Ageing, functioning patterns and their environmental determinants in the spinal cord injury (SCI) population: A comparative analysis across eleven European countries implementing the International Spinal Cord Injury Community Survey

Spinal cord injury; Aging; EuropeLesión de la médula espinal; Envejecimiento; EuropaLesió de la medul·la espinal; Envelliment; EuropaBackground As the European population with Spinal Cord Injury (SCI) is expected to become older, a better understanding of ageing with SCI using functioning, the health indicator used to model healthy ageing trajectories, is needed. We aimed to describe patterns of functioning in SCI by chronological age, age at injury and time since injury across eleven European countries using a common functioning metric, and to identify country-specific environmental determinants of functioning. Methods Data from 6’635 participants of the International Spinal Cord Injury Community Survey was used. The hierarchical version of Generalized Partial Credit Model, casted in a Bayesian framework, was used to create a common functioning metric and overall scores. For each country, linear regression was used to investigate associations between functioning, chronological age, age at SCI or time since injury for persons with para- and tetraplegia. Multiple linear regression and the proportional marginal variance decomposition technique were used to identify environmental determinants. Results In countries with representative samples older chronological age was consistently associated with a decline in functioning for paraplegia but not for tetraplegia. Age at injury and functioning level were associated, but patterns differed across countries. An association between time since injury and functioning was not observed in most countries, neither for paraplegia nor for tetraplegia. Problems with the accessibility of homes of friends and relatives, access to public places and long-distance transportation were consistently key determinants of functioning. Conclusions Functioning is a key health indicator and the fundament of ageing research. Enhancing methods traditionally used to develop metrics with Bayesian approach, we were able to create a common metric of functioning with cardinal properties and to estimate overall scores comparable across countries. Focusing on functioning, our study complements epidemiological evidence on SCI-specific mortality and morbidity in Europe and identify initial targets for evidence-informed policy-making

Place of residence & financial hardship: the situation of people with spinal cord injury

Abstract Background Even with universal health coverage, people with long-term medical conditions can face financial hardship. However, financial hardship can be not only the result of an increase in health care costs; it has other socio-economic determinants that can cause social inequalities in terms of health. This study aims to estimate the impact of the place of residence on the financial hardship of people with spinal cord injury (SCI) in Switzerland. Switzerland is an interesting case to analyze because of its political system, where each of the 26 cantons is autonomous and responsible for raising its own income (through taxes) and providing public services. Methods Using cross-sectional data from the Swiss Spinal Cord Injury Cohort Study (SwiSCI), this paper estimates the probability of financial hardship by place of residence. The data set, recorded between 2011 and 2013, comprises information from 1549 participants aged 16 years and older, living with SCI. Results The results show that people face different probabilities of financial hardship, depending on their place of residence. In general, people in the French-speaking cantons have a higher probability of financial hardship compared with people living in the German- or Italian-speaking cantons. People in the cantons of Geneva and Graubünden have almost five times the probability of financial hardship, compared with people in the canton with the lowest probability of financial hardship, Zug. Conclusions The place of residence is a determinant of the financial situation of a household where a member deals with a long-term health condition. The differences might arise due to variations in health care costs, the tax burden and social support system, which are regulated and administered by each canton

Ecuador: el ciclo económico y la política fiscal

El presente estudio pretende analizar la importancia del manejo fiscal como herramienta estabilizadora en la economía. Si bien, gran parte de los economistas han centrado sus estudios en la Política Monetaria y sus efectos sobre el nivel de la economía, el estudio de la Política Fiscal en los últimos tiempos se ha desarrollado con el fin de inferir en ciertas esferas, donde los agregados monetarios no han podido intervenir. Los estudios empíricos muestran cómo las variables fiscales son altamente vulnerables a las fluctuaciones económicas. El manejo desordenado y sin ninguna planificación hace que los efectos de la aplicación de políticas expansivas de gastos, o de un incremento en las tasas tributarias carezcan de efectos sobre el producto. Uno de los principales objetivos de este estudio es establecer cuales son las condiciones del Ecuador, y qué es lo que puede hacer la política fiscal para minimizar los costos que tiene que cubrir la sociedad por las oscilaciones del producto. Una de las más grandes discusiones teóricas en la actualidad se refiere precisamente a las consecuencias de la intervención estatal en los mercados. En efecto, unos sostienen que esta intervención debe ser la menor posible, mientras otros defienden bajo la consideración de que sirve para reducir los impactos y lograr redistribuir el ingreso y la riqueza en la sociedad. Desde mi perspectiva, la intervención del Estado en la economía se justifica siempre que existan imperfecciones en el mercado. Dado que nunca encontraremos en el mercado, ni información ni competencia perfecta, la intervención del Estado será una de las principales características de todas las economías. Por tal motivo, estudiar las herramientas que debe poner en acción el gobierno para inferir situaciones e influir en las decisiones de los agentes económicos es imprescindible. Lograr la estabilidad es el primer paso para conseguir el crecimiento sostenido.....

Health Conditions and Social Interactions

This paper evaluates the impact of an antipoverty program on the health condition of individuals. The program combines a cash transfer with financial incentives for positive behavior to poor families. Its main purposes are to improve the living conditions of eligible households and to promote their investment in their children through school attendance and the provision of basic health services. Since the design of the program includes information on eligible and ineligible families, it is possible to evaluate its direct effect as well as its indirect effect. While the direct impact is measured by the effect of cash grants on eligible individuals, its indirect impact is estimated by the effect generated for the treated neighbors on their non-treated peers. The results show that eligible and ineligible individuals significantly improved their health status due to the program’s interventions: the sickness incidences decreased, the sickness spell was reduced, and people seemed to be able to manage normal activities with less difficulty. Thus anti-poverty programs, despite the fact that constitute a big weight in the public finance of a country, have an important multiplicative effect on the population. It not only generates, in the short run, an increase in the demand for health services but also changes in a positive way the behaviour of people by educating them on the importance of health and nutrition. This result will impact treated and non-treated families in the long run due to the high interaction that characterizes poor societies: families are learning from others.Randomization, experimental design, social interactions

Labor market costs for long-term family caregivers: the situation of caregivers of persons with spinal cord injury in Switzerland

Abstract Background Family members are key in the provision of care to persons facing disability. To undertake the role as caregivers, they face many costs, being the setback in the labor market one of the most relevant. Methods We analyze comprehensive data from long-term family caregivers of persons with spinal cord injury (SCI) in Switzerland. Using information about their working situation before and after becoming caregivers, we estimated the reduction in working hours and the associated income loss. Results On average, family caregivers reduced their working hours by about 23% (8.4 h per week), which has a monetary value of CHF 970 per month (EUR 845). Women, older caregivers, and less educated caregivers have a much higher opportunity cost in the labor market: CHF 995 (EUR 867), CHF 1,070 (EUR 932), and CHF 1,137 (EUR 990) respectively. In contrast, family members who care for a person that works have a much lower impact on their working status, CHF 651 (EUR 567). Interestingly, the reduction in their working time is only a third of the extra work they face as caregivers. Conclusion Health and social systems rely on the unpaid work of family caregivers. To guarantee their long-term involvement, family caregivers need to be recognized for their work and potentially compensated. Without family caregivers, it is very unlikely societies can cope with the increasing need for care, as professional services are limited and expensive

Ageing, functioning patterns and their environmental determinants in the spinal cord injury (SCI) population: A comparative analysis across eleven European countries implementing the International Spinal Cord Injury Community Survey.

BackgroundAs the European population with Spinal Cord Injury (SCI) is expected to become older, a better understanding of ageing with SCI using functioning, the health indicator used to model healthy ageing trajectories, is needed. We aimed to describe patterns of functioning in SCI by chronological age, age at injury and time since injury across eleven European countries using a common functioning metric, and to identify country-specific environmental determinants of functioning.MethodsData from 6'635 participants of the International Spinal Cord Injury Community Survey was used. The hierarchical version of Generalized Partial Credit Model, casted in a Bayesian framework, was used to create a common functioning metric and overall scores. For each country, linear regression was used to investigate associations between functioning, chronological age, age at SCI or time since injury for persons with para- and tetraplegia. Multiple linear regression and the proportional marginal variance decomposition technique were used to identify environmental determinants.ResultsIn countries with representative samples older chronological age was consistently associated with a decline in functioning for paraplegia but not for tetraplegia. Age at injury and functioning level were associated, but patterns differed across countries. An association between time since injury and functioning was not observed in most countries, neither for paraplegia nor for tetraplegia. Problems with the accessibility of homes of friends and relatives, access to public places and long-distance transportation were consistently key determinants of functioning.ConclusionsFunctioning is a key health indicator and the fundament of ageing research. Enhancing methods traditionally used to develop metrics with Bayesian approach, we were able to create a common metric of functioning with cardinal properties and to estimate overall scores comparable across countries. Focusing on functioning, our study complements epidemiological evidence on SCI-specific mortality and morbidity in Europe and identify initial targets for evidence-informed policy-making

Basic sociodemographic and lesion characteristics of European country study participants by collaborating country.

Basic sociodemographic and lesion characteristics of European country study participants by collaborating country.</p

Fig 2 -

a. Trends of functioning scores by chronological age groups and type of injury in countries with representative samples. For each group, the mean (marked with a green x) and its 95% Confidence Interval (the box around the mean) of functioning scores are displayed. The coefficient of the regression with functioning score as outcome (y) and continuous chronological age variable as predictor (x), their correspondent p-value and used number of cases are displayed for each country and lesion level (tetraplegia in blue versus paraplegia in brown). The groups where only mean is displayed have a sample of one person. b. Trends of functioning scores by chronological age groups and type of injury in countries with convenience samples. For each group, the mean (marked with a green x) and its 95% Confidence Interval (the box around the mean) of functioning scores are displayed. The coefficient of the regression with functioning score as outcome (y) and continuous chronological age variable as predictor (x), their correspondent p-value and used number of cases are displayed for each country and lesion level (tetraplegia in blue versus paraplegia in brown). The groups where only mean is displayed have a sample of 1 person.</p

Fig 5 -

a. Relative importance of each environmental factors in explaining the total variation of functioning scores in countries with representative samples, when controlling for chronological age and type of injury. For each country, the full model variation when considering EFs and chronological age and type since injury as predictors is indicated in each country figure’s title. b. Relative importance of each environmental factors in explaining the total variation of functioning scores countries with convenience samples, when controlling for chronological age and type of injury. For each country, the full model variation when considering EFs and chronological age and type since injury as predictors is indicated in each country figure’s title.</p

Fig 4 -

a. Trends of functioning scores by type since injury groups and type of injury in countries with representative samples. For each group, the mean (marked with a green x) and its 95% Confidence Interval (the box around the mean) of functioning scores are displayed. The coefficient of the regression with functioning score as outcome (y) and continuous chronological age variable as predictor (x), their correspondent p-value and used number of cases are displayed for each country and lesion level (tetraplegia in blue versus paraplegia in brown). The groups where only mean is displayed have a sample of 1 person. b. Trends of functioning scores by time since injury groups and type of injury in countries with convenience samples. For each group, the mean (marked with a green x) and its 95% Confidence Interval (the box around the mean) of functioning scores are displayed. The coefficient of the regression with functioning score as outcome (y) and continuous chronological age variable as predictor (x), their correspondent p-value and used number of cases are displayed for each country and lesion level (tetraplegia in blue versus paraplegia in brown).</p