Future at risk: A study on the Club of Rome

Sustainability, in its modern meaning, has been discussed for more than forty years. However, many experts believe that humanity is still far from being sustainable. Some experts have argued that humanity should seek survivable development because it is too late for sustainable one, since 1990s. Obviously, some problems prevented humanity from becoming sustainable. This thesis focuses on the agenda of sustainability discussions and seeks for the essential topics missing from it. For this purpose, the research is conducted on 21 out of 33 books endorsed by the Club of Rome. All of these books are titled ‘a report to the Club of Rome’. The Club of Rome is an organization that has been constantly working on the problems of humankind for the past 40 years. This thesis has three main components: first, the messages of the reports to the Club of Rome, second, academics perceptions of the Club, and third, the Club member perceptions of its evolution, messages and missing topics. This thesis investigates the evolution of four aspects in the reports. The first one is the agenda of the reports. The second one is the basic approaches of the Club (i.e., global, long-term and holistic). The third one is the ways that the reports treat free market and growth ideology. The fourth one is the approach of the reports toward components of the global complex system (i.e., society, economy and politics). The outline of the thesis is as follows. First, the original reports are briefly summarized. After this, the academic perceptions are discussed and structured around three concepts (i.e., futures studies, sustainability and degrowth). In the final step, the perceptions of the experts are collected and analysed, using a variation of Delphi method, called ‘in-depth interviews’, and ‘quality content analysis’ method. This thesis is useful for those interested in sustainability, global problems, and the Club of Rome. This thesis concludes that the reports from 1972 up to 1980 were cohesive in discussing topics related to the problems of humankind. The topics of the reports are fragmented after this period. The basic approaches of CoR are visible in all the reports. However, after 1980, those approaches and especially holistic thinking are only visible in the background. Regarding the free market and growth ideology, although all the reports are against them, the early reports were more explicitly expressing their disagreement. A milestone is noticeable around 1980 when such objections went completely to the background. However, recent reports are more similar to those of 1970s both in adopting a holistic approach and in explicitly criticizing free market and growth ideology. Finally, concerning the components of global complex system, the society is excluded and the focus of the reports is on politics, economy and their relation. Concerning the topics missing from the debate, this thesis concludes that no major research has been conducted on the fundamental and underlying reasons of the problems (e.g. beliefs, values and culture). Studying the problems without considering their underlying reasons, obviously, leads to superficial and ineffective solutions. This might be one of the reasons that sustainability discussions have as yet led to no concrete result.

Survival and Quality of Life among Patients with Severe Lower Extremity Peripheral Arterial Disease

Lower extremity peripheral arterial disease (PAD) is associated with decreased functional status, diminished quality of life (QoL), amputation, myocardial infarction, stroke, and death. Nevertheless, public awareness of PAD as a morbid and mortal disease is low. The aim of this study was to assess the incidence of major lower extremity amputation due to PAD, the extent of reamputations, and survival after major lower extremity amputation (LEA) in a population based PAD patient cohort. Furthermore, the aim was to assess the functional capacity in patients with LEA, and the QoL after lower extremity revascularization and major amputation. All 210 amputees due to PAD in 1998–2002 and all 519 revascularized patients in 1998–2003 were explored. 59 amputees alive in 2004 were interviewed using a structured questionnaire of QoL. Two of each amputee age-, gender- and domicile-matched controls filled in and returned postal self-administered QoL questionnaire as well as 231 revascularized PAD patients (the amount of these patients who engaged themselves to the study), and one control person for each patient completed postal self-administered QoL questionnaire. The incidence rate of major LEA was 24.1/100 000 person-years and it was considerably high during the years studied. The one-month mortality rate was 21%, 52% at one-year, and the overall mortality rate was 80%. When comparing the one-year mortality risk of amputees, LEAs were associated with a 7.4-fold annual mortality risk compared with the reference population in Turku. Twenty-two patients (10%) had ipsilateral transversions from BK to AK amputation. Fifty patients (24%) ended up with a contralateral major LEA within two to four amputation operations. Three bilateral amputations were performed at the first major LEA operation. Of the 51 survivors returning home after their first major LEA, 36 (71%) received a prosthesis; (16/36, 44%) and were able to walk both in- and outdoors. Of the 68 patients who were discharged to institutional care, three (4%) had a prosthesis one year after LEA. Both amputees and revascularized patients had poor physical functioning and significantly more depressive symptoms than their controls. Depressive symptoms were more common in the institutionalized amputees than the home-dwelling amputees. The surviving amputees and their controls had similar life satisfaction. The amputees felt themselves satisfied and contented, whether or not they lived in long-term care or at home. PAD patients who had undergone revascularizations had poorer QoL than their controls. The revascularized patients’ responses on their perceived physical functioning gave an impression that these patients are in a declining life cycle and that revascularizations, even when successful, may not be sufficient to improve the overall function. It is possible that addressing rehabilitation issues earlier in the care may produce a more positive functional outcome. Depressive symptoms should be recognized and thoroughly considered at the same time the patients are recovering from their revascularization operation. Also primary care should develop proper follow-up, and community organizations should have exercise groups for those who are able to return home, since they very often live alone. In rehabilitation programs we should consider not only physical disability assessment but also QoL.