In the Journals

In the Journals May 2016 Part I

Following Anna’s post on current special issues, here are abstracts from this month’s journal outputs.

American Ethnologist

Skill and masculinity in Olympic weightlifting: Training cues and cultivated craziness in Georgia

Perry Sherouse

At the Georgian Weightlifting Federation in Tbilisi, Georgia, a mainstay of coaching is the training cue, a shouted word or phrase that coaches use to prompt weightlifters to perform in a certain psychological, physical, or technical way. In this practice, coaches cultivate and naturalize dimensions of physiology and psychology, aligning masculinity with animality, lack of restraint, and emotional surfeit, and femininity with gracefulness, control, and good technique. Although Olympic weightlifting remains stereotypically hypermasculine, coaches compliment female weightlifters’ technique as superior to men’s and train their athletes to integrate masculine “nature” and feminine “culture” in the expression of physical strength. In doing so, coaches do not instill fully formed subjectivities but manage embodied forms, using exclamatory cues to disaggregate the athlete into action, affect, and anatomy. 

“I am a radioactive mutant”: Emergent biological subjectivities at Kazakhstan’s Semipalatinsk Nuclear Test Site

Magdalena E. Stawskowski

The Semipalatinsk Nuclear Test Site in Kazakhstan was conceived as an experimental landscape where science, technology, Soviet Cold War militarism, and human biology intersected. As of 2015, thousands of people continue to live in rural communities in the immediate vicinity of this polluted landscape. Lacking good economic options, many of them claim to be “mutants” adapted to radiation, while outsiders see them as genetically tainted. In such a setting, how do post-Soviet social, political, and economic transformations operate with radioactivity to co-constitute a “mutant” subjectivity? Today, villagers think of themselves as biologically transformed but not disabled, showing that there is no uniform way of understanding the effects of radioactive pollution, including among scientists. 

Cultural Anthropology

What if the Environment is a Person? Lineages of Epigenetic Science in a Toxic China

Janelle Lamoreaux

The walk from the university toxicology laboratory to the children’s hospital is not far; Wang Bo and I have plenty of time to stop at a sidewalk fruit vendor’s stand to purchase a watermelon, a gift we will present to the staff at the hospital. Today we will meet with Lin Ming to discuss his life as a medical student, charged with treating infants who have a variety of conditions requiring neonatal surgery. Lin and I know each other from the developmental and reproductive toxicology laboratory where I conducted the bulk of my fieldwork. There, Lin prepared and analyzed samples for studies on the potential epigenetic factors involved in the development of congenital disorders. While Lin’s work in the lab centered on test tubes and tissue samples, his professional life in the children’s hospital rotates around distressed children and their anxious family members.

Taking Love Seriously in Human-Plant Relations in Mozambique: Toward an Anthropology of Affective Encounters

Julie Soleil Archambault

Behind the tall palm-leaf fences that compartmentalize domestic space in Inhambane hide luxurious gardens. Home to bougainvillea, hibiscus, crotons, impatiens, aloes, and other succulent plants, these gardens are valued for their aesthetic qualities. “We grow plants because plants are beautiful, to embellish the yard,” I am told. Some gardens have flower beds lined with coconut shells or empty beer bottles buried neck-deep into the sandy soil. Others are bedecked with wind chimes made of old compact discs and hanging nuts and bolts that jingle in the breeze. Jack Goody (1993), who once observed that there were no flowers in Africa, would have been impressed had he made it to this sleepy town in southern Mozambique where ornamental plants are a visible feature of the urban landscape, albeit one that blends in more than it stands out. In the city center, the front lawns of government offices, schools, churches, and gas stations have all undergone some degree of landscaping, and most institutions have their resident gardeners. The private gardens I am interested in are usually also under the care of a specific individual who answers requests for cuttings and who seeks out, in everyday meanderings, new species to add to his or her collection. Indeed, plants are also inconspicuously present as moving objects that traverse the city from a workplace, the yard of a relative, or straight from the bush to one’s own yard, and, every so often, from several yards to the graveyard. Plants in Inhambane are remarkably mobile for things with roots, and they are often kept in bags, for want of flowerpots, in part to facilitate this circulation.

Last Chance Incorporated

Jason Pine

The Monarch trailer lies in the dirt off the side of the road, surrounded by a swarm of objects. A tube lodged in its back issues short, charcoal-black breaths. Tired and heaving.

A filthy man appears at the door. He descends the stairs, moving with agility. Flapping winter rags trail just behind. The baggy clothes are not hand-me-downs from someone else’s life; they once fit him. They slacken, twist and gather up, in sync with the movements of his spindly limbs. Tenaciously holding onto their reverie of a bigger, more robust man—a John Deere or NASCAR man—they ghost him. A figure indistinct like some underimagined protagonist in a fever dream.

An allegorical figure tenuously holding together.


Health and Place

The interplay between neighbourhood characteristics: The health impact of changes in social cohesion, disorder and unsafety feelings

Annemarie Ruijsbroek, Mariël Droomer, Wim Hardyns, Peter P. Groenewegen, Karien Stronks

This study examined how the health of Dutch residents in 2012 was influenced by changes in neighbourhood social cohesion, disorder, and unsafety feelings between 2009 and 2011. Multilevel regression analyses on repeated cross-sectional survey data included 43,635 respondents living in 2100 areas. Deteriorating social cohesion and unsafety feelings were negatively associated with general health, while improvement in social cohesion was associated with better general health of the population. When the interplay of neighbourhood features was considered, deteriorating neighbourhood safety appeared decisive for health, i.e. improving social cohesion did not mitigate the health effect of deteriorating neighbourhood safety. Our results show it is important to take concurrent interactions between neighbourhood features into account when examining their health impact.

Walking groups in socioeconomically deprived communities: A qualitative study using photo elicitation

Sarah Hanson, Cornelia GuellAndy Jones

Walking groups can benefit health but uptake is more likely amongst those who are socially well-situated and need them least. This study worked with a new walking group in a community in England with poor health and socio-economic indicators to understand non-participation and barriers to involvement. It used a qualitative approach. Participant generated photographs captured the physical and social environments in which they walked and these were used with semi-structured interviews to inductively explore walking group participation and the wider social context of walking. We found that prior to joining there were low expectations of any health benefit and walking groups were not viewed as ‘proper’ activity. The group format and social expectations presented a barrier to joining. Having joined participants described a developing awareness of the health benefits of walking. The shared sense of achieving health goals with others sustained the group rather than socialising, per se. We suggest that walking group participation is a complex social practice. Promoting walking groups as a social activity for this group of people may well have been counter-productive.

How could differences in ‘control over destiny’ lead to socio-economic inequalities in health? A synthesis of theories and pathways in the living environment

Margaret Whitehead, Andy Pennington, Lois OrtonShilpa Nayak, Mark Petticrew, Amanda Sowden, Martin White

We conducted the first synthesis of theories on causal associations and pathways connecting degree of control in the living environment to socio-economic inequalities in health-related outcomes. We identified the main theories about how differences in ‘control over destiny’ could lead to socio-economic inequalities in health, and conceptualised these at three distinct explanatory levels: micro/personal; meso/community; and macro/societal. These levels are interrelated but have rarely been considered together in the disparate literatures in which they are located. This synthesis of theories provides new conceptual frameworks to contribute to the design and conduct of theory-led evaluations of actions to tackle inequalities in health.

Does disorder get “into the head” and “under the skin”? Layered contexts and bi-directional associations

Laura Upenieks, Markus H. Schafer, James Iveniuk

This paper utilizes a layered context approach to examine how neighborhood and household conditions are associated with the objective and subjective well-being of older adults. Using two waves of data from the National Social Life, Health, and Aging Project (n=2261), we assess subjective mental health through self-reported measures of perceived stress and distress and objective physical health through C-reactive protein (CRP). Environmental disorder was measured by independent, trained interviewers. Cross-sectional results indicate that household disorder is positively associated with perceived stress and distress, overwhelming the association between neighborhood disorder and mental health outcomes. Yet longitudinal findings point to a reverse process, whereby highly stressed women experience deterioration in their home environment across the two waves. Few significant findings surfaced for CRP. Taken together, our findings illustrate the complex interplay between health and proximal environments and underscore how feedback cycles operate between “health” and “place” across multiple outcomes.

The double burden of neoliberalism? Noncommunicable disease policies and the global political economy of risk

Sara Glasgow, Ted Schrecker

The growing prevalence of NCDs in low- and middle-income countries (LMICs) is now recognized as one of the major global health policy issues of the early 21st century. Current official approaches reflect ambivalence about how health policy should approach the social determinants of health identified by the WHO Commission on the topic that released its report in 2008, and in particular the role of macro-scale economic and social processes. Authoritative framing of options for NCD prevention in advance of the September, 2011 UN high-level meeting on NCDs arguably relied on a selective reading of the scientific (including social scientific) evidence, and foregrounded a limited number of risk factors defined in terms of individual behavior: tobacco use, unhealthy diet, alcohol (ab)use and physical inactivity. The effect was to reproduce at a transnational level the individualization of responsibility for health that characterizes most health promotion initiatives in high-income countries, ignoring both the limited control that many people have over their exposure to these risk factors and the contribution of macro-scale processes like trade liberalization and the marketing activities of transnational corporations to the global burden of NCDs. An alternative perspective focuses on “the inequitable distribution of power, money, and resources” described by the WHO Commission, and the ways in which policies that address those inequities can avoid unintentional incorporation of neoliberal constructions of risk and responsibility.

The uneven seepage of science: Diabetes and biosociality in China

Mikkel Bunkenborg

The rapid growth of the Chinese economy in the post-Mao era has been accompanied by a sharp increase in the prevalence of diabetes and recent studies suggest that there is now more than a 100 million diabetics in China. This article explores how biomedical diabetes treatment contributes to configure subjectivities and collectivities in contemporary China. Based on an ethnographic study of diabetics, it argues that biomedical knowledge of diabetes is subtly inflected as it is transmitted by doctors, pharmaceutical companies, and patients, and that these differentiated modes of transmission work against the emergence of a singular diabetic subjectivity and biosociality.

Delivering breast cancer care in urban India: Heterotopia, hospital ethnography and voluntarism

Alison Macdonald

Despite substantial strides to improve cancer control in India, challenges to deliver oncology services persist. One major challenge is the provision and accessibility of adequate infrastructure. This paper offers ethnographic insight on the conceptual and material conditions that are currently shaping the delivery of oncology in Mumbai, focusing specifically on the way India’s socio-economic context necessitates non-biomedical acts of voluntarism or ‘seva’ (selfless service). Developing the premise that hospitals are not identical clones of a biomedical model, detailed attention is paid to the way ‘care’ emerges through ‘praxis of place’ ( Casey, 2003) within the cancer hospital as a multi-scalar ‘heterotopic’ (Street and Coleman, 2012) site. Such a perspective enables global/local tensions to come into view, together with the heterogeneous confluence of juxtaposing materialities, imaginations, social practices and values that both propels and constrains the everyday delivery of care. The paper reflects on the theoretical implications of hospital seva in Mumbai in light of social science studies of hospital ethnography and health activism and contributes important ethnographic insight into the current global health debates regarding effective implementation of cancer services in India.

Knowing hypertension and diabetes: Conditions of treatability in Uganda

Susan Reynolds Whyte

In Uganda, hypertension and diabetes have only recently been included in the health policy agenda. As they become treatable disorders, they take on more distinct contours in people’s minds. This article relates knowledge about these two conditions to health institutions and technology for diagnosing and treating them. The response to the AIDS epidemic in Uganda provides an important context for, and contrast with, the emergence of hypertension and diabetes as social phenomena. Ethnographic fieldwork shows the interplay between experience of these conditions and the political economy of treatability.


Health, Risk & Society

Call for papers: The practice and experience of risk work: developing theoretical understandings

In this Call for Papers we invite risk researchers to submit articles for a special issue of Health, Risk & Society scheduled for publication in 2017. The special issue will focus on The Practice and Experience of Risk Work and will bring together articles which develop theoretical understandings of the experiences and practices of various front-line practitioners who are required to interpret and manage risk within their everyday work. The deadline for submission is 30 November 2016.

Risk in dementia care: searching for the evidence

Mabel Stevenson, Brian J. Taylor, Joanne Knox

Effective and efficient search methods are required to retrieve robust evidence to inform the study of risk communication such as in dementia care. In this article, we draw on a study which appraised 12 bibliographic databases and one online search engine for this purpose by measuring their ability to identify relevant papers published up to December 2013 when applying a consistent search strategy on the topic of research on risk concepts and risk communication in dementia. We also searched reference lists of literature reviews. We retrieved 31 relevant articles. We took measures of sensitivity (ability to retrieve relevant papers) and precision (ability to avoid retrieving irrelevant papers), and we identified unique articles and the dispersion of relevant results when using database relevancy-sorting functions. We found that Cumulative Index to Nursing and Allied Health and PsycINFO had the highest levels of sensitivity; Social Services Abstracts, Social Care Online and Applied Social Sciences Index and Abstracts had the highest levels of precision. We rated Google Scholar (using the first 300 hits retrieved) third on sensitivity, seventh on precision, and found it had a more effective sort by relevancy function than any of the databases. We found that five databases and Google Scholar retrieved at least one study not identified by any other database. We found that none of the databases retrieved all of the relevant articles identified by that database within the first 25% of results when using the sort by relevancy function (where this was available). We concluded that it is necessary to use a number of databases for effective searching on this topic. The approaches we report in this article assist in creating a comprehensive search strategy and can be used by researchers to build social science risk knowledge methodically.

‘Give people work, and the blood pressure will sink’: lay engagement with cardiovascular risk factors in North Karelia in the 1970s

Mikko Jauho

In high-income countries such as Finland, personal healthcare is organised around the management of lifestyle risks and minimisation of such risks forms a key part of public health policy. While the scientific development of the lifestyle risk model has been thoroughly studied, there has been less research on the history of popular experiences of the model. In this article, I examine lay people’s response to a pioneering heart disease prevention programme in north-eastern Finland in the 1970s, the North Karelia Project, which promoted the lifestyle risk model. I use archival data from early 1970s that recorded the project interactions with the local population and their reactions to the project. I show that although local residents in North Karelia responded positively to the project, they did not necessarily subscribe to its preventive and risk minimising objectives. In an area of limited health resources, the project provided local residents with access to medical expertise. Local reactions indicated a clash of a cultural notion of illness embedded in the social life-world of Karelians with a specific rationality of government emphasising individual responsibility vis-à-vis heart conditions. Local residents who were critical of the public health risk model tended to minimise the role of lifestyle risk factors in cardiovascular disease causation or subsumed these factors into a more encompassing explanation that stressed the effects of the on-going structural social change in the area, highlighting the sense of loss caused by the waning of traditional small farm existence and their anxiety about the resulting economic and social insecurity.

‘I’m not clear on what the risk is’: women’s reflexive negotiations of uncertainty about alcohol during pregnancy

Kate Holland, Kerry McCallum, Alexandra Walton

Health guidelines in many countries advise women that not drinking alcohol during pregnancy is the safest option for their babies. This advice is based on a lack of evidence about what is a safe amount of alcohol and increasing concern about Foetal Alcohol Spectrum Disorders. While there is some knowledge of factors informing women’s views and practices in relation to alcohol consumption during pregnancy, there is little knowledge or understanding of the ways women interpret and respond to the abstinence public health advice in Australia and its bearing, if any, on their own practices. In this article, we examine women’s experiences of alcohol consumption during pregnancy and their views of the abstinence advice. We locate our analysis within the body of thinking that views pronouncements about risks during pregnancy as bound up with social and cultural values and ideas about what it means to be a ‘good’ or ‘bad’ mother, as much as they are about science. We draw on a study that we undertook in 2014 of 20 women, who were either pregnant, had recently had a child or who had young children, or who were planning for pregnancy, who took part in one-to-one qualitative interviews or participated in focus group discussions in Canberra, Australia. We found that the women in our study variously described receiving reassurance after drinking in early pregnancy; opting to abstain as the safest option in the face of uncertainty; and having an occasional drink if they felt like it. In response to the abstinence advice, we found that some women understood it as a responsible message, even if they had not necessarily adhered to it, while others criticised it as an example of policing pregnant women. Overall, the women in our study accepted that it was possible to drink responsibly during pregnancy and defended this view through strategies of normalising the occasional drink, emphasising a woman’s right to make her own decisions, and associating low-level consumption with low risk.

‘It’s really complicated’: How Canadian university women students navigate gendered risk and human papillomavirus (HPV) vaccine decision-making

Michelle Wyndham-West

In this article I examine how a group of female university students in Ontario, Canada navigated the notion of ‘gendered risk’ that underpins the current promotion of human papillomavirus (HPV) vaccine. In 2010, I interviewed 24 female university students from across the province of Ontario focussing on their experiences of making decisions about whether or not to have the HPV vaccine. I found that each student’s vaccine decision – whether it was to forgo vaccination, to wait to make a decision or to vaccinate – involved the consideration of notions of gender, negotiation of sexual health issues and management of the uncertainty of a relatively new vaccine. These considerations created a complex situation and produced a complex decision-making context, one that required the women to reflect on the ways in which they exercised their ethical agency. As a result, the women in my sample practiced identity-based vaccine decision-making that was driven by their developing sense of self as a young woman emerging into adulthood.

When it’s good to be a bad nurse: expanding risk orders theory to explore nurses’ experiences of moral, social and identity risks in obstetrics units

Katie Striley, Kimberly Field-Springer

Discourses about health risks can have major implications for individuals and cultures. In this article, we use risk orders theory to examine nurses’ perceptions of patient safety risk in Obstetrics departments of US hospitals. According to risk orders theory, risk discourses can create social worlds that have the capacity to threaten individuals’ social bonds, identity and moral character, and the imaginative potential of entire cultures. Risk orders theory proposes three orders of risk. First-order risks are constructed from claims about tangible dangers that individuals believe result from their actions or inactions. Second-order risks are threats experienced by individuals because of communication about first-order risk, including threats to social relationships or social risks, and threats to the sense of moral character or moral risk. Third-order risks are threats to collective agency and imagination underpinning shared culture. In this article, we draw on data from a survey of obstetric nurses who attended the Association of Women’s Health, Obstetric and Neonatal Nurses conference in 2010 in Las Vegas, Nevada. We use a qualitative thematic analysis of 131 obstetrics nurses’ narrative responses on a critical incident survey to refine theoretical constructs of risk orders theory. We identified a third type of second-order risk, identity risks, or threats to the sense of self. We also identified three types of third-order risks: agency-constraining risks threaten members of a culture’s ability to act freely; agent-constraining risks threaten cultural members’ ability to define themselves freely; double-binding risks threaten their ability to make choices freely. We found that second-order and third-order risks did threaten some obstetrics nurses’ social bonds, identity as a nurse, moral character and imaginative potential.

What is the nature and value of a risk management tool in a large-scale complex programme of collaborative applied health research?

Jo Day, Janet Heaton, Nicky Britten

In this article we examine a risk management tool that was used in a pilot programme of applied health research in the south-west of England funded by the National Institute for Health Research (NIHR). During a wider internal evaluation of the NIHR Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, we became interested in how risk was being defined and managed in the programme. Our search of the empirical literature showed that little attention had been given to risk governance within large-scale organisational change programmes in the health field. Through analysis of official documents and interviews with senior managers, we examined the nature and the value of the risk tool that was used by the programme managers. This highlighted that the programme was believed to be a ‘relatively risky’ initiative that required active management. The senior managers developed a risk tool for this purpose, which was regularly used throughout the pilot. It was perceived to have value in three main ways – providing assurance to members of the collaboration, responsiveness to the wider context and acceptability as part of routine programme implementation. Our analysis also highlighted intentional risk-taking within a complex partnership programme that sought to facilitate the translation of evidence into everyday practice. We discuss the implications of our insights for the further development of risk tools and the potential value of ‘edgework’ as a theoretical framework to inform further research of risk management in complex programmes.


International Journal of Social Psychiatry

A population study of public stigma about psychosis and its contributing factors among Chinese population in Hong Kong

Sherry Kit Wa Chan, Wendy Wan Yee Tam, Kit Wai Lee, Christy Lai Ming Hui, Wing Chung Chang, Edwin Ho Ming Lee, Eric Yu Hai Chen

Purpose: Public stigma is an important barrier to the recovery of patients with psychosis. This study aimed to explore public stigma associated with a newly adopted Chinese name for psychosis ‘si-jue-shi-tiao’ in a representative Chinese population in Hong Kong, focusing on factors contributing to public stigma. Exposure to mass media and its relationship with the stigma were explored in detail.

Methods: Random telephone survey of general population in Hong Kong was conducted. Information including basic demographics, psychosis literacy, recent news recall about psychosis and stigma, measured with the revised Link’s Perceived Discrimination-Devaluation Scale (LPDDS) were obtained. Univariate analysis of LPDDS score and demographic variables, news exposure, previous contacts with people with psychosis and knowledge about psychosis were conducted. Further hierarchical regression analysis was performed.

Results: A total of 1,016 subjects were interviewed. The sample was comparable with the whole Hong Kong population aged 18 years and above. Those of female gender, with higher educational level and better knowledge about symptoms and treatment of psychosis had higher score of LPDDS. The model significantly explained 8.3% of variance of LPDDS score (F(7, 895) = 12.606, p < .0001, p < .0001). The negative news recall had trend significance in the model.

Conclusion: The finding suggested that discrimination among the general public against people with psychosis was still common. Specific strategies will need to be established in targeting media news reporting about psychosis, knowledge disseminating and needs of specific population. Further researches should be conducted to understand the mechanisms of the stigma development in relation to these factors so that more focused and effective strategies could be developed.

Participants’ employment status and experiences in the year after the Experienced Involvement training

Anna Hegedüs, Elena Seidel, Regine Steinauer

Background: Peer support workers (PSWs) are an emerging workforce within the Swiss mental health system. The ‘Experienced Involvement’ (EX-IN) training programmes prepare and certify individuals who have experienced mental health problems to work as PSWs.

Aims: This study examined the influence of EX-IN training on participants’ employment status and their experiences in the year after training.

Method: We employed quantitative and qualitative methods. Quantitative data were collected at baseline, immediately after completion and at 1 year post-training. Additionally, individual narrative interviews were conducted with 10 participants at 1 year post-training.

Results: At 1 year of completion, the majority of participants were in paid employment. Difficulties included unclear PSW roles. The qualitative analyses revealed the following categories: ‘Evolving from the patient role despite experiencing effects or consequences of mental illness’, ‘Feeling welcome and being confronted with conflicting expectations’, ‘Helping others while being needy at the same time’ and ‘Doing something worthwhile and the fear of failure’.

Conclusion: Clear role descriptions, well-defined expectations, team preparation, acknowledgement of vulnerabilities and institution-level support PSWs are important to safeguard both PSWs and service users by minimising the destabilisation risk. Future EX-IN training graduates can benefit from the establishment of remunerated PSW roles in psychiatric services.

Socially restrictive attitudes towards people with mental illness among the non-psychiatry medical professionals in a university teaching hospital in South India

Shashwath Sathyanath, Rohan Dilip Mendonsa, Anitha Maria Thattil, Varikkara Mohan Chandran, Ravichandra S Karkal

Background: Unfortunately, stigmatizing attitudes towards mentally ill are common among medical students, nurses as well as doctors. This is a major obstacle in the delivery of mental health services.

Aims: To assess the socially restrictive attitudes towards mentally ill among the medical professionals and to investigate the association between such attitudes and relevant variables.

Methods: We assessed the attitudes towards people with mental illness among the medical professionals (N = 130) in a medical university using shortened version of the 40-item Community Attitudes toward the Mentally Ill (CAMI) scale.

Results: We found that socially restrictive attitudes were endorsed by quite a number of faculty members and trainees. Significantly higher number of faculty members (22.5%) compared to the trainees (9.1%) endorsed unfavourable attitudes towards previously mentally ill man getting married. Similarly, significantly more number of faculty (22.5%) were averse to the idea of living next door to someone who has been mentally ill compared to the trainees (9.1%). However, significantly lesser number of faculty members (16.1%) compared to the trainees (30.3%) believed that previously mentally ill people should be excluded from taking public office. Personal acquaintance with a mentally ill individual was the only variable that was associated with significantly lesser socially restrictive attitudes among the medical professionals, irrespective of their age, gender and clinical exposure to people with mental illness.

Conclusion: Socially restrictive attitudes towards people with mental illness are prevalent among substantial number of medical professionals in a low-income country like India. Personal acquaintance with people who have mental illness appears to be the only significant factor that reduces medical professionals’ socially restrictive attitudes towards them.

The impact of occupation according to income on depressive symptoms in South Korean individuals: Findings from the Korean Welfare Panel Study

Woorim Kim, Eun-Cheol Park, Tae-Hoon Lee, Yeong Jun Ju, Jaeyong Shin, Sang Gyu Lee

Background: In South Korea, societal perceptions on occupation are distinct, with people favouring white collar jobs. Hence both occupation type and income can have mental health effects.

Aim: To examine the relationship between occupational classification and depression, along with the combined effect of occupational classification and household income.

Methods: Data were from the Korean Welfare Panel Study (KOWEPS), 2010–2013. A total of 4,694 economically active participants at baseline were followed. Association between occupational classification and depression, measured using the Center for Epidemiological Studies Depression (CES-D) scale 11, was investigated using the linear mixed effects model.

Results: Blue collar (β: 0.3871, p = .0109) and sales and service worker groups (β: 0.3418, p = .0307) showed higher depression scores than the white collar group. Compared to the white collar high-income group, white collar low income, blue collar middle income, blue collar middle-low income, blue collar low income, sales and service middle-high income, sales and service middle-low income and sales and service low-income groups had higher depression scores.

Conclusion: Occupational classification is associated with increasing depression scores. Excluding the highest income group, blue collar and sales and service worker groups exhibit higher depression scores than their white collar counterparts, implying the importance of addressing these groups.

Attitudes towards depression, psychiatric medication and help-seeking intentions amid financial crisis: Findings from Athens area

Marina Economou, Joanna Despina Bergiannaki, Lily Evangelia Peppou, Ismini Karayanni, George Skalkotos, Athanasios Patelakis, Kyriakos Souliotis, Costas Stefanis

Background: The financial crisis has yielded adverse effects on the population worldwide, as evidenced by elevated rates of major depression. International recommendations for offsetting the mental health impact of the recession highlight the need for effective treatment, including reduction in the stigma attached to the disorder.

Aims: This study endeavoured to explore lay attitudes to depression and psychiatric medication during a period of financial crisis and to identify their correlates. Furthermore, it investigated their link to help-seeking intentions.

Method: A random and representative sample of 621 respondents from Athens area participated in the study (Response Rate = 81.7%). The telephone interview schedule consisted of the Personal Stigma Scale, a self-constructed scale tapping attitudes to psychiatric medication and one question addressing help-seeking intentions.

Results: The preponderant stigmatising belief about depression pertains to perceiving the disorder as a sign of personal weakness. In addition, stereotypes of unpredictability and dangerousness were popular among the sample. Nonetheless, stigmatising beliefs are much stronger with regard to psychiatric medication; perceived as addictive, capable of altering one’s personality, less effective than homeopathic remedies and doing more harm than good. Help-seeking intentions were predicted by education, unemployment and attitudes to psychiatric medication solely.

Conclusion: Research on the mental health effects of the global recession should encompass studies investigating the stigma attached to mental disorders and its implications.

Intimate partner violence–related experiences and mental health among college students in Japan, Singapore, South Korea and Taiwan

Akiko Kamimura, Maziar M Nourian, Nushean Assasnik, Kathy Franchek-Roa

Background: Intimate partner violence (IPV) is a significant public health threat that contributes to a wide range of mental and physical health problems for victims.

Aims: The purpose of this study was to examine IPV-related experiences and mental health outcomes among college students in Japan, Singapore, South Korea and Taiwan.

Methods: The data were obtained from the Inter-University Consortium for Political and Social Research (ICPSR), the International Dating Violence Study (IDVS) 2001–2006 (ICPSR 29583; N = 981; Japan n = 207; Singapore n = 260; South Korea n = 256; Taiwan n = 258).

Results: Co-experience of physical IPV victimization and perpetration was associated with borderline personality traits and posttraumatic stress disorder (PTSD), but not with depression. Childhood sexual abuse, gender hostility and violence socialization were significant predictors of borderline personality traits, depression and PTSD. While country and gender variations in mental health are noted, there are two specific populations that may need special attention for mental health interventions: Taiwanese women especially for borderline personality traits and PTSD, and Japanese men especially for depression.

Conclusion: IPV victimization and perpetration, childhood sexual abuse, gender hostility and violence socialization have a significant impact on the mental health of college students in Japan, Singapore, South Korea and Taiwan. Since IPV and mental health are significant public health issues, research on IPV and mental health consequences of IPV victimization and perpetration in these countries should be further expanded in order to better understand the interventions that will be effective in treating victims, perpetrators and victim/perpetrators of IPV.

The effectiveness of psychosocial interventions implemented after the Indian Ocean Tsunami: A systematic review

Kyle Lipinski, Lucia L Liu, Paul WC Wong

Background: Currently, the number of natural disasters has increased sixfold when compared to the 1960s. The 2004 Indian Ocean Tsunami offered provided an opportunity for scientifically investigating the effectiveness of post-disaster programs across countries with diverse ethnic, religious and cultural backgrounds.

Aim: This study aimed to assess the effectiveness of psychological interventions focused on the prevention or reduction in post-traumatic stress disorder (PTSD) symptoms and/or enhancement of psychological well-being implemented after the 2004 Tsunami.

Methods: We systematically searched through MEDLINE, PsycINFO and The Published International Literature on Traumatic Stress (PILOTS) databases using the following keywords: ‘tsunami’ OR ‘Indian Ocean’, AND ‘intervention’.

Results: Our systematic review included 10 studies which adopted 10 different psychological interventions. A total of 8 of the 10 studies reported positive results in reducing PTSD symptoms and most interventions showed high levels of cultural sensitivity. No significant harmful effects of the included interventions were identified although two studies used potentially harmful interventions.

Conclusion: Evidence-based practice is a process of collaborative decision-making between the affected ones and interventionists. The practitioner assesses not only the availability of the level of evidence of the preferred interventions, but he or she also assesses his or her own expertise, the availability of resources, the surrounding context and the characteristics, values and preferences of relevant stakeholders.

Systematic review of the prevalence of mental illness stigma within the Greek culture

Vasiliki Tzouvara, Chris Papadopoulos, Gurch Randhawa

Background: A number of primary studies have now assessed mental illness stigma within the Greek culture. A synthesis and appraisal of all available evidence is now required and will contribute to our growing understanding of the relationship between the cultural context and the formation of stigmatising attitudes.

Aim: To systematically review the prevalence of mental illness public stigma within the Greek and Greek Cypriot culture.

Method: Empirical articles with primary data pertaining to the prevalence of mental illness public stigma among Greek and/or Greek Cypriot populations were retrieved. Included studies were assessed for quality and extracted data were narratively synthesised.

Results: A total of 18 studies met the inclusion criteria. Methodological quality was highly variable; only 1 study was adequately statistically powered, 10 studies employed at least some element of probability sampling and obtained response rates of at least 70%, while 10 and 13 studies employed reliable and validated prevalence tools, respectively. Studies sampled the general population (n = 11), students (n = 4), healthcare professionals (n = 2), police officers, employers and family members (all n = 1). Stigma was consistently identified in moderate and high proportions across all of these groups, particularly in terms of social discrimination and restrictiveness, social distance and authoritarianism. However, some evidence of benevolence and positivity towards high-quality social care was also identified.

Conclusion: The review highlights the wide-scale prevalence of mental illness stigma within the Greek culture and the need for further rigorous research including culturally tailored stigma interventions.


Philosophy, Ethics, and Humanities in Medicine (open access)

Establishing the first institutional animal care and use committee in Egypt

Sohair R. Fahmy, Khadiga Gaafar


Although animal research ethics committees (AREC) are well established in Western countries, this field is weakly developed and its concept is poorly understood in the Middle East and North Africa region.


Our main objective was to introduce the concept and requirements of ethical approaches in dealing with experimental animal in research and teaching in Egypt.


Due to its very recent inception, Cairo University, Faculty of Science IACUC decided to operate in accordance with Guide for the Care and Use of Laboratory Animals 8th Edition 2011 (the Guide) since Egypt has not yet compiled its own guide.


Fifty protocols were reviewed in 2013–2014. Only ten protocols were reviewed in 2013, but in 2014, forty protocols were reviewed. In 2013 all protocols were approved and in 2014, number of approvals were 35, the number of deferrals were 4, and one refused protocol. Master’s theses (MSc) research protocols constituted the majority of the total reviewed protocols. This is attributed to the decision of the Board of the Faculty of Science, Cairo University in September, 2013 that the approval of the IACUC is mandatory before conducting any research involving animals or theses registration.


The first IACUC was established in the Cairo University, Faculty of Science, since 2012. The challenges encountered by the committee were diverse, such as the absence of laws that control the use of animal models in scientific research, lack of guidelines (protocols for experimental animals in research) and, mandatory ethical approval for any experimental animal research.

Doctor can I buy a new kidney? I’ve heard it isn’t forbidden: what is the role of the nephrologist when dealing with a patient who wants to buy a kidney?

Giorgina Barbara Piccoli, Laura Sacchetti, Laura Verzè, Franco Cavallo, Working group of the students of the Torino Medical School

Organ trafficking is officially banned in several countries and by the main Nephrology Societies. However, this practice is widespread and is allowed or tolerated in many countries, hence, in the absence of a universal law, the caregiver may be asked for advice, placing him/her in a difficult balance between legal aspects, moral principles and ethical judgments.

In spite of the Istanbul declaration, which is a widely shared position statement against organ trafficking, the controversy on mercenary organ donation is still open and some experts argue against taking a negative stance. In the absence of clear evidence showing the clinical disadvantages of mercenary transplantation compared to chronic dialysis, self-determination of the patient (and, with several caveats, of the donor) may conflict with other ethical principles, first of all non-maleficence. The present paper was drawn up with the participation of the students, as part of the ethics course at our medical school. It discusses the situation in which the physician acts as a counselor for the patient in the way of a sort of “reverse” informed consent, in which the patient asks advice regarding a complex personal decision, and includes a peculiar application of the four principles (beneficence, non-maleficence, justice and autonomy) to the donor and recipient parties.

 A charter for biomedical research ethics in a progressive, caring society

Sylvie Vandoolaeghe, Alessandra Blaizot, Danie Boudiguet, Valérie Bougault, Eduardo Dei, Benoît Foligne, Anne Goffard, Hélène Lefranc, Bénédicte Oxombre, Thomas Trentesaux, Bernard Vandenbunder, Isabelle Wolowczuk, Laurence Delhaes and the “ethic and research” working group


Given that advances in research continuously raise new ethical issues, a multidisciplinary working group of investigators involved in biomedical research has gathered to discuss and compare ethical viewpoints in their daily practice.


The working group has drafted a Charter for Ethics in Biomedical Research that encompasses all the steps in the research process, i.e. from the initial idea to analysis and publication of the results.


Based on key principles for ethically responsible research, the Charter may serve as a tool for performing research, discussing research issues and training researchers.


The Charter should stimulate researchers to think about their responsibility for research in a progressive, caring society.

Medical professionalism: what the study of literature can contribute to the conversation

Johanna Shapiro, Lois L. Nixon, Stephen E. Wear, David J. Doukas

Medical school curricula, although traditionally and historically dominated by science, have generally accepted, appreciated, and welcomed the inclusion of literature over the past several decades. Recent concerns about medical professional formation have led to discussions about the specific role and contribution of literature and stories. In this article, we demonstrate how professionalism and the study of literature can be brought into relationship through critical and interrogative interactions based in the literary skill of close reading. Literature in medicine can question the meaning of “professionalism” itself (as well as its virtues), thereby resisting standardization in favor of diversity method and of outcome. Literature can also actively engage learners with questions about the human condition, providing a larger context within which to consider professional identity formation. Our fundamental contention is that, within a medical education framework, literature is highly suited to assist learners in questioning conventional thinking and assumptions about various dimensions of professionalism.


 Science, Technology, & Human Values

On the Tacit Governance of Research by Uncertainty: How Early Stage Researchers Contribute to the Governance of Life Science Research

Lisa Sigl

The experience of uncertainties in exploring the unknown—and dealing with them—is a key characteristic of what it means to be a life science researcher, but we have only started to understand how this characteristic shapes cultures of knowledge production, particularly in times when other—more social—uncertainties enter the field. Although the lab studies tradition has explored the workings of epistemic uncertainties, the range of potent uncertainty experiences in research cultures has been broadened within the neoliberal reorganization of academic institutions. Most importantly, the stronger dependency on competitive project funding has led to increased social uncertainties. Being employed part-time and for shorter periods of time, researchers often find themselves in the precarious situation of high employment uncertainty. This article argues that the currently predominant form of organizing academic research (the project) creates a structural link between epistemic and social uncertainties. It then describes empirically different modes of coping with these uncertainties that researchers deploy and that seem to have become a variable in the governance of research cultures. To do so, it takes the academic life sciences in Austria as an example and explores them using approaches from both science and technology studies and labor studies.

Whose Life Counts: Biopolitics and the “Bright Line” of Chloropicrin Mitigation in California’s Strawberry Industry

Julie Guthman, Sandy Brown

In the context of the mandated phaseout of methyl bromide, California’s strawberry industry has increased its use of chloropicrin, another soil fumigant that has long been on the market. However, due to its 2010 designation as a toxic air contaminant, the US Environmental Protection Agency and California’s Department of Pesticide Regulation have developed enhanced application protocols to mitigate exposures of the chemical to bystanders, nearby residents, and farmworkers. The central feature of these mitigation technologies are enhanced buffer zones between treated fields and nearby buildings. Not only do buffer zones inherently privilege neighbors over farmworkers, but the determinations of the size of these buffer zones are also based on acceptable threshold levels and probabilities that allow significant exposures to those they are designed to protect. Moreover, these protocols require human monitors to detect sensory irritation. While the science and technology studies literature is highly useful for understanding the inextricability of science and politics in developing protective measures and is attentive to what counts as data in setting acceptable thresholds, it tends to overlook that social sorting is intrinsic to such regulation. We thus turn to Foucault’s biopolitics to make sense of regulations that are designed to protect but inherently allow some to become ill. Doing so illuminates how determinations of the bright line are at once technical–political as well as implicit decisions about whose bodies count.

Fleck the Public Health Expert: Medical Facts, Thought Collectives, and the Scientist’s Responsibility

Ilana Löwy

Ludwik Fleck is known mainly for his pioneering studies of science as a social activity. This text investigates a different aspect of Fleck’s epistemological thought—his engagement with normative aspects of medicine and public health and their political underpinnings. In his sinuous professional trajectory, Fleck navigated between two distinct thought styles: fundamental microbiological research and practice-oriented investigations of infectious diseases. Fleck’s awareness of tensions between these two approaches favored the genesis of his theoretical reflections. At the same time, his close observation of medical and epidemiological practices led him to the conclusion that collectively produced scientific facts are situated and fragile. Thought collectives, Fleck explained, can err or yield to external pressures, with potentially disastrous consequences. While Fleck the reflexive experimental scientist has been creatively translated into the science studies idiom, Fleck the reflexive practical microbiologist and public health expert still awaits inspired translation.

Ludwik Fleck: On Medical Experiments on Human Beings

Ilana Löwy

Ludwik Fleck’s article, “On medical experiments on human beings” was published in 1948 in the main Polish medical journal; it was destined for general practitioners. Fleck was prisoner in the concentration camp Buchenwald, where he witnessed Nazi murderous “experiments” on the camp’s imamates; he testified about these experiments in the Nuremberg Trial of Nazi doctors. This article, and Tadeusz Kielanowski’s comment on Fleck text, stress, however, that an exclusive focus on the – hopefully rare – criminal activities of doctors may be misleading. It is important to prevent the numerous ethical transgressions of ‘normal’ medical science and routine clinical practice.

Toxic Lunch in Bhopal and Chemical Publics

Rahul Mukherjee

On November 28, 2009, as part of events marking the twenty-fifth anniversary of the disaster at the Union Carbide plant in Bhopal, gas survivors protested the contents of the report prepared by government scientists that mocked their complaints about contamination. The survivors shifted from the scientific document to a mediated lunch invitation performance, purporting to serve the same chemicals as food that the report had categorized as having no toxic effects. I argue that the lunch spread, consisting of soil and water from the pesticide plant, explicitly front-staged and highlighted the survivor’s forced intimate relationship with such chemicals, in order to reshape public perception of risks from toxins. Chemical matter like sevin tar and naphthol tar bound politicians, scientists, corporations, affected communities, and activists together, as these stakeholders debated the potential effects of toxic substances. This gave rise to an issue-based “chemical public.” Borrowing from such theoretical concepts as “ontologically heterogeneous publics” and “agential realism,” I track the existing and emerging publics related to the disaster and the campaigns led by the International Campaign for Justice in Bhopal advocacy group.

Continued in Part II.

By Melanie Boeckmann

aiming for a PhD in Public Health, currently working in health policy and research.

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