Browsing by Subject "disability"

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  • Sjöblom, Stina (2007)
    Services for disabled people are changing as a part of the ongoing processes of change in the area of welfare services in the municipalities. The study examines the role and position of social work within these processes. With a starting point in the close connections between social movements and social work, I have pointed out the impact of the Disabled people’s movement on the ideas of disability, the so called disability models. Parallell to the changes in the society and the shifting discourse of disability models, social work is changing as well. In this study focus lies on empowerment and dialogue as ideas which are both theoretically and ethically motivated, but also important as practical elements in social work. The study points out research that has influenced the discussion on disability models and empowerment in social work. Understanding about disability influence how society is planned, how legislation and criteria for services are formulated and practised. This understanding influences the substance in the social workers’ practice and the alternatives in the everyday life of disabled people who use services. An other dimension of these processes is the one that takes place in the meeting between social workers and disabled people. This study contributes to the discussion of the role and position of social work. At the same time there is a goal that contributes to practise as well: to increase the self-reflection and knowledge within services for disabled people, to enhance the possibilities for co-operation and to find some ideas and tools for developping dialogical practice. The research question has risen from practical needs. In my contacts as a social worker, with disabled people and social workers from all parts of Finland, I have created a general picture about social work within services for disabled people. The questions that have risen from practise are connected with encounters, dialogue, practises, co-operation and the ethics. The research question examines what influences the end result that social work is carried out way it is. The qualitative research project started with an action research approach with focus on development, and it transformed during the research process. This is the reason why the same process is described in this study with two different approaches. First, in the participatory action research frame, and secondly, from the individual perspective in the frame of content analysis of focus group interviews. The study results point out something of the potential that social work possesses and raises questions about whether the full potential of social workers is in use today. The results also point at the limitations. The interesting question then is: who is setting the limits and how does this connect with the potential not in use. Are the limits set from outside or do social workers have the chance to participate in defining them? The study reveals facts that influence and to a certain point explains the existing differences between different municipalities, when it comes to the social work offered within services for disabled people. The significance for research is that in the scope of Finnish social work, the marginal group of social workers who work with services for disabled people, in this study are heard and documented.
  • Katsui, Hisayo; Kazakunova, Gulmira; Mojtahedi, Mina C. (2020)
    The main aim of this paper is to tease out the historical and deeply rooted ethical standards, spirituality, and social values that have long supported the social service system in Kyrgyzstan, which, today, faces pressure to align with the United Nations Convention on the Rights of Persons with Disabilities. The data are based on an intervention conducted as part of the European Union‐Social Protection Systems programme in Kyrgyzstan between 2017 and 2018 where 30 university lecturers were part of. Interviews both to the Kyrgyz trainers with disabilities and to the trainees of the university lecturers as well as follow‐up survey conducted in 2019 form important part of data for this paper. We first investigate the conventional ethical standards, spiritual explanations, and social values related to disabilities within the Kyrgyz social protection system and social services. We elaborate on the Kyrgyz context of the societal ethics, spirituality, and values around disability in the Kyrgyz university education for social workers. Second, we analyse the transformation of the perception of disability among the university lecturers. We conclude this paper with a discussion on the negotiation between a charity‐based approach that reinforces the stigmatization of disability and a human rights‐based approach that promotes paradigm change, to contribute to global discourse of social change towards disability inclusion.
  • Heikkilä, Mikaela; Katsui, Hisayo; Mustaniemi-Laakso, Maija (2020)
    Universal human rights of all are complemented with particular, targeted protection of some, especially those that traditionally have been left behind. By juxtaposing the ideas of universality and particularity, the article studies vulnerability as a particularising tool within human rights with a comparative approach to the influential vulnerability theory by Martha Fineman. By outlining the similarities and the differences between the two approaches of vulnerability theory and human rights project, the article sheds light on how the particular protection needs of persons with disabilities play out in the universalistic logic of vulnerability. The article argues that both universal and particular obligations of responsive states – and responsive humans – are needed as a way of materialising substantive equality for persons with disabilities as vulnerable legal subjects. Such obligations cannot be codified in full detail, but the intrinsic essence of rights requires each right to be interpreted in context and with regard to the particular individual vulnerabilities and resilience of each person. In operationalising the obligations arising from such rights, the human rights project and the vulnerability theory complement and reinforce each other in terms of specifying the rationale and the detailed benchmarks for state action.
  • Eivergård, Kristina; Enmarker, Ingela; Livholts, Mona Birgitta; Aléx, Lena; Hellzén, Ove (2021)
    Aims and objectives To examine how gendered discursive norms and notions of masculinity and femininity were (re)produced in professional conversations about users of long‐term municipality psychiatric care. Focus is on the staff’s use of language in relation to gender constructions. Background Psychiatric care in Sweden has undergone tremendous changes in recent decades from custodian care in large hospitals to a care mainly located in a municipal context. People who need psychiatric care services often live in supporting houses. In municipal psychiatric care, staff conduct weekly professional meetings to discuss daily matters and the users’ needs. Official reports of the Swedish government have shown that staff in municipal care services treat disabled women and men differently. Studies exploring gender in relation to users of long‐term psychiatric care in municipalities have problematised the care and how staff, through language, construct users’ gender. Therefore, language used by staff is a central tool for ascribing different gender identities of users. Design The content of speech derived from audio recordings were analysed using Foucauldian discursive analysis. The COREQ checklist was used in this article. Results The results indicate that by relying on gender discourses, staff create a conditional care related to how the users should demonstrate good conduct. In line with that, an overall discourse was created: Disciplined into good conduct. It was underpinned by three discourses inherent therein: The unreliable drinker and the confession, Threatened dignity, Doing different femininities. Conclusion The community psychiatric context generates a discourse of conduct in which staff, via spoken language (re)produces gendered patterns and power imbalances as a means to manage daily work routines. Such practices of care, in which constant, nearly panoptic, control despite the intention to promote autonomy, urgently require problematising current definitions of good conduct and normality.
  • Russo, Fabrizio; De Salvatore, Sergio; Ambrosio, Luca; Vadalà, Gianluca; Fontana, Luca; Papalia, Rocco; Rantanen, Jorma; Iavicoli, Sergio; Denaro, Vincenzo (2021)
    Low back pain (LBP) is currently the leading cause of disability worldwide and the mostcommon reason for workers’ compensation (WC) claims. Studies have demonstrated that receivingWC is associated with a negative prognosis following treatment for a vast range of health conditions.However, the impact of WC on outcomes after spine surgery is still controversial. The aim of thismeta-analysis was to systematically review the literature and analyze the impact of compensationstatus on outcomes after lumbar spine surgery. A systematic search was performed on Medline,Scopus, CINAHL, EMBASE and CENTRAL databases. The review included studies of patientsundergoing lumbar spine surgery in which compensation status was reported. Methodologicalquality was assessed through ROBINS-I and quality of evidence was estimated using the GRADErating. A total of 26 studies with a total of 2668 patients were included in the analysis. WC patientshad higher post-operative pain and disability, as well as lower satisfaction after surgery whencompared to those without WC. Furthermore, WC patients demonstrated to have a delayed return towork. According to our results, compensation status is associated with poor outcomes after lumbarspine surgery. Contextualizing post-operative outcomes in clinical and work-related domains helpsunderstand the multifactorial nature of the phenomenon.
  • Taimela, Elli (Helsingin yliopisto, 2019)
    Disability imposes personal suffering but also economic consequences for individuals, employers, and the society. Finding an optimal method for disability prevention can be considered beneficial and increasingly important for a country with a prominent public sector and a weakening labor force participation rate like Finland. Previous studies show evidence of the effectiveness of worksite health promotion programs that target care for employees who face a high risk for disability. Evidence shows positive cost-effectiveness of targeted occupational health interventions in preventing short-term disability but a wider benefit-cost analysis of targeted occupational health interventions with a view on both short-term and long-term disability prevention has not previously been conducted. This study untangles the treatment effect of targeted occupational health interventions on societal net benefits resulted from disability prevention. Short-term disability as a concept is viewed through sickness absence, and long-term disability is represented by the disability benefits granted by the Finnish disability benefit system. The costs of disability preventing actions are limited to health care utilization. The research setting of this study has been observational, and the empirical analysis is conducted as a retrospective review of prospectively collected register data. The data registers cover health and disability related information of over 20,000 employees in Finland. In the main analysis, 1,679 treated employees identified with a high risk for disability are compared to 2,107 untreated high-risk employees. The benefit-cost analysis is constructed with the Average Treatment Effect framework combined with Net Benefits framework. The treatment of the framework of this study is an attendance to a targeted, pre-planned health check after an occupational health survey. The outcome of the framework is the net benefits that result from prevention of sickness absence workdays and granted disability benefits, and the investment costs resulted from health care utilization. The results are formed with Analysis of Covariance. Other methods to conduct the empirical analysis include polynomial regression, Multiple Imputation of Chained Equations, Propensity Scores, and Inverse Probability Weighting. The results of this study show that targeted occupational health interventions are likely to impose positive net benefits to the society. The Average Treatment Effect on the net benefits of high-risk employees, 1,875 euros with a 95% confidence interval from -759 to 4,509 euros (p-value: .155) (ANCOVA), can be considered worthwhile to the society. In the research setting, the net benefits were in practice gained from the prevention of long-term disability. The treatment was not effective on the costs of short-term disability or the total health care utilization costs per employee. Sensitivity analyses indicate that targeted occupational health interventions are not on average effective when predicted to employees without a disability risk.
  • Hakola, Tuulia (2002)
    The Finnish pension system is structured mainly with a pay-as-you-go –principle. Accordingly, the working population pays the pensions of the already retired population. If there is a change in the worker-retiree –ratio, financing of the pension system can become problematic. Therefore, the timing of retirement or the average retirement age matters. The decision to retire is influenced by a number of economic and non-economic factors. This thesis focuses on the economic incentives of retirement. The thesis uses large panel data sets to construct these incentives for the Finnish population. The aim of the study is to assess how much these incentives affect the probability of retirement. The first essay divides retirement into retirement with the disability pension, with the unemployment pension and with the old-age pension. Higher replacement rate increases the conditional probability of retirement, but this relationship is non-monotonic. Most clearly the replacement rate increases the probability of retirement through the unemployment pension, and it has no effect on the timing of the old-age retirement. The second essay shows that ignoring the difference between disability application and transition probability produces results that are halfway between the two. The essay also tests the impact of a number of different life-cycle incentives. Results on the pure life-cycle incentives are counter-intuitive, whereas the option value results are of the expected sign. The third essay considers part-time retirement. Financial compensation is estimated for each individual in full-time work, part-time work and in full-time retirement. Results show that the part-time pension has been financially most advantageous to those who chose this option. The essay also estimates that fifty per cent of the partially retired would have chosen full-time retirement, had they not had the part-time option. The fourth essay takes also the employer incentives into account. It tests an implicit contracts model on a linked employer-employee panel data. Results show that joint incentives of early retirement matter more when the economic conditions are bad. The essay also shows that experience-rating of the displacements affects the firm behaviour.
  • Kapanen, Heini (Helsingfors universitet, 2011)
    Objectives. The thesis objective was to analyze how person-centred planning is applied to develop short term care in interaction between the disabled children, their families and the workers of the family service centre of Eteva Järvenpää. The thesis contributes to developing the methods of person-centred planning. I applied theoretical frameworks of activity theory and developmental work research, family-based work framework and disability phenomenon. The research questions were: What development needs did the families of disabled children have for the services? How were viewpoints of disabled children, their families and Eteva workers noticed in person-centred planning in the interaction between the disabled children, their families and Eteva workers? What disturbances and development challenges emerged during the person-centred planning? Methods. I first analysed the local history of the disability sector and the short term care to analyse challenges arising from the local history. The actual research material consisted of interviews with four families, two person-centred planning discussions and two discussions where the person-centred planning was reflected by the families.I used interaction voice analysis as defined by the activity theory and developmental work research. From the recorded interviews and discussions I analysed scripts, disturbances, innovation attempts and innovations. From the discussions I analysed also the interaction types (cooperation, coordination and communication). Results and conclusions. As problems, the families considered the scarce resources and the inflexibility of services. The challenges of developing the short term care were how to transfer information from short term care to home, how to develop activities for the children and how to take into account the individual needs of the children in the short term care. Both from the local history analysis and from the family interviews arised the conflict between caring and fulfilling the individual needs. In person-centred planning, the voice of the child was either interpreted by other family members or guided by family members or workers. I modelled the progress of person-centred planning in a two-dimensional coordination. Person-centred planning should be deepened in cooperation between the child, the family and the workers in everyday situations at home and during the short term care. The challenge is to expand person-centred planning to become cross-organizational cooperation connecting the actors of the child's service network in everyday life.
  • Haagsma, Juanita A.; Olij, Branko F.; Majdan, Marek; van Beeck, Ed F.; Vos, Theo; Castle, Chris D.; Dingels, Zachary; Fox, Jack T.; Hamilton, Erin B.; Liu, Zichen; Roberts, Nicholas L. S.; Sylte, Dillon O.; Aremu, Olatunde; Baernighausen, Till Winfried; Borzi, Antonio M.; Briggs, Andrew M.; Carrero, Juan J.; Cooper, Cyrus; El-Khatib, Ziad; Ellingsen, Christian Lycke; Fereshtehnejad, Seyed-Mohammad; Filip, Irina; Fischer, Florian; Haro, Josep Maria; Jonas, Jost B.; Kiadaliri, Aliasghar A.; Koyanagi, Ai; Lunevicius, Raimundas; Meretoja, Tuomo J.; Mohammed, Shafiu; Pathak, Ashish; Radfar, Amir; Rawaf, Salman; Rawaf, David Laith; Riera, Lidia Sanchez; Shiue, Ivy; Vasankari, Tommi Juhani; James, Spencer L.; Polinder, Suzanne (2020)
    Introduction Falls in older aged adults are an important public health problem. Insight into differences in fall-related injury rates between countries can serve as important input for identifying and evaluating prevention strategies. The objectives of this study were to compare Global Burden of Disease (GBD) 2017 estimates on incidence, mortality and disability-adjusted life years (DALYs) due to fall-related injury in older adults across 22 countries in the Western European region and to examine changes over a 28-year period. Methods We performed a secondary database descriptive study using the GBD 2017 results on age-standardised fall-related injury in older adults aged 70 years and older in 22 countries from 1990 to 2017. Results In 2017, in the Western European region, 13 840 per 100 000 (uncertainty interval (UI) 11 837-16 113) older adults sought medical treatment for fall-related injury, ranging from 7594 per 100 000 (UI 6326-9032) in Greece to 19 796 per 100 000 (UI 15 536-24 233) in Norway. Since 1990, fall-related injury DALY rates showed little change for the whole region, but patterns varied widely between countries. Some countries (eg, Belgium and Netherlands) have lost their favourable positions due to an increasing fall-related injury burden of disease since 1990. Conclusions From 1990 to 2017, there was considerable variation in fall-related injury incidence, mortality, DALY rates and its composites in the 22 countries in the Western European region. It may be useful to assess which fall prevention measures have been taken in countries that showed continuous low or decreasing incidence, death and DALY rates despite ageing of the population.
  • Kokkinen, Lauri; Kouvonen, Anne; Buscariolli, André; Koskinen, Aki; Varje, Pekka; Väänänen, Ari (2019)
    Purpose: The aim of the study was to investigate sickness absence due to mental disorders in human service occupations. Methods: Participants (n = 1,466,100) were randomly selected from two consecutive national 9-year cohorts from the Statistics Finland population database; each cohort represented a 33% sample of the Finnish population aged 25-54 years. These data were linked to diagnosis-specific records on receipt of sickness allowance, drawn from a national register maintained by the Social Insurance Institution of Finland, using personal identification numbers. Results: Sociodemographic-adjusted hazard ratios (HRs) for sickness absence due to mental disorders in all human service occupations combined were 1.76 for men (95% confidence interval [CI], 1.70-1.84) and 1.36 for women (95% CI, 1.34-1.38) compared with men and women in all other occupations, respectively. Of the 15 specific human service occupations, compared with occupations from the same skill/education level without a significant human service component, medical doctors, psychologists, and service clerks were the only occupations with no increased hazard for either sex, and the HRs were highest for male social care workers (HR 3.02: 95% CI, 2.67-3.41). Conclusions: Most human service occupations had an increased risk of sickness absence due to mental disorders, and the increases in risks were especially high for men. (C) 2018 Elsevier Inc. All rights reserved.
  • Syrjänen, Sakari (Helsingfors universitet, 2014)
    Objectives of the study: Multidiscipline knowledge is needed in evaluation of person's functional capacity in work: physical and psychosocial factors must be considered. Generic models and tools are needed to provide common practices to evaluate work-ability (or demands of the work) and to understand the relevance of multifaceted factors underneath. Reflective processing of one's own knowledge and intuitions is seen to improve a person's ability to understand the relevance of unfamiliar information and to achieve a higher cognitive congruence in a multi-professional group. That can be achieved through group-learning practices. In a current research effect of IMBA- methods training is studied. It is assumed that training will increase the cognitive congruence between professionals evaluating work-ability. Methods: Three training groups were arranged in 2005. 51 professionals of vocational rehabilitation participated (43 women and 8 men). They evaluated both the functional capacities of a person and the demands of work before and after their IMBA-training. Evaluations were done on the basis of written case-information. The data of these evaluation tasks is data of this study. Both independent samples and repeated measures settings was used. The effect of training is analyzed as a measure of absolute agreement indexes (ICC and rrg) Results and conclusions: The results agreed with the hypothesis: After IMBA training the level of absolute agreement was higher in evaluating both the demands of work and the functional capacities of a person. Differences between training groups, features of the task or familiarity of the material didn't seem to influence the effect. Agreement got higher in evaluating physical and psychosocial factors of workability. The effect was very systematic. The evaluations were more congruent after training even though the effect was not strong enough to reach statistical significance with these samples. What was surprising was that demands of work were systematically evaluated lower after training as the functional capacities of persons were evaluated the same or a little higher after the training. Interesting question is: Do the professionals overestimate the demands of the work in general when making evaluations based on their intuitive thinking? If that's the case, the customers of vocational rehabilitation are seen as more disabled compared to demands the work than they are in real. The possibility of a systematic error like this in evaluating workability must be studied more in the future.
  • Kallio, Suvi (Helsingin yliopisto, 2019)
    Disability and poverty are tightly interlinked, but disability inclusion often remains on the sidelines of poverty reduction programmes. Abilis Foundation supports organisations of persons with disabilities in developing countries, and income generation and poverty reduction projects are one of its key thematic areas. The objective of this study, commissioned by Abilis Foundation, is to evaluate the effectiveness and sustainability of Abilis funded income generation projects in Sierra Leone, and to identify the factors influencing the livelihoods of persons with disabilities in Sierra Leone. The primary data consists of semi-structured interviews and a focus group discussion with adult persons with disabilities who had participated in Abilis funded income generation projects between 2015–2018. Discussions with other relevant informants and data from the project documents were included in the analysis to strengthen the validity of the results. The analysis follows qualitative content analysis principles. All income generating activities supported in the sample projects were still on-going during the time of study, even though most businesses continued to be very small-scale. The results indicate that limited financial assets (resulting in, inter alia, lack of equipment and materials) and strong competition restrain persons with disabilities from expanding their businesses. Social assets and education support their livelihood opportunities but are only useful when other factors enable people to draw on their social and human assets as well. Widespread poverty affects all aspects of life in Sierra Leone, and persons with disabilities are even more vulnerable because they are often socially marginalized and face widespread discrimination that restrains their access to assets and restricts their participation in economic activities, decision-making, and social life in general. It is essential to consider context-specific local characteristics, target beneficiaries, and market dynamics when planning poverty reduction programmes and livelihood activities. Successful poverty reduction efforts must consider aspects beyond mere income generation. Key elements for successful poverty reduction and livelihood programmes include enhancing the opportunities of persons with disabilities to adopt diverse livelihood strategies, empowerment of persons with disabilities to have their voices heard and to gain control in their own lives, and promoting security and appropriate coping mechanisms to reduce vulnerability and to increase their resilience.
  • Kauppila, Aarno (Helsingfors universitet, 2013)
    My master's thesis is a study of citizenship and its ideals in disability policy from the perspective of critical ability studies. The main focus of ability studies is to analyze ableism and how it produces ideals of perfect humanness. Therefore, from the perspective of ableism these ideals produce disability and impairments as something intolerable as well as inherently and ontologically negative. My study focused on the disability policy paradigm as it is after the convention on the rights of persons with disabilities from the year 2006. The disability policy paradigm emphasizes both the rights of people with disabilities to full citizenship and their participation in society. The study data included 20 documents from European, national and municipal disability policies, released from 2006 onwards. In this study I explored how ableism defines the construction of full citizenship and how ableism affects individual's possibilities to participate as citizen according to the current disability policy. As my research method, I applied interpretative reading style based on the New Rhetoric. In the current disability policy paradigm the ideal of full citizenship is based on individualistic and neoliberalistic views, which emphasize self-mastery and independence. This ideal is impossible for people with disabilities because self-mastery and independence are defined as autonomy from other people and social services. Moreover, falling short from the ideal is located in ontologically negative space. Subsequently the bodies with impairments are always seen as imperfect and defective as well as economically burdening. Emphasizing the physical imperfectness of individuals defines their possibilities to participate in society because this participation is emulating the ideal. Also, the individuals with disabilities are forced to repeat their imperfectness in order to obtain social services, which enable participation. Ontological discrimination of people with disabilities is evident in the disability policy, even though it contradicts the aims of the policy.
  • Markkanen, Minna (Helsingfors universitet, 2011)
    The aim of this study was to examine accessibility in folk high schools from the perspective of students with disabilities or learning difficulties. Accessibility in education means that psychological, sociological and physical environment enables equal study opportunities. Therefore the focus in this survey was on equal study opportunity deficiencies. Folk high schools are an essential subject for accessibility research as they follow the equal educational policy of liberal adult education. This study is a part of Liberal adult education -research project (2010-2012), which is the first accessibility research in Finnish liberal adult education. The equality-based claim of accessibility together with the need to separate the experiences of students with disabilities and learning difficulties from common experiences led naturally to comparative research frame. Firstly, experiences of the experimental group (students with disabilities or learning difficulties, N=278) were compared to experiences of the comparison group (students representing the educational majority, N=498). Secondly, experiences within the experimental group were examined according to gender, need of support and educational background. This study was mostly quantitative survey study. Data was collected from folk high school students with an inquiry created for this study. Data-analysis was mainly made by using analysis of variance (GLM) and test of Kruskal-Wallis. Qualitative data was analysed as an additional element by quantification. Equal study opportunity deficiencies were found in teaching and studying, other people's awareness and attitudes, own attitudes, information and peer group, where the experimental group found significantly more accessibility deficiencies than the comparison group. The most considerable difference was found in teaching and studying, wherein also the quality of deficiencies was explained differently between the groups. Within the experimental group women experienced more accessibility deficiencies than men. Also regular and great need of support and low educational background were connected with the experience of greater accessibility deficiencies. As a conclusion it seems that the equality-based accessibility in folk high schools could be improved especially by differentiating teaching and learning. This study also proved general need for more exact definition of the intention of accessibility: is the priority to develop common quality or equality of education, and is the aim to remove the barriers or advance support to overcome them.
  • Fagerlund, Pi; Salmela, Jatta; Pietiläinen, Olli; Salonsalmi, Aino; Rahkonen, Ossi; Lallukka, Tea (Helsingin yliopisto, 2021)
    Abstract Background: Pain is known to be socio-economically patterned and associated with disability. However, knowledge is scarce concerning life-course socio-economic circumstances and pain among young adults. Our aim was to examine the associations of childhood and current socio-economic circumstances with acute pain and chronic pain with low and high disability levels among young Finnish municipal employees. Methods: We analyzed questionnaire data retrieved from the Young Helsinki Health Study (n=4683) covering 18–39-year-old employees of the City of Helsinki, Finland. We included a comprehensive set of indicators of childhood and current socio-economic circumstances and examined their associations with acute pain and with chronic pain with low and high disability levels. The level of chronic pain–related disability was assessed by the Chronic Pain Grade Questionnaire. Multinomial logistic regression analyses were conducted with stepwise adjustments for socio-demographic, socio-economic and health-related covariates. Results: Childhood and current socio-economic disadvantage were associated with acute and chronic pain, particularly with chronic pain with high disability level. The strongest associations after adjustments for covariates remained between chronic pain with high disability level and low education level (OR 3.38, 95% CI 2.18–5.24), manual occupation (OR 3.75, 95% CI 1.92–7.34) and experiencing frequent economic difficulties (OR 3.07, 95% CI 2.00–4.70). Conclusions: Pain is highly prevalent already among young employees and there is a socio-economic gradient in both pain chronicity and chronic pain–related disability. Life-course socio-economic determinants of pain should be considered in pain-preventing strategies and in clinical practice.
  • Helminen, Eeva-Eerika; Arokoski, Jari P. A.; Selander, Tuomas A.; Sinikallio, Sanna H. (2020)
    Objective: To identify predictors of long-term pain and disability in knee osteoarthritis. Design: A longitudinal cohort study of five years. Setting: Primary care providers. Subjects: In all, 108 patients (mean age = 63.6 years, standard deviation (SD) = 7.2 years) with knee pain (> 40 mm on a 100 mm visual analogue scale in the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index pain scale) and radiographic grading (Kellgren-Lawrence: 2-4) of knee osteoarthritis who participated in a randomized controlled trial. Main measures: Disease-specific pain and functioning were assessed using the corresponding WOMAC subscales. Generic functioning was assessed by the RAND-36 subscales for function and physical and mental component summary scores. Possible baseline predictors for these outcomes were (1) demographic and disease-related variables and (2) psychological variables of mood (anxiety, depression), pain-related cognitions (pain self-efficacy, pain catastrophizing, kinesiophobia), and positive resource factors (life satisfaction, sense of coherence). Results: Multivariate linear mixed model analyses revealed that minimal anxiety at baseline predicted significantly better results for pain (WOMAC, P = 0.019) and function (WOMAC, P = 0.001, RAND-36 function P = 0.001). High pain self-efficacy predicted significantly better scores in RAND-36 function (P = 0.006), physical (P = 0.004) and mental (P = 0.001) component summaries. Pain catastrophizing predicted higher pain (P = 0.015), whereas fear of movement predicted poorer functioning in RAND-36 physical (P = 0.016) and mental (P = 0.009) component summaries. Those satisfied with life reported higher scores in RAND-36 function (P = 0.002) and mental component summary (P = 0.041). A low number of comorbidities predicted significantly better results in pain (WOMAC P = 0.019) and function (WOMAC P = 0.033, RAND-36 P = 0.009). Conclusion: Anxiety, pain-related cognitions, and psychological resources predict symptoms in knee osteoarthritis in the long term.
  • Jokela, Markus; Airaksinen, Jaakko; Virtanen, Marianna; Batty, G. David; Kivimaki, Mika; Hakulinen, Christian (2020)
    Objective We examined how personality traits of the Five Factor Model were related to years of healthy life years lost (mortality and disability) for individuals and the population. Method Participants were 131,195 individuals from 10 cohort studies from Australia, Germany, the United Kingdom, and the United States (n = 43,935 from seven cohort studies for the longitudinal analysis of disability, assessed using scales of Activities of Daily Living). Results Lower Conscientiousness was associated with higher mortality and disability risk, but only when Conscientiousness was below its median level. If the excess risk associated with low Conscientiousness had been absent, population life expectancy would have been 1.3 years longer and disability-free life 1.0 years longer. Lower emotional stability was related to shorter life expectancy, but only among those in the lowest 15% of the distribution, and disability throughout the distribution: if the excess risk associated with low emotional stability had been absent, population life expectancy would have been 0.4 years longer and disability-free life 2.4 years longer. Conclusions Personality traits of low Conscientiousness and low emotional stability are associated with reduced healthy life expectancy of individuals and population.
  • Paunio, Tiina; Korhonen, Tellervo; Hublin, Christer; Partinen, Markku; Harkonmäki, Karoliina; Koskenvuo, Markku; Kaprio, Jaakko (2014)
    BACKGROUND: Disturbed sleep is associated with mood disorders. Both depression and insomnia may increase the risk of disability retirement. The longitudinal links among insomnia, depression and work incapacity are poorly known. METHODS: We examined association of self-reported sleep quality with incident symptoms of depression and disability retirement due to depressive disorders in a longitudinal population-based sample of twins (n=12,063 individuals). These adults were categorized by their sleep quality in 1975 and 1981, excluding individuals with depressed mood in 1975/1981. The outcomes were the Beck Depression Inventory (BDItot) and its subscale Negative Attitudes Towards Self (BDINATS) in 1990 as dichotomized measures, and the incidence of disability retirement due to depressive disorder during 1991-2004. RESULTS: Onset of poor sleep between 1975 and 1981 predicted incident depression (BDItot OR=4.5, 95% CI: 2.7-7.4, BDINATS OR=2.0, 95% CI: 1.4-2.7), while persistent poor sleep showed somewhat weaker effects (BDItot; OR=2.5, 95% CI: 1.0-6.0, BDINATS OR=1.9, 95% CI: 1.1-3.3). Among those with few recent stressful life events, onset of poor sleep predicted strongly depression (BDINATS OR=9.5, 95% CI: 3.7-24.2). Likewise onset of poor sleep by 1981 increased the risk of disability retirement due to depression (OR=2.9, 95% CI: 1.8-4.9) with a similar risk among those with persistent poor sleep (OR=2.7, 95% CI: 1.3-5.7). LIMITATIONS: Lack of baseline diagnostic interviews; sleep quality based on self-report. CONCLUSIONS: Poor sleep is of importance in etiology of depression and disability retirement due to depression. This emphasizes the importance of early detection and treatment of sleep disturbances.
  • Kataja, Ulla (Helsingfors universitet, 2015)
    Aims: Public health care in Finland has the main responsibility of rehabilitation, which means that public health care has to provide for persons with the severe disabilities the therapy or the rehabilitation needed. If a person fulfills the criteria of having severe disablity he is admitted Disability Allowance at its middle or highest rate. This is required for getting medical rehabilitation for persons with severe disabilities, which in Finland is financed by KELA. The speech therapy for the severely disabled organized by KELA is mainly carried out by private sector. There were approximately 500 private speech therapists under the contract of KELA during 2011-2014. Altogether 7439 persons were receiving speech therapy by KELA in 2014. The speech therapists under the contract of KELA are divided somewhat unevenly in Finland, therefore the availability of speech therapy is not equal in the whole land. Particularly areas with less inhabitants seem to suffer from inequality. The UN Convention on the Rights of Persons with Disabilities in 3.5.2008 was aimed at guaranteeing equal human rights to disabled people and to promote and support their human value. Methods: This Master's thesis looks at the availability of speech therapy in Finland both quantitatively based on open statistics by KELA and qualitatively on the nature of positive and negative decisions in the Medical District of Kanta-Häme. Results and Conclusions: The availability of speech therapy for persons with severe disabilities is not by KELAs statistics fully equal in Finland. The uneven division of speech therapists has lead to the fact that there are for example, at the insurance district of Oulu considerably more speech therapists than at the insurance district of Satakunta.The speech therapists under contract of KELA are like many other highly educated people situated close by the universities and other schooling areas, By U.N agreement the persons with disabilities should have rehabilitation near where they live and timing it optimally.The severity of language impairment was the main reason in positive decisions in the Medical District of Kanta-Häme and the insufficiency of arguments in the negative ones, which seem to refer to the fact that there, with an adequate application, speech therapy is guaranteed for the persons with most severe disabilities. One of the aims of the future social welfare and health care reform is to improve the availability of speech therapy in Finland. It remains to be seen how successfully it will answer the growing need.
  • Määttänen, Laura; Ripatti, Liisa; Rautava, Päivi; Koivisto, Mari; Haataja, Leena (2020)
    Aim To study whether cerebral palsy (CP) increases the risk of hospital-treated injuries in children up to 13 years of age. Methods A Finnish population-based cohort (n=328 903) of children born during 2001 to 2006 was followed up for hospital-treated injuries until the end of 2014 via linkage of nation-wide registers. The rate of first injury was compared in children with and without CP. The effect of CP type, gender, severe comorbidities (intellectual disability, epilepsy, hearing or visual impairment), and the type of injury was evaluated. Results Children with CP had an increased risk of injury compared with children without CP (unadjusted HR: 1.2, 95% CI: 1.0 - 1.4, p=0.40). Girls with CP (n=191) had a higher risk of injury compared with girls without CP (29% vs 22%, HR: 1.4, 95% CI: 1.1 to 1.8, p = 0.01). Any comorbidity increased the risk of injury (HR: 1.5, 95% CI: 1.1 to 2.2, p = 0.015) among children with CP. Children with CP had a higher risk of traumatic brain injury (HR: 1.7, 95% CI 1.2 to 2.4, p = 0.002) than children without CP. Conclusion Girls with CP had the highest risk of hospital-treated injury. Children with CP are particularly prone to traumatic brain injuries.