Gerontology in the developing Brazil: Achievements and challenges in public policies

Aim:   In the last three decades, the segment of population aged 60 years and older has more than doubled in Brazil. People aged 80 years and older are expected to be the fastest-growing segment in the near future. This aim of this study was to analyze the legal structures currently in place in Brazil and to provide a framework for care policies and practices towards older-adults.
Methods:   This article focuses on past and present major socioeconomic burdens on this segment of the Brazilian population as well as on public achievements to overcome inequities.
Results:   Both the public health and the social security systems have been directed to provide preferential assistance to the aged. Nonetheless, the elderly remain the most impoverished segment of Brazil and carry the burden of an overall lack of specialized services. Moreover, socioeconomic inequalities and population diversity in Brazil affects elderly care, adding complexity to this unique scenario.
Conclusion:   Brazil has adopted legal hallmarks that substantially shifted public practices towards the elderly segment from a philanthropic status to a legitimate right for care and assistance. The demographic transition that took place provides an opportunity for innovative solutions in public policies for older adults in a developing economic environment.     

A Preliminary Study of the Population-Adjusted Effectiveness of Substance Abuse Prevention Programming: Towards Making IOM Program Types Comparable

The Institute of Medicine distinguishes between programs based on who is targeted: the entire population (universal), those at risk (selective), or persons exhibiting the early stages of use or related problem behavior (indicated). Evaluations suggest that although universal programs can be effective in reducing and preventing substance use, selective and indicated programs are both more effective and have greater cost-benefit ratios. This paper tests these assumptions by comparing the impact of these program types in reducing and preventing substance use at the individual level (i.e., those exposed to intervention services) and in the population (i.e., those exposed and not exposed to intervention services). A meta-analysis was performed on 43 studies of 25 programs to examine program comparability across IOM categories. When examining unadjusted effect sizes at the individual level, universal programs were modestly more successful in reducing tobacco use, but selective and indicated programs were modestly more successful in reducing alcohol and marijuana use. When adjusted to the population level, the average effect sizes for selective and indicated programs were reduced by approximately half. At the population level, universal programs were more successful in reducing tobacco and marijuana use and selective and indicated programs were more successful in reducing alcohol use. Editors’ Strategic Implications: The authors’ focus on the public health value of a prevention strategy is compelling and provides a model for analyses of other strategies and content areas.     

Mental health in the population approaching retirement age. Preliminary findings of the TURVA project

The present paper deals with a Finnish long-term prospective study, the objective of which is to shed light on adjustment to retirement and old age. In this phase, only the preliminary findings of the initial survey carried out in 1982 are available. For the purposes of the study, a random sample of 200 individuals was drawn from among Turku inhabitants born in 1920. Another sample, consisting of 189 persons of the same age, was drawn from rural municipalities in the neighborhood of Turku. An extensive structured psychosocial interview could be conducted with a total of 339 subjects. The research methods used included e.g. the 36-item version of Goldberg's General Health Questionnaire (GHQ). Relatively little mental disturbance was revealed in the interview, and no major differences occurred between the urban and the rural sample. Somewhat over one-third of both samples were probable psychiatric cases as defined according to the GHQ.     

Design and conduct of occupational epidemiology studies: III. Design aspects of case-control studies

Currently available approaches for the design of occupational case-control studies are reviewed. An accompanying paper reviews methods of analysis. We commence by drawing a distinction between cohort-based and registry-based studies. Methods for selecting cases and controls are then reviewed, including cumulative incidence and incidence density sampling, matching, sources of controls, and issues in control selection. Finally, the advantages and disadvantages of the case-control approach are summarized.     

Overseas Occupational Therapists in Australia: the Issue of Recognition

The Australian government established the Council on Overseas Professional Qualifications (COPQ) in 1969. In response to approaches by the occupational therapy profession, an Expert Panel in Occupational Therapy was established in 1979 in order to develop a screening examination to be used in assessing the competency of overseas trained occupational therapists. This paper describes the development of the COPQ examination for all overseas qualified occupational therapists wishing to work in Australia; the experience of candidates since its inception in 1983; and the problems associated with achieving recognition of the COPQ examination throughout Australia given the lack of uniform recognition procedures in the various States and Territories. The need for a consistent national approach to the policy of recognition and employment of overseas trained occupational therapists is addressed, with stress placed on the need for all employer groups, in both the public and the private sectors, to cooperate with COPQ's assessment procedures.