Sociology of health & illness最新文献

This paper examines how economic rationalities shape antibiotic usage with the aim of expanding options for the reduction of antimicrobial resistance (AMR). Antibiotic usage is typically attributed to the individual behaviours of patients, pet owners and prescribers, an emphasis that has neglected sociological explanations, particularly the economic rationalities that are transforming healthcare. We used sociological theory of pharmaceutical capitalisation and economisation to explore in-depth interviews on antibiotic usage with scientists, policymakers, prescribers, patients and pet owners in Australia. Antibiotics attracted values in terms of cost to the patient and pet owner, profit for the clinic, how the drugs saved time away from work and childcare, and how they eased the pressures of self-care, parenting and pet ownership. Economic transactions that are only partially under individual patient and prescriber control shape antibiotic use. In these circumstances, antibiotic use is influenced by other social agents-for example, business managers and clinic owners-decentring prescriber authority. Adoption of socio-economic values of antibiotic usage and inclusion of its other economic agents is needed to improve AMR intervention effectiveness.

Multimorbidity, meaning multiple long-term conditions impacting a person's health, has become a rising societal and public health issue. The article contributes to the sociological study of chronic illness and multimorbidity by analysing how the blurriness of illnesses and entanglement of symptoms in multimorbidity is experienced and negotiated by people with coexisting chronic conditions. Drawing on qualitative interviews with people who live with endometriosis, fibromyalgia or hormonal migraine in Finland, we show how people with multiple chronic conditions distinguish between evolving symptoms based on past embodied experiences to make decisions about how to best manage their health. We argue that coexisting illnesses become entangled in ambiguous and open-ended ways, which, if left unaddressed, complicates treatment. Our analysis of illness experiences is aligned with the growing body of literature that argues that the single-disease model underlying healthcare systems fails to address the needs of patients living with multiple chronic conditions. Our emphasis on evolving entanglements between illnesses and the blurriness of conditions makes visible crucial discrepancies between lived illness and existing biomedical models and healthcare structures.

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.

Standardised health care is primarily focused on remediation and delivered episodically through costly and fragmented health-care systems. Such an approach is untenable, given the diversity and complexity of peoples' health-care needs, increasing prevalence of chronic disease and existing heath inequities. A life course perspective fundamentally challenges our current understanding of health care and has great potential to promote innovation in health-care practice, systems and policy. However, the way that health develops and manifests across the life course is a highly complex process underpinned by a plethora of causal antecedents, consequences and interdependencies that have yet to be adequately captured and articulated in current life course frameworks. The field of cancer survivorship and its recent rise to prominence provides a highly relevant and compelling case example to inform development and refinement of existing life course frameworks. Cancer survivorship exemplifies what can be described as an integrated diachronic life course perspective, which serves as a conceptual framework to enhance our understanding of health development across the life course and guide health-care practice, systems and policy to meet the increasingly complex health-care needs of current and future generations.

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.

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.

Fibromyalgia is a syndrome characterised by persistent unexplained pain and fatigue. People with fibromyalgia report receiving little support to manage symptoms, difficult interactions with healthcare practitioners and stigma associated with this contested condition. In this article, we employ Dorothy E Smith's Sociology for People to undertake a systems-focused literature review from the standpoint of people with fibromyalgia, moving beyond individual subjectivities to map how problems are socially organised. This is a novel application of a Sociology for People which, although previously used to structure research projects, has not previously been reported as a framework for literature review. Our findings highlight how, within a biomedically orientated healthcare system, practitioners' activities are organised to withdraw support from people with fibromyalgia and characterise problems as "psychological". Those looking to make service improvements for this patient group need to specifically challenge biomedical systems and ideology, in order to promote alternative models of care. We highlight a Sociology for People as a powerful lens for systems-focused literature review that links frontline experiences with dominant power relations, and provides an alternative to traditional qualitative evidence syntheses. Additionally, the theoretically-grounded and creative use of published literatures is an ethical approach adding value to extant research.

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.

This article provides an analysis of the negotiation process surrounding in vitro fertilisation (IVF) decisions in contemporary China, based on an ethnography conducted in Beijing. Building on the theoretical framework of applying a 'reprolens' and scholarly debates on the transforming family landscape in contemporary China, I delineate the complex dynamics through which women negotiate their choice of IVF with their families, documenting the ways in which power is distributed. I highlight not only individual-family power dynamics but also the intricate gendered ones within the family. I argue that family relationships shape the desire for IVF and the decision to pursue it; this journey, in turn, can reshape family dynamics. I propose the term familial bargaining to suggest a relational and dynamic perspective for examining how IVF negotiation is bound up with family relationships. At the intersection of biology and technology, IVF also affects the choreography of familial bargaining, as its different aspects serve as bargaining chips. Further, familial bargaining offers a nuanced perspective that helps to unveil the tensions and micro-politics between the gendered individual and the family in a broader sense.

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.