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

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

The Emperor's New Clothes: Labor Reform and Social Democratization in Chile

This article analyzes the relationship between political and social democratization in recent democratic transitions by illustrating how the two processes were at odds in the case of labor reform in Chile (1990–2001). Labor reform served simultaneously to consolidate political democracy and slow down the momentum of social democratization. It was a tool for signalling policy change to legitimate the democratic regime, but at the same time leaving the liberal economy intact. The Chilean case calls into question the thesis of a natural progression from political to social rights prevalent in democratic theory, and allows us to generalize about the way marketization places limits on democratic deepening. The article first discusses what would be appropriate criteria of social democratization considering contemporary labor issues and labor relations in Chile. It then investigates the political process of labor reform. Ongoing legal debates through the 1990s show the extent of path dependence set in motion by the timid nature of the first social reforms in Chile’s new demoncracy and their muting effect on citizenship

Prevalence, recovery patterns and predictors of quality of life and costs after non-fatal injury: the Brabant Injury Outcome Surveillance (BIOS) study

Item does not contain fulltextINTRODUCTION: Trauma is a major public health problem worldwide that leads to high medical and societal costs. Overall, improved understanding of the full spectrum of the societal impact and burden of injury is needed. The main purpose of the Brabant Injury Outcome Surveillance (BIOS) study is to provide insight into prevalence, predictors and recovery patterns of short-term and long-term health-related quality of life (HRQoL) and costs after injury. MATERIALS AND METHODS: This is a prospective, observational, follow-up cohort study in which HRQoL, psychological, social and functional outcome, and costs after trauma will be assessed during 24 months follow-up within injured patients admitted in 1 of 10 hospitals in the county Noord-Brabant, the Netherlands. Data will be collected by self-reported questionnaires at 1 week (including preinjury assessment), and 1, 3, 6, 12 and 24 months after injury. If patients are not capable of filling out the questionnaires, proxies will be asked to participate. Also, information about mechanism and severity of injury, comorbidity and indirect and direct costs will be collected. Mixed models will be used to examine the course of HRQoL, functional and psychological outcome, costs over time and between different groups, and to identify predictors for poor or good outcome. RELEVANCE: This study should make a substantial contribution to the international collaborative effort to assess the societal impact and burden of injuries more accurately. The BIOS results will also be used to develop an outcome prediction model for outcome evaluation including, besides the classic fatal, non-fatal outcome. TRIAL REGISTRATION NUMBER: NCT02508675

Living in Dignity in the XXIst Century: Poverty and Inequality, a paradox in Societies of Rights and Democracy?

In 2010, The Council of Europe Social Cohesion, Research and Early Warning Division and the Directorate General of Employment, Social Affairs and Inclusion of European Commission launched the project entitled "Human rights of people experiencing poverty". This Guide is therefore the outcome of the meetings, exchanges of experiencex and theoretical discussions between more than 50 experts from academic, associative and trade union circles, and from individuals who, for various reasons, can be regarded as direct witness of contemporary poverty. Part I of this guide begins with the analysis of the inequalities in wealth distribution and of their effects in terms of insecurity and rising poverty; it then looks at the negative consequences of all forms of categorization leading to exclusion, ghettoisation and social stratification; lastly, it lays the foundation for new anti-poverty strategies , exploring the issue of the various foms of social interdependence, offering a different interpretation of the concepts of development, efficiency and security. Part II takes a detailed look at current trends in Europe. It makes a critical analysis of the way in which poverty is generally defined and measured; it highlights the contradictions between the promotion of human rights and democracy and the reality of the contemporary situation in which raising inequalities put paid any prospects of genuine social cohesion; it explores the "irrationality" of the current management of material and non material ressources ; and lastly it shows the errorsof the taxation and reditribution policies pursued in most European countries in terms of thei lack of progressivity in order to ensure social justice. Part III begins with a new definition of poverty taking into account the social interdependence; the idea of equal access to resources; the objective of the well-being of all. Finally, the last section puts forwards a series of concrete proposals giving substance to a new strategy based on reference concepts of a new type - shared social responsibility and commons - wich the Guide explores in detail and which provide tha opportunity to take a fresh look at the role of public institutions.Cette ouvrage est le produit de rencontres, d'\ue9changes d'exp\ue9rience et de d\ue9bats th\ue9oriques entre plus d'une cinquantine d'experts originaires du mileiu universitaire, associatif ou syndical, mais aussi d'individus qui, pour des raisons diverses, sont des t\ue9moins directs de la pauvret\ue9 contemporaine. Il s'agit du r\ue8sultat du projet de la Division de la coh\ue9sion sociale, recherche et anticipation du Conseil de l'Europe et de la Direction g\ue9n\ue9rale "Emploi, affaires sociale et inclusion" de la Commission europ\ue9enne "Les droits humains des personnes en situatio de pauvret\ue9"