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

Obituaries are often the only published record of an individual's life and elicit community reactions, including stigmatization. Because obituaries are typically written by the bereaved, their content reflects the writer's perceptions of mores governing the social context of the next-of-kin and decedent. When a cause of death is stigmatized, it can influence the way the bereaved write the obituary. However, what constitutes a stigmatized cause of death may change as larger societal discourses of morality shift and conditions or events become framed differently. Using a sample of obituaries (N = 210) from obituary aggregator Legacy.com of "off-time," or premature, deaths in West Virginia from 2010, 2015, 2017, and 2019, this article explores whether the presentation of overdose deaths in obituaries changes alongside the shift in the public framing of the opioid crisis as medical rather than criminal. I find obituaries including terms associated with drug use and overdose become both more common and explicit over the course of the study period. This suggests that the shift in public framing of the opioid crisis from criminalization to medicalization corresponds with a decrease in drug stigmatization in obituaries. Obituary analysis can be a useful means of exploring the stigmatization of other controversial causes of death, such as suicide, cirrhosis, and lung cancer. • Causes of death are typically left out of obituaries for deaths related to stigmatized behaviors. • What constitutes a stigmatized cause of death may change amid shifts in morality or the public reframing of issues. • Over the opioid crisis, the public framing of opioid use shifts from criminalization to medicalization. • Amid this shift, West Virginian obituaries become more likely to include details about decedents' drug use and overdose. • "Overdose obituaries" may be a way the bereaved challenge stigma and change public narratives about addiction. [ABSTRACT FROM AUTHOR]

This article utilises ideal typical models, or sociological heuristics, when analysing COVID-19 pandemic responses in an international context. Axes of differentiation include Authoritarian-Libertarian and Left-Right tendencies, encapsulating four generic worldviews that potentially patterned societal responses to the novel coronavirus: (1) hierarchical, (2) dismissive or fatalistic, (3) individualistic, and (4) egalitarian. Taking the 'shock period' (circa 2020–2021) as the primary window of analysis, the article schematises contrasting orientations that have since left their mark in a context of COVID-19 endemicity. In conclusion, a case is made for an explicitly egalitarian and anti-authoritarian stance amidst countervailing, even fascistic, tendencies. The possibility of another politics of life is underscored given the spectre of ongoing crises in a global context. • Pandemic responses do not occur in a social vacuum. • Sociological heuristics provide a handle on the polarising COVID-19 debacle. • Left-Right and Authoritarian-Libertarian tendencies patterned pandemic responses. • Societal responses to COVID-19 ranged from hierarchical to egalitarian. • A case is made for an anti-authoritarian and egalitarian stance. [ABSTRACT FROM AUTHOR]

Breast cancer is the second most common cancer, with more than 2.31 million cases diagnosed worldwide in 2022. Cancer medicine subjects the body to invasive procedures in the hope of offering a chance of recovery. In the course of treatment, the body is pricked, burned, incised and amputated, sometimes shattering identity and often changing the way women perceive the world. In sub-Saharan Africa, incidence rates are steadily increasing and women are particularly young when they develop breast cancer. Despite this alarming situation, the scientific literature on breast cancer in sub-Saharan Africa is poor and largely dominated by medical literature. Using a qualitative approach and a theoretical framework at the intersection of the sociology of gender and the sociology of the body, we explore the discourse strategies of women with breast cancer in Mali regarding their relationship to the body and to others. Based on 25 semi-directive interviews, we analyse the experiences of these women. Using the image of the Amazon woman, whose struggle has challenged gender because of its masculine attributes, we explore whether these women's fight against their breast cancer could be an opportunity to renegotiate gender relations. The experience of these women is characterised by the deconstruction of their bodies, pain and suffering. The masculinisation of their bodies and their inability to perform certain typically female functions in society (such as cooking or sexuality) challenges their female identity. The resistance observed through the sorority, discreet mobilisation and display of their bodies does not seem to be part of a renegotiation of gender relations, but it does play an active role in women's acceptance of the disease and their reconstruction. • The scars left on women's bodies reflect poor access to oncology care. • Breast cancer treatment causes body deconstruction, pain and suffering for women. • Sororities and discreet mobilisations are a kind of women's resistance. • Showing their scars helped women rebuild their identities. • Among women with breast cancer, continuity in gender relations was observed. [ABSTRACT FROM AUTHOR]

In the mid-twentieth century, the social movement of death revivalism sought to resist the medicalisation of dying and grief through promotion of the dying person retaining autonomy, and societal openness toward death and bereavement. Despite this advocacy, present-day dying in high income countries is largely institutionalised, with value placed on control over the body and emotions. These phenomena are at odds with the ambitions of death revivalism, and demonstrate the re-medicalisation of dying and grief. Furthermore, contemporary society is continually advancing into the post-digital age, reflected in digital technologies being a tacit part of human existence. Within this framework, this study aims to investigate how people living with life-limiting illness and their loved ones experience, negotiate, and resist medicalisation of dying and grief through online internet forums. We collected posts through web-scraping and utilised Natural Language Processing techniques to select 7048 forum posts from 2003 to 2020, and initially categorise data, before utilising Inductive Thematic Analysis, which generated two major themes. The theme of 'Comfort' describes online forums facilitating psychosocial support which was often used to compensate for systemic deficiencies, especially during the Covid-19 pandemic. Common sources of comfort included animal companions and spirituality, in stark contrast with the medicalised model. The theme of 'Capability' describes online forums acting as solutions for people facing disempowering care systems, including providing information on legal rights and benefits which may not be otherwise easily available, and facilitating collective advocacy. Our findings indicate that community-led online forums can play an effective and sustainable role in democratising care and retaining agency when facing life-limiting illness and grief. Future palliative and bereavement care research must focus on how online forums can be integrated into existing systems, made transparent and accessible, be adequately funded and structured, and be optimised, including compensating for service disruption encountered during future pandemics. • Medicalisation can disempower and institutionalise dying and bereaved people. • The important value of digital technologies at the end-of-life must be considered. • Online forums can provide support and comfort for people facing dying or grief. • Dying and grieving people do not only value medical aspects of their experience. • Online forums can help people regain autonomy and challenge medicalised structures. [ABSTRACT FROM AUTHOR]

The experience of depression is diverse based on social locations and context. A sociological perspective building on masculinity, illness work, and the self provides a useful theoretical framework to understand how older men negotiate emotional suffering. This article examines older men's accounts of their depression experience from a social constructionist approach. This analysis is based on data from 77 in-depth interviews with depressed older men who participated in a larger mixed-method study, the Men's Health and Aging Study (MeHAS). We show how older men construct depression accounts in which they integrate biological and social factors associated with feeling a loss of control. This is experienced as a shamed masculine self given their inability to perform manhood acts, which leads them to severe social bonds. Men's accounts also shed light on how they resist the shaming of the masculine self by deploying two primary strategies: acting overtly masculine through aggressive behavior and by retracting from social interactions that may lead to feelings of shame. These strategies appear futile and they are only partially able to embrace alternative masculine values in line with roles as grandparents and older, wiser men. Depression in older men is characterized by an ongoing negotiation of limited statuses and roles given dominant conceptions of masculinity.

While medical sociology has long incorporated insights from pragmatist philosophy, recent contributions call for a more explicit engagement with this tradition. Complementing Greenhalgh and Engebretsen's (2022) call for a pragmatist analysis of public health policymaking and crisis, we systemize medical sociology's engagement with pragmatism. We suggest three precepts of pragmatist philosophy as they relate to medical sociology: First, a focus on consequences in action, or understanding medical phenomena through what is done rather than established definitions; Second, problem solving, or how medical actors move between habit and creativity; And third, negotiation of meaning, or analyzing patient-provider communication through ongoing action and interpretation. Such systematization, we argue, would enrich both new and existing topics in medical sociology, from medicalization to mask-wearing. [ABSTRACT FROM AUTHOR]

In recent years, trans medicine has increasingly shifted towards gender-affirming care, focusing on assisting transgender people in finding safe and effective ways to support their gender identity. Through standards of care, clinical guidelines, and classification systems, international experts have established global norms with profound downstream implications. However, how local providers respond to these new norms remains underexplored. Drawing on ethnographic work in clinical settings, conferences, and 30 in-depth interviews with healthcare providers, I argue that family-centered gender-affirming care has emerged in China as providers strive to balance global ideals of "good" trans medicine with the constraints of the local healthcare system. While international standards assist providers in adopting a less pathologizing and binary view of care, they provide limited practical guidance for navigating local social and institutional challenges. Faced with a lack of legal and institutional support, providers increasingly rely on family members' involvement to mitigate medical dispute risks. This reliance manifests in two forms: restrictive gatekeeping , where care is delayed or denied based on family members' attitudes and providers' assessment of transgender adults' ability to lead a "normal life," and affective gatekeeping , where providers use psychological support and gender diversity education to involve family members as caregivers. These findings enrich sociological studies in global health by illustrating how the interactions between global norms and local healthcare systems can both alleviate and reproduce barriers to care. • Global norms around gender-affirming care are adapted to align with China's local healthcare infrastructure. • Healthcare providers embrace a more inclusive, non-binary approach to trans medicine. • Social and institutional challenges undercut the practical implementation of global norms around gender-affirming care. • Family involvement in gender-affirming care reproduces medical gatekeeping and barriers to access. [ABSTRACT FROM AUTHOR]

The recent introduction of polygenic risk scores within preimplantation genetic testing (PGT-P) has been met with many concerns. To get more insights into the perspectives of relevant stakeholders on the socio-ethical aspects of PGT-P, an interview study with 31 healthcare professionals involved in reproductive medicine and genetics in Europe and North-America was performed. Healthcare professionals in our study were concerned that PGT-P was going too far in terms of selection, with regards to both medical conditions and non-medical traits. Healthcare professionals were worried about the ethical 'slippery slope' of PGT-P, the increasing medicalization of reproductive health, the commercial context of PGT-P, and potential stigmatization and discrimination. There were also concerns that the availability and the 'technological imperative' of PGT-P could lead to pressure and a sense of responsibility for parents to use PGT-P. Additionally, it could cause new anxieties about the child's health before the child has even been born. Since PGT-P provides polygenic risk scores before birth, the autonomy of the child has to be considered. These socio-ethical concerns heighten existing debates regarding reproductive genetic technologies and show that the specifics of PGT-P make this screening option especially ethically controversial. • Introduction of polygenic risk scores in preimplantation genetic testing. • Healthcare professionals concerned about socio-ethical implications. • Associated with 'slippery slope', going too far, discrimination and stigmatization. • Increased sense of medicalization and commercialization of reproduction and health. • Worries about effects on prospective parents and on the future child's autonomy. [ABSTRACT FROM AUTHOR]

Experts often face credibility challenges during times of crisis. However, opioid use disorder (OUD) researchers preserved their scientific credibility despite the increasing public scrutiny of medical knowledge during the opioid epidemic. Building on 30 in-depth interviews with OUD researchers, this article examines how researchers conduct scientific research, collaborate with non-expert stakeholders, and communicate research outcomes to the public. It distinguishes between performative credibility – a discourse enacted through languages, meanings, and symbols in constructing the reality of credibility, and descriptive credibility – the description, perception, and measurements of credibility under a given credibility discourse. It argues that the crisis of expertise is situational – it depends on whether and how performative credibility is sustained. This article finds that OUD researchers enact at least three credibility discourses: professional, data-driven, and community-centered. While researchers can have multiple discourses in mind, their choices of enacting a specific credibility discourse when interacting with non-experts and the public are contingent upon their rankings in the profession, medical training backgrounds, forms of patient interactions, and access to OUD medications. This case recenters sociological studies of expertise and trust on the enacting power of experts' statements and actions. It also reveals the relevance of social locations in understanding the formation of the credibility crisis. Finally, it provides a conceptual framework for understanding public (mis)trust in science and medicine. • The crisis of expertise is situational. • Responses to credibility challenges are contingent upon experts' social locations. • The diversity of credibility discourses helps sustain public trust in science. • Epistemic contests among experts reduce the severity of public challenges. • The anticipation of science being politicized promotes public distrust. [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.

Does an undocumented immigration status predict the use of medical services? To explore this question, this paper examines medical care utilization of undocumented Latino immigrants compared to Latino legal immigrants and citizens, and non-Latino whites in Orange County, California. Data were collected through a random sample telephone survey of 805 Latinos and 396 non-Hispanic whites between January 4 and January 30, 2006. Findings show that undocumented immigrants had relatively low incomes and were less likely to have medical insurance; experience a number of stresses in their lives; and underutilize medical services when compared to legal immigrants and citizens. Predictors of use of medical services are found to include undocumented immigration status, medical insurance, education, and gender. Undocumented Latinos were found to use medical services less than legal immigrants and citizens, and to rely more on clinic-based care when they do seek medical services.

Many countries, including Australia, the United Kingdom and the United States have established national screening programs in the effort to advance the early diagnosis of cancers. Australia has population screening programs for breast, bowel and cervical cancers, and this article focuses on breast and cervical cancer screening as the two longest running programs in Australia. While these screening programs are well-established and report relatively high participation rates, the effectiveness of population screening is a contested issue, subject to significant, ongoing debate about its purported benefits (Armstrong, 2019). In this article, we draw on ideas from sociology of science on the construction of scientific facts to analyse how evidentiary claims are presented in policy documents for Australia's breast and cervical cancer screening programs, and the implications for those who are the targets of screening. We explore how screening-related information assumes the status of scientific 'facts', and argue that presenting information as neutral and objective obscures the political choices involved in its generation. Importantly, some of the claims presented in the policy documents have a tendency to emphasise the benefits, and minimise the risks and harms of population-based screening. In doing so, we suggest that the current national policies may be contributing to sustaining expectations of screening that are higher than warranted. Higher expectations may bring with them unintended societal and economic costs to the public. We conclude by noting how deeply ingrained socio-cultural meanings of cancer shape public expectations of the protective value of screening, which allows current screening approaches to become further entrenched and resistant to challenge. • National cancer screening programs are justified on the basis of selective evidence. • Screening policy emphasises the benefits of interventions and downplays the risks. • Minimising the risks of screening sustains higher expectations than are warranted. • Screening is entrenched due to a risk management ethos and the fear of cancer. • Screening policy needs to better address the fragile balance of benefits and risks. [ABSTRACT FROM AUTHOR]

How do caregivers make decisions about participating in morally contested care, such as abortion? Debates about conscience in the delivery of health care generally assume that participation decisions stem from religious beliefs and moral values. Few studies have examined this question in the context of everyday practice. Drawing on 50 interviews with the staff of a labor and delivery unit offering abortion care—including nurses, maternal-fetal medicine specialists, obstetrics and gynecology residents, and anesthesiologists—we show that respondents have varied definitions of "participation" in abortion care and that participation decisions are driven by an array of factors beyond personal beliefs. We present a conceptual model of "moral work" that shows conscience to be an emerging, iterative process influenced not only by beliefs—religious and non-religious—but also by personal and work experiences and social and institutional contexts. Our study brings new insights into understanding conscience and participation in contested care. • Caregivers' experiences force us to rethink conscience and participation in abortion care. • Factors beyond religious and moral values shape abortion care participation decisions. • Caregivers have varied definitions of "participation" in abortion work. • Participation decisions are an iterative process of "moral work" in abortion care. • Religious beliefs can motivate the provision of abortion care, not just refusal. [ABSTRACT FROM AUTHOR]

Neighborhood plays an important role in the provision of elderly care in the context of rapid population aging and dwindling traditional family support in China. This study investigates the association between neighborhood characteristics and depression and its mechanisms among older adults in Shanghai, focusing on social cohesion and social engagement. Based on data from the first wave of Shanghai Urban Neighborhood Survey (SUNS), we show that social cohesion is a channel through which neighborhood attributes are linked with the elderly's subjective well-being. Different from findings in Western societies, Chinese older adults living in neighborhoods of lower socioeconomic status are more likely to interact with their neighbors and thus perceive a higher level of social cohesion. Social cohesion, in turn, is associated with a lower rate of depression. We argue that housing policy in the pre-reform period that integrated work and housing led to the formation of unique Chinese neighborhoods, and that those living in socioeconomically disadvantaged neighborhoods have strong social ties, which moderate the negative consequences of living in a disadvantaged one. Moreover, a neighborhood with a lower dependency ratio provides more opportunities for volunteer participation which significantly associates with increased social cohesion and decreased depressive symptoms. • Social cohesion is a mechanism of neighborhood effect on depression. • The elderly in poorer neighborhoods are more likely to interact with neighbors. • The elderly in poorer neighborhoods perceive a higher level of social cohesion. • Social cohesion is associated with decreased depression among the Shanghai elderly. • Social cohesion mediates the relationship between social engagement and depression. [ABSTRACT FROM AUTHOR]

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

Abstract Background Cancer is a leading cause of premature death in women worldwide, and is associated with socio-economic disadvantage. Yet many interventions designed to reduce risk and improve health fail to reach the most marginalised with the greatest needs. Our study focused on socially marginalised women at two women's centres that provide support and training to women in the judicial system or who have experienced domestic abuse. Methods This qualitative study was framed within a sociological rather than behavioural perspective involving thirty participants in individual interviews and focus groups. It sought to understand perceptions of, and vulnerability to, cancer; decision making (including screening); cancer symptom awareness; and views on health promoting activities within the context of the women's social circumstances. Findings Women's experiences of social adversity profoundly shaped their practices, aspirations and attitudes towards risk, health and healthcare. We found that behaviours such as unhealthy eating and smoking need to be understood in the context of inherently risky lives. They were a coping mechanism whilst living in extreme adverse circumstances, navigating complex everyday lives and structural failings. Long term experiences of neglect, harm and violence, often by people they should be able to trust, led to low self-esteem and influenced their perceptions of risk and self-care. This was reinforced by negative experiences of navigating state services and a lack of control and agency over their own lives. Conclusion Women in this study were at high risk of cancer, but it would be better to understand these risk factors as markers of distress and duress. Without appreciating the wider determinants of health and systemic disadvantage of marginalised groups, and addressing these with a structural rather than an individual response, we risk increasing cancer inequities by failing those who are in the greatest need. Highlights • Marginalised women were at very high risk of cancer and late presentation. • Lifelong adversity shaped practices, health aspirations and attitudes to risk. • Risk factors presented as coping mechanisms and markers of distress and poverty. • Structural failings, distrust and lack of control shaped trust in health systems. • A response is needed that addresses structural failings and systemic disadvantage. [ABSTRACT FROM AUTHOR]

Abstract Community sanitation interventions increasingly leverage presumed innate human disgust emotions and desire for social acceptance to change hygiene norms. While often effective at reducing open defecation and encouraging handwashing, there are growing indications from ethnographic studies that this strategy might create collateral damage, such as reinforcing stigmatized identities in ways that can drive social or economic marginalization. To test fundamental ethnographic propositions regarding the connections between hygiene norm violations and stigmatized social identities, we conducted 267 interviews in four distinct global sites (in Guatemala, Fiji, New Zealand, USA) between May 2015 and March 2016. Based on 148 initial codes applied to 23,278 interview segments, text-based analyses show that stigmatizing labels and other indices of contempt readily and immediately attach to imagined hygiene violators in these diverse social settings. Moral concerns are much more salient at all sites than disease/contagion ones, and hygiene violators are extended little empathy. Contrary to statistical predictions, however, non-empathetic moral reactions to women hygiene violators are no harsher than those of male violators. This improved evidentiary base illuminates why disgust- and shame-based sanitation interventions can so easily create unintended social damage: hygiene norm violations and stigmatizing social devaluations are consistently cognitively connected. Highlights • Sanitation interventions increasingly seek to change community hygiene norms. • Identifies hygiene norms at Guatemala, Fiji, New Zealand, and USA sites. • Cross-cultural comparison shows hygiene norm violators are consistently stigmatized. • Illuminates how disgust-based sanitation interventions create social damage. [ABSTRACT FROM AUTHOR]

In this review article, we examine some of the conceptual contributions of sociology of health and illness over the past fifty years. Specifically, we focus on research dealing with medicalization, the management of stigma, research on adherence and compliance, and patient-doctor interaction. We show how these themes that originated within sociology, diffused in other disciplines. Sociology in Social Science and Medicine started as an applied research tradition but morphed into a robust, stand-alone social science tradition. [ABSTRACT FROM AUTHOR]

Abstract Much of our understanding of prognosis in clinical settings comes from end-of-life situations but prognostication is also a concern in chronic illnesses. Parents of children living with seizures wonder what the future holds: will the child outgrow their seizures, or will they remain a part of their child's life? Based on video recordings of clinic consultations between pediatric neurologists and families, we examine how clinicians convey a child's prognosis. We find that neurologists mainly communicate the prognosis indirectly through the goals they set for the child, the time frame of attaining these goals, and the uncertainties they highlight regarding the attainability of the goals. By modulating goals and erring on the side of optimism, clinicians maintain a collaborative relationship even if the prognosis turns increasingly dire. Highlights • Clinicians prognosticate chronic illnesses in indirect ways. • Clinicians convey a prognosis by the goals they set, their timing, and certainties. • Prognosis in chronic illness is optimistically biased. • Prognosis in chronic illness maintains a long-term patient-physician relationship. [ABSTRACT FROM AUTHOR]

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

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

In the past decade, healthcare delivery has faced two major disruptions: the mapping of the human genome and the rise of evidence-based practice. Sociologists have documented the paradigmatic shift towards evidence-based practice in medicine, but have yet to examine its effect on other health professions or the broader healthcare arena. This article shows how evidence-based practice is transforming public health in the United States. We present an in-depth qualitative analysis of interview, ethnographic, and archival data to show how Michigan's state public health agency has navigated the turn to evidence-based practice, as they have integrated scientific advances in genomics into their chronic disease prevention programming. Drawing on organizational theory, we demonstrate how they managed ambiguity through a combination of sensegiving and sensemaking activities. Specifically, they linked novel developments in genomics to a long-accepted public health planning model, the Core Public Health Functions. This made cutting edge advances in genomics more familiar to their peers in the state health agency. They also marshaled state-specific surveillance data to illustrate the public health burden of hereditary cancers in Michigan, and to make expert panel recommendations for genetic screening more locally relevant. Finally, they mobilized expertise to help their internal colleagues and external partners modernize conventional public health activities in chronic disease prevention. Our findings show that tools and concepts from organizational sociology can help medical sociologists understand how evidence-based practice is shaping institutions and interprofessional relations in the healthcare arena. [ABSTRACT FROM AUTHOR]

There is a growing literature demonstrating the health benefits of social capital (defined as the resources accessed through social connections). However, social capital is also acknowledged to be a “double-edged” phenomenon, whose effects on health are not always positive. We sought to systematically review studies that have found a negative (i.e. harmful) association between social capital and health outcomes. Our objective was to classify the different types of negative effects, following a framework originally proposed by Portes (1998). We conducted a literature search in Pubmed, Embase and PsychInfo. We identified 3530 manuscripts. After detailed review, we included 44 articles in our systematic review. There are at least two negative consequences of social capital besides the classification proposed by Portes: behavioral contagion and cross-level interactions between social cohesion and individual characteristics. When leveraging the concept of social capital for health promotion interventions, researchers need to take account of these potential “downsides” for health outcomes. [ABSTRACT FROM AUTHOR]

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

Exercise addiction has sparked a growing interest in the scientific and clinical literature, yet this behavioral addiction has mainly been investigated quantitatively, from a positivistic perspective. This article explores the subjective and embodied dimensions of exercise addiction, broadening current conceptions of this emerging, still unofficial mental health category. Building on carnal sociology, and through a thematic analysis of mobile interviews conducted with 17 self-proclaimed "exercise addicts" from Canada, this article examines the interrelations between the embodiment of exercise addiction and the normative social elements at stake in the shaping of the category, providing insights on how exercise is experienced as an addiction. Results show that most participants describe this addiction as "soft" and "positive", highlighting the virtues of exercising. However, their bodily accounts also reveal a suffering body, bringing forth the vices related to excessive exercising. Participants also put in relation the quantifiable and the sensible body, revealing the porous boundaries of this construct: exercise addiction can sometimes be regulatory in certain contexts and counternormative in others. Thus, it appears that "exercise addicts" enact various contemporary normative requirements, which vary from asceticism and body-ideals but also to the phenomenon of social and temporal acceleration. We argue that exercise addiction questions how certain behaviors, deemed potentially problematic, illustrate the tensions and complex articulations between embodying and resisting social normativity. • Exercice addiction (EA) has paradoxical effects on health and well-being. • The phenomena involves both suffering and thriving experiences. • Such behavioral addictions are inextricably tied to embodied experiences. • EA exemplifies the tensions between embodying and resisting social norms. • Mobile interviews offer innovative techniques to research embodied experiences. [ABSTRACT FROM AUTHOR]

The distribution of work, knowledge, and responsibilities between doctors and nurses is a longstanding object of interest for medical sociologists. Whereas the strategies through which nurses and doctors construct their professional boundary have been thoroughly examined, little is known about why the regulation of the medical-nursing boundary varies across care settings. In the article, I argue that this gap in knowledge can be attributed to insufficient examination of the ‘negotiation context’, namely the features of the social and organisational environment that directly affect doctor-nurse boundary negotiations. Adopting a negotiated order perspective, and drawing data from a hospital ethnography, the article describes the different ways of constructing the medical-nursing boundary ( separating, replacing, and intersecting ) which were observed in three different care settings (a neurology ward, a neurosurgical ward, and an intensive care unit). Constant comparison of the observed interactional patterns led to the identification of three factors that significantly affected the construction of the medical-nursing boundary, specifically: patients' state of awareness, the type of clinical approach adopted by nurses and doctors, and the level of acuity on the ward. The article advances our knowledge of the medical-nursing boundary by shedding light on its flexible and contextual nature and by adding further nuance to the boundary-blurring/boundary-reinforcing dichotomy. New features of the ‘negotiation context’ are identified that enable more convincing explanations of why the medical-nursing boundary varies across care settings. Finally, the study advances the negotiated order theory by offering a framework for considering the structural differences that shape local negotiations. [ABSTRACT FROM AUTHOR]

Health policy studies usually conceptualise access to medicines as a result of the institutional configuration of policies, legislation, and pharmaceutical markets. This study adopts a different approach that stems from the sociology of health and Science and Technology Studies (STS). Based on an ethnographically inspired qualitative research of access practices of patients with oncological and rare diseases in Russia, we argue that access to medicines is a fluid and unstable trajectory constructed by the everyday practices of patients. Instead of seeing patients as passive recipients of institutionally arranged access, we focus on their practices of building access and identify four types of work they do to steer their access trajectories in the desired direction. These types of work include persisting work, complying work, adjusting work, and knowing work. In many studies of access, these types of work remain invisible, and thus the efforts and skills that patients need to make access possible remain unnoticed, undervalued, and unaccounted for. • Access to medicines is a trajectory constructed by everyday practices of patients. • Access trajectory is shaped by patients' invisible work. • There are four types of patient' work: persisting, complying, adjusting, and knowing. • Patients' practices and wider healthcare context mutually construct each other. [ABSTRACT FROM AUTHOR]

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

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

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]

The built environment and social cohesion are increasingly recognized as being associated with older adults' quality of life (QoL). However, limited research in this area still exists and the relationship has remained unexplored in the area of Metro Vancouver, Canada. This study examined the association between the built environment and social cohesion with QoL of 160 community-dwelling older adults (aged ≥ 65 years) on low income from Metro Vancouver. Cross-sectional data acquired from the Walk the Talk (WTT) study were used. Health-related QoL (HRQoL) and capability wellbeing were assessed using the EQ-5D-5L and the ICECAP-O, respectively. Measures of the environment comprised the NEWS-A (perceived built environment measure), the Street Smart Walk Score (objective built environment measure), and the SC-5PT (a measure of social cohesion). The primary analysis consists of Tobit regression models to explore the associations between environmental features and HRQoL as well as capability wellbeing. Key findings indicate that after adjusting for covariates, older adults' capability wellbeing was associated with street connectivity and social cohesion, while no statistically significant associations were found between environmental factors and HRQoL. Our results should be considered as hypothesis-generating and need confirmation in a larger longitudinal study. [ABSTRACT FROM AUTHOR]

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

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

Despite widespread epidemiological evidence of a social gradient in obesity, there has been less attention focused on understanding this from a sociological perspective. Furthermore, whilst pleasure is an obvious feature of contemporary cultural representations of food and eating, this has not figured prominently in sociological understandings of the social gradient. Using qualitative data from biographical interviews conducted with adults living in materially deprived parts of South Yorkshire (UK) we introduce the idea of discordant pleasure in relation to everyday eating as a way of shedding light on the social gradient in obesity. We highlight in particular, the ways in which materially deprived individuals who were defined as obese described the tensions between the pleasures of eating and the struggles for bodily control, alongside the affective dimensions – frustration and shame – that this process engendered. We draw on Berlant's work on lateral and interruptive agency to make sense of these accounts, suggesting that classed agency and discordant pleasure are important dimensions in understanding the social gradient in obesity under neoliberalism. [ABSTRACT FROM AUTHOR]

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

The misuse of antibiotics has become a major public health problem given the global threat of multi-resistant organisms and an anticipated ‘antimicrobial perfect storm’ within the next few decades. Despite recent attempts by health service providers to optimise antibiotic usage, widespread inappropriate use of antibiotics continues in hospitals internationally. In this study, drawing on qualitative interviews with Australian pharmacists, we explore how they engage in antibiotic decisions in the hospital environment. We develop a sociological understanding of pharmacy as situated within evolving interprofessional power relations, inflected by an emerging milieu whereby antibiotic optimisation is organisationally desired but interprofessionally constrained. We argue that the case of antibiotics articulates important interprofessional asymmetries, positioning pharmacists as delimited negotiators within the context of medical prescribing power. We conclude that jurisdictional uncertainties, and the resultant interprofessional dynamics between pharmacy and medicine, are vital delimiting factors in the emerging role of pharmacists as ‘antimicrobial stewards’ in the hospital environment. Moreover, we argue that a nuanced understanding of the character of interprofessional negotiations is key to improving the use of antibiotics within and beyond the hospital. [ABSTRACT FROM AUTHOR]

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