Between anxiety and hope: the experiences of women with vulval intraepithelial neoplasia during their illness trajectory - a qualitative approach

The vulvar intraepithelial neoplasia (VIN) is a rare chronic skin condition that may progress to an invasive carcinoma of the vulva. Major issues affecting women's health were occurring symptoms, negative influences on sexuality, uncertainty concerning the illness progression and changes in the body image. Despite this, there is little known about the lived experiences of the illness trajectory. Therefore, the aim of this study was to describe the experiences of women with VIN during the illness trajectory. In a secondary data analysis of the foregoing qualitative study we analysed eight narrative interviews with women with VIN by using thematic analysis in combination with critical hermeneutics. Central for these women during their course of illness was a sense of "Hope and Fear". This constitutive pattern reflects the fear of recurrence but also the trust in healing. The eight narratives showed women's experiences during their course of illness occurred in five phases: "there is something unknown"; "one knows, what IT is"; "IT is treated and should heal"; "IT has effects on daily life"; "meanwhile it works". Women's experiences were particularly influenced by the feeling of "embarrassment" and by "dealing with professionals". Current care seems to lack adequate support for women with VIN to manage these phases. We suggest, based on our study and the international literature, that new models of counselling and providing information need to be developed and evaluated.

The direct-democratic challenge to evidence-based policy making: Questioning the governmental PISA narrative in Swiss school policy

The democratic deficit of evidence-based policymaking and the little attention the approach pays to values and norms have repeatedly been criticized. This article argues that direct-democratic campaigns may provide an arena for citizens and stakeholders to debate the belief systems inherent to evidence. The study is based on a narrative analysis of Program for International Student Assessment (PISA) reports, as well as of newspaper coverage and governmental information referring to PISA in Swiss direct-democratic campaigns on a variety of school policy issues. The findings show that PISA reports are discursive instruments rather than ‘objective evidence’. The reports promote a narrative of economic progress through educational evidence that is adopted without scrutiny by governmental coalitions in direct-democratic campaigns to justify school policy reforms. Yet, the dominant PISA narrative is contested in two counter-narratives, one endorsed by numerous citizens, the other by a group of experts. These counter-narratives question how PISA is used by an ‘expertocracy’ to prescribe reforms, as well as the performance ideology inherent to. Overall, these findings suggest that direct-democratic campaigns may make more transparent how evidence is produced and used according to existing belief systems. Evidence, on the other hand, may be a stimulus for democratic discourse by feeding the debate with potential policy problems and solution. Thus, direct-democratic debates may reconcile normative positions of citizens with the desire to base decisions on empirical evidence.

A novel approach for assessing shifting cultivation dynamics in a regional conservation hotspot - insights from nort-eastern Madagascar

The north-eastern escarpment of Madagascar has been deemed a global hotspot of biodiversity due to its high levels of endemic speciesbeing heavily threatened by accelerated deforestation rates and landscape changes. The main concern for conservation of the remaining humid primary forests is the shifting cultivation practices of local smallholder farmers for rice production. According to the mainstream narrative, human population growth leads to a shortening of crop-fallow cycles and thus to the accelerated conversion of forests to agricultural land. However, little is currently known about the dynamic changes between forest and shifting cultivation systems at the regional level. Existing land cover change analyses in this area have so far only focused on binary forest to non-forest changes and have therefore failed to account for the dynamic nature of the change processes between forest and different agriculture land use systems. This can be partly explained by the significant challenge to delineate shifting cultivation systems on land cover maps using traditional remote sensing classification approaches. To address this gap we therefore applied a novel GIS approach, that was originally developed for the assessment of shifting cultivation dynamics in Laos and has so far never been applied elsewhere, to map shifting cultivation of different crop-fallow lengths as well as permanent agriculture land use at the regional level. Change analyses of land use maps between 1995 and 2011 allowed us to comprehend the general trends of land use trajectories and their spatial variation. This more detailed understanding of land use change dynamics is key to plan for successful interventions to slow forest loss while at the same time improving local livelihoods. We further believe that this approach holds great potential for conservation monitoring in this resource-rich but povertyprone conservation hotspot.