Coordination of a complex welfare system case: rehabilitation entity in Finland

The main purpose of this article is to analyse the institutional and political structures of the Finnish rehabilitation entity and the governmental efforts to improve the governance of the rehabilitation policy. Rehabilitation in Finland is a complex welfare system which has undergone several coordination attempts during the last two decades. The centrality of the coordination of this welfare system is obvious. Based on the content analysis of three Government's rehabilitation reports from 1994 to 2002 and their background papers, this article provides two main findings. First, the rehabilitation entity seems to be based on different funding strategies, different governing and different coordination models between the rehabilitation subsystems. Second, the governance discourse in the reports seems to be unchanging with a predominantly hierarchical mode. The article concludes with a discussion on the challenges to coordinate this kind of a complex welfare system as an entity and also how to overcome those challenges. Copyright © 2010 John Wiley & Sons, Ltd.     

意大利辅助用具免费供给残疾人体系(英文)

Aids are only one of the instruments with which the disabled person can often reach a good level of autonomy,he can improve his conditions of life and prevent the aggravating of his situation.Aids serve also to facilitate care on the part of the family.The rights confirmed by Law 104 can also be achieved through the use of aids.The Italian state has planned a system of care with regards to aids so that some of them can be purchased with different tax concessions but essential aids,those necessary for the reaching of autonomy goals and prevention defined by an individual rehabilitative project,are supplied free of charge.In Italy essential aids are part therefore of a rehabilitation plan that is identified for each person with disabilities by a team made up of different professionals.     

Comparison of an individual systematic interview method and the oral health impact profile. Responsiveness and ability of describing treatment effect of oral rehabilitation

Summary The Schedule for the Evaluation of Individual Quality of Life – Direct Weighting (SEIQoL‐DW) has shown potential for generating information and measuring Oral Health–Related Quality of Life (OHRQoL) in oral rehabilitation. The Oral Health Impact Profile‐49 (OHIP‐49) has been widely used in population studies. The purpose of this study was to compare the responsiveness and ability of the SEIQoL‐DW and the OHIP‐49 to qualitatively describe the change following oral rehabilitation. Twenty‐two participants treated with fixed or removable prosthesis were interviewed before and after treatment using the SEIQoL‐DW and the OHIP‐49 questionnaire. The participants rated the subjective perception of change and answered two global oral rating questions. A clinical examination was performed to identify dental status variables. No significant difference was found between pre‐ and post‐treatment SEIQoL‐DW scores. A significant difference between pre‐ and post‐treatment OHIP‐49 scores was found. The SEIQoL‐DW and OHIP‐49 change scores was significantly correlated. The dental status variables such as number of teeth, number of teeth replaced, number of occluding units, type of treatment, extractions and removable dental prosthesis (RDP) before treatment did not influence the change scores. The effect size was low for the SEIQoL‐DW (0·15) and moderate for the OHIP‐49 (0·60). Improvement in subjective perception of change was related to both improvement and deterioration in change scores. More aspects were mentioned in the SEIQoL‐DW compared to the OHIP‐49. Based on the change in overall score and effect size, the SEIQoL‐DW showed a weaker responsiveness than the OHIP‐49. The SEIQoL‐DW, however, described the change more detailed than the OHIP‐49.     

Treating Indigenous Australians with Alcohol/Drug Problems: Assessing Quality of Life

This study investigated the quality of life (QoL) of clients in an Indigenous Australian residential alcohol and drug treatment center. Qualitative and quantitative data were collected from a random sample of Indigenous clients utilizing the Self Evaluated Individual Quality of Life–Direct Weight tool. The findings from this study provide support for the inclusion of QoL as important in understanding the recovery process from substance misuse. A discrepancy was found between the self-reported aspirations of clients and the focus of the treatment provided, and recommendations were provided for inclusion of new areas in the education provided to the clients of this service.     

Audiologist-patient communication profiles in hearing rehabilitation appointments

ObjectiveTo profile the communication between audiologists and patients in initial appointments on a biomedical-psychosocial continuum; and explore the associations between these profiles and 1) characteristics of the appointment and 2) patients’ decisions to pursue hearing aids.MethodsSixty-three initial hearing assessment appointments were filmed and audiologist-patient communication was coded using the Roter Interaction Analysis System. A hierarchical cluster analysis was conducted to profile audiologist-patient communication, after which regression modelling and Chi-squared analyses were conducted.ResultsTwo distinct audiologist-patient communication profiles were identified during both the history taking phase (46 = biopsychosocial profile, 15 = psychosocial profile) and diagnosis and management planning phase (45 = expanded biomedical profile, 11 = narrowly biomedical profile). Longer appointments were significantly more likely to be associated with an expanded biomedical interaction during the diagnosis and management planning phase. No significant associations were found between audiologist-patient communication profile and patients’ decisions to pursue hearing aids.ConclusionInitial audiology consultations appear to remain clinician-centred. Three quarters of appointments began with a biopsychosocial interaction; however, 80% ended with an expanded biomedical interaction.Practice implicationsFindings suggest that audiologists could consider modifying their communication in initial appointments to more holistically address the needs of patients.     

自体髂骨移植重建冠状突治疗陈旧性肘关节后脱位

目的探讨陈旧性肘关节后脱位的治疗方法。方法自2008年5月到2010年4月收治8例复杂性肘关节骨折脱位,后期出现肘关节不稳,形成陈旧性肘关节后脱位。作者采用肘关节前后侧入路,取髂骨重建尺骨冠突,微型T板固定,同时修补重建内侧副韧带。术后前臂中立位固定3周,进行肘关节屈伸功能锻炼。结果经过6～26个月的随访,平均15个月。8例重建的尺骨冠突均达到骨性愈合,肘关节稳定性好,未再发生后脱位;无疼痛,肘关节屈伸功能平均120°,前臂旋前/旋后平均80°/85°。Morrey肘关节功能评分:优4例,良3例,差1例,优良率为88%。结论髂骨移植重建尺骨冠突,此方法操作简单,可重新恢复肘关节的稳定结构,髂骨愈合能力强,可早期进行功能锻炼,肘关节功能恢复良好。     

试论康复机构如何培育核心竞争力

本文简要阐述了组织核心竞争力的概念及特征,重点就康复机构核心竞争力进行分析,并提出了培育核心竞争力的方法与策略。