Chacra Farming, Peasant Livelihood Portfolios and Identities in the Peruvian Andes

Nearly fifty years after land reform in Peru, and in the face of dramatic climatic and social change, small-scale, high-altitude agriculture and the livelihoods of peasant households have fundamentally changed.Nonetheless, low-input subsistence agriculture, known as chacra agriculture, remains a prominent feature in Andean landscapes and peasant livelihoods. Drawing on research conducted in two agro-pastoral communities in the Ancash region of Peru, this thesis seeks to show how and why households in these communities continue to rely on the chacra as part of their livelihood strategies. While seeking to understand the role of the chacra in peasant livelihood portfolios, I consider the ways in which the chacra is meaningful beyond its purely subsistence value. Findings show that agricultural and pastoral activities are largely inseparable within these communities: household resource use, labor and incomes are intrinsically shaped by this agro-pastoral system, even as livelihood strategies have diversified. Moreover, while it is evident that the chacra remains consequential in the subsistence of peasant households, it is closely tied to Andean and peasant identities, representing a connection to the landscape, secure access to land, and the ability to feed and maintain wellbeing in the family. This research suggests that a more holistic understanding of Andean chacra agriculture as part of a larger agro-pastoral system, a diversified livelihood portfolio and a broader value system, would help to explain the persistence of the chacra while also improving our ability to respond to the mounting challenges to high-altitude, subsistence agriculture

Inequalities in Health and Service Use among People with Borderline Intellectual Impairment

This report, produced in collaboration with Professor Angela Hassiotis and others, sets out the extent to which people with borderline intellectual impairment face inequalities in health and use of services compared with the rest of the population, and seeks to improve awareness of these inequalities. Findings - Borderline intellectual impairment is common, affecting at least one adult in ten in England. The term is used here to refer to people with good verbal skills and living in private households, but who may experience cognitive impairments. - The findings in this report are consistent with previous research: people with borderline intellectual impairment are a disadvantaged group and their needs are not well understood. - Such adults face high levels of poor mental health, poorer general health, and many limitations in their daily lives. - Their level of use of mental health treatment and services does not appear to be commensurate with their higher level of need. This indicates that they are underserved compared with the rest of the population. - This may be due to a lack of professional awareness of their needs, to services not adapting enough to meet those needs, or to difficulties the individual faces in seeking treatment and support. - Adults with borderline intellectual impairment constitute key users of primary and secondary health care, and employment, education and welfare support. Improving awareness of the needs of this group should form part of wider plans to reduce inequalities in health and service use in England. Methods Secondary analysis of data from the Adult Psychiatric Morbidity Survey (APMS) was conducted to profile the circumstances of people with borderline intellectual impairment. APMS is one of the most authoritative and comprehensive national household surveys to assess both intellectual functioning and mental health in adults in England

Common Mental Disorders

Common mental disorders (CMDs) comprise different types of depression and anxiety. They cause marked emotional distress and interfere with daily function,but do not usually affect insight or cognition. Although usually less disabling than major psychiatric disorders, their higher prevalence means the cumulative cost of CMDs to society is great. The revised Clinical Interview Schedule (CIS-R) has been used on each Adult Psychiatric Morbidity Survey (APMS) in the series to assess six types of CMD: depression, generalised anxiety disorder (GAD), panic disorder, phobias, obsessive compulsive disorder (OCD), and CMD not otherwise specified (CMD-NOS). Many people meet the criteria for more than one CMD. The CIS-R is also used to produce a score that reflects overall severity of CMD symptoms. • Since 2000, there has been a slight but steady increase in the proportion of women with CMD symptoms (as indicated by a CIS-R score of 12 or more), but overall stability at this level among men. The increase in prevalence was evident mostly at the more severe end of the scale (CIS-R score 18 or more). • Since the last survey (2007), increases in CMD have also been evident among late midlife men and women (aged 55 to 64), and approached significance in young women (aged 16 to 24). • The gap in rates of CMD symptoms between young men and women appears to have grown. In 1993, 16 to 24 year old women (19.2%) were twice as likely as 16 to 24 year old men (8.4%) to have symptoms of CMD (CIS-R score 12 or more). In 2014, CMD symptoms were about three times more common in women of that age (26.0%) than men (9.1%). • CMDs were more prevalent in certain groups of the population. These included Black women, adults under the age of 60 who lived alone, women who lived in large households, adults not in employment, those in receipt of benefits and those who smoked cigarettes. These associations are in keeping with increased social disadvantage and poverty being associated with higher risk of CMD. Most people identified by the CIS-R with a CMD also perceived themselves to have a CMD. This was not the case for most of the other disorders assessed in the APMS. • While most of these people had been diagnosed with a mental disorder by a professional, the disorders they reported having been diagnosed with tended to be ‘depression’ or ‘panic attacks’. However, the disorder most commonly identified by the CIS-R was GAD. This difference may reflect the language and terminology used by people when discussing their mental health with a professional

Positive and negative symptoms in schizophrenia: A longitudinal analysis using latent variable structural equation modelling

BACKGROUND: Recent network models of schizophrenia propose it is the consequence of mutual interaction between its symptoms. While cross-sectional associations between negative and positive symptoms are consistent with this idea, they may merely reflect their involvement in the diagnostic process. Longitudinal analyses however may allow the identification of possible causal relationships. The European Schizophrenia Cohort (EuroSC) provides data suitable for this purpose. METHODS: EuroSC includes 1208 patients randomly sampled from outpatient services in France, Germany and the UK. Initial measures were repeated after 12 and 24 months. Latent variable structural equation modelling was used to investigate the direction of effect between positive and negative symptoms assessed with the Positive and Negative Syndrome Scale, controlling for the effects of depressed mood and antipsychotic medication. RESULTS: The structural model provided acceptable overall fit [χ2 (953) = 2444.32, P < 0.001; CFI = 0.909; RMSEA = 0.046 (90% CI: 0.043, 0.048); SRMR = 0.052]. Both positive and negative symptoms were persistent, and strongly auto-correlated. There were also persistent cross-sectional associations between positive and negative symptoms. While the path from latent positive to negative symptoms from T1 to T2 approached conventional levels of statistical significance (P = 0.051), that from T2 to T3 did not (P = 0.546). Pathways in the reverse direction were uniformly non-significant. CONCLUSIONS: There was no evidence that negative symptoms predict later positive symptoms. The prediction of negative symptoms by positive symptoms was ambiguous. We discuss implications for conceptualization of schizophrenic processes

Effective elements of cognitive behaviour therapy for psychosis: results of a novel type of subgroup analysis based on principal stratification

Background. Meta-analyses show that cognitive behaviour therapy for psychosis (CBT-P) improves distressing positive symptoms. However, it is a complex intervention involving a range of techniques. No previous study has assessed the delivery of the different elements of treatment and their effect on outcome. Our aim was to assess the differential effect of type of treatment delivered on the effectiveness of CBT-P, using novel statistical methodology. Method. The Psychological Prevention of Relapse in Psychosis (PRP) trial was a multi-centre randomized controlled trial (RCT) that compared CBT-P with treatment as usual (TAU). Therapy was manualized, and detailed evaluations of therapy delivery and client engagement were made. Follow-up assessments were made at 12 and 24 months. In a planned analysis, we applied principal stratification (involving structural equation modelling with finite mixtures) to estimate intention-to-treat (ITT) effects for subgroups of participants, defined by qualitative and quantitative differences in receipt of therapy, while maintaining the constraints of randomization. Results. Consistent delivery of full therapy, including specific cognitive and behavioural techniques, was associated with clinically and statistically significant increases in months in remission, and decreases in psychotic and affective symptoms. Delivery of partial therapy involving engagement and assessment was not effective. Conclusions. Our analyses suggest that CBT-P is of significant benefit on multiple outcomes to patients able to engage in the full range of therapy procedures. The novel statistical methods illustrated in this report have general application to the evaluation of heterogeneity in the effects of treatment

Resource extraction and infrastructure threaten forest cover and community rights

Mineral and hydrocarbon extraction and infrastructure are increasingly significant drivers of forest loss, greenhouse gas emissions, and threats to the rights of forest communities in forested areas of Amazonia, Indonesia, and Mesoamerica. Projected investments in these sectors suggest that future threats to forests and rights are substantial, particularly because resource extraction and infrastructure reinforce each other and enable population movements and agricultural expansion further into the forest. In each region, governments have made framework policy commitments to national and cross-border infrastructure integration, increased energy production, and growth strategies based on further exploitation of natural resources. This reflects political settlements among national elites that endorse resource extraction as a pathway toward development. Regulations that protect forests, indigenous and rural peoples’ lands, and conservation areas are being rolled back or are under threat. Small-scale gold mining has intensified in specific locations and also has become a driver of deforestation and degradation. Forest dwellers’ perceptions of insecurity have increased, as have documented homicides of environmental activists. To explain the relationships among extraction, infrastructure, and forests, this paper combines a geospatial analysis of forest loss overlapped with areas of potential resource extraction, interviews with key informants, and feedback from stakeholder workshops. The increasing significance of resource extraction and associated infrastructure as drivers of forest loss and rights violations merits greater attention in the empirical analyses and conceptual frameworks of Sustainability Science

Institutional Care and Poverty: Evidence and Policy Review

This report contains evidence and policy analysis which is summarised in Findings published online by the Joseph Rowntree Foundation (www.jrf.org.uk). The body of the report is structured in chapters which are devoted to different forms of institutional care. Readers interested in particular forms of care should focus on those chapters which are referenced separately. The general aim of the study was to conduct an international evidence and policy review of ‘institutional care’ and poverty in order to identify effective and costed strategies for reducing the risks in the four countries of the UK

Gambling, geographical variations and deprivation: findings from the adult psychiatric morbidity survey

Gambling problems are prevalent in the UK, especially in the most deprived boroughs of the country. Individual-level characteristics may exist alongside a social and geographical gradient. The study aimed to establish whether living in specific geographic areas increases problem gambling likelihood. It used data from the 2007 Adult Psychiatric Morbidity Survey. It adopted a twofold categorization distinguishing recreational from problem/pathological gambling. It used the 2004 Overall Index of Multiple Deprivation to measure deprivation of the district of residence, and primary sampling units, based on postcode sectors, to take into account area characteristics in multi-level mixed-effects regression models. The determinants of recreational gambling operated solely at the individual level. These included male sex, stable relationship and employment, though a number of clinical variables were also important: impulsivity, hazardous use or dependency on alcohol, and current smoking. In contrast, an appreciable proportion of the variance in problem/pathological gambling was explained by area-level clustering. Unlike recreational gamblers, problem/pathological gamblers appear to cluster in specific areas. Thus, there are grounds for restricting the location and density of gambling opportunities and for providing selective prevention programmes targeting geographic areas characterized by contextual determinants

Practising the Space Between: Embodying Belief as an Evangelical Anglican Student

This article explores the formation of British evangelical university students as believers. Drawing on ethnographic fieldwork conducted with a conservative evangelical Anglican congregation in London, I describe how students in this church come to embody a highly cognitive, word-based mode of belief through particular material practices. As they learn to identify themselves as believers, practices of reflexivity and accountability enable them to develop a sense of narrative coherence in their lives that allows them to negotiate tensions that arise from their participation in church and broader social structures. I demonstrate that propositional belief – in contexts where it becomes an identity marker – is bound up with relational practices of belief, such that distinctions between “belief in” and “belief that” are necessarily blurred in the lives of young evangelicals

Chapter 3: Mental health treatment and services

In this chapter reported use of psychotropic medication and psychological therapy are examined, as well as the extent of use of health care services for a mental health reason (GP, inpatient and outpatient health care) and day and community service use. It should be noted that rates presented are based on participant self-reports, not health records. Misclassifications of type of treatment or service are possible, and which was the providing organisation was not established