Progress and the Lack of Progress in Addressing Infant Health and Infant Health Inequalities in Ireland during the 20th Century

There is a growing literature which documents the importance of early life environment for outcomes across the life cycle. Research, including studies based on Irish data, demonstrates that those who experience better childhood conditions go on to be wealthier and healthier adults. Therefore, inequalities at birth and in childhood shape inequality in wellbeing in later life, and the historical evolution of the mortality and morbidity of children born in Ireland is important for understanding the current status of the Irish population. In this paper, I describe these patterns by reviewing the existing literature on infant health in Ireland over the course of the 20th century. Up to the 1950s, infant mortality in Ireland (both North and South) was substantially higher than in other developed countries, with a large penalty for those born in urban areas. The subsequent reduction in this penalty, and the sustained decline in infant death rates, occurred later than would be expected from the experience in other contexts. Using records from the Rotunda Lying-in Hospital in Dublin, I discuss sources of disparities in stillbirth in the early 1900s. Despite impressive improvements in death rates since that time, a comparison with those born at the end of the century reveals that Irish children continue to be born unequal. Evidence from studies which track people across the life course, for example research on the returns to birthweight, suggests that the economic cost of this early life inequality is substantial.

Life expectancy for community-based patients with heart failure from time of diagnosis

AIMS: Heart failure has been demonstrated in previous studies to have a dismal prognosis. However, the modern-day prognosis of patients with new onset heart failure diagnosed in the community managed within a disease management programme is not known. The purpose of this study is to report on prognosis of patients presenting with new onset heart failure in the community who are subsequently followed in a disease management program.

METHODS AND RESULTS: A review of patients referred to a rapid access heart failure diagnostic clinic between 2002 and 2012 was undertaken. Details of diagnosis, demographics, medical history, medications, investigations and mortality data were analysed. A total of 733 patients were seen in Rapid Access Clinic for potential new diagnosis of incident of heart failure. 38.9% (n=285) were diagnosed with heart failure, 40.7% (n=116) with HF-REF and 59.3% (n=169) with HF-PEF. There were 84 (29.5%) deaths in the group of patients diagnosed with heart failure; 41 deaths (35.3%) occurred in patients with HF-REF and 43 deaths (25.4%) occurred in patients with HF-PEF. In patients with heart failure, 52.4% (n=44) died from cardiovascular causes. 63.8% of HF patients were alive after 5 years resulting on average in a month per year loss of life expectancy over that period compared with aged matched simulated population.

CONCLUSIONS: In this community-based cohort, the prognosis of heart failure was better than reported in previous studies. This is likely due to the impact of prompt diagnosis, the improvement in therapies and care within a disease management structure.

The Right to Participation of Minorities and Irish Travellers

The idea of participation is becoming increasingly important in international human rights law and recent political and constitutional theory. There is an emerging international law right of minorities to participate in public life. There are many problems though with putting this right into practice. It is not enough to offer formal opportunities for representation or even to facilitate more participatory processes. This article explores how participation is more easily proclaimed than practised by examining the position of one ethnic minority, Travellers, in a liberal democracy, Ireland. While there are many formal opportunities for participation, these do not necessarily result in effective participation on a basis of equality, and may still result in decisions which fail to consider the Traveller culture and identity. Travellers still suffer from an imbalance of power in these arrangements. There are hopeful avenues to pursue in improving participation, the role of civil society and the use of a dialogue between non-governmental organisations and international organisations to put pressure on a national government, including special representation to offset the disadvantages of traditional representative democracy and emphasising the role of special parliamentary bodies; and the need to address the politics of recognition so as to strengthen the hand of disadvantaged groups such as Travellers.

Assessing the conservation status of the freshwater pearl mussel in the North of Ireland - Relevance of growth and age characteristics

In order to conserve the freshwater pearl mussel in Ireland, populations that have a high risk of extinction must he identified and given priority for conservation. Growth of freshwater pearl mussels has been found to vary among populations on a wide geographic scale as well as on a local scale. Populations having a high growth constant (k), because of the small size of individuals and their shorter life-span and thus lower reproductive output, may be more likely to become extinct than those which have a low k and hence larger size and greater reproductive output. This study attempts to estimate the growth constant (k) in rivers in Donegal and Northern Ireland based on measuring lire largest shell in each population. Large differences in values of k were found among rivers and these are discussed in relation to catchment bedrock types and the identification of conservation priorities. Appropriate conservation strategies are recommended for Margaritifera margaritifera populations in the north of Ireland.

Why multiples matter: Reconceptualising the population referred to child and family social workers

Building on a body of previous research by the author and colleagues in relation to multiple adverse childhood experiences (MACE), this paper addresses the question of ‘why multiples matter’ in relation to issues of cumulative adversity. Illustrative evidence is drawn from three research domains, epidemiology, multiple services use and child maltreatment to demonstrate the collective weight of evidence to suggest a targeting of those children and families experiencing multiple adversities to diminish the effects of such adversities realised across the life-course. Whilst the history of previous largely unsuccessful attempts to widen the range of children prioritised for intervention by child and family social workers might lead to pessimism in relation to their ability to respond to a MACE informed public health agenda, there are clear possibilities for developing agency structures, assessment tools and social work practices directed toward meeting the needs of those sub populations already prioritised by social workers: namely Children in Need, Children in need of Protection and Looked after Children.

THE IMPACT OF BURNING AND GRAZING OF HEATHLAND PLANTS AND INVERTEBRATES IN COUNTRY ANTRIM

The impact of burning and grazing on plant, ground beetle and spider species was investigated experimentally in stands of varying ages (burnt in 1982 and 1988 and unburnt plots) on an area of heather moorland in County Antrim, north-east Ireland. Burning initiated complex succession pathways which appear to have characteristic plant and invertebrate species associations. Removal of Calluna dominance initiated a period of high plant species diversity. Investigation of initial post-fire regeneration suggested that the frequency of occurrence of plant species changed over time and was affected by grazing. Grouping of species by the position of their renewal bud, i.e. their life-form, did not account for all observed interspecific variation. The dominant species after burning were Eriophorum vaginatum, E. angustifolium and Vaccinium myrtillus. Studies of vegetation canopy structure showed that, even with the exclusion of the main grazing herbivores, Calluna will not re-establish itself as the dominant species until several years after burning. The ground beetle Nebria salina was trapped more often on plots burnt in 1988 than on unburnt plots or those burnt in 1982. In comparison, Pterostichus niger and Carabus granulatus were trapped in greater numbers on plots burnt in 1982 than on unburnt plots and plots burnt in 1988. The large species Carabus problematicus and Carabus glabratus were trapped in greater numbers on unburnt plots. Similarly, more of the spiders Ceratinella brevipes and Centromerita concinna were trapped on the plots burnt in 1982. In comparison, Lepthyphantes zimmermanni and Robertus lividus were trapped more often on unburnt plots than on plots burnt in 1982 and 1988. Results are discussed with respect to the importance of the continuation of traditional heathland management practices.

Pre-Retirement Age Migration to Remote Rural Areas

Recent literature suggests that the increasingly blurred relationship between paid employment and retirement facilitates a retirement transition period, a life course stage, which may involve a change of residence. The role of such pre-retirement age mobility in the repopulation of rural areas has, however, received relatively little academic scrutiny. This paper draws upon findings from a two-year study conducted in three UK case study areas. It examines the extent of pre-retirement age (aged 50–64) migration into remote rural communities and the impacts this type of movement has upon economic activity, social and community engagement and service provision. It is argued that while this under-researched cohort offers opportunities to support the social and economic sustainability of rural communities (at least in the short and medium term), there are notable challenges which are likely to emerge as it ages in situ. The findings are particularly relevant given national trends on population ageing.

A Contested Landscape: Monuments, public memory, and post-Soviet Identity in Stavropol’, Russia

Much recent literature in cultural, political and social geography has considered the relationship between identity, memory, and the urban landscape. This paper interrogates such literature through exploring the complex materialisation of memorialisation in post-Soviet Russia. Using the example of the statue of General Alexei Ermolov in Stavropol', an analysis of the cityscape reveals interethnic tensions over differing interpretations of the life and history of the person upon whom the statue is based. The existence of a rich literature on Ermolov and the Russian colonial experience in the North Caucasus helps to explain this. The symbolic cityscape of Stavropol' plays an important role in interethnic relations in the multi-ethnic city; it is both an arena through which Russian identity is communicated with people and produced and reproduced, and an arena through which Russian citizens compete with each other for authority on historical narratives that operate at and between a number of scales. People's readings of the cityscape can reveal much about power and space in contemporary Russia.

Vasculogenic and osteogenesis-enhancing potential of human umbilical cord blood endothelial colony-forming cells

Umbilical cord blood-derived endothelial colony-forming cells (UCB-ECFC) show utility in neovascularization, but their contribution to osteogenesis has not been defined. Cocultures of UCB-ECFC with human fetal-mesenchymal stem cells (hfMSC) resulted in earlier induction of alkaline phosphatase (ALP) (Day 7 vs. 10) and increased mineralization (1.9×; p <.001) compared to hfMSC monocultures. This effect was mediated through soluble factors in ECFC-conditioned media, leading to 1.8-2.2× higher ALP levels and a 1.4-1.5× increase in calcium deposition (p <.01) in a dose-dependent manner. Transcriptomic and protein array studies demonstrated high basal levels of osteogenic (BMPs and TGF-ßs) and angiogenic (VEGF and angiopoietins) regulators. Comparison of defined UCB and adult peripheral blood ECFC showed higher osteogenic and angiogenic gene expression in UCB-ECFC. Subcutaneous implantation of UCB-ECFC with hfMSC in immunodeficient mice resulted in the formation of chimeric human vessels, with a 2.2-fold increase in host neovascularization compared to hfMSC-only implants (p = .001). We conclude that this study shows that UCB-ECFC have potential in therapeutic angiogenesis and osteogenic applications in conjunction with MSC. We speculate that UCB-ECFC play an important role in skeletal and vascular development during perinatal development but less so in later life when expression of key osteogenesis and angiogenesis genes in ECFC is lower.

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.

First steps: study protocol for a randomized controlled trial of the effectiveness of the Group Family Nurse Partnership (gFNP) program compared to routine care in improving outcomes for high-risk mothers and their children and preventing abuse

Background: Evidence from the USA suggests that the home-based Family Nurse Partnership program (FNP), extending from early pregnancy until infants are 24 months, can reduce the risk of child abuse and neglect throughout childhood. FNP is now widely available in the UK. A new variant, Group Family Nurse Partnership (gFNP) offers similar content but in a group context and for a shorter time, until infants are 12 months old. Each group comprises 8 to 12 women with similar expected delivery dates and their partners. Its implementation has been established but there is no evidence of its effectiveness.

Methods/Design: The study comprises a multi-site randomized controlled trial designed to identify the benefits of gFNP compared to standard care. Participants (not eligible for FNP) must be either aged <20 years at their last menstrual period (LMP) with one or more previous live births, or aged 20 to 24 at LMP with low educational qualifications and no previous live births. 'Low educational qualifications' is defined as not having both Maths and English Language GCSE at grade C or higher or, if they have both, no more than four in total at grade C or higher. Exclusions are: under 20 years and previously received home-based FNP and, in either age group, severe psychotic mental illness or not able to communicate in English. Consenting women are randomly allocated (minimized by site and maternal age group) when between 10 and 16 weeks pregnant to either to the 44 session gFNP program or to standard care after the collection of baseline information. Researchers are blind to group assignment. The primary outcomes at 12 months are child abuse potential based on the revised Adult-Adolescent Parenting Inventory and parent/infant interaction coded using the CARE Index based on a video-taped interaction. Secondary outcomes are maternal depression, parenting stress, health related quality of life, social support, and use of services.

Discussion: This is the first study of the effectiveness of gFNP in the UK. Results should inform decision-making about its delivery alongside universal services, potentially enabling a wider range of families to benefit from the FNP curriculum and approach to supporting parenting.

Physical Activity and Cognitive Function in the Elderly: a Systematic Review

Background: Physical activity appears important contributor for healthy aging, including cognitive function. However, it is unclear whether late life physical activity alone is beneficial to cognitive function. We performed a systematic review to examine the effect of late life physical activity in maintaining cognitive function in older persons.
Methods: Search Strategy and Selection criteria: The search sources consisted of PubMed, MEDLINE, CINAHL, Cochrane Controlled Trials Register (CENTRAL), and the University of Washington Medical School Library Database between July 15, 2011 and August 15, 2012 with language restricted to English. Studies that were published in journals on or after January 2000 with participants older than 60 years of age were reviewed. Randomized controlled trials including at least 30 participants and lasting for at least 6 months and all observational studies of at least 100 participants and lasting at least 1 year in duration were eligible for inclusion Two reviewers assessed the applicability and results of these studies.
Results: Twenty-six studies fulfilling the inclusion criteria are included. Twenty-one studies reported that late life physical activity resulted in maintenance or enhancement of cognitive function. Three studies reported a dose-response relationship between physical activity and cognition.
Conclusions: Late life physical activity is beneficial for cognitive function in the elderly. However, the majority of the evidence is of medium quality with moderate risk of bias. Larger, randomized controlled trials are needed to better define the association between late life physical activity and cognitive function. Further research is required to determine which types of exercise have the greatest benefits on specific cognitive domains. Despite these caveats, current data are sufficient to recommend that moderate level, late life physical activity may be an effective method to improve cognitive function and delay the onset and progression of cognitive disease in the elderly.

Physical Stature Decline and the Health Status of the Elderly Population in England

Few research papers in economics have examined the extent, causes or consequences of physical stature decline in aging populations. Using repeated observations on objectively measured data from the English Longitudinal Study of Ageing (ELSA), we document that reduction in height is an important phenomenon among respondents aged 50 and over. On average, physical stature decline occurs at an annual rate of between 0.08% and 0.10% for males, and 0.12% and 0.14% for females—which approximately translates into a 2cm to 4cm reduction in height over the life course. Since height is commonly used as a measure of long-run health, our results demonstrate that failing to take age-related height loss into account substantially overstates the health advantage of younger birth cohorts relative to their older counterparts. We also show that there is an absence of consistent predictors of physical stature decline at the individual level. However, we demonstrate how deteriorating health and reductions in height occur simultaneously. We document that declines in muscle mass and bone density are likely to be the mechanism through which these effects are operating. If this physical stature decline is determined by deteriorating health in adulthood, the coefficient on measured height when used as an input in a typical empirical health production function will be affected by reverse causality. While our analysis details the inherent difficulties associated with measuring height in older populations, we do not find that significant bias arises in typical empirical health production functions from the use of height which has not been adjusted for physical stature decline. Therefore, our results validate the use of height among the population aged over 50.

Trends in Economic Stress and the Great Recession in Ireland: An Analysis of the CSO Survey in Income and Living Conditions (SILC)

Since 2008, Ireland has experienced the most severe economic and labour market crisis since the foundation of the State. These economic and labour market changes have had a stark impact on the standard of living across the Irish population. The rapid deterioration in the labour market, the rising level of household indebtedness and stringent austerity measures to plug the public finance deficit have had a widespread impact yet there is debate about where the heaviest burden has fallen and where the economic stress has been felt most. The paper analyses data from the Survey of Income and Living Conditions for the period 2004 to 2011. The aim of the paper is to develop and test a measure of economic stress, which will capture some of the aspects of the rapid change in economic fortunes on Irish households that are not picked up by income alone. This includes tapping into features of the recession such as debt problems, unsustainable housing costs, and other difficulties associated with managing on reduced household income in a period of uncertainty. In testing such a measure we examine trends over time from boom to bust in the Irish economy and consider how economic stress is distributed across different socio-economic groups. The paper explores the distribution and level of economic stress across income class groups, social classes and the life-course and tests the thesis of ‘middle class squeeze’.

Exploring lay views on physical activity and their implications for public health policy. A case study from East Belfast

It is now recognised that inactive lifestyles underpin much of the disease burden evident in the richer nations of the world. Indeed, the WHO has identified physical inactivity as a 'global public health problem' and has established minimum physical activity (PA) targets for people at different stages of the life-course. Yet, according to WHO, just under 1/3 of working age adults across the globe meet those targets and it is not at all clear how the disjunction between the recommendations of policy makers and the behaviour of ordinary people might be surmounted. Using an opportunity to examine the impact of an urban regeneration project on community residents in East Belfast (Northern Ireland) this paper examines the views of some 113 people on how to increase rates of PA in an area of multiple deprivation. The results of the analysis suggest that lay people rarely consider PA as a discrete issue, or one that centres on individuals and their motivation, but rather as one component in a complex web of concerns, processes and events that include such things as the actions of neighbours and relatives, material and political environments, vandalism, violence, and the weather. We explore and unravel the nature of those concerns using novel methods of content analysis that generate 'issue webs'. Particular attention is paid to the ways in which lay people conceptualize 'activity' and to the manner in which they point to ways of encouraging activity that are rooted in everyday life rather than in the corpocentric, agent-centred and often sport dominated strategies favoured by local policy makers. Our results support those who argue that interventions to increase rates of PA need to move beyond behavioural approaches that focus on individuals and consider the social, political and material contexts in which 'activity' occurs.