Ideologies & Narratives in Relation to ‘Fat’ Children as Bullies, ‘Easy Targets’ and Victims

In this study, we explore narratives in relation to ‘fatness’, drawing on focus group interviews with parents, early years practitioners, teachers and young people. The study is located in a larger study on bullying and resilience, with no specific focus on obesity or ‘fatness’. Analysis of the interview data highlighted a recurrent focus on ‘fatness’ within the participants’ narratives, by labelling and stigmatising the ‘fat kid’ and ‘bigger children’. We conclude that obesity and fatness, as abnormalities, are now included in commonsense talk in relation to ‘easy targets’, victims and bullies.     

Planning an integrated agriculture and health program and designing its evaluation: Experience from Western Kenya

Multi-sectoral programs that involve stakeholders in agriculture, nutrition and health care are essential for responding to nutrition problems such as vitamin A deficiency among pregnant and lactating women and their infants in many poor areas of lower income countries. Yet planning such multi-sectoral programs and designing appropriate evaluations, to respond to different disciplinary cultures of evidence, remain a challenge. We describe the context, program development process, and evaluation design of the Mama SASHA project (Sweetpotato Action for Security and Health in Africa) which promoted production and consumption of a bio-fortified, orange-fleshed sweetpotato (OFSP). In planning the program we drew upon information from needs assessments, stakeholder consultations, and a first round of the implementation evaluation of a pilot project. The multi-disciplinary team worked with partner organizations to develop a program theory of change and an impact pathway which identified aspects of the program that would be monitored and established evaluation methods. Responding to the growing demand for greater rigour in impact evaluations, we carried out quasi-experimental allocation by health facility catchment area, repeat village surveys for assessment of change in intervention and control areas, and longitudinal tracking of individual mother-child pairs. Mid-course corrections in program implementation were informed by program monitoring, regular feedback from implementers and partners’ meetings. To assess economic efficiency and provide evidence for scaling we collected data on resources used and project expenses. Managing the multi-sectoral program and the mixed methods evaluation involved bargaining and trade-offs that were deemed essential to respond to the array of stakeholders, program funders and disciplines involved.     

Housing hardship and energy insecurity among native-born and immigrant low-income families with children in the United States

The costs for rent and utilities account for the largest share of living expenses, yet these two critical dimensions of material hardship have seldom been examined concurrently in population-based studies. This paper employs multivariate statistical analysis using American Community Survey data to demonstrate the relative risk ratio of low-income renter-occupied households with children experiencing ‘rent burden', ‘energy insecurity', or a ‘double burden’ as opposed to no burden. Findings suggest that low-income households are more likely to experience these economic hardships in general but that specific groups are disproportionately burdened in different ways. For instance, whereas immigrants are more likely to experience rental burden, they are less likely to experience energy insecurity and are also spared from the double burden. In contrast, native-born African Americans are more likely than all other groups to experience the double burden. These results may be driven by the housing stock available to certain groups due to racial residential segregation, decisions regarding the quality of housing low-income householders are able to afford, as well as home-country values, such as modest living and energy conservation practices, among immigrant families. This paper also points to important policy gaps in safety net benefits related to housing and energy targeting low-income households.     

Changes in risky gambling prevalence among a New Zealand population cohort

Evidence suggests that problem gambling is an unstable state where gamblers move into and out of risk over time. This article looks at longitudinal changes in risky gambling and the factors associated with an increased risk (measured by the Problem Gambling Severity Index [PGSI]) in the current New Zealand context, which has experienced a doubling of the electronic gaming machine (EGM) market over the last two decades. Respondents from a nationally representative baseline sample (n = 2672) were recontacted two years later to assess changes in gambling behaviours. Among the 901 respondents reached at follow-up, average gambling risk increased over time, and the prevalence of those who had at least some level of gambling risk (i.e. low-risk or greater) more than doubled (from 4.7% to 12.4%). The majority (80.2%) of those who were at risk at follow-up had not been at risk at baseline. Multivariate linear regression analyses show that the predictors of low to moderate increased risk include Pacific ethnicity; high neighbourhood deprivation status; baseline frequent, continuous gambler type; baseline PGSI status; and playing EGMs. These findings highlight the need to develop theories of gambling addiction trajectories and to identify the earliest point along the trajectory where public health interventions should occur.     

Biosecurity Policy and the Use of Geospatial Predictive Tools to Address Invasive Plants: Updating the Risk Analysis Toolbox

International and national biosecurity policies consider risk assessment a critical component of overall plant health risk analysis. The Agreement on the Application of Sanitary and Phytosanitary Measures, the International Plant Protection Convention, and the Convention on Biological Diversity all provide guidelines and recommendations on how to use risk assessment. This article discusses how these instruments address risk assessment, and makes recommendations on how the risk assessment process needs to incorporate current geospatial predictive science and geographic information systems into the plant health biosecurity risk analysis toolbox.     

Recovery From Mental Health Problems: Scratching The Surface Without Ethnography

This article examines a central plank of mental health policy (‘recovery’) in societies which have attempted to reverse the long-term warehousing of those with a diagnosis of mental disorder (de-institutionalisation). The emergence of the concept is traced in relation to the shift from an institutional to a more dispersed and community-based form of service organisation. Different usages of the term ‘recovery’, each with distinct implications for practice are considered on the part of three main interest groups (traditional bio-medical psychiatrists; social psychiatrists emphasising social skills training; and dissenting service users). These different usages suggest that ‘recovery’ is a polyvalent concept that creates an uneasy consensus point to define the management philosophies of local services enacting mental health policy. Also mental health work is about more than the group of patients mainly considered in relation to recovery (those with ‘severe and enduring mental health problems’). Practice-near research strategies are now required to investigate the varied practical scenarios these contradictions generate and ethnographic research is therefore indicated. Without multiple ethnographies, we will be left with competing rhetoric about recovery and its meaning or meanings may be rendered worthless.     

Unraveling Health Disparities Among Sexual and Gender Minorities: A Commentary on the Persistent Impact of Stigma

ABSTRACT

LGBT (lesbian, gay, bisexual, and transgender) populations experience disparities in health outcomes, both physical and mental, compared to their heterosexual and cisgender peers. This commentary confronts the view held by some researchers that the disparate rates of mental health problems reported among LGBT populations are the consequences of pursuing a particular life trajectory, rather than resulting from the corrosive and persistent impact of stigma. Suggesting that mental health disparities among LGBT populations arise internally, de novo, when individuals express non-heterosexual and non-conforming gender identities ignores the vast body of evidence documenting the destructive impact of socially mediated stigma and systemic discrimination on health outcomes for a number of minorities, including sexual and gender minorities. Furthermore, such thinking is antithetical to widely accepted standards of health and wellbeing because it implies that LGBT persons should adopt and live out identities that contradict or deny their innermost feelings of self.     

Enhancing the Career Planning Self-Determination of Young Adults with Mental Health Challenges

The impact of an intervention on the self-determination and career planning engagement of young adults with mental health challenges was studied. Sixty-seven young adults, 20 to 30 years of age, with mental health diagnoses (e.g., depression, bipolar disorder) were randomly assigned to intervention and control groups. Statistically significant greater increases were made by the intervention group versus the control group for self-determination and career planning engagement, and self-determination at least partially mediated increases in career planning engagement. With career planning self-determination interventions, young adults with mental health challenges might be able to achieve better career and life outcomes than is typical for this population.     

多维视角下的老年人社会健康影响因素分析

采用全国老年人口健康状况调查项目2002年~2005年纵向数据作为研究样本,对中国老年人社会健康的影响因素进行多维分析。通过结构方程模型,在方法上解决了社会健康的多维性、抽象概念的定量分析和测量误差的问题。研究发现,经济社会因素是影响老年人社会健康的主要方面,其中老年人自身的经济条件是最重要的因素;心理健康是影响老年人社会健康的关键因素,其它因素通过心理健康对社会健康起间接作用;由于社会生活方式的改变,家庭因素对老年人社会健康的直接影响正在弱化,但是家庭因素对老年人社会健康的间接影响依然存在。     

Risk Assessment for Hospital-Acquired Diseases: A Risk-Theory Approach

We introduce a new approach to hospital-acquired disease risk assessment from public health databases. In a spirit similar to actuarial risk theory, we define an adjustment coefficient that can quantify the risk associated with a hospital department, allowing comparisons of similar departments. The adjustment coefficient characterizes the tail of the distribution of the total patient length of stay in a department before the first disease event occurs. We show that this coefficient is the solution of a Lundberg-like equation, and we provide a nonparametric estimation procedure for this measure, based on a Cramér-Lundberg approximation for the tail of the distribution. Using simulations, we provide evidence of the robustness of the approximation to various individual risk models. In addition, we illustrate the relevance of this approach by evaluating the risk associated with a standard patient safety indicator in 20 hospitals of southeastern France.