Socioeconomic inequalities and disability pension in middle-aged men.
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BACKGROUND: The issue of inequalities in health has generated much discussion and socioeconomic status is considered an important variable in studies of health. It is frequently used in epidemiological studies, either as a possible risk factor or a confounder and the aim of this study was to analyse the relation between socioeconomic status and risk of disability pension. METHODS: Five complete birth year cohorts of middle-aged male residents in Malmo were invited to a health survey and 5782 with complete data constituted the cohort in this prospective study. Each subject was followed for approximately 11 years and nationwide Swedish data registers were used for surveillance. RESULTS: Among the 715 men (12%), granted disability pension during follow-up, three groups were distinguished. The cumulative incidence of disability pension among blue collar workers was 17% and among lower and higher level white collar workers, 11% and 6% respectively. With simultaneous adjustment for biological risk factors and job conditions, the relative risk for being granted a disability pension (using higher level white collar workers as reference) was 2.5 among blue collar workers and 1.6 among lower level white collar workers. CONCLUSIONS: Socioeconomic status, as defined by occupation, is a risk factor for being granted disability pension even after adjusting for work conditions and other risk factors for disease. (+info)
Kidney transplanted children come of age.
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BACKGROUND: The aim of renal replacement therapy in children is to restore their potential for normal growth and development in order to reach mature adulthood. Because pediatric kidney transplantation started in the late 1960s, it is now possible to document the progress and outcome of these patients from transplantation in childhood to survival into adulthood. METHODS: In this single-center study, all 150 children born before December 1977 and having received a kidney transplant between 1970 and 1993 were selected for long-term follow-up. The mean age at transplantation was 12.1 years (range 3.2 to 16.7), and the mean follow-up was 13.1 years (range 2.0 to 25.0). In December 1995, 124 grown-up patients with a mean age of 25.4 years (range 18.4 to 40.3) were alive, 89 with a functioning graft. Fifty had the first graft functioning longer than 10 years. The fate of all patients was traced, and those living were analyzed in regard to their somatic and socioeconomic states. RESULTS: The actuarial 25-year survival rate for the patients was 81%, and for the first graft it was 31%. The best graft survival rates were observed after living related donation, preemptive transplantation, and immunosuppression with cyclosporine. The latter benefit, however, vanished after eight years. The mean creatinine clearance declined over the years from 76 to 45 ml/min/1.73 m2, and the incidence of hypertension increased to more than 80% of the patients. Malignancies occurred in 2.6%. Final height was stunted in 44% of noncystinotic patients, whereas all patients with cystinosis were extremely growth retarded. Twenty-seven percent suffered from additional disabilities. A majority of adult patients were rehabilitated in regard to education and socioeconomic status, and 14% were unemployed. CONCLUSIONS: The results indicate that renal transplantation in children leads to a high degree of rehabilitation in adulthood. The life of a kidney transplant, however, is limited, which points out the need for more specific immunosuppression with fewer side-effects in order to reach the goal of lifelong graft function. (+info)
Quality of care in rehabilitation medicine.
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This paper discusses the generally accepted approaches to the study of the quality of care in medical rehabilitation. It reviews clements of structure, process and outcome of rehabilitation care that are relevant during various phases of rehabilitation and suggests drawing criteria and standards for assessment of quality from these elements of care. (+info)
Oncology Rehabilitation Program at the Ottawa Regional Cancer Centre: program description.
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The Ottawa Regional Cancer Centre offers an Oncology Rehabilitation Program to patients with cancer. Between January 1997 and December 1998, 254 patients with cancer participated in the program. This paper describes the program and its participants. The program's strengths, limitations and future directions are also discussed. (+info)
The cost of Medicaid-covered services provided to disabled adults with neurologic disorders: implications for managed care.
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OBJECTIVES: To estimate the mean annual per capita cost of care provided to disabled adult Medicaid recipients with neurologic conditions and to compare mean annual costs for disabled adult Medicaid recipients with those of nondisabled adult Medicaid recipients. STUDY DESIGN: Medicaid eligibility and claims files for all of calendar year 1993 were obtained from the state of Pennsylvania. Mean annual per capita costs are mean Medicaid expenditures on claims filed for Medicaid-covered services and pharmaceuticals provided in 1993 to full-year eligible Medicaid recipients. PATIENTS AND METHODS: Disabled adults aged 18 to 64 years with one or more of several neurologic conditions were identified from medical diagnoses (International Classification of Diseases, 9th Revision codes) reported on claims. A comparison group of nondisabled adults was chosen from the Medicaid Eligibility File. Annual costs were estimated for a wide range of specific services as well as for 3 broad service categories. RESULTS: There were large differences between disabled and nondisabled adults in mean annual per capita costs of acute care and other medical services ($4142 vs $1451), rehabilitation and support services ($3835 vs $235), and pharmaceuticals ($1116 vs $382). Mean costs also differed significantly among persons with different neurologic conditions. The mean annual per capita cost for all services was $5368 for adults with epilepsy and $19,356 for those with a spinal cord injury. All differences are statistically significant (P < .001). CONCLUSIONS: States may want to separately capitate rehabilitation and support services given the large differences in the magnitude and relative distribution of costs for disabled and nondisabled Medicaid recipients. (+info)
A new pattern mouth stick.
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The motivation for the severely handicapped tetraplegic patient in using the mouth stick is quite considerable as through this simple oral aid they are able to carry out small jobs and be involved in social activities. We feel that this modified pattern mouth stick fulfils the aims which we require of it. (+info)
Surviving the prospective payment system: potential problems and solutions to ensure quality of care.
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In response to diagnosis-related group payment systems and changing social structures, many hospital systems have created alternative discharge sites, thus shifting care to subacute units offering comprehensive inpatient programs of cost-effective restorative care. The growth in expenditures for these postacute services led to the implementation of the prospective payment system (PPS). This article discusses factors involved in calculating reimbursement and solutions to such problems as inadequate reimbursement, quality of care, and documentation requirements. For subacute care to succeed clinically and financially, a basis for collaboration between hospital-based referring physicians and subacute unit directors must be established; patient satisfaction and quality of care must be monitored closely; and a well-trained nursing staff with frequent in-service training in patient care should be employed. The reorganization tactics suggested in this article may help a subacute facility function in an efficient way at acceptable costs while maintaining high quality patient care. (+info)
Psychosocial components of cardiac recovery and rehabilitation attendance.
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OBJECTIVE: To examine the relations between demographic factors, specific psychosocial factors, and cardiac rehabilitation attendance. DESIGN: Cohort, repeated measures design. SETTING: A large tertiary care centre in western Canada PATIENTS: 304 consecutive consenting patients discharged following acute myocardial infarction and/or coronary artery bypass graft surgery. MAIN OUTCOME MEASURES: The Jenkins self-efficacy expectation scales and activity checklists of behaviour performance for maintaining health and role resumption, modified version of the self-motivation inventory, and the shortened social support scale. RESULTS: Those who had higher role resumption behaviour performance scores at two weeks after discharge were significantly less likely to attend cardiac rehabilitation programmes. At six months after discharge, those who attended cardiac rehabilitation demonstrated higher health maintenance self-efficacy expectation and behaviour performance scores. Health maintenance self-efficacy expectation and behaviour performance improved over time. Women reported less social support but showed greater improvement in health maintenance self-efficacy expectation. Changes in self-efficacy scores were unrelated to-but changes in health maintenance behaviour performance scores were strongly associated with-cardiac rehabilitation attendance. CONCLUSIONS: Cardiac patients and practitioners may have misconceptions about the mandate and potential benefits of rehabilitation programmes. Patients who resumed role related activities early and more completely apparently did not see the need to "rehabilitate" while those who attended cardiac rehabilitation programmes enhanced their secondary prevention behaviours. (+info)