Socioeconomic Factors Associated with Poor Prognosis in Patients with Alcoholic Liver Cirrhosis

Background: Alcohol liver cirrhosis is a life-threatening condition, especially if alcohol cessation is not accomplished. Past studies have shown that alcohol abuse is closely linked to low socioeconomic status and social marginalization. Public assistance (PA), or Seikatsu-hogo, a Japanese public assistance ensuring medical care to low-income population, was employed as a proxy for social marginalization. This study aims to investigate the prognostic effect of being a PA recipient on overall mortality in patients with alcoholic cirrhosis.Methods: Patients diagnosed as alcoholic liver cirrhosis in a community hospital between 2006 to 2017 were included in this retrospective cohort study. Baseline demographics and mortality data were extracted from electronic health records. Cirrhosis severity at baseline was measured by mean model for end-stage liver disease (MELD) score and Albumin-Bilirubin (ALBI) score. Primary outcome was survival probability obtained by the Kapan Meier method and Cox proportional hazards regression. Results: 244 participants were included, among which 62 were PA recipients. Baseline cirrhosis severity score was not different between the two groups. Incidence proportion for overall mortality was 48.4% and 31.9% for PA recipients and non-PA recipients, respectively (p=0.002). In cox regression model, adjusted for age, ALBI score and HCV infection, hazard ratio for PA reception was1.57 (95% CI: 0.97-2.5, p=0.06). Conclusions: Being a PA recipient may be a poor prognostic factor of mortality in patients with alcoholic liver cirrhosis.

Social marginalization in regions of Siberia and Far East of Russia: Factors, Features, Trends

The social marginalization is one of the most acute problems of modern Russia as it results in its development slowdown and a loss in its social and human capital. The marginalization is particularly wide-spread in the regions of the Asian part of the country. The marginalization is characterized by a complex of problems including the social diseases, the spread of crimes in various forms, the economic and social benefits deprivation, etc. Due to the impoverishment of the human capital, the progress is slow in the Siberian and Far Eastern regions, and this threatens the sustainable economic development here. In this paper, the authors propose a system of indicators and a methodology enabling a comprehensive assessment of the social marginalization. An attempt is made in the paper to link some statistical indicators of the social deprivation with the most striking characteristics of the marginalization in the society. Also, in the paper, the heterogeneity and the regional specificity of this phenomenon are shown. The main factors of geographic, economic, cultural and institutional origin making their impact on the level of marginalization have also been identified.

Who Can Buffer Marginalization Risk? Affect Experience, Affect Valuation, and Social Marginalization in Japan and Brazil

Previous research has associated social marginalization with the rejection of mainstream cultural values. Since cultural values reflect affect valuation, the present research investigates the relationships between social marginalization and ideal/actual affect in two different non-WEIRD cultures, Brazil and Japan. As a social marginalization index, we used the NEET-Hikikomori Risk Scale (NHR). We predicted that cultural differences would emerge in the valuation of affective states. Affect valuation theory suggests that in East Asia, individuals are encouraged to pursue and value low arousal positive emotions (LAP: e.g., calmness, serenity) over high arousal positive emotions (HAP: e.g., excitement, elation, etc.) as they can harm social relationships in these societies. In contrast, Latin American cultures value HAP over LAP, because social relationships are promoted through vibrant positive emotional expression in these cultures. Hence, we hypothesized that individuals’ ideal affect, actual affect, and the discrepancy between ideal and actual affect would be associated with higher risk of social marginalization. Participants from Japan (N = 54) and Brazil (N = 54) reported their ideal affect and actual affect and completed the NEET-Hikikomori Risk Scale (NHR). Regression analyses showed that actual HAP and the discrepancy between ideal and actual HAP were negatively associated with NHR in Brazil, but no association was found in the Japanese data. The other variables, including ideal affect, were only minorly or not significantly associated with NHR. Though the study has limitations regarding its small sample size, we can explore future perspectives and discuss the relationships between emotion and cultural marginalization. Socioecological factors that promote actual HAP in Brazilians may encourage other mainstream cultural ideals, which buffers against cultural marginalization.

The Social Marginalization of People Living with a Mentally Ill Label–Family, Friends, and Work

This paper is based on qualitative research among people diagnosed with a mental illness who voluntarily attend a mental health center. Such individuals are given a degrading “mentally ill” label, which transforms them into a “new” person. This study showed that—due to their label—research participants are often socially marginalized—not only in the public but also in the private sphere. As members of an “organized deviant group” (the mental health center), they follow a “deviant career” and find a job outside the regular job market. Their marginalization is not only caused by their health problems (by their impairment), but they are also disabled through social reactions to these problems. Psychiatry based on the biological model of the disease cannot, therefore, help them without the cooperation of social science approaches dealing with social marginalization.