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1.  Pilot Study of Old-age Pensioners 
British Medical Journal  1969;1(5641):432-436.
Two groups of old-age pensioners in St. Paul's Cray were screened for physical illness, social and family connexions, and personal activities. The first group comprised 100 people (10% random sample of a suburban practice of 12,000 patients), and the second group comprised the total population of a sheltered area (85 people).
The findings showed that geographical separation of relatives was a significant factor in the isolation of old people. Lack of exercise and obesity seriously increased the risk of urinary infection; malnutrition and nutritional anaemia were found to be other potentially important problems in the elderly. In 13% of the elderly population three out of five seriously adverse factors (over 80, isolation, housebound, living alone, serious chronic Illness) were found to be present.
It is imperative that the group of high-risk elderly should receive the services they need; it is suggested that a policy of an adequate sheltered area supported by a geriatric service should be an extension of group medical practice.
PMCID: PMC1981920  PMID: 5763964
2.  Fostering disability-inclusive HIV/AIDS programs in northeast India: a participatory study 
BMC Public Health  2007;7:125.
Manipur and Nagaland in northeast India are among the Indian states with the highest prevalence of HIV. Most prevention and care programs focus on identified "high risk" groups, but recent data suggest the epidemic is increasing among the general population, primarily through heterosexual sex. People with disability (PWD) in India are more likely than the general population to be illiterate, unemployed and impoverished, but little is known of their HIV risk.
This project aimed to enable HIV programs in Manipur and Nagaland to be more disability-inclusive. The objectives were to: explore HIV risk and risk perception in relation to PWD among HIV and disability programmers, and PWD themselves; identify HIV-related education and service needs and preferences of PWD; and utilise findings and stakeholder consultation to draft practical guidelines for inclusion of disability into HIV programming. Data were collected through a survey and several qualitative tools.
The findings revealed that participants believe PWD in these states are potentially vulnerable to HIV transmission due to social exclusion and poverty, lack of knowledge, gender norms and obstacles to accessing HIV programs. Neither HIV nor disability organisations currently address the risks, needs and preferences of PWD.
The Guidelines produced in the project and disseminated to stakeholders emphasise opportunities for taking action with minimal cost and resources, such as using the networks and expertise of both HIV and disability sectors, producing HIV material in a variety of formats, and promoting accessibility to mainstream HIV education and services. The human rights obligations and public health benefits of modifying national and state policies and programs to assist this highly disadvantaged population are also highlighted.
PMCID: PMC1924853  PMID: 17594502
3.  Financial woes of the Canada Pension Plan hold implications for physicians 
Although it is unlikely that many Canadian physicians are relying on the Canada Pension Plan (CPP) for retirement security, a forecast that the program is in financial trouble has implications for the medical profession. One is the prospect of a generation of poverty-stricken seniors who could put undue stress on the health care system; another is that as the number of CPP disability claims continues to skyrocket, there may have to be more rigorous scrutiny of hard-to-define medical conditions.
PMCID: PMC1337876
4.  Swedish social insurance officers' experiences of difficulties in assessing applications for disability pensions – an interview study 
BMC Public Health  2007;7:128.
In this study the focus is on social insurance officers judging applications for disability pensions. The number of applications for disability pension increased during the late 1990s, which has resulted in an increasing number of disability pensions in Sweden. A more restrictive attitude towards the clients has however evolved, as societal costs have increased and governmental guidelines now focus on reducing costs. As a consequence, the quantitative and qualitative demands on social insurance officers when handling applications for disability pensions may have increased. The aim of this study was therefore to describe the social insurance officers' experiences of assessing applications for disability pensions after the government's introduction of stricter regulations.
Qualitative methodology was employed and a total of ten social insurance officers representing different experiences and ages were chosen. Open-ended interviews were performed with the ten social insurance officers. Data was analysed with inductive content analysis.
Three themes could be identified as problematic in the social insurance officers' descriptions of dealing with the applications in order to reach a decision on whether the issue qualified applicants for a disability pension or not: 1. Clients are heterogeneous. 2. Ineffective and time consuming waiting for medical certificates impede the decision process. 3. Perspectives on the issue of work capacity differed among different stakeholders. The backgrounds of the clients differ considerably, leading to variation in the quality and content of applications. Social insurance officers had to make rapid decisions within a limited time frame, based on limited information, mainly on the basis of medical certificates that were often insufficient to judge work capacity. The role as coordinating actor with other stakeholders in the welfare system was perceived as frustrating, since different stakeholders have different goals and demands. The social insurance officers experience lack of control over the decision process, as regulations and other stakeholders restrict their work.
A picture emerges of difficulties due to disharmonized systems, stakeholder-bound goals causing some clients to fall between two stools, or leading to unnecessary waiting times, which may limit the clients' ability to take an active part in a constructive process. Increased communication with physicians about how to elaborate the medical certificates might improve the quality of certificates and thereby reduce the clients waiting time.
PMCID: PMC1913505  PMID: 17597536
5.  Referrals to social workers: a comparative study of a local authority intake team with a general practice attachment scheme 
We studied clients seen by social workers in two settings, one a conventional intake team in a social services department and another where clients were referred to social workers attached to a primary health care team.
In both groups a high proportion of clients were either physically ill or disabled and the attachment group had a high proportion of clients with mental ill health. A large proportion of both groups were elderly and in general they had similar characteristics.
However, clients referred to intake teams were more likely to be unemployed, to be living on benefits in council or rented accommodation, and to have had some contact with social services before. The attachment group consisted of more women who were either housewives or working, living on either their own earnings or their husbands', and were more likely to own their own homes and not to have had previous contact with social services.
Clients referred to attached social workers were more likely to have an emotional or relationship problem, and many had practical problems as well. The implication is that attachment schemes will tap a wider section of the community and that the additional clients will have as many and as severe problems as clients referred to intake teams.
PMCID: PMC2159502  PMID: 7381817
6.  Stakeholder cooperation 
Societies today are very complex. Effective and successful implementation of care policies is needed. The concept of stakeholder approach is about creating tools and instruments to organise the communication between all parties involved.
EASPD organised in 2006 the conference ‘ageing and disability—disabled people are ageing, ageing people are getting disabled’ in Austria. For the first time organisations from the care sector for ageing people and from the disability sector were working together to discuss their concepts and their experience and to develop strategies. In this conference main results of this cooperation will be analysed.
The care sector for elderly people in many countries is now facing the same problems as the disability sector 20 years ago: services are mainly medical oriented, the main solutions are care homes, services are social not right driven, the choice for individuals is very limited, … . We will come up with some suggestions to bridge the gap between the disability sector and the care sector in order to equalise the opportunities for elderly people with care needs.
PMCID: PMC2707585
equalisation of opportunities; stakeholder cooperation; choice; human rights
7.  Behavioural disabilities in psychogeriatric patients and residents of old people's homes. 
A comparison was made of the behavioural disabilities of two groups of elderly institutionalised people, one in psychogeriatric hospital wards and the other in residential homes. The results indicated that despite considerable overlap, there is evidence of significantly greater disability in the hospital population, particularly as regards incontinence, confusion, communication difficulties, and need for supervision. Comparison with previous data suggests that there is an increasing number of elderly people with such problems in the care of social services departments. This trend, if supported and continued, is likely to reduce further the distinction between old people in hospital and those in social services homes, with important implications for future planning of the care and management of the elderly.
PMCID: PMC1052053  PMID: 7400722
8.  Domiciliary care for the elderly sick--economy or neglect? 
British Medical Journal  1977;1(6052):30-33.
This paper reports an investigation of the costs of domiciliary care for 139 elderly sick patients under the care of the home nursing service. The data suggest that there may be little economic advantage in home care for seriously disabled elderly people. The revenue cost of domiciliary care was equal to or greater than the average associated with residential or hospital custodial care in such patients. Even so, the cost of services received at home did not disclose the real need for domiciliary care, since at present this is obscured by compulsory rationing and the separation of responsibility between health and social services. It is suggested that the supposed economic advantage of domiciliary care will depend increasingly on restricting such services, thus increasing the degree of neglect to some patients.
PMCID: PMC1603602  PMID: 831975
9.  Health insurance system and payments provided to patients for the management of severe acute pancreatitis in Japan 
The health insurance system in Japan is based upon the Universal Medical Care Insurance System, which gives all citizens the right to join an insurance scheme of their own choice, as guaranteed by the provisions of Article 25 of the Constitution of Japan, which states: “All people shall have the right to maintain the minimum standards of wholesome and cultured living.” The health care system in Japan includes national medical insurance, nursing care for the elderly, and government payments for the treatment of intractable diseases. Medical insurance provisions are handled by Employee’s Health Insurance (Social Insurance), which mainly covers employees of private companies and their families, and by National Health Insurance, which provides for the needs of self-employed people. Both schemes have their own medical care service programs for retired persons and their families. The health care system for the elderly covers people 75 years of age and over and bedridden people 65 years of age and over. There is also a system under which the government pays all or part of medical expenses, and/or pays medical expenses not covered by insurance. This is referred to collectively as the “medical expenses payment system” and includes the provision of medical assistance for specified intractable diseases. Because severe acute pancreatitis has a high mortality rate, it is specified as an intractable disease. In order to lower the mortality rate of various diseases, including severe acute pancreatitis, the specification system has been adopted by the government. The cost of treatment for severe acute pancreatitis is paid in full by the government from the date the application is made for a certificate verifying that the patient has an intractable disease.
PMCID: PMC2779366  PMID: 16463206
Medical care system; Acute pancreatitis; Japan’s health insurance system; Government payment system
10.  Cardiorespiratory fitness and risk of disability pension: a prospective population based study in Finnish men 
Background: Early retiring is a major social problem in many western countries.
Aim: To investigate whether good cardiorespiratory fitness prevents disability pensioning in Finnish middle-aged men.
Methods: Subjects were a random population based sample of 1307 men who were 42-60 years old at baseline, had not retired before baseline or died during follow up, and had undergone a cycle ergometer test at baseline. Cardiorespiratory fitness was assessed at baseline with a maximal but symptom limited exercise test on an electrically braked cycle ergometer.
Results: During a follow up of 11 years on average, 790 (60.4%) men were awarded a disability pension, only 254 (19.4%) men reached the old-age pension without previous early pension, and 263 (20.1%) men were still working at the end of follow up. After adjustment for age, body mass index, alcohol consumption, smoking, education, occupation, and baseline chronic diseases, an inverse association was observed between cardiorespiratory fitness and the risk of disability pension. Men with VO2max <25.98 ml/kg/min (lowest fifth) had a 3.28-fold (95% CI 1.70 to 6.32) and men with the duration of exercise test <9.54 minutes (lowest fifth) had a 4.66-fold (95% CI 2.43 to 8.92) risk of disability pension due to cardiovascular diseases compared with men in the highest fifths. Men with lowest fitness level also had an increased risk of disability pension due to musculoskeletal disorders, or all reasons combined.
Conclusions: Physical fitness is inversely associated with the risk of disability pension and especially with the risk of disability due to cardiovascular diseases.
PMCID: PMC1740405  PMID: 14504365
11.  Popular Criteria for the Welfare Deservingness of Disability Pensioners: The Influence of Structural and Cultural Factors 
Social Indicators Research  2011;110(3):1103-1117.
Research has shown that several criteria underlie people’s opinions about the welfare deservingness of benefit recipients. However, it remains unknown which factors are associated with the emphasis that people place on such criteria. Using a 2006 Dutch national survey on the welfare deservingness of disability pension recipients, we study the influence of structural and cultural factors on people’s emphasis on three deservingness criteria: control, need, and reciprocity. OLS regression analyses show that people’s emphasis on specific deservingness criteria is strengthened by structural factors that indicate the possibility of resource competition such as the following: age, lower levels of education, unemployment, and lower income. However, actual personal experience with receiving welfare benefits weakens criteria emphasis. Cultural factors such as the espousal of views from the political right and the possession of a strong work ethic are associated with a heightened emphasis on deservingness criteria.
PMCID: PMC3545196  PMID: 23329864
Deservingness; Disability; Opinion; Welfare
12.  Community-Partnered Cluster-Randomized Comparative Effectiveness Trial of Community Engagement and Planning or Resources for Services to Address Depression Disparities 
Journal of General Internal Medicine  2013;28(10):1268-1278.
Depression contributes to disability and there are ethnic/racial disparities in access and outcomes of care. Quality improvement (QI) programs for depression in primary care improve outcomes relative to usual care, but health, social and other community-based service sectors also support clients in under-resourced communities. Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors.
To compare the effectiveness of Community Engagement and Planning (CEP) and Resources for Services (RS) to implement depression QI on clients’ mental health-related quality of life (HRQL) and services use.
Matched programs from health, social and other service sectors were randomized to community engagement and planning (promoting inter-agency collaboration) or resources for services (individual program technical assistance plus outreach) to implement depression QI toolkits in Hollywood-Metro and South Los Angeles.
From 93 randomized programs, 4,440 clients were screened and of 1,322 depressed by the 8-item Patient Health Questionnaire (PHQ-8) and providing contact information, 1,246 enrolled and 1,018 in 90 programs completed baseline or 6-month follow-up.
Self-reported mental HRQL and probable depression (primary), physical activity, employment, homelessness risk factors (secondary) and services use.
CEP was more effective than RS at improving mental HRQL, increasing physical activity and reducing homelessness risk factors, rate of behavioral health hospitalization and medication visits among specialty care users (i.e. psychiatrists, mental health providers) while increasing depression visits among users of primary care/public health for depression and users of faith-based and park programs (each p < 0.05). Employment, use of antidepressants, and total contacts were not significantly affected (each p > 0.05).
Community engagement to build a collaborative approach to implementing depression QI across diverse programs was more effective than resources for services for individual programs in improving mental HRQL, physical activity and homelessness risk factors, and shifted utilization away from hospitalizations and specialty medication visits toward primary care and other sectors, offering an expanded health-home model to address multiple disparities for depressed safety-net clients.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-013-2484-3) contains supplementary material, which is available to authorized users.
PMCID: PMC3785665  PMID: 23649787
depression; community partnered participatory research; CPPR; community-based participatory research; CBPR
13.  Referral to specialized geriatric services. Which elderly people living in the community are likely to benefit? 
Canadian Family Physician  1997;43:925-930.
PROBLEM BEING ADDRESSED: As the Canadian population ages, family physicians encounter increasing numbers of elderly people with medical, functional, psychological, and social difficulties. In the past two decades, most regions of Canada have developed systems of specialized geriatric services, available on a consultative basis, to assist family physicians evaluating and managing elderly patients with these difficulties. For many family physicians, however, it is often unclear which of their elderly patients are likely to benefit from referral to these geriatric services. OBJECTIVE OF PROGRAM: Using an interdisciplinary approach, specialized geriatric services seek to optimize health, maximize function, promote independence, and prevent or delay institutionalization of elderly people. Yet not all elderly people benefit from referral to specialized geriatric services. This article offers a clear and clinically practical framework to help family physicians identify elderly patients in their practices who are likely to benefit from referral to specialized geriatric services. MAIN COMPONENTS OF PROGRAM: By synthesizing previous work on the concept of frail elderly persons into a 2 x 2 matrix, the level and intensity of geriatric intervention most appropriate for different segments of the elderly population is clarified. CONCLUSIONS: Using the simple approach described in this article, family physicians should be able to use available geriatric resources easily and efficiently to optimize the health and function of their elderly patients.
PMCID: PMC2255546  PMID: 9154364
14.  How to Evaluate Disability 
A disability assessment for non-therapeutic reasons is the most common evaluation requested of treating psychiatrists. Mental disorders affect approximately 20 percent of Americans each year. People who are unable to work need some financial assistance. As part of the system, it’s our goal to assist them in this process. When a disability claim is filed, psychiatrists take into account the individual’s impairments and disabilities. A psychiatrist’s evaluation of disability involves knowledge and experience. There are many ethics related challenges, especially when performing disability evaluation of their own patients. Disability training should therefore be part of residency curriculum for training of psychiatry residents.
PMCID: PMC3682212  PMID: 23785336
disability; impairment; psychiatry residency; independent psychiatric examination; AMA guidelines
15.  What's so special about being 65? The challenge facing eldercare departments. 
There is no abrupt change in physiology, pathology or pharmacology occurring at or around the age of 65 years. There is some evidence of a change in the effect of illness, and of the prevalence of disability with advancing age. However, these changes are individual and gradual, and more associated with passing 75-80 years rather than 65. The main change occurring in the seventh decade arises from retirement from paid employment, and is therefore financial. Hence, in contrast to personal financial support, Health and Social Services departments would be ill advised to use the age of 65 as a threshold. Age-related admission policies may perpetuate ageism, and needs-related policies may therefore be preferable. The challenge facing departments of geriatric medicine and psychiatry is to present their services attractively to patients, carers and purchasers, who need to recognize the rationale for the purchase of these forms of care, with reference not only to benefit to patients, but also to their informal carers.
PMCID: PMC1294321  PMID: 8196035
16.  Implications for health services. 
Health services for older people in the NHS have developed pragmatically, and reflect the nature of disease in later life and the need to agree objectives of care with patients. Although services are likely to be able to cope with the immediate future, the growth of the elderly population anticipated from 2030 calls for long-term planning and research. The issue of funding requires immediate political thought and action. Scientifically the focus needs to be on maximizing the efficiency of services by health services research and reducing the incidence of disability in later life through research on its biological and social determinants. Senescence is a progressive loss of adaptability due to an interaction between intrinsic (genetic) processes with extrinsic factors in environment and lifestyle. There are grounds for postulating that a policy of postponement of the onset of disability, by modifications of lifestyle and environment, could reduce the average duration of disability before death. The new political structures of Europe offer under exploited-unexploited opportunities for the necessary research.
PMCID: PMC1692137  PMID: 9460074
17.  RCT of a client-centred, caseworker-delivered smoking cessation intervention for a socially disadvantaged population 
BMC Public Health  2011;11:70.
Disadvantaged groups are an important target for smoking cessation intervention. Smoking rates are markedly higher among severely socially disadvantaged groups such as indigenous people, the homeless, people with a mental illness or drug and alcohol addiction, and the unemployed than in the general population. This proposal aims to evaluate the efficacy of a client-centred, caseworker delivered cessation support intervention at increasing validated self reported smoking cessation rates in a socially disadvantaged population.
A block randomised controlled trial will be conducted. The setting will be a non-government organisation, Community Care Centre located in New South Wales, Australia which provides emergency relief and counselling services to predominantly government income assistance recipients. Eligible clients identified as smokers during a baseline touch screen computer survey will be recruited and randomised by a trained research assistant located in the waiting area. Allocation to intervention or control groups will be determined by time periods with clients randomised in one-week blocks. Intervention group clients will receive an intensive client-centred smoking cessation intervention offered by the caseworker over two face-to-face and two telephone contacts. There will be two primary outcome measures obtained at one, six, and 12 month follow-up: 1) 24-hour expired air CO validated self-reported smoking cessation and 2) 7-day self-reported smoking cessation. Continuous abstinence will also be measured at six and 12 months follow up.
This study will generate new knowledge in an area where the current information regarding the most effective smoking cessation approaches with disadvantaged groups is limited.
Trial registration number
PMCID: PMC3038158  PMID: 21281519
18.  Verifiability of diagnostic categories and work ability in the context of disability pension award: A survey on "gatekeeping" among general practitioners in Norway 
BMC Public Health  2008;8:137.
Disability benefits exist to redeem social and financial consequences of reduced work ability from medical conditions. Physicians are responsible for identifying the medical grounds for benefit claims. The aim of this study was to explore physicians' views on verifiability of medical conditions and related work ability in this context.
Information on verifiability of diagnostic categories and work ability was obtained from a survey among a representative sample of general practitioners (GPs) in Norway (n = 500, 25.2% response rate). Verifiability was defined as to what extent the assessment is based on objective criteria versus on information from the patient. We enquired about the diagnostic categories used in official statistics on main disability benefit causes in Norway and elsewhere.
On a scale from 0 (low verifiability) to 5 (high verifiability), the mean level of verifiability across all diagnostic categories was 3.7 (SD = 0.42). Degree of verifiability varied much between diagnostic categories, and was low in e.g. unspecified rheumatism/myalgia and dorsopathies, and high in neoplasms and congenital malformations, deformation and chromosomal abnormalities. Verifiability of work ability was reported to be more problematic than that of diagnostic categories. The diagnostic categories rated as the least verifiable, are also the most common in disability pension awards.
Verifiability of both diagnostic categories and work ability in disability assessments are reported to be moderate by GPs. We suggest that the low verifiability of diagnostic categories and related work ability assessments in the majority of disability pension awards is important in explaining why GPs find the gatekeeping-function problematic.
PMCID: PMC2387147  PMID: 18439251
19.  Consumer-directed services: lessons and implications for integrated systems of care 
Over the past decade, policy makers in developed countries have begun to pay increasing attention to reform of the long-term care system for the frail elderly and younger people with disabilities. A continuum of strategies have generated interest, including integrated systems of care with agency/professionally managed service packages on the one end, and programs offering cash benefits along with the flexibility to decide how to best use these funds to meet individual needs and preferences, on the other. The latter approach, known as “consumer-directed care,” is found in various forms and degrees in Europe and North America. Primarily organised around the provision of home and community care, consumer-directed services are aimed at empowering clients and family carers, giving them major control over the what, who and when of needed care. Consumer-directed care appears to be the antithesis of integrated care. However, it actually holds important lessons and implications for the latter. This policy paper explores the rationale and models of consumer-directed services at home, reviews developments, designs and outcomes of programs in the Austria, Germany, the Netherlands, and the US. It also discusses how this experience could be helpful in shaping better and more responsive integrated models of care for vulnerable long term care populations.
PMCID: PMC1483950  PMID: 16896379
consumer-directed care; home and community services; long term care; integrated care
20.  Personalized Health Care System with Virtual Reality Rehabilitation and Appropriate Information for Seniors 
Sensors (Basel, Switzerland)  2012;12(5):5502-5516.
The concept of the information society is now a common one, as opposed to the industrial society that dominated the economy during the last years. It is assumed that all sectors should have access to information and reap its benefits. Elderly people are, in this respect, a major challenge, due to their lack of interest in technological progress and their lack of knowledge regarding the potential benefits that information society technologies might have on their lives. The Naviga Project (An Open and Adaptable Platform for the Elderly and Persons with Disability to Access the Information Society) is a European effort, whose main goal is to design and develop a technological platform allowing elder people and persons with disability to access the internet and the information society. Naviga also allows the creation of services targeted to social networks, mind training and personalized health care. In this paper we focus on the health care and information services designed on the project, the technological platform developed and details of two representative elements, the virtual reality hand rehabilitation and the health information intelligent system.
PMCID: PMC3386697  PMID: 22778598
elders' health care; information access; wellbeing; ambient assisted living; disability
21.  Extending Employment beyond the Pensionable Age: A Cohort Study of the Influence of Chronic Diseases, Health Risk Factors, and Working Conditions 
PLoS ONE  2014;9(2):e88695.
In response to the economic consequences of ageing of the population, governments are seeking ways with which people might work into older age. We examined the association of working conditions and health with extended employment (defined as >6 months beyond the pensionable age) in a cohort of older, non-disabled employees who have reached old-age retirement.
A total of 4,677 Finnish employees who reached their old-age pensionable date between 2005 and 2011 (mean age 59.8 years in 2005, 73% women) had their survey responses before pensionable age linked to national health and pension registers, resulting in a prospective cohort study.
In all, 832 participants (17.8%) extended their employment by more than 6 months beyond the pensionable date. After multivariable adjustment, the following factors were associated with extended employment: absence of diagnosed mental disorder (OR 1.25, 95% confidence interval = 1.01–1.54) and psychological distress (OR 1.68; 1.35–2.08) and of the work characteristics, high work time control (OR 2.31; 1.88–2.84). The projected probability of extended employment was 21.3% (19.5–23.1) among those free of psychiatric morbidity and with high work time control, while the corresponding probability was only 9.2% (7.4–11.4) among those with both psychiatric morbidity and poor work time control. The contribution of chronic somatic diseases was modest.
In the present study, good mental health in combination with the opportunity to control work time seem to be key factors in extended employment into older age. In addition, high work time control might promote work life participation irrespective of employees' somatic disease status.
PMCID: PMC3929527  PMID: 24586372
22.  Community care in Northern Ireland: a promising start. 
BMJ : British Medical Journal  1994;308(6932):839-842.
Integrated health and social services, generous funding, and a special sense of community have got Northern Ireland off to a promising start after the government's community care reforms. Public ignorance about the new arrangements remains a problem, but there is little evidence of serious hardship in any client group. The biggest threat is to nursing and residential homes, which face closure as increasing numbers of elderly and disabled people opt to stay at home. After only a year and without the benefit of formal evaluation, however, the real problems for disabled people and their carers may not yet have emerged.
PMCID: PMC2539997  PMID: 8167494
23.  Factors Influencing Quality of Life for Disabled and Nondisabled Elderly Population: The Results of a Multiple Correspondence Analysis 
Objectives. The aim of our study is to examine the role of some factors (sociodemographic patterns, social relationship support, and trust in healthcare actors) on structure of quality of life among the Italian elderly population, by stratifying according to presence or absence of disability. Methods. Using data of the Italian National Institute of Statistics (ISTAT) survey, we obtained a sample of 25,183 Italian people aged 65+ years. Multiple Correspondence Analysis (MCA) was used to test such a relationship. Results. By applying the MCA between disabled and nondisabled elderly population, we identified three dimensions: “demographic structure and social contacts,” “social relationships,” “trust in the Italian National Health Services (INHS).” Furthermore, the difference in trust on the INHS and its actors was seen among disabled and non-disabled elderly population. Conclusions. Knowledge on the concept of quality of life and its application to the elderly population either with or without disability should make a difference in both people's life and policies and practices affecting life. New domains, such as information and trusting relationships both within and towards the care network's nodes, are likely to play an important role in this relationship.
PMCID: PMC3710593  PMID: 23878536
24.  Social service offices as a point of entry into substance abuse treatment for poor South Africans 
In South Africa, district social service offices are often the first point of entry into the substance abuse treatment system. Despite this, little is known about the profile of people presenting with substance-related problems at these service points. This has a negative impact on treatment service planning. This paper begins to redress this gap through describing patterns of substance use and service needs among people using general social services in the Western Cape and comparing findings against the profile of persons attending specialist substance abuse treatment facilities in the region.
As part of a standard client information system, an electronic questionnaire was completed for each person seeking social assistance. Data on socio-demographic characteristics, the range of presenting problems, patterns of substance use, perceived consequences of substance use, as well as types of services provided were analysed for the 691 social welfare clients who reported substance use between 2007 and 2009. These data were compared against clients attending substance abuse treatment centres during the same time period.
Findings indicate that social services offices are used as a way of accessing specialist services but are also used as a service point, especially by groups under-represented in the specialist treatment sector. Women, people from rural communities and people with alcohol-related problems are more likely to seek assistance at social service offices providing low threshold intervention services than from the specialist treatment sector.
The study provides evidence that social services are a point of entry and intervention for people from underserved communities in the Western Cape. If these low-threshold services can be supported to provide good quality services, they may be an effective and efficient way of improving access to treatment in a context of limited service availability.
PMCID: PMC3414793  PMID: 22642796
Substance abuse; Epidemiology; South Africa; Social services
25.  Alcohol Use in Adolescence and Risk of Disability Pension: A 39 Year Follow-up of a Population-Based Conscription Survey 
PLoS ONE  2012;7(8):e42083.
The role of alcohol consumption for disability pension (DP) is controversial and systematic reviews have not established causality. We aimed to assess the role of adolescent alcohol use for future DP. We wanted to find out whether an increased risk mainly would affect DP occurring early or late in life as well as whether the level of alcohol consumption and patterns of drinking contribute differently in DP receiving.
Methodology/Principal Findings
The study is a 39-year follow-up of 49 321 Swedish men born in 1949–1951 and conscripted for compulsory military service in 1969–1970. As study exposures (i) “risk use” of alcohol composed of measures related to pattern of drinking, and (ii) the level of consumption based on self-reported volume and frequency of drinking had been used. Information on DP was obtained from social insurance databases through 2008. “Risk use” of alcohol was associated with both “early DP” and “late DP”, i.e. granted below and above the approximate age of 40 years, with crude hazard ratio (HR) of 2.89 (95% confidence intervals (CI) 2.47–3.38) and HR of 1.87 (95%CI: 1.74–2.02), respectively. After adjustment for covariates, HR was reduced to 1.32 (95%CI: 1.09–1.59) and 1.14 (95%CI: 1.05–1.25), respectively. Similar patterns were seen for moderate (101–250 g 100% alcohol/week) and high (>250 g) consumption, though the risk disappeared when fully adjusted.
Alcohol use in adolescence, particularly measured as “risk use”, is associated with increased risk of future DP. The association is stronger for “early DP”, but remains significant even for DP granted in older ages. Therefore, pattern of drinking in adolescent should be considered an important marker for future reduced work capacity.
PMCID: PMC3411655  PMID: 22870284

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