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Patient-led research and displacements of biomedical knowledge production, distribution, and consumption. 患者主导的研究与生物医学知识的生产、传播和消费的位移。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-03-01 Epub Date: 2024-04-26 DOI: 10.1177/13634593241249096
Dixi Louise Strand, Mari Holen

Patient and Public Involvement in Research (PPIR) has become an increasingly prevalent and integral part of biomedical research. In this paper, we focus on patient-led research, taking as our case the construction of new biomedical knowledge regarding the rare disease ADNP syndrome. Specifically, we seek to understand how concepts of experiential knowledge and lay expertise become integral to rather than separate from scientific expertise. In the case of ADNP, the parent-led research "mimes" biomedical knowledge practices in a way that, on the one hand, enhances the legitimacy of science and scientific expertise, and on the other displaces and transforms science by the fact that other knowledge agents (patients, next-of-kin) enter these practices.

患者和公众参与研究(PPIR)已成为生物医学研究中日益普遍和不可或缺的一部分。在本文中,我们以构建有关罕见疾病 ADNP 综合征的新生物医学知识为案例,重点讨论患者主导的研究。具体而言,我们试图了解经验知识和非专业知识的概念如何成为科学专业知识的组成部分,而不是与之分离。就 ADNP 而言,家长主导的研究 "模拟 "了生物医学知识的实践,一方面增强了科学和科学专业知识的合法性,另一方面,其他知识主体(患者、近亲)也参与了这些实践,从而取代并改变了科学。
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引用次数: 0
Beyond the neoliberal label: A historical perspective on sexual actors and responsibility in HIV prevention in England (1986-2023). 超越新自由主义标签:从历史角度看英格兰预防艾滋病的性行动者和责任(1986-2023 年)。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-03-01 Epub Date: 2024-03-18 DOI: 10.1177/13634593241238862
Alvaro Martinez-Lacabe

Framed across three distinct periods of the history of neoliberalism and the HIV epidemic in England, this article conducts a detailed examination of the concept of personal responsibility and its contested uses within HIV prevention. The article questions the theoretical potential of neoliberal subjectivities to comprehend behaviours related to the pharmaceuticalised governance (or lack thereof) of gay men's sexual health, exploring the gap between theories emphasising individual responsibility and the practical experiences of gay men. The analysis draws on testimonials from gay men in oral history interviews and archival sources. The article illustrates how the pervasive notion of personal responsibility in England has been co-opted by neoliberal ideologies, leading to the stigmatisation of gay men whose sexual behaviours diverge from public health mandates. The widespread stigmatisation resulting from this ideology underscores a significant limitation in the theoretical framework of neoliberal subjectivities. This constraint extends beyond merely failing to grasp the complexity of sexual behaviours; it also reflects a lack of understanding of any other behaviour related to public health. Therefore, the article concludes by advocating the necessity of employing and constructing alternative theoretical frameworks to comprehend the pharmaceutical governance or lack thereof of gay men's sexual health. Through a concise autoethnography of the authors' pharmaceutical sexual health governance, the article introduces the concept of biocommesuration as an illustrative analysis that transcends the limitations of neoliberal subjectivities.

本文以英国新自由主义和艾滋病流行的三个不同历史时期为框架,对个人责任的概念及其在艾滋病预防中的有争议的使用进行了详细的研究。文章质疑了新自由主义主体性在理解与男同性恋者性健康药物治疗(或缺乏药物治疗)相关行为方面的理论潜力,探讨了强调个人责任的理论与男同性恋者实际经验之间的差距。分析借鉴了男同性恋者在口述历史访谈和档案资料中的证词。文章说明了在英格兰普遍存在的个人责任概念是如何被新自由主义意识形态所利用,从而导致那些性行为与公共卫生要求相悖的男同性恋者被污名化。这种意识形态导致的广泛污名化凸显了新自由主义主体性理论框架的重大局限性。这种局限性不仅在于未能把握性行为的复杂性,还反映出对其他任何与公共卫生有关的行为都缺乏了解。因此,文章最后主张,有必要采用和构建替代性理论框架,以理解药品对男同性恋者性健康的管理或缺乏管理的问题。通过对作者性健康医药治理的简明自述,文章引入了生物组化的概念,作为超越新自由主义主体性局限的说明性分析。
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引用次数: 0
Composing adult lives with a ventilator at the intersection of developmental and neoliberal discourses of time. 在发展与新自由主义时间论述的交汇点上,用呼吸机谱写成人生活。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-01 Epub Date: 2024-01-17 DOI: 10.1177/13634593241226646
Elizabeth J Straus, Helen Brown, A Fuchsia Howard, Gail Teachman

This paper explores temporalities and experiences of time drawn from an analysis of interview data from a critical narrative inquiry of the experiences of young adults living with home mechanical ventilation (HMV). The analysis centers the ideological effects of dominant discourses that shape understandings of time in the Euro-Western world and the ways in which young adults' stories prompt a rethinking of time in health research and praxis. Data generation involved interviews and photo-elicitation with five young adults (ages 18-40). A critical narrative analysis of participants' stories surfaced the influence of ableist, developmentalist, and neoliberal discourses of time and the creative resistance that points to the potential of crip orientations to time in opening up possibilities for living. Implications for practice and research are offered.

本文通过分析对使用家用机械通风机(HMV)的年轻成年人的经历进行的批判性叙事调查的访谈数据,探讨了时间性和时间体验。分析集中于主流话语的意识形态影响,这些话语塑造了欧洲-西方世界对时间的理解,以及年轻人的故事如何促使人们重新思考健康研究和实践中的时间。数据生成包括对五位年轻人(18-40 岁)的访谈和照片征集。通过对参与者的故事进行批判性叙事分析,我们发现了能力主义、发展主义和新自由主义时间论述的影响,以及创造性的反抗,这些反抗表明了 "瘸腿 "时间取向在开启生活可能性方面的潜力。本文提出了对实践和研究的启示。
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引用次数: 0
Rethinking the logic of early diagnosis in cancer. 重新思考癌症早期诊断的逻辑。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-01 Epub Date: 2024-02-26 DOI: 10.1177/13634593241234481
Christina Sadolin Damhus, Mette Bech Risør, John Brandt Brodersen, Alexandra Brandt Ryborg Jønsson

To reduce morbidity and mortality of cancer, more countries have implemented strategies to detect cancer, based on the logic of 'the sooner the better'. Time is thereby an essential component in how cancer research, policies, and prevention are practiced today. Where the logic of early diagnosis benefits some, the logic also produces harms. In this article, we use a cross-disciplinary case-study design to discuss how different notions of time and linearity are essential in today's research ontology of cancer, describe the individual and societal consequences of such ontology, and invite a rethinking of time in cancer. Drawing on theoretical concepts of time together with cancer epidemiological, historical and ethnographical data, we analyse how the logic of early diagnosis has been established as a stable concept. Although evidence supporting the logic points in different directions, the message 'the sooner the better' is currently not being challenged by research, policy or society. This at least partly, can be explained by a linear perception of time and societal traces of neoliberalism and acceleration in our society together with cancer still being a somewhat enigmatic disease that requires acute action. To support a sustainable healthcare sector, we argue there is a need to nuance the logic of early diagnosis. Continuing the linear perception of symptoms and cancer, risks doing more harm than good by making more people patients unnecessarily and by spending health resources on those with the least need.

为了降低癌症的发病率和死亡率,越来越多的国家实施了基于 "越早越好 "逻辑的癌症检测战略。因此,时间是当今癌症研究、政策和预防工作的重要组成部分。早期诊断的逻辑在使某些人受益的同时,也产生了危害。在本文中,我们采用跨学科的案例研究设计,讨论不同的时间和线性概念如何在当今的癌症研究本体论中占据重要地位,描述这种本体论对个人和社会造成的后果,并邀请人们重新思考癌症中的时间问题。根据时间的理论概念以及癌症流行病学、历史和人种学数据,我们分析了早期诊断的逻辑是如何被确立为一个稳定的概念的。尽管支持这一逻辑的证据指向不同的方向,但 "越早越好 "的信息目前并未受到研究、政策或社会的质疑。这至少可以部分地归因于我们对时间的线性认知、新自由主义和社会加速发展的社会痕迹,以及癌症仍然是一种需要采取紧急行动的神秘疾病。为了支持可持续发展的医疗保健行业,我们认为有必要对早期诊断的逻辑进行细微调整。如果继续对症状和癌症进行线性认知,就有可能弊大于利,使更多人不必要地成为病人,并将医疗资源花费在最不需要的人身上。
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引用次数: 0
Mind-Stuff and Withdrawal of the Senses: Toward an Interpretation of Pratyahara in Contemporary Postural Yoga. 心灵与感官的抽离:当代姿势瑜伽中的Pratyahara诠释。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-01 Epub Date: 2024-02-04 DOI: 10.1177/13634593231222450
Elizabeth McKibben

Yoga has become a popular health and wellbeing practice that draws on ancient philosophy. Pratyahara is a core tenet of yoga practice and is often translated to mean withdrawal of the senses. Withdrawing from the senses plays a key role in aiding yoga practitioners to find spiritual enlightenment by transcending the worldly. Withdrawing from the material world, however, does not neatly fit within the parameters of the contemporary postural yoga industry. This paper looks at the conceptual origins of pratyahara through stances relevant to health research. The author weaves biomedical, esthetic, and neoliberal onto-epistemological stances through health discourse to discuss how postural yoga both resists and replicates power imbalances. In so doing the author emphasizes the paradoxical nature of pratyahara as it is reflected in socio-political tensions of the yoga industry. To conclude, the author suggests that pratyahara itself can be useful in resolving this tension as yoga fulfills a philosophical prerogative for social change.

瑜伽借鉴了古老的哲学,已成为一种广受欢迎的健康和保健方法。Pratyahara 是瑜伽练习的核心原则,通常被翻译为 "远离感官"。远离感官在帮助瑜伽练习者通过超越世俗找到精神启迪方面起着关键作用。然而,从物质世界抽身并不完全符合当代体位瑜伽行业的参数。本文通过与健康研究相关的立场,探讨了 "pratyahara "的概念起源。作者通过健康话语将生物医学、美学和新自由主义的认识论立场交织在一起,讨论体位瑜伽是如何抵制和复制权力不平衡的。在此过程中,作者强调了瑜伽行业的社会政治紧张局势所反映出的 "pratyahara "的矛盾性。最后,作者认为,瑜伽实现了促进社会变革的哲学特权,因此,"pratyahara "本身有助于解决这种紧张关系。
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引用次数: 0
Narratives about distributed health literacy during the COVID-19 pandemic. 讲述 COVID-19 大流行期间的分布式健康知识。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-01 Epub Date: 2023-12-14 DOI: 10.1177/13634593231215715
Susana Silva, Helena Machado, Ilaria Galasso, Bettina M Zimmermann, Carlo Botrugno

The promotion of health literacy was a key public health strategy during the COVID-19 pandemic. However, the role of social networks and relationships for support with health literacy-related tasks in the context of the COVID-19 pandemic is scarcely understood. Moving beyond traditional notions of health literacy, which focus on individual skills and knowledge, this study uses the concept of distributed health literacy to explore how individuals make meaning of and respond to health literacy and make their literacy skills available to others through their relational and socially situated and lived experiences of the COVID-19 pandemic. Drawing on 89 semi-structured interviews conducted in three European countries (Italy, Portugal, and Switzerland) between October and December 2021, we found narratives of stabilization, hybridization, and disruption that show how health literacy concerning COVID-19 is a complex social construct intertwined with emotional, cognitive, and behavioral responses distributed among individuals, communities, and institutions within socioeconomic and political contexts that affect their existence. This paper opens new empirical directions to understand the critical engagement of individuals and communities toward health information aimed at making sense of a complex and prolonged situation of uncertainty in a pandemic.

在 COVID-19 大流行期间,促进健康知识普及是一项重要的公共卫生策略。然而,在 COVID-19 大流行的背景下,人们对社会网络和关系在支持健康素养相关任务方面所起的作用知之甚少。传统的健康素养概念侧重于个人的技能和知识,而本研究则超越了这一概念,采用分布式健康素养的概念来探讨个人如何通过他们在 COVID-19 大流行中的关系、社会环境和生活经历来理解健康素养的意义并对其做出回应,以及如何将自己的素养技能提供给他人。根据 2021 年 10 月至 12 月期间在三个欧洲国家(意大利、葡萄牙和瑞士)进行的 89 次半结构式访谈,我们发现了关于稳定、混合和破坏的叙述,这些叙述显示了有关 COVID-19 的健康素养是如何与情感、认知和行为反应交织在一起的复杂社会建构,这些反应分布在影响其生存的社会经济和政治背景下的个人、社区和机构中。本文开辟了新的实证研究方向,以了解个人和社区对健康信息的关键参与,从而理解大流行病中复杂而漫长的不确定状况。
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引用次数: 0
Reply: How do we avoid polarization of interdisciplinary research on cancer diagnosis? 答复:如何避免癌症诊断跨学科研究的两极分化?
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-01 Epub Date: 2024-07-30 DOI: 10.1177/13634593241258410
Christina Sadolin Damhus, Mette Bech Risør, John Brandt Brodersen, Alexandra Brandt Ryborg Jønsson
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引用次数: 0
'Hearts' and 'minds': Illustrating identity tensions of people living and working through marketising policy change of allied health disability services in Australia. 心 "与 "思想":说明澳大利亚残疾专职医疗服务市场化政策变革中生活和工作的人们的身份紧张关系。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-01 Epub Date: 2024-02-13 DOI: 10.1177/13634593241230018
Kristen Foley, Stacie Attrill, Chris Brebner

Service-based caring sectors like disability are increasingly being operated via market logic, including shifts towards personalised funding. These shifts must be brought to life in/through people already located in relation to ideas and values that underpin historical policies. Our manuscript examines how identities are re/shaped in relation to marketised policy change and explores how identity change unfolds (or not) during periods of transition: situated within the transition to the National Disability Insurance Scheme executed in Australia as a major disability funding reform. Our qualitative dataset involves interview and focus group data collected with service recipients/carers (n = 28), providers/managers (n = 17) and advocates (n = 2) during shift from government- to personally-controlled funding of allied health services for people with disability in Australia (2017-2020). We used layered sociological inference to develop and interrogate processes of tension and identity change amidst lived experience(s) of policy change. Our analysis elucidates how various identities were encouraged, desired, resisted and constrained in relation to the policy transition. We bring together sub-themes from analysis of recipient/carer data (getting value-for-money; critiquing service quality; and experiencing system shortfalls) and manager/provider data (learning to transact; the call to care; and structural frictions in/and identity transitions) to interpret that recipients/carers are Feeling (like) the dollar sign and that managers/providers are Troubling profits. In both cases 'hearts' and 'minds' are perceived to be diametrically opposed and symbolic in/against processes of marketisation. We synthesise our data into an illustrative framework that facilitates understanding of how this perception of opposed 'hearts' and 'minds' seems to constrain the identity transitions encouraged by personalised funding, and explore ways in which desired identities might be supported amidst marketising policy transition.

以服务为基础的关爱部门,如残疾人部门,正越来越多地通过市场逻辑运作,包括向个性化资助转变。这些转变必须通过与支撑历史政策的理念和价值观相关的人群来实现。我们的手稿研究了在市场化的政策变化中,身份是如何被重塑的,并探讨了在过渡时期,身份的变化是如何展开的(或没有展开):在澳大利亚,国家残疾保险计划的过渡是一项重大的残疾资助改革。我们的定性数据集包括从政府到个人控制的澳大利亚残疾人联合医疗服务资助转变期间(2017-2020 年)收集的访谈和焦点小组数据,访谈对象包括服务接受者/护理者(n = 28)、提供者/管理者(n = 17)和倡导者(n = 2)。我们利用分层社会学推论来发展和探究在政策变化的生活经历中的紧张和身份变化过程。我们的分析阐明了在政策转型过程中,各种身份是如何受到鼓励、期望、抵制和限制的。我们将对受助者/护理者数据(物有所值;对服务质量的批评;以及对系统不足的体验)和管理者/提供者数据(学会交易;对护理的呼唤;以及身份转换中的结构性摩擦)分析得出的次主题结合在一起,解释了受助者/护理者正在感受(喜欢)美元符号,而管理者/提供者正在为利润而烦恼。在这两种情况下,"心 "和 "思想 "被认为是截然相反的,是市场化进程中的象征。我们将数据归纳为一个说明性框架,该框架有助于理解这种 "心 "与 "意 "对立的观念是如何限制个性化资助所鼓励的身份转变的,并探讨在市场化政策过渡中支持理想身份的方法。
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引用次数: 0
"You kind of blame it on the alcohol, but. . .": A discourse analysis of alcohol use and sexual consent among young men in Vancouver, Canada. "你会把这归咎于酒精,但是......":.":对加拿大温哥华年轻人饮酒和同意性行为的话语分析。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-01 Epub Date: 2023-12-14 DOI: 10.1177/13634593231214942
Trevor Goodyear, John L Oliffe, Hannah Kia, Emily K Jenkins, Rod Knight

There is growing awareness about issues of sexual consent, especially in autonomy-compromising or "non-ideal" contexts, including sex involving alcohol. Understanding the conditions needed for consensual sex to occur in this emergent milieu is critically important, especially for young men (ages 18-30 years) who normatively combine drinking alcohol with sex and are most often perpetrators of sexual violence. This study offers a discourse analysis of young men's alcohol use and sexual consent. Data are drawn from qualitative interviews with 76 young men (including gay, bisexual, queer, and straight men) in Vancouver, Canada, from 2018 to 2021. Informed by Kukla's non-ideal theory of sexual consent and critical and inclusive masculinities, this analysis identified three discursive frames: careful connections, watering it down, and blurred lines. In careful connections young men discussed their efforts to actively promote sexual and decisional autonomy for themselves and their sexual partners when drinking. Yet, in watering it down young men invoked discourses of disinhibition, deflection, and denial to normalize alcohol use as being somewhat excusatory for sexual violence, downplaying the role and responsibility of men. Lastly, men operationalized blurred lines through a continuum of consent and of "meeting (masculine) expectations" when discussing sexual violence and victimization while intoxicated. Together, these discursive frames provide insights into the gendered nature of sexual violence and the extent to which idealized notions of sexual consent play out in the everyday lives of young men who use alcohol with sex. Findings hold philosophical and pragmatic implications for contemporary efforts to scaffold sexual consent.

人们越来越意识到性同意的问题,尤其是在有损自主权或 "非理想 "的情况下,包括涉及酒精的性行为。了解在这一新兴环境中发生双方同意的性行为所需的条件至关重要,尤其是对年轻男性(18-30 岁)而言,他们通常将饮酒与性行为结合在一起,而且往往是性暴力的实施者。本研究对年轻男性的饮酒和性同意进行了话语分析。数据来自 2018 年至 2021 年对加拿大温哥华 76 名年轻男性(包括男同性恋、双性恋、同性恋和异性恋男性)的定性访谈。根据库克拉(Kukla)关于性同意的非理想理论以及批判性和包容性男子气概,本分析确定了三种话语框架:谨慎联系、淡化和模糊界限。在谨慎联系中,年轻男性讨论了他们在饮酒时积极促进自己和性伴侣的性自主和决定自主的努力。然而,在 "淡化"(watering it down)中,年轻男性引用了抑制、转移和否认的话语,将饮酒正常化,认为饮酒在某种程度上可以为性暴力开脱,淡化了男性的角色和责任。最后,在讨论醉酒后的性暴力和受害问题时,男性通过 "同意 "和 "满足(男性)期望 "的连续统一体来模糊界限。总之,这些话语框架提供了关于性暴力的性别本质以及理想化的性同意概念在酗酒和性行为的年轻男性日常生活中的表现程度的见解。研究结果对当代为性同意提供支架的努力具有哲学和实用意义。
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引用次数: 0
How do we avoid polarization of interdisciplinary research on cancer diagnosis? A critical comment to: "Rethinking the Logic of Early Diagnosis in Cancer" by Damhus, Risør, Brodersen, and Jønsson (2024). 如何避免癌症诊断跨学科研究的两极分化?评论"对 Damhus、Risør、Brodersen 和 Jønsson 所著《癌症早期诊断逻辑的反思》(2024 年)的批判性评论。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-01 Epub Date: 2024-07-25 DOI: 10.1177/13634593241258392
Rikke Sand Andersen, Michal Frumer, Camilla Hoffmann Merrild, Sara Marie Hebsgaard Offersen, Rikke Aarhus, Marie Louise Tørring
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引用次数: 0
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