Impact of average household income and damage exposure on post-earthquake distress and functioning: A community study following the February 2011 Christchurch earthquake.

Post-traumatic stress, depression and anxiety symptoms are common outcomes following earthquakes, and may persist for months and years. This study systematically examined the impact of neighbourhood damage exposure and average household income on psychological distress and functioning in 600 residents of Christchurch, New Zealand, 4–6 months after the fatal February, 2011 earthquake. Participants were from highly affected and relatively unaffected suburbs in low, medium and high average household income areas. The assessment battery included the Acute Stress Disorder Scale, the depression module of the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder Scale (GAD-7), along with single item measures of substance use, earthquake damage and impact, and disruptions in daily life and relationship functioning. Controlling for age, gender and social isolation, participants from low income areas were more likely to meet diagnostic cut-offs for depression and anxiety, and have more severe anxiety symptoms. Higher probabilities of acute stress, depression and anxiety diagnoses were evident in affected versus unaffected areas, and those in affected areas had more severe acute stress, depression and anxiety symptoms. An interaction between income and earthquake effect was found for depression, with those from the low and medium income affected suburbs more depressed. Those from low income areas were more likely, post-earthquake, to start psychiatric medication and increase smoking. There was a uniform increase in alcohol use across participants. Those from the low income affected suburb had greater general and relationship disruption post-quake. Average household income and damage exposure made unique contributions to earthquake-related distress and dysfunction.

Willingness to pay for potential enhancements to a low-cost cataract surgical package in rural southern China.

PURPOSE: To assess determinants of patients' willingness to pay (WTP) for potential components of a multi-tiered cataract surgical package offered by a non-governmental organization (NGO) in rural China. DESIGN: Cross-sectional study. METHODS: Demographic and clinical data were collected from 505 patients presenting for cataract screening or surgery in Yangjiang, China. Willingness to pay for potential enhancements to the current surgery package was assessed using a bidding format with random payment cards. RESULTS: Among 426 subjects (84.4%) completing interviews, the mean age was 73.9 ± 7.3 years, 67.6% were women and 73% (n = 310) would pay for at least one offering, with 33-38% WTP for each item. Among those who would pay, the mean WTP for food was US$1.68 ± 0.13, transportation US$3.24 ± 0.25, senior surgeon US$50.0 ± 3.36 and US$89.4 ± 4.19 for an imported intra-ocular lens (IOL). The estimated total recovery from these enhancements under various assumptions would be US$20-50 (compared to the current programme price of US$65). In multivariate models, WTP for the senior surgeon increased with knowledge of a person previously operated for cataract (OR = 2.13, 95% CI 1.42-3.18, p < 0.001). Willingness to pay for the imported IOL increased with knowledge of a previously operated person (OR = 1.85, 95% CI 1.24-2.75, p < 0.01) and decreased with age >75 years (OR = 0.61, 0.40-0.93, p < 0.05). CONCLUSIONS: Opportunities exist to increase cataract programme revenues through multi-tiered offerings in this setting, allowing greater subsidization of low-income patients. Personal familiarity with cataract surgery is important in determining WTP. © 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.

Social identification and prevalence of PTSD in Northern Ireland

Background Understanding of the psychological impact of politically motivated violence is poor. Aims To examine the prevalence of post-traumatic symptoms subsequentto the ‘troubles’ in Northern Ireland. Method A telephone survey of 3000 adults, representative of the population in Northern Ireland and the border counties of the Irish Republic, examined exposure to political violence, post-traumatic stress disorder (PTSD) and national identity. Results Ten per cent of respondents had symptoms suggestive of clinical PTSD. These people were most likely to come from low-income groups, rate national identity as relatively unimportant and have higher overall experience of the ‘troubles’than other respondents. Conclusions Direct experience of violence and poverty increase the risk of PTSD, whereas strong national identification appears to reduce this risk.

A Sheep in Wolf’s Clothing: Exploring Researcher Vulnerability

ABSTRACT Methodological concerns surrounding the research of vulnerable consumers tend to focus on respondents’ welfare, that they are not harmed or further disadvantaged by the research process (Reinharz 1992; Finch 1984). Consequentially, researcher vulnerability has been largely neglected within the consumer research literature. This paper aims to identify the ways that research with vulnerable consumers can impact on consumer researchers. Reflecting on our doctoral research experiences with vulnerable consumers, namely low income families and consumers confined to the home due to disability, we identify areas where the physical and psychological vulnerability of the researcher was exposed and the resulting strategies employed.

The Belfast Victorian Terrace: A Sustainable Approach?

To help the building of new low-carbon housing, recent years have seen the widespread demolition of Victorian housing in UK cities. In this regard, Belfast is no different from its counterparts on the British mainland, where Compulsory Purchase Orders force people to sell and vacate their terraced homes to make way for newly constructed 'sustainable' housing. The global economic downturn has temporarily slowed down this process leaving many Belfast terraces now blocked up awaiting future demolition. This stay of execution is an unlikely but welcome opportunity to review and assess the true value to owner, streetscape and city of this important and common house-type. Important questions need to be asked. Should sound Victorian terraces be demolished? What is the genuine cost of demolition and replacement in terms of community and environment? With reference to case studies in a Belfast context, the argument will be made that new is not necessarily better, that the existing Victorian terrace is an important and valuable resource and one that, with intelligent intervention, offers a genuinely sustainable alternative to new-build housing.

Family Histories and Rural Inheritance in Kenya

Inheritance systems and practices have a key role in people’s ability to exit poverty, or, conversely, plunging them further into it. As land is the major asset in low-income developing countries, how property is passed on and divided between future generations is a significant factor. This paper looks at inheritance through minimally-structured interviews with several generations of Kenyan families, seeking to explain that the how and why of poverty can be understood in the wider family context. It analyses their fortunes and misfortunes over a given time period in the context of property ownership rights. It also looks at the impact of education and the inheritance of cultural capital. When both fertility and survival are high, traditional patterns of land inheritance can lead to progression sub-division of land with long-term adverse implications for sustainability. While inheritance in Kenya is male dominated, the paper nonetheless examines the position of women in the chain as vectors of male property rights. The application of male-oriented customary law where inheritance is concerned, rather than the use of statutory legislation, was found to be the reality for the overwhelming majority of the participants in the study.

School Neighborhood Disadvantage as a Predictor of Long-Term Sick Leave Among Teachers: Prospective Cohort Study

This ongoing prospective study examined characteristics of school neighborhood and neighborhood of residence as predictors of sick leave among school teachers. School neighborhood income data for 226 lower-level comprehensive schools in 10 towns in Finland were derived from Statistics Finland and were linked to register-based data on 3,063 teachers with no long-term sick leave at study entry. Outcome was medically certified (> 9 days) sick leave spells during a mean follow-up of 4.3 years from data collection in 2000-2001. A multilevel, cross-classified Poisson regression model, adjusted for age, type of teaching job, length and type of job contract, school size, baseline health status, and income level of the teacher's residential area, showed a rate ratio of 1.30 (95% confidence interval: 1.03, 1.63) for sick leave among female teachers working in schools located in low-income neighborhoods compared with those working in high-income neighborhoods. A low income level of the teacher's residential area was also independently associated with sick leave among female teachers (rate ratio = 1.50, 95% confidence interval: 1.18, 1.91). Exposure to both low-income school neighborhoods and low-income residential neighborhoods was associated with the greatest risk of sick leave (rate ratio = 1.71, 95% confidence interval: 1.27, 2.30). This study indicates that working and living in a socioeconomically disadvantaged neighborhood is associated with increased risk of sick leave among female teachers.

Haematite in Lateritic Soils Aids Groundwater Disinfection

Microbiologically contaminated water severely impacts public health in low-income countries, where treated water supplies are often inaccessible to much of the population. Groundwater represents a water source that commonly has better microbiological quality than surface water. A 2-month intensive flow and quality monitoring programme of a spring in a densely settled, unsewered parish of Kampala, Uganda, revealed the persistent presence of high chloride and nitrate concentrations that reflect intense loading of sewage in the spring’s catchment. Conversely, thermotolerant coliform bacteria counts in spring water samples remained very low outside of periods of intense rainfall. Laboratory investigations of mechanisms responsible for this behavior, achieved by injecting a pulse of H40/1 bacteriophage tracer into a column packed with locally derived granular laterite, resulted in near-total tracer adsorption. X-ray diffraction (XRD) analysis showed the laterite to consist predominantly of quartz and kaolinite, with minor amounts (<5%) of haematite. Batch studies comparing laterite adsorption capacity with a soil having comparable mineralogy, but with amorphous iron oxide rather than haematite, showed the laterite to have a significantly greater capacity to adsorb bacteriophage. Batch study results using pure haematite confirmed that its occurrence in laterite contributes substantially to micro-organism attenuation observed and serves to protect underlying groundwater.

Context matters! Thinking about what you give

Many of us when faced with someone who is in less fortunate circumstances than ourselves think what can I do to help? What can I give? But for those of us who are not millionaires much of what we give is related to what we can afford and what we think might be of use to someone. So we may think of giving someone who is hungry some food, sponsoring a child in school, or buying a copy of The Big Issue. For those travelling to low income communities many of us would like to bring something that may be useful to our host communities. But what do we bring?

This article presents some of the findings from the Trickle Out Project fieldwork looking about how we can make donations that are appropriate to on the ground conditions in less developing countries

Comparing Poverty Indicators in an Enlarged European Union

In this article, we explore the extent to which a consideration of welfare regime and socioeconomic differences in poverty levels and patterns can assist us in making an informed assessment of alternative poverty indicators. Poverty in the EU is normally defined in terms of income thresholds at the level of each member state. However, with the enlargement of the EU, such measures have come in for increasing criticism. One set of reservation relates to the limitations imposed by an entirely national frame of reference. An alternative critique focuses on the fact that low income is an unreliable indicator of poverty. In this article, we seek to explore the strength of both arguments by comparing the outcomes associated with ‘at risk of poverty’ and consistent poverty at both national and EU levels. Developing an appropriate assessment of poverty levels in the enlarged EU, particularly in periods of rapid change, is likely to require that we make use of a number of indicators none of which capture the full complexity of cross-national poverty outcomes. However, our analysis suggests that if a choice is to be made between the available indicators, the ‘mixed consistent poverty’ indicator developed in this study is best suited to achieving the stated EU objective of assessing the scale of exclusion from minimally acceptable standards of living in individual countries while also measuring the extent to which the whole population of Europe is sharing in the benefits of high average prosperity.

Knowledge of UK physical activity guidelines:Implications for better targeted health promotion

Objective. The aim of this study is to investigate the correlates of knowledge of the UK physical activity (PA) guidelines.

Method. A Northern Ireland-wide population survey (2010/2011) of 4653 adults provided cross-sectional data on PA, knowledge of guidelines and socio demographic characteristics. Multinomial logistic regression was used to investigate the associations between knowledge and socio-demographic characteristics (Model 1); and modifiable health behaviours (Model 2).

Results. Results showed that 47% of respondents were unaware of PA guidelines. Males who had a lower level of education (OR 5.91; 95% CI 1.67, 20.94), lived in more deprived areas (OR 4.80; 95% CI 1.87, 12.30), low income (OR 2.36; 95% CI 1.63, 3.41) and did no PA (OR 2.74; 95% CI 1.31, 5.76) were more likely to be unaware of the guidelines. Females who were younger (OR 1.03; 95% CI 1.02, 1.05) and reported poor health (OR 2.71; 95% CI 1.61, 4.58) were more likely to be unaware of the guidelines.

Conclusion. There is a lack of awareness about the levels of PA needed to promote health. An understanding of the characteristics of those who are unaware of the guidelines has important implications for the design of targeted, effective health promotion.

Inequality, state ownership and the European Union: How economic context and economic ideology shape support for the European Union

This article investigates the extent to which economic ideology affects people's support for European Union integration and how this is conditioned by economic context. We argue that people on the economic left who live in a country with conditions of high income inequality and little state ownership will support European integration, because more integration would move public policy in a left-wing direction. By contrast, people on the left who live in a country with conditions of low income inequality and widespread public ownership are likely to be eurosceptic, as further integration would result in a more right-wing public policy. We empirically confirm our hypotheses and discuss the implications for European Union democracy.

Comparative Assessment of Methods for Measuring Consensual Poverty: Sort Card Versus CAPI

Poverty means more than having a low income and includes exclusion from a minimally accepted way of life. It is now common practice in Europe to measure progress against poverty in terms of low income, material deprivation rates and some combination of both. This makes material deprivation indicators, and their selection, highly significant in its own right. The ‘consensual poverty’ approach is to identify deprivation items which a majority of the population agree constitute life’s basic necessities, accepting that these items will need revised over time to reflect social change. Traditionally, this has been carried out in the UK through specialised poverty surveys using a Sort Card (SC) technique.

Based on analysis of a 2012 omnibus survey, and discussions with three interviewers, this article examines how perception of necessities is affected by mode of administration – SC and Computer Assisted Personal Interviewing (CAPI). More CAPI respondents scored deprivation items necessary. Greatest disparities are in material items where 25 out of 32 items were significantly higher via CAPI. Closer agreement is found in social participation with 3 out of 14 activities significantly different. Consensus is higher on children’s material deprivation.
We consider influencing variables which could account for the disparities and believe that the SC method produces a more considered response. However, in light of technological advances, we question how long the SC method will remain socially acceptable. This paper concludes that the CAPI method can be easily modified without compromising the benefits of the SC method in capturing thoughtful responses.

The worldwide epidemic of diabetic retinopathy

Diabetic retinopathy (DR), a major microvascular complication of diabetes, has a significant impact on the world′s health systems. Globally, the number of people with DR will grow from 126.6 million in 2010 to 191.0 million by 2030, and we estimate that the number with vision-threatening diabetic retinopathy (VTDR) will increase from 37.3 million to 56.3 million, if prompt action is not taken. Despite growing evidence documenting the effectiveness of routine DR screening and early treatment, DR frequently leads to poor visual functioning and represents the leading cause of blindness in working-age populations. DR has been neglected in health-care research and planning in many low-income countries, where access to trained eye-care professionals and tertiary eye-care services may be inadequate. Demand for, as well as, supply of services may be a problem. Rates of compliance with diabetes medications and annual eye examinations may be low, the reasons for which are multifactorial. Innovative and comprehensive approaches are needed to reduce the risk of vision loss by prompt diagnosis and early treatment of VTDR.

Social Ecological Constraints to Park Use in Communities with Quality Access

Evidence correlates physical activity, psychological restoration, and social health to proximity to parks and sites of recreation. The purpose of this study was to identify perceived constraints to park use in low-income communities facing significant health disparities, with access to underutilized parks. We used a series of focus groups with families, teens, and older adults in neighborhoods with similar demographic distribution and access to parks over 125 acres in size. Constraints to park use varied across age groups as well as across social ecological levels, with perceived constraints to individuals, user groups, communities, and society. Policies and interventions aimed at increasing park use must specifically address barriers across social ecological levels to be successful.