Sociology of health & illness最新文献

Family Planning (FP) lets people control the number and timing of child-births through using contraceptives and/or restoring fertility. Nigeria has several FP policies for managing its population, yet contraceptives usage remains suboptimal despite high FP awareness, suggesting that several factors might be inhibiting FP uptake. The literature spotlights gender as factoring into FP use due to Nigeria's patriarchal society, with men positioned as gatekeepers to women's sexual/reproductive health/expression. Therefore, we investigate if/how gender is considered in Nigeria's FP policies. We thematically analysed the 'National Reproductive Health Policy', 'National Family Planning Communication Plan' and 'Nigeria Family Planning Blueprint (Scale-Up Plan)', from a critical realist viewpoint. Our analysis generated an overarching theme-'A Gendered Human Right', with three further themes: Women's Right-Women's Issue', 'Adolescent Girls-not left out' and 'Men's Right as Supporters'. FP was portrayed as the right of women, adolescents (particularly girls ≥ 10 yrs) and men. It was highly feminised, with women, not men, majorly shouldering the FP responsibility and women's FP access was presented as hindered by men. Moreover, we advance recommendations for optimising Nigeria's policies to address gender imbalances hampering women's FP access and uphold the rights of all people, women/girls especially.

The psychosocial needs of people with acquired brain injury (ABI) have been neglected based on ableist assumptions of incapability to participate in mental health treatment. Although people without disabilities benefit from evidence-based mental health supports, these treatments remain inaccessible for those with disabilities after ABI. Discursive simplifications used in dominant conceptualisations of health and disability may maintain this inaccessibility. This paper examines the role of discursive constraints in concealing the complexities of ABI recovery, undermining the gradients of mental health exclusion among different ABI subpopulations, and muddying possibilities for enhancing mental health accessibility. An alternate discourse that challenges disabling societies in service of centring the whole person is proposed. Discursive opportunities are thus created by conceptualising the objective and subjective dimensions of disability as intermeshed, providing both the motivation to incentivise mental health inclusion, as well as a method to achieve it. By recognising the unavoidable impact of bodily impairments on social participation, participatory ideals can be actualised by accommodating ABI-related disabilities in mental health treatments. The possibilities for transformative research and practice are illuminated through examples of mental health treatments that have been preliminarily adapted using accommodations, and a research agenda for realising these possibilities is proposed.

When the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, there was a firestorm of controversy about the elimination of the bereavement exclusion. Proponents of this change and of the proposed "complicated grief" designation believed that this change would help clinicians recognise major depression in the context of recent bereavement. Other researchers and clinicians have raised concerns about medicalising grief. In 2022 "prolonged grief disorder" (PGD) was officially included in the DSM-5-TR in the trauma- and stressor-related disorders section. Not surprisingly, there has been a push to identify biomarkers and to use neuroimaging to identify the neurobiological basis of PGD. Some researchers have even suggested that PGD is a 'reward circuit disorder' akin to addiction and that naltrexone, an opioid antagonist, may be a promising treatment. The purpose of this paper is to show how medicalising grief reinforces a research agenda dedicated to the search for pharmaceutical and psychological 'magic bullets.' Following George and Whitehouse (2021), we propose that an ecopsychosocial approach-one that incorporates environmental and contextual factors-is needed.

'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'.

Since the advent of the COVID-19 pandemic, several ways of understanding time have emerged: what we may call 'COVID time'. Based on 40 qualitative online interviews in 2022 with Australians living across the continent, this article examines how people situated themselves and COVID-19 in historical time. It further explores how material aspects, place and space (or "pandemic materialities") factored into lived experiences and temporal imaginaries. We focus on how time-related concepts such as synchronisation and the definition of crises and events are interrelated in the participants' understandings of COVID as either over or a continuing crisis. The sociomaterial dimensions that served to alert people to risk and encourage them to engage in preventive action are identified as ways in which COVID time was experienced, remembered, understood and imagined. While some respondents claimed that the present moment was 'post-COVID', for others, the pandemic was far from over in 2022 and indeed stretched into the future. We use a sociomaterial lens to show how respondents portray the 'temporal technologies' and 'objectifications' of the event of COVID-19-the tangible materialisations of its temporal status as either relegated to the past or continuing as a mode of present and future crisis.

Interaction with a lay referral system (informal networks that provide health advice during illness) influences the treatment-seeking decisions of individuals with perceived healthcare needs. We examined how this occurred in urban slums in Nigeria with scarce formal healthcare and unstable social networks. Using existing theories of social networks and lay referral, we examined the use of these systems for treatment-seeking decisions in slums, including the use of digital technologies. We interviewed 30 adults (aged 18-64) of diverse age, gender, network size and use of digital technologies for health advice in two Nigerian slums. We analysed the data using a thematic inductive-deductive approach. Lay referral was multidimensional: discussion of illness during daily bonding, social demonstration of self and purposeful exchange of support. People limited lay referrals to a few family members and friends, avoiding wider interactions due to mistrust. Use of online sources was scarce due to limited access to smart devices and low digital health literacy. Lay referral motivated timely care seeking but also facilitated unhelpful advice. Slum residents were agentic in their use of their lay referral system. The effectiveness of their agency may be improved if trusted and reliable health advice sources are available in addition to their social network.

Little is known regarding the future reproductive decision-making of parents of children with rare genetic conditions. Our research draws on data from an online survey and qualitative photo-elicitation interviews with families living with Noonan Syndrome. We demonstrate how genetic knowledge and prenatal genetic testing become embedded in reproductive practices. Yet the idea of using selective genetic technologies to influence reproductive outcomes remains highly emotive. Our analysis reveals that for these parents, the rationalities of reproduction, although technologised and biomedicalised, remain centred on caring for their disabled child. Genetic subjectivities become entangled with responsibilities of care-giving and emotion tied to the realities of living with disability. We argue that for these parents, reproductive decisions are relational and affective, situated within families and communities and shaped by access to emotional, financial, physical and temporal resources. Our findings provide new insights into the ontologies of selective genetic technologies and reproductive governance in families living with disability.

Caring for the extremely premature infant born in the grey zone of viability is the most difficult area of neonatal medicine. Little research has been done on antenatal communication between neonatologists and parents anticipating the birth of a periviable infant. This article analyses 25 antenatal consultations between neonatologists and parents in one Midwestern hospital in the United States of America. It explores how neonatologists position comfort care as one of two predominant care trajectories for extremely premature infants born into the grey zone of viability. We found comfort care featured minimally in and was often marginalised by neonatologists' language. The two dominant discourses contributing to this were acute medicine's life-saving capacity and a limited temporal window marked by gestational age where comfort measures were deemed appropriate. Antenatal consultations framed by shared decision-making could be approached as a form of care characterised by a relational openness and responsiveness to parents' views on care. This asks neonatologists to enter antenatal consultations for periviability without knowing ahead of time which care trajectory will necessarily call one's attention or the particular response one should take, thus highlighting the skills of reflexivity in addition to an attentiveness and openness towards those receiving care.

A wealth of scholarship demonstrates the developmental benefits of risky play for children. However, this scholarship has overwhelmingly focused on the experiences of children and their caregivers from Euro-Western nations. It is imperative to explore child and caregiver perspectives on child risk, injury and play in communities where children experience a disproportionate burden of injuries resulting from play such as in refugee communities. For this research, we focused on Syrian refugee camps (n = 3) and villages (n = 4) across Lebanon and conducted semi-structured interviews with children (n = 79) and caregivers (n = 56) to explore perspectives on child risk, injury and play. Our approach was informed through tenets of post-structural feminist theory, and a critical discourse analysis was conducted. Two major discourses were identified: (1) children engage in dangerous and injurious play; and (2) environmental and social barriers limit play opportunities. Findings suggest that the children often experienced discrimination and severe injuries as a result of engagement in play which resulted in long-term financial and physical burdens. These findings challenge Euro-Western risky play paradigms and inform injury prevention and play scholarship with the voices of families from equity-deserving communities.

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.