The SPHERE Study: Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses. [ISRCTN24081411]

Background: The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease (CHD) in general practice across two different health systems on the island of Ireland.CHD is a common cause of death and a significant cause of morbidity in Ireland. Secondary prevention has been recommended as a key strategy for reducing levels of CHD mortality and general practice has been highlighted as an ideal setting for secondary prevention initiatives. Current indications suggest that there is considerable room for improvement in the provision of secondary prevention for patients with established heart disease on the island of Ireland. The review literature recommends structured programmes with continued support and follow-up of patients; the provision of training, tailored to practice needs of access to evidence of effectiveness of secondary prevention; structured recall programmes that also take account of individual practice needs; and patient-centred consultations accompanied by attention to disease management guidelines.

Methods: SPHERE is a cluster randomised controlled trial, with practice-level randomisation to intervention and control groups, recruiting 960 patients from 48 practices in three study centres (Belfast, Dublin and Galway). Primary outcomes are blood pressure, total cholesterol, physical and mental health status (SF-12) and hospital re-admissions. The intervention takes place over two years and data is collected at baseline, one-year and two-year follow-up. Data is obtained from medical charts, consultations with practitioners, and patient postal questionnaires. The SPHERE intervention involves the implementation of a structured systematic programme of care for patients with CHD attending general practice. It is a multi-faceted intervention that has been developed to respond to barriers and solutions to optimal secondary prevention identified in preliminary qualitative research with practitioners and patients. General practitioners and practice nurses attend training sessions in facilitating behaviour change and medication prescribing guidelines for secondary prevention of CHD. Patients are invited to attend regular four-monthly consultations over two years, during which targets and goals for secondary prevention are set and reviewed. The analysis will be strengthened by economic, policy and qualitative components.

The executive committee of the Greek Professional Association of Social Work in an age of austerity: examining its response

This paper explores the response by the Greek Association of Social Workers (SKLE) to Greece's current economic crisis. Socioeconomic conditions in Greece have deteriorated rapidly since the imposition of a Structural Adjustment Programme as a condition of the loan Troika provided to Greece to address its class-based public debt crisis. Interviews were conducted with SKLE Executive Committee members to examine SKLE's response in the context of newly raised inequalities. Research results show that SKLE recognised the negative consequences to both service users and its members. However, SKLE continues to reformulate its strategy mostly as a social partner. SKLE's previous strategy entailed amongst other things the analysis of policy proposals and participation in welfare related government committees. This strategy is no longer relevant because decision-making powers have been transferred to transnational bodies. This paper elaborates on these findings and discusses the barriers that prohibit SKLE from differentiation of its strategy. Although the research is country specific, it has implications for the broader global debate because professional associations must reformulate their strategies for better serving of both their constituents and the collective good based on the social justice mandate of the profession.

‘It ain’t easy being green’: Sustainable Development between Environment and Economy in Northern Ireland’

Given the relative lack of research on sustainable development in Northern Ireland, this paper focuses on the tensions between environmental governance and regulation on the one hand, and the ‘post-conflict’ imperative for Northern Ireland to compete and grow as a regional economy without continued British state subvention and subsidisation. The paper outlines how this ‘trade-off’ between ‘environment’ and ‘economy’ is essentially misplaced. It argues that this trade-off can be avoided if there is a shift in focus from an ‘environment versus the economy’ policy position to one in which the ‘triple bottom line’ (social, economic and environmental) of sustainable development becomes the over-arching policy agenda. Sustainable development, unlike either orthodox environmental or economic policy, also connects centrally with the unique ‘post-conflict transformation’ agenda of Northern Ireland. For example, promoting a human rights civic culture, tackling socioeconomic inequality and social exclusion, and building a shared future based on supporting sustainable communities and an innovative model of a ‘green(ing) economy’ goes beyond orthodox economic growth. However, it is clear from the Executive’s Programme for Government, failure to support the creation of an independent Environment Protection Agency, and above all the prioritisation of orthodox economic growth based on foreign direct investment that neither environmental protection nor sustainable development is or will be high on the political or policy agenda in Northern Ireland.

Explaining levels of deprivation in the European Union

In this paper we seek to explain variations in levels of deprivation between EU countries. The starting-point of our analysis is the finding that the relationship between income and life-style deprivation varies across countries. Given our understanding of the manner in which the income-deprivation mismatch may arise from the limitations of current income as a measure of command over resources, the pattern of variation seems to be consistent with our expectations of the variable degree to which welfare-state regimes achieve 'decommodification' and smooth income flows. This line of reasoning suggests that cross-national differences in deprivation might, in significant part, be due not only to variation in household and individual characteristics that are associated with disadvantage but also to the differential impact of such variables across countries and indeed welfare regimes. To test this hypothesis, we have taken advantage of the ECHP (European Community Household Panel) comparative data set in order to pursue a strategy of substituting variable names for country/welfare regime names. We operated with two broad categories of variables, tapping, respectively, needs and resources. Although both sets of factors contribute independently to our ability to predict deprivation, it is the resource factors that are crucial in reducing country effects. The extent of cross-national heterogeneity depends on specifying the social class and situation in relation to long-term unemployment of the household reference person. The impact of the structural socio-economic variables that we label 'resource factors' varies across countries in a manner that is broadly consistent with welfare regime theory and is the key factor in explaining cross-country differences in deprivation. As a consequence, European homogeneity is a great deal more evident among the advantaged than the disadvantaged.

Don Juan, 2012

A long poem in ottava rima, based on Byron's Don Juan, concerning the Eurocrisis and the social consequences of an economic policy of austerity, particularly as it has impacted on Greece.

The Political Economy of Swift's Satires and other Prose Works

Jonathan Swift wrote perceptively about the emerging commercial society
in Britain in the early eighteenth century. His particular focus was on the
financial revolution and its implications for economic and political stability
as well as for shifts of power between the landed and commercial
classes. Following his return to Ireland Swift’s focus shifted to the developmental
problems of his native country. In several pamphlets he advocated
consumption of domestic products, challenged existing political
structures and made trenchant criticisms of absenteeism and other dysfunctional
aspects of the land tenure system. Swift’s politico-economic
concerns are fully reflected in his best known work, Gulliver’s Travels but
his most pointed criticism of the emerging commercial system is contained
in A Modest Proposal. Written in the form of an economic pamphlet, A
Modest Proposal is ostensibly designed to address the problem of poverty
in Ireland. In addition to its implicit criticism of economic policy in Ireland,
the pamphlet challenges the separation of economics and morality as
evidenced in the writings of William Petty and Bernard Mandeville. Swift
parodies Petty’s political arithmetic but it is suggested here that he also
had in his sights the consequentialist reasoning present in the work of
both authors but explicitly so in Mandeville.
Keywords: financial revolution, public debt, paper credit, rationality, political
arithmetic, consequentialism, Petty (William), Mandeville (Bernard)

Movement of Capital and Trade in Services:Distinguishing Myth from Reality Regarding the GATS and the Liberalization of the Capital Account

This article will analyze the interplay between capital movements and trade
in services as structured in World Trade Organization (WTO) law, and it will
assess the implications of the capital account liberalization for the freedom of
WTO Members to pursue their economic policies. Although the movement
of capital is largely confined to the domain of international financial or monetary
policy, it is regulated by WTO law due to its role in the process of
financial services liberalization, which generally requires liberalized capital
flows. From a legal perspective, the interplay between capital movements
and trade in services requires striking a delicate balance between the right
of market access and the parallel right of economic stability. Indeed, a liberalized
regime for capital movements could pose serious stability problems
during times of crisis. For this reason, it is necessary that Members are able
to derogate from their obligations and adopt emergency measures.
Regulating the movement of capital in the General Agreement on Trade in
Services (GATS) requires stretching the regulatory oversight of WTO law
over different aspects of international economic policy. Indeed, capital movements are a fundamental component of the balance of payments and have a
major role in shaping monetary, fiscal, and financial policies. This article will
analyze how the discipline provided by the GATS on capital movements will
affect not only trade in services, but also the Members’ policy space on
monetary and fiscal policy. The article will conclude that while the GATS offers enough policy space for the maintenance of financial stability, it does
not fully take into consideration the need of Members to control capital
movements in order to conduct monetary policies.

The Risk Implications of Globalisation: An Exploratory Analysis of 105 Major Industrial Incidents (1971–2010)

This paper revisits work on the socio-political amplification of risk, which predicts that those living in developing countries are exposed to greater risk than residents of developed nations. This prediction contrasts with the neoliberal expectation that market driven improvements in working conditions within industrialising/developing nations will lead to global convergence of hazard exposure levels. It also contradicts the assumption of risk society theorists that there will be an ubiquitous increase in risk exposure across the globe, which will primarily affect technically more advanced countries. Reviewing qualitative evidence on the impact of structural adjustment reforms in industrialising countries, the export of waste and hazardous waste recycling to these countries and new patterns of domestic industrialisation, the paper suggests that workers in industrialising countries continue to face far greater levels of hazard exposure than those of developed countries. This view is confirmed when a data set including 105 major multi-fatality industrial disasters from 1971 to 2000 is examined. The paper concludes that there is empirical support for the predictions of socio-political amplification of risk theory, which finds clear expression in the data in a consistent pattern of significantly greater fatality rates per industrial incident in industrialising/developing countries.