Effect of long-term care insurance policy on depression in non-disabled people: evidence from China.

BACKGROUND: Policy effect might be multidimensional and spill over to non-recipients. It is unclear how the implementation of Long-Term Care Insurance (LTCI) policy affects depression in non-disabled people and how this effect differs in different non-disabled groups. METHODS: Using time-varying differences-in-differences method and nationally representative health survey data in wave 2011, wave 2013, wave 2015 and wave 2018 from the China Health and Retirement Longitudinal Study, we assessed the effect of LTCI policy on depression in non-disabled people aged 45 years and older, and discussed the heterogeneity of effect across different population characteristics: retirement, financial support and social participation status. RESULTS: We found LTCI policy statistically significant reduced depression by 0.76 units in non-disabled people compared to non-pilot cities. Depression in non-disabled people who unretired, with financial support and without social participation was reduced by 0.8267, 0.7079 and 1.2161 units, respectively. CONCLUSIONS: Depression in non-disabled people was statistically significant reduced because of LTCI policy in China, and non-disabled people who unretired, with financial support and without social participation benefited more from LTCI policy. Our findings highlight the depression-reducing effect of LTCI policy in non-recipients and suggest that non-disabled people who unretired, with financial support and without social participation should be concerned during LTCI policy progress.

Links across disabilities: unveiling associations between functional domains.

BACKGROUND: Persons with disabilities experience higher risks of mortality as well as poorer health as compared to the general population. The aim of this study is to estimate the correlations between functional difficulties across several domains in six countries. METHODS: National census data with questions on disability from six countries (Mauritius, Morocco, Senegal, Myanmar, Vietnam, and Uruguay) was used in this study. We performed logistic regressions to assess the extent to which having a functional difficulty in one domain is correlated with having a functional difficulty in each of the other domains and report weighted odds ratios (ORs) overall and within age-groups ('18-44' years and '45+' years). Models adjust for age, sex, and location (rural or urban). Sensitivity analyses around different choices of predictors and response variables were conducted. FINDINGS: For all countries, reporting a functional difficulty in one domain was consistently and significantly positively correlated with reporting a functional difficulty in other domains (overall) and for each of the two age-groups considered - '18-44' years and '45+' years. All ORs were greater than one. Cognition, mobility, and hearing were the domains that were the most correlated ones with other domains. The highest pairwise correlations were for i/ hearing and cognition; ii/ mobility and cognition. Results were robust to changing the severity thresholds for functional difficulties. Across countries, Uruguay, the only high-income country among the six countries under study, had the lowest correlations between functional domains. CONCLUSIONS: There are consistent positive associations in the experience of functional difficulties in various domains in the six countries under study. Such correlations may reflect barriers to social services including healthcare services and resources (e.g. assistive devices) that may lead to an avoidable deterioration of functioning across domains. Further research is needed on the trajectories of functional difficulties and on structural barriers that people with functional difficulties may experience in their communities and in healthcare settings in particular. This is important as some functional difficulties may be preventable.

Tackling physical inactivity and inequalities: implementing a whole systems approach to transform community provision for disabled people and people with long-term health conditions.

BACKGROUND: Physical inactivity is a global public health priority. There are known health and well-being consequences of being inactive, and the benefits of being physically active are well established. However, there are persistent inequalities when it comes to how physically active people are, with disabled people, people living with long-term health conditions, and people residing in areas of socio-economic deprivation being particularly affected. Methods such as whole system approaches (WSAs), which are dynamic, multifaceted, and engage all relevant stakeholders, have gained momentum as an approach to address such complex public health problems. However, evidence relating to the implementation of WSAs to address physical inactivity is lacking. The aim of the Prevention and Enablement Model (PEM) was to take a whole system approach in Essex to encourage and support disabled people and/or individuals living with long-term health conditions to be more active, happier, and to live more independently. METHODS: The aim of this study was to explore the enablers, challenges, and reflections associated with the process of designing and implementing the PEM. Semi-structured interviews (n = 12) were used to collect data from people involved in the PEM's design, implementation and/or delivery. Data was analysed using Braun and Clarke's reflexive thematic analysis. RESULTS: Four themes were identified: (1) Working collaboratively: Specific enablers of time and space were identified as important in the planning and implementation of a WSA (2) Leadership and planning: Distributed and flexible leadership was identified as central to successful implementation (3) Re-orientating practice: Highlighted the transformative potential of a whole system approach and how it contrasts with conventional work practices, and (4) Reflection and learning: Informing ongoing refinements and further implementation of successful system change. CONCLUSIONS: These findings highlight the challenge and complexity of implementing a WSA that involves diverse stakeholders from across adult social care, the NHS, and the third sector. Several important enablers are identified, such as leadership and planning, and the challenges and discomfort that can arise whilst changing systems. Ongoing efforts are required to ensure that different elements of the system collaborate effectively to address inequalities in physical activity participation, through the implementation of a WSA.

[Development and improvement of the long-term care system in Russia].

Recent demographic trends, particularly the aging of the population, make the issue of ensuring a dignified old age urgent. Russia, as a developed country in the socio-economic sense, at the state level strives to increase the life expectancy of the population; at the same time, it is necessary to set and ensure the achievement of targets for improving the quality of life of the older generation. An important element here is the provision of palliative medical care to people of retirement age and people with disabilities. Until recently, there was virtually no long-term care system in Russia, and the burden was distributed between the healthcare system and the relatives of citizens in need of care. The launch of a pilot project to develop a long-term care system within the framework of the national project "Demography" showed the widespread demand for palliative care services. The article analyzes all aspects of the development of the long-term care system in Russia, identifying both positive results of the pilot project and points of growth. The main obstacle to implementing a long-term care system at the federal level is agreeing on a funding model. Here it makes sense to rely on successful international experience and consider the practical implementation of long-term care programs in various countries. However, the development of a long-term care system and ensuring the processes of its sustainable functioning is an important element of the state's social policy, which must be included in the standard list of social services and developed everywhere.

Can a disability studies-medical sociology rapprochement help re-value the work disabled people do within their rehabilitation?

This paper draws attention to the health-related work that disabled people do when engaging with rehabilitation services. Medical sociology has a rich history of looking at the 'illness work' that patients do, while disability studies scholars have explored the cultural value placed upon paid work and the effects on social status of being unable to work. Yet, a longstanding froideur between these two disciplines, which have fundamentally opposed ontologies of illness and disability, means that neither discipline has attended closely to the rehabilitation-related work that disabled people do. The concept of 'adjusting' to illness highlights seemingly irreconcilable disciplinary differences. Yet this article argues that the notion of 'adjustment work' can elucidate the socio-political character of the work disabled people do in their rehabilitation, which could create a more substantial and sustainable dialogue on this subject between disability studies and medical sociology. To make this case, we discuss interview data from the Rights-based Rehabilitation project, which sought to explore disabled people's lived experiences of rehabilitation.

Control of a Production Manipulator with the Use of BCI in Conjunction with an Industrial PLC.

Research in the field of gathering and analyzing biological signals is growing. The sensors are becoming more available and more non-invasive for examining such signals, which in the past required the inconvenient acquisition of data. This was achieved mainly by the fact that biological sensors were able to be built into wearable and portable devices. The representation and analysis of EEGs (electroencephalograms) is nowadays commonly used in various application areas. The application of the use of the EEG signals to the field of automation is still an unexplored area and therefore provides opportunities for interesting research. In our research, we focused on the area of processing automation; especially the use of the EEG signals to bridge the communication between control of individual processes and a human. In this study, the real-time communication between a PLC (programmable logic controller) and BCI (brain computer interface) was investigated and described. In the future, this approach can help people with physical disabilities to control certain machines or devices and therefore it could find applicability in overcoming physical disabilities. The main contribution of the article is, that we have demonstrated the possibility of interaction between a person and a manipulator controlled by a PLC with the help of a BCI. Potentially, with the expansion of functionality, such solutions will allow a person with physical disabilities to participate in the production process.

Willingness to pay, familiarity and political attitudes: The case of integrating people with intellectual disabilities.

BACKGROUND: Integrating people with intellectual disabilities into the community has become a major goal in improving society in general. Our study adds an important layer to discussions of how to achieve this goal. METHOD: We examine both the willingness to integrate people into the community and their willingness to pay for this integration. Using a representative sample of 813 Israeli respondents, we consider two factors in these attitudes: familiarity with the issue and people's political attitudes. RESULTS: We found that most people are willing to integrate people with intellectual disabilities into the community and some people are willing to pay for this integration. Those who are familiar with people with intellectual disabilities and those from the left side of the political map are more willing to pay to achieve this goal. CONCLUSIONS: Familiarity and political attitudes matter in the willingness to pay to integrate people with intellectual disabilities into the community.

Effects of Social Exclusion on Psychological-Well-Being and Suicidal Possibilities Among People With Physical Disabilities.

This study aimed to examine the effect of social exclusion on psychological well-being and suicide possibilities among people with physical disabilities. This descriptive and cross-sectional type study was conducted among people with physical disabilities who are members of the Association of Disabled People. Data were collected using the face-to-face interview method with the "Participant Information Form," "Social Exclusion Scale for the People with Disabilities," "Psychological Well-Being Scale," and "Suicide Probability Scale." It was found that the disabled people participating in the study experienced moderate social exclusion with a score of 72.35 + 31.53, a moderate level of well-being with a score of 34.79 + 16.80, and above a moderate level of suicidal ideation with a score of 78.58 + 9.85. Also, there was a negative moderate and significant relationship between social exclusion and psychological well-being (p < 0.01; r: -0.492), while there was a positive strong relationship between social exclusion and the possibility of suicide (p < 0.01; r: 0.518).

[The establishment of possibilities to increase life quality of patients of nursing homes: the resources of ergo-therapy].

In connection with the growing number of people with disabilities in the Russian Federation, there is a need to improve rehabilitation care and bring it into line with international models. The article discusses possibilities of ergo-therapy in improving quality of life of people with disabilities living in nursing homes. The results of qualitative study of medical and social work in nursing homes of elderly and disabled people are presented. The purpose of the study was to identify needs in professional ergo-therapy work in stationary type institutions. The article presents the results of original study carried out in 2023 using method of interviewing medical and social workers (n = 13) in two regions (Saratov, Penza). The study permitted to identify the most acute problem areas requiring ergo-therapy to improve the quality of life of patients in nursing homes for disabled and elderly persons. The study resulted in conclusions that to improve the quality of life both of patients in residential institutions and the level of satisfaction of citizens with social policy it is necessary to organize and implement ergo-therapy service in stationary institutions. The current situation requires presence of ergo-therapists in social institutions and health care, as their role and importance in supporting patients are increasing.

Personal factors that affect disabled people's access to healthcare in the Bosomtwe District of Ghana.

The health status and quality of life of disabled people are of immense public health concern and the Sustainable Development Goals cannot be achieved if the healthcare needs of disabled people are not met. A qualitative case study was conducted in the Bosomtwe District of Ghana to ascertain personal factors that affect disabled people's access to healthcare in the context of disability stigma. A total of 30 disabled participants were selected through purposive sampling, and data were collected through an interview guide utilizing a face-to-face interview and focus group discussion. Themes were developed and presented as findings and relevant quotes have been provided to support the findings. The study found factors such as self-stigma, knowledge about disability condition, financial challenges, location and accessibility challenges, communication challenges and lack of personal assistants which affect their access to healthcare. The experiences of disabled people have influenced them to construct their meanings regarding their conditions and subsequent health-seeking behavior. It is recommended that the district health directorate in collaboration with the National Commission for Civic Education should intensify public health education in the district which should be custom-made to suit the community's needs and understanding of disability taking into account local culture and belief system.

A Two-Phase Machine Learning Framework for Context-Aware Service Selection to Empower People with Disabilities.

The use of software and IoT services is increasing significantly among people with special needs, who constitute 15% of the world's population. However, selecting appropriate services to create a composite assistive service based on the evolving needs and context of disabled user groups remains a challenging research endeavor. Our research applies a scenario-based design technique to contribute (1) an inclusive disability ontology for assistive service selection, (2) semi-synthetic generated disability service datasets, and (3) a machine learning (ML) framework to choose services adaptively to suit the dynamic requirements of people with special needs. The ML-based selection framework is applied in two complementary phases. In the first phase, all available atomic tasks are assessed to determine their appropriateness to the user goal and profiles, whereas in the subsequent phase, the list of service providers is narrowed by matching their quality-of-service factors against the context and characteristics of the disabled person. Our methodology is centered around a myriad of user characteristics, including their disability profile, preferences, environment, and available IT resources. To this end, we extended the widely used QWS V2.0 and WS-DREAM web services datasets with a fusion of selected accessibility features. To ascertain the validity of our approach, we compared its performance against common multi-criteria decision making (MCDM) models, namely AHP, SAW, PROMETHEE, and TOPSIS. The findings demonstrate superior service selection accuracy in contrast to the other methods while ensuring accessibility requirements are satisfied.

Can a MacIntyrian Care about Severely Disabled Strangers?

I argue that Alasdair MacIntyre has important resources to provide in the debate over the moral status of severely disabled people. In contrast, Gregory Poore suggests that MacIntyre's virtue theory cannot account for our responsibilities to severely disabled people. Given that MacIntyre bases his theory around community membership, this charge is made especially severe in the case of severely disabled strangers. I present an interpretation of MacIntyre that accounts for responsibilities to severely disabled strangers. I then argue that Poore is wrong to conclude that MacIntyre does not include severely disabled people in communities.

A double jeopardy: COVID-19 impacts on the travel behavior and community living of people with disabilities.

The COVID-19 pandemic response has had a significant impact on the general population's ability to participate in their communities. Individuals with disabilities, an already socially disadvantaged population, are more vulnerable to and have likely been disproportionately impacted by COVID-19 response conditions. Yet, the extent to which the daily community living activities of people with disabilities have been impacted is unknown. Thus, this study assesses their travel behavior and community living during the COVID-19 pandemic conditions compared with those of the general population. A web survey was conducted using Qualtrics's online panel data (respondents included 161 people with any type of disability and 232 people without a disability). Regression models found that people with disabilities reduced their daily travel to a greater extent but at varying degrees, depending on the destination types and travel modes. Reductions in taxi rides (including ride-hailing services) were most significant among people with cognitive and sensory (e.g., vision and hearing) disabilities. By place type, cognitive disability was associated with a trip reduction for multiple destination types-grocery, restaurants, outdoor recreation, indoor recreation, and healthcare providers. Findings from this study could contribute to decision- and policy-making in planning, transportation, and community services during the remainder of the COVID-19 pandemic, in future major public health crises, and post-COVID, because the adjustments in travel behavior and community living might be longer-term.

Internal and External Training Workload Quantification in 4 Experienced Paracanoeing Athletes.

CONTEXT: Paracanoeing is one of the adapted sports eligible for different motor impairments. The acute:chronic workload ratio (ACWR) is an index between acute and chronic training workload. However, no studies have analyzed this variable in paracanoeing, relating it with training recovery markers. OBJECTIVE: This study aimed to quantify the internal (session rating of perceived exertion) and external (distance traveled and total training time) training workloads in 4 experienced paracanoe athletes over 9 months and 5 canoeing events. DESIGN: Cross-sectional study. SETTING: Rehabilitation Hospital Network, Paralympic Program. PARTICIPANTS: Four experienced paracanoe athletes participated in 36 weeks of training for 5 events. MAIN OUTCOMES MEASURES: The daily and weekly training workload, monotony, ACWR, distance, and total training time were described for all the training phases. The perceived recovery status scale (PRS) and medicine ball throw (MBT) were used to quantify recovery. RESULTS: The average daily and weekly training workload varied from 213.1 to 239.3 and 767.3 to 1036.8 arbitrary units, respectively. Average ACWR results ranged from 0.96 to 1.10 in the 4 athletes, findings that were outside the safety zone in 38% of the training weeks. All the correlations between MBT and PRS were classified as weak (ρ between .20 and .39, P > .05). ACWR showed a very weak correlation with MBT and moderately and highly significant correlations with PRS in 2 athletes, respectively. CONCLUSIONS: The training workloads of 4 paracanoe athletes may serve as a comparison with other periodization models. Pretraining recovery assessments (MBT and PRS) exhibited a low, nonsignificant correlation. However, ACWR correlated significantly with PRS in 2 athletes and might be a suitable tool for daily training adjustments.

[SOCIAL HEALTH OF PEOPLE WITH DISABILITIES IN THE CONTEXT OF SOCIAL CHANGE].

Absolutely all over the world there is a constant increase in the number of people with disabilities, as a result of a number of economic, social, ecological, demographic reasons. The share of disabled people on the territory of the Pridnestrovian Moldavian Republic has remained high in recent years. The article touches upon the issues of qualitative indicators of the social health of people with disabilities, gives a fundamental characteristic of social health. A questionnaire survey was conducted in February 2018 among people with disabilities, and for the purpose of additional study, interviews with people of working age with disabilities were conducted in March 2022. The results of the author's research on the territory of the Pridnestrovian Moldavian Republic among people with disabilities on the subject of studying the processes of socialization and social adaptation in society are presented. Based on the conducted quantitative and qualitative research methods, the main trends regarding the social health of people with disabilities were identified. The main barriers on the way to successful integration processes hindering socialization and social adaptation are outlined. The above results necessitate the modernization of the current system of targeted support for people with disabilities.

Physical accessibility of primary care facilities for people with disabilities: a cross-sectional survey in 31 countries.

BACKGROUND: Primary care is the first point of care, also for people with disabilities. The accessibility of primary care facilities is therefore very important. In this study we analysed comparative data on physical accessibility of general practices (GP practices) in 31 (mainly) European countries. METHODS: We used data from the QUALICOPC study, conducted in 2011 among GPs in 34 (mainly European) countries and constructed a physical accessibility scale. We applied multilevel analysis to assess the differences between and within countries and to test hypotheses, related to characteristics of the practices and of the countries. RESULTS: We found large differences between countries and a strong clustering of physical accessibility within countries. Physical accessibility was negatively related to the age of the GPs, and was less in single-handed and in inner city practices. Of the country variables only the length of the period of social democratic government participation during the previous decades was positively related to physical accessibility. CONCLUSION: A large share of the variation in physical accessibility of GP practices was on the level of countries. This means that national policies can be used to increase physical accessibility of GP practices.

[Legal Regulation of Hospital-Substituting Aspects of Social Services for Elderly and Disabled Citizens at Home.]

The article presents information about a significant number of people older than working age, disabled people and recipients of social services in stationary form and about the unfavorable forecast of the number of people older than 65 years for 2024 and 2030 in the Russian Federation, which determines the need for legal regulation of their lifestyle issues with respect for human rights to lead an independent lifestyle. The authors present an analysis of the federal and regional legal framework in terms of determining the circumstances under which a citizen is recognized as needing social services, the participation of local self-government bodies and subordinate organizations in the provision of social services, the implementation of social support, the introduction of hospital-substituting social service technologies. The article discusses the trends and ways to improve the legal regulation of social services for elderly and disabled citizens at home from the perspective of the introduction of hospital-substituting elements.

[The characteristics of repeated medical social expertise of adult population of the Russian Federation in 2018-2020].

The medical social expertise is considered as recognition of a person as the disabled and specification, in accordance with established procedure, of needs of examined person in social protection measures, including rehabilitation, based on evaluation of disabilities caused by persistent dysfunction of organism. The main normative legal acts governing activities of institutions of medical social expertise are the Federal Law of November 24, 1995 "On social protection of disabled people in the Russian Federation", the Decree of the Government of the Russian Federation of February 20, 2006 № 95 "On the procedure and conditions for recognition disabled person". Because of COVID-19 pandemic conditions, the normative legal base has undergone a number of changes. In particular, on 09.04. 2020, the Resolution of the Government of the Russian Federation № 467 "On the temporary procedure for recognizing a person as disabled" came into force. The actual article considers the features of this temporarily order related to the repeated medical and social examination and its results as of 2020. The qualitative analysis of permitted to get patterns of increasing and decreasing (improvement or deterioration) of particular statistical indices.

Disability inclusiveness of government responses to COVID-19 in South America: a framework analysis study.

BACKGROUND: Disabled people are particularly exposed to the risks of COVID-19, as well as to the measures taken to address it, and their impact. The aim of the study was to examine the disability-inclusiveness of government responses to COVID-19 in four South American Countries: Argentina, Brazil, Chile, and Peru. METHODS: We conducted documentary research, using framework analysis to analyse reports, legislation, decrees, and other official documents that communicated measures taken in response to the pandemic, published from February 1st until May 22nd, 2020. We included documents reporting measures that affected disabled people either directly (measures specifically designed for disabled people) or indirectly (measures for the general population). We developed an analytical framework based on recommendations for disability-inclusive response to COVID-19 published by the Economic Commission for Latin America and the Carribean, the World Health Organisation, and other international organisations. RESULTS: We analysed 72 documents. The findings highlight that while some positive measures were taken, the needs of disabled people were not fully considered. Several countries published recommendations for a disability-inclusive response to COVID-19, without ensuring their translation to practice. All countries took at least some steps to ensure access to financial support, health, and education for disabled people, but at the same time they also implemented policies that had a detrimental impact on disabled people. The populations that are most exposed to the impacts of COVID-19, including disabled people living in institutional care, were protected in several cases only by recommendations rather by legislation. CONCLUSIONS: This study illustrates how the official government responses taken by four countries in the region - while positive, in several aspects - do not fully address the needs of disabled people, thus further disadvantaging them. In order to ensure response to COVID - 19 is disability inclusive, it is necessary to translate recommendations to practice, consider disabled people both in mainstream policy and in disability-specific measures, and focus on the long-term reconstruction phase.

Disabled People's Organisations increase access to services and improve well-being: evidence from a cluster randomized trial in North India.

BACKGROUND: Disabled People's Organisations (DPOs) are the mainstay of disability responses worldwide. Yet there is no quantitative data assessing their effectiveness in low-and middle-income countries (LMICs). The aim of this study was to measure the effectiveness of DPOs as a low-cost intervention to improve well-being and access to services and facilities for people with disabilities. METHODS: We undertook a cluster randomised intervention control trial across 39 distinct rural villages in Uttarakhand State, North India. A total of 527 participants were included from 39 villages: 302 people from 20 villages were assigned to the intervention arm and 225 from 19 villages were assigned to the control group. Over a 2-year period, people with disabilities were facilitated to form DPOs with regular home visits. Participants were also given financial support for public events and exposure visits to other DPOs. Seven domains were used to measure access and participation. RESULTS: DPO formation had improved participation in community consultations (OR 2.57, 95% CI 1.4 to 4.72), social activities (OR 2.46, 95% CI 1.38 to 4.38), DPOs (OR 14.78, 95% CI 1.43 to 152.43), access to toilet facilities (OR 3.89, 95% CI 1.31 to 11.57), rehabilitation (OR 6.83, 95% CI 2.4 to 19.42) and Government social welfare services (OR 4.82, 95% CI 2.35 to 9.91) in intervention when compared to the control. People who were part of a DPO had an improvement in having their opinion heard (OR 1.94, 95% CI 1.16 to 3.24) and being able to make friends (OR 1.63, 95% CI 1 to 2.65) compared to those who were not part of a DPO. All other well-being variables had little evidence despite greater improvement in the DPO intervention group. CONCLUSIONS: This is the first randomised control trial to demonstrate that DPOs in LMICs are effective at improving participation, access and well-being. This study supports the ongoing role of DPOs in activities related to disability inclusion and disability services. This study also suggests that supporting the establishment, facilitation and strengthening of DPOs is a cost-effective intervention and role that non-governmental organisations (NGOs) can play. TRIAL REGISTRATION: ISRCTN36867362, 9th Oct 2019 (retrospectively registered).