Systemic and Reflexive: Foundations of Cumulative Dis/Advantage and Life-Course Processes.

Cumulative dis/advantage has been defined as the systemic tendency for interindividual divergence in a given characteristic to increase with the passage of time. Over recent decades, evidence supporting cumulative dis/advantage (CDA) as a cohort-based process that produces inequalities on a range of life-course outcomes has steadily increased. This paper reviews this growing body of work, grounding the discussion in CDA's foundation as a general sociological construct with broad relevance. I emphasize the distinction between outcome and process, and then distinguish multiple levels of social analysis at which CDA operates. From this review, I extract two principles, endogenous system dynamics and life-course reflexivity, that can be cross-classified to provide a framework for analyzing contemporary research frameworks and initiatives relevant to CDA. I argue that the full sociological impact and implications of CDA research has been unevenly developed and applied, and conclude by suggesting some possible directions for further building on CDA's insights.

[Medical sociology: origin and field of action]. / Sociología médica: origen y campo de acción.

A review of the published literature on the origin of medical sociology and its field of action was made. For this, several publications were analyzed and the most relevant aspects were summarized. Although the concept of disease has always been linked to sociocultural aspects, only until the mid-twentieth century, Medicine recognized the importance of sociology to explain health-related issues, especially the social determinants of health. Currently, sociologists work in a multidisciplinary way with doctors to investigate and analyze issues concerning the health of people, to improve the welfare and quality of life of the population. In this sense, the contribution of Sociology has not only enriched the understanding of some diseases, but also different aspects of the work of Medicine.

Se hizo una revisión de la literatura publicada sobre el origen de la sociología médica y su campo de acción. Para ello, se analizaron diversas publicaciones y se resumieron los aspectos más relevantes. A pesar de que la enfermedad siempre ha estado ligada a aspectos socioculturales, recién a mediados del siglo XX, la medicina reconoce la importancia de la sociología en la explicación de temas relacionados a la salud, especialmente para explicar los determinantes sociales de la salud. En la actualidad, los sociólogos trabajan de manera multidisciplinaria con médicos para investigar y analizar cuestiones concernientes a la salud de las personas, para mejorar el bienestar y la calidad de vida de la población. En este sentido, el aporte de la sociología no solo ha enriquecido la comprensión de algunas enfermedades, sino también diferentes aspectos en el quehacer de la medicina.

Grant writing: Moving from generating ideas to applying to grants that matter.

There is an extraordinary burden placed upon the healthcare system and people as a result of health disparities that exist within the United States. If there is going to be a concerted effort to develop innovative strategies to reduce health disparities, input from the community and behavioral scientists can and should be included in this approach and narrative. Grant writing provides one vehicle to express the narrative and to provide a means to fund research and programs within clinic-based and community settings. This paper describes a four-step inquiry process to guide healthcare professionals with varying degrees of clinical and scholarship interests through the grant writing process. They include: (1) Why write grants (motivations), (2) what is the area of focus? (Interests), (3) whom should be on the project? (partnerships), and (4) what needs to happen next to move the idea forward? (actions) The complexity of psychosocial issues means that behavioral science is well suited to develop both hypotheses-driven and phenomenological research to understand bio-psycho-social health issues. Grant writing does not need to be mysterious or daunting. It can provide a means to an end, not only to fund research but also as a means to an end of health disparities.

Studying Scale-Up and Spread as Social Practice: Theoretical Introduction and Empirical Case Study.

BACKGROUND: Health and care technologies often succeed on a small scale but fail to achieve widespread use (scale-up) or become routine practice in other settings (spread). One reason for this is under-theorization of the process of scale-up and spread, for which a potentially fruitful theoretical approach is to consider the adoption and use of technologies as social practices. OBJECTIVE: This study aimed to use an in-depth case study of assisted living to explore the feasibility and usefulness of a social practice approach to explaining the scale-up of an assisted-living technology across a local system of health and social care. METHODS: This was an individual case study of the implementation of a Global Positioning System (GPS) "geo-fence" for a person living with dementia, nested in a much wider program of ethnographic research and organizational case study of technology implementation across health and social care (Studies in Co-creating Assisted Living Solutions [SCALS] in the United Kingdom). A layered sociological analysis included micro-level data on the index case, meso-level data on the organization, and macro-level data on the wider social, technological, economic, and political context. Data (interviews, ethnographic notes, and documents) were analyzed and synthesized using structuration theory. RESULTS: A social practice lens enabled the uptake of the GPS technology to be studied in the context of what human actors found salient, meaningful, ethical, legal, materially possible, and professionally or culturally appropriate in particular social situations. Data extracts were used to illustrate three exemplar findings. First, professional practice is (and probably always will be) oriented not to "implementing technologies" but to providing excellent, ethical care to sick and vulnerable individuals. Second, in order to "work," health and care technologies rely heavily on human relationships and situated knowledge. Third, such technologies do not just need to be adopted by individuals; they need to be incorporated into personal habits and collaborative routines (both lay and professional). CONCLUSIONS: Health and care technologies need to be embedded within sociotechnical networks and made to work through situated knowledge, personal habits, and collaborative routines. A technology that "works" for one individual in a particular set of circumstances is unlikely to work in the same way for another in a different set of circumstances. We recommend the further study of social practices and the application of co-design principles. However, our findings suggest that even if this occurs, the scale-up and spread of many health and care technologies will be neither rapid nor smooth.

Lay knowledge, social movements and the use of medicines: Personal reflections.

This article consists of two personal reflections about the changing status of lay knowledge over the last 20 years. The first reflection is by Nicky Britten from the perspective of a sociologist working in medical schools whose interest in this topic was motivated by my own personal experience of health care and of teaching general practitioners. Starting with the problematic deficit model of 'ignorant patients', I trace the literature on patient-centredness, shared decision-making, lay knowledge, public involvement in research and social movements. Looking at medicines use in particular, I deplore the continued hegemony of the concept of compliance in the face of extensively documented problems with the licensing, regulation, prescribing and monitoring of medicines. I argue that lay knowledge is now taken more seriously, not so much because of advocacy by clinicians and academics, but because of social movements and social action. We may have moved from 'anecdotes' to 'lived experience' but there is still a way to go, particularly when it comes to medicines use. I end with a possible future scenario. The second reflection is by Kath Maguire and is a response from the perspective of someone who came to work in this field with the express purpose of improving engagement with lay knowledge. It questions my own 'layness' and explores the issues raised by Nicky Britten using the lens of lived experience. Finally, it questions the paradigm of social movements and highlights the importance of developing different ways of listening.

Medical sociology as a vocation.

This article extends Weber's discussion of science as a vocation by applying it to medical sociology. Having used qualitative methods for nearly 40 years to interpret problems of meaning as they arise in the context of health care, I describe how ethnography, in particular, and qualitative inquiry, more generally, may be used as a tool for understanding fundamental questions close to the heart but far from the mind of medical sociology. Such questions overlap with major policy questions such as how do we achieve a higher standard for quality of care and assure the safety of patients. Using my own research, I show how this engagement takes the form of showing how simple narratives of policy change fail to address the complexities of the problems that they are designed to remedy. I also attempt to explain how I balance objectivity with a commitment to creating a more equitable framework for health care.

Challenging research: completing participatory social research with children and adolescents in a hospital setting.

OBJECTIVE: A discussion of the challenges to completing participatory social research with children and adolescents in a hospital setting. BACKGROUND: Beginning with the dominant medical culture of hospitals, coupled with a persistent skepticism of social and in particular, qualitative research and its contribution to knowledge in medical circles, restrictive contextual challenges also include attitudinal, methodological, and logistical considerations. Together, these challenges hamper good participatory research practice and the capacity to maintain quality data, as well as impede children's participation in research, which has the capacity to contribute to healthcare design, policy, and planning processes. METHODS: Two studies in pediatric settings in Australia, one of which was completed in 2008 and the other which was discontinued in 2011, provide the basis for this research discussion. The discussion addresses the issues that persist in inhibiting the completion of participatory social research and the resulting impacts on research, children's right to participate, and the volume of evidence that is ultimately available from children's perspectives to support and inform healthcare design, planning, and policy in pediatric settings. CONCLUSIONS: Recommendations for changes that could strengthen and improve this research experience include building awareness of the potential value of this research; increasing its influence; building the capacity and knowledge of gatekeepers, ethics committees, and researchers working in this context; and recognizing and valuing children's competence and participation. KEYWORDS: Evidence-based design, hospital, methodology, patients, pediatric.

Using clinical vignettes to assess doctors' and medical students' ability to identify sociocultural factors affecting health and health care.

BACKGROUND: Methods are needed for assessing clinicians' cultural knowledge frameworks. METHOD: We used a mail survey containing four short clinical vignettes to explore respondents' ability to identify sociocultural factors affecting health and health care. Participants included 299 physicians working at the University Hospitals of Geneva, 156 private physicians, and all 134 local medical students in their clinical years. Twenty-one sociocultural "domains" were identified through inductive coding of responses. For each vignette, we obtained the sum of codes as a measure of the respondent's awareness of sociocultural factors that might affect care in this particular situation. As internal consistency was reasonably high (0.68), we computed a single total score as the sum of responses given to all four vignettes. RESULTS: Reponses correlated with factors that might be expected to impact clinicians' awareness of sociocultural factors affecting care. Medical students, females, respondents who had received cultural competence training, those with greater interest in caring for immigrant patients, and those with high self-assessed skills at exploring psychosocial and migration-related issues scored higher on the vignettes. CONCLUSIONS: Brief clinical vignettes appear to be a relevant and feasible method for exploring physicians' knowledge of social and cultural factors affecting health and health care.

Rooting inquiry in tradition: the health baraza as a tool for social research in Kenya.

The baraza is a customary form of community assembly in East Africa. We examined the use of the health baraza as a process that can improve data collection and deepen community understanding of sociocultural issues surrounding HIV/AIDS. In the evaluation of the United States Agency for International Development (USAID)-Academic Model for Prevention and Treatment of HIV/AIDS Partnership (USAID-AMPATH) in Kenya, investigators facilitated mabaraza (the plural of baraza) to gather information of relevance to program success, improvement, and community collaboration. Seven mabaraza were held at local health facilities. Mabaraza rapidly evoked essential information for the USAID-AMPATH program and facilitated vibrant discussion of themes that were of interest to local communities. Mabaraza combined individual and community outlooks, producing emic understanding of the program's meaning to local populations. The baraza assemblage is a promising technique for applied sociology, participatory research, and program evaluation.

Infectious disease modeling of social contagion in networks.

Many behavioral phenomena have been found to spread interpersonally through social networks, in a manner similar to infectious diseases. An important difference between social contagion and traditional infectious diseases, however, is that behavioral phenomena can be acquired by non-social mechanisms as well as through social transmission. We introduce a novel theoretical framework for studying these phenomena (the SISa model) by adapting a classic disease model to include the possibility for 'automatic' (or 'spontaneous') non-social infection. We provide an example of the use of this framework by examining the spread of obesity in the Framingham Heart Study Network. The interaction assumptions of the model are validated using longitudinal network transmission data. We find that the current rate of becoming obese is 2 per year and increases by 0.5 percentage points for each obese social contact. The rate of recovering from obesity is 4 per year, and does not depend on the number of non-obese contacts. The model predicts a long-term obesity prevalence of approximately 42, and can be used to evaluate the effect of different interventions on steady-state obesity. Model predictions quantitatively reproduce the actual historical time course for the prevalence of obesity. We find that since the 1970s, the rate of recovery from obesity has remained relatively constant, while the rates of both spontaneous infection and transmission have steadily increased over time. This suggests that the obesity epidemic may be driven by increasing rates of becoming obese, both spontaneously and transmissively, rather than by decreasing rates of losing weight. A key feature of the SISa model is its ability to characterize the relative importance of social transmission by quantitatively comparing rates of spontaneous versus contagious infection. It provides a theoretical framework for studying the interpersonal spread of any state that may also arise spontaneously, such as emotions, behaviors, health states, ideas or diseases with reservoirs.

Partnering with children diagnosed with mental health issues: contributions of a sociology of childhood perspective to participatory action research.

This paper explores the use of participatory action research (PAR) with children diagnosed with mental health issues. We argue that critiques from the sociology of childhood are useful for guiding PAR with children. First, we describe and critique values and assumptions that underlie research and practice with children who experience mental health issues. Second, we outline key qualities of the sociology of childhood, discuss their implications for PAR with children diagnosed with mental health issues, and touch on ethical issues. Five themes are explored: (a) values, (b) ontology/epistemology, (c) views about children, (d) agency/power in children's relationships with adults, and (e) intervention/change focus. We conclude by encouraging community psychologists to consider PAR with children diagnosed with mental health issues.

Social epidemiology: social determinants of health in the United States: are we losing ground?

The United States ranks in the lower tiers of OECD countries in life expectancy, and recent studies indicate that socioeconomic inequalities in health have been widening in the past decades. Over this period, many rigorous longitudinal studies have identified important social, behavioral, and environmental conditions that might reduce health disparities if we could design effective interventions and make specific policy changes to modify them. Often, however, neither our policy changes nor our interventions are as effective as we hoped they would be on the basis of findings from observational studies. Reviewed here are issues related to causal inference and potential explanations for the discrepancy between observational and experimental studies. We conclude that more attention needs to be devoted to (a) identifying the correct etiologic period within a life-course perspective and (b) understanding the dynamic interplay between interventions and the social, economic, and environmental contexts in which interventions are delivered.

Geographic life environments and coronary heart disease: a literature review, theoretical contributions, methodological updates, and a research agenda.

A growing literature investigates associations between neighborhood social environments and coronary heart disease (CHD). After reviewing the literature, we present a theoretical model of the mechanisms through which geographic life environments may influence CHD, focusing particularly on the social-interactional environment. We suggest that, in addition to the common notions of social cohesion or fragmentation and social disorder, eco-epidemiologists should consider neighborhood identities and stigmatization processes. We posit that neighborhood social interactions affect the wide set of affective, cognitive, and relational experiences individuals have in their neighborhoods, which in turn influence the psycho-cognitive antecedents of behavior and in the end shape health behavior. Finally, we discuss key methodological challenges relevant to the advent of a new generation of neighborhood studies, including the operational definition of neighborhoods, non-residential environments, ecometric measurement, model specification strategies, mediational models, selection processes and notions of empirical/structural confounding, and the relevance of observational versus interventional studies.

Sociological interpretations of professionalism.

CONTEXT: Professionalism is a hot topic in medical education, yet there is debate about what professionalism actually is. The reason is that medical educators primarily frame professionalism as a list of characteristics or behaviours. However, many sociologists of the professions favour more explanatory theories that incorporate political, economic and social dimensions into understanding of the nature and function of professionalism. OBJECTIVES: This paper reviews a range of approaches used in the sociology of the professions to support the argument that medical education needs to reframe its priorities for research into, and the development of, professionalism in medical education. METHODS: The literature on the sociology of the professions was reviewed and summarised in relation to medical education. CONCLUSIONS: A focus on individual characteristics and behaviours alone is insufficient as a basis on which to build further understanding of professionalism and represents a shaky foundation for the development of educational programmes and tools. Contemporary sociological literature on professionalism should have greater prominence in this domain.

Práticas de saúde, sentidos e significados construídos: instrumentos teóricos para sua interpretação / Health practices, constructed meanings and senses: theoretical instruments to help the interpretative analysis / Prácticas de salud, sentidos y significados construidos: instrumentos teóricos para su interpretación

This paper approaches the difficulties faced by professionals and students to interpret cultural meanings and senses constructed from health practices. The main objective is to update the theoretical instruments that are available to the interpretative analysis of this construction process. A list of linked topics is provided, introducing two health-related paradigms: the classical one and that of vitality. Then we discuss a social structure design that, together with the practitioners and a set of elements, triggers reactions and social transformations. We explore the conception of perception as social construction and the concept of habitus as mediation between structure and praxis. We created figures to position the interpretative elements. The conclusion is that it is in the role of practitioner that we can build new meanings and senses and "be built" by them, and that health practices may produce new models to face the sanitary crisis, as if they were "escape points" within a reality of social inequalities.

Este trabalho reflete sobre a dificuldade em interpretar sentidos e significados culturais construídos com base nas práticas de saúde. Tem como objetivo atualizar os instrumentos teóricos acessíveis para uma análise interpretativa desse processo de construção. Segue um roteiro de tópicos encadeados que se inicia com a apresentação de dois paradigmas ligados à saúde: o clássico e o da vitalidade. Discute-se um desenho de estrutura social que, juntamente com os atores das práticas e um conjunto de elementos, engendra reações e transformações sociais. Explora-se a concepção de percepção como construção social e o conceito de habitus enquanto mediação entre estrutura e práxis. Foram construídas figuras para posicionar elementos interpretativos. Concluímos que é na condição de praticante que podemos construir novos sentidos e significados e "sermos construídos" por eles, e que as práticas de saúde podem produzir novos modelos de enfrentamento da crise sanitária como "respiradouros" numa realidade de desigualdades sociais.

Este trabajo reflexiona sobre la dificultad de interpretar sentidos y significados culturales construidos a partir de las prácticas de salud. Tiene por objeto actualizar los instrumentos teóricos acessibles para un análisis interpretativo de este proceso de construcción. Sigue una ruta de tópicos encadenados que se inicia con la presentación de dos paradigmas vinculados a la salud: el clásico y el de la vitalidad. Se discute un diseño de estructura social que, junto con los actores de las prácticas y un conjunto de elementos, engendra reacciones y transformaciones sociales. Se explora la concepción de percepción como construcción social y el concepto de hábitos como mediación entre estructura y praxis. Se han construido figuras para posicionar elementos interpretativos. Concluimos que es en la condición de parcticante en que podemos construir nuevos sentidos y significados y "seremos construidos" por ellos, y que las prácticas de salud pueden producir nuevos modelos para afrontar la crisis sanitaria como "respiraderos" en una realidad de desigualdades sociales.

Comparison of two methods of eliciting time preference for future health states.

Mean estimates of time preference rates for health vary widely in the literature. If these studies are to inform discounting practice and analyses of health-affecting behaviour, it is crucial to understand why this is the case. One reason for the variation in time preference rates is the use of different elicitation methods. The influence of elicitation method has received little attention in the time preference literature. This study compares directly an open-ended and a closed-ended method. Both private and social time preferences for health are elicited. The closed-ended method produced much lower mean rates than the open-ended method. This is in contrast to the contingent valuation literature which shows that closed-ended methods produce higher estimates of willingness to pay than open-ended methods. That the elicitation methods produce different mean estimates is clearly worrying if the interest is in estimating the true time preference rate. However, the results of this study suggest that if the interest is in testing different types of time preferences or investigating the relationship between time preference and individual characteristics then the choice of elicitation method is less important.