Sociology of health & illness最新文献

The quality and access to healthcare systems depend on community health resources, infrastructure, and funding; however, a significant disparity in these resources persists globally. The effectiveness of national health systems depends on a balanced approach to health spending, access to facilities and a skilled local health workforce. What accounts for country-level differences in those critical community and societal health resources? We proposed and tested a model that leverages political and socioeconomic factors to predict various health resources and services in countries. Data, including community health training, research, and support, universal health coverage, healthcare infrastructure, and per capita health expenditure, were collected and analysed by statistical methods, like bivariate correlations and hierarchical multiple linear regressions from 105 countries. Countries with more grassroots activism, fiscal decentralisation, freedom, and globalisation and less perceived corruption and inequality had more community and societal health resources. In multivariate analyses, stronger community health training and research is associated with the globalisation index, freedom score, government fiscal decentralisation, and income inequality. The strongest predictor of health insurance coverage and hospital beds was the country's population education index, and of nurses and midwives-per-capita and health expenditures-per-capita was GDP-per-capita. These insights could guide policymaking to reduce global health inequalities.

By examining the laboratory practices behind designing and crafting organoids-miniature, three-dimensional cellular structures that replicate organ functions-we highlight a critical shift in biomedical research. Over the past 16 years, advances in stem cell research have transitioned from generating stem cells to utilising these cells in building sophisticated organ models and bioengineered tissues. This transition represents a significant move from the 'what' of cell creation to the 'how' of constructing and interpreting three-dimensional human models. Through ethnographic research (including observations and interviews) in Europe and North America, we explore how organoids are constructed and the underlying logic driving their development. Our analysis underscores the growing importance of these in vitro models for human health, urging a sociological examination of their 'near human' status. We argue that understanding the implications of this shift-particularly how it influences perceptions of human representation and diversity in biomedical research-requires critical scrutiny from sociologists of health and illness. This paper aims to address the urgent need to investigate not just the experimental challenges but also the socio-political dimensions of using organoids as proxies for human physiology.

'Widening Access' in UK medicine seeks to improve access on the basis of socioeconomic background (SEB). However, evidence has emerged of 'socially stratified' careers, as doctors from less advantaged backgrounds are more likely to train in less competitive specialties, such as psychiatry or primary care. These patterns have been welcomed to date as this improves access to care, yet less positive consequences have been overlooked. Based on in-depth interviews (n = 54) with medical students, qualified doctors and medical educators from less advantaged backgrounds (n = 38), this article asks how values influence medical careers, for what this can tell us about the causes of social stratification and how this informs status hierarchies within the profession. Using the work of Bourdieu, we find that while participants value empathy and compassionate care they believe both are less valuable when securing more competitive careers, and may signal less skill. This helps explain why doctors from less advantaged careers may prefer more community orientated roles, which are often less competitive, and why these specialties may also attract less status and respect. A related risk is that doctors from less advantaged backgrounds are over-represented in areas imposing the highest emotional demands to become the profession's 'emotional proletariat'.

Understanding how and why someone dies unexpectedly is key to bereaved family members. The coronial process in England investigates instances where the cause of death is unknown, violent or unnatural and/or occurred in state detention. Families are held to be at the centre of this process and the coroner's role has extended to concern about therapeutic jurisprudence, that is, how legal processes can minimise negative consequences for participants without jeopardising due process. Therapeutic jurisprudence involves unresolved tensions, however, and an epistemic power imbalance. Within the inquest, knowledge is produced, evaluated and contested, and epistemic privilege may be unevenly distributed. The inquest is also a process that, as we demonstrate, requires epistemic courage and resistance on the part of families. Families with relatives who are autistic, have learning disabilities and/or mental ill health can experience epistemic and structural injustice before an unexpected death which makes the distinctiveness of their experiences important to understand. Here, we report on a qualitative interview project which focused on how bereaved families experience the coronial process after their relative died in receipt of health and/or social care support.

Young adults living with chronic illness often experience considerable uncertainty across the emotional, cultural and medical spheres of their everyday lives. The process of seeking, receiving and reckoning with a diagnosis has frequently been an in-road for qualitative examinations of these experiences. As a result, the biomedical diagnosis has often taken centre stage in research concerning how uncertainty is managed and/or more stability is found. However, the significance of diagnosis can shift over time, and in many cases, the promise of diagnosis deteriorates as life unfolds. This study draws on a series of in-depth qualitative interviews with 33 young adults (ages 19-29) living with a range of chronic illnesses, which include auto-immune illnesses, fatigue syndromes and neurological conditions. Undertaking an inductive interpretative analysis based on constructivist grounded theory, we examine the role and meaning of diagnosis for our participants and find that they iteratively de-centre diagnosis in various circumstances. We suggest that while the way young adults manage chronic illness may involve seeking a diagnosis, navigating the shortcomings of diagnosis takes a significant emotional toll, and a failure to recognise this work is one important way that the experience of chronic illness when young can be misunderstood.

Health data generated by apps and devices are increasingly popular and expected to affect various aspects of doctor-patient relationships. No longer confined to medically authorised and certified health technologies, a range of biomedical data-from heart rate to blood pressure or oxygen saturation-are captured and processed by consumer health devices. This article outlines different responses of physicians to patients collecting data with popular consumer devices and considers how the data may challenge or reify medical authority. Based on semi-structured interviews with doctors and chronically ill patients in Germany from 2021 to 2023, we compare cases from diabetes, sleep disorders, cardiovascular conditions, obesity and ME/CFS and explore when, how and for what reasons different medical specialists consider patient-generated data (PGD) from consumer devices in outpatient settings. Their response registers vary: whereas some physicians reject PGD that seem to compete with their diagnostic activities, others tolerate the data (collection), whereas still others more readily include them into their diagnostic practices. This suggests nuanced strategies for navigating the demarcation between accepting or rejecting 'uninvited' participation through PGD from consumer apps and devices.

Despite alarms raised that adolescents' social media use can aggravate the harmful impact of residential risks (e.g. local violence) to their mental health, the mechanisms are poorly understood. To better understand potential mechanisms, we interviewed Latino adolescents living in a hypersegregated U.S. city, for whom social media may aggravate existing inequalities in residential risks to their mental health. Through an abductive analysis, we identified two processes suggesting how social media can amplify the deleterious impact of residential risks to their mental health. We refer to the first as additive, whereby social media heightens awareness of residential risks. The second is extension, whereby social media lengthens one's risk awareness, speeds up potential for risk awareness and multiplies who may become aware. We found evidence suggestive of parallel processes yielding diminution, whereby social media can minimise the deleterious effects of residential risks via adding and extending exposure to mental health resources, like collective efficacy. Further, the potential for extension (to both risks and resources) appears limited because social media practices (e.g. reposting, seeking viral attention) can foster indifference. Findings suggest the need to consider how adolescents activate resources via social media to avoid overstating its negative impact on mental health.

This paper investigates the social support provided by domestic animals to humans during the COVID-19 pandemic. The study comprises interviews with 39 British and American pet owners during March 2021, the point at which the UK had recently emerged from the third national lockdown and US states were under various restrictions. A thematic network approach to data analysis revealed four global themes, illustrating how pets provided buffers to the stress of the pandemic, facilitated ontological security by maintaining a sense of routine and purpose, offered myriad types of emotional support and enhanced and enabled wider social support. Taken together, these results reinforce and extend knowledge pertaining to the importance of companion animals for social support.

Attention deficit hyperactivity disorder (ADHD) is a paradigmatic case for childhood medicalisation. Critical studies of medicalisation have pointed to the increasing clinical role of schools, with teachers tending to rely on medical treatment of students with ADHD and are perceived as a primary source of diagnostic information. Based on 27 semi-structured interviews with teachers working in two Israeli elementary and middle schools, this research explored how teachers mediate the medicalisation process and understand their responsibilities in the classroom amidst the emphasis on inclusion in contemporary Israel. We found that teachers offer a wide range of explanations of the disorder and its prevalence, and their attitudes to medication are ambivalent. We argue that teachers develop pedagogical (lay) expertise in the field of ADHD in parallel with and in opposition to medical solutions. Such expertise is based on practical experience and close interaction with students. A top-down ideological imperative of inclusion, combined with uncertainty about ADHD, has generated a bottom-up set of preformative practices of 'containment' of troubled students. Teachers' emerging knowledge and practices raise questions about the relationship between medicalisation, policy, expertise and the pragmatic value of medical categories when applied outside the medical establishment.

The use of restrictive practices within health and social care has attracted policy and practice attention, predominantly focusing on children and young people with mental health conditions, learning disabilities and autism. However, despite growing appreciation of the need to improve care quality for people living with dementia (PLWD), the potentially routine use of restrictive practices in their care has received little attention. PLWD are at significant risk of experiencing restrictive practices during unscheduled acute hospital admissions. In everyday routine hospital care of PLWD, concerns about subtle and less visible forms of restrictive practices and their impacts remain. This article draws on Deleuze's concepts of 'assemblage' and 'event' to conceptualise restrictive practices as institutional, interconnection social and political attitudes and organisational cultural practices. We argue that this approach illuminates the diverse ways restrictive practices are used, legitimatised and perpetuated in the care of PLWD. We examine restrictive practices in acute care contexts, understanding their use requires examining the wider socio-political, organisational cultures and professional practice contexts in which clinical practices occurs. Whereas 'events' and 'assemblages' have predominantly been used to examine embodied entanglements in diverse health contexts, examining restrictive practices as a structural assemblage extends the application of this theoretical framework.