The consequences of the COVID-19 pandemic are still working through health systems worldwide, and further reflections about the nature of health and disease, and about how to design and implement effective public health interventions are much needed. For numerous diseases and conditions, as well as for COVID-19, our knowledge base is rich. We know a lot about the biology of the disease, and we have plenty of statistics that relate health to socio-economic factors. In this paper, we argue that we need to add a third dimension to this knowledge base, namely a thorough description of the lifeworld of health and disease, in terms of the mixed biosocial mechanisms that operate in it. We present the concepts of lifeworld and of mixed mechanisms, and then illustrate how they can be operationalised and measured through mixed methodologies that combine qualitative and quantitative approaches. Finally, we explain the complementarity of our approach with the biological and statistical dimensions of health and disease for the design of public health interventions.
White blood cell (WBC) and mean platelet volume (MPV) counts are related to stroke events, but relationship between their combined indicator (WBC count-to-MPV count ratio (WMR)) and the risk of fatal stroke occurrence is unclear so far. In this retrospective analysis, we enrolled 27,163 participants aged 50 years or older without a stroke history in the Guangzhou Biobank Cohort Study. After a mean follow-up time of 15.0 (SD = 2.2) years with 389,242 person-years, 816 stroke (401 ischaemic, 259 haemorrhagic and 156 unclassified) deaths were recorded. Cox’s proportional hazards regression was used to estimate the hazard ratios (HRs) and the 95% confidence intervals (CIs). Compared with those in the lowest quartile, participants with the highest WMR had different risks for fatal all stroke and fatal ischaemic stroke, respectively, although an increased risk for fatal ischaemic stroke was observed among participants in the fourth WMR quartile and further hs-CRP adjustment; those in the WMR change with 10% increase had a 36% increased risk of fatal all stroke and a 79% increased risk of fatal haemorrhagic stroke, compared to those in a stable (the WMR change between −10% and 10%). Our findings suggest that higher WMR and its longitudinal change were associated with an increased risk of fatal stroke occurrence in middle-aged to older Chinese; it may be a potential indicator for the future fatal stroke occurrence in relatively healthy elderly populations.
Previous studies have shown that highly educated women are more likely to realise their fertility aspirations, or experience a faster progression to a higher order birth, compared to lower educated women. This is often explained by improved economic or social resources among the higher educated. However, it is unclear whether educational differences in health behaviours may also contribute to these differential fertility outcomes. In this study, we use data from Waves 1–7 of the UK Longitudinal Household Study, combined with data from the Nurse Health Assessment from Wave 2 to estimate couples’ likelihood of experiencing additional childbirth within six years. A discrete-time event history model is employed to analyse the transition to a higher order birth, while accounting for both partners’ level of education as well as smoking patterns and body mass index. We find that couples in which the female partner is highly educated are more likely to experience childbirth within six years compared to others. In addition, female smoking is negatively associated with the likelihood of childbirth, while no significant effect has been found for male health factors. Female health indicators explain some of the variation in fertility outcomes for women with lower secondary education compared to degree-educated women. However, education remains a significant predictor of the transition to higher order births, also after accounting for male and female health indicators. It is therefore important to consider both socio-economic and health factors in order to understand variations in fertility outcomes.
This study focuses on the constitution of financial reserves in Switzerland from a longitudinal perspective. Personal income after retirement derives from financial reserves whose constitution depends both on positional factors, such as sex and birth cohorts, and processual factors, such as occupational trajectories, in the institutional context of the Swiss pension system (structural factors). We hypothesise that some processual, positional and structural factors interact with each other to shape financial reserves available in old age. We assess this set of factors and their interactions using the occupational trajectory types stemming from optimal matching analysis (OMA) combined with the hierarchical clustering and regression tree methods. We used the retrospective biographic data SHARELIFE gathered during the third wave of the SHARE survey in 2009. The results show that occupational trajectories are influential factors accounting for much of the financial reserves available in later life. However, these processual factors interact with positional factors such as sex and birth cohort. The retirement schemes generalised in Switzerland during the period under consideration add up to the effect of positional factors on the constitution of financial reserves.
The Early Intervention Foundation (EIF) was founded in 2013 as part of the ‘first wave’ of What Works Centres and is part of the government’s What Works Network. We are an independent charity with a mission to ensure that effective early intervention is available and is used to improve the lives of children and young people at risk of poor outcomes.
In this chapter, Jo Casebourne gives five lessons from the EIF’s experiences: start with audiences’ need; be clear what you mean by evidence; focus on getting evidence used; build strong partnerships and relationships; and, measure your impact.
Evidence synthesis, and particularly the creation of systematic reviews, is an often overlooked part of the work of the What Works Network, where most attention goes to larger, flashier and more expensive randomised trials. In this chapter, two leading experts on systematic reviews discuss their use in evidence synthesis, and how, why and when they can be used to great effect.
In this chapter the editors draw together the learnings from the previous 17 chapters, as well as their own insights into the What Works Network. They produce timely and concrete advice for how to set up a successful What Works Centre, and outline challenges for the future of the network. In addition, they suggest a new format for potential future ‘what works’ initiatives that encourages greater collaboration and less creation of new legal entities.
This chapter, the first in Part II, focuses on the challenges and criticisms levelled at the What Works Network, and addresses the extent to which they are valid and can be mitigated. It covers ten challenges, including: focusing on the right issues; criticisms of randomised controlled trials; issues extrapolating from one domain or geography to another; what counts as evidence; the issues of areas with no evidence; failures to achieve scale for successful interventions; the difficulty of criticising the government from whom centres receive their funding; the difficulty of measuring outcomes; short-termism; and erasure.
The Education Endowment Foundation is the What Works Centre for Education, and the first of the 21st-century What Works Centres to be established. Since its founding in 2011, it has funded hundreds of randomised controlled trials in education, and seen dramatic changes in the use of evidence by schools and teachers. In this chapter, the authors cover the Education Endowment Foundation’s approach to evidence generation, evidence synthesis and evidence mobilisation, as well as their thoughts on the future of evidence in education.
Grassroots movements exist in a number of professions, helping increase demand for evidence as well as aiding in its mobilisation. This chapter, written by a serving police officer about his role as the London coordinator of the Society for Evidence Based Policing, describes how to foster, create and sustain an evidence-based movement at the frontline of a profession.
This chapter is ideal for anyone interested in evidence and trying to create a critical mass of demand within their line of work, or for anyone running an evidence or research organisation who wants to see the outputs of their research made wider user of by a professional group.
