Mapping patterns of multiple deprivation using self-organising maps: An application to EU-SILC data for Ireland

The development of conceptual frameworks for the analysis of social exclusion has somewhat out-stripped related methodological developments. This paper seeks to contribute to filling this gap through the application of self-organising maps (SOMs) to the analysis of a detailed set of material deprivation indicators relating to the Irish case. The SOM approach allows us to offer a differentiated and interpretable picture of the structure of multiple deprivation in contemporary Ireland. Employing this approach, we identify 16 clusters characterised by distinct profiles across 42 deprivation indicators. Exploratory analyses demonstrate that, controlling for equivalised household income, SOM cluster membership adds substantially to our ability to predict subjective economic stress. Moreover, in comparison with an analogous latent class approach, the SOM analysis offers considerable additional discriminatory power in relation to individuals' experience of their economic circumstances. The results suggest that the SOM approach could prove a valuable addition to a 'methodological platform' for analysing the shape and form of social exclusion. (c) 2009 Elsevier Inc. All rights reserved.

Persistent income poverty and deprivation in the European Union: An analysis of the first three waves of the European Community Household Panel

Poverty research has increasingly focused on persistent income poverty, both as a crucial social indicator and as a target for policy intervention. Such an approach can lead to an identification of a sub-set of poor individuals facing particularly adverse circumstances and/or distinctive problems in escaping from poverty. Here we seek to establish whether, in comparison with cross-sectional measures, persistent poverty measures also provide a better measure of exclusion from a minimally acceptable way of life and relate with other important variables in a logical fashion. Our analysis draws upon the first three waves of the ECHP and shows that a persistent poverty measure does constitute a significant improvement over its cross-sectional counterpart in the explanation of levels of deprivation. Persistent poverty is related to life-style deprivation in a manner that comes close to being uniform across countries. The measure of persistence also conforms to our expectations of how a poverty measure should behave in that, unlike relative income poverty lines, defining the threshold level more stringently enables us to identify progressively groups of increasingly deprived respondents. Overall the persistent poverty measure constitutes a significant advance on cross-sectional income measures. However, there is clearly a great deal relating to the process of accumulation and of erosion of resources, which is not fully captured in the persistent poverty measure. In the absence of such information, there is a great deal to be said for making use of both types of indictors in formulating and evaluating policies while we continue to improve our understanding of longer-term processes.

Moving in and out of poverty - The impact of welfare regimes on poverty dynamics in the EU

Although many of the debates around social exclusion and cumulative disadvantage relate to processes that occur across time, there has been relatively little research into poverty dynamics except in a few notable countries such as Britain, the USA and Germany. This neglect is almost entirely because of the absence of comparative longitudinal data on income for other countries, but it is regrettable given the central importance of this area. By studying poverty dynamics we not only get a better insight into the processes leading to patterns of disadvantage and inequality, but we can also understand better the influence of different welfare state regimes on the social risks experienced by different types of individuals and households. The extent to which different national contexts protect their citizens from poverty persistence, or vary in the factors leading to poverty persistence, tells us a great deal about the workings of their socioeconomic systems and welfare regimes.

In this article we use the recent availability of five waves of the European Community Household Panel Survey to outline the nature of poverty persistence and poverty dynamics across a large number of countries. In doing so we ask three important questions. First, is poverty a more common experience when viewed longitudinally rather than cross-sectionally, and how is this affected by the income poverty line used? Second, can we identify a tendency toward poverty persistence, and does this vary in its extent across countries? Third and lastly, what types of events are more likely to lead to entry into and exit from poverty, and does the importance of these events differ between countries? The article shows that the experience of poverty is far wider than is appreciated from cross-sectional data, and also tends to be more concentrated on a particular population than would be expected from cross-sectional rates. Moreover, the pattern of poverty persistence is congruent with welfare regime theory. The importance of country institutions and welfare regimes is also underlined by the finding that social welfare and market incomes play different roles in poverty transitions across countries, and that Southern European, or residualist, welfare regimes focus poverty risks on the experience of the household's primary earner to a far greater extent than Northern European welfare states do.

Multiple deprivation and persistent poverty in the European Union

The literature on Social exclusion has focused attention on the processes leading to exposure to multiple disadvantage. Despite the influence this perspective has had on both academic and policy discussions, conceptual analysis has remained imprecise and empirical evidence modest. We have made use of the European Community Household Panel (ECHP) in order to examine the extent to which persistent income poverty results in multiple deprivation. Our analysis shows that only a modest proportion of the persistently poor can he characterized as being exposed to such deprivation. While persistent poverty and multiple deprivation combine to produce extremely high levels of economic strain, there is no evidence that they interact in a significant fashion. We argue that understanding deprivation is not facilitated by focusing on a cleavage between a multiply deprived minority and a comfortable majority, and we consider the policy implications of this argument.

The relationship between income and deprivation: A dynamic perspective

Income poverty lines may fail to distinguish households experiencing deprivation/exclusion. Analysing a large sample of Irish households, we find that current income is an important influence on deprivation levels, hut so are many other aspects of a household's current situation and how it arrived there. It is also important to distinguish different dimensions in using deprivation indicators with income to measure poverty.

RESOURCES, DEPRIVATION AND THE MEASUREMENT OF POVERTY

Ringen has advocated the use of both income and deprivation criteria in identifying those excluded from society due to lack of resources, a widely accepted definition of poverty. We illustrate with Irish data how this might be done, paying particular attention to how appropriate indicators of deprivation are to be selected. The results show that employing both income and deprivation criteria rather than income alone can make a substantial difference to both the extent and composition of measured poverty. This highlights the restrictive nature of poverty conceived in terms of exclusion rather than minimum rights to resources.

Economic Vulnerability and the Severity of Debt Problems::An Analysis of the Irish EU-SILC 2008

In this article, using Ireland where debt issues are of particular salience, as a test case, we seek to locate over-indebtedness and the severity of debt problems in the context of the broader economic circumstances of households. In doing so, we first identify an economically vulnerable segment of households and then explore the debt experience of vulnerable and non-vulnerable households. Our analysis reveals a striking contrast between the debt experiences of less than one in five households defined as economically vulnerable and all others. Financial exclusion, relating to access to a bank account and a credit card, was found to increase debt levels. However, such effects were modest. The impact of economic vulnerability seems to be largely a consequence of its relationship to a wide
range of socio-economic attributes and circumstances. The manner in which a potential debt crisis
unfolds will be shaped by the broader socio-economic structuring of life-chances. Any attempt to
respond to such problems by concentrating on financial exclusion or household behaviour or, indeed,
triggering factors without taking the wider social structuring of economic vulnerability is likely to be
both seriously misguided and largely ineffective.

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.

Trends in economic vulnerability in the Republic of Ireland

In this paper we evaluate trends in levels of economic vulnerability in Ireland during the period 1994-2001. We also document changes in the consequences of such vulnerability for social exclusion and in the social demographic factors with which it is associated. Over time there was a sharp decline in economic vulnerability. Furthermore, the degree of differentiation between the vulnerable and non-vulnerable classes in relation to both economic exclusion and social exclusion, more broadly conceived, remained relatively constant. Ireland is characterised by levels of socio-economic inequality that place it at the more unequal end of the European spectrum. However, the dramatic reductions in levels of vulnerability across the socio-economic spectrum demonstrate that the fruits of the economic boom have been distributed relatively widely.

Economic vulnerability, multidimensional deprivation and social cohesion in an enlarged European community

In this article we have sought to combine regional and social exclusion perspectives on economic exclusion in the enlarged European Community. Our analysis, based on the European Quality of Life Survey, confirms that while the economically vulnerable, identified through latent class analysis, constitute substantially larger groups in the poorer economic clusters, they are much more sharply differentiated from others in the richer clusters. While the economically vulnerable are also disadvantaged in relation to measures of multidimensional deprivation and social cohesion, between economic clusters differences on these dimensions cannot be accounted for by corresponding variations in levels and intensity of economic vulnerability. In fact, the impact of such vulnerability on social cohesion is greater in the more affluent clusters. Copyright © 2005 SAGE Publications.

Studies to Reduce Unnecessary Medication Use in Frail Older Adults:A Systematic Review

BACKGROUND: Overuse of unnecessary medications in frail older adults with limited life expectancy remains an understudied challenge. OBJECTIVE: To identify intervention studies that reduced use of unnecessary medications in frail older adults. A secondary goal was to identify and review studies focusing on patients approaching end of life. We examined criteria for identifying unnecessary medications, intervention processes for medication reduction, and intervention effectiveness. METHODS: A systematic review of English articles using MEDLINE, EMBASE, and International Pharmaceutical Abstracts from January 1966 to September 2012. Additional studies were identified by searching bibliographies. Search terms included prescription drugs, drug utilization, hospice or palliative care, and appropriate or inappropriate. A manual review of 971 identified abstracts for the inclusion criteria (study included an intervention to reduce chronic medication use; at least 5 participants; population included patients aged at least 65 years, hospice enrollment, or indication of frailty or risk of functional decline-including assisted living or nursing home residence, inpatient hospitalization) yielded 60 articles for full review by 3 investigators. After exclusion of review articles, interventions targeting acute medications, or studies exclusively in the intensive care unit, 36 articles were retained (including 13 identified by bibliography review). Articles were extracted for study design, study setting, intervention description, criteria for identifying unnecessary medication use, and intervention outcomes. RESULTS: The studies included 15 randomized controlled trials, 4 non-randomized trials, 6 pre-post studies, and 11 case series. Control groups were used in over half of the studies (n = 20). Study populations varied and included residents of nursing homes and assisted living facilities (n = 16), hospitalized patients (n = 14), hospice/palliative care patients (n = 3), home care patients (n = 2), and frail or disabled community-dwelling patients (n = 1). The majority of studies (n = 21) used implicit criteria to identify unnecessary medications (including drugs without indication, unnecessary duplication, and lack of effectiveness); only one study incorporated patient preference into prescribing criteria. Most (25) interventions were led by or involved pharmacists, 4 used academic detailing, 2 used audit and feedback reports targeting prescribers, and 5 involved physician-led medication reviews. Overall intervention effect sizes could not be determined due to heterogeneity of study designs, samples, and measures. CONCLUSIONS: Very little rigorous research has been conducted on reducing unnecessary medications in frail older adults or patients approaching end of life.

Measuring the psychosocial characteristics of family caregivers of palliative care patients:psychometric properties of nine self-report instruments

Researchers and clinicians have experienced substantial difficulties locating measures that are suitable for use within palliative care settings. This article details the psychometric properties of nine instruments designed to assess the following psychosocial characteristics of family caregivers: competence, mastery, self-efficacy, burden, optimism, preparedness, social support, rewards, and mutuality. Results are based on the responses of 106 primary family caregivers caring for relatives dying of cancer. Principal components extraction with varimax rotation was used to explore the underlying structure of each measure. Following the exclusion of complex variables, suggested components for most measures comprised relatively homogenous items, which were good to excellent measures of each component. Some components comprised only two items; however, Cronbach's alphas typically indicated moderate to high levels of internal consistency. Overall, the results of this study suggest that most of the measures analyzed, excepting the mastery and mutuality scales, can be recommended to examine the family caregiver experience and test supportive interventions.

Beyond ourselves: Passion and the dark side of identification in an ethical organization

How are organizational discourses enacted by people at work? In this article, instead of treating subjects as somewhat distinct from such discourses, I argue that the two are inescapably intertwined. The concept of 'ek-stasis' helps us to understand this. Ekstasis invokes an idea of the 'self ' that, through processes of identification, is always located outside of itself, embedded in a wider sociality. I explore this dynamic through an in-depth study of the powerful discourse of 'ethical living', and its enactment in one contemporary development sector organization, EWH. This ek-static enactment was somewhat ambivalent: involving mutual recognition between colleagues, but also processes of exclusion and policing. I highlight how attention to feeling and passion was important in understanding the relation between workplace discourse and identification processes, in this setting. This study shows that a view of workplace selves as ek-static is useful for understanding the enactment of discourse at work, and that this enactment can be both passionate and ambivalent. © The Author(s) 2010.

Corneal biomechanical properties in primary open angle glaucoma and normal tension glaucoma

PURPOSE: To determine and compare the corneal biomechanical properties between eyes with primary open angle glaucoma (POAG) and eyes with normal tension glaucoma (NTG). PATIENTS AND METHODS: Prospective cross-sectional study. Consecutive eligible POAG and NTG patients attending the Glaucoma Clinic had assessment of their corneal biomechanical properties-corneal hysteresis (CH) and corneal resistance factor (CRF)-using the Ocular Response Analyzer by an observer masked to the diagnosis. Exclusion criteria included previous intraocular surgery, corneal pathology, inflammatory connective tissue disease, and refraction of 5-dimensional or over. If both eyes were eligible, then the right eye was used for analysis. The main outcome measures were corneal hysteresis and CRF measurements. Data analysis was performed using the t test and general linear model. RESULTS: Eighty-one patients (80 whites) were analyzed. Forty had NTG, whereas 41 had POAG. Thirty-five were females. There was a statistically significant difference in mean CH (NTG 9.6±1.3 mm Hg; POAG 9.0±1.4 mm Hg; P=0.01), but not in mean CRF (NTG 9.9±1.4; POAG 10.8±1.7; P=0.06). The highest recorded Goldmann applanation intraocular pressure (IOP) was statistically significantly associated with lower CH (P=0.01) and higher CRF (P=0.02). CONCLUSIONS: There was a small but statistically significant difference in the mean CH between POAG and NTG (CH was higher in NTG). The highest recorded Goldmann applanation IOP was also statistically significantly correlated with lower CH and higher CRF, suggesting that alterations to the corneal biomechanical properties may occur as a result of chronic raised IOP in POAG. © 2008 by Lippincott Williams & Wilkins.

Effect of cataract extraction on the Glaucoma Progression Index (GPI) in glaucoma patients

PURPOSE: To determine the effect of cataract extraction on the glaucoma progression index (GPI) in glaucoma patients with coexisting cataract.

PATIENTS AND METHODS: This is a retrospective noncomparative study. Consecutive eligible patients with glaucoma who underwent phacoemulsification alone or in combination with augmented trabeculectomy were included. All patients had Swedish Interactive Threshold Algorithm-standard 24-2 visual fields within 10 months of surgery. Exclusion criteria included other ocular morbidity, intraoperative complications, and perimetric reliability indices greater than 33%. Comparison was made between the immediate visual fields before and after surgery. The main outcome measure was the change in GPI. Changes in the pattern standard deviation (PSD) and mean deviation (MD) were also assessed. Comparison of means was performed with the paired t test.

RESULTS: Thirty-three eyes of 33 patients (all Whites) were analyzed. The mean age at surgery was 77.0+/-8.7 years. Visual field tests were performed 3.3+/-3.0 months SD before surgery and 5.4+/-2.6 months after surgery. There was a statistically significant increase in the GPI after cataract surgery (from 71.5+/-18.5% to 74.6+/-17.1%; P=0.02). The improvement in MD was also statistically significant (from -11.8+/-5.3 to -10.2+/-5.3 dB; P <0.01), but the change in PSD did not reach statistical significance.

CONCLUSIONS: Uncomplicated cataract extraction resulted in a statistically significant improvement in the 24-2 Swedish Interactive Threshold Algorithm-standard GPI and MD, but not in PSD. Both the MD and the GPI may be influenced by lens opacities, which could make detection of glaucoma visual field progression more difficult for clinicians in glaucoma patients with concurrent cataract.