Who Feels Inferior? A Test of the Status Anxiety Hypothesis of Social Inequalities in Health

The empirical association between income inequality, population health and other social problems is now well established and the research literature suggests that the relationship is not artefactual. Debate is still ongoing as to the cause of this association. Wilkinson, Marmot and colleagues have argued for some time that the relationship stems from the psycho-social effects of status comparisons. Here, income inequality is a marker of a wider status hierarchy that provokes an emotional stress response in individuals that is harmful to health and well-being. We label this the ‘status anxiety hypothesis’. If true, this would imply a structured relationship between income inequality at the societal level, individual income rank and anxiety relating to social status. This paper sets out strong and weak forms of the hypothesis and then presents three predictions concerning the structuring of ‘status anxiety’ at the individual level given different levels of national income inequality and varying individual income. We then test these predictions using data from a cross-national survey of over 34,000 individuals carried out in 2007 in 31 European countries. Respondents from low inequality countries reported less status anxiety than those in higher inequality countries at all points on the income rank curve. This is an important precondition of support for the status anxiety hypothesis and may be seen as providing support for the weaker version of the hypothesis. However, we do not find evidence to support the stronger version of the hypothesis which requires the negative effect of income rank on status anxiety to be exacerbated by increasing income inequality.

Reentry as a Rite of Passage

Mary Douglas argues that, ‘There are some things we cannot experience without ritual.’ Ex-prisoner reintegration may be one of them. The punishment process involves an inordinate amount of ritual behavior, from the drama of the courtroom to the elaborate de-individuation processes involved in institutionalization. Durkheim argues that these rituals served a distinct purpose for society: engendering social solidarity and shaping penal sensibilities. Like the commission of a crime, the reintegration of the former outcast back into society represents a challenge to the moral order, a delicate transition fraught with danger and possibility. However, unlike punishment, reintegration is not a process characterized by well-orchestrated and familiar rituals. This lack might explain the failings of prisoner reentry in contemporary society. This article reviews the sociological and anthropological literature on rituals, explaining what they are and what they do, focusing in particular on the role of status degradation ceremonies in criminal justice work. Drawing on this literature, the core elements that would be needed to develop rituals of reintegration powerful enough to counteract these degradation effects are discussed, and the potential impact of such hypothetical rituals is explored.

Cancer Cachexia Care: The Contribution of Qualitative Research to Evidence-Based Practice

Background: Despite its prevalence and prognostic impact, primary cachexia is not well understood. Its potential to cause considerable psychological stress indicates the need for qualitative research to help understand the perspectives of those affected.

Objective: The aims of this study were to describe the perspectives of patients with primary cachexia, of their relatives, and of the healthcare professionals involved in their care and to demonstrate how this evidence can be applied in practice at 4 different levels of application ranging from empathy to coaching.

Methods: A review of the qualitative literature and empirical qualitative investigation was used to understand the experiences of patients and relatives and the perspectives of professionals.

Results: The main worries expressed by patients and relatives concerned appetite loss, changing appearance, prognosis, and social interaction. We also describe their coping responses and their views of professionals’ responses. The main concerns of professionals related to poor communication, lack of clinical guidance, and lack of professional education.

Conclusions: Understanding patients’, families’, and professionals’ perspectives, and mapping that understanding onto what we know about the trajectory and prognosis of the condition, provides the evidence base for good practice. Qualitative research has a central role to play in providing the knowledge base for the nursing care of patients with cachexia.

Implications for Practice: The evidence provided can improve nurses’ insight and assist them in assessment of status, the provision of guidance, and coaching. There is a need for the development of a holistic, information-based integrated care pathway for those with cancer cachexia and their families.

The Revival of Private Property and Its Limits in Post-Mao China

This monograph examines the nature and significance of the re-emergence of private property in rapidly changing post-Mao China.

In examining this issue, the study explores a key dichotomy in Chinese law, that is, ‘public versus private’, and examines the manner in which the Chinese define ownership. The study stresses the importance of lack of clarity in the boundaries between the public and the private in property rights.

While there is a limited move towards the recognition of private property in real estate in contemporary China, this analysis also shows that ownership in the law, and ownership as understood and practised socially, often diverge significantly.

From the Qing dynasty reforms of the late nineteenth century onwards, ‘modernist’ law and entrenched social practice have often opposed each other. In contrast to the official, and indeed legal, support for unitary and exclusive property rights, the reality of the property regime has been a fragmentation of property rights. ‘Modern’ conceptions and theories of property rights emerged in the context of nation-building from the late Qing onwards, and unitary and exclusive property rights were considered as ‘badges’ of modernity.

These conceptions and theories served (and still serve) the purposes of control and governance but were, and still are, often resisted in social practice and popular thinking, leading to alienation and conflict. As a result, analysis of the nature and the social and political implications of re-emerging private property rights provides important insights for our understanding of the changing nature of modern China.

The value of water quality improvements in the region Berlin-Brandenburg as a function of distance and state residency

This study uses a discrete choice experiment (DCE) to elicit willingness to pay estimates for changes in the water quality of three rivers. As many regions the metropolitan region Berlin-Brandenburg struggles to achieve the objectives of the Water Framework Directive until 2015. A major problem is the high load of nutrients. As the region is part of two states (Länder) and the river sections are common throughout the whole region we account for the spatial context twofold. Firstly, we incorporate the distance between each respondent and all river stretches in all MNL and RPL models, and, secondly, we consider whether respondents reside in the state of Berlin or Brandenburg. The compensating variation (CV) calculated for various scenarios shows that overall people would significantly benefit from improved water quality. The CV measures, however, also reveal that not considering the spatial context would result in severely biased welfare measures. While the distance decay effect lowers CV, state residency is connected to the frequency of status quo choices and not accounting for residency would underestimate possible welfare gains in one state. Another finding is that the extent of the market varies with respect to attributes (river stretches) and attribute levels (water quality levels).

Balanced Weights and Three-Sided Coalition Formation

We consider three-sided coalition formation problems when each agent is concerned about his local status as measured by his relative rank position within the group of his own type and about his global status as measured by the weighted sum of the average rankings of the other types of groups. We show that a core stable coalition structure always exists, provided that the corresponding weights are balanced and each agent perceives the two types of status as being substitutable.

Agriculture, settlement and society in Early Medieval Ireland

During the early medieval period, Ireland was politically organised into a large number of very small kingdoms. Unlike much of Western Europe, it had not been incorporated into the Roman Empire, and as a consequence, settlement remained exclusively rural in character until the Viking period. Extensive documentary, archaeological, zooarchaeological and macro-plant evidence provides a detailed reconstruction of the livestock and arable economy of the period. Cattle ownership formed the basis of wealth as well as being an indicator of status in society, and this is reflected in its clear dominance of the livestock economy during this period. From the eighth century onwards, however, cereal production appears to grow in importance as subsistence farming gave way to the production of agricultural surplus. This is reflected in cereal diversification and in the construction of watermills and more efficient grain-drying kilns. At the same time, settlement underwent significant changes and the relative importance of cattle in some areas began to decline.

Impaired functioning of thermolabile methylenetetrahydrofolate reductase is dependent on riboflavin status: implications for riboflavin requirements.

BACKGROUND: Methylenetetrahydrofolate reductase (MTHFR; EC 1.7.99.5) supplies the folate needed for the metabolism of homocysteine. A reduction in MTHFR activity, as occurs in the homozygous state for the 677C-->T (so-called thermolabile) enzyme variant (TT genotype), is associated with an increase in plasma total homocysteine (tHcy). OBJECTIVE: In vitro studies suggest that the reduced activity of thermolabile MTHFR is due to the inappropriate loss of its riboflavin cofactor. We investigated the hypothesis that MTHFR activity in the TT genotype group is particularly sensitive to riboflavin status. DESIGN: We studied tHcy and relevant B-vitamin status by MTHFR genotype in a cross-sectional study of 286 healthy subjects aged 19-63 y (median: 27 y). The effect of riboflavin status was examined by dividing the sample into tertiles of erythrocyte glutathionine reductase activation coefficient, a functional index of riboflavin status. RESULTS: Lower red blood cell folate (P = 0.0001) and higher tHcy (P = 0.0082) concentrations were found in the TT group than in the heterozygous (CT) or wild-type (CC) groups. However, these expected relations in the total sample were driven by the TT group with the lowest riboflavin status, whose mean tHcy concentration (18.09 micromol/L) was almost twice that of the CC or CT group. By contrast, adequate riboflavin status rendered the TT group neutral with respect to tHcy metabolism. CONCLUSIONS: The high tHcy concentration typically associated with homozygosity for the 677C-->T variant of MTHFR occurs only with poor riboflavin status. This may have important implications for governments considering new fortification policies aimed at the prevention of diseases for which this genotype is associated with increased risk.

Differences in mitochondrial and nuclear DNA status of high-density and low-density sperm fractions after density centrifugation preparation

Background: In order to isolate the â??bestâ?? sperm for assisted conception a discontinuous two-step density gradient centrifugation is usually employed. This technique is known to isolate a subpopulation with good motility, morphology and nuclear DNA (nDNA) integrity. As yet its ability to isolate sperm with unfragmented mitochondrial DNA (mtDNA) is unknown. Methods: Semen was obtained from men (n=28) attending our Regional Fertility Centre for infertility investigations. We employed a modified long polymerase chain reaction to study mtDNA and a modified alkaline Comet assay to determine nDNA fragmentation. Results: The high- density fraction displayed significantly more wild type mtDNA (75% of samples) than that of the low- density fraction (25% of samples). In the high-density fraction, there was a higher incidence of single, rather than double or multiple deletions and the deletions were predominantly small scale (0.1-4.0kb). There was a strong correlation between nDNA fragmentation, the number of mtDNA deletions (r=0.7, p

Methylation status of oestrogen receptor-a-gene promoter sequences in human ovarian epithelial cell lines.

We have determined the methylation status of the CpG island of the oestrogen receptor gene in seven human ovarian cell lines. Cell lines expressing oestrogen receptor showed no evidence of hypermethylation. In three of four cell lines that produced no detectable oestrogen receptor protein, hypermethylation was observed at the NotI site of the CpG island. These results indicate that aberrant hypermethylation may be responsible for a significant proportion of epithelial ovarian tumours in which oestrogen receptor expression is lost.