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Book ; Article ; Online: How important are the unit of analysis and equivalence scales when measuring income poverty and inequality? Evidence from Ireland

Regan, Mark / Kakoulidou, Theano

2022

Abstract: We analyse the effect of varying equivalization scales and income-sharing units (households, tax-units and benefit-units) on inequality and poverty statistics using Irish microdata. We find that benchmark equivalence scales result in substantial ... ...

Abstract	We analyse the effect of varying equivalization scales and income-sharing units (households, tax-units and benefit-units) on inequality and poverty statistics using Irish microdata. We find that benchmark equivalence scales result in substantial variation in the degree of income poverty estimated at the household level, particularly for young children and the elderly. We test multiple permutations of child and adult weights in a set of hypothetical equivalence scales. Our simulation results show that over a range of commonly observed adult-child equivalence weights - 0.5 to 0.7 for adults and 0.3 to 0.5 for children, Irish income poverty rates in 2019 ranged from 15.0 per cent to 19.5 per cent - most of this variation is attributable to changes in the adult weight. Inequality statistics tend to be less sensitive to the choice of equivalence scale but are sensitive to the choice of income-sharing unit. At the household level, the Gini coefficient varies between 0.29 and 0.32. At the tax-/benefit-unit level the range is elevated, with the Gini remaining stable over time but between 0.33 and 0.35. Other inequality metrics, such as the p90p10 ratio, exhibit increased volatility over the business cycle at sub-household unit levels.
Keywords	ddc:330 ; D63 ; I32 ; inequality ; poverty ; equivalence scales ; unit of analysis
Subject code	338
Language	English
Publisher	Dublin: The Economic and Social Research Institute (ESRI)
Publishing country	de
Document type	Book ; Article ; Online
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Article ; Online: A systematic review and meta-analysis assessing the use of tranexamic acid (TXA) in acute gastrointestinal bleeding.

O'Donnell, Oisín / Gallagher, Clodagh / Davey, Matthew G / Coulter, Jonathan / Regan, Mark

Irish journal of medical science

2023 Volume 193, Issue 2, Page(s) 705–719

Abstract: Introduction: Gastrointestinal bleeding results in significant morbidity, cost and mortality. TXA, an antifibrinolytic agent, has been proposed to reduce mortality; however, many studies report conflicting results.: Methods: The aim of the study was ... ...

Abstract	Introduction: Gastrointestinal bleeding results in significant morbidity, cost and mortality. TXA, an antifibrinolytic agent, has been proposed to reduce mortality; however, many studies report conflicting results. Methods: The aim of the study was to perform the first systematic review and meta-analysis of RCTs to evaluate the efficacy TXA for both upper and lower gastrointestinal bleeding. This was performed per PRISMA guidelines. PubMed, EMBASE, Cochrane and Scopus databases were searched for RCTs. Dichotomous variables were pooled as risk ratios (RR) with 95% confidence intervals (CI) using the MH method with random effects modelling. Results: Fourteen RCTs were identified with 14,338 patients and mean age of 58.4 years. 34.9% (n = 5008) were female and 65.1% (n = 9330) male. There was no significant difference in mortality between TXA and placebo (RR 0.86 95% CI (0.74 to 1.00), P: 0.05). The secondary outcomes, similarly, did not yield significant results. These included rebleeding, need for surgical intervention (RR: 0.75 95% CI (0.53, 1.07)), endoscopic intervention (RR: 0.92 95% CI (0.70, 1.22)), transfusion requirement (RR: 1.01 95% CI (0.94, 10.7)) and length of stay (RR: 0.03 95% CI (- 0.03, 0.08)). There was no increased risk of VTE, RR: 1.29 95% CI (0.53, 3.16). One trial (n = 12,009) reported an increased risk of seizure in the TXA group, RR: 1.73 95% CI (1.03-2.93). Conclusion: TXA does not reduce mortality in patients with acute upper or lower gastrointestinal bleeding and may confer an increased risk of seizures. The authors do not recommend the use of TXA in acute gastrointestinal bleeding.
MeSH term(s)	Humans ; Male ; Female ; Middle Aged ; Tranexamic Acid/therapeutic use ; Antifibrinolytic Agents/therapeutic use ; Gastrointestinal Hemorrhage/drug therapy ; Blood Transfusion ; Blood Loss, Surgical
Chemical Substances	Tranexamic Acid (6T84R30KC1) ; Antifibrinolytic Agents
Language	English
Publishing date	2023-10-04
Publishing country	Ireland
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	390895-1
ISSN	1863-4362 ; 0021-1265
ISSN (online)	1863-4362
ISSN	0021-1265
DOI	10.1007/s11845-023-03517-0
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Article ; Online: Failure to take-up public healthcare entitlements: Evidence from the Medical Card system in Ireland.

Keane, Claire / Regan, Mark / Walsh, Brendan

Social science & medicine (1982)

2021 Volume 281, Page(s) 114069

Abstract: While population health and welfare can be improved through the provision of non-cash benefits, such as free healthcare, many welfare improving schemes have low rates of take up amongst those eligible for such a benefit. One interesting example of this ... ...

Abstract	While population health and welfare can be improved through the provision of non-cash benefits, such as free healthcare, many welfare improving schemes have low rates of take up amongst those eligible for such a benefit. One interesting example of this is the Medical Card scheme in Ireland. Medical Cards are a non-cash benefit that provide free primary, community, and hospital care, as well as heavily subsidised prescriptions drugs, for those below specific income means-test threshold. However, despite the significant benefits afforded by a Medical Card, many people forego entitlement. While this has been of concern to policymakers, the prevalence of, and reason for, non-take up, have to date not been examined in-depth. Using detailed household demographic, healthcare, income and expenditure data, this paper estimates the Medical Card take-up rate, examines the reasons for non-take, and estimates the additional healthcare cost burden to individuals due to non-take-up. The paper estimates that 31% of eligible individuals do not take up a Medical Card. Private health insurance coverage, receipt of social welfare, employment status and health status are all strongly correlated with take up. Results suggest that of a lack of information about eligibility status and social stigma are key factors driving non take up. The paper estimates that families who forego their entitled Medical Card typically spend an additional €202 annually on healthcare. Furthermore, as a consequence of higher purchase rates of, perhaps unnecessary, private health insurance, families not taking up their entitlement spend an additional €489 per annum on PHI premia. Welfare losses are likely to be even higher if forgoing medical care due to cost results in future negative health outcomes.
MeSH term(s)	Delivery of Health Care ; Health Expenditures ; Humans ; Income ; Insurance, Health ; Ireland
Language	English
Publishing date	2021-05-24
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	4766-1
ISSN	1873-5347 ; 0037-7856 ; 0277-9536
ISSN (online)	1873-5347
ISSN	0037-7856 ; 0277-9536
DOI	10.1016/j.socscimed.2021.114069
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Book ; Online: Child poverty in Ireland and the pandemic recession

Regan, Mark / Maître, Bertrand

2020

Abstract: The Irish experience of the Great Recession was characterised by a large increase in unemployment, little change in relative poverty measures but a large increase in basic deprivation, which affected children worst. We show that, from 2004 to 2018, ... ...

Abstract	The Irish experience of the Great Recession was characterised by a large increase in unemployment, little change in relative poverty measures but a large increase in basic deprivation, which affected children worst. We show that, from 2004 to 2018, parental employment and high household work intensity decreased the risk of a child living in poverty. In the face of widespread COVID-19 employment losses, we simulate how child income poverty rates will evolve over the course of 2020. Without an economic recovery, child income poverty rates could rise as high as 23 per cent, a one-third increase in the rate relative to the start of 2020. A partial economic recovery decreases the surge in child income poverty, which rises to a maximum of 19 per cent, a one-seventh increase in the rate relative to the start of 2020. We conclude that a partial economic recovery in the latter half of the year, coupled with an extension of emergency income supports for the entirety of 2020, would bring child income poverty levels only moderately above the level they would have been at in a counterfactual where COVID-19-related job losses did not occur (an average increase of between one-eleventh to a maximum of oneseventh).
Keywords	ddc:330 ; Coronavirus ; Kinderarmut ; Prognose ; Irland
Subject code	331 ; 336
Language	English
Publisher	Dublin: The Economic and Social Research Institute (ESRI)
Publishing country	de
Document type	Book ; Online
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Article ; Online: Impact of the 12-gene recurrence score in influencing adjuvant chemotherapy prescription in mismatch repair proficient stage II/III colonic carcinoma-a systematic review and meta-analysis.

Davey, Matthew G / O'Neill, Maeve / Regan, Mark / Meshkat, Babak / Nugent, Emmeline / Joyce, Myles / Hogan, Aisling M

International journal of colorectal disease

2023 Volume 38, Issue 1, Page(s) 71

Abstract: Introduction: The 12-gene recurrence score (RS) is a clinically validated assay which predicts recurrence risk in patients with stage II/III colon cancer. Decisions regarding adjuvant chemotherapy may be guided using this assay or based on the judgement ...

Abstract	Introduction: The 12-gene recurrence score (RS) is a clinically validated assay which predicts recurrence risk in patients with stage II/III colon cancer. Decisions regarding adjuvant chemotherapy may be guided using this assay or based on the judgement of tumour board. Aims: To assess the concordance between the RS and MDT decisions regarding adjuvant chemotherapy in colon cancer. Methods: A systematic review was performed in accordance with PRISMA guidelines. Meta-analyses were performed using the Mantel-Haenszel method using the Review Manager version 5.4 software. Results: Four studies including 855 patients with a mean age of 68 years (range: 25-90 years) met inclusion criteria. Overall, 79.2% had stage II disease (677/855) and 20.8% had stage III disease (178/855). For the entire cohort, concordant results between the 12-gene assay and MDT were more likely than discordant (odds ratio (OR): 0.38, 95% confidence interval (CI): 0.25-0.56, P < 0.001). Patients were more likely to have chemotherapy omitted than escalated when using the RS (OR: 9.76, 95% CI: 6.72-14.18, P < 0.001). For those with stage II disease, concordant results between the 12-gene assay and MDT were more likely than discordant (OR: 0.30, 95% CI: 0.17-0.53, P < 0.001). In stage II disease, patients were more likely to have chemotherapy omitted than escalated when using the RS (OR: 7.39, 95% CI: 4.85-11.26, P < 0.001). Conclusions: The use of the 12-gene signature refutes the decision of tumour board in 25% of cases, with 75% of discordant decisions resulting in omission of adjuvant chemotherapy. Therefore, it is possible that a proportion of such patients are being overtreated when relying on tumour board decisions alone.
MeSH term(s)	Humans ; Aged ; DNA Mismatch Repair/genetics ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Neoplasm Staging ; Colonic Neoplasms/drug therapy ; Colonic Neoplasms/genetics ; Colonic Neoplasms/pathology ; Chemotherapy, Adjuvant ; Carcinoma
Language	English
Publishing date	2023-03-13
Publishing country	Germany
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-023-04364-2
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Article ; Online: Influence of neoadjuvant treatment strategy on perioperative outcomes in locally advanced rectal cancer.

McFeetors, Carson / O'Connell, Lauren V / Choy, Megan / Dundon, Niamh / Regan, Mark / Joyce, Myles / Meshkat, Babak / Hogan, Aisling / Nugent, Emmeline

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2024 Volume 26, Issue 4, Page(s) 684–691

Abstract: Aim: Neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer facilitates tumour downstaging and complete pathological response (pCR). The goal of neoadjuvant systemic chemotherapy (total neoadjuvant chemotherapy, TNT) is to further ... ...

Abstract	Aim: Neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer facilitates tumour downstaging and complete pathological response (pCR). The goal of neoadjuvant systemic chemotherapy (total neoadjuvant chemotherapy, TNT) is to further improve local and systemic control. While some patients forgo surgery, total mesorectal excision (TME) remains the standard of care. While TNT appears to be noninferior to nCRT with respect to short-term oncological outcomes few data exist on perioperative outcomes. Perioperative morbidity including anastomotic leaks is associated with a negative effect on oncological outcomes, probably due to a delay in proceeding to adjuvant therapy. Thus, we aimed to compare conversion rates, rates of sphincter-preserving surgery and anastomosis formation rates in patients undergoing rectal resection after either TNT or standard nCRT. Methods: An institutional colorectal oncology database was searched from January 2018 to July 2023. Inclusion criteria comprised patients with histologically confirmed rectal cancer who had undergone neoadjuvant therapy and TME. Exclusion criteria comprised patients with a noncolorectal primary, those operated on emergently or who had local excision only. Outcomes evaluated included rates of conversion to open, sphincter-preserving surgery, anastomosis formation and anastomotic leak. Results: A total of 119 patients were eligible for inclusion (60 with standard nCRT, 59 with TNT). There were no differences in rates of sphincter preservation or primary anastomosis formation between the groups. However, a significant increase in conversion to open (p = 0.03) and anastomotic leak (p = 0.03) was observed in the TNT cohort. Conclusion: In this series TNT appears to be associated with higher rates of conversion to open surgery and higher anastomotic leak rates. While larger studies will be required to confirm these findings, these factors should be considered alongside oncological benefits when selecting treatment strategies.
MeSH term(s)	Humans ; Rectal Neoplasms/therapy ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Neoadjuvant Therapy/methods ; Male ; Middle Aged ; Female ; Aged ; Treatment Outcome ; Proctectomy/methods ; Anastomotic Leak/etiology ; Retrospective Studies ; Anastomosis, Surgical ; Conversion to Open Surgery/statistics & numerical data ; Chemoradiotherapy, Adjuvant/methods ; Organ Sparing Treatments/methods ; Neoplasm Staging ; Rectum/surgery ; Rectum/pathology ; Adult
Language	English
Publishing date	2024-02-29
Publishing country	England
Document type	Journal Article
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.16929
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Zs.A 5799: Show issues

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Article ; Online: Alternative method of tractioning the Sengstaken-Blakemore tube.

Murphy, Evelyn Patricia / O'Brien, Sean Michael / Regan, Mark

BMJ case reports

2017 Volume 2017

MeSH term(s)	Esophageal and Gastric Varices/surgery ; Gastrointestinal Hemorrhage/prevention & control ; Guidelines as Topic ; Hemostatic Techniques/instrumentation ; Humans ; Hypertension, Portal/complications ; Tampons, Surgical ; Treatment Outcome
Language	English
Publishing date	2017-03-20
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2016-218401
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Article ; Online: Evaluating the oncological safety of neoadjuvant chemotherapy in locally advanced colon carcinoma: a systematic review and meta-analysis of randomised clinical trials and propensity-matched studies.

Davey, Matthew G / Amir, Amira H / Ryan, Odhrán K / Donnelly, Mark / Donlon, Noel E / Regan, Mark / Meshkat, Babak / Nugent, Emmeline / Joyce, Myles / Hogan, Aisling M

International journal of colorectal disease

2023 Volume 38, Issue 1, Page(s) 193

Abstract: Purpose: Use of neoadjuvant chemotherapy (NAC) for locally advanced colon cancer (LACC) remains controversial. An integrated analysis of data from high-quality studies may inform the long-term safety of NAC for this cohort. Our aim was to perform a ... ...

Abstract	Purpose: Use of neoadjuvant chemotherapy (NAC) for locally advanced colon cancer (LACC) remains controversial. An integrated analysis of data from high-quality studies may inform the long-term safety of NAC for this cohort. Our aim was to perform a systematic review and meta-analysis of randomised clinical trials (RCTs) and propensity-matched studies to assess the oncological safety of NAC in patients with LACC. Methods: A systematic review was performed as per preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Survival was expressed as hazard ratios using time-to-effect generic inverse variance methodology, while surgical outcomes were expressed as odds ratios (ORs) using the Mantel-Haenszel method. Data analysis was performed using Review Manager version 5.4. Results: Eight studies (4 RCTs and 4 retrospective studies) including 31,047 patients with LACC were included. Mean age was 61.0 years (range: 19-93 years) and mean follow-up was 47.6 months (range: 2-133 months). Of those receiving NAC, 4.6% achieved a pathological complete response and 90.6% achieved R0 resection (versus 85.9%, P < 0.001). At 3 years, patients receiving NAC had improved disease-free survival (DFS) (OR: 1.28, 95% confidence interval (CI): 1.02-1.60, P = 0.030) and overall survival (OS) (OR: 1.76, 95% CI: 1.10-2.81, P = 0.020). When using time-to-effect modelling, a non-significant difference was observed for DFS (HR: 0.79, 95% CI: 0.57-1.09, P = 0.150) while a significant difference in favour of NAC was observed for OS (HR: 0.75, 95% CI: 0.58-0.98, P = 0.030). Conclusion: This study highlights the oncological safety of NAC for patients being treated with curative intent for LACC using RCT and propensity-matched studies only. These results refute current management guidelines which do not advocate for NAC to improve surgical and oncological outcomes in patients with LACC. Trial registration: International Prospective Register of Systematic Review (PROSPERO) registration: CRD4202341723.
MeSH term(s)	Humans ; Middle Aged ; Neoadjuvant Therapy/adverse effects ; Colonic Neoplasms/drug therapy ; Colonic Neoplasms/surgery ; Disease-Free Survival ; Odds Ratio ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2023-07-11
Publishing country	Germany
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-023-04482-x
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Book ; Article ; Online: The potential costs and distributional effect of Covid-19 related unemployment in Ireland

Beirne, Keelan / Doorley, Karina / Regan, Mark / Roantree, Barra / Tuda, Dora

2020

Abstract: This paper simulates the impact that Covid-19 related job losses will have on family incomes and the public finances. It finds that in the central 'medium' unemployment scenario of 600,000 job losses, around 400,000 families will see their disposable ... ...

Abstract	This paper simulates the impact that Covid-19 related job losses will have on family incomes and the public finances. It finds that in the central 'medium' unemployment scenario of 600,000 job losses, around 400,000 families will see their disposable income fall by more than 20 per cent in the absence of policy changes, with proportionately larger losses for those in higher income families. Measures announced by the Government - notably the flat-rate Pandemic Unemployment Payment of €350 per week - reduce the numbers exposed to such extreme losses by about a third, but at significant cost to the Exchequer. The paper also finds that the additional cost of the Government's Temporary Wage Subsidy Scheme may be minimal, in part because its current design is less generous to lower earners than the Pandemic Unemployment Payment they would receive if laid off.
Keywords	ddc:330 ; D31 ; E24 ; H31 ; covid-19 ; Ireland ; tax-benefit policy ; distribution
Subject code	331
Language	English
Publisher	Colchester: University of Essex, Institute for Social and Economic Research (ISER)
Publishing country	de
Document type	Book ; Article ; Online
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Book ; Online: The potential costs and distributional effect of COVID-19 related unemployment in Ireland

Beirne, Keelan / Doorley, Karina / Regan, Mark / Roantree, Barra / Tuda, Dora

2020

Abstract	This paper simulates the impact that Covid-19 related job losses will have on family incomes and the public finances. It finds that in the central 'medium' unemployment scenario of 600,000 job losses, around 400,000 families will see their disposable income fall by more than 20 per cent in the absence of policy changes, with proportionately larger losses for those in higher income families. Measures announced by the Government - notably the flat-rate Pandemic Unemployment Payment of €350 per week - reduce the numbers exposed to such extreme losses by about a third, but at significant cost to the Exchequer. The paper also finds that the additional cost of the Government's Temporary Wage Subsidy Scheme may be minimal, in part because its current design is less generous to lower earners than the Pandemic Unemployment Payment they would receive if laid off.
Keywords	ddc:330 ; Arbeitslosigkeit ; Coronavirus ; Wirtschaftskrise ; Soziale Kosten ; Verteilungswirkung ; Irland
Subject code	331
Language	English
Publisher	Dublin: The Economic and Social Research Institute (ESRI)
Publishing country	de
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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