Purpose With a growing population of older persons globally, the need for mainstream assistive te... more Purpose With a growing population of older persons globally, the need for mainstream assistive technology (AT) as well as assistive technology specifically intended for older persons is on the increase. The association between age and functional limitations strongly indicates a growing demand due the current demographic development. There was however until recently limited data that can describe the situation, monitor development and compare between countries and populations. Quality data is essential for developing regional, national and international responses to current and future need for AT globally. The Global Report on Assistive Technology (GReAT) was launched on 16 th May 2022 and highlights both substantial gaps in provision of AT and AT related services globally and in particular in low-and middle-income countries. As part of the process leading up to the GReAT, World Health Organization and partners developed the "rapid Assistive Technology Assessment" (rATA) survey to enable data collection that for the first time can provide estimates of AT use and need in a global perspective. The purpose of this presentation is to present key indicators from rATA among older persons in the countries that participated in the global data collection. Method Data from recent, nationally representative rATA surveys of perceived use of and need for AT among older persons (60 years and older) in more than 30 countries across all WHO regions will be analyzed against sex, rural/urban and Human Development Index (HDI). rATA includes indicators on access to and need for AT, specification of products in use and in need, urban/rural location, and on aspects of provision and quality of services and products. Results Prevalence of access to assistive products increases with increasing level of development (HDI index) among persons aged 60 years and above. The need in this age group reduces on the other hand with increasing HDI levels, indicating a higher level of met need in countries with higher HDI. The estimated global need among persons aged 60 years and above is 68.7% including spectacles and 31.2 % excluding spectacles. It is expected that further analyses will reveal similarities across countries/regions in the association between AT use and need and demographic and socioeconomic indicators. It is however also expected that we will demonstrate substantial differences in the levels of use and need between countries with different level of development (HDI). These results are important for developing models for estimating needs and building broad-based evidence for developing AT programs in diverse contexts.
American Journal of Physical Medicine & Rehabilitation, 2012
The purpose of this article was to examine the application of the International Classification of... more The purpose of this article was to examine the application of the International Classification of Functioning, Disability, and Health (ICF) in the field of psychiatry in the last 10 yrs since the ICF was launched. The hypothesis is that the application of the ICF in the field of psychiatry has not been yet much explored. Therefore, the objective of this article was to provide reasons to explain the difficult implementation of the ICF in this field, which in turn, might account for the lack of studies. A literature search was conducted using the terms ICF AND mental illness OR mental disorders OR psychiatry in titles, abstracts, and key words of articles collected in the databases ISI Web of Knowledge, ScienceDirect and Medline from 2001 to 2010. A total of 64 full-length articles were retrieved and reviewed, and among them, 13 were eventually included in this review because they were related to the ICF in psychiatry. Of the 13 studies identified concerning the ICF and mental disorders, 7 focus on the implementation of the ICF in the clinical practice, and 6 are theoretical papers discussing the potential benefits of the ICF for the field of psychiatry. A number of reasons can be suggested to explain the paucity of studies on the use of the ICF in psychiatry in the last 10 yrs: (1) the novelty of the ICF and the dominance of the medical model, (2) the belief that disability is just about physical conditions, (3) the influence of medication on capacity and performance, (4) the complex structure of the ICF, (5) the intrinsic limitations of the ICF, and (6) limitations in the accessibility of the ICF to some medical professionals.
Background: It is a contemporary and global challenge that the increasing number of older people ... more Background: It is a contemporary and global challenge that the increasing number of older people requiring care will surpass the available caregivers. Solutions are needed to help older people maintain their health, prevent disability, and delay or avoid dependency on others. Technology can enable older people to age in place while maintaining their dignity and quality of life. Literature reviews on this topic have become important tools for researchers, practitioners, policy makers, and decision makers who need to navigate and access the extensive available evidence. Due to the large number and diversity of existing reviews, there is a need for a review of reviews that provides an overview of the range and characteristics of the evidence on technology for aging in place. Objective: This study aimed to explore the characteristics and the range of evidence on technologies for aging in place by conducting a scoping review of reviews and presenting an evidence map that researchers, policy makers, and practitioners may use to identify gaps and reviews of interest. Methods: The review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Literature searches were conducted in Web of Science, PubMed, and Scopus using a search string that consisted of the terms "older people" and "technology for ageing in place," with alternate terms using Boolean operators and truncation, adapted to the rules for each database. Results: A total of 5447 studies were screened, with 344 studies included after full-text screening. The number of reviews on this topic has increased dramatically over time, and the literature is scattered across a variety of journals. Vocabularies and approaches used to describe technology, populations, and problems are highly heterogeneous. We have identified 3 principal ways that reviews have dealt with populations, 5 strategies that the reviews draw on to conceptualize technology, and 4 principal types of problems that they have dealt with. These may be understood as methods that can inform future reviews on this topic. The relationships among populations, technologies, and problems studied in the reviews are presented in an evidence map that includes pertinent gaps. Conclusions: Redundancies and unexploited synergies between bodies of evidence on technology for aging in place are highly likely. These results can be used to decrease this risk if they are used to inform the design of future reviews on this topic. There is a need for an examination of the current state of the art in knowledge on technology for aging in place in low-and middle-income countries, especially in Africa.
This report is a contribution towards describing the lives of people with disabilities in Yemen. ... more This report is a contribution towards describing the lives of people with disabilities in Yemen. The report is a result of field work conducted during two weeks of May, 2006, on behalf of the World Bank. A family perspective is necessary to understand the questions of disability in a culture where social and cultural life is family based. Disabled people and their families faces many challenges in a country like Yemen. Families with a disabled family member have to reorganize their resources of time, labour capacity and capital in order to meet the new challenges that the care for a disabled member places upon them. The families risk falling out of the social and economic relations within which they understand themselves and there is a risk of losing access to the resources that are necessary to manage as a family group. As they have difficulties in performing the income generating tasks that are considered normal in their community there are very few job opportunities for disabled ...
Disability and poverty, and the relationship between the two, are complex and dynamic phenomena, ... more Disability and poverty, and the relationship between the two, are complex and dynamic phenomena, and thus not easy to grasp in one theoretical model or within one scienti c paradigm. Explanations of the disability-poverty circle may be social, structural, political, and cultural. It is interesting that the challenge to most literature on disability and poverty emerges through the voices of the poor and disabled themselves. This book provides an insight into the lives of people with disabilities living in poverty, and the vulnerability implied by living in poverty. Individuals with disabilities have struggled to survive under very di cult conditions, bringing evidence to the fact that they also represent a tremendous resource which can be used to improve the situation for the poorest of the poor. Without this expertise, and without challenging and breaking up established power structures, the ght against poverty will be jeopardised. Disability and poverty and the relationship between the two are complex and dynamic phenomena and thus not easy to grasp in one theoretical model or within one scienti c paradigm. As exempli ed in the chapters in this book, explanations to the disability-poverty circle may be social, structural, political and cultural. A refreshing, and even provoking, perspective is brought forward in questioning the very distinction between the two (Hansen and Sait, Chapter Six). As both concepts have developed, they may at least be seen as overlapping. It is particularly interesting that this challenge to most literature on disability and poverty emerges through the voices of the poor and disabled themselves. This demonstrates the potential value of the particular methodological approach in this book and that disabled people and poor people have something to o er in the development of our understanding of the disability-poverty relationship. It has not been the purpose of this book to develop or test a model of disability and poverty but rather to disentangle the complex relationship through a combination of perspectives, and in particular through the voices and experiences of individuals with disabilities themselves. We, as authors, believe that this is necessary in order to fully understand the working mechanisms behind the persistent situation of 'poverty within poverty' (Yeo and Moore, 2003) faced by a large number of individuals with disabilities, particularly
HandiVIH-A population-based survey to understand the vulnerability of people with disabilities to... more HandiVIH-A population-based survey to understand the vulnerability of people with disabilities to HIV and other sexual and reproductive health problems in Cameroon: protocol and methodological considerations. BMJ Open 2016;6:e008934.
A~tract-A survey among 3061 secondary school children in four provinces in Zimbabwe was conducted... more A~tract-A survey among 3061 secondary school children in four provinces in Zimbabwe was conducted in 1994. In the present paper, the relationships between cultural and social factors and use of inhalants and cannabis are explored. Respondents were selected by means of a two-stage sample design, first based on a complete list of schools in the four provinces and subsequently on lists of students at the randomly selected schools. Stratification was based on the identification of four different sociocultural groups. Data collection followed stande~rdised procedures and was conducted by a research team from University of Zimbabwe. Cultural orientation was operationalised by means of a Likert-type 14item scale on choice of media, language and music. Exploratory principal component analysis revealed a two-factor solution, representing a global or Western cultural orientation and a local or Zimbabwean cultural orientation. Drug use by older siblings and best friends represented social factors. A combined model of cultural and social variables was :;ubject to a multiple logistic regression analysis. Results revealed that the social variables and global cultural orientation were significantly associated with increased use of both drugs, whereas a local cultural orientation was found not to be associated with use of these substances. Findings are discussed in the light of historical and cultural factors.
Background: The UN's international year in 1981 for people with disabilities, led to a greater in... more Background: The UN's international year in 1981 for people with disabilities, led to a greater interest in Community-Based Rehabilitation (CBR) in a number of countries. Method: This article describes measures and concepts in rehabilitation introduced by the World Health Organisation (WHO) and other parts of the UN. Results and interpretation: CBR is one of the most important developments in international rehabilitation during the last decades. Other important developments have been the launch of UN "standard rules" concerning basic rights for people with disabilities supervised by a UN special rapporteur, and development of models for classifying and diagnosing disability; i.e. ICIDH (International Classification of Impairment, Disabilities and Handicaps), DALY (Disability Adjusted Life Years) and ICF (International Classification of Functioning, Disability and Health). Debates concerning definitions and classifications of rehabilitation have first of all been important for planning and implementation of rehabilitation, but also for preserving the human rights and dignity of people with disabilities.
International Journal of Social Psychiatry, Jul 2, 2019
Exposure to war and conflict increase the risk of mental health problems. Poor living conditions ... more Exposure to war and conflict increase the risk of mental health problems. Poor living conditions are known to negatively impact mental health. It is hypothesized that exposure to negative events after armed conflict interacts with past negative experiences, socioeconomic factors and current mental health problems. A cross-sectional survey was carried out in three contexts of previous internal armed conflict: Nepal, Guatemala, and Northern Ireland. Three nationally representative samples were drawn, comprising a net sample of 3,229 respondents. Both recent negative events and past negative events linked to the previous conflicts were found to be associated with elevated risk of Post-Traumatic Stress Syndrome (PTSD). Economic marginalization and urban residency also contributed to current risk of PTSD. The results support the study hypothesis that both past and recent negative events in combination with economic marginalization contribute to explain current risk of PTSD. It is necessary both to improve living conditions more broadly and to establish and develop health services that have the capacity to screen, prevent and treat mental health problems also in poor contexts, in particular against a background of previous armed conflict.
This report is from the National study on living conditions among people with disabilities carrie... more This report is from the National study on living conditions among people with disabilities carried out in Nepal in 2014-2015. The study was carried out as a household survey with two-stage stratified sampling, including a screening/listing procedure using the Washington Group on Disability Statistics 6 questions, one Household questionnaire administered to households with (Case HHs) and without disabled members (Control HHs), one Individual Case questionnaire administered to individuals who were found to qualify as being disabled in the screening (Case individuals), and an Individual Control questionnaire administered to matched non-disabled individuals in the Control HHs (Control individuals). The study covers a range of indicators on level of living, such as socioeconomic indicators, economic activity, income, ownership and infrastructure, health (including reproductive health), access to health information, access to services, education, access to information, social participation, and exposure to discrimination and abuse (see all questionnaires in Appendix).
Background Worldwide , there are 27.5 million internally displaced persons. Sudan has the largest... more Background Worldwide , there are 27.5 million internally displaced persons. Sudan has the largest internally displaced population in the world, estimated at five million. The immediate cause of displacement was the civil war. This study aimed at investigating the impact of prolonged forced displacement on mental health of internally displaced persons (IDP) in squatter settlements in Sudan. The objective of this study was to identify the changes of prevalence in mental disorders among the IDPs over a period of one year. Method: A one-year follow up community-based study was conducted in 2011 among internally displaced adults living in central Sudan. Two locations and a total of 1549 persons were randomly sampled. The same standardized tools were used in each of the two study phasesspecifically, the General Health Questionnaire (GHQ) and the International Neuropsychiatric Interview (MINI)and the same socio-demographic information was collected. The data was collected by clinical psychologists using interviews and a house-to-house sampling procedure. Results: Relatively small but significant increases in the number of new cases of common mental disorders were observed. Major depression increased by 1.4%, generalized anxiety by 2.8%, social phobia by 1.4%, and posttraumatic stress (PTSD) by 0.8%. The odds for major depression was 25% lower in the age group 30-39 compared to those below 30 years. Residing in the rural areas [OR: 2.34, 95% CI (1.77, 3.10)] and having elementary education [OR: 1.46, 95% CI (1.00, 2.16)] were associated with higher odds for social phobia. The risk for PTSD increased with age and higher levels of education. However, lower risks for PTSD were observed in the rural areas as compared to the urban location [OR: 0.65, 95% CI (0.48, 0.89)], and longer duration of stay in an area was associated with a 4% decrease in the likelihood for PTSD. Employment, whether on a temporary or permanent basis, was associated with increased odds for distress (GHQ). Conclusion: The study provides evidence of a negative impact of prolonged displacement on mental well-being, calling for greater attention to and protection for IDPs for the sake of improving their mental health.
Objective: To indicate trends in drug use among secondary school students in Zimbabwe by comparin... more Objective: To indicate trends in drug use among secondary school students in Zimbabwe by comparing results from surveys conducted in 1990 and 1994. Design: Two classroom surveys using comparable instruments for data collection were conducted among secondary school children of different socio-economic subgroups in four provinces in Zimbabwe; one in 1990 and one in 1994. The comparison is restricted to Mashonaland. Both surveys applied a two stage sampling strategy with stratified random sampling of schools at first stage. Cross tabulations with age standardization and multiple regression analysis were applied to compare self reported drug use in the two studies. Setting: 17 secondary schools in Harare, Mashonaland East, Mashonaland West, Bulawayo and Matabeleland North Provinces were involved in the study. Subjects: Study A (1990): 2 581 secondary school students, 56pc boys, age range 12 to 21, mean age 15.5 years. Study B (1994): 3 061 secondary school students, 51.9pc boys age range 11 to 23, mean age 15.0 years. Main outcome measure: Prevalence of self reported use of tobacco, alcohol, inhalants and cannabis. Results: Comparing results from the two studies indicates: a. Drug use is highest among private school students. b. Use of alcohol and tobacco increases with increasing socio-economic status. c. Use of inhalants and cannabis varies and is less pronounced between socio-economic subgroups. d. A general increase from 1990 to 1994 in life time drug use prevalence among private school students. e. An increase in life time alcohol prevalence among rural students. f. Increased frequency of use of alcohol and cannabis among boys. Conclusions: Sociocultural differences with regards to drug use is demonstrated, suggesting a two way diffusion of Western drug use habits to rural areas and of traditional drug use to urban areas. In taking the necessary reservations with regard to the comparability of results from the two studies, the analysis indicates an increasing trend in use of the four most common drugs primarily among private school students and an increase in alcohol use among rural students.
In this survey a total of 2,783 secondary school students of both sexes, mean age 15.5 years, fro... more In this survey a total of 2,783 secondary school students of both sexes, mean age 15.5 years, from randomly selected schools in both rural and urban areas of Zimbabwe were studied using a self report questionnaire. The results strongly indicated that drug use was quite prevalent among the students. The main drugs involved, in descending order, were: alcohol, tobacco, inhalants (solvents), amphetamines and cannabis. Others included mandrax, tranquilisers, sedatives and the hallucinogen mudzepete. No students reported use of heroin, cocaine, LSD or opium. Drug use increased with age and involved both sexes, the problem being more acute in the urban schools. A differential use pattern is revealed, implying valuable information for targeted prevention efforts.
Background: Resident-to-resident aggression in nursing homes is a public health problem of growin... more Background: Resident-to-resident aggression in nursing homes is a public health problem of growing concern, impacting the safety, health and well-being of all residents involved. Despite this, little research has been conducted on its occurrence particularly in large-scale national studies. The aim of this study was to explore the extent and nature of resident-to-resident aggression in Norwegian nursing homes, as reported by nursing staff. Methods: We conducted a cross-sectional exploratory study, where nursing staff in 100 randomly selected Norwegian nursing homes completed a pen and paper survey measuring how often they had observed incidents of resident-to-resident aggression during the past year. These rates were separated according to nursing home size, location and units of workplace. Results: Of the 3693 nursing staff who participated (response rate 60.1%), 88.8% had observed one or more incidents of resident-to-resident aggression during the past year, with acts of verbal and physical aggression being the most commonly reported. Nursing staff working in dementia special care units, larger nursing homes and nursing homes located in suburban/urban municipalities, reported more incidents of resident-to-resident aggression than staff in short-term and long-term units, small institutions, and nursing homes located in rural municipalities. Conclusions: This is the first national study of resident-to-resident aggression in Norwegian nursing homes and is one of the largest surveys worldwide exploring the extent and nature of resident-to-resident aggression in long-term care settings. Overall, we found a high occurrence of all types of aggression, suggesting a need for strategies to improve residents' safety and quality of life in nursing homes.
Purpose With a growing population of older persons globally, the need for mainstream assistive te... more Purpose With a growing population of older persons globally, the need for mainstream assistive technology (AT) as well as assistive technology specifically intended for older persons is on the increase. The association between age and functional limitations strongly indicates a growing demand due the current demographic development. There was however until recently limited data that can describe the situation, monitor development and compare between countries and populations. Quality data is essential for developing regional, national and international responses to current and future need for AT globally. The Global Report on Assistive Technology (GReAT) was launched on 16 th May 2022 and highlights both substantial gaps in provision of AT and AT related services globally and in particular in low-and middle-income countries. As part of the process leading up to the GReAT, World Health Organization and partners developed the "rapid Assistive Technology Assessment" (rATA) survey to enable data collection that for the first time can provide estimates of AT use and need in a global perspective. The purpose of this presentation is to present key indicators from rATA among older persons in the countries that participated in the global data collection. Method Data from recent, nationally representative rATA surveys of perceived use of and need for AT among older persons (60 years and older) in more than 30 countries across all WHO regions will be analyzed against sex, rural/urban and Human Development Index (HDI). rATA includes indicators on access to and need for AT, specification of products in use and in need, urban/rural location, and on aspects of provision and quality of services and products. Results Prevalence of access to assistive products increases with increasing level of development (HDI index) among persons aged 60 years and above. The need in this age group reduces on the other hand with increasing HDI levels, indicating a higher level of met need in countries with higher HDI. The estimated global need among persons aged 60 years and above is 68.7% including spectacles and 31.2 % excluding spectacles. It is expected that further analyses will reveal similarities across countries/regions in the association between AT use and need and demographic and socioeconomic indicators. It is however also expected that we will demonstrate substantial differences in the levels of use and need between countries with different level of development (HDI). These results are important for developing models for estimating needs and building broad-based evidence for developing AT programs in diverse contexts.
American Journal of Physical Medicine & Rehabilitation, 2012
The purpose of this article was to examine the application of the International Classification of... more The purpose of this article was to examine the application of the International Classification of Functioning, Disability, and Health (ICF) in the field of psychiatry in the last 10 yrs since the ICF was launched. The hypothesis is that the application of the ICF in the field of psychiatry has not been yet much explored. Therefore, the objective of this article was to provide reasons to explain the difficult implementation of the ICF in this field, which in turn, might account for the lack of studies. A literature search was conducted using the terms ICF AND mental illness OR mental disorders OR psychiatry in titles, abstracts, and key words of articles collected in the databases ISI Web of Knowledge, ScienceDirect and Medline from 2001 to 2010. A total of 64 full-length articles were retrieved and reviewed, and among them, 13 were eventually included in this review because they were related to the ICF in psychiatry. Of the 13 studies identified concerning the ICF and mental disorders, 7 focus on the implementation of the ICF in the clinical practice, and 6 are theoretical papers discussing the potential benefits of the ICF for the field of psychiatry. A number of reasons can be suggested to explain the paucity of studies on the use of the ICF in psychiatry in the last 10 yrs: (1) the novelty of the ICF and the dominance of the medical model, (2) the belief that disability is just about physical conditions, (3) the influence of medication on capacity and performance, (4) the complex structure of the ICF, (5) the intrinsic limitations of the ICF, and (6) limitations in the accessibility of the ICF to some medical professionals.
Background: It is a contemporary and global challenge that the increasing number of older people ... more Background: It is a contemporary and global challenge that the increasing number of older people requiring care will surpass the available caregivers. Solutions are needed to help older people maintain their health, prevent disability, and delay or avoid dependency on others. Technology can enable older people to age in place while maintaining their dignity and quality of life. Literature reviews on this topic have become important tools for researchers, practitioners, policy makers, and decision makers who need to navigate and access the extensive available evidence. Due to the large number and diversity of existing reviews, there is a need for a review of reviews that provides an overview of the range and characteristics of the evidence on technology for aging in place. Objective: This study aimed to explore the characteristics and the range of evidence on technologies for aging in place by conducting a scoping review of reviews and presenting an evidence map that researchers, policy makers, and practitioners may use to identify gaps and reviews of interest. Methods: The review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Literature searches were conducted in Web of Science, PubMed, and Scopus using a search string that consisted of the terms "older people" and "technology for ageing in place," with alternate terms using Boolean operators and truncation, adapted to the rules for each database. Results: A total of 5447 studies were screened, with 344 studies included after full-text screening. The number of reviews on this topic has increased dramatically over time, and the literature is scattered across a variety of journals. Vocabularies and approaches used to describe technology, populations, and problems are highly heterogeneous. We have identified 3 principal ways that reviews have dealt with populations, 5 strategies that the reviews draw on to conceptualize technology, and 4 principal types of problems that they have dealt with. These may be understood as methods that can inform future reviews on this topic. The relationships among populations, technologies, and problems studied in the reviews are presented in an evidence map that includes pertinent gaps. Conclusions: Redundancies and unexploited synergies between bodies of evidence on technology for aging in place are highly likely. These results can be used to decrease this risk if they are used to inform the design of future reviews on this topic. There is a need for an examination of the current state of the art in knowledge on technology for aging in place in low-and middle-income countries, especially in Africa.
This report is a contribution towards describing the lives of people with disabilities in Yemen. ... more This report is a contribution towards describing the lives of people with disabilities in Yemen. The report is a result of field work conducted during two weeks of May, 2006, on behalf of the World Bank. A family perspective is necessary to understand the questions of disability in a culture where social and cultural life is family based. Disabled people and their families faces many challenges in a country like Yemen. Families with a disabled family member have to reorganize their resources of time, labour capacity and capital in order to meet the new challenges that the care for a disabled member places upon them. The families risk falling out of the social and economic relations within which they understand themselves and there is a risk of losing access to the resources that are necessary to manage as a family group. As they have difficulties in performing the income generating tasks that are considered normal in their community there are very few job opportunities for disabled ...
Disability and poverty, and the relationship between the two, are complex and dynamic phenomena, ... more Disability and poverty, and the relationship between the two, are complex and dynamic phenomena, and thus not easy to grasp in one theoretical model or within one scienti c paradigm. Explanations of the disability-poverty circle may be social, structural, political, and cultural. It is interesting that the challenge to most literature on disability and poverty emerges through the voices of the poor and disabled themselves. This book provides an insight into the lives of people with disabilities living in poverty, and the vulnerability implied by living in poverty. Individuals with disabilities have struggled to survive under very di cult conditions, bringing evidence to the fact that they also represent a tremendous resource which can be used to improve the situation for the poorest of the poor. Without this expertise, and without challenging and breaking up established power structures, the ght against poverty will be jeopardised. Disability and poverty and the relationship between the two are complex and dynamic phenomena and thus not easy to grasp in one theoretical model or within one scienti c paradigm. As exempli ed in the chapters in this book, explanations to the disability-poverty circle may be social, structural, political and cultural. A refreshing, and even provoking, perspective is brought forward in questioning the very distinction between the two (Hansen and Sait, Chapter Six). As both concepts have developed, they may at least be seen as overlapping. It is particularly interesting that this challenge to most literature on disability and poverty emerges through the voices of the poor and disabled themselves. This demonstrates the potential value of the particular methodological approach in this book and that disabled people and poor people have something to o er in the development of our understanding of the disability-poverty relationship. It has not been the purpose of this book to develop or test a model of disability and poverty but rather to disentangle the complex relationship through a combination of perspectives, and in particular through the voices and experiences of individuals with disabilities themselves. We, as authors, believe that this is necessary in order to fully understand the working mechanisms behind the persistent situation of 'poverty within poverty' (Yeo and Moore, 2003) faced by a large number of individuals with disabilities, particularly
HandiVIH-A population-based survey to understand the vulnerability of people with disabilities to... more HandiVIH-A population-based survey to understand the vulnerability of people with disabilities to HIV and other sexual and reproductive health problems in Cameroon: protocol and methodological considerations. BMJ Open 2016;6:e008934.
A~tract-A survey among 3061 secondary school children in four provinces in Zimbabwe was conducted... more A~tract-A survey among 3061 secondary school children in four provinces in Zimbabwe was conducted in 1994. In the present paper, the relationships between cultural and social factors and use of inhalants and cannabis are explored. Respondents were selected by means of a two-stage sample design, first based on a complete list of schools in the four provinces and subsequently on lists of students at the randomly selected schools. Stratification was based on the identification of four different sociocultural groups. Data collection followed stande~rdised procedures and was conducted by a research team from University of Zimbabwe. Cultural orientation was operationalised by means of a Likert-type 14item scale on choice of media, language and music. Exploratory principal component analysis revealed a two-factor solution, representing a global or Western cultural orientation and a local or Zimbabwean cultural orientation. Drug use by older siblings and best friends represented social factors. A combined model of cultural and social variables was :;ubject to a multiple logistic regression analysis. Results revealed that the social variables and global cultural orientation were significantly associated with increased use of both drugs, whereas a local cultural orientation was found not to be associated with use of these substances. Findings are discussed in the light of historical and cultural factors.
Background: The UN's international year in 1981 for people with disabilities, led to a greater in... more Background: The UN's international year in 1981 for people with disabilities, led to a greater interest in Community-Based Rehabilitation (CBR) in a number of countries. Method: This article describes measures and concepts in rehabilitation introduced by the World Health Organisation (WHO) and other parts of the UN. Results and interpretation: CBR is one of the most important developments in international rehabilitation during the last decades. Other important developments have been the launch of UN "standard rules" concerning basic rights for people with disabilities supervised by a UN special rapporteur, and development of models for classifying and diagnosing disability; i.e. ICIDH (International Classification of Impairment, Disabilities and Handicaps), DALY (Disability Adjusted Life Years) and ICF (International Classification of Functioning, Disability and Health). Debates concerning definitions and classifications of rehabilitation have first of all been important for planning and implementation of rehabilitation, but also for preserving the human rights and dignity of people with disabilities.
International Journal of Social Psychiatry, Jul 2, 2019
Exposure to war and conflict increase the risk of mental health problems. Poor living conditions ... more Exposure to war and conflict increase the risk of mental health problems. Poor living conditions are known to negatively impact mental health. It is hypothesized that exposure to negative events after armed conflict interacts with past negative experiences, socioeconomic factors and current mental health problems. A cross-sectional survey was carried out in three contexts of previous internal armed conflict: Nepal, Guatemala, and Northern Ireland. Three nationally representative samples were drawn, comprising a net sample of 3,229 respondents. Both recent negative events and past negative events linked to the previous conflicts were found to be associated with elevated risk of Post-Traumatic Stress Syndrome (PTSD). Economic marginalization and urban residency also contributed to current risk of PTSD. The results support the study hypothesis that both past and recent negative events in combination with economic marginalization contribute to explain current risk of PTSD. It is necessary both to improve living conditions more broadly and to establish and develop health services that have the capacity to screen, prevent and treat mental health problems also in poor contexts, in particular against a background of previous armed conflict.
This report is from the National study on living conditions among people with disabilities carrie... more This report is from the National study on living conditions among people with disabilities carried out in Nepal in 2014-2015. The study was carried out as a household survey with two-stage stratified sampling, including a screening/listing procedure using the Washington Group on Disability Statistics 6 questions, one Household questionnaire administered to households with (Case HHs) and without disabled members (Control HHs), one Individual Case questionnaire administered to individuals who were found to qualify as being disabled in the screening (Case individuals), and an Individual Control questionnaire administered to matched non-disabled individuals in the Control HHs (Control individuals). The study covers a range of indicators on level of living, such as socioeconomic indicators, economic activity, income, ownership and infrastructure, health (including reproductive health), access to health information, access to services, education, access to information, social participation, and exposure to discrimination and abuse (see all questionnaires in Appendix).
Background Worldwide , there are 27.5 million internally displaced persons. Sudan has the largest... more Background Worldwide , there are 27.5 million internally displaced persons. Sudan has the largest internally displaced population in the world, estimated at five million. The immediate cause of displacement was the civil war. This study aimed at investigating the impact of prolonged forced displacement on mental health of internally displaced persons (IDP) in squatter settlements in Sudan. The objective of this study was to identify the changes of prevalence in mental disorders among the IDPs over a period of one year. Method: A one-year follow up community-based study was conducted in 2011 among internally displaced adults living in central Sudan. Two locations and a total of 1549 persons were randomly sampled. The same standardized tools were used in each of the two study phasesspecifically, the General Health Questionnaire (GHQ) and the International Neuropsychiatric Interview (MINI)and the same socio-demographic information was collected. The data was collected by clinical psychologists using interviews and a house-to-house sampling procedure. Results: Relatively small but significant increases in the number of new cases of common mental disorders were observed. Major depression increased by 1.4%, generalized anxiety by 2.8%, social phobia by 1.4%, and posttraumatic stress (PTSD) by 0.8%. The odds for major depression was 25% lower in the age group 30-39 compared to those below 30 years. Residing in the rural areas [OR: 2.34, 95% CI (1.77, 3.10)] and having elementary education [OR: 1.46, 95% CI (1.00, 2.16)] were associated with higher odds for social phobia. The risk for PTSD increased with age and higher levels of education. However, lower risks for PTSD were observed in the rural areas as compared to the urban location [OR: 0.65, 95% CI (0.48, 0.89)], and longer duration of stay in an area was associated with a 4% decrease in the likelihood for PTSD. Employment, whether on a temporary or permanent basis, was associated with increased odds for distress (GHQ). Conclusion: The study provides evidence of a negative impact of prolonged displacement on mental well-being, calling for greater attention to and protection for IDPs for the sake of improving their mental health.
Objective: To indicate trends in drug use among secondary school students in Zimbabwe by comparin... more Objective: To indicate trends in drug use among secondary school students in Zimbabwe by comparing results from surveys conducted in 1990 and 1994. Design: Two classroom surveys using comparable instruments for data collection were conducted among secondary school children of different socio-economic subgroups in four provinces in Zimbabwe; one in 1990 and one in 1994. The comparison is restricted to Mashonaland. Both surveys applied a two stage sampling strategy with stratified random sampling of schools at first stage. Cross tabulations with age standardization and multiple regression analysis were applied to compare self reported drug use in the two studies. Setting: 17 secondary schools in Harare, Mashonaland East, Mashonaland West, Bulawayo and Matabeleland North Provinces were involved in the study. Subjects: Study A (1990): 2 581 secondary school students, 56pc boys, age range 12 to 21, mean age 15.5 years. Study B (1994): 3 061 secondary school students, 51.9pc boys age range 11 to 23, mean age 15.0 years. Main outcome measure: Prevalence of self reported use of tobacco, alcohol, inhalants and cannabis. Results: Comparing results from the two studies indicates: a. Drug use is highest among private school students. b. Use of alcohol and tobacco increases with increasing socio-economic status. c. Use of inhalants and cannabis varies and is less pronounced between socio-economic subgroups. d. A general increase from 1990 to 1994 in life time drug use prevalence among private school students. e. An increase in life time alcohol prevalence among rural students. f. Increased frequency of use of alcohol and cannabis among boys. Conclusions: Sociocultural differences with regards to drug use is demonstrated, suggesting a two way diffusion of Western drug use habits to rural areas and of traditional drug use to urban areas. In taking the necessary reservations with regard to the comparability of results from the two studies, the analysis indicates an increasing trend in use of the four most common drugs primarily among private school students and an increase in alcohol use among rural students.
In this survey a total of 2,783 secondary school students of both sexes, mean age 15.5 years, fro... more In this survey a total of 2,783 secondary school students of both sexes, mean age 15.5 years, from randomly selected schools in both rural and urban areas of Zimbabwe were studied using a self report questionnaire. The results strongly indicated that drug use was quite prevalent among the students. The main drugs involved, in descending order, were: alcohol, tobacco, inhalants (solvents), amphetamines and cannabis. Others included mandrax, tranquilisers, sedatives and the hallucinogen mudzepete. No students reported use of heroin, cocaine, LSD or opium. Drug use increased with age and involved both sexes, the problem being more acute in the urban schools. A differential use pattern is revealed, implying valuable information for targeted prevention efforts.
Background: Resident-to-resident aggression in nursing homes is a public health problem of growin... more Background: Resident-to-resident aggression in nursing homes is a public health problem of growing concern, impacting the safety, health and well-being of all residents involved. Despite this, little research has been conducted on its occurrence particularly in large-scale national studies. The aim of this study was to explore the extent and nature of resident-to-resident aggression in Norwegian nursing homes, as reported by nursing staff. Methods: We conducted a cross-sectional exploratory study, where nursing staff in 100 randomly selected Norwegian nursing homes completed a pen and paper survey measuring how often they had observed incidents of resident-to-resident aggression during the past year. These rates were separated according to nursing home size, location and units of workplace. Results: Of the 3693 nursing staff who participated (response rate 60.1%), 88.8% had observed one or more incidents of resident-to-resident aggression during the past year, with acts of verbal and physical aggression being the most commonly reported. Nursing staff working in dementia special care units, larger nursing homes and nursing homes located in suburban/urban municipalities, reported more incidents of resident-to-resident aggression than staff in short-term and long-term units, small institutions, and nursing homes located in rural municipalities. Conclusions: This is the first national study of resident-to-resident aggression in Norwegian nursing homes and is one of the largest surveys worldwide exploring the extent and nature of resident-to-resident aggression in long-term care settings. Overall, we found a high occurrence of all types of aggression, suggesting a need for strategies to improve residents' safety and quality of life in nursing homes.
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