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There is evidence to suggest that patients delayed seeking urgent medical care during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. A delay in health-seeking behavior could increase the disease severity of patients in the prehospital setting. The combination of COVID-19-related missions and augmented disease severity in the prehospital environment could result in an increase in the number and severity of physician-staffed prehospital interventions, potentially putting a strain on this highly specialized service.
The aim was to investigate if the COVID-19 pandemic influences the frequency of physician-staffed prehospital interventions, prehospital mortality, illness severity during prehospital interventions, and the distribution in the prehospital diagnoses.
A retrospective, multicenter cohort study was conducted on prehospital charts from March 14, 2020 through April 30, 2020, compared to the same period in 2019, in an urban area. Recorded data included demographics, prehospital diagnosis, physiological parameters, mortality, and COVID-status. A modified National Health Service (NHS) National Early Warning Score (NEWS) was calculated for each intervention to assess for disease severity. Data were analyzed with univariate and descriptive statistics.
There was a 31% decrease in physician-staffed prehospital interventions during the period under investigation in 2020 as compared to 2019 (2019: 644 missions and 2020: 446 missions), with an increase in prehospital mortality (OR = 0.646; 95% CI, 0.435 – 0.959). During the study period, there was a marked decrease in the low and medium NEWS groups, respectively, with an OR of 1.366 (95% CI, 1.036 – 1.802) and 1.376 (0.987 – 1.920). A small increase was seen in the high NEWS group, with an OR of 0.804 (95% CI, 0.566 – 1.140); 2019: 80 (13.67%) and 2020: 69 (16.46%). With an overall decrease in cases in all diagnostic categories, a significant increase was observed for respiratory illness (31%; P = .004) and cardiac arrest (54%; P < .001), combined with a significant decrease for intoxications (-58%; P = .007). Due to the national test strategy at that time, a COVID-19 polymerase chain reaction (PCR) result was available in only 125 (30%) patients, of which 20 (16%) were positive.
The frequency of physician-staffed prehospital interventions decreased significantly. There was a marked reduction in interventions for lower illness severity and an increase in higher illness severity and mortality. Further investigation is needed to fully understand the reasons for these changes.
The aim of this paper is to analyse how the nature of retirement is related to post-retirement life conditions among early retirees. As to the nature of retirement, we make use of the concepts of push, pull and jump to describe why individuals retire early. Push is analysed as an outcome of poor health and firings, pull as a mechanical (reflective) response to economic and symbolic signals of the welfare state, while jump is described as a reflexive process; jumpers strive for new experiences (a new life project) and/or social gains (to be more together with grandchildren). Post-retirement life conditions are analysed in a four-dimensional citizenship perspective: (a) economic, (b) social and (c) political citizenship, as well as the feeling of having (d) ‘equal social worth’ vis-à-vis fellow citizens. Results show that role transitions are strongly affected by the nature of retirement. Jumpers largely seem to be shielded from low levels of citizenship in old age. Those pushed out of the labour market indeed run a rather high risk of lacking citizenship, epitomised as loss of economic and social citizenship as well as a low sense of having equal social worth vis-á-vis fellow citizens. No conclusive results were found for older workers subject to pull. Pullers made up a rather small proportion of total sample.
Why would people favour government support for childcare services for working parents? We examine whether five hypotheses explaining individuals’ attitudes toward the welfare state are applicable in a context of childcare policies. We apply multilevel analysis on the ESS 2008 data, including individual and country-level variables. On the individual level, both self-interest and ideology have limited influence on support for childcare policies. Support for these policies does not differ much between countries, but we manage to account for two thirds of the differences that are there. We find evidence for institutional effects (childcare hours), public interest (female employment and part-time work) and cultural variables (Protestantism and seeing provision as government responsibility). The results suggest that a distinction between Calvinism and Lutheranism may be useful when studying the relation between Protestantism and the welfare state. Finally, making country clusters on childcare, we conclude that existing care regime typologies do not fit the recent data.
Keywords: legitimacy, childcare, welfare state, public opinion, social care Typologies
What explains why certain individuals favour specific welfare policies? Many social science scholars have asked this question. Traditionally, people's attitudes vis-a-vis particular policies are explained by whether they can profit from them, and by their political and religious beliefs. More recently, studies also examined whether existing policies, socio-economic or cultural realities in a country could influence individuals’ attitudes toward those policies. Most of these earlier studies, however, focused on opinions toward traditional social protection measures, while social services such as childcare were less highlighted. Therefore, we investigate which individual characteristics and national social realities and social policies affect the attitudes of individuals toward government support for childcare services for working parents. We use 2008 European Social Survey (ESS) data to examine whether five theories used to explain opinions toward welfare states are applicable to childcare for working parents as well. Step by step, we evaluate these theories related to individual and contextual characteristics in separate models, to finally test them in a few multilevel models.
While elderly women are found to be vulnerable to poverty in many countries, we still lack in depthinsight as to why this may be. While previous studies rightfully stress the importance of work history, family history and pension regulations in this regard, we demonstrate how an explicit focus on their interaction can improve our understanding of the mechanisms producing poverty among elderly women. To this end, we use Belgian register data covering the lifespan of roughly 9.000 women aged 65 to 71 in 2008. We find that pension policies largely determine how lifecourse events affect old-age poverty risk – whether directly, or indirectly – through their influence on labour market participation. However, an explanation of poverty risk among certain groups of women, such as among married women, purely in terms of pension policy is incomplete. Our analyses suggest that, for those women, asset ownership may also be key for poverty prevention.
Keywords: pension policy, lifecourse, female employment, poverty, elderly Women
Poverty among elderly women is a pressing issue, but by no means a new one. The abundant literature explaining this phenomenon, can largely be divided in two strands: social policy, which mainly focuses on pension regulations in circumventing old-age poverty (e.g. Zaidi et al., 2006; Smeeding and Williamson, 2001), and family sociology, which examines family transitions, career trajectories and their interactions relative to old-age poverty (e.g. Brown and Lin, 2012; Wilmoth and Koso, 2002). While both fi elds have successfully illustrated their merits, there has been little convergence between the two.
In this chapter, we illustrate the necessity of investigating how family histories, career histories and social policy interact. Research studying elderly women's income packages in industrialised countries has shown that their largest source of income consists of pension benefits (Choi, 2006). Arguably therefore, the level of pension benefits largely determines poverty risk among elderly women. Consequently, detrimental lifecourse events can be mitigated by the pension regulations in place. This contribution examines how integrating both a lifecourse and a pension policy perspective improves our understanding of poverty among elderly women in Belgium.
The precarious financial situation of many elderly women in developed countries is well established. Nevertheless, in-depth insight into the persistent vulnerability of this group remains largely absent. In this article, we demonstrate how a specific focus on the interaction between work history, family history and pension regulations can provide greater insight into the mechanisms that produce poverty among elderly women in Belgium. To that end, we make use of register data on some 9,000 women aged 65–71. Data on the poverty risk of these women is linked to career and family data, spanning over 45 years. We find that pension policy can indeed account for the higher poverty risk of some groups of elderly women (e.g. divorcees) as compared to others (e.g. widows). Similarly, pension policy can, to a large extent, directly or indirectly explain how previous lifecourse events, such as marital dissolution or childbirth, affect old-age poverty risk. However, our study also reveals some unexpected findings. Most notably, pension regulations fail to account for the beneficial situation of married women. Indeed, our analyses suggest that capital (income) may prove more decisive than pension rights in explaining the low poverty risk of married women when compared to other marital groups. Drawing from our findings, we conclude with some suggestions as to where pension policy should go from here.
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