Objectives: This study investigates the transitions of community-dwelling patients with a proximal femoral fracture towards recovery of independence using multistate modeling. The prognostic value... Show moreObjectives: This study investigates the transitions of community-dwelling patients with a proximal femoral fracture towards recovery of independence using multistate modeling. The prognostic value of factors affecting the short-term rate of recovery of independence in activities of daily living was assessed for the resilient portion of the population. Design: An inception cohort was recruited between 2016 and 2019. Setting and Participants: Only community-dwelling older patients admitted with a proximal femoral fracture were included. Measures: Follow-up was performed at 6 weeks and 3 months, when the patients' living situation and level of independence were recorded. Multistate modeling was used to study the transition rates of the population through prespecified states of the recovery process. Using this model, prognostic factors for the recovery of independence were identified for resilient patients (defined as those patients who managed to return home at any point in the follow-up after discharge). Results: A total of 558 patients were included, and 218 (40.9%) recovered to prefracture levels of independence. Of the resilient patients, 20.7% were discharged home directly, and 79.3% via a rehabilitation home. In this patient group, a more favorable American Society of Anesthesiologists classification, better prefracture mobility, and the absence of a prefracture fear of falling were statistically significantly associated with a successful recovery. A low level of prefracture independence was inversely associated, meaning that patients with a low level of prefracture independence had a higher chance of successful recovery. Conclusions and Implications: This study identified 4 factors with an independent prognostic value for the recovery of independence in resilient patients after a proximal femoral fracture. These factors could be used to construct clinical profiles that contribute to the assessment of the patient's post-acute care needs and recovery capacity. In addition, multistate modeling has been shown to be an effective and versatile tool in the study of recovery prognostics. (C) 2020 The Author(s). Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Show less
Oostindie, G.J.; Ferdinand, M.; Veenendaal, W.P. 2020
For a great majority of former colonies, the outcome of decolonization was independence. Yet scattered across the globe, remnants of former colonial empires are still non-sovereign as part of... Show moreFor a great majority of former colonies, the outcome of decolonization was independence. Yet scattered across the globe, remnants of former colonial empires are still non-sovereign as part of larger metropolitan states. There is little drive for independence in these territories, virtually all of which are small island nations, also known as sub-national island jurisdictions (SNIJs). Why do so many former colonial territories choose to remain non-sovereign? In this paper we attempt to answer this question by conducting a global comparative study of non-sovereign jurisdictions. We start off by analyzing their present economic, social and political conditions, after which we assess local levels of (dis)content with the contemporary political status, and their articulation in postcolonial politics. We find that levels of discontent and frustration covary with the particular demographic, socio-economic and historical-cultural conditions of individual territories. While significant independence movements can be observed in only two or three jurisdictions, in virtually all cases there is profound dissatisfaction and frustration with the contemporary non-sovereign arrangement and its outcomes. Instead of achieving independence, the territories’ real struggle nowadays is for obtaining ‘true equality’ with the metropolis, as well as recognition of their distinct cultural identities.Keywords: decolonization, equality, independence, islands, non-sovereign, sub-national island jurisdictions Show less
