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Since the depathologisation movement in 2007 to challenge the pathologisation of trans identities in Western psychiatry, significant developments have occurred, including revisions to Standards of Care and diagnostic criteria such as ICD-11's gender incongruence and DSM-5's gender dysphoria, acknowledging gender diversity as an expected part of human development. This paper argues that Japanese medical models reflect global issues but also have unique aspects shaped by cultural and linguistic nuances. Using critical discourse analysis, this paper examines how depathologisation discourses are perceived in the Japanese medical community, focusing on the term seidouitsusei-syōgai (gender identity disorder), presenting three ways in which seidouitsusei-syōgai is used: psychiatric disorder, syōgai / sikkan (impairment/disability/disorder), and diagnostic category. These uses are influenced by legal and social reforms, healthcare access and alignment with international classifications, while the medical profession's authority remains unexamined. Reflecting the structural challenges of diagnostic models in trans medicine, the interpretation of seidouitsusei-syōgai differs from the English phrase 'gender identity disorder' due to the specific connotations of syōgai in the Japanese context. By examining Japan's approach to depathologisation and medicalisation, this paper enriches the understanding of trans medicine and the impact of depathologisation discourse in Japan. • Japanese medical views on trans depathologisation through critical discourse analysis. • Focusing interpretations of seidouitsusei-syōgai(=gender identity disorder). • 3 usages, psychiatric, syōgai/sikkan and diagnostic, are influenced by social factors. • The authoritative role of the medical profession remains unexamined. • Japan sharing structural problems of diagnostic model but has specific connotations. [ABSTRACT FROM AUTHOR]

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]

A perception at the core of studies that consider the link between social rank and stress (typically measured by the so-called stress hormone cortisol) is that the link is direct. Examples of such studies are Bartolomucci (2007) , Beery and Kaufer (2015) , and Koolhaas et al. (2017). A recent and stark representation of this body of work is a study by Smith-Osborne et al. (2023) , who state that "social hierarchies directly influence stress status" (Smith-Osborne et al. p. 1537, italics added). In the present paper, we reflect on this "direct" perspective. We conjecture that the link between social rank and stress involves an intervening variable: an indirect relationship arises when the loss of rank triggers a behavioral response in the form of risk taking aimed at regaining rank, and it is the engagement in risk-taking behavior that is the cause of an elevated level of cortisol. Smith-Osborne et al., as well as others whose papers are cited by Smith-Osborne et al. and who, like Creel (2001) and Avitsur et al. (2006) , conducted comprehensive research on the association between rank (social standing) and stress, do not refer to risk taking at all. We present four strands of research that lend support to our conjecture: evidence that in response to losing rank, individuals are stressed; evidence that in response to losing rank, individuals resort to risk-taking behavior aimed at regaining their lost rank; evidence that there exists a link between engagement in risky activities or exposure to risk and elevated levels of cortisol; and an analytical perspective on incidence and intensity, namely a perspective that shows how the willingness to take risks responds to a change in rank, specifically, how a loss of rank triggers a greater willingness to take risks and how this trigger is stronger for individuals whose rank is higher. • The link between social rank and stress involves an intervening variable. • Loss of rank triggers a behavioral response in the form of risk taking. • This response is aimed at regaining rank. • Risk-taking behavior is the cause of an elevated level of cortisol. [ABSTRACT FROM AUTHOR]

This paper explores news media discourse about care.data: an NHS England programme of work for amalgamating and sharing patient data from primary care for planning and research. It was scrapped in 2016 after three years of public outcry, delays and around 1.5 million opt-outs. I examine UK news media coverage of this programme through the 'fire object' metaphor, focusing upon the visions of purpose and value it inspired, the abrupt discontinuities, juxtapositions and transformations it performed, and the matters of concern that went unheeded. Findings suggest that, in care.data's pursuit of a societal consensus on NHS patient data exploitations, various visions for new and fluid data flows brought to presence narratives of transforming the NHS, saving lives, and growing the economy. Other realities and concerns that mattered for certain stakeholders, such as data ownership and commercialisation, public engagement and informed consent, commitment and leadership, operational capabilities, and NHS privatisation agendas, remained absent or unsettled. False dichotomies kept the controversy alive, sealing its fate. I conclude by arguing that such failed programmes can turn into phantom-like objects , haunting future patient data schemes of similar aspirations. The paper highlights the role news media can have in understanding such energetic public controversies. • Care.data was an NHS England's programme for extracting and analysing primary care data. • Care.data was scrapped in 2016 after public outcries and more than 1.5 million opt-outs. • I analyse UK news media to examine discourses around care.data's discontinuities and shifts. • Ethical concerns and design flaws empowered multiple visions to develop and compete. • Care.data arrived at an inevitable antagonistic deadlock that was hard to resolve. [ABSTRACT FROM AUTHOR]

Health inequalities are a perennial concern for policymakers and in service delivery to ensure fair and equitable access and outcomes. As health inequalities are socially influenced by employment, income, and education, this impacts healthcare services among socio-economically disadvantaged groups, making it a pertinent area for investigation in seeking to promote equitable access. Researchers widely acknowledge that health equity is a multi-faceted problem requiring approaches to understand the complexity and interconnections in hospital planning as a precursor to healthcare delivery. Operations research offers the potential to develop analytical models and frameworks to aid in complex decision-making that has both a strategic and operational function in problem-solving. This paper develops a simulation-based modelling framework (SimulEQUITY) to model the complexities in addressing health inequalities at a hospital level. The model encompasses an entire hospital operation (including inpatient, outpatient, and emergency department services) using the discrete-event simulation method to simulate the behaviour and performance of real-world systems, processes, or organisations. The paper makes a sustained contribution to knowledge by challenging the existing population-level planning approaches in healthcare that often overlook individual patient needs, especially within disadvantaged groups. By holistically modelling an entire hospital, socio-economic variations in patients' pathways are developed by incorporating individual patient attributes and variables. This innovative framework facilitates the exploration of diverse scenarios, from processes to resources and environmental factors, enabling key decision-makers to evaluate what intervention strategies to adopt as well as the likely scenarios for future patterns of healthcare inequality. The paper outlines the decision-support toolkit developed and the practical application of the SimulEQUITY model through to implementation within a hospital in the UK. This moves hospital management and strategic planning to a more dynamic position where a software-based approach, incorporating complexity, is implicit in the modelling rather than simplification and generalisation arising from the use of population-based models. [ABSTRACT FROM AUTHOR]

Stigma and discrimination are increasingly understood as shaping health, and in turn conceptualised as social processes shaped by power and structural inequities. A challenge to analysis and implementing interventions is developing theory that can integrate analysis of structure, agency and power. One theoretical framework already promoted by prominent scholars as supporting this need is Bourdieu's social practice theory. This paper explores the application to date of Bourdieu's theory on stigma, discrimination and health. The paper describes how existing health literature has used concepts of symbolic violence, fields, capitals and habitus to develop insight into stigma power. The discussion explores how this theoretical framework is though underutilised and there has been little consideration of new programmatic approaches based on this theory. Directions for future research include the need for integrated approaches to analysis, especially using habitus to explore stigma power, and addressing processes of change. Directions for conceptualising interventions address how a mismatch of field and habitus could foster change and then the role for prophets in fostering symbolic revolutions. All these potential directions must in turn be integrated within the vast scholarship on stigma. In conclusion, further application and development of Bourdieu's social practice theory could help address the theoretical challenges facing the field of stigma, discrimination and health research. • Bourdieu's theory has been widely promoted to support stigma, discrimination and health research. • Exploration of existing literature shows wide application and development. • Aspects of the theory, notably habitus, are little used. • The theory is little used in interventions; directions for future development are described. [ABSTRACT FROM AUTHOR]

Medical travel and transnational healthcare involve various difficulties such as the distance and disconnect between patients and healthcare providers, language barriers or logistical challenges of moving ill bodies across space. Medical travel facilitation steps in with some sort of brokerage service that contributes to overcoming or managing these difficulties and, as this paper suggests, acts to create a quality of 'smoothness'. By unpacking three salient facilitation practices, namely connecting, communicating, and coordinating, this paper conceptualises the empirically derived category of 'smoothness'. This as a disposition, outcome, and spatio-temporal manoeuvre of medical travel facilitation. Based on the way in which such practices of mediation act to create smoothness, namely in an attentive, persistent, and collective tinkering manner, this paper suggests that some practices of medical travel facilitation are productively thought not just about setting up the possibility of care transnationally, but that they are key forms of care in itself. Based on these findings, smoothness is considered to be a central but also contested quality of medical travel facilitation and brokerage in a broader sense, but as proposed here, also for care. This conclusion potentially has implications not just for the study of transnational healthcare and mediation activities, but also that of care and transnational mobilities more generally. • Medical travel facilitation creates smoothness in mediating transnational healthcare. • Conceptualising smoothness as a disposition, outcome and spatio-temporal manoeuvre. • Brokerage and an STS-take on medical travel facilitation and care. • Smoothness as a quality of medical travel facilitation, brokerage and possibly care. • Medical travel facilitation between Oman and India. [ABSTRACT FROM AUTHOR]

Despite overwhelming evidence to the contrary, the concept of 'race' as a biological unit continues to persist in various scientific disciplines, notably in the field of medicine. This paper explores the persistence of 'race as biology' in medical research via examining select citational practices that have perpetuated this problematic concept. Citations serve as a cornerstone in scientific literature, signifying reliability and expert affirmation. By analyzing citation threads and historical patterns, we aim to shed light on the creation and perpetuation of false scientific truths and their impact on medical research, training, and practice. We focus on two prominent examples, eGFR and Spirometry, and trace key articles' citational histories, highlighting the flawed evidence in support of racial corrections in medical assessments. The eGFR equation incorporates 'race' as a factor based on the erroneous belief that Black individuals have higher muscle mass than white individuals. Our analysis reveals that key cited sources for this belief lack robust and well-developed datasets. Similarly, Spirometry measurements incorporate racial correction factors, relying on questionable evidence dating back to the Civil War era. Citations serve as a cornerstone in scientific literature, signifying reliability and expert affirmation. They play a crucial role in shaping theoretical positions and validating data and assumed knowledge. Evaluating citation threads and key articles consistently referenced over time can reveal how falsehoods and erroneous assertions are constructed and maintained in scientific fields. This study underscores the need for critical examination of citational practices in medical research and urges a shift toward a more cautious approach when citing sources that support 'race as biology.' The paper calls for a reevaluation of pedagogical approaches and assigned readings in medical education to prioritize an anti-racist perspective in future research endeavors. • Algorithms in contemporary medicine often involve "race" as a biological variable. • We offer a review of the citation threads in eGFR and Spirometry algorithms. • Support for race as variable relies on faulty, weak, and unsupportive citations. • Medical training must attend to and use caution around "truths" about racialized bodies. [ABSTRACT FROM AUTHOR]

Populism has emerged as a central explanation employed by both media outlets and scholars for the mishandling of the COVID-19 crisis. Nonetheless, the relationship between public health and populism extends before and beyond the pandemic. This paper offers a comprehensive overview of existing evidence and theoretical conceptualisations on the intersection of populism, health emergencies, and contrarian scientific positions, drawing from a diverse range of disciplines. I conducted a scoping review of 283 original studies, analysing their analytical framework, geographic focuses, and methodological approaches. Employing quantitative text analysis, I summarised the research field into 18 common topics, organised into five coherent categories: citizen's perspective, political elites, political communication, pandemic consequences, and non-COVID-related issues. While the scholarly interest in this area has surged since the onset of the pandemic, it has predominantly concentrated on specific cases, such as Brazil and the US, often conflating different policy types. The evidence summary elucidates that populism assumes varying roles within distinct contexts, and there is no linear relationship between political populism and specific approaches to health crises and science. I further compare definitions of populism within the context of health and scientific positions. I propose that future research should employ a policy typology for health emergency responses, assessing political positions based on policy arenas. This paper contributes to the understanding of the complex interplay between political populism, contrarian scientific perspectives, and public health. • Descriptive summary of multiple disciplines and theoretical frameworks. • Research interest in this theme surged after the COVID-19 pandemic. • Geographic focus and generalisation of specific cases such as Brazil and the US. • Lack of linear and universal association between populism and health emergencies. • Adoption of a common policy typology to guide future research. [ABSTRACT FROM AUTHOR]

Since 2007, the number of HIV diagnoses in Turkey has increased more than 600% and the AIDS-related deaths have more than doubled. Despite trans community being severely impacted by the growing epidemic, there exists a conspicuous absence of epidemiological data regarding the HIV burden of trans people. This paper examines the medical experiences of HIV-positive trans women who engage in sex work and the harmful violence they encounter at the hands of health providers. The paper emphasizes the urgent need for comprehensive interventions to address the intersecting issues of HIV risk, structural violence, and discrimination faced by HIV-positive trans sex workers, one of the most marginalized communities worldwide. To interpret better how transphobia and HIVphobia become deeply entangled in Turkish medical settings, the paper draws from the concepts of iatrogenesis , necropolitics, and immunity. By bringing together these conceptual tools with long-term ethnographic data and in-depth interviews, this paper demonstrates that trans women are treated by healthcare providers as though they are always-already infectious. The paper contends that aggressive immunitarian boundaries, erected between healthcare personnel and individuals deemed "contagious others," are central to doctors' denial of medical care and reluctance to touch, examine, or even admit trans patients, particularly when they are HIV-positive. • Social immunization lies at the core of doctors' refusal of care for trans patients. • Social immunization is central to the operation of necropolitics and iatrogenesis. • Doctors establish violent boundaries in an attempt to "protect" themselves. • Trans women are assumed to be inherently contagious by healthcare providers. • Trans communities are slowly debilitated through denial of healthcare services. [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]

Existing research has documented various determinants of mental health related to individuals' social connections, but less is known about the role of the structural features of interpersonal networks. This is especially true in the case of bridging , which refers to ties to people who are otherwise disconnected from each other. By intersecting theories of social networks and gerontology, this study employs within- and between-person analysis with data from the National Social Life, Health, and Aging Project (NSHAP) to examine the association between social network bridging and depression in later life. The study finds that bridging, particularly between kin and non-kin members in the network, is associated with increased depressive symptoms in later life. This association is contingent on social support and strain respondents experienced, and it exhibits variations within individuals over time, especially among older adults in the youngest age cohort (57–64 years old included in NSHAP in 2005). In closing, the paper discusses the extent to which heterogeneous network structures may be one mechanism that shapes mental health trajectories in the context of later life-course experiences. • The paper discusses how bridging disparate network members produces strain that elevates depression risks in later life. • Older adults' bridging potential in personal networks is classified into three distinct types. • The association between bridging and elevated depressive symptoms is unique to bridging unconnected kin and non-kin. • The effect of bridging is more so for the youngest age cohort than older cohorts. [ABSTRACT FROM AUTHOR]

In their 2010 book, Lorna Weir and Eric Mykhalovskiy conceptualised the role of vigilance in unknown and emerging infectious disease threats. Theirs is a macro-level account which draws on empirical data to describe vigilance as a set of technical and political arrangements that govern collection, analysis, interpretation and communication of data as it pertains to unknown threats. In this paper we expand their work to detail a conceptual analysis of the role of vigilance at the micro-level during periods of high infectious disease threat. Our data are daily press conferences and associated non-discursive tools in New South Wales (NSW), Australia during times of heightened COVID-19 risk. This paper is a conceptual analysis that draws on theories of vigilance and related concepts to show how a key aspect of vigilance is making previously unseen threats visible or present. Communications formulated and encouraged three types of vigilance as a set of governing relations: institutional or authority-based; individual outward-facing; and individual inward-facing. We also describe the relationship between vigilance and related concepts that are used in response to anticipated public threats. Authority based vigilance involved contact tracing and policing of movement and behaviours. In individual outward facing vigilance people were asked to be alert to, analyse, and react to risk in their immediate environment. Inward facing vigilance required people to gather and react to information about their own behaviours and within their own bodies. There was a relationship between different types of vigilance; as risk increased and authority-based vigilance was less successful in containing the spread of infection, individual vigilance had a stronger role to play. This extension of vigilance at the micro-level sees some of the same unintended consequences as Weir and Mykhalovskiy describe at the global level, particularly in how burdens are inequitably distributed and experienced. • Citizens became an arm of vigilance apparatus during COVID-19 pandemic in Australia. • Vigilance was authority-based; individual outward facing; individual inward facing. • Disadvantaged populations carried higher vigilance burden. • Earlier conceptions of vigilance in infectious disease emergencies are extended. [ABSTRACT FROM AUTHOR]

This paper begins with the common phrase 'good girl' as a lens through which to explore the insidious nature of patronising and paternalistic language on women's agency in obstetric care. Here we see how misogynistic language is both violence against women in its own right, and serves to create a context in which more extreme obstetric violence can be precipitated. Based on thematic analysis of discussion on Mumsnet, and on contributions to a research-focused Facebook group, this paper illustrates the complexity of recognising and refuting misogyny as a female patient as well as the damage that can occur from a cultural context in which this language is normalised. Here, words both boast a materiality through the environments they reify, and become transient and slippery, with semiotic uncertainty. • Use of misogynistic language in obstetric and fertility care is widespread. • This language may be difficult to identify and address. • Language that positions women as incompetent creates a context in which violence may occur during childbirth. • Experiences of obstetric violence are common even in the UK, amongst well-educated women. [ABSTRACT FROM AUTHOR]

Previous studies of service reconfiguration in healthcare have explored the influence of power on processes and outcomes. However, in these accounts the moral agency of managers is often underemphasised. This paper draws on the theoretical tools provided by the sociology of morality to help deepen understanding of the interaction between power and moral agency in service reconfiguration in healthcare. It presents results from a qualitative study of a pan-organisational service reconfiguration in the NHS in England, involving nineteen in-depth interviews with those leading the change and the analysis of twelve programme documents. We combine concepts of the moral background and epistemic governance to interpret participants' conviction that the service change was 'the right thing to do'. The paper shows how epistemic work carried out by service change regulations shaped the moral background within which participants worked. This, in turn, channelled their moral agency – specifically their commitment to patient care – in a way that also reflected central priorities. The paper adds to sociological understandings of service reconfiguration through considering the interaction of structure, agency and power, while also developing the concept of the moral background to show how power relations can influence moral beliefs. • Managers can show strong faith in uncertain evidence for healthcare service change. • The moral background explains this in a way which considers power and moral agency. • Confidence in evidence depends on background assumption of future as predictable. • Confidence also depends on premise that finances are not open to moral evaluation. • Service change regulations carry out epistemic work on background assumptions. [ABSTRACT FROM AUTHOR]

Virtual agents (VAs) and immersive virtual reality (VR) applications broaden the opportunities for accessing healthcare by transposing certain processes from the analogue world into a virtual realm. While these innovations offer a number of advantages including improved access for individuals in diverse geographic locations and novel therapeutic options, their implementation raises significant ethical, social, and legal implications. Key considerations pertain to the doctor-patient relationship, privacy and data protection, justice, fairness, and equal access as well as to issues of accountability, liability, and safety. This paper conducts a comprehensive review of the existing literature to analyse the ethical, social, and legal ramifications of employing VAs and VR applications in healthcare. It examines the recommended strategies to mitigate potential adverse effects and addresses current research gaps in this domain. • Virtual agents (VA) and immersive virtual reality (VR) are explored in the healthcare sector. • The paper investigates their ethical, legal, and social implications (ELSI) on basis of a literature review. • Key considerations pertain to the doctor-patient relationship, data protection, equal access, liability, and safety. • The paper gives an overview of the recommendations made to mitigate risks. [ABSTRACT FROM AUTHOR]

Child and maternal health, a key marker of overall health system performance, is a policy priority area by the World Health Organization and the United Nations, including the Sustainable Development Goals. Previous realist work has linked child and maternal health outcomes to globalization, political tradition, and the welfare state. It is important to explore the role of other key policy-related factors. This paper presents a realist synthesis, categorising policy instruments according to the established NATO model, to develop an explanatory model of how policy instruments impact child and maternal health outcomes. A systematic literature search was conducted to identify studies assessing the relationships between policy instruments and child and maternal health outcomes. Data were analysed using a realist framework. The first stage of the realist analysis process was to generate micro-theoretical initial programme theories for use in the theory adjudication process. Proposed theories were then adjudicated iteratively to produce a set of final programme theories. From a total of 43,415 unique records, 632 records proceeded to full-text screening and 138 papers were included in the review. Evidence from 132 studies was available to address this research question. Studies were published from 1995 to 2021; 76% assessed a single country, and 81% analysed data at the ecological level. Eighty-eight initial candidate programme theories were generated. Following theory adjudication, five final programme theories were supported. According to the NATO model, these were related to treasure, organisation, authority-treasure, and treasure-organisation instrument types. This paper presents a realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes from a large, systematically identified international body of evidence. Five final programme theories were supported, showing how policy instruments play an important yet context-dependent role in influencing child and maternal health outcomes. • A realist synthesis was conducted. • Assessed relationship between policy instruments and child and maternal health. • Synthesis informed by 132 unique studies. • Five final programme theories were supported. • Impact of policy instruments was context-dependent. [ABSTRACT FROM AUTHOR]

Participation of citizens and service users is increasingly commonplace in research, policy and technology development. Alongside this development, social scientists have become increasingly incorporated into large-scale research and innovation projects to facilitate participatory spaces. This requires reflection on the mechanisms, outcomes and, ultimately, the accountabilities of participation. In this paper, we propose the lens of care framework for approaching such reflections. We illustrate its value by using it to account for our role in establishing participatory spaces as part of a European Horizon 2020-funded research and innovation project, entitled EmERGE. We describe the codesign processes we developed and implemented with the aim of enabling heterogeneous voices, distinct experiences and multiple ideas to be articulated to inform the development and implementation of a digital platform for HIV care. We show how the lens of care framework enables us to trouble participation along prior theoretical distinctions between patients/citizens roles, invited/uninvited spaces and inclusive/scientistic voices and provides novel lines of inquiry to capture the relational and emergent processes of participation in digital health innovation. In the EmERGE project, spaces of participation were co-created within and by the community, whose members skilfully arranged the material, social and temporal set-up. Within these spaces we were able to articulate voices, deliberate knowledge and study the potentialities of technology so that initial technological inscriptions of empowerment through information-push were challenged and were, eventually, replaced by more interactive forms of clinician-patient engagement in digital HIV care. Through the lens of care , this paper aims to provide a reflective tool for researchers and practitioners who are involved in the design, implementation, and evaluation of participatory projects. • Demonstrates how participation has been troubled along three key dimensions. • Develops the lens of care framework to reflect and evaluate participatory processes. • Elaborates the codesign process to develop a digital health platform for HIV care. • Analyses the selection of actors and knowledges within participatory spaces. • Guides researchers to take responsibility for the worlds they co-construct. [ABSTRACT FROM AUTHOR]

The first Transplant Games took place in 1978 in Portsmouth, England. Since then, numerous Olympic-style sporting 'Games' have been established, each aiming to increase public awareness of organ donation, demonstrate the benefits of transplantation, and encourage patient fitness. Despite this, there is limited research exploring the psycho-social and health impacts of the Games. Drawing on qualitative research conducted at the 2022 British Transplant Games and the 2022 European Transplant and Dialysis Games, this paper explores the Games through a therapeutic landscapes framework, a concept that examines the ways in which environments contribute to health and wellbeing. Building upon work that acknowledges the relational and contingent nature of health-in-place, I argue that the Games are a therapeutic landscape of social relations for transplant recipients in three ways: providing a landscape of belonging , a landscape of hope , and a landscape of motivation. Through this therapeutic landscapes perspective, the Transplant Games are presented as a peer-to-peer clinic – a care space where individuals are more actively involved in their health on a reciprocal level than in the traditional hospital clinic. In turn, this paper emphasises the crucial role of affective peer support in producing health-promoting environments. This research seeks to make a practical contribution to the wider transplant community by promoting the Games as an environment which may positively contribute to both physical and mental wellbeing. • The Transplant Games function as a therapeutic landscape for organ recipients. • They provide a peer-to-peer clinic where participants are active in their health. • The Games provide a landscape of belonging, acceptance, understanding and family. • In showing you can still lead a healthy life, the Games become a landscape of hope. • As a landscape of motivation, the Games improve both physical and mental health. [ABSTRACT FROM AUTHOR]

Achieving sufficient COVID-19 vaccination coverage has been hindered in many areas by vaccine hesitancy. Many studies based on large survey samples have characterized vaccine refusal, but there are fewer in-depth qualitative studies that explore hesitant adoption: the middle-ground between vaccine acceptance and refusal, and how individuals may move across this continuum depending on their lived experience. For this paper, we use the narratives of 25 adults living in off-road, predominately Alaska Native communities to describe the complex decision-making processes undertaken by ' hesitant adopters', defined in our study as those who completed their initial COVID-19 series despite reporting hesitancy. Interviewees' stories help illustrate how hesitant adopters' decision-making processes involved making sense of information through interactions with trusted individuals, lived experiences, observations, emotions, and personal motivations. For the majority of these hesitant adopters' (n = 20, 80%) interpersonal interactions were key in helping to make the decision to get vaccinated. Over half of the interviewees (n = 14, 56%) described how conversations with individuals they trusted, including healthcare providers, family, friends, and interactions through their professional network made them feel safe. One third of the hesitant adopters (n = 7, 28%) attributed their decision to get vaccinated based on the influence of Alaska Native Elders including their knowledge, personal experiences, as well as being motivated by the desire to protect them. Independent research was also important to about a quarter of hesitant adopters (n = 6, 24%), and for these interviewees it was the process of gathering information on their own and learning from others, especially healthcare providers who could answer their questions and alleviate their concerns. This paper illustrates the temporality of vaccine decision-making: vaccine acceptance for those who are hesitant may be an ongoing process that is influenced by personal experience, relationships, and context. • Understanding hesitant adoption provides insights into increasing vaccine acceptance • In remote Alaska, Elders may influence the decisions community members make • Images and conversations reinforced narratives of safety and efficacy • Agency in information-seeking increased vaccine confidence [ABSTRACT FROM AUTHOR]

The changing organisation and governance of healthcare work represents a persistent focus of micro-politics. Whilst there is a developed literature describing the micro-political struggles that occur amongst healthcare occupations, there is little understanding about how, when and why actors become politically aware and active. Framed by research on political activation and the concept of identity work, this paper reports on a narrative interview study with 65 people, specifically doctors, nurses and managers, working in the English healthcare system. The narratives show that healthcare workers become increasingly aware of and engaged in micro-political activities through incremental stages based on their accumulating experiences. These stages are opportunities for identity work as actors make sense of their experiences of micro-politics, their occupational affiliations and their evolving sense of self. This identity work is shaped by actors' changing views about the morality of playing politics, the emotional implications of their engagement, and their deepening political commitments. The study shows that political socialisation and activation can vary between occupations and rather than assuming political affiliations are given or acquired the papers highlights the reflective agency of healthcare actors. • The study shows how healthcare workers become politically active. • Political activation develops through accumulated experiences of micro-politics. • Political activation involves identity work to construct a coherent sense of self. • Identity work centres on questions of morality, emotion and ideology. • Hybrid roles complicate political activation and affiliation. [ABSTRACT FROM AUTHOR]

Envenomation challenges international public health, and antivenom serum is a strategic tool in the management of this condition. However, although antivenom serum has been in use since the late 19th century, the accessibility, quality and safety of this essential health product are still causes for concern in the most affected areas. The reasons for such a situation are multiple and include the poverty of snakebite victims, the high production costs of serum, the logistical difficulties pertaining to the mostly rural location of envenomation events, however one root cause has been the recurring difficulty to standardize antivenom serum as a health commodity. This paper, grounded in "Science and Technology Studies" (STS) focuses on this standardization issue, and argues that it can be explained in two complementary ways: on one hand, the difficulty to standardize serum relates to the nature of venom itself, and on the other hand, it relates to the social and institutional characteristics of envenomation as a neglected disease. The argument is supported by the analysis of reports published by the World Health Organization expert committee on biological standardization from 1947 to 2022 and dealing with the standardization of venom and antivenom. The paper describes the successive standardization strategies implemented by international public health actors. This analysis shows that standardization procedures are shaped by a series of interactions between objects (venom and antivenom), scientific bodies of knowledge that characterize them (eg. toxinology or venomics), organizational and financial public health regimes that frame their circulation. The difficulties raised by the standardization of antivenom reveal the problematic articulation between these domains. Acknowledging this problematic articulation, the discussion emphasizes its consequences for the understanding of relations between medical technologies, global markets and so-called "natural resources". One conclusion drawn from these findings is to call for a "One Health" approach that would take into greater account the diversity and complexity of non-human life. • Antivenoms are essential in the fight against snakebite related mortality and incapacity. • The standardization of antivenoms has been historically difficult to ensure. • This situation is conditioned by the nature of venom as a biological product. • It also relates to the status of envenomation as a neglected condition. • This situation entangles nature, market, biomedical knowledge, health policies. [ABSTRACT FROM AUTHOR]

Mothers are commonly blamed for the ill-health of their children, and this is well documented in research. However, few studies have considered gendered patterns of blame for hereditary conditions caused by mutations from both parents through dual, shared genetic inheritance. This paper explores the 'gendering' of blame in the context of an inherited blood disorder known as sickle cell disease. The findings are drawn from 18 focus group discussions with 117 caregivers of children with sickle cell disease in Malawi and Uganda. Although one mutation from each parent is required for the disease to develop, low awareness about their status as healthy carriers of a sickle cell trait complicated the caregivers' recognition and acceptance of their genetic link to the child's condition. This study demonstrates how fathers and other members of the paternal side of the child's family would deflect blame from their own lineage by directing sole 'genetic responsibility' for the child's disease towards mothers. We discuss the implications of gendered blame on household dynamics and healthcare-seeking for children with sickle cell disease in this setting. • Sickle cell disease develops if the child inherits one mutation from each parent. • Low awareness about sickle cell disease led to gendered blame-shifting. • Mothers were attributed sole genetic responsibility for the child's condition. • Invisible inheritance through healthy carriers may cause gendered patterns of blame. [ABSTRACT FROM AUTHOR]

Taylor Swift is arguably one of the most popular and influential celebrities. Of particular interest is her power as a role model for millions of fans across the world. Swift has spoken openly about different cultural issues, including her struggles with disordered eating and diet culture. Thus, the purpose of this paper was to explore whether Swift's disclosures of her own eating and body image struggles influenced her fans. Over 200 TikTok and Reddit posts related to Swift and eating disorders or body image, as well as their associated comments, were qualitatively coded to examine relevant themes. Key themes included: 1) Swift as a role model for disordered eating recovery; 2) use of or identification with specific Swift songs to illustrate struggles with eating or body image; 3) continued objectification of Swift's body; and 4) conflicted reaction to a scene in Swift's video for 'Anti-Hero' that depicted the word 'fat' on a scale. Overall, Swift's disclosures of her own eating/body image struggles positively influenced her fans' relationships with their eating behaviors and body image. This analysis illustrates the positive influence celebrities can have while also highlighting the limitations of personal disclosures to impact understanding of systemic issues like anti-fat bias. • Taylor Swift is a positive role model for users. • Swift content positively impacted fans' disordered relationships to food and body. • Swift content can reduce stigma of eating disorders and contribute to recovery. • In contrast, themes of objectification and anti-fat bias were present. [ABSTRACT FROM AUTHOR]

According to popular understandings, children grow from a state of dependence to eventually become independent adults. Interdependence helps to disrupt the in/dependence binary and is a useful concept for making sense of the experiences young people with variations in sex characteristics in relation to healthcare. This study used semi-structured interviews with 32 health professionals, 33 caregivers and 12 young people recruited in the UK and Sweden. The analysis is guided by the questions: (1) how do young people, carers and health professionals position themselves in the adult/young person relationship in the context of healthcare? (2) how is the (in/ter)dependence of young people imagined when young people, carers and health professionals talk about healthcare? Our analysis shows how carers and health professionals might support dominant understandings about young people growing towards independence while providing little opportunity for young people's agency and voice. Interviews with young people gave clear examples of their negotiating relational ways of being, seeking agency in the context of healthcare and not simply becoming independent of adults. This analysis also draws attention to the ways young people might be silenced within healthcare contexts. The present paper is based on secondary analysis of data from the SENS. It works with concepts of relationality and interdependence to draw out the possibilities of voice and agency for young people with variations in sex characteristics in healthcare contexts. • Youth with variations in sex characteristics are sometimes silenced in the clinic. • There is sometimes too little room for youth agency in healthcare. • A relational approach could improve the healthcare experiences of young people. • Working towards interdependence, not simply independence, can support youth. • It is important to value knowledge that is based on intersex lived experience. [ABSTRACT FROM AUTHOR]

There is a critical shortage of health professionals globally which is affecting the possibility of attaining universal health coverage. Developing countries in sub-Saharan Africa such as Ghana and Nigeria are disproportionately affected and the shortfall in health professionals is envisaged to worsen over the next decade. Countries have responded differently in addressing this shortage. To understand the differing response to the same policy issue in two countries that share similar characteristics in terms of geolocation, socioeconomic indices and disease burden, this paper offers a comparative policy analysis of the two countries using the 3-I framework and punctuated equilibrium theory as comparative policy analysis tools. The analysis identified the ideas, interests, and institutions at play and how they have led to different policy outcomes in both countries. The analysis also shows the interaction between subsystems, policy images and policy venues and how this interaction led to policy change, in the case of Ghana and lag in the case of Nigeria. Our findings show four critical areas in addressing health workforce shortages in both countries – a general approach to addressing the issue, welfare and remuneration, workforce autonomy and career progression, and financing for workforce improvement. For Ghana, there has been significant policy change including implementing strategies for increasing the production of health professionals and addressing remuneration and welfare issues. For Nigeria, there has been seems to be a lag in policy change. While the findings show that Ghana's approach has seemingly put them on a good path toward universal health coverage, applying any lessons should, however, be contextual, considering other country-level and health systems factors that are relevant to addressing health workforce shortages. • African countries bear the disproportionate burden of global health worker shortage. • Different countries in the region have had different policy responses to the issue. • Ghana's response has been strategic, positive, and leading them towards UHC. • Nigeria has witnessed policy stagnancy, encumbered by health systems politics. • To achieve UHC, health worker shortages need strategic context-based policy solutions. [ABSTRACT FROM AUTHOR]

Using cross-sectional data from a representative sample of the French population (the 2008 Disability Health survey), this paper examines whether the SF-6D, a widely used preference-based measure of health-related quality of life in economic evaluations, fully captures the variation in subjective well-being (SWB) due to chronic illnesses. We conduct a mediation analysis to disentangle the direct and indirect, through the SF-6D, effects of various chronic conditions on SWB (happiness). Our results show that the SF-6D reflects changes in happiness due to most illnesses except mental illness. Changes in SWB mediated by the SF-6D account for 74% of the total effect. The variation unexplained by the SF-6D is significant and increases substantially in the presence of multimorbidity when a chronic illness is combined with anxiety or depression. Overall, our results suggest that the SF-6D incompletely captures the subjective experience of chronically ill patients, especially those with comorbid conditions. • 74% of the effect of chronic illness on happiness is captured by the SF-6D. • The SF-6D does not fully capture the effect of mental illness on happiness. • The effect not captured by the SF-6D increases significantly with multimorbidity. [ABSTRACT FROM AUTHOR]

Women's empowerment status varies greatly in India according to caste, class, ethnicity and region. This paper aims to investigate the caste/tribe disparity in women's empowerment by region, the main correlates of each domain of empowerment, and the association of women's empowerment with nutritional and health care access outcomes, specifically anaemia, menstrual hygiene, and institutional delivery. Using National Family Health Survey-5 (2019–2021) data, we have created a modified survey-based women's empowerment index (SWPER) using principal component analysis with Oblique varimax rotation. The first four components are interpreted as an attitude to violence, freedom of movement, decision-making power and social independence. Several multivariate regression models were used to understand the factor associated with empowerment and the association of women's empowerment with different health outcomes. The results indicate that women from the forward castes are the most empowered in most domains except decision-making. However, after controlling other background variables, the forward castes women are found to be the most empowered in attitude to violence, whereas Scheduled Castes and Scheduled Tribes women were found to be the most empowered women in decision-making. With regards to social independence, deprived castes women are more empowered than the forward castes women. The likelihood of empowerment in social independence domain increases with increasing wealth. There are wide regional variations in empowerment level between different social groups. Caste/tribe identity plays a significant role in determining health outcomes in India. Among all empowerment domains, social independence emerges as the most significant associated factor with improved health across all caste/tribe groups. The path to women's empowerment in India must recognize the intersectionality of caste/tribe identities, and address regional disparities. Social independence emerges as a critical determinant across all caste/tribe groups for improving health. Measures should be taken to empower women through the underlying factors of social independence. • This study uses SWPER index to assess women empowerment within India's caste/tribe. • Forward caste women are most empowered in all domains except decision-making. • Scheduled Tribe women from Northeast India are most empowered in decision-making. • Social independence empowerment domain is crucial for improving women's health. [ABSTRACT FROM AUTHOR]

In this paper, I examine the embodied transformative memory of GuateMaya feminist group, GuateMaya Mujeres Resistiendo-Los Angeles (GMR-LA). Through a decolonial feminist perspective and feminist ethnographic approach, I built an intimate relationship with the grassroot group in Los Angeles. GMR-LA comprises Guatemala's 36-year (1960–1996) war survivors and women in the diaspora who continue to amplify the cultural memory of the disappeared. The article will delve into the concept of healing cartographies and the ethnographic work I employed in Los Angeles from 2019 to 2023. A particular method I used was body mapping to examine the embodied transformative memory of the groups and women who seek justice. Body mapping has been used with HIV-positive patients and migrant children. Latin American feminist decolonial geographers (Cabnal, 2010; Zaragocin and Caretta 2020; GeoBrujas, 2021b) are using the method of body mapping as a decolonial, counter-cartographic perspective that highlights Indigenous peoples' lived experiences. I use the method to explore the relationships between the body, memory, and healing from intergenerational trauma. Informed by decolonial feminists, I aim to center the oral and embodied testimonios of the GuateMaya feminist group and be guided by a body-mind-spirit perspective to amplify the concerns, visions, and futures of GuateMaya feminist groups across the hemisphere. • GuateMaya feminist group in the diaspora. • Guatemalan women survivors of genocide. • Body mapping a feminist popular education method. • Embodied transformative memory. [ABSTRACT FROM AUTHOR]

Increasing evidence suggests that new technologies tend to substitute for low skilled labour and complement highly skilled labour. This paper considers the manner in which new technology impacts on two distinct groups of highly skilled health care labour, cardiologists and cardiac surgeons. We consider the diffusion impact of PCI as it replaces CABG in the treatment of cardiovascular disease in the English NHS, and explicitly estimate the degree to which the cardiac surgical workforce reacts to this newer technology. Using administrative data we trace the complementarity between CABG and PCI during the mature phase of technology adoption, mapped against an increasing employment of cardiologists as they replace cardiothoracic surgeons. Our findings show evidence of growing employment of cardiologists, as PCI is increasingly expanded to older and sicker patients. While in cardiothoracic surgery, surgeons compensate falling CABG rates in a manner consistent with undertaking replacement activity and redeployment. While for cardiologists this reflects the general findings in the literature, that new technology enhances rather than substitutes for skilled labour, for the surgeons the new technology leads to redeployment rather than a downsizing of their labour. [ABSTRACT FROM AUTHOR]

• The paper examines appointment cancellations for English cancer patients during COVID-19. • Pandemic patients waited 19 more days for rescheduled appointments than pre-pandemic. • Pandemic cohort had 14% fewer outpatient, 32% fewer inpatient visits, 50% less hospitalized. • No mortality difference suggests hospitals prioritized acute cases despite fewer resources. • Later cancellations less disruptive; provider-initiated linked to higher survival rates. [ABSTRACT FROM AUTHOR]

Gentrification, growing income inequality, urban development, and the affordable housing crisis necessitate understanding the impact of the concern of displacement on health — prior to or even in the absence of a displacement event. In this paper, I use the term "exclusionary displacement pressure" to unify the literature on exclusionary displacement and displacement pressure, highlighting the disproportionate and inequitable impacts of displacement pressure among communities of color. Through following 35 residents over 2.5-years (2019–2022) in one predominantly low-income Hispanic/Latinx immigrant neighborhood in Denver, Colorado, I examine how exclusionary displacement pressure shapes their health and wellbeing over time. Through paying attention to how participants' lived experience is shaped by structural vulnerability (e.g. lack of documentation status, inadequate work, limited access to safety net systems), I identify how exclusionary displacement pressure is constantly internalized and responded to as a unique embodied health experience, wearing on individuals over time and reproducing population health inequities. The framework of embodied health experiences captures the wide range of health-related impacts, from diagnosable health conditions to idioms of distress, using participant's own language of suffering to express how they were feeling , battling , and enduring the pressure. Theorizing on structural vulnerability within specific subpopulations with intersecting identities, such as low-income immigrant Hispanic/Latinx communities, provides a bottom-up refinement to existing theories of embodied health. Understanding the place-health experiences of individuals in changing neighborhoods over time is also critically important to define time points at which context-specific supports and interventions are appropriate. • Gentrification impacts health through exclusionary displacement pressure. • Embodied health experiences highlight residents' structural vulnerability. • Stabilizing interventions are needed in advance of physical displacement. [ABSTRACT FROM AUTHOR]

The United States offers two markedly different subsidy structures for private health insurance. When covered through employer-based plans, employees and their dependents benefit from the exclusion from taxable income of the premiums. Individuals without access to employer coverage may obtain subsidies for Marketplace coverage. This paper seeks to understand how the public subsidies embedded in the privately financed portion of the U.S. healthcare system impact the payments families are required to make under both ESI and Marketplace coverage, and the implications for finance equity. Using the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) and Marketplace premium data, we assess horizontal and vertical equity by calculating public subsidies for and expected family spending under each coverage source and using Lorenz curves and Gini and concentration coefficients. Our study pooled the 2018 and 2019 MEPS-HC to achieve a sample size of 10,593 observations. Our simulations showed a marked horizontal inequity for lower-income families with access to employer coverage who cannot obtain Marketplace subsidies. Relative to both the financing of employer coverage and earlier Marketplace tax credits, the more generous Marketplace premium subsidies, first made available in 2021 under the American Rescue Plan Act, substantially increased the vertical equity of Marketplace financing. While Marketplace subsidies have clearly improved equity within the United States, we conclude with a comparison to other OECD countries highlighting the persistence of inequities in the U.S. stemming from its noteworthy reliance on employer-based private health insurance. • United States uses employer and individual private health insurance coverage. • No recent investigations of horizontal and vertical equity of U.S. private coverage. • Analysis of Gini coefficients and Lorenz curves suggests regressivity. • Public policies including insurance subsidies can reduce inequities. [ABSTRACT FROM AUTHOR]

Health as a common good is of paramount importance for the world, especially in developing countries. This paper contributes to the literature by analysing the effect of climate vulnerability on child health outcomes in a sample of 107 developing countries over the period 2000–2020. We also analyse the mediating role of women's political empowerment and women's education in the relationship between climate vulnerability and child health outcomes. Using the method of generalised moments in a two-stage system and linear regression absorbing several levels of fixed effects, we found robust evidence that climate vulnerability worsens child health outcomes. We also found that women's political empowerment (WPE) and women's education mitigate the negative effect of climate vulnerability on child health outcomes. These results remain robust against several alternative tests and therefore highlight the need to better examine how the health consequences of climate vulnerability are structured by gender in developing countries. Given the importance of women as agents of change, it would be more beneficial for policymakers to include them in the decision-making process. • We use a dataset covering 107 developing countries over 21 years. • Child health outcomes: IMR, NMR, under-5 mortality rate, and vaccination coverage. • Linear regression absorbing multi-levels of fixed effects, and S-GMM are used. • Climate vulnerability leads to worse child health outcomes. • WPE and female education mitigate the effects of vulnerability on child health. [ABSTRACT FROM AUTHOR]

Sterilization is now the most common contraceptive method used by women of in the U.S., and sterilization devices have played an important role in its increased popularity. This mixed methods study examines a random sample of 2500 U.S. Food and Drug Administration (FDA) adverse event reports made between 2006 and 2017 about Essure, a sterilization device. Quantitative coding was used to examine patient problems; pain and bleeding were reported most frequently. Qualitative coding analyzed impacts of symptoms on patients' everyday lives and patients' healthcare experiences, including intimate relationships, mothering, and paid employment. Findings suggest that some patients struggled when their reported "subjective" symptoms didn't result in "objective" clinical signs of problems, and when physicians dismissed or deflected their concerns in diagnostic encounters. This paper raises important issues regarding the symptoms patients associated with Essure, the diagnosis of device-driven disease and injury, and the FDA's regulation of medical devices. • Essure patients organized to report their problems to the FDA. • Patients reported pain, bleeding, and other problems. • Providers sometimes dismissed patients complaints. • Providers who investigated patients' complaints faced difficulties in diagnosis. • Patients reported regretting having the device implanted. [ABSTRACT FROM AUTHOR]

This paper argues that studies of the 'commercial determinants of health' (CDoH) need to acknowledge fully the part the capitalist mode of commodity production and exchange plays in producing negative health outcomes. This proposition is supported by recourse to a recent development in political economy that has established a more-than-human, relational and monist (or 'flat') ontology of capitalism, in place of the more conventional neo-Marxist perspective. This ontology reveals a dynamic to capitalism that operates beyond human intentionality, driven by the supply of, and demand for the capacities of commodities. This dynamic determines the production and consumption of all commodities, some among which (such as tobacco, alcohol and processed foods) contribute to ill-health. A case study of food consumption reveals how these supply and demand affects drive 'unhealthy' food choices by consumers. Ways to undermine this more-than-human dynamic are offered as an innovative approach to addressing the effects of commerce and capitalism upon health. • Shows how capitalism underpins the 'commercial determinants of health'. • Applies a post-anthropocentric and relational analysis of data on food consumption. • More-than-human forces in capitalism increase unhealthy foodstuff consumption. • Supply and demand operate independently of both producers' and consumers' intentions. [ABSTRACT FROM AUTHOR]

High quality primary care is a foundational element of effective health services. Internationally, primary care physicians (general practitioners (GPs), family doctors) are experiencing significant workload pressures. How non-patient-facing work contributes to these pressures and what constitutes this work is poorly understood and often unrecognised and undervalued by patients, policy makers, and even clinicians engaged in it. This paper examines non-patient-facing work ethnographically, informed by practice theory, the Listening Guide, and empirical ethics. Ethnographic observations (104 h), in-depth interviews (n = 16; 8 with GPs and 8 with other primary care staff) and reflexive workshops were conducted in two general practices in England. Our analysis shows that 'hidden work' was integral to direct patient care, involving diverse clinical practices such as: interpreting test results; crafting referrals; and accepting interruptions from clinical colleagues. We suggest the term 'hidden care work' more accurately reflects the care-ful nature of this work, which was laden with ambiguity and clinical uncertainty. Completing hidden care work outside of expected working hours was normalised, creating feelings of inefficiency, and exacerbating workload pressure. Pushing tasks forward into an imagined future (when conditions might allow its completion) commonly led to overspill into GPs' own time. GPs experienced tension between their desire to provide safe, continuous, 'caring' care and the desire to work a manageable day, in a context of increasing demand and burgeoning complexity. • The non-patient-facing work of general practitioners is often invisible or hidden. • Hidden work is associated with complexity and uncertainty. • Behind-the-scenes work is care work, just as direct work with patients is care work. • Doctors face tensions between completing tasks and working a manageable day. • Combining practice theory with the Listening Guide embraces multi-vocality. [ABSTRACT FROM AUTHOR]

Interactions in the healthcare system today involve an important new set of actors: evaluative health platforms (EHPs). These platforms are not neutral intermediaries, but active moderators of how patients express opinions, choose providers, and consume health-related information. This paper adds to our understanding of the varied and evolving commercial interests of EHPs and the implications these have for patient voice. We analyze 71 platforms in the USA, UK, and Germany and identify five ideal types: subscribers, analyzers, advertisers, regulators, and scammers. Each platform type enacts a unique competitive strategy through an evaluative infrastructure which constrains but also generates possibilities for patient voice. Based on our typology, we develop three contributions. First, we nuance universalizing claims about the consequences of platform capitalism by specifying the diverse strategies underpinning competition between EHPs in different countries, and showing how each strategy leads evaluative infrastructures to develop in ways that impact patient voice. Second, we show how patients can navigate the challenges of a complex EHP space by exercising their ability to choose between platforms. Finally, we outline the conditions platforms need to fulfil to become empowering. Overall, this study highlights the varied and complex relationship between platform business models and user voice, which exists not only in healthcare, but also in many other fields. • Typology of evaluative health platforms (EHPs) in the US, the UK, and Germany. • EHP business models and content moderation techniques vary considerably. • EHPs have a wide range of implications for patient voice. • More transparency and competition can help platforms increase patient empowerment. [ABSTRACT FROM AUTHOR]

By drawing perspectives from the multi-level perspectives in sociotechnical transition and the normalisation process theory, this article explores how ongoing (i.e., incomplete) national level reforms in health information management (HIM) shape the normalisation of electronic medical records (EMRs) in Philippine rural health work. Based on document review, interviews, and observations, we argue that an ongoing HIM regime transition—transitioning from paper-based to an electronic HIM regime—may exert ambivalent institutional pressures on health workers through their institutions' implementation context. The ambivalence of the implementation context—one that accommodates both EMR and paper-based medical records—offers conflicting social, cognitive, and material resources for normalising EMRs. In such a context, we find that health workers performed selective participation and partial implementation in normalising EMRs in their routine healthcare work. In selective participation, select health workers—often, the technologically savvy—could actively participate in the EMR implementation while others focused on their clinical work. At the same time, since only a few could use the EMR in routine work, EMRs were implemented partially in particular instances where it is deemed more valuable and applicable. We emphasised in this article how complementing the idea of normalisation with sociotechnical transition may reveal the emergence of pressures from various institutions and stakeholders that advances (or impede) the normalisation of healthcare innovations. • The implementation process involves regime transition and normalisation work. • Institutional pressures from regime transition shape the implementation context. • The Philippines has an ambivalent health information management (HIM) regime. • Techy health workers participated in electronic medical record (EMR) implementation. • EMRs were implemented partially in select areas within the rural health units. [ABSTRACT FROM AUTHOR]

How is professional purpose impacted in the context of a crisis? Building on discussions about professional purpose and identity, the paper explores how the understanding that professionals have about the framing, scope of functioning and aims of their profession is impacted during a time of crisis. The paper draws on interviews with 41 kinesiologists working at an accidents & emergencies (A&E) hospital in Chile during the COVID-19 pandemic. The paper shows professional purpose as a fluid, situated notion that gets re-shaped in light of contextual features. In the face of new and changing demands during times of crisis, professionals reconfigure their professional purpose to take advantage of the opportunities available. This reconfiguration takes place in response to the external context of the profession (its positioning in the public domain) and the internal relational context of the profession (its positioning with other professionals). The paper suggests a research agenda to develop a processual, situated approach to the interrogation of professional purpose to embed contextual features in scholarship in this area. • Professional purpose is fluid, situated and shaped by contextual circumstances. • During times of crisis, professionals reconfigure their professional purpose. • Meanings attached to a profession are impacted by internal and external factors. • Public recognition, social status, and prestige impact professional purpose. • Specialist authoritative expert status amongst peers shapes professional purpose. [ABSTRACT FROM AUTHOR]

This paper examines the daily practices of caring for COVID-19 patients in Wuhan, China, in early 2020 and the challenges that nurses faced. The paper shows that the affective contagion, especially among patients, introduced unexpected challenges for nurses in caring for COVID-19-infected patients. Nurses had to contend with the challenges of treating both physical and psychological problems in patients simultaneously. As a result, it was necessary for nurses to adapt to the different rhythm of COVID-19 wards to address these challenges and do so through taking on a range of general and specific nursing tasks and playing a diverse range of roles on the wards, from garbage collector to "psychological counselor." Thus, the paper brings attention to the experiences and demands of providing nursing care in an emergency pandemic context, in particular the necessity of responding to both the physical and the psychological needs of patients. These insights could better prepare health services in China and elsewhere in the world for responding effectively to potential future pandemics. • The affective contagion introduced unexpected challenges for nurses in COVID-19 wards. • Nurses adapt to the different working rhythm in COVID-19 wards than in "normal" wards. • A hierarchy of necessity emerged in the context of caring for COVID-19 patients. [ABSTRACT FROM AUTHOR]

In this paper we explore the impact of the emerging COVID-19 pandemic on the governance of healthcare in the Netherlands. In doing so, we re-examine the idea that a crisis necessarily leads to processes of transition and change by focusing on crisis as a specific language of organizing collective action instead. Framing a situation as a crisis of a particular kind allows for specific problem definitions, concurrent solutions and the inclusion and exclusion of stakeholders. Using this perspective, we examine the dynamics and institutional tensions involved in governing healthcare during the pandemic. We make use of multi-sited ethnographic research into the Dutch healthcare crisis organization as it responded to the COVID-19 pandemic, focusing on decision-making at the regional level. We tracked our participants through successive waves of the pandemic between March 2020 and August 2021 and identified three dominant framings of the pandemic-as-crisis: a crisis of scarcity, a crisis of postponed care and a crisis of acute care coordination. In this paper, we discuss the implications of these framings in terms of the institutional tensions that arose in governing healthcare during the pandemic: between centralized, top-down crisis management and local, bottom-up work; between informal and formal work; and between existing institutional logics. • The COVID-19 pandemic is framed as a crisis of different kinds in healthcare. • Framing impacts decision-making and inclusion of stakeholders. • Ethnographic research provides insights into the consequences of these frames. [ABSTRACT FROM AUTHOR]

Life expectancy in the United States is decreasing. Health disparities are widening. Growing evidence for and integration of social and structural determinants into theory and practice has not yet improved outcomes. The COVID-19 pandemic reinforced the fact. In this paper, we argue that the biomedical model and its underlying scientific paradigm of causal determinism, which currently dominate population health, cannot meet population health needs. While criticism of the biomedical model is not new, this paper advances the field by going beyond criticism to recognize the need for a paradigm shift. In the first half of the paper, we present a critical analysis of the biomedical model and the paradigm of causal determinism. In the second half, we outline the agentic paradigm and present a structural model of health based on generalizable, group-level processes. We use the experience of the COVID-19 pandemic to illustrate the practical applications of our model. It will be important for future work to investigate the empirical and pragmatic applications of our structural model of population health. • Population health must move beyond the biomedical model. • This requires going beyond the model to critique the paradigm of causal determinism. • The agentic paradigm is an alternative to causal determinism. • The structural model is an alternative to the biomedical model. • The structural model highlights structural resilience and congruence in the population. [ABSTRACT FROM AUTHOR]

This paper examines the experiences of adolescents from mixed migratory status families affected by deportation. We analyze the impacts on their mental and emotional health when they are separated from one parent in the United States, forcibly displaced with another to Oaxaca, and experience the consequences of their deportation in Mexico. We use a qualitative and ethnographic methodology. This paper focuses on data from semi-structured interviews and focus groups with 15 parents who had been deported from the United States and 53 adolescents who moved with them to Mexico. The data was collected between 2018 and 2020. The main findings show the existence of emotions that are sustained in the transnational flow and acquire new nuances upon return. They also show the emergence of new conditions related to family separation, all of which have an impact on the adolescents' well-being and on important areas of their lives, such as education. The research contributes to knowledge in two main ways: 1) it addresses the impacts of parental deportation on the well-being of adolescents in mixed-status families, which have typically focused on children; 2) it studies how parental deportation affects the mental and emotional health of adolescents de facto deported to Mexico, a field still little studied. • De facto deportation has mental health consequences among adolescents. • The forced nature of de facto deportation produces helplessness, aggression and anger. • The code of silence associated with deportation generates fear, stress, anxiety. • Ambiguous loss is accentuated at important moments in academic and developmental life. • Family separation and de facto deportation affect school performance. [ABSTRACT FROM AUTHOR]

Discrete choice models (DCMs) for moral choice analysis will likely lead to erroneous model outcomes and misguided policy recommendations, as only some characteristics of moral decision-making are considered. Machine learning (ML) is recently gaining interest in the field of discrete choice modelling. This paper explores the potential of combining DCMs and ML to study moral decision-making more accurately and better inform policy decisions in healthcare. An interdisciplinary literature search across four databases – PubMed, Scopus, Web of Science, and Arxiv – was conducted to gather papers. Based on the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA) guideline, studies were screened for eligibility on inclusion criteria and extracted attributes from eligible papers. Of the 6285 articles, we included 277 studies. DCMs have shortcomings in studying moral decision-making. Whilst the DCMs' mathematical elegance and behavioural appeal hold clear interpretations, the models do not account for the 'moral' cost and benefit in an individual's utility calculation. The literature showed that ML obtains higher predictive power, model flexibility, and ability to handle large and unstructured datasets. Combining the strengths of ML methods with DCMs has the potential for studying moral decision-making. By providing a research agenda, this paper highlights that ML has clear potential to i) find and deepen the utility specification of DCMs, and ii) enrich the insights extracted from DCMs by considering the intrapersonal determinants of moral decision-making. • Explores the potential of using machine learning for studying moral decision-making. • Using traditional choice models for moral choice analysis will likely lead to misleading insights. • Machine learning is gaining interest in the field of choice modelling. • Remains unclear how to combine both paradigms for studying moral decision-making. • A research agenda is being put forward for the field of health preference research. [ABSTRACT FROM AUTHOR]

This paper investigates how restriction policies have impacted elderly self-assessed health (SAH) in Europe during the pandemic, and how the Covid-19 infection interacts with policy stringency to modulate the SAH deterioration. Using the Survey of Health, Aging and Retirement in Europe (SHARE) between October 2019 and August 2021, including 9,034 adults aged 50 years and above, alongside with a stringency index from the Oxford's Coronavirus Government Response Tracker (OxCGRT), we design both an adjusted probit model and a recursive bivariate probit model to test for endogeneity of Covid-19 infection. Estimations results show a bell curve between stringency and SAH degradation: a deleterious effect of restrictions at low levels of stringency up to a tipping point after which more stringent policies become protective. Covid-19 infection moderates this association. Depending on individuals' initial health, the effect of restrictions is uneven: highly stringent policies become damaging for individuals most likely to enter a vulnerabilization path, for whom the bell curve is thus inverted. Overall, this study shows clear patterns of association between policy stringency and perceived health among older Europeans, and highlights the potential trade-off between targeting as many people as possible, those in poor health or those on the edge of vulnerability. • The association between policy stringency and SAH degradation is a bell curve. • Strict restrictions only affect the SAH of people likely to become vulnerable. • Covid-19 infection moderates the deterioration of SAH caused by policy stringency. • The recursive bivariate probit model controls for endogeneity in infection. [ABSTRACT FROM AUTHOR]

To access contemporary healthcare, patients must find and navigate a complex socio-technical network of human and digital actors linked in multi-modal pathways. Asynchronous, digitally-mediated triage decisions have largely replaced synchronous conversations between humans. In this paper, we draw on a large qualitative dataset from a multi-site study of remote and digital technologies in general practice to understand widening inequities of access. We theorise our data by bringing together traditional candidacy theory (in particular, concepts of self-assessment, help-seeking, adjudication and negotiation) and socio-technical and technology structuration theories (in particular, concepts of user configuration, articulation, distanciation, disembedding, and recursivity), thus producing a novel theory of digital candidacy. We propose that both human and technological actors (in different ways) embody social structures which affect how they 'act' in social situations. Digital technologies contain inbuilt assumptions about users' capabilities, needs, rights, and skills. Patients' ability to self-assess as sick, access digital platforms, self-advocate, and navigate multiple stages in the pathway, including adapting to and compensating for limitations in the technology, vary widely and are markedly patterned by disadvantage. Not every patient can craft an accurate digital facsimile on which the subsequent adjudication decision will be made; those who create incomplete, flawed or unpersuasive digital facsimiles may be deprioritised or misdirected. Staff who know about such patients may use articulation measures to ensure a personalised and appropriate access package, but they cannot identify or fully mitigate all such cases. The decisions and actions of human and technological agents at the time of an attempt to access care can significantly influence, disrupt, and reconstitute candidacy both immediately and recursively over time, and also recursively shape the system itself. These findings underscore the need for services to be (co-)designed with attention to the exclusionary tendencies of digital technologies and technology-supported processes and pathways. • Digital access and triage involves a network of technological and human agents. • Digitalised systems exacerbate existing inequities, and create new ones. • Technologies are encoded with assumptions, limiting their use and accessibility. • These assumptions lock out some users, recursively affecting health service usage. • Individual practices' digital options must depend on local staff and patient needs. [ABSTRACT FROM AUTHOR]

There is widespread appreciation for the role of research in addressing health problems. However, there is limited evidence on the extent to which research can be targeted to specific diseases. Analyses highlighting a concentration of research funding towards certain diseases have prompted growing scrutiny over the allocation of research funding. In this paper, we show that research funding targeted to a disease often results in publications relating to other diseases. Using data from the world's largest biomedical research funders, we estimated the frequency and direction of this cross-disease spillover by examining 337,573 grant–publication pairs for four diseases. We found the majority of our grant–publication pairs were cross-disease spillovers. We also found some variation between "rich" and "poor" diseases, in terms of the frequency and direction of cross-disease spillover. These differences are likely to be related to characteristics of the diseases themselves, as well as features of the research environment. One implication of frequent cross-disease spillover is that although more investment in areas of research such as neglected diseases is necessary, it may not be sufficient to improve the alignment between research funding and health needs. • The organisation of medical research funding is increasingly disease-focused. • We explored whether such efforts contribute to non-focal diseases. • We mapped 337,573 publications from a sample of grants for 4 disease foci. • We found variation in frequency and direction of cross-disease spillovers. • Focusing on disease is one of way to improve health, but there are other ways too. [ABSTRACT FROM AUTHOR]