Disruption, discontinuity and a licence to live: Responding to cancer diagnoses.

Although a diagnosis of a life-limiting cancer is likely to evoke emotions, such as fear, panic and anxiety, for some people it can also provide an opportunity to live life differently. This article is based on research undertaken in Aotearoa New Zealand on the topic of exceptional cancer trajectories. Eighty-one participants who had been identified as living with a cancer diagnosis longer than clinically expected were interviewed, along with 25 people identified by some of the participants as supporters in their journey. For some participants the diagnosis provided the opportunity to rethink their lives, to undertake lifestyle and consumption changes, to be culturally adventurous, to take up new skills, to quit work and to change relationships with others. The concepts of biographical disruption and posttraumatic growth are considered in relation to these accounts, and it is argued that the event of a cancer diagnosis can give license for people to breach social norms.

'A healthy lifestyle is a journey': exploring health perceptions and self-defined facilitators to health through photo-elicitation.

OBJECTIVE: The aim of this study was to explore health perceptions and self-defined facilitators to health in general population. An additional aim of the study was to assess if these perceptions were connected with the context of the Covid-19 pandemic. DESIGN: We applied photo-elicitation method by gathering original photographs and narratives (captions) via social media and e-mails. Participants (N = 50) were asked to answer the question: 'What does it mean to be healthy?'. Data were collected online in Poland. We generated and interpreted the main themes associated with common perceptions of health and self-defined facilitators to health using polytextual thematic analysis. RESULTS: The health perception themes were, health as: a 'long journey'; keeping balance; and self-acceptance. The main facilitators to health were: enjoyment of activities that are part of a healthy lifestyle; planning time for rest; contact with nature, and supportive relationships. Participants' perceptions of how Covid-19 impacted on their health differed. CONCLUSIONS: The findings provide evidence for individual health perceptions and self-defined facilitators to health and can support the development of future health interventions.

Nutritionism and the construction of 'poor choices' in families facing food insecurity.

The dominant research approach to both food insecurity and charitable meal provision is nutritionistic, deficit-orientated and ignores wider socio-economic issues. This reinforces existing power dynamics and overlooks the agency of people living food-insecure lives. We critique this dominant approach and draw on the everyday experiences of families facing food insecurity to ground an alternative approach that emphasises food as a social determinant of health.

Critical health psychology in New Zealand: Developments, directions and reflections.

We examine how critical health psychology developed in New Zealand, taking an historical perspective to document important influences. We discuss how academic appointments created a confluence of critical researchers at Massey University, how interest in health psychology arose and expanded, how the critical turn eventuated and how connections, both local and international, were important in building and sustaining these developments. We discuss the evolution of teaching a critical health psychology training programme, describe the research agendas and professional activities of academic staff involved and how this sustains the critical agenda. We close with some reflections on progress and attainment.

The problematic messages of nutritional discourse: A case-based critical media analysis.

Nutritional science has assumed a fundamental importance in shaping food meanings and practices in the developed world. This study critically analysed the content of one weekly nutrition column written by a nutritional expert in a popular New Zealand magazine, from a social constructionist perspective, to investigate how nutritional advice constructs food, food practices and eaters. The analysis identified a range of ways in which the nutrition information communicated in the articles was potentially problematic for readers. The articles advocated eating for health with recommendations based on nutritional science, but depicted nutritional information as inconclusive, changeable and open to interpretation. Fear-based messages were used to motivate making 'healthy' food choices, through linking 'unhealthy' food choices with fatness and chronic ill health. Unhealthy foods were portrayed as more enjoyable than healthy foods, social occasions involving food were constructed as problematic, and exercise was defined only as a way to negate food consumption. Healthy eating was portrayed as a matter of personal choice, obscuring the situational factors that impact on food choice and health. We conclude that the nutritional advice analysed in this study constructs a way of understanding food that, if internalised by eaters, may evoke anxiety, confusion and dissatisfaction around food and eating.

Moral discourses and pharmaceuticalised governance in households.

This article extends our understanding of the everyday practices of pharmaceuticalisation through an examination of moral concerns over medication practices in the household. Moral concerns of responsibility and discipline in relation to pharmaceutical consumption have been identified, such as passive or active medication practices, and adherence to orthodox or unorthodox accounts. This paper further delineates dimensions of the moral evaluations of pharmaceuticals. In 2010 and 2011 data were collected from 55 households across New Zealand and data collection techniques, such as photo- and diary-elicitation interviews, allowed the participants to develop and articulate reflective stories of the moral meaning of pharmaceuticals. Four repertoires were identified: a disordering society repertoire where pharmaceuticals evoke a society in an unnatural state; a disordering self repertoire where pharmaceuticals signify a moral failing of the individual; a disordering substances repertoire where pharmaceuticals signify a threat to one's physical or mental equilibrium; a re-ordering substances repertoire where pharmaceuticals signify the restoration of function. The research demonstrated that the dichotomies of orthodox/unorthodox and compliance/resistance do not adequately capture how medications are used and understood in everyday practice. Attitudes change according to why pharmaceuticals are taken and who is taking them, their impacts on social relationships, and different views on the social or natural production of disease, the power of the pharmaceutical industry, and the role of health experts. Pharmaceuticals are tied to our identity, what we want to show of ourselves, and what sort of world we see ourselves living in. The ordering and disordering understandings of pharmaceuticals intersect with forms of pharmaceuticalised governance, where conduct is governed through pharmaceutical routines, and where self-responsibility entails following the prescription of other agents. Pharmaceuticals symbolise forms of governance with different sets of roles and responsibilities.

How do environmental factors influence walking in groups? A walk-along study.

Insufficient attention has been given to the influence of context on health-related behaviour change. This article reports on walk-along interviews conducted with 10 leaders of walking groups while leading their groups to investigate the influence of contextual factors on walking behaviours in groups. Data analysis used ideas from thematic analysis and grounded theory, approaching the data inductively. We identified that characteristics of place influenced the type of walking that people do in groups and the processes used by walkers to make sense of their behaviours in the places they walk. This research provides insight into how place influences walking in groups. It also suggests recommendations for co-ordinators and policymakers that could be used to facilitate behaviour change, when designing interventions targeting public health within the community.

Looking within and beyond the community: lessons learned by researching, theorising and acting to address urban poverty and health.

Urban poverty and health inequalities are inextricably intertwined. By working in partnership with service providers and communities to address urban poverty, we can enhance the wellness of people in need. This article reflects on lessons learned from the Family100 project that explores the everyday lives, frustrations and dilemmas faced by 100 families living in poverty in Auckland. Lessons learned support the need to bring the experiences and lived realities of families to the fore in public deliberations about community and societal responses to urban poverty and health inequality.

Home as a hybrid centre of medication practice.

This article presents research that explores how medications are understood and used by people in everyday life. An intensive process of data collection from 55 households was used in this research, which included photo-elicitation and diary-elicitation interviews. It is argued that households are at the very centre of complex networks of therapeutic advice and practice and can usefully be seen as hybrid centres of medication practice, where a plethora of available medications is assimilated and different forms of knowledge and expertise are made sense of. Dominant therapeutic frameworks are tactically manipulated in households in order for medication practices to align with the understandings, resources and practicalities of households. Understanding the home as a centre of medication practice decentralises the role of health advisors (whether mainstream or alternative) in wellness practices.

Public Beliefs about Antibiotics, Infection and Resistance: A Qualitative Study.

We aimed to gain an in-depth understanding of public views and ways of talking about antibiotics. Four focus groups were held with members of the public. In addition, 39 households were recruited and interviews, diaries of medicine taking, diaries of any contact with medication were used to explore understanding and use of medication. Discussions related to antibiotics were identified and analyzed. Participants in this study were worried about adverse effects of antibiotics, particularly for recurrent infections. Some were concerned that antibiotics upset the body's "balance", and many used strategies to try to prevent and treat infections without antibiotics. They rarely used military metaphors about infection (e.g., describing bacteria as invading armies) but instead spoke of clearing infections. They had little understanding of the concept of antibiotic resistance but they thought that over-using antibiotics was unwise because it would reduce their future effectiveness. Previous studies tend to focus on problems such as lack of knowledge, or belief in the curative powers of antibiotics for viral illness, and neglect the concerns that people have about antibiotics, and the fact that many people try to avoid them. We suggest that these concerns about antibiotics form a resource for educating patients, for health promotion and social marketing strategies.

The debate about the funding of Herceptin: a case study of 'countervailing powers'.

In December 2008 the newly elected Prime Minister of New Zealand bypassed the agency that negotiates with manufacturers about the cost of medicines and agreed to fund Herceptin for women with early stage breast cancer for a twelve months course of treatment. This paper describes the unfolding of this decision and seeks to explain it in terms of the theory of countervailing powers, which has recently been applied to understand the rapid growth of medicines and the governance of the pharmaceutical industry. We explore the role of various actors in this debate about Herceptin funding, drawing on documentary analysis based on a systematic search of journals, websites and media databases. The case of Herceptin both confirms and questions the propositions of countervailing powers theory. On the one hand the manufacturers of the drug proved to be highly influential in their attempts to get Herceptin funded and were generally supported by consumer groups. On the other hand some scientists and regulators attempted to challenge the power of the manufacturers, with the regulators not showing signs of corporate bias as one might expect. Groups did not, as has been proposed, exert power monolithically, with several groups exhibiting opposing factions. The media, ignored in this literature, are considered as a potential countervailing force in the debate. In the end the government bypassed the recommendation of its regulators, thereby undermining the latter's efforts to act as a countervailing power.

Blogging for weight loss: personal accountability, writing selves, and the weight-loss blogosphere.

Body weight is a key concern in contemporary society, with large proportions of the population attempting to control their weight. However, losing weight and maintaining weight loss is notoriously difficult, and new strategies for weight loss attract significant interest. Writing about experiences of weight loss in online journals, or blogging, has recently expanded rapidly. Weight-loss bloggers typically write about daily successes and failures, report calorie consumption and exercise output, and post photographs of their changing bodies. Many bloggers openly court the surveillance of blog readers as a motivation for accountability to their weight-loss goals. Drawing from a sample of weight-loss blogs authored by women, we explore three issues arising from this practice of disclosing a conventionally private activity within an online public domain. First, we examine motivations for blogging, focusing on accountability. Secondly, we consider the online construction of self, exploring how weight-loss bloggers negotiate discourses around fatness, and rework selves as their bodies transform. Finally, we consider the communities of interest that form around weight-loss blogs. This 'blogosphere' provides mutual support for weight loss. However, participating in online social spaces is complicated and bloggers must carefully manage issues of privacy and disclosure.

The Civil Air Patrol's role in medical countermeasure distribution in Michigan.

Michigan's unique geological features and highly variable climatic conditions make distribution of medical countermeasures during a public health emergency situation very challenging. To enhance distribution during these situations, the Civil Air Patrol (CAP) has agreed to support the state of Michigan by transporting life-saving medical countermeasures to remote areas of the state. The Michigan Strategic National Stockpile (MISNS) program has successfully developed, exercised, and enhanced its partnership with the CAP to include distribution of federally provided Strategic National Stockpile (SNS) assets. The CAP has proven to be a reliable and valuable partner, as well as a cost-effective and time-efficient means of transporting vital resources during a public health emergency.

"Near and far": social distancing in domiciled characterisations of homeless people.

For domiciled individuals, homeless people provide a disturbing reminder that all is not right with the world. Reactions to seeing homeless people frequently encompass repulsion, discomfort, sympathy and sometimes futility. This paper considers domiciled constructions of homeless people drawn from interviews with 16 participants recruited in the central business district of a New Zealand city. It documents how, when trying to make sense of this complex social problem, domiciled people draw on shared characterizations of homeless people. The concept of "social distance" is used to interrogate the shifting and sometimes incongruous reactions evident in participant accounts. "Social distancing" is conceptualised as a dynamic communal practice existing in interactions between human beings and reflected in the ways that domiciled people talk about their experiences with homeless individuals.

Emplacement and everyday use of medications in domestic dwellings.

To extend knowledge of relationships between people and domestic settings in the context of medication use, we conducted fieldwork in twenty households in New Zealand. These households contained a range of 'medicative' forms, including prescription drugs, traditional remedies, dietary supplements and enhanced foods. The location and use of these substances within domestic dwellings speaks to processes of emplacement and identity in the creation of spaces for care. Our analysis contributes to current understandings of the ways in which objects from 'outside' the home come to be woven into relationships, identities and meanings 'inside' the home. We demonstrate that, as well as being pharmacological objects, medications are complex, socially embedded objects with histories and memories that are ingrained within contemporary relationships of care and home-making practices.

Nutritional health, subjectivity and resistance: women's accounts of dietary practices.

Food is related to health, both directly and symbolically, in complex ways. Also, social practices around food are highly gendered, and, in the context of family life, fall largely to mothers. This study examines mothers' talk about nutritional health, and food, health and dietary practices in the context of everyday life, using a discursive analysis of the talk from focus group discussions. Findings show that discourses surrounding nutritional health offer women a variety of conflictual subjectivities. If they do not engage in 'correct' dietary practices, women are positioned as immoral, both as individuals and as mothers. Further, their ability to determine which foods are 'healthy' or 'unhealthy' is undermined through a distrust of 'facts' and scientific evidence, and they are rendered susceptible to exploitation through claims made for food as health promoting. Together, these areas of conflict perpetuate subjectivities of anxiety around dietary practices.The women seek to re-position themselves and overcome these contradictions by offering a variety of legitimations for their dietary practices. In doing so, they resist nutritional health messages and reveal how such messages can have unintended effects.

The mobile hermit and the city: considering links between places, objects, and identities in social psychological research on homelessness.

This article explores aspects of a homeless man's everyday life and his use of material objects to maintain a sense of place in the city. We are interested in the complex functions of walking, listening and reading as social practices central to how this man forges a life as a mobile hermit across physical and imagined locales. This highlights connections between physical place, use of material objects, imagination, and sense of self. Our analysis illustrates the value of paying attention to geographical locations and objects in social psychological research on homelessness.

A Personal Projects Analysis: examining adaptation to low back pain.

Personal Projects Analysis (PPA) offers an alternative approach to studying adaptation to illnesses. This study investigated adaptation to low back pain using PPA to examine the relationship between participants' perceptions of pain, and their functioning and well-being. Participants appraised their five most important projects on 26 dimensions, such as project value, success and difficulty. Factor analyses of the project ratings yielded five dispositions (Integrity, Personal Agency, Social Visibility, Pain Salience and Stressfulness). In regression analysis all five dispositions significantly predicted Physical and Social Function, Disruption of Roles, and Well-being. ;Pain Salience' was the strongest predictor of functional outcomes, and ;Stressfulness' was the best predictor of well-being.

Now let me tell you in my own words: narratives of acute and chronic low back pain.

PURPOSE: In the past, qualitative studies have focused on chronic low back pain (LBP), yet 90% of LBP is acute and episodic. The purpose of this study was to examine the broader experience (acute as well chronic) of LBP in the community. METHODS: This study was part of a Personal Project Analysis of adaptation to LBP. Participants answered an open-ended question that invited them to tell researchers about their LBP. The narratives were analysed using thematic content analysis and structure was analysed using the narrative types described in 'The Wounded Storyteller' (Frank A. The Wounded Story Teller: Body, Illness and Ethics. Chicago: The University of Chicago Press; 1995). FINDINGS: Two themes were identified: (1) the challenges to the authenticity of LBP and (2) the consequences of living with LBP, which had two threads: the disruption of life due to physical limitations, and the emotional distress incurred. The narratives were solely told as chaos narratives. CONCLUSIONS: The emotional and behavioural responses of individuals with LBP and the tensions that exist between the individual and others, especially healthcare providers, is explained in the context of LBP as a moral event. Understanding the narratives as chaos narratives provides insight into ways to improve the quality of the interactions between patients and health care providers.

Ricin B chain targeted to the endoplasmic reticulum of tobacco protoplasts is degraded by a CDC48- and vacuole-independent mechanism.

The B chain of ricin was expressed and delivered to the endoplasmic reticulum of tobacco protoplasts where it disappeared with time in a manner consistent with degradation. This turnover did not occur in the vacuoles or upon secretion. Indeed, several lines of evidence indicate that, in contrast to the turnover of endoplasmic reticulum-targeted ricin A chain in the cytosol, the bulk of expressed ricin B chain was degraded in the secretory pathway.