Trade Liberalization, Social Policies and Health: A theoretical and empirical exploration

This thesis theoretically and empirically explores how trade liberalization and social protection policies interact to influence health. It is conducted from a political economy of health perspective. A systematic review of the literature finds that trade liberalization is often conceptualized in public health work in problematic ways. Because the health impacts of trade liberalization are especially under-conceptualized in the context of labour markets, this thesis empirically explores the 2005 phase-out of the Multi-Fibre Arrangement (MFA). This phase-out abruptly liberalized the textile and clothing (T&C) sector and triggered substantial shifts in employment across a wide range countries. Data from 32 T&C reliant countries were analysed in reference to the pre- and post-MFA periods of 2000-2004 and 2005-2009. Fuzzy-set qualitative comparative analysis (fsQCA) was used to examine the association between: a) T&C employment changes, b) countries’ level of labour market and welfare state protections, and c) changes in adult female and infant mortality rates. FsQCA is a cross-case method which enables logical statements to be made about the combinations of causal conditions that are sufficient for an outcome. Process tracing was used to further investigate these fsQCA results through in-depth case work. Findings suggest that the worsening of adult female mortality rates is related to T&C workers’ lack of social protection in the context of trade liberalization. Overall, it is found that social protection is often inaccessible to the type of workers who may be the most vulnerable to processes of liberalization, and that many workers are particularly vulnerable due to the structure of social protection policies. Social protection policies can therefore both moderate pathways to health and influence the type of health-related pathways resulting from trade liberalizing policies. This work contributes to our understanding of the complex pathways between trade liberalization and health and sets the stage for further investigations

Assessing the Health Impact of Trade: A Call for an Expanded Research Agenda Comment on “The Trans-Pacific Partnership: Is It Everything We Feared for Health?”

Labonté et al provide an insightful analysis of the Trans-Pacific Partnership (TPP) and its impact on a selection of important health determinants. Their work confirms concerns raised by previous analyses of leaked drafts and offers governments serious and timely reasons to carefully consider provisions of the agreement prior to moving forward with ratification. It also contributes more generally to a growing literature focused on identifying the health impacts of trade. This commentary uses the authors’ analysis as a starting point to reflect on two interrelated issues relevant both for taking seriously one of the article’s main recommendations and future work in the area of trade and health

iSTART 2: Improvements for Efficiency and Effectiveness

iSTART (interactive strategy training for active reading and thinking) is a Web-based reading strategy trainer that develops students\u27 ability to self-explain difficult text as a means to improving reading comprehension. Its curriculum consists of modules presented interactively by pedagogical agents: an introduction to the basics of using reading strategies in the context of self-explanation, a demonstration of self-explanation, and a practice module in which the trainee generates self-explanations with feedback on the quality of reading strategies contained in the self-explanations. We discuss the objectives that guided the development of the second version of iSTART toward the goals of increased efficiency for the experimenters and effectiveness in the training. The more pedagogically challenging high school audience is accommodated by (1) a new introduction that increases interactivity, (2) a new demonstration with more and better focused scaffolding, and (3) a new practice module that provides improved feedback and includes a less intense but more extended regimen. Version 2 also benefits experimenters, who can set up and evaluate experiments with less time and effort, because pre- and post testing has been fully computerized and the process of preparing a text for the practice module has been reduced from more than 1 person-week to about an hour\u27s time

Regional inequalities in self-reported conditions and non-communicable diseases in European countries: Findings from the European Social Survey (2014) special module on the social determinants of health

Background: Within the European Union (EU), substantial efforts are being made to achieve economic and social cohesion, and the reduction of health inequalities between EU regions is integral to this process. This paper is the first to examine how self-reported conditions and non-communicable diseases (NCDs) vary spatially between and within countries. Methods: Using 2014 European Social Survey (ESS) data from 20 countries, this paper examines how regional inequalities in self-reported conditions and NCDs vary for men and women in 174 regions (levels 1 and 2 Nomenclature of Statistical Territorial Units, ‘NUTS’). We document absolute and relative inequalities across Europe in the prevalence of eight conditions: general health, overweight/obesity, mental health, heart or circulation problems, high blood pressure, back, neck, muscular or joint pain, diabetes and cancer. Results: There is considerable inequality in self-reported conditions and NCDs between the regions of Europe, with rates highest in the regions of continental Europe, some Scandinavian regions and parts of the UK and lowest around regions bordering the Alps, in Ireland and France. However, for mental health and cancer, rates are highest in regions of Eastern European and lowest in some Nordic regions, Ireland and isolated regions in continental Europe. There are also widespread and consistent absolute and relative regional inequalities in all conditions within countries. These are largest in France, Germany and the UK, and smallest in Denmark, Sweden and Norway. There were higher inequalities amongst women. Conclusion: Using newly available harmonized morbidity data from across Europe, this paper shows that there are considerable regional inequalities within and between European countries in the distribution of self-reported conditions and NCDs

The Next Frontier in Communication and the ECLIPPSE Study: Bridging the Linguistic Divide in Secure Messaging

Health systems are heavily promoting patient portals. However, limited health literacy (HL) can restrict online communication via secure messaging (SM) because patients’ literacy skills must be sufficient to convey and comprehend content while clinicians must encourage and elicit communication from patients and match patients’ literacy level. This paper describes the Employing Computational Linguistics to Improve Patient-Provider Secure Email (ECLIPPSE) study, an interdisciplinary effort bringing together scientists in communication, computational linguistics, and health services to employ computational linguistic methods to (1) create a novel Linguistic Complexity Profile (LCP) to characterize communications of patients and clinicians and demonstrate its validity and (2) examine whether providers accommodate communication needs of patients with limited HL by tailoring their SM responses. We will study >5 million SMs generated by >150,000 ethnically diverse type 2 diabetes patients and >9000 clinicians from two settings: an integrated delivery system and a public (safety net) system. Finally, we will then create an LCP-based automated aid that delivers real-time feedback to clinicians to reduce the linguistic complexity of their SMs. This research will support health systems’ journeys to become health literate healthcare organizations and reduce HL-related disparities in diabetes care

Transition within transition: how young people learn to leave behind institutional care whilst their carers are stuck in neutral

This paper discusses findings from a qualitative longitudinal study which explored the process of leaving long-stay institutional state care in Romania during 2002–4, a period at the heart of accelerated EU enforced childcare reform. 28 young people were interviewed before leaving care and 17 were tracked up to 8 months after discharge. 18 practitioners were also interviewed. The findings confirmed Pinkerton's (2006) emphasis on the impact of global and national factors on the individual experience of leaving care. This study took place in a country undergoing widespread change. The care leavers' irreversible transition took place within the simultaneous professional transition of their carers and that of the community with which they needed to integrate. This insight is widely relevant in the current context of public funding cuts and changes in welfare policy in many countries, including the Central and Eastern European (CEE) countries. Bridges (2009) was used to understand the experiences of care leavers and their carers. Bridges stresses the role of the leader in creating protective conditions for traversing three unavoidable transition stages: 1. ending old identity/behaviour; 2. a neutral zone of deconstruction and transformation; and 3. a new beginning. Preparation for leaving care can be viewed as learning to end care, followed by the neutral zone which begins at discharge. When lacking family support, formal carers are the young people's main transition guides. However, their professional transition also needs management. Because of top-down, accelerated childcare reforms, the Romanian carers' transitions appeared stuck in the neutral zone, affecting preparation for leaving care. Yet, the availability of learning opportunities after discharge changed the nature of the neutral zone for most of the sample who did better than expected at follow-up. This, supported by Bridges' proposal that learning during transition influences future coping, offers a foundation for new theory

Individual differences in explicit and implicit visuomotor learning and working memory capacity

The theoretical basis for the association between high working memory capacity (WMC) and enhanced visuomotor adaptation is unknown. Visuomotor adaptation involves interplay between explicit and implicit systems. We examined whether the positive association between adaptation and WMC is specific to the explicit component of adaptation. Experiment 1 replicated the positive correlation between WMC and adaptation, but revealed this was specific to the explicit component of adaptation, and apparently driven by a sub-group of participants who did not show any explicit adaptation in the correct direction. A negative correlation was observed between WMC and implicit learning. Experiments 2 and 3 showed that when the task restricted the development of an explicit strategy, high WMC was no longer associated with enhanced adaptation. This work reveals that the benefit of high WMC is specifically linked to an individual’s capacity to use an explicit strategy. It also reveals an important contribution of individual differences in determining how adaptation is performed

The fibrinogen-binding M1 protein reduces pharyngeal cell adherence and colonization phenotypes of M1T1 Group A Streptococcus

Background: The group A Streptococcus (GAS) M1 protein binds fibrinogen (Fg) to block phagocytosis and to form a proinflammatory complex. Results: M1 and Fg limit GAS adherence and invasion of pharyngeal keratinocytes in vitro. Conclusion: Protease SpeB modulates M1 expression and GAS host cell interactions differentially during the course of infection. Significance: M1 protein is shown to impede pharyngeal colonization in vivo. Group A Streptococcus (GAS) is a leading human pathogen producing a diverse array of infections from simple pharyngitis ("strep throat") to invasive conditions, including necrotizing fasciitis and toxic shock syndrome. The surface-Anchored GAS M1 protein is a classical virulence factor that promotes phagocyte resistance and exaggerated inflammation by binding host fibrinogen (Fg) to form supramolecular networks. In this study, we used a virulentWTM1T1GASstrain and its isogenic M1-deficient mutant to examine the role of M1-Fg binding in a proximal step in GAS infection-interaction with the pharyngeal epithelium. Expression of the M1 protein reduced GAS adherence to human pharyngeal keratinocytes by 2-fold, and this difference was increased to 4-fold in the presence of Fg. In stationary phase, surfaceM1protein cleavage by theGAScysteine protease SpeB eliminated Fg binding and relieved its inhibitory effect on GAS pharyngeal cell adherence. In a mouse model of GAS colonization of nasal-Associated lymphoid tissue, M1 protein expression was associated with an average 6-fold decreasedGAS recovery in isogenic strain competition assays. Thus, GAS M1 protein-Fg binding reduces GAS pharyngeal cell adherence and colonization in a fashion that is counterbalanced by SpeB. Inactivation of SpeB during the shift to invasive GAS disease allows M1-Fg binding, increasing pathogen phagocyte resistance and proinflammatory activities

The Monarch Initiative in 2019: an integrative data and analytic platform connecting phenotypes to genotypes across species.

In biology and biomedicine, relating phenotypic outcomes with genetic variation and environmental factors remains a challenge: patient phenotypes may not match known diseases, candidate variants may be in genes that haven\u27t been characterized, research organisms may not recapitulate human or veterinary diseases, environmental factors affecting disease outcomes are unknown or undocumented, and many resources must be queried to find potentially significant phenotypic associations. The Monarch Initiative (https://monarchinitiative.org) integrates information on genes, variants, genotypes, phenotypes and diseases in a variety of species, and allows powerful ontology-based search. We develop many widely adopted ontologies that together enable sophisticated computational analysis, mechanistic discovery and diagnostics of Mendelian diseases. Our algorithms and tools are widely used to identify animal models of human disease through phenotypic similarity, for differential diagnostics and to facilitate translational research. Launched in 2015, Monarch has grown with regards to data (new organisms, more sources, better modeling); new API and standards; ontologies (new Mondo unified disease ontology, improvements to ontologies such as HPO and uPheno); user interface (a redesigned website); and community development. Monarch data, algorithms and tools are being used and extended by resources such as GA4GH and NCATS Translator, among others, to aid mechanistic discovery and diagnostics