Health最新文献

The exploratory study examines how patients in Denmark experience health data on the eHealth platform sundhed.dk. The study takes its starting point in the communicative process taking place between patients as platform users and the eHealth platform as a communicative agent. In dialogue with literature at the intersection of eHealth and communication studies, it develops the analytical lens of affective gaps, connecting Peters notion of communicative gaps with Lupton's concept of affective atmospheres. Empirically, the study unpacks the complex, often conflicting experiences that arise when patients attempt to make meaning of and engage with their health data. Building on 24 in-depth, purposefully sampled interviews, the article presents a thorough thematic analysis, showing that patients need to simultaneously deal with states of being (1) informed and insecure, (2) confident and frustrated, and (3) in control and in doubt. Receiving health data on eHealth platforms is a complex and often challenging process for patients, provoking profound and at times unsettling experiences, oftentimes creating vulnerabilities. While gaps and uncertainty have always been a part of health communication, eHealth platforms amplify and reconfigure these dynamics, thus presenting novel challenges for patient-healthcare professional communication. In conclusion, the article calls for further research into the communicative user-platform relations that shape patient experiences with health data, positioning patients as the primary receivers of eHealth communication.

Emerging as a commercial category in 2016, 'femtech' has been publicly celebrated as a category of consumer-based digital health technologies designed to support the unmet and systemically marginalized health needs of women in areas such as menstruation, fertility, pregnancy, postpartum, and menopause, through data-driven apps, wearables, and self-diagnostic tools. Since its emergence, the term femtech has become culturally significant and has taken on a life of its own across commercial, public, and healthcare discourses. Despite the growth of femtech scholarship, clarity is lacking on how different disciplines have challenged the assumptions about sex, gender, health, technology, and innovation that shape dominant understandings of 'who' femtech is for (i.e. fem) and 'what' it constitutes (i.e. tech). Motivated by this research gap, a critical conceptual review was conducted to provide new entry points into critical debates. This article novelly adapts 'diffractive reading' as a methodological approach to bring disciplinary perspectives on femtech into conversation with one another across anthropology, computer science, cultural studies, gender studies, information studies, law, media studies, medicine, and science and technology studies. This article focuses on insights drawn between critiques of femtech which trouble the ideologies, discourses, and practices that shape dominant understandings of 'fem' and 'tech'. In thinking through and with the conceptual boundaries of femtech, this review underscores the ongoing need to examine femtech's role in shaping global dynamics of reproductive, labor, and environmental justice, in addition to neoliberal approaches to healthcare more broadly.

Australia is world renowned when it comes to its successful response to HIV prevention, but their HIV epidemiological trend has shifted towards the increase of new HIV diagnoses among migrants. This paper reveals a neglected determinant of migrants' health within Australian HIV care, and that is: racism. To provoke a debate on the saliency of racism, I used autoethnographic case study to analyse my encounter with racism in Australian HIV care. I argue migrants who live with HIV can be racially classified by health care professionals into 'good' or 'bad migrants' based on biomedical measures, neoliberal values and dehumanising health care provision. A migrant patient becomes a bad migrant if the person is perceived to be incapable of taking personal responsibility over their treatment, is a burden to the health system and deserving of poor HIV care. Decolonising HIV care is a necessity to stop the subtle yet insidious social reproduction of racism.

The present study examined how individuals who have been clinically diagnosed as obese explain their decision to undergo bariatric surgery and how they deal with the stigmatization that such a decision may entail. A total of 23 participants (15 women and 8 men) who were awaiting bariatric surgery within the Spanish healthcare system, were interviewed about their weight trajectory and their decision to undergo this surgery. In order to examine the participants' stories, a narrative analysis of the interviews was conducted, with attention to both content (what they told) and structure (how they told) and examining the stories in line with the socially and culturally available narratives that they had access to, and the context in which the stories were produced. The participants explained their weight trajectory through the origin of their weight, the failure to control it, and their decision to have surgery to solve the weight problem. The narrative of a sick body that needs to be restored appeared to function as a schema or script through which participants attempted to defend themselves from anti-fat narratives that assume personal failure while at the same time presenting themselves as deserving to be operated on. Through their narratives, they positioned themselves as undeserving of stigma but did not challenge the stigma itself.

The legitimacy of complementary and alternative medicines (CAMs) and their integration into mainstream healthcare have long been a topic in sociological discussions. This study examines the institutional influences on Chinese medicine (CM), an important CAM in mainland China and Hong Kong. In-depth interviews with practitioners and observations in public hospitals facilitate a comparison of the professional boundaries, statuses, and jurisdictions of CM in the two regions. In mainland China, CM has a high degree of state-granted legitimacy with blurred professional boundaries between CM and Western medicine (WM) in a highly integrated healthcare system. However, these blurred boundaries have had the following unintended consequences: (i) devaluation of traditional knowledge in CM education and practices, (ii) biomedicalisation of CM practices wherein a substantial reliance on WM has decreased the utilisation of healing principles in CM and (iii) ambiguity in the efficacy of CM due to the co-use of CM and WM. In contrast, the demarcated professional boundaries in Hong Kong have allowed CM to maintain its knowledge base, even though CM is practised within strict parameters. This study reveals that institutional requirements (on efficiency, accountability and profitability) prioritise the biomedical model and drive the biomedicalisation of CM. Therefore, the lack of clear professional boundaries in the current integrative medical system in mainland China have eroded the knowledge base of CM and undermined the efficacy-based legitimacy of CM.

Theoretical and practical guidance on how to navigate uncertainties in healthcare are scarce. Here, we draw from Gibson's ethic of openness to explore clinicians' experiences navigating uncertainty with individuals who experience low back pain (LBP) and provide guidance on avenues for navigating uncertainty in LBP and healthcare more broadly. Our analysis suggests that clinicians practice within different philosophical commitments when providing care for individuals with LBP, with some of them aligning with a (post)positivist approach with pre-determined endpoints and others an ethic of openness, with no fixed endpoints and consideration of multiple options and perspectives. Based on our analysis, an ethic of openness may help to surface these philosophical commitments, creating space for possibilities other than denying uncertainty and oversimplifying (evidence-based) practice. We argue that an ethic of openness may assist clinicians to navigate uncertainty in fruitful ways - embracing uncertainty, engaging in reflexivity and creativity, moving clinicians to directions that are likely to best meet the needs of patients.

A great deal of research has shown that health inequalities are the product of socially unequal wear and tear of bodies, socially differentiated use of the healthcare system and unequal access to care, as well as healthcare professionals' differentiating practices. However, public policies are rarely the focus of recent investigations on the production of health inequalities. How can public policies produce or even amplify health inequalities, but also reduce them, or fail to do so? This study aims to investigate the impact of online appointment booking on effective access to Covid-19 vaccination. Through a quantitative survey of the first weeks of vaccination against Covid-19 in 2021 in an undeserved French suburb called Seine-Saint-Denis, this paper shows how the vaccination policy has contributed to reproducing and amplifying inequalities towards Covid-19: middle and upper classes are significantly more represented among people vaccinated (67%) than in the population of Seine-SaintDenis (41%), and working classes are significantly less represented (33%) than in Seine-Saint-Denis (59%). The people vaccinated are more highly educated and more often French than the population of SeineSaint-Denis. Online appointment favoured more educated people.

In recent years, medical sociology has produced a significant amount of publications about the effects of the COVID-19 pandemic on medical care provision and healthcare professionalism around the globe. This study builds on this line of research by looking at a rarely discussed case of pandemic management-the case of Russia's centralized and state-dominated medical sector. In our analysis, we focus on the organizational level and the institutional work of front-line health professionals. Using a neoinstitutional theoretical lens, we show how, as a result of the conflict between professional and managerial logics, pockets of extreme institutional uncertainty emerged within Russian healthcare: "non-COVID" healthcare facilities and hospitals rapidly restructured for COVID-19 care. Qualitative interviews with healthcare professionals indicate that institutional misalignment inside these "gray zones" translated into the material dimension, significantly impeding the effectiveness of the pandemic response. While sociological literature frequently portrays Russian health professionals as fully subjected to administrative constraints and disempowered, our data allows us to trace their informal institutional work and agency during the health crisis. Through these materially mediated work, our informants attempted to deal with both the challenges of the pandemic and institutional contradictions of the Russian healthcare system. Professionals' institutional work brought some improvements to Russia's pandemic-affected clinical settings. However, being informal and purposefully hidden, it neither constituted a viable solution for medical organizations, nor contributed to the strengthening of professionals' autonomy.

Cystic fibrosis (CF) is a severe genetic disorder historically associated with low life expectancy. The introduction of CF transmembrane conductance regulator (CFTR) modulator drugs like Trikafta has dramatically improved health outcomes for many people with CF (pwCF), shifting their lived experiences in unexpected ways. This qualitative study explores the psychological and social consequences of such improvements, focusing specifically on identity disruption and emotional adaptation. Utilizing a phenomenological approach, in-depth interviews were conducted with CF patients who had used Trikafta for at least 2 years, alongside an analysis of publicly available blog narratives. The findings reveal two central themes: identity disruption and ambivalent loss. Participants described profound challenges in adjusting to their new health status, including difficulties in redefining their identity after years of viewing themselves as chronically ill. Additionally, they reported a paradoxical sense of loss, grieving aspects of their previous illness experience, such as a sense of urgency in life decisions and strong connections within the CF community. While participants also shared hopeful and forward-looking narratives, this study centers on the less-explored emotional complexities that emerge when long-standing illness-based identities are disrupted. The findings underscore the need for comprehensive psychological support systems to help PwCF process identity shifts and sustain a sense of continuity in their lives.

For people with mental and somatic illnesses, the interpretive process of attending to a multitude of bodily sensations and recognising them as potential symptoms represents daily and 'chronic homework'. Based on 16 months of ethnographic fieldwork in Denmark, this study explores diagnostic work and healthcare seeking among people with severe mental and somatic illnesses. As multiple studies have shown, the transformation process for a perceived sensation to become a symptom is a socially constructed interpretative process highly dependent on social legitimisation and shaped by prior cultural knowledge. We found that people with severe mental and somatic illnesses often struggle to 'read' the body and its boundaries and to define and distinguish when a symptom becomes a potential sign of illness. Furthermore, they often lack opportunities for social recognition of symptoms due to the absence of social relations. Finally, lifelong experiences with the healthcare system have taught them that they must distinguish between 'mental' and 'somatic' symptoms to fit the systemic organisation of the healthcare system. This deeply rooted mind-body dualism in the organisation of healthcare services and the daily struggles of diagnostic work to comply with this organisation impacted the interlocutors' healthcare seeking strategies. Moreover, even though they 'make up their minds' to seek healthcare, they risk being met with diagnostic overshadowing and reductionist clinical approaches.