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The expansion of hospice care worldwide has been received differently by medical communities in different societies. Nonetheless, existing efforts to explain how culture affects the reception of hospice care are inadequate. On the basis of fieldwork conducted in Chinese medical institutions and care facilities between 2017 and 2022, this paper draws on a theoretical framework that distinguishes between declarative culture and nondeclarative culture at the personal level to explain the discrepancies between healthcare professionals' beliefs regarding the value of hospice care and their daily healthcare practice. Moreover, this paper uses the concept of cultural scaffolding to demonstrate that the culture of hospice care and the culture of medical institutions are not separate, independent entities but rather evolve together to produce new and local forms of hospice care in the Chinese context. This analysis helps clarify the obstacles and opportunities associated with hospice care in China and contributes to existing research on the reception of hospice care worldwide. • Explains discrepancies between healthcare professionals' beliefs about hospice and daily practice. • Theoretical framework that distinguishes between declarative and nondeclarative culture. • Localized hospice care emerges as culture of hospice care and culture of medical institutions interact. • Clarifies the obstacles and opportunities faced by hospice care in China. • Contributes to existing research on the reception of hospice care worldwide. [ABSTRACT FROM AUTHOR]

In recent years, there has been renewed interest in diversifying the understanding and discussion about the causes of depression to move beyond biomedical determinism—a view that biomedical factors are the ultimate cause of an individual's depression. There is increasing emphasis on diversity in how people seek to articulate the causes of depression to incorporate non-biomedical dimensions. Furthermore, the biomedical understanding of depression has been increasingly questioned due especially to emerging limitations in pharmacotherapy. These shifts encourage social analyses that explore what narratives as to the causes of depression are constructed and presented with relative plausibility in different contexts and why and how. By analysing published memoirs of individuals diagnosed with depression in Japan, this study aims to provide fresh insights into narratives around the causes of depression. It illustrates how memoirs portray depression and its perceived causes in characteristic ways in a nation that adopts Western diagnostic systems, biomedical therapeutics and other relevant technologies. I will show that 'burnout' is the dominant theme in the Japanese data, diverging from the predominantly biomedical narrative in Western societies. This burnout narrative depicts depression as the somewhat unfortunate but unsurprising result of overwork arising from individual active adaptations to structural features of the Japanese work culture. I argue that reasons, rather than causes, articulate the making of the burnout narrative by revealing the interplay between the structural and individual and ultimately enrich the understanding of depression. The paper concludes with a call for exploring the shifting relationship between illness and normalcy that the burnout narrative implies. I suggest that further studies could explore how the boundaries between normalcy and illness are enacted and re-enacted and to what avail through public discourse and through shifting diagnostic schemata in the context of different national norms and practices. • There are international differences in how depression is experienced and represented. • Biomedical explanations of depression are frequently documented in the literature. • This paper shows ways in which depression is explained in the language of burnout. • Burnout emphasises the interaction between the individual and the structural. • Distinguishing reasons from causes helps better understand burnout and depression. [ABSTRACT FROM AUTHOR]

In the UK mental health and associated NHS services face considerable challenges. This paper aims to form an understanding both of the complexity of context in which services operate and the means by which services have sought to meet these challenges. Systemic principles as have been applied to public service organisations with reference to interpersonal relations, the wider social culture and its manifestation in service provision. The analysis suggests that the wider culture has shaped service demand and the approaches adopted by services resulting in a number of unintended consequences, reinforcing loops, increased workload demands and the limited value of services. The systemic modelling of this situation provides a necessary overview prior to future policy development. The paper concludes that mental health and attendant services requires a systemic understanding and a whole system approach to reform. [ABSTRACT FROM AUTHOR]

A rising emphasis on patient involvement in clinical research and healthcare improvement has led to the steady incorporation of patients and caregivers into this work. However, interactional factors shaping recruitment processes are not well understood. In this paper, we present a qualitative analysis of interviews with twenty-six patients, family members, engagement staff and healthcare providers who are engaged in healthcare improvement work in the United States. We focus on how stakeholders account for recruitment decisions to participate in healthcare improvement work. We find that expressions of and judgments about patients' and caregivers' cultural health capital shape providers' decisions to extend invitations to participate in healthcare improvement work. These findings extend current conceptualizations of cultural health capital beyond the clinical encounter to reveal factors shaping patient recruitment into healthcare improvement work. In theorizing how cultural health capital shapes action in this new setting, we found that healthcare providers, engagement staff, and patients/caregivers attended to different aspects of cultural health capital when accounting for why they extended or received a recruitment pitch. We further found that participating in healthcare improvement work led to a boost in cultural health capital for patients and caregivers, which they could use to develop transmissible forms of cultural health capital for less centrally involved patients and caregivers. Finally, we describe how participants in healthcare improvement collaboratives account for a lack of diversity among partners. These findings help us hypothesize the consequences of recruitment processes that rely on displays and judgments of cultural health capital and identify possibilities for change. Using the case of healthcare improvement work in Collaborative Learning Health Systems, our findings advance past work on cultural health capital in medical sociology by theorizing the role of cultural health capital in recruitment processes. • Providers recruit patients for healthcare improvement work with subjective criteria. • Providers often recruit high-resourced, privileged patients that they "vibe" with. • Partners build cultural health capital from doing healthcare improvement work. • Recruiting for cultural health capital may exclude patients from diverse backgrounds. • The role of recruitment should be considered to improve partner representation. [ABSTRACT FROM AUTHOR]

This paper utilizes eighteen months of ethnographic and interview research undertaken in 2003 and 2004 as well as follow-up fieldwork from 2005 to 2007 to explore the sociocultural factors affecting the interactions and barriers between U.S. biomedical professionals and their unauthorized Mexican migrant patients. The participants include unauthorized indigenous Triqui migrants along a transnational circuit from the mountains of Oaxaca, Mexico, to central California, to northwest Washington State and the physicians and nurses staffing the clinics serving Triqui people in these locations. The data show that social and economic structures in health care and subtle cultural factors in biomedicine keep medical professionals from seeing the social determinants of suffering of their unauthorized migrant patients. These barriers lead clinicians inadvertently to blame their patients--specifically their biology or behavior--for their suffering. This paper challenges the focus of mainstream cultural competency training by showing that it is not the culture of the patient, but rather the structure and culture of biomedicine that form the primary barriers to effective multicultural health care.

Urban health scholars explore the connection between the urban space and health through ontological perspectives that are shaped by their disciplinary traditions. Without explicit recognition of the different approaches, there are barriers to collaboration. This paper maps the terrain of the urban health scholarship to identify key urban health research traditions; and to articulate the main features distinguishing these different traditions. We apply a meta-narrative review guided by a bibliometric co-citation network analysis to the body of research on urban health retrieved from the Web of Science Core Collection. Five urban health research traditions were identified: (1) sustainable urban development , (2) urban ecosystem services , (3) urban resilience , (4) healthy urban planning , and (5) urban green spaces. Each research tradition has a different conceptual and thematic perspective to addressing urban health. These include perspectives on the scale of the urban health issue of interest, and on the conceptualisation of the urban context and health. Additionally, we developed a framework to allow for better differentiation between the differing research traditions based on (1) perspectives of the urban system as complicated or complex, (2) the preferred locus of change as a function of structure and agency and (3) the geographic scale of the urban health issue that is addressed. These dimensions have even deeper implications for transdisciplinary collaboration as they are underpinned by paradigmatic differences, rather than disciplinary differences. We conclude that it is essential for urban health researchers to reflect on the different urban health approaches and seek coherence by understanding their similarities and differences. Such endeavours are required to produce and interpret transdisciplinary knowledge for the goal of improving health by transforming urban systems. • Co-citation analysis of research publications shows five distinct urban health research traditions. • The scholarship of urban health is siloed with few scholars spanning boundaries. • Each research tradition has a different ontological perspective to urban health. • Articulating distinctiveness of approaches may foster transdisciplinary research. [ABSTRACT FROM AUTHOR]

We examine a 12-min video-recorded interaction among a patient (KN) in a disordered state of consciousness (DOC) and a speech language pathologist clinician (CL) that takes place in a medical rehabilitation setting. The video is a demonstration of how caregivers could use a clinical assessment to observe their loved one's behavior to communicate potential behavioral changes to healthcare professionals. The purpose of this paper is to make visible the communication practices used by participants that may not be obvious to researchers, medical rehabilitation practitioners, and clinical assessment developers. We use phenomenological, linguistic and conversation analytic approaches to analyze the interaction. We found that KN demonstrates multiple conversational competencies, some (but not all) of which are acknowledged by CL, and most of which are not directly addressed by the assessment scoring criteria. For example, KN demonstrates conversational competency by responding non-verbally to CL's prompts from the assessment protocol and following along with the unspoken rules of discourse. He does this primarily through gaze, which broadcasts the focus of his attention and actively signals his participation in the conversation. Though KN does not always respond correctly to CL's questions, he nevertheless demonstrates implicit conversational competencies during turns of talk such as returning to 'neutral' position which signals the completion of a turn of talk. KN's conversational competencies may be missed by CL and the assessment protocol but we argue that they are important in understanding KN's capacity. Our analyses show that competency is not simply a performance by one person who appropriately and correctly responds to a series of questions in a prescribed time frame. Competence is a collaborative achievement among participants, co-produced in situ , and influenced by linguistic and cultural habits of talk and epistemic norms that privilege clinical knowledge and expertise. • Competency is a collaborative achievement grounded on participants' conversational strategies. • Analytic pluralism allows for analyses using multiple perspectives. • Clinical assessments have unacknowledged epistemic privilege. [ABSTRACT FROM AUTHOR]

Abstract: This paper extends and problematises recent sociological research on the medicalisation of sleep, focussing on trends and transformations in the prospective ‘customisation’ of sleep in the 24/7 society. What exactly does customisation mean in this context; how does it relate to the medicalisation of sleep; and how salient or significant are these trends to date in the 24/7 society? These are the key questions this paper seeks to address, taking workplace napping and wakefulness promoting drugs amongst the ‘healthy’ as our comparative case studies. Both we argue, despite their apparent differences and embryonic status to date, provide alternative routes to broadly similar ends. Namely they customise our sleep patterns and practices to fit around the escalating temporal demands of daily life, thereby helping remedy the increasing misalignment between biological and social time. Each, moreover, seeks to improve or optimise safety, productivity and performance in late modern society, where alertness is prized, sleepiness is problematised and vigilance is valorised. The paper concludes with some further reflections on these matters, including relations between the biomedicalisation and the customisation of sleep and a research agenda on the biopolitics of sleep and wakefulness. [Copyright &y& Elsevier]

Abstract: Sleep is a biological imperative associated with cardiometabolic disease risk. As such, a thorough discussion of the sociocultural and demographic determinants of sleep is warranted, if not overdue. This paper begins with a brief review of the laboratory and epidemiologic evidence linking sleep deficiency, which includes insufficient sleep and poor sleep quality, with increased risk of chronic cardiometabolic diseases such as obesity, diabetes and hypertension. Identification of the determinants of sleep deficiency is the critical next step to understanding the role sleep plays in human variation in health and disease. Therefore, the majority of this paper describes the different biopsychosocial determinants of sleep, including age, gender, psychosocial factors (depression, stress and loneliness), socioeconomic position and race/ethnicity. In addition, because sleep duration is partly determined by behavior, it will be shaped by cultural values, beliefs and practices. Therefore, possible cultural differences that may impact sleep are discussed. If certain cultural, ethnic or social groups are more likely to experience sleep deficiency, then these differences in sleep could increase their risk of cardiometabolic diseases. Furthermore, if the mechanisms underlying the increased risk of sleep deficiency in certain populations can be identified, interventions could be developed to target these mechanisms, reduce sleep differences and potentially reduce cardiometabolic disease risk. [Copyright &y& Elsevier]

Abstract: Explanations for immigrant health outcomes often invoke culture through the use of the concept of acculturation. The over reliance on cultural explanations for immigrant health outcomes has been the topic of growing debate, with the critics’ main concern being that such explanations obscure the impact of structural factors on immigrant health disparities. In this paper, we highlight the shortcomings of cultural explanations as currently employed in the health literature, and argue for a shift from individual culture-based frameworks, to perspectives that address how multiple dimensions of inequality intersect to impact health outcomes. Based on our review of the literature, we suggest specific lines of inquiry regarding immigrants’ experiences with day-to-day discrimination, as well as on the roles that place and immigration policies play in shaping immigrant health outcomes. The paper concludes with suggestions for integrating intersectionality theory in future research on immigrant health. [Copyright &y& Elsevier]

Abstract To contribute to understanding the association between silence and suffering in the context of war and political repression, this study sheds light on the meaning-making process and explores the underlying mechanisms by which silence leads to suffering and how this suffering could be alleviated. The ethnographic research was conducted in 2015–2016, with 43 participants from northern Rwanda, who survived massacres after the 1994 genocide but were prevented from speaking about the experience by political constraints. The findings first describe their suffering, through grief, social isolation and loss of meaning in life and death (expressed as existential questions). Their suffering was worsened by 'unspeakability'; that is, the political context that prevents victims from speaking freely about their war experience, including discussion of those who killed and those who were killed. Unspeakability exacerbated suffering since participants were obstructed from applying ready narratives (e.g. funerary rituals, traditional reconciliation systems) or constructing their own narratives which could ordinarily help them to process mourning and reconciliation and to make sense of the loss. They selectively employed silence for coping and protection, avoiding speaking about the past to maintain everyday life. However, at the same time, unprocessed mourning remained a serious problem, resulting in mental health problems such as hallucinations of the spirits of the dead; participants expressed a strong need for mourning rituals. Overall, this paper highlights the ways in which the suffering of the silenced population worsens when meaning-making processes are obstructed. To alleviate the suffering, it is essential to secure mourning rituals for all survivors, particularly those who, as part of the defeated group of war, are silenced and marginalized in history. Highlights • Elaborates suffering of silenced people in post-genocide Rwanda. • Examines how silence exacerbates suffering and what support could be helpful. • Reveals the obstructed meaning-making process by which silence worsens suffering. • Recommends mourning rituals for silenced survivors to make sense of the loss. [ABSTRACT FROM AUTHOR]

Abstract This paper provides evidence of different teenage-smoking dynamics between genders with social progression. In particular, we find that descending from more gender-equal societies makes girls relatively more prone to smoke than those from less gender-equal societies relative to their male counterparts. Using data from over 6,000 second-generation immigrant teenagers sharing culture and institutions from one host country (Spain) but coming from 45 different countries of ancestry, we find that the higher the degree of gender equality in the country of ancestry, the higher the likelihood that girls smoke relative to boys. Our result holds even after we control for parental, sibling, and peer smoking, as well as for country-of-ancestry indicators of economic development and the smoking gender gap, among others. Highlights • Gender social norms determine the gender smoking gap among teenagers. • Descending from less traditional societies raises females smoking relative to males. • Result are robust to including both individual and country-of-ancestry controls. [ABSTRACT FROM AUTHOR]

Abstract: This paper is concerned with the phenomenological repercussions of being positioned within widely available discursive constructions of cancer. One of the many challenges of being diagnosed with cancer is that it requires the person to make sense of the diagnosis and to find meaning in their changed circumstances. From a social constructionist point of view, such meaning is made out of discursive resources which are available within one’s culture. This paper critically reviews some of the dominant discourses surrounding cancer which are available within English-speaking Western industrialized cultures. It maps out the discursive positions available to those diagnosed with cancer and it traces some of their implications for how cancer may be experienced and how it may be lived with. As such, this paper is concerned with the social and psychological consequences of being positioned within dominant cancer discourses. [Copyright &y& Elsevier]

Abstract: This paper responds to the call for culturally-relevant intervention research by introducing a methodology for identifying community norms and resources in order to more effectively implement sustainable interventions strategies. Results of an analysis of community norms, specifically attitudes toward gender equity, are presented from an HIV/STI research and intervention project in a low-income community in Mumbai, India (2008–2012). Community gender norms were explored because of their relevance to sexual risk in settings characterized by high levels of gender inequity. This paper recommends approaches that interventionists and social scientists can take to incorporate cultural insights into formative assessments and project implementation These approaches include how to (1) examine modal beliefs and norms and any patterned variation within the community; (2) identify and assess variation in cultural beliefs and norms among community members (including leaders, social workers, members of civil society and the religious sector); and (3) identify differential needs among sectors of the community and key types of individuals best suited to help formulate and disseminate culturally-relevant intervention messages. Using a multi-method approach that includes the progressive translation of qualitative interviews into a quantitative survey of cultural norms, along with an analysis of community consensus, we outline a means for measuring variation in cultural expectations and beliefs about gender relations in an urban community in Mumbai. Results illustrate how intervention strategies and implementation can benefit from an organic (versus a priori and/or stereotypical) approach to cultural characteristics and analysis of community resources and vulnerabilities. [Copyright &y& Elsevier]

Abstract: The prevalence of child obesity has increased steadily in the recent decades. Drawing on Bourdieu’s theory of lifestyle connecting objective conditions with preferences, values and behaviour, this paper seeks to provide an extension to previous research, which has found child body formation to be correlated with parental socioeconomic background. The paper shows how parental level of capital, especially cultural capital, influences the prevalence of child overweight and parental perceptions of child weight-levels. Parents with higher levels of cultural capital are less likely to have overweight children and more likely to perceive weight-levels in accordance with the BMI categories. The results also demonstrate clear gender differences. Parents have a tendency to overestimate their daughters’ weight-levels while underestimating the weight-levels of their sons compared to the BMI categories. The study is based on Danish survey data from 2007 and uses statistical estimation techniques. [Copyright &y& Elsevier]

The low rate of help-seeking and high rate of suicide completion among men has prompted public health officials to create suicide prevention campaigns that specifically target men. Drawing from data collected as part of a larger study of fire recovery in a rural county in Northern California, this paper utilizes 68 interviews with fire survivors (24 men and 44 women) and 40 interviews with mental health service providers to examine how rural residents interpret this type of campaign. To track patterns of help-seeking over time, I also draw upon 26 follow-up interviews – 20 with fire survivors (7 men and 13 women) and 6 with service providers – conducted one year after the first wave of interviews. In total, 134 in-depth interviews were conducted. This paper also draws on a secondary data source; I conducted content analysis of an internal Health and Human Services Agency focus group report used in the development of a local male-targeted suicide prevention campaign, Captain Awesome. As I show, male-targeted suicide prevention efforts have little salience in rural communities in which treatment resources are limited and stigma abounds. Perceptions about material conditions – i.e., treatment resources being few and far between – contribute to residents establishing a norm of not seeking help. Rural culture which emphasizes self-sufficiency and independence contributes to a pattern of both men and women repeating a narrative that frames men who seek help as weak. While research has identified women as key drivers for men's physical health maintenance, my research suggests that the same pattern might not hold around mental health maintenance in rural settings. In sum, I argue that male-targeted campaigns have limited resonance and efficacy in rural communities where material conditions and cultural narratives create physical and psychological barriers to accessing to treatment. • Male-targeted suicide prevention campaigns have little salience in rural areas. • Perceptions of limited treatment resources contribute to low rates of help-seeking in rural places. • A rural ethos emphasizing self-sufficiency contributes to low help-seeking. • Both men and women residents of rural places reinforce stigma against help-seeking. • Suicide prevention campaigns need to be developed with regional specificity. [ABSTRACT FROM AUTHOR]

This paper explores the interaction between peer relationships and sexual health among street youth in three Sub-Saharan African cities: Accra (Ghana), Bukavu (Democratic Republic of Congo), and Harare (Zimbabwe). It begins by conceptualising peer relationships for youth globally and considers why these are pivotal for young people living in street settings. The paper reconceptualizes street peer relationships not as replacement families, but as sharing 'social anchorage' in the street space. It draws on qualitative ethnographic data from Growing up on the Streets, a longitudinal research project with a participatory methodology undertaken between 2012 and 2016 and engaging street youth (aged 14–20 at project outset) trained in ethnographic observations as research assistants (n = 18), following a network of ten peers (n = 229 by 2016), reporting their experiences in weekly interviews with facilitators. A wider network attended focus groups (n = 399). The project engaged a 'capability' approach, with ten capabilities defined by street youth as key to their daily lives. Empirical evidence is from a subset of data qualitatively coded (using NVivo) against capabilities 'Health and Wellbeing' and 'Friendship', across all interviews, focus groups and cities (n = 212 sources). In exploring this intersection, the paper demonstrates beneficial and adverse impacts of peer influence on sexual health, including misinformation about contraceptives and death from an informal sector abortion; highlighting findings from across the three cities around primacy of same-sex peer relations, mistrust between genders and in healthcare providers. The paper finds that while street youth remain subject to cultural norms around gender identities, street peer relationships hold a persuasive power; contributing to both everyday survival and moments of acute need. It concludes that recognising the right of young people to live and seek livelihoods in urban settings, and adopting the social networks they create to advance street youth's sexual health has become even more relevant in a (post)pandemic world. • Young people are the majority living in new urban informality. • A new conceptualization positions street peer relations as socio-spatially anchored. • Peers can play a critical role in the sexual wellbeing of young street people. • Policy, practice and peer social networks can advance sexual health of street youth. [ABSTRACT FROM AUTHOR]

Abstract: This paper addresses how the notion of ‘culture’ has been understood and employed by both epidemiologists and anthropologists with respect to the literature on HIV/AIDS in Sub-Saharan Africa. It examines the shift towards non-biomedical understandings of the epidemic. The concept of ‘culture’ has been ‘bandied about’ [Schoepf, B.G. (2004). AIDS, history and struggles over meaning. In E. Kalipeni, S. Craddock, J.R. Oppong, & J. Ghosh (Eds.), HIV and AIDS in Africa: Beyond epidemiology. Oxford: Blackwell.], and yet no authors in the literature reviewed here attempt a more systematic account of the ‘bandying about’ itself. This paper thus attempts to address and close this gap. For biomedical researchers and epidemiologists, broadly speaking, ‘culture’ appears to compromise intervention, whilst for medical anthropologists, ‘culture’ is often seen as having the potential to assist intervention. ‘Culture’ comes to be multifaceted and laden with varying assumptions, which range from ‘culture’ being bounded and timeless, to ‘culture’ being linked to macro-processes, historically shaped, and contested. In turn, ‘culture’ has variously been understood as both the cause of, and solution to, the epidemic. It is also understood as having structured local interpretations of, and responses to, the epidemic. At the same time as noting the apparent dichotomy between the biomedical and social approaches, however, the models may inadvertently share certain assumptions about ‘culture’ as an essentializing signifier of difference. To this extent HIV/AIDS research could be improved by incorporating wider anthropological debates about the problems of the ‘culture’ concept. [Copyright &y& Elsevier]

Abstract: This paper considers how internationally supported medical research is understood and interpreted by its actual and potential study subjects, exposing the limits to bioethical discourses amidst economic inequalities and contrasting socio-cultural worlds. It focuses on the Medical Research Council (MRC) Laboratories in The Gambia and particularly their Pneumococcal Vaccine Trial (PVT) that was conducted jointly with the Gambian government during 2001–2004. In many respects this was an exemplar of international best practice in trial communication and informed consent procedures. Yet ethnographic and survey research finds that Gambian parents’ perspectives on participation are shaped not by trial specificities, but by broader, historically shaped views and experiences of the MRC as an institution. There is a pervasive view that the MRC offers good, free medication to participants, but that it also ‘steals blood’. Widespread concerns with blood-stealing emerge from local frames of understanding in which blood is treated as a tradeable good, in which blood accumulation and depletion in bodily processes relates to its exchange in hospital and medical research practices, and in which transactions can be more or less (un)reasonable. Yet such thinking, rooted in an ‘economy of blood’, has been overlooked by medical research staff and indeed by historians and anthropologists of Africa whose analyses of blood-stealing have been overly transfixed on rumour and the occult. This paper argues that such cultural framings, which guide local critical commentary on trans-national research orders, require serious attention and need to inform open dialogues between scientists and the public if medical research in resource-poor settings is to continue to be sustainable and politically legitimate. [Copyright &y& Elsevier]

The paper explores the attitudes of medical physicians towards adverse incident reporting in health care, with particular focus on the inhibiting factors or barriers to participation. It is recognised that there are major barriers to medical reporting, such as the 'culture of blame'. There are, however, few detailed qualitative accounts of medical culture as it relates to incident reporting. Drawing on a 2-year qualitative case study in the UK, this paper presents data gathered from 28 semi-structured interviews with specialist physicians. The findings suggest that blame certainly inhibits medical reporting, but other cultural issues were also significant. It was commonly accepted by doctors that errors are an `inevitable' and potentially unmanageable feature of medical work and incident reporting was therefore `pointless'. It was also found that reporting was discouraged by an anti-bureaucratic sentiment and rejection of excessive administrative duties. Doctors were also apprehensive about the increased potential for managers and non-physicians to engage in the regulation of medical quality through the use of incident data. The paper argues that the promotion of incident reporting must engage with more than the ubiquitous 'culture of blame' and instead address the 'culture of medicine', especially as it relates to the collegial and professional control of quality. [ABSTRACT FROM AUTHOR]

This paper is a follow-up of earlier findings by the Kagera AIDS Research Project (KARP), which documented declining trends in the prevalence and incidence of HIV infection in the Kagera region of Tanzania. The paper examines socio-cultural and sexual behavioral changes as possible determinants of the observed declining trends in Bukoba, the largest urban area of the region. The study used in-depth interviews, focus group discussions, field observations and ethnographic assessments to collect the required data. The findings suggest that since the initial years of the epidemic there have been significant changes in sexual behaviors, norms, values, and customs that are considered high-risk for HIV transmission. The findings show an increase in condom use, abstinence, zero grazing (sticking to one sexual partner) and uptake of voluntary HIV testing while traditional practices such as polygamy, widow inheritance, excessive alcohol consumption, and sexual networking are declining. We suggest that these changes are partly a result of the severity of the epidemic itself in the study area, and interventions that have been carried out in this area since 1987. The major interventions have included health education, the distribution of condoms, AIDS education in schools, voluntary HIV counseling and testing. These are encouraging findings that give hope and we believe that other places within Tanzania and other countries experiencing a severe AIDS crisis have much to learn from this experience. However, changes in norms and behavior are vulnerable; people in Kagera are still at risk and there is a need for continued intervention together with monitoring of the direction of the epidemic. [Copyright &y& Elsevier]

Child adoption in the face of reproduction gone awry continues to remain an under researched aspect of contemporary Indian reality. This paper seeks to unpack some of the critical cultural issues underscoring the deep-seated reluctance towards adoption. Drawing on a larger multi-sited research project examining the experience of infertility and assisted conception in India, the paper sheds light on the state of current adoption practices in India. Thus, when faced with infertility, couples in this research emerged as favouring secret gamete donation as a means of bypassing infertility rather than the option of adoption.Invoking the concept of systematic misrecognition, the paper situates the modalities of salvaging infertility, either through medically assisted conception or adoption, as structuring infertile people''s quest for children. The paper relates the perceived stigma associated with infertility treatment and adoption with the inclusion of a “third party” that fractures the culturally conceptualized boundaries of family as inextricably tied to the conjugal bond. It is therefore argued that secrecy is born out of a need to obfuscate a “public and visible” violation of a culturally priced ideal that views an intimate connection between the “married body” and the progeny. Adoption continues to remain an undesirable option because the links between an adopted child and the social parent become a public, vocal, and visible admission of infertility that cannot be subsumed, like donated gamete conception, under a conspiracy of silence. [Copyright &y& Elsevier]

This paper provides an analytical framework for explaining the practice of diagnostic disclosure by drawing on theoretical developments regarding the question of "culture in action." Based on ethnographic and interview data collected from fieldwork at a major cancer hospital in China from 2015 to 2019, this paper explains how doctors and family members make decisions about diagnostic disclosure. We argue that it is important to understand the practice of diagnostic disclosure as motivated by the actors' values on the one hand, and constrained and enabled by the actors' skills on the other hand. It is also necessary to distinguish between personal and public values, as well as medical and interpersonal skills. Based on these distinctions, we will be better equipped to explain why diagnostic disclosure has encountered difficulties in family-centered societies, such as China. • Decisions about diagnostic disclosure can be explain by theories of "culture in action". • Diagnostic disclosure is motivated by actors' values, as well as constrained and enabled by skills. • It is necessary to distinguish between different levels and kinds of values and skills. [ABSTRACT FROM AUTHOR]

What are the prospects for a cross-cultural, interdisciplinary and methodologically plural approach to wellbeing? This question is addressed using Self-Determination Theory (SDT), a psychological theory based on quantitative empirical methods, to structure qualitative analysis of wellbeing in life history interviews in Chiawa, rural Zambia. Enquiry goes beyond simply reading across methods, disciplines and contexts, to consider fundamental differences in constructions of the human subject, and how these relate to understandings of wellbeing. Field research took place in two periods, August–November, 2010 and 2012. Analysis draws primarily on 46 individual case studies, conducted through open-ended interviews. These were identified through a survey with an average of 390 male and female household heads in each round, including 25% female headed households. As SDT predicts, the interviews confirm its key elements of autonomy, competence and relatedness as vital to wellbeing. However, these are expressed in ways that highlight material and relational, rather than psychological, factors. Key findings are: the mutual constitution of autonomy, competence and relatedness; the appreciation of autonomy as independence in action; the importance of social competence; and the centrality of relatedness. People appear as social and above all moral subjects. The paper concludes by endorsing SDT's utility in interdisciplinary approaches to wellbeing, but only if it admits its own cultural grounding in the construction of a psychological subject. This would go beyond recognising that autonomy, competence and relatedness may take socially and culturally distinctive forms, to questioning their universal status as basic psychological needs. Implications for organisations working on wellbeing are discussed. [ABSTRACT FROM AUTHOR]

Recent research has focused attention on the role of patients' and clinicians' cultural skills and values in generating inequalities in health care experiences. Yet, examination of how social structural factors shape people's abilities to build, refine, and leverage strategies for navigating the health care system have received less attention. In this paper I place focus on one such social structural factor, social support, and examine how social support operates as a flexible resource that helps people navigate the health care system. Using the case of families navigating pediatric cancer care this study combines in-depth interviews with parents of pediatric cancer patients ( N = 80), direct observation of clinical interactions between families and physicians ( N = 73), and in-depth interviews with pediatric oncologists ( N = 8). Findings show that physicians assess parental visibility in the hospital, medical vigilance, and adherence to their child's treatment and use these judgments to shape clinical decision-making. Parents who had help from their personal networks had more agility in balancing competing demands, and this allowed parents to more effectively meet institutional expectations for appropriate parental involvement in the child's health care. In this way, social support served as a flexible resource for some families that allowed parents to more quickly adapt to the demands of caring for a child with cancer, foster productive interpersonal relationships with health care providers, and play a more active role in their child's health care. [ABSTRACT FROM AUTHOR]

Culture is essential for humans to exist. Yet surprisingly little attention has been paid to identifying how culture works or developing standards to guide the application of this concept in health research. This paper describes a multidisciplinary effort to find consensus on essential elements of a definition of culture to guide researchers in studying how cultural processes influence health and health behaviors. We first highlight the lack of progress made in the health sciences to explain differences between population groups, and then identify 10 key barriers in research impeding progress in more effectively and rapidly realizing equity in health outcomes. Second, we highlight the primarily mono-cultural lens through which health behavior is currently conceptualized, third, we present a consensus definition of culture as an integrating framework, and last, we provide guidelines to more effectively operationalize the concept of culture for health research. We hope this effort will be useful to researchers, reviewers, and funders alike. [ABSTRACT FROM AUTHOR]

A recurring concern in genomics research is the possibility that it could lead to stigma for participants, their families and the population groups they belong to. Little evidence exists to explain how and when this ought to be a concern in genomics research in Africa whilst there is growing international evidence drawing into question the direct link between stigma and genetics. In this paper, we interrogate practical instances from African genomics research where stigma was identified as a concern in an attempt to nuance and refine accounts of when stigma should be considered as an ethical issue. The paper describes examples involving gendered blame, polygamy, beliefs in supernatural disease causation and sensitive information about group lineage. We propose that the concern may not be about stigma so much as broader research-related harm, including for instance reputational harm to population groups. Furthermore, we propose to shift the analytical gaze from establishing causal relationships to exploring the intersection of genomics with pre-existing stigma. Finally, we emphasize the importance of ensuring genomics researchers are culturally competent, meaning able to recognise when cultural factors impact on the possibility that genomics research could cause harm. • Gendered blame, polygamy and supernatural causal beliefs relate to stigma. • African genomics research intersects with pre-existing stigma and may cause harm. • Genomics can reveal sensitive information about group ancestry. • Genomics researchers need to be culturally competent to minimize risk of harm. [ABSTRACT FROM AUTHOR]

Social exclusion in later life is associated with decreased quality of life and poorer health outcomes. Reducing the number of people at risk of exclusion is a key theme in European social policy, but there is limited understanding of the relationship between neighbourhood characteristics, personal attributes and the level and development of social exclusion in later life. In this paper, cross-classified multilevel growth curve models for predicting exclusion are fitted to seven waves of data from the English Longitudinal Study of Ageing, collected between 2002 and 2015, allowing for the investigation of causal mechanisms linking area characteristics and exclusion in later life, including access to services and amenities, participation in civic, cultural and leisure activities and relationships with friends and family. Results show that living in a deprived area is associated with increased levels of exclusion, and this explained the higher levels of exclusion found for urban compared with rural areas. Population turnover among local residents did not impact on exclusion levels, but length of residence and the degree to which a person feels attached to their neighbourhood did, with ageing in place and stronger attachments predicting lower levels of social exclusion. In terms of individual characteristics, men, those in poor health, people with low levels of wealth or education, and those aged 80 or older, were more likely to experience increased levels of exclusion, while retirement and marriage provided a protective effect. The paper contributes new insights into the pathways through which characteristics of both individuals and neighbourhoods predict social exclusion in later life, and concludes by discussing the policy implications raised by the research. • This is the first longitudinal study of area effects on exclusion in later life. • It studies exclusion from amenities, civic, cultural, leisure and social activities. • Area deprivation is associated with higher levels of social exclusion in later life. • A sense of neighbourhood belonging lowers feelings of exclusion in later life. [ABSTRACT FROM AUTHOR]

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]

Research on gene-environment interaction was facilitated by breakthroughs in molecular biology in the late 20th century, especially in the study of mental health. There is a reliable interaction between candidate genes for depression and childhood adversity in relation to mental health outcomes. The aim of this paper is to explore the role of culture in this process in an urban community in Brazil. The specific cultural factor examined is cultural consonance, or the degree to which individuals are able to successfully incorporate salient cultural models into their own beliefs and behaviors. It was hypothesized that cultural consonance in family life would mediate the interaction of genotype and childhood adversity. In a study of 402 adult Brazilians from diverse socioeconomic backgrounds, conducted from 2011 to 2014, the interaction of reported childhood adversity and a polymorphism in the 2A serotonin receptor was associated with higher depressive symptoms. Further analysis showed that the gene-environment interaction was mediated by cultural consonance in family life, and that these effects were more pronounced in lower social class neighborhoods. The findings reinforce the role of the serotonergic system in the regulation of stress response and learning and memory, and how these processes in turn interact with environmental events and circumstances. Furthermore, these results suggest that gene-environment interaction models should incorporate a wider range of environmental experience and more complex pathways to better understand how genes and the environment combine to influence mental health outcomes. [ABSTRACT FROM AUTHOR]

As health and social service professions increasingly emphasize commitments to equity, advocacy and social justice, non-traditional entrants to the professions increasingly bring much-needed diversity of social backgrounds and locations. Long the domain of elite social classes, the professions are not always welcoming cultures for those from lower social class backgrounds. This paper draws on notions of material, social and cultural capital, along with habitus , to examine the experiences of professionals with lower-class backgrounds, in educational programs and in their professions. The critical interpretive qualitative study draws on interviews with 27 professionals across Canada in medicine, nursing, social work and occupational therapy. While participants were clearly set apart from their colleagues by class origins, which posed distinct struggles, they also brought valuable assets to their work: enhanced connection and rapport with clients/patients, approachability, structural analysis and advocacy, plus nuanced re-envisioning of professional ethics to minimize power dichotomies. Rather than helping lower-class entrants adapt to the professions, it may be more beneficial to alter normative professional cultures to better suit these practitioners. • People from lower-class backgrounds may struggle in the professions. • The material, social and cultural capitals expected cast them as cultural outsiders. • They may more readily enact the social justice and equity aims of the professions. • We need transformational change to professional cultures of elitism and exclusion. [ABSTRACT FROM AUTHOR]

The conditions under which people labour in mental health research affect how and what knowledge is produced – and who benefits or doesn't from involvement in health research systems. There has been, however, little sustained investigation of the uneven modalities of labour exploitation across what are increasingly financialised systems of mental health research. This theoretical paper advances conceptual and empirical investigations of labour in health research – outlining how material precarity and epistemic precarity often go hand in hand, and largely drawing on examples from the UK. The intertwining of labour relations and epistemic cultures can be understood by bringing together insights from two bodies of knowledge not commonly in contact with one another – survivor/service user research and critical research on universities and academic labour. The article addresses how mental health research makes significant use of the labour of (i) contract researchers (many of whom work on precarious and exploitative contracts); (ii) lay contributors (through 'patient and public involvement'); and (iii) research participants (where the conditions underpinning participation in various kinds of research increasingly blur the distinction between volunteering, and 'gig' work). Labour relations affect, and are affected by, efforts to change epistemic cultures and reduce epistemic inequalities, and epistemic and material precarity make efforts to improve research culture much more difficult. Those experiencing both material and epistemic precarity in health research systems need to be at the heart of efforts to combat both. • Labour conditions in mental health research affect how and what knowledge is produced. • Health research systems frequently rely on exploited labour. • Material and epistemic precarity frequently go hand in hand in mental health research. • Improving research cultures in mental health research demands addressing labour relations. • Those experiencing material/epistemic precarity should be core to improvement efforts. [ABSTRACT FROM AUTHOR]

Health systems in fragile states need to respond to shifting demographics, burden of disease and socio-economic circumstances in the revision of their health service packages. This entails making difficult decisions about what is and is not included therein, especially in resource-constrained settings offering or striving for universal health coverage. In this paper we turn the lens on the 2017–2021 development of Afghanistan's Integrated Package of Essential Health Services (IPEHS) to analyse the dynamics of the priority setting process and the role and value of evidence. Using participant observation of meetings and interviews with 25 expert participants, we conducted a qualitative study of the consultation process aimed at examining the characteristics of its technical, socio-cultural and organisational aspects, in particular data use and expert input, and how they influenced how evidence was discussed, taken up, and used (or not used) in the process. Our analysis proposes that the particular dynamics shaped by the context, information landscape and expert input shaped and operationalized knowledge sharing and its application in such a way to constitute a sort of "vernacular evidence". Our findings underline the importance of paying attention to the constellation of the priority setting processes in order to contribute to an ethical allocation of resources, particularly in contexts of resource scarcity and humanitarian need. • Describes the process of Afghanistan's latest health system revision. • Examines the complex process of priority setting in a fragile state. • Vernacular evidence is created through expert consultation where data gaps exist. • Unpacking the constellation of expert input is critical in priority setting. • Balanced process facilitation improves discussion around ethical resource allocation. [ABSTRACT FROM AUTHOR]

There is growing recognition of the importance of religion and religious beliefs as they relate to the experience of HIV, globally and in Papua New Guinea in particular. Based on 36 in-depth qualitative interviews conducted with people living with HIV receiving HIV antiretroviral therapy in 2008, this paper examines the cultural aetiology of HIV of in Papua New Guinea, the country with the highest reported burden of HIV in the Pacific. Narratives provided drew upon a largely moral framework, which viewed HIV acquisition as a consequence of moral failing and living an un-Christian life. This explanation for suffering viewed the individual as responsible for their condition in much the same way that neo-liberal biomedical discourses do. Moral reform and re-establishing a relationship with God were seen as key actions necessary to effect healing on the material body infected with HIV. Religious understandings of HIV drew upon a pre-existing cultural aetiology of dis -ease and misfortune widespread in Papua New Guinea. Understanding the centrality of Christianity to explanations of disease, and subsequently the actions necessary to bring about health, is essential in order to understand how people with HIV in receipt of antiretroviral therapies internalise biomedical perspectives and reconcile these with Christian beliefs. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents the preliminary findings of gender difference in the perception of radiation risk in the aftermath of the Fukushima nuclear disaster in Japan. In-depth interviews were conducted with the residents of Fukushima and other parts of Japan in November 2011 and July 2012. Compared to mothers, fathers in general expressed less concern for radiation. Fathers prioritized their responsibilities as the breadwinner for their families and saw radiation risk as a threat to economic stability and masculine identity. As a result, mothers' health concerns were dismissed, and they were prevented from taking preventive actions. The social norms in the dominant institutions such as corporations and the government influenced men's perception of radiation risk. The findings illustrate the importance of sociocultural context in which meanings of health risk are constructed. [Copyright &y& Elsevier]

Current institutional frameworks in sex- and gender-based analysis (SGBA) are promising, but significant gaps remain in their relation to recent developments in research praxis. In this paper we draw from our own experiences with a national health research funding agency, the Canadian Institutes of Health Research (CIHR), to critically examine the uptake and implementation of its current frameworks and practices of sex and gender analysis in health research. We conducted semi-structured interviews with a cohort of 18 health researchers alongside an institutional policy analysis to show how sex and gender have been understood, integrated, and addressed within the agency and initiative. Our findings reveal that attention to date has focused on representation (human and data) while deeper justice issues that are attentive to intersectionality, positionality and reflexivity—remain ambiguous. Finally, we discuss possible strategies for institutions to improve the uptake of knowledge, training, and policy to better support intersectional and culturally-relevant frameworks across the diverse research community. • Research institutes are taking up new concepts and frameworks of sex and gender analysis. • We examine whether sex and gender frameworks are attending to power and knowledge production. • Intersectionality positionality and reflexivity remain underdressed in sex and gender analysis. [ABSTRACT FROM AUTHOR]

Abstract: The notion that infant sleep environments are ‘good’ or ‘bad’ and that parents who receive appropriate instruction will modify their infant-care habits has been fundamental to SIDS reduction campaigns. However infant sleep location recommendations have failed to emulate the previously successful infant sleep position campaigns that dramatically reduced infant deaths. In this paper we discuss the conflict between ‘safeguarding’ and ‘well-being’, contradictory messages, and rejected advice regarding infant sleep location. Following a summary of the relevant background literature we argue that bed-sharing is not a modifiable infant-care practice that can be influenced by risk-education and simple recommendations. We propose that differentiation between infant-care practices, parental behaviors, and cultural beliefs would assist in the development of risk-reduction interventions. Failure to recognize the importance of infant sleep location to ethnic and sub-cultural identity, has led to inappropriate and ineffective risk-reduction messages that are rejected by their target populations. Furthermore transfer of recommendations from one geographic or cultural setting to another without evaluation of variation within and between the origin and destination populations has led to inappropriate targeting of groups or behaviors. We present examples of how more detailed research and culturally-embedded interventions could reorient discussion around infant sleep location. [Copyright &y& Elsevier]

Abstract: Sleeping, dreaming, and health or well-being are all closely related phenomena from an experiential and cultural point of view, and yet all three are often studied in isolation from one another. In this paper, I use an ethnographic and clinical lens to compare and contrast patterns of sleeping and dreaming and their relationship to health in a rural Indonesian society and among urban middle class people in the US. I demonstrate how culturally shaped patterns of sleeping and dreaming become linked through social practice and the implication of these practices for health and well being. I underscore, in particular, the seamless connection between waking and non-waking life, how daytime activities affect patterns of sleeping and dreaming, but also how the emotional and behavioral residues of the night affect daytime life and experience. Data for the Indonesia case were collected during extended fieldwork in 1981–1983, while the U.S. data come from my ongoing part-time private practice of psychotherapy and psychoanalysis. [Copyright &y& Elsevier]

Abstract: In South Africa, both HIV and gender-based violence are highly prevalent. Gender inequalities give men considerable relational power over young women, particularly in circumstances of poverty and where sex is materially rewarded. Young women are often described as victims of men, but this inadequately explains women’s observed sexual agency. This paper takes a different approach. We use qualitative interviews and ethnographic observation among 16 young women from the rural Eastern Cape to explore ways young women construct their femininities and exercise agency. The data were collected as part of an evaluation of Stepping Stones, which is a participatory behavioural intervention for HIV prevention that seeks to be gender transformative. Agency was most notable in particular stages of the dating ‘game’, especially relationship initiation. Constructions of desirable men differed but generally reflected a wish to avoid violence, and a search for mutual respect, sexual pleasure, romance, modernity, status and money. Agency was constrained once relationships were consented to, as men expected to control their partners, using violent and non-violent methods. Women knew this and many accepted this treatment, although often expressing ambivalence. Many of the women expressed highly acquiescent femininities, with power surrendered to men, as a ‘choice’ that made their lives in cultural terms more meaningful. In marked contrast to this was a ‘modern’ femininity, centred around a desire to be ‘free’. A visible third position, notably emerging after the Stepping Stones intervention, rested not on a feminist challenge to patriarchy, but on an accommodation with men’s power whilst seeking to negotiate greater respect and non-violence within relations with men. These multiple and dynamic femininities open up possibilities for change. They demonstrate the need to engage with women, both as victims of patriarchy and active supporters of the gender order. The multiplicity of women’s hopes and desires and circumstances of emotional and relational fulfilment provides potential for interventions with women that acknowledge existing gender inequalities, validate women’s agency, reduce violence and prevent HIV. [Copyright &y& Elsevier]

Abstract: This study explores the effects of the electronic medical record (EMR) on the power of the medical profession. It is based on twenty-five in-depth interviews with administrators and physicians across three departments of a large, US integrated health system, as well as ethnographic observation, all of which took place between September of 2009 and December of 2010. While scholarship on professional power has tended toward the opposite poles of professional dominance and deprofessionalization or proletarianization, I find that doctors'' interactions with the EMR reconcile these perspectives by making physicians'' professional identities consistent with their subordination to bureaucratic authority. After examining the electronic medical record as a disciplinary technology, the paper analyzes variation in the extent to which practitioners'' professional identities are reconciled with bureaucratic subordination across the different departments studies. [Copyright &y& Elsevier]

Abstract: This paper draws on two conceptual frameworks, therapeutic landscapes and postcolonial theory, to discuss aspects of medical tourism not addressed in extant literature. Building on the intersection between postcolonial and therapeutic landscapes scholarship, it highlights inequalities related to the production of national therapeutic landscapes located in postcolonial regions as well as their discursive (re)positioning as medical tourism destinations. As a framework, therapeutic landscapes can facilitate an understanding of medical tourism sites as curative spaces which combine modern and alternative forms of medicine with travel and leisure. Postcolonial theory critiques the economic, moral and cultural tensions emerging from the intersection between corporations that provide cheaper and more attractive medical services, and the nations on the periphery struggling to offer high medical standards that may not be accessible to their own local populations. In an effort to enhance scholarship on medical tourism, these conceptual frameworks are offered as points of departure, rather than sites of arrival, through which critical dialog on medical tourism can be sustained and broadened. [Copyright &y& Elsevier]

Abstract: Cultural explanations of black suicide have focused on the US and stressed religiosity as a protective factor. This paper adds to this literature by (1) expanding the analysis of the impact of religiosity on black suicide to 10 nations, and (2) assessing the extent to which a broader cultural construct (self expressionism) affects black suicide acceptability. Data are from Wave 4 of the World Values Surveys 1991–2001 and refer to 3580 black males nested in ten countries. A hierarchical linear regression model determined that religiosity predicted black suicide acceptability across ten nations. Self expressionism was positively associated with individual level suicide acceptability. Further, a cross-level interaction was found wherein individual level and societal level self expressionism combined to affect suicide acceptability. The variability in suicide acceptability among black males is predicted, in part, by both individual and group levels of adherence to values contained in a major cultural axis of nations: self expressionism. These new found associations compliment the impact of a standard predictor, religiosity, on suicide acceptability. [Copyright &y& Elsevier]

Abstract: The hygiene hypothesis offers an explanation for the correlation, well-established in the industrialized nations of North and West, between increased hygiene and sanitation, and increased rates of asthma and allergies. Recent studies have added to the scope of the hypothesis, showing a link between decreased exposure to certain bacteria and parasitic worms, and increased rates of depression and intestinal auto-immune disorders, respectively. What remains less often discussed in the research on these links is that women have higher rates than men of asthma and allergies, as well as many auto-immune disorders, and also depression. The current paper introduces a feminist understanding of gender socialization to the epidemiological and immunological picture. That standards of cleanliness are generally higher for girls than boys, especially under the age of five when children are more likely to be under close adult supervision, is a robust phenomenon in industrialized nations, and some research points to a cross-cultural pattern. I conclude that, insofar as the hygiene hypothesis successfully identifies standards of hygiene and sanitation as mediators of immune health, then attention to the relevant patterns of gender socialization is important. The review also makes clear that adding a feminist analysis of gender socialization to the hygiene hypothesis helps explain variation in morbidity rates not addressed by other sources and responds to a number of outstanding puzzles in current research. Alternative explanations for the sex differences in the relevant morbidity rates are also discussed (e.g., the effects of estrogens). Finally, new sources of evidence for the hygiene hypothesis are suggested in the form of cross-cultural and other natural experiments. [Copyright &y& Elsevier]

Abstract: Most malaria risk reduction strategies are firmly embedded in biomedical practices and public health perspectives. National and international programmes to ‘control’ malaria are particularly characterised by the promotion of public health interventions which converge on the disease vector, the malaria mosquito, notably through the use of indoor household spraying with insecticides, and the deployment of insecticide-treated bednets (ITNs). With convincing evidence for the effectiveness of ITNs in reducing the incidence of malaria, control programmes have emphasised the notion of ‘scaling-up’ bednet coverage. Much previous research on people’s ‘compliance’ with bednet programmes has tended to focus on the quantification of bednet usage and on deriving explanations for ‘non-compliance’ based on household or individual indicators such as wealth, age, gender or educational level, or on climatic factors such as season and temperature. However, malaria risk behaviours are also rooted in wider aspects of local livelihoods, and socio-cultural beliefs and practices which interplay with the use and, crucially, non-use, of bednets. This paper draws on empirical data derived from in-depth, one-to-one semi-structured interviews, focus groups and participatory methods (mapping and diagramming) with participants in two villages in rural Tanzania to explore the nature of these practices and vulnerabilities, and their potential impact on malaria exposure risk. Participants included farmers and pastoralists, both men and women, as well as village ‘officials’. By eliciting local understandings of malaria-related behaviours we explore how malaria risks are played out in people’s everyday lives, and the circumstances and decision-making which underpin non-usage of bednets. Our findings reveal the importance of shifting sleeping patterns in response to livelihood needs and socio-cultural practices and events. These arrangements militate against the consistent and sustained use of the bednet which are called for by public health policies. In particular we demonstrate the importance of the spatial and temporal dimensions of farming practices and the role of conflict over access to shared land; the impact of livelihood activities on malaria risks for school-aged children; risk behaviours during ‘special’ socio-cultural events such as funeral ceremonies; and routine, outdoor activities around dawn and dusk and the gendered nature of these practices. [Copyright &y& Elsevier]

Abstract: Assisted reproductive technologies (ARTs) have historically been sites of heated public controversy. However, with widespread use, the boundary-challenging risks surrounding ARTs have become less newsworthy. One exception includes their use by “older mothers,” particularly postmenopausal mothers. In this paper, I review the social science literature related to the risks of ARTs and the conceptualizations of “older mothers”. Next, I move to analyze the specific case of 60-year-old Ranjit Hayer, who gave birth to twins in Calgary, Canada, through the context of the Canadian media coverage the week following the birth, using concepts from cultural approaches to risk perception, constructivist studies of technology, and risk communication theory. I argue that risk discourses emerge when technologies and users expose and challenge the contingent stability of the sociotechnical discourses surrounding them. This leads to a public re-opening of a “closed” technology and user and a reconstruction of the risks associated with them. This case demonstrates how an apparently “settled” sociotechnical network becomes reframed in terms of risk, and how the negotiation of this risk reveals, constructs, and interweaves various boundary discourses. [Copyright &y& Elsevier]

Abstract: Posttraumatic stress disorder (PTSD) is one of the emblematic psychiatric conditions in contemporary public consciousness, indexing not only disordered minds, but also disordered human relations. With efforts currently mounting to refine criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), an important task is to re-examine the emotional foundations of trauma and their elaboration in social context. A body of clinical research on psychological trauma indicates that the emotion shame is central to the development and course of PTSD. However, current diagnostic criteria and bio-behavioral research do not account for these findings. In light of an emerging understanding of PTSD as a disturbance of affect systems (), this paper proposes a novel theoretical model that describes how shame underlies peri-traumatic and posttraumatic experiences of threats to the social self. It first presents a rationale for investigating traumatic shame that draws on affect theory and current findings in PTSD research. Next, it discusses the foundations of shame in perceptions of status inferiority and failure to conform to normative expectations and their elaboration in PTSD. Then it describes psychological, social, and cultural domains that are critical for contextualizing shame meanings and expressions. Finally, it recommends revisions to the diagnostic criteria for PTSD in DSM-V. [Copyright &y& Elsevier]

This paper analyzes the community health of the Wikwemikong Unceded Indian Reserve (WUIR), Ontario, Canada. Results are reported from fieldwork including participant observation, key informant interviewing and self-reported data measuring health status, risk behaviour, place of residence, self-identity, and personal history extracted from 350 interviews conducted during a community-wide needs assessment. The research aimed to create a health plan for the community; however, subsequent analysis of the needs assessment results indicates that internal diversity exists in health status and needs between the seven villages that comprise WUIR. The analysis suggests variation in health status and risk-taking behaviour among community members may be related to varying colonial histories among the villages. The implications of intra-community variation in health status in First Nations are discussed in relation to influential health policy theories such as the determinants of health and health transfer policy in Canada. [Copyright &y& Elsevier]

The majority of theoretical models have defined stigma as occurring psychologically and limit its negative effects to individual processes. This paper, via an analysis of how ‘face’ is embodied in China, deepens an articulation of how the social aspects of stigma might incorporate the moral standing of both individual and collective actors defined within a local context. We illustrate (1) how one''s moral standing is lodged within a local social world; (2) how one''s status as a ‘moral’ community member is contingent upon upholding intrapersonal and social-transactional obligations; and (3) how loss of face and fears of moral contamination might lead to a ‘social death’. We first draw from Chinese ethnographies that describe the process of human cultivation before one can achieve fully ‘moral’ status in society. We integrate findings from empirical studies describing how social-exchange networks in China are strictly organized based on the reciprocation of favors, moral positioning, and ‘face’. We further ground these Chinese constructs within a theoretical framework of different forms of capital, and discuss the severe social consequences that loss of face entails. By utilizing the examples of schizophrenia and AIDS to illustrate how loss of moral standing and stigma is interwoven in China, we propose a model highlighting changes in moral status to describe how stigma operates. We suggest that symbolic restoration of moral status for stigmatized groups takes place as local-level stigma interventions. By analyzing the moral aspects of ‘face’, we propose that across cultures, stigma is embedded in the moral experience of participants, whereby stigma is conceived as a fundamentally moral issue: stigmatized conditions threaten what matters most for those in a local world. We further propose that stigma jeopardizes an actor''s ability to mobilize social capital to attain essential social statuses. [Copyright &y& Elsevier]

“Survivor” has become a ubiquitous and largely unquestioned term in culture and cancer discourse. While anecdotal evidence suggests women with breast cancer find fault with survivor images and discourse, the extent to which women identify with or reject the survivor identity has not been empirically studied. This paper examines whether women treated for breast cancer embrace survivorship. Data come from 39 in-depth interviews with women in the United States who completed treatment for breast cancer 3–18 months prior to the interview. Despite the positive meanings attached to survivorship, many women altered the meaning of survivorship or rejected survivorship. In particular, the survivor discourse alienated women who struggle with the threat of recurrence, who feel their cancer experience was not severe enough to merit this title, or who desire a private disease experience. These findings illustrate the failure of our cultural conceptions of cancer to adequately reflect lived experience and highlight how individuals actively “craft” illness meanings. [Copyright &y& Elsevier]

The research literature about ‘brain death’ is largely characterized by biomedical, bioethical and legal writing. This has led to overlooking wider but no less pertinent social, historical and cultural understandings about death. By ignoring the work of other social and clinical colleagues in the study of dying, the literature on the determination of death has become unnecessarily abstract and socially disconnected from parallel concerns about death and dying. This has led, and continues to lead to, incomplete suggestions and narrow discussions about the nature of death as well as an ongoing misunderstanding of general public and health care staff responses to brain death criteria. This paper provides a sociological outline of these problems through a review of the key literature on the determination of death. [Copyright &y& Elsevier]