BackgroundIn the past 15 years mortality rates from liver disease have doubled in the UK. Brief alcohol advice is cost effective, but clinically meaningful reductions in alcohol consumption only occur in around 1 in 10 individuals. AimTo provide evidence that detecting early liver disease in the community is feasible, practical, and that feedback of liver risk can increase the proportion of subjects reducing alcohol consumption. Design and settingA community feasibility study in nine general practice sites in Hampshire. MethodHazardous and harmful drinkers were identified by WHO AUDIT questionnaire and offered screening for liver fibrosis. ResultsIn total, 4630 individuals responded, of whom 1128 (24%) hazardous or harmful drinkers were offered a liver fibrosis check using the Southampton Traffic Light (STL) test; 393 (38%) attended and test results were returned by post. The STL has a low threshold for liver fibrosis with 45 (11%) red, 157 (40%) amber, and 191 (49%) green results. Follow-up AUDIT data was obtained for 303/393 (77%) and 76/153 (50%) subjects with evidence of liver damage reduced drinking by at least one AUDIT category (harmful to hazardous, or hazardous to low risk) compared with 52/150 (35%, P<0.011) subjects without this evidence; in the subset of harmful drinkers patterns (AUDIT >15), 22/34 (65%) of STL positives, reduced drinking compared with 10/29 (35%, P<0.017) STL negatives. ConclusionDetection of liver disease in the community is feasible, and feedback of liver risk may reduce harmful drinking.

In Australia, like other advanced liberal democracies, the adoption of a recovery orientation was hailed as a major leap forward in mental health policy and service provision. We argue that this shift in thinking about the meaning of recovery requires further analysis of the gendered dimension of self-identity and relationships with the social world. In this article we focus on how mid-life women constructed meaning about recovery through their everyday practices of self-care within the gendered context of depression. Findings from our qualitative research with 31 mid-life women identified how the recovery process was complicated by relapses into depression, with many women critically questioning the limitations of biomedical treatment options for a more relational understanding of recovery. Participant stories revealed important tacit knowledge about recovery that emphasised the process of realising and recognising capacities and self-knowledge. We identify two central themes through which women's tacit knowledge of this changing relation to self in recovery is made explicit: the disciplined self of normalised recovery, redefining recovery and depression. The findings point to the need to reconsider how both recovery discourses and gendered expectations can complicate women's experiences of moving through depression. We argue for a different conceptualisation of recovery as a social practice through which women realise opportunities to embody different 'beings and doings'. A gendered understanding of what women themselves identify is important to their well-being, can contribute to more effective recovery oriented policies based on capability rather than deficit.

ObjectiveThe aims of this paper were to identify, characterise and explain clinician factors that shape decision-making around antidepressant discontinuation in UK primary care.DesignFour focus groups and three interviews were conducted and analysed using thematic analysis.ParticipantsTwenty-one general practitioners (GPs), four GP assistants, seven nurses and six community mental health team workers and psychotherapists took part in focus groups and interviews.SettingParticipants were recruited from seven primary care regions and two National Health Service Trusts providing community mental health services in the South of England.ResultsParticipants highlighted a number of barriers and enablers to discussing discontinuation with patients. They held a range of views around responsibility, with some suggesting it was the responsibility of the health professional (HP) to broach the subject, and others suggesting responsibility rested with the patients. HPs were concerned about destabilising the current situation, discussed how continuity and knowing the patient facilitated discontinuation talks, and discussed how confidence in their professional skills and knowledge affected whether they elected to raise discontinuation in consultations.ConclusionsFindings indicate a need to consider support for HPs in the management of antidepressant medication and discussions of discontinuation in particular. They may also benefit from support around their fears of patient relapse and awareness of when and how to initiate discussions about discontinuation with their patients.

Mothers with young children have been consistently identified in public health discourses as having lower levels of leisure time physical activity than the general population. They are subsequently positioned as an at risk population susceptible to, for example, weight gain and postnatal depression. Women's ethic of care and good mother discourses work together to constrain mother's physical activity levels. In addition, public health discourses attempt to mobilize mothers into engaging in regular, rigorous sessions of leisure time physical activity, which often creates a calculative relation to self as women try to meet the expectations prescribed by health professionals. In this article, however, we employ Foucault's ethics of self to explore how 18 mothers with young children problematized and resisted prescriptive notions such as the ethic of care to create a space to begin to practice self-care through participation in leisure-time physical activity.

In this article we situate empirical research into women's problematic experiences of anti-depressant medication within broader debates about pharmaceuticalization and the rise of the neurochemical self. We explore how women interpreted and problematized anti-depressant medication as it impeded their recovery in a number of ways. Drawing upon Foucauldian and feminist work we conceptualize anti-depressants as biotechnologies of the self that shaped how women thought about and acted upon their embodied (and hence gendered) subjectivities. Through the interplay of biochemical, emotional and socio-cultural effects medication worked to shape women's self-in-recovery in ways that both reinscribed and undermined a neurochemical construction of depression. Our analysis outlines two key discursive constructions that focused on women's problematization of the neurochemical self in response to the side-effects of anti-depressant use. We identified how the failure of medication to alleviate depression contributed to women's reinterpretation of recovery as a process of 'working' on the emotional self. We argue that women's stories act as a form of subjugated knowledge about the material and discursive forces shaping depression and recovery. These findings offer a gendered critique of scientific and market orientated rationalities underpinning neurochemical recovery that obscure the embodied relations of affect and the social conditions that enable the self to change.

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In many western nations government policies are directed at increasing levels of participation in community sport. Recent research suggests that the sustainability of community sports system is under pressure due to declining volunteer numbers. Volunteers are often players transitioning from playing roles into non-playing roles such as administration and coaching. While a human resource management approach has been adopted to manage volunteers, little is understood in relation to the factors that contribute to players making the transition from playing to volunteering. Using Atchley's (1989) continuity theory, we propose a transitionextension framework that examines the psychological and social factors that provide the impetus for the transition to volunteering. The framework also examines those factors that contribute to volunteers extending their involvement and may help community sport organisations provide an environment that will nurture volunteers in the transition phase to retain and extend their involvement to become long term volunteers.

Australia, like other countries in neo-liberal democracies, is grappling with the gendered health 'problem' of depression. More concerning is the issue of recovery and relapse, with depression being the third largest cause of disability-adjusted life years (DALY). In addition, advanced liberal discourses of health position recovery as an exercise of individual responsibility to return to a functioning and productive norm and prevent recurrence. This moral enterprise of health articulates a 'recovery imperative' which overlooks the gendered context which may have created the conditions for women's depression and may in turn impede their recovery. Drawing on insights from governmentality and feminist post-structuralism, the article critically examines the effects of normalized recovery discourses on women's subjectivities. Data for the study were collected between 2005 and 2007 through in-depth interviews with 31 mid-life Australian women. Three key themes; 'in' recovery, 'eight out of ten' recovered, and recovering the authentic self, illustrate how the 'recovery imperative' may be implicated in perpetuating the cycle of recovery and relapse.