<原著>地域リハビリテーションと在宅ケアシステムの関連性

過疎と高齢化が進行する慶應義塾大学月ヶ瀬リハビリテーションセンター近隣の3自治体に対し在宅高齢障害者の生活自立を支援する目的として, 昭和59-63年より慶應義塾大学月ヶ瀬リハビリテーションセンターが地域自治体と連携して始めた, 地域リハビリテーション教室, 訪問リハビリテーションなど地域リハビリテーション支援活動に関する実績と効果について検討した。その結果, 支援対象者の把握や選定方法, 家庭訪問の優先順位などに明確な基準がないことや提供されるサービスに過不足などがあるなどシステムの未整備に伴うと考えられる問題が存在していることが明らかになった。これらの問題を解決し, 過疎地における在宅支援サービスを効率的に行うためには, 地域で提供できうる全てのサービス・社会資源を把握し, それらを必要とする在宅障害者を的確に選択し資源配分するなどリハビリテーション医学の見地にたった情報ネットワークの形成など効率的な在宅ケア支援システムの確立が重要である。We surveyed the results and effects of community rehabilitation support activities, such as a community rehabilitation school and a home rehabilitation survice. These activities began between 1984 and 1988 through collaborative efforts between the Tsukigase Rehabilitation Center and local communities in order to facilitate the self-reliance of disabled elderly people staying at home in three communities located near the Rehabilitation Center in which depopulation and aging are rapidly progressing. We found that the support system lacks clear criteria for surveying and selecting those in need of support, and for determining who has priority for receiving the home rehabilitation service. It was also found that there were abundances and hortages of the services provided, revealing the presence of problems hich were thought toderive from a lack of organization in the support system. In order to solve these problems and effectively provide home support service in these communities, it is of utmost importance to establish an effective home support system based on rehabilitation medicine. such as an information network system. This kind of a system will help us determine all the services and social resources available in certain communities, select those in need of support, and distribute the services effectively.国立情報学研究所で電子

The fields of HIV and disability: past, present and future

This article provides an historic overview of the fields of disability and HIV. We describe this area of concern in terms of "fields" versus "a single field" because of the two related but distinct trends that have evolved over time. The first field involves people living with HIV and their experiences of disability, disablement and rehabilitation brought on by the disease and its treatments. The second involves people with disabilities and their experiences of vulnerability to and life with HIV. These two fields have evolved relatively independently over time. However, in the final section of this article, we argue that the divide between these fields is collapsing, and that this collapse is beginning to produce a new understanding about shared concerns, cross-field learning and the mutual benefits that might be realized from integrating policy and programmatic responses. We close by identifying directions that we expect these merging fields to take in the coming years

Mid-term review- UK Roma national integration strategy: Roma at the intersection of ethnic-inclusive, post-racial and hyper-ethnic policies

Rather than developing a specific strategy to promote Roma integration, the UK government decided to use mainstream legislation. However, the complex mechanisms of UK policy-making, means that responsibility for integration is defused. Because of the devolved governmental systems and the localisation agenda, Gypsy, Traveller and Roma (GTR) populations often find that they are subject to different forms of inclusion and exclusion depending on their specific geopolitical location. In this paper, the authors suggest that in addition to experiencing the impact of devolution, ‘mainstreaming’ approaches to Roma integration are failing because GTR communities find themselves located at the intersection of three different policy ideologies in the UK: ‘ethnic inclusive policies’ (that seek to promote Roma inclusion), ‘post racial policies’ (that obscure-specific forms of structural inequalities) and ‘hyper-ethnic’ policies, (targeted in a discriminatory manner towards certain communities). With the British about to exit from the European Union, concerns are also being raised about the future of Roma communities and the commitment to their inclusion

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

BackgroundExposure to domestic violence and abuse (DVA) during childhood and adolescence increases the risk of negative outcomes across the lifespan.ObjectivesTo synthesise evidence on the clinical effectiveness, cost-effectiveness and acceptability of interventions for children exposed to DVA, with the aim of making recommendations for further research.Design(1) A systematic review of controlled trials of interventions; (2) a systematic review of qualitative studies of participant and professional experience of interventions; (3) a network meta-analysis (NMA) of controlled trials and cost-effectiveness analysis; (4) an overview of current UK provision of interventions; and (5) consultations with young people, parents, service providers and commissioners.SettingsNorth America (11), the Netherlands (1) and Israel (1) for the systematic review of controlled trials of interventions; the USA (4) and the UK (1) for the systematic review of qualitative studies of participant and professional experience of interventions; and the UK for the overview of current UK provision of interventions and consultations with young people, parents, service providers and commissioners.ParticipantsA total of 1345 children for the systematic review of controlled trials of interventions; 100 children, 202 parents and 39 professionals for the systematic review of qualitative studies of participant and professional experience of interventions; and 16 young people, six parents and 20 service providers and commissioners for the consultation with young people, parents, service providers and commissioners.InterventionsPsychotherapeutic, advocacy, parenting skills and advocacy, psychoeducation, psychoeducation and advocacy, guided self-help.Main outcome measuresInternalising symptoms and externalising behaviour, mood, depression symptoms and diagnosis, post-traumatic stress disorder symptoms and self-esteem for the systematic review of controlled trials of interventions and NMA; views about and experience of interventions for the systematic review of qualitative studies of participant and professional experience of interventions and consultations.Data sourcesMEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index, Applied Social Sciences Index and Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, Social Care Online, Sociological Abstracts, Social Science Citation Index, World Health Organization trials portal and clinicaltrials.gov.Review methodsA narrative review; a NMA and incremental cost-effectiveness analysis; and a qualitative synthesis.ResultsThe evidence base on targeted interventions was small, with limited settings and types of interventions; children were mostly &lt; 14 years of age, and there was an absence of comparative studies. The interventions evaluated in trials were mostly psychotherapeutic and psychoeducational interventions delivered to the non-abusive parent and child, usually based on the child’s exposure to DVA (not specific clinical or broader social needs). Qualitative studies largely focused on psychoeducational interventions, some of which included the abusive parent. The evidence for clinical effectiveness was as follows: 11 trials reported improvements in behavioural or mental health outcomes, with modest effect sizes but significant heterogeneity and high or unclear risk of bias. Psychoeducational group-based interventions delivered to the child were found to be more effective for improving mental health outcomes than other types of intervention. Interventions delivered to (non-abusive) parents and to children were most likely to be effective for improving behavioural outcomes. However, there is a large degree of uncertainty around comparisons, particularly with regard to mental health outcomes. In terms of evidence of cost-effectiveness, there were no economic studies of interventions. Cost-effectiveness was modelled on the basis of the NMA, estimating differences between types of interventions. The outcomes measured in trials were largely confined to children’s mental health and behavioural symptoms and disorders, although stakeholders’ concepts of success were broader, suggesting that a broader range of outcomes should be measured in trials. Group-based psychoeducational interventions delivered to children and non-abusive parents in parallel were largely acceptable to all stakeholders. There is limited evidence for the acceptability of other types of intervention. In terms of the UK evidence base and service delivery landscape, there were no UK-based trials, few qualitative studies and little widespread service evaluation. Most programmes are group-based psychoeducational interventions. However, the funding crisis in the DVA sector is significantly undermining programme delivery.ConclusionsThe evidence base regarding the acceptability, clinical effectiveness and cost-effectiveness of interventions to improve outcomes for children exposed to DVA is underdeveloped. There is an urgent need for more high-quality studies, particularly trials, that are designed to produce actionable, generalisable findings that can be implemented in real-world settings and that can inform decisions about which interventions to commission and scale. We suggest that there is a need to pause the development of new interventions and to focus on the systematic evaluation of existing programmes. With regard to the UK, we have identified three types of programme that could be justifiably prioritised for further study: psycho-education delivered to mothers and children, or children alone; parent skills training in combination with advocacy: and interventions involving the abusive parent/caregiver. We also suggest that there is need for key stakeholders to come together to explicitly identify and address the structural, practical and cultural barriers that may have hampered the development of the UK evidence base to date.Future work recommendationsThere is a need for well-designed, well-conducted and well-reported UK-based randomised controlled trials with cost-effectiveness analyses and nested qualitative studies. Development of consensus in the field about core outcome data sets is required. There is a need for further exploration of the acceptability and effectiveness of interventions for specific groups of children and young people (i.e. based on ethnicity, age, trauma exposure and clinical profile). There is also a need for an investigation of the context in which interventions are delivered, including organisational setting and the broader community context, and the evaluation of qualities, qualifications and disciplines of personnel delivering interventions. We recommend prioritisation of psychoeducational interventions and parent skills training delivered in combination with advocacy in the next phase of trials, and exploratory trials of interventions that engage both the abusive and the non-abusive parent.Study registrationThis study is registered as PROSPERO CRD42013004348 and PROSPERO CRD420130043489.FundingThe National Institute for Health Research Public Health Research programme.</jats:sec

Consumer rights and responsibilities : findings from Northern Territory forums

Consumer rights and responsibilities : findings from Northern Territory forum

Evaluation of a healthy ageing intervention for frail older people living in the community

Aim: To evaluate a healthy ageing intervention in the form of a program of physical and social activity for frail older people living in the community. Methods: New members of an activity program were surveyed before and after attending the program and interviewed face-to-face prior to the program, immediately after the program and through a telephone interview two months following the program.Results: Program participants reported better health, social function and mental well-being; greater engagement in household and leisure activities; and increased enjoyment and confidence through participating in the program. Some participants could not attend the whole program due to poor health or difficulties securing transport. Conclusion: The results suggest the program was successful in enhancing the health and well-being of those community-dwelling older adults who stayed in the program. However, the high drop-out rate suggests that flexibility is required in community-based healthy ageing programs

The Value of a Gardening Service for the Frail Elderly and People With a Disability Living in the Community

Little is known about the significance of gardening services for frail elderly people. This study explored the value of a gardening service for frail older people and people with a disability living in the community. Using qualitative and quantitative data collected from pre-gardening (n = 38) and post-gardening service delivery interviews (n = 35) and the Housing Enabler, the value of a gardening service was examined. Findings suggest that the service had a positive impact on the independence and emotional well-being of frail aged people and younger people with a functional disability, with little impact on physical health. Results indicate that gardening services should be fundamental to planning for these populations to remain or return to living in the community