Demand and Financial Constraints in Eliminating Architectural and Technical Barriers for People with Disabilities in Poland.

The purpose of the study is to analyse the availability of financial resources for people with disabilities and to assess the needs satisfaction level of the disabled in order to eliminate architectural and technical barriers in Poland. The research conducted among the disabled affected by physical disability indicates that mobility barriers and obstacles remain among the most important problems encountered by people with disabilities. The research has shown that the problem of barriers increases with age. The elimination of architectural barriers requires, each time, higher financial expenditure, whereas the elimination of technical barriers improves the life quality of people with disabilities at low financial outlays. The average funding in Poland amounted to PLN 827.53 in 2016, including the funding of EUR 1453.60 for the elimination of architectural barriers and approx. EUR 582 for the removal of technical barriers. The financial resources allocated for this purpose do not cover the actual needs of the people with disabilities. The analysis revealed that the demand for investment in the elimination of barriers is increasing with age, whereas the expenditure of the Polish state is decreasing.

Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia.

BACKGROUND: Ghana has developed two main community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia: the integrated community case management (iCCM) and the community-based health planning and services (CHPS). The aim of the study was to assess the cost-effectiveness of these strategies under programme conditions. METHODS: A cost-effectiveness analysis was conducted. Appropriate diagnosis and treatment given was the effectiveness measure used. Appropriate diagnosis and treatment data was obtained from a household survey conducted 2 and 8 years after implementation of iCCM in the Volta and Northern Regions of Ghana, respectively. The study population was carers of children under-5 years who had fever, diarrhoea and/or cough in the last 2 weeks prior to the interview. Costs data was obtained mainly from the National Malaria Control Programme (NMCP), the Ministry of Health, CHPS compounds and from a household survey. RESULTS: Appropriate diagnosis and treatment of malaria, diarrhoea and suspected pneumonia was more cost-effective under the iCCM than under CHPS in the Volta Region, even after adjusting for different discount rates, facility costs and iCCM and CHPS utilization, but not when iCCM appropriate treatment was reduced by 50%. Due to low numbers of carers visiting a CBA in the Northern Region it was not possible to conduct a cost-effectiveness analysis in this region. However, the cost analysis showed that iCCM in the Northern Region had higher cost per malaria, diarrhoea and suspected pneumonia case diagnosed and treated when compared to the Volta Region and to the CHPS strategy in the Northern Region. CONCLUSIONS: Integrated community case management was more cost-effective than CHPS for the treatment of malaria, diarrhoea and suspected pneumonia when utilized by carers of children under-5 years in the Volta Region. A revision of the iCCM strategy in the Northern Region is needed to improve its cost-effectiveness. Long-term financing strategies should be explored including potential inclusion in the National Health Insurance Scheme (NHIS) benefit package. An acceptability study of including iCCM in the NHIS should be conducted.

Upgrading Existing Buildings to Universal Design. What Cost-Benefit Analyses Can Tell Us.

This article is based on a project aimed at finding the benefits of different measures to upgrade existing public buildings and outdoor areas to be accessible for all. The study was initiated by The Ministry of Children and Equality. The ministry asked for a study of benefits based on a stated preferences (SP) method and an easy-to-complete calculation tool for CBA. In the project 18 commonly used measures and their typical costs were identified. The benefits of each measure were analysed in a stated preference study. The SP analyses included 9 multiple choices in 4 different sequences in an Internet based survey with 800 respondents. The project concluded that it is possible to use stated preferences survey to identify the respondent's valuation of measures to improve accessibility in existing buildings. Some of the measures have a high cost-/benefit ratio. The project report including the calculation manual is based on the average valuation for each measure. But in the background analyses (not referred in the report) there are also some analyses of valuations for target groups for the various measures. The target groups were defined for each measure based on information about the respondents' abilities and use of technical aids. The analyses presented in this paper indicate how valuation varies between the target groups and the average population. This is named the measures profile. Some measures have benefits for the target group that are only twice as high as for the average citizen while another type of measures has high benefits only the target group. The first type which has a wide profile often has high overall socioeconomic benefits, while the last group with a narrow profile more often has low overall socioeconomic benefits, but may be very important for certain user groups and therefore essential for the elimination of discrimination and exclusion of those groups.

On Assessing the Costs and Benefits of Universal Design of ICT.

In the ICT and IT domains, Universal Design is typically viewed as a burden and an expense, and its application is often justified only by ethics and/or legislation. Advocates for Universal Design (UD) are arguing that it is cost-effective, but so far there are few studies that document this in a detailed way. In this work, we discuss related research and studies dealing with the costs and benefits of accessible and usable ICT solutions. In particular, we discuss the findings regarding what is a universally designed solution, what is needed to make such a solution, how much does it cost, what impact can be anticipated by the extra effort, and how it can be measured. Finally, we suggest an approach for carrying out cost-benefit analyses of developing universally designed solutions. There is a weak indication that the economical benefits of UD solutions are much higher than the initial and running costs.

A Delphi study of occurring information in housing adaptation certificates.

BACKGROUND: Since 1993, the Housing Adaptation Act has provided disabled people the opportunity to receive grants for adapting their homes. A housing adaptation certificate certifying the necessity of adaptations must accompany any application and if information in housing adaptation certificates is not sufficient, the applicant is risking not having necessary housing adaptations. OBJECTIVE: The aim of this study was to identify and describe what information is missing, unnecessary or vague, in the housing adaptation certificates; to determine how often this occur, and how problematic this can be for the decision process. MATERIAL AND METHODS: 105 housing adaptation grant managers took part in a three-round Delphi survey. RESULTS: At least 65% consensus was reached regarding the following six statements: missing information about disability duration, possession of relevant assistive devices, consequences of the disability in housing, prognosis of consequences, who the informant is, or contains preferences for specific solutions. Missing, unnecessary or vague information pose serious or less serious problems and 38-72% of the participants reported that this often or always occur. CONCLUSION: Housing adaptation certificates need to be improved. SIGNIFICANCE: The results of this study are used to design a checklist for use by housing adaptation certificate writers.

Factors associated with participation frequency and satisfaction among people applying for a housing adaptation grant.

BACKGROUND: People applying for a housing adaptation (HA) grant are at great risk of participation restrictions due to declining capacity and environmental barriers. AIM: To investigate the association of person-, environment-, and activity-related factors with participation frequency and satisfaction among people applying for a housing adaptation grant. MATERIAL AND METHODS: Baseline cross-sectional data were collected during home visits (n = 128). The association between person-, environment-, and activity-related factors and participation frequency and satisfaction was analysed using logistic regressions. RESULTS: The main result is that frequency of participation outside the home is strongly associated with dependence in activities of daily living (ADL) and cognitive impairments, while satisfaction with participation outside the home is strongly associated with self-reported health. Moreover, aspects of usability in the home were associated with frequency of participation outside the home and satisfaction with participation in the home and outside the home alone. CONCLUSION: Dependence in ADL, cognitive impairments, self-rated health, and aspects of usability are important factors contributing to participation frequency and satisfaction among people applying for a housing adaptation grant, particularly outside the home. SIGNIFICANCE: Our findings indicate that more attention should be directed towards activity-related factors to facilitate participation among HA applicants, inside and outside the home.

Evaluación de un programa comunitario para reducir el aislamiento de personas mayores debido a barreras arquitectónicas / Evaluation of a community program to reduce isolation in older people due to architectural barriers

Objetivo. Se llevó a cabo una intervención comunitaria para reducir el aislamiento de las personas mayores debido a barreras arquitectónicas. Este estudio evalúa sus efectos. Métodos. Estudio cuasiexperimental antes-después. Se localizaron en la comunidad personas mayores aisladas en tres zonas desfavorecidas en 2009-11. Salieron quincenalmente con voluntariado y una silla-oruga motorizada. Se estudió la satisfacción y se comparó, con pruebas de McNemar, su estado de salud percibido, su calidad de vida y su salud mental antes y después de cuatro salidas. Resultados. Participaron 74 personas (edad mediana: 83 años; rango intercuartílico: 78-89). La salud percibida mejoró un 21%, la mental un 24% y el malestar psicológico se redujo un 16%. El 98% estaban satisfechas. Conclusiones. La intervención mejoró la salud percibida y la salud mental de las personas participantes. Debería evitarse que estas personas residan en edificios con barreras arquitectónicas, y si no es posible, implementar programas similares a éste (AU)

Objective. Social isolation impairs health. An intervention to reduce isolation due to architectural barriers in elderly persons was carried out in Barcelona (Spain). This study aimed to evaluate its effects on health. Methods. We conducted a quasi-experimental before-after study. Isolated older people were identified in three deprived urban areas from 2009 to 2011. Participants had twice-weekly outings with volunteers in a stair-climbing power wheelchair. User satisfaction was evaluated and perceived health status, quality of life, and mental health before and after four outings were compared with McNemar tests. Results. There were 74 participants (median age: 83 years; IQR: 78-89). Perceived health improved by 21%, mental health by 24%, and psychological distress was reduced by 16%. Most participants (98%) were satisfied. Conclusion. The intervention improved perceived health and mental health. Elderly people with impaired mobility should not live in buildings with architectural barriers and, if this cannot be avoided, similar programs should be implemented (AU)

Evaluation of housing adaptation interventions: integrating the economic perspective into occupational therapy practice.

OBJECTIVE: The home environment is a key determinant of health, quality of life, and well-being. Given its relevance for such aspects, the scarcity of evaluations of housing adaptation (HA) interventions aimed at removing environmental barriers and accessibility problems in the homes of people with disabilities is surprising. This article aims to contribute to the development of strategies for economic evaluations of HA interventions, by stimulating the dissemination and application of the concepts of effectiveness, cost, and cost-effectiveness as used within health economics. METHODS: The focus is limited to three overarching questions for the evaluation of HA interventions. Considering X and Y as two hypothetical interventions for the same individual case, the article asks: (i) Will X be more effective than Y?; (ii) Will X cost more than Y?, and (iii) Will X be more cost-effective than Y? Vignette-like descriptions of fictional cases are used to exemplify the economic concepts explained in the article. RESULTS AND CONCLUSION: In the conclusion, the need is stressed for new experimental data regarding both costs and outcomes of HA interventions, in order to realize sound evaluations with the potential to inform policy and professionals in this field. Given the heterogeneity among national contexts, systematic approaches applied in a coherent manner could strengthen cross-national research and collaborations.

Reducing the risk of an awDA lawsuit.

Improving access to your dental office now is cheaper than waiting to be sued.

Analysis of the cost effectiveness of a suicide barrier on the Golden Gate Bridge.

BACKGROUND: The Golden Gate Bridge (GGB) is a well-known "suicide magnet" and the site of approximately 30 suicides per year. Recently, a suicide barrier was approved to prevent further suicides. AIMS: To estimate the cost-effectiveness of the proposed suicide barrier, we compared the proposed costs of the barrier over a 20-year period ($51.6 million) to estimated reductions in mortality. METHOD: We reviewed San Francisco and Golden Gate Bridge suicides over a 70-year period (1936-2006). We assumed that all suicides prevented by the barrier would attempt suicide with alternative methods and estimated the mortality reduction based on the difference in lethality between GGB jumps and other suicide methods. Cost/benefit analyses utilized estimates of value of statistical life (VSL) used in highway projects. RESULTS: GGB suicides occur at a rate of approximately 30 per year, with a lethality of 98%. Jumping from other structures has an average lethality of 47%. Assuming that unsuccessful suicides eventually committed suicide at previously reported (12-13%) rates, approximately 286 lives would be saved over a 20-year period at an average cost/life of approximately $180,419 i.e., roughly 6% of US Department of Transportation minimal VSL estimate ($3.2 million). CONCLUSIONS: Cost-benefit analysis suggests that a suicide barrier on the GGB would result in a highly cost-effective reduction in suicide mortality in the San Francisco Bay Area.

The role of health systems factors in facilitating access to psychotropic medicines: a cross-sectional analysis of the WHO-AIMS in 63 low- and middle-income countries.

BACKGROUND: Neuropsychiatric conditions comprise 14% of the global burden of disease and 30% of all noncommunicable disease. Despite the existence of cost-effective interventions, including administration of psychotropic medicines, the number of persons who remain untreated is as high as 85% in low- and middle-income countries (LAMICs). While access to psychotropic medicines varies substantially across countries, no studies to date have empirically investigated potential health systems factors underlying this issue. METHODS AND FINDINGS: This study uses a cross-sectional sample of 63 LAMICs and country regions to identify key health systems components associated with access to psychotropic medicines. Data from countries that completed the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) were included in multiple regression analyses to investigate the role of five major mental health systems domains in shaping medicine availability and affordability. These domains are: mental health legislation, human rights implementations, mental health care financing, human resources, and the role of advocacy groups. Availability of psychotropic medicines was associated with features of all five mental health systems domains. Most notably, within the domain of mental health legislation, a comprehensive national mental health plan was associated with 15% greater availability; and in terms of advocacy groups, the participation of family-based organizations in the development of mental health legislation was associated with 17% greater availability. Only three measures were related with affordability of medicines to consumers: level of human resources, percentage of countries' health budget dedicated to mental health, and availability of mental health care in prisons. Controlling for country development, as measured by the Human Development Index, health systems features were associated with medicine availability but not affordability. CONCLUSIONS: Results suggest that strengthening particular facets of mental health systems might improve availability of psychotropic medicines and that overall country development is associated with affordability.

An economic evaluation of setting up physical barriers in railway stations for preventing railway injury: evidence from Hong Kong.

BACKGROUND: Setting physical barriers, for example platform screen doors (PSDs), has been proven to be effective in preventing falls onto railway tracks, but its cost-effectiveness is not known. For economic evaluation of public health interventions, the importance of including non-health factors has been noted despite a lack of empirical studies. This study aimed to investigate the effectiveness and cost-effectiveness of PSDs, which are installed in part of the Hong Kong railway system, for preventing railway injuries. METHODS: Data on railway injuries from 1997 to 2007 were obtained from the railway operators. Poisson regression was used to examine the risk reduction. Two incremental cost-effectiveness ratios (ICER) were calculated to assess the cost-effectiveness based on (1) disability-adjusted life years (DALYs) only and (2) DALYs with potential fare revenue and passengers' waiting time lost due to railway circulation collapse. RESULTS: The PSD installation has effectively reduced railway injuries (adjusted 5-year average percentage change: -68.8%, p<0.0001) with no apparent substitution effect to the other platforms observed. To be cost-effective, the cost of gaining a healthy life year (ICER) should not exceed three times the per capita GDP (US$74,700). The PSD installation would only be cost-effective if the loss of fare revenue and passengers' waiting time, in addition to DALY, were included (ICER: US$65,400), while the ICER based on DALY only would be US$77,900. CONCLUSION: The challenges of complexity for economic evaluation appear in many community-based health interventions. A more extensive perspective for exploring other outcome measurements and evaluation methods to reflect a fair and appropriate value of the intervention's cost-effectiveness is needed.

The Disability Discrimination Act and Access: practical suggestions.

UNLABELLED: This paper presents the results of a study exploring the implementation of the Disability Discrimination Act Access Guidelines amongst General Dental Practitioners based in Aylesbury town centre. Fourteen potential barriers to compliance are identified around the key concerns of cost, planning regulations and lack of information. Practical suggestions are then offered in line with the 'Inclusive Approach' to enable practitioners to meet the requirements and overcome practical difficulties. CLINICAL RELEVANCE: From October 2004, all general dental practices have been required to take, or begin to plan, reasonable steps to improve access to their dental surgeries in order to comply with the Disability Discrimination Act.

Disability part 3: improving access to dental practices in Merseyside.

Several Merseyside dental practices took part in disability access audits of practice premises and practice staff took part in disability awareness training. Grants were awarded to part-fund improvements to practice facilities in line with the recommendations in the audit reports. The dental teams reported that the awareness training was very valuable and many common issues arose from the audits. Access for disabled people needs to be considered in all practice developments to ensure that dental practices comply with Part III of the Disability Discrimination Act by 2004.