La Accesibilidad universal y el diseño para todos: los ejes determinantes de las políticas de igualdad de oportunidades III

Capítol del llibre "Tratado sobre la discapacidad", R. De Lorenzo, L. Cayo Pérez Bueno. Navarra: Thomson Aranzadi,2007. Planteja el significat dels conceptes "Accessibilitat Universal", que és fonamentalment la condició que han de complir els entorns, processos, bens, productes i serveis, així com els objectes o instruments, eines i dispositius, per a ser comprensibles, utilitzables i practicables per a totes les persones en condicions de seguretat i comoditat i de la manera més autònoma possible.. Això pressuposa el "Disseny per a tothom" i s'entén que sense perjudici dels ajustos raonables que s'hagin d'adoptar.

La Accesibilidad universal en los municipios: guía para una política integral de promoción y gestión

Conscientes de las complejidades que presenta la organización administrativa local y la diversidad que caracteriza a los Ayuntamientos de España, y lejos de querer establecer fórmulas mágicas o generalizar soluciones, con esta Guía se pretende aportar ideas útiles mediante propuestas y algunos ejemplos; con ella se quiere ayudar a promover distintas intervenciones a favor de la accesibilidad en los municipios. En este sentido, esta Guía pretende ser soporte para desarrollar una nueva etapa de intervención municipal en accesibilidad, que vaya más allá de la mera supresión de barreras y se prevenga su creación. Las medidas que se desarrollan son posibles vías para que los gobiernos locales puedan gestionar y promocionar de forma eficaz la accesibilidad en el municipio y así establecer una base sobre la cual todos los ciudadanos puedan desarrollar sus libertades individuales plenamente.

Guía para el diseño e implementación de un master en accesibilidad universal. La aplicación del diseño para todos en entornos, productos y servicios

Esta Guía nace con la intención de impulsar en esta situación poco favorable el desarrollo del mencionado curso de postgrado en la universidad española. En ese sentido, pretende ser un recurso a utilizar por el profesorado universitario y el grupo de expertos en accesibilidad que constituya el futuro equipo docente de esta iniciativa formativa, como punto de partida para el necesario proceso de concreción curricular que tendrán que realizar. Queremos destacar aquí que esta guía no se concibe, por tanto, como el programa de un Master en accesibilidad Universal, aunque incluye a modo de ejemplo una propuesta concreta, sino como un conjunto de recursos a utilizar para elaborarlo, respetando así el principio de autonomía universitaria y docente en el que creemos firmemente.

Prevalence of frailty indicators and association with socioeconomic status in middle-aged and older adults in a swiss region with universal health insurance coverage : a population-based cross-sectional study

Frailty prevalence in older adults has been reported but is largely unknown in middle-aged adults. We determined the prevalence of frailty indicators among middle-aged and older adults from a general Swiss population characterized by universal health insurance coverage and assessed the determinants of frailty with a special focus on socioeconomic status. Participants aged 50 and more from the population-based 2006-2010 Bus Santé study were included (N = 2,930). Four frailty indicators (weakness, shrinking, exhaustion, and low activity) were measured according to standard definitions. Multivariate logistic regressions were used to determine associations. Overall, 63.5%, 28.7%, and 7.8% participants presented no frailty indicators, one frailty indicator, and two or more frailty indicators, respectively. Among middle-aged participants (50-65 years), 75.1%, 22.2%, and 2.7% presented 0, 1, and 2 or more frailty indicators. The number of frailty indicators was positively associated with age, hypertension, and current smoking and negatively associated with male gender, body mass index, waist-to-hip ratio, and serum total cholesterol level. Lower income level but not education was associated with higher number of frailty indicators. Frailty indicators are frequently encountered in both older and middle-aged adults from the Swiss general population. Despite universal health insurance coverage, household income is independently associated with frailty.

Universal banking, competition and risk in a macro model

A stylized macroeconomic model is developed with an indebted, heterogeneous Investment Banking Sector funded by borrowing from a retail banking sector. The government guarantees retail deposits. Investment banks choose how risky their activities should be. We compared the benefits of separated vs. universal banking modelled as a vertical integration of the retail and investment banks. The incidence of banking default is considered under different constellations of shocks and degrees of competitiveness. The benefits of universal banking rise in the volatility of idiosyncratic shocks to trading strategies and are positive even for very bad common shocks, even though government bailouts, which are costly, are larger compared to the case of separated banking entities. The welfare assessment of the structure of banks may depend crucially on the kinds of shock hitting the economy as well as on the efficiency of government intervention.

Optimal Universal and Categorical Benefits with Classification Errors and Imperfect Enforcement

We determine he optimal combination of a universal benefit, B, and categorical benefit, C, for an economy in which individuals differ in both their ability to work - modelled as an exogenous zero quantity constraint on labour supply - and, conditional on being able to work, their productivity at work. C is targeted at those unable to work, and is conditioned in two dimensions: ex-ante an individual must be unable to work and be awarded the benefit, whilst ex-post a recipient must not subsequently work. However, the ex-ante conditionality may be imperfectly enforced due to Type I (false rejection) and Type II (false award) classification errors, whilst, in addition, the ex-post conditionality may be imperfectly enforced. If there are no classification errors - and thus no enforcement issues - it is always optimal to set C>0, whilst B=0 only if the benefit budget is sufficiently small. However, when classification errors occur, B=0 only if there are no Type I errors and the benefit budget is sufficiently small, while the conditions under which C>0 depend on the enforcement of the ex-post conditionality. We consider two discrete alternatives. Under No Enforcement C>0 only if the test administering C has some discriminatory power. In addition, social welfare is decreasing in the propensity to make each type error. However, under Full Enforcement C>0 for all levels of discriminatory power. Furthermore, whilst social welfare is decreasing in the propensity to make Type I errors, there are certain conditions under which it is increasing in the propensity to make Type II errors. This implies that there may be conditions under which it would be welfare enhancing to lower the chosen eligibility threshold - support the suggestion by Goodin (1985) to "err on the side of kindness".

General Practitioners' willingness to pay for continuing medical education in a fee-for-service universal coverage health care system

Background: Sponsoring of physicians meetings by life science companies has led to reduced participation fees but might influence physician's prescription practices. A ban on such sponsoring may increase participation fees. We aimed to evaluate factors associated with physicians' willingness to pay for medical meetings, their position on the sponsoring of medical meetings and their opinion on alternative financing options. Methods: An anonymous web-based questionnaire was sent to 447 general practitioners in one state in Switzerland, identified through their affiliation to a medical association. The questionnaire evaluated physicians' willingness to pay for medical meetings, their perception of a bias in prescription practices induced by commercial support, their opinion on the introduction of a binding legislation and alternative financing options, their frequency of exchange with sales representatives and other relevant socioeconomic factors. We built a multivariate predictor logistic regression model to identify determinants of willingness to pay. Results: Of the 115 physicians who responded (response rate 26%), 48% were willing to pay more than what they currently pay for congresses, 79% disagreed that commercial support introduced a bias in their prescription practices and 61% disagreed that it introduced a bias in their colleagues' prescription practices. Based on the multivariate logistic regression, perception of a bias in peers prescription practices (OR=7.47, 95% CI 1.65-38.18) and group practice structure (OR=4.62, 95% CI 1.34-22.29) were significantly associated with an increase in willingness to pay. Two thirds (76%) of physicians did not support the introduction of a binding legislation and 53% were in favour of creating a general fund administered by an independent body. Conclusion: Our results suggest that almost half of physicians surveyed are willing to pay more than what they currently pay for congresses. Predictors of an increase in physicians' willingness to pay were perception of the influence of bias in peers prescription practices and group practice structure. Most responders did not agree that sponsoring introduced prescribing bias nor did they support the 2 introduction of a binding legislation prohibiting sponsoring but a majority did agree to an independent body that would centrally administer a general fund.

The quality of primary care in a country with universal health care coverage.

BACKGROUND: Standard indicators of quality of care have been developed in the United States. Limited information exists about quality of care in countries with universal health care coverage.OBJECTIVE: To assess the quality of preventive care and care for cardiovascular risk factors in a country with universal health care coverage.DESIGN AND PARTICIPANTS: Retrospective cohort of a random sample of 1,002 patients aged 50-80 years followed for 2 years from all Swiss university primary care settings.MAIN MEASURES: We used indicators derived from RAND's Quality Assessment Tools. Each indicator was scored by dividing the number of episodes when recommended care was delivered by the number of times patients were eligible for indicators. Aggregate scores were calculated by taking into account the number of eligible patients for each indicator.KEY RESULTS: Overall, patients (44% women) received 69% of recommended preventive care, but rates differed by indicators. Indicators assessing annual blood pressure and weight measurements (both 95%) were more likely to be met than indicators assessing smoking cessation counseling (72%), breast (40%) and colon cancer screening (35%; all p < 0.001 for comparisons with blood pressure and weight measurements). Eighty-three percent of patients received the recommended care for cardiovascular risk factors, including > 75% for hypertension, dyslipidemia and diabetes. However, foot examination was performed only in 50% of patients with diabetes. Prevention indicators were more likely to be met in men (72.2% vs 65.3% in women, p < 0.001) and patients < 65 years (70.1% vs 68.0% in those a parts per thousand yen65 years, p = 0.047).CONCLUSIONS: Using standardized tools, these adults received 69% of recommended preventive care and 83% of care for cardiovascular risk factors in Switzerland, a country with universal coverage. Prevention indicator rates were lower for women and the elderly, and for cancer screening. Our study helps pave the way for targeted quality improvement initiatives and broader assessment of health care in Continental Europe.

Cultural relativism in the Universal Periodic Review of the Human Rights Council

This Working Paper aims to offer an up-to-date list of cultural relativist players and arguments with respect to human rights, constituted by China, Viet Nam, Myanmar, Iran, Pakistan, Yemen, Syria, Malaysia and Cuba. This working paper argues that Indonesia, Iraq, Colombia and Mexico are not in the same cultural relativist group of states maintained by renowned scholars, notably Cristina Cerna and Dianne Otto. As such, apart from this form of cultural relativism based on the respect for the self-determination of indigenous peoples and communities, this working paper exposes two different categories of radical cultural relativism based on revolutionary discourse and/or radical Islamism, as well as targets the credibility on the latter two based on the information facilitated by the United Nations (UN) Human Rights Council (HRC) Universal Periodic Review (UPR).

Call for Submissions: White Paper on Universal Health Insurance - Supporting Documents

  The Department of Health has published a White Paper on Universal Health Insurance. The White Paper sets out in detail the elements of the proposed Universal Health Insurance model for Ireland. As such, it provides detail on the overall design of the model, the proposed system for deciding on the standard package of services and the financing mechanisms for the system. This is a most fundamental reform of the health system and we recognise the importance of consulting extensively and inclusively with all interested parties.  It is important to seek your views on the policy as it is set out in the White Paper, and we view this as a valuable opportunity for citizens to contribute to the development of policy on the future of their health system.  Therefore, we would like to hear from any individual, group, organisation or other body that wishes to contribute to the consultation on the White Paper. In particular, but not limited to, we would welcome your views on the following issues: A consultation document setting out a number of key questions under each of the above headings has been developed and can be downloaded here. There is an opportunity at the end of the document for views or comments on other aspects of the White Paper to be provided. Alternatively, additional views or comments can be sent as an email or hard copy to the addresses below. It is intended to establish a separate independent Expert Commission to examine the issues around the basket of services to be provided under UHI and within the overall health system. The Minister will announce details of the Commission in the near future. Therefore, it would be useful if the submissions on the White Paper refrained from commenting in detail on the services to be provided under UHI. Views on the basket of services will be sought by the Commission when it commences its consultation process. The White Paper can be downloaded here, and two further supporting documents Background Policy Paper on Designing the Future Health Basket and Background Policy Paper on Raising Resources for Universal Health Insurance, which informed the development of the White Paper are also available for download. Links to other supporting documentation that informed the White Paper are also provided below. Submissions can be submitted: By E-mail to: uhiwhitepaper@health.gov.ie By Post to: UHI White Paper UHI UnitDepartment of HealthRoom 7.26Hawkins HouseHawkins StreetDublin 2 The closing date for submissions is close of business 28th May 2014 and will be strictly adhered to. All submissions received will be subject to the Freedom of Information Acts 1997 & 2003 and may be released in response to a Freedom of Information request. Download the consultation document (MS Word) (From the website of the Health Research Board) Integration of health and wellbeing services with general health services The integration of health and social care services

The Path to Universal Healthcare: White Paper on Universal Health Insurance

  The Government is committed to ending the unfair, unequal and inefficient two-tier health system and to introducing a single-tier system, supported by universal health insurance The Government will achieve a single-tier system via a multi-payer model of universal health insurance (UHI), in line with the Programme for Government (PfG), involving competing private health insurers and a State-owned VHI. UHI will be gradually rolled out over several years, with full implementation by 2019 at the latest. Click here to download the White Paper (PDF, 1.5mb) Read the UHI Explained document (PDF, 200kb). See the stakeholder briefing (PDF, 400kb)

Universal screening and decolonization for control of MRSA in nursing homes : a cluster randomized controlled study

OBJECTIVE The risk of carrying methicillin-resistant Staphylococcus aureus (MRSA) is higher among nursing home (NH) residents than in the general population. However, control strategies are not clearly defined in this setting. In this study, we compared the impact of standard precautions either alone (control) or combined with screening of residents and decolonization of carriers (intervention) to control MRSA in NHs. DESIGN Cluster randomized controlled trial SETTING NHs of the state of Vaud, Switzerland PARTICIPANTS Of 157 total NHs in Vaud, 104 (67%) participated in the study. INTERVENTION Standard precautions were enforced in all participating NHs, and residents underwent MRSA screening at baseline and 12 months thereafter. All carriers identified in intervention NHs, either at study entry or among newly admitted residents, underwent topical decolonization combined with environmental disinfection, except in cases of MRSA infection, MRSA bacteriuria, or deep skin ulcers. RESULTS NHs were randomly allocated to a control group (51 NHs, 2,412 residents) or an intervention group (53 NHs, 2,338 residents). Characteristics of NHs and residents were similar in both groups. The mean screening rates were 86% (range, 27%-100%) in control NHs and 87% (20%-100%) in intervention NHs. Prevalence of MRSA carriage averaged 8.9% in both control NHs (range, 0%-43%) and intervention NHs (range, 0%-38%) at baseline, and this rate significantly declined to 6.6% in control NHs and to 5.8% in intervention NHs after 12 months. However, the decline did not differ between groups (P=.66). CONCLUSION Universal screening followed by decolonization of carriers did not significantly reduce the prevalence of the MRSA carriage rate at 1 year compared with standard precautions

Stroke initial severity and outcome relative to insurance status in a universal health care system in Switzerland

Contexte et but de l'étude :Le statut socio-économique est suspecté d'avoir une influence significative sur l'incidence des attaques cérébrales (AVC), sur les facteurs de risque cardio-vasculaire, ainsi que sur le pronostic. L'influence de ce statut socio-économique sur la sévérité de l'AVC et sur les mécanismes physiopathologiques sous-jacents est moins connue.Méthode :Sur une période de 4 ans, nous avons collecté de manière prospective (dans un registre) des données concernant tous les patients avec AVC aigus admis à l'Unité Cérébrovasculaire du CHUV. Les données comprenaient le statut assécurologique du patient (assurance privée ou générale), les données démographiques, les facteurs de risque cérébrovasculaires, l'utilisation de traitements aigus de recanalisation vasculaire, le délai avant l'admission à l'hôpital, ainsi que la sévérité et le pronostic de l'AVC en phase aiguë, à 7 jours et à 3 mois des symptômes. Les patients avec assurance privée ont été comparés à ceux avec assurance générale.Résultats :Sur 1062 patients avec AVC, 203 avaient une assurance privée et 859 avaient une assurance générale. Il y a avait 585 hommes et 477 femmes. Les deux populations étaient similaires en âge. Les facteurs de risque cardio-vasculaire, la médication préventive, le délai d'arrivée à l'hôpital, l'incidence du taux de thrombolyse et l'étiologie de l'AVC ne différaient pas dans les deux populations. Le score de gravité de l'AVC en phase aiguë, mesuré par le NIHSS, était significativement plus élevé chez les patients avec assurance générale. Un pronostic favorable, mesuré par le score de Rankin modifié (mRS), était plus fréquemment obtenu à 7 jours et à 3 mois chez les patients avec assurance privée.Commentaires :Un statut socio-économique bas est associé à une incidence plus élevée de maladies cérébrovasculaires ainsi qu'à un plus mauvais pronostic, comme cela a été démontré dans différents pays. Il a été suspecté que l'accès à une prise en charge spécialisée en phase aiguë ou en rééducation soit différent selon le statut socio-économique. Comme la Suisse a un système de santé universel, avec une couverture assécurologique obligatoire pour chaque habitant, il y a là une occasion unique de comparer l'influence de l'aspect socio-économique sur la sévérité et le pronostic de l'AVC. De plus, les patients ont été admis dans la même Unité Cérébrovasculaire et pris en charge par la même équipe médicale.Conclusion et perspectives :Le lien entre le statut assécurologique et le statut socio-économique a déjà été prouvé par le passé dans d'autres pays. Nous avons mis en évidence une sévérité plus importante et un plus mauvais pronostic chez les patients avec assurance générale dans la population étudiée. L'étiologie de cette différence dans un système de santé à couverture universelle comme celui de la Suisse reste peu claire. Elle devrait être étudiée à plus grande échelle.

Creació d'una ontologia universal

L'objectiu d'aquest treball és introduir al lector en les tecnologies que condueixen al desenvolupament de la web semàntica, destacant-ne les parts més importants d'aquestes i veient com cadascuna amplia la funcionalitat de la seva predecessora a l'hora d'aportar un sentit semàntic als documents.