Health最新文献

Corporate Social Responsibility (CSR) refers to initiatives undertaken by corporations that aim to make a positive impact on society. It is unclear to what extent these aims are achieved in relation to population health. We explored the evidence for mechanisms by which CSR has positive or negative effects on population health through a systematic-narrative hybrid review of 97 relevant articles. We found few examples overall that could trace a CSR initiative through to verifiable impacts on the population. Our review found that generally the evidence for the impacts of CSR on population health was patchy, highly heterogenous and of varying quality. We found some potential positive impacts of CSR on health; including on poverty alleviation, development, health care, the environment and the health and wellbeing of workers. Some CSR initiatives were rebranding of core functions, such as HR practices and employee wellbeing strategies, or were a partial redressing of the problems the corporation itself is creating, such as CSR initiatives that sought to improve workplace safety, reduce corporate environmental footprints or relocate people displaced by mining activities. We situate these impacts in relation to the role and intent of CSR, and argue that meaningful progress on CSR can only be made with greater transparency and reporting of initiatives to more fulsomely evaluate their impacts - as well as the political economy in which these sit. It is further critical to strengthen government regulation and oversight to maximise any public good that can come from CSR, and minimise the negative consequences reported in research literature.

The concept of agency in substance use recovery remains contested, positioned between deficit-based models emphasizing dependence and recovery paradigms highlighting personal strengths and capacities. However, the latter approach has faced criticism for individualizing responsibility, overemphasizing independence, and promoting normative notions of citizenship. This is particularly visible in the context of recovery without treatment. Commonly referred to as "natural recovery," many people recover without engaging with formal addiction treatment or mutual aid. This study explores the lives of individuals in recovery without treatment, using an assemblage perspective to capture its complexity and relational nature. Eighteen in-depth interviews with participants in recovery without treatment from alcohol and/or other drug problems were conducted following the lifeline interview method. Transcripts were analyzed using reflective thematic analysis informed by assemblage theory. Two overarching themes emerged: (1) "agency while losing and gaining control," illustrating addiction as an ambivalent aspect of subjectivity that both enables and constrains; and (2) "agency, multiplicity, and emergence," demonstrating how agency operates within dynamic assemblages of shifting elements and forces, rather than as a fixed state. Our findings imply an understanding of agency as interdependent and emergent within multiplicities. Hence, we argue that recovery and the influential strengths-based concept of recovery capital should be cautious of simplifying practices that risk reproducing individualist and normative notions of recovery. We discuss recovery as a practice of freedom and identify avenues for further research.

There is growing evidence of the harms caused by the mass production and consumption of animal products and the benefits of plant-based diets - ethically, environmentally, and for human health. While human and planetary health are increasingly viewed as interconnected, the healthcare system remains largely anthropocentric and disengaged from sustainability goals. Given its influential role, the healthcare system can either support or hinder the acceptance of plant-based diets as part of addressing ecological and public health crises. This article explores the experiences of vegan parents in their interactions with primary care providers (PCPs) based on qualitative interviews with 25 vegan parents. Our findings indicate that while some parents reported neutral or supportive experiences, negative and unsupportive interactions with PCPs were more typical. Fear of stigma led some to avoid disclosing their family's veganism altogether. These findings highlight important concerns about the quality and equity of healthcare, patient autonomy, and the healthcare system's potential role in supporting and promoting plant-based diets and sustainable food practices more broadly. As powerful institutional authorities, the healthcare system and its key actors, such as PCPs, can and should support moving towards more sustainable and ethical food and health futures.

This study explores young people's perceptions of citizenship and recovery for individuals with severe mental health challenges using the story completion method. In this qualitative approach, participants were invited to complete an open-ended story stem about a fictional character, Billie, whose journey of recovery unfolds through their narratives. We analyzed 47 stories, with lengths ranging from 65 to 598 words (M = 253 words), applying both horizontal (thematic) and vertical (narrative progression) analyses. The findings reveal that participants often framed Billie's recovery in terms of social roles-such as student, friend, or worker-emphasizing the fluctuating and relational nature of recovery. At the same time, the narratives also reflect societal expectations and implicit biases surrounding mental health and citizenship. Broader systemic factors, such as rights, resources, and societal responsibilities, were less frequently addressed. The results suggest that young people's perspectives on mental health recovery are largely shaped by relational contexts but may lack a critical awareness of structural barriers to inclusive citizenship. This study underscores the potential of the story completion method as both a research tool and an educational intervention, fostering dialog on stigma, inclusion, and mental health recovery.

In 2011, noninvasive prenatal testing (NIPT) disrupted clinical screening and testing paradigms. While concerns have been raised over public and patient-oriented NIPT usage, providers' views of NIPT remain understudied. This is significant because providers offer pre-test counseling to pregnant patients. This study sought to better understand how prenatal care providers view NIPT in the context of risk and uncertainty. After obtaining institutional ethical approval, semi-structured interviews were conducted with certified nurse-midwives and obstetrician-gynecologists (n = 20). Interviews were audio-recorded, transcribed and coded using abductive analysis. Providers perceived chromosomal risk as an ever-present uncertainty that they worked to help patients make sense of, and providers perceived NIPT as a binary risk assessment tool to decrease uncertainty and increase patient knowledge. These results indicate that while providers may be more likely to use NIPT as a way to limit uncertainty, the social consequences of this move are that providers may inadvertently offload decisional responsibility onto patients, impacting respect for patients' autonomy.

With the rise of machine learning-based decision support systems, the responsibility for potential errors is regularly questioned. Scholarly work regarding this issue has criticized a "responsibility gap," that is, unattributable responsibility for the effects of machine learning-supported decisions. One proposition to close the responsibility gap is to include scientists, who lay the basis for the functioning of machine learning models in distributed responsibility models, assigning them a share of responsibility for potential errors. However, to date, responsibility models that include scientists have not gained a foothold in regulation. To provide an empirical basis for the discussion around novel responsibility models, this study provides a social scientific analysis of an interdisciplinary machine-learning consortium that works on machine learning-based decision support systems for healthcare - an area where errors have particularly fundamental consequences for individuals. We investigate researchers' speculations about their responsibility for the downstream effects of their ML research results after translation to clinical practice. We find that researchers point to tensions in the scientific sector as well as to agential, local, and temporal shifts of their research outputs during translation to clinical practice as a major source of what we call "suspension of responsibility." Our insights contribute to debates about novel responsibility models that are fair to patients, doctors, and scientists and can inform similar debates beyond healthcare.

Over the last two decades evidence has been mounting for the effectiveness of arts interventions as public health measures. With mental health services under-resourced and overwhelmed by need, support is growing for a diversity of non-clinical approaches to support individuals in community settings. In their declaration of the organisation's collective vision, the Victorian Mental Illness Awareness Council (VMIAC) emphasises the need for diverse forms of support beyond traditional biomedical services. This paper reports on findings from a pilot Shared Reading intervention, conducted in partnership with VMIAC in 2023, for people who have lived experience of mental distress in Victoria, Australia. Shared Reading is a form of interactive, creative bibliotherapy that combines the benefits of engaging with literature with those of taking part in a communal activity. In-depth interviews with participants revealed that multiple levels of recognition made this non-clinical activity therapeutic for participants. Utilising Honneth's theory of recognition, these findings expand conceptual understandings of the therapeutic effects of Shared Reading as a psychosocial intervention for people with experiences of mental distress.

The definition of specialised rehabilitation in Europe has changed from a focus on patients' bodily functions and work tasks to a patient-centred focus prioritising patients' wishes, allowing patients to actively collaborate and set their own goals. This study aimed to explore interprofessional healthcare teams' discursive practice regarding the implementation of patient participation in specialised rehabilitation units in Norway. Data were collected from three focus groups with seven different health professions, totalling 18 healthcare professionals. A corpus-assisted critical discourse analysis outlined by Fairclough was used to analyse the data. Three interdiscursive discourses based on different and opposing ideologies were found: (1) the discourse of standardisation, in which healthcare professionals used international models for rehabilitation goal setting; (2) the discourse of interprofessional experts, in which healthcare professionals constructed themselves as experts; and (3) the discourse of patient responsibility, in which the patients were constructed as having rights and autonomy. The sociocultural practice of implementing patient participation in specialised rehabilitation in Norway highlighted a hegemonic struggle between standardisation; paternalistic and autonomy ideologies; ethical dilemmas between healthcare professionals' knowledge and use of standardised goals; and patients' autonomy, knowledge, and will.

Building on research on the critical role of laypeople in medicalization and the multi-dimensional character of this process, this study explores the effects and meanings of the ADHD category for mothers and teachers of diagnosed children. Based on interviews with 27 schoolteachers from two different schools and 42 mothers of children diagnosed with ADHD, we show that despite the growing acceptance of ADHD as a medical diagnosis, it exhibits only minor narrative, institutional, and moral effects in school and family arenas. The diagnostic label attributed to children does not resolve blame games and uncertainty about the source of children's difficulties and does not provide many pragmatic benefits for either mothers or teachers. We argue that these limited narrative, moral and institutional effects are shaped by the moral positionings available to mothers and teachers, the institutional status of ADHD as a category of disability, and educational policy. We distinguish medicalization's institutional and interpersonal dimensions and explore their complex interrelations. Our analysis resonates with recent moves in medical sociology toward more pragmatic and practice-based analyses of the effects of medical categories, particularly when enacted outside traditional healthcare settings.

Chronic pain, defined as pain persisting for more than three months, affects one in four Belgian adults. Treating chronic pain comprises challenges for patients and clinicians as the term encompasses diverse conditions such as fibromyalgia, migraine, and long-term pain without a known biomedical cause. Additionally, growing evidence highlights the limited efficacy of opioids in managing chronic non-cancer pain. This has prompted critical policy changes in pain management, including shifts away from opioid use. This study explores how Belgian policy documents depict patients, healthcare providers, and therapeutic relationships within the context of opioid use in the treatment of chronic non-cancer pain. A critical discourse analysis of 32 Belgian Dutch-language policy documents was performed using Fairclough's framework. This approach examines how language in texts reflects and shapes social power dynamics and ideologies, and allows us to gain insight into the policy discourses surrounding opioid use for chronic pain. Based on our analysis, we suggest that written policy texts about the use of opioids to manage chronic pain are constructed through the deployment of three discourses: a medical authority discourse, a patient empowerment discourse, and a high-risk medication discourse. While all discourses are rooted in the biopsychosocial pain model, they prioritize different aspects of chronic pain management. Whereas the medical authority discourse emphasizes the decision-making role of physicians, the patient empowerment discourse shifts attention to patients' experiences and preferences. Lastly, the high-risk medication discourse underscores opioids' addictive potential. These discourses reflect varying perspectives on chronic pain management and have different implications for clinical practice. The findings offer valuable insights into how Belgian policy documents discursively construct or challenge therapeutic relationships and stigma.