Autonomy Of People Research Articles

Current aspects regarding “smart homes”/ ambient assisted living (AAL) including rehabilitation specific devices, for people with disabilities/ special needs

Introduction: The population life expectancy has increased (“over half the EU’s population predicted to be over-65 by 2070”), according to recent prevalence studies, being a result of the advancement of technology and medical science. This aging population has implications for society because there is increased number of older people requiring better quality of life. Materials and Methods: AAL represents the systems that may support completely the living area of a person and has the potential to facilitate the elderly to live longer and more safety in their family environments, allowing them to continue their current activities, facilitating participation in more activities at home and in the community and improving the cost-effectiveness, the quality of health and social services. A practical use of technology is the introduction of home networks, which involve notions such as: "smart homes ", “tele-health / tele-care” and even, possibly, “tele-medicine” to allow people with serious illnesses / conditions / and special needs to maintain an appropriate quality of life (QOL) at home. Discussions and Conclusions: AAL can contribute to an increased autonomy, self-confidence and mobility in people whose activity is limited to home environment, such as "the oldest olds” and/ or those with severe neuro-/ loco-motors disabilities, and so to reduce the risk of institutionalization, enhance security, prevent social isolation, thus allowing “older adults to age in place”. An important role in achieving this goal is representing by working in a multidisciplinary team (experts in the field of health - rehabilitation, gerontology -, social experts, technical/ informatics experts, engineering and robotics experts). Keywords: ambient assistive living, quality of life, special needs, tele-medicine, rehabilitation,

On the Heterogeneity of Existing Repositories of Movements Intended for the Evaluation of Fall Detection Systems.

Due to the serious impact of falls on the autonomy and health of older people, the investigation of wearable alerting systems for the automatic detection of falls has gained considerable scientific interest in the field of body telemonitoring with wireless sensors. Because of the difficulties of systematically validating these systems in a real application scenario, Fall Detection Systems (FDSs) are typically evaluated by studying their response to datasets containing inertial sensor measurements captured during the execution of labelled nonfall and fall movements. In this context, during the last decade, numerous publicly accessible databases have been released aiming at offering a common benchmarking tool for the validation of the new proposals on FDSs. This work offers a comparative and updated analysis of these existing repositories. For this purpose, the samples contained in the datasets are characterized by different statistics that model diverse aspects of the mobility of the human body in the time interval where the greatest change in the acceleration module is identified. By using one-way analysis of variance (ANOVA) on the series of these features, the comparison shows the significant differences detected between the datasets, even when comparing activities that require a similar degree of physical effort. This heterogeneity, which may result from the great variability of the sensors, experimental users, and testbeds employed to generate the datasets, is relevant because it casts doubt on the validity of the conclusions of many studies on FDSs, since most of the proposals in the literature are only evaluated using a single database.

AnAbEL: towards empowering people living with dementia in ambient assisted living

Ambient assisted living aims to support the well-being of people with special needs by offering assistive solutions. Systems focused on dementia increase the autonomy of people living with dementia by monitoring their activities. Topics such as activity recognition and specific solutions such as reminders and tracking users by Global Positioning System offer great advances in user safety and help them preserve a healthier lifestyle. However, these solutions are often addressed to secondary parties, providing them activity logs or alerts, but excluding the main user, the person living with dementia. Although the primary users are taken into consideration at some design stages using user-centred design frameworks, the final products tend to not fully address user needs. This paper presents an ambient intelligent system aimed at reducing this limitation by providing reminders and advice to the person living with dementia in the first instance. The system still involves caregivers if unusual or unhealthy behaviour continues. The solution is deployed in order to be validated by professionals from London city boroughs who work in housing and dementia related services, with an emphasis on enhancing healthy lifestyles by empowering the user in the early stages of dementia with autonomy. Through continued activity monitoring in real-time, the system can provide reminders and warnings to users to keep healthy routines. Continuous monitoring provides user behaviour tracking, and the context-aware logic used involves caregivers through alerts when necessary to ensure user safety. This article describes the process followed in developing the system, and covers previous concerns and practical feedback from health professionals over the deployment of the system in a real environment. Our approach also includes a novel indoor localization system to distinguish users and allows a more specific delivery of services in multi-occupancy scenarios.

6 voces en 10 minutos: Herramientas para educación en niños

6 voces en 10 minutos: Experiencias en educación en ArgentinaHerramientas para educación en niñosLos profesionales de la salud requieren una formación especializada adecuada en los principios de la práctica de la enseñanza/aprendizaje para implementar con éxito educación diabetológica tanto a niños/as, adolescentes y sus cuidadores. La misma debe ser diseñada para la promoción de la autonomía de las personas con diabetes.Las intervenciones educativas que demostraron ser eficaces incluyen como estrategias: en primer lugar, considerar al niño/a y la familia como paciente, la edad de la persona con diabetes, si se está frente a un/a bebé, niño/a o púber, su contexto, su modalidad de aprendizaje, y de esa manera integrarla en la atención clínica de rutina como un proceso continuo de prestación de servicio. Las intervenciones deben estar enfocadas en los factores psicosociales, implicando la responsabilidad continua de los padres/madres o cuidadores, tanto en la niñez como en la adolescencia. Es fundamental hacer uso de técnicas que posibiliten el ejercicio en la resolución de situaciones de la vida cotidiana, establecimiento de metas terapéuticas construidas de manera conjunta entre la familia y el equipo de salud, habilidades de comunicación, capacidad de resolución de conflictos familiares, siempre vehiculizadas a través de actividades lúdicas y recreativas, de manera grupal o individual.

Qualitative study about prospective memory's difficulties in the elderly: nature of memory subjective complaint and mnemonics used

Prospective memory is the ability to remember to execute an action at the appropriate time. Although it is essential in the daily activities and thus in the maintenance of people autonomy, some questions remain unanswered, and in particular its effects on age and its efficiency. This qualitative exploratory study aims to a better understanding of the extent and nature of the difficulties experienced by the elderly in terms of prospective memory in real life, and reminders used by them. Semi-directive and directive interviews were conducted with 14 people over 66 of age and assessed by manual content analyzes. The results show disturbances of prospective memory expressed by the elderly, which differ according to the type of task and seem to be fitting with the results found in natural environment. They also show that external memory aids are more often used by older people even if they are considered by them to be less effective than the interns one. Our results give some insight into the reminders, which are spontaneously used or not used by the elderly and allow to look ahead to new perspectives in terms of memory rehabilitation.

Relational aspects of meaning in life among older people – a group-interview gerontechnology study

AbstractEarlier studies show that experiencing life as meaningful in old age promotes holistic wellbeing and health among older people. As more and more people are living with reduced capacities in their own homes, there is an urgent need to find new ways of promoting holistic wellbeing of the ageing population. Analysing data gathered from existential discussion groups on Service TV (STV), we show how strongly relationality and meaning in life are intertwined for older people. Our findings indicate that respect and support for the autonomy of older people is very important: in order to continue living at home, and prepare for a future with reduced capacities, they need family members for support. Autonomy of ageing becomes relational as choices and wishes are negotiated with family members. Relationships also contribute to loss of meaning. When older people felt that they were not close enough to their family, longed for friends of the same age, were bereaved or widowed, the relational gap caused a violation of meaning. In contrast, participation and activities with peers brought deep joy and connectedness to the lives of the participants. STV provided a new channel for participants to find and form meaningful relationships. Therefore, it is concluded that relationality can be supported by technological means of care.

Retraction: Servicing the Senior Swallow: A Family-Centered Private Practice Model of Service Delivery

Notice of Retraction https://doi.org/10.1044/2020_Dec2020ASHA Purpose Person-centered care shifts the focus of treatment away from the traditional medical model and moves toward personal choice and autonomy for people receiving health services. Older adults remain a priority for person-centered care because they are more likely to have complex care needs than younger individuals. Even more specifically, the assessment and treatment of swallowing disorders are often thought of in terms of setting-specific (i.e., acute care, skilled nursing, home health, etc.), but the management of dysphagia in older adults should be considered as a continuum of care from the intensive care unit to the outpatient multidisciplinary clinic. In order to establish a framework for the management of swallowing in older adults, clinicians must work collaboratively with a multidisciplinary team using current evidence to guide clinical practice. Private practitioners must think critically not only about the interplay between the components of the evidence-based practice treatment triad but also about the broader impact of dysphagia on caregivers and families. The physical health and quality of life of both the caregiver and the person receiving care are interdependent. Conclusion Effective treatment includes consideration of not only the patient but also others, as caregivers play an important role in the recovery process of the patient with swallowing disorders.

Evidence-based policies, nudge theory and Nancy Cartwright: a search for causal principles

AbstractNancy Cartwright argues that evidence-based policies should not only rely on randomized controlled trials (RCTs) to test their effectiveness – they should also use horizontal and vertical searches to find support factors and causal principles that help define how those policies work. This paper aims at analyzing Cartwright's epistemology regarding evidence-based policies and their use of RCTs while applying her findings to current research involving nudges as behavioral public policy interventions. Holding a narrowly instrumental view of rationality, nudge theory tends to neglect other expressive components. Policymakers, in their quest for causal principles, should consider the expressive rationality of individuals in their research. This inclusion would not only increase the effectiveness of nudges, but also address some ethical issues related to people's autonomy when targeted by these interventions.

'We've Paid your Vagina to Make Children!ʼ: Bridewealth and Women's Marital and Reproductive Autonomy in Port‐Vila, Vanuatu

ABSTRACTIn Vanuatu, the practice of bridewealth is widespread. However, according to international and national development organizations based in the capital Port‐Vila, this practice impedes women's freedom, including women's reproductive autonomy. In this paper, using data gathered in Port‐Vila between 2009 and 2018, I examine the practice of marriage in Port‐Vila and argue against this development discourse. I analyse the transformations of marriage showing the increasing autonomy of young people in the selection of marriage partners and the links between marriage, bridewealth and reproductive autonomy. I emphasize the changes in the nature of bridewealth marriage in a contemporary urban context and its implications for female fertility control. I conclude that bridewealth is only one among several factors that influence women's reproductive autonomy in Port‐Vila.

Citizenship and leisure in pandemic times

ABSTRACT The new Coronavirus pandemic changed all aspects of reality. The unscheduled subversion of our space-time references painted the subject of leisure in colors that were previously neglected. The panorama at the beginning of 2020 was characterized by the predominance of monopolistic and globalized structures for the commercialization of leisure, by the difficulty of maintaining socially-based initiatives committed to participatory practices, and by the inequality in the practice of leisure as a right. The impacts of the health crisis accentuated these aspects, uncovering a situation that managers, public administrators, scholars and citizens are invited to reflect on. Considering the rapid acceleration of the digitalization of leisure experiences, the inequality in the access to leisure activities and the fact that the right to leisure is constitutionally provided for in Brazil, one must ask which bodies would be in charge of guaranteeing this right, including the education for leisure focused on people's autonomy. Although this guarantee is related to public policies, it is worth noting that institutions in the socio-cultural field, as is the case of Sesc - Serviço Social do Comércio (Social Service of Commerce), can get involved in such debates.

Older people's perceived autonomy in residential care: An integrative review.

Autonomy has been recognised as a key principle in healthcare, but we still need to develop a consistent understanding of older people’s perceived autonomy in residential care. This study aimed to identify, describe and synthesise previous studies on the perceived autonomy of older people in residential care. Ethical approval was not required, as this was a review of published literature. We carried out an integrative review to synthesise previous knowledge published in peer-review journals in English up to September 2019. Electronic and manual searches were conducted using the CINAHL, Philosopher’s Index, PubMed, SocINDEX, Scopus and Web of Science databases. The data were analysed using the constant comparison method. The review identified 46 studies. Perceived autonomy referred to the opportunities that older people had to make their own choices about their daily life in residential care, and achieving autonomy promoted both health and quality of life. Autonomy was linked to older people’s individual capacities, including their level of independence, physical and mental competence, personal characteristics, and whether relatives shared and supported their perceived autonomy. Professionals could facilitate or hinder older peoples’ autonomy in a number of ways, including providing opportunities for autonomy, how daily care needs and activities were managed, and controlling older people’s choices. Professionals’ characteristics, such as education and attitudes, and the older people’s living environments were also associated with their perceived autonomy and included organisational characteristics and physical and social care facilitators. Older people’s perceived autonomy promoted health and quality of life in residential care. However, their autonomy was associated with a number of protective and restrictive individual and environmental factors, which influenced whether autonomy was achieved.

Measures of Participation in Persons With Musculoskeletal Conditions.

Measures of Participation in Persons With Musculoskeletal Conditions.

Psychological Well-Being and Youth Autonomy: Comparative Analysis of Spain and Colombia.

The construct of autonomy appears in literature associated with individual psychological wellbeing. In Ryff’s model, autonomy is presented as one of the dimensions of wellbeing, along with self-acceptance, positive relationships with others, environmental mastery, purpose in life, and personal growth. The present study compared the levels of autonomy and psychological wellbeing between Spanish and Colombian young people. Ryff’s Scale of Psychological Wellbeing and the Transition to Adulthood Autonomy (EDATVA) scales were used on a sample of 1,146 young people aged between 16 and 21; 506 Spaniards and 640 Colombians. Results showed differences in autonomy and in two of the four dimensions proposed by the EDATVA: self-organization and critical thinking. Similarly, important differences were observed in the subscales of positive relations and purpose in life. The importance of contextual factors in the development of psychological well-being and autonomy in young people in transition to adulthood is discussed.

Personal budgets and the pedagogical project of care institutions in Flanders

ABSTRACT The care for disabled people in Flanders is currently undergoing a major social policy reform under the introduction of a personal budget scheme. Disability services in Flanders are explicitly expected to develop a demand-driven provision of care services. This transition stems from the urge for autonomy and self-determination of disabled people and is aimed to deinstitutionalise the care for people with disabilities. The central question addressed is the way in which the introduction of personal budgets influences the ability of Flemish care institutions to shape their practice. Our findings depict that care institutions emphasise the importance of a dialogical process, in which different views of ‘good care’ can be discussed. However, in policy implementation, a particular focus on ‘a self-aware and autonomous individual’ as an objective would make this process more challenging. Our analysis identifies how a far-reaching focus on autonomy and self-determination does not guarantee high-quality care. Nor would the opposite: major autonomy for care institutions. Rather than balancing the negotiating positions, the Flemish personal budget scheme tends to push disability services into an executive role in which the possibilities of a pedagogy as an emancipatory project shrink.

Transgender embodiment: a feminist, situated neuroscience perspective

The policing of boundaries of acceptable sexual identities and behaviour is a recurring theme in numerous marginalities. Gender (especially womanhood) is often instantiated socially through the harms to which members of that gender are subjected. For transgender people, the assumption that genitals define gender translates the ubiquitous misapprehension that genitals and sex are binary into an assumption that gender must also be binary. This circumscribes the potentiality of cultural intelligibility for trans gender identities, and may interfere with the ability of transgender people to select the most appropriate medical and social means of expressing their authentic identities, even altering what is possible or appropriate, thereby curtailing trans people’s authenticity and freedom. We therefore distinguish social from bodily aspects of gender dysphoria, proposing a model of their distinct, intersecting origins. We explore ways in which transgender medicine reflects aspects of other gendered surgeries, proposing a biopsychosocial understanding of embodiment, including influences of culture on the neurological representation of the body in the somatosensory cortex. This framework proposes that cultural cissexism, causes trans people to experience (neuro)physiological damage, creating or exacerbating the need for medical transition within a framework of individual autonomy. Our social-constructionist feminist neuroscientific account of gendered embodiment highlights the medical necessity of bodily autonomy for trans people seeking surgery or other biomedical interventions, and the ethical burden therein.

Health promotion and disease prevention of people aged 60 year or older

Abstract The number of people aged 60 years or older is increasing over the world. According to the World Health Organization, keeping the health and functional independence of older people is one of the major challenges facing the European region. Older people in Lithuania are not linked to take care of their health. As a result, most of the people aged 65 years or older have a poor health. In 2018, 51.6 % of people aged 65 or older had limited knowledge of health literacy in health promotion. In order to change health-related behavior, Kaunas city municipality Public health bureau started to run a healthy ageing project. The project started in September 2018 and finished in December 2020. The aim of the project was to improve the health literacy level of Kaunas city citizens aged 60 years or older and to form positive changes in their health behaviour by implementing public health promotion program in Kaunas city. Different evidence-based physical activities were organized during the project: taichi, line dancing, aquatic exercise, functional training, and physiotherapy exercise. 888 residents aged over 60 years participated in 816 project activities. Healthy cooking classes with professional chefs were also organized for older people. As a result, 120 elderly people gained knowledge and skills in property nutrition during 40 healthy cooking classes. To improve older people's mental health, psycho-emotional activities such as mindfulness-awareness and brainstorming sessions were organized. A total of 314 older people participated in the 37 trainings of improving the psycho-emotional state. Women were more likely to participate in health promotion activities. In order to attract more men, collaboration and involvement of local communities was outgoing. Key messages Empowering older people to make healthy choices can help to prolong the autonomy of older people and thus bring significant economic and social benefits. Collaboration and involvement of local communities can bring relevant effect for public health in building complex strategy of healthy aging.

Patient engagement, autonomy, access to mental care services – the case for integrated care in Crete

Abstract Access to comprehensive primary care (PC) services is imperative to address the complex biopsychosocial needs of patients with mental illness and their families, while it holds the potential to safeguard mental health and enhance resilience in communities. Integration of mental health and social care services in primary care has not yet been achieved, while access to such services for the mentally ill is still hindered by patient-, provider- and system-oriented barriers. Improving service integration, quality and access requires active engagement of patients and families in the design and planning of services. Interprofessional collaboration, interdisciplinary approaches and sound deliberative processes are only the start of initiating discussions to establish the needs of local communities. Mapping care paths, involving stakeholders and engaging in practice-based research are impeded by the organisation and design of care provision, including siloed processes and semantic ambiguity in establishing common ground. Academic centres ought to act as hubs for bringing together all actors, creating living labs and addressing the needs of people in urban and rural areas. The case study from Crete will focus on the following questions: What actions are needed to improve access of people with mental health disorders to PC services and how could PC mediate effective communication with mental health services?To what extent people with mental health disorders experience violence, abuse or discriminatory behaviour in PC?To what extent PC services recognize and facilitate autonomy, self-determination and inclusion of people with mental health disorders?To what extent stakeholders and PC services engage people with mental health disorders in decision making process and local governance?To what extent educational interventions for PC practitioners could result in the reduction of discriminatory behaviour and safeguard the dignity among people with mental health disorders?

Built environment and autism: towards a set of spatial requirements for autism friendly cities

Abstract Background The opportunity for people functioning in an atypical way to autonomously and fully interact with the city is often compromised or denied, due to the gap between their specific spatial needs and the physical and functional organization of the urban environment. The need to reconsider the living environments taking into account the vast diversity of people gained an increasing importance in the overall debate and specifically in the field of urban planning and design. The research aims at investigating the relationship between the urban environment and people with Autism Spectrum Disorder (ASD). Methods A scoping review of current available original studies research exploring the relationship between autism and built environment was conducted. PubMed, Scopus, PsychInfo and Web Of Science where searched. Studies included provided spatial requirements for designing autism friendly environment. Results In total, 801 studies were identified and 22 were included. Current researches and applications investigating the role of spatial configuration as a means for improving the autonomy of people with ASD almost exclusively focus on closed and dedicated spaces (residences, schools, care facilities, healing gardens) mostly devoted to children. Starting from this and the data collected, a first set of enabling urban spatial requirements addressing the atypical urban functioning of people with ASD - the reduction of sensory overload and the use of visual supports - in order to promote their possibility to walk autonomously and safely across the everyday city is proposed. Conclusions Despite the wide variability of the spectrum which makes it very difficult to define effective design criteria for all people with ASD, it's possible to identify a set of recurrent spatial needs. Furthermore, designing cities for people with ASD can also contribute to healthier and more inclusive urban environments for other groups of vulnerable inhabitants.

Disability, Trust and Special purpose Asset in the Italian Law System

Law 22 June 2016, no. 112 (so-called “after us” Law) substantially introduced the trust in Italy. It was issued with the stated objective of promoting the well-being, full social inclusion, and autonomy of people with disabilities. It is aimed at facilitating, through favorable tax regimes, the establishment of trusts, destination restrictions ex-art. 2645-ter of the Italian Civil Code and special funds governed by a fiduciary entrustment contract. On closer inspection, the “after us” Law, for its systematic contribution well beyond the tax-benefit purposes expressly mentioned, could be considered a first and albeit incomplete trust law, aimed at discouraging the establishment of trusts governed by a foreign law: this, since a large part of the elements indicated in art. 8 Conv. of the Hague so that a specific law can qualify as trust law. Certainly, relevant appear the subjective prerequisites for the application of the law and, in particular, the serious disability not determined by aging or pathologies related to senility and the absence of family support. Attention then focuses on the vexata quaestio of trust’s legal nature and its affinity with the deeds of patrimonial destination ex-art. 2645-ter of the Italian Civil Code, as well as with the fiduciary agreements.

Applied Cognitive Technologies to Support the Autonomy of People with Intellectual and Developmental Disabilities

Increasingly, access to technology is a necessity if one is to participate fully in all life domains. Technology is critical to enable people with and without disabilities to live autonomous, self-determined lives. This article provides a synthesis of recent information concerning technology that might promote the autonomy of people with intellectual and developmental disabilities, focusing on technology emerging from the field of applied cognitive technologies. To explore these issues, we provided a synthesis of the major theoretical perspectives pertaining to autonomy and self-determination, emphasizing the notion of autonomy-as-volition, and selected exemplary research findings that illustrate how technology can promote autonomy. There is clear evidence that people with intellectual and developmental disabilities can be supported to be more autonomous across multiple domains using applied cognitive technologies. In today’s ever increasingly technical world, access to usable technology is not simply a convenience, it is a necessity. If people with IDD are to be supported to live, learn, work, and play in their communities, they need to have access to cognitively accessible technology.