644 research outputs found
Les assistĂ©s peuvent-ils ĂȘtre autonomes ? Sociologie comprĂ©hensive des politiques dâinsertion
LâĂ©tude de la portĂ©e du contrat dâinsertion du Revenu minimum dâinsertion (RMI) permet dâapprĂ©hender les relations des populations vulnĂ©rables avec les institutions de lâĂtat social, notamment avec la norme dâautonomie individuelle quâil cherche de plus en plus Ă promouvoir. Ă partir dâenquĂȘtes par entretiens semi-directifs rĂ©alisĂ©es de 2005 Ă 2007 auprĂšs de plus de 70 allocataires vivant dans la rĂ©gion de Paris en France et ayant un contrat dâinsertion en cours de validitĂ©, cet article Ă©labore une typologie des relations des allocataires du RMI avec cet instrument et explore les relations entre les deux acceptions qui peuvent ĂȘtre donnĂ©es Ă lâautonomie des pauvres.Studying the contracts of the Revenu minimum dâinsertion (RMI) provides an understanding of the relations between vulnerable populations and the institutions of the welfare state, and in particular the expectation of individual autonomy that it increasing promotes. Based on semi-structured interviews with more than 70 recipients of the RMI benefit living in the Paris region who had an active insertion contract, this article develops a typology of the relations between this policy instrument and the recipients. It also explores the relations between the two meanings that can be given to the autonomy of the poor
France is in the midst of a poverty crisis
What impact has the Covid-19 pandemic had on poverty? Nicolas Duvoux presents findings from a major report on the impact of the virus in France. He writes that there is clear evidence the pandemic has accelerated levels of inequality in the country
Measuring the link between class and wealth in Europe
Economists and sociologists have often adopted different approaches to measuring inequality. Drawing on a new study, Nicolas Duvoux, Adrien Papuchon and Senmiao Yang attempt to bridge this gap by analysing wealth and income distributions among occupational groups in five European countries
Les sciences sociales Ă lâĂ©preuve de lâexpertise
Dans son premier numĂ©ro, Sociologie a interrogĂ© la posture du sociologue dans le champ mĂ©diatique. Dans le prolongement dâun autre questionnement initiĂ© lors du colloque « Le sociologue dans la CitĂ©. Ăthique et utilitĂ© publique » tenu Ă lâEhess, les rapports de la production de connaissance en sciences sociales avec lâaide Ă la dĂ©cision politique, le champ de lâexpertise, font ici lâobjet dâune attention particuliĂšre (...)
Subjective poverty as perceived lasting social insecurity: lessons from a French survey on poverty, inequality and the welfare state (2015-2018)
Literature has long been attentive to the study of subjective happiness or well-being. Key questions developed in the late 1970âs have recently been framed as indicators of subjective economic stress or used to build âconsensual poverty linesâ. Yet, these notions differ from an authentic â i.e. direct â measure of subjective poverty. We use 2015-2018 French data to determine the share of the population who considers itself as poor and study its social composition. Our results demonstrate that class, family composition and income instability matter as determinants of subjective poverty. The key feature of the group of those who consider themselves as poor is a degraded attitude towards their own future. Finally, we propose a sociological understanding of our subjective poverty indicato
Quelle réforme pour le revenu de solidarité active et la Prime pour l'emploi ?
Alors quâil est depuis longtemps question de rĂ©former les aides Ă lâemploi destinĂ©es aux salariĂ©s les moins bien rĂ©munĂ©rĂ©s, la difficultĂ© rĂ©cemment rencontrĂ©e par le gouvernement pour baisser les cotisations sociales salariĂ©es sur les bas salaires (mesure censurĂ©e par le Conseil constitutionnel) a relancĂ© le dĂ©bat sur les rĂ©formes des dispositifs existants pour les plus bas revenus : la Prime pour lâemploi et le revenu de solidaritĂ© active. Dans le cadre des rĂ©flexions du LIEPP sur lâĂ©valuation de lâusage de la fiscalitĂ© Ă des fins de politiques sociales, nous publions ci-aprĂšs trois textes dĂ©finissant trois orientations possibles pour les rĂ©formes du RSA et de la PPE. Ces textes sont issus dâune journĂ©e dâĂ©tudes organisĂ©e le 29 janvier 2014, intitulĂ©e « Le contribuable et lâassistĂ©. Le dĂ©bat RSA/PPE entre principes et paramĂštres ». Ils sâintĂ©ressent aux enjeux de l'utilisation de la fiscalitĂ© dans le soutien Ă l'activitĂ© des travailleurs modestes mais aussi aux profondes limites du systĂšme actuel. La France a, depuis 2000, dĂ©veloppĂ© un impĂŽt nĂ©gatif, dâabord sous la forme de la prime pour lâemploi (PPE) puis comme un Ă©lĂ©ment du Revenu de SolidaritĂ© active. Il sâagit ici bien dâune dĂ©pense fiscale Ă visĂ©e de politique d'emploi et de politique sociale. Plusieurs Ă©lĂ©ments invitent en effet Ă interroger la cohĂ©rence et l'efficacitĂ© des choix retenus : les caractĂ©ristiques propres du RSA ainsi que le non-recours massif Ă sa composante activitĂ©, ont conduit Ă une rĂ©flexion sur la question. De son cĂŽtĂ©, la PPE, dont le barĂšme a Ă©tĂ© gelĂ©, pose un problĂšme de rĂ©partition. DistribuĂ©e largement, elle souffre de « saupoudrage » et d'une faible rĂ©activitĂ©. Prenant acte de ces faiblesses structurelles croisĂ©es des deux dispositifs destinĂ©s Ă soutenir les travailleurs modestes, le rapport remis par le dĂ©putĂ© Christophe Sirugue au Premier Ministre Ă l'Ă©tĂ© 2013 a proposĂ© une « prime d'activitĂ© » fusionnant la PPE et le RSA activitĂ©.Alors que la rĂ©duction des cotisations sociales salariĂ©es pour les salaires entre 1 et 1,3 SMIC a Ă©tĂ© privilĂ©giĂ©e pour « rendre le travail payant » ou du moins plus attractif, en bas de lâĂ©chelle des salaires, une dĂ©cision du Conseil Constitutionnel du 06/08/2014 , rejetant une telle baisse au motif dâune mĂ©connaissance du principe dâĂ©galitĂ© devant la loi a remis la question de la fusion RSA / PPE Ă lâordre du jour ? Comment rĂ©pondre de la maniĂšre la plus efficace Ă un dĂ©fi crĂ©Ă© par la faiblesse des salaires dâun cĂŽtĂ©, lâincohĂ©rence et les Ă©checs des politiques publiques de lâautre
Quelle réforme pour le revenu de solidarité active et la Prime pour l'emploi ?
Alors quâil est depuis longtemps question de rĂ©former les aides Ă lâemploi destinĂ©es aux salariĂ©s les moins bien rĂ©munĂ©rĂ©s, la difficultĂ© rĂ©cemment rencontrĂ©e par le gouvernement pour baisser les cotisations sociales salariĂ©es sur les bas salaires (mesure censurĂ©e par le Conseil constitutionnel) a relancĂ© le dĂ©bat sur les rĂ©formes des dispositifs existants pour les plus bas revenus : la Prime pour lâemploi et le revenu de solidaritĂ© active. Dans le cadre des rĂ©flexions du LIEPP sur lâĂ©valuation de lâusage de la fiscalitĂ© Ă des fins de politiques sociales, nous publions ci-aprĂšs trois textes dĂ©finissant trois orientations possibles pour les rĂ©formes du RSA et de la PPE.
Ces textes sont issus dâune journĂ©e dâĂ©tudes organisĂ©e le 29 janvier 2014, intitulĂ©e « Le contribuable et lâassistĂ©. Le dĂ©bat RSA/PPE entre principes et paramĂštres ». Ils sâintĂ©ressent aux enjeux de l'utilisation de la fiscalitĂ© dans le soutien Ă l'activitĂ© des travailleurs modestes mais aussi aux profondes limites du systĂšme actuel. La France a, depuis 2000, dĂ©veloppĂ© un impĂŽt nĂ©gatif, dâabord sous la forme de la prime pour lâemploi (PPE) puis comme un Ă©lĂ©ment du Revenu de SolidaritĂ© active. Il sâagit ici bien dâune dĂ©pense fiscale Ă visĂ©e de politique d'emploi et de politique sociale.
Plusieurs éléments invitent en effet à interroger la cohérence et l'efficacité des choix retenus : les caractéristiques propres du RSA ainsi que le non-recours massif à sa composante activité, ont conduit à une réflexion sur la question. De son cÎté, la PPE, dont le barÚme a été gelé, pose un problÚme de répartition. Distribuée largement, elle souffre de « saupoudrage » et d'une faible réactivité. Prenant acte de ces faiblesses structurelles croisées des deux dispositifs destinés à soutenir les travailleurs modestes, le rapport remis par le député Christophe Sirugue au Premier Ministre à l'été 2013 a proposé une « prime d'activité » fusionnant la PPE et le RSA activité.
Alors que la rĂ©duction des cotisations sociales salariĂ©es pour les salaires entre 1 et 1,3 SMIC a Ă©tĂ© privilĂ©giĂ©e pour « rendre le travail payant » ou du moins plus attractif, en bas de lâĂ©chelle des salaires, une dĂ©cision du Conseil Constitutionnel du 06/08/2014 , rejetant une telle baisse au motif dâune mĂ©connaissance du principe dâĂ©galitĂ© devant la loi a remis la question de la fusion RSA / PPE Ă lâordre du jour ? Comment rĂ©pondre de la maniĂšre la plus efficace Ă un dĂ©fi crĂ©Ă© par la faiblesse des salaires dâun cĂŽtĂ©, lâincohĂ©rence et les Ă©checs des politiques publiques de lâautre
Early transplantation maximizes survival in severe acute-on-chronic liver failure: results of a Markov decision process model
BACKGROUND:
Uncertainties exist surrounding the timing of liver transplantation (LT) among patients with acute-on-chronic liver failure grade 3 (ACLF-3), regarding whether to accept a marginal quality donor organ to allow for earlier LT or wait for either an optimal organ offer or improvement in the number of organ failures, in order to increase post-LT survival.
METHODS:
We created a Markov decision process model to determine the timing of LT among patients with ACLF-3 within 7 days of listing, to maximize overall one-year survival probability.
RESULTS:
We analyzed six groups of candidates with ACLF-3: patients age â€60 or >60 years, patients with 3 organ failures alone or 4-6 organ failures, and hepatic or extrahepatic ACLF-3. Among all groups, LT yielded significantly greater overall survival probability versus remaining on the waiting list for even 1 additional day (p 60 years or with 4-6 organ failures. Probability of improvement from ACLF-3 to ACLF-2 does not influence these recommendations, as the likelihood of organ recovery was less than 10%.
CONCLUSION:
During the first week after listing for patients with ACLF-3, earlier LT in general is favored over waiting for an optimal quality donor organ or for recovery of organ failures, with the understanding that the analysis is limited to consideration of only these three variables.
LAY SUMMARY:
In the setting of grade three acute-on-chronic liver failure (ACLF-3), questions remain regarding the timing of transplantation in terms of whether to proceed with liver transplantation with a marginal donor organ versus waiting for an optimal liver, and whether to transplant a patient with ACLF-3 or wait until improvement to ACLF-2. In this study, we used a Markov decision process model to demonstrate that earlier transplantation of patients listed with ACLF-3 maximizes overall survival, as opposed to waiting for an optimal donor organ or for improvement in the number of organ failures
Liver transplantation for alcoholic cirrhosis: Long term follow-up and impact of disease recurrence
Background. Alcoholic liver disease has emerged as a leading indication for hepatic transplantation, although it is a controversial use of resources. We aimed to examine all aspects of liver transplantation associated with alcohol abuse. Methods. Retrospective cohort analysis of 123 alcoholic patients with a median of 7 years follow-up at one center. Results. In addition to alcohol, 43 (35%) patients had another possible factor contributing to cirrhosis. Actuarial patient and graft survival rates were, respectively, 84% and 81% (1 year); 72% and 66% (5 years); and 63% and 59% (7 years). After transplantation, 18 patients (15%) manifested 21 noncutaneous de novo malignancies, which is significantly more than controls (P=0.0001); upper aerodigestive squamous carcinomas were over-represented (P=0.03). Thirteen patients had definitely relapsed and three others were suspected to have relapsed. Relapse was predicted by daily ethanol consumption (P=0.0314), but not by duration of pretransplant sobriety or explant histology. No patient had alcoholic hepatitis after transplantation and neither late onset acute nor chronic rejection was significantly increased. Multiple regression analyses for predictors of graft failure identified major biliary/vascular complications (P=0.01), chronic bile duct injury on biopsy (P=0.002), and pericellular fibrosis on biopsy (P=0.05); graft viral hepatitis was marginally significant (P=0.07) on univariate analysis. Conclusions. Alcoholic liver disease is an excellent indication for liver transplantation in those without coexistent conditions. Recurrent alcoholic liver disease alone is not an important cause of graft pathology or failure. Potential recipients should be heavily screened before transplantation for coexistent conditions (e.g., hepatitis C, metabolic diseases) and other target-organ damage, especially aerodigestive malignancy, which are greater causes of morbidity and mortality than is recurrent alcohol liver disease
Vascular invasion and survival after liver transplantation for hepatocellular carcinoma: a study from the European Liver Transplant Registry
Background: Studies suggest that vascular invasion may be a superior prognostic marker compared with traditional selection criteria, e.g. Milan criteria. This study aimed to investigate the prognostic value of micro and macrovascular invasion in a large database material.
Methods: Patients liver transplanted for HCC and cirrhosis registered in the European Liver Transplant Registry (ELTR) database were included. The association between the Milan criteria, Up-to-seven criteria and vascular invasion with overall survival and HCC specific survival was investigated with univariate and multivariate Cox regression analyses.
Results: Of 23,124 patients transplanted for HCC, 9324 had cirrhosis and data on explant pathology. Patients without microvascular invasion, regardless of number and size of HCC nodules, had a five-year overall survival of 73.2%, which was comparable with patients inside both Milan and Up-to-seven criteria. Patients without macrovascular invasion had an only marginally reduced survival of 70.7% after five years. Patients outside both Milan and Up-to-seven criteria without micro or macrovascular invasion still had a five-year overall survival of 65.8%.
Conclusion: Vascular invasion as a prognostic indicator remains superior to criteria based on size and number of nodules. With continuously improving imaging studies, microvascular invasion may be used for selecting patients for transplantation in the future
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