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The chapter provides an account of the changing role played by active labour market policies (ALMPs) in Europe since the post-war years. Focusing on six countries (Sweden, Denmark, France, Germany, Italy, and the United Kingdom), it shows that the role of ALMPs is related to the broad economic situation. At times of rapid expansion and labour shortage, like the 1950s and 1960s, their key objective was to upskill the workforce. After the oil shocks of the 1970s, the raison d'être of ALMPs shifted from economic to social policy, and since the mid-1990s, we see the development of a new function, well captured by the notion of activation, which refers to the strengthening of work incentives and the removal of obstacles to employment, mostly for low-skilled people. The adequacy between economic context and policy is not always optimal, though. Like other ones, this policy domain suffers from inertia, with the result that the countries that have led the way in one period have more difficulty adapting to the economic conditions prevailing in the following one.

The Corrosion of Career? - Occupational Trajectories of Business Economists and Engineers in Switzerland

Achievement careers are regarded as a distinctive element of the post-war period in occidental societies. Such a career was at once a modal trajectory of the modern parts of middleclass men and a social emblem for progress and success. However, if the achievement career came to be a biographical pattern with great normative power, its precise sequential course remained vague. Theories of the 1960s and 1970s described it as an orderly advancement within large firms. By the 1990s, scholars postulated an erosion of the organizational structures that once contributed to the institutionalization of careers, accompanied by a weakening of the normative weight of the achievement career by management discourse. We question the thesis of the corrosion of achievement career by analysing the trajectories of 442 engineers and business economists in Switzerland in regard to their orderliness, loyalty, and temporal rhythm. An inspection of types of careers and cohorts reveals that even if we face a decline of loyalty over time, hierarchical orderliness is not touched by those changes. Foremost, technical-industrial careers fit the loyal and regular pattern. Hence, this trajectory-type represents only a minority and is by far the slowest and least successful in terms of hierarchical ascension.

Expertise et négociations fiscales à la Société des Nations (1923-1939)

À travers l'analyse du comité fiscal de la Société des Nations, cet article aborde la question de l'autonomie et de l'influence des organismes économiques multilatéraux instaurés après la Première Guerre mondiale. Il démontre ainsi comment ce comité abandonne progressivement son statut initial de négociations intergouvernementales pour se transformer en une réunion de praticiens fiscaux qui défendent des intérêts propres. Mais l'étude du cas suisse met également en évidence l'impact de plus en plus limité de ces discussions multilatérales sur les politiques nationales et les relations bilatérales. Dès le milieu des années 1920, les débats genevois ne font en effet plus contrepoids à la politique d'attraction fiscale de la Suisse. Expertise and fiscal negotiations at the League of Nations (1923-1939): This article considers the autonomy and the influence of multilateral economic organisations during the inter-war years through the study of the League of Nations' fiscal committee. It shows that this committee gradually discarded intergovernmental negotiations and became a tax practitioners' club that defended its own interest. But a look at the Swiss case also demonstrates that the impact of these multilateral discussions on national policies and bilateral relations quickly decreased. From the middle of the 1920s, the debates in Geneva no longer hampered the fiscal attractiveness of Switzerland as a tax haven.

Tintin, oui mais avec modération. Les tâtonnements de la bande dessinée en Suisse romande

L'arrivée des aventures de Tintin dans la presse illustrée helvétique ne se fera pas sans heurts. Au-delà de l'habituelle réappropriation nationale du héros belge, d'importants réaménagements sont pratiqués par l'hebdomadaire catholique genevois L'Écho Illustré, et ce surtout pendant les années 1930. En analysant cette réadaptation, cet article tente de questionner le rapport à l'image distrayante d'un magazine confessionnel qui souhaiterait y voir figurer une portée éducative et morale. D'autre part, le contexte de la presse suisse pendant cette période est encore relativement peu enclin à accueillir la publication de bandes dessinées. Il s'agit donc d'observer de quelle manière ce nouveau média s'intègre dans un support déjà bien établi comme la presse illustrée de la Suisse de l'Entre-deux-guerres. The way Tintin becomes part of the Swiss illustrated press is at least eventful. Beside the usual re-nationalization of the Belgian hero, the catholic weekly magazine from Geneva, L'Écho Illustré, realizes important changes in the comics layout, mostly through the Thirties. By analyzing these readjustments, we would like to explore the link between a confessional magazine and entertaining images, considering that this kind of press would like these images to achieve an additional educative and moral goal. Moreover, the Swiss press's context studied here is still relatively unresponsive to publish comics. The aim of this paper is finally to observe how a new media is integrated into an already well-established framework such as the illustrated press in Switzerland during the inter-war years.

The corrosion of career? Occupational trajectories of engineers and business economists in Switzerland

This doctoral thesis deals with the rise and potential fall of achievement career as an institutional biographical pattern. I start with the assumption that the achievement career, as a result of the spread of large-scale bureaucratic companies, the male-breadwinner family model, and meritocratic ideals, came to life in the first half of the twentieth century. During the so-called 30 glorieuses, it became even a normatively dominant and also politically significant male biographical pattern. But the structural changes that announced the end of the post-war golden age seemed also to threaten and-according to certain scholars-erode this type of occupational trajectory. In order to understand this dynamic I will try to reconstruct the achievement career in Switzerland empirically. I examine (1) the structural changes of the economic field from 1970 to 2000, (2) the transformations of the trajectories during this period, and (3) ways in which the concerned individuals interpret and react to these changes.

Social Investment Policies in Times of Permanent Austerity

The objective of this paper is to identify the political conditions that are most likely to be conducive to the development of social investment policies. It starts from the view put forward by theorists of welfare retrenchment that in the current context of permanent austerity, policy is likely to be dominated by retrenchment and implemented in a way that allows governments to minimise the risk of electoral punishment (blame avoidance). It is argued that this view is inconsistent with developments observed in several European countries, were some welfare state expansion has taken place mostly in the fields of childcare and active labour market policy. An alternative model is put forward, that emphasises the notion of "affordable credit claiming". It is argued that even under strong budgetary pressures, governments maintain a preference for policies that allow them to claim credit for their actions. Since the traditional redistributive policies tend to be off the menu for cost reasons, governments have tended to favour investments in childcare and active labour market policy as credit claiming tools. Policies developed in this way while they have a social investment flavour, tend to be rather limited in the extent to which they genuinely improve prospects of disadvantaged people by investing in their human capital. A more ambitious strategy of social investment sees unlikely to develop on the basis of affordable credit claiming. The paper starts by presenting the theoretical argument, which is then illustrated with examples taken from European countries both in the pre-crisis and in the post-crisis years.

Cigarette et affiche publicitaire: histoire d'une liaison dangereuse durant les Trente Glorieuses

The advertising poster's main characteristic is the ability to convey a commercial message quickly and publicly thanks to its straightforward image and text. The young people, being the tobacco industry's principal target, are particularly exposed to these messages. This kind of advertisement becomes a mean of counterstroke as soon as the cigarette's harmfulness is acknowledged. Some of the cigarette industry's strategies can be revealed by the historical analysis of a 253 posters corpus selected among the main cigarette manufacturers in Switzerland at the time of the post-war economic boom. With the misuse of sport's theme, the overvaluation of the filter's efficiency, the use of a vocabulary that implies lightness and by erasing the image of smoke in its advertisement, the industry tries to reassure the smoker wrongly.

Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery.

INTRODUCTION AND HYPOTHESIS: This study aims to estimate fecal, urinary incontinence, and sexual function 6 years after an obstetrical anal sphincter tear. METHODS: Among 13,213 women who had a vaginal delivery of a cephalic singleton at term, 196 women sustained an anal sphincter tear. They were matched to 588 controls. Validated questionnaires grading fecal and urinary incontinence, and sexual dysfunction were completed by the participants. RESULTS: Severe fecal incontinence was more frequently reported by women who had sustained an anal sphincter tear compared to the controls. Women with an anal sphincter tear had no increased risk of urinary incontinence, but reported significantly more pain, difficulty with vaginal lubrication, and difficulty achieving orgasm compared to the controls. A fetal occiput posterior position during childbirth was an independent risk factor for both severe urinary incontinence and severe sexual dysfunction. CONCLUSIONS: Fecal incontinence is strongly associated with an anal sphincter tear. A fetal occiput posterior position represents a risk factor for urinary incontinence and sexual dysfunction.

Establishing an association between a peri-operative perfusion score system (PerfSCORE) and post-operative patient morbidity/mortality during CPB cardiac surgery.

BACKGROUND: To date, there is no quality assurance program that correlates patient outcome to perfusion service provided during cardiopulmonary bypass (CPB). A score was devised, incorporating objective parameters that would reflect the likelihood to influence patient outcome. The purpose was to create a new method for evaluating the quality of care the perfusionist provides during CPB procedures and to deduce whether it predicts patient morbidity and mortality. METHODS: We analysed 295 consecutive elective patients. We chose 10 parameters: fluid balance, blood transfused, Hct, ACT, PaO2, PaCO2, pH, BE, potassium and CPB time. Distribution analysis was performed using the Shapiro-Wilcoxon test. This made up the PerfSCORE and we tried to find a correlation to mortality rate, patient stay in the ICU and length of mechanical ventilation. Univariate analysis (UA) using linear regression was established for each parameter. Statistical significance was established when p < 0.05. Multivariate analysis (MA) was performed with the same parameters. RESULTS: The mean age was 63.8 +/- 12.6 years with 70% males. There were 180 CABG, 88 valves, and 27 combined CABG/valve procedures. The PerfSCORE of 6.6 +/- 2.4 (0-20), mortality of 2.7% (8/295), CPB time 100 +/- 41 min (19-313), ICU stay 52 +/- 62 hrs (7-564) and mechanical ventilation of 10.5 +/- 14.8 hrs (0-564) was calculated. CPB time, fluid balance, PaO2, PerfSCORE and blood transfused were significantly correlated to mortality (UA, p < 0.05). Also, CPB time, blood transfused and PaO2 were parameters predicting mortality (MA, p < 0.01). Only pH was significantly correlated for predicting ICU stay (UA). Ultrafiltration (UF) and CPB time were significantly correlated (UA, p < 0.01) while UF (p < 0.05) was the only parameter predicting mechanical ventilation duration (MA). CONCLUSIONS: CPB time, blood transfused and PaO2 are independent risk factors of mortality. Fluid balance, blood transfusion, PaO2, PerfSCORE and CPB time are independent parameters for predicting morbidity. PerfSCORE is a quality of perfusion measure that objectively quantifies perfusion performance.

Changing the awareness of low vitamin D status in a rheumatology population: a pre/post-study.

INTRODUCTION: In 2009 hypovitaminosis D was highly prevalent in a population of Swiss rheumatology patients (86%). We aimed to evaluate the evolution of vitamin D status in the same population two years later, after the results of the first study were disseminated to local physicians and patients, in order to determine the evolution of the problem and the impact of physician information. METHOD: Patients in our rheumatology clinic were screened for 25-OH vitamin D. Results were categorised as: deficient (<10 ng/ml or <25 nmol/l), insufficient (10 to 30 ng/ml or 25 to 75 nmol/l) or normal (>30 ng/ml or >75 nmol/l). We also used another cut-off of 20 ng/ml (50 nmol/l). We evaluated the evolution of 25-OH vitamin D dosages and vitamin D3 prescriptions between 2008 and 2011 in our institution and the number of publications on vitamin D in three important medical journals of the French speaking part of Switzerland. RESULTS: Compared with 2009, significantly more patients had normal results in 2011. Fifty-two percent of patients had levels >20 ng/ml in 2009 and 66% in 2011, difference statistically significant (p = 0.001). During the years separating the two study periods the number of 25-OH vitamin D dosages and the prescription of high doses of vitamin D3 increased in our hospital. In addition the number of publications on vitamin D increased between 2008 and 2011. CONCLUSION: We concluded that lower prevalence in hypovitaminosis D is certainly related to better adherence to daily supplements, and to better information and awareness of the physicians about hypovitaminosis D.

Post-traumatic mutism in children: clinical characteristics, pattern of recovery and clinicopathological correlations.

Among the numerous clinical syndromes observed after severe traumatic head injury, post-traumatic mutism is a disorder rarely reported in adults and not studied in any detail in children. We report seven children between the ages of 3 1/2 and 14 years who sustained severe head injury and developed post-traumatic mutism. We aim to give a precise clinical characterization of this disorder, discuss differential diagnosis and correlations with brain imaging and suggest its probable neurological substrate. After a coma lasting from 5 to 25 days, the seven patients who suffered from post-traumatic mutism went through a period of total absence of verbal production lasting from 5 to 94 days, associated with the recovery of non-verbal communication skills and emotional vocalization. During the first days after the recovery of speech, all patients were able to produce correct small sentences with a hypophonic and monotonous voice, moderate dysarthria, word finding difficulties but no signs of aphasia, and preserved oral comprehension. The neurological signs in the acute phase (III nerve paresis in three of seven patients, signs of autonomic dysfunctions in five of seven patients), the results of the brain imaging and the experimental animal data all suggest the involvement of mesencephalic structures as playing a key role in the aetiology of post-traumatic mutism.

Does history of falling predict length of stay in post-scute geriatric rehabilitation?

Objectives: To investigate the associations between falls before¦hospital admission, falls during hospitalization, and length of stay in¦elderly people admitted to post-acute geriatric rehabilitation.¦Method: History of falling in the previous 12 months before admission¦was recorded among 249 older persons (mean age 82.3 ± 7.4 years,¦69.1% women) consecutively admitted to post-acute rehabilitation. Data¦on medical, functional and cognitive status were collected upon¦admission. Falls during hospitalization and length of stay were recorded¦at discharge.¦Results: Overall, 92 (40.4%) patients reported no fall in the 12 months¦before admission; 63(27.6%) reported 1 fall, and 73 (32.0%) reported¦multiple falls. Previous falls occurrence (one or more falls) was¦significantly associated with in-stay falls (19.9% of previous fallers fell¦during the stay vs 7.6% in patients without history of falling, P = .01),¦and with a longer length of stay (22.4 ± 10.1 days vs 27.1 ± 14.3 days,¦P = .01). In multivariate robust regression controlling for gender, age,¦functional and cognitive status, history of falling remained significantly¦associated with longer rehabilitation stay (2.8 days more than non¦fallers in single fallers, p = .05, and 3.3 days in multiple fallers, p = .0.1).¦Conclusion: History of falling in the 12 months prior to post acute¦geriatric rehabilitation is independently associated with a longer¦rehabilitation length of stay. Previous fallers also have an increased risk¦of falling during rehabilitation stay. This suggests that hospital fall¦prevention measures should particularly target these high risk patients.

Health services utilization associated with cognitive impairment and dementia in older patients undergoing post-acute rehabilitation.

OBJECTIVE: To investigate the relationship between levels of cognitive impairment and health services utilization in older patients undergoing post-acute rehabilitation. DESIGN: Cross-sectional study. SETTING: Post-acute rehabilitation facility. PARTICIPANTS: Patients (N = 1764) aged 70 years and older admitted over 3 years. MEASUREMENTS: Sociodemographic, medical, and functional data were collected upon admission. Based on discharge diagnoses, patients were classified as cognitively intact, cognitively impaired with no dementia (CIND), and demented. RESULTS: Dementia and CIND were diagnosed in 425 (24.1%) and 301 (17.1%) patients, respectively. Gradients from cognitively intact to cognitively impaired to demented patients were observed in median length of stay (19, 22, and 25 days, P < .001), and institutionalization rates at discharge (4.2%, 7.6%, and 28.8%, P < .001). Among patients discharged home, similar gradients were observed in utilization of home care (68.2%, 79.7%, and 83.3%, P < .001) and day care (3.1%, 7.1%, and 14.3%, P < .001). After adjustment, compared with cognitively intact patients, only those with dementia still had longer stays (+2.7 days) and increased odds of institutionalization (adjOR 6.1, 95% CI 4.0-9.3, P < .001). Among patients discharged home, use of home and day care remained higher in those with dementia (adjOR 1.8, 95% CI 1.2-2.7, P = .005, and adjOR 1.8, 95% CI 1.2-2.7, P = .005, respectively), while CIND patients had higher odds of using home care (adjOR 1.6, 95% CI 1.1-2.4, P = .028). CONCLUSION: Among patients undergoing post-acute rehabilitation, those with dementia had increased use of both institutional and community care, whereas those with CIND had increased use of home care services only. Future studies should investigate specific strategies susceptible to reduce the related burden on health care systems.

Does history of falling predict length of stay in post-acute geriatric rehabilitation?

Objectives:To investigate the associations between falls before hospital¦admission, falls during hospitalization, and length of stay in elderly¦people admitted to post-acute geriatric rehabilitation. Method: History¦of falling in the previous 12 months before admission was recorded¦among 249 older persons (mean age 82.3±7.4 years, 69.1% women)¦consecutively admitted to post-acute rehabilitation. Data on medical,¦functional and cognitive status were collected upon admission. Falls¦during hospitalization and length of stay were recorded at discharge.¦Results: Overall, 92 (40.4%) patients reported no fall in the 12 months¦before admission; 63(27.6%) reported 1 fall, and 73(32.0%) reported¦multiple falls. Previous falls occurrence (one or more falls) was significantly¦associated with in-stay falls (19.9% of previous fallers fell¦during the stay vs 7.6% in patients without history of falling, P=.01),¦and with a longer length of stay (22.4 ± 10.1 days vs 27.1 ± 14.3 days,¦P=.01). In multivariate robust regression controlling for gender, age,¦functional and cognitive status, history of falling remained significantly¦associated with longer rehabilitation stay (2.8 days more in single fallers,¦p=.05, and 3.3 days more in multiple fallers, p=.0.1, compared to¦non-fallers). Conclusion: History of falling in the 12 months prior to¦post acute geriatric rehabilitation is independently associated with a¦longer rehabilitation length of stay. Previous fallers have also an¦increased risk of falling during rehabilitation stay. This suggests that¦hospital fall prevention measures should particularly target these high¦riskpatients.