Cross-national agreement on disability weights:the Eurpoean disability weights project

Background: Disability weights represent the relative severity of disease stages to be incorporated in summary measures of population health. The level of agreement on disability weights in Western European countries was investigated with different valuation methods.

Methods: Disability weights for fifteen disease stages were elicited empirically in panels of health care professionals or non-health care professionals with an academic background following a strictly standardised procedure. Three valuation methods were used: a visual analogue scale (VAS); the time trade-off technique (TTO); and the person trade-off technique (PTO). Agreement among England, France, the Netherlands, Spain, and Sweden on the three disability weight sets was analysed by means of an intraclass correlation coefficient (ICC) in the framework of generalisability theory. Agreement among the two types of panels was similarly assessed.

Results: A total of 232 participants were included. Similar rankings of disease stages across countries were found with all valuation methods. The ICC of country agreement on disability weights ranged from 0.56 [95% CI, 0.52–0.62] with PTO to 0.72 [0.70–0.74] with VAS and 0.72 [0.69–0.75] with TTO. The ICC of agreement between health care professionals and non-health care professionals ranged from 0.64 [0.58–0.68] with PTO to 0.73 [0.71–0.75] with VAS and 0.74 [0.72–0.77] with TTO.

Conclusions: Overall, the study supports a reasonably high level of agreement on disability weights in Western European countries with VAS and TTO methods, which focus on individual preferences, but a lower level of agreement with the PTO method, which focuses more on societal values in resource allocation.

Cross-national compartability of burden of disease estimates:the European disability weights project

Objective: To investigate the sources of cross-national variation in disability-adjusted life-years (DALYs) in the European Disability
Weights Project.

Methods: Disability weights for 15 disease stages were derived empirically in five countries by means of a standardized procedure and the cross-national differences in visual analogue scale (VAS) scores were analysed. For each country the burden of dementia in women, used as an illustrative example, was estimated in DALYs. An analysis was performed of the relative effects of cross-national variations in demography, epidemiology and disability weights on DALY estimates.

Findings: Cross-national comparison of VAS scores showed almost identical ranking orders. After standardization for population size and age structure of the populations, the DALY rates per 100 000 women ranged from 1050 in France to 1404 in the Netherlands. Because of uncertainties in the epidemiological data, the extent to which these differences reflected true variation between countries was difficult to estimate. The use of European rather than country-specific disability weights did not lead to a significant change in the burden of disease estimates for dementia.

Conclusions: Sound epidemiological data are the first requirement for burden of disease estimation and relevant between-countries comparisons. DALY estimates for dementia were relatively insensitive to differences in disability weights between European countries.

The breast cancer related burden of morbidity and mortality in six European coutries

Background: The burden of breast cancer expressed in Disability Adjusted Life Years (DALYs) was compared for six European countries and its sensitivity to different sources of variation examined. Methods: DALYs were calculated using country-specific epidemiological data and European Disability Weights. Epidemiological data for 1996 were obtained for Denmark, England and Wales, France, the Netherlands, Spain and Sweden. Disability weights were empirically derived. Results:  Denmark and the Netherlands lost the largest number of DALYs (approximately 1100 DALYs per 100,000 women). They were followed by England (87% of the Danish burden), France (72%), Sweden (68%) and Spain (67%). 70 to 80% of the burden was caused by mortality. Cross-national variation in disease epidemiology was the largest source of variation in the burden of breast cancer. Variation in disability weights and uncertainty in epidemiological data had smaller effects. Conclusion: To compare the burden of breast cancer and most other types of cancer mortality rates provide sufficient information.

The global burden of musculoskeletal conditions for 2010: an overview of methods.

The objective of this paper is to provide an overview of methods used for estimating the burden from musculoskeletal (MSK) conditions in the Global Burden of Diseases 2010 study. It should be read in conjunction with the disease-specific MSK papers published in Annals of Rheumatic Diseases. Burden estimates (disability-adjusted life years (DALYs)) were made for five specific MSK conditions: hip and/or knee osteoarthritis (OA), low back pain (LBP), rheumatoid arthritis (RA), gout and neck pain, and an 'other MSK conditions' category. For each condition, the main disabling sequelae were identified and disability weights (DW) were derived based on short lay descriptions. Mortality (years of life lost (YLLs)) was estimated for RA and the rest category of 'other MSK', which includes a wide range of conditions such as systemic lupus erythematosus, other autoimmune diseases and osteomyelitis. A series of systematic reviews were conducted to determine the prevalence, incidence, remission, duration and mortality risk of each condition. A Bayesian meta-regression method was used to pool available data and to predict prevalence values for regions with no or scarce data. The DWs were applied to prevalence values for 1990, 2005 and 2010 to derive years lived with disability. These were added to YLLs to quantify overall burden (DALYs) for each condition. To estimate the burden of MSK disease arising from risk factors, population attributable fractions were determined for bone mineral density as a risk factor for fractures, the occupational risk of LBP and elevated body mass index as a risk factor for LBP and OA. Burden of Disease studies provide pivotal guidance for governments when determining health priority areas and allocating resources. Rigorous methods were used to derive the increasing global burden of MSK conditions.

Physical disability and sexual esteem

The current study investigated the impact of physical disability on sexual feelings, sexual experiences, and sexual esteem. Thirty-five respondents (18 males and 17 females), with physical disabilities between 19 to 60 years (SD = 10, mean = 38) participated in focus groups where they discussed how their physical disability impacted on their sexuality. They also responded to a series of questions that were designed to examine disability-specific issues in sexual esteem using a four-point Likert-type scale. The data demonstrated that the participants struggled with many social and sexual barriers that were associated with having a physical impairment. This appeared to lead to increased feelings of negativity in many participants, including a belief that they were less sexually desirable than an able-bodied person and that having a disability seriously limited their sexual expression. The implications of these findings for practitioners and suggestions for future research are discussed.

The impact of physical disability on body esteem

The current study investigated the impact of physical disability on body esteem. A total of 35 people (18 males and 17 females) with physical disabilities between 19 to 60 years (mean = 38 years, SD = 10), participated in focus groups where they discussed their feelings about how their disability affected their body esteem. They also responded to a series of questions that were designed to examine disability-specific issues in body esteem using a four point Likert-type scale. The data demonstrated that the body esteem of the participants was commonly affected by physical disability. It also suggested that feedback from the social environment is a likely mediator of body esteem. Suggestions for future research and implications for clinicians are discussed.

Substance abuse by offenders with mild intellectual disability

This study compared the rate of self-reported alcohol and other drug use in a sample of 30 young adults with mild intellectual disability whose offending behaviour had resulted in involvement in the criminal justice system, with a matched comparison group of 30 non-offenders. Performance on an alcohol and other drug knowledge test was also compared. The results indicated that many individuals with mild intellectual disability regularly consumed alcohol and used illicit drugs. Furthermore, the data suggest a possible link between substance abuse and offending behaviour in this population. Individuals who had offended reported greater use of both legal and illicit drugs than their non-offending counterparts and many reported that they had been under the influence of alcohol or illicit drugs at the time of committing the offence that had resulted in their current placement within the criminal justice system. Although deficits in knowledge were apparent in both groups, the offenders demonstrated greater overall knowledge about alcohol and other drugs.

Population based intervention to change back pain beliefs and disability : three part evaluation

Objective To evaluate the effectiveness of a population based, state-wide public health intervention designed to alter beliefs about back pain, influence medical management, and reduce disability and costs of compensation. Design Quasi-experimental, non-randomised, non-equivalent, before and after telephone surveys of the general population and postal surveys of general practitioners with an adjacent state as control group and descriptive analysis of claims database. Setting Two states in Australia Participants 4730 members of general population before and two and two and a half years after campaign started, in a ratio of2:1:1; 2556 general practitioners before and two years after campaign onset. Main outcome measures Back beliefs questionnaire, knowledge and attitude statements about back pain, incidence of workers' financial compensation claims for back problems, rate of days compensated, and medical payments for claims related to back pain and other claims. Results In the intervention state beliefs about back pain became more positive between successive surveys (mean improvement in questionnaire score 1.9 (95% confidence interval 1.3 to 2.5), P<0.001 and 3.2 (2.6 to 3.9), P < 0.001, between baseline and the second and third survey, respectively). Beliefs about back pain also improved among doctors. There was a clear decline in number of claims for back pain, rates of days compensated, and medical payments for claims for back pain over the duration of the campaign. Conclusions A population based strategy of provision of positive messages about back pain improves population and general practitioner beliefs about back pain and seems to influence medical management and reduce disability and workers' compensation costs related to back pain.

The subjective well-being of people caring for a family member with a severe disability at home: a review

This review concerns the life quality of people caring for a relative with a severe disability within their family. It involves the balance between the advantages such care brings to the care recipient and the costs borne by the family. A brief history indicates that the forces that encourage family care are minimally concerned with family welfare. Moreover, an analysis of both qualitative and quantitative data indicates that primary caregivers are at considerable risk of high stress, clinical depression, and abnormally low subjective quality of life. It is concluded that increased public expenditure directed to the care of people with severe disability is urgently required.

Factors that influence employer decisions in hiring and retaining an employee with a disability

This paper is based on results of a national study in Australia. Questionnaires were completed by 643 employers, each of whom had employed a person with a disability between 1996--1998. Employers rated the importance of several factors relevant to decisions to hire and retain a person with a disability. Individual factors were rated most important, with grooming/hygiene and work-performance factors rated highest. Management factors and cost factors were rated moderately important. Social factors were rated least important. Analyses of variance were conducted, identifying several employer differences in ratings. The paper discusses employer values as well as the need to include employers in a partnership approach.

Employer benefits and costs of employing a person with a disability

This paper is based on results of a national study in Australia. Questionnaires were completed by 643 employers, each of whom had employed a person with a disability between 1996-1998. Employers rated the importance of several factors relevant to decisions to hire and retain a person with a disability. Individual factors were rated most important, with grooming/hygiene and work-performance factors rated highest. Management factors and cost factors were rated moderately important. Social factors were rated least important. Analyses of variance were conducted, identifying several employer differences in ratings. The paper discusses employer values as well as the need to include employers in a partnership approach.

Case studies in learning disability: implications for instruction

A significant number of children with learning disabilities may hold negative attributions about themselves which not only impact on their willingness to learn but put themselves at risk of developing depression. A multi-disciplinary assessment team found evidence for the existence of at least two distinct patterns of learning disability. It was concluded that interventions must focus not only on content areas but on the individual attributions the child holds about his or her ability and potential.

Development and validation of the physical disability sexual and body esteem scale

The Physical Disability Sexual and Body Esteem (PDSBE) scale was developed to assess respondents' capacity to feel positive about their sexuality and their body while living with a physical impairment. The current paper presents four studies that were conducted to develop and assess the psychometric properties of the 10 item PDSBE scale. The first study was an exploratory factor analysis involving 348 participants with physical disabilities. The factors were: Sexual Esteem, Attractiveness to Others, and Body Esteem. The second study was a confirmatory factor analysis, with a total of 338 participants. This analysis confirmed the factor structure established in study 1. The third study revealed good test-retest reliability on a total of 47 participants with physical disabilities. The final study was conducted with 748 participants with physical disabilities and showed that the PDSBE had high reliability and good convergent and divergent validity. Mean scores showed that women scored significantly higher than men on the total PDSBE scale and on the Sexual Esteem and Attractiveness to Others subscales. Future applications for the PDSBE scale are discussed.