Social Determinants of Shingles Vaccination in the United States.

OBJECTIVE: Only about one-third of older adults in the United States are vaccinated against shingles, contributing to approximately 1 million shingles cases annually. This study examines how sociodemographic characteristics, health behaviors, and self-rated health are associated with shingles vaccine uptake. METHOD: Data come from the 2017 wave of the Behavioral Risk Factor Surveillance System survey, using a subset of older adults aged 60-plus (N = 208,301). Logistic regression models test (a) for associations between individual-level sociodemographic characteristics and vaccine uptake and (b) whether health behaviors and self-rated health moderate these associations. RESULTS: Black and Hispanic older adults have almost 50% lower odds of shingles vaccination, compared to non-Hispanic Whites. Abstaining from alcohol, being employed, living with children, and having poor self-rated health are also associated with lower uptake. Unmarried (vs married) individuals have lower odds of vaccination that are explained by broad differences in health behavior. DISCUSSION: Our study contributes to understanding how shingles vaccination coverage systematically differs among social groups. In doing so, it provides guidance for public health interventions to increase uptake. This line of research is increasingly salient in a world facing novel virus threats and antivaccine social movements.

[Medical Psychology and Medical Sociology in Transition - Review and Perspectives of the two Disciplines in Germany]. / Medizinische Psychologie und Medizinische Soziologie im Wandel ­ Bestandsaufnahme und Perspektiven der beiden Fächer in Deutschland.

AIM OF THE STUDY: Through the Master Plan for Medical Studies 2020 and the development of the National Competence-Based Learning Target Catalogue Medicine (NKLM), significant changes in university medicine were started. The aim of the study was a systematic analysis of the state and perspectives of the disciplines of medical psychology and sociology at the medical faculties in Germany. METHODOLOGY: An online survey was conducted on 5 topics (structure, teaching, research, care, perspectives). 46 departments and institutes of medical psychology and sociology were invited to the survey. RESULTS: 40 of the 46 contacted institutions have called up the online questionnaire, 35 have answered in full (return: 76.1%). 77% of the institutions are autonomous. In the median, the institutions have 15 employees (range: 1 to 149). 9 universities have established a model curriculum. More than half of the institutions use and train simulation patients. The main research priorities are clinical research, health care research, neuroscience and classical medical psychology or sociological research topics. The institutions receive primarily public funding and publish 19 publications (80% international, median) each year. Publication opportunities are considered "satisfactory" by 54% of institutions (2003: 44%), and by 29% as "very satisfactory" (2003: 21%). 9 out of 27 medical psychology institutes provide clinical services to patients and relatives with mental or chronic physical illness. Almost half of the institutions expect the Master Plan 2020 to further increase the relevance of the subjects. DISCUSSION: Since 2003 there has been a substantial increase in scientific staff, third-party funding and publications. The sites show a pronounced heterogeneity in terms of size and equipment, which leads to an imbalance in terms of teaching and research as well as clinical services. CONCLUSION: The subjects of medical psychology and medical sociology have developed very heterogeneously in terms of independence, size, equipment and possibilities at the various faculties in Germany. Therefore, it is very important in the future that the 2 disciplines intensify the dialogue with each other and also with other psychosocial disciplines in order to influence the current development regarding NKLM and Master Plan 2020 constructively. On the one hand, this calls for an expansion of disadvantaged institutions and a consolidation of the existing autonomous institutions.

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.

Sociology of the professions: what it means for podiatry.

BACKGROUND: The health professions have progressed and evolved considerably over the last few decades in response to demographic, technological, societal and political changes. They continue to do so as the volume and complexity of population health needs steadily increase. Role boundary expansion is among the key changes to the health professions, including podiatry to meet demand. Nonetheless podiatry's role boundary expansion has not been achieved swiftly or without resistance from neighbouring and dominant professions. This paper seeks to explain the nature of this resistance with respect to the sociology of the professions literature and to shed light on some of the factors and processes at play when role boundary changes arise in health care. DISCUSSION: Six of the most contemporaneously relevant sociology of the professions theories are summarised: Taxonomic, Marxian, Bourdieusian, Foucauldian, Boundary Work and Neo-Weberian paradigms. CONCLUSION: This review highlights that some paradigms are more relevant than others in the current socio-political landscape. It also illustrates that there is a common theme underlying each approach to defining the professions and their boundaries: competition. This may help health professionals, including podiatrists, to understand and manage the challenges and resistance experienced when professions attempt to expand role boundaries to meet increasing and changing population health needs.

Medical intelligence, security and global health: the foundations of a new health agenda.

Medical intelligence, security and global health are distinct fields that often overlap, especially as the drive towards a global health security agenda gathers pace. Here, we outline some of the ways in which this has happened in the recent past during the recent Ebola epidemic in West Africa and in the killing of Osama Bin laden by US intelligence services. We evaluate medical intelligence and the role it can play in global health security; we also attempt to define a framework that illustrates how medical intelligence can be incorporated into foreign policy action in order delineate the boundaries and scope of this growing field.

From patient deference towards negotiated and precarious informality: An Eliasian analysis of English general practitioners' understandings of changing patient relations.

This article contributes to sociological debates about trends in the power and status of medical professionals, focussing on claims that deferent patient relations are giving way to a more challenging consumerism. Analysing data from a mixed methods study involving general practitioners in England, we found some support for the idea that an apparent 'golden age' of patient deference is receding. Although not necessarily expressing nostalgia for such doctor-patient relationships, most GPs described experiencing disruptive or verbally abusive interactions at least occasionally and suggested that these were becoming more common. Younger doctors tended to rate patients as less respectful than their older colleagues but were also more likely to be egalitarian in attitude. Our data suggest that GPs, especially younger ones, tend towards a more informal yet limited engagement with their patients and with the communities in which they work. These new relations might be a basis for mutual respect between professionals and patients in the consulting room, but may also generate uncertainty and misunderstanding. Such shifts are understood through an Eliasian framework as the functional-democratisation of patient-doctor relations via civilising processes, but with this shift existing alongside decivilising tendencies involving growing social distance across broader social figurations.

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.

The social origin of the illness experience--an outline of problems.

INTRODUCTION AND OBJECTIVE: The main research objective is a study of social influences on the processes of experiencing illness in the sociological meaning of the term 'illness experience' focusing attention on the subjective activity inspired by being ill, taking into account interpretive (meaning-making) activity. The goal of the analysis is to specify 'social actors' jointly creating the phenomena of 'illness' and 'being ill', taking into consideration the evolution of the position of medical sociology on this issue. BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE: The ways of experiencing illness in contemporary society, including processes of creating the meanings of the phenomena of 'illness' and 'being ill', are the outcome of not only the application of biomedical knowledge, but are also parallelly a sociocultural 'construct' in the sense that they are under the impact of social and cultural influences. In the sociology of illness experience it is pointed out that illness experience develops in connection with experiencing somatic discomfort, this process occurring in the context of influences of culture, society and socially accepted norms and values. These relationships are interpreted by the sociological, interactionist model which presents illness as a 'social construct'. CONCLUSIONS: Sociological studies on the social construction of 'illness' and 'being ill' construct a model of these phenomena, complementary to the biomedical model, conducive to the validation of the patient's perspective in the processes of medical treatment, and to the humanization of the naturalistically oriented, biomedical approach to illness, i.e. to adjust it more accurately to typically human needs manifesting themselves in the situation of being ill.

Six paths for the future of social epidemiology.

Social epidemiology is now an accepted part of the academic intellectual landscape. However, in many ways, social epidemiology also runs the risk of losing the identity that distinguished it as a field during its emergence. In the present article, we scan the strengths of social epidemiology to imagine paths forward that will make the field distinct and useful to the understanding of population health in future. We suggest 6 paths to such a future, each emerging from promising research trends in the field in which social epidemiologists can, and should, lead in coming years. Each of these paths contributes to the formation of distinct capacities that social epidemiologists can claim and use to elaborate or fill in gaps in the already strong history of social epidemiology. They present an opportunity for the field to build on its strengths and move forward while leading in new and critical areas in population health.

To tell the truth. A critical trend in medical sociology--an introduction to the problems.

INTRODUCTION AND OBJECTIVE: The presented analysis is a reconstruction of the origins, inspirations for development, and theoretical foundations of the critical and unmasking trend in Polish and Western medical sociology. ABBREVIATED DESCRIPTION OF THE STATE OF KNOWLEDGE: As a part of the critical medical sociology initiated in Poland by Professor Magdalena Sokolowska, a diagnosis of the (dys)functionality of contemporary medicine is carried out, emphasizing pathologies in the realization of its basic social functions, both at the level of systemic and institutional solutions, as well as stressing their consequences which include inter alia social health inequalities. Within the critical sociomedical research orientation, the diagnoses of the social role of medicine and distortions in the ways it is exercised are placed in the broad structural, political, and cultural contexts, which makes it possible to point to the principal causes of the analyzed phenomena. SUMMARY: The crucial 'value added' of critical sociological analyses of medicine and health policy are directives intended to humanize medicine and health systems in contemporary societies, taking social and cultural realities into consideration. We understand the humanization of medicine in terms of its better adjustment to human needs that emerge in the situations of illness and being ill, with the simultaneous guarantee of universal and equal access to medical services.

Standardising antisocial personality disorder: the social shaping of a psychiatric technology.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is one of the most influential and controversial terminological standards ever produced. As such, it continues to provide a valuable case study for sociologists of health and illness. In this article I take as my focus one particular DSM category: antisocial personality disorder (ASPD). The analysis charts the shifting understandings of personality disorders associated with antisocial behaviour in the DSM and in US psychiatry more broadly from 1950 to the present day. Memos, letters and minutes produced by the DSM-III committee and held in the American Psychiatric Association (APA) archives ground the discussion. Finally, the article explores more recent constructions of antisocial personality disorder and examines the anticipatory discourse pertaining to the rewriting of this category expected in the forthcoming DSM-5. In presenting an in-depth socio-historical narrative of the development - and potential future - of standards for pathological antisociality, this analysis casts new light on the ASPD construct. In particular, by considering it as a technology, I elaborate how processes of path dependency constrain innovation and how imaginaries of users and publics are implicated in the APA debates constitutive of this.

A sociological approach to ageing, technology and health.

Abstract This special monograph issue builds on sociology of health and illness scholarship and expands the analytical lens to examine how old people, healthcare professionals, and technology designers create, use, and modify science and technology to negotiate and define health and illness. Far from passive consumers, elders are technogenarians, creatively utilising and adapting technological artefacts such as walking aids and medications to fit their needs. This publication adds theoretical and empirical depth to our understanding of the multiple and overlapping socio-historical contexts surrounding ageing bodies and ageing enterprises, including the biomedicalisation of ageing that includes the rise of anti-ageing or longevity medicine; and the rise of gerontechnology industries and professions -- fields that largely accept the ageing body as a given. This collection sociologically investigates how and where these two trends overlap and diverge in relation to a global context of ageing and ageism, and calls for further scholarship in this area. Combining science and technology studies and sociology of health and illness frameworks together provides an empirical basis from which to analyse technogenarians in action, as well as the stakeholders and institutions involved in the ageing, health, and technology matrix.

Adherencia terapéutica y cronicidad: modelo psicosocial / Therapeutic adhesion and chronicity psychosocial model

Debido a la prevalencia epidemiológica de las enfermedades crónicas y a las diversas modalidades que los pacientes asumen frente a los tratamientos, el objetivo del presente trabajo es investigar la adherencia terapéutica en padecimientos crónicos. El modelo psicosocial reconoce que la dimensión psicosocial es tan importante como la naturaleza misma de la enfermedad, por lo tanto desde esta perspectiva analizamos y evaluamos las características que asume la adherencia terapéutica en dos grupos de pacientes crónicos: trombovasculares y oncohematológicos, a través de las percepciones que el paciente posee acerca de su padecimiento, circunstancias personales y dimensión subjetiva, apoyo social, cuidados informales, equipo de salud e institución. La metodología elegida es la cualitativa. Tipo de diseño: exploratorio, descriptivo y transversal. Unidades de análisis: los pacientes crónicos hematológicos. Muestra: intencional no probabilística, 30 entrevistas de un Universo de 19244 pacientes. Instrumento: entrevista semiestructurada diseñada por la autora. Los resultados obtenidos evidencian altos grados de adherencia terapéutica y entre los aspectos que más influyen se destacan casi en un mismo nivel la "dimensión subjetiva/circunstancias personales del paciente", el "equipo de salud/institución", y la presencia de "procesos protectores". Se recomienda a los sistemas formales de salud la creación de dispositivos de atención para padecimientos de larga evolución.

In view of the epidemiologic prevalence of chronic diseases and the diverse modalities that the patients assume towards treatments, the aim of the present work is to investigate the therapeutic adhesion in chronic sufferings. The psychosocial model recognizes that the psychosocial dimension is as important as the intrinsic nature of the disease, therefore from this perspective we analyzed and evaluated the characteristics that the therapeutic adhesion assumes in two groups of chronic patients: thrombovascular and oncohematological patients, through the patient's perceptions about their personal suffering, circumstances and subjective dimension, social support, informal cares, health team and institution. The chosen methodology is the qualitative one. Type of design: exploratory, descriptive and cross- sectional. Analysis units: the hematological chronic patients. Sample: intentional non probabilistic, 30 interviews of a universe of 19244 patients. Instrument: semi-structured interview designed by the author. The results demonstrate high degree of therapeutic adhesion and the most influential aspects that stand out in an almost equal level, appears the "subjective dimension/ personal circumstances of the patient", the "health team/institution", and the presence of "protective processes". The creation of devices for sufferings of long evolution is recommended to the formal systems of health.

Progestins and medical treatment of endometriosis - physiology, history and society.

The transitory effect of hormonal treatment is the alleged main reason to criticize progestins (PGS) and combined pills (OP) in the managment of endometriosis. To the contrary their poor efficacy in the long run is often underlined. As a result, medical treatment is too seldom advised in endometriosis. In this article, we shall focus on the analysis of the reasons of the paucity of the medical interest given to progestins, reasons, which are not of a scientific or objective nature. The ultimate aim of this analysis is to develop arguments in favour of continuous administration of hormones as to obtain not simply an anovulation but a state of prolonged amenorrhea much more efficacious than the simple suppression of ovulation too often advised. And, with an emphasis on the fundamental role of surgery in the treatment of endometriosis, to give the greatest consideration to the specific nature of this disease, which is a chronic disease, justifying the long duration of hormonal administration.

Tecnología, demanda social y “medicina del deseo” / Technology, social requirement, and ‘‘wish - fulfilling medicine’’

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Trends that will affect your future ... mind-body and the social dimension.

The SchwartzReport tracks emerging trends that will affect the world, particularly the United States. For EXPLORE, it focuses on matters of health in the broadest sense of that term, including medical issues, changes in the biosphere, technology, and policy considerations, all of which will shape our culture and our lives.