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Disabled
Terms modified by Disabled Selected AbstractsUnhealthy Disabled: Treating Chronic Illnesses as DisabilitiesHYPATIA, Issue 4 2001SUSAN WENDELL Chronic illness is a major cause of disability, especially in women. Therefore, any adequate feminist understanding of disability must encompass chronic illnesses. I argue that there are important differences between healthy disabled and unhealthy disabled people that are likely to affect such issues as treatment of impairment in disability and feminist politics, accommodation of disability in activism and employment, identification of persons as disabled, disability pride, and prevention and "cure" of disabilities. [source] Should Actuarial Risk Assessments be Used with Sex Offenders who are Intellectually Disabled?JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2004Andrew J. R. Harris Background, Objective actuarial assessments are critical for making risk decisions, determining the necessary level of supervision and intensity of treatment (Andrews & Bonta 2003). This paper reviews the history of organized risk assessment and discusses some issues in current attitudes towards sexual offenders with intellectual disabilities. Method, We present two risk assessment tools (RRASOR and STABLE-2000) that appear to have practical utility with this population. Data are presented from a community sample of 81 sexual offenders who are intellectually disabled suggesting that the RRASOR may provide a useful metric of risk for this population. Dynamic risk is assessed using the STABLE-2000. This tool, based on 16 areas empirically associated with sexual recidivism, samples the individuals' current behaviour, skill deficits and personality factors. Change in these factors serves to flag the supervisor to changing risk levels. Conclusions, In addressing the question of whether we should seek special risk measures normed on people with intellectually disabilities, given the current lack of alternative tools, we conclude that it is reasonable to make use of the risk assessments that have been validated on the general sex offender population. [source] Justice for the Disabled: A Contractualist ApproachJOURNAL OF SOCIAL PHILOSOPHY, Issue 1 2009Christie Hartley First page of article [source] Occupational Attainment and Earnings: The Case of the DisabledLABOUR, Issue 3 2004Peter Skogman Thoursie It extends the traditional wage decomposition by incorporating explained and unexplained differences in occupational attainment. Data from the Swedish Level of Living Survey for 1981 and for 1991 have been used. The results show that in both years the disabled worked in low-level occupations to a greater extent relative to the non-disabled. This is due to the fact that disabled workers have lower qualifications. The unexplained component due to differences in returns on wage determinants is insignificant in the 1981 case but is highly significant in 1991, constituting around 50,60 per cent of the average log wage differential. [source] Why Am I Not Disabled?MEDICAL ANTHROPOLOGY QUARTERLY, Issue 1 2003Making State Subjects, Making Statistics in Post-;Mao China In this article I examine how and why disability was defined and statistically quantified by China's party-state in the late 1980s. I describe the unfolding of a particular epidemiological undertaking,China's 1987 National Sample Survey of Disabled Persons,as well as the ways the survey was an extension of what Ian Hacking has called modernity's "avalanche of numbers." I argue that, to a large degree, what fueled and shaped the 1987 survey's codification and quantification of disability was how Chinese officials were incited to shape their own identities as they negotiated an array of social, political, and ethical forces, which were at once national and transnational in orientation, [disability, China, epidemiology, biopower, identity] [source] Life of the mind: The interface of psychopharmaceuticals, domestic economies, and social abandonmentAMERICAN ETHNOLOGIST, Issue 4 2004Joćo Biehl ABSTRACT In this article, I address the embroilment of medical science in the lifeworlds of the urban poor in Brazil, particularly the place of psychopharmaceuticals within households. I explore how psychiatric diagnostics and treatments are integrated into a domestic "dramaturgy of the real" and how family members use them to assess human value and to mediate the disposal of persons considered unproductive or unsound. I focus on the life of Catarina, who was deemed mad and left by her family in an asylum in southern Brazil. Disabled and abandoned, Catarina began to compile a "dictionary" of words that have meaning for her. By tracing Catarina's words back to the people, households, and medical institutions that she had once been a part of, I illuminate the complex network in which her abandonment and pathology took form as well as the edges of human imagination that she keeps expanding. From this examination, one comes to understand how economic globalization, state and medical reform, and acceleration of claims over human rights and citizenship coincide with and impinge on a local production of social death. One also sees how mental disorders gain form at the juncture between the subject, her biology, and the technical and political coding of her sense of being alive. Hers is not just bare life, though: Thinking through her condition, Catarina anticipates social ties and one more chance. This is also a story of the methodological and ethical challenges I faced as I supported Catarina's search for consistency and her demands for continuity. [source] The Future of the Disabled in Liberal Society: an Ethical AnalysisNURSING PHILOSOPHY, Issue 3 2001Steven Edwards [source] Aggressive Behavior in the Disabled: RevisitedPAIN MEDICINE, Issue 2 2000Rollin M. Gallagher MD First page of article [source] Rescue of the reeler phenotype in the dentate gyrus by wild-type coculture is mediated by lipoprotein receptors for reelin and disabled 1THE JOURNAL OF COMPARATIVE NEUROLOGY, Issue 1 2006Shanting Zhao Abstract Reelin is a positional signal for the lamination of the dentate gyrus. In the reeler mutant lacking Reelin, granule cells are scattered all over the dentate gyrus. We have recently shown that the reeler phenotype of the dentate gyrus can be rescued in vitro by coculturing reeler hippocampal slices with slices from wild-type hippocampus. Here we studied whether Reelin from other brain regions can similarly induce this rescue effect and whether it is mediated via the Reelin receptors apolipoprotein E receptor 2 (ApoER2) and very-low-density lipoprotein receptor (VLDLR). We found that coculturing reeler hippocampal slices with slices from wild-type olfactory bulb, cerebellum, and neocortex rescued the reeler phenotype as seen before with hippocampal slices, provided that the Reelin-synthesizing cells of these regions were placed near the marginal zone of the reeler hippocampal slice. However, coculturing wild-type hippocampal slices with hippocampal slices from mutants deficient in ApoER2 and VLDLR did not rescue the reeler-like phenotype in these cultures. Similarly, no rescue of the reeler-like phenotype was observed in slices from mutants lacking Disabled 1 (Dab1), an adapter protein downstream of Reelin receptors. Conversely, reeler hippocampal slices were rescued by coculturing them with slices from Dab1,/, mutants or ApoER2,/,/VLDLR,/, mice. These findings show that Reelin from other brain regions can substitute for the loss of hippocampal Reelin and that rescue of the reeler phenotype observed in our coculture studies is mediated via lipoprotein receptors for Reelin and Dab1. J. Comp. Neurol. 495:1,9, 2006. © 2006 Wiley-Liss, Inc. [source] Telepathology as an Aid in Mohs Micrographic SurgeryDERMATOLOGIC SURGERY, Issue 6 2004Suresh Chandra MB Background. Mohs surgeons are occasionally confronted by challenging pathology ideally requiring the advice of a dermatopathologist. The Internet transmission of digital images of the pathology (telepathology) allows for such opinions to be easily and rapidly obtained. Objective. The objective was to obtain images utilizing a digital camera focused directly through one microscope eyepiece with subsequent e-mail to a pathologist for an immediate opinion. Methods. The particular area of interest on the slide is selected. The lens of the digital camera is placed directly on one eyepiece of the microscope and using the zoom and autofocus options of the camera a sharp image is obtained. The camera flash must be disabled. The images are immediately downloaded to computer and e-mailed to the pathologist for an opinion. Results. Three case reports illustrate that the pathologist is able to offer suggestions on a diagnosis with a high degree of confidence using the e-mailed images. Conclusion. Digital camera technology now allows for images to be taken directly through an eyepiece of the microscope. These images can be almost instantaneously e-mailed to a pathologist anywhere in the world for an immediate opinion. The technique provides for greater surety where doubt exists about the pathology during Mohs surgery. [source] Tribulations of transition care for the developmentally disabledDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2004John V Banta MD No abstract is available for this article. [source] Political abuse of psychiatryACTA PSYCHIATRICA SCANDINAVICA, Issue 399 2000J. L. T. Birley The abuse of psychiatry in Nazi Germany 60 years ago was the abuse of the ,duty to care'. Its scale was enormous; 300,000 people were sterilized and 100,000 killed in Germany alone and many thousands further afield, mainly in eastern Europe. This episode occurred in a country with a high reputation for its medicine, including psychiatry, and for its interest in the ethics of medical research. The economic conditions which preceded the violent political upheaval had led to increasing concern about ,the burden on the State' of the mentally ill and disabled. These preoccupations are still with us today. There may still be lessons to be learnt from the Nazi episode. [source] Movement-Induced Focal Motor Seizures and Choreoathetosis As- sociated with Nonketotic Hyperglycemia: A Case ReportEPILEPSIA, Issue 2000Hisashi Tanaka Case Report: We report the case of a diabetic woman who developed right-sided reflex seizures and bilateral choreoathetosis during an episode of nonketotic hyperglycemia. The patient was a 67-year-old woman with a 14-year history of HCV-related liver cirrhosis who experienced polydipsia and polyuria in January 1998. She began to have episodes of abnormal hyperkinetic movements of the right upper extremity and tonic-clonic seizures in the right arm triggered by voluntary movements of right or bilateral arms in the beginning of March 1998. The seizures increased in frequency and consequently left her disabled. She was admitted to our hospital with complaints of these abnormal motor phenomena on March 9, 1998. Neurological examinations revealed that she was alert, well-oriented, and that cranial nerve functions were normal. Slight motor weakness of the right upper limb and deep tendon hyporeflexes were observed in all extremities. Sensations and cerebellar functions were intact. Choreic or athetotic involuntary movements were seen in the bilateral upper limbs and neck. These involuntary movements were increased by voluntary movement or posturing of the upper limbs. The focal tonic-clonic seizures were easily triggered by voluntary movements such as knotting a cord. This seizure suddenly began by tonic movements in the right upper limb and gradually progressed to the right hemi-face and neck without loss of consciousness. The average duration of seizures was about one minute. The laboratory data demonstrated mild leukocytopenia, thrombocytopenia, hepatic dysfunction, and hyperglycemia without ketosis. Fasting blood glucose was 41 I mg/dl, and HbAlc was 14.5%. Blood ammonia was within normal levels. Cranial CT revealed no abnormalities. Brain MRI on T I-weighted images demonstrated bilateral high signal intensity in the putamen. An interictal EEG revealed a symmetrical slow background activity of 7,8 Hz. An ictal EEG recording showed a 2.5 4 Hz irregular sharp and slow wave discharge in the bilateral frontal-central regions. Treatment with carbamazepine was ineffective for the seizures. However, the seizures completely disappeared after the administration of insulin on March 17. Under good control of the hyperglycemia, the abnormal involuntary movements decreased gradually and then completely disappeared; the patient became neurologically asymptomatic by March 30. The follow-tip EEG demonstrated 9-Hz alpha background activity without any epileptic discharges. Conclusions: Nonketotic hyperglycemia has been rarely reported to cause stimulus-induced seizures or hyperkinetic involuntary movements such as hemichorea-ballism. To our knowledge, this is the first reported case of both induced seizures and involuntary movements simultaneously caused by hyperglycemia. Movement-induced seizures and choreoathetoid movements in this patient can be considered to result from transiently-increased activity in the basal ganglia and/or cerebral cortex associated with metaholic disorders. [source] Effects of Qi therapy (external Qigong) on symptoms of advanced cancer: a single case studyEUROPEAN JOURNAL OF CANCER CARE, Issue 5 2005M.S. LEE phd The aim of this study was to examine the effectiveness of Qi therapy (external Qigong) in the management of symptoms of advanced cancer in a man. We used a single case study design to evaluate the effectiveness of Qi therapy (external Qigong) in a 35-year-old man with advanced cancer (Stage IV) involving metastases in the stomach, lung and bone (Karnofsky performance scale: KPS, 40: requires special care and assistance, disabled). Treatment involved six days of pre-assessment, eight treatment sessions on alternate days over 16 days, and a two-week follow-up phase. A visual analogue scale (VAS) was used to assess the patient's self-reported symptoms of cancer over the intervention and follow-up periods. Following treatment, VAS scores' analysis revealed beneficial effects on pain, vomiting, dyspnoea, fatigue, anorexia, insomnia, daily activity and psychological calmness. These improvements were maintained over the two-week follow-up phase. After the first Qi therapy session, the patient discontinued medication and could sit by himself; after the fourth session, the patient was able to walk and use the toilet without assistance (improvement in KPS: 70: care for self, unable to perform normal activity or to do active work). Although limited by the single case study approach, our results support previous studies on this topic and provide reasons to conduct controlled clinical trials. [source] How are we doing with the treatment of essential tremor (ET)?EUROPEAN JOURNAL OF NEUROLOGY, Issue 6 2010Persistence of patients with ET on medication: data from 528 patients in three settings Background:, The pharmacological treatment of essential tremor (ET) is not optimal. There are only two first-line medications and troublesome side effects are common. It is not uncommon for patients to simply stop taking medication. Yet, no published data substantiate or quantify this anecdotal impression. Objectives:, To determine, amongst patients with ET who were prescribed medication for tremor, what proportion are still taking medication and what proportion have stopped? Methods:, Five hundred and twenty-eight patients with ET from three distinct study settings (clinical, brain donors, population) were interviewed. Results:, A clear pattern that emerged across settings was that the proportion of patients with ET who had stopped medication was sizable and consistently similar (nearly one-third): 31.4% (clinical), 24.3% (brain donors), 30.0% (population), 29.8% (overall). A similarly high proportion of cases with severe tremor had stopped their medication: 31.9% (clinical), 36.4% (brain donors). For the four most commonly used medications (propranolol, primidone, diazepam, topiramate), one-half or more of the treated patients had stopped the medication; amongst the less commonly used medications, the proportion who stopped was even higher. Conclusions:, Nearly one of every three patients with ET who had been prescribed medication for tremor had discontinued pharmacotherapy. Even more revealing was that a similar proportion of cases with severe tremor had stopped medication. These data make tangibly evident that there is a sizable population of patients with ET who are untreated and disabled, and underscore the inadequacy of current pharmacotherapeutic options for this common neurological disease. [source] Diversity, Identities and Strategies of Women Trade Union ActivistsGENDER, WORK & ORGANISATION, Issue 4 2000Fiona Colgan Diversity among women trade union activists is explored with reference to feminism and the women's movement, and the social and civil rights movements of black, disabled and lesbian and gay groups. Relationships between this diversity and women's individual and group identities and priorities are traced through some of the women's own descriptions and reflections on their trade union activism. These are drawn from our research with the public service union UNISON, in particular, two questionnaire surveys and semi-structured interviews. We draw on theories of social identity, the relations of out-group status and gender group consciousness to help to understand and explain the complexity of the social interactions involved. This frames our central analysis of the role of self-organization in the union in the construction of women's identities and consciousnesses, and the potential of self-organization as a site for collective action leading to organizational challenge, change and transformation. [source] Types and Patterns of Later-life MigrationGEOGRAFISKA ANNALER SERIES B: HUMAN GEOGRAPHY, Issue 3 2000William H. Walters This paper refines previous typologies of later-life mobility by explicitly evaluating the spatial migration patterns and household characteristics of retired American migrants. Migrants' lifecourse attributes (economic status, disability, presence of spouse), large-scale migration patterns (internal migration) and household characteristics (living arrangements, economic independence, residential independence) are used to identify three types of post-retirement mobility. The first type, amenity migration, has a distinctive spatial pattern that suggests a search for attractive climate and leisure amenities. The second type of mobility, assistance migration, can be traced to low income and the absence of a spouse in the household. It often results in residential and economic dependence , specifically, in co-residence with adult children or other labor force members. The third type of mobility, migration in response to severe disability and spouse absence, tends to result in nursing home residence. While amenity migration has long been associated with good health and favorable economic status, this analysis reveals that many disabled and lower-income retirees share the inmigration pattern typical of amenity migrants. In fact, amenity migration is the predominant type of mobility among those migrants with fewer than two unfavorable lifecourse attributes (low income, severe disability and spouse absence). Unlike previous lifecourse typologies, this study shows no clear relationship between moderate disability and co-residence with adult children. The results suggest that co-residence is primarily a strategy for reducing living costs rather than a means of coping with moderate disability. [source] Comprehensive geriatric assessment of elderly highlanders in Qinghai, China I: Activities of daily living, quality of life and metabolic syndromeGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2009Kozo Matsubayashi Aim: To reveal the comparison of comprehensive geriatric functions of elderly highlanders in Qinghai Plateau in China among three different ethnic groups. Methods: Activities of daily living (ADL), screening-based depression, quality of life (QOL) and checking-up of metabolic syndrome including community-based oral glucose tolerance test were assessed in 393 community-dwelling elderly subjects aged 60 years or more (247 Han elderly subjects, 49 Mongolian ones and 97 Tibetan ones). Results: Tibetan elderly highlanders were more disabled in ADL, but had higher QOL than Han elderly ones in Qinghai Plateau. Blood pressure measurements, rate of hypertension and hemoglobin concentrations in Tibetan elderly highlanders were lower than Han ones. Rates of diabetes and impaired glucose tolerance in elderly highlanders were relatively lower than other Asian elderly lowlanders. Conclusion: Prevalence of metabolic syndrome in elderly highlanders in Qinghai was still not high, however, we should pay attention to its tendency related with socialglobalism in the near future. Further investigation on physiological adaptability to hypoxic environment and human ageing phenomena in a global context may open a new research frontier for ageing science. [source] Changes in TMIG-Index of Competence by subscale in Japanese urban and rural community older populations: Six years prospective studyGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2003Yoshinori Fujiwara Objective: To examine the longitudinal changes in higher-level functional capacity in Japanese urban and rural community older populations. Design: Population-based cross-sectional, and prospective cohort studies. Setting: Koganei city in a suburb of Tokyo, and Nangai village, Akita Prefecture, Japan. Participants: One thousand, five hundred and six older persons (793 in Koganei and 713 in Nangai) aged 65,83 years living at home. Main outcome measures: Disability in Instrumental Self-Maintenance (IADL), Intellectual Activity or Social Role, measured by the Tokyo Metropolitan Institute of Gerontology Index of Competence. Results: At baseline, older men and women in the rural area, Nangai, had higher prevalence of disability in Intellectual Activity compared with respective counterparts in the urban area, Koganei. By contrast, disability in Social Role was more prevalent among elderly people in Koganei than in Nangai. In both areas older men and women had lowest prevalence of disability in IADL among three subscales. The six-year longitudinal survey on older persons who had initially no disability in all three subscales demonstrated that in urban Koganei older persons were most likely to be disabled in Social Role with advancing age, followed in turn by Intellectual Activity and IADL. By contrast, elderly people in rural Nangai were most likely to be disabled in Intellectual Activity, followed by Social Role and instrumental ADL. The Cox-proportional hazard model analysis for those who had no IADL disability at baseline revealed that the baseline level of Intellectual Activity or Social Role predicted significantly future onset of IADL disability in both areas even after controlling for sex, age, and chronic medical conditions. Conclusions: In both urban and rural community older populations, disability in Social Role and Intellectual Activity preceded IADL disability, and predicted significantly the future onset of IADL disability. [source] Collaboration, facilities and communities in day care services for older peopleHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2001Sarah Burch BA Abstract Collaborative working in care for older people is often seen as a desirable goal. However, there can be problems with this approach. This paper reports on a single blind randomized controlled trial which was carried out to compare outcomes of rehabilitation in two settings: a day hospital and social services day centres augmented by visiting therapists. The subjects were 105 older patients. Principal outcome measures were the Barthel Index, Philadelphia Geriatric Centre Morale Scale and the Caregiver Strain Index. Two aspects of the trial are examined here. Firstly, we investigated whether trial patients were more disabled than regular day centre attendees. Levels of health and well being amongst trial patients were compared with those of a random sample of 20 regular attendees from both of the participating day centres and an additional voluntary sector day centre. Secondly, key staff from the different settings were interviewed to assess how well the day centre model had worked in practice. Trial patients were significantly more disabled than regular day centre attendees according to the Barthel Index (P < 0.001), but this difference was no longer significant after three months of treatment. The day centre model had several problems, principally discharge policy, acceptability, facilities and attitudes of staff and regular attendees. Positive aspects of the day centre model, as well as successful rehabilitation, included shared skills, knowledge and resources. This paper suggests that collaborative working in day centres requires multipurpose facilities. If health staff maintain a permanent presence, benefits can include improved joint working, easier access to health care and the use of rehabilitative therapy as a preventative strategy. Day care settings can be analyzed as representing different types of communities. Allowing older users a greater degree of choice in facilities may increase the acceptability of care. [source] Explaining the differences in income-related health inequalities across European countriesHEALTH ECONOMICS, Issue 7 2004Eddy van Doorslaer Abstract This paper provides new evidence on the sources of differences in the degree of income-related inequalities in self-assessed health in 13 European Union member states. It goes beyond earlier work by measuring health using an interval regression approach to compute concentration indices and by decomposing inequality into its determining factors. New and more comparable data were used, taken from the 1996 wave of the European Community Household Panel. Significant inequalities in health (utility) favouring the higher income groups emerge in all countries, but are particularly high in Portugal and , to a lesser extent , in the UK and in Denmark. By contrast, relatively low health inequality is observed in the Netherlands and Germany, and also in Italy, Belgium, Spain Austria and Ireland. There is a positive correlation with income inequality per se but the relationship is weaker than in previous research. Health inequality is not merely a reflection of income inequality. A decomposition analysis shows that the (partial) income elasticities of the explanatory variables are generally more important than their unequal distribution by income in explaining the cross-country differences in income-related health inequality. Especially the relative health and income position of non-working Europeans like the retired and disabled explains a great deal of ,excess inequality'. We also find a substantial contribution of regional health disparities to socio-economic inequalities, primarily in the Southern European countries. Copyright © 2004 John Wiley & Sons, Ltd. [source] Unhealthy Disabled: Treating Chronic Illnesses as DisabilitiesHYPATIA, Issue 4 2001SUSAN WENDELL Chronic illness is a major cause of disability, especially in women. Therefore, any adequate feminist understanding of disability must encompass chronic illnesses. I argue that there are important differences between healthy disabled and unhealthy disabled people that are likely to affect such issues as treatment of impairment in disability and feminist politics, accommodation of disability in activism and employment, identification of persons as disabled, disability pride, and prevention and "cure" of disabilities. [source] Neck pain and disability: A cross-sectional survey of the demographic and clinical characteristics of neck pain seen in a rheumatology clinicINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2005A.O. Frank Summary This hospital-based cross-sectional cohort study examines the clinical and demographic features of neck pain, disability (using the Northwick Park neck pain questionnaire) and relationships to handicap in employment. Of 173 consecutive referrals to a rheumatology clinic with neck pain, 70% had neck/arm pain without neurological involvement, 13% other conditions, 11% nerve involvement and 5% other spinal pain. 141 patients (mean age 50 years) had mechanical or degenerative neck pain, of which 13% was probably work-related and 13% was trauma-related. 44 had taken sickness absence for an average of 30 weeks. Comorbidities were frequent (lumbar pain 51%). Those in work were significantly less disabled than those not working (p = 0.001) and those off sick (p < 0.01). Those reporting sleep disturbance, tearfulness and crying were significantly more disabled (p = 0.0001) than those who did not. Neck pain in secondary care is complicated by physical and emotional comorbidities. Comprehensive management requires a biopsychosocial model of care. [source] A model for intervention research in late-life depressionINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2009George S. Alexopoulos Abstract Objective To serve as a conceptual map of the role of new interventions designed to reduce the burden of late-life depression. Methods We identified three needs to be addressed by intervention research: (1) the need for novel interventions given that the existing treatments leave many older adults depressed and disabled; (2) the need for procedures enabling community-based agencies to offer interventions of known efficacy with fidelity; and (3) the need to increase access of depressed older adults to care. Results Our model orders novel interventions according to their role in serving depressed older adults and according to their position in the efficacy, effectiveness, implementation, and dissemination testing continuum. We describe three interventions designed by our institute to exemplify intervention research at different level of the model. A common element is that each intervention personalizes care both at the level of the individuals served and the level of community agencies providing care. To this end, each intervention is designed to accommodate the strengths and limitations of both patients and agencies and introduces changes in the patients' environment and community agencies needed in order to assimilate the new intervention. Conclusions We suggest that this model provides conceptual guidance on how to shorten the testing cycle and bring urgently needed novel treatments and implementation approaches to the community. While replication studies are important, propose that most of the support should be directed to those projects that take rational risks, and after adequate preliminary evidence, make the next step along the testing continuum. Copyright © 2009 John Wiley & Sons, Ltd. [source] Retrenching or renovating the Australian welfare state: the paradox of the Howard government's neo-liberalismINTERNATIONAL JOURNAL OF SOCIAL WELFARE, Issue 1 2009Philip Mendes Most conventional studies of the former Australian Liberal,National Coalition government refer to its neo-liberal ideological agenda: its concern to reduce government interference with free market outcomes by restricting access to social security payments. That analysis suggests a substantial retrenchment of the Australian welfare state based on redirecting responsibility for the disadvantaged from government to corporations, private individuals and families. Yet there is increasing evidence from reliable sources that the government has not reduced social expenditure, and that increasing resources have been directed, particularly via the family payments system, towards some disadvantaged groups such as low-income families and the aged. Utilising the theory of the US political scientist Paul Pierson, this article explores the joint paradox of Australian neo-liberalism: the punitive treatment of some disadvantaged groups such as the disabled and lone parents versus the generosity towards other groups and, more generally, the growth rather than decline in social expenditure. The author asks what this paradox tells us about the likely future of the welfare state in Australia and elsewhere. [source] Pictures and silences: memories of sexual abuse of disabled peopleINTERNATIONAL JOURNAL OF SOCIAL WELFARE, Issue 4 2002Darja Zavir The article de,individualises the debate about sexual abuse of disabled people, especially women, by showing that both the sexual and asexual identity of impaired persons are invariably fashioned within the institutional arrangement of domination and subjugation. It shows that if disabled persons are seen as asexual or if they are sexualised, they cannot escape sexual violence, which is not an aberration, but is intrinsic to the social construction of disability. The article includes personal testimonies of women with different disabilities from Slovenia, who were abused either at home or in public care and shows some responses of the professionals and caregivers who minimise the importance of abuse. It claims that ignoring the memories of sexual abuse is part of a subtle and unintentional discrimination, which reflects a continuity of prejudices and hatred toward disabled children and adults in the private realm as well as in public care. People from ethnic minorities, such as Roma, are still today more often diagnosed as mentally disabled, which shows that the disability diagnosis has to be seen as part of cultural responses towards an economically and socially marginalised group. The author uses different perspectives: historical, social work theories, cultural studies and feminist analysis. [source] Prioritisation of public investments in social infrastructures using multicriteria value analysis and decision conferencing: a case studyINTERNATIONAL TRANSACTIONS IN OPERATIONAL RESEARCH, Issue 4 2006Carlos A. Bana e Costa Abstract Not-for-profit private organisations that provide social services to children, the elderly and the disabled apply for financial support to develop or to renew their social infrastructures, through the Portuguese Institute for Social Welfare. In the context of scarce financial resources, the Institute decision-makers felt the need to adopt an improved "rationality" in resource allocation, in order to increase transparency and to ensure that the collective best use is made of a limited budget. This paper describes the socio-technical process followed in building a multicriteria value model, under a decision conferencing framework in which participation and interaction among decision-actors were key features in the development of the three main phases of problem structuring, evaluation and prioritisation. [source] Complexity Prediction Instrument to detect ,complex cases' in respiratory wards: instrument developmentJOURNAL OF ADVANCED NURSING, Issue 1 2008Elena Lobo Abstract Title.,Complexity Prediction Instrument to detect ,complex cases' in respiratory wards: instrument development. Aim., This paper is a report of a study to test the hypothesis that the Spanish version of the Complexity Prediction Instrument is a reliable and valid measure of complexity of patients with respiratory disease and to identify the frequency of positive indicators of potential complexity. Background., Respiratory patients are often disabled and severely ill, with co-morbid physical conditions and associated psychosocial problems and need complex nursing care. Method., Trained nurses assessed 299 consecutive adult patients admitted to a respiratory service in Spain from May 2003 until June 2004 with the new, Spanish version of the instrument. Criterion-related validity was tested by studying its ability to predict complexity of care in terms of: severity of illness, scored using the Cumulative Illness Rating Scale; length of hospital stay; ,multiple consultations' during admission; and ,multiple specialists' after discharge. Findings., The hypothesis was supported: patients rating above the standard cut-off point on the Complexity Prediction Instrument scored statistically significantly higher on most of the measures of care complexity studied. Linear regression models showed that the tool was associated with ,length of hospital stay', and predicted both ,multiple consultations' and ,multiple specialists', after controlling for potential confounders. The proportion of ,probable complex cases' was 59·5%. Five positive indicators of potential complexity had a frequency higher than 50%. Conclusion., The Complexity Prediction Instrument is reliable and valid in a new clinical area, respiratory disease. It may be used by nurses for the early prediction of complexity of care. International comparisons may be facilitated with this new Spanish version. [source] Functional Trajectories in Older Persons Admitted to a Nursing Home with Disability After an Acute HospitalizationJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2009Thomas M. Gill MD OBJECTIVES: To characterize the functional trajectories of older persons admitted to a nursing home with disability after an acute hospitalization. DESIGN: Prospective cohort study of 754 community-living persons aged 70 and older who were initially nondisabled in four essential activities of daily living (ADLs). SETTING: Greater New Haven, Connecticut. PARTICIPANTS: The analytical sample included 296 participants who were newly admitted to a nursing home with disability after an acute hospitalization. MEASUREMENTS: Information on nursing home admissions, hospitalizations, and disability in essential ADLs was ascertained during monthly telephone interviews for up to 9 years. Disability was defined as the need for personal assistance in bathing, dressing, walking inside one's home, or transferring from a chair. RESULTS: The median time to the first nursing home admission with disability after an acute hospitalization was 46 months (interquartile range 27.5,75.5), and the mean number±standard deviation of ADLs that participants were disabled in upon admission was 3.0±1.2. In the month preceding hospitalization, 189 (63.9%) participants had no disability. The most common functional trajectory was discharged home with disability (46.3%), followed by continuous disability in the nursing home (27.4%), discharged home without disability (21.6%), and noncontinuous disability in the nursing home (4.4%). Only 96 (32.4%) participants returned home at (or above) their premorbid level of function. CONCLUSION: The functional trajectories of older persons admitted to a nursing home with disability after an acute hospitalization are generally poor. Additional research is needed to identify the factors responsible for these poor outcomes. [source] Cognitive Status, Muscle Strength, and Subsequent Disability in Older Mexican AmericansJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2005Mukaila A. Raji MD Objectives: To examine the association between Mini-Mental State Examination (MMSE) score and subsequent muscle strength (measured using handgrip strength) and to test the hypothesis that muscle strength will mediate any association between impaired cognition and incident activity of daily living (ADL) disability over a 7-year period in elderly Mexican Americans who were initially not disabled. Design: A 7-year prospective cohort study (1993,2001). Setting: Five southwestern states (Texas, New Mexico, Colorado, Arizona, and California). Participants: Two thousand three hundred eighty-one noninstitutionalized Mexican-American men and women aged 65 and older with no ADL disability at baseline. Measurements: In-home interviews in 1993/1994, 1995/1996, 1998/1999, and 2000/2001 assessed social and demographic factors, medical conditions (diabetes mellitus, stroke, heart attack, and arthritis), body mass index (BMI), depressive symptomatology, handgrip muscle strength, and ADLs. MMSE score was dichotomized as less than 21 for poor cognition and 21 or greater for good cognition. Main outcomes measures were mean and slope of handgrip muscle strength over the 7-year period and incident disability, defined as new onset of any ADL limitation at the 2-, 5-, or 7-year follow-up interview periods. Results: In mixed model analyses, there was a significant cross-sectional association between having poor cognition (MMSE<21) and lower handgrip strength, independent of age, sex, and time of interview (estimate=,1.41, standard error (SE)=0.18; P<.001). With the introduction of a cognition-by-time interaction term into the model, there was also a longitudinal association between poor cognition and change in handgrip strength over time (estimate=,0.25, SE=0.06; P<.001), indicating that subjects with poor cognition had a significantly greater decline in handgrip strength over 7 years than those with good cognition, independent of age, sex, and time. This longitudinal association between poor cognition and greater muscle decline remained significant (P<.001) after controlling for age, sex, education, and time-dependent variables of depression, BMI, and medical conditions. In general estimation equation models, having poor cognition was associated with greater risk of 7-year incident ADL disability (odds ratio=2.01, 95% confidence interval (CI)=1.60,2.52); the magnitude of the association decreased to 1.66 (95% CI=1.31,2.10) when adjustment was made for handgrip strength. Conclusion: Older Mexican Americans with poor cognition had steeper decline in handgrip muscle strength over 7 years than those with good cognition, independent of other demographic and health factors. A possible mediating effect of muscle strength on the association between poor cognition and subsequent ADL disability was also indicated. [source] | ||||||||||||||||||||||||||||||||||||||||||||||