Please find below the first half of this month’s roundup. In addition, Aaron Seaman has posted an entry for a special issue of Disability and the Global South on the topic of Global Mental Health. You can find it here. Enjoy.
The evidence that demonstrates the negative effects of maternal psychological stress during pregnancy on a wide variety of offspring outcomes is growing. Animal studies suggest that negative influences of maternal stress during pregnancy persist across multiple generations, but the direct evidence to confirm that the effect is present among human populations is scarce. This study draws evidence on the intergenerational influences of maternal stress from the Kwangju uprising (May 18–27, 1980), arguably the bloodiest incident that occurred in South Korea since the end of the Korean War in 1953. The results of difference-in-difference estimations suggest that in utero exposure to the Kwangju uprising significantly diminished the offspring birth weight and length of gestation, and increased the risks of low birth weight and preterm birth. Exposure to stress during the second trimester of pregnancy exerted the strongest negative effect on grandchildren’s birth outcomes.
Perceived quality of an alternative to acute hospitalization: An analytical study at a community hospital in Hallingdal, Norway
Øystein Lappegard, Per Hjortdahl
There is growing international interest in the geography of health care provision, with health care providers searching for alternatives to acute hospitalization. In Norway, the government has recently legislated for municipal authorities to develop local health services for a selected group of patients, with a quality equal to or better than that provided by hospitals for emergency admissions. General practitioners in Hallingdal, a rural district in southern Norway, have for several years referred acutely somatically ill patients to a community hospital, Hallingdal sjukestugu (HSS). This article analyzes patients’ perceived quality of HSS to demonstrate factors applicable nationally and internationally to aid in the development of local alternatives to general hospitals. We used a mixed-methods approach with questionnaires, individual interviews and a focus group interview. Sixty patients who were taking part in a randomized, controlled study of acute admissions at HSS answered the questionnaire. Selected patients were interviewed about their experiences and a focus group interview was conducted with representatives of local authorities, administrative personnel and health professionals. Patients admitted to HSS reported statistically significant greater satisfaction with several care aspects than those admitted to the general hospital. Factors highlighted by the patients were the quiet and homelike atmosphere; a small facility which allowed them a good overall view of the unit; close ties to the local community and continuity in the patient–staff relationship. The focus group members identified some overarching factors: an interdisciplinary and holistic approach, local ownership, proximity to local general practices and close cooperation with the specialist health services at the hospital. Most of these factors can be viewed as general elements relevant to the development of local alternatives to acute hospitalization both nationally and internationally. This study indicates that perceived quality should be one of the main motivations for developing alternatives to general hospital admissions.
Dispensing emotions: Norwegian community nurses’ handling of diversity in a changing organizational context
Jonas Debesay, Ivan Harsløf, Bernd Rechel, Halvard Vike
Since the mid-1990s, public sector health care services in Norway have been restructured, in line with New Public Management ideas. This restructuring has coincided with demographic changes that have led to a more culturally diverse patient population. Both developments have created new challenges for community nurses in managing their work. This qualitative study applies the concept of “emotional labor” to examine nurses’ experiences in working with ethnic minority patients in the context of pressures arising from organizational reforms. The analysis sheds light on the nurses’ attempts to comply with system-induced efficiency considerations, while catering to the special situation of patients with language barriers and unfamiliar cultural traditions. The article demonstrates how efficiency requirements and time constraints either aggravate the nurses’ insecurity in dealing with minority patients or, in some cases, compel them to assume more work responsibilities so as to mitigate the effects of such constraints.
What must I do to succeed?: Narratives from the US premedical experience
Katherine Y. Lin, Renee R. Anspach, Brett Crawford, Sonali Parnami, Andrea Fuhrel-Forbis, Raymond G. De Vries
How does a lay person become a doctor? How is a physician made? These questions have been central to work of medical sociologists for well over a half-century. Despite this abiding focus on socialization, nearly all of the literature on this process in the US is informed by studies of the medical school and residency years, with almost no empirical attention paid to the premedical years. Our study addresses this gap in knowledge. To better understand the premedical years we conducted 49 in-depth interviews with premedical students at a selective, public Midwestern university. We found that students understand and explain decisions made during the premedical years with narratives that emphasize the qualities of achievement-orientation, perseverance, and individualism. We also find that these qualities are also emphasized in narratives employed to account for the choice to collaborate with, or compete against, premedical peers. Examination of premedical narratives, and the qualities they emphasize, enriches our understanding of how premedical education shapes a physician’s moral development, and underscores the need to include the premedical years in our accounts of “becoming a doctor.”
We call it a virus but I want to say it’s the devil inside’: Redemption, moral reform and relationships with God among people living with HIV in Papua New Guinea
Angela Kelly-Hanku, Peter Aggleton, Patti Shih
There is growing recognition of the importance of religion and religious beliefs as they relate to the experience of HIV, globally and in Papua New Guinea in particular. Based on 36 in-depth qualitative interviews conducted with people living with HIV receiving HIV antiretroviral therapy in 2008, this paper examines the cultural aetiology of HIV of in Papua New Guinea, the country with the highest reported burden of HIV in the Pacific. Narratives provided drew upon a largely moral framework, which viewed HIV acquisition as a consequence of moral failing and living an un-Christian life. This explanation for suffering viewed the individual as responsible for their condition in much the same way that neo-liberal biomedical discourses do. Moral reform and re-establishing a relationship with God were seen as key actions necessary to effect healing on the material body infected with HIV. Religious understandings of HIV drew upon a pre-existing cultural aetiology of dis-ease and misfortune widespread in Papua New Guinea. Understanding the centrality of Christianity to explanations of disease, and subsequently the actions necessary to bring about health, is essential in order to understand how people with HIV in receipt of antiretroviral therapies internalise biomedical perspectives and reconcile these with Christian beliefs.
The effect of social support on the health of Indigenous Australians in a metropolitan community
Pippa Waterworth, Michael Rosenberg, Rebecca Braham, Melanie Pescud, James Dimmock
The factors driving the disparity in health outcomes between Indigenous and non-Indigenous Australians continue to be poorly understood. Despite this, studies confirm that social connections are a very important part of Indigenous life, and it is likely these connections play an important role in influencing health outcomes among this population. Examining the support provided by social connections in relation to health behaviour may assist our understanding of health outcomes among Indigenous Australians. The current study is focused on exploring Indigenous participants’ impressions of their social network and social support using Participatory Action Research methodology and qualitative methods. The objective was to identify the influence of social support on the health outcomes of Indigenous people within a Western Australian metropolitan community. Seventeen members of the community were interviewed during the study. The participants had extensive social networks that mainly comprised members of their kinship group. The consequences of this social network included: (1) the positive effects of social support from bonded relationships; (2) the negative effects of social support produced by over-obligation and unidirectional support involving bonded relationships; (3) limited or inadequate social support caused by withdrawal from bonded relationships; (4) lack of social support from bridging relationships; and (5) a strong desire for connection and a sense of belonging.
Social capital, collective action and access to water in rural Kenya
Elijah Bisung, Susan J. Elliott, Corinne J. Schuster-Wallace, Diana M. Karanja, Abudho Bernard
Globally, an estimated 748 million people remain without access to improved sources of drinking water and close to 1 billion people practice open defecation (WHO/UNICEF, 2014). The lack of access to safe water and adequate sanitation presents significant health and development challenges to individuals and communities, especially in low and middle income countries. Recent research indicates that aside from financial challenges, the lack of social capital is a barrier to collective action for community based water and sanitation initiatives (Levison et al., 2011; Bisung and Elliott, 2014). This paper reports results of a case study on the relationships between elements of social capital and participation in collective action in the context of addressing water and sanitation issues in the lakeshore village of Usoma, Western Kenya. The paper uses household data (N = 485, 91% response rate) collected using a modified version of the social capital assessment tool (Krishna and Shrader, 2000). Findings suggest that investment in building social capital may have some contextual benefits for collective action to address common environmental challenges. These findings can inform policy interventions and practice in water and sanitation delivery in low and middle income countries, environmental health promotion and community development.
The psychological toll of slum living in Mumbai, India: A mixed methods study
Ramnath Subbaraman, Laura Nolan, Tejal Shitole, Kiran Sawant, Shrutika Shitole, Kunal Sood, Mahesh Nanarkar, Jess Ghannam, Theresa S. Betancourt, David E. Bloom, Anita Patil-Deshmukh
In India, “non-notified” slums are not officially recognized by city governments; they suffer from insecure tenure and poorer access to basic services than “notified” (government-recognized) slums. We conducted a study in a non-notified slum of about 12,000 people in Mumbai to determine the prevalence of individuals at high risk for having a common mental disorder (i.e., depression and anxiety), to ascertain the impact of mental health on the burden of functional impairment, and to assess the influence of the slum environment on mental health. We gathered qualitative data (six focus group discussions and 40 individual interviews in July–November 2011), with purposively sampled participants, and quantitative data (521 structured surveys in February 2012), with respondents selected using community-level random sampling. For the surveys, we administered the General Health Questionnaire-12 (GHQ) to screen for common mental disorders (CMDs), the WHO Disability Assessment Schedule 2.0 (WHO DAS) to screen for functional impairment, and a slum adversity questionnaire, which we used to create a composite Slum Adversity Index (SAI) score. Twenty-three percent of individuals have a GHQ score ≥5, suggesting they are at high risk for having a CMD. Psychological distress is a major contributor to the slum’s overall burden of functional impairment. In a multivariable logistic regression model, household income, poverty-related factors, and the SAI score all have strong independent associations with CMD risk. The qualitative findings suggest that non-notified status plays a central role in creating psychological distress—by creating and exacerbating deprivations that serve as sources of stress, by placing slum residents in an inherently antagonistic relationship with the government through the criminalization of basic needs, and by shaping a community identity built on a feeling of social exclusion from the rest of the city.
Enacting the ‘neuro’ in practice: Translational research, adhesion and the promise of porosity
Caragh Brosnan, Mike Michael
This article attends to the processes through which neuroscience and the neuro are enacted in a specific context: a translational neuroscience research group that was the setting of an ethnographic study. The article therefore provides a close-up perspective on the intersection of neuroscience and translational research. In the scientific setting we studied, the neuro was multiple and irreducible to any particular entity or set of practices across a laboratory and clinical divide. Despite this multiplicity, the group’s work was held together through the ‘promise of porosity’ – that one day there would be translation of lab findings into clinically effective intervention. This promise was embodied in the figure of the Group Leader whose expertise spanned clinical and basic neurosciences. This is theorized in terms of a contrast between cohesion and adhesion in interdisciplinary groupings. We end by speculating on the role of ‘vivification’ – in our case mediated by the Group Leader – in rendering ‘alive’ the expectations of interdisciplinary collaboration.
Ambivalence, equivocation and the politics of experimental knowledge: A transdisciplinary neuroscience encounter
Des Fitzgerald, Melissa M Littlefield, Kasper J Knudsen, James Tonks, Martin J Dietz
This article is about a transdisciplinary project between the social, human and life sciences, and the felt experiences of the researchers involved. ‘Transdisciplinary’ and ‘interdisciplinary’ research-modes have been the subject of much attention lately – especially as they cross boundaries between the social/humanistic and natural sciences. However, there has been less attention, from within science and technology studies, to what it is actually like to participate in such a research-space. This article contributes to that literature through an empirical reflection on the progress of one collaborative and transdisciplinary project: a novel experiment in neuroscientific lie detection, entangling science and technology studies, literary studies, sociology, anthropology, clinical psychology and cognitive neuroscience. Its central argument is twofold: (1) that, in addition to ideal-type tropes of transdisciplinary conciliation or integration, such projects may also be organized around some more subterranean logics of ambivalence, reserve and critique; (2) that an account of the mundane ressentiment of collaboration allows for a more careful attention to the awkward forms of ‘experimental politics’ that may flow through, and indeed propel, collaborative work more broadly. Building on these claims, the article concludes with a suggestion that such subterranean logics may be indissociable from some forms of collaboration, and it proposes an ethic of ‘equivocal speech’ as a way to live with and through these kinds of transdisciplinary experiences.
Rejecting knowledge claims inside and outside science
Citizens, policy-makers and scientists all face the problem of assessing maverick scientific claims. Via a case study, I show the different resources available to experts and non-experts when they make these judgements and reflect upon what this means for technological decision-making in the public domain.
This article draws on empirical material concerning the communication and use of knowledge in experimental physics and its relations to the culture of theoretical physics. The role that trust plays in these interactions is used to create a model of social distance between interacting theoretical and experimental cultures. This article thus seeks to reintroduce trust as a fundamental element in answering the problem of disunity in the sociology of knowledge.
Catelijne Coopmans, Graham Button
‘Tacit’ and ‘explicit’ knowledge, and their relation to expertise, have a long-standing importance within social studies of science and technology. At the centre of the development of thinking about these topics has been the work of Harry Collins and Robert Evans. In this article, we bring to bear observations of the work of people involved in grading eye disease, and their seeming display of expertise, tacit and explicit knowledge, on three thrusts identified in the work of Collins, and Collins and Evans. These thrusts are the following: (1) a concern with the appearance of tacit knowledge in the activities of experts, (2) a commitment to studying expertise as ‘real’ and substantive rather than attributed, and (3) a commitment to promoting the recognition and fostering the management of expertise by providing analytical distinctions regarding expertise and its reliance on tacit knowledge. By considering what is involved in the work of grading eyes, we relocate the interest in tacit and explicit knowledge, and their bearing on expertise, in how expert knowledge is displayed and made recognizable in and through courses of action and interaction.
Actor and analyst: A response to Coopmans and Button
Harry Collins, Robert Evans
We question the logic of Coopmans and Button’s critique of our analysis of expertise on three grounds. First, their critique depends on a clear distinction between actor and analysts that we show cannot be maintained. Second, we question their reticence to allow the use of taxonomies in the analysis of expertise, suggesting that it is contradicted by their own descriptions of expert work, and we accuse them of making a mistake in the way they relate commonsense to specialist skills. Finally, we express our puzzlement at the antiseptic-like precautions that some ethnomethodologists apply to analysts’ categories, especially given that – as we show – analysts’ categories sometimes provide a superior resource for understanding and can change the actors’ world as well as describing it.
This paper offers a counterpoint to the prevailing account of waste in the human sciences. This account identifies waste, firstly, as the anomalous product of arbitrary social categorizations, or ‘matter out of place’, and, secondly, as a distinctly human way of leaving behind and interpreting traces, or a mirror of culture. Together, these positions reflect a more or less constructivist and anthropocentric approach. Most commonly, waste is placed within a framework that privileges considerations of meaning over materiality and the threat of death over the perpetuity of life processes. For an alternative I turn to bio-semiotics and cross-species scholarship around the question of the animal. Specifically, the paper asks what theories of waste would look like if instead of taking ‘dirt’ as their starting point, they began with trans-species encounters with animal scat. Following bio-semiotics and efforts to deconstruct the animal/human binary, it is suggested that the objectual forms commonly referred to as ‘waste’ are not arbitrarily classified but purposefully expended, and thus symptomatic of life’s spatio-temporal continuation. Waste matter, therefore, is best construed not as anthropocentric but as semi-biotic: a sign of the form of life to which it once belonged. This alternative perspective has implications for how approaches to industrial forms of mass waste can be reconceived.
Race, Time and Folded Objects: The HeLa Error
Given their commitment to practices, science studies have bestowed considerable attention upon objects. We have the boundary object, the standardized package, the network object, the immutable mobile, the fluid object, even a fire object has entered the scene. However, these objects do not provide us with a way of understanding their historicity. They are timeless, motionless pictures rather than things that change over time, and while enacting ‘historical moments’ they do not make visible the histories they contain within them. What kind of object could embody history and make that history visible? Inspired by Michel Serres, I suggest the folded object is a way to attend to the temporality and spatiality of objects. In this article I explore this new object by unravelling the history of a DNA reference sequence. I show how, ever since it was produced in the early 1980s, attempts have been made to filter race out of the sequence. That effort has failed due to what one could call ‘political noise’. Making and remaking the sequence have left traces that cannot be erased.