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Siraj MS. Living Organ Donation for Transplantation in Bangladesh: Reality and Problems. HEC Forum 2024; 36:207-243. [PMID: 36355267 DOI: 10.1007/s10730-022-09500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
The stipulation of living organ transplantation policy and practice in Bangladesh is family-oriented, with relatives being the only people legally eligible to donate organs. There have been very few transplantations of bone marrows, liver lobes, and kidneys from related-living donors in Bangladesh. The major question addressed in this study is why Bangladesh is not getting adequate organs for transplantation. In this study, I examin the stipulations of the policy and practice of living organ donation through the lens of 32 key stakeholders including physicians and nurses, a health administrator, organ donors and recipients, and their family members, as they can shed light on the realities and problems of organ donation for transplantation in Bangladesh. My ethnography reveals that the family members are always encouraged to donate organs for transplantation, and saving the lives of relatives through organ donation is seen as a moral obligation. Many view saving the life of a relative by donating one's organs as equivalent to saving one's own life. An assessment of the dynamics of biomedicine, religion, and culture leads to the conclusion that the family-oriented organ donation policy and practice have been widely endorsed and accepted in Bangladesh, and Islamic ethical principles and collective family ethos undergird that policy and practice. However, the unavailability of medical resources, lack of post-operative coverage for organ donors, religious misconceptions and unawareness of the general public, and the absence of posthumously donated vital organs for transplantation are perceived to be the most common barriers to a successful living donor-recipient pair organ transplantation. By overcoming these obstacles, Bangladesh can develop a successful living donor-recipient pair organ transplantation program that will ensure improved healthcare outcomes, promote altruism and solidarity among Bangladeshi families, and protect the poor from having their organs sold to wealthy patients.
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Affiliation(s)
- Md Sanwar Siraj
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.
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2
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Wardrope A, Reuber M. The hermeneutics of symptoms. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2022; 25:395-412. [PMID: 35503189 PMCID: PMC9427902 DOI: 10.1007/s11019-022-10086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/22/2022] [Accepted: 04/02/2022] [Indexed: 11/28/2022]
Abstract
The clinical encounter begins with presentation of an illness experience; but throughout that encounter, something else is constructed from it - a symptom. The symptom is a particular interpretation of that experience, useful for certain purposes in particular contexts. The hermeneutics of medicine - the study of the interpretation of human experience in medical terms - has largely taken the process of symptom-construction to be transparent, focussing instead on how constellations of symptoms are interpreted as representative of particular conditions. This paper examines the hermeneutical activity of symptom-construction more closely. I propose a fourfold account of the clinical function of symptoms: as theoretical entities; as tools for communication; as guides to palliative intervention; and as candidates for medical explanation or intervention. I also highlight roles they might play in illness experience. I use this framework to discuss four potential failures of symptom-interpretation: failure of symptom-type and symptom-token recognition; loss of the complete picture of illness experience through overwhelming emphasis on its symptomatic interpretation; and intersubjective feedback effects of symptom description altering the ill person's own perceptions of their phenomenal experience. I conclude with some suggestions of potential remedies for failures in the process of symptom-construction.
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Affiliation(s)
- Alistair Wardrope
- Department of Neuroscience, The University of Sheffield, Sheffield, UK.
- Department of Clinical Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - Markus Reuber
- Department of Neuroscience, The University of Sheffield, Sheffield, UK
- Department of Clinical Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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3
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Baines K. “It's normal to admit you're not okay”: New York City college students shaping mental health through journaling. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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4
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Malpass A, Mcguire C, Macnaughton J. 'The body says it': the difficulty of measuring and communicating sensations of breathlessness. MEDICAL HUMANITIES 2022; 48:63-75. [PMID: 33509802 PMCID: PMC8867268 DOI: 10.1136/medhum-2019-011816] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 06/12/2023]
Abstract
Breathlessness is a sensation affecting those living with chronic respiratory disease, obesity, heart disease and anxiety disorders. The Multidimensional Dyspnoea Profile is a respiratory questionnaire which attempts to measure the incommunicable different sensory qualities (and emotional responses) of breathlessness. Drawing on sensorial anthropology we take as our object of study the process of turning sensations into symptoms. We consider how shared cultural templates of 'what counts as a symptom' evolve, mediate and feed into the process of bodily sensations becoming a symptom. Our contribution to the field of sensorial anthropology, as an interdisciplinary collaboration between history, anthropology and the medical humanities, is to provide a critique of how biomedicine and cultures of clinical research have measured the multidimensional sensorial aspects of breathlessness. Using cognitive interviews of respiratory questionnaires with participants from the Breathe Easy groups in the UK, we give examples of how the wording used to describe sensations is often at odds with the language those living with breathlessness understand or use. They struggle to comprehend and map their bodily experience of sensations associated with breathlessness to the words on the respiratory questionnaire. We reflect on the alignment between cognitive interviewing as a method and anthropology as a disciplinary approach. We argue biomedicine brings with it a set of cultural assumptions about what it means to measure (and know) the sensorial breathless body in the context of the respiratory clinic (clinical research). We suggest the mismatch between the descriptions (and confusion) of those responding to the respiratory questionnaire items and those selecting the vocabularies in designing it may be symptomatic of a type of historical testimonial epistemic injustice, founded on the prioritisation of clinical expertise over expertise by experience.
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Affiliation(s)
- Alice Malpass
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK
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5
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Mahmud L. Feminism in the House of Anthropology. ANNUAL REVIEW OF ANTHROPOLOGY 2021. [DOI: 10.1146/annurev-anthro-101819-110218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although early feminist insights about reflexivity and fieldwork relations have become core tenets of anthropological theories, feminism itself has been marginalized in anthropology. This review examines feminist contributions to American cultural anthropology since the 1990s across four areas of scholarship: the anthropology of science and medicine, political anthropology, economic anthropology, and ethnography as writing and genre. Treating feminist anthropology as a traveling theory capable of addressing critical social problems beyond gender, this article aims not merely to recredit feminism in anthropology, but also to show its potential to transform anthropology into an antiracist, decolonial, and abolitionist project.
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Affiliation(s)
- Lilith Mahmud
- Department of Anthropology, University of California, Irvine, California 92697, USA
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6
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Shaw A, Kaytaz ES. Yoga bodies, yoga minds: contextualising the health discourses and practices of modern postural yoga. Anthropol Med 2021; 28:279-296. [PMID: 34328039 DOI: 10.1080/13648470.2021.1949943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Esra S Kaytaz
- Centre for Trust, Peace and Social Relations, Coventry University, Coventry, UK
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7
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Lock M, Argentieri MA, Shields AE. The contribution of ethnography to epigenomics research: toward a new bio-ethnography for addressing health disparities. Epigenomics 2021; 13:1771-1786. [PMID: 33653089 DOI: 10.2217/epi-2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This article describes ethnography as a research method and outlines how it excels in capturing the salient experiences of individuals among diverse communities in their own words. We argue that the integration of ethnographic findings into epigenomics will significantly improve disparities-focused study designs within environmental epigenomics by identifying and contextualizing the most salient dimensions of the 'environment' that are affecting local communities. Reciprocally, epigenetic findings can enhance anthropological understanding of human biological variation and embodiment. We introduce the term bio-ethnography to refer to research designs that integrate both of these methodologies into a single research project. Emphasis is given in this article, through the use of case studies, to socially disadvantaged communities that are often underrepresented in scientific literature. The paper concludes with preliminary recommendations for how ethnographic methods can be integrated into epigenomics research designs in order to elucidate the manner in which disadvantage translates into disparities in the burden of illness.
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Affiliation(s)
- Margaret Lock
- Department of Social Studies of Medicine, McGill University, Montreal H3A 1X1, Canada
| | - M Austin Argentieri
- School of Anthropology & Museum Ethnography, University of Oxford, Oxford OX2 6PE, UK.,Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02114, USA
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8
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Kirmayer LJ, Fung K, Rousseau C, Lo HT, Menzies P, Guzder J, Ganesan S, Andermann L, McKenzie K. Guidelines for Training in Cultural Psychiatry. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:195-246. [PMID: 32345034 PMCID: PMC7918872 DOI: 10.1177/0706743720907505] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This position paper has been substantially revised by the Canadian Psychiatric Association (CPA)'s Section on Transcultural Psychiatry and the Standing Committee on Education and approved for republication by the CPA's Board of Directors on February 8, 2019. The original position paper1 was first approved by the CPA Board on September 28, 2011.
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Affiliation(s)
- Laurence J Kirmayer
- James McGill Professor and Director, Division of Social and Transcultural Psychiatry, 5620McGill University, Montreal, Quebec; Director, Culture and Mental Health Research Unit, Jewish General Hospital, Montreal, Quebec
| | - Kenneth Fung
- Clinical Director, Asian Initiative in Mental Health, University Health Network, Toronto, Ontario; Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; President, Society for the Study of Psychiatry and Culture, Toronto, Ontario
| | - Cécile Rousseau
- Professor, Division of Social and Cultural Psychiatry, 5620McGill University, Montreal, Quebec
| | - Hung Tat Lo
- Director, Asian Clinic, Hong Fook Mental Health Association, Toronto, Ontario
| | - Peter Menzies
- Psychiatrist, Four Directions Therapeutic and Consulting Services, working with First Nations communities in northern Ontario
| | - Jaswant Guzder
- Professor, Department of Psychiatry, 5620McGill University, Montreal, Quebec; Senior Clinician, Cultural Consultation Service, Institute of Community and Family Psychiatry, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec; Senior Clinician, Child Psychiatry, Jewish General Hospital, Montreal, Quebec
| | - Soma Ganesan
- Clinical Professor of Psychiatry, University of British Columbia, Vancouver, British Columbia; Director, Cross Cultural Psychiatry Program, University of British Columbia, Vancouver, British Columbia
| | - Lisa Andermann
- Psychiatrist, Mount Sinai Hospital, Toronto, Ontario; Associate Professor, Equity, Gender and Populations Division, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Kwame McKenzie
- CEO, Wellesley Institute, Toronto, Ontario; Professor of Psychiatry, University of Toronto, Toronto, Ontario; Director, Department of Health Equity, Centre for Addiction and Mental Health, Toronto, Ontario
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9
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Abstract
As complex institutions extend into and govern greater spheres of social life, ethnographers contend with policy in an ever-widening range of fieldsites. This review examines anthropology of policy as an emerging subfield of political anthropology, focusing on policy making as central to contemporary governance in English-language ethnographies. Broadening the analytical field in the study of policy to include the targets of policy and their allies is one of the central contributions of an anthropological approach to policy making. Anthropological studies of policy production, implementation, and effects face significant methodological and ethical challenges. Scholarly debates in the United States and Europe continue to erupt over the production of scholarship intended to inform policy making, including the co-option of ethnography. While turning the anthropological gaze on powerful political actors could contribute to decolonization efforts within the discipline, ethically adopting ethnographic research into policy making requires complex alliances with communities targeted by policy.
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Affiliation(s)
- Winifred Tate
- Department of Anthropology, Colby College, Waterville, Maine 04910, USA
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10
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Micollier E. From epistemology to the method: phenomenology of the body,
qì
cultivation (
qìgōng)
and religious experiences in Chinese worlds. ANTHROPOLOGY OF CONSCIOUSNESS 2020. [DOI: 10.1111/anoc.12125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Evelyne Micollier
- Université de Paris, IRD (French National Research Institute for Sustainable Development), INALCO, CESSMA (UMR 245)
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11
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Blom DE, Knudson KJ. Paleopathology and children in the Andes: Local/situated biologies and future directions. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2020; 29:65-75. [PMID: 31585823 DOI: 10.1016/j.ijpp.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/31/2019] [Accepted: 08/10/2019] [Indexed: 06/10/2023]
Abstract
In the decades since Verano (1997) published his foundational piece on Andean paleopathology, scholars have recognized the importance of the bioarchaeology of childhood. Yet, scholarship on ancient childhood in the Andes deemphasizes paleopathology. Nonadult paleopathological data are often employed in large-scale, biocultural studies focused on environmental or political adaptations; however, they can also elucidate children's individual lived experiences and roles in society. To generate culturally-meaningful paleopathological data, we must take a contextualized approach to our analyses and interpretations. Disparate use of chronological age in published datasets makes synthesis across studies problematic, and ethnohistorical and ethnographic data on Andean children demonstrate that developmental age categories, rather than chronological age ranges, are most appropriate. Further, paleopathological data can best inform our investigations when they are combined with related datasets such as those on sex, diet, activity, and mobility. With that in mind, we use the theoretical framework of "local biologies" (and the related "situated biologies"), where biology is viewed as heavily contingent on culturally-specific beliefs and practices and local physical, sociocultural, and political environments (Lock, 1993, 2001; Niewöhner and Lock, 2018). Local biologies approaches can enrich social bioarchaeology and paleopathology to by specifically situating children and their experiences within the ancient Andean world.
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Affiliation(s)
- Deborah E Blom
- University of Vermont, Department of Anthropology, United States.
| | - Kelly J Knudson
- Arizona State University, School of Human Evolution and Social Change, United States
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12
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Löwy I. Non-invasive prenatal testing: A diagnostic innovation shaped by commercial interests and the regulation conundrum. Soc Sci Med 2020; 304:113064. [PMID: 32534823 DOI: 10.1016/j.socscimed.2020.113064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/01/2020] [Accepted: 05/14/2020] [Indexed: 12/27/2022]
Abstract
Non-invasive prenatal testing (NIPT) is grounded in the analysis of free circulating fetal DNA (cfDNA) in pregnant women's blood. The rolling out of this screening method was in large part driven by commercial firms, which hoped to reach a huge potential market by offering a test that was expected to be risk-free, reliable, inexpensive, and able to detect a wide range of genetic traits of the future child. To date, most predictions about the scope and uses of NIPT have not materialized: in 2020 NIPT detects only a limited number of genetic anomalies, while results have to be confirmed by amniocentesis. NIPT has become a commercial success. Nevertheless the implementation of NIPT has tended to diverge across different national settings. In countries that already have state-sponsored screening for Down risk, NIPT has been offered by the state health insurance to women defined as "high risk", using a variant of the test that detects only three autosomal aneuploidies: trisomy 21, 13 and 18. These countries effectively regulate the supply of NIPT on grounds of cost-effectiveness and reliability. In countries without state-sponsored screening for Down risk, in contrast, multiple versions of NIPT covering a wider range of birth defects are commonly available on the free market, and purchased by women at low as well as high risk of having an affected child. Market-based healthcare systems tend to present women who can afford to pay for NIPT with a largely unregulated choice of technologies - though reimbursement rules imposed by private insurance providers may serve in effect to regulate use by those consumers who cannot afford to pay for tests from their own pockets. This regulatory divergence is shaped by the presence or absence of prior state-sponsored screening programs for Down risk.
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Affiliation(s)
- Ilana Löwy
- Cermes3 : INSERM, U 988, CNRS, UMR 8211, EHESS and Paris Descartes University, France.
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13
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Carruth L, Ateye MJ, Nassir A, Hosh FM, Mendenhall E. Diabetes in a humanitarian crisis: Atypical clinical presentations and challenges to clinical- and community-based management among Somalis in Ethiopia. Glob Public Health 2020; 15:828-839. [PMID: 31994445 DOI: 10.1080/17441692.2020.1718735] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This study was designed to better understand the clinical presentations and challenges of managing type-2 diabetes mellitus (T2DM) in a humanitarian crisis-affected population. Findings are based on a long-term ethnographic study of humanitarian response in eastern Ethiopia by the first author from 2008 to 2018, and in addition, a mixed-method case study of T2DM in July-August 2018. For the case study, the authors collected anthropometric, demographic, and biological data from 85 persons with T2DM diagnosis and 23 of their adult siblings. The team then conducted participant-observation and 28 ethnographic interviews with a purposive sample of patients, their siblings, and local health providers, policymakers, and aid workers. T2DM was characterised in this sample by progressive weight loss, weakness, lethargy, loss of teeth, and persistently high average blood glucose levels (HbA1c), at initial clinical presentation, and then in subsequent years, even while taking prescribed medications and/or insulin. Patients struggled to access medical care, refrigerate insulin, and follow dietary recommendations due to chronic food insecurity and long-term dependence on limited food aid rations. Local health providers who are trained and supplied mostly through humanitarian relief funding lack the education and resources to effectively help patients manage non-communicable chronic conditions.
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Affiliation(s)
- Lauren Carruth
- School of International Service, American University, Washington, DC, USA
| | - Mohamed Jama Ateye
- School of International Service, Norwegian Refugee Council, American University, Jigjiga, Ethiopia
| | - Ahmed Nassir
- Elahelay Health Post, Aysha Woreda Health Bureau, Aysha, Ethiopia
| | - Farah Mussa Hosh
- School of International Service, American University, Dire Dawa, Ethiopia
| | - Emily Mendenhall
- School of Foreign Service, Georgetown University, Washington, DC, USA
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14
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Leatherman T, Goodman A. Building on the biocultural syntheses: 20 years and still expanding. Am J Hum Biol 2019; 32:e23360. [PMID: 31814227 DOI: 10.1002/ajhb.23360] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/25/2019] [Accepted: 11/13/2019] [Indexed: 02/05/2023] Open
Abstract
Building a New Biocultural Synthesis: Political Economic Perspectives in Human Biology called for an integration of political economy with ecological and adaptability perspectives in biocultural anthropology. A major goal of this volume was to explore the utility of including political-economic and sociocultural processes in analyses of human biological variation, nutrition, and health. A second goal was to enhance collaboration among subfields and work against the "chasm" that separated complementary perspectives in cultural and biological anthropology. Twenty years hence, new ways to link social inequalities and human biology have emerged in part through contributions of developmental origins of health and disease, epigenetics, microbiomes, and other new methods for tracing pathways of embodiment. Equally important, notions of "local/situated biologies" and "reactive genomes," provide frameworks for understanding biology and health at the nexus of ecologies, societies, and histories. We review and highlight these contributions toward expanding critical approaches to human biology. Developments over the past two decades have reinforced the central role of social environments and structural inequalities in shaping human biology and health. Yet, within biocultural approaches, a significant engagement with historical, political-economic, and sociocultural conditions remains relatively rare. We review potential barriers to such analyses, focusing on theoretical and methodological challenges as well as the subfield structure of anthropology. Achieving politically and socially contextualized and relevant critical biocultural approaches remains a challenge, but there is reason for optimism amid new theoretical and methodological developments and innovations brought by new generations of scholars.
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Affiliation(s)
- Thomas Leatherman
- Department of Anthropology, University of Massachusetts, Amherst, Massachusetts
| | - Alan Goodman
- School of Natural Sciences, Hampshire College, Amherst, Massachusetts
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15
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Zivkovic T. Lifelines and End-of-life Decision-making: An Anthropological Analysis of Advance Care Directives in Cross-cultural Contexts. ETHNOS 2019. [DOI: 10.1080/00141844.2019.1696857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Carruth L, Mendenhall E. "Wasting away": Diabetes, food insecurity, and medical insecurity in the Somali Region of Ethiopia. Soc Sci Med 2019; 228:155-163. [PMID: 30913529 DOI: 10.1016/j.socscimed.2019.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 01/17/2023]
Abstract
Most research on diabetes has taken place in cities or in high-income countries, even though most diabetes deaths occur in low and middle-income countries, and diabetes disproportionately affects the poor. This research, by contrast, investigates rising concerns about diabetes among Somalis in eastern Ethiopia--in communities where obesity is rare and people face chronic food insecurity, forced displacement, recurrent humanitarian crises, and lack of access to medical care. Findings presented in this article build on ethnographic research with Somalis in eastern Ethiopia since 2007, and include anthropometric and demographic data collection with Somali diabetes patients and select adult siblings of these patients (n = 108) plus in-depth ethnographic interviews with a subset of the diabetes patients, their siblings, and medical providers serving Somali communities (n = 29) in July-August 2018. Most Somali patients we spoke with shared symptoms of progressive weight loss, weakness, and loss of teeth--or what people called "wasting away"--even when complying with prescribed pharmaceutical regimens and/or insulin. Diabetes and "wasting away" were characterized by Somalis as humoral pathologies; but rather than a consequence of obesity or pathological weight gain, these were perceived to be a consequence of stress, trauma, anger, displacement, loss of healthy fatness, and lack of access to fresh and healthy food over their lifetimes. Somalis' simultaneous experiences of progressive nutritional wasting and adult-onset diabetes echo how "tropical diabetes" was defined and experienced for thousands of years prior to the development of effective early diagnostics and biomedical treatments. This analysis therefore suggests heterogeneity and overlaps within and between categories of "type 1" and "type 2 diabetes" in populations with differential exposures to stress, crisis, and poverty. Exposures to food insecurity and medical insecurity, in particular, are pathogenic, and shape diabetes patients' clinical presentations and prognoses, as well as local etiologies and patterns of disease.
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Affiliation(s)
- Lauren Carruth
- School of International Service, American University, 4400 Massachusetts Ave NW, Washington DC, 20016, USA.
| | - Emily Mendenhall
- School of Foreign Service, Georgetown University, 513 Intercultural Center, 37th and O Street, NW, Washington DC, 20057, USA.
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17
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Annandale E, Wiklund M, Hammarström A. Theorising women's health and health inequalities: shaping processes of the 'gender-biology nexus'. Glob Health Action 2018; 11:1669353. [PMID: 31587620 PMCID: PMC6792043 DOI: 10.1080/16549716.2019.1669353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Since the theoretical frameworks and conceptual tools we employ shape research outcomes by guiding research pathways, it is important that we subject them to ongoing critical reflection. A thoroughgoing analysis of the global production of women's health inequality calls for a comprehensive theorization of how social relations of gender and the biological body mutually interact in local contexts in a nexus with women's health. However, to date, the predominant concern of research has been to identify the biological effects of social relations of gender on the body, to the relative neglect of the co-constitutive role that these biological changes themselves may play in ongoing cycles of gendered health oppressions. Drawing on feminist and gender theoretical approaches, and with the health of women and girls as our focus, we seek to extend our understanding of this recursive process by discussing what we call the 'shaping processes' of the 'gender-biology nexus' which call attention to not only the 'gender-shaping of biology' but also the 'biologic-shaping of gender'. We consider female genital mutilation/cutting as an illustration of this process and conclude by proposing that a framework which attends to both the 'gender-shaping of biology' and the 'biologic-shaping of gender' as interweaving processes provides a fruitful approach to theorising the wider health inequalities experienced by women and girls.
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Affiliation(s)
- Ellen Annandale
- Department of Sociology, University of York , York , England
| | - Maria Wiklund
- Department of Community Medicine and Rehabilition, Physiotherapy, Umeå University , Umeå , Sweden
| | - Anne Hammarström
- Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden.,The Stress Research Institute, Stockholm University , Stockholm , Sweden
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18
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Bosire E, Mendenhall E, Omondi GB, Ndetei D. When Diabetes Confronts HIV: Biological Sub-citizenship at a Public Hospital in Nairobi, Kenya. Med Anthropol Q 2018; 32:574-592. [PMID: 30117196 DOI: 10.1111/maq.12476] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/14/2018] [Accepted: 08/02/2018] [Indexed: 12/31/2022]
Abstract
This article investigates how international donor policies cultivate a form of biological sub-citizenship for those with diabetes in Kenya. We interviewed 100 patients at a public hospital clinic in Nairobi, half with a diabetes diagnosis. We focus on three vignettes that illustrate how our study participants differentially perceived and experienced living with and seeking treatment and care for diabetes compared to other conditions, with a special focus on HIV. We argue that biological sub-citizenship, where those with HIV have consistent and comprehensive free medical care and those with diabetes must pay out-of-pocket for testing and treatment, impedes diabetes testing and treatment. Once diagnosed, many are then systematically excluded from the health care system due to their own inability to pay. We argue that the systematic exclusion from international donor money creates a form of biological sub-citizenship based on neoliberal economic policies that undermine other public health protections, such as universal primary health care.
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Affiliation(s)
- Edna Bosire
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Emily Mendenhall
- Science, Technology, and International Affairs Program, Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
| | | | - David Ndetei
- Africa Mental Health Foundation, Nairobi, Kenya.,Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Kelly-Hanku A, Ase S, Fiya V, Toliman P, Aeno H, Mola GM, Kaldor JM, Vallely LM, Vallely AJ. Ambiguous bodies, uncertain diseases: knowledge of cervical cancer in Papua New Guinea. ETHNICITY & HEALTH 2018; 23:659-681. [PMID: 28158947 DOI: 10.1080/13557858.2017.1283393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Within their local realities, people experience and interpret disease in diverse ways that do not necessarily correlate or converge with Western biomedical interventions. In the high cervical cancer burden setting of Papua New Guinea, understanding how people experience and interpret cervical cancer is necessary for effective intervention. Drawing on work by Street on the production of unstable biomedical knowledge, we explored how ambiguity and uncertainty, coupled with cultural taboos and linguistic limitations, affect what and how people 'know' about women's reproductive organs and their associated disease. DESIGN A qualitative research approach was used to explore and understand how people in PNG articulate matters of health and disease as they relate to cervical cancer and HPV infection. Specifically, how unstable biomedical knowledge is produced and sustained. We employed a mixed-methods approach in collecting data from 208 (147 women) participants between 2011 and 2012 across 3 provinces in PNG. RESULTS We found that knowledge and awareness about cervical cancer were poor. Five thematic areas emerged in our analysis, which included the gendered knowledge of women's reproductive health, the burden of cervical cancer in the community and the role (or limitation) of language. We further identified four ways in which ambiguity and uncertainty operate on both sociocultural and biological levels, and in the intersection between to produce unstable biomedical knowledge. These included poor knowledge of where the cervix is located and the uncertainty or unreliability of (lay) diagnoses of disease. CONCLUSION Local understandings of cervical cancer reflected the limitations of Tok Pisin as a lingua franca as well as the wider uncertain biomedical environment where diagnoses are assembled and shared. There is a clear need to improve understanding of the female reproductive organs in order that people, women in particular, can be better informed about cervical cancer and ultimately better receptive to intervention strategies.
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Affiliation(s)
- A Kelly-Hanku
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
- b Kirby , UNSW , Sydney , Australia
| | - S Ase
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - V Fiya
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - P Toliman
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - H Aeno
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - G M Mola
- c School of Medical Sciences , University of Papua New Guinea , Goroka , Papua New Guinea
| | | | | | - A J Vallely
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
- b Kirby , UNSW , Sydney , Australia
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Lock M. Mutable environments and permeable human bodies★. JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE 2018. [DOI: 10.1111/1467-9655.12855] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Margaret Lock
- Department of Social Studies of Medicine; McGill University; 3647 Peel Street Montréal, Québéc H3A 1X1 Canada
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Abstract
The Anthropocene has been officially declared as a new geological epoch owing to the lasting impact made by humans on environments, negatively affecting the health and even survival of human populations. Furthermore, over the past decade, molecular science has shown that the human genome is reactive to environments that are external and internal to the body. Hence, environments impact directly on individual bodies by bringing about epigenetic changes in the genome. Following a discussion of human exceptionalism and its limitations, I argue that an anthropology of embodiment should be situated in time and space, and recognition given to local biologies as a subcategory of situated biologies evident globally. Examples are then given of the intergenerational transmission of epigenetic effects due to environmental toxic exposures with a concluding call for anthropologists to engage with the worldwide challenge.
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Affiliation(s)
- Margaret Lock
- Social Studies of Medicine, McGill University, Montreal, Quebec H3A 1X1, Canada
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Brisson J, Nguyen VK. Science, technology, power and sex: PrEP and HIV-positive gay men in Paris. CULTURE, HEALTH & SEXUALITY 2017; 19:1066-1077. [PMID: 28276922 DOI: 10.1080/13691058.2017.1291994] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The pre-exposure prophylaxis (PrEP) drug Truvada is a new HIV prevention technology that is predominantly promoted as relevant to HIV-negative gay men. This paper explores what PrEP represents for HIV-positive gay men living in Paris, based upon data collected through interviews and ethnographic research. While HIV-positive gay men do not directly consume Truvada through PrEP, they nonetheless hold opinions and understandings of this drug, specifically as it relates to their own sexuality. This paper expands the representations and meanings of this new technology in a different light through the voices of gay men living with HIV in Paris. The main argument of this article is that PrEP as an additional HIV prevention tool blurs the lines between science, technologies and human sexuality.
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Affiliation(s)
- Julien Brisson
- a Department of Social and Preventative Medicine , University of Montreal , Quebec , Canada
| | - Vinh-Kim Nguyen
- a Department of Social and Preventative Medicine , University of Montreal , Quebec , Canada
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Cohn S, Lynch R. Diverse bodies: the challenge of new theoretical approaches to medical anthropology. Anthropol Med 2017; 24:131-141. [PMID: 28880577 DOI: 10.1080/13648470.2017.1334395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Simon Cohn
- a Department of Health Services Research and Policy , London School of Hygiene and Tropical Medicine , London , United Kingdom
| | - Rebecca Lynch
- a Department of Health Services Research and Policy , London School of Hygiene and Tropical Medicine , London , United Kingdom
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Sueiras P, Romano-Betech V, Vergil-Salgado A, de Hoyos A, Quintana-Vargas S, Ruddick W, Castro-Santana A, Islas-Andrade S, Altamirano-Bustamante NF, Altamirano-Bustamante MM. Today´s medical self and the other: Challenges and evolving solutions for enhanced humanization and quality of care. PLoS One 2017; 12:e0181514. [PMID: 28759585 PMCID: PMC5536364 DOI: 10.1371/journal.pone.0181514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 07/03/2017] [Indexed: 11/18/2022] Open
Abstract
Background Recent scientific developments, along with growing awareness of cultural and social diversity, have led to a continuously growing range of available treatment options; however, such developments occasionally lead to an undesirable imbalance between science, technology and humanism in clinical practice. This study explores the understanding and practice of values and value clusters in real-life clinical settings, as well as their role in the humanization of medicine and its institutions. The research focuses on the values of clinical practice as a means of finding ways to enhance the pairing of Evidence-Based Medicine (EBM) with Values-based Medicine (VBM) in daily practice. Methods and findings The views and representations of clinical practice in 15 pre-CME and 15 post-CME interviews were obtained from a random sampling of active healthcare professionals. These views were then identified and qualitatively analyzed using a three-step hermeneutical approach. A clinical values space was identified in which ethical and epistemic values emerge, grow and develop within the biomedical, ethical, and socio-economic dimensions of everyday health care. Three main values—as well as the dynamic clusters and networks that they tend to form—were recognized: healthcare personnel-patient relationships, empathy, and respect. An examination of the interviews suggested that an adequate conceptualization of values leads to the formation of a wider axiological system. The role of clinician-as-consociate emerged as an ideal for achieving medical excellence. Conclusions By showing the intricate clusters and networks into which values are interwoven, our analysis suggests methods for fine-tuning educational interventions so they can lead to demonstrable changes in attitudes and practices.
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Affiliation(s)
- Perla Sueiras
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Victoria Romano-Betech
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Alejandro Vergil-Salgado
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Adalberto de Hoyos
- CIECAS, Instituto Politécnico Nacional, Lauro Aguirre 120, Agricultura, Miguel Hidalgo, Ciudad de México, México
| | - Silvia Quintana-Vargas
- Instituto de Salud Pública del Estado de Guanajuato, Tamazuca 4, Centro, Guanajuato, México
| | - William Ruddick
- Center for Bioethics, New York University, New York, NY, United States of America
| | - Anaclara Castro-Santana
- National Research Council for Science and Technology (CONACYT), Ciudad de México, México
- Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700, Insurgentes Cuicuilco, Ciudad de México, México
| | - Sergio Islas-Andrade
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, México
| | - Nelly F. Altamirano-Bustamante
- Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700, Insurgentes Cuicuilco, Ciudad de México, México
- * E-mail: (NFAB); (MMAB)
| | - Myriam M. Altamirano-Bustamante
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, México
- * E-mail: (NFAB); (MMAB)
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Gibbon S. Entangled local biologies: genetic risk, bodies and inequities in Brazilian cancer genetics. Anthropol Med 2017; 24:174-188. [PMID: 28721744 PMCID: PMC5757500 DOI: 10.1080/13648470.2017.1326756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/02/2017] [Indexed: 11/16/2022]
Abstract
Engaging recent social science work examining the truth making claims of science and biomedicine, this paper explores how biology is being localised in Brazilian cancer genetics. It draws from ethnographic fieldwork in urban regions of southern Brazil working with and alongside patients, families and practitioners in cancer genetic clinics. It examines how different sorts of 'local biologies' are articulated in the context of research, clinical practice and among implicated patient communities and the way these can 'recursively' move across different spheres and scales of social action to extend and transform the meaning of the biological. It shows how the mattering of the biological in Brazilian cancer genetics is fundamentally informed by questions of inequity and care, even while multiple local biologies may obscure rather than reveal the biopolitics of cancer. In an era of epigenetics this raises new opportunities and challenges for anthropological analysis as intervention.
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Affiliation(s)
- Sahra Gibbon
- Department of Anthropology, University College London, London, United Kingdom
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Abstract
The term 'neglected tropical diseases' (NTDs) points to the need for a biosocial perspective. Although 'diseases' are widely understood as biological phenomena, 'neglect' is inherently social. Social priorities, social relations and social behaviour profoundly influence the design, implementation and evaluation of control programmes. Yet, these dimensions of neglect are, themselves, neglected. Instead, emphasis is being placed on preventive chemotherapy - a technical, context-free approach which relies almost entirely on the mass distribution of drugs, at regular intervals, to populations living in endemic areas. This article reflects on the processes which have enabled an NTD 'brand' identity to emerge, and it comments on a disquieting disengagement with some of the more critical insights about the consequences of mass drug administration. Building on the work of biosocial scholars studying other aspects of health and disease, a more adequate, evidence-based approach is delineated. Developing such an approach is an iterative process, requiring on-going engagement with both biological and social insights as they emerge. Considerable theoretical, methodological and political challenges lie ahead, but it is essential they are overcome, if the sustainable control of NTDs is to become a reality.
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Scheid V, Tuffrey V, Bovey M. Chinese herbal medicine for treating menopausal symptoms in London women: developing a good practice protocol via the factor analysis of prescribing patterns in a clinical study. Complement Ther Med 2017; 32:33-40. [DOI: 10.1016/j.ctim.2017.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 11/07/2016] [Accepted: 03/15/2017] [Indexed: 12/31/2022] Open
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Abstract
AbstractSocial inequality in cancer survival is well known, and within public health promotion enhancing awareness of cancer symptoms is often promoted as a way to reduce social differences in stage of cancer at the time of diagnosis. In order to add to our knowledge of what may lie behind social inequalities in cancer survival encountered in many high-income countries, this article explores the situatedness of bodily sensations. Based on comparative ethnographic fieldwork, we argue that the socially and biologically informed body influences how people from lower social classes experience sensations. Overall, we point out how the sensorial is tied to the embodiment of the social situation in the sense that some bodies make more ‘noise’ than others. It follows that standardised approaches to improving early care seeking by increasing knowledge and awareness may overlook essential explanations of social differences in symptom appraisal.
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30
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Sanz C. Out-of-Sync Cancer Care: Health Insurance Companies, Biomedical Practices, and Clinical Time in Colombia. Med Anthropol 2017; 36:187-201. [DOI: 10.1080/01459740.2016.1267172] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Camilo Sanz
- Department of Anthropology, University of Michigan , Ann Arbor, Michigan, USA
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31
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Raman S, Nicholls R, Ritchie J, Razee H, Shafiee S. How natural is the supernatural? Synthesis of the qualitative literature from low and middle income countries on cultural practices and traditional beliefs influencing the perinatal period. Midwifery 2016; 39:87-97. [DOI: 10.1016/j.midw.2016.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/03/2016] [Accepted: 05/07/2016] [Indexed: 11/26/2022]
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Abstract
Chronic pelvic pain in women is a key site through which explorations of the meanings of female gender and pain might further insights into the broader question of the embodied experience of women in relation to pain. A biocultural approach is used to present an analysis of interviews with 40 New Zealand women in which they reflect on ‘how come’ they have chronic pelvic pain. Women consistently employ a mechanistic rendition of medical discourse and understandings in their constructions of ‘how come’ they have pain, accompanied by a reiteration of ‘not knowing’ and a normalizing of their pelvic pain. We explore how this normalizing works within the narratives to establish women's pelvic pain as intrinsically gendered. Etiological meanings that are constructed in medical terms and yet are unable to be interpreted within a dualist frame of normality and pathology, we argue, permeate and shape gendered experience of chronic pain conditions.
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Affiliation(s)
- Victoria M Grace
- School of Sociology and Anthropology, University of Canterbury, Christchurch, New Zealand.
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Dorazio-Migliore M, Migliore S, Anderson JM. Crafting a praxis-oriented culture concept in the health disciplines: conundrums and possibilities. Health (London) 2016; 9:339-60. [PMID: 15937036 DOI: 10.1177/1363459305052904] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
‘Culture’ is a key concept in the social sciences. It also figures prominently in health science discourses. Yet, it is an imprecise and politically charged term. Due to a variety of factors, health care professionals may tend to use notions of culture that can be easily applied. Dangers are posed when using simplified culture concepts, however, because they act as ‘interpretive lenses’ - lenses that may generate cultural stereotypes, lead health professionals to miss key interactions and processes in the provision of care, and simplify the cultural complexities surrounding the position(s) of both the health care providers and their clients. Two cases of eldercare are analysed to demonstrate the multi-layered intricacies of the concept of culture. The overall point is that ‘culture’ is a highly complex and dynamic term; the way in which it is conceptualized and used has enormous consequences for health care.
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Affiliation(s)
- Margaret Dorazio-Migliore
- University of British Columbia, Kwantlen University College & University of British Columbia, Canada.
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O'Connor C. Embodiment and the Construction of Social Knowledge: Towards an Integration of Embodiment and Social Representations Theory. JOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR 2016. [DOI: 10.1111/jtsb.12110] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Cliodhna O'Connor
- Department of Psychology; Maynooth University; Maynooth, Co. Kildare Ireland
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Fitzgerald D, Rose N, Singh I. Revitalizing sociology: urban life and mental illness between history and the present. THE BRITISH JOURNAL OF SOCIOLOGY 2016; 67:138-160. [PMID: 26898388 DOI: 10.1111/1468-4446.12188] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper proposes a re-thinking of the relationship between sociology and the biological sciences. Tracing lines of connection between the history of sociology and the contemporary landscape of biology, the paper argues for a reconfiguration of this relationship beyond popular rhetorics of 'biologization' or 'medicalization'. At the heart of the paper is a claim that, today, there are some potent new frames for re-imagining the traffic between sociological and biological research - even for 'revitalizing' the sociological enterprise as such. The paper threads this argument through one empirical case: the relationship between urban life and mental illness. In its first section, it shows how this relationship enlivened both early psychiatric epidemiology, and some forms of the new discipline of sociology; it then traces the historical division of these sciences, as the sociological investment in psychiatric questions waned, and 'the social' become marginalized within an increasingly 'biological' psychiatry. In its third section, however, the paper shows how this relationship has lately been revivified, but now by a nuanced epigenetic and neurobiological attention to the links between mental health and urban life. What role can sociology play here? In its final section, the paper shows how this older sociology, with its lively interest in the psychiatric and neurobiological vicissitudes of urban social life, can be our guide in helping to identify intersections between sociological and biological attention. With a new century now underway, the paper concludes by suggesting that the relationship between urban life and mental illness may prove a core testing-ground for a 'revitalized' sociology.
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Affiliation(s)
| | - Nikolas Rose
- Department of Social Science, Health and Medicine, King's College London
| | - Ilina Singh
- Department of Psychiatry and Oxford Uehiro Centre for Practical Ethics, University of Oxford
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Koch E. Negotiating "The Social" and Managing Tuberculosis in Georgia. JOURNAL OF BIOETHICAL INQUIRY 2016; 13:47-55. [PMID: 26738742 DOI: 10.1007/s11673-015-9689-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
In this paper I utilize anthropological insights to illuminate how health professionals and patients navigate and negotiate what for them is social about tuberculosis in order to improve treatment outcomes and support patients as human beings. I draw on ethnographic research about the implementation of the DOTS (Directly Observed Therapy, Short Course) approach in Georgia's National Tuberculosis Program in the wake of the Soviet healthcare system. Georgia is a particularly unique context for exploring these issues given the country's rich history of medical professionalism and the insistence that the practice of medicine is a moral commitment to society. I argue for critical attention to the ways in which treatment recipients and providers navigate what, for them, is "social" about therapeutic practices and their significance for avoiding biological and social reductionism.
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Affiliation(s)
- Erin Koch
- Department of Anthropology, University of Kentucky, 211 Lafferty Hall, Lexington, KY, 40506-0024, USA.
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37
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Filipe AM. Making ADHD Evident: Data, Practices, and Diagnostic Protocols in Portugal. Med Anthropol 2015; 35:390-403. [DOI: 10.1080/01459740.2015.1101102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
Indigenous populations worldwide are experiencing social, cultural, demographic, nutritional, and psychoemotional changes that have a profound impact on health. Regardless of their geographical location or sociopolitical situation, health indicators are always poorer for indigenous populations than for nonindigenous ones. The determinants of this gap are multiple and interactive, and their analysis requires a biocultural framework. Indigenous populations suffer from lower life expectancy, high infant and child mortality, high maternal morbidity and mortality, heavy infectious disease loads, malnutrition, stunted growth, increasing levels of cardiovascular and other chronic diseases, substance abuse, and depression. The devastating effects of colonization, the loss of ancestral land, and language and cultural barriers for access to health care are among the most salient themes characterizing the poor health situation of indigenous people. Anthropology is extremely well suited to address the interplay among social, economic, and political forces that shape the local experiences of illness.
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Affiliation(s)
| | - J. Josh Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon 97403
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Gillard S, Turner K, Neffgen M. Understanding recovery in the context of lived experience of personality disorders: a collaborative, qualitative research study. BMC Psychiatry 2015; 15:183. [PMID: 26227023 PMCID: PMC4521354 DOI: 10.1186/s12888-015-0572-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 07/22/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Concepts of recovery increasingly inform the development and delivery of mental health services internationally. In the UK recent policy advocates the application of recovery concepts to the treatment of personality disorders. However diagnosis and understanding of personality disorders remains contested, challenging any assumption that mainstream recovery thinking can be directly translated into personality disorders services. METHODS In a qualitative interview-based study understandings of recovery were explored in extended, in-depth interviews with six people purposively sampled from a specialist personality disorders' service in the UK. An interpretive, collaborative approach to research was adopted in which university-, clinical- and service user (consumer) researchers were jointly involved in carrying out interviews and analysing interview data. RESULTS Findings suggested that recovery cannot be conceptualised separately from an understanding of the lived experience of personality disorders. This experience was characterised by a complexity of ambiguous, interrelating and conflicting feelings, thoughts and actions as individuals tried to cope with tensions between internally and externally experienced worlds. Our analysis was suggestive of a process of recovering or, for some, discovering a sense of self that can safely coexist in both worlds. CONCLUSIONS We conclude that key facilitators of recovery - positive personal relationships and wider social interaction - are also where the core vulnerabilities of individuals with lived experience of personaility disorders can lie. There is a role for personality disorders services in providing a safe space in which to develop positive relationships. Through discursive practice within the research team understandings of recovery were co-produced that responded to the lived experience of personality disorders and were of applied relevance to practitioners.
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Affiliation(s)
- Steve Gillard
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Kati Turner
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Marion Neffgen
- South West London & St George's Mental Health NHS Trust, Springfield University Hospital, Glenburnie Way, London, SW17 7DJ, UK.
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40
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Crocker R. Emotional Testimonies: An Ethnographic Study of Emotional Suffering Related to Migration from Mexico to Arizona. Front Public Health 2015; 3:177. [PMID: 26217657 PMCID: PMC4500103 DOI: 10.3389/fpubh.2015.00177] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/29/2015] [Indexed: 12/29/2022] Open
Abstract
It is increasingly argued that social and economic inequities poorly affect overall health. One of the means through which these inequities are translated to the body is via negative emotions, which carry known psychological and physiological responses. This paper examines migration-related psychosocial stressors impacting first-generation Mexican immigrants in southern Arizona, and reports on the primary emotional experiences immigrants associate with these stressors. Data were drawn from a qualitative, ethnographic study conducted over the course of 14 months during 2013-2014 with first-generation Mexican immigrants (N = 40) residing in Tucson Arizona and service providers working directly in the immigrant community (N = 32). Results indicate that the primary structural vulnerabilities that cause emotional hardship among immigrants are pre-migration stressors and adversity, dangerous border crossings, detention and deportation, undocumented citizenship status, family separation, and extreme poverty. Many of these factors have intensified over the past decade due to increased border security and state level anti-immigrant legislation in Arizona. Immigrants connected these hardships to the emotions of trauma (50%), fear (65%), depression (75%), loneliness (75%), sadness (80%), and stress (85%), and most respondents reported suffering from three or more of these emotions. Given the heavy emotional toll of migration and the direct impact that regional legislation and border security had on well-being, this paper argues that emotion be considered an important mechanism for health declines in the immigrant community. In order to stem the frequency and intensity of emotional stress in the Mexican immigrant community in Tucson, it is imperative to support organizations and policies that promote community building and support networks and also expand access to and availability of mental health services for immigrants regardless of documentation status.
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Affiliation(s)
- Rebecca Crocker
- School of Anthropology, University of Arizona, Tucson, AZ, USA
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41
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Mendenhall E. Beyond Comorbidity: A Critical Perspective of Syndemic Depression and Diabetes in Cross-cultural Contexts. Med Anthropol Q 2015; 30:462-478. [PMID: 25865829 DOI: 10.1111/maq.12215] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article examines the comorbidity concept in medical anthropology. I argue that the dearth of articles on comorbidity in medical anthropology may result from the rise of syndemic theory. Syndemics recognize how social realities shape individual illness experiences as well as distribution of diseases across populations. I discuss synergistic interactions foundational to the syndemics construct through my research of depression and diabetes comorbidity in vulnerable populations from urban United States, India, and South Africa. I argue that social and economic factors that cluster with depression and diabetes alone and together exemplify the biosocial processes that are at the heart of syndemics. In doing so, I illustrate how social, cultural, and economic factors shape individual-level experiences of co-occurring diseases despite similar population-level trends. Finally, I discuss the relevance of syndemics for the fields of medicine and public health while cautioning what must not be lost in translation across disciplines.
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Affiliation(s)
- Emily Mendenhall
- Science, Technology, and International Affairs Program, Edmund A. Walsh School of Foreign Service, Georgetown University
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Napier AD. Producing The Lancet and University College London Commission on Culture and Health. Med Anthropol 2015; 34:291-6. [PMID: 25830933 DOI: 10.1080/01459740.2015.1030644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A David Napier
- a Department of Anthropology , University College London , United Kingdom
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Heinz A, Müller DJ, Krach S, Cabanis M, Kluge UP. The uncanny return of the race concept. Front Hum Neurosci 2014; 8:836. [PMID: 25408642 PMCID: PMC4219449 DOI: 10.3389/fnhum.2014.00836] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 09/30/2014] [Indexed: 11/13/2022] Open
Abstract
The aim of this Hypothesis and Theory is to question the recently increasing use of the "race" concept in contemporary genetic, psychiatric, neuroscience as well as social studies. We discuss "race" and related terms used to assign individuals to distinct groups and caution that also concepts such as "ethnicity" or "culture" unduly neglect diversity. We suggest that one factor contributing to the dangerous nature of the "race" concept is that it is based on a mixture of traditional stereotypes about "physiognomy", which are deeply imbued by colonial traditions. Furthermore, the social impact of "race classifications" will be critically reflected. We then examine current ways to apply the term "culture" and caution that while originally derived from a fundamentally different background, "culture" is all too often used as a proxy for "race", particularly when referring to the population of a certain national state or wider region. When used in such contexts, suggesting that all inhabitants of a geographical or political unit belong to a certain "culture" tends to ignore diversity and to suggest a homogeneity, which consciously or unconsciously appears to extend into the realm of biological similarities and differences. Finally, we discuss alternative approaches and their respective relevance to biological and cultural studies.
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Affiliation(s)
- Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin Berlin, Germany
| | - Daniel J Müller
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto Toronto, ON, Canada
| | - Sören Krach
- Department of Child and Adolescent Psychiatry, Philipps-University Marburg Marburg, Germany
| | - Maurice Cabanis
- Center for Mental Health, Klinikum Stuttgart Stuttgart, Germany
| | - Ulrike P Kluge
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin Berlin, Germany
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Abstract
All over Latin America, indigenous populations are rapidly changing their lifestyle. This work elaborates on the complex experience of indigenous people in transition. Poverty, discrimination, marginalization, and endurance are defining characteristics of their everyday life. Global health programs represent excellent opportunities for addressing these issues. These initiatives, however, are at risk of being short-sighted, ethnocentric, and paradigmcentric. Global health programs would be increasingly more successful if they break disciplinary boundaries and invite actors with different perspectives to a dialogue that does not emphasize biology over culture or academic over community expertise.
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Affiliation(s)
- Claudia Valeggia
- a Department of Anthropology , Yale University , New Haven , Connecticut , USA
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Weaver LJ, Mendenhall E. Applying syndemics and chronicity: interpretations from studies of poverty, depression, and diabetes. Med Anthropol 2014; 33:92-108. [PMID: 24512380 DOI: 10.1080/01459740.2013.808637] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Medical anthropologists working with global health agendas must develop transdisciplinary frameworks to communicate their work. This article explores two similar but underutilized theoretical frameworks in medical anthropology, and discusses how they facilitate new insights about the relationships between epidemiological patterns and individual-level illness experiences. Two cases from our fieldwork in New Delhi and Chicago are presented to illustrate how syndemics and chronicity theories explain the epidemic problems of co-occurring depression and type 2 diabetes. We use these case studies to illustrate how the holistic agendas of syndemics and chronicity theories allow critical scholars to attend to the macrosocial factors contributing to the rise of noncommunicable diseases while still honoring the diversity of experiences that make individual illness experiences, and actual outcomes, unique. Such an approach not only promotes a more integrative medical anthropology, but also contributes to global health dialogues around diabetes, depression, and their overlap.
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Affiliation(s)
- Lesley Jo Weaver
- a Department of Anthropology , Emory University , Atlanta , Georgia , USA
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Abstract
Human beings are meaning-making creatures, who not only suffer in an immediately felt way, but who can interpret and articulate their discontents through the use of language. The goal of this article is to map different languages of suffering that have been—and still are—in use, when human beings make sense of their problems in living. I argue that our current conception of suffering has been pathologized and biomedicalized with the diagnostic manuals serving as a significant source from which a diagnostic language of suffering emanates. I briefly present four other languages of suffering—religious, existential, moral, and political ones—that are today often delegitimatized by the dominant psychiatric language. Building on pragmatist and hermeneutic philosophies, my goal is to argue that different languages enable different forms of understanding and action, and that we need many different languages in order to fully understand the human condition.
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Koch E. Tuberculosis is a threshold: the making of a social disease in post-Soviet Georgia. Med Anthropol 2013; 32:309-24. [PMID: 23768217 DOI: 10.1080/01459740.2012.751384] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this article I use Margaret Lock's concept of local biology as a standpoint to view tuberculosis as a threshold where distinctions between social and biological aspects of disease are negotiated. I conceptualize tuberculosis as a threshold in two ways: first as a passageway, and second as a space for navigating the limits of tolerance to therapeutics. The article is based on ethnographic research about responses to tuberculosis in post-Soviet Georgia. I focus on how health professionals and patients make claims to social aspects of illness by recuperating historical examples for tuberculosis treatment as a moral commitment to society, and in the context of emergent patient-centered treatment services.
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Affiliation(s)
- Erin Koch
- Department of Anthropology, University of Kentucky, Lexington, Kentucky 40506, USA.
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Abstract
Our purpose for this study was to identify clusters of midlife women by menopausal symptoms in a multiethnic sample, and to determine ethnic differences in the clusters. This was a secondary analysis of data from 501 women in a larger Internet study on menopausal symptom experiences. The data were analyzed using factor analysis, hierarchical cluster analysis, and multinominal logistic analysis. A three cluster solution was adopted (F = 575.71, p <.01). The clusters differed significantly in the country of birth and ethnicity (p <.05). Only in the low symptomatic cluster were there significant ethnic differences in menopausal symptoms.
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Affiliation(s)
- Eun-Ok Im
- a School of Nursing, University of Pennsylvania , Philadelphia , Pennsylvania , USA
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