Discourse, materiality and power: Dietary supplements and their users

Throughout human existence people have used herbs and other medicinal substances to protect themselves against illness and treat their ailments. Gathering wild herbs has, however, been replaced today by the many products on the shelves of health stores and pharmacies in developed countries with health systems similar to New Zealand. Previous studies of supplements and their use have largely focused on how many people use them, or subsumed supplement use within wider studies of complementary and alternative medicine (CAM). Supplement use, however, has characteristics that make it different from CAM therapies more broadly. Yet there have been only a few investigations where supplement users have been asked directly about their practices, and those that have been done have tended to be under-theorised and so lack depth. This study used a constructionist approach, within which supplements and their users were examined from both humanist and post-humanist perspectives. I used semi-structured interviews to generate data with 36 participants who were regular users of supplements. The interviews were supplemented by observations of the displays of products that participants brought to my attention in the home and retail settings where the interviews took place. A critical theoretical analysis was undertaken, framed by Deleuze and Guattari’s concept of the rhizomatic assemblage of multiple, interconnected actants which are always in a process of change. Within this wider framework, aspects of the data were examined using other theoretical concepts including deconstruction, the agency of matter, and Foucault’s ideas of power and caring for the self. The study revealed that popular assumptions about supplements as being natural, holistic and risk free can be deconstructed to show a wide variety of nuances and competing interpretations. Material things are significant in supplement use; not only the products themselves but the non-human communication technologies that allow individuals and companies the means to research, promote, sell or buy supplements when and where they choose across the globe. Using the experience and new knowledge acquired through these non-human things, supplement users become confident in their ability to resist over-scrutiny of their practices by the orthodox health system and this confidence becomes woven in to how they present themselves and their life story

Designing with Mobile Digital Storytelling in Rural Africa

We reflect on activities to design a mobile application to enable rural people in South Africa’s Eastern Cape to record and share their stories, which have implications for ‘cross-cultural design,’ and the wider use of stories in design. We based our initial concept for generating stories with audio and photos on cell-phones on a scenario informed by abstracting from digital storytelling projects globally and our personal experience. But insights from ethnography, and technology experiments involving storytelling, in a rural village led us to query our grounding assumptions and usability criteria. So, we implemented a method using cell-phones to localise storytelling, involve rural users and probe ways to incorporate visual and audio media. Products from this method helped us to generate design ideas for our current prototype which offers great flexibility. Thus we present a new way to depict stories digitally and a process for improving such software

Polymorphisms in immunoregulatory genes and the risk of histologic chorioamnionitis in Caucasoid women: a case control study

BACKGROUND: Chorioamnionitis is a common underlying cause of preterm birth (PTB). It is hypothesised that polymorphisms in immunoregulatory genes influence the host response to infection and subsequent preterm birth. The relationship between histologic chorioamnionitis and 22 single nucleotide polymorphisms in 11 immunoregulatory genes was examined in a case-control study. METHODS: Placentas of 181 Caucasoid women with spontaneous PTB prior to 35 weeks were examined for histologic chorioamnionitis. Polymorphisms in genes IL1A, IL1B, IL1RN, IL1R1, tumour necrosis factor (TNF), IL4, IL6, IL10, transforming growth factor beta-1 (TGFB1), Fas (TNFRSF6), and mannose-binding lectin (MBL2) were genotyped by polymerase chain reaction and sequence specific primers. Multivariable logistic regression including demographic and genetic variables and Kaplan-Meier survival analyses of genotype frequencies and pregnancy outcome were performed. RESULTS: Sixty-nine (34%) women had histologic evidence of acute chorioamnionitis. Carriage of the IL10-1082A/-819T/592A (ATA) haplotype [Multivariable Odds ratio (MOR) 1.9, P = 0.05] and MBL2 codon 54Asp allele (MOR 2.0, P = 0.04), were positively associated with chorioamnionitis, while the TNFRSF6-1377A/-670G (AG) haplotype (MOR 0.4, P = 0.03) and homozygosity for TGFB1-800G/509T (GT) haplotype (MOR 0.2, P = 0.04) were negatively associated. CONCLUSION: These findings demonstrate that polymorphisms in immunoregulatory genes IL10, MBL2, TNFRSF6 and TGFB1 may influence susceptibility to chorioamnionitis

A bespoke smoking cessation service compared with treatment as usual for people with severe mental ill health: the SCIMITAR+ RCT

BackgroundThere is a high prevalence of smoking among people with severe mental ill health (SMI). Helping people with SMI to quit smoking could improve their health and longevity, and reduce health inequalities. However, those with SMI are less likely to access and engage with routine smoking cessation services than the general population.ObjectivesTo compare the clinical effectiveness and cost-effectiveness of a bespoke smoking cessation (BSC) intervention with usual stop smoking services for people with SMI.DesignA pragmatic, two-arm, individually randomised controlled trial.SettingPrimary care and secondary care mental health services in England.ParticipantsSmokers aged ≥ 18 years with SMI who would like to cut down on or quit smoking.InterventionsA BSC intervention delivered by mental health specialists trained to deliver evidence-supported smoking cessation interventions compared with usual care.Main outcome measuresThe primary outcome was self-reported, CO-verified smoking cessation at 12 months. Smoking-related secondary outcomes were self-reported smoking cessation, the number of cigarettes smoked per day, the Fagerström Test for Nicotine Dependence and the Motivation to Quit questionnaire. Other secondary outcomes were Patient Health Questionnaire-9 items, Generalised Anxiety Disorder Assessment-7 items and 12-Item Short-Form Health Survey, to assess mental health and body mass index measured at 6 and 12 months post randomisation.ResultsThe trial randomised 526 people (265 to the intervention group, 261 to the usual-care group) aged 19 to 72 years (mean 46 years). About 60% of participants were male. Participants smoked between 3 and 100 cigarettes per day (mean 25 cigarettes per day) at baseline. The intervention group had a higher rate of exhaled CO-verified smoking cessation at 6 and 12 months than the usual-care group [adjusted odds ratio (OR) 12 months: 1.6, 95% confidence interval (CI) 0.9 to 2.8; adjusted OR 6 months: 2.4, 95% CI 1.2 to 4.7]. This was not statistically significant at 12 months (p = 0.12) but was statistically significant at 6 months (p = 0.01). In total, 111 serious adverse events were reported (69 in the BSC group and 42 in the usual-care group); the majority were unplanned hospitalisations due to a deterioration in mental health (n = 98). The intervention is likely (57%) to be less costly but more effective than usual care; however, this result was not necessarily associated with participants’ smoking status.LimitationsFollow-up was not blind to treatment allocation. However, the primary outcome included a biochemically verified end point, less susceptible to observer biases. Some participants experienced difficulties in accessing nicotine replacement therapy because of changes in service provision. Efforts were made to help participants access nicotine replacement therapy, but this may have affected participants’ quit attempt.ConclusionsPeople with SMI who received the intervention were more likely to have stopped smoking at 6 months. Although more people who received the intervention had stopped smoking at 12 months, this was not statistically significant.Future workFurther research is needed to establish how quitting can be sustained among people with SMI.Trial registrationCurrent Controlled Trials ISRCTN72955454.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 50. See the NIHR Journals Library website for further project information

Is (poly-) substance use associated with impaired inhibitory control? A mega-analysis controlling for confounders.

Many studies have reported that heavy substance use is associated with impaired response inhibition. Studies typically focused on associations with a single substance, while polysubstance use is common. Further, most studies compared heavy users with light/non-users, though substance use occurs along a continuum. The current mega-analysis accounted for these issues by aggregating individual data from 43 studies (3610 adult participants) that used the Go/No-Go (GNG) or Stop-signal task (SST) to assess inhibition among mostly "recreational" substance users (i.e., the rate of substance use disorders was low). Main and interaction effects of substance use, demographics, and task-characteristics were entered in a linear mixed model. Contrary to many studies and reviews in the field, we found that only lifetime cannabis use was associated with impaired response inhibition in the SST. An interaction effect was also observed: the relationship between tobacco use and response inhibition (in the SST) differed between cannabis users and non-users, with a negative association between tobacco use and inhibition in the cannabis non-users. In addition, participants' age, education level, and some task characteristics influenced inhibition outcomes. Overall, we found limited support for impaired inhibition among substance users when controlling for demographics and task-characteristics

Talking about 1080: risk, trust and protecting our place

The use of 1080 for pest control by the Department of Conservation (DoC) and the Animal Health Board (AHB) is officially considered the only viable means of preventing environmental damage from possums and protecting farming from the spread of bovine tuberculosis in the West Coast region. Although 1080 has been used for decades in New Zealand, opposition to its use has intensified in recent years, particularly to aerial 1080. The public discourse revolves around the magnitude and likelihood of risks to the environment and human health, within a wider societal climate where the importance of avoiding such risks is taken for granted. Public health staff in the region spend significant time investigating complaints about misapplied 1080 baits and discussing health concerns. To date, however, there has been little formal investigation of community attitudes and reasons for the opposition to 1080. This study sought to discover how different sectors of the community perceived 1080, and how they explained why they held those views. In-depth interviews were held with twelve key informants recruited from organisations and groups that were already publicly identified as supporting or opposing 1080. Data from the interviews were analysed thematically within a framework of contemporary socio-cultural risk theory. The analysis showed that opinions on risk were nuanced and individualised, ranging from total opposition to total support with many positions in between, rather than being sharply divided into pro- and anti-1080 blocs as is generally assumed. All participants, including those who asserted that their support for 1080 was derived from scientific evidence, drew on both quantitative information and subjective, contextual experience to explain their views. Moreover, perceptions about risk were strongly mediated by two other important factors: deep attachment to the natural environment, and issues of trust and distrust in the way pest control was managed by the local and national authorities of DoC and the AHB. Fundamentally conflicting philosophies about the way the natural environment should be managed appeared to be behind claims by both supporters and opponents that those who did not agree with them had hidden agendas, and were putting the region at risk. Health concerns were not only about physical health risk but more about overall wellbeing, especially in relation to water contamination. Only the Māori rūnanga and DoC had a positive view of their reciprocal relationship which had developed through a combined forum over the past decade. Key recommendations include the need for changes to community engagement and increased transparency on the part of DoC and the AHB. Insights from this study may also apply to other parts of New Zealand where 1080 is hotly contested, as well as to situations where environmental and health risks are raised in opposition to developments such as wind farms or water resource management

Talking about 1080: risk, trust and protecting our place

The use of 1080 for pest control by the Department of Conservation (DoC) and the Animal Health Board (AHB) is officially considered the only viable means of preventing environmental damage from possums and protecting farming from the spread of bovine tuberculosis in the West Coast region. Although 1080 has been used for decades in New Zealand, opposition to its use has intensified in recent years, particularly to aerial 1080. The public discourse revolves around the magnitude and likelihood of risks to the environment and human health, within a wider societal climate where the importance of avoiding such risks is taken for granted. Public health staff in the region spend significant time investigating complaints about misapplied 1080 baits and discussing health concerns. To date, however, there has been little formal investigation of community attitudes and reasons for the opposition to 1080. This study sought to discover how different sectors of the community perceived 1080, and how they explained why they held those views. In-depth interviews were held with twelve key informants recruited from organisations and groups that were already publicly identified as supporting or opposing 1080. Data from the interviews were analysed thematically within a framework of contemporary socio-cultural risk theory. The analysis showed that opinions on risk were nuanced and individualised, ranging from total opposition to total support with many positions in between, rather than being sharply divided into pro- and anti-1080 blocs as is generally assumed. All participants, including those who asserted that their support for 1080 was derived from scientific evidence, drew on both quantitative information and subjective, contextual experience to explain their views. Moreover, perceptions about risk were strongly mediated by two other important factors: deep attachment to the natural environment, and issues of trust and distrust in the way pest control was managed by the local and national authorities of DoC and the AHB. Fundamentally conflicting philosophies about the way the natural environment should be managed appeared to be behind claims by both supporters and opponents that those who did not agree with them had hidden agendas, and were putting the region at risk. Health concerns were not only about physical health risk but more about overall wellbeing, especially in relation to water contamination. Only the Māori rūnanga and DoC had a positive view of their reciprocal relationship which had developed through a combined forum over the past decade. Key recommendations include the need for changes to community engagement and increased transparency on the part of DoC and the AHB. Insights from this study may also apply to other parts of New Zealand where 1080 is hotly contested, as well as to situations where environmental and health risks are raised in opposition to developments such as wind farms or water resource management

Designing with mobile digital storytelling in rural Africa

We reflect on activities to design a mobile application to enable rural people in South Africa's Eastern Cape to record and share their stories, which have implications for 'cross-cultural design,' and the wider use of stories in design. We based our initial concept for generating stories with audio and photos on cell-phones on a scenario informed by abstracting from digital storytelling projects globally and our personal experience. But insights from ethnography, and technology experiments involving storytelling, in a rural village led us to query our grounding assumptions and usability criteria. So, we implemented a method using cell-phones to localise storytelling, involve rural users and probe ways to incorporate visual and audio media. Products from this method helped us to generate design ideas for our current prototype which offers great flexibility. Thus we present a new way to depict stories digitally and a process for improving such software