Cancer-related fatigue:A critical appraisal

This aim of this systematic review was to determine the prevalence and pattern of cancer-related fatigue (CRF), and identify factors associated with its development. Relevant literature was identified through an electronic database search using specified keywords. Included studies investigated CRF in adult cancer patients using a multidimensional fatigue measure. The methodological quality was assessed using six published standards. CRF is apparent both during and after anti-cancer therapy, however, the prevalence of CRF varied between studies. The variables associated with the development and persistence of CRF remain to be identified. Inconsistencies were evident in the pattern of CRF and its associated factors. This is likely to have arisen from the inherent difficulties in the measurement of a subjective sensation, further complicated by the myriad of outcome measures used. More methodologically sound research; assessing CRF from the commencement of therapy, considering all pertinent variables is needed.

Nurse-mediated serum cholesterol reduction and health locus of control--a device for targeting health promotion?

Varying intensities of nurse-mediated health education advice were administered to subjects over a three-month period. Mean serum total cholesterol was calculated for each group at the outset and completion of the study. A multidimensional health locus of control (MHLC) scales questionnaire was self-completed by subjects at the outset. A highly significant association between internality and reduction in serum total cholesterol in the high-intensity intervention group was observed. The completion of a MHLC scale questionnaire may assist health professionals in identifying which subjects may most benefit from high-intensity health education advice when raised serum total cholesterol is prevalent.

Enabling Social Work Students to Deal with the Consequences of Political Conflict: Engaging with Victim/Survivor Service Users and a ‘Pedagogy of Discomfort’

This paper describes the evaluation of an educational project, delivered in a Bachelor in Social Work degree (BSW) program in Northern Ireland. The project aimed to equip social work students to be more culturally competent in this divided society, with a central focus on including victim/survivor service users in social work training. A number of pedagogical approaches are noted, with particular consideration of Boler's ‘pedagogy of discomfort’ as a model that includes the multidimensional nature of the learning process when topics carry a high emotional tariff. The evaluation of the students' experience indicated that: there was strong support among students for the project; the unique contribution of service users was affirmed; and the project appeared to increase students' awareness and capacity to practice in a divided society. The evaluation of the trainers' experience highlighted key processes in the delivery of collaborative training. The authors argue that the lessons learned are broadly applicable to other forms of service user and carer involvement in social work training and in other societies in which health and social care professionals have to deal with the legacies of political conflict.

Social Class Variation in Risk: A Comparative Analysis of the Dynamics of Economic Vulnerability

A joint concern with multidimensionality and dynamics is a defining feature of the pervasive use of the terminology of social exclusion in the European Union. The notion of social exclusion focuses attention on economic vulnerability in the sense of exposure to risk and uncertainty. Sociological concern with these issues has been associated with the thesis that risk and uncertainty have become more pervasive and extend substantially beyond the working class. This paper combines features of recent approaches to statistical modelling of poverty dynamics and multidimensional deprivation in order to develop our understanding of the dynamics of economic vulnerability. An analysis involving nine countries and covering the first five waves of the European Community Household Panel shows that, across nations and time, it is possible to identify an economically vulnerable class. This class is characterized by heightened risk of falling below a critical resource level, exposure to material deprivation and experience of subjective economic stress. Cross-national differentials in persistence of vulnerability are wider than in the case of income poverty and less affected by measurement error. Economic vulnerability profiles vary across welfare regimes in a manner broadly consistent with our expectations. Variation in the impact of social class within and across countries provides no support for the argument that its role in structuring such risk has become much less important. Our findings suggest that it is possible to accept the importance of the emergence of new forms of social risk and acknowledge the significance of efforts to develop welfare states policies involving a shift of opportunities and decision making on to individuals without accepting the 'death of social class' thesis.

Governing Ireland:From Cabinet Government to Delegated Governance

The structures of Irish government were once considered reliably stable, professional and efficient. The economic crash of 2008 swept away all such sureties. How did we fail to foresee the challenges and avert a crisis that has undermined the state in every respect? Initial explanations have focused on the absence of robust mechanisms to challenge policy, a lack of imagination and expertise in policy design, and inadequacies in policy implementation and evaluation. Others still have pointed to the inability of traditional structures of decision-making and oversight to manage the multidimensional nature of modern policy problems, as well as an increasingly complex administrative system.

This new book offers a fresh and sustained scrutiny of the Irish system of national government. It examines the cabinet, the departments of Finance and the Taoiseach, ministerial relationships with civil servants, the growth and decline of agencies, the executive's relationship with Dáil Éireann and other monitoring agencies, the impact of the European Union, the courts, the media and social partnership. Distinguished academics are brought together in this volume to reassess Irish governance structures in the context of much greater diversity in policy processes and delegation in government. The book is essential reading for anyone interested in how the Irish state is governed, including practitioners and students of Irish politics.

Welfare regime and social class variation in poverty and economic vulnerability in Europe: an analysis of EU-SILC

In this paper we address a set of interrelated issues. These comprise increasing concerns about reliance on nationally based income poverty measures in the context of EU enlargement, the relative merits of one-dimensional versus multidimensional approaches to poverty and social exclusion and the continuing relevance of class-based explanations of life chances. When identifying economically vulnerable groups we find that, contrary to the situation with national income poverty measures, levels of vulnerability vary systematically across welfare regimes. The multidimensional profile of the economically vulnerable sharply differentiates them from the remainder of the population. While they are also characterised by distinctively higher levels of multiple deprivation, a substantial majority of the economically vulnerable are not exposed to such deprivation. Unlike the national relative income approach, the focus on economic vulnerability reveals a pattern of class differentiation that is not dominated by the contrast between the self-employed and all others. In contrast to a European-wide relative income approach, it also simultaneously captures the fact that absolute levels of vulnerability are distinctively higher among the lower social classes in the less comprehensive and generous welfare regimes while class relativities are significantly sharper at the other end of the spectrum.

"New" and "Old" Social Risks: Life Cycle and Social Class Perspectives on Social Exclusion in Ireland

The life cycle concept has come to have considerable prominence in Irish social policy debate. However, this has occurred without any systematic effort to link its usage to the broader literature relating to the concept. Nor has there been any detailed consideration of how we should set about operationalising the concept. In this paper we argue the need for "macro" life cycle perspectives that have been influenced by recent challenges to the welfare state to be combined with "micro" perspectives focusing on the dynamic and multidimensional nature of social exclusion. We make use of Irish EU-SILC 2005 data in developing a life cycle schema and considering its relationship to a range of indicators of social exclusion. At the European level renewed interest in the life cycle concept is associated with the increasing emphasis on the distinction between "new" and "old" social risks and the notion that the former are more "individualised". Inequality and poverty rather than being differentially distributed between social classes are thought to vary between phases in the average work life. Our findings suggest the "death of social class" thesis is greatly overblown. A more accurate appreciation of the importance of new and old social risks requires that we systematically investigate the manner in which factors such as social class and the life cycle interact.

Measuring material deprivation with EU-SILC: Lessons from the Irish survey

In this paper we consider the consequences for measurement of material deprivation, consistent poverty and economic vulnerability of the shift from the ECHP data set to the EU-SILC instrument. Despite the restricted number of deprivation items available in EU-SILC, we show that there is a substantial overlap between such measures when they are estimated using EU-wide and a set of Irish specific indicators. By placing the EU-wide measures in the context of the full range of Irish indicators, we demonstrate that they allow us to identify clusters of individuals sharply differentiated in terms of their multidimensional deprivation profiles. They also provide an understanding of the socio-economic factors associated with such differentiation that departs in only modest respects from that derived from the more comprehensive set of Irish specific indicators.

Income, deprivation and economic stress in the enlarged European Union

At risk of poverty indicators based on relative income measures suggest that within the enlarged EU societies located at quite different points on a continuum of affluence have similar levels of poverty. Substantial differences in levels of income between societies do not in themselves invalidate this approach. However, the relative income approach fails to capture the fact that, if countries are grouped in terms of level of GDP, between economic cluster differences in life-style deprivation are sharper at lower income levels. Support for the argument relating to restricted reference groups is found in relation to the contrast between the twelve most affluent EU countries and all others. The limitations of relative income poverty lines have little to do with the process of enlargement as such. Instead the major problem involves the weak association between income and deprivation in the more affluent countries. However, as a consequence of such difficulties, such indicators do not provide entirely meaningful comparisons of levels of disadvantage across economic clusters. The current analysis, rather than supporting the alternative of a focus on absolute income or an EU wide poverty line, suggests that we should take the argument for adopting a multidimensional approach to the measurement of poverty more seriously.

Levels and patterns of material deprivation in Ireland: After the 'Celtic tiger'

In this article we use the first full wave of the Irish component of the EU Statistics on Income and Living Conditions survey to evaluate conflicting interpretations of levels and patterns of material deprivation in Ireland after the 'Celtic Tiger'. Radical critics of Irish economic policies have seen the Irish case as a particularly good illustration of the tendency for globalization to be accompanied by widespread economic vulnerability and marginalization. Here, employing a multidimensional perspective we identify one fifth of the population as being economically vulnerable and one in 14 as vulnerable to maximal deprivation, in that they exhibit high risks of deprivation across a range of life-style deprivation dimensions. Current levels and depth of material deprivation are a good deal more modest than suggested by radical critics of the Irish experience of economic globalization.

Analyzing Intergenerational Influences on Income Poverty & Economic Vulnerability with EU-SILC

The European Union Statistics of Income and Living Conditions
(EU-SILC) 2005 wave includes a special module on inter-generational
transmission of poverty. In addition to the standard data relating to income
and material deprivation, information relating to parental background and
childhood circumstances was collected for all household members aged over
24 and less than 66 at the end of the income reference period. In principle,
the module provides an unprecedented opportunity to apply a welfare regime
perspective to a comparative European analysis of the relationship between
poverty and social exclusion and parental characteristics and childhood
economic circumstances. In this paper, we seek to exploit such potential. In
pursuing this objective, it is necessary to take into account some of the
limitations of the data. We do by restricting our attention to a set of
countries where data issues seem less extreme. Finally, we compare findings
from one dimensional and multidimensional approaches to poverty and social
exclusion in order to provide an assessment of the extent to which our
analysis of welfare regime variation provides a coherent account of the
intergenerational transmission of disadvantage.

Identifying childhood deprivation:How well do national indicators of poverty and social exclusion in Ireland Perform?

In the context of the significance that the life-cycle has been afforded in social policy discussion in Ireland, current national measures of poverty and social exclusion have been criticised for failing to capture such phenomena accurately in relation to particular stages of the life-course. In this paper we have taken advantage of the inclusion of a special module on childhood deprivation in EU-SILC 2009 to create reliable measures of both household basic deprivation and childhood deprivation. Overall, our analysis leads us to the conclusion that those exposed to childhood deprivation are generally a sub-set of the children captured by population indicators. Adopting a multidimensional and dynamic perspective on household resources and deprivation enables us to capture the large majority of children exposed to childhood deprivation. Restricting our attention to childhood deprivation would lead us to miss out on a significant number of children living in households experiencing basic deprivation but not exposed to childhood deprivation. It would be unwise to assume that such deprivation has no consequences for children. While there is clearly a value in supplementing existing national measures with child specific indicators, it would not appear sensible to rely solely on the latter.

Assessing pain in preterm infants in the neonatal intensive care unit:moving to a 'brain-oriented' approach

Preterm infants in the neonatal intensive care unit undergo repeated exposure to procedural and ongoing pain. Early and long-term changes in pain processing, stress-response systems and development may result from cumulative early pain exposure. So that appropriate treatment can be given, accurate assessment of pain is vital, but is also complex because these infants' responses may differ from those of full-term infants. A variety of uni- and multidimensional assessment tools are available; however, many have incomplete psychometric testing and may not incorporate developmentally important cues. Near-infrared spectroscopy and/or EEG techniques that measure neonatal pain responses at a cortical level offer new opportunities to validate neonatal pain assessment tools.

Initial validation of the Behavioral Indicators of Infant Pain (BIIP)

Accurate pain assessment in preterm infants in the neonatal intensive care unit (NICU) is complex. Infants who are born at early gestational ages (GA), and who have had greater early pain exposure, have dampened facial responses which may lead to under-treatment. Since behavioral and physiological responses to pain in infants are often dissociated, using multidimensional scales which combine these indicators into a single score may limit our ability to determine the effects of interventions on each system. Our aim was to design a unidimensional scale which would combine the relatively most specific, individual, behavioral indicators for assessing acute pain in this population. The Behavioral Indicators of Infant Pain (BIIP) combines sleep/wake states, 5 facial actions and 2 hand actions. Ninety-two infants born between 23 and 32 weeks GA were assessed during 3, 1 min Phases of blood collection. Outcome measures included changes in BIIP and in Neonatal Infant Pain Scale (NIPS) scores coded in real time from continuous bedside video recordings; changes in heart rate (HR) were obtained using custom physiological processing software. Scores on the BIIP changed significantly across Phases of blood collection (p

Healthcare professionals’ response to cachexia in advanced cancer: A qualitative study

Purpose/Objectives: To explore healthcare professionals' experience, understanding, and perception of the needs of patients with cachexia in advanced cancer.

Research Approach: A qualitative approach based on symbolic interactionism.

Setting: A regional cancer center in a large teaching hospital in the United Kingdom.

Participants: 34 healthcare professionals who had experience providing care to patients with cachexia in advanced cancer.

Methodologic Approach: Data collection consisted of two phases: focus group and semistructured interviews. Interviews were digitally recorded and transcribed verbatim for analysis. This article reports on findings from the second phase of data collection.

Findings: Analysis revealed that professional approaches to cachexia were influenced by three overarching and interthinking themes: knowledge, culture, and resources. Healthcare professionals commonly recognized the impact of the syndrome; however, for nonpalliative healthcare professionals, a culture of avoidance and an overreliance on the biomedical model of care had considerable influence on the management of cachexia in patients with advanced cancer.

Conclusions: Cachexia management in patients with advanced cancer can be difficult and is directed by a variable combination of the influence of knowledge, culture of the clinical area, and available resources. Distinct differences exist in the management of cachexia among palliative and nonpalliative care professionals.

Interpretation: This study presented a multiprofessional perspective on the management of cachexia in patients with advanced cancer and revealed that cachexia is a complex and challenging syndrome that needs to be addressed from a holistic model of care.

Knowledge Translation: Cachexia management in patients with advanced cancer is complex and challenging and is directed by a combination of variables. An overreliance on the biomedical model of health and illness occurs in the management of cachexia in patients with advanced cancer. Cachexia needs to be addressed from a holistic model of care to reflect the multidimensional needs of patients and their families.