Welfare systems and adequacy of pension benefits in Europe

During the post-war years many European countries have implemented far-reaching but diverse pension systems with the objective of providing those in retirement with adequate incomes. In this study, we explore the link between pension systems and the adequacy of retirement income. We analyse the mix of public and private pensions and consider the impact of different policies on poverty rates amongst pensioners. We suggest that only a few European countries have been successful in providing combinations of private and public pensions that improve the adequacy of retirement income

Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial.

AIMS: To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. METHODS AND RESULTS: This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI -0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or €4356 (95% CI €284, €8323). CONCLUSION: An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective. CLINICAL TRIAL REGISTRATION: ISRCTN 48334791

The effect of aortic morphology on peri-operative mortality of ruptured abdominal aortic aneurysm

Aims To investigate whether aneurysm shape and extent, which indicate whether a patient with ruptured abdominal aortic aneurysm (rAAA) is eligible for endovascular repair (EVAR), influence the outcome of both EVAR and open surgical repair. Methods and results The influence of six morphological parameters (maximum aortic diameter, aneurysm neck diameter, length and conicality, proximal neck angle, and maximum common iliac diameter) on mortality and reinterventions within 30 days was investigated in rAAA patients randomized before morphological assessment in the Immediate Management of the Patient with Rupture: Open Versus Endovascular strategies (IMPROVE) trial. Patients with a proven diagnosis of rAAA, who underwent repair and had their admission computerized tomography scan submitted to the core laboratory, were included. Among 458 patients (364 men, mean age 76 years), who had either EVAR (n = 177) or open repair (n = 281) started, there were 155 deaths and 88 re-interventions within 30 days of randomization analysed according to a pre-specified plan. The mean maximum aortic diameter was 8.6 cm. There were no substantial correlations between the six morphological variables. Aneurysm neck length was shorter in those undergoing open repair (vs. EVAR). Aneurysm neck length (mean 23.3, SD 16.1 mm) was inversely associated with mortality for open repair and overall: adjusted OR 0.72 (95% CI 0.57, 0.92) for each 16 mm (SD) increase in length. There were no convincing associations of morphological parameters with reinterventions. Conclusion Short aneurysm necks adversely influence mortality after open repair of rAAA and preclude conventional EVAR. This may help explain why observational studies, but not randomized trials, have shown an early survival benefit for EVAR. Clinical trial registration: ISRCTN 48334791

Ethnic minorities, retirement planning and personal accounts

Purpose – The purpose of this paper is to examine issues relating to public and private pensions for individuals from some of the major ethnic minority groups in the UK. Design/methodology/approach – The paper draws on data from in-depth interviews and focus groups with 64 respondents from the six largest ethnic minority groups in the UK, as well as from a white British control group. Findings – The research found that a belief in the need for retirement planning was held by respondents of all backgrounds, that there was a widespread view that state pension should be increased to a more adequate level, and concern amongst some respondents that they would be unable to receive retirement income from pension schemes if they were to retire in another country. Research limitations/implications – The limitations of the research largely concern the limited sample of respondents (n?=?64), the use of English in all interviews and significant reliance on the internet in order to contact potential respondents. Practical implications – It is suggested that more widespread information about retirement planning is needed in minority ethnic media and that in promoting the forthcoming scheme of Personal Accounts, the government should make clear the extent to which the scheme will allow members to receive retirement income in another country, for those who choose to retire abroad. Originality/value – The paper contributes new information about attitudes to the forthcoming scheme of Personal Accounts, and explores retirement strategies of ethnic minority individuals in the UK

Permanent sovereignty over natural resources in the 21st century: natural resource governance and the right to self-determination of indigenous peoples under international law

Permanent sovereignty over natural resources has emerged as a fundamental principle in international law, allowing postcolonial states to assert full sovereignty or ‘sovereign rights’ over natural resources found within the limits of their jurisdiction. Despite the postcolonial context in which the first United Nations General Assembly resolutions in the field were adopted, there has been an increasing recognition that the right to permanent sovereignty should be given a wider scope and could start to legitimise the claims of non-state actors and communities in defining ownership and usage rights over the natural resources within a state. Indeed, international law has evolved to recognise a number of substantive and procedural rights for indigenous peoples, including: ownership rights over natural resources; the right to participate in decision-making and to prior and informed consent in the context of natural resources extraction projects; and the sharing of benefits arising from the exploration and commercial exploitation of natural resources in indigenous lands. This paper argues that the principle of permanent sovereignty over natural resources complements and further refines the right of self-determination of ‘peoples’ under international law while establishing important parameters for the allocation of property rights in natural resources. Moreover, by implementing substantive and procedural rights that allow indigenous peoples to exercise resource rights, it is suggested that states have transferred sovereign powers over natural resources to non-state actors, thus upsetting the notion of permanent sovereignty as a right belonging to states