Socio-economic inequalities in cerebral palsy prevalence in the United Kingdom: a register-based study

Evidence is unclear as to whether there is a socio-economic gradient in cerebral palsy (CP) prevalence beyond what would be expected from the socio-economic gradient for low birthweight, a strong risk factor for CP. We conducted a population-based study in five regions of the UK with CP registers, to investigate the relationship between CP prevalence and socio-economic deprivation, and how it varies by region, by birthweight and by severity and type of CP. The total study population was 1 657 569 livebirths, born between 1984 and 1997. Wards of residence were classified into five quintiles according to a census-based deprivation index, from Q1 (least deprived) to Q5 (most deprived). Socio-economic gradients were modelled by Poisson regression, and region-specific estimates combined by meta-analysis.

The prevalence of postneonatally acquired CP was 0.14 per 1000 livebirths overall. The mean deprivation gradient, expressed as the relative risk in the most deprived vs. the least deprived quintile, was 1.86 (95% confidence interval [95% CI 1.19, 2.88]). The prevalence of non-acquired CP was 2.22 per 1000 livebirths. For non-acquired CP the gradient was 1.16 [95% CI 1.00, 1.35]. Evidence for a socio-economic gradient was strongest for spastic bilateral cases (1.32 [95% CI 1.09, 1.59]) and cases with severe intellectual impairment (1.59 [95% CI 1.06, 2.39]). There was evidence for differences in gradient between regions. The gradient of risk of CP among normal birthweight births was not statistically significant overall (1.21 [95% CI 0.95, 1.54]), but was significant in two regions. There was non-significant evidence of a reduction in gradients over time.

The reduction of the higher rates of postneonatally acquired CP in the more socioeconomically deprived areas is a clear goal for prevention. While we found evidence for a socio-economic gradient for non-acquired CP of antenatal or perinatal origin, the picture was not consistent across regions, and there was some evidence of a decline in inequalities over time. The steeper gradients in some regions for normal birthweight cases and cases with severe intellectual impairment require further investigation.

Resilience and Vulnerability in the Midst of Socio-Political Violence in Northern Ireland: One Family’s Experience of a Paramilitary Style Assault.

This article focuses on the experience of one particular family living amidst the socio-political violence in Northern Ireland to illustrate the impact of a particular traumatic event – a paramilitary assault due to mistaken identity. These attacks are often colloquially referred to as a ‘punishment shootings’ or ‘beatings’. The therapeutic process is described in narrative terms, providing a framework for; understanding the systemic effect on family relationships of the initial problematic ‘storying’ of the event, and the process of ‘re-storying’ a new more coherent narrative that integrates the trauma experience. Thus, temporary family vulnerability becomes transformed into increased family resilience. This process has general applicability in work with traumatized families.

The Politics of Actually Existing Unsustainability:Human Flourishing in a Climate-Changed, Carbon-Constrained World

Going against both the naive techno-optimist of ‘greening business as usual’ and a resurgent ‘catastrophism’ within green thinking and politics, The Politics of Actually Existing Unsustainability offers an analysis of the causes of unsustainability and diminished human flourishing. The books locates the causes of unsustainability in dominant capitalist modes of production, debt-based consumer culture, the imperative for orthodox economic growth and the dominant ideology of neoclassical economics. It suggests that valuable insights into the causes of and alternatives to unsustainability can be found in a critical embracing of human vulnerability and dependency as both constitutive and ineliminable aspects of what it means to be human. The book defends resilience, the ability to ‘cope with’ rather than somehow ‘solve’ vulnerability. The book offers a trenchant critique of the dominant neoclassical economic ‘groupthink’, viewing it not as some value-neutral form of ‘expert knowledge’, but as a thoroughly ideological ‘common sense’. Outlining a green political economic alternative replacing economic growth with economic security, it argues economic growth has done its work in the minority, affluent world, which should now focus on improving human flourishing, lowering socio-economic equality and fostering solidarity as part of a new re-orientation of public policy. Complementing this, a, ‘green republicanism’ is developed as an innovative and original contribution to contemporary debates on a ‘post-growth’ economy and society. The Politics of Actually Existing Unsustainability draws widely from a range of disciplines and thinkers, from cultural critic Susan Sontag to the critical theory of the Frankfurt School, contemporary debates in green political thinking, and the latest thinking in heterodox and green economics, to produce a highly relevant, timely, and provocatively original statement on the human predicament in the twenty-first century.

The Architecture of Home in Cairo: Socio-Spatial Practice of the Hawari's Everyday Life

The hawari of Cairo - narrow non-straight alleyways - are the basic urban units that have formed the medieval city since its foundation back in 969 AD. Until early in the C20th, they made up the primary urban divisions of the city and were residential in nature. Contemporary hawari, by contrast, are increasingly dominated by commercial and industrial activity. This medieval urban maze of extremely short, broken, zigzag streets and dead ends are defensible territories, powerful institutions, and important social systems. While the hawari have been studied as an exemplar for urban structure of medieval Islamic urbanism, and as individual building typologies, this book is the first to examine in detail the socio-spatial practice of the architecture of home in the city. It investigates how people live, communicate and relate to each other within their houses or shared spaces of the alleys, and in doing so, to uncover several new socio-spatial dimensions and meanings in this architectural form.

In an attempt to re-establish the link between architecture past and present, and to understand the changing social needs of communities, this book uncovers the notion of home as central to understand architecture in such a city with long history as Cairo. It firstly describes the historical development of the domestic spaces (indoor and outdoor), and provides an inclusive analysis of spaces of everyday activities in the hawari of old Cairo. It then broadens its analysis to other parts of the city, highlighting different customs and representations of home in the city at large. Cairo, in the context of this book, is represented as the most sophisticated urban centre in the Middle East with different and sometimes contrasting approaches to the architecture of home, as a practice and spatial system.

In order to analyse the complexity and interconnectedness of the components and elements of the hawari as a 'collective home', it layers its narratives of architectural and social developments as a domestic environment over the past two hundred years, and in doing so, explores the in-depth social meaning and performance of spaces, both private and public.

Social capital at work as a predictor of employee health: Multilevel evidence from work units in Finland

The majority of previous research on social capital and health is limited to social capital in residential neighborhoods and communities. Using data from the Finnish 10-Town study we examined social capital at work as a predictor of health in a cohort of 9524 initially healthy local government employees in 1522 work units, who did not change their work unit between 2000 and 2004 and responded to surveys measuring social capital at work and health at both time-points. We used a validated tool to measure social capital with perceptions at the individual level and with co-workers' responses at the work unit level. According to multilevel modeling, a contextual effect of work unit social capital on self-rated health was not accounted for by the individual's socio-demographic characteristics or lifestyle. The odds for health impairment were 1.27 times higher for employees who constantly worked in units with low social capital than for those with constantly high work unit social capital. Corresponding odds ratios for low and declining individual-level social capital varied between 1.56 and 1.78. Increasing levels of individual social capital were associated with sustained good health. In conclusion, this longitudinal multilevel study provides support for the hypothesis that exposure to low social capital at work may be detrimental to the health of employees. (c) 2007 Elsevier Ltd. All rights reserved.

Average household income, crime, and smoking behaviour in a local area: The Finnish 10-Town study

Social environments, like neighbourhoods, are increasingly recognised as determinants of health. While several studies have reported an association of low neighbourhood socio-economic status with morbidity, mortality and health risk behaviour, little is known of the health effects of neighbourhood crime rates. Using the ongoing 10-Town study in Finland, we examined the relations of average household income and crime rate measured at the local area level, with smoking status and intensity by linking census data of local area characteristics from 181 postal zip codes to survey responses to smoking behaviour in a cohort of 23,008 municipal employees. Gender-stratified multilevel analyses adjusted for age and individual occupational status revealed an association between low local area income rate and current smoking. High local area crime rate was also associated with current smoking. Both local area characteristics were strongly associated with smoking intensity. Among ever-smokers, being an ex-smoker was less likely among residents in areas with low average household income and a high crime rate. In the fully adjusted model, the association between local area income and smoking behaviour among women was substantially explained by the area-level crime rate. This study extends our knowledge of potential pathways through which social environmental factors may affect health. (c) 2007 Elsevier Ltd. All rights reserved.