Sociology of health & illness最新文献

Artificial intelligence (AI) is increasingly used in health care to improve diagnostics and treatment. Decision-making tools intended to help professionals in diagnostic processes are developed in a variety of medical fields. Despite the imagined benefits, AI in health care is contested. Scholars point to ethical and social issues related to the development, implementation, and use of AI in diagnostics. Here, we investigate how three relevant groups construct ethical challenges with AI decision-making tools in prostate cancer (PCa) diagnostics: scientists developing AI decision support tools for interpreting MRI scans for PCa, medical doctors working with PCa and PCa patients. This qualitative study is based on participant observation and interviews with the abovementioned actors. The analysis focuses on how each group draws on their understanding of 'good health care' when discussing ethical challenges, and how they mobilise different registers of valuing in this process. Our theoretical approach is inspired by scholarship on evaluation and justification. We demonstrate how ethical challenges in this area are conceptualised, weighted and negotiated among these participants as processes of valuing good health care and compare their perspectives.

The relationship between religion and health tends to be framed positively. Religion has been found to act as a coping mechanism and source of support in times of ill health. In this paper, we focus on the disruptive effect of chronic illness on religious practice and cultural engagement. Drawing on interviews with ethnic minority adults with end-stage kidney disease, who also identify as religious, we introduce the concept 'cultural disruption'. While religious practice and belief was found to provide strength and comfort we also found that chronic illness had a disruptive impact on religious and cultural practice that participants attempted to manage. To highlight the potential disruptive effect of chronic illness on religious faith and cultural engagement we identify three elements of cultural disruption-disruption to religious practice, disruption to sense of self and identity and disruption to wellbeing. We conclude by suggesting that understanding and accounting for the potential of cultural disruption when diagnosing, treating and supporting people with chronic illness offers an alternative entry point to the life-worlds of patients who identify as religious and the things that are important to them.

Under the conditions of neo-liberal individual responsibilisation, self-tracking has become the predominant model of health management. More recently, though, intuition-based approaches to exercise and eating are also gaining traction. These two approaches are often located in opposition. While self-tracking uses datafication and calculability to structure health decisions, intuitive approaches encourage abandonment of rules and restrictions around exercise and food in favour of corporeal self-awareness and attunement to sensation. Although navigating these competing approaches is a common experience for all populations, the tensions between them are felt particularly acutely by people with complex health histories, such as eating disorders (EDs). In this article, we draw on mixed-methods longitudinal data, analysed using phenomenological analysis, to propose a novel framework - 'intuitive tracking'-which moves beyond understandings of self-tracking as the antithesis of intuitive engagement with exercise and health. Drawing on longitudinal interviews and photo elicitation with 19 women who are in recovery from EDs and using weightlifting as a tool to support their recovery, we demonstrate how attentiveness to bodily and emotional cues is successfully combined with an emphasis on monitoring health behaviours to support wellbeing. We conclude that theoretical understandings of self-tracking can and should make space for intuition-led decision-making.

In this article, we explore the intricacies of veteran care and show how care practices come to incorporate veterans' 'self-performances' to raise political attention and funding for future rehabilitation activities. By bringing into dialogue theories of care and theories of performance and representation, we illustrate how a seemingly classic form of care-veteran rehabilitation-takes the form of representative performance. Drawing on ethnographic fieldwork and interviews with the Danish Invictus Games team, we demonstrate how politics, research and TV documentaries are integrated into veteran care practices. Through this integration, mentally wounded veterans, while performing 'themselves' for shifting audiences with shifting agendas, come to assume the roles of both caregivers and care receivers. Crucially, we highlight that wounded veterans, while undertaking their personal rehabilitation journey, are curated into and (un)willingly positioned as representatives of others. By showing how caring for wounded veterans goes hand in hand with caring for fictive, future wounded veterans and for political, research and media agendas, this article offers new ways of thinking of and with care.

Class-based perspectives on the persistent social gradients in health within modern welfare states largely focus on the adverse consequences of unfettered neoliberalism and entrenched meritocratic socioeconomic selection. Namely, neoliberal-driven economic inequality has fuelled resentment and stress among lower-status groups, while these groups have become more homogeneous with regard to health behaviours and outcomes. We synthesise several sociological and historical literatures to argue that, in addition to these class-based explanations, socioeconomic inequality may contribute to persistent social gradients in health due to elite class self-interest-in particular elites' preferences for overdiagnosis, overprescription and costly high-technology medical treatments over disease prevention, and for increased tolerance for regulatory capture. We demonstrate that this self-interest provides parsimonious explanations for several contemporary trends in U.S. health inequality including (A) supply-side factors in drug-related deaths, (B) longitudinal trends in the social gradients of obesity and chronic disease mortality and (C) the immigrant health advantage. We conclude that sociological theories of elite class self-interest usefully complement theories of the psychosocial effects of neoliberalism and of meritocratic social selection while answering recent calls for research on the role advantaged groups play in generating inequalities in health, and for research that moves beyond technological determinism in health sociology.

Smiling is an embodied and complex social act. Smiling is presented as facilitating individual health and wellbeing, but the value placed on smiling raises questions about structural conditions acting on the body. While smiling has been considered sociologically, psychologically and historically, we argue that further exploration of the embodied smile offers fruitful avenues for future research. This article attempts to advance understanding of the smile and its importance by: (I) Bringing together literature on smiling as a social act and smiling as embodied. (II) Systematically identifying key themes, which recognise sociological insights and the relevance of oral health. (III) Pointing to useful directions for future sociological research into smiling. In this article, we review literature on body techniques; impression management and social interaction; gender, race and smiling; and emotional, aesthetic and affective labour. We move on to embodiment, considering the mouth as a body project and in relation to the ageing body, before reflecting on the significance of oral health and dentistry. We highlight future directions for sociological research on smiling, building on eight interrelated and cross-cutting themes: norms and expectations, aesthetic ideals, self and identity, health and wellbeing, body work, commodification and labour, inclusion and exclusion and resistance.

This article investigates how mental health counsellors on helplines in Sweden deal with racism from callers who self-categorise as non-racialised. Previous studies have identified racism as a problem in health care interactions, but there is limited knowledge about the features of racialised talk and how staff respond. In this study, we use conversation analysis and membership categorisation analysis to examine racialised talk in 17 audiorecorded calls, a subset of 458 calls to suicide preventive helplines. The analysis shows that racialisation functions as a resource for callers to make sense of their mental health difficulties. This speaks to the complexity of responding to racism in a mental health setting, as counsellors must see to callers' needs, and calling out racialised talk may alienate callers. Call-takers manage this problem in three ways: (1) questioning racialised talk, (2) supporting the callers' stance in a way that makes it ambiguous if call-takers are coproducing racism or affiliating with callers' lives being difficult and (3) supporting callers' problems as mental health issues while resisting a potentially racist trajectory. The study offers direct insight into the workings of racism in health care and how practitioners can balance health care users' needs for support with an antiracist position.

In this article we use an existential media framework to explore the asynchronous, written and digital form of GP-patient communication that takes place through e-consultations in a Danish general practice context. This approach acknowledges e-consultation as more than a tool for information delivery and frames GP and patient not as skilful media users but as dependent co-existers: Both thrown into and trying to navigate the digital healthcare ecology. Through a thematic analysis of 38 semi-structured qualitative interviews with patients and GPs we carve out three themes unpacking the existential dimensions of e-consultation: 1. Patient and GP are placed in a Culture of non-stop connectivity and we show the ambivalences arising herein fostering both relief, reassurance and new insecurities. 2. Ethical challenges of responsible co-existence points to dilemmas of boundary setting and caring for self and co-exister in the digital encounter. 3. We-experiences illustrates the potential of e-consultation to signal GP presence, even when the GP is silent. We also discuss the existential ethics of care emerging from the contemporary digital healthcare ecology and call for empirically grounded studies of the existential dimensions tied to encounters in contemporary digital care infrastructures.

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.

Absolute prevalence of tobacco smoking has fallen in recent decades but inequalities by socioeconomic position (SEP) persist. Adolescence is a critical period for smoking initiation and habits formed during this period likely continue into adulthood. Explanations for inequalities in adolescent smoking have tended to focus on individualistic theories based on differentials in knowledge and psychology. These have been criticised for their blindness to processes of social stratification and social context that influence smoking behaviours. Based on previous social theories, we put forward, and test empirically, two potential structural explanations for inequalities in smoking, using nationally representative longitudinal cohort data on 6039 Irish young people aged 9-18 years. Descriptive analyses confirmed the adverse SEP gradient in smoking prevalence as well as SEP gradients in variables representing individual-level characteristics and structural-level explanations. Despite lower self-esteem being associated with a higher likelihood of smoking, there was no significant indirect pathway between SEP and smoking via self-esteem. Path analyses found that differentials in exposure to parental smoking and levels of oppositional values mediate the relationship between SEP and smoking. Our results favour structural and group-based explanations for inequalities, that is, the 'smoking exposure' and 'social resistance' models, over explanations based on individual psychology.