Disability Allowances Research Articles

Links between mental disorders and the use of disability allowances and services in France

The French social system offers many kinds of allowances and support (in work, everyday life and social life fields) to persons with disabilities. People with severe mental disorders are often considered as having less access than other disabled persons to the various forms of compensation offered by the national solidarity system. Purpose of research : Our objective was to study, for people with diverse kinds of mental disorders, those who are frequent users of support devoted to disability. By proceeding to an ascending hierarchical classification from the data of the Disability and Health National survey of 2008-2009 and by studying the characteristics of these groups with regards to the available resources of the disability field we wished to clarify the determinants of recourse. Two groups who very frequently have both various kinds of mental disorders (including mental retardation) and physical disorders have a very high rate of using solidarity support linked to disability. A third group, whose recourse to the field of the disability system is less high without being negligible includes people with different medical and social profiles, having signs of social difficulties and physical troubles which may precede or follow their mental problems instead of belonging to a same complex pattern. This self-reported data survey inevitably comprises approximate data as regards to diagnoses and impairments, but no other survey brings such diversified information and it usefully highlights that people with mental disorders should not be considered has having only mental disorders as long as they use the French disability system.

A study on the reform of income security act for the disabled to ensure minimum income—Application of comparative perspectives among some OECD countries—

본 연구는 장애가 초래하는 경제적 비보장에 직면해 있는 장애인들의 자립 및 삶의 질을 제고하기 위해 최저소득보장을 위한 장애인 소득보장법제의 개편 방안을 제시하는 것을 목적으로 하고 있다. 이를 위해 소득보장정책을 포함한 우리나라 장애인 정책의 통시적 고찰과 미래 전망을 토대로 개편의 기본 방향을 도출하고, 장애인연금법 등 장애인 소득보장정책의 현 법제에 대한 비판적 검토를 토대로 장애인 소득보장 법제 개편의 핵심 쟁점을 도출하고 국제비교적 관점에 입각하여 합리적 개선 방안을 제시하고 있다최저소득보장을 위한 장애인 소득보장법제 개편 방안으로서, ‘장애인 권리보장 및 복지지원에 관한 법률안’의 소득보장 조문을 장애인 소득보장에 관한 개별 법률인 장애인연금법에 반영하여 전면 개정하되, 법률의 명칭을 ‘장애인 소득보장법’으로 변경하는 것을 제안하고 있다. 장애인 소득보장법에 포함될 핵심 내용으로서, 최저소득보장을 위한 장애급여는 성인 장애인 대상의 소득보전급여인 장애인연금과 추가비용급여인 장애수당(장애아동수당)으로 급여 성격에 따라 이원화되며, 소득보전급여의 수급 요건인 소득활동능력 평가는 기존의 의학적 손상 평가에서 기능적 소득활동능력과 상황적 요인 등을 추가적으로 고려하는 다차원적 평가로 전환하는 것을 제안하고 있다. 또한 장애연금의 지급액 준거는 생산가능인구 특성을 반영하여 기초연금 지급액이 아닌 최저임금과 연동되어 소득활동능력 손상 정도에 따라 차등하여 지급되며, 장애로 인한 추가비용 지출을 보전하는 추가비용 급여는 정확한 추가비용 계측을 토대로 소득수준에 관계없이 장애정도와 장애유형을 고려하여 차등화하는 완전 사회수당급여로 단계적으로 전환하는 것을 제안하고 있다.The purpose of this study is to propose a reform plan of the Income Security Act for the Disabled for the minimum income guarantee. To achieve this goal, we derived the basic direction of reorganization based on the temporal considerations and future prospects of Korea s disability policy, and the core issues of reform of income security act based on the critical review of the current legislation of disability income security policy such as disability pension law and suggested a rational improvement plan based on international comparative perspective among OECD countries. As a measure to reform the Income Security Act for the Disabled to ensure minimum income, the Act on the disability pension is fully amended to reflec the Protection of Rights and Welfare Support for Persons with Disabilities. The core contents to be included in the Income Security Act for the Disabled are dualization of disability benefits such as disability pensions, which are income preservation benefits for adults with disabilities, and disability allowances, which are additional costs. It is proposed to switch from the conventional medical impairment assessment to a multidimensional assessment that additionally considers functional income activity capacity and situational factors. In addition, the criteria for the payment of disability pensions are based on the characteristics of the working population and are linked to the minimum wage, not the basic pension, depending on the amount of impairment of income activity. Based on the measurement of additional costs, it is proposed to gradually transition to a full social allowance, which is differentiated in consideration of the degree of disability and the type of disability regardless of income level.

Cohort Profile Update: The Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS).

already in the first or second decade of life, while patients are either in full-time education or just entering the workforce. The negative impact on social life or ability to achieve, either scholastically or professionally, can severely affect professional as well as family life. Indeed, 450% of patients with Crohn’s disease indicate that their disease has an influence on their professional and personal life. 6 The course of the disease is often characterized by progressive worsening of the patient’s condition, with increasing frequency of hospitalization and considerable indirect costs through absenteeism and disability allowances. 7 Disease activity is known to be

Az Alkotmánybíróság fontosabb döntései 2019. január 1-je és március 31-e között

The Constitutional Court (hereinafter: CC) made 81 decisions in the first quarter of 2019. From these, 26 decisions were on the merits, meanwhile the others were mainly rejections on formal grounds. In the competences of norm control, the CC has annulled three legal regulations, it established two constitutional requirements and it declared two times legislative omission. The mostly practiced competence of the CC is still the constitutional complaint procedure, mainly the one against judicial decisions. In its competence, the Court annulled four judicial decisions. The Article summarises six significant decisions of the CC from the first quarter of the year. The CC ruled that in case of reviewing the disability allowances, only real physical improvement can be taken into account when classifying a person in a better conditioned grade of disability [CC decision 3024/2019. (II. 4.)] The Court examined the limits of the freedom of speech when judging upon a petition where the petitioner has committed vandalism by launching paint-colours against a public statue [CC decision 1/2019. (II. 13.)]. In decision 3/2019. (III. 9.) the Court established that the new provisions of the Criminal Code against the supporting of illegal migration are in conformity with the Fundamental Law, however, it established a constitutional requirement: the new statutory definition shall not be applicable to the altruistic conducts that perform the obligation of helping the vulnerable and the poor. The CC protected the right to a fair trial in the administrative procedures when in CC decision 5/2019. (III. 11.) it declared: the reasoning is a compelling element of the administrative decision, and a government decree may not establish an exemption from this constitutional obligation. Lately, in its decision 9/2019. (III. 22.) the CC has stepped up in the interests of the children with difficulties in integration, studies and conduct by establishing a legal omission on the part of the lawmaker.

The family-oriented open dialogue approach in the treatment of first-episode psychosis: Nineteen–year outcomes

Open Dialogue (OD) is a family-oriented early intervention approach which has demonstrated good outcomes in the treatment of first-episode psychosis (FEP). Nevertheless, more evidence is needed. In this register-based cohort study the long-term outcomes of OD were evaluated through a comparison with a control group over a period of approximately 19 years. We examined the mortality, the need for psychiatric treatment, and the granting of disability allowances. Data were obtained from Finnish national registers regarding all OD patients whose treatment for FEP commenced within the time of the original interventions (total N = 108). The control group consisted of all Finnish FEP patients who had a follow-up of 19–20 years and who were guided to other Finnish specialized mental healthcare facilities (N = 1763). No difference between the samples was found regarding the annual incidence of FEP, the diagnosis, and suicide rates. Over the entire follow-up, the figures for durations of hospital treatment, disability allowances, and the need for neuroleptics remained significantly lower with OD group. Findings indicated that many positive outcomes of OD are sustained over a long time period. Due to the observational nature of the study, randomized trials are still needed to provide more information on effectiveness of approach.

CLINICAL AND ECONOMIC EVALUATION OF LACOSAMIDE IN PATIENTS WITH PARTIAL EPILEPSY

Aims of study: 1) development of a model for forecasting of impact of Lacosamide administration for antiseizure therapy of local convulsions in patients, who are resistant to previous antiseizure therapy, for the account of healthcare and social security budget of the constituent members of the Russian Federation; 2) assessment of clinical and economical feasibility of Lacosamide administration from the point of view of healthcare and social security budget of the constituent members of the Russian Federation, by example of Kaliningrad region. Materials and methods. General model of Microsoft Excel was developed for analysis of impact of Lacosamide administration to healthcare and social security budget of the constituent members of the Russian Federation in three scenarios: Lacosamide as concomitant drug to standard therapy in comparison with standard therapy without Lacosamide (scenario 1), Lacosamide in comparison with Perampanel, both as concomitant drug to standard therapy (scenario 2) and early administration of Lacosamide as the first concomitant drug to standard monotherapy in comparison with its late administration (scenario 3). The Model allows calculation of the direct medical costs (for the drugs and medical services) and direct non-medical costs (payment of temporary and permanent disability allowances) from the point of view of healthcare and social security system of a constituent member of the Russian Federation. The simulation uses the results of clinical studies and meta-analyses of the antiseizure drugs under consideration, data of state statistical monitoring, and results of previous epilepsy burden analysis conducted in the Russian Federation. The costs in model are calculated on the basis of registered prices on drugs from the List of vital and essential medicines (VEM), price of public purchases of drugs and regulations of financial costs per unit of medical aid in Russia in 2015. We conducted the analysis of impact of Lacosamide administration to the budget of the constituent member of the Russian Federation by example of Kaliningrad region. Results . Scenario 1: in case of increase of total costs by 6.75%; 10.42% and 17.38% in the first, second and third year respectively, administration of Lacosamide as concomitant drug, in comparison with standard therapy without Lacosamide, allows to obtain additional therapy response in 4, 6, 11 patients and remission in 1, 1 and 2 patients, who are resistant to the previous antiseizure therapy. Scenario 2: Taking into consideration the commeasurable efficacy and safety, the economic advantages of Lacosamide over Perampanel are 1.64, 2.65, 4.74 million rubles in the first, second and third year respectively. Scenario 3: administration of Lacosamide as the first concomitant drug after the failed monotherapy allows reaching of the increased therapy response rate and remissions number in comparison with Lacosamide administration as the second concomitant drug and reduce the budget expenses for antiseizure therapy by 11.45 and 1.85 million rubles in the first and the second year respectively.

Impact of the recent recession on self-harm: Longitudinal ecological and patient-level investigation from the Multicentre Study of Self-harm in England

BackgroundEconomic recessions are associated with increases in suicide rates but there is little information for non-fatal self-harm. AimsTo investigate the impact of the recent recession on rates of self-harm in England and problems faced by patients who self-harm. MethodAnalysis of data from the Multicentre Study of Self-harm in England for 2001–2010 and local employment statistics for Oxford, Manchester and Derby, including interrupted time series analyses to estimate the effect of the recession on rates of self-harm. ResultsRates of self-harm increased in both genders in Derby and in males in Manchester in 2008–2010, but not in either gender in Oxford, results which largely followed changes in general population unemployment. More patients who self-harm were unemployed in 2008–10 compared to before the recession. The proportion in receipt of sickness or disability allowances decreased. More patients of both genders had employment and financial problems in 2008–2010 and more females also had housing problems, changes which were also largely found in employed patients. LimitationsWe have assumed that the recession began in 2008 and information on problems was only available for patients having a psychosocial assessment. ConclusionsIncreased rates of self-harm were found in areas where there were greater rises in rates of unemployment. Work, financial and housing problems increased in people who self-harmed. Changes in welfare benefits may have contributed. Declaration of interestNone.

Long-term neurodevelopmental outcome of children from euploid pregnancies with increased nuchal translucency in the first trimester screening.

To assess the long-term neurodevelopmental outcome of children born from singleton euploid pregnancies with increased fetal nuchal translucency (NT) in the first trimester ultrasound screening and without structural anomalies in the second trimester ultrasound screening. This is a register-based retrospective cohort study carried out at a tertiary referral centre from 2002 to 2007. Children were followed up until 2012. All fetuses had increased NT (>95th percentile) at the first trimester ultrasound screening and normal findings in the second trimester ultrasound screening. Data about the neurodevelopmental outcome was retrieved from the hospital databases, The National Institute for Health and Welfare, and the Finnish Causes of Death Statistics Database. Information about received disability allowances was gathered from the Social Insurance Institute of Finland. The study population consists of 691 children. The mean follow-up time was 6.5 years. Neurodevelopmental disorders occurred in 29 children (4.2%). Twelve of these 29 children (1.7%) had severe neurodevelopmental impairment. The long-term neurodevelopmental outcome of children after increased fetal NT is reassuring. This information should be added to the parental counselling of such cases. © 2014 John Wiley & Sons, Ltd.

PARE0012 Patient Advocacy: Standing up for Access to Physical Therapy Care for Arthritis Patients

BackgroundDutch arthritis patients, who need physical therapy care, have been severely limited in available health insurance options between 2012 and 2014. Due to a lack of scientific evidence concerning long-term...

Costs of allergic diseases from birth to two years in Finland

Costing studies are needed to identify the resources used for treatment and inform payers of the costs incurred. The objectives were to determine the costs of diagnosing and treating atopic dermatitis, food allergy and asthma, and to compare the share of costs to society and to the family during the first two years of life. The data were obtained from an ongoing mother-infant nutrition study. The sample comprised 60 infants who developed allergic disease by the age of 24 months and 56 healthy infants with no allergic disease. The costs included diagnosis and treatment of the allergy, disability allowances, travel expenses and time spent by parents. The median costs per infant were €275 (range 94-1306) for atopic dermatitis, €1408 (163-5408) for asthma, €3182 (628-11195) for food allergy, and €10 (0-619) for the healthy infants due to the suspicion of allergic disease. The highest costs in atopic dermatitis were caused by primary care visits, topical treatments, travel costs and parents' time, and those for food allergy by hospital out-patient care, infant formulae for cow's milk allergy, disability allowances and travel costs. The families paid 43% of the costs arising from atopic dermatitis, 13.6% of those from food allergy and 16.5% of those from asthma. Cow's milk allergy emerged as the most expensive allergic disease, especially for the society, and concurrent asthma in particular further increased the costs.

Supported Employment in The Netherlands: New challenges for integrated employment

In The Netherlands, Supported Employment is working through a European initiative: HELIOS and a project with international partnerships with Northern Ireland, Ireland, Portugal and later Spain. Successful experiences have come about, mainly in the region of Rotterdam, and have accounted for the subsequent creation of an Association of The Netherlands and the broader implementation of this alternative workplace model. Currently supported employment with an emphasis on job coaching is used, although there is a major struggle against the sheltered employment centers and disability allowances, which limit participation in employment. A new law proposes a better framework more focused on developing the skills of people and encouraging them into employment. There is suggestion of the need to restructure the reality of sheltered employment, enhance the figure of the job coach and encourage the assessment, analysis of results and effectiveness of organizations, especially in the current atmosphere of economic insufficiency.

Programmes pour premiers épisodes psychotiques : une revue systématique de la littérature

Schizophrenia and its related disorders are prevalent, disabling and costly. Recent longitudinal studies found that the first two to five years of schizophrenia-spectrum disorders are characterised by symptomatic and functional deterioration. This led to the hypothesis of the existence of a critical period in the treatment of individuals suffering from psychosis: an assertive intervention during the first two to five years of psychosis could improve long term outcomes and prevent the emergence of psychosocial deficits.The objectives of this review are to describe different specialised first-episode psychosis services (FEP) and report their results at different times of follow-up in order to determine what specific approaches they should include, the optimal duration of treatment, and the characteristics of the patients who benefit the most from such programs.We systematically reviewed psycINFO and MEDLINE in search of studies dealing with efficacy or efficiency of specialized FEP programs. We only included research that had at least one comparison group and excluded those dealing with primary prevention of psychosis or prodromal interventions.Five, all Scandinavian, programs and their results at different follow-up times are presented. The Parachute project started in 1994 in Sweden with the objectives to use low dosages of antipsychotics (AP), to minimize hospitalisations, to offer specialized individual and familial psychotherapy, and to assure continuity of care during a five-year period. It compared the Parachute study group with a prospective and a historical group. At three years, the Parachute group had spent less days hospitalised (but more days in a crisis home), was associated with a lower percentage of patients receiving disability allowances and had a trend toward better efficiency than the control groups. The Danish National schizophrenia project started in 1997 and included 16 centers that offered a two-year specialised FEP treatment. Patients were randomly assigned to treatment as usual (TU), treatment as usual enriched with support psychodynamic psychotherapy (SPP) and integrated treatment (IT). At the end of the two-year treatment period, patients receiving IT had significantly less positive symptoms, less negative symptoms and better scores in the global assessment scale (GAS) than TU. The Opus project started in 1998 in Denmark. It is a randomised, controlled study comparing a two-year FEP integrated treatment (IT) with standard treatment (ST). After the two-year period, patients were transferred to ST and were assessed at five years (three years after the end of the IT). At the end of the active phase of treatment, patients in IT group had better positive, negative and GAS scores, used lower dosages of AP and used less illicit drugs. At five-years, the only difference between IT and ST groups was that the IT group was associated with more patients living independently. The Open Dialogue project started in 1994 in Finland. It compared conventional treatment (CT) with acute psychosis integrated treatment (API) and Open dialogue approach in acute psychosis treatment (ODAP). At the two-year assessment, API and ODAP groups had less relapses, spent less days hospitalised, used less AP and had better GAS scores than CT. The ODAP group had better scores on the brief psychiatric rating scale than the API group and was associated with fewer patients receiving disability allowances than the CT group. At five-years, there was no difference in the outcomes between API and ODAP, but the authors suggest that the ODAP group was more efficient, because it had similar results as the API group while using less resources. The Soteria Nacka project started in 1990 in Sweden. It compared patients receiving only outpatient specialised FEP treatment (CE) with those receiving outpatient and crisis home specialised FEP treatment (CC). At the five-year assessment, the CC group had better GAS scores than the CE group, but only for patients suffering from a psychosis in the schizophrenia-spectrum. Also, less patients in the CC group used AP and when they did, they had lower dosages. The CC group was also associated with more patients working or studying at the end of the five-year follow-up and with significantly more patients in remission compared to the CE group. Finally, the Opus project, Parachute project and Soteria Nacka found that patients suffering from a psychosis in the schizophrenia-spectrum are those who benefit the most from the specialized, comprehensive, FEP-programs.The programs specialised in the treatment of FEP show encouraging results mainly during their active phase. This review suggests that a two-year treatment period is not long enough to enable patients to maintain the improvements obtained during the active phase of an integrated treatment. Future studies should aim to determine--the characteristics of the patients that most benefit from--the specific interventions that should be included in and--the ideal duration of treatment of the comprehensive FEP programs.

An evaluation of the implementation of a multidisciplinary persistent pain service in the inner London Borough of Tower Hamlets

AimThe aim of this study was to evaluate the implementation phase of a multidisciplinary persistent pain service (PPS).BackgroundA multidisciplinary PPS was established in January 2008 at the London Borough of Tower Hamlets. Referral is made into the service via general practitioners (GPs). Patients see an appropriate mix of clinicians; they include a pain specialist, physiotherapists, an occupational therapist, psychologists and/or health and advice worker.MethodData were collected by using patient questionnaires, monthly activity reports from clinicians, service administration and patient and staff interviews.FindingsService activity steadily increased to full capacity after nine months. Eighty-two percent (31/38) of Tower Hamlets GP clinics referred patients to the service; the referrals were appropriate. The discharge rate at nine months was 5% while 9% failed to attend or declined to attend. Patients saw on average two clinical specialities, post multidisciplinary team discussion and had four appointments. The majority of patients were female (89/144, 62%); between 41 and 60 years old (55%), unemployed (79%), received disability or incapacity allowances (28%), had pain for more than 10 years (27%) and were not fluent in English (37%). The patient and practitioner interviews highlighted: difficulties keeping track of patients as they progressed through the service, inconsistent administration that affected patient satisfaction, lack of understanding of treatment process and plans and cross discipline learning benefit for staff.ConclusionImplementing a multidisciplinary service requires forethought, and regular monitoring to ensure efficiency. For multidisciplinary services we recommend: GP education, clear delineation of responsibilities between staff, efficient systems for tracking patient progress, regular staff meetings and jointly negotiated treatment plans that patients can keep.

Diachronic trends of employment outcome of prevocational training in psychiatric rehabilitation

BackgroundAlthough many rehabilitation programmes of prevocational training for chronic mentally ill persons living in the community have been funded, there is scarce literature about the diachronic trends of their long-term employment outcome. Thus the aim of the present study was to compare the 2-year employment outcome of three groups of chronic psychiatric outpatients, having attended similar prevocational rehabilitation programmes in different periods of time.MethodsThe first group (1984 to 1986) comprised 67 rehabilitees, the second (1988 to 1989) 53 rehabilitees and the third (2000 to 2001) 56 rehabilitees. The three groups were compared with regard to employment follow-up achievements and hospitalisation rates assessed at the end of the 2-year follow-up period by a constructed overall index, encompassing employment qualitative and quantitative characteristics.ResultsThe third group compared to the first and second ones presented a worse employment outcome. No differences were found among the three groups with regard to hospitalisation rates.ConclusionsThere has been a decline in the employment outcome of prevocational training during the current decade. This decline can be attributed to contextual adverse factors such as unemployment, a more demanding labour market and disability allowances offered by the state (the 'benefit trap'). Moreover, the training itself may be 'old-fashioned' enough, thus providing the trainees with inadequate skills to obtain and maintain a competitive job.

Indirect costs of breast cancer in Lithuania in 2008

Introduction. The costs of breast cancer constitute a huge economic impact on so ciety. Indirect costs associated with breast cancer present a significant challenge to the health care system as well. This is primarily due to temporary and permanent disability, disability allowances and pensions or premature death. Aim. The objective of this study was to estimate annual indirect costs of breast can cer from a societal perspective in Lithuania for the year 2008. Materials and methods. A survey of 379 women treated in five major Lithuanian hospitals was conducted in the period of October 2008 – March 2009. Economic data concerning sick-leave and disability due to illness was gathered via survey; data on breast cancer mortality was obtained from the Lithuanian Health Information Center. Results and Discussion. Productivity loss due to premature death reached €14.280 million, productivity loss due to morbidity amounted to €27.036 million – the major portion of these costs accounted for a production loss due to permanent disability. Temporary disability allowances and permanent disability pensions were estimated at €6.116 million and €8.550 million, respectively. The paper also highlights the impact of the disease on the whole society and upon survi vors personally. Decreasing the production losses due to breast cancer should be emphasized. Effective treatment strategies should be implemented in order to balance the costs of the disease. Conclusions. Total indirect breast cancer costs, estimated from a societal perspective, reached €55.982 million in 2008 in Lithuania with an average annual amount

Income from Inactivity under Article 15 of the OECD Model Tax Convention – Part 2

In Part 2 of this article, the author continues the examination of the topic of the taxation of income from inactivity under Art. 15 of the OECD Model Tax Convention by considering stand-by fees, severance payments and sign-on fees. Compensation for the cancellation of an employment, sickness benefits and disability allowances and income derived from non-competition agreements were dealt with in Part 1, which was published in the October 2009 issue of the Bulletin for International Taxation.

Income from inactivity under Article 15 of the OECD Model Tax Convention : Part 1

In this two-part article, the author first introduces the topic of the taxation of income from inactivity under Art. 15 of the OECD Model Tax Convention. He then considers, in Part 1, compensation for the cancellation of employment, sickness benefits and disability allowances and income derived from non-competition agreements.

Colin L Talley, A history of multiple sclerosis, Healing Society: Disease, Medicine, and History Series, Westport, CT, Praeger, 2008, pp. xvii, 201, £27.95, $49.95 (hardback 978-0-275-99788-5).

Colin L Talley’s A history of multiple sclerosis will find itself on the shelves of many of the estimated 2.5 million people worldwide with multiple sclerosis (MS), in medical schools, history departments and health activists’ offices. The intended readership is wide and it does deliver. Based partly on his PhD research, Talley has written an accessible and relevant history. His main argument is that institutional contexts have been vital in enabling the changes in our experience of MS as disease and illness. His particular assertion is that, if we wish to improve the lot of people with MS, history tells us that the solution lies in state intervention—the provision of increased disability allowances, improved legislation and enhanced funding of biomedical research. Like the only other monograph on this subject, by the neurologist-historian T Jock Murray, Talley’s begins with the emergence of MS from the disease category paraplegia, the nature and location of Jean-Martin Charcot’s studies, and the numerous attempts to explain the cause, occurrence and course of MS. Much of this is familiar. Murray’s focus was upon physicians and scientists, whereas Talley brings to the fore the social and cultural context. In the latter half of the book Talley approaches the history of the illness experience. Based on the medical literature and patient records (from hospitals in New York and Los Angeles, and Tracy Jackson Putnam’s private practice), his argument is that despite equivocal evidence, physicians, encouraged by their patients, have been therapeutic activists. Talley also asserts that the (American) National Multiple Sclerosis Society put MS on medical, public, political and philanthropic maps, and to great effect. MS research funding boomed. He continues with a review of the secondary literature of disabilities studies, premised on a social model perspective of disability, to make his case for the role of the political economy in enhancing the experience of disability. In particular he highlights the inherent historical bias against the young and female disabled. In the penultimate chapter Talley brings his historically informed argument to the biomedical politics of today. With his customary plain English, he weaves together the science of an auto-immunity framework, an explanation of how interferon(s) modulate the immune system, and an analysis of where and with whose money this basic and applied science was carried out. Talley explores the long trajectories of MS contingent upon collective and political construction, avoiding esoteric language and swathes of methodologies from the scientific, social science and history disciplines. From his introductory medical description of MS through to a succinct explanation of grounded theory and a closing reiteration of the potentialities of reframing (an auto-immunity) paradigm, his argument throughout is clear. Some, however, may take issue with his selection of sources. His comparative discussion of European MS societies is based on two secondary literature articles. His assessment of national contribution to the “advances in the understanding of MS as an autoimmune disease” by way of numbers of laboratories and clinics identified in “seventy-seven key studies” is problematic (pp. 112–13). On this basis, the UK MS Society, which began funding fellowships in 1954 and to date has directed over £75 million to research, was not an identifiable financier of any advance. Consideration of Interferon: the science and selling of a miracle drug by Toine Pieters (2005) could have broadened the perspective here. The opening line, “We are at a point of great hope” (p. 133) in Talley’s concluding chapter will raise eyebrows. But he is on a mission. One that is well crafted and heartfelt.

‘Recovered from cancer but still ill’: strategies used to legitimise extreme persistent fatigue in disease-free cancer patients

This article analyses the experience of former cancer patients who, many years after the treatment of their illness, suffer from 'extreme persistent fatigue'. The aim is to demonstrate how this symptom can be experienced as problematic and to detail coping strategies that individuals use in order to live with it. This qualitative exploratory study took place in the Netherlands and was based on semi-structured interviews with 12 former cancer patients suffering from extreme fatigue 7-10 years after their illness was treated. The aim of the informants is to achieve a medical diagnosis of cancer-related fatigue, which increases their chances of receiving care and understanding, and thus gives a social and medical legitimacy to their suffering. The search for legitimacy appeared to be especially evident in the demands for disability allowances. Counselling and care in cancer patients should be more focused on the prevention of persistent fatigue during and after cancer diagnosis and treatments.

Cohort Profile: The Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS)

already in the first or second decade of life, while patients are either in full-time education or just entering the workforce. The negative impact on social life or ability to achieve, either scholastically or professionally, can severely affect professional as well as family life. Indeed, 450% of patients with Crohn’s disease indicate that their disease has an influence on their professional and personal life. 6 The course of the disease is often characterized by progressive worsening of the patient’s condition, with increasing frequency of hospitalization and considerable indirect costs through absenteeism and disability allowances. 7 Disease activity is known to be