To better gain insight into patient responses to insomnia, we take a medical anthropologically informed approach to patient beliefs and behaviors, particularly those related to self-diagnosis, management, help-seeking, and self-treatment of insomnia. We conducted 24 in-depth qualitative interviews in which participants were asked their beliefs about the origin of their insomnia, its anticipated course, their evaluation of symptoms, their responses, and their expectations surrounding treatment. Important and novel data were generated about patient beliefs and behaviors related to problem sleeping. Patients identified barriers to treatment, particularly those contextualized within a general social stigma and personal isolation, in which their problems sleeping were not taken seriously. The interview format was particularly conducive to making patients comfortable discussing the personal changes they made to their medically prescribed treatment plans, or supplanting their medical therapy with some kind of complimentary and alternative medicine (CAM) therapy. These are important issues in the long term management of chronic insomnia. We underscore concern about the need to evaluate the efficacy of therapies that so many people with insomnia are driven to try.

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Drawing on ethnographic research conducted along the Sierra Leone-Guinea border during wartime, this article explores the contested nature of the body and bodily illness during times of spectacular political violence. For both perpetrators and survivors of conflict, the body and bodily illness became tools over which each sought to control definitions of Self and identity. Finally, the article considers emic interpretations and contested meanings of the local illness hypertension, or haypatensi, that occurred among the displaced. I document how discussions of haypatensi allowed horrific subjective experiences to become mediated, enabling conflict survivors to understand and express the pain of their trauma and vulnerability, and begin recourse toward reestablishing order and control over their lives. Even these discussions of illness, however, involved competition over control of meanings and prescriptive models with medical practitioners. Haypatensi thus reveals how lived, traumatic experiences and their cultural representations within illness are linked.

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The purpose of this ethnographic study was to conduct an exploratory research investigation examining the phenomenon of barebacking among men-who-have-sex-with-men (MSM) on the Internet. The researchers selected a case sample of 100 MSM advertisers on an Internet bareback sex site to assess HIV transmission risk as related to HIV serostatus, partner selection, and sexual risk-taking. The data suggest that while intentionally seeking to transmit or contract HIV was ex-Please note that this electronic prepublication galley may contain typographical errors and may be missing artwork, such as charts, photographs, etc. Pagination in this version will differ from the published version.

BackgroundTrauma care represents a complex patient journey, requiring multidisciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, co-operation and coordination across diverse groups. We aimed to define and improve relational aspects of trauma care at Gold Coast University Hospital.MethodsWe conducted a mixed-methods collaborative ethnography using the relational coordination survey—an established tool to analyse the relational dimensions of multidisciplinary teamwork—participant observation, interviews and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance.FindingsWe engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation programme in contributing positively to team culture and relational ties. A range of 16 interventions—focusing on structural, process and relational dimensions—were co-created with participants and are now being implemented and evaluated by various trauma care providers.ConclusionsThrough engagement of clinicians spanning organisational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage healthcare leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.

Environmental influences on sexual behavior are difficult to examine given their temporal distance from the sexual act and the cost of long-term longitudinal studies. We examined environmental influences on risky sexual behavior in young gay men using the Situational Presentation (Sitpres) methodology, where situations in which relevant environmental variables are presented as computer vignettes with the variables randomly allocated, and participants rate the likelihood of their engaging in unsafe sexual behavior. A total of 100 gay men aged between 18 and 26 years of age completed 20 situational presentations with the outcome being the likelihood of engaging in unprotected anal intercourse. On regression analysis, 3 environmental variables significantly predicted safer sex: perceived gay/bisexual men's norms toward condom use; availability of HIV prevention messages; and what one's religion says about gay sex. Not significant were family, media, legal, and work/school attitudes to homosexuality. Demographic variables that were predictors included education, age, sexual orientation, and degree of being "out" about sexual orientation. These data suggest that environmental factors can be approximated using the Sitpres methodology, and that more proximal environmental variables have a stronger impact than distal ones.