3 results
Outcomes of truncal valve replacement in neonates and infants: a meta-analysis
- William A. Hardy, Lillian Kang, Joseph W. Turek, T. Konrad Rajab
-
- Journal:
- Cardiology in the Young / Volume 33 / Issue 5 / May 2023
- Published online by Cambridge University Press:
- 27 March 2023, pp. 673-680
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background:
Infants with truncus arteriosus typically undergo repair by repurposing the truncal valve as the neo-aortic valve and using a valved conduit homograft for the neo-pulmonary valve. In cases where the native truncal valve is too insufficient for repair, it is replaced, but this is a rare occurrence with a paucity of data, especially in the infant population. Here, we conduct a meta-analysis to better understand the outcomes of infant truncal valve replacement during the primary repair of truncus arteriosus.
Methods:We systematically reviewed PubMed, Scopus, and CINAHL for all studies reporting infant (<12 months) truncus arteriosus outcomes between 1974 and 2021. Exclusion criteria were studies which did not report truncal valve replacement outcomes separately. Data extracted included valve replacement type, mortality, and reintervention. Our primary outcome was early mortality, and our secondary outcomes were late mortality and reintervention rates.
Results:Sixteen studies with 41 infants who underwent truncal valve replacement were included. The truncal valve replacement types were homografts (68.8%), mechanical valves (28.1%), and bioprosthetic valves (3.1%). Overall early mortality was 49.4% (95% CI: 28.4–70.5). The pooled late mortality rate was 15.3%/year (95% CI: 5.8–40.7). The overall rate of truncal valve reintervention was 21.7%/year (95% CI: 8.4–55.7).
Conclusions:Infant truncal valve replacement has poor early and late mortality as well as high rates of reintervention. Truncal valve replacement therefore remains an unsolved problem in congenital cardiac surgery. Innovations in congenital cardiac surgery, such as partial heart transplantation, are required to address this.
Six - Socioeconomic status in ageing Poland: a question of cumulative advantages and disadvantages
- Edited by Kathrin Komp, Helsingin yliopisto, Finland, Stina Johansson, Umeå universitet, Sweden
-
- Book:
- Population Ageing from a Lifecourse Perspective
- Published by:
- Bristol University Press
- Published online:
- 11 March 2022
- Print publication:
- 25 March 2015, pp 85-106
-
- Chapter
- Export citation
-
Summary
Introduction
In this chapter, we focus on the development of intra-cohort and inter-cohort socioeconomic inequalities in an ageing society in a period of deep social change. Based on the Polish experience, we trace lifecourse patterns in times of system transition that change individuals’ aspirations, opportunities and behaviours, with an attempt to recognise the mechanisms that drive the ‘within’ and ‘between’ cohort inequalities observed today. The main goal is to analyse whether the mechanism of cumulative advantages and disadvantages (CAD) is an important factor in shaping diversity in societies of post-transitional countries, as it is in the more stable western countries.
In modern societies, diversity and socioeconomic inequalities are very often found to be greater in older cohorts than in younger cohorts (Morgan and Kunkel, 2007; Lynch and Brown, 2011). According to the theory of CAD, this situation results from the differentiation of lifecourses as people age (Dannefer, 1987; O’Rand, 1996; Ferraro et al, 2009). An initial socioeconomic advantage of an individual, expressed in possession or access to certain resources and capitals, is cumulative throughout the lifecourse and results in higher advantages in their later life. On the other hand, the disadvantaged position in the early stages of life will eventually result in a lower socioeconomic status, usually measured by education, income and occupation. Consequently, according to CAD, the intra-cohort inequalities should increase with time, as the cohort grows older. Regarding the ageing population, such an assumption has significant meaning as the life expectancy and the share of older age groups increase, as well as their impact and role in society. However, CAD assumes a stability of the mechanism which work for advantage or disadvantage of individuals over the lifecourse, which may not necessarily be the case during significant changes in societies.
The between-cohort inequalities are best explained by the lifecourse approach, as a combination of the effects of ageing, life stage and historical time (Elder, 1994). An individual's ageing entails biological and mental changes, while different life stages are associated with different opportunities and social expectations. Historical time, in which specific cohorts proceed through their particular life stages, sets similar conditions and experiences for a majority of individuals. People construct their lifecourses through choices and actions within the opportunities and constraints of history and social circumstances (Grenier, 2012).
eight - Older volunteers in Poland: the heritage of a Socialist regime
- Edited by Andrea Principi, Per H. Jensen, Aalborg Universitet Institut for Statskundskab, Denmark, Giovanni Lamura
-
- Book:
- Active Ageing
- Published by:
- Bristol University Press
- Published online:
- 05 March 2022
- Print publication:
- 14 May 2014, pp 173-196
-
- Chapter
- Export citation
-
Summary
Introduction
After 1989, Poland transitioned from a centrally planned economy (controlled and monitored by the state) to an economy with a substantial share of the private sector, before eventually becoming a member of the European Union (EU) in 2004. In line with other post-Socialist welfare states, Poland aimed its welfare regime system in the direction of a liberal-residual regime type, even though a clear type of welfare regime had not been fully developed (Ferge, 2001). As with other post-transitional European states, Poland is characterised by a mix of various social insurances, social assistance and privatisation and, more importantly, has experienced stronger economic development over the last few years, which has led to a higher level of social well-being than in the former countries of the USSR (Fenger, 2007).
Before the collapse of the Socialist regime in Poland, the dominant family model was the dual earner/female double burden model, characterised by high female employment and women taking full responsibility for house and care duties. This dual breadwinner household is still quite common today. New forms of households have since emerged, such as cohabitation and single young households or single parents (Slany, 2002). During the last two decades, Poland has grappled with the challenges of inflation, privatisation, unemployment and major system reforms. An ageing population and low activity rates among the older generations have presented minor problems for policy makers. Until recently, the pension system and extensive early retirement options, along with an eligible retirement age for women at 60 and for men at 65, have favoured early exit from the labour market. As a result, the employment rates for older generations are among the lowest in Europe. The same applies to participation by seniors in voluntary activity. And the fact that this generation grew up and for most of their lives lived under a Socialist system is not to be overlooked.
The 1990s were a time of rebuilding civil society in Poland, both in the social self-consciousness and in the system regulations. Non-governmental organisations (NGOs) offered support in areas where governmental policy and public institutions were ineffective. Since the 2000s it has been a time of professionalisation and stabilisation of the third sector. Nevertheless, the participation rates of Poles in voluntary activity are well below the European average.