The Psychiatrization of Poverty: Rethinking the Mental Health-Poverty Nexus

The positive association between ‘mental illness’ and poverty is one of the most well established in psychiatric epidemiology. Yet, there is little conclusive evidence about the nature of this relationship. Generally, explanations revolve around the idea of a vicious cycle, where poverty may cause mental ill health, and mental ill health may lead to poverty. Problematically, much of the literature overlooks the historical, social, political, and cultural trajectories of constructions of both poverty and ‘mental illness’. Laudable attempts to explore the social determinants of mental health sometimes take recourse to using and reifying psychiatric diagnostic categories that individualize distress and work to psychiatrically reconfigure ‘symptoms’ of oppression, poverty, and inequality as ‘symptoms’ of ‘mental illness’. This raises the paradoxical issue that the very tools that are used to research the relationship between poverty and mental health may prevent recognition of the complexity of that relationship. Looking at the mental health–poverty nexus through a lens of psychiatrization (intersecting with medicalization, pathologization, and psychologization), this paper recognizes the need for radically different tools to trace the messiness of the multiple relationships between poverty and distress. It also implies radically different interventions into mental health and poverty that recognize the landscapes in which lived realities of poverty are embedded, the political economy of psychiatric diagnostic and prescribing practices, and ultimately to address the systemic causes of poverty and inequality

Low pay and the living wage

Editorial Introducing Special Issue of Employee Relation

Process evaluation in the field: global learnings from seven implementation research hypertension projects in low-and middle-income countries.

BACKGROUND:Process evaluation is increasingly recognized as an important component of effective implementation research and yet, there has been surprisingly little work to understand what constitutes best practice. Researchers use different methodologies describing causal pathways and understanding barriers and facilitators to implementation of interventions in diverse contexts and settings. We report on challenges and lessons learned from undertaking process evaluation of seven hypertension intervention trials funded through the Global Alliance of Chronic Diseases (GACD). METHODS:Preliminary data collected from the GACD hypertension teams in 2015 were used to inform a template for data collection. Case study themes included: (1) description of the intervention, (2) objectives of the process evaluation, (3) methods including theoretical basis, (4) main findings of the study and the process evaluation, (5) implications for the project, policy and research practice and (6) lessons for future process evaluations. The information was summarized and reported descriptively and narratively and key lessons were identified. RESULTS:The case studies were from low- and middle-income countries and Indigenous communities in Canada. They were implementation research projects with intervention arm. Six theoretical approaches were used but most comprised of mixed-methods approaches. Each of the process evaluations generated findings on whether interventions were implemented with fidelity, the extent of capacity building, contextual factors and the extent to which relationships between researchers and community impacted on intervention implementation. The most important learning was that although process evaluation is time consuming, it enhances understanding of factors affecting implementation of complex interventions. The research highlighted the need to initiate process evaluations early on in the project, to help guide design of the intervention; and the importance of effective communication between researchers responsible for trial implementation, process evaluation and outcome evaluation. CONCLUSION:This research demonstrates the important role of process evaluation in understanding implementation process of complex interventions. This can help to highlight a broad range of system requirements such as new policies and capacity building to support implementation. Process evaluation is crucial in understanding contextual factors that may impact intervention implementation which is important in considering whether or not the intervention can be translated to other contexts

Decadal to multidecadal variability and the climate change background

Three prominent quasi-global patterns of variability and change are observed using the Met Office's sea surface temperature (SST) analysis and almost independent night marine air temperature analysis. The first is a global warming signal that is very highly correlated with global mean SST. The second is a decadal to multidecadal fluctuation with some geographical similarity to the El Niño–Southern Oscillation (ENSO). It is associated with the Pacific Decadal Oscillation (PDO), and its Pacific-wide manifestation has been termed the Interdecadal Pacific Oscillation (IPO). We present model investigations of the relationship between the IPO and ENSO. The third mode is an interhemispheric variation on multidecadal timescales which, in view of climate model experiments, is likely to be at least partly due to natural variations in the thermohaline circulation. Observed climatic impacts of this mode also appear in model simulations. Smaller-scale, regional atmospheric phenomena also affect climate on decadal to interdecadal timescales. We concentrate on one such mode, the winter North Atlantic Oscillation (NAO). This shows strong decadal to interdecadal variability and a correspondingly strong influence on surface climate variability which is largely additional to the effects of recent regional anthropogenic climate change. The winter NAO is likely influenced by both SST forcing and stratospheric variability. A full understanding of decadal changes in the NAO and European winter climate may require a detailed representation of the stratosphere that is hitherto missing in the major climate models used to study climate change

Abuse-related post-traumatic stress during the childbearing year

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75405/1/j.1365-2648.2004.03051.x.pd

Including all voices in international data-sharing governance

Background Governments, funding bodies, institutions, and publishers have developed a number of strategies to encourage researchers to facilitate access to datasets. The rationale behind this approach is that this will bring a number of benefits and enable advances in healthcare and medicine by allowing the maximum returns from the investment in research, as well as reducing waste and promoting transparency. As this approach gains momentum, these data-sharing practices have implications for many kinds of research as they become standard practice across the world. Main text The governance frameworks that have been developed to support biomedical research are not well equipped to deal with the complexities of international data sharing. This system is nationally based and is dependent upon expert committees for oversight and compliance, which has often led to piece-meal decisionmaking. This system tends to perpetuate inequalities by obscuring the contributions and the important role of different data providers along the data stream, whether they be low- or middle-income country researchers, patients, research participants, groups, or communities. As research and data-sharing activities are largely publicly funded, there is a strong moral argument for including the people who provide the data in decision-making and to develop governance systems for their continued participation. Conclusions We recommend that governance of science becomes more transparent, representative, and responsive to the voices of many constituencies by conducting public consultations about data-sharing addressing issues of access and use; including all data providers in decision-making about the use and sharing of data along the whole of the data stream; and using digital technologies to encourage accessibility, transparency, and accountability. We anticipate that this approach could enhance the legitimacy of the research process, generate insights that may otherwise be overlooked or ignored, and help to bring valuable perspectives into the decision-making around international data sharing.</p

Ethical issues in human genomics research in developing countries

<p>Abstract</p> <p>Background</p> <p>Genome-wide association studies (GWAS) provide a powerful means of identifying genetic variants that play a role in common diseases. Such studies present important ethical challenges. An increasing number of GWAS is taking place in lower income countries and there is a pressing need to identify the particular ethical challenges arising in such contexts. In this paper, we draw upon the experiences of the MalariaGEN Consortium to identify specific ethical issues raised by such research in Africa, Asia and Oceania.</p> <p>Discussion</p> <p>We explore ethical issues in three key areas: protecting the interests of research participants, regulation of international collaborative genomics research and protecting the interests of scientists in low income countries. With regard to participants, important challenges are raised about community consultation and consent. Genomics research raises ethical and governance issues about sample export and ownership, about the use of archived samples and about the complexity of reviewing such large international projects. In the context of protecting the interests of researchers in low income countries, we discuss aspects of data sharing and capacity building that need to be considered for sustainable and mutually beneficial collaborations.</p> <p>Summary</p> <p>Many ethical issues are raised when genomics research is conducted on populations that are characterised by lower average income and literacy levels, such as the populations included in MalariaGEN. It is important that such issues are appropriately addressed in such research. Our experience suggests that the ethical issues in genomics research can best be identified, analysed and addressed where ethics is embedded in the design and implementation of such research projects.</p

Bentham, Not Epicurus: The Relevance of Pleasure to Studies of Drug-Involved Pain

There is a disproportionate focus on pain over pleasure in policy-relevant research on drugs. This is unfortunate because theories of and findings on drug-involved pleasure can be used to inform knowledge of drug-involved pain. The cross-fertilization of theories and findings is bolstered by the availability of a conceptual framework that links drug-involved pain and pleasure in a comprehensive, powerful, simple, and instrumental manner. This article proposes such a framework. It consists of four types of drug-involved pain and pleasure: drug-specific corporal; drug-related corporal; economic; and, social. This quaternary scheme is illustrated with findings from four literatures, namely those on methamphetamine use; alcohol-related sexual contact among college students; resource transfer among drug users and dealers; and, relational and communal issues related to drugs. The article concludes with implications for the field

Toward a New Philosophy of Preventive Nutrition: From a Reductionist to a Holistic Paradigm to Improve Nutritional Recommendations

The reductionist approach has been predominant to date in human nutrition research and has unraveled some of the fundamental mechanisms at the basis of food nutrients (e.g., those that involve deficiency diseases). In Western countries, along with progress in medicine and pharmacology, the reductionist approach helped to increase life expectancy. However, despite 40 y of research in nutrition, epidemics of obesity and diabetes are growing each year worldwide, both in developed and developing countries, leading to a decrease in healthy life years. Yet, interactions between nutrition-health relations cannot be modeled on the basis of a linear cause-effect relation between 1 food compound and 1 physiologic effect but rather from multicausal nonlinear relations. In other words, explaining the whole from the specific by a bottom-up reductionist approach has its limits. A top-down approach becomes necessary to investigate complex issues through a holistic view before addressing any specific question to explain the whole. However, it appears that both approaches are necessary and mutually reinforcing. In this review, Eastern and Western research perspectives are first presented, laying out bases for what could be the consequences of applying a reductionist versus holistic approach to research in nutrition vis-a-vis public health, environmental sustainability, breeding, biodiversity, food science and processing, and physiology for improving nutritional recommendations. Therefore, research that replaces reductionism with a more holistic approach will reveal global and efficient solutions to the problems encountered from the field to the plate. Preventive human nutrition can no longer be considered as "pharmacology" or foods as "drugs.

Can 'functionlaity' save the community management model of rural water supply?

As attention increasingly turns to the sustainability of rural water supplies - and not simply overall levels of coverage or access - water point functionality has become a core concern for development practitioners and national governments, especially in Sub-Saharan Africa. Within the long-enduring Community-Based Management (CBM) model this has resulted in increased scrutiny of the “functionality” of the local water point committee (WPC) or similar community management organisation. This paper reviews the literature written from both practice-focused and critical-academic perspectives and identifies three areas that pose challenges to our understanding of water point functionality as it relates to CBM. These concern the relative neglect of (i) the local institutional and socio-economic landscape, (ii) broader governance processes and power dynamics, and (iii) the socio-technical interface. By examining these three areas, the paper engages with the specific issue of WPC functionality, whilst also considering broader issues relating to the framing of problems in development and the methodological and disciplinary ways that these are addressed. Furthermore, by focusing on community management of rural water points, the paper lays the ground for a more substantial critique of the continuing persistence of the CBM model as a central development strategy