Jonathan Pratschke

Social Polarisation, the Labour Market and Economic Restructuring in Europe: An Urban Perspective

It is frequently argued that changes in the occupational structure and labour markets of European cities have the potential to undermine social cohesion. The term ‘social polarisation’ has been widely employed to characterise this effect, either in a broadly descriptive manner or in line with specific hypotheses. In the first part of this article, alternative definitions are reviewed and the results of empirical research on social polarisation are summarised. Some of its limitations are discussed and its theoretical origins explored. In the second part, attention is turned to the ‘mechanisms’ driving change in workplaces and urban labour markets in Europe. It is argued that an accurate account of changing occupational structures and labour markets in European cities—and a balanced assessment of their consequences for social cohesion—can only be obtained by building up a complex and carefully contextualised analysis of the ways in which these ‘mechanisms’ interact in different cities.

Landslide risk perception: a case study in Southern Italy

Perceptions of risk are a key issue when seeking to develop systems, practices and policies to protect local populations. This is particularly evident when risk mitigation strategies involve non-structural measures such as relocation and warning systems which presuppose the active involvement of the communities in question. This study adopts an interdisciplinary approach to studying the perceptions, knowledge and opinions on landslide risk amongst residents in Sarno, a small town in Southern Italy which was hit by disastrous landslides on 5–6 May 1998. The paper presents the results of a survey conducted in the months of March, April and May 2013 using a purpose-designed questionnaire. The survey was conducted using face-to-face interviews with 100 residents, 60 of whom live inside the so-called “red zone”, a territory declared at high residual risk soon after the events of 1998. The questionnaire included questions relating to perceived risk exposure, trust in institutions responsible for risk management, evaluations of risk mitigation measures and the early-warning strategy. The results of the study clearly emerges, amongst other issues, that the organisms which are responsible for risk management in Sarno need to develop more effective communication strategies in order to transmit knowledge about the actions implemented to reduce landslide risk in the area.

Acute phase protein levels in dogs with mast cell tumours and sarcomas

The acute phase proteins (APP) form part of a non-specific host response to inflammation. They may be induced by a range of different causes, including infection, inflammation, cancer and trauma. As they form part of the earliest response to such insults, they have potential for early identification of disease. In people, APP levels have been shown to correlate both with the extent of disease and also the prognosis in several forms of neoplasia, including prostate, oesophageal and colorectal cancer. As such, they can be used as prognostic and monitoring tools. To date, similar studies in veterinary patients have been limited, largely retrospective in nature and many are non-specific for tumour type. The purpose of this study was to evaluate a panel of four APPs in dogs with naturally occurring mast cell tumours (MCTs) and sarcomas to identify in the first instance whether increased levels of individual APPs, or identifiable combinations of APPs, was linked with the presence of disease. In the patients with MCTs, C-reactive protein (CRP) and α-1 acid glycoprotein levels increased, with a concurrent drop in serum amyloid A levels. In the sarcoma patients, CRP, α-1 acid glycoprotein and haptoglobin were increased. These findings suggest that specific solid tumour types in dogs may be associated with specific changes in APP profiles.

Female employment and the economic crisis

ABSTRACT One of the characteristics of the Italian peninsula is a sharp North-South gradient on many economic and labour market variables. This gradient is particularly marked in relation to female employment, making Italy a particularly useful ‘laboratory’ for studying changes in gender roles. Esping-Andersens description of the decline of the ‘male breadwinner’ model and the search for a ‘new equilibrium’ in gender roles is suggestive, but the assumption that current processes will inevitably converge towards a relatively homogeneous social configuration (exemplified by the Scandinavian countries) is rather unconvincing. We will show in this article that the Italian case comprises macro-regions with very different female employment rates and highly differentiated welfare systems. Furthermore, one of the effects of the economic crisis has been to obstruct the entry of women into paid work, particularly in the South where employment rates are already at a very low level. When discussing trends and changes in womens roles, it is important to remember that the resulting transformations are plural, contingent and discontinuous and strongly shaped by prevailing socio-economic conditions. In the context of a prolonged and severe crisis, the differences between Northern and Southern Italy have been further accentuated, impeding the development of coherent policy responses and obstructing change in gender roles.

Mechanisms and mediation in survival analysis: towards an integrated analytical framework

BackgroundA wide-ranging debate has taken place in recent years on mediation analysis and causal modelling, raising profound theoretical, philosophical and methodological questions. The authors build on the results of these discussions to work towards an integrated approach to the analysis of research questions that situate survival outcomes in relation to complex causal pathways with multiple mediators. The background to this contribution is the increasingly urgent need for policy-relevant research on the nature of inequalities in health and healthcare.MethodsThe authors begin by summarising debates on causal inference, mediated effects and statistical models, showing that these three strands of research have powerful synergies. They review a range of approaches which seek to extend existing survival models to obtain valid estimates of mediation effects. They then argue for an alternative strategy, which involves integrating survival outcomes within Structural Equation Models via the discrete-time survival model. This approach can provide an integrated framework for studying mediation effects in relation to survival outcomes, an issue of great relevance in applied health research. The authors provide an example of how these techniques can be used to explore whether the social class position of patients has a significant indirect effect on the hazard of death from colon cancer.ResultsThe results suggest that the indirect effects of social class on survival are substantial and negative (-0.23 overall). In addition to the substantial direct effect of this variable (-0.60), its indirect effects account for more than one quarter of the total effect. The two main pathways for this indirect effect, via emergency admission (-0.12), on the one hand, and hospital caseload, on the other, (-0.10) are of similar size.ConclusionsThe discrete-time survival model provides an attractive way of integrating time-to-event data within the field of Structural Equation Modelling. The authors demonstrate the efficacy of this approach in identifying complex causal pathways that mediate the effects of a socio-economic baseline covariate on the hazard of death from colon cancer. The results show that this approach has the potential to shed light on a class of research questions which is of particular relevance in health research.

Evaluating Springboard: impact of a family support programme in Ireland

The article reports results from an evaluation of Springboard, a family support programme introduced in Ireland during 1998. The evaluation is based on a non‐experimental design involving a pre‐post comparison of 319 children and 191 parents who participated in the programme. The two main outcomes reported here are childrens psychological well‐being (measured by the Strengths and Difficulties Questionnaire ‐ SDQ), and the parent‐child relationship (measured by the Parent‐Child Relationship Inventory ‐ PCRI). Results showed improvements in SDQ and PCRI scores, equivalent to an effect size in the range 0.2 to 0.3, which is similar to the effect sizes produced by other family support programmes. At the end of the intervention, there was still a substantial amount of unmet need among children. The evaluation has two limitations: first, the use of a non‐experimental method means that we cannot be certain that all of the improved outcomes can be attributed to Springboard; second, the diverse interventions which constitute Springboard, and family support programmes generally, means that it is impossible to separate effective from ineffective interventions within the programme.

Influence of socioeconomic status on allograft and patient survival following kidney transplantation

Whether socioeconomic status confers worse outcomes after kidney transplantation is unknown. Its influence on allograft and patient survival following kidney transplantation in Ireland was examined.

Direct and indirect influences of socio-economic position on the wellbeing of older adults: a Structural Equation Model using data from the first wave of the Irish Longitudinal Study on Ageing

ABSTRACT The authors use Structural Equation Modelling techniques to analyse the determinants of wellbeing amongst older adults using data from the first wave of the Irish Longitudinal Study on Ageing (TILDA), a rich source of data on people aged over 50 and living in private households. The analysis uses a two-group linear statistical model to explore the influence of socio-economic position on the wellbeing of men and women, with Full Information Maximum Likelihood estimation to handle missing data. The fit indices for the final model are highly satisfactory and the measurement structure is invariant by gender and age. The results indicate that socio-economic position has a significant direct influence on wellbeing and a strong indirect influence which is mediated by health status and lifestyle. The total standardised effect of Socio-economic Position on Socio-emotional Wellbeing is statistically significant (p ⩽ 0.05) and equal to 0.32 (men) and 0.43 (women), a very strong influence which risks being underestimated in standard multivariate models. The authors conclude that health, cognitive functioning and wellbeing reflect not just the ageing process, but also the impact of social inequalities across the lifecourse and how they are transmitted across different life spheres. These results can help to orient future research on factors which mediate between socio-economic position and wellbeing, an important policy-related issue.

Causes and outcomes of emergency presentation of rectal cancer

Emergency presentation of rectal cancer carries a relatively poor prognosis, but the roles and interactions of causative factors remain unclear. We describe an innovative statistical approach which distinguishes between direct and indirect effects of a number of contextual, patient and tumour factors on emergency presentation and outcome of rectal cancer. All patients diagnosed with rectal cancer in Ireland 2004–2008 were included. Registry information, linked to hospital discharge data, provided data on patient demographics, comorbidity and health insurance; population density and deprivation of area of residence; tumour type, site, grade and stage; treatment type and optimality; and emergency presentation and hospital caseload. Data were modelled using a structural equation model with a discrete‐time survival outcome, allowing us to estimate direct and mediated effects of the above factors on hazard, and their inter‐relationships. Two thousand seven hundred and fifty patients were included in the analysis. Around 12% had emergency presentations, which increased hazard by 80%. Affluence, private patient status and being married reduced hazard indirectly by reducing emergency presentation. Older patients had more emergency presentations, while married patients, private patients or those living in less deprived areas had fewer than expected. Patients presenting as an emergency were less likely to receive optimal treatment or to have this in a high caseload hospital. Apart from stage, emergency admission was the strongest determinant of poor survival. The factors contributing to emergency admission in this study are similar to those associated with diagnostic delay. The socio‐economic gradient found suggests that patient education and earlier access to endoscopic investigation for public patients could reduce emergency presentation.

The influence of socioeconomic status on patient survival on chronic dialysis

Socioeconomic status (SES) has been linked to worse end‐stage kidney disease survival. The effect of SES on survival on chronic dialysis, including the impact of transplantation, was examined. A retrospective, observational study investigated the association of SES with dialysis patient survival, with censoring at time of transplantation. Adult patients commencing dialysis from 1990 to 2009 in an Irish tertiary center received a spatial SES score using the 2011 Pobal Haase‐Pratschke Deprivation Index and were compared by quartile. Cox proportional hazard models and Kaplan–Meier survival analysis examined any association of SES with survival. The 1794 patients included had a median follow‐up of 3.8 years. Patients in the lowest SES area quartile were significantly younger than the highest, mean age 56.7 vs. 59 years, P = 0.006, respectively. There was no association between SES area score and survival in an unadjusted model (hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.99–1.01). Survival in the highest SES area quartile was superior to the lowest SES in a multivariable adjusted model including age, gender, and dialysis modality (HR 0.83, 95% CI 0.70–0.99, P = 0.04). These results were only mildly attenuated by censoring at time of transplantation (highest SES area quartile deprived vs. lowest SES area quartile, HR 0.85, 95% CI 0.70–1.03, P = 0.09). Superior patient survival was identified in the highest SES areas compared with the lowest following age‐adjusted analyses, despite the older population in the most affluent areas. Further research should focus on identifying modifiable targets for intervention that account for this socioeconomic‐related survival advantage.