Pathways and obstacles to social recovery following the elimination of SARS-CoV-2 from Aotearoa New Zealand: a qualitative cross-sectional study.

BACKGROUND: Many public health experts have claimed that elimination strategies of pandemic response allow 'normal social life' to resume. Recognizing that social connections and feelings of normality are important for public health, this study examines whether, and for whom, that goal is realized, and identifies obstacles that may inhibit its achievement. METHODS: Thematic analysis of narratives obtained via a qualitative cross-sectional survey of a community cohort in Aotearoa | New Zealand. RESULTS: A majority of participants reported that life after elimination was 'more or less the same' as before the pandemic. Some became more social. Nevertheless, a sizeable minority reported being less social, even many months after elimination. Key obstacles to social recovery included fears that the virus was circulating undetected and the enduring impact of lockdowns upon social relationships, personal habits and mental health. Within our sample, old age and underlying health conditions were both associated with a propensity to become less social. CONCLUSIONS: Elimination strategies can successfully allow 'normal social life' to resume. However, this outcome is not guaranteed. People may encounter difficulties with re-establishing social connections in Zero-COVID settings. Measures designed to overcome such obstacles should be an integral part of elimination strategies.

BE KIND: Negotiating Ethical Proximities in Aotearoa/New Zealand during COVID-19.

Citizens do not merely respond to states of emergency; in democratic societies, they help constitute them. This essay analyzes New Zealanders' engagements in ethical reasoning during the country's first COVID-19 lockdown. Specifically, I examine how we can understand a variety of public responses to emergency measures-including breaching regulations, threatening rule-breakers, sealing off neighborhoods, and recasting citizen-returnees as "strangers"-as negotiations of ethical proximities focused on keeping appropriately close that which is thought should be near, and keeping distanced that deemed best held afar.

"L'ENFER, C'EST LES AUTRES": Proximity as an Ethical Problem during COVID-19.

During the COVID-19 emergency, people around the world are debating concepts like physical distancing, lockdown, and sheltering in place. The ethical significance of proximity-that is, closeness or farness as ethical qualities of relations (Strathern 2020)-is thus being newly troubled across a range of habits, practices, and personal relationships. Through five case studies from Australia, Ireland, New Zealand, South Africa, and the United States, contributors to this Colloquy shed light on what the hype of the pandemic often conceals: the forms of ethical reflection, reasoning, and conduct fashioned during the pandemic.

Situating biologies of traditional Chinese medicine in Central Europe.

Since the concept of 'local biologies' was proposed in the 1990s, it has been used to examine biosocial processes that transform human bodies in similar and different ways around the globe. This paper explores understandings of biosocial differentiation and convergence in the case of Traditional Chinese Medicine (TCM) in the Czech Republic. Specifically, it examines how Czech TCM practitioners view TCM as universally applicable while fine-tuning it to situated biosocial conditions, experimenting with the compatibilities of various human and plant bodies as part of their generalised, clinical practice. Drawing upon ethnographic research among TCM practitioners in the Czech Republic, it suggests that in addition to the individualization of TCM therapeutics to suit particular patients, Czech TCM is characterised by collective particularization, shaped by local concerns over ethnic, environmental and cultural differences. By looking critically at TCM practitioners' sensitivities to localised biological similarities and differences it aims to contribute to understandings of the expansion of TCM in Central Europe, as well as more broadly to current social science debates over the risks and opportunities inherent in abandoning the assumption of a universal human body and biology.

Equality, efficiency and effectiveness: going beyond RCTs in A. L. Cochrane's vision of health care.

A. L. Cochrane's Effectiveness and Efficiency frequently appears as a key reference in debates over, and a justification for, contemporary evidence-based medicine. Cochrane's concern in this text with the equality of care as the ultimate rationale for why effectiveness and efficiency of cure are needed has, however, largely disappeared from debate. In this article, we reconsider Cochrane's approach through the use of case studies of plural forms of medicine in the Czech Republic, namely traditional Chinese medicine, homeopathy and spa care. In addition to bringing equality back into the picture, we also identify four expansions to Cochrane's original vision arising from the difficulties of separating cure from care; the overlap between prevention and cure; the complex actions of some multi-faceted therapies; and recent reconceptualisations of the placebo effect. In conclusion, we suggest that instead of the widely used strictly vertical "evidence pyramid", a descriptor of the horizontal and additive ordering of evidence might be more appropriate. We also argue that in healthcare systems characterised by a multiplicity of approaches, if we want to truly benefit from this heterogeneity, we must take seriously each medical tradition's approaches to prevention, cure, care, as well as efficiency, efficacy and equality.

Efficacious Holidays: The Therapeutic Dimensions of Pleasure and Discipline in Czech Respiratory Spas.

As evidence-based medicine has increasingly become the standard for assessing the efficacy of health care, the Czech Republic finds itself in a dilemma, with centuries of sanatorium-style spa treatments resisting easy categorization. Despite some critics' contentions that spas are "pointless holidays" and reductions in government funding of health spas, in 2014 Czech courts affirmed every Czech citizen's right to spa treatments if their health status merits it. Drawing on research in two children's respiratory spas, this article considers the experiences of patients aged 2-15 and their accompanying parents or guardians (mainly mothers) to suggest that in addition to the range of therapeutic procedures highlighted within spa cures, more amorphous aspects-such as pleasure and discipline-may be just as central to spas' successes. Indeed, as some spa physicians contend, spas may be considered a "package deal," to which EBM criteria is not easily applied.

Digital mental health strategies used by young people in Aotearoa New Zealand during the COVID-19 pandemic: 'Just do it yourself, DIY'.

Objective: With rising rates of mental health distress amongst youth during the COVID-19 pandemic, digital resources have been identified as a valuable tools for delivering support to young people. However, many of the websites and apps developed by professionals to support the youth do not take account of the importance young people place on exercising their own agency in managing their mental health. This article investigates how young people in Aotearoa New Zealand used digital resources to manage their mental health needs during the COVID-19 pandemic. Methods: The study gathered information from semi-structured interviews with 34 young people aged 16-22 years. The data was analysed using reflexive thematic analysis. Results: Six themes were identified including: searching for online information about mental health; evaluating digital mental health resources; controlling mood through online activity; looking for escape in the virtual world; staying connected online; and giving and receiving support. Conclusion: Young people's practices demonstrated their investment in their own agency, a general reluctance to engage with professional resources and recognition of the need to balance the risks and benefits of the informal strategies they preferred. Young people appeared sceptical of professionally-designed mental health resources and interventions and preferred to adapt and re-purpose the wide range of platforms and networks available in their informal digital worlds.

Community healthcare workers' experiences during and after COVID-19 lockdown: A qualitative study from Aotearoa New Zealand.

Shortly after the COVID-19 pandemic reached Aotearoa New Zealand, stringent lockdown measures lasting 7 weeks were introduced to manage community spread of the virus. This paper reports the findings of a qualitative study examining how lockdown measures impacted upon the lives of nurses, midwives and personal care assistants caring for community-based patients during this time. The study involved nationwide surveys and in-depth interviews with 15 registered nurses employed in community settings, two community midwives and five personal care assistants. During the lockdown, nurses, midwives and personal care assistants working in the community showed considerable courage in answering their 'call to duty' by taking on heightened care responsibilities and going 'the extra mile' to help others. They faced significant risks to personal and professional relationships when they were required to take on additional and complex responsibilities for community-based patients. Despite the hypervigilant monitoring of their personal protective equipment (PPE), the need to safeguard family and community members generated considerable stress and anxiety. Many also faced personal isolation and loneliness as a result of lockdown restrictions. Moreover, the negative impacts of experiences during lockdown often continued to be felt once restrictions had been lifted, inflecting life during periods in which community transmission of COVID-19 was not occurring. This article makes five core service delivery and policy recommendations for supporting community-based nurses, midwives and personal care assistants in respiratory disease pandemics: acknowledging the crucial role played by community-based carers and the associated stress and anxiety they endured by championing respect and compassion; demystifying the 'heroism' or 'self-sacrifice' projected onto care workers; the timely provision of adequate protective equipment; improving remuneration, with adequate provision for time off; and regular counselling, peer support groups and education on work-life balance delivered by support workers in recognition of stressors arising from these complex and isolated working conditions.

Multi-sited therapeutic assemblages: Virtual and real-life emplacement of youth mental health support.

This paper draws together work on therapeutic assemblages, geographic assemblages, and therapeutic landscapes to develop the concept of "multi-sited therapeutic assemblages." Assemblage theory has been productively used in health research since it achieved prominence in the social sciences two decades ago. One facet that, however, remains as yet under-developed in the literature on "therapeutic assemblages" (as well as their close kin, "health assemblages," "ill-health assemblages," "care assemblages," etc.) is that of the multi-sited therapeutic assemblage. This paper demonstrates the significance of the multi-locality of therapeutic assemblages by mapping the mental health support activities of young New Zealanders. Grounded theory analysis of interviews with 150 New Zealand youth (which took place from 2015 to 2020) about their online and offline engagements in mental health support highlights the importance of the emplacement of therapeutic practices whilst also foregrounding their multi-sitedness. It enables opportunities to examine how therapeutically-meaningful places can be constituted both as independent sites and simultaneously re-made through their fluid, dynamic and temporal relations with one another. Through this analytic perspective, care and other elements of the therapeutic come to be understood as neither anchored to a single site nor constituted through the inter-relation of home and clinic, but defined via a shifting, dynamic, and multi-directional assemblage of multiple places, people, and resources. This has noteworthy implications for how we envisage relationships between a wide variety of therapeutic digital and real-life sites, as well as for examining scholarly and practical understandings of the emplacement of care.

From lockdown to rahui and teddy bears in windows: Initial responses to Covid-19 in Aotearoa/New Zealand.

Scholarly examinations of states of emergency frequently underscore how the crisis imaginary is employed to rapidly and unjustifiably expand state power. This line of analysis affords great insight into the misuse of state power. It also, however, tends to depict the citizenry as either weak and overwhelmed or at best, duped by the workings of the state, and thus ignores the possibility of democratic processes continuing within a state of emergency. Aotearoa/New Zealand's response to Covid-19 reveals a collaborative dynamic in which the citizenry actively engaged in constituting the state of emergency, and suggests the need for a broader examination of how collective responsibility, care and blame are envisioned and enacted, not only by governments but by (neo-liberal) citizenries during times of national crisis.

Social group dynamics predict stress variability among children in a New Zealand classroom.

Previous research proposes stress as a mechanism for linking social environments and biological bodies. In particular, non-human primate studies investigate relationships between cortisol as a measure of stress response and social hierarchies. Because human social structures often include hierarchies of dominance and social status, humans may exhibit similar patterns. Studies of non-human primates, however, have not reached consistent conclusions with respect to relationships between social position and levels of cortisol. While human studies report associations between cortisol and various aspects of social environments, studies that consider social status as a predictor of stress response also report mixed results. Others have argued that perceptions of social status may have different implications for stress response depending upon social context. We propose here that characteristics of children's social networks may be a better predictor of central tendencies and variability of stress response than their perceptions of social status. This is evaluated among 24 children from 9.4 to 11.3 years of age in one upper middle-class New Zealand primary school classroom, assessed through observation within the classroom, self-reports during semi-structured interviews and 221 serial saliva samples provided daily over 10 consecutive school days. A synthetic assessment of the children's networks and peer-relationships was developed prior to saliva-cortisol analysis. We found that greater stability of peer-relationships within groups significantly predicts lower within-group variation in mid-morning cortisol over the two-week period, but not overall within-group differences in mean cortisol.

Languages of labor: negotiating the "real" and the relational in Indo-Fijian women's expressions of physical pain.

Medical personnel in public clinics in Fiji routinely contend that state-funded medical resources are misallocated on patients who complain of, but do not actually experience, physical pain. Frequently, these patients are identified as being Indo-Fijian women (i.e., women of South Asian origin in Fiji). In this article, I examine clinical interactions between medical staff and female Indo-Fijian patients to demonstrate how "real" and 'unreal' pain are distinguished in the clinical setting and to indicate some of the roles clinical encounters play in community processes that ascribe alternative meanings to physical pain. Focusing on how both physicians and women patients foster certain interpretations of physical pain over others, I argue that the category of 'unreal' pain, as employed by Fiji's physicians, consists of pain that medical professionals consider to be induced by psychological or physical, work-related stresses. I then show how Indo-Fijian women engage in a complementary but distinct discourse that emphasizes links between physical labor and pain and suggests that, in some cases, expressions of physical pain are as much an idiom of pride as an idiom of distress.

Domestic experiments: familial regimes of coping with childhood asthma in New Zealand.

In this article, I examine the self-positioning of many New Zealand mothers of children with asthma as parent-experts whose authority supersedes that of implementing the self-management strategies advocated by medical professionals. In a socio-political context that emphasizes neoliberal values of autonomy and self-responsibility, these parent-experts experiment with a variety of pharmaceutical regimes, determining familial modes of care that privilege the achievement of what they consider to be 'normal childhoods.' While some families accept asthma as a chronic condition and encourage children to adopt standardized, daily preventative regimes, others craft alternative strategies of pharmaceutical use that allow them to experientially maintain asthma as a sporadic and temporary, if frequent and sometimes dramatic, interruption of everyday life. Childhood asthma care practices are thus not only vested in kinship networks, but often arise out of familial-based experiments whose goal is to determine regimes that enable the preservation of 'normality.'