Validation of a mobility item bank for older patients in primary care

Background: To develop and validate an item bank to measure mobility in older people in primary care and to analyse differential item functioning (DIF) and differential bundle functioning (DBF) by sex. Methods: A pool of 48 mobility items was administered by interview to 593 older people attending primary health care practices. The pool contained four domains based on the International Classification of Functioning: changing and maintaining body position, carrying, lifting and pushing, walking and going up and down stairs. Results: The Late Life Mobility item bank consisted of 35 items, and measured with a reliability of 0.90 or more across the full spectrum of mobility, except at the higher end of better functioning. No evidence was found of non-uniform DIF but uniform DIF was observed, mainly for items in the changing and maintaining body position and carrying, lifting and pushing domains. The walking domain did not display DBF, but the other three domains did, principally the carrying, lifting and pushing items. Conclusions: During the design and validation of an item bank to measure mobility in older people, we found that strength (carrying, lifting and pushing) items formed a secondary dimension that produced DBF. More research is needed to determine how best to include strength items in a mobility measure, or whether it would be more appropriate to design separate measures for each construct.

What do older people understand by mobility-related difficulties?

Despite the centrality of the difficulty concept in the study of disability, there has been little research on its significance from the point of view of people with functional limitations. The main objective of this study was to describe what older people understand when asked about difficulty in undertaking mobility activities. As a secondary objective, we considered whether there are any differences depending on the type of activities, according to the International Classification of Functioning (ICF) mobility domains. Methods: Seventeen community-dwelling men and women aged 70 years old or over were interviewed by means of a questionnaire containing 55 items covering the ICF mobility domains. The participants responded to the items while thinking aloud, saying what led them to give a specific answer about their level of difficulty. Inductive content analysis was conducted and categories, subthemes and themes were identified. Results: Causes of difficulty (pathologies, impairments, symptoms) and accommodations (task modifications and use of aids) were the two themes identified; and their importance (and that of the subthemes included) varied across the types of activity. All the participants said that they had no difficulty in at least one task, despite mentioning changes in the way they performed them. Conclusions: Older people's opinions were consistent with theoretical models of disability and with the standard practice of measuring functional limitations by asking about the degree of difficulty; however, the design of these measures needs to be improved in order to detect perceptions of no difficulty in the presence of task modification.

Patients' and professionals' views on managing fibromyalgia

BACKGROUND: Managing fibromyalgia is a challenge for both health care systems and the professionals caring for these patients, due, in part, to the fact that the etiology of this disease is unknown, its symptoms are not specific and there is no standardized treatment. OBJECTIVE: The present study examines three aspects of fibromyalgia management, namely diagnostic approach, therapeutic management and the health professional-patient relationship, to explore specific areas of the health care process that professionals and patients may consider unsatisfactory. METHODS: A qualitative study involving semistructured interviews with 12 fibromyalgia patients and nine health professionals was performed. RESULTS: The most commonly recurring theme was the dissatisfaction of both patients and professionals with the management process as a whole. Both groups expressed dissatisfaction with the delay in reaching a diagnosis and obtaining effective treatment. Patients reported the need for greater moral support from professionals, whereas the latter often felt frustrated and of little help to patients. Patients and professionals agreed on one point: the uncertainty surrounding the management of fibromyalgia and, especially, its etiology. CONCLUSION: The present study contributes to a better understanding regarding why current management of fibromyalgia is neither effective nor satisfactory. It also provides insight into how health professionals can support fibromyalgia patients to achieve beneficial results. Health care services should offer greater support for these patients in the form of specific resources such as fibromyalgia clinics and health professionals with increased awareness of the disease.

Assessment of the Association of Health with the Liberalisation of Trade in Services under the World Trade Organisation

Background: The liberalisation of trade in services which began in 1995 under the General Agreement on Trade in Services (GATS) of the World Trade Organisation (WTO) has generated arguments for and against its potential health effects. Our goal was to explore the relationship between the liberalisation of services under the GATS and three health indicators – life expectancy (LE), under-5 mortality (U5M) and maternal mortality (MM) - since the WTO was established. Methods and Findings: This was a cross-sectional ecological study that explored the association in 2010 and 1995 between liberalisation and health (LE, U5M and MM), and between liberalisation and progress in health in the period 1995–2010, considering variables related to economic and social policies such as per capita income (GDP pc), public expenditure on health (PEH), and income inequality (Gini index). The units of observation and analysis were WTO member countries with data available for 2010 (n = 116), 1995 (n = 114) and 1995–2010 (n = 114). We conducted bivariate and multivariate linear regression analyses adjusted for GDP pc, Gini and PEH. Increased global liberalisation in services under the WTO was associated with better health in 2010 (U5M: 20.358 p,0.001; MM: 20.338 p = 0.001; LE: 0.247 p = 0.008) and in 1995, after adjusting for economic and social policy variables. For the period 1995–2010, progress in health was associated with income equality, PEH and per capita income. No association was found with global liberalisation in services. Conclusions: The favourable association in 2010 between health and liberalisation in services under the WTO seems to reflect a pre-WTO association observed in the 1995 data. However, this liberalisation did not appear as a factor associated with progress in health during 1995–2010. Income equality, health expenditure and per capita income were more powerful determinants of the health of populations.

Sexual health and socioeconomic-related factors in Spain

Purpose: The aim of the present study was to describe sexual health in Spain according to three important indicators of the World Health Organization definition and explore the influence of socioeconomic factors. Methods: We performed a population-based cross-sectional study of sexually active people aged 16-44 years residing in Spain in 2009 (2365 women and 2532 men). Three main aspects of sexual health were explored: sexual satisfaction, safe sex, and sexual abuse. The independent variables explored were age, age at first intercourse, reason for first intercourse, type of partner, level of education, country of origin, religiousness, parity, and social class. Bivariate and multivariate logistic regression models were fitted. Results: Both men and women were quite satisfied with their sexual life, their first sexual intercourse, and their sexual relationships during the previous year. Most participants had practiced safe sex both at first intercourse and during the previous year. Levels of sexual abuse were similar to those in other developed countries. People of disadvantaged socioeconomic position have less satisfying, more unsafe, and more abusive sexual relationships. Women experienced more sexual abuse and had less satisfaction at their first intercourse. Conclusions: The state of sexual health in Spain is relatively good. However, we observed inequalities according to gender and socioeconomic position.

Kitāb Manāhij al-albāb al-Miṣrīyah fī mabāhij al-ādāb al-ʻaṣrīyah

taʼlīf Rifāʻah Rāfiʻ.

Redrawing Identity Boundaries through Integration Policies: Strategies of Inclusion/Exclusion of Immigrants in Québec and South Tyrol. EDAP Paper 01/2013

Following the research agenda introduced by Will Kymlicka, this qualitative study offers an interpretation of how the sub-national elites of Québec and South Tyrol police the integration of immigrants. For these national minority groups, which are constantly undergoing a process of redefinition of their collective identities by differentiating themselves from the Others who do not belong to the in-group, immigrants have progressively become the most significant Others as they are not part of the original system of compromises. This article questions how sub-national elites are handling this relatively new kind of ethnocultural diversity brought about by large-scale permanent immigration on two levels: first, the political narrative of the ruling sub-national parties, their electoral appeals, manifestos and speeches; second, the policy arrangements for the integration of immigrants in education, language and social policy. The initial approach of the article is pessimistic, as it assumes that sub-national elites will marginalize immigrants to please core nationalist supporters. In fact, the hypotheses to be tested are whether the national minority groups of Québec and South Tyrol engage in a process of reconstruction of their ethnic identity bounded by opposition to real or imagined Others – the newcomers; and whether they adopt practical measures that force newcomers to be assimilated into the group or to be marginalized. The comparison between Québec and South Tyrol provides a basic understanding of the impact of immigration in two sub-national polities that are very different, but still adopt similar political narratives and policy strategies with regard to the integration of newcomers.

It's not (only) about Erika Steinbach. Three myths in the German discourse on the resettlements. OSW Point of View, August 2010

The activity of the Federation of Expellees and its chairperson Erika Steinbach, including efforts aimed at establishing the Centre Against Expulsions have been and will continue to be a source of controversy in Germany’s domestic policy, as well as in Polish–German and Czech–German relations. Steinbach has become a central figure in German inter-party conflicts and in disputes with the country’s immediate neighbours. In her efforts to gain more publicity for injustice and suffering in the German past she has resorted to controversial methods and has thus latched onto another stage in the historical debate on the consequences of World War II. This time it is related to and interpreted from the point of view of the German victims. The consequences of the present debate on how Germany suffered during the war do matter and will continue to matter both for Germany itself and for Germany’s relations with its near neighbours. Contrary to popular belief, the debate, still underway and in the shape imposed by Erika Steinbach, is likely to bring some benefit to Poland.

The finance-welfare state nexus. ACES Cases No. 2013.1

At the height of the financial crisis, the Western welfare state prevented a repeat of the Great Depression. But there were also suggestions that social policy had contributed to the crisis, particularly by promoting households’ access to credit in pursuit of welfare goals. Others claim that it was the withdrawal of state welfare that led to the disaster. Against this background that motivated our interest, we propose a systematic way of assessing the relationship between financial market and public welfare provisions. We use structural vector auto-regression to establish the causal link and its direction. Two hypotheses about this relationship can be inferred from the literature. First, the notion that welfare states ‘decommodify’ livelihoods or that there is an equity-efficiency tradeoff would suggest that welfare states substitute to varying degrees for financial market offers of insurance and savings. By contrast, welfare states may support private interests selectively and/or help markets for households to function better; thus the nexus would be one of complementarity. Our empirical strategy is to spell out the causal mechanisms that can account for a substitutive or complementary relationship and then to see whether advanced econometric techniques find evidence for the existence of either of these mechanisms in six OECD countries. We find complementarity between public welfare (spending and tax subsidies) and life insurance markets for four out of our six countries, notably even for the United States. Substitution between welfare and finance is the more plausible interpretation for France and the Netherlands, which is surprising. Data availability constrains us from testing the implications for the welfare state contribution to the crisis directly but our findings suggest that the welfare state cannot generally be blamed for the financial crisis.

Gender Equality in the Case Law of the European Court of Justice. IES WORKING PAPER 2/2009

The principle of gender equality forms a part of the EU’s social policy and serves equally men and women. So far, fourteen directives concerning gender equality have been adopted in the EU, with the New Equal Treatment Directive as the latest one. The EU has developed different models to promote gender equality: equal treatment, positive action and most recently gender mainstreaming. The equal treatment model is primarily concerned with formal equality and it unfortunately prevails in the ECJ’s rulings. Indeed, this paper argues that so far, the ECJ has not managed to develop a firm and consistent case law on gender equality, nor to stretch it coherently to positive action and gender mainstreaming. It seems that in spite of some progress in promoting the position of women, the ECJ’s case law has recently taken a step backwards with its conservative judgments in e.g. the Cadman case. Overall, this paper aims at summing up and evaluating the most important cases of the ECJ on gender equality.

The Path to European Integration: A Historical Institutionalist Perspective, CES Germany & Europe Working Papers, No. 05.2, 25 October 1994

Many European and American observers of the EC have criticized "intergovemmentalist" ac­ counts for exaggerating the extent of member state control over the process of European integra­ tion. This essay seeks to ground these criticisms in a "historical institutionalist" account that stresses the need to study European integration as a political process which unfolds over time. Such a perspective highlights the limits of member-state control over long-term institutional de­ velopment, due to preoccupation with shorHerm concerns, the ubiquity of unintended conse­ quences, and processes that "lock in" past decusions and make reassertions of member-state control difficult. Brief examination of the evolution of social policy in the EC suggests the limita­ tions of treating the EC as an international regime facilitating collective action among essentially sovereign states. It is ore useful to view integration as a "path-dependent" process that has pro­ duced a fragmented but still discernible "multitiered" European polity.

The Fall of the East German Birth Rate After Unification: Crisis or Means of Adaptation? CES Germany & Europe Working Papers, No. 05.6, 26 June 1995

Since the fall of the Wall, Eastern Germans have drastically changed their demographic behavior. Marriages and births have dropped to an unprecedented low level. Our paper tracks birth rates of the East German population, past, present, and future. We propose a simulation model of future cohort fertility. The hypotheses we develop build on the historical record of reproductive behavior in the German Democratic Republic (GDR) since 1960 and on an analysis of the pattern of change between 1990 and 1994. The particular emphasis lies in the assumption that East German couples will rapidly westernize their family size by trying to reach completed fertility levels of the corresponding West German cohort. This implies that the resulting adaptation process includes the postunification crisis as a logical first step.

What Does Globalization Have to Do with the Erosion of Welfare States? Sorting Out the Issues. CES Germany & Europe Working Papers, No. 07.5, 1996

Is it really true that the economic processes described as globalization are eroding West European and North Ameri­ can welfare states (WS) ? This paper is a first step in a project aimed at answering the question. Focusing on conflict­ ing arguments about the economic mechanisms which generate pressures on WS, it groups them into three answers to the title question: globalization has everything, nothing, or something to do with it. Tentatively concluding that the third answer, that domestic and international economic mechanisms do interact in specific ways to strain WS, it sets the stage for the second stage of the project. That is to analyze the political mechanisms shaping the policy re­ sponses to those strains and perhaps themselves contributing to those strains. To expore the issues to be addressed in this second step. a brief preliminary exploration of recent social policy patterns suggests that domestic political fac­ tors go a long way toward explaining them without much recourse to globalization, especially in the U.S. but also, if to a lesser extent, in Western Europe.

Shaping Tolerant Attitudes towards Immigrants: The Role of Welfare State Expenditures

This article contributes to the ongoing discussion on how tolerance may be fostered in Western European countries and to the question of how contextual factors such as welfare state expenditures may contribute to this formation. Tolerance is understood as a basic democratic principle that helps civil societies cope with rising levels of diversity stemming from increased immigration and individualism. Within the tolerance literature it is commonly agreed upon that a comprehensive welfare state is capable of bridging class divides and overcoming social categorization. However, over the past decades European welfare states experienced an ongoing influx of immigrants, challenging their general purpose and increasing notions of ‘welfare chauvinism’. Drawing on insights from both tolerance and welfare state solidarity literature, we implement hierarchical analyses based on Eurobarometer data to assess the potential influence of welfare state universalism on political and social tolerance in 15 Western European countries. Moreover, we demonstrate that this relationship is highly conditional on the degree of ethnic heterogeneity within a country.

The Project Share collection.

Cumulates abstracts which appeared in Journal of human services abstracts.