quality of care. Although young adults and professionals identified many of the same problems with Irish diabetes services, professionals appeared to be more critical of diabetes services than young adults. Young adults generally expressed high levels of satisfaction with services, even where they noted that aspects of those services were sub-optimal.

CONCLUSION

Good quality care appears to be unequally distributed throughout Ireland. National austerity measures appear to be negatively impacting health services for young adults with diabetes. There is a need for more Endocrinologist and diabetes nurse specialist posts to be funded in Ireland, as well as allied health professional posts.

What's distressing about having type 1 diabetes? A qualitative study of young adults' perspectives

BACKGROUND

Diabetes distress is a general term that refers to the emotional burdens, anxieties, frustrations, stressors and worries that stem from managing a severe, complex condition like Type 1 diabetes. To date there has been limited research on diabetes-related distress in younger people with Type 1 diabetes. This qualitative study aimed to identify causes of diabetes distress in a sample of young adults with Type 1 diabetes.

METHODS

Semi-structured interviews with 35 individuals with Type 1 diabetes (23-30 years of age).

RESULTS

This study found diabetes related-distress to be common in a sample of young adults with Type 1 diabetes in the second phase of young adulthood (23-30 years of age). Diabetes distress was triggered by multiple factors, the most common of which were: self-consciousness/stigma, day-to-day diabetes management difficulties, having to fight the healthcare system, concerns about the future and apprehension about pregnancy. A number of factors appeared to moderate distress in this group, including having opportunities to talk to healthcare professionals, attending diabetes education programmes and joining peer support groups. Young adults felt that having opportunities to talk to healthcare professionals about diabetes distress should be a component of standard diabetes care.

CONCLUSIONS

Some aspects of living with diabetes frequently distress young adults with Type 1 diabetes who are in their twenties. Clinicians should facilitate young adults' attendance at diabetes education programmes, provide them with opportunities to talk about their diabetes-related frustrations and difficulties and, where possible, assist in the development of peer-support networks for young adults with diabetes.

Men's attitudes towards chlamydia screening: a narrative review

OBJECTIVES

Chlamydia trachomatis is a sexually transmissible infection (STI) that affects significant numbers of men. Research on men's perspectives on chlamydia screening (or testing) has been limited. We conducted a narrative review to examine: (1) what factors encourage or discourage men from attending health services for chlamydia screening, and/or from accepting screening once it has been offered to them, and (2) where men want chlamydia screening services to be located.

METHODS

A narrative review of the recent peer-reviewed literature (published between 1999 and 2009) on men's attitudes towards chlamydia screening. To be included, articles had to explore men's perspectives on screening (which could be ascertained through quantitative or qualitative studies, or from relevant discussion papers or reviews).

RESULTS

Forty-eight articles were included in all. Men's attitudes towards chlamydia screening are influenced by their knowledge about the infection, their perceived vulnerability to the infection, the degree of embarrassment and shame that they associate with screening and the stigma that they associate with screening. Men prefer to be offered urine testing for chlamydia. Men want to be offered screening by non-judgemental professionals. Men's attitudes towards screening for chlamydia in general practice, genito-urinary medicine clinics, home and outreach settings are also explored in this review.

CONCLUSIONS

Several factors influence men's attitudes towards screening. Two central themes underlie and influence many of these factors: men's needs to make positive impressions on others, and men's identification with particular ideals of masculinity. The review concludes with suggestions for future research on this topic.

The cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland

OBJECTIVE

The objective of this study was to estimate the cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland.

METHODS

Prospective cost analysis of an opportunistic screening programme delivered jointly in three types of healthcare facility in Ireland. Incremental cost-effectiveness analysis was performed using an existing dynamic modelling framework to compare screening to a control of no organised screening. A healthcare provider perspective was adopted with respect to costs and included the costs of screening and the costs of complications arising from untreated infection. Two outcome measures were examined: major outcomes averted, comprising cases of pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in women, neonatal conjunctivitis and pneumonia, and epididymitis in men; and quality-adjusted life-years (QALY) gained. Uncertainty was explored using sensitivity analyses and cost-effectiveness acceptability curves.

RESULTS

The average cost per component of screening was estimated at €26 per offer, €66 per negative case, €152 per positive case and €74 per partner notified and treated. The modelled screening scenario was projected to be more effective and more costly than the control strategy. The incremental cost per major outcomes averted was €6093, and the incremental cost per QALY gained was €94,717. For cost-effectiveness threshold values of €45,000 per QALY gained and lower, the probability of the screening being cost effective was estimated at <1%.

CONCLUSIONS

An opportunistic chlamydia screening programme, as modelled in this study, would be expensive to implement nationally and is unlikely to be judged cost effective by policy makers in Ireland.

Young adults’ preferred options for receiving chlamydia screening test results: a cross-sectional survey of 6085 young adults

Summary

We investigated how young adults aged 18-29 years would like to be notified of chlamydia screening test results, and, when they test positive, their willingness and preferred mechanism for informing their partners. We conducted a cross-sectional survey of 6085 young adults and found that a call to their mobile phone was their preferred way of receiving positive test results (selected by 50%), followed by email. Text messages (short message service [SMS]) and calls to landline phones were unpopular options, selected by between 5 and 10%. Over 75% of respondents stated they would inform their current partner of a positive chlamydia diagnosis, and 50% would inform their previous partners. Most were willing to receive yearly reminders to go for a chlamydia test. Young adults preference for being informed of chlamydia test results by mobile phone call, rather than by email or SMS text, especially if they test positive, suggests they place high value on the security of the communication mechanism. Offering a range of mechanisms for receipt of test results may increase the acceptability and coverage of sexually transmitted infection (STI) control strategies.

Where do young adults want opportunistic chlamydia screening services to be located?

BACKGROUND

This study measured the acceptability of urine-based chlamydia screening to young adults, where young adults wanted opportunistic chlamydia screening services to be located, and by whom they wanted to be offered screening.

METHODS

A cross-sectional survey of 5685 university students and 400 young adult healthcares setting attendees (age: 18-29 years).

RESULTS

Ninety-six percent of males and 93% of females said that they would find it acceptable to be offered chlamydia screening. Seventy-six percent of males and 77% of females wanted to be offered screening by a doctor or nurse. Young women would prefer female staff. Most respondents preferred that screening be located in traditional healthcare settings such as General Practices, and offered by either doctors or nurses. More than 90% of respondents did not want screening services to be located in pharmacies and almost all rejected public non-health care screening settings.

CONCLUSIONS

Opportunistic chlamydia screening services should be located in traditional healthcare/medical settings, and screening should be offered by doctors and nurses.

A descriptive social and health profile of a community sample of adults and adolescents with Asperger syndrome

Background

Little is known about the health and social profile of adolescents and adults with Asperger syndrome (AS) living in the community. We conducted a study to describe the living, employment and psycho-social situation of a community sample of forty two adults and adolescents with AS, and to describe these indivdiuals' experiences of accessing health services and taking medication.

Findings

Most respondents (including those over eighteen years of age) lived at home with their parents. Most had trouble reading and responding to other people's feelings, and coping with unexpected changes. Difficulties with life skills, such as cleaning, washing and hygiene were prevalent. The majority of respondents were socially isolated and a large minority had been sexually or financially exploited. Almost all respondents had been bullied. Mental health problems such as anxiety or depression were common. 30% of respondents said that they regularly became violent and hit other people and 15% had attempted suicide. More positively, the majority of respondents felt that they could access health services if they had a health problem.

Conclusions

The results of this study suggest a relatively poor social and health profile for many people with Asperger syndrome living in the community, with high levels of social problems and social exclusion, and difficulties managing day to day tasks such as washing and cleaning; these findings support the results of other studies that have examined psycho-social functioning in this group.

"Pee-in-a-Pot": acceptability and uptake of on-site chlamydia screening in a student population in the Republic of Ireland

BACKGROUND

The aim of the study was to explore the acceptability and uptake of on-campus screening using a youth friendly approach in two Third Level higher education institutions (HEIs). This study is part of wider research exploring the optimal setting for chlamydia screening in Ireland.

METHODS

Male and female students were given the opportunity to take a free anonymous test for chlamydia during a one week programme of "pee-in-a-pot" days at two HEI campuses in the West of Ireland. The study was set up after extensive consultation with the two HEIs and advertised on the two campuses using a variety of media in the two weeks preceding the screening days. Screening involved the provision and distribution of testing packs at communal areas and in toilet facilities. In Ireland, chlamydia notifications are highest amongst 20-29 year olds and hence the screening criterion was aimed at 18-29 year olds. Urine samples were tested using a nucleic acid amplification test (NAAT). Following the screening days, qualitative in-depth interviews were conducted with participants about their experiences of the event.

RESULTS

Out of 1,249 test kits distributed in two HEIs, 592 specimens were collected giving a return rate of 47.5%. Tests excluded (54) were due to labelling errors or ineligibility of participants' age. Two thirds of those tested were females and the mean age was 21 years. Overall, 3.9% (21/538) of participants tested positive, 5% (17/336) among females and 2% (4/191) among males. Participant interviews identified factors which enhanced student participation such as anonymity, convenience, accessibility of testing, and the informal and non-medical approach to testing.

CONCLUSIONS

Screening for chlamydia using on-campus "pee-in-a-pot" days is an acceptable strategy in this population. This model can detect and treat asymptomatic cases of chlamydia and avoid many of the barriers associated with testing for sexually transmitted infections (STIs) in clinical settings.

Disclosure of STI testing activities by young adults: the influence of emotions and social networks

Thirty young adults (between 18 and 29 years of age) who had sought STI testing were interviewed about their experiences of 'passing' during the STI testing process (keeping their testing practices a secret from other individuals), and also their experiences of disclosing to other individuals the fact that they had sought STI testing. Respondents kept their STI testing practices secret from others in order to preserve their identities as 'normal' individuals. They feared that their identities would become stigmatised if other people were to find out about their testing practices. Keeping their practices a secret was difficult and emotionally draining. Consequently, respondents usually chose to inform a few key individuals about their testing activities. These individuals provided respondents with emotional support and helped them to pass as normal. Healthcare professionals were a particular, valued group to whom respondents disclosed their need for STI testing. A number of respondents reported experiencing stigmatising reactions from healthcare professionals, however, which had deleterious consequences for these respondents' willingness to seek treatment for their STI. Findings are discussed in relation to Goffman's impression management framework (1959, 1963) and develop Goffman's work by highlighting the roles played by emotions and social networks in impression management activities.

Triggers of self-conscious emotions in the sexually transmitted infection testing process

Background

Self-conscious emotions (shame, guilt and embarrassment) are part of many individuals' experiences of seeking STI testing. These emotions can have negative impacts on individuals' interpretations of the STI testing process, their willingness to seek treatment and their willingness to inform sexual partners in light of positive STI diagnoses. Because of these impacts, researchers have called for more work to be completed on the connections between shame, guilt, embarrassment and STI testing. We examine the specific events in the STI testing process that trigger self-conscious emotions in young adults who seek STI testing; and to understand what it is about these events that triggers these emotions.

Semi-structured interviews with 30 adults (21 women, 9 men) in the Republic of Ireland.

Findings

Seven specific triggers of self-conscious emotions were identified. These were: having unprotected sex, associated with the initial reason for seeking STI testing; talking to partners and peers about the intention to seek STI testing; the experience of accessing STI testing facilities and sitting in clinic waiting rooms; negative interactions with healthcare professionals; receiving a positive diagnosis of an STI; having to notify sexual partners in light of a positive STI diagnosis; and accessing healthcare settings for treatment for an STI. Self-conscious emotions were triggered in each case by a perceived threat to respondents' social identities.

Conclusion

There are multiple triggers of self-conscious emotions in the STI testing process, ranging from the initial decision to seek testing, right through to the experience of accessing treatment. The role of self-conscious emotions needs to be considered in each component of service design from health promotion approaches, through facility layout to the training of all professionals involved in the STI testing process.

Young women's decisions to accept chlamydia screening: influences of stigma and doctor-patient interactions

BACKGROUND

An understanding of the factors that encourage young women to accept, and discourage them from accepting, STI (sexually transmitted infection) testing is needed to underpin opportunistic screening programs for the STI Chlamydia trachomatis (opportunistic screening involves healthcare professionals offering chlamydia tests to people while they are attending health services for reasons that are usually unrelated to their sexual health). We conducted a qualitative study to identify and explore: how young women would feel about being offered opportunistic tests for chlamydia?; how young women would like to be offered screening, and who they wanted to be offered screening by?; and what factors would influence young women's partner notification preferences for chlamydia (who they would notify in the event of a positive diagnosis of chlamydia, how they would want to do this).

METHODS

Semi-structured interviews with 35 young women between eighteen and twenty nine years of age. The study was conducted in the Dublin and Galway regions of the Republic of Ireland. Young adults were recruited from General Practice (GP) practices, Third Level College health services, Family Planning clinics and specialist STI treatment services.

RESULTS

Respondents were worried that their identities would become stigmatised if they accepted screening. Younger respondents and those from lower socio-economic backgrounds had the greatest stigma-related concerns. Most respondents indicated that they would accept screening if it was offered to them, however; accepting screening was seen as a correct, responsible action to engage in. Respondents wanted to be offered screening by younger female healthcare professionals. Respondents were willing to inform their current partners about positive chlamydia diagnoses, but were more ambivalent about informing their previous partners.

CONCLUSIONS

If an effort is not put into reducing young women's stigma-related concerns the population coverage of Chlamydia screening might be reduced.

Healthcare routines of university students with Type 1 diabetes

TITLE

Healthcare routines of university students with Type 1 diabetes.

AIM

This paper is a report of a study examining the benefits that university students with Type 1 diabetes associate with diabetes self-care routines, and the barriers that they experience in enacting self-care routines in the university environment.

BACKGROUND

Many young adults with Type 1 diabetes attend university, and it is thought that these students might experience difficulties with their self-care routines while they are there.

METHOD

A qualitative method was chosen to explore students' own perspectives. Seventeen students with diabetes were interviewed twice, and each kept a research diary for a 2-week period. Interviews and diaries were analyzed using standard qualitative techniques. The study was conducted in 2004-2005.

FINDINGS

Routines had a number of identity-producing benefits for students. However, students often experienced difficulties routinizing their self-care practices at university. These difficulties stemmed both from the irregular nature of university life and from students' desires not to let their diabetes interfere with their student lives. Most participants learned to adjust to university and enact self-care routines, although they could still experience routine difficulties during times of transition and stress.

CONCLUSION

Healthcare professionals need to be aware of the difficulties that university students with Type 1 diabetes experience with their self-care routines. This awareness needs to encompass older students in the second, third and fourth years of their undergraduate degrees and postgraduate students as well as students in their first year at university.

What prompts young adults in Ireland to attend health services for STI testing?

BACKGROUND

In-depth understanding of the factors that prompt young adults to attend health services for sexually transmitted infection (STI) testing are needed to underpin sexual health programes. We conducted a qualitative study to identify and explore why young adults (18-29 years) in Ireland attended specialist and community health services for STI testing; the factors that supported/undermined their decisions to seek STI testing; and any factors that led to delay in seeking STI testing.

METHODS

Semi-structured interviews with 30 adults (21 women, 9 men). Young adults were recruited from General Practice (GP) practices, Third Level College health services, Family Planning clinics and specialist STI treatment services for men who have sex with men (MSM). Interview questions examined why respondents decided to go for STI testing, whether they acted upon this desire immediately or decided to wait, and what they felt were important barriers/enablers to their health-seeking attempts. Interviews were thematically analyzed using standard qualitative techniques.

RESULTS

Respondents sought STI testing for one of four reasons: they had reached a transitional moment in their lives (they were either about to stop using condoms with their sexual partner or were emerging from a period of their lives where they had a series of risky sexual relationships); they had had unprotected sex with a casual partner; they had symptoms of infection; and/or they were required to do so by their employer. Catalytic factors included media and government health promotion campaigns and knowing someone with an STI. However, many respondents delayed seeking testing. Reasons included respondents' concerns about stigma and that they would be judged by healthcare professionals, and feelings of invulnerability. Importantly, several respondents who waited up to four weeks to make an appointment after their initial decision to seek STI testing did not view this as delay.

CONCLUSION

Sexual health promotion campaigns for young people should address the reasons why they delay testing, specifically through measures to avoid stigma (supply-side) and reassure young adults (demand-side). Strategies to increase testing-uptake should focus on these four key opportunities - young adults leaving relationships, those entering relationships where condoms will not be used, those who have had unprotected sex and those with STI-related symptoms.

The body projects of university students with type 1 diabetes

Young adults with type 1 diabetes are a "forgotten group." Their perspectives are rarely addressed by research studies, meaning that we know little about the reasons why they engage (or not) in diabetes self-care practices. The limited work that has investigated these young people's perspectives suggests that they experience a tension between being healthy and being normal. In this article, I examine this tension from the viewpoints of a particular group of young adults with diabetes: university students. I examine what being normal means for these students and how their attempts to be normal impact upon their diabetes control. I argue that normalcy for these students is constructed and maintained through the body. Respondents attempt to be normal by engaging in what Shilling refers to as "body projects." Each of the body projects that students are involved in developing is intended to produce a particular kind of normal embodied identity that is unaffected by diabetes. Unfortunately, the constitutional practices of particular body projects often undermine those of others, and can be risky for students' diabetes control. As such, students have to reach a balance between their different body projects. This article helps to address the lack of research on the perspectives of young adults with diabetes, and contributes to theoretical research on the concept of body projects.

Technologies, diabetes and the student body

This paper uses qualitative methodologies to understand young people's use of technology in the management of Type 1 diabetes. The paper begins by outlining the nature of Type 1 diabetes. We provide an account of recent debates on the consumption of health-care technologies. We consider the advantages of qualitative approaches for studying young people with diabetes. Our specific focus is on university students with diabetes who are commonly represented as having a lifestyle that is ill-suited to good management of the disease. We consider the pros and cons that these young people associate with their technologies, and the role that place plays in these young people's accounts. We argue that diabetes' management technologies provide these young people with the ability to discipline their bodies and position their identities as 'normal' students in student spaces, as well as to manage risks to their health and identities. However, we highlight that the use of these technologies, especially in public spaces such as student night-clubs and bars, poses risks for students with diabetes, for example, by highlighting their 'difference' from other students.

Diets and discipline: the narratives of practice of university students with type 1 diabetes

Type 1 diabetes is one of the most common chronic conditions of adolescence and young adulthood. It is characterised by a demanding and complex management regime. Individuals with diabetes must engage in continual self-care actions such as eating healthily and exercising if they are to minimise their risks of developing long-term diabetes' complications. Research has demonstrated, however, that many young adults experience difficulties with exercising and eating healthily. Narrative approaches could provide important insights into the reasons why young people do or do not experience difficulties here. In this article I examine the food consumption and exercise narratives of a particular group of young adults with type 1 diabetes, university students, to see what personal, social and cultural factors influence their practices.