The Trouble of Stigma in the Age of Datafication: Screening for Mental Health Issues in a Refugee Camp in Jordan.

Drawing on ethnographic fieldwork in a refugee camp in Jordan, this article investigates how datafication through digital screening technologies helps shape mental health issues in the face of widespread uneasiness about the subject, especially among the intended beneficiaries. We argue that the refugees and their health care providers face a dilemma: on the one hand, the desire to make mental health issues visible and clinically actionable through datafication and, on the other hand, the wish to keep mental health issues out of public view to avoid potential stigma.

Of Numbers and Moods: Screening for Mental Health Issues in a Rohingya Refugee Camp in Bangladesh.

Screening refugees for mental health issues, medical assistants use a digital tool that produces a numerical score but also, importantly, attunes to the moods of their clients and the atmospheres of their homes. In this article, we propose the concept of numeration-attunement as helpful for medical anthropology. Drawing on ethnographic fieldwork conducted among medical assistants working in the Kutapalong refugee camp in Bangladesh, we explore their assessment of the mental health of the refugees: its numeration-attunement. To develop the notion of numeration-attunement, we draw on numeration research as well as phenomenology. Comprehending how medical assistants assess the mental health of refugees requires attention both to numeration and datafication by way of a screening tool as well as the revelatory character of attunement to moods.

Feasibility of transcutaneous auricular vagus nerve stimulation in treatment of drug resistant epilepsy: A multicenter prospective study.

BACKGROUND: Transcutaneous auricular vagus nerve stimulation (ta-VNS) is a new non-invasive technique developed as treatment option for drug resistant epilepsy. A few studies have been carried out showing that the efficacy and tolerability of ta-VNS is comparable with traditional implanted VNS but the feasibility of the therapy has been poorly described. This study aimed to explore potential clinical benefits of ta-VNS and to evaluate adaptation, compliance, as well as the usability of the device from a service design perspective. METHODS: A prospective, multicenter, clinical, investigator-initiated trial was conducted using the NEMOS® ta-VNS device. After eight weeks baseline, all subjects started ta-VNS with individually adjusted currents for four hours per day for six-months (first endpoint) followed by optional 12 months follow-up (second endpoint). The primary outcome was six months retention rate of ta-VNS therapy. Secondary outcomes included the user retention rate at 12 months follow-up, compliance, changes in scores of psychometric measures. For the study of feasibility, a service design questionnaire on medical devices used in the home was developed. RESULTS: In total 37 subjects had been included in the study after 45 months where the study was prematurely terminated due to recruitment problems and due to a high drop-out rate. Twenty-two subjects (59 %) completed the first six months of the study and in total six subjects (16 %) completed the following 12 months follow-up. The reasons for discontinuation were a mixture of medical and practical issues of which the majority were related to a combination of both. Those, who managed to continue to use ta-VNS throughout the study, gave generally higher scores for the device usability and compatibility with lifestyle. The study turned out to be inadequately powered to reach any conclusion in terms of the clinical benefits of ta-VNS but present an example of difficulties that are encountered in conducting high-quality studies with digital devices. CONCLUSION: The feasibility of ta-VNS therapy showed to be relatively modest which is most likely due to practical usability issues and lifestyle fits. The results of this study stress the importance of generating data based on patients experiences at an early stage during the development phase and when designing clinical trials on medical devices that depend on patient's active participation and motivation.

CareCoor: augmenting the coordination of cooperative home care work.

OBJECTIVES: The present study aims to augment the network of home care around elderly. We investigate the nature of cooperative work between relatives and home care workers around elderly persons; present the CareCoor system developed to support that work; and report experiences from two pilot tests of CareCoor. METHODS: We employed ethnographic fieldwork methods and conducted participatory design workshops to throw light on the nature of cooperative home care work, and to elicit implications for the design of an IT system that would support the work of relatives and home care workers around elderly persons. The design implications led to the development of a prototype, called CareCoor, which is accessible via a tablet PC and on the Internet. CareCoor was subsequently evaluated in two pilot tests. The first lasted a week and included three elderly, their next of kin and the affiliated home care workers, while the second test lasted for six weeks and involved five elderly people, their next of kin and relevant home care workers. RESULTS: In the paper we make three major points, namely, (1) home care work is highly cooperative in nature and involves substantial coordinative efforts on the part of the actors involved, (2) the network of care around elderly can be augmented with new technology that allows all members of the network to follow, influence and be a part of the cooperative care of the elderly, and (3) CareCoor, the prototype introduced in this study, shows promise as it was well received during test and evaluation. CONCLUSION: Home care work is increasingly important due to the ageing populations of Europe, the USA and large parts of Asia. Home care work between relatives and home care workers is inherently a cooperative effort, and can be facilitated and augmented by new information technology such as CareCoor. The pilot tests of CareCoor revealed promising results and will be further developed and evaluated in a larger test.