Eleni Koutsogeorgou

Quality-of-life and disability in patients with stroke

ObjectiveThe aim of this study was to assess the impact of stroke on health-related quality-of-life (HRQoL) and disability, the relationships between the two constructs, and to what extent these two constructs are affected when perceived health state changes. DesignThe World Health Organization Disability Assessment Schedule (WHO-DAS II) and the 36-Item Short-Form Health Survey (SF-36) were administered via mail to a sample of adult stroke survivors. Comparison against normative Italian values was made using one-sample t test. SF-36 and WHO-DAS II scores were compared between employed and unemployed patients and between patients self-reporting improved, unchanged, and decreased health state using analysis of variance with least significant difference post hoc test. The relationships between SF-36 and WHO-DAS II were assessed using Pearson correlation. ResultsA total of 111 patients were enrolled. The SF-36 and WHO-DAS II scores of stroke patients were worse in comparison with Italian normative values. Moderate to strong correlations between all scales and the summary score of WHO-DAS II and SF-36 were found: The worse the disability is, the lower the HRQoL. Patients reporting worse health status in the previous year reported higher levels of disability and lower HRQoL. Employed persons had higher HRQoL and lower disability levels. ConclusionsThe generic HRQoL instrument and disability schedule used in this study demonstrated strong relationship between these two dimensions. It also gave a more detailed picture of the aspects of disability and HRQoL that are most relevant for the persons after stroke and that should be studied further in the future research.

The selection of items for the preliminary version of the COURAGE in Europe built environment instrument

The built environment can increase or decrease disability through its impact on mobility or accessibility to infrastructures, and through its relation to social environment. There is a need for the development of a tool which allows to assess built environment in both objective and self-reported manner, contemplating also issues of accessibility and disability, and that allows data comparability across countries and populations. The present paper describes the preliminary process of the development of a new built environment instrument. It describes the process of the selection, creation and categorisation of a pool of items from the 31 instruments resulting from the UDHP Project. A pool of items was created and was used to produce two lists: the outdoor checklist, and the self-reported questionnaire. These two lists formed the basis of the COURAGE in Europe built environment instrument. The outcome of this selection and categorisation process was the creation of two lists of items, that are meant to measure the interaction between the built environment and aspects of health and disability in ageing.

Social capital, disability, and usefulness of the International Classification of Functioning, Disability and Health for the development and monitoring of policy interventions

This paper provides theoretical links between the model of health and disability based on the International Classification of Functioning, Disability and Health (ICF) and the complex notion of ‘social capital’. In practice, social capital mechanisms could contribute to better health through their use in health-promotion actions, and, in general, through their integration in inclusive policies and systems for facilitating the biopsychosocial model of disability. The present paper shows how ICF could offer an informational platform for conceptualizing and potentially measuring the causal linkages between social capital and health and disability.

The relationship between health-related quality-of-life and disability in patients with controlled epilepsy: a cross-sectional observational study.

ObjectiveThe aims this study were to assess the impact of epilepsy on the health-related quality-of-life (HRQoL) of patients and on patterns of disability and to describe the relationship between disability and HRQoL in adult patients with controlled epilepsy. DesignDisability was measured with the World Health Organization Disability Assessment Schedule, second version (WHO-DAS II), whereas HRQoL was measured with the 36-item Short-Form Health Survey (SF-36). The relationships between SF-36 and WHO-DAS II were evaluated with Pearson correlation. The impact of epilepsy on disability and HRQoL was assessed by comparing WHO-DAS II and SF-36 scores with the Italian normative values and by evaluating different disability and HRQoL profiles in patients self-reporting change in health state against those reporting no change. ResultsFew differences between patients’ and normative scores were observed. In particular, patients with a stable health state reported higher HRQoL and lower disability status, compared with those reporting an improvement or a decline in health state. The relationships between WHO-DAS II and SF-36 were significant but were generally low or moderate. ConclusionsDisability and HRQoL scores of patients with controlled epilepsy were not significantly different compared with those of the general population, in particular among stable patients. Measures of HRQoL and disability evaluate different psychosocial aspects of epilepsy and can be used jointly to evaluate outcomes.

Linking COURAGE in Europe Built Environment instrument to the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY)

OBJECTIVES The aim of the paper is to prove that the COURAGE in Europe Built Environment (CBE) instrument selected items are relevant to health and disability assessment and evaluation. STUDY DESIGN The two lists of the CBE preliminary items--outdoor checklist and self-reported questionnaire--were linked to the World Health Organizations International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) through established linking rules. RESULTS The pool of the CBE 162 preliminary items were linked to a total of 184 categories of ICF-CY, and belonged mainly to two out of the four of the ICF-CY components. Fifteen of the items were not linked to any category of the ICF-CY classification at all. The linking process showed that more than 90% of CBE preliminary items were linked to ICF-CY categories and more than 4/5 of them were linked to the ICF-CY component of environmental factors. CONCLUSION The fact that most of the linked CBE preliminary items referred to few ICF categories, on one hand showed that the ICF framework encompasses a lot of different aspects related to functioning and disability; on the other hand ICF categories are not very detailed for a comprehensive description of the built environment features.

Using Social Capital to Construct a Conceptual International Classification of Functioning, Disability, and Health Children and Youth Version–based Framework for Stronger Inclusive Education Policies in Europe

Inclusive education is part of social inclusion; therefore, social capital can be linked to an inclusive education policy and practice. This association is explored in this article, and a practical measure is proposed. Specifically, the World Health Organizations International Classification of Functioning, Disability and Health Children and Youth Version (ICF-CY) is proposed as the link between social capital and inclusive education. By mapping participation and trust indicators of social capital to the ICF-CY and by using the Matrix to Analyse Functioning in Education Systems (MAFES) to analyze the functioning of inclusive education policies and systems, a measure for stronger inclusive education policies is proposed. Such a tool can be used for policy planning and monitoring to ensure better inclusive education environments. In conclusion, combining enhanced social capital linked to stronger inclusive education policies, by using the ICF-CY, can lead to better health and well-being for all.

Healthy and active ageing: Social capital in health promotion

Objectives: This paper examines the context of health promotion actions that are focused on/contributing to strengthening social capital by increasing community participation, reciprocal trust and support as the means to achieve better health and more active ageing. Method: The methodology employed was a literature review/research synthesis, and a thematic analysis. Results: Four core themes emerged from the analysis: a) active ageing; b) the relationship between social capital and ageing; c) the importance of social capital in health promotion; and d) policy implications. The role of social capital in health promotion stresses empowerment, intergenerational support, the building of social trust, and the need to tackle loneliness among older adults. The importance of community/social participation emerged from the literature review as a key contributor to the maintenance and promotion of a healthier ageing population. Conclusion: Supporting long-term social capital building within communities can lead to improved public health and well-being for an ageing population.

What factors are important in smoking cessation amongst deprived communities? A qualitative study

Objective: There is limited evidence regarding effective smoking cessation interventions in deprived communities. This study explored what factors are considered most important in smoking cessation, from the perspective of a group of NHS Stop Smoking Service users from a deprived community. Design: A qualitative study. Setting: A deprived community in Brighton and Hove City, Southeast England. Methods: Fifteen adults who had used the local NHS Stop Smoking Service were recruited to the focus groups. Thematic analysis was used to identify key themes regarding factors that were considered most helpful during the smoking cessation attempt. Results: Factors deemed most important for a successful smoking cessation attempt were counsellors’ attitude and knowledge, flexibility of appointments, personalized one-to-one support including additional support between sessions, all provided in an accessible local community setting. Individuals were most likely to decide to quit smoking for health reasons, and support from family and friends was important during the quit attempt. Conclusion: This study shows that smokers from deprived communities require more intensive, flexible and personalized support from a stop smoking service which should ideally be located in their community setting. A more innovative, tailored and less prescriptive approach to providing stop smoking services may help to improve cessation rates among smokers in deprived communities.

Analysis of general population surveys with regard to comparable estimates of disability and its correlates across selected European surveys.

ABSTRACTThis article presents a methodology developed by the Multidisciplinary Research on Health and Disability in Europe project researchers for the retrieval of information about disability using the conceptual framework of the International Classification of Functioning, Disability and Health. A comprehensive review and analysis of European surveys was performed and it is presented here briefly. Recommendations and guidelines for future statistical studies and development of disability surveys are provided. The methodology proposed shows the utility and feasibility of the ICF in research.

Women with Disability across Europe: Issues on Updated and Available Data

The collection of comparable estimates of Women with Disability (WwD) is essential for successful policy-making, and can be directly addressed to the reduction of the barriers that WwD have to face so to achieve full participation in all aspects of their lives. In order to minimize and prevent barriers for WwD, a common policy and a research framework is needed within the European countries. Therefore, the aim of this paper is to underline the issues related to availability, type, and comparability of European data about WwD, and to suggest how to overcome some of the open needs. In particular, the International Classification of Functioning, Disability and Health (ICF) issued by the World Health Organization could be the core conceptual model for collecting data and measuring disability, acting as the basis for relevant social policies, since information at all levels on the functioning of WwD is essential for policy purposes.