Author Phyllis Chesler speaks at Women and Health conference

General note: Title and date provided by Bettye Lane.

Clean Cookstoves and Health in Samlout, Cambodia

This paper discusses results from a study of the use of cleaner cooking solutions and general health status of people in rural areas from the Battambang province of Cambodia. Data collection included 372 demographic, health and socio-economic surveys with households living in 6 villages in the Samlout district, general health examinations, and measurements of stove use and household concentrations of PM 2.5. The data reveal that health in this population is a major concern, with a very high prevalence of reported abdominal pain, nausea, chronic cough, chest pains, and fever during examinations.  At the household level, we find that clean stove ownership is significantly correlated with the educational status of household head and socio-economic status of a household. Respondents from households with clean stoves appear less likely (though not statistically significantly so) to report household individuals having health problems such as occasional cough, high blood pressure and tuberculosis. Concentrations of PM2.5 are positively correlated with prevalence of occasional cough, high blood pressure and tuberculosis. Based on these results, we advise field testing and evaluation of targeted health interventions in these villages to address the numerous concerns of the local population, including exploring the potential role of clean stoves.

The effect of complex workplace dietary interventions on employees dietary behaviours, nutrition knowledge and health status

Background The growing prevalence and associated burden of diet-related non-communicable diseases is a global public health concern. The environments in which people live and work influences their dietary behaviours. Aim The focus of this thesis was on the effectiveness of complex workplace dietary interventions. The comparative effectiveness of a complex workplace environmental dietary modification intervention and an educational intervention were assessed both alone and in combination relative to a control workplace setting. Methods The systematic review was guided by the PRISMA statement. In a cluster controlled trial, four workplaces were purposively allocated to control, nutrition education alone (Education), environmental dietary modification alone (Environment) and nutrition education and environmental dietary modification (Combined intervention). The interventions were guided by the MRC framework. In the control workplace, data were collected at baseline and follow-up. In the intervention related sub-study, the relationships between nutrition knowledge, diet quality and hypertension were examined. Results The systematic review provided limited evidence. In the FCW study, 850 employees aged 18-64 years were recruited at baseline with N(response rate %) in each workplace as follows: Control: 111(72%), Education: 226(71%), Environment: 113(91%), Combined intervention: 400(61%). Complete follow-up data was obtained for 517 employees (61%). There were significant positive changes in dietary intakes of saturated fat(p=0.013), salt(p=0.010) and nutrition knowledge(p=0.034) between baseline and follow-up at 7-9 months in the combined intervention versus the control workplace in the fully adjusted multivariate analysis. Small but significant changes in BMI(-1.2kg/m2 (p=0.047) were also observed in the combined intervention. In the sub-study, nutrition knowledge was positively significantly associated with diet quality and blood pressure but no evidence of a mediation effect of the DASH score was detected between nutrition knowledge and blood pressure. Conclusion This thesis provides critical evidence on the effectiveness of complex workplace dietary interventions in a manufacturing working population.

Parental Bereavement: Looking Beyond Grief - Challenges and Health

For most parents there is no imaginable event more devastating than the death of their child. Nevertheless, while bereaved parents grieve they are also expected to carry on with their life. The day-to-day activities that were once routine for these parents may now be challenging due to the emotional turmoil they are experiencing. To date parental bereavement has been described as complex, intense, individualized, and life-long and their grief responses are interwoven with their daily activities, but the nature of their daily life challenges are not known.

This dissertation highlights the significance of how parents respond to their bereavement challenges because bereaved parents have higher morbidity and mortality rates than non-bereaved parents or adults who have lost their spouse or parents. Many bereaved parents in their daily routines include activities that allow them to maintain a relationship with their deceased child. These behaviors have been described as “continuing bonds”, but with this dissertation the continuing bonds concept is analyzed to provide a clear conceptual definition, which can be used for future research.

Using the Adaptive Leadership Framework as the theoretical lens and a mixed method, multiple case study design, the primary study in this dissertation aims to provides knowledge about the challenges parents face in the first six months following the death of their child, the work they use to meet these challenges, and the co-occurrence of the challenges, and work with their health status. Bereaved parents challenges are unique to their individual circumstances, complex, interrelated and adaptive, as they have no easy fix. Their challenges were pertaining to their everyday life without their child and classified as challenges related to: a) grief, b) continuing bonds, c) life demands, d) health concerns, f) interactions, and g) gaps in the health care system. Parents intuitively responded to the challenges and attempted to care for themselves. However, the role of the healthcare system to assist bereaved parents during this stressful time so that their health is not negatively impacted was also recognized. This study provides a foundation about parental bereavement challenges and related work that can lead to the development and testing of interventions that are tailored to address the challenges with a goal of improving bereaved parents health outcomes.

Maternal-Fetal Attachment and Health Behaviors among Women with HIV/AIDS

Background: Mothers with HIV often face personal and environmental risks for poor maternal health behaviors and infant neglect, even when HIV transmission to the infant was prevented. Maternal-fetal attachment (MFA), the pre-birth relationship of a woman with her fetus, may be the precursor to maternal caregiving. Using the strengths perspective in social work, which embeds MFA within a socio-ecological conceptual framework, it is hypothesized that high levels of maternal-fetal attachment may protect mothers and infants against poor maternal health behaviors. Objective: To assess whether MFA together with history of substance use, living marital status, planned pregnancy status, and timing of HIV diagnosis predict three desirable maternal health behaviors (pregnancy care, adherence to prenatal antiretroviral therapy–ART, and infant’s screening clinic care) among pregnant women with HIV/AIDS. Method: Prospective observation and hypothesis-testing multivariate analyses. Over 17 consecutive months, all eligible English- or Spanish-speaking pregnant women with HIV ( n = 110) were approached in the principal obstetric and screening clinics in Miami-Dade County, Florida at 24 weeks’ gestation; 82 agreed to enroll. During three data collection periods from enrollment until 16 weeks after childbirth (range: 16 to 32 weeks), participants reported on socio-demographic and predictor variables, MFA, and pregnancy care. Measures of adherence to ART and infant care were extracted from medical records. Findings: Sociodemographic, pregnancy, and HIV disease characteristics in this sample suggest changes in the makeup of HIV-infected pregnant women parallel to the evolution of the HIV epidemic in the USA over the past two decades. The MFA model predicted maternal health behaviors for pregnancy care (R2 = .37), with MFA, marital living status, and planned pregnancy status independently contributing ( = .50, = .28, = .23, respectively). It did not predict adherence to ART medication or infant care. Relevance: These findings provide the first focused evidence of the protective role of MFA against poor maternal health behaviors among pregnant women with HIV, in the presence of adverse life circumstances. Social desirability biases in some self-report measures may limit the findings. Suggestions are made for orienting future inquiry on maternal health behaviors during childbirth toward relationship and protection.

Sleep Quality as a Mediator of the Relationship Between Attachment Anxiety and Health Outcomes During Romantic Conflict

Attachment anxiety, or a fear of abandonment by those close to you, is an important predictor of many individual and interpersonal outcomes. Individuals high in attachment anxiety are more likely to experience physical illness due to disrupted immune functioning and deregulated stress responses. I was interested in examining potential mechanisms accounting for why individuals high in attachment anxiety are more likely to become ill. One variable that has been demonstrated to mediate the relationship between stress and health is sleep quality. As attachment anxiety is characterized by the experience of stress and worry over abandonment by romantic partners, I predicted sleep quality would mediate the relationship between attachment anxiety and health. Further, I predicted attachment anxiety would interact with romantic threat, in that individuals high in attachment anxiety who perceive threat to their relationships would have poor sleep quality (compared with individuals low in attachment anxiety and individuals high in anxiety who do not perceive threat) which would mediate the most unhealthy outcomes. I tested these hypotheses using three online diary studies. In the first two studies, participants completed a seven-night diary describing their sleep quality, health, and interaction with their partner. In Study 3, I surveyed participants once a week for eight weeks to examine longer-term health outcomes. Sleep quality did indeed mediate the relationship between attachment anxiety and various health outcomes over one week (Study 2), and showed a trend towards mediating effects over two months (Study 3). Interestingly, however, attachment anxiety did not interact with perceived romantic threat to predict health in the mediation analyses. Implications for sleep as a mediating variable are discussed, as well as the lack of attachment anxiety by romantic threat interaction.

THE EPIDEMIOLOGY AND HEALTH ECONOMICS OF ANKLE INJURIES

The thesis focuses on a central theme of the epidemiology and health economics of ankle sprains to inform health policy and the provision of health services. It describes the burden, prognosis, resource utilization, and costs attributed to these injuries. The first manuscript systematically reviewed 34 studies on the direct and indirect costs of treating ankle and foot injuries. The overall costs per patient ranged from $2,075- $3,799 (2014 USD) for ankle sprains; $290-$20,132 for ankle fractures; and $6,345-$45,731 for foot fractures, reflecting differences in injury severity, treatment methods, and study characteristics. The second manuscript provided an epidemiological and economic profile of non-fracture ankle and foot injuries in Ontario using linked databases from the Institute for Clinical Evaluative Sciences. The incidence rate of ankle sprains was 16.9/1,000 person-years. Annually, ankle and foot injuries cost $21,685,876 (2015 CAD). The mean expenses per case were $99.98 (95% CI, $99.70-100.26) for any injury. Costs ranged from $133.78-$210.75 for ankle sprains and $1,497.12-$1,755.69 for dislocations. The third manuscript explored the impact of body mass index on recovery from medically attended grade 1 and 2 ankle sprains using the Foot and Ankle Outcome Score. Data came from a randomized controlled trial of a physiotherapy intervention in Kingston, Ontario. At six months, the odds ratio of recovery for participants with obesity was 0.60 (0.37-0.97) before adjustment and 0.74 (0.43-1.29) after adjustment compared to non-overweight participants. The fourth manuscript used trial data to examine the health-related quality of life among ankle sprain patients using the Health Utilities Index version 3 (HUI-3). The greatest improvements in scores were seen at one month post-injury (HUI-3: 0.88, 95% CI: 0.86-0.90). Individuals with grade 2 sprains had significantly lower ambulation scores than those with grade 1 sprains (0.70 vs. 0.84; p<0.05). The final manuscript used trial data to describe the financial burden (direct and indirect costs) of ankle sprains. The overall mean costs were $1,508 (SD: $1,452) at one month and increased to $2,206 (SD: $3,419) at six months. Individuals with more severe injuries at baseline had significantly higher (p<0.001) costs compared to individuals with less severe injuries, after controlling for confounders.

Introduction: resilience and the Anthropocene: the stakes of ‘renaturalising’ politics

The Anthropocene marks a new geological epoch in which human activity (and specifically Western production and consumption practices) has become a geological force. It also profoundly destabilizes the grounds of Western political philosophy. Visions of a dynamic earth system wholly indifferent to human survival liquefy modernity’s division between nature and politics. Critical thought has only begun to scratch the surface of the Anthropocene’s re-naturalization of politics. This special issue of Resilience: International Policies, Practices and Discourses explores the politics of resilience within the wider cultural and political moment of the Anthropocene. It is within the field of resilience thinking that the implications of the Anthropocene for forms of governance are beginning to be sketched out and experimental practices are undertaken. Foregrounding the Anthropocene imaginary’s re-naturalization of politics enables us to consider the political possibilities of resilience from a different angle, one that is irreducible to neoliberal post-political rule.

Resilience and critique

I would like to thank Philip Hammond and Julian Reid for their thoughtful reviews. For Reid, the ‘life’ focus of resilience thinking is just another liberal/ neoliberal governmentality, enabling the reproduction and extension of biopolitical rule, thus my book provides interesting insights, but is not necessarily essential for the making of such claims. For Hammond, the conceptual distinctions made in the book shed some useful insights into current discussions of how policy understandings are being transformed and the emergence of the new doxa of complexity and its relational ontology (drawing adherents from across the, now defunct, Left–Right ideological divide).

Resilience and the ‘everyday’: beyond the paradox of ‘liberal peace’

Over the last decade there has been a shift towards critical understandings of ‘liberal peace’ approaches to international intervention, which argue that local culture holds the key to the effectiveness of peace interventions. In this ‘bottom-up’ approach, peace, reconciliation, and a ‘culture of law’ then become secondary effects of sociocultural norms and values. However, these liberal peace critiques have remained trapped in the paradox of liberal peace: the inability to go beyond the binaries of liberal universalism and cultural relativism. This understanding will be contrasted with the rise of ‘resilience’ approaches to intervention – which build on this attention to the particular context of application but move beyond this paradox through philosophical pragmatism and the focus on concrete social practices. This article clarifies the nature of this shift through the focus on the shifting understanding of international intervention to address the failings of the ‘war on drugs’ in the Americas.

How the World Learned to Stop Worrying and Love Failure: Big Data, Resilience and Emergent Causality

In modernity, failure was the discourse of critique, today, it is increasingly the discourse of power: failure has changed its allegiances. Over the last two decades, failure has been enfolded into discourses of power, facilitating the development of new policy approaches. Foremost among governing approaches that seek to include and to govern through failure is that of resilience. This article seeks to reflect upon how the understanding of failure has become transformed in this process, particularly linking this transformation to the radical appreciation of contingency and of the limits to instrumental cause-and-effect approaches to rule. Whereas modernity was shaped by a contestation over failure as an epistemological boundary, under conditions of contingency and complexity there appears to be a new consensus on failure as an ontological necessity. This problematic ‘ontological turn’ is illustrated using examples of changing approaches to risks, especially anthropogenic understandings of environmental threats, formerly seen as ‘natural’.

Architecture and health care: a place for sociology.

Sociologists of health and illness have tended to overlook the architecture and buildings used in health care. This contrasts with medical geographers who have yielded a body of work on the significance of places and spaces in the experience of health and illness. A review of sociological studies of the role of the built environment in the performance of medical practice uncovers an important vein of work, worthy of further study. Through the historically situated example of hospital architecture, this article seeks to tease out substantive and methodological issues that can inform a distinctive sociology of healthcare architecture. Contemporary healthcare buildings manifest design models developed for hotels, shopping malls and homes. These design features are congruent with neoliberal forms of subjectivity in which patients are constituted as consumers and responsibilised citizens. We conclude that an adequate sociology of healthcare architecture necessitates an appreciation of both the construction and experience of buildings, exploring the briefs and plans of their designers, and observing their everyday uses. Combining approaches and methods from the sociology of health and illness and science and technology studies offers potential for a novel research agenda that takes healthcare buildings as its substantive focus.

The association between anticholinergic medication burden and health related outcomes in the ‘oldest old’: A systematic review of the literature

Background: Increased exposure to anticholinergic medication is problematic, particularly in those aged 80 years and older.

Objective: The aim of this systematic review was to identify tools used to quantify anticholinergic medication burden and determine the most appropriate tool for use in longitudinal research, conducted in those aged 80 years and older.

Methods: A systematic literature search was conducted across six electronic databases to identify existing tools. Data extraction was conducted independently by two researchers; studies describing the development of each tool were also retrieved and relevant data extracted. An assessment of quality was completed for all studies. Tools were assessed in terms of their measurement of the association between anticholinergic medication burden and a defined set of clinical outcomes, their development and their suitability for use in longitudinal research; the latter was evaluated on the basis of criteria defined as the key attributes of an ideal anticholinergic risk tool.

Results: In total, 807 papers were retrieved, 13 studies were eligible for inclusion and eight tools were identified. Included studies were classed as ‘very good’ or ‘good’ following the quality assessment analysis; one study was unclassified. Anticholinergic medication burden as measured in studies was associated with impaired cognitive and physical function, as well as an increased frequency of falls. The Drug Burden Index (DBI) exhibited most of the key attributes of an ideal anticholinergic risk tool.

Conclusion: This review identified the DBI as the most appropriate tool for use in longitudinal research focused on older people and their exposure to anticholinergic medication burden.

Tropical limestone forest resilience and late Pleistocene foraging during MIS-2 in the Tràng An massif, Vietnam

In this paper we present a multi-proxy study of tropical limestone forest and its utilization by human groups during the major climatic and environmental upheavals of MIS-2 (29-11.7 kBP). Our data are drawn from new field research within the Tràng An World Heritage property on the edge of the Red River Delta, northern Vietnam. Key findings from this study include 1) that limestone forest formations were resilient to the large-scale landscape transformation of the Sunda continent at the end of the last glaciation; 2) that prehistoric human groups were probably present in this habitat through-out MIS-2; and 3) that the forested, insular, karst of Tràng An provided foragers with a stable resource-base in a wider changing landscape. These results have implications for our understanding of the prehistoric utilization of karst environments, and resonance for their conservation in the face of climate and environmental change today.

SACN Carbohydrates and Health Report

The Scientific Advisory Committee on Nutrition (SACN) was asked by the Department of Health and the Food Standards Agency to examine the latest evidence on the links between consumption of carbohydrates, sugars, starch and fibre and a range of health outcomes (such as heart disease, type 2 diabetes, bowel health and tooth decay) to ensure the government’s position on consumption was up-to-date. In addition to the main report, you can read the SACN press release In its review of the evidence, SACN found that: High levels of sugar consumption are associated with a greater risk of tooth decay. The higher the proportion of sugar in the diet, the greater the risk of high energy intake. Drinking high-sugar beverages results in weight gain and increases in BMI in teenagers and children. Consuming too many high-sugar beverages increases the risk of developing type 2 diabetes. In light of these findings, SACN recommends that: Free sugars should account for no more than 5% daily dietary energy intake. The term free sugars is adopted, replacing the terms Non Milk Extrinsic Sugars (NMES) and added sugars. Free sugars are those added to food or those naturally present in honey, syrups and unsweetened fruit juices, but exclude lactose in milk and milk products. The consumption of sugar-sweetened beverages (e.g. fizzy drinks, soft drinks and squash) should be minimised by both children and adults.