Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting

 Background: The value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions.Methods: The study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate in the survey and up to four people from each organization were invited to complete the survey (n = 175). To further explore definitions of evidence and generate experiential data on EIDM practice, key informant interviews were conducted with a range of LG employees working in areas relevant to public health.Results: In total, 135 responses were received (75% response rate) and 13 interviews were conducted. Analysis revealed varying levels of access, confidence and organizational culture to support EIDM. Significant relationships were found between domains: confidence, culture and access to research evidence. Some forms of evidence (e.g. community views) appeared to be used more commonly and at the expense of others (e.g. research evidence). Overall, a mixture of evidence (but more internal than external evidence) was influential in public health decision-making in councils. By comparison, a mixture of evidence (but more external than internal evidence) was deemed to be useful in public health decision-making.Conclusions: This study makes an important contribution to understanding how evidence is used within the public health LG context

Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomised controlled trials

Objective Mindfulness-based interventions (MBIs) can reduce risk of depressive relapse for people with a history of recurrent depression who are currently well. However, the cognitive, affective and motivational features of depression and anxiety might render MBIs ineffective for people experiencing current symptoms. This paper presents a meta-analysis of randomised controlled trials (RCTs) of MBIs where participants met diagnostic criteria for a current episode of an anxiety or depressive disorder. Method Post-intervention between-group Hedges g effect sizes were calculated using a random effects model. Moderator analyses of primary diagnosis, intervention type and control condition were conducted and publication bias was assessed. Results Twelve studies met inclusion criteria (n = 578). There were significant post-intervention between-group benefits of MBIs relative to control conditions on primary symptom severity (Hedges g = −0.59, 95% CI = −0.12 to −1.06). Effects were demonstrated for depressive symptom severity (Hedges g = −0.73, 95% CI = −0.09 to −1.36), but not for anxiety symptom severity (Hedges g = −0.55, 95% CI = 0.09 to −1.18), for RCTs with an inactive control (Hedges g = −1.03, 95% CI = −0.40 to −1.66), but not where there was an active control (Hedges g = 0.03, 95% CI = 0.54 to −0.48) and effects were found for MBCT (Hedges g = −0.39, 95% CI = −0.15 to −0.63) but not for MBSR (Hedges g = −0.75, 95% CI = 0.31 to −1.81). Conclusions This is the first meta-analysis of RCTs of MBIs where all studies included only participants who were diagnosed with a current episode of a depressive or anxiety disorder. Effects of MBIs on primary symptom severity were found for people with a current depressive disorder and it is recommended that MBIs might be considered as an intervention for this population

The Politics of Exhaustion and the Externalization of British Border Control. An Articulation of a Strategy Designed to Deter, Control and Exclude

In response to contemporary forms of human mobility, there has been a continued hardening of borders seeking to deter, control and exclude certain groups of people from entering nation states in Europe, North America and Australasia. Within this context, a disconcerting evolution of new and increasingly sophisticated forms of border control measures have emerged, which often play out within bilateral arrangements of “externalised” or “offshore” border controls. Drawing on extensive first‐hand field research among displaced people in Calais, Paris and Brussels in 2016–2019, this paper argues that the externalization of the British border to France is contingent upon a harmful strategy, which can be understood as the “politics of exhaustion.” This is a raft of (micro) practices and methods strategically aimed to deter, control and exclude certain groups of people on the move who have been profiled as “undesirable,” with a detrimental (un)intended impact on human lives

Three lions on her shirt: hot and banal nationalism for England’s sportswomen

It has long been claimed that sport plays an important role in the formulation of national identity. Key to understanding this relationship is Michael Billig’s (1995) concept of banal nationalism which is used in this article to examine national symbols that act as daily reminders of the nation. Specifically, the article discusses the relationship between Englishness and sport by drawing upon data from interviews with representative English sportswomen in association football, cricket, netball and rugby union. The article demonstrates the important role that (men’s) sport plays in developing a sense of national identity in England and, in particular, one that is distinct from Britishness. Furthermore, the significance of national symbols are evidenced as banal reminders of national identity for England’s sportswomen

Vitalism in contemporary chiropractic: a help or a hinderance?

Background: Chiropractic emerged in 1895 and was promoted as a viable health care substitute in direct competition with the medical profession. This was an era when there was a belief that one cause and one cure for all disease would be discovered. The chiropractic version was a theory that most diseases were caused by subluxated (slightly displaced) vertebrae interfering with “nerve vibrations” (a supernatural, vital force) and could be cured by adjusting (repositioning) vertebrae, thereby removing the interference with the body’s inherent capacity to heal. DD Palmer, the originator of chiropractic, established chiropractic based on vitalistic principles. Anecdotally, the authors have observed that many chiropractors who overtly claim to be “vitalists” cannot define the term. Therefore, we sought the origins of vitalism and to examine its effects on chiropractic today. Discussion: Vitalism arose out of human curiosity around the biggest questions: Where do we come from? What is life? For some, life was derived from an unknown and unknowable vital force. For others, a vital force was a placeholder, a piece of knowledge not yet grasped but attainable. Developments in science have demonstrated there is no longer a need to invoke vitalistic entities as either explanations or hypotheses for biological phenomena. Nevertheless, vitalism remains within chiropractic. In this examination of vitalism within chiropractic we explore the history of vitalism, vitalism within chiropractic and whether a vitalistic ideology is compatible with the legal and ethical requirements for registered health care professionals such as chiropractors. Conclusion: Vitalism has had many meanings throughout the centuries of recorded history. Though only vaguely defined by chiropractors, vitalism, as a representation of supernatural force and therefore an untestable hypothesis, sits at the heart of the divisions within chiropractic and acts as an impediment to chiropractic legitimacy, cultural authority and integration into mainstream health care

England’s proxy warriors? Women, war and sport

It has been claimed that the one place Englishness exists is on the sports field, and usually it is men’s sport that appears central to creating a sense of English national identity. However, in light of England’s sporting success across multiple women’s sports (namely cricket, netball, association football and rugby union), there warrants a need to begin to question the place of these female athletes in discussions of the nation. Drawing on extensive interview data with women who have represented England at sport, this paper seeks to ‘give a voice’ to these women whose experiences have often been ignored by both the popular press and academics alike. This research discusses the way in which English women represent their nation, both on the field of play and more broadly, and sheds light on the complexity of the intersections of gender and national identity. Attention is also paid to the role of women as warriors in the conventional sense. It is argued that, through playing international, representative sport, the women actively embody the nation, with national identity often overriding gendered identity in these instances. In this sense, they become proxy warriors for the nation

The (In)Visibility of Gender in Scandinavian Climate Policy-Making

© 2014 Taylor & Francis. This article explores the link between gender representation and climate policy-making in Scandinavia. We ask to what extent equal descriptive representation (critical mass) results in substantive representation (critical acts). Our study shows that women and men are equally represented in administrative and political units involved in climate policy-making, and in some units women are in the majority. However, a text analysis of the outcomes, that is, the Scandinavian climate strategies, reveals a silence regarding gender, further confirmed through interviews. Accordingly, a critical mass of women does not automatically result in gender-sensitive climate policy-making, recognizing established gender differences in material conditions and in attitudes toward climate issues. In interviews, we also note that policy-makers are largely unaware of gender differences on climate issues in the Scandinavian context. We discuss why a critical mass of women in climate policy-making has not led to critical acts and offer alternative explanations informed by feminist IR theory. For example, poststructural feminism claims that masculine norms are deeply institutionalized in climate institutions; hence, policy-makers adapt their actions to the masculinized institutional environment. Thus, substantive representation should be understood in relation to gendered institutional processes