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Medicalization represents an increasingly significant form of social control. Emergent evidence suggests that workplace managers take up medicalized practices and discourses to produce a compliant labor force, but this phenomenon has received limited sociological attention. This paper extends prior theories of medicalization to investigate therapeutic management in the low-wage workplace. I draw upon eight months of ethnographic fieldwork in Disability Works, a nonprofit job training program for people with mental illnesses, and interviews with other providers and advocates within this field. Disability Works harnesses therapy, psychiatry, and "softer" therapeutic practices such as mindfulness meditation, sleep hygiene, and positive affirmations to produce its workforce. This paper identifies two dimensions of therapeutic management: (1) it aims to inculcate work norms at the level of client-workers' embodied dispositions, and (2) it aims to transform structural problems into individual ones. Findings illuminate therapeutic management as an emergent workplace regime and may guide future research on its effects. • "Therapeutic management" is an emergent managerial style. • Ethnographic fieldwork and interviews illustrate practices of therapeutic management. • This style draws on therapy, psychiatry, and pseudo-therapeutic practices. • Therapeutic management aims to inculcate work norms at the dispositional level. • Therapeutic management aims to transform structural problems into individual ones. [ABSTRACT FROM AUTHOR]

Abstract Sociological interest in the digitization of health has predominantly been studied using qualitative approaches. Research in this field has grown steadily since the late 1990′s but to date, no synthesis has been conducted to integrate this now rather comprehensive corpus of data. In this paper we present a meta-ethnography of 15 papers reporting qualitative studies of digitally mediated patient – professional interactions. By dissecting the detailed descriptions of digitized practices in this most basic relationship in health care, we explore how these studies can illuminate important aspects of social relations in contemporary society. Our interpretative synthesis enables us to reassert a sociological view that places changes in social structures and interaction at the core of questions about the digitization of health care. Our synthesis of this literature identifies four key concepts that point at structural processes of change. We argue that when patient-professional interactions are digitized, relations are respatialized, and there are reconnections of relational components. These lead to empirically specific reactions , which can be characterized as reconstitutions and renegotiations of social practices which in turn are related to the reconfiguration of basic social institutions. We propose a new direction for exploring the digitalization of health care to illuminate how digital health is related to contemporary social change. Highlights • A synthesis of 15 qualitative studies on digitized patient-provider interaction. • Four concepts emerged: respatialization; reconnection; reaction; reconfiguration. • Our synthesis goes beyond the micro level and point at structural processes of change. • We propose a conceptual framework to explore the societal relevance of e-health. [ABSTRACT FROM AUTHOR]

Based on ethnographic fieldwork among men who have sex with men and transgender women in Tanzania, this article explores the various types of work that may go into enrolment into PrEP programming and using pre-exposure prophylaxis (PrEP). PrEP protects against HIV acquisition and is widely touted as an essential tool in 'ending AIDS by 2030'. While taking PrEP has often been portrayed as 'just taking a pill a day' in public health campaigns, a striking observation during fieldwork was that enrolling in PrEP programming and adhering to PrEP involved a wide range of tasks. Inspired by this fieldwork experience and the literature on sociology of work, more specifically illness work and patient work, we started to think of these tasks as work. This paper identifies the range of tasks that PrEP users in Dar es Salaam had to perform as part of their enrolment and usage of PrEP. We provide a description of these tasks, organised into three categories of work that we refer to as (a) readying work, (b) user work, and (c) social navigation work that jointly make up what we propose to call biomedical prevention work. We further suggest that this analytical framework can be applicable to other biomedical prevention methods in other contexts. • Describes what it may entail to use PrEP among key populations in Dar es Salaam • PrEP use among men who have sex with men and transgender women • We argue that PrEP users do 'work' to use PrEP as HIV prevention • Presents novel conceptual framework: Biomedical Prevention Work • Framework describes how people may take preventative care with biomedical technology [ABSTRACT FROM AUTHOR]

Instead of diminishing with the spectacular advancement of medical expertise in the country , unqualified biomedical practice in India has been strengthened by the growth of the pharmaceutical production in the twenty first century. In public health discourse, the view that the informal health practitioners have to be punished and abolished has been countered by the recommendation that they could be trained and incorporated in primary health care where public health amenities are inadequate. The quality of care provided by the informal health care practitioners has also been subject to clinical assessment based on standardized patient vignettes. Based on a sociological approach, this paper examines the time line of chronically ill patients under lived conditions to arrive at an understanding of the role of informal health practitioners in long term treatment and highlights the setbacks. This paper draws on 253 household surveys from two villages in Madhya Pradesh, in depth interviews with four unqualified practitioners in the area, twenty five unstructured interviews of chronic patients, twenty five structured interviews on the cases of untimely death and FGDs with health workers in 2021. Informal health care practitioners offer consultation cum dispensing of medicines and are the primary source of biomedical care in the remote study area without any public transport. But they are 'for profit' economic actors who are ill-equipped to handle chronic diseases. What sets them aside from the qualified private doctors in the town is their social obligation to balance their profit motive with the ethics of proximity and neighborly ties with the villagers amidst whom they reside. These features of the market and community place the informal health care practitioners at the cusp of economy and society and defy simple binaries that they are either crooks or assets. • Unqualified health practitioners provide medical care in India where none is available. • Assessing their practices, clientele and exact role is crucial to health care policy. • One point standardized patient vignettes are used to assess their quality of care. • Their treatment of chronically and severely ill patients over time also has to be examined. • They are 'for profit' economic actors, but embedded in the community. [ABSTRACT FROM AUTHOR]

Abstract Changes in the nature and structure of healthcare pathways have implications for healthcare professionals' jurisdictional boundaries. The introduction of treatment focused BRCA1 and 2 genetic testing (TFGT) for newly diagnosed patients with breast cancer offers a contemporary example of pathway change brought about by technological advancements in gene testing and clinical evidence, and reflects the cultural shift towards genomics. Forming part of an ethnographically informed study of patient and practitioner experiences of TFGT at a UK teaching hospital, this paper focuses on the impact of a proposal to pilot a mainstreamed TFGT pathway on healthcare professionals' negotiations of professional jurisdiction. Based upon semi-structured interviews (n = 19) with breast surgeons, medical oncologists and members of the genetics team, alongside observations of breast multidisciplinary team meetings, during the time leading up to the implementation of the pilot, we describe how clinicians responded to the anticipated changes associated with mainstreaming. Interviews suggest that mainstreaming the breast cancer pathway, and the associated jurisdictional reconfigurations, had advocates as well as detractors. Medical oncologists championed the plans, viewing this adaptation in care provision and their professional role as a logical next step. Breast surgeons, however, regarded mainstreaming as an unfeasible expansion of their workload and questioned the relevance of TFGT to their clinical practice. The genetics team, who introduced the pilot, appeared cautiously optimistic about the potential changes. Drawing on sociological understandings of the negotiation of professional jurisdictions our work contributes a timely, micro-level examination of the responses among clinicians as they worked to renegotiate professional boundaries in response to the innovative application of treatment-focused BRCA testing in cancer care – a local and dynamic process which we refer to as an 'oncogenetic taskscape in the making'. Highlights • A micro-level examination of clinicians' work assembling an 'oncogenetic taskscape'. • Mainstreaming genomic testing requires changes to professional jurisdictions. • Technology's clinical relevance informs clinicians' acceptance of mainstreaming. • Clinical implementation of new technology requires inter-professional collaboration. [ABSTRACT FROM AUTHOR]

Hurricane Ike, the third costliest hurricane in US history, made landfall in the Galveston Bay Area in September, 2008. Existing literature postulates that maladaptive behavior such as increased alcohol use is often exhibited by disaster survivors in coping with both disaster-related traumatic events and post-disaster stressful events. In addition, it has also been postulated that survivors’ perceptions of social cohesion and social control can potentially serve to moderate such behavior. The purpose of this paper is to study such hypotheses for Hurricane Ike. In particular, we investigate the following four hypotheses: (H1) There is an increase of alcohol use by survivors of Hurricane Ike in the Galveston Bay Area; (H2) There are positive associations between both Ike-related trauma and post-Ike stress events and the increase in alcohol use; (H3) There are negative associations between both perceived social cohesion and social control and the increase in alcohol use following Ike; and finally that (H4) perceived social cohesion and social control serve to moderate the associations between both Ike-related trauma and post-Ike stress events and increased alcohol use after Ike. Using public use survey-weighted data from the Galveston Bay Recovery Study (GBRS) of Ike survivors (N = 658), we tested these hypotheses using logistic regressions controlling for other key socioeconomic variables. Our results confirm H1 and H2. Hypotheses H3 and H4 are partially confirmed with respect to social control, but show that (i) there is a positive association between perceived social cohesion and the increase in alcohol use following Ike, and that (ii) while perceived social cohesion and social control do moderate the association between post-Ike stress events and increased alcohol use, they have no effect on the association between Ike-related trauma and increased alcohol use. [ABSTRACT FROM AUTHOR]

Medicalization is increasingly recognized as a bidirectional process, with patients and their families as agents. The paper considers the specific case of the medicalization of autism in Italy, from the point of view of parents of autistic people with different levels of support needs. Through reporting and comparing results of two independently conducted qualitative studies, this paper aims to analyze how parents embrace and resist the medicalization of autism in their everyday lives and in healthcare contexts. Both studies involved participant-observation with services that targeted autistic people and interviews with parents, professionals, and autistic people. Results show that parents of autistic people both embrace and resist medicalization. While parents (sometimes ambivalently) accept the responsibilization inherent in their engagement with interventions (a sort of "therapeutization" of life) and reject lay expertise by deferring to experts' knowledge, they also resist the application of medical labels, language and practices in various ways in their everyday lives. Both embracing and resisting medicalization can be useful for achieving overarching social goals of being a good parent, helping their children, and pursuing respect and social harmony. Medicalization derives not only from the cultural dominance of medical discourses, which seems to incorporate resistance to medicalization stances, but also from the absence of continuity and coordination of services, particularly in the Italian context of public (but increasingly privatizing) health and welfare services. • Parents accept the responsibilization inherent in medicalization and resist it. • Both embracing and resisting medicalization is useful for achieving social goals. • Medicalization is due to the cultural dominance of medicine. • Medicalization also derives from the absence of continuity of services. • Cultural and biopolitical context impact on how people engage with medicalization. [ABSTRACT FROM AUTHOR]

In the paper, we are looking at the relationship between globalisation and the professional project, using nursing in Kerala as an exemplar. Our focus is on the intersection of the professional project, gender and globalisation processes. Included in our analysis are the ways in which gender affects the professional project in the global south, and the development of a professional project which it is closely tied to global markets and global migration, revealing the political-economic, historical, and cultural factors that influence the shape and consequences of nurse migration. The phenomenon that enabled our analysis, by showing these forces at work in a particular time and place, was an outbreak of strikes by nurses working in private hospitals in Kerala in 2011–2012. [ABSTRACT FROM AUTHOR]

Abstract: Drawing on end of life care as an illustrative case, this paper critically examines the provision of care in the home, identifying a number of inherent tensions. For 60 years the hospital has been the preferred site of care. However, the UK caring division of labour is currently undergoing a process of (re)domestication and the provision of home care is increasingly regarded as a ‘gold standard’ for the organisation of care, in institutional and domestic contexts. In this paper we argue that while ‘home care’ policies serve a range of professional and political agendas, they contain unacknowledged contradictions and strains, creating challenges for both family and professional carers. The realities of home care are examined through reconceptualising qualitative data generated from three research projects concerned with dying in the community. We argue that, whilst previous work has highlighted the burdens the redomestication of care places upon carers, home care philosophies and policies have led to over-romanticised notions of care which privilege the value of caring relationships without acknowledging the dynamic interaction of such social relationships with the actual work of caring. Moreover, such policy trends have created a nexus of social expectations and obligations for which modern society is unprepared. With reference to both end of life care, and home care more widely, we argue that health care planners and professionals need to think more critically about the way care is delivered. Home is not merely about a physical space, but the social and emotional relationships therein. Good ‘home care,’ characterised by attention to patient-centred needs and flexible in design and scope, does not have to be located within the private sphere; relationships may actually be maintained and nurtured by enabling people to have a realistic choice of care in an institution. [Copyright &y& Elsevier]

This paper discusses how HIV/AIDS prevention, treatment and mitigation activities and funding for such work can lead to community conflict. The central role of communities in combating HIV/AIDS is widely agreed, with the contributions of social capital networks and civil society seen as pivotal; a rights-based approach to HJV/AIDS activities is considered essential. Yet experiences from a UK Department for International Development funded project in Nigeria suggest that greater critical attention must be given to the impacts and effects of HIV/AIDS on communities, and the ways in which conflict can develop, emerge and be sustained, resulting in severe breakdown of social cohesion and reduction or cessation of HIV/AIDS activities. It is argued here that conflict can be fuelled by the different priorities and perceptions of community members and groups vis-â-vis those of development organisations, and by the impact of funds on often desperately poor communities. Case studies analyse the development of the conflict, failed attempts at resolution, and two post-conflict project interventions whose design and implementation were informed by its experiences and outcome. The paper concludes by considering the potential input of participatory approaches, community psychology and change management in the development and implementation of HIV/AIDS interventions specifically so as to reduce potential for conflict. Its intention is to contribute to the debate on how best to implement genuinely community-based and managed HIV/AIDS interventions. © 2004 Elsevier Ltd. All rights reserved. [ABSTRACT FROM AUTHOR]

In recent years what can loosely be described as a sociology of complementary and alternative medicine (CAM) has begun to emerge. Although work has been conducted with lay therapists, orthodox practitioners, and consumers, overall, research in this area remains patchy and underdeveloped. Despite its role at the forefront of integration, the sociological study of the apparent affinity between nursing and CAM is virtually non-existent. This paper provides an exploratory analysis of how writers within the CAM nursing sub-world adopt a recourse to history (nostalgic and nostophobic referencing) as a strategy to authenticate the relationship between nursing and CAM and so facilitate continuing integration. A text analysis, of articles written on CAM in four nursing journals, was conducted. Eighty papers satisfied the inclusion criteria. Evidence is presented of the way in which writers attempt to authenticate integration of CAM through reference to its apparent interconnectedness with the historically grounded core of nursing values, and more specifically, with the key historical figure of the nurse Florence Nightingale (1820–1910). It is argued that these rhetorical strategies can be understood in the context of the need to engage in (primarily) intra-professional persuasion: to protect and develop the values of their nursing sub-world over alternatives. The findings are preliminary. Themes identified are illustrative of the potential offered by an analysis of nostalgic and nostophobic referencing in this context, and not a definitive account of it. Further research should examine individually produced texts from other sources, and documents produced by relevant professional bodies. [Copyright &y& Elsevier]

Classic studies of medical education have examined how professional socialization reproduces the prevailing professional culture, as well as how students actively negotiate their place in educational processes. However, sociological research has not re-examined student culture in light of structural transformations in medical education, such as the introduction of new assessment types and their use as modes of commensuration. In this paper, we examine data from two studies of online forums where medical trainees and applicants to medical school discuss their experiences preparing for tests of professional skills, including judgment, empathy, and communication. Examining how medical students talk about these tests on such forums allows us to understand the meaning-making processes at work as students negotiate the commensuration processes such tests enable. We examine how these negotiations take place in online forums, where participants confront common challenges, form common perspectives, and share common solutions, all hallmarks of student culture. Through qualitative analysis, we find that online communities are spaces where students grapple with these new forms of commensuration, interrogate the standards and quantifications that underlie them, and collectively negotiate how to approach these assessments. Using the case of online forum communities, our findings advance past work on student culture in medical sociology by theorizing student culture as an extra-organizational phenomenon that spans multiple career stages. In so doing, we highlight the importance of online forum data for studying social processes. • Students grapple with their experiences of assessment in online forums. • Forums show students' meaning-making as they negotiate commensuration processes. • Students confront common challenges and share solutions, forming "student culture". • We theorize student culture as an extra-organizational phenomenon. • We highlight the importance of online forum data for studying social processes. [ABSTRACT FROM AUTHOR]

Early works in medical sociology have been pivotal in the development of scholarly knowledge about emotions, emotional socialization, and empathy within medical training, medical education, and medical contexts. Yet despite major shifts in both medical education and in medicine writ-large, medical sociologists’ focus on emotions has largely disappeared. In this paper, we argue that due to recent radical transformations in the medical arena, emotional socialization within medical education should be of renewed interest for sociologists. Developments in medical education such as increased diversity among enrollees, the rise of patient health movements, and curricular transformation have made this context a particularly interesting case for sociologists working on a variety of questions related to structural, organizational, and cultural change. We offer three areas of debate within studies in medical education that sociologists may be interested in studying: 1) gendered and racialized differences in the performance of clinical skills related to emotion, 2) differences in self-reported empathy among subspecialties, and 3) loss of empathy during the third year or clinical year of medical school. [ABSTRACT FROM AUTHOR]

The embodiment of health identities is a growing area of interest. Questions posed in this literature include: how important is the body in our understandings/experiences of health, how are everyday definitions of health and self embodied despite chronic illness, and how do social relations influence these interpretations? Mindful of such questions, this paper draws on a qualitative study of mild to moderate asthma among young people in Ireland. In-depth interviews were undertaken with 31 respondents aged between 5 and 17, including boys ( n = 15) and girls ( n = 16) from different class and ethnic backgrounds. Core themes included: the importance of play, physical activity and sport; diet/nutrition; and physical appearance. Asthma sometimes presented challenges in relation to specific domains, notably strenuous physical activity, though in many other respects its potential impact was discursively minimised. Attentive to various modalities of the lived body, we illustrate how health identities are negotiated among young people diagnosed with a chronic illness. Connections are also made with the sociology of childhood and (ill) health, which views young people as active agents. [ABSTRACT FROM AUTHOR]

Among various social factors associated with health behavior and disease, social cohesion has not captured the imagination of public health researchers as much as social capital as evidenced by the subsuming of social cohesion into social capital and the numerous studies analyzing social capital and the comparatively fewer articles analyzing social cohesion and health. In this paper we provide a brief overview of the evolution of the conceptualization of social capital and social cohesion and we use philosopher Erich Fromm’s distinction between “having” and “being” to understand the current research focus on capital over cohesion. We argue that social capital is related to having while social cohesion is related to being and that an emphasis on social capital leads to individualizing tendencies that are antithetical to cohesion. We provide examples drawn from the literature where this conflation of social capital and cohesion results in non-concordant definitions and subsequent operationalization of these constructs. Beyond semantics, the practical implication of focusing on “having” vs. “being” include an emphasis on understanding how to normalize groups and populations rather than providing those groups space for empowerment and agency leading to health. [ABSTRACT FROM AUTHOR]

Medicalization is a central topic of concern in the sociology of disability and of health and illness. In this paper, I examine how medicalization is inequitably applied and circulates in the context of schools, specifically in serving students with educational disabilities. My aim is to advance understandings of medicalization through this case. Using a mixed-methods design, I first show, descriptively, how race and gender intersectionally predict educational disability status in a dataset of all Wisconsin public school students. Next, I examine how racial and gender disparities in disability status are produced at the micro level, using interviews with 27 Wisconsin teachers, including in-depth discussions of 73 individual students that were struggling academically or behaviorally. My quantitative findings show variation by race, gender, and disability category: White children have higher probability of special education receipt than comparable children of color for academic difficulties, but lower probability for behavioral difficulties, and girls have lower probability than comparable boys overall. My interview data suggest that these disparate outcomes reflect stratified medicalization processes, in which institutional constraints, status beliefs, and cultural discourses of race and gender shape both stratified noticing of schooling difficulties and stratified interpretation of those difficulties as medicalized conditions. • White children and boys are more likely than comparable peers to receive special education for higher-status disabilities. • Children of color and boys are more likely than comparable peers to receive special education for lower-status disabilities. • These inequalities are explained by stratified definitional processes of medicalization by teachers. • Institutional constraints and cultural discourses of race and gender shape stratified medicalization processes. • These processes include stratified noticing and stratified interpretation of students' difficulties. [ABSTRACT FROM AUTHOR]

Diet is understood to be one of the most important influences on public health and chronic disease, and is particularly implicated in the so-called 'obesity epidemic'. Yet interventions aiming to improve the population's dietary habits have failed to translate into widespread health improvements. Simultaneously, the knowledge landscape has become increasingly contentious, with fat activism challenging dominant approaches to how obesity is framed and addressed. This paper is based on 24 ethnographic interviews, and explores the work of health practitioners promoting therapeutic carbohydrate restriction ('low-carb' diets) for people with metabolic health conditions. Drawing on Michel Callon's study of technological innovation, I show practitioners engaging in 'on-the-job sociology'—situated sociological work to justify, and forge a space for, innovative dietary intervention. These innovators employ physiological explanations of hormones, satiety (or hunger), and pleasure (or shame), supported with personal experience, to emphasise material connections between particular eating habits and the sustainability of dietary improvement in everyday life. They resist fat activist influence on healthcare practice (that has resulted in practitioners avoiding conversations about diet, fatness and health), as well as the more extensively critiqued practices of health promotion. Deflecting blame/shame from individuals, innovators spotlight the role of the food industry in undermining public understandings of food and physiology, and dietary improvement that is achievable and sustainable. Through on-the-job sociology, innovators forge a space to engage patients in collaborative dietary experimentation and improvement. This study highlights the importance of on-the-job sociology in the contemporary knowledge landscape, providing new insights about public health in the making. • Supporting sustainable dietary change has proved difficult in healthcare practice. • Innovator practitioners promote low-carb dietary technology for metabolic conditions. • Innovators use 'on-the-job sociology' to link physiology and dietary sustainability. • On-the-job sociology resists health promotion, fat activist and industry regimes. • On-the-job sociology creates space for collaborative dietary work with patients. [ABSTRACT FROM AUTHOR]

Hospitals remain the most common location of death in a significant number of countries, and specialist palliative care is positioned as a crucial resource for improving hospital care for those nearing end of life. Little is known, however, about a substantive aspect of this work: how hospital palliative clinicians anticipate and organize a patient's dying trajectory. In this paper I draw from a larger original ethnographic research study of palliative specialists in two Canadian hospitals. Abductive analysis resulted in framing their work as affective labour, both reflecting and re-creating a larger affective economy shaping the affective states of everyone involved in the provision and uptake of care. I articulate six analytically ideal outcomes of clinicians' affective labour that organize end of life, including: 1) proactive co-authorship of disease trajectory; 2) mutual acknowledgement of a dying trajectory; 3) naturalizing direction and outcome of care, 4) ensuring a minimum of social disruption, 5) identification as compassionate and efficient care providers, and 6) increased specialist knowledge and interventions. In so doing, clinicians' practices become understandable as labour to meet a diversity of – at times conflicting – individual, organizational, and societal mandates that necessarily include, but extend well beyond, the patient and her immediate social network. This is the first study to consider hospital palliative care as an affective economy, and presents a theoretically innovative and empirically grounded model to advance new ways of conceptualizing hospital palliative care. I conclude by considering how this model, and the unique insights it affords, can inform the future development of end of life care in hospital settings. • Hospital palliative care is shaped by diverse health system priorities. • Clinicians use affective labour to meet patient, family member, and system needs. • Hospital palliative care can be understood and modeled as an "affective economy". • Negotiation and ambivalence are constitutive features of hospital palliative care. [ABSTRACT FROM AUTHOR]

Abstract: Accompanying patients from active treatment towards specialist palliative care is a complex sphere of clinical practice that can be fraught with interpersonal and emotional challenges. While medical specialists are expected to break ‘bad news’ to their patients and ease their transitions to specialist palliative care if required, few have received formal training in such interpersonal complexities. Furthermore, there also often exists clinical ambiguity around whether to continue active treatment vis-à-vis refocusing on quality of life and palliation. In this paper we explore the experiences of twenty Australian medical specialists, focussing on issues such as: dilemmas around when and how to talk about dying and palliation; the art of referral and practices of representation; and, accounts of emotion and subjective influences on referral. The results illustrate how this transitional realm can be embedded in emotions, relationships and the allure of potentially life-prolonging intervention. We argue that the practice of referral should be understood as a relational and contextually-bound process. [Copyright &y& Elsevier]

Abstract: The increasing imperative to find what works in health services has meant a rise in research trialing interventions deemed ‘complex’. While the strength of these interventions comes from taking a ‘whole of problem’ approach using multiple and inter-linking strategies, ways of examining implementation are under-explored. Building sustainability is an important part of implementing complex intervention research, but this too has received little exploration in the implementation literature. This paper explores issues of implementation and sustainability by examining the case of PRISM (Program of Resources, Information and Support for Mothers), a community randomised trial in Victoria, Australia aimed at improving maternal health and wellbeing. It examines documents placed on the project website. Three groups of documents relating to implementation of the intervention were examined – implementation reports, media reports and community newsletters. Analysing these documents allowed a focus on the ‘work’ of the intervention – who does the work and what activities comprise the work – in order to examine implementation as it relates to sustainability. Document analysis provides a useful way of considering implementation and sustainability of complex intervention research. It can ‘value add’ to findings from process evaluation and extend our understanding of an intervention beyond outcome measures. Analysis of the documents in this case provides insights into why sustainability of an intervention may be difficult to achieve during implementation. [Copyright &y& Elsevier]

Abstract: In the past two decades, research on the sociology of diagnosis has attained considerable influence within medical sociology. Analyzing the process and factors that contribute to making a diagnosis amidst uncertainty and contestation, as well as the diagnostic encounter itself, are topics rich for sociological investigation. This paper provides a reformulation of the sociology of diagnosis by proposing the concept of ‘social diagnosis’ which helps us recognize the interplay between larger social structures and individual or community illness manifestations. By outlining a conceptual frame, exploring how social scientists, medical professionals and laypeople contribute to social diagnosis, and providing a case study of how the North American Mohawk Akwesasne reservation dealt with rising obesity prevalence to further illustrate the social diagnosis idea, we embark on developing a cohesive and updated framework for a sociology of diagnosis. This approach is useful not just for sociological research, but has direct implications for the fields of medicine and public health. Approaching diagnosis from this integrated perspective potentially provides a broader context for practitioners and researchers to understand extra-medical factors, which in turn has consequences for patient care and health outcomes. [Copyright &y& Elsevier]

Abstract: This paper seeks to make sense of the sleeping practices of people who are recovering from heroin use. It brings together two hitherto unrelated literatures: the sociology of sleep and studies on heroin use and recovery. Conceptual resources developed within the sociology of sleep are deployed to facilitate the analysis of interview data generated as part of a qualitative investigation into the everyday lives of recovering heroin users living in England. Twenty one men and 19 women were interviewed with 37 of the 40 being interviewed twice, giving a corpus of 77 interviews. Without exception all the participants in the research experienced extensive sleeping problems that were not only exacerbated by the pharmacological effects of heroin, but were made worse by the way of life that accompanied their using. Irregular and anarchic sleeping practices mirrored the study participants’ disrupted and difficult lives. Attempts to establish sleep routines, and normative sleeping patterns, constitutes an important marker of recovery, but after years, and for some decades, of chaotic, intermittent and irregular sleeping, cultivating sleep presents a series of difficult challenges. Their embodied biographies of heroin use constrain the promotion of sleep, and attempts to develop rituals and routines to restore sleeping patterns are confounded by the involuntary aspects of sleep and their recalcitrant bodies. These findings are significant because not only is the quality of sleep critical to health outcomes but it also forms an important but hitherto relatively overlooked aspect of recovery from heroin use. [Copyright &y& Elsevier]

Abstract: Genotype–environment interaction (G×E) refers to situations in which genetic effects connected to a phenotype are dependent upon variability in the environment, or when genes modify an organism''s sensitivity to particular environmental features. Using a typology suggested in the G×E literature, we provide an overview of recent papers that show how social context can trigger a genetic vulnerability, compensate for a genetic vulnerability, control behaviors for which a genetic vulnerability exists, and improve adaptation via proximal causes. We argue that to improve their understanding of social structure, sociologists can take advantage of research in behavior genetics by assessing the impact of within-group variance of various health outcomes and complex human behaviors that are explainable by genotype, environment and their interaction. Insights from life course sociology can aid in ensuring that the dynamic nature of the environment in G×E has been accounted for. Identification of an appropriate entry point for sociologists interested in G×E research could begin with the choice of an environmental feature of interest, a genetic factor of interest, and/or behavior of interest. Optimizing measurement in order to capture the complexity of G×E is critical. Examining the interaction between poorly measured environmental factors and well measured genetic variables will overestimate the effects of genetic variables while underestimating the effect of environmental influences, thereby distorting the interaction between genotype and environment. Although the expense of collecting environmental data is very high, reliable and precise measurement of an environmental pathogen enhances a study''s statistical power. [Copyright &y& Elsevier]

Abstract: The rapidly growing and evolving literature on the social environment and its influence on health outcomes currently lacks a clear taxonomy of dimensions of the social environment and the differing mechanisms through which each influences health-related behavior. This paper identifies five dimensions of the social environment—social support and social networks, socioeconomic position and income inequality, racial discrimination, social cohesion and social capital, and neighborhood factors—and considers each in the context of physical activity to illustrate important differences between them. Increasing the specificity of terminology and methods in social environmental research on health will enable more systematic inquiry and accelerate the rate of scientific discovery in this important area. [Copyright &y& Elsevier]

Changes in concepts of health and disease have led to increased interest in health related quality of life in medicine. Quality of life measures tend to treat quality of life as a stable construct that can be measured externally. They do not consider people's differing expectations and assume that what quality of life means to people is stable over time. This paper reports on a study which aimed to find out how measures of oral health related quality of life (OHRQoL) vary between and change within individuals. Longitudinal semi-structured open-ended interviews were carried out with twenty people with socially noticeable broken, decayed or missing teeth who were or were not seeking dental treatment. The data were collected and analysed using the iterative processes of grounded systems theory based on Glaserian (Theoretical Sensitivity, The Sociology Press, Mill Valley, CA, 1978) grounded theory and Luhmann's (Social Systems, Stanford University, Stanford, 1984) social systems theory. During the data analysis it emerged that participants' were adopting positions on seven dimensions of oral health relating to the positions that people would adopt with respect norm, attribution, trust, accessibility, commodity, authenticity, and character. The core distinction that accommodated people's varying positions was that people constructed their own margins of relevance of oral health. The margins of relevance indicated a variable from a hypothetical extreme of 'super-relevant' to the other extreme of 'not relevant'. The margins of relevance could shift, meaning that assessments of quality of life would vary. Oral health related quality of life is therefore defined as the cyclical and self-renewing interaction between the relevance and impact of oral health in everyday life. [ABSTRACT FROM AUTHOR]

Set within the determinants of health framework and drawing upon Statistics Canada's longitudinal National Population Health Survey, this paper explores the self-assessed health of Canada's immigrant population. Using both descriptive and multivariate techniques, including logistic regression and survival analysis, the intent is to identify differences in self-assessed health between the immigrant and native-born populations, the factors that contribute to immigrant self-assessed health, and the factors associated with declining self-assessed health status. In each case, the key questions are whether differences in health status exist between the native- and foreign-born. Results indicate mixed support for the Healthy Immigrant Effect, with the native- and foreign-born neither more nor less likely to rank their health as fair or poor. However, results from the proportional hazards model indicated that the native-born were at lower risk to transition to poor health. [ABSTRACT FROM AUTHOR]

This paper describes educational differences in starting excessive alcohol consumption during 61/2 years of follow-up among 1648 initially alcohol-consuming Dutch adults. The longitudinal GLOBE study provides the unique possibility to study explanations for educational differences due to the collection of extensive baseline information on educational level, alcohol consumption, stressors (tension reduction theory) and vulnerability indicators (differential vulnerability theory) in 1991. Alcohol consumption was again assessed in 1997. We report that lower educated people were almost three times more likely to start excessive alcohol consumption during follow-up compared to the highest educated persons. Both educational differences in exposure to stressors (financial problems) and vulnerability (low social support) contributed to the educational differences in starting excessive alcohol consumption and explained 23% of the educational variation in starting excessive alcohol consumption. Remaining educational differences were however still statistically significant. These results are discussed with regard to implications for interventions and possible additional explanatory mechanisms. [Copyright &y& Elsevier]

This paper presents conclusions drawn from a comparative analysis of three qualitative case studies of participation processes at the regional level in Quebec''s healthcare system in Canada. Our objective is twofold: primarily, to draw on our observations to elaborate and discuss a sociological framework for the analysis of public participation; and secondarily, to use our data to criticise many pervasive but questionable preconceptions in the scientific literature on public participation. The framework used applies the social theory of P. Bourdieu in conjunction with the representation framework of H.F. Pitkin to demonstrate how any form of participation will imply some implicit or explicit delegation. The significance of the analysis is its focus on the social operations implied in these acts of delegation and in the use of the concept of symbolic struggles to understand the conflicts arising when the intrinsic legitimacy of the public is appropriated. [Copyright &y& Elsevier]

This article sets out to provide a demographic analysis of the production of social inequality through IVF trajectories in a reproductive technology centre of a French hospital. However specific this example may be, it reveals one of the paradoxes of social inequalities in health: lay experience of risk in reproductive technology shows profound inequalities related to social status, despite the fact that equality would seem to be guaranteed in France, since the social security system covers the full cost of the treatments. We will try to understand this paradox through a lifecourse approach. Thus, it will be shown that social inequality in reproductive health is deeply rooted in social scenarios of infertility that lead to differentiated medical experience: there is little benefit and even a worsening in the situation of lower class women, who were faced with unpredictable risks related to the collective testing of these new technologies. Conversely, the possibility of inventing new lifestories, which may or may not include motherhood, was given to upper class women who take calculated risks to delay the scheduling of their pregnancies. In short, this study confirms that the production of social inequality in reproductive health can only be understood in connection with the social dynamics of lifestyles, resulting in specific medical patterns. This paper also leads to the assumption that these social scenarios are related to attempts to enhance the different forms of capital: economic, cultural and social capital. In addition, the presence of risks aggravates this inequality process. This raises another question: do reproductive technologies result in reinforcing social inequality? [Copyright &y& Elsevier]

The contemporary social organisation of medical work is characterised by internal hierarchies and stratification in the form of professional elites and managerial hybrids. This paper examines the changes in medical restratification brought about by the introduction of inter-organisational care networks. The study focuses in particular on the social position of doctors and the contingencies that enable or constrain intra-professional hierarchies across inter-organisational boundaries. This ethnographic study of major system change within the English healthcare system finds that a relatively small group of 'multiplex' elites have significant influence in both national policy-making and regional service re-configuration based upon multiple sources of clinical and reputational capital. Subsequent forms of restratification at the regional level are found to mirror such status markers whilst also revealing important local contingencies, especially where professional markers of distinction are coupled with and dependent upon organisational markers of distinction. • Major system change triggers inter-organisational medical restratification. • Multiplex elite are well-placed to acquire network elite roles. • Network restratification is contingent on concessions to less influential doctors. • Network restratification is contingent upon organisational markers of distinction. [ABSTRACT FROM AUTHOR]