Foreign assistance : assistance to disabled persons in developing countries : report to congressional requesters /

"February 15, 1991"--P. [1].

Law in the community: the University of Greenwich/Greenwich Association of Disabled People Centre for Independent Living (GAD) research project

The GAD Advocacy Service is funded by the London Borough of Greenwich Directorate of Neighbourhood Services; its remit to support disabled people experiencing Hate Crime, Domestic Violence and Harassment. Run by disabled personnel and giving advice to all disabled people it is unique in London. Since its inception in 2004, the Advocacy Service has been stretched to its limit - there is a need to extend the remit of the Advocacy Service to give specialist legal advice on other issues. In 2003, the CEDRM-UK project was set up in the University of Greenwich Law Department as part of the Disability Rights Promotion International Legal Education and Research Project; its objectives were firstly, to facilitate the collection of data on the effectiveness of legislation in promoting the rights of disabled persons; and secondly, to pilot new methods in teaching and training in Human Rights Law – students acquire an expertise in Human Rights Law through research into the practical application of legislation relating to civil and human rights in the daily life of the community. In July 2007, GAD and CEDRM-UK embarked on a joint project to report on the work of the Advocacy Service and to create a database to support its caseload. The 2008-9 Project team will report on their work and findings relating to facilitating equality in the workplace; the inclusion of cancer, HIV and multiple sclerosis within the legal definition of disability and the implications of the statutory duty to promote disability equality for the provision of extracurricular activities for schoolchildren. [From the Author]

Physical access for persons with disabilities

For persons with disabilities, the activities that able-bodied people take for granted can be major, often insurmountable challenges. Attempting to enter a restaurant for lunch with friends can result in lengthy and adversarial litigation if the facility is not accessible to a person with a disability or other mobility impairment. This litigation would be initiated after the individual was effectively refused service; a refusal based on hislher personal physical characteristics. If a shopping mall is not equipped with "access amenities", then the disabled person may be excluded from shopping there and thus exercising consumer freedom. If workplaces are not equipped to accommodate the access needs of persons with disabilities, then those people are effectively barred from gainful employment there. If a municipal goveniment building is inaccessible to disabled persons, then they may be excluded from participating in council meetings. These are all activities that the majority of the population enjoys as a matter of course, in that they represent the functions of a free citizen in a free society. If a person is excluded from such activities because of some personal characteristic, then that person is subjected to differential or discr~minatory treatment. The guarantees provided in Canadian feden! and provincial rights legislation, are such that people are not to be discriminated againsL Where buildings and facilities othen\iise open to the public are not accessible for persens with disabilities, then those people are being discriminated against. To challenge these discriminatory practices, individuals initiate complaints through the administrative justice system. To address the extent to which this is a problem, many sources were consulted. Constitutional lawyers, tribunal members, advocates for the disabled and land use planners were interviewed. Case law and legislation were reviewed. Literature on citizenship theory, dispute resolution and dispute avoidance was compiled and assessed. And, the field of land use planning was analyzed (drawing on the WTiter's educational and experiential background) as a possible alternative method for effecting systemic access for persons with disabilities. The conclusion of this study is that there does exist a proactive method for assuring access, a method that can apply the systemic remedy needed to deal with this problem. The current method, which is an adversarial and piecemeal complaint process, has proven ineffective in remedying this discrimination problem~ Failure to provide an appropriate remedy means that persons with disabilities will not enjoy the degree of citizen status enjoyed by the able-bodied. This is the current circumstance, and since equity is the aim of rights legislation, and since such legislative and administrative frameworks have failed in that purpose, then an alternative method is necessary. An alternative model is the one in which land use planning is based. It has conflict avoidance and conflict minimization as underpinnings. And, most importantly, land use planning is already a proyen method of combatting discrimination.

Resocialisation of Disabled Veterans in Former Yugoslavia

The team examined 147 amputated war veterans in the former Yugoslavia between February and December 1998. The official end of the war, substitution of lost body parts and adjustment to the new state of physical disability added extra tasks to these people's efforts to rejoin "normal life". The resocialisation process of amputated persons, i.e. the process of their return into the social environment with the related readjustment and establishment, was observed through its objective and subjective indicators. In addition to obtaining information about socio-demographic characteristics and current working status, the group focused on the psychological dimension, i.e. the individual reality of the disabled persons. In this sense they began with research into the personal, social and professional identity (how they see themselves under these altered circumstances and how they determine their place in the world). To do so they used the model of basic personality supports and observed the resocialisation according to the psychological support systems. They therefore focused on the following topics: body, social identity and belonging, personal identity, working status and engagement, individual responsibility and expectations from the social environment, and orientation towards the future. These were considered with respect to certain significant socio-demographic characteristics of the interviewees. The data were gathered through standardised interviews. Bearing in mind the unpopularity of this subject among experts in the country and the lack of material in specialist literature, the group chose to use descriptive research logic in order to "record" the situation in this field and to establish a framework for future studies which may be methodologically and statistically more complex and thematically more focused.

Development, feasibility and performance of a health risk appraisal questionnaire for older persons

BACKGROUND: Health risk appraisal is a promising method for health promotion and prevention in older persons. The Health Risk Appraisal for the Elderly (HRA-E) developed in the U.S. has unique features but has not been tested outside the United States. METHODS: Based on the original HRA-E, we developed a scientifically updated and regionally adapted multilingual Health Risk Appraisal for Older Persons (HRA-O) instrument consisting of a self-administered questionnaire and software-generated feed-back reports. We evaluated the practicability and performance of the questionnaire in non-disabled community-dwelling older persons in London (U.K.) (N = 1090), Hamburg (Germany) (N = 804), and Solothurn (Switzerland) (N = 748) in a sub-sample of an international randomised controlled study. RESULTS: Over eighty percent of invited older persons returned the self-administered HRA-O questionnaire. Fair or poor self-perceived health status and older age were correlated with higher rates of non-return of the questionnaire. Older participants and those with lower educational levels reported more difficulty in completing the HRA-O questionnaire as compared to younger and higher educated persons. However, even among older participants and those with low educational level, more than 80% rated the questionnaire as easy to complete. Prevalence rates of risks for functional decline or problems were between 2% and 91% for the 19 HRA-O domains. Participants' intention to change health behaviour suggested that for some risk factors participants were in a pre-contemplation phase, having no short- or medium-term plans for change. Many participants perceived their health behaviour or preventative care uptake as optimal, despite indications of deficits according to the HRA-O based evaluation. CONCLUSION: The HRA-O questionnaire was highly accepted by a broad range of community-dwelling non-disabled persons. It identified a high number of risks and problems, and provided information on participants' intention to change health behaviour.

Review of the long-term disability associated with hip fractures

Objectives To determine the proportion of hip fracture patients who experience long-term disability and to re-estimate the resulting burden of disease associated with hip fractures in Australia in 2003. Methods A literature review of the functional outcome following a hip fracture (keywords: morbidity, treatment outcome, disability, quality of life, recovery of function, hip fractures, and femoral neck fractures) was carried out using PubMed and Ovid MEDLINE. Results A range of scales and outcome measures are used to evaluate recovery following a hip fracture. Based on the available evidence on restrictions in activities of daily living, 29% of hip fracture cases in the elderly do not reach their pre-fracture levels 1 year post-fracture. Those who do recover tend to reach their pre-fracture levels of functioning at around 6 months. These new assumptions result in 8251 years lived with disability for hip fractures in Australia in 2003, a 4.5-fold increase compared with the previous calculation based on Global Burden of Disease assumptions that only 5% of hip fractures lead to long-term disability and that the duration of short-term disability is just 51 days. Conclusions The original assumptions used in burden of disease studies grossly underestimate the long-term disability from hip fractures. The long-term consequences of other injuries may similarly have been underestimated and need to be re-examined. This has important implications for modelling the cost-effectiveness of preventive interventions where disability-adjusted life years are used as a measure of health outcome.

Initial burden of disease estimates for South Africa, 2000

BACKGROUND This paper describes the first national burden of disease study for South Africa. The main focus is the burden due to premature mortality, i.e. years of life lost (YLLs). In addition, estimates of the burden contributed by morbidity, i.e. the years lived with disability (YLDs), are obtained to calculate disability-adjusted life years (DALYs); and the impact of AIDS on premature mortality in the year 2010 is assessed. METHOD Owing to the rapid mortality transition and the lack of timely data, a modelling approach has been adopted. The total mortality for the year 2000 is estimated using a demographic and AIDS model. The non-AIDS cause-of-death profile is estimated using three sources of data: Statistics South Africa, the National Department of Home Affairs, and the National Injury Mortality Surveillance System. A ratio method is used to estimate the YLDs from the YLL estimates. RESULTS The top single cause of mortality burden was HIV/AIDS followed by homicide, tuberculosis, road traffic accidents and diarrhoea. HIV/AIDS accounted for 38% of total YLLs, which is proportionately higher for females (47%) than for males (33%). Pre-transitional diseases, usually associated with poverty and underdevelopment, accounted for 25%, non-communicable diseases 21% and injuries 16% of YLLs. The DALY estimates highlight the fact that mortality alone underestimates the burden of disease, especially with regard to unintentional injuries, respiratory disease, and nervous system, mental and sense organ disorders. The impact of HIV/AIDS is expected to more than double the burden of premature mortality by the year 2010. CONCLUSION This study has drawn together data from a range of sources to develop coherent estimates of premature mortality by cause. South Africa is experiencing a quadruple burden of disease comprising the pre-transitional diseases, the emerging chronic diseases, injuries, and HIV/AIDS. Unless interventions that reduce morbidity and delay morbidity become widely available, the burden due to HIV/AIDS can be expected to grow very rapidly in the next few years. An improved base of information is needed to assess the morbidity impact more accurately.

A clarion call for action based on refined DALY estimates for South Africa

Initial estimates of the burden of disease in South Africa in 20001 have been revised on the basis of additional data to estimate the disability-adjusted life-years (DALYs) for single causes for the first time in South Africa. The findings highlight the fact that despite uncertainty in the estimates, they provide important information to guide public health responses to improve the health of the nation...

The global epidemiology and contribution of cannabis use and dependence to the global burden of disease: results from the GBD 2010 study

Aim Estimate the prevalence of cannabis dependence and its contribution to the global burden of disease. Methods Systematic reviews of epidemiological data on cannabis dependence (1990-2008) were conducted in line with PRISMA and meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Culling and data extraction followed protocols, with cross-checking and consistency checks. DisMod-MR, the latest version of generic disease modelling system, redesigned as a Bayesian meta-regression tool, imputed prevalence by age, year and sex for 187 countries and 21 regions. The disability weight associated with cannabis dependence was estimated through population surveys and multiplied by prevalence data to calculate the years of life lived with disability (YLDs) and disability-adjusted life years (DALYs). YLDs and DALYs attributed to regular cannabis use as a risk factor for schizophrenia were also estimated. Results There were an estimated 13.1 million cannabis dependent people globally in 2010 (point prevalence0.19% (95% uncertainty: 0.17-0.21%)). Prevalence peaked between 20-24 yrs, was higher in males (0.23% (0.2-0.27%)) than females (0.14% (0.12-0.16%)) and in high income regions. Cannabis dependence accounted for 2 million DALYs globally (0.08%; 0.05-0.12%) in 2010; a 22% increase in crude DALYs since 1990 largely due to population growth. Countries with statistically higher age-standardised DALY rates included the United States, Canada, Australia, New Zealand and Western European countries such as the United Kingdom; those with lower DALY rates were from Sub-Saharan Africa-West and Latin America. Regular cannabis use as a risk factor for schizophrenia accounted for an estimated 7,000 DALYs globally. Conclusion Cannabis dependence is a disorder primarily experienced by young adults, especially in higher income countries. It has not been shown to increase mortality as opioid and other forms of illicit drug dependence do. Our estimates suggest that cannabis use as a risk factor for schizophrenia is not a major contributor to population-level disease burden.

Burden of depressive disorders by country, sex, age, and year : findings from the Global Burden of Disease Study 2010

Background Depressive disorders were a leading cause of burden in the Global Burden of Disease (GBD) 1990 and 2000 studies. Here, we analyze the burden of depressive disorders in GBD 2010 and present severity proportions, burden by country, region, age, sex, and year, as well as burden of depressive disorders as a risk factor for suicide and ischemic heart disease. Methods and Findings Burden was calculated for major depressive disorder (MDD) and dysthymia. A systematic review of epidemiological data was conducted. The data were pooled using a Bayesian meta-regression. Disability weights from population survey data quantified the severity of health loss from depressive disorders. These weights were used to calculate years lived with disability (YLDs) and disability adjusted life years (DALYs). Separate DALYs were estimated for suicide and ischemic heart disease attributable to depressive disorders.Depressive disorders were the second leading cause of YLDs in 2010. MDD accounted for 8.2% (5.9%-10.8%) of global YLDs and dysthymia for 1.4% (0.9%-2.0%). Depressive disorders were a leading cause of DALYs even though no mortality was attributed to them as the underlying cause. MDD accounted for 2.5% (1.9%-3.2%) of global DALYs and dysthymia for 0.5% (0.3%-0.6%). There was more regional variation in burden for MDD than for dysthymia; with higher estimates in females, and adults of working age. Whilst burden increased by 37.5% between 1990 and 2010, this was due to population growth and ageing. MDD explained 16 million suicide DALYs and almost 4 million ischemic heart disease DALYs. This attributable burden would increase the overall burden of depressive disorders from 3.0% (2.2%-3.8%) to 3.8% (3.0%-4.7%) of global DALYs. Conclusions GBD 2010 identified depressive disorders as a leading cause of burden. MDD was also a contributor of burden allocated to suicide and ischemic heart disease. These findings emphasize the importance of including depressive disorders as a public-health priority and implementing cost-effective interventions to reduce its burden.Please see later in the article for the Editors' Summary.

Uutta, vanhaa ja lainattua : Tampereen Kaupunkilähetyksen kristillissosiaalisen työn asemoituminen hyvinvointivaltion rakentumisessa vuosina 1939−1973

The main purpose of this study was to provide a full account of the Christian social work carried out at the Tampere City Mission (TCM) as well as the Missions sphere of operations from the Second World War to the early 1970s, comprising a period of significant change. The study consists of charting the processes of change and connections within the activities of the TCM and how examining these were linked to the general tendencies of the period, in lay work, social work, professionalization and the representation of gender. The positioning of the activities is described on the basis of these tendencies. The main sources for the study were the archives of the Mission, for example the minutes of meetings, correspondences as well as annual reports, and the archives of its partners, such as the City of Tampere, the Evangelical Lutheran parishes of Tampere and the State Welfare Administration. The archives of the Helsinki, Turku and Stockholm Missions supplied comparison reference and other material. In particular, social welfare and Christian social work technical journals of were used as printed sources. The principal method used was the genetic method of historiology. The research subject was also evaluated from the point of view of third sector research in addition to that of professionalization studies and gender studies. By the beginning of the research period, the TCM had turned more and more dedicatedly into a multipurpose social service organization maintaining social services such as old people s homes and children´s homes. This development continued, even though new areas of activity emerged and older ones fell into disuse. Social innovations sprang up, marriage counseling being one of them. On the national level, the TCM pioneered the provision of sheltered industrial work for intellectually disabled persons as well as housing services for them. As new activities were initiated, they overlapped with the established ones, and the TCM handed some of its child protection functions over to the municipality, in accordance with the current adaptation theory. The use of its own property to produce ever-changing social services may be the reason why the association s work continued on with vitality. Functional networks and political aid in the field of social services also bolstered the association. As in other Nordic countries, nonprofit organizations served as partners rather than competitors, with the State establishing institutional welfare arrangements. In the 1960s the municipal takeover of social services impacted the TCM activities. Rules for government subsidies and municipal allowances were not well established; hence these funds were not easily available, making improvements difficult. The TCM was a community in which women had a relatively strong position and an opportunity to make a difference. Female staff were reasonably equal to men, and women worked as heads of a several institutions. Care work employed a number of men, which went against the traditional segregation of labour between the sexes. The TCM s operations were from early on very professionalized, and were developed with particular care. Keywords: Christian social work, third sector, professionalization, gender

¿Barreras invisibles? Actitudes de los estudiantes universitarios ante sus compañeros con discapacidad

El presente trabajo analiza los conocimientos, opiniones y actitudes de los estudiantes universitarios sobre sus compañeros con discapacidad. La integración educativa y social de estos estudiantes es objeto de preocupación y estudio en todo el sistema educativo español, incluida la enseñanza superior en la que 21.942 universitarios con discapacidad se encontraban matriculados en el curso 2013-2014. El estudio se realiza en el marco de dos Proyectos de Innovación Educativa[1] de la Universidad de Málaga en los que se examinaron las actitudes del personal docente e investigador, el alumnado en general y el alumnado con discapacidad de esta institución. En este artículo se recogen las perspectivas de los estudiantes sin discapacidad, necesarias para medir el grado de aceptación dentro de las aulas universitarias. Se empleó una encuesta suministrada mediante correo electrónico a la totalidad de la población de estudiantes de la Universidad de Málaga (N= 32.464). El tamaño de la muestra fue de 620 estudiantes, por lo que trabajamos con un margen de error del 3,9% para la estimación de los porcentajes con un nivel de confianza del 95%. Los datos, analizados mediante análisis estadístico, visibilizan la importancia de un elevado grado de información y conocimiento así como de una experiencia directa con la discapacidad. Ambas circunstancias se traducen en actitudes más positivas y favorables. Tan solo el 20% de los alumnos manifestó haber recibido en alguna ocasión cualquier tipo de información sobre este asunto por parte de la Universidad; no obstante, la mayoría valora positivamente la presencia de alumnos con discapacidad en la Universidad, la posibilidad de contar ellos como compañeros de clase y el enriquecimiento que supone esta convivencia dentro del aula. Se discuten posibles acciones para mejorar las actitudes hacia los estudiantes con discapacidad. Además, se plantea incluir una perspectiva que promueva el empoderamiento de estos estudiantes. [1] PIE 10-135 y PIE 13-103.

ezGo: A voice operated wheelchair with biosignal monitoring for home environments

In this paper we present ezGo, an electric powered wheelchair with a speech based interface and biosignal monitoring instrumentation. The user can use the voice, a natural communication method, for controlling the chair movement and obtain information about his health. Additionally a set of semi-autonomous modes with macro recording enable the execution of navigation tasks with little effort and improved precision. The main purpose of the system is to provide severely disabled persons with an assistive device that can improve their confidence and daily independence. The obtained results on usability tests showed that users consider ezGo a valuable help on their daily tasks and a very desirable addition to standard wheelchairs.

Les Services documentaires adaptés aux personnes handicapées de l’Université de Montréal : Le savoir accessible…la connaissance…la liberté !

[RÉSUMÉ FRANÇAIS] Les Services documentaires adaptés aux personnes handicapées (SDAPH) de l'Université de Montréal ont pour objectif de rendre la documentation matériellement et intellectuellement accessible dans les délais les plus courts. Dans les locaux des SDAPH, plusieurs équipements adaptés sont disponibles et utilisés tant par le personnel que par les étudiants, afin de permettre la conversion des documents sous la forme convenant à chaque étudiant. Le personnel qualifié initie les personnes handicapées à l'utilisation des différents équipements adaptés à leurs besoins. Il voit à ce que chaque étudiant ait accès le plus tôt possible aux documents qui lui sont nécessaires, dans le respect de son échéancier académique et avec le support qui convient à son handicap.

Évaluation des effets de l'utilisation des aides à la mobilité motorisées chez les personnes âgées de plus de 50 ans

Le vieillissement démographique augmente rapidement la représentation des personnes âgées de plus de 50 ans parmi les utilisateurs d’aides à la mobilité motorisées (AMMs), telles que le fauteuil roulant motorisé et le quadriporteur. Le but général de la thèse est de rendre compte d’une démarche d’analyse des effets des AMMs au cours des premiers 18 mois d’utilisation chez les adultes d’âge moyen et les aînés. Notre question de recherche concerne la nature et l'importance des effets sur le fonctionnement, la pertinence sociale et le bien-être subjectif, ainsi que les liens entre les divers facteurs impliqués dans leur impact optimal. La thèse s’articule en trois volets, synthétique, méthodologique et analytique, dont les principaux résultats sont présentés dans quatre articles scientifiques. Le volet synthétique comprend une recension systématique qui révèle la représentation marginale des personnes âgées de plus de 50 ans dans les publications scientifiques sur les effets des AMMs et le faible niveau de preuve dans ce champ d’études. Les travaux liés à ce volet proposent également un cadre d’analyse reliant l’intention d’utiliser l’AMM, les habitudes de déplacements, les dimensions d’effets des AMMs sur le fonctionnement, la pertinence sociale et le bien-être subjectif, ainsi que quatre catégories de cofacteurs associés à l’utilisation (personne, aide technique, intervention, environnement). Le volet méthodologique assemble un dispositif de mesure comprenant 5 questionnaires et 18 indicateurs arrimés au cadre d’analyse et démontre l’applicabilité de l’ensemble des questionnaires pour une administration téléphonique. La validation transculturelle de deux questionnaires implique deux études réalisées auprès d’utilisateurs d’AMMs âgés de 50 à 84 ans (n=45). Ces travaux confirment la fidélité test-retest et l’équivalence des questionnaires traduits avec la version d’origine. Finalement, le volet analytique se concentre sur l’étude des habitudes de déplacements chez 3 cohortes (n=116) de personnes âgées de 50 à 89 ans, recrutées en fonction du stade d’utilisation de l’AMM. Les résultats suggèrent une amélioration de l’aire de mobilité après l’utilisation initiale ou long terme de l’AMM en comparaison avec une cohorte en attente de l’AMM, ainsi qu’une augmentation significative de la fréquence des déplacements autour du domicile et dans le voisinage. Trois facteurs associés à une aire de mobilité optimale, à savoir le genre, la nature des objectifs de participation de l’utilisateur et le type d’appareil utilisé, sont identifiés par des analyses de régression linéaires contrôlant pour l’âge. La thèse soutient l’importance de tenir compte de l’environnement et d’une combinaison de facteurs reliés à la personne et à l’aide technique pour saisir les effets des AMMs au cours des premiers mois d’utilisation. Ces résultats ouvrent la voie au suivi systématique des utilisateurs d’AMMs par les professionels de réadaptation, puisqu’ils confirment l’utilité du dispositif pour en mesurer les effets et ciblent les déterminants de la mobilité des utilisateurs d’AMMs âgés de plus de 50 ans.