Audit and comprehensive health assessment programme in the primary healthcare of adults with intellectual disability: a pilot study

International research has demonstrated significant shortcomings in the health of adults with intellectual disability (ID). Because general practitioners (GPs) are the main providers of primary healthcare for this population, strategies to improve general practice care are an important aspect of rectifying these shortcomings. The present pilot study aimed to determine the effect of various interventions on health maintenance activities and to assess their acceptability to GPs, with a view to informing larger scale studies. The GPs were recruited through an earlier questionnaire-based postal survey. The GPs identified all their adult patients with ID, then obtained consent for participation from three patients randomly selected by the investigators. The GPs completed two self-evaluation forms and case note audits 12 months apart, read a synopsis of the relevant literature provided by the researchers, and completed a comprehensive health assessment (CHA) of their three patients. Forty-five GPs agreed to participate in the CHA programme (CHAP), and 15 completed the project. Thirty-eight patients completed the project. The number of patient-GP dyads who completed the project was too small to demonstrate statistically significant changes in health issues over time. The GPs found that the synopsis of the literature was the best intervention for increasing knowledge and was also the most practical to use in general practice. The CHAP was the intervention that prompted the most action from the GP which would not have been undertaken otherwise. The CHAP appeared to provide a superior review process compared to the other interventions used in the present study. The numbers of health maintenance activities found to be overdue and the number of health issues detected as a result of the process were considerable. The CHAP served as a communication tool and an educative instrument, providing a basis for future studies and strategies to improve the general practice care of adults with ID.

Reconciling Globalisation and Technological Change: Growing Income Inequalities and Remedial Policies

From the mid-1970s through the 1980s and into the 1990s, wage inequality and skill differentials in earnings and employment increased sharply in OECD countries. After 1973 and especially in the 1980s, the US experienced a dismal real wage performance for the less skilled. Among the factors singled out by economists as possible major contributors to this development are economic globalisation processes and skill-biased technological change. Although these are most commonly considered as independent influences, after critically outlining views about these factors, this article argues that strong interdependence exists between them. The article then examines potential policy responses to this growing inequality.

Violation of multiparticle Bell inequalities for low- and high-flux parametric amplification using both vacuum and entangled input states

We show how polarization measurements on the output fields generated by parametric down conversion will reveal a violation of multiparticle Bell inequalities, in the regime of both low- and high-output intensity. In this case, each spatially separated system, upon which a measurement is performed, is comprised of more than one particle. In view of the formal analogy with spin systems, the proposal provides an opportunity to test the predictions of quantum mechanics for spatially separated higher spin states. Here the quantum behavior possible even where measurements are performed on systems of large quantum (particle) number may be demonstrated. Our proposal applies to both vacuum-state signal and idler inputs, and also to the quantum-injected parametric amplifier as studied by De Martini The effect of detector inefficiencies is included, and weaker Bell-Clauser-Horne inequalities are derived to enable realistic tests of local hidden variables with auxiliary assumptions for the multiparticle situation.

Non-compact generalized variational inequalities for quasi-monotone and hemi-continuous operators with applications

Some results are obtained for non-compact cases in topological vector spaces for the existence problem of solutions for some set-valued variational inequalities with quasi-monotone and lower hemi-continuous operators, and with quasi-semi-monotone and upper hemi-continuous operators. Some applications are given in non-reflexive Banach spaces for these existence problems of solutions and for perturbation problems for these set-valued variational inequalities with quasi-monotone and quasi-semi-monotone operators.

An e-marketplace of healthcare and social care services: the perceived interest

Purpose – The health and social care sector is receiving growing attention due to the increased life expectancy and to the public demand for a better quality of life and better health services. New cost-efficient approaches are required, and the paper aims to present and discuss the main results of a study undertaken in a Portuguese municipality on the perceived relevance of an e-marketplace of social and healthcare services for the inhabitants in general, and for people with special needs in particular, and the identification of the most relevant services to be offered through this platform. Design/methodology/approach – A wide survey was undertaken to identify the needs of potential users and their expectancies with relation to the proposed platform. The results of the study are a support for the project promoters to understand the viability of the solution and the requirements to the deployment of the pilot experiment, as well as to drive the selection of domains of activities/classes of services to be offered by the platform. Findings – Services such as information about healthcare services, home monitoring/accompanying services 24 hours per day, and personal hygiene services provided at home are the ones recognized by the inquired citizens as the most important, which indicates that the potential users will be mostly people with special needs or their family or caregivers. Originality/value – While still at a preliminary development phase, the project represents a good opportunity to develop a totally innovative service with high potential impact for the senior population and for individuals with special needs.

Active Assistance for Senior Healthcare: A Wearable System for Fall Detection

Elders lose independence and wellbeing, accompanied by decreased functions in terms of hearing, vision, strength and coordination abilities. These factors contribute to balance difficulties that eventually lead to falls. The injuries due to falls, at this age, are risky, since most of the times may cause a significant – and permanent – decrease of quality of life or, in extreme cases, death. In this context, a fall detection system can bring an added value to assist elderly people.This paper describes a system consisting of a wearable sensor unit, a smartphone and a website. When the sensor detects a fall it sends an alert using the smartphone via Bluetooth 4.0, to notify the family members or stakeholders. The sensor device includes an inertial unit, a barometer, and a temperature and humidity sensor. The website displays the log of previous falls and enables the configuration of emergency contact numbers. The proposed fall detection system is one of multiple components within a larger project under development that offers a holistic perspective on falls; the complete wearable solution will also feature, among others, physical protection (minimizing the impact of falls that occur).