Dying in hospital in Ireland: an assessment of the quality of care in the last week of life: National audit of end-of-life care in hospitals in Ireland, 2008/9

The context of this report is set by the fact that most people die in a hospital or similar setting, outside the home. When you consider that most people are also born in hospital, and may spend some time there over the course of a lifetime, it becomes clear that hospitals are central to our passage into life and out of it, touching people at the most important and intimate moments of their lives. In this sense, the work of hospitals mirrors the cycle of life and the expectations of society about its role at each stage of the life cycle. The report assesses the quality of care provided by Irish hospitals in the last week of life. The word ‘hospital’ shares a common linguistic root with words like hospice and hospitality. Hospitality – understood as being welcomed and cared for with kindness and attentiveness - is still what everyone seeks when they come to hospital, including patients and their families who are going through the journey of dying, death and bereavement. That is why the Hospice Friendly Hospitals Programme (2007-2012) commissioned this first ever national audit of endof-life care in Irish hospitals. This report contributes to the growing practice within the Irish hospital system of auditing performance against standards in order to ensure that every aspect of its work meets, and even exceeds, the highest standards of care and excellence. Given that end-of-life care standards did not exist at the time the audit – but have since been published as Quality Standards for End-of-Life Care in Hospitals1 – it may be more appropriate to regard this report as a ‘pre-audit’ or ‘baseline-audit’. It is Government policy, since February 2009, to introduce a mandatory licensing system whereby each hospital will only be allowed to practice if, on the basis of audited performance, it meets acceptable quality standards of service

Harm reduction strategies for cannabis-related problems: a literature review and typology

Measures that seek to minimise the health and social consequences of substance use are an integral part of national drug strategies in many European countries. Against the backdrop of a high prevalence of cannabis use in the economically advanced countries, and increasing demand for treatment for cannabis-related problems, a range of harm reduction measures have been implemented by peers, statutory bodies and third-sector organisations. Based on a systematic review of the literature, the author describes these different forms of intervention, identifies innovative strategies and presents a simple typology that can be used when exploring existing measures or seeking to develop new policies. This typology covers different kinds of legal, socio-organisational and health-related interventions. All study designs were eligible for inclusion, with the exception of case reports, non-systematic reviews, editorials and news stories. Studies had to be published between 2011 and 2022, in English, and they had to refer to Europe, the Americas, Australia or New Zealand. A two-concept search was implemented using Embase.com and a number of other databases, combined with citation searches and manual website searching to improve coverage of research reports and advocacy documents. A total of 35 documents were deemed eligible, many of which rely on qualitative research methods

Optimising the Sampling Methodology for CSO Household Surveys

This report assesses alternative sampling designs for CSO household surveys, such as the Quarterly National Household Survey (QNHS), the annual Survey on Income and Living Conditions (SILC) and Household Budget Survey (HBS), as well as considering the design of a potential future General Household Survey. The aim of the report is to provide recommendations in relation to appropriate sampling designs, including considerations in relation to sample size, the degree of clustering, stratification and selection procedures for areas and households

The Sinn Féin surge in the 2020 General Election in Ireland: A spatial analysis of tally data

The authors use a spatial autoregressive model to analyse how local areas voted in the 2020 General Election in Ireland. They seek to shed light on the mechanisms underlying the surge in support for Sinn Féin in this election, which marked a structural shift in Irish politics. The analysis relies on an original source of data – the tally – and the authors reconstruct the boundaries of electoral districts using Voronoi polygons. The results suggest that the surge in support for Sinn Féin may have been due to a diffusion process which generated a wave of support, against the backdrop of austerity policies in the aftermath of the Great Recession. The authors argue that it is not possible to provide a convincing explanation of the Sinn Féin surge at the 2020 General Election without simultaneously explaining how, where and when this occurred

The measurement of social disadvantage and its spatial articulation in the Republic of Ireland

This article contributes to policy research by developing a reliable aggregate measure of social need in small areas and by describing how this index can be used to evaluate public interventions in disadvantaged areas. Spatially-targeted initiatives to combat disadvantage have been implemented in many OECD countries, and the availability of EU funding has encouraged their diffusion. The longitudinal analysis and evaluation of these initiatives is difficult using existing indices, as these do not facilitate comparisons over time. In this article, we describe an alternative approach that relies on Confirmatory Factor Analysis and permits diachronic analyses

Risk and Protection Factors for Substance Use Among Young People

This report presents the results of a study of substance use among young people in Ireland based on information collected in 2008 during face-to-face interviews with 991 people, aged between 15 and 18. The target population comprised school-attending students and young people who, having left school, were attending either a Youthreach centre for education or FÁS Community Training Centre. This latter population is described in this study as “early school-leavers” and represents approximately 12% of the full annual cohort of early school-leavers. This is therefore one of the largest studies ever undertaken on substance use among young people in Ireland, and differs from other studies in two important ways. First, whereas previous studies on substance use in this section of the population focused almost exclusively on young people attending school, this study aims specifically to explore the factors associated with substance use among those who left school early. Secondly, the study aims to identify the risk and protective factors that influence young people’s decisions regarding substance use. The study thus emphasises the underlying conditions for and dynamics of substance use with a view to identifying factors that could be addressed through appropriate policies. In pursuing these two objectives, considerable emphasis is placed on comparing the respective risk and protective factors across the two groups: those who have left school early and are now either attending a Youthreach centre for education or FÁS Community Training Centre, and those who are still attending school. The analysis identifies a limited number of highly significant risk and protective factors that can increase or decrease the risk of using substances among 15 to 18-year-olds in Ireland. When attention is focused on those factors that are amenable to change, the most important conclusion is that both the family (the young person’s parents above all) and the educational institution can have a major impact on this decision

“Like with like” or “do like?” Modeling peer effects in the classroom

Objective: The authors discuss the role of peer networks in shaping the decision to enroll at university. Using panel data from Italy, they apply innovative statistical methods to study a sample of students as they complete high school and decide whether or not to attend university. Methods: The authors use simultaneous autoregressive (SAR) models to analyze a four-wave panel database of Italian students. They explore the role of endogenous, exogenous, and correlated peer effects in relation to the decision about whether or not to enroll at university. Results: The findings suggest that endogenous peer effects exert a significant influence on the probability of enrolling after controlling for homophilous preferences and a range of variables. Exogenous peer effects do not appear to influence this outcome. Sensitivity tests suggest that the results of the estimation are robust to selection. Conclusions: This article contributes to an emerging body of literature on the use of SAR models to study peer effects, illustrating its considerable potential in the study of educational outcomes

A Longitudinal Study of Area-level Deprivation in Ireland, 1991-2011

The diffusion of deprivation indices and their application in a wide variety of contexts raises a number of conceptual and methodological issues, particularly in relation to the analysis of change over time. We seek to address these issues by developing an aggregate-level theoretical approach which can guide the construction of a statistical model for enumeration districts in Ireland using five waves of census data (1991, 1996, 2002, 2006, 2011). We use a powerful and flexible family of statistical models—multiple-group mean and covariance structural equation modelling—to obtain comparable estimates of affluence and deprivation for each wave of data. The scores for the three component dimensions—referred to as demographic vitality, social class composition, and labour market situation—are mapped using GIS techniques, together with an overall measure of affluence and deprivation. Using the maps and other results we provide an original discussion of the sociospatial impacts of the economic boom in Ireland between 1996 and 2006, and the subsequent downturn. We highlight the importance of population flows and housing-market dynamics in understanding the nature of each phase and when evaluating the sustainability of economic growth

Population Change and Residential Segregation in Italian Small Areas, 2011–2021: An Analysis With New Spatial Units

This article explores spatial patterns of demographic change and residential segregation in Italy over the past decade, a topic which has not been studied in detail in the literature. Population ageing and migration are unfolding rapidly in a number of European countries, generating tensions and challenges at local level. Aggregate regional or national statistics can conceal significant variations at local level, which are of considerable interest and relevance. This is particularly the case in Italy, where spatial heterogeneity and regional disparities are marked. The analysis presented in this paper uses a new source of data derived from large public archives, which permits comparisons to be made at local level with the 2011 census of population. In this way, it is possible to map out and to analyse demographic trends at a fine level of spatial definition. In order to exploit the potential of these data, the authors use a new set of spatial units which were derived by applying automatic rezoning procedures. These output areas are well suited to the study of the age structure of local populations, population change, and migration in a uniform way across the entire national territory, as the empirical results confirm

Integrative review on place-based and other geographically defined responses to drug-related threats in communities

The prospect of achieving significant improvements in population health, reducing social gradients, and preventing drug use by mobilising the resources present within communities has attracted the attention of many public bodies and international agencies. By documenting the efficacy of place-based initiatives using well-designed trials, successful initiatives have stimulated interest in this new paradigm. There have been several high-profile initiatives to tackle substance use among young people. We dedicate considerable attention in this evidence review to the assessment of impacts in the context of place-based initiatives, as a fundamental question is whether they represent an effective way of addressing drug-related harms and threats. The EMCDDA’s Action Framework for developing and implementing responses to drug problems underlines the importance of outcome assessment: when intervening to address drug-related harms, it is important to monitor progress and to evaluate initiatives. Several place-based initiatives to reduce drug-related harms have been studied using appropriate research designs, the largest of which have been discussed in journal articles and reports, providing a wealth of data on their effects and characteristics