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Prior to the COVID–19 outbreak, food insecurity was already a serious public health problem in Canada, impacting 12.7 percent of households. In recent years, activists, practitioners and researchers from a range of health–related disciplines, have debated the legitimacy of food banks and other charitable food programs, contending that policy and programs at the federal level must be prioritized to address the underlying root causes of poverty. This paper challenges the discourse that charitable food programs prevent or distract from Canada's social equity goals. Alternatively, this paper argues that programs and initiatives at the local level can emerge to bring short–term stability and self–sufficiency to local communities while also advocating for longer–term structural change. Drawing upon structuration theory and critical ecologies of anti–Black racism, we examine the work of BlackFoodToronto, a food sovereignty initiative, to illustrate the negotiation of power and agency, and how groups and networks react to and reshape confining and enabling structures through collaborative practice. In addressing Canada's food security crisis, this paper offers an alternative perspective of community–based, nonprofit and charitable programs, which in practice, can help inform future food security policy and related health equity and community development strategies. [ABSTRACT FROM AUTHOR]

In this editorial introduction, we explore how digital health is being explored at the intersection of sociology of health and science and technology studies (STS). We suggest that socio‐material approaches and practice theories provide a shared space within which productive tensions between sociology of health and STS can continue. These tensions emerge around the long‐standing challenges of avoiding technological determinism while maintaining a clear focus on the materiality and agency of technologies and recognising enduring sets of relations that emerge in new digital health practices while avoiding social determinism. The papers in this Special Issue explore diverse fields of healthcare (e.g. reproductive health, primary care, diabetes management, mental health) within which heterogenous technologies (e.g. health apps, mobile platforms, smart textiles, time‐lapse imaging) are becoming increasingly embedded. By synthesising the main arguments and contributions in each paper, we elaborate on four key dimensions within which digital technologies create ambivalence and (re)configure health practices. First, promissory digital health highlights contradictory virtues within discourses that configure digital health. Second, (re)configuring knowledge outlines ambivalences of navigating new information environments and handling quantified data. Third, (re)configuring connectivity explores the relationships that evolve through digital networks. Fourth, (re)configuring control explores how new forms of power are inscribed and handled within algorithmic decision‐making in health. We argue that these dimensions offer fruitful perspectives along which digital health can be explored across a range of technologies and health practices. We conclude by highlighting applications, methods and dimensions of digital health that require further research. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is a prominent cause of death, disability, and dementia in sub-Saharan Africa (SSA). The Stroke Investigative Research and Education Network works collaboratively with stroke survivors and individuals serving as community controls to comprehensively characterize the genomic, sociocultural, economic and behavioral risk factors for stroke in SSA. Purpose: In this paper, we aim to: i) explore the attitudes, beliefs, and practices related to stroke in Ghana and Nigeria using the process of qualitative description; and ii) propose actions for future research and community-based participation and education. Methods: Stroke survivors, their caregivers, health care professionals, and community representatives and faith-based leaders participated in one of twenty-six focus groups, which qualitatively explored community beliefs, attitudes and practices related to stroke in Ghana and Nigeria. Arthur Kleinman’s Explanatory Model of Illness and the Social Ecological Model guided the questions and/or thematic analysis of the qualitative data. We hereby describe our focus group methods and analyses of qualitative data, as well as the findings and suggestions for improving stroke outcomes. Results and discussion: The major findings illustrate the fears, causes, chief problems, treatment, and recommendations related to stroke through the views of the participants, as well as recommendations for working effectively with the SIREN communities. Findings are compared to SIREN quantitative data and other qualitative studies in Africa. As far as we are aware, this is the first paper to qualitatively explore and contrast community beliefs, attitudes, and practices among stroke survivors and their caregivers, community and faith-based leaders, and health professionals in multiple communities within Nigeria and Ghana. [ABSTRACT FROM AUTHOR]

Abstract: Aim: This paper reports on the findings from 6 focus groups conducted with Australian medical students. The focus groups sought students' perspectives on how the influence of commercial interests on medical practice and education could be managed. Method: We conducted 6 focus groups with medical students in New South Wales, Australia. Participants were recruited via student‐run medical society and faculty e‐mail lists. Forty‐nine students from 6 medical schools in New South Wales participated. The research team reflected on the extent to which students uncritically appealed to science in the abstract as a management solution for conflicts of interest. Data analysis was largely inductive, looking for uses of scientific terminology, EBM, and appeals to “science” in the management of COI and applied theoretical analyses of scientism. Results: The students in our study suggested that science and evidence‐based medicine, rather than ethics or professionalism, were the best tools to deal with undue influence and bias. This paper uses philosophy of science literature to critically examine these scientistic appeals to science and EBM as a means of managing the influence of pharmaceutical reps and commercial interests. We argue that a scientistic style of reasoning is reinforced through medical curricula and that students need to be made aware of the epistemological assumptions that underpin science, medicine, and EBM to address the ethical challenges associated with commercialised health care. Conclusion: More work is needed to structure medical curricula to reflect the complexities of practice and realities of science. However, curricula change alone will not sufficiently address issues associated with commercial interests in medicine. For real change to occur, there needs to be a broader social and professional debate about the ways in which medicine and industry interact, and structural changes that restrict or mitigate commercial influences in educational, research, and policy settings. [ABSTRACT FROM AUTHOR]

Forms of large‐scale change, such as the regiona l re‐distribution of clinical services, are an enduring reform orthodoxy in health systems of high‐income countries. The topic is of relevance and importance to medical sociology because of the way that large‐scale change significantly disrupts and transforms therapeutic landscapes, relationships and practices. In this paper we review the literature on large‐scale change. We find that the literature is dominated by competing forms of knowledge, such as health services research, and show how sociology can contribute new and critical perspectives and insights on what is for many people a troubling issue. [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]

Background: The Neurotrauma Evidence Translation (NET) Trial aims to design and evaluate the effectiveness of a targeted theory-and evidence-informed intervention to increase the uptake of evidence-based recommended practices for the management of patients who present to an emergency department (ED) with mild head injuries. When designing interventions to bring about change in organisational settings such as the ED, it is important to understand the impact of the context to ensure successful implementation of practice change. Few studies explicitly use organisational theory to study which factors are likely to be most important to address when planning change processes in the ED. Yet, this setting may have a unique set of organisational pressures that need to be taken into account when implementing new clinical practices. This paper aims to provide an in depth analysis of the organisational context in which ED management of mild head injuries and implementation of new practices occurs, drawing upon organisational level theory. Methods: Semi-structured interviews were conducted with ED staff in Australia. The interviews explored the organisational context in relation to change and organisational factors influencing the management of patients presenting with mild head injuries. Two researchers coded the interview transcripts using thematic content analysis. The “model of diffusion in service organisations” was used to guide analyses and organisation of the results. Results: Nine directors, 20 doctors and 13 nurses of 13 hospitals were interviewed. With regard to characteristics of the innovation (i.e. the recommended practices) the most important factor was whether they were perceived as being in line with values and needs. Tension for change (the degree to which stakeholders perceive the current situation as intolerable or needing change) was relatively low for managing acute mild head injury symptoms, and mixed for managing longer-term symptoms (higher change commitment, but relatively low change efficacy). Regarding implementation processes, the importance of (visible) senior leadership for all professions involved was identified as a critical factor. An unpredictable and hectic environment brings challenges in creating an environment in which team-based and organisational learning can thrive (system antecedents for innovation). In addition, the position of the ED as the entry-point of the hospital points to the relevance of securing buy-in from other units. Conclusions: We identified several organisational factors relevant to realising change in ED management of patients who present with mild head injuries. These factors will inform the intervention design and process evaluation in a trial evaluating the effectiveness of our implementation intervention. [ABSTRACT FROM AUTHOR]

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

Postgraduate physician assistant (PA) programs designed to train individuals for the workplace have existed since the advent of the profession itself. These residency programs continue to grow in number despite the lack of outcome data supporting improvements in PA learning, effects on career development, or improved patient care. Leadership bodies of the PA profession in the US have been at odds regarding the meaning and ramification of postgraduate programs on specialty credentialing, accreditation standards, insurance reimbursement, and employment. Using Bourdieu's cultural conflict theory as a framework, we analyze the issues confronting postgraduate PA training programs. Our paper discusses implications related to shifts in power amongst the different stakeholders concluding that, although formal postgraduate PA training can be beneficial to both the PA and the medicine, considerations related to underlying agendas need attention. [ABSTRACT FROM AUTHOR]

The aim of this paper is to bring together data concerning the social attributes and backgrounds of a cohort of general practitioners, to relate this to certain features of the organizations within which the doctors work, and to make certain suggestions about the implications of the results for the sociology of the professions. Sociological studies of the professions appear to originate from two main theoretical orientations. One approach views a profession as a relatively monolithic and homogeneous social grouping, and examines the features which distinguish a profession from other occupations. Examples of this approach are the work of Parsons,[1] Cogan,[2] Goode[3] and Greenwood.[4] This approach, which may be called the 'attributes' approach, unquestionably has its uses. For example, it is possible to assess the degree to which various occupations can be said to conform to the model of a 'profession'. Both Akens and Quinney,[5] and Hickson and Thomas,[6] for example, have developed sets of items upon which occupations may be assessed to discover how far they resemble an 'ideal' profession. [ABSTRACT FROM AUTHOR]