Disability in young people and adults after head injury: 12-14 year follow up of a prospective cohort

Background: There is a need to establish how long term outcome evolves after head injury (HI) and factors related to this, to inform opportunities for intervention. Objective: To determine late outcome in adults 12-14 years after hospital admission for HI and to examine relationships between injury, early and late factors and disability. Methods: A prospective cohort with HI, whose outcome was reported previously at 1 and 5-7 years after injury were followed up after 12-14 years. Participants were assessed using structured and validated measures of disability (Glasgow Outcome Scale-Extended), psychological well-being, alcohol use and health status. Results: Of 219 survivors followed-up at 5-7 years, 34 (15.5%) had died by 12-14 years. Disability remained common in survivors at 12-14 years (51%), as found at one and 5-7 years (53%). For those disabled at 1 year, outcome was dismal, with 80% dead or disabled at 12-14 years. Older age at injury, a premorbid history of brain illness or physical disability and post-injury low self-esteem and stress were associated with disability at 12-14 years. Disability changed between 5-7 and 12-14 years in 55% of survivors, improving in 23%. Late changes in disability between 5-7 and 12-14 years were associated with self-perceptions of locus of control as being 'powerful others' at 5-7 years. Conclusions: Disability is common 12-14 years after hospital admission with a head injury. For some there is a dynamic process of change in disability over time that is associated with self-perceptions of control that could be a target for intervention based research

Different ways of dealing with tensions: practices of (re)negotiation in local social economies

Purpose The purpose of this paper is to propose a nuanced understanding of the diverse practices social enterprises engage in to fulfil their commitments of delivering social/environmental goods and/or services while earning income to sustain their activities. Design/methodology/approach This research paper is based on an empirical investigation which used an ethnographic approach to study the social economy in two distinct city regions in the north of England. Findings Against a common-sense view of social enterprises being able to balance (with ease) social and economic goals, this paper suggests, based on empirical insights, that such a harmonious rendition tends to neglect the messiness at the heart of such organisations. Heeding ongoing reflections, explanations and negotiations as key ingredients in keeping social enterprises “balanced”, this paper argues that negotiating tensions is a constantly dynamic process. Originality/value Using an ethnographic approach, this paper offers insights into the complexities and tensions social enterprises constantly deal with and it shows these tensions must be constantly renegotiated. </jats:sec

Social innovation, social enterprise, and local public services: undertaking transformation?

This article discusses some of the challenges encountered in embedding effective and sustainable social enterprise and social innovation within established political institutional systems to deliver local welfare services. It draws upon evidence analyzing social innovation and social enterprise in Scotland to contribute to the debate over whether social innovations and social enterprises are able to meet expectations in addressing the significant challenges faced by welfare systems. The article clarifies the meaning of both these contested concepts and explains how social innovation and social enterprise relate to similar ideas in social and public policy. The evidence suggests that actually operating social enterprises and social innovations do not embrace the image of them promoted by enthusiasts as either “entrepreneurial” or “innovative”. Furthermore, they bring distinctive challenges in delivering local welfare services, including potential tensions or rivalry with existing public agencies. The article suggests that social enterprises and social innovations are not themselves instigators nor catalysts for systemic change, but that their impact is constrained by structural conditions and institutional factors beyond their control