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See detailIs universal healthcare truly universal? Socioeconomic and migrant inequalities in healthcare
Paccoud, Ivana UL

Doctoral thesis (2022)

Through the principle of Universal Healthcare Coverage, many governments across Europe and beyond seek to ensure that all people have equal access to good quality healthcare services, without facing a ... [more ▼]

Through the principle of Universal Healthcare Coverage, many governments across Europe and beyond seek to ensure that all people have equal access to good quality healthcare services, without facing a financial burden. Despite this, studies have highlighted persistent migrant and socio-economic inequalities in the use of healthcare services, and personal health records. Therefore, understanding the complex mechanisms that produce and maintain social inequalities in the effective use of healthcare services is thus an important step towards advancing equity in healthcare. This thesis draws on Bourdieu's forms of capital (cultural, social, economic, and symbolic) to conceptualise and empirically test social inequalities related to healthcare. In doing so, it investigates the factors contributing to socioeconomic and migrant inequalities in the use, navigation and optimisation of healthcare services as well as personal health records. The three studies that make up this thesis empirically test these ideas through statistical modelling on population-based datasets as well as through the analysis of two cross-sectional surveys in Luxembourg and the Greater region. The first study draws on the fifth wave of the Survey of Health, Aging, and Retirement in Europe (SHARE). It used cluster analysis and regression models to explain how the unequal distribution of material and non-material capitals acquired in childhood shape health practices, leading to different levels of healthcare utilisation in later life. The results suggest that although related, both material and non-material capitals independently contribute to health practices associated with the use of healthcare services. The second study used data from a cross-sectional survey to investigate inequalities in the navigation and optimisation of healthcare services, taking into consideration the interplay between perceived racial discrimination and socioeconomic position. It revealed disparities between individuals born in Eastern Europe and the Global South and those born in Luxembourg which were explained by the experience of racial discrimination. It also found that the impact of discrimination on both health service navigation and optimisation was reduced after accounting for social capital. The last study used data from a cross-sectional survey developed as a part of a collaborative project (INTERREG-APPS) to examine the socioeconomic and behavioural determinants in the intention to use personal health record in the Greater region of Luxembourg (Baumann et al., 2020). This study found that people’s desire and actual access to personal health electronic records is determined by different socioeconomic factors, while educational inequalities in the intention to regularly use personal health records were explained by the role of behavioural factors. Taking together, the findings presented in this thesis thus show the value of mobilising Bourdieu’s theoretical framework to understand the mechanisms through which social inequalities in healthcare develop. In addition, it showed the importance of considering racial discrimination when examining migrant, and racial/ethnic differences in health. [less ▲]

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See detailUnderstaining and explaining cross-border mobility : a free will / predisposition approach
Nonnenmacher, Lucas UL

Doctoral thesis (2022)

This dissertation investigates the drivers of cross-border mobility from a multidisciplinary perspective. Both qualitative and quantitative methodologies are used in order to understand and explain why ... [more ▼]

This dissertation investigates the drivers of cross-border mobility from a multidisciplinary perspective. Both qualitative and quantitative methodologies are used in order to understand and explain why workers cross borders. The major contribution of this dissertation is to highlight new determinants of cross-border mobility such as previous migration experience and health state. These drivers have been disregarded in the literature in the past. Moreover, this dissertation validates the motivations of the workers as a relevant driver of cross-border mobility and provides a state of play of the situation of the cross-border workers in Europe, with a specific focus on French cross- border workers. Firstly, this dissertation provides a review of the explanations of cross- border mobility in the existing literature. Secondly, this dissertation analyses the subjective drivers of cross-border mobility using a qualitative dataset composed of 30 interviews of French workers in Luxembourg collected between January 2018 and May 2019. Results highlight that cross-border workers motivate their decision to commute abroad with financial, professional and personal reasons. Furthermore, the motivations of the cross-border workers vary with respect to their socioeconomic profile. Based on these empirical findings, a model of cross-border labour supply was designed. Thirdly, this dissertation assesses the association between migration capital and cross-border mobility using the French part of the European Labour Force Survey called the Enquête Emploi between 2010 and 2018. Results indicate that migrants commute abroad more than non migrants and are also more likely to do so. Migrant children are more likely to commute abroad, suggesting that the capacity to deal with distance and borders can be transmitted throughout generations. The migration capital is a relevant predictor of commuting behaviour, since the higher the capital endowment, the higher the likelihood is to commute abroad. Additional findings can be mentioned. Internal migration does not increase the likelihood to commute abroad. The acquired migration experience is more useful than the inherited migration experience to be engaged in cross-border mobility. Fourthly, this dissertation examines health disparities between cross-border workers and non cross-border workers using the Enquête Emploi between 2013 and 2018. Results 6 suggest a healthy cross-border phenomenon, the existence of major health disparities among cross-border workers and the rejection of the spillover phenomenon for this specific population. Finally, this dissertation concludes that cross-border mobility is a complex phenomenon still partially explained, probably because of the lack of harmonised dataset about cross-border workers within the EU. Further research on cross- border mobility is needed to better understand this population, especially in public health, where everything remains to be done. [less ▲]

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See detailThe positional value of education in the Americas: dynamics of inequality in labour market returns for highly unequal countries, 2000-2019
Ceron, Francisco UL; Chauvel, Louis UL

Scientific Conference (2022, April 22)

The article examines how the labour market value of education has changed in the context of the expansion of higher education. However, one drawback is understanding how it generates differences between ... [more ▼]

The article examines how the labour market value of education has changed in the context of the expansion of higher education. However, one drawback is understanding how it generates differences between high and low-skilled labour markets, particularly in contexts of high inequality and informality. This could be linked to specific mechanisms by which employers value educational credentials as signalled skills. Using the Luxembourg Income Study (LIS), we analyse trends over two decades in 11 American countries. Our results confirm the previous results for the claim that education has become increasingly positional, compared with the absolute model of education. However, we find that the relative gains in wages for workers with higher levels of education, as the pool of higher education graduates expand over time, increased only slightly in high-skilled occupations, while their relative gains decreased for lower-skilled occupations. This trend is present in both absolute and positional models of education. Moreover, when looking at the structure of labour markets in terms of the linkage between educational credentials and occupational groups, we higher the tertiary education specificity of occupations, the higher the earnings for workers with advantaged positions. These findings are consistent with processes of displacement of low-skilled workers due to increasing competition among highly educated workers, from the positional model of education. [less ▲]

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See detailProjet Approche Patient Partenaire de Soins (APPS) - Projekts Ansatz der Patienten-Partner-Betreuung
Odero, Angela UL; Baumann-Croisier, Pierre; Chauvel, Louis UL et al

Conference given outside the academic context (2022)

Notre projet a permis d’observer une volonté affichée d’évoluer vers davantage d’engagement du patient dans la relation de soin et dans les structures de soins de santé. Le développement attendu passera ... [more ▼]

Notre projet a permis d’observer une volonté affichée d’évoluer vers davantage d’engagement du patient dans la relation de soin et dans les structures de soins de santé. Le développement attendu passera par une approche systémique de l’engagement tant sur des aspects micro (de la relation de soin) méso (dans la coordination des structures de soins) et macro (avec l’engagement des politiques de santé). Le développement doit s’appuyer sur les initiatives existantes : en ce sens le projet Interreg est une belle façon de promouvoir les échanges de bonnes pratiques au service de cet engagement du patient. [less ▲]

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See detailThe positional value of education in the Americas: dynamics of inequality in labour market returns for highly unequal countries, 2000-2019
Ceron, Francisco UL; Chauvel, Louis UL

Scientific Conference (2021, November 17)

The article examines how the labour market value of education has changed in the context of the expansion of higher education. However, one drawback is understanding how it generates differences between ... [more ▼]

The article examines how the labour market value of education has changed in the context of the expansion of higher education. However, one drawback is understanding how it generates differences between high and low-skilled labour markets, particularly in contexts of high inequality and informality. This could be linked to specific mechanisms by which employers value educational credentials as signalled skills. Using the Luxembourg Income Study (LIS), we analyse trends over two decades in 11 American countries. Our results confirm the previous results for the claim that education has become increasingly positional, compared with the absolute model of education. However, we find that the relative gains in wages for workers with higher levels of education, as the pool of higher education graduates expand over time, increased only slightly in high-skilled occupations, while their relative gains decreased for lower-skilled occupations. This trend is present in both absolute and positional models of education. Moreover, when looking at the structure of labour markets in terms of the linkage between educational credentials and occupational groups, we higher the tertiary education specificity of occupations, the higher the earnings for workers with advantaged positions. These findings are consistent with processes of displacement of low-skilled workers due to increasing competition among highly educated workers, from the positional model of education. [less ▲]

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See detailInequality of educational opportunity differentially impacts women’s and men’s later-life cognitive performance
Leist, Anja UL; Bar-Haim; Chauvel, Louis UL

Scientific Conference (2021, June)

Find the published paper here: https://doi.org/10.1016/j.ssmph.2021.100837

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See detailRewealthization in twenty-first century Western countries: the defining trend of the socioeconomic squeeze of the middle class
Chauvel, Louis UL; Bar Haim, Eyal; Hartung, Anne et al

in Journal of Chinese Sociology (2021), 8

The wealth-to-income ratio (WIR) in many Western countries, particularly in Europe and North America, increased by a factor of two in the last three decades. This represents a defining empirical trend: a ... [more ▼]

The wealth-to-income ratio (WIR) in many Western countries, particularly in Europe and North America, increased by a factor of two in the last three decades. This represents a defining empirical trend: a rewealthization (from the French repatrimonialisation)—or the comeback of (inherited) wealth primacy since the mid-1990s. For the sociology of social stratification, “occupational classes” based on jobs worked must now be understood within a context of wealth-based domination. This paper first illustrates important empirical features of an era of rising WIR. We then outline the theory of rewealthization as a major factor of class transformations in relation to regimes stabilized in the post-WWII industrial area. Compared to the period where wealth became secondary to education and earnings for middle-class lifestyles, rewealthization steepens society's vertical structure; the "olive-shaped" Western society is replaced by a new one where wealth "abundance" at the top masks social reproduction and frustrations below. [less ▲]

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See detailProcessus de civilisation, inégalités extrêmes et violence de masse
Chauvel, Louis UL

in Scheidel, Walter (Ed.) UNE HISTOIRE DES INÉGALITÉS : DE L’ÂGE DE PIERRE AU XXIe SIÈCLE (2021)

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See detailDetecting the ‘Black Hole’ of age-period excess mortality in 25 countries: Age-period-cohort residual analysis
Chauvel, Louis UL; Leist, Anja UL; Smith, Herbert L.

in Bell, Andrew (Ed.) Age, Period, and Cohort Effects (2021)

In a time of worldwide availability of annual age-specific mortality data, we lack basic tools for detecting and graphing, from a comparative perspective, fine-grained deviations from mortality trends. We ... [more ▼]

In a time of worldwide availability of annual age-specific mortality data, we lack basic tools for detecting and graphing, from a comparative perspective, fine-grained deviations from mortality trends. We provide a new age-period-cohort-based methodology, combining information from age-period (AP) and APC-Detrended (APCD) analyses to detect all-cause mortality increases. Plotting the resulting AP coefficients and APCD residuals in equilateral Lexis diagrams, mortality patterns can easily be distinguished as age, period, or cohort trends and fluctuations. We highlight abnormalities as interactions of age and period (‘Black Holes’). We then investigate the ‘Black Holes’ of mortality of young-adult cohorts in the early 1990s in Spain, other southern European countries, and the U.S., in emphasizing their simultaneously occurring mortality crises. Additional analyses with WHO mortality data and epidemiological evidence from other studies show that these mortality increases likely result from lack of treatment and inadequate public health responses to the beginnings of the HIV/AIDS epidemic. We discuss other possible applications of the new method. [less ▲]

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See detailInequality of educational opportunity at time of schooling predicts cognitive functioning in later adulthood
Leist, Anja UL; Bar-Haim, Eyal; Chauvel, Louis UL

in SSM - Population Health (2021), 15

Objectives. Our understanding of how societal conditions and educational policies influence cognitive development across the life course is improving. We tested the extent to which inequality of ... [more ▼]

Objectives. Our understanding of how societal conditions and educational policies influence cognitive development across the life course is improving. We tested the extent to which inequality of educational opportunity (IEO), the country- and cohort-specific correlation of parents' and their offspring's length of schooling, offers systematically different opportunities to contribute to cognitive development, which in turn influences cognitive abilities up to older ages. Methods. A total of 46,972 individuals of three cohorts born 1940–63 from 16 European countries and Israel provided up to six cognitive assessments and information on covariates in the SHARE survey 2004–2017. Individual-level data were linked to indicators of IEO at time of schooling, and economic, health, and human development, provided by World Bank, WHO, and the UN. Results. In multilevel (mixed-effects) models with random individual and country-cohort effects and adjusted for a large set of confounders, higher IEO was associated with lower levels of cognitive functioning in men and women. Interaction analyses suggested lower cognitive levels particularly of women who were schooled in higher IEO contexts and had lower educational attainment. Associations with rate of change in cognitive functioning were present only in women, however there was little clinically relevant cognitive decline across the window of observation. Result patterns were mostly consistent after including additional contextual indicators, and in a subsample with childhood information. Discussion. Findings suggest that IEO is able to substantially influence cognitive development with long-lasting impacts. Lower-educated women of the cohorts under investigation may have been particularly vulnerable to high-inequality educational contexts. [less ▲]

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See detailCross-border mobility in European countries: associations between cross-border worker status and health outcomes
Nonnenmacher, Lucas UL; Baumann, Michèle UL; Le Bihan, Etienne UL et al

in BMC Public Health (2021), 21

Mobility of workers living in one country and working in a different country has increased in the European Union. Exposed to commuting factors, cross-border workers (CBWs) constitute a potential high-risk ... [more ▼]

Mobility of workers living in one country and working in a different country has increased in the European Union. Exposed to commuting factors, cross-border workers (CBWs) constitute a potential high-risk population. But the relationships between health and commuting abroad are under-documented. Our aims were to: (1) measure the prevalence of the perceived health status and the physical health outcomes (activity limitation, chronic diseases, disability and no leisure activities), (2) analyse their associations with commuting status as well as (3) with income and health index among CBWs. Based on the ‘Enquête Emploi’, the French cross-sectional survey segment of the European Labour Force Survey (EU LFS), the population was composed of 2,546,802 workers. Inclusion criteria for the samples were aged between 20 and 60 years and living in the French cross-border departments of Germany, Belgium, Switzerland and Luxembourg. The Health Index is an additional measure obtained with five health variables. A logistic model was used to estimate the odds ratios of each group of CBWs, taking non-cross border workers (NCBWs) as the reference group, controlling by demographic background and labour status variables. A sample of 22,828 observations (2456 CBWs vs. 20,372 NCBWs) was retained. The CBW status is negatively associated with chronic diseases and disability. A marginal improvement of the health index is correlated with a wage premium for both NCBWs and CBWs. Commuters to Luxembourg have the best health outcomes, whereas commuters to Germany the worst. CBWs are healthier and have more income. Interpretations suggest (1) a healthy cross-border phenomenon steming from a social selection and a positive association between income and the health index is confirmed; (2) the existence of major health disparities among CBWs; and (3) the rejection of the spillover phenomenon assumption for CBWs. The newly founded European Labour Authority (ELA) should take into account health policies as a promising way to support the cross-border mobility within the European Union. [less ▲]

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See detailSocioeconomic and behavioural factors associated with access to and use of Personal Health Records
Paccoud, Ivana UL; Baumann, Michèle UL; Le Bihan, Etienne UL et al

in BMC Medical Informatics and Decision Making (2021), 21

Background: Access to and use of digital technology are more common among people of higher socioeconomic status. These differences might be due to lack of interest, not having physical access or having ... [more ▼]

Background: Access to and use of digital technology are more common among people of higher socioeconomic status. These differences might be due to lack of interest, not having physical access or having lower intentions to use this technology. By integrating the digital divide approach and the User Acceptance of Information Technology (UTAUT) model, this study aims to further our understanding of socioeconomic factors and the mechanisms linked to different stages in the use of Personal Health Records (PHR): desire, intentions and physical access to PHR. Methods: A cross-sectional online and in-person survey was undertaken in the areas of Lorraine (France), Luxembourg, Rhineland-Palatinate and Saarland (Germany), and Wallonia (Belgium). Exploratory factor analysis was performed to group items derived from the UTAUT model. We applied linear and logistic regressions controlling for country-level heterogeneity, health and demographic factors. Results: A total of 829 individuals aged over 18 completed the questionnaire. Socioeconomic inequalities were present in the access to and use of PHR. Education and income played a significant role in individuals' desire to access their PHR. Being older than 65 years, and migrant, were negatively associated with desire to access PHR. An income gradient was found in having a physical access to PHR, while for the subgroup of respondents who expressed desire to have access, higher educational level was positively associated with intentions to regularly use PHR. In fully adjusted model testing the contribution of UTAUT-derived factors, individuals who perceived PHRs to be useful and had the necessary digital skills were more inclined to use their PHR regularly. Social influence, support and lack of anxiety in using technology were strong predictors of regular PHR use. Conclusion: The findings highlight the importance of considering all stages in PHR use: desire to access, physical access and intention to regularly use PHRs, while paying special attention to migrants and people with lower socioeconomic backgrounds who may feel financial constraints and are not able to exploit the potential of PHRs. As PHR use is expected to come with health benefits, facilitating access and regular use for those less inclined could reduce health inequalities and advance health equity. [less ▲]

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See detailLogically Centralized Security for Software-Defined Networking
Kreutz, Diego UL

Doctoral thesis (2020)

Software-Defined Networking (SDN) decouples the control and data planes of traditional networks, logically centralizing the functional properties of the network in the SDN controller. While this ... [more ▼]

Software-Defined Networking (SDN) decouples the control and data planes of traditional networks, logically centralizing the functional properties of the network in the SDN controller. While this centralization brought advantages such as a faster pace of innovation, it also disrupted some of the natural defenses of traditional architectures against different threats. Until now, SDN research has essentially been concerned with the functional side, despite some specific works relating to non-functional properties like ‘security’, ‘dependability’, or ‘quality of service’. Security is an essential non-functional property of SDN. The lack of reliable security-by-design mechanisms can quickly lead to the compromise of the entire network. For instance, most of the current security mechanisms in SDN controllers lead to exploitable vulnerabilities that allow adversaries to easily control or even shut down the entire control plane. The growing concern regarding insider threats substantially amplifies the problem. The reason lies in the fact that current Software-Defined Networks (SDNs) (e.g., OpenFlow-enabled networks) rely on weak protection mechanisms. To address these crucial security issues in the SDN control plane, it is necessary, though not sufficient, that we start by securely identifying, authenticating, and authorizing all devices before allowing them to become part of the network. Though SDN security is the central tenet of this thesis, we believe that the problem is much more generic. In essence, there is still a lack of a systematic approach to ensuring such relevant non-functional properties as security, dependability, or quality of service. Current approaches are mostly ad-hoc and piecemeal, which has led to efficiency and effectiveness problems. This reflection led us to claim that the successful enforcement of non-functional properties as a pillar of SDN robustness calls for a systematic approach. We further advocate, for its materialization, the re-iteration of the successful formula behind SDN– ‘logical centralization’. In consequence, we propose ANCHOR, a subsystem architecture for SDN that promotes the logical centralization of non-functional properties. We start by presenting the general concept and architectural principles, suggesting how they can satisfactorily enhance the current state of the art with regard to any non-functional property (security, dependability, performance, quality of service, etc.). We claim and justify that centralizing such mechanisms is vital for their effectiveness, by allowing us to: define and enforce global policies for those properties; reduce the complexity of controllers and forwarding devices; ensure higher levels of robustness for critical services; foster interoperability of the non-functional property enforcement mechanisms; and finally, better foster the resilience of the architecture itself. We focus on ‘security’ as a use case in the rest of the thesis, discussing the specialization of the ANCHOR architecture to logically-centralized enforcement of security properties. However, by presenting a principled solution to the main problem of the thesis (SDN security), we also show the effectiveness of the general ANCHOR concept, opening avenues for further research on its extension to other desirable non-functional properties, such as dependability and Quality of Service (QoS). We identify the current security gaps in SDNs, and investigate the adequate security mechanisms that should populate the architecture middleware, globally and consistently. ANCHOR sets out to provide — in a homogeneous manner to all controllers and forwarding devices — essential security mechanisms such as strong entropy, resilient pseudo-random generators, secure device registration, association and recommendation, amongst other crucial services. We present the design of those mechanisms and protocols. With the objective of promoting generalized use of encryption and authentication in the control plane, we additionally propose and describe a secure control plane communication infrastructure, Keep It Simple and Secure (KISS), based on a novel lightweight mechanism for generating cryptographic secrets — integrated Device Verification Value (iDVV). iDVV can be used in a number of ways, in a number of protocols, and outperforms widely used alternatives. In the context of this thesis, the KISS infrastructure is set up by ANCHOR and used to ensure the security of interactions amongst it, controllers and forwarding devices. Being conceptually logically-centralized, ANCHOR presents a single-point-of-failure (SPoF) challenge, which we address, through incremental measures, some of which can be selectively present in concrete designs. As a baseline, we harden the design, by endowing it with robust functions in the different modules. We increase assurance by discussing and informally proving correctness of all mechanisms and algorithms, and we also formally verify the main algorithms through a proof-assistant. By only using symmetric cryptography, we make the system Post-Quantum Secure (PQS). We also embed measures to achieve Perfect Forward Secrecy (PFS) in all algorithms, protecting pre-compromise communications in the presence of successful attacks. Finally, for higher criticality systems, we take additional algorithmic and architectural measures to mitigate the effects of possible security failures. We provide for Post-Compromise Security (PCS) through the semi-automatic restart of operation after a full compromise of ANCHOR. We present as well a design of resilience mechanisms — the continued prevention of failure/compromise by automatic means — through fail-fast recovery techniques. The prototypes’ implementation aspects and the evaluation of the two fundamental pieces of our work (ANCHOR and KISS) are performed in the respective chapters. The above-mentioned discussion and informal proof of correctness of all mechanisms and algorithms is given in appendices. We also formally machine- verified the main algorithms. [less ▲]

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See detailThe Western Middle Classes under Stress: Welfare State Retrenchments, Globalization, and Declining Returns to Education
Chauvel, Louis UL

in Mir Rossii (2020), 29(4), 85-111

Following the work of Pierre Bourdieu and Gustav Schmoller before him, the multipolarity of the middle classes between higher and lower, and between cultural and economic capitals is well acknowledged ... [more ▼]

Following the work of Pierre Bourdieu and Gustav Schmoller before him, the multipolarity of the middle classes between higher and lower, and between cultural and economic capitals is well acknowledged. This old vision is useful to understand the “middle classes adrift” of the last 20 years in France and Continental Europe. The expansion of the “new wage earner middle class” of the 1960s to 1990s is now an old dream of the welfare state expansion of Western societies, and the European social structure now faces a trend of “repatrimonialization”, meaning a U-turn towards a decline in the value of mid-qualified work and an expansion of the return to the inheritance of family assets. This paper addresses three main points. First, a new description of repatrimonialization is useful in the specific European context of middle-class societies. We need a redefinition of the system of middle classes (plural) in the context of the construction and decline of strong welfare states. Second, there are three ruptures in the social trends of the ‘wage earner society’ of the 1960s to 1990s. In this period, economic growth, social homogenization and social protection were major contextual elements of the expansion of ‘the new middle class,’ based on educational meritocracy, the valorization of credentialed skills, and the expansion of the average wage compared to housing and capital assets (‘depatrimonialization’). After the 1990s, the rupture and reversal of these trends, with ‘stagnation’, ‘new inequalities’ and ‘social uncertainty’ as new trends, generated a backlash in the “middle class society”. Third, I analyze the demographic and social consequences of these new trends in terms of the shrinking of the middle classes in a context where the inheritance of assets and resources changed the previous equilibrium. Finally, I highlight the importance of addressing the problem of social stability when large strata of the middle class have less interest in the maintenance of the social order. [less ▲]

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See detailThe patients’ perspective on access to and use of Personal Health Records
Paccoud, Ivana UL; Baumann, Michèle UL; Le Bihan, Etienne UL et al

Scientific Conference (2020)

We present the patients' perspective regarding the use of Personal Health Records, and give insights on patients' characteristics, such as socioeconomic and behavioural factors, that are associated with ... [more ▼]

We present the patients' perspective regarding the use of Personal Health Records, and give insights on patients' characteristics, such as socioeconomic and behavioural factors, that are associated with the access to and use of Personal Health Records. The findings come from the INTERREG APPS project that investigated preferences for and intention to use Personal Health Records in four cross-border regions, in Lorraine/France, Luxembourg, Rhineland-Palatinate and Saarland/Germany, and Wallonia/Belgium. [less ▲]

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See detailCore Values that Influence the Patient—Healthcare Professional Power Dynamic: Steering Interaction towards Partnership
Odero, Angela UL; Pongy, Manon UL; Chauvel, Louis UL et al

in International Journal of Environmental Research and Public Health (2020), 7(8458),

Healthcare has long been marked by the authoritative-physician–passive-patient interaction, with patients seeking help and physicians seeking to restore patients back to health. However, lobalisation ... [more ▼]

Healthcare has long been marked by the authoritative-physician–passive-patient interaction, with patients seeking help and physicians seeking to restore patients back to health. However, lobalisation, social movements, and technological advancements are transforming the nature of this relationship. We aim to identify core values that influence the power dynamic betweenpatients and healthcare professionals, and determine how to steer these interactions towards partnership, a more suitable approach to current healthcare needs. Patients with physical chronic diseases (10 men, 18 women) and healthcare professionals (11 men, 12 women) were interviewed, sessions transcribed, and the framework method used to thematically analyse the data. Validation was done through analyst triangulation and member check recheck. Core values identified as influencing the patient-healthcare professional power dynamic include: (A) values that empower patients (acceptance of diagnosis and autonomy); (B) values unique to healthcare professionals (HCPs) (acknowledging patients experiential knowledge and including patients in the therapeutic process); and (C) shared capitals related to their interactions (communication, information sharing and exchange, collaboration, and mutual commitment). These interdependent core values can be considered prerequisites to the implementation of the patient-as-partner approach in healthcare. Partnership would imply a paradigm shift such that stakeholders systematically examine each other’s perspective, motivations, capabilities, and goals, and then adapt their interactions in this accord, for optimal outcome. [less ▲]

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See detailLosing ground in the income hierarchy: relative deprivation revisited
D'Ambrosio, Conchita UL; Bossert, Walter

in Journal of Economic Inequality (2020), 18

The paper discusses a one-parameter generalization of individual relative deprivation measures to a two-period setting that differs from earlier approaches. The parameter is, by definition, independent of ... [more ▼]

The paper discusses a one-parameter generalization of individual relative deprivation measures to a two-period setting that differs from earlier approaches. The parameter is, by definition, independent of the income distributions under consideration—it is to be chosen by a social planner. Its value has an intuitive interpretation: it represents the additional weight assigned to the income shortfalls associated with agents who passed the individual in question when moving from yesterday’s income distribution to today’s. Therefore, the choice of this parameter represents an important value judgment on the part of a social planner regarding the relative impact of being left behind. As a special case, it is illustrated how the well-known Yitzhaki index can be extended to this environment. [less ▲]

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See detailOrienter les soins vers le patient partenaire. Un livre blanc pour la Grande Région
Consortium Interreg APPS; Baumann, Michèle UL; Chauvel, Louis UL et al

Book published by INTERREG APPS (2020)

Les différents chapitres de ce livre proposent une approche holistique pour faire évoluer le système de santé vers le partenariat de soins. Résultat de trois années de recherche et de concertation, le ... [more ▼]

Les différents chapitres de ce livre proposent une approche holistique pour faire évoluer le système de santé vers le partenariat de soins. Résultat de trois années de recherche et de concertation, le Livre Blanc s’appuie sur des recherches documentaires (analyse de la littérature scientifique et de la législation spécifique de chaque pays), des entretiens et des enquêtes auprès de nombreux acteurs, le repérage et l’analyse d’initiatives en GR et la discussion orientée vers le consensus. Par ailleurs, les propositions de recommandations ont été élaborées et discutées lors d’un séminaire interrégional réalisé en décembre 2019. Le Livre Blanc est structuré en 5 parties qui s’adressent chacune à un public ciblé. La première partie situe le contexte dans lequel s’est réalisé le projet et décrit la méthodologie du programme. La seconde partie est consacrée aux aspects réglementaires de l’approche patient partenaire et à leurs conséquences sur les pratiques et les initiatives analysées sur le terrain. Elle est destinée de manière privilégiée aux mandataires politiques. La troisième partie propose une réflexion sur le développement de stratégies de partenariat au niveau des institutions de santé. Elle concerne les gestionnaires des établissements de santé. La quatrième partie vise à amener les professionnels à s’interroger sur ce que le partenariat de soins peut leur apporter dans leurs pratiques de soins. Elle s’adresse, en particulier, aux acteurs en contact direct avec les patients. La cinquième et dernière partie suggère différentes voies possibles de développement de l’APPS dans les domaines de l’enseignement et de la recherche. Toutes ces parties s’adressent bien évidemment au patient, qui est au coeur de l’APPS. Les prises de position proposées par ce Livre Blanc s’appuient sur les données collectées par le consortium de recherche de 2017 à 2020. Dès lors, ce document ne peut être exhaustif et est appelé à évoluer, basé davantage sur une fonction vectrice de normes que de règles. Pour davantage d’information et pour connaitre nos activités et nos publications, rendezvous sur le site web du projet APPS (https://www.patientpartner.org/). [less ▲]

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See detailLife Satisfaction and mobility: Their associations with career attitudes, and health-related factors among postgraduates having studied in universities intra EU and outside EU
Odero, Angela UL; Chauvel, Louis UL; Hartung, Anne UL et al

in BMC Public Health (2020), 20(3),

Background. University postgraduates’ mobility towards, and outside the EU is continuously increasing, creating a competitive context in which maintaining a high life satisfaction (LS) is a public health ... [more ▼]

Background. University postgraduates’ mobility towards, and outside the EU is continuously increasing, creating a competitive context in which maintaining a high life satisfaction (LS) is a public health challenge. However, the relationship between LS and its determinants among this population are under-documented. Our aims were to measure LS indicators of mobile postgraduates (Intra EU: Who pursue part of their studies in Europe; Outside EU: Who study outside of Europe) versus non-mobile (pursue their studies in Luxembourg), and to analyze the associations between LS and career attitudes, socioeconomic characteristics, and health-related factors for each group. Method. Six hundred and sixty-four (644) students obtained financial aid from the Luxembourgish government independent of their family’s socioeconomic situation. Contacted by post, they completed an online questionnaire. Analyses included a multiple linear regression model in which only significant relationships (p < 0.05) were used. Results.Three groups were created: Mobile intra EU (n = 381), mobile outside EU (n = 43) and non-mobile (n = 66) postgraduates. Health satisfaction was positively linked to LS, in all groups. Among the mobile outside EU group, majority (63.2%) were men and 57.9% did not live alone - health was the only determinant which contributed to their LS. Among the mobile intra EU, majority (57.8%) were women, and 64.3% not living alone. Autonomy and career adaptability attitudes were positively associated with their LS (b: 0.210 and 0.119, respectively), whereas the worry factor was negatively (b: − 0.153 and -0.159) associated. The non-mobile, were the oldest of the three groups. Majority (51.6%) were women, and 93.7% did not live alone. Career optimism and planning attitudes were positively correlated to their LS (regression parameter estimates (b: 0.400 and 0.212, respectively). Conclusions.Attention should be devoted to the LS of local and cosmopolitan students, as it seems to be a relevant health indicator. Overall, the farther the mobility was, the higher the postgraduates’ general LS (8.5/10) was; this indicator was higher than the LS indicator for the age group 25–34 years 7.53/10 (EU-28, in 2013). University’ services could promote the development of career projects and the promotion of health to enhance postgraduates’ LS. University policy makers need to ensure this for all students. [less ▲]

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