Health status and psychological outcomes after trauma: A prospective multicenter cohort study

Introduction Survival after trauma has considerably improved. This warrants research on non-fatal outcome. We aimed to identify characteristics associated with both short and long-term health status (HS) after trauma and to describe the recovery patterns of HS and psychological outcomes during 24 months of follow-up. Methods Hospitalized patients with all types of injuries were included. Data were collected at 1 week 1, 3, 6, 12, and 24 months post-trauma. HS was assessed with the EuroQol-5D-3L (EQ-5D3L) and the Health Utilities Index Mark 2 and 3 (HUI2/3). For the screening of symptoms of post-traumatic stress, anxiety and depression, the Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS) subscale anxiety (HADSA) and subscale depression (HADSD) were used. Recovery patterns of HS and psychological outcomes were examined with linear mixed model analyses. Results A total of 4,883 patients participated (median age 68 (Interquartile range 53–80); 50% response rate). The mean (Standard Deviation (SD)) pre-injury EQ-5D-3L score was 0.85 (0.23). One week post-trauma, mean (SD) EQ-5D-3L, HUI2 and HUI3 scores were 0.49 (0.32), 0.61 (0.22) and 0.38 (0.31), respectively. These scores significantly improved to 0.77 (0.26), 0.77 (0.21) and 0.62 (0.35), respectively, at 24 months. Most recovery occurred up until 3 months. At long-term follow-up, patients of higher age, with comorbidities, longer hospital stay, lower extremity fracture and spine injury showed lower HS. The mean (SD) scores of the IES, HADSA and HADSD were respectively 14.80 (15.80), 4.92 (3.98) and 5.00 (4.28), respectively, at 1 week post-trauma and slightly improved over 24 months post-trauma to 10.35 (14.72), 4.31 (3.76) and 3.62 (3.87), respectively. Discussion HS and psychological symptoms improved over time and most improvements occurred within 3 months post-trauma. The effects of severity and type of injury faded out over time. Patients frequently reported symptoms of post-traumatic stress. Trial registration ClinicalTrials.gov identifier: NCT02508675

Psychological health status after major trauma across different levels of trauma care:A multicentre secondary analysis

Introduction: Concentration of trauma care in trauma network has resulted in different trauma populations across designated levels of trauma care. Objective: Describing psychological health status, by means of the impact event scale (IES) and the hospital anxiety and depression scale (HADS), of major trauma patients one and two years post-trauma across different levels of trauma care in trauma networks. Methods: A multicentre retrospective cohort study was conducted. Inclusion criteria: aged ≥ 18 and an Injury Severity Score (ISS) &gt; 15, surviving their injuries one year after trauma. Psychological health status was self-reported with HADS and IES. Subgroup analysis, univariate, and multivariable analysis were done on level of trauma care and trauma region for HADS and IES as outcome measures. Results: Psychological health issues were frequently reported (likely depressed n = 31, 14.7 %); likely anxious n = 32, 15.2 %; indication of a post-traumatic stress disorder n = 46, 18.0 %). Respondents admitted to a level I trauma centre reported more symptoms of anxiety (3, P25-P75 1–6 vs. 5, P25-P75 2–9, p = 0.002), depression (2, P25-P75 1–5 vs. 5, P25-P75 2–9, p &lt; 0.001), and post-traumatic stress (6, P25-P75 0–15 vs. 13, P25-P75 3–33, p = 0.001), than patients admitted to a non-level I trauma centre. Differences across trauma regions were reported for depression (3, P25-P75 1–6 vs. 4, P25-P75 2–10, p = 0.030) and post-traumatic stress (7, P25-P75 0–18 vs. 15, P25-P75 4–34, p &lt; 0.001). Conclusions: Major trauma patients admitted to a level I trauma centre have more depressive, anxious, and post-traumatic stress symptoms than when admitted to a non-level I trauma centre. These symptoms differed across trauma regions, indicating populations differences. Level of trauma care and trauma region are important when analysing psychological health status.</p

Redemocratisation, labour relations and the development of human resources in Chile (1990-1993)

SIGLEAvailable from British Library Document Supply Centre-DSC:D203293 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Equality and Income Security in Market Economies: What's Wrong with Insurance?

This article critically assesses the marketization of income security, and identifies links between equality, self-reliance and welfare reform. Marketization in emergent economies is distinguished by a strong separation between the use of insurance for the mainstream economy and relief for the poor. The impact of this model on the shaping of working lives and on market rigidity is discussed through a review of implications in the areas of subsistence, integrity interests and employment transitions. The broad faith in insurance solutions is argued to derive from a highly abstract approach to welfare reform and to result in a lack of attention to uneven and unstable markets, and to self-government as a motive to work. Evidence of this emerges from a comparison of insurance in its more ideal form (in Chile) with modified models (Brazil and Korea). In the last two cases a developmental orientation has aided in the provision of broad-based security. Other factors that appear to enhance the importance of direct assistance are also discussed, including aspects of state administration and labour services that limit work opportunity and individual autonomy in uneven economies. The segregated dual approach to income security is argued to be broadly deficient, but not because insurance is inherently wrong. Countries as diverse as Barbados and Denmark show that more cohesive economies are a better foundation for integrating insurance with general welfare and for income security and individual enterprise broadly conceived

Welfare-as-freedom, the human economy and varieties of capitalist state

This contribution advocates a political economy perspective on systems of well-being. I argue deeper regulatory features of human economy give rise to common institutions in areas such as education, work and care, and that the constraints this imposes on governance explains how a more egalitarian form of public sector development is a key factor in gender equality, control of core human activities, and forms of time. A systems approach to well-being critically engages freedom-focussed perspectives on welfare and the proposal for a Universal Basic Income (UBI), which has received public traction since 2016. Identifying the systemic foundations for wellbeing as control within core human activities and social relations suggests UBI should be seen as an important but insufficient element of systems of well-being. To depict patterns of continuity and change, this chapter compares a set of OECD cross-country data, with particular attention to hierarchical-competitive and developmental-horizontal Anglo-liberal and Nordic trajectories