-
International Journal For Equity in... Jan 2021Equity and inclusion are important principles in policy development and implementation. The aim of this study is to explore the extent to which equity and inclusion were...
BACKGROUND
Equity and inclusion are important principles in policy development and implementation. The aim of this study is to explore the extent to which equity and inclusion were considered in the development of Malawi's National Disability Mainstreaming Strategy and Implementation Plan.
METHODS
We applied an analytical methodology to review the Malawi's National Disability Mainstreaming Strategy and Implementation Plan using the EquIPP (Equity and Inclusion in Policy Processes) tool. The EquIPP tool assesses 17 Key Actions to explore the extent of equity and inclusion.
RESULTS
The development of the Malawi National Disability Mainstreaming Strategy and Implementation Plan was informed by a desire to promote the rights, opportunities and wellbeing of persons with disability in Malawi. The majority (58%) of the Key Actions received a rating of three, indicating evidence of clear, but incomplete or only partial engagement of persons with disabilities in the policy process. Three (18%) of the Key Actions received a rating of four indicating that all reasonable steps to engage in the policy development process were observed. Four (23%) of the Key Actions received a score five indicating a reference to Key Action in the core documents in the policy development process.
CONCLUSIONS
The development of disability policies and associated implementation strategies requires equitable and inclusive processes that consider input from all stakeholders especially those whose wellbeing depend on such policies. It is pivotal for government and organisations in the process of policy or strategy development and implementation, to involve stakeholders in a virtuous process of co-production - co-implementation - co-evaluation, which may strengthen both the sense of inclusion and the effectiveness of the policy life-cycle.
Topics: Community Participation; Disabled Persons; Health Policy; Humans; Malawi; Policy Making; Vulnerable Populations
PubMed: 33413443
DOI: 10.1186/s12939-020-01378-y -
Journal of Rehabilitation Medicine Jul 2017Disability has a profound impact, both on those who live with it and on society that responds to the needs of people experiencing disability. Society has a primary...
Disability has a profound impact, both on those who live with it and on society that responds to the needs of people experiencing disability. Society has a primary obligation to respond to the impact of disability. Rehabilitation has an essential role to play here; but its relationship to disability embodies a broader social ambiguity about what it means to experience disability. On the one hand, disability is a mark of a minority group persons with disabilities, which has, historically, been socially disadvantaged. On the other, disability is a matter of how health conditions and associated impairments interact with the physical and social world to create limits on what people can do or become. However, just as health problems are universal over the life course, so too is disability. Everyone experiences disability. This paper explores the historical underpinnings of these two perspectives on disability, in particular how they impact on rehabilitation practice and policy. After surveying the social consequences of these perspectives, the paper attempts to reconcile them in order to enhance the overall effectiveness and relevance of the social response to disability.
Topics: Disabled Persons; Humans
PubMed: 28661547
DOI: 10.2340/16501977-2251 -
BMC Public Health Nov 2018Labour-market marginalisation (LMM) and common mental disorders (CMDs) are serious societal problems. The aims were to describe trajectories of LMM (both work disability...
BACKGROUND
Labour-market marginalisation (LMM) and common mental disorders (CMDs) are serious societal problems. The aims were to describe trajectories of LMM (both work disability and unemployment) among young adults with and without CMDs, and to elucidate the characteristics associated with these trajectories.
METHODS
The study was based on Swedish registers and consisted of all individuals 19-30 years with an incident diagnosis of a CMD in year 2007 (n = 7245), and a matched comparison group of individuals without mental disorders during the years 2004-07 (n = 7245). Group-based trajectory models were used to describe patterns of LMM both before, and after the incident diagnosis of a CMD. Multinomial logistic regressions investigated the associations between sociodemographic and medical covariates and the identified trajectories.
RESULTS
Twenty-six percent (n = 1859) of young adults with CMDs followed trajectories of increasing or constant high levels of work disability, and 32 % (n = 2302) followed trajectories of increasing or constant high unemployment. In the comparison group, just 9 % (n = 665) followed increasing or constant high levels of work disability and 21 % (n = 1528) followed trajectories of increasing or constant high levels of unemployment. A lower share of young adults with CMDs followed trajectories of constant low levels of work disability (n = 4546, 63%) or unemployment (n = 2745, 38%), compared to the level of constant low work disability (n = 6158, 85%) and unemployment (n = 3385, 50%) in the comparison group. Remaining trajectories were fluctuating or decreasing. Around 50% of young adults with CMDs had persistent levels of LMM at the end of follow-up. The multinomial logistic regression revealed that educational level and comorbid mental disorders discriminated trajectories of work disability, while educational level, living area and age determined differences in trajectories of unemployment (R = 0.02-0.05, p < 0.001).
CONCLUSIONS
A large share, nearly 50%, of young adults with CMDs, substantially higher than in the comparison group of individuals without mental disorders, display increasing or high persistent levels of either work disability or unemployment throughout the follow-up period. Low educational level, comorbidity with other mental disorders and living in rural areas were factors that increased the probability for LMM.
Topics: Adult; Disabled Persons; Female; Humans; Male; Mental Disorders; Sweden; Unemployment; Young Adult
PubMed: 30400785
DOI: 10.1186/s12889-018-6141-y -
The Journals of Gerontology. Series B,... Oct 2019Late-life disability is highly dynamic but within-person short-term fluctuations have not been assessed previously. We analyze how substantial such late-life disability...
OBJECTIVES
Late-life disability is highly dynamic but within-person short-term fluctuations have not been assessed previously. We analyze how substantial such late-life disability fluctuations are and whether they are associated with time-to-death, long-term disability trajectories, frailty, and sociodemographics.
METHODS
Monthly survey data (Precipitating Events Project Study) on activities of daily living/instrumental activities of daily living (ADL/IADL) disability (0-9) in the last years of life from 642 deceased respondents providing 56,308 observations were analyzed with a two-step approach. Observation-level residuals extracted from a Poisson mixed regression model (first step), which depict vertical short-term fluctuations from individual long-term trajectories, were analyzed with a linear mixed regression model (second step).
RESULTS
Short-term disability fluctuations amounted to about one ADL/IADL limitation, increased in the last 4 years of life, and were closely associated with disability increases. Associations with frailty or sociodemographics characteristics were absent except for living alone.
DISCUSSION
Short-term disability fluctuations in late life were substantial, were linked to mortality-related processes, and represent a concomitant feature of disability increases in late life.
Topics: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Connecticut; Disabled Persons; Female; Frail Elderly; Humans; Male; Mortality; Poisson Distribution; Socioeconomic Factors; Surveys and Questionnaires; Time Factors
PubMed: 31298701
DOI: 10.1093/geronb/gbz089 -
European Journal of Physical and... Aug 2014In the current population we observe a rise of chronic health problems often with multiple characteristics. This results in a growing number of people who are... (Review)
Review
In the current population we observe a rise of chronic health problems often with multiple characteristics. This results in a growing number of people who are experiencing long-term disabilities or difficulties in functioning because of disability. These conditions require a complex response over an extended period of time, that involves coordinated inputs from a wide range of health professionals. This paper argues the central role and benefit of rehabilitation and describes the rehabilitation as an integral component in the management of people with chronic disabilities. It also presents the most important related definitions: long-term care, rehabilitation for chronic disease and disability, the aim of physical and rehabilitation medicine (PRM). An interdisciplinary team is ideal for an effective implementation of rehabilitation for chronic disease and disability. However, the article mainly focuses on defining the role and contribution of the PRM physician in the rehabilitation of persons with long-term disabilities. The article includes: descriptions of his/her key role and competencies, particularly with regard to medical and functional status and prognosis, of the ability to comprehensively define the rehabilitation needs of the patient/person with respect to ICD-WHO classification domains, of the cooperation with other medical specialists and health professionals, of determining the rehabilitation potential, of developing the rehabilitation plan tailored to specific needs, as well as of the contribution of PRM physician in the follow-up care pathways.
Topics: Clinical Competence; Disabled Persons; Disease Management; Humans; Long-Term Care; Physical and Rehabilitation Medicine
PubMed: 25061984
DOI: No ID Found -
PM & R : the Journal of Injury,... Nov 2010The current biomedical and psychosocial frameworks that form the conceptual basis of medicine today are insufficient to address the needs of the medically complex and... (Review)
Review
The current biomedical and psychosocial frameworks that form the conceptual basis of medicine today are insufficient to address the needs of the medically complex and environmentally challenged populations of patients often cared for by physical medicine and rehabilitation specialists. The expanded biopsycho-ecological model of health, illness, injury, and disability operating through mechanisms of Health Environmental Integration (HEI) encourages a more complete understanding of illness, injury, activity limitation, and participation restriction as arising at the interface between the person and the environment. HEI recognizes complex interacting multilevel functional hierarchies beginning at the cellular level and ending at the individual's experience of the environment. Although the foci of illness and injury are within the body and mind, the physical and social environments contain elements that can cause or exacerbate disease and barriers that interact in ways that lead to injuries and disabilities. Furthermore, these environments hold the elements from which treating agents, facilitators, and social supports must be fashioned. The highly integrative biopsycho-ecological framework provides an expanded basis for understanding the objective causes and subjective meanings of disabilities. Disabilities are reduced through HEI by seeking to maximally integrate the body and mind (the self) with both the surrounding physical environment and other people in society. HEI offers mechanisms for interdisciplinary research, an expanded framework for education and empowerment, and a blueprint for optimizing day-to-day clinical care at both the individual patient and treatment population levels in the ever-changing scientific, political, and policy environments.
Topics: Disability Evaluation; Disabled Persons; Health Status; Humans; Mind-Body Relations, Metaphysical; Models, Theoretical; Physical and Rehabilitation Medicine; Social Environment; Social Support
PubMed: 21093839
DOI: 10.1016/j.pmrj.2010.06.013 -
The American Journal of Geriatric... Mar 2021Assess a conceptual model linking caregiving factors to care recipient mortality in a large representative sample of older adults with disability.
OBJECTIVE
Assess a conceptual model linking caregiving factors to care recipient mortality in a large representative sample of older adults with disability.
DESIGN
Descriptive longitudinal study with 5-year mortality follow-up among older adults with disability. Baseline in person and telephone interviews/assessments of older adults with disability and their family caregivers carried out in 2011.
SETTING
Representative samples of older US population and their family caregivers.
PARTICIPANTS
US representative samples of older adults with disability aged 65 and over (National Health and Aging Study) and their family caregivers (National Study of Caregiving; www.nhats.org; N = 1,262).
MEASUREMENT
Controlling for known risk factors for mortality in older adults, including age, gender, race, education, socioeconomic status, disability, and cognitive status, we assess the role of three caregiving factors (depression, anxiety, and burden) and three mediating factors (care recipient depression, anxiety, and unmet needs for care) as predictors of care recipient mortality.
RESULTS
Caregiver burden, care recipient depression, and care recipient unmet needs are independent predictors of care recipient mortality.
CONCLUSION
Caregiving factors may play an important role in the survival of their care recipients. This is a relatively unexplored research area that calls for fine-grained studies capturing caregiver-care recipient health-related interactions over time.
Topics: Aged; Aged, 80 and over; Anxiety; Caregiver Burden; Caregivers; Depression; Disabled Persons; Female; Humans; Longitudinal Studies; Male; Prognosis; Stress, Psychological; Survival Rate
PubMed: 32718853
DOI: 10.1016/j.jagp.2020.06.025 -
Family Practice Management Mar 2006
Topics: Disabled Persons; Health Policy; Humans; Therapeutics; United States
PubMed: 16568588
DOI: No ID Found -
Medical Care Sep 2020In 2003, national disability-associated health care expenditures (DAHE) were $398 billion. Updated estimates will improve our understanding of current DAHE.
BACKGROUND
In 2003, national disability-associated health care expenditures (DAHE) were $398 billion. Updated estimates will improve our understanding of current DAHE.
OBJECTIVE
The objective of this study was to estimate national DAHE for the US adult population and analyze spending by insurance and service categories and to assess changes in spending over the past decade.
RESEARCH DESIGN
Data from the 2013-2015 Medical Expenditure Panel Survey were used to estimate DAHE for noninstitutionalized adults. These estimates were reconciled with National Health Expenditure Accounts (NHEA) data and adjusted to 2017 medical prices. Expenditures for institutionalized adults were added from NHEA data.
MEASURES
National DAHE in total, by insurance and service categories, and percentage of total expenditures associated with disability.
RESULTS
DAHE in 2015 were $868 billion (at 2017 prices), representing 36% of total national health care spending (up from 27% in 2003). DAHE per person with disability increased from $13,395 in 2003 to $17,431 in 2015, whereas nondisability per-person spending remained constant (about $6700). Public insurers paid 69% of DAHE. Medicare paid the largest portion ($324.7 billion), and Medicaid DAHE were $277.2 billion. More than half (54%) of all Medicare expenditures and 72% of all Medicaid expenditures were associated with disability.
CONCLUSIONS
The share of health care expenditures associated with disability has increased substantially over the past decade. The high proportion of DAHE paid by public insurers reinforces the importance of public programs designed to improve health care for people with disabilities and emphasizes the need for evaluating programs and health services available to this vulnerable population.
Topics: Activities of Daily Living; Adult; Age Factors; Aged; Chronic Disease; Disabled Persons; Female; Health Expenditures; Humans; Male; Medicaid; Medicare; Middle Aged; Physical Functional Performance; Racial Groups; Residence Characteristics; Sex Factors; Social Work; Socioeconomic Factors; United States; Work Capacity Evaluation
PubMed: 32826747
DOI: 10.1097/MLR.0000000000001371 -
Journal of Occupational Rehabilitation Dec 2018Purpose Amputation is a life changing event that can significantly impact an individual's physical and mental well-being. Our objective was to review literature... (Review)
Review
Purpose Amputation is a life changing event that can significantly impact an individual's physical and mental well-being. Our objective was to review literature exploring the impact of amputation upon a person's functioning and inclusion in the workplace. Methods Medline, CINAHL, and PsycINFO were searched using keywords related to amputation, employment and community reintegration. Eligible studies were published since 2000 and one of the following study designs: randomized controlled trial, non-randomized controlled trial, retrospective study, prospective study, concurrent cohort study, or cross sectional study. Studies for civilians with amputation as well as service members and Veterans with amputation were considered for inclusion. Results The search identified 995 articles, 25 of which met inclusion/exclusion criteria and were included in the review. While strong evidence for correlations and predictors of outcomes after amputation were limited, multiple factors were identified as contributing to physical functioning and employment after amputation. Conclusions Outcomes after amputation can vary widely with many potentially inter-related factors contributing. The factors identified may also serve to inform the development of interventions aiming to improve functional performance and reintegration after amputation. Furthermore, the review highlights the need for more high quality prospective studies.
Topics: Amputation, Traumatic; Disabled Persons; Employment; Humans; Lower Extremity; Rehabilitation, Vocational; Return to Work; Self-Help Devices; Upper Extremity; Walking
PubMed: 29397480
DOI: 10.1007/s10926-018-9757-y