Pie Fight

The need for mastery. Or, speaking as one who has never really mastered anything, the need to at least be occasionally doing something I'm not completely crap at

 

The problem i’m having right now is that I'm doing very little that I'm good at. At work, I'm doing research on a very complicated project with no real support from above. Maybe one day I'll be a great researcher -- more likely I'll be a good one. But right now I'm not even good, and all my time is taken up by a project that demands (and deserves) someone who is. So I spend my days struggling, struggling at something that I came into this project with high hopes of being good at. As a result, my confidence needs a bit of body work.

 

The obvious corollary of spending all my time doing something I'm not good at is that I'm not spending any time doing what I am good at: no presentations, no quick, clever writing, no syntheses. So I'm not getting the emotional rewards I'm used to from those tasks.

 

And I'm not doing much I'm good at in my spare time either. No blogging, because voice recognition software is such a nightmare compared to typing. I spent twice as long correcting the above two paragraphs as I did writing them. And speaking one's thoughts isn't nearly as creative and free-form as typing them -- at least not in the way one speaks to a computer.

 

I was good at running: now I can't run. I was good at pullups: can't do those any more either. I'm swimming every day, and I'm innately terrible at it. At the very best, I can devote the next two years to becoming mediocre, then sustaining that objective mediocrity over enough years that I see myself as relatively good or even great. That goal has medium and long term emotional (not to mention physical) rewards, but in the short term it's a bit like getting hit in the head with a wet hammer every day.

 

I'm good at being a student though, so maybe when my courses start in October that will give me a lift.

 

And I feel good at and about my parenting, but I don't get to spend enough time doing it. Maybe that's why I feel such a strong desire right now to cut back on my days: in addition to all the other pleasures of spending more time with Astrid, I would be doing something that helps me feel good about myself.

phd - Long-term nutritional status after stroke and its relationship to self-assessed quality of life

uea:

Supervisors:  Dr Phyo Myint, Dr Lee Hooper and Professor John Potter

Background: While feeding of stroke patients acutely has been well studied, and nutrition support services are in place during hospital stay and on initial re-introduction to the community, less is known about the long term nutritional status of stroke patients, many of whom are left with physical eating difficulties. Evidence from Sweden and Denmark suggest that over 20% of stroke patients may be malnourished 6 months after a stroke ^{1 2}, and there is some evidence that poor nutritional status contributes to poor quality of life ³ 

Objective: To examine (1)  the changes in nutritional and hydration status with time after stroke; (2) the association between knowledge and attitude of the patient, support available within the community after discharge from acute hospital and their long-term nutritional status; and (3) how their nutritional status relates to quality of life post-stroke.

Design: Observational cohort study with 18-month follow-up using both quantitative and qualitative methods.

Methodology:  Eighty stroke patients (ambulatory and living independently) will be recruited over 9 months. Assessments and measurements made at baseline (at discharge from secondary care/rehabilitation to own home) will include patient characteristics, pre-stroke dietary habits and baseline biological, social and lifestyle data.  Participants’ nutritional status, dietary and fluid intake, self-reported health, quality of life and mood, as well as formal and informal support around food and eating will be assessed and repeated at 3,  9 and 18 months.

Main outcome measures: The main outcome measures will be nutritional status, determinants of long-term nutritional status and the relationship between nutritional status and functional health including quality of life.

Areas of training: This study will provide students with training and experience in qualitative and quantitative methods and systematic review methodology across clinical and laboratory settings.

References:
1) Jonsson A-C, Lindgren I, Norrving B, Lindgren A.  Weight loss after stroke: a population-based study from the Lund Stroke Register.  Stroke 2008;39:918-923.

2) Brynningsen PK, Damsgaard EM, Husted SE.  Improved nutritional status in elderly patients 6 months after stroke.  Journal of Nutritional Health and Aging 2007;11(1):75-79.

3) Perry L, McLaren S.  An exploration of nutrition and eating disabilities in relation to quality of life at 6 months post-stroke.  Health and Social Care in the Community 2004;12(4):288-297.

Entry requirements:
Applicants should hold a 2:1 degree or above or a master's degree in health and health realated areas or biological sciences.

 

Students can register from 1 April 2009 for a three year* full-time MPhil/PhD degree.

Funding
Funding includes UK/EU tuition fees, maintenance expenses of £12,940 and some appropriate training costs.  Overseas students will be expected to pay the difference between UK/EU and Overseas tuition fees.

Further information
For further information on any of the research projects please contact the first named supervisor in the project details.

Entry requirements
Entry requirements are stated in each individual project outline.

Closing date for applications
The deadline for applications is 16 February 2009.

Interview dates
Friday 6 March 2009.
(For the two psychology projects there will be a two stage interview process.  At the first stage candidates will be invited to visit the University.  They will meet the supervisors and there will be opportunities to see the facilities, to meet other staff and students and to discuss the research projects.)

PhD: Children’s perceptions of illness and the accuracy of parents’ and doctors’ assessments

University of East Anglia: Children’s perceptions of illness and the accuracy of parents’ and doctors’ assessments

Supervisors: Dr Georgia Panagiotaki and Professor Shirley Reynolds

Project outline:
The study of children’s illness perceptions concerns the development of their ideas about causes, treatments and prevention of physical and mental conditions. Recently, a ‘naïve theory of biology’ view proposed that even pre-schoolers are surprisingly knowledgeable about the transmission of illnesses, and the causes and treatments of physical conditions (Inagaki & Hatano, 2006), while from 7 years children recognise the difference between mental and physical conditions (Buchanan-Barrow & Barrett, 2005). 

The implication is that if children are indeed able to understand illness-related issues, then adults should be able to communicate with them at a relatively complex level. This is important, considering the benefits of effective communication: decreased anxiety about medical procedures; treatment compliance; speedier recovery; and children’s empowerment (Jaaniste et al., 2007).

Communication can only be effective if doctors and parents understand children’s thinking. Little is known about adults’ assessments of children’s ideas in this area. The few existing studies suggest that doctors overestimate young children’s, and underestimate older children’s knowledge (Perrin & Perrin, 1983). Parents typically think that their children know more than they actually do (Rubovits & Wolynn, 1999). The implication is that by misjudging children’s views, adults’ communication with them is often ineffective.

This research will address several research questions: 1) What do children know and feel about physical/mental illnesses and what factors influence how this knowledge develops? 2) How accurately do parents assess their children’s perceptions? 3) To what extent are parents’ own illness perceptions related to their children’s? 4) How accurately do doctors assess the perceptions of children of different ages? and 5) What influences their accuracy?

The research involves interviews with schoolchildren, their parents, and health professionals. The student will also be involved in the design of appropriate methods for assessing children’s understanding, while addressing theoretical and methodological problems of previous research.

References:  
Buchanan-Barrow, E. & Barret, M. (2005). The development of children’s conceptions of mental illness.
     ESRC End of Award Report  [RES-000-22-0073]. Available from www.esrc.ac.uk

Inagaki, K., & Hatano, G. (2006). Young children’s conception of the biological world. Current Directions in Psychological Science, 15 (4), 177-181

Jaaniste, T., Hayes, B., & von Baeyer, C. (2007). Providing children with information about forthcoming medical procedures: A review and synthesis. Clinical Psychology: Science and Practice, 14 (2), 124-143

Perrin, E., & Perrin, J. (1983). Clinicians’ assessments of children’s understanding of illness. American Journal of Diseases in Childhood, 137, 874-878

Rubovits, D., & Wolynn, T. (1999). Children’s illness cognition: What mothers think. Clinical Pediatrics, 38 (2), 99-105

Entry requirements:
Applicants should hold a 2:1 degree or above or a master's degree in psychology.

PhD: qualitative study to investigate the information needs of people living with Parkinson's

That is the title of a PhD being funded at the University of East Anglia. I do not qualify, as the candidate needs to have previously existing research skills. However, it sounds interesting enough that I am pasting the description below.

Main Supervisors: Dr Charlotte Salter, Dr Alexia Papageorgiou,

Background
Many useful information resources exist for people with Parkinson’s, championed by among others the UK PDS.  Information needs differ between people. However, there is little evidence that the amount and type of information provided to patients with chronic neurological conditions at or soon after diagnosis, has any impact on both short and long term measurable outcomes. Moreover, there are no data as to whether there is a minimum or core amount of information that should be provided.  

Aims
The aim of this qualitative pilot study is to develop a checklist of critical or core information that can be imparted to people with Parkinson’s Disease by healthcare professionals at diagnosis and in the period immediately following diagnosis.

Methods
In-depth, semi-structured interviews will need to be conducted with a full range of stakeholders including patients, carers and clinical staff, about their views on the most important pieces of information to be given at the diagnostic consultation and early follow up.  For the data analysis the framework approach is suggested to analyse the interview data.  The stages of framework analysis include: familiarisation; thematic coding and development of a coding frame; indexing; and, charting and would facilitate the needs of this study.   However, the student would be encouraged to develop and modify this qualitative in-depth methodology.  Therefore, experience in qualitative research methods at undergraduate or postgraduate level is essential.

Outcomes
It is envisaged that common themes will be identified as well as overlap and difference between stakeholders in information giving and receipt.  A checklist will be developed that incorporates agreed core information needs for every patient but is also responsive to different patients’ needs and preferences.

This study will link to a future planned programme of research for which further funding will be sought.   In particular the checklist will be tested and validated through an RCT.

References 

Grosset KA and Grosset DG. Effect of educational intervention on medication timing in Parkinson's disease: a randomized controlled trial. BMC Neurology 2007; 7:20

MacMahon DG, Thomas S. Practical approach to quality of life in Parkinson's disease: the nurse's role. J Neurol 1998; 245 [suppl 1]:S19-S22

McPherson, C., Higginson,

I.

, and Hearn, J (2001) “Effective methods of giving information in cancer: a systematic literature review of randomized controlled trials”.  Journal of Public Health Medicine Vol.23,No.3 pp.227-234

NHS National Institute for Health and Clinical Excellence.   Parkinson’s disease:  Diagnosis and management in primary and secondary care.  NICE clinical guideline 35.  June 2006

Ritchie & Spencer. (1994) ‘Qualitative data analysis for applied policy research’, in A. Bryman and R. G. burgess (eds), Analyzing qualitative data. 

London

: Routledge, pp. 173-94

Attractive, PhD

Faculty of Children and Health
Thomas Coram Research Unit

Dr Claire Cameron: Gender and caring work; early childhood services and the welfare state

Possible ESRC Studentship application in 2009 or 2010: Gender Issues in Early Childhood Care and Education Services
Early childhood education and care (ECEC) remains one of the most highly gendered fields of employment. Using reflective analytic techniques, based on viewing films made of nurseries in different countries, this study will investigate male and female workers’ understandings of practice in early childhood work and identify differences based on gender and gender identity as well as providing one way better to understand the implications of a gendered workforce for practice in early childhood care and education services. The study will also throw light on why so few men work in ECEC services, and why the situation is so resistant to change. The findings will inform the development of policies and practices that more effectively recruit male and female workers into early childhood services and retain them.

Could research driven efforts to promote family literacy increase polarisation for the worst off ?

IOE researchers find that:

"Reading to the child every day and having a mother who thinks it is important to stimulate young children are positively associated with all cognitive outcomes and negatively with problem behaviour."

Children who were read to daily did better in the naming vocabulary cognitive test, which involved the children being shown a picture and asked to identify the object.

They also performed better in the foundation stage profiles and had higher behaviour scores.

Youngsters whose mothers thought it was important to talk to them and teach them the alphabet also did better than their peers in tests where children were shown a picture of an object and asked to identify a similar object among a number of other pictures, and when asked to reproduce patterns using coloured blocks.

These children also had better foundation stage profiles, whereas children who watch three or more hours of TV a day, on average, achieved lower scores on the tests

If programmes to encourage family literacy catch on with the working class, that will be good. But I wonder: will it mean that the children of the worst parents will be that much further behind? That is, could the most disadvantaged 5% find themselves even more polarised?

This would be an interesting question to pursue. How would I do it?

The economics of health care and health literacy

What about the economics of health literacy? The woman at UCLA expresses her parental paediatric health literacy improvement in terms of its savings in health care dollars, mostly through reduced emergency room visits. What are the key economic issues related to health literacy? Do we have an idea how much poor health literacy costs in the UK and EU? is there any way that I could research the economic side of health literacy, given my shaky educational foundations?

In terms of health, scientific, civic and possibly even financial (fiduciary?) literacy, it would be interesting to look at public understanding the economics of health care, for example opinions about and understanding of the role of NICE. To me, this does fall under the ambit of health literacy, particularly in terms of understanding that individual health is often a collective problem requiring collective solutions, sacrifices and -- most importantly -- negotiation.

The inverted pyramid: patient choice, consumer sovereignty and self managed care in a modern welfare state

As welfare states shift to healthcare models in which individuals are expected to make more choices, be better informed and do more self management of their own health care, individuals and families with poorer literacy, numeracy and/or health literacy skills at a particular disadvantage? If so, what are possible solutions and what are states attempting?

Discipline with a D

If I'm going to do a PhD -- and I am -- then I have to develop myself in a discipline. At my age and with my shady background, sociology is the leading and possibly the only contender. It's probably too late for psychology, and definitely too late for economics.

The need to develop myself and discipline has implications for where and what I study.

Health literacy: social practice or skill?

I wonder if the social practice (as opposed to skill) argument is even stronger for health literacy than for literacy itself. I suspect that it is. And that this would be an interesting research topic. How would I investigate it?

Measuring and mapping health literacy in the UK

This looks interesting, but I certainly can't afford to pay to do it:

Measuring the level of health literacy in the UK and mapping its distribution geographically

    Supervisors: Dr Joanne Protheroe and Professor Gill Rowlands

The National Primary Care Research & Development Centre invites applications for the following three-year PhD project. Applicants must have self-arranged funding as there is no financial support tied to the project. The anticipated composite tuition fee for this project is £3, 300p.a for UK/EU candidates.

The purpose of this study is to examine the current measures of Health Literacy available in the US and to develop a corresponding measure in England. This will then be used to examine distribution of Health Literacy in England.

Health literacy is ‘the capacity of an individual to obtain, interpret and understand basic health information and services in ways that are health enhancing’. Much of the research in health literacy has been conducted in the US and Canada. There is limited research on health literacy in the UK.

The initial objective of this project would be to develop a measure of health literacy which could then be retrospectively applied to a 2003 dataset of education, literacy and numeracy skills in England in a secondary analysis. This would then allow geographical mapping of levels of health literacy and comparisons could be made with deprivation scores, health outcomes and other geographically available data. This would result in important policy-relevant data to allow the development and prioritising of interventions designed to improve health literacy.

The successful applicant will be sited within the Self-Management Research Theme of the National Primary Care Research and Development Centre (NPCRDC). This is one of the four central research themes within the Centre. The proposed PhD would provide an excellent grounding for a future career in health services research.
Applications are welcomed from candidates holding, or expecting to obtain, a first or upper second-class honours degree in health sciences or a related subject. A Masters in an associated area and good grounding in quantitative research skills are desirable.
Formal applications should be submitted in the form of a CV and covering letter outlining suitability for the study to the School of Community Based Medicine Postgraduate Research Director Dr Peter Bower (peter.bower@manchester.ac.uk).

Contact details for two academic or professional referees should also be provided.

Deadline: There is no closing date for applications but as this project is due to commence ahead of October 2009 early expression of interest is advised. For further information on the project please contact Dr Joanne Protheroe at joanne.protheroe@manchester.ac.uk                            or

        NPCRDC website

The role of parental literacy and numeracy (and health literacy) in raising children with chronic illness or disability and managing their care

It would be extremely interesting to work with a children's hospital such as Great Ormond Street to better understand the impact of parental literacy and numeracy and health literacy levels on the care of children with chronic illnesses or disabilities. Key issues would be what challenges poor literacy skills do (and do not) give rise to, and, where challenges exist, how parents -- possibly working with their children, other family members or other parents of children with similar conditions -- negotiate them. It would also be very interesting to see what steps the health care system takes to assess and assist with literacy, numeracy and/or health literacy needs -- both at organisational/structural level (e.g. the hospital as an entity) and at individual level, e.g. nurses, doctors, etc. Are patient education materials developed with the input of low literacy families and/or children themselves? How much of a difference to improved efforts in this area make to patients and their families, both in terms of health and satisfaction with the service? And what are the economics of improved attention to family literacy and numeracy issues?

When and why does improved health information improve health behaviours? When and why does it not? Can I make strong statements about the relationship between health information and health behaviours?

A great deal of current government health policy is predicated on the notion that improving health information or providing more health information to purportedly under informed citizens will improve their health behaviour. What is the evidence for this supposition? What is the evidence against it? What social and policy factors have contributed to the current government emphasis on information provision? Is the government overemphasising the power of information, for example by assuming that if underprivileged citizens have the same health (e.g. diet and exercise) information as more privileged citizens, their health behaviours will converge? Would governments have a greater impact on health by focusing on structural or systemic factors such as urban planning or national food policies that emphasised and subsidised the production and distribution of healthier foods, rather than, for instance, corn syrup? What social and political factors impel governments to focus on  individual behaviour and choice rather than structural change? For example, the UK government has in recent years provided parents and children's with a great deal of information about the benefits of exercise and healthy diets -- yet childhood obesity rates continue to rise. Is the government taking the right approach? Are other viable approaches available to it?

These questions may be particularly significant given the rise of the obesogenic environment, not just in countries that have a recent tradition of unhealthy diets -- e.g. the US and UK -- but also in countries such as those of the Mediterranean that in the last decade have seen a rapid rise in unhealthy eating. A particularly interesting PhD project might be to compare the strengths, weaknesses, successes and failures of information-driven health (especially diet) behaviour campaigns in the UK, US and Spain, while also looking at the arguments and debates within each country.

If I researched this topic under the aegis of health literacy, my focus would have to be on the literacy/numeracy related aspects of information delivery, information seeking and/or avoiding, individuals' beliefs about the importance or lack of importance of health information in their lives, and governments' understanding of the role of information in motivating behaviour, especially among different social classes or family types. LSBU or UCL. Elsewhere?

If I researched it under the aegis of child health, my focus could be broader.

On a general level, it would be extremely interesting to research the relationship between information and behaviour. I think the current government understanding is based on the notion that if only you can help individuals ovecome their various information deficits, you can markedly change their behaviour is in ways that economically benefit the state and would purportedly benefit the individuals. I think this notion is very simplistic, and does not take into account societal Contexts and structures.

Health literacy: improving patient information leaflets

In this PhD project, I would re-write a patient information leaflet (or a patient information webpage) so the instructions in it were significantly easier to understand. Such an information leaflet would likely be targeted at patients with a chronic condition that requires understanding and adherence, for example, a leaflet explaining how to use a diabetes stick pen. Rewriting such a leaflet would draw on my experience writing patient education materials for low literacy adults in the United States, but would also require collaboration and ultimate sign off by medical professionals here in the UK before the new patient information leaflet could be trialled. Working with a hospital or primary care trust or other health agency, I would then trial this more user-friendly patient information leaflet in comparison with the original leaflet, preferably in a random control trial. A successful trial -- e.g. one in which revised PIL led to increased adherence or higher patient satisfaction with the medical service -- would be inherently beneficial and would point to the urgent need for patient information leaflets that took greater account of patients' literacy and numeracy levels. An unsuccessful trial -- e.g. one in which neither adherence nor satisfaction or any other key variable increased -- might point to weaknesses in the revised PIL, or might possibly highlight the complex challenges associated with increasing patient understanding, adherence and satisfaction, potentially highlighting shortcomings of information-centred approaches to improving patient outcomes. That is, it might provide evidence that improved health information does not necessarily improve health behaviours.

EPPI review of research on preventing obesity

As a follow-up to my earlier post, here is an EPPI systematic map of reviews of research into preventing obesity, with a specific focus on childhood obesity. Again, however the emphasis appears to be on information rather than on structural changes. I know this is inevitable to a large degree: it's much easier to alter and experiment with information than it is to change the shape of a city.

We located 54 reviews of obesity-relevant research with a social and environmental focus, of which 32 were systematic reviews. Our results reflect the rapid recent growth in interest in this topic. Over half the reviews were published in 2004 or later.

Most of the reviews covered the population as a whole and did not have a specific focus on children or young people. The reviews covered a wide range of intervention types and settings. Some were focused on specific intervention strategies such as mass media campaigns, financial instruments or point-of-sale information. Some investigated multi-component interventions which integrated social and environmental change with education and strategies for individual behaviour change, in either school or community settings. A number of reviews included studies covering all of these areas. 

Many reviews focused on studies which evaluated interventions which aimed to alter the social values attached to food and exercise, using, for example, education or social marketing techniques. We found few reviews which included studies evaluating large-scale structural changes to the physical environment or the availability or cost of food, exercise or sport.

The pop quiz mentality

I find this rather irritating.

Few people know and understand the �government's guidelines on healthy eating, smoking and drinking despite the millions of pounds spent on awareness campaigns, it emerged today.

Data from the annual Health Survey for England revealed that although obesity has nearly doubled in the last 14 years, two-thirds of men and women do not know the amount of exercise they should be taking. Only 27% of men and 31% of women eat the recommended five portions of fruit and vegetables a day.

Less than a third knew the maximum amount of alcohol they should drink a day, the report found. And only 14% of men and 11% of women could always correctly identify a portion of fruit or vegetables.

These sorts of "gotcha" surveys -- or more accurately, "gotcha" reporting of survey results -- add little to our understanding or to our ability to improve public health. The frame of reference in this type of reporting is one that postulates that health is mostly about individual knowledge and information, rather than decision-making and the environment's role in shaping behaviour. And it postulates that it's about having exactly the right knowledge, as opposed to having pretty good knowledge but living in an environment that encourages good (if unwitting) health behaviours.

I mean, exactly how much exercise should I be taking? I don't know. Is it 30 minutes a day, every day? would knowing the exact recommendation shape my behaviour? And look at the use of the word "always" in the final sentence of that quote. That suggests to me that most people get it mostly right most of the time, which does turn out to be the case, as the article later concedes. More importantly, the article also notes that "Despite their lack of knowledge of what the government recommends, people's consumption of fruit and vegetables and exercise levels have gone up."

To me, this is the most important bit. We don't have to make everyone in expert, or make them able to pass a pop quiz. What will work best is shifting society as a whole so that Cork trauma or is about diet and physical activity shift enmasse towards the good.

Kill the journalist

In a Times Educational Supplement article on England's excellent performance in the Trends in International Mathematics and Science Study (TIMSS), I read the following boneheaded statement:

Timss appears to provide little evidence to support the view that cutting class sizes will raise test performance. The country with the best results in primary science, Singapore, also has the largest classes: 95% of pupils are in classes of more than 32.

 

I'm not sure, but is this the equivalent of saying that since you don't need to peel pears, you don't need to peel oranges? There are likely to be huge cultural differences in Singapore that eliminate many of the problems faced in western nations when we have large class sizes. The key variable is disobedience in the classroom: you can clearly get away with large class sizes absent significant disobedience, but when that variable is factored in  the maximum acceptable number of students in the class must surely need to go down. So the Singapore number has little to say about our own questions about class size, given the inevitability of widespread disobedience in our classrooms.

Getting families walking

Below, the text of a Department of Health tender on a programme to get families walking. What's interesting here is that this programme is specifically trying to alter behaviour without altering the social determinants of that behaviour, especially environment in the form of walkable cities. Though there may be other programs that are seeking to address the problem from that (structural) side.

The Department of Health requires a contractor to develop and deliver a pilot community-based walking project.

The outcome of the pilot is for there to be a sustainable increase in the number of children, young people and families walking as part of their daily lives and as a first choice mode of travel.

The work contributes towards Healthy Weight Healthy Lives ambition to get at least a third of England walking at least 1,000 more steps daily by 2012.

The Change4Life marketing programme is targeting 4.7 million families with children under the age of 11. With behaviours and attitudes being developed in formative years this is a key group in which to bring about change.

Proposals should:

• have an emphasis on ‘on the ground’ schemes as opposed to information campaigns. Wherever possible, full use should be made of any available research on motivation/trigger points that encourage increased walking levels.
• be structured as preventative intervention and not include any form of patient referral, physical activity care pathway or other treatment intervention.
• identify ways to increase walking amongst families, particularly those hard to reach (eg BME) and PCT Spearhead Areas where health inequalities are greater. The school run is already adequately addressed and should not be focussed on.

Work may either be based on or build on an existing or new delivery structure but should, amongst other things, reinforce the wider health and well-being benefits of walking and walking briskly, demonstrate sustainability, consider how variations between rural and urban communities and consider any complementary work with adult walking programmes.

In related news:

Nearly one in four children are obese or overweight when they start primary school and one in three are too fat by the time they leave, according to official figures.

The new data from the government's national child measurement programme in schools showed there had been no progress since last year in reducing the numbers of overweight children and provoked calls for greater efforts to tackle the obesity epidemic in the young.

National Obesity Forum spokesman Tam Fry said: "We had high hopes that there would have been a marked improvement after all the money that is being thrown at the problem but it seems that more radical measures will be needed to reduce obesity levels."

But is this programme not working, at least somewhat? if the trend has been towards increased obesity, and that trend has been arrested, whether through this programme or through other means, then that counts as at least a draw, doesn't it?

On that note, I remember a friend of mine once complaining that even though she had started walking a lot, she hadn't lost any weight. She didn't seem to notice or appreciate the actual impact, which was that she had stopped gaining weight.

Everything we need to know about the new welfare reform White Paper, alas

Matthew Norman, writing in the Independent:

Perhaps I do David Freud, architect of the White Paper on welfare reform, a disservice. Maybe, during all his years raising £50bn for the likes of Railtrack and EuroDisney, Mr Freud sat up night after night with the ProPlus, studying the issue until dawn broke over a lavish home far removed, we may guess, from the sink estates he claims he wants to salvage from workless despair.

And yet, by his own words, it seems not. "I didn't know anything about welfare when I started," he told The Daily Telegraph in February, "but that may have been an advantage... In a funny way, the solution was obvious." The special hilarity here, apart from the notion of any obvious answer to so ferociously complex a social conundrum, is how long he took to travel from absolute ignorance to omniscience.

Hired by the Works and Pensions Secretary James Purnell to address this small matter, it took him – wait for it now; just wait for it – three weeks to research and write his initial report. Admittedly by New Labour policy-creation standards, this is hardly a rush job. But by any more conventional measure, 21 days is on the brisk side for so monumental an intellectual challenge.

Still, let's not fall into that very trap by rushing to judge Mr Freud as a man prone to the lure of the simplistic. Indeed, writing in yesterday's Times, he touched impressively on the thinking behind the wizard wheeze of forcing long-term incapacity benefit claimants back to work. "Some of our greatest national heroes suffered from disabilities," he explained, "from Nelson with his lost eye to Churchill with his 'Black Dog' depression, to the physicist Stephen Hawking..."

Spurs

You know what Tottenham are like? They're like some okay-looking guy who gets his first really pretty girlfriend, and  then thinks that because he qualifies for pretty girls now, his own girl ain't pretty enough for him.

Yeah, Ramos seems shit hot, but this is being done for all the wrong reasons, and in the worst possible way.

But, but...

If a straw man argument is when someone invents an easily tackled enemy that isn't actually there, what do you call it when someone completely ignores highly visible evidence that refutes their thesis? An 'ostrich man' argument?

Here's some dimwit in the Guardian writing a moany piece about how the Bourne Ultimatum has no strong characters, while almost completing ignoring Pamela Landy.

I mean, she actually asks the question 'why can't women in action movies ever do anything useful?' I won't spoil the film, but let it hereby be noted that 'doing something useful' pretty much sums up the Pam Landy character.

Why the fat face?

A well written article on the role of environment, architecture and work in shaping people's bodies. Nothing new here, but nicely put. However, the following assertion is overstated:

In forgetting to think about how our environment shapes us, it becomes easy to think that our food is made for us. The difficult truth is that, increasingly, capitalism makes us for our food.

No, capitalism does not 'make us for our food'. But it would be very fair to say that our food is not made for us, it is made for our lifestyles (and those are to a large degree made by capitalism).

Welcome to the schmuck of the day club

Today's schmuck of the day club inductee is medical student Alex Thomas, who whines

The constant analysis of GPs' salaries is really starting to irritate me. If the public think it is such an easy ride being a GP, why aren't there more of them applying for the job themselves?

[...]

in addition to A grades in chemistry and biology, applicants may have to be able to discuss Proust or be almost fluent in Spanish or be able to quote extensively from Chaucer, in the original Middle English.

Does this sound easy so far?

Erm, do you sound like a twat so far, Mr Proust Discusser?

So irksome did I find Mr Thomas that I: a) launched the Schmuck of the day club; B) started blogging again; and C) overcame my usual lethargy and wrote a letter to the (Guardian) editor. Well done, Alex - just the cure! Here's that letter:

Let’s hope that medical student Alex Thomas ( Fancy becoming another one of those overpaid GPs?, 17 August) is better at reading patients’ symptoms than he is at plain old reading. In complaining that the public believes that GPs are overpaid and that their job is easy, he is erecting a straw man: the vast majority of the public don’t think being a GP is easy. We do, however, think they are getting a jammy deal. Just because a job is hard and demands great commitment doesn’t mean it should command a six-figure salary, particularly when nurses, whose job is at least as hard as a GPs, are so poorly remunerated.

This advice strikes me as so demanding as to be counter-productive

New health advice:

The new guidelines say:

· 30 minutes of moderate exercise a day is still the minimum, but vigorous as opposed to moderate activity should be "explicitly" recommended

· Combining days of moderate exercise with other days of vigorous exercise is better for you

· Moderate exercise should be in addition to daily activities such as casual walking, shopping or taking out the rubbish

· People should do two weight-training sessions a week

I would imagine that this would help dissuade many people from bothering to do even moderate exercise, since they'll reason that it's not enough.

PhD on different systems for educating disaffected teens

It'd be fun to do a PhD comparing the strengths and weaknesses of how America educates disaffected teens with how England does it.

Practice exam question: Inside the black box of the family

Practice exam question: Explain why policy makers should invest more time in understanding processes internal to the family.

Hmm, can start here with Okin's notion of justice, and her contention that underlying all the inequalites specifically affecting women is the unequal distribution of unpaid labour in teh household. And Hobson's contention that the family is a site of great inequality, of a sort which doesn't mirror societal inequality. They should invest more time in understanding it because we have limited understanding of it - i'll discuss the theories of household bargaining that we have. But mainly they should invest more time in understanding it because, as feminist theorists observe, social policy is both shaped by and shaping of what goes on within the so-called black box of the family. And social policy understanding has always been skewed towards the public sphere, but as Hobson argues, the policy divide between public and private is arbitrary, ideological, and not gender neutral. Because women take on more of the caring duties within the family and tend to have weaker bargaining positions economically, policy which does not seek to peer into the black box is policy that tacitly supports, approves of and furthers the current gender gap.

Practice exam question: "Malestream" theories

Practice question: "In the field of social policy, mainstream theories would be more appropriately referred to as malestream theories." Discuss.

Ok, how to address this one? First of all, I don't know a lot about mainstream theories. I know a fair amount about EA, and I know that Willensky's was based on social expenditure. And I know that Marshall was the mac daddy of social citizenship, and that in general social citizenship is defined as one's ability to participate fully in the activities of society. What I could say is that I'll argue that mainstream theories have been said to be malestream because they were far more concerned with the welfare of men than with women. This concern expressed itself  through a concentration on class and an ignorance of the role of gender in personal welfare, as well as an implicit assumption that women's primary role was as carer rather than provider.

Practice exam question: citizenship, gender, and Wollstonecraft's dilemma

In what ways can policies that seek to address the distribution of unpaid and caring work be seen as an attempt to solve Wollstonecraft's dilemma by requiring both women and men to be "citizen workers"?

Ok, I'm a bit shaky on this material right now, but the purpose of this practice question is to get me up to speed with the key concepts and contributors. So here goes a kitchen skink approach, which I'l clean up later.

Middle class myopia about the socio-economics of food

UPDATE: While my criticism of Blythman's article focused on the idiocy of her belief that public health policy can be based on middle class behaviour and assumptions, the article also deserved a right royal bollocking for its dodgy use of research. Adopting the faux objectivity characteristic of so much of the American press, it pretended to present two sides of the story by: A) offering accepted scientific evidence, then B) providing oppositional critiques of the mainstream science. See the trick here? It presents two sides of teh argument, but only lets one side critique the other. Thankfully, wiser men than me have called her on it. The best bit is the second letter, which points out that one of her key critics of putting folic acid in bread runs an online health food shop that sells - you guessed it - folic acid. Joanna, you got played.

This is one of the most egregious, up its own ass articles I've ever read. Joanna Blythman's normally pretty good, but in this piece she seems to be willfully myopic about the ways that socio-economic realities and the diets of the poor. Eg, she quotes, approvingly, this guy:

"It is noticeable that the FSA isn't proposing adding it to wholemeal bread because it already contains it. Why doesn't the FSA just tell people to eat more wholemeal bread?"

Um, because that wouldn't work, especially not with the mums who need this. (Hint: they don't have the same approach to food as you.)

Ok, that's one stupid question answered; how about another one?

The other main objection is that fortification is a sledgehammer to crack a nut. The estimate is that adding folic acid to bread will save 120 babies in the UK every year from spina bifida, but for every baby saved, half a million people, male and female, will have to take the added folic acid. "Why not target potential young mothers rather than mass-supplementing the population at large ?" asks Holford.

Hey, toughie! How about 'Because the young mothers who need this don't respond to government messages on health and diet?' You do; they don't - wishing ain't gonna change that. Or maybe the poor all quit smoking when I wasn't looking.

Pathetic.

Via Ezra Klein, here's an american example of the genre, in which well-off journalists who work from home bash those who don't make the time to cook proper meals after a 10-hour day.

More money, less control

The very good Mike Baker of the BBC writes:

As Blair departs, many will hope for an end to "initiative-itis" and policy overload. No more targets. No more bully-pulpit politics. No more "modernising" of the comprehensives. But they will be disappointed. Gordon Brown is just as fond of targets. He will insist on a something-for-something return for every extra pound that goes to education.

In a recent interview, he told me education would be "my passion ... my priority". The big question for Brown is: why, after so much more investment, do teachers, lecturers and parents still feel dissatisfied?

I think Julian Le Grand's "knights and knaves" work answers that final question.

Miss, that little boy crumpled on the ground over there pushed me

At least once a week now, the Guardian has a column bemoaning the cruelty and arrogance of atheists, and the dire lot of the religious in this country. For example, Madeline Bunting recently railed against outspoken atheists such as Richard Dawkins.

Don't get me wrong, I think Dawkins is a bore. But when they criticism him and his anti-religion ilk, Bunting and the burgeoning religious crew writing inthe Guardian appear to operate under the fallacy that it's only the anti-religious lot who are attempting to impose their values, and that religion is a poor bullied weakling. Tell that to the gays, Madeline (famous apologist for homophobic Muslim clerics). And tell that to the 17-year-old girl in Ireland who the religious crew is trying to force to stay in Ireland and bring her baby to term, rather than go to England for a termination, even though the baby has no head, and is guaranteed to die within three days of birth. And tell it, Madeline, to the UK women unfortunate enough to have as a doctor one of the 40% of GPs who say they would refuse to refer a woman on for an abortion, on 'moral grounds'.

Religion has been imposing itself on the rest of us for thousands and thousands of years. Just because in a relatively enlightened country such as the UK it has less power to do so than before, doesn't mean it still isn't doing it all the time, and still trying to do it even more. Just because you take this for granted, Maddy, doesn't mean it isnt' happening. So enough with this silly notion that religion is the victim because a handful of verbal atheists are giving it a heckling. It's been bullying us for years, and isn't going to stop until we force it to.

The old new American two-party system

Earlier today I posted a John Quiggin bit to delicious - I thought it was a great piece of political analysis. Yglesias agrees:

John Quiggen makes an important point. An awful lot of the recent changes in American history can be understood as efforts to graft a proper two-party dynamic onto a country that thanks to both an unusual institutional set-up and the legacy of the Civil War and Jim Crow didn't really have one. The rise of the "New Right" essentially turned the GOP into one half of a two-party system, at which point it became devastatingly effective because the opposition was still behaving like one half of the old, more fluid system. Much recent progressive activism has centered around trying to turn the Democrats into "the other party" of a two-party system.

Patience capital and non-cognitive development

Download patience_capital_and_the_demise_of_the_aristocracy.pdf

I'm not sure I buy the premise of the above paper on 'Patience capital and the demise of the aristocracy', but it's an interesting one, and some of the arguments are interesting. For instance, there's a good point about the fact that urban artisans had a life characterised by a steep income slope (making nothing as an apprentice, pretty little as a journeyman, and hopefully a good deal more as a master) that encouraged long-term planning and financial discipline; this in contrast to those (both poor and rich) in rural areas, for whom the land was worth basically the same when they were 20 as when they were 60. For the latter, lifetime income had more of a tendency to be flat from year to year; thus notions of investment in the future and the accumulation of capital would have been less salient - or so goes the theory. (See bottom of page for data on the landed aristocracy's attitude to business.)

Most interesting for my studies, though, is the notion of patience capital (think the Marshmallow Test, and the ways in which parents strive to teach their children patience and other key non-cognitive skills) is an interesting one.

It may be particularly related to positive outcomes for low-income children who attend decent daycare programmes, argue some. Remember, these kids - eg in the Abecedarian or Perry High Scope project - tend not to show greater cognitive development than their peers over time, but they do show better outcomes. Here's a snippet:

Heckman (2000)
and Heckman and Krueger (2003) review the evidence from a large number of
programs targeting disadvantaged children through family development sup-
port. They show that most programs were successful in permanently raising the
treated children’s non-cognitive skills, turning them more motivated to learn,
less likely to engage in crime, and altogether more future-oriented than children
of non-treated families. On the other hand, the programs were less successful in
raising cognitive skills as measured by IQ test scores.3 The most effective pro-
grams where those targeted to children at a young age, although positive effects
are also documented for programs targeting adolescents. These studies show
how important family transmission is in this particular form of human capital
accumulation, of which the notion of patience discussed in this paper is a com-
ponent. Similar conclusions are reached by a number of studies in child develop-
ment psychology (see e.g., Goleman 1995, Shonkoff and Philips 2000 and Taylor,
McGue, and Iacono 2000). Coleman and Hoffer (1983) argue that the emphasis
on patience and self-discipline is the key of the effectiveness of Catholic schools
in the US. [p 8]

There's also an argument in there that would be useful for understanding cultural transmission, eg through engaging in Lareau-ish analysis of parenting styles:

In our model, in contrast, parents invest in their children’s patience. In this re-
spect, our paper is related to the growing literature on cultural transmission (e.g.,
Bisin and Verdier 2000 and 2001, Hauk and Saez-Marti 2002, Saez-Marti and
Zenou 2004).5 In this literature, parents evaluate their children’s life prospects
from the standpoint of their own preferences, and actively try to manipulate chil-
dren’s preference to induce choices that parents regard as desirable. As these
papers, we argue that economic incentives are crucial in determining the effort
parents exert in affecting their children’s preferences. [p 10]

OK, up above  I promised data on the landed aristocracy's attitudes to business.  (it's really worth having a look at the table in the pdf; for some reason I can't seem to paste it into this post.)

Table 2 reports the professional choice of Cambridge graduates during
the period 1750–1899. The vast majority of students at Cambridge during this pe-
riod were sons of members of the landowning class, so their professional choices
(other than landowning) give us a good idea of which professions younger sons
entered. Strikingly, until 1850, not a single graduate got involved in banking or
business (widely defined as any “profit-oriented activity”), and even after 1850
the percentage remains surprisingly low.

Unions, by Ezra

Ezra Klein is putting up a lot of posts on unions of late, partly in response to dear old Tyler Cowen.

Yapping about childcare

A Kenan Malik-led talk on childcare in the early years.

Digital dandy

Lovely guide on how to set up a regularly updating online collection of different types of feeds, aggregating info in fields you're interested in. I'll definitely do something like this for adult ed.

School lotteries

UPDATE: Harry Brighouse, Mike Baker and Fiona Millar all have their say. All good stuff. Here's an excerpt from CT comments:

Essentially most of the selection criteria remain the same, and selection is still limited to those in catchment, with the single change that the factor ‘closeness-to-school’ has been replaced by ‘random selection’ (still within catchment, and still balanced against other factors such as siblings’ school location, exceptional circumstances etc).

I’d have to agree wholeheartedly with this change, because ‘closeness-to-school’ is a factor that is by definition manipulable by parents, and more importantly, more easily manipulable by wealthier parents. A defensible choice agenda has to pay SOME attention to the ease and difficulty with which people can make the relevant choices, otherwise the resulting distribution looks likely be inegalitarian, right?

Now, on to my own thoughts. My first one is that I'm very much in favour of school lotteries, as it'll cut down on people like Ladyfriend and I from moving to where the good schools are, and will force the middle class to use voice to improve the schools they're stuck with rather than exit to congregate at the best state schools. As for the fear that the middle class will abandon state schools, I ain't buying. Only 7% of the school population attend independent schools, and they are generally very expensive - too expensive for most middle class parents. Tony Blair and his gang forget this - they seem to assume that most of the middle class is in a similar income bracket as themselves (a mistake also made by the odious Nick Cohen in his incessant rants about how hard life is for couples who earn 'only' 100k between them.) Here in the real world, most of the middle class can afford the partial exit of moving to where the best school are, but not the full exit of leaving the state school system entirely. And as for the idea that so long as the middle class's kids are in state schools, everything's hunky dory: bollocks! When some state schools are full of middle class kids and other state schools only a few miles away are full of low income kids, it's a de facto indepent private school system, but at taxpayer expense.

However, the beeb has an article saying that there's research arguing that lotteries don't actually level the playing field. The article is quoted below, but as far as I can tell, it says very little about the issue at hand. Perhaps the Beeb was just looking for something, anything, and thought this was enough?

Dr Jarvis said: "Our research suggests that lotteries of over-subscribed school places would produce the worst of both worlds - greater educational polarisation and longer, more environmentally damaging car journeys to distant schools by middle-class parents."
[....]

She and Dr Alvanides looked at 50 primary schools in Newcastle and selected two for intensive study, one in an affluent part of the city, the other in a deprived area.

They worked closely with 10 families from one school and eight from the other.

All but two of the 18 had been allocated a place at their "first choice"  school.

None of the poorer families owned a car and walked their children to school, whereas most of the affluent families had two cars and drove there.

When preparing their applications almost all the poorer families had visited just one school, their priority being a "happy child". They paid little heed to future secondary school transfers.

The better-off families had visited two or more, some going to five or more - including private schools - in their search for a "good school". They spent a lot on after-school activities.

The researchers believe they have uncovered significant lessons, most importantly on "the false view that policy makers have of the way parents in different walks of life make choices (assuming they have choices to make) about their children's education".

Daddy got mad mad dollah

What does it mean to be so rich that it's almost literally impossible to spend your wealth faster than the interest accrues on it? Via Ezra:

They're just not like you and me -- they're so very much richer:

Mr. Ellison’s net worth last year was around $16 billion. And it will probably be much bigger when the list comes out in a few weeks. With $16 billion and a 10 percent rate of return, Mr. Ellison would need to spend more than $30 million a week simply to keep from accumulating more money than he already has, to say nothing of trying to spend down the $16 billion itself.

He spent something like $100 million on his Japanese-style mansion in Woodside, Calif., making it among the more expensive private residences ever built. But that is only about three weeks worth of the interest he earns on his wealth. And a house doesn’t actually spend down his net worth because it is an asset that can be resold. At least part of the $100 million is just a different way of saving.

Mr. Ellison would have to spend that $30 million a week — $183,000 an hour — on things that can’t be resold, like parties or meals, just to avoid increasing his wealth.

This article has some fairly shocking information. For instance, and here I quote Ezra quoting the author:

"only 4 percent of the richest Americans said that providing an inheritance ranked in their top five reasons for saving." Weirder yet, "the data shows that elderly super-rich people who do not have children save just as much as the ones who do."

So why do the super-rich hoard their wealth? Status, power and greed, basically.

Some economists have dived into the question, and their hypotheses basically boil down to greed. "[The superrich] get something different from having money — clout, power, the ability to dominate an industry. Or perhaps these are just competitive people who care about their position compared with other people on the list." Maybe so. Or maybe this is just humankind's innate loss aversion -- our tendency to irrationally avoid loss even more than we court gain -- at work.

Can you imagine how much good all that money could do? And how much better off countries would be if people with this much money didn't spend so much time fighting for lower taxes?

Ladies and gentlemen

Harry Brighouse links to a series of fab-sounding papers on gender egalitarianism. Authors include Gornick and Meyers, Crompton, and plenty of others. The papers can be found here. Just so you I can see what I'd be missing by not clicking through, I've pasted a list of them below, though the links don't seem to work down there. Damn t'internets! Bring back the slateboard!

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         

Background           Paper:
Janet Gornick and Marcia Meyers	"Institutions                   that Support Gender Egalitarianism in Parenthood and Employment"
Responses                 and Papers:
Rosemary               Crompton	"National                   Particularities, Caring, and the Domestic Division of Labour:           Their Impact on Gender Egalitarianism in Parenthood and Employment"
Ruth           Milkman	"Class                   Disparities, Market Fundamentalism and Work-Family Policy:           Lessons from California"
Lane               Kenworthy	"Who                   Should Care for One- to Three-           Year-Olds?"
Harry               Brighouse and Erik Olin Wright	"In                   Defense of Strong Gender Egalitarianism           (even if this requires Illiberal Policies for its Achievement)"
Shireen Hassim	"Whose                   Utopia? A Response to Gornick and Meyers 'Institutions           that Support Egalitarianism in Parenthood and Employment'"
Peter               McDonald	"Comments                   upon: Institutions that Support Gender Egalitarianism in Parenthood           and Employment by Janet C. Gornick and Marcia K. Meyers"
Rosalyn               Baxandall	"Winning                   Day Care through Grass Roots Struggle           In New York City"
Scott               Coltrane	"Fatherhood,           Gender and Work-Family Policies"
Kymberly               Morgan	"The                   Political Path to a Dual-Earner/Dual-Carer Society: Pitfalls           and Possibilities"
Myra               Marx Ferree	"An                   American Utopia? A roadmap to reconciliation politics in the                     US"
Nancy           Folbre	"The           Qualities and Inequalities of Care"
Kathrin           Zippel	"The                   Missing Link for Promoting Gender Equality:           Family-Work & Anti-Discrimination Policies"
Johanna           Brenner	"Beyond                     the Family/Household and the Bureaucratic Welfare State"
Heidi           Hartmann and Vicky Lovell	"Paid           Sick Days: The Missing Component"
Michael               Shalev	"Trouble                     in Utopia: Class Divisions in Preferences, Interests and                     Politics"
Collette               Fagan	"Some                   brief Comments for the Conference on           Institutions for Gender Egalitarianism"
Barbara               R. Bergmann	"Taking                     Gender Equality into Account in Work-Family Policies" (revised)
Cameron           Macdonald	"What’s                   Culture Got to Do with It? Mothering Ideologies as Barriers                   to Gender Equity"

A length of string and an old piece of gum were good enough for me

And they're good enough for today's kids, too. Hi-tech 'educational' toys offer nothing that parental interaction doesn't, according to research.

A government-funded study examining the role of technology in the lives of three- and four-year-old children and their families found that the hi-tech devices - one of the fastest growing sectors of the toy market, aimed at infants as young as nine months - are no more effective than traditional ways of introducing basic literacy and number skills.

Toy laptops and mobile phones were of greater value to young children as an aid to imaginative play such as pretending to make phone calls than in teaching specific skills, researchers at the University of Stirling concluded after tracking families for 15 months.

Youngsters also gained an understanding of the social role of technology simply by watching their parents use computers, digital cameras and mobile phones for work and leisure - far outstripping the benefits of using computers for unrealistic exercises and games while at nursery.

[....]

Lydia Plowman, professor of education at Stirling University, said parents interviewed experienced "a lot of anxiety" about the role of new technology, and felt under pressure from manufacturers to buy educational electronic toys such as Leappads and games consoles.

Professor Plowman, announcing her research yesterday at a conference, Happy Families?, hosted by the Family and Parenting Institute, said such toys were neither harmful nor "particularly beneficial".

She said: "I don't think there is any problem about children having these toys at home, but in terms of basic literacy and number skills I don't think they are more efficient than the more traditional approaches."