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In a world of growing health inequity and ecological injustice, how do we revitalize medicine and public health to tackle new problems? This groundbreaking collection draws together case studies of social medicine in the Global South, radically shifting our understanding of social science in healthcare. Looking beyond a narrative originating in nineteenth-century Europe, a team of expert contributors explores a far broader set of roots and branches, with nodes in Sub-Saharan Africa, South America, Oceania, the Middle East, and Asia. This plural approach reframes and decolonizes the study of social medicine, highlighting connections to social justice and health equity, social science and state formation, bottom-up community initiatives, grassroots movements, and an array of revolutionary sensibilities. As a truly global history, this book offers a more usable past to imagine a new politics of social medicine for medical professionals and healthcare workers worldwide. This title is also available as open access on Cambridge Core.
In a world of growing health inequity and ecological injustice, how do we revitalize medicine and public health to tackle new problems? This groundbreaking collection draws together case studies of social medicine in the Global South, radically shifting our understanding of social science in healthcare. Looking beyond a narrative originating in nineteenth-century Europe, a team of expert contributors explores a far broader set of roots and branches, with nodes in Sub-Saharan Africa, South America, Oceania, the Middle East, and Asia. This plural approach reframes and decolonizes the study of social medicine, highlighting connections to social justice and health equity, social science and state formation, bottom-up community initiatives, grassroots movements, and an array of revolutionary sensibilities. As a truly global history, this book offers a more usable past to imagine a new politics of social medicine for medical professionals and healthcare workers worldwide. This title is also available as open access on Cambridge Core.
Research participants” feedback about their participation experiences offers critical insights for improving programs. A shared Empowering the Participant Voice (EPV) infrastructure enabled a multiorganization collaborative to collect, analyze, and act on participants’ feedback using validated participant-centered measures.
Methods:
A consortium of academic research organizations with Clinical and Translational Science Awards (CTSA) programs administered the Research Participant Perception Survey (RPPS) to active or recent research participants. Local response data also aggregated into a Consortium database, facilitating analysis of feedback overall and for subgroups.
Results:
From February 2022 to June 2024, participating organizations sent surveys to 28,096 participants and received 5045 responses (18%). Respondents were 60% female, 80% White, 13% Black, 2% Asian, and 6% Latino/x. Most respondents (85–95%) felt respected and listened to by study staff; 68% gave their overall experience the top rating. Only 60% felt fully prepared by the consent process. Consent, feeling valued, language assistance, age, study demands, and other factors were significantly associated with overall experience ratings. 63% of participants said that receiving a summary of the study results would be very important to joining a future study. Intersite scores differed significantly for some measures; initiatives piloted in response to local findings raised experience scores.
Conclusion:
RPPS results from 5045 participants from seven CTSAs provide a valuable evidence base for evaluating participants’ research experiences and using participant feedback to improve research programs. Analyses revealed opportunities for improving research practices. Sites piloting local change initiatives based on RPPS findings demonstrated measurable positive impact.
Clean Break Theatre Company is a women-only theatre company that grew out of a prisoner-led drama workshop that took place between 1977–1979 in HMP Askham Grange. In addition to its considerable impact on criminalised women and public understandings of the socio-political impact of their experiences, Clean Break has had a significant but under-acknowledged impact on contemporary British theatre. We examine three areas of Clean Break's theatre making history and organisational practices: its origin stories; its education and engagement work; and how the company's performance practices have, across five decades, 'then' and 'now', adapted to directly intervene in carceral society. By highlighting Clean Break's distinct activist theatre making processes and practices, the book makes explicit the genealogical connections of the company's past work and its impacts on contemporary feminist theatre practices.
OBJECTIVES/GOALS: We aimed to conduct an updated genome-wide meta-analysis of keloids in expanded populations, including those most afflicted by keloids. Our overall objective was to improve understanding of keloid development though the identification and further characterization of keloid-associated genes with genetically predicted gene expression (GPGE). METHODS/STUDY POPULATION: We used publicly available summary statistics from several large-scale DNA biobanks, including the UK Biobank, FinnGen, and Biobank Japan. We also leveraged data from the Million Veterans Program and performed genome-wide association studies of keloids in BioVU and eMERGE. For each of these datasets, cases were determined from ICD-9/ICD-10 codes and phecodes. With these data we conducted fixed effects meta-analysis, both across ancestries and stratified by broad ancestry groups. This approach allowed us to consider cumulative evidence for genetic risk factors for keloids and explore potential ancestry-specific components of risk. We used FUMA for functional annotation of results and LDSC to estimate ancestry-specific heritability. We performed GPGE analysis using S-PrediXcan with GTEx v8 tissues. RESULTS/ANTICIPATED RESULTS: We detected 30 (23 novel) genomic risk loci in the cross-ancestry analysis. Major risk loci were broadly consistent between ancestries, with variable effects. Keloid heritability estimates from LDSC were 6%, 21%, and 34% for European, East Asian, and African ancestry, respectively. The top hit (P = 1.7e-77) in the cross-ancestry analysis was at a replicated variant (rs10863683) located downstream of LINC01705. GPGE analysis identified an association between decreased risk of keloids and increased expression of LINC01705 in fibroblasts (P = 3.6e10-20), which are important in wound healing. The top hit in the African-ancestry analysis (P = 5.5e-31) was a novel variant (rs34647667) in a conserved region downstream of ITGA11. ITGA11 encodes a collagen receptor and was previously associated with uterine fibroids. DISCUSSION/SIGNIFICANCE: This work significantly increases the yield of discoveries from keloid genetic association studies, describing both common and ancestry-specific effects. Stark differences in heritability support a potential adaptive origin for keloid disparities. Further work will continue to examine keloids in the broader context of other fibrotic diseases.
OBJECTIVES/GOALS: Empowering the Participant Voice (EPV) is a 6-CTSA Rockefeller-led collaboration to developcustom REDCap infrastructure to collect participant feedback using the validated Research Participant Perception Survey (RPPS), demonstrate its value in use cases, and disseminate it for broad adoption. METHODS/STUDY POPULATION: The EPV team developed data and survey implementation standards, and specifications for the dashboard and multi-lingual RPPS/REDCap project XML file. The VUMC built a custom At-a-Glance Dashboard external module that displays Top Box scores (percent best answer), with conditional formatting to aid analysis, and response/completion rates. Results populate site dashboards, and aggregate to a multi-site dashboard for benchmarking. Results can be filtered by participant/study characteristics. Sites developed individual use cases, leveraging local infrastructure, initiatives and stakeholder input. Infrastructure and guides were designed for dissemination through public websites. RESULTS/ANTICIPATED RESULTS: Five sites sent 23,797surveys via email, patient portal or SMS. 4,133 (19%) participants diverse in age, race, and ethnicity, returned responses. Sites analyzed their data and acted on selected findings, improving recruitment, communication and feeling valued. Aggregate scores for feeling listened to and respected were hight (>90%%); scores for feeling prepared by the consent process were lower (57-77%) and require action. Some groups experiences were better than others. Sites differed significantly in some scores. Dissemination of EPV is underway. Infrastructure and guides are downloadable free of charge, with advice from the EPV team. In 2023, a sixth site began piloting a lower literacy survey version and syncing data to the consortium dashboard. DISCUSSION/SIGNIFICANCE: The EPV RPPS/REDCap infrastructure enabled sites to collect participant feedback, identify actionable findings and benchmark with peers. Stakeholders and collaborators designed and tested local initiatives to increase responses and diversity, address disparities, and discover better practices.
Children with attention-deficit/hyperactivity disorder (ADHD) commonly exhibit impairments in their executive functions. Caregivers are primarily responsible for the daily management of their children's ADHD and executive functioning difficulties. Psychoeducation, a cornerstone of ADHD treatment, can empower caregivers by providing them the knowledge and resources they require to support their child with ADHD. This study examined the efficacy of a suite of six caregiver psychoeducation sessions delivered by a specialised ADHD service. Two of these sessions pertained to (i) Understanding ADHD and (ii) Executive Functioning in ADHD. The other four covered information around Family Self-Care and Stress Management, Social Connectedness and Communication, Sensory Processing and Self-Regulation in ADHD and, Medication.
Participants and Methods:
All sessions were delivered between May 2016 and July 2022, in 2 to 3-hour sessions each. Caregivers completed pre and post-session questionnaires, rating (i) their understanding of each of the topics, (ii) whether they identified effective strategies to help their child with ADHD meet their needs, and (iii) whether they improved their knowledge of resources they can access to assist with ADHD management. Altogether, 666 caregiver responses were collected across all sessions, 35% (n=234) of which were from the Understanding ADHD sessions and 4.2% (n = 28) from the Executive Functioning sessions.
Results:
Wilcoxon signed-rank tests with Bonferroni adjusted alpha level of 0.016 were conducted to examine each session's pre- and post-session responses. Results showed that the Understanding ADHD workshops impelled significant improvements in attendee-rated levels of topic understanding (z = -8.79, p <.001, r = -.41), strategies gained (z = -8.54, p <.001, r = -.40) and perceived resource accessibility (z = -6.40, p <.001, r = -.30). Attendees reported moderate to large improvements following the Executive Functioning in ADHD sessions, including in their topic understanding (z = -4.18, p <.001, r = -.57), strategies gained (z = -3.93, p <.001, r = -.54) and perceived resource accessibility (z = -4.23, p <.001, r = -.61). Improvements across all three areas were also noted across the other four caregiver sessions, except for the medication session where no significant changes in strategies gained and perceived access to resources were noted.
Conclusions:
This study provides evidence that caregiver sessions within a Tier-4 service are efficacious and can (i) meet caregivers' needs to better understand ADHD, executive functioning difficulties as well as of other ADHD-related issues, and (ii) may equip caregivers with the knowledge to access resources to appropriately manage their children with ADHD - a possible precursor to improved clinical and functional outcomes in children. That the session on ADHD medications only led to improved understanding of the topic but not to perceived gains in strategies or perceived access to strategies could be attributed to low pre-and post-session questionnaire response rates as well as to the nature of those sessions which were purely informative and did not discuss strategies and resources. Nonetheless, longitudinal studies, with control groups, should determine whether any post-intervention improvements are sustained over time and should establish whether these are associated with improved outcomes in children.
For many years the labour market model in the UK was bound up with a predominant concern with job quantity, but with considerably less attention to job quality (Lauder, 1999). Recently however, there has been a shift in policymaking towards a greater concern with the idea of ‘good work’. In active labour market policy (ALMP) the shift is most readily seen in a growing interest in labour market progression, and a process of policy searching for how employment services might support greater labour market mobility.
Within this context, this chapter explores ALMP approaches and practice in the UK alongside a wider national discourse about increasing good work. The chapter evaluates the extent to which ALMP is a weak link in seeking progress towards good work: firstly, as a result of the historically embedded nature of the employer engagement function within particular types of networks of employers with basic labour demand needs; and secondly how this has been supported by a work-first system in which jobseekers are encouraged, and can be mandated, to accept available opportunities. The argument is made that within this system there is only limited scope for public employment services to engage with a good work agenda, or to exert upward institutional pressure on job quality. However, the current context of labour and skills shortages offers ALMP an opportunity to capitalize on some upward pressures on job quality.
The chapter is structured as follows. The labour market context in the UK is described initially, followed by an appraisal of recent developments around the good work agenda and a discussion of the labour market trends which frame current opportunities. The following sections then provide a discussion of the evolution of ALMP in the UK, and the role of employer engagement within ALMP set against a changing policy context: but one in which work-first remains largely embedded. The final section provides a discussion of what this evidence suggests about the relationship between ALMP and job quality.
Context
Historically, the focus of employment policy in the UK has been on reducing unemployment. Hence, the quantity of jobs available has been a primary concern.
The United Kingdom is characterised by an uneven economic geography, with large and persistent regional disparities in economic activity (Gardiner et al, 2013; Martin et al, 2016). Labour market outcomes and conditions vary quite widely over space. Even set within the context of rising employment rates generally in recent years, concentrations of labour market disadvantage persist in a range of settings. This includes areas of deprivation in large urban areas and former industrial towns (Beatty and Fothergill, 2020a, 2020b), as well as in some seaside towns (Beatty et al, 2017). Areas with comparatively weak local economies suffered most in the 2008–09 recession (Lee, 2014) and also appear to have been most severely impacted by the COVID-19 pandemic (Houston, 2020).
The characteristics of place shape labour market outcomes both through the types of jobs that are available locally, as well as through factors which influence the ability of local residents to benefit from the available employment opportunities (either in the immediate area or through commuting). This includes, for example, factors such as transport infrastructure, training opportunities and the availability of childcare which can enable or constrain residents’ ability to access employment opportunities (Green, 2020).
In line with national trends, unemployment rates in the area types identified earlier have largely been on a long-term decline prior to the COVID-19 pandemic, although they tend to remain above the national average (Beatty and Fothergill, 2020a). However, since the 1990s there has also been a concern with rates of economic inactivity, in addition to unemployment. A major driver of this concern has been inactivity due to ill health and the comparatively large historic growth in the numbers of claimants of sickness-related benefits (Beatty et al, 2009; Barnes and Sissons, 2013). More recently, there has also been a shift to increasing concerns with issues of in-work poverty and poor job quality among those entering the labour force (Jung and Collings, 2021). From the perspective of the policy approach to active labour market policy (ALMP), this concern with job quality has primarily been articulated in terms of access to opportunities for labour market progression (Sissons, 2020).
These disparities in labour market outcomes, in terms of unemployment, economic inactivity and job quality and wages, have driven increasing interest in greater local tailoring or ownership of ALMP interventions.
Negative emotionality (NE) was evaluated as a candidate mechanism linking prenatal maternal affective symptoms and offspring internalizing problems during the preschool/early school age period. The participants were 335 mother–infant dyads from the Maternal Adversity, Vulnerability and Neurodevelopment project. A Confirmatory Bifactor Analysis (CFA) based on self-report measures of prenatal depression and pregnancy-specific anxiety generated a general factor representing overlapping symptoms of prenatal maternal psychopathology and four distinct symptom factors representing pregnancy-specific anxiety, negative affect, anhedonia and somatization. NE was rated by the mother at 18 and 36 months. CFA based on measures of father, mother, child-rated measures and a semistructured interview generated a general internalizing factor representing overlapping symptoms of child internalizing psychopathology accounting for the unique contribution of each informant. Path analyses revealed significant relationships among the general maternal affective psychopathology, the pregnancy- specific anxiety, and the child internalizing factors. Child NE mediated only the relationship between pregnancy-specific anxiety and the child internalizing factors. We highlighted the conditions in which prenatal maternal affective symptoms predicts child internalizing problems emerging early in development, including consideration of different mechanistic pathways for different maternal prenatal symptom presentations and child temperament.
Online grocery shopping could improve access to healthy food, but it may not be equally accessible to all populations – especially those at higher risk for food insecurity. The current study aimed to compare the socio-demographic characteristics of families who ordered groceries online v. those who only shopped in-store.
Design:
We analysed enrollment survey and 44 weeks of individually linked grocery transaction data. We used univariate χ2 and t-tests and logistic regression to assess differences in socio-demographic characteristics between households that only shopped in-store and those that shopped online with curbside pickup (online only or online and in-store).
Setting:
Two Maine supermarkets.
Participants:
863 parents or caregivers of children under 18 years old enrolled in two fruit and vegetable incentive trials.
Results:
Participants had a total of 32 757 transactions. In univariate assessments, online shoppers had higher incomes (P < 0 0001), were less likely to participate in Special Supplemental Nutrition Program for Women, Infants, and Children or Supplemental Nutrition Assistance Program (SNAP; P < 0 0001) and were more likely to be female (P = 0·04). Most online shoppers were 30–39 years old, and few were 50 years or older (P = 0·003). After controlling for age, gender, race/ethnicity, number of children, number of adults, income and SNAP participation, female primary shoppers (OR = 2·75, P = 0·003), number of children (OR = 1·27, P = 0·04) and income (OR = 3·91 for 186–300 % federal poverty line (FPL) and OR = 6·92 for >300 % FPL, P < 0·0001) were significantly associated with likelihood of shopping online.
Conclusions:
In the current study of Maine families, low-income shoppers were significantly less likely to utilise online grocery ordering with curbside pickup. Future studies could focus on elucidating barriers and developing strategies to improve access.
Young people who leave Out-of-Home Care (OoHC) are a significantly vulnerable cohort. No after-care support program to date has been completely informed by young people and their care team. This scoping study explored the perspectives of young people and their wider care team on: (1) challenges surrounding the transition process; and (2) how these challenges can be addressed. Semi-structured interviews and focus group sessions were conducted with 33 stakeholders from OoHC (i.e., young people in care; young people who had transitioned from care; carers; caseworkers and senior OoHC executives). Four themes captured the challenges of transitioning out of care, including: (1) inadequate processes underpinning the transition; (2) instability within the family unit; (3) financial challenges and (4) lack of independence during care. Stakeholders agreed that greater support during the transition process is necessary, including life-skills training while in care and a post-care worker and/or mentor to provide after-care support. These findings provide compelling insights into the challenges that young people transitioning from OoHC experience and possible solutions for how such challenges can be addressed. These findings will inform the development and delivery of a co-designed and specialised after-care support service for this population.
Considering the important role that paid support workers play in care of older people with dementia, it is vital that researchers and relevant organisations understand the factors that lead to them feeling valued for the work that they do, and the consequences of such valuing (or lack thereof). The current study employed semi-structured interviews to understand the individual experiences of 15 support workers based both in residential care homes and private homes. The General Inductive Approach was used to analyse the interview transcriptions and to develop a conceptual model that describes the conditions that lead to support workers feeling valued for the work that they do. This model consists of organisational or individual strategies, the context in which support work takes place, and various interactions, actions and intervening conditions that facilitate or prevent support workers feeling valued. A significant finding in this research was the role of interpersonal relationships and interactions which underlie all other aspects of the conceptual model developed here. By understanding the importance of how employers, families of older adults with dementia and peers interact with support workers, we may promote not only the quality of work that support workers deliver, but also the wellbeing of the support workers themselves.
In an era of free movement UK employers have had ready access to a supply of labour from the European Union to fill low-skilled jobs. This has enabled them to adopt business models, operating within broader supply chains, that take advantage of this source of labour and the flexibility that many migrant workers – especially those who are new arrivals to the UK – are prepared to offer them. Drawing mainly on evidence from employers on the role of migrant workers in selected sectors with a substantial proportion of low-skilled jobs, this article explores the challenges and opportunities they face in transitioning to a new post-Brexit immigration regime.