A Swiss neighbourhood index of socioeconomic position: Development and Association with Mortality

Background Area-based measures of socioeconomic position (SEP) suitable for epidemiological research are lacking in Switzerland. The authors developed the Swiss neighbourhood index of SEP (Swiss-SEP). Methods Neighbourhoods of 50 households with overlapping boundaries were defined using Census 2000 and road network data. Median rent per square metre, proportion households headed by a person with primary education or less, proportion headed by a person in manual or unskilled occupation and the mean number of persons per room were analysed in principle component analysis. The authors compared the index with independent income data and examined associations with mortality from 2001 to 2008. Results 1.27 million overlapping neighbourhoods were defined. Education, occupation and housing variables had loadings of 0.578, 0.570 and 0.362, respectively, and median rent had a loading of −0.459. Mean yearly equivalised income of households increased from SFr42 000 to SFr72 000 between deciles of neighbourhoods with lowest and highest SEP. Comparing deciles of neighbourhoods with lowest to highest SEP, the age- and sex-adjusted HR was 1.38 (95% CI 1.36 to 1.41) for all-cause mortality, 1.83 (95% CI 1.71 to 1.95) for lung cancer, 1.48 (95% CI 1.44 to 1.51) for cardiovascular diseases, 2.42 (95% CI 1.94 to 3.01) for traffic accidents, 0.93 (95% CI 0.85 to 1.02) for breast cancer and 0.86 (95% CI 0.78 to 0.95) for suicide. Conclusions Developed using a novel approach to define neighbourhoods, the Swiss-SEP index was strongly associated with household income and some causes of death. It will be useful for clinical- and population-based studies, where individual-level socioeconomic data are often missing, and to investigate the effects on health of the socioeconomic characteristics of a place.

Diversitat funcional (discapacitat) i espiritualitat

Aquest treball pretén reflexionar al voltant de l’espiritualitat i la diversitat funcional, especialment des de l’òptica del treball dels professionals de l’acció social i des del que es promou des de les institucions. Pel que fa a la diversitat funcional, revisarem críticament el terme discapacitat i dependència i tindrem en compte les diferents dimensions de la persona, especialment l’espiritual. La premissa “la recerca del sentit de la vida és una força primària de la vida humana que té relació amb la felicitat” (Benavent) serà l’eix vertebral de la major part d’idees que aquest article pretén abordar.

Bridging the gap between post-secondary students with disabilities and faculty members with their perceptions of access and accommodation

The purpose of this study was to identify factors related to successful university course completion for students with disAbilities including the knowledge that faculty members and students with disAbilities have about accommodation issues; the accommodations that students with disAbilities and faculty use and find effective in the university setting; faculty members' perceptions of and attitudes toward students with disAbilities; and the attitudes that students with disAbilities have toward faculty. Fiftyseven participants were involved in the research, eight students with disabilities and forty-nine faculty members. The main objective of the research was to describe how the skills, knowledge, and attitudes of students and faculty members, and organizational supports interact to support students' academic success. The utilization and effectiveness of accommodations to overcome barriers associated with disAbility in a post-secondary setting are described in relation to students' and faculty members' perceptions of academic success.

Effectiveness of personal planning for residents re-entering the community during the facility initiative in Ontario

This paper reports on the relocation of people with intellectual disabilities (ID) from large-scale provincially run institutions that took place in Ontario as part of the Facility Initiative. Three case studies were examined in order to report on this process as experienced by those who lived and worked through it. Specifically, the planning process conducted by the Ministry of Community and Social Services (MCSS) to assist each person with hislher transition to community living was examined using the current standard of practice in person- centered planning approaches. Effectiveness was evaluated as the ability to apply a person-centered approach across settings and people, as well as what factors facilitated or hindered its application. Results show that, in general, the personal plans do not appear to reflect the pre-transition experience of the person. Also, the transitional planning process did not appear person-centered nor facilitate further person-centered planning in the community.

Back to Basics: Exploring gestural habits as cues for anticipating self-injurious episodes in a child with Autism and Deafness

This research project is a longitudinal qualitative case study. It contributes to an understanding of self-injurious behaviour (SIB) by inviting the reader through the narrative of the lived experience of a fifteen year old child-informant and the network of individuals in his life. The value and importance of a case-study is that it focuses on the authenticity of the experience of living with disability. Through the use of detailed field observations, interviews and photo documents, the study thoroughly explores three main areas: quality of movements, potential cues as pre-cursors to episodes of self-injury, and purposeful communication. The research begins with a review of literature on Autism, Deafness and Self-injury, formulates the research design and orientation of Physical Education, Phenomenology and Semiotics, and then systematically explores four distinct phases in the analytical process. The aim was to explore self-injurious episodes in the child informant in hopes to translate the meaning of the behaviour and potentially utilize this to provide more opportunities for adapted physical activity. The findings reveal distinct patterns of movement cues utilized for different purposes. The implications of the findings are self-injurious episodes in the child informant are preceded by distinct patterns of movement that are potentially communicative. Suggested future direction of the research is expanding the scope to other disabilities for which verbal communication is challenging, and standardizing the translating tools to assist in understanding the communication of movement.

A Phenomenologically Sensitized Analysis of Images Depicting Stressed Embodiment in an Adolescent Male with Autism Spectrum Disorder (ASD)

Each person with Autism Spectrum Disorder (ASD) comes with unique characteristics (idiosyncratic) that give clues to the world they know (Connolly, 2008). It is through their body that they (a) know the world they are experiencing, (b) make meaning, and (c) express certain behaviours. I used Laban’s Movement Analysis (LMA) to practice an attuned and appreciative approach to describing and understanding the body movement in one severe manifestation of autism in an adolescent male. LMA observes human movement across many disciplines and can be applied in many contexts providing a body honoring discourse for description (Connolly, 2008). The framework examines movement in body, space, quality, and relation. Each theme provides a detailed description of the individual’s movement, thus, giving us a richer understanding of patterns and possible triggers to self-injurious behaviours (SIB). During the summer of August 2013, I participated in Brock University’s annual Autism Camp and worked with a 15 year old male named “Aaron” who manifests with low functioning autism. The purpose of my research project was to code and analyze a series of photos taken to help gain insight into movement patterns associated with stressed embodiment and self-injury in “Aaron”. As I understood more about these embodied expressions, I uncovered valuable information on how to read patterns and discover what triggers these events, thus providing strategies on how to help people do more refined observations and make meaning of the behaviour. Laban’s movement analysis provided a sensitized discourse appropriate to the embodied expressions depicted in the photos.

Les déterminants de la santé des personnes exposées à des crises majeures : le cas des déplacés internes au Burundi

PROBLÉMATIQUE La violence collective, à travers les guerres civiles et autres conflits politiques violents, constitue un lourd fardeau pour la santé publique. Plus de la moitié des décès causés par l’ensemble des conflits dans le monde entier se trouvent en Afrique. L’une des conséquences est le déplacement massif des populations qui se réfugient vers l’extérieur du pays, mais aussi de plus en plus à l’intérieur des frontières nationales. Ceux qui ne traversent pas sont appelés déplacés internes. Leur état de santé est au moins aussi vulnérable que celui de réfugiés, mais est très peu documenté. De 1993 à 2005, le Burundi a plongé dans une crise politico-sociale sans précédent. En 2001, environ 10 % de la population vivaient dans des camps de déplacés. OBJECTIF Documenter l’état de santé des personnes déplacées par la guerre au Burundi et identifier ses déterminants. CADRE CONCEPTUEL Le cadre conceptuel est basé sur la modélisation de l’association entre les événements traumatiques, les facteurs de l’environnement post-traumatique et l’état de santé des déplacés internes burundais. MÉTHODE Une enquête transversale a été menée dans deux camps de déplacés au Burundi. Les données ont été obtenues de façon rétrospective sur l’exposition aux événements traumatiques et de manière transversale pour l’état de santé et les facteurs de l’environnement post-traumatique. Les participants ont été interrogés sur les événements traumatiques vécus personnellement ou par leurs proches selon une courte échelle élaborée à cet effet. De même, les facteurs de l’environnement post-traumatique ont été documentés. Pour la mesure de l’état de santé, un questionnaire comportant certains des 17 items du profil de santé de Duke a été utilisé. Deux traductions ont été réalisées et plusieurs items ont été adaptés. RÉSULTATS Les événements traumatiques vécus par les déplacés internes burundais sont négativement associés à l’état de santé physique, à l’état de santé sociale, à l’état de santé perçu et, positivement, avec l’incapacité. De même, plusieurs facteurs de l’environnement post-traumatique sont associés à l’état de santé. Par contre, certaines associations sont à interpréter selon leurs interactions avec les événements traumatiques. Celles-ci agissent parfois comme modificateurs d’effet, en amortissant ou en amplifiant le lien associatif initial entre certains événements traumatiques et l’état de santé des déplacés. CONCLUSION : Les résultats font ressortir un effet différentiel associé d’une part aux événements traumatiques vécus précédemment et d’autre part, en interaction avec ces derniers, à l’environnement post-traumatique. Notre thèse en arrive à la conclusion que les facteurs de l’environnement post-traumatique constituent des déterminants importants de l’état de santé des déplacés de guerre.

Resilience and Individualized Community Integration Interventions for Persons with Traumatic Brain Injuries

Investigators, caregivers, administrators and service users in the field of rehabilitation are increasingly interested in the concept of resilience, but the literature has very little to offer on interventions aimed at supporting the resilience of persons and their loved ones. This article describes the Personnalized Accompagnement Community Integration (ICII), which is intended to support the resilience of persons with moderate to severe traumatic brain injuries (TBIs). An ICII implementation is currently underway and is expected to support social participation and stimulate the resilience of persons with TBIs. It is based on four frames of reference: community integration founded on the person’s perception of their community integration, the ecosystemic model, the handicap production process (HPP) model, and the goal-setting process. ICII adopts an intervention perspective centered on the life plan of the person with a TBI.

Aprendizagem de aluno com deficiência intelectual e desenvolvimental em contexto de sala de aula

O presente estudo propôs-se estudar a temática da aprendizagem de um aluno com deficiência intelectual e desenvolvimental em contexto de sala de aula e as implicações no desenvolvimento de processo educativo. Foi realizado com um jovem que atingiu este ano a maioridade e que esteve a frequentar o 9º ano de escolaridade. Este jovem apresenta características que o definem como portador de Deficiência Intelectual e Desenvolvimental (DID). Realizou-se a análise documental através das informações que constam do processo educativo do jovem, das entrevistas efectuadas aos professores que o acompanharam no seu percurso escolar e dos registos de observação de aulas. Procedeu-se à discussão dos resultados, onde se aferiu que as escolas regulares apresentam, actualmente condições para responder às necessidades académicas, pessoais e sociais destes jovens, contudo o processo de aprendizagem destes alunos deveria passar por uma preparação para a vida ativa através do estabelecimento de protocolos com Entidades formadoras, que visam formação a nível técnico e que proporcionam a inclusão em mercado laboral. É imperioso compreender que o processo de aprendizagem destes jovens com Necessidades Edicativas Especiais (NEE) implica uma multiplicidade de aspetos, sendo o direito à igualdade de oportunidades primordial, considerando que todos têm direito a ser diferentes quando a igualdade os descaracteriza.

Access to historic environments for tourists with disabilities: a compromise?

Historic environments, the basis for heritage tourism, are difficult to access for people with disabilities. Many countries have introduced legislation to promote equal rights for people with disabilities. Historic environments, however, enjoy protection under national planning systems which limit the physical access improvements that can be made. The significance of historic environments for tourism in the UK is outlined. Barriers restricting tourists with disabilities accessing historic sites are reviewed from the heritage tourism service provider's viewpoint. Interests of the major stakeholders are considered in terms of the apparent conflict between conservation and access issues as heritage tourism service providers seek to comply with disability discrimination legislation. From a study of access improvements made by major heritage tourism service providers, good practice is identified. However, physical access improvements to enable tourists with disabilities to visit historic environments are a compromise because of the strength of conservation interests. Questions remain as to whether this compromise is acceptable to the tourist with disabilities and whether intellectual access is an acceptable substitute for physical presence.

Clinical potential and design of programmable mechanical impedances for orthotic applications

A person with a moderate or severe motor disability will often use specialised or adapted tools to assist their interaction with a general environment. Such tools can assist with the movement of a person's arms so as to facilitate manipulation, can provide postural supports, or interface to computers, wheelchairs or similar assistive technologies. Designing such devices with programmable stiffness and damping may offer a better means for the person to have effective control of their surroundings. This paper addresses the possibility of designing some assistive technologies using impedance elements that can adapt to the user and the circumstances. Two impedance elements are proposed. The first, based on magnetic particle brakes, allows control of the damping coefficient in a passive element. The second, based on detuning the P-D controller in a servo-motor mechanism, allows control of both stiffness and damping. Such a mechanical impedance can be modulated to the conditions imposed by the task in hand. The limits of linear theory are explored and possible uses of programmable impedance elements are proposed.

Leveraging everyday technology for people living with dementia: a case study

– The purpose of this paper is to present the self-described “journey” of a person with dementia (Brian; author 3) in his re-learning of old technologies and learning of new ones and the impact this had on his life. Design/methodology/approach – This is a single case study detailing the participant's experiences collaborating with a researcher to co-create methods of facilitating this learning process, which he documented in the form of an online blog and diary entries. These were analysed using NVivo to reveal the key themes. Findings – Brian was able to relearn previously used technologies and learn two new ones. This lead to an overarching theme of positive outlook on life supported by person-centredness, identity and technology, which challenged negative perceptions about dementia. Research limitations/implications – The paper provides an example of how learning and technology improved the life of one person with dementia. By sharing the approach the authors hope to encourage others to embrace the challenge of designing and developing innovative solutions for people with a dementia diagnosis by leveraging both current mainstream technology and creating novel bespoke interventions for dementia. Originality/value – The personal perspective of a person with dementia and his experiences of (re-) learning provide a unique insight into the impact of technology on his life.

Testing of disability identification tool for schools

There has been an ongoing concern about the lack of reliable data on disabled children in schools. To date there has been no consistent way of identifying and categorising disabilities. Schools in England are currentlyrequired to collect data on children with Special Educational Need (SEN), but this does not capture information about all disabled children. The lack of this information may seriously restrict capacity at all levels of policy and practice to understand and respond to the needs of disabled children and their families in line with Disability Discrimination Act (2005) and the single Equality Act (2010). The aim of the project was to test the draft tools for identifying disability and accompanying guidance in a sample of all types of maintained schools in order to assess their usability and reliability and whether they resulted in the generation of robust and consistent data that could reliably inform school returns for the annual School Census.

Interpreting communication of people with profound and severe learning difficulties

The present paper highlights some of the issues involved in interpreting the communication behaviours of people with profound and multiple learning difficulties (PMLDs). Both inference and intention can play an important role in the communication process, and this raises a number of difficulties and dangers where one of the communication partners is not in a position to correct misunderstandings. The present authors discuss the importance of validating communication and pose a number of key questions to ask those who are most significant in the life of a person with PMLDs. A case study is provided that illustrates a number of these issues.

Brief behavioural activation for adolescent depression: working with complexity and risk

Given the long-term negative outcomes associated with depression in adolescence, there is a pressing need to develop brief, evidence based treatments that are accessible to more young people experiencing low mood. Behavioural Activation (BA) is an effective treatment for adult depression, however little research has focused on the use of BA with depressed adolescents, particularly with briefer forms of BA. In this article we outline an adaptation of brief Behavioral Activation Treatment of Depression (BATD) designed for adolescents and delivered in eight sessions (Brief BA). This case example illustrates how a structured, brief intervention was useful for a depressed young person with a number of complicating and risk factors.