The political economy of gender interventions: Social forces, kinship, violence, and finance in post-conflict Timor-Leste

This thesis applies a structural feminist political economy analysis to explain the uneven outcomes from gender interventions promoting gender-equitable distribution of state resources, protection from gender-based violence, and women’s economic empowerment in post-conflict Timor-Leste. Scholars of the “local turn” in peacebuilding, which arose in response to peacebuilding’s failures in creating sustainable peace, have argued local cultures and institutions were more legitimate, authentic, and sustainable sites to build peace than international models. In contrast, I identify the emergence and continuity of an elite class coalition dominating the state, which relies upon a highly gendered allocation of resources and a concomitant shoring up of exploitative militarised and patriarchal gender relations. Hence, I argue the outcomes from gender interventions in post-conflict Timor-Leste have been shaped by the actions and interests of a dominant coalition of rural and Dili-based social forces, all members of the Liurai-Dato (King-Noble) class. I use qualitative data and extensive fieldwork to show how members of the Liurai-Dato class depend on gender and kinship for legitimacy, wealth, and continuity, which have mitigated against gender just outcomes for gender interventions. Not only did the interventions take place in this setting of elite dominance, peacebuilders made concessions to elites and violent men in order to keep the peace, a tendency amplified by local turn approaches. These approaches to security have reinforced the valorisation of armed masculinity, associated most strongly with the dominant class, which have in turn justified the unequal distribution of state petroleum resources. As well, gender relations construct social relations through kinship, accumulation through brideprice, and the political economy of domestic violence, rendering legal and political reforms ineffective. Lastly, peacebuilding programs sought to use microfinance to empower women and grow the economy, but its main beneficiaries were the Liurai-Dato class, repeating patterns of accumulation and rule-through-debt established during Indonesian-era microfinance

A mixed methods systematic review of the effects of patient online self-diagnosing in the ‘smart-phone society’ on the healthcare professional-patient relationship and medical authority

Background: As technology continues to advance, the internet is becoming increasingly popular. Self-diagnosis and health information seeking online is growing more common and it will be important to understand the influence this may have on the patient-healthcare professional relationship. Methods: A mixed-method systematic review of quantitative, qualitative and mixed method studies concerning the public and healthcare professionals’ perceptions of online self-diagnosis and health information seeking and how this can impact the patient-healthcare professional relationship. We searched MEDLINE, EMBASE, CINAHL, ACM & SCOPUS between 2007 and 2018. Relevant data were extracted, and a thematic analysis was conducted and conceptualised using the Normalisation Process Theory framework. Results: Of 6107 records identified, 25 articles met the review eligibility criteria which included 16 qualitative, 8 quantitative and 1 mixed method study. The findings indicated that patients found the internet as a complementary information source alongside healthcare professionals. Health care professionals were perceived to be the most reliable and valued information source. People feel responsible for their own health and find the internet to be a source that provides information rapidly with accessibility at their convenience. Most healthcare professionals agreed on the importance of collaboration with patients and the need to develop a partnership and shared decision-making process but struggled to find time in the consultation to do so efficiently. Some healthcare professionals felt that the internet was advantageous for patients looking after their own health, while others felt it was due to a lack of trust in their expertise. Patients tended to present information to the healthcare professional to support the therapeutic relationship rather than to challenge it and to become more involved in the decision-making process of their healthcare. Conclusion: The results of this review suggests that patients value healthcare professionals as a source of medical advice more than the internet. While health professionals’ views were mixed our findings indicate that online health information seeking can potentially improve the patient-healthcare professional relationship as patients reported they usually conducted an online search to form a partnership with the healthcare professional as opposed to trying to prove them wrong

Quantifying the locality of the food supply in a large healthcare organisation

AIM: Shocks to the food system (such as extreme weather events, wars, and pandemics) are felt by institutional food systems. For hospitals, these shocks affect the quantity, quality, and variety of foods that can be offered to patients. One strategy to buffer the hospital food supply from external threats is to prioritise ingredients produced locally. Thus, the aim of the current research is to describe the country of origin of all foods purchased by a large, metropolitan healthcare organisation and to identify opportunities for improving the locality of the food supply.METHODS: This study was of a cross-sectional, observational design. The country of origin for all foods procured over a 1-year period by a large, urban healthcare organisation was determined by proportion of food budget spend. State of origin was identified for fresh fruit, vegetables, and meat. The organisation was in Queensland, Australia and utilised a cook-fresh, room-service foodservice model. Descriptive analysis was used to to determine the number of items and the proportion of budget spend on all foods produced in Australia, and by food category. Similar descriptive statistics were generated to determine the proportion of the budget spend on fresh fruits, vegetables and meats produced in Queensland.RESULTS: Over the 1-year period, 659 individual food items were purchased by the hospital foodservice, and 502 food items were included in the anlaysis. In total, 53% of the food budget was spent on Australian foods (100% Australian ingredients) and almost all fruit (73%) and vegetables (91%) were Australian grown. Procuring fresh fruit (28%), vegetables (35%), and meat (46%) from within the state was less common, and this may reflect the primary states of production across Australia, and seasonal variability of the food supply.CONCLUSIONS: Findings offer priority areas for improving the locality of the food supply. Future research to determine if procuring more foods locally has benefits to consistency of the food supply is warranted.</p

Research groups: How big should they be?

Understanding the relationship between scientific productivity and research group size is important for deciding how science should be funded. We have investigated the relationship between these variables in the life sciences in the United Kingdom using data from 398 principle investigators (PIs). We show that three measures of productivity, the number of publications, the impact factor of the journals in which papers are published and the number of citations, are all positively correlated to group size, although they all show a pattern of diminishing returns—doubling group size leads to less than a doubling in productivity. The relationships for the impact factor and the number of citations are extremely weak. Our analyses suggest that an increase in productivity will be achieved by funding more PIs with small research groups, unless the cost of employing post-docs and PhD students is less than 20% the cost of a PI. We also provide evidence that post-docs are more productive than PhD students both in terms of the number of papers they produce and where those papers are published

Sialic acid transport and catabolism are cooperatively regulated by SiaR and CRP in nontypeable Haemophilus influenzae

BACKGROUND: The transport and catabolism of sialic acid, a critical virulence factor for nontypeable Haemophilus influenzae, is regulated by two transcription factors, SiaR and CRP. RESULTS: Using a mutagenesis approach, glucosamine-6-phosphate (GlcN-6P) was identified as a co-activator for SiaR. Evidence for the cooperative regulation of both the sialic acid catabolic and transport operons suggested that cooperativity between SiaR and CRP is required for regulation. cAMP was unable to influence the expression of the catabolic operon in the absence of SiaR but was able to induce catabolic operon expression when both SiaR and GlcN-6P were present. Alteration of helical phasing supported this observation by uncoupling SiaR and CRP regulation. The insertion of one half-turn of DNA between the SiaR and CRP operators resulted in the loss of SiaR-mediated repression of the transport operon while eliminating cAMP-dependent induction of the catabolic operon when GlcN-6P was present. SiaR and CRP were found to bind to their respective operators simultaneously and GlcN-6P altered the interaction of SiaR with its operator. CONCLUSIONS: These results suggest multiple novel features for the regulation of these two adjacent operons. SiaR functions as both a repressor and an activator and SiaR and CRP interact to regulate both operons from a single set of operators

An analysis of the diagnostic accuracy and peer-to-peer health information provided on online health forums for heart failure

Aims: To examine the accuracy of diagnostic responses and types of information provided on online health forums. Design: Qualitative descriptive study. Methods: This paper reports the findings of a thematic analysis of peer responses to posts included on heart failure online health forums, to understand the quality and types of information provided. Responses posted between March 2016 and March 2019 were screened, collected and analysed thematically using Braun &amp; Clarke. Themes were conceptually underpinned by Normalization Process Theory. Responses were assessed for quality against the NICE and SIGN guidelines to determine whether they were evidence based or not. Results: The total number of responses collected for analysis was 639. Five main themes were identified: diagnostic, experiential, informational, peer relations and relationships with healthcare professionals. Out of 298 diagnostic responses, 5% were guideline evidence-based and 6% had information that were partly evidence-based. Non-evidence based and potentially dangerous responses were 10%. Experiential responses were 10%; 23% included advice that was not supported with any clinical evidence; and 46% signposted users to other online references/healthcare professionals. Conclusion: Online health communication largely focuses on provision of experiential responses to assist those in need of pre- or post-diagnosis advice and support. However, there is evidence of inaccurate information provision which suggests the use of a moderator would be beneficial. Impact: This study suggests heart failure online health forums are a source of support, however, there are potential risks. Increasing nurses and other health care professional's awareness of online health forums will be important. Additional training is needed to help them learn more about patient's use of online health forums, to gain a better understanding about the types of information sought, and how best to address such knowledge deficits. Healthcare systems must ensure sufficient time and resources are available to meet information needs for people with heart failure

Teachers' concerns about pupils' mental health in a cross-sectional survey of a population sample of British schoolchildren.

BACKGROUND: Schools are becoming central to the identification and referral of children and young people with poor mental health. Understanding how well a teacher concern predicts mental disorder in a child or young person is important for mental health teams who need to respond to referrals. METHOD: This secondary analysis of the 2004 British Child and Adolescent Mental Health Survey used the first item of the Strengths and Difficulties Questionnaire (SDQ) Impact subscale to indicate concern about a child or young person's mental health. Mental disorder according to DSM IVR criteria was assessed using the multi-informant Development and Well-Being Assessment. We compared the proportion with and without mental disorder according to the presence or absence of teacher concern. RESULTS: Teacher concern was moderately predictive (49% with teacher concern had a disorder) and sensitive (teacher concern present among 56% with disorder), while lack of teacher concern was highly predictive (only 5% had disorder) and specific (94% no disorder). Teacher concern was associated with significantly poorer mental health (mean teacher SDQ total difficulty score 19.6, SD 5.6 with disorder, mean 15.0; SD 5.1 if no disorder) compared to children without teacher concern (mean 9.6, SD 5.5 with disorder, and 4.9; SD 4.3 if no disorder; F (3, 5,931) = 1527.228, p = .001). If both teacher and parents were concerned, the child or young person was much more likely to have a disorder. CONCLUSION: A lack of teacher concern can reassure mental health practitioners in the vast majority of cases. While teacher concern does identify those with poorer mental health, it is only moderately predictive of a disorder. When concerned about a child or young person, discussions with parents or others who know them may help teachers identify those who most need support. KEY PRACTITIONER MESSAGE: The emphasis on schools as a major setting to provide support and identify the need for referral to specialist mental health services means service commissioners, providers and practitioners could benefit from insight into how predictive a teacher's concern is of childhood mental health conditions and how this may vary with the type of disorder If teachers are not concerned about a child, practitioners can be reassured that there is unlikely to be a significant problem with their mental health, although this will be less certain in schools whose pupils are likely to have a higher than average levels of difficulty Teacher concerns do not necessarily differentiate between clinically impairing and mild/ moderate mental health difficulties, but do identify children in poorer mental health Asking for corroboration of concern from other sources increases the strength of the association to severe mental health disorders.Place2be Governments of England, Scotland, Wale

Understanding the use of heart failure online health forums: a qualitative study

Aims: Heart failure is a major public health challenge and is described as an epidemic. Many people resort to the internet as a source of health information and online health forums have become an increasingly common way to obtain information and support regarding health-related issues. This study aims to explore what information people concerned about heart failure seek from online health forums, and how this shapes decision-making, trust, and interactions with healthcare professionals. Methods and results: Widely available internet search engines (Google, Yahoo, and Bing) were used to identify online health forums, accessed by people seeking information on heart failure. Comments posted between 2016 and 2019 were screened, downloaded, and analysed thematically. Normalization Process Theory provided the underlying conceptual lens to inform analysis. Ten online health forums were identified, and 204 individual posts analysed. Three themes were identified [(information and support needs; online diagnosis; and relationship with healthcare professionals (HCPs)]. The most common purpose for using online health forums was to plug information/knowledge gaps surrounding diagnosis or treatments (e.g. discussion of results, medication/health insurance queries). They were used as a tool to aid decision-making regarding, (i) whether to seek further medical attention and (ii) lifestyle choices, medications, and other advice surrounding concerns. Negative experiences with HCPs were discussed, and sometimes online health forums appeared to promote distrust with HCPs. Conclusion: Online health forums offer a supportive platform and help fill key informational gaps. However, online forums may amplify distrust with HCPs