Explaining the variety of social policy responses to economic crisis: How parties and welfare state structures interact

This paper maps and explains the reactions of four welfare states - Australia, Belgium, the Netherlands and Sweden - to three global crisis situations - the oil shocks of the 1970s, the worldwide recession of the early 1990s, and the financial crisis from 2008 onwards. Two main conclusions follow from the analysis: First, using a comprehensive typology of social policy reactions to crises, we show that crisis reactions were surprisingly diverse. There is no uniform policy response, as policies range from retrenchment through non-response to welfare state expansion. Second, explaining the variation regarding expansion vs. retrenchment we focus on the partisan composition of government, and the size of the existing welfare state, which may operate as an important automatic stabilizer during recessions. While none of these factors alone is sufficient, their interaction is able to explain most of the specific social policy responses adopted in the four countries studied. -- Das Arbeitspapier beschreibt und erklärt die Reaktionen von vier Wohlfahrtsstaaten - Australien, Belgien, die Niederlande und Schweden - auf drei globale Krisensituationen - die Ölpreisschocks der 1970er Jahre, die weltweite Rezession in den frühen 1990ern und die Finanzkrise nach 2008. Zwei Schlussfolgerungen können gezogen werden: Erstens zeigen wir, basierend auf einer umfassenden Typologie sozialpolitischer Krisenreaktionen, dass Krisenreaktionen überraschend unterschiedlich ausfielen. Es gibt keine einheitliche Krisenantwort, Reaktionen reichen vielmehr von Kürzungen, über bewusste Nicht-Reaktion, bis hin zu sozialpolitischem Ausbau. Zweitens konzentrieren wir uns zur Erklärung der Variation im Hinblick auf Rückbau und Ausbau einerseits auf die parteipolitische Zusammensetzung der Regierung und andererseits auf die Größe des existierenden Wohlfahrtsstaats, der in Zeiten wirtschaftlicher Rezession als wichtiger automatischer Stabilisator wirken kann. Obgleich keiner dieser Faktoren allein ausreicht, ist ihre Interaktion in der Lage, die meisten spezifischen sozialpolitischen Reaktionen der vier Länder zu erklären.

Staphylococcus aureus bloodstream infection: A pooled analysis of five prospective, observational studies

Objectives: Staphylococcus aureus bacteraemia is a common, often fatal infection. Our aim was to describe how its clinical presentation varies between populations and to identify common determinants of outcome. Methods: We conducted a pooled analysis on 3395 consecutive adult patients with S. aureus bacteraemia. Patients were enrolled between 2006 and 2011 in five prospective studies in 20 tertiary care centres in Germany, Spain, United Kingdom, and United States. Results: The median age of participants was 64 years (interquartile range 50–75 years) and 63.8% were male. 25.4% of infections were associated with diabetes mellitus, 40.7% were nosocomial, 20.6% were caused by methicillin-resistant S. aureus (MRSA), although these proportions varied significantly across studies. Intravenous catheters were the commonest identified infective focus (27.7%); 8.3% had endocarditis. Crude 14 and 90-day mortality was 14.6% and 29.2%, respectively. Age, MRSA bacteraemia, nosocomial acquisition, endocarditis, and pneumonia were independently associated with death, but a strong association was with an unidentified infective focus (adjusted hazard ratio for 90-day mortality 2.92; 95% confidence interval 2.33 to 3.67, p < 0.0001). Conclusion: The baseline demographic and clinical features of S. aureus bacteraemia vary significantly between populations. Mortality could be reduced by assiduous MRSA control and early identification of the infective focus.Junta de Andalucía PI 0185/201

Explaining the variety of social policy responses to economic crisis : how parties and welfare state structures interact

This paper maps and explains the reactions of four welfare states – Australia, Belgium, the Netherlands and Sweden – to three global crisis situations – the oil shocks of the 1970s, the worldwide recession of the early 1990s, and the financial crisis from 2008 onwards. Two main conclusions follow from the analysis: First, using a comprehensive typology of social policy reactions to crises, we show that crisis reactions were surprisingly diverse. There is no uniform policy response, as policies range from retrenchment through non-response to welfare state expansion. Second, explaining the variation regarding expansion vs. retrenchment we focus on the partisan composition of government, and the size of the existing welfare state, which may operate as an important automatic stabilizer during recessions. While none of these factors alone is sufficient, their interaction is able to explain most of the specific social policy responses adopted in the four countries studied

The New Politics of Crisis Management: Global Voices on the Role of Social Policies. Proceedings of the UNRISD Conference ‘New Directions in Social Policy: Alternatives from and for the South. Geneva: United Nations Research Institute for Social Development

Kaasch A. The New Politics of Crisis Management: Global Voices on the Role of Social Policies. Proceedings of the UNRISD Conference ‘New Directions in Social Policy: Alternatives from and for the South. Geneva: United Nations Research Institute for Social Development.; 2014

Global social policy in the field of health systems : international organisations and their policy models.

This thesis is a discussion of some fundamental elements of global social policy concepts. The dimension of global social policy that is about the social policy models of global actors has been characterised by primarily referring to pension policy. Analysing global policy ideas of national health systems, this thesis tests to what extent these definitions and concepts of global social policy hold true when taking into account policy models other than for pension policy. The analysis focuses on a number of international (inter-governmental) organisations that appear as global social policy actors in the field of health systems, most notably the World Health Organisation (WHO), the World Bank, the International Labour Organisation (lLO) and the Organisation for Economic Cooperation and Development (OECD). Based primarily on a detailed document analysis, the thesis is structured to study, and to compare, the organisations' mandates as global health actors, the models for health systems developed by these organisations, and their communication channels. The characterisations of the global policy models of health systems are then compared to those for pension systems and related to more general understandings of global social policy. The key arguments developed in this thesis are that (l) not all social policy fields are characterised by the same structures and processes; that (2) not all social policy fields are about competition and contestations, but for models of health systems, we find a significant degree of similarity between the models promulgated by international organisations; and that (3) global social policy analysis would benefit from more nuanced ways of understanding the nature of its actors, the specifics of its ideas and concepts, and the implications of different communication channels

Impact of adherence to individual quality-of-care indicators on the prognosis of bloodstream infection due to Staphylococcus aureus: a prospective observational multicentre cohort

Objectives To analyse the adherence and impact of quality-of-care indicators (QCIs) in the management of Staphylococcus aureus bloodstream infection in a prospective and multicentre cohort. Methods Analysis of the prospective, multicentre international S. Aureus Collaboration cohort of S. Aureus bloodstream infection cases observed between January 2013 and April 2015. Multivariable analysis was performed to evaluate the impact of adherence to QCIs on 90-day mortality. Results A total of 1784 cases were included. Overall, 90-day mortality was 29.9% and mean follow-up period was 118 days. Adherence was 67% (n = 1180/1762) for follow-up blood cultures, 31% (n = 416/1342) for early focus control, 77.6% (n = 546/704) for performance of echocardiography, 75.5% (n = 1348/1784) for adequacy of targeted antimicrobial therapy, 88.6% (n = 851/960) for adequacy of treatment duration in non-complicated bloodstream infections and 61.2% (n = 366/598) in complicated bloodstream infections. Full bundle adherence was 18.4% (n = 328/1784). After controlling for immortal time bias and potential confounders, focus control (adjusted hazard ratio = 0.76; 95% CI, 0.59–0.99; p 0.038) and adequate targeted antimicrobial therapy (adjusted hazard ratio = 0.75; 95% CI, 0.61–0.91; p 0.004) were associated with low 90-day mortality. Discussion Adherence to QCIs in S. Aureus bloodstream infection did not reach expected rates. Apart from the benefits of application as a bundle, focus control and adequate targeted therapy were independently associated with low mortality

Chimaeribacter arupi a new member of the Yersineacea family has the characteristics of a human pathogen

Chimaeribacter arupi (heterotypic synonym: “Nissabacter archeti”) is a facultative anaerobic, newly described Gram-negative rod and belongs to the Yersineacea family. Here, we report the case of a 19-month-old female infant patient who presented to the emergency unit with somnolence and fever. C. arupi was isolated from a positive blood culture, taken via an implanted Broviac catheter, proving a bloodstream infection by the pathogen. The objective of this study was to utilize whole genome sequencing to assess the genes encoding potential virulence associated factors, which may play a role in host tropism, tissue invasion and the subsequent stages in the pathogenesis of a bloodstream infection with C. arupi. The genome of the isolate was completely sequenced employing Illumina MiSeq and Nanopore MinION sequencing and the presumptive virulence associated factors and antimicrobial resistance genes were investigated in more detail. Additionally, we performed metabolic profiling and susceptibility testing by microdilution. The presence of predicted TcfC-like α-Pili suggests that C. arupi is highly adapted to humans as a host. It utilizes flagellar and type IV pili-mediated motility, as well as a number of γ1-pili and a σ-pilus, which may be used to facilitate biofilm formation and adherence to host epithelia. Additionally, long polar fimbriae may aid in tissue invasion. The bacterium possesses antioxidant factors, which may enable temporary survival in phagolysosomes, and a capsule that potentially provides protection from phagocytosis. It may acquire iron ions from erythrocytes through the type 6 secretion system and hemolysins. Furthermore, the isolate exhibits beta-lactamase-mediated penicillin and aminopenicillin resistance. Based on the analysis of the whole genome, we conclude that C. arupi possesses virulence factors associated with tissue invasion and may thus be a potential opportunistic pathogen of bloodstream infections

Diagnostic Utility of Broad Range Bacterial 16S rRNA Gene PCR with Degradation of Human and Free Bacterial DNA in Bloodstream Infection Is More Sensitive Than an In-House Developed PCR without Degradation of Human and Free Bacterial DNA

We compared a commercial broad range 16S rRNA gene PCR assay (SepsiTest) to an in-house developed assay (IHP). We assessed whether CD64 index, a biomarker of bacterial infection, can be used to exclude patients with a low probability of systemic bacterial infection. From January to March 2010, 23 patients with suspected sepsis were enrolled. CD64 index, procalcitonin, and C-reactive protein were measured on admission. Broad range 16S rRNA gene PCR was performed from whole blood (SepsiTest) or blood plasma (IHP) and compared to blood culture results. Blood samples spiked with Staphylococcus aureus were used to assess sensitivity of the molecular assays in vitro. CD64 index was lower in patients where possible sepsis was excluded than in patients with microbiologically confirmed sepsis (P=0.004). SepsiTest identified more relevant pathogens than blood cultures (P=0.008); in three patients (13%) results from blood culture and SepsiTest were congruent, whereas in four cases (17.4%) relevant pathogens were detected by SepsiTest only. In vitro spiking experiments suggested equal sensitivity of SepsiTest and IHP. A diagnostic algorithm using CD64 index as a decision maker to perform SepsiTest shows improved detection of pathogens in patients with suspected blood stream infection and may enable earlier targeted antibiotic therapy

Early oral switch therapy in low-risk Staphylococcus aureus bloodstream infection (SABATO): study protocol for a randomized controlled trial

Background Current guidelines recommend that patients with Staphylococcus aureus bloodstream infection (SAB) are treated with long courses of intravenous antimicrobial therapy. This serves to avoid SAB-related complications such as relapses, local extension and distant metastatic foci. However, in certain clinical scenarios, the incidence of SAB-related complications is low. Patients with a low-risk for complications may thus benefit from an early switch to oral medication through earlier discharge and fewer complications of intravenous therapy. The major objective for the SABATO trial is to demonstrate that in patients with low-risk SAB a switch from intravenous to oral antimicrobial therapy (oral switch therapy, OST) is non-inferior to a conventional course of intravenous therapy (intravenous standard therapy, IST). Methods/Design The trial is designed as randomized, parallel-group, observer-blinded, clinical non-inferiority trial. The primary endpoint is the occurrence of a SAB-related complication (relapsing SAB, deep-seated infection, and attributable mortality) within 90 days. Secondary endpoints are the length of hospital stay; 14-day, 30-day, and 90-day mortality; and complications of intravenous therapy. Patients with SAB who have received 5 to 7 full days of adequate intravenous antimicrobial therapy are eligible. Main exclusion criteria are polymicrobial bloodstream infection, signs and symptoms of complicated SAB (deep-seated infection, hematogenous dissemination, septic shock, and prolonged bacteremia), the presence of a non-removable foreign body, and severe comorbidity. Patients will receive either OST or IST with a protocol-approved antimicrobial and are followed up for 90 days. Four hundred thirty patients will be randomized 1:1 in two study arms. Efficacy regarding incidence of SAB-related complications is tested sequentially with a non-inferiority margin of 10 and 5 percentage points. Discussion The SABATO trial assesses whether early oral switch therapy is safe and effective for patients with low-risk SAB. Regardless of the result, this pragmatic trial will strongly influence the standard of care in SAB. Trial registration ClinicalTrials.gov NCT01792804 registered 13 February 2013; German Clinical trials register DRKS00004741 registered 4 October 2013, EudraCT 2013-000577-77. First patient randomized on 20 December 2013