Transitions from private to public health coverage among children: estimating effects on out-of-pocket medical costs and health insurance premium costs

Objective. To assess the effects of transitions from private to public health insurance by children on out‐of‐pocket medical expenditures and health insurance premium costs. Data Sources. Data are drawn from the 1996 and 2001 panels of the Survey of Income and Program Participation. We construct a nationally representative, longitudinal sample of children, ages 0–18, and their families for the period 1998–2003, a period in which states raised public health insurance eligibility rates for children. Study Design. We exploit the Survey of Income and Program Participation's longitudinal design to identify children in our sample who transition from private to public health insurance. We then use a bootstrapped instrumental variable approach to estimate the effects of these transitions on out‐of‐pocket expenditures and health insurance premium costs. Principal Findings. Children who transition from private to public coverage are relatively low‐income, are disproportionately likely to live in single‐mother households, and are more likely to be Black or of Hispanic origin. Child health status is highly predictive of transitions. We estimate that these transitions provide a cash‐equivalent transfer of nearly U.S.$1,500 annually for families in the form of reduced out‐of‐pocket and health insurance premium costs. Conclusions. Transitions from private to public health coverage by children can bring important social benefits to vulnerable families. This suggests that instead of being a net societal cost, such transitions may provide an important social benefit.     

Comparing physical activity and sedentary behavior levels between deaf and hearing adolescents

BackgroundDeaf adolescents may engage in less physical activity (PA) and longer sedentary time than their hearing peers. Yet, literature comparing PA levels and sedentary time between deaf and hearing control groups, as well as studies examining predictors of PA among deaf adolescents, are lacking.ObjectiveThis cross-sectional survey aimed to compare PA levels and sedentary time between the two groups and examine predictors (i.e., gender and social inclusion) of PA participation among deaf adolescents.MethodsParticipants were 98 deaf and 99 hearing adolescents, who completed the survey measuring the variables of interest.ResultsDeaf adolescents had a higher level of sedentary behavior as well as lower levels of light PA, moderate-to-vigorous PA, and total metabolic equivalent task (MET) than the hearing group. Only a small proportion of participants (deaf: 4%; hearing: 24%) met the World Health Organization's PA recommendation. Gender was found to negatively predict total MET among deaf, while social inclusion was a positive predictor.ConclusionsDeaf adolescents may have restricted PA participation. Measures should be used to promote social inclusion for increasing PA levels of this population.     

Volunteer participation among older adults in Japan: an analysis of the determinants of participation and reasons for non-participation

The purpose of this study is to examine participation in volunteer work among older adults in Japan; in particular, to identify the determinants of volunteer participation and reasons for non-participation. Subjects were 593 older peoples aged 60–74 residing in a suburb of Tokyo, Japan. Multivariate logistic regression analyses were conducted to examine the relationship between relevant characteristics and volunteer participation. Among females, those who had lived in the community longer, residing in a single household, actively participating in hobbies or continuing education, not working and reporting better self-rated health were more likely to participate in volunteer activities. By contrast, there were no specific correlations among males. 51.0% of the non-participants reported that they would like to participate in volunteer work in the future. The most frequently given reason for non-participation was “Don’t have time to participate”. Additional concerns were related to accessibility such as “Don’t know where I should go to participate”. For promoting volunteer activities among older Japanese, diverse volunteer activities should be offered with consideration to differences in lifestyle by gender and also by available flexible time. A plan for improving the accessibility to volunteer work is also needed.     

Experiential aspects of employment and their relationship with work outcomes: A cross-sectional study using a novel measure of participation in workers with and without physical disabilities

BackgroundPeople with disabilities often report restrictions to employment participation. Recent theorising emphasises the need for broadened conceptualisations of participation, incorporating subjective participation experiences.ObjectiveTo examine relationships between subjective, experiential aspects of employment participation and work-specific outcomes in adults with and without physical disabilities.MethodsUsing a cross-sectional study design, 1624 working Canadian adults with and without physical disabilities completed (a) the recently-developed Measure of Experiential Aspects of Participation (MeEAP) to assess six experiential aspects of employment participation: autonomy, belongingness, challenge, engagement, mastery and meaning and (b) work-outcome measures of perceived work stress, productivity loss, health-related job disruptions and absenteeism. Forced entry multivariable regression analyses were conducted.ResultsAmong respondents with and without disabilities, greater autonomy and mastery were associated with less work stress (ps < .03); greater belongingness was associated with less productivity loss (p < .0001). Greater engagement was associated with fewer job disruptions (p = .02) but only for respondents with physical and non-physical disability. This sub-group scored lower on all experiential aspects of participation than workers with no disability or physicaldisability only (ps < .05).ConclusionsResults provide some support for the hypothesis that people with more positive employment participation experiences also report better work outcomes. The concept and measurement of experiential aspects of participation have value for advancing understanding of factors related to employment outcomes in workers with disabilities. Research is needed to determine how positive participation experiences manifest in workplace settings, and antecedents and consequences of positive and negative employment participation experiences.     

Parents' experiences of having their children take part in participatory action research creating a serious game about radiotherapy

IntroductionRadiotherapy (RT) is one of several treatment modalities used for children diagnosed with cancer. Several studies have designed interventions aimed to alleviate the stress that can occur in conjunction with RT. To include children in the design of interventions is rare and dependent on the parents giving consent to participation in research on their children's behalf. The aim was to illuminate, from the parents' perspective, the experience of their children being part in the co-creation of a serious game and their previous experiences of RT.MethodsTen parents of children taking part in a participatory action research study of the development of a serious game were invited to an interview and seven parents consented. An inductive, manifest content analysis was performed.ResultsThe analysis resulted in an overarching theme: Parents' pre-understanding from their child's cancer treatment created a sensitivity to their child's wishes and a willingness to contribute to science. Four categories are presented: Intrinsic factors influenced the intent to participate, Extrinsic factors that had an effect on participation, Parents role in the game development, and Radiotherapy impinged the child and the parent.ConclusionTo be able to pay it forward to healthcare and other families with a child diagnosed with cancer was a contributing factor for parents' willingness to consent to participation after their children had undergone RT, especially since their children wanted to do so. Parents indicated interest in the developmental process and in following their children being part of the creation of a serious game about RT.Implication for practiceTo understand why parents allow their children to participate in studies creates opportunities for the research community to structure studies that facilitate participation.     

A systematic review of the benefits of occupation-based intervention for patients with upper extremity musculoskeletal disorders

Study DesignSystematic review of intervention studies (level 3a).IntroductionOccupation-based intervention (OBI) uses daily activities as a treatment modality. Its growing use with patients diagnosed with upper extremity musculoskeletal disorders (UE MSK) has driven interest in its supporting body of evidence.Purpose of the StudyThe purpose of this study was to locate, appraise, and summarize current evidence of the effectiveness of OBI in treating patients with UE MSK.MethodsSearches of PubMed, CINAHL, the Cochrane Register for Controlled Trials, and PEDro databases were conducted using predetermined keywords. Studies included in this systematic review described the use of OBI in UE MSK. Two examiners independently reviewed and assessed the quality of each study using the PEDro scale.ResultsResults of the database searches yielded 991 studies, 13 of which were deemed eligible to include in this review (6 randomized controlled trials, 4 pretreatment/post-treatment cohort or case series studies, and 3 single case reports). Quality of the studies varied, with 4 rated poor, 2 moderate, and 4 excellent. Overall, individuals receiving OBI showed superior benefits in patient-reported, performance, and physical measures assessing the upper extremity.DiscussionFindings of this review provide preliminary evidence for the use of OBI with patients with UE MSK, however, generalizability of the evidence was compromised due to heterogeneity in study subjects as well as conceptualization, dosage, and delivery of OBI.ConclusionsThe existing literature reflects promising trends in the use of OBI, underscoring its utility as a treatment option for UE MSK-related impairment, limitations, and restrictions. Nonetheless, scientific evidence concerning the effectiveness of OBI needs to be improved by conducting high-quality studies that clearly conceptualize this intervention and heighten understanding of its role in hand therapy practice.     

Propositions de réflexion à partir de l’article de Cyril Desjeux sur les modalités de coopération entre personnes valides et handicapées. Commentaire.

In this short article, we provide a commentary on Cyril Desjeux’ article (“Care” made for disabled persons: What are the ethical and power issues?). We return here to several questions raised by his article. The first concerns the various ways of qualifying an act as “help”, “care” or “cure”, the tensions that can result from this process, and the issues raised by these qualifications for the actors. In particular, we insist on the relationship between this process of qualification and professional issues, as it can challenge the boundary between medical and non-medical professions. Secondly, we situate the debates addressed by Cyril Desjeux in recent developments concerning the status of sick and disabled people, the promotion of their autonomy and their participation in decisions that concern them. We draw the reader's attention to the unexpected and potential negative effects of the willingness to involve disabled people, when this will turns into a normative directive. Finally, we emphasize the originality of Cyril Desjeux’ article in Alter journal. It presents “research-in-action” that goes beyond the strict academic framework.     

Factors associated with the participation of children with complex communication needs

The aim of this study was to conduct a preliminary analysis of relations between child and environmental variables, including factors related to communication aid provision, and participation in informal everyday activities in a sample of children with complex communication needs.Ninety-seven caregivers of children provided with communication aids responded to a questionnaire survey. Child variables assessed were level of ability, trait emotional self-efficacy, and competence in communication aid use. Environmental variables assessed were the impact of childhood disability on the family, family socio-economic category, perceived reliability of electronic communication aids provided to children, and ease of use of the aid. The outcome measure was the intensity of child participation in informal activities.Significant correlations were observed between participation scores and the following variables: child age, level of ability, trait emotional self-efficacy, and family impact of childhood disability. Regression analyses highlighted trait emotional self-efficacy and, to a lesser degree, family impact of childhood disability as the strongest potential predictors of participation.While aspects of child personality may be difficult to disentangle from behaviours related to disability type or developmental age, this research highlights a clinical requirement to assess systematically child behaviours relating to their general emotional functioning.     

How do young children with DCD participate and enjoy daily activities?

Developmental problems may decrease participation of children. The objective of this study was to evaluate multidimensional aspects of participation amongst preschool children with and without DCD. Participants included 63 children with mean age of 4.96 years (SD = 0.62; range = 4.02-6.35 years). Twenty one children were diagnosed with DCD, 21 children without DCD who were referred to OT due to mild developmental problems, and 21 children from mainstream public kindergartens whom did not require any developmental intervention. All three groups were matched for age, gender, and socioeconomic status. Children were administered the M-ABC2 and their parents completed the PSQ questionnaire. Results indicate significant differences in level of independence and subjective measures of participation (enjoyment and parents’ satisfaction) between the DCD group and the two other groups. The results indicate that from a young age, and in comparison to their peers, the participation of children with DCD is compromised. The integration of the DSM diagnostic criteria and the ICF perception of health enables us to capture the full scope of DCD and its complexity.