Abstract: OBJECTIVE: To highlight the prevalence of manual and/or powered wheelchair use within the general French population living at home or in institutions, to describe the users and to identify factors determining wheelchair use. METHODS: Data were obtained from national community-based Handicaps-Incapacités-Dépendance surveys on disability and dependency carried out on 2 representative samples of the French population in institutions (n = 15,288) and at home (n = 16,945). RESULTS: The prevalence of wheelchair use is 62 per 10,000 people living in France. Forty-three percent of users live in institutions. They frequently show multiple impairments and severe disabilities. They have a mean age of 70 years and 64% are women. After taking confounding factors into account, results show that wheelchair use is not sex-related and decreases slightly with age. On the other hand, wheelchair use is related to widowhood, to the extent of impairments and disabilities, to confinement, to exposure to environmental obstacles and to institutional life. CONCLUSION: Sociodemographic studies on the use of wheelchairs need to pay greater attention to people living in institutions. The prevalence of wheelchair use in France appears to be far lower than in other western countries, and this observation needs to be examined further with intercultural comparisons.

Abstract: PURPOSE: The definition and aims of rehabilitation are both topics of frequent debate. Recently several authors have suggested defining rehabilitation and its goals in terms of 'person-centredness'. However such attempts to define rehabilitation in this way have not occurred without running into their own difficulties and criticisms. Consequently, one may question whether person-centredness is a good candidate to characterize and define rehabilitation. The purpose of this article is to reflect upon the historical background and conceptual underpinnings of this term and their relevance for understanding contemporary person-centred rehabilitation. METHOD: We conducted a conceptual and historical analysis of the notion of person-centredness in relation to rehabilitation. We ask first whether person-centredness has a consistent and fixed definition and meaning? Secondly, where does person-centredness come from, what is its conceptual history and does an historical approach enable us to identify a unique source for person-centredness? RESULTS: In the context of rehabilitation, we have identified four main understandings or interpretations of the term person-centredness, each of which denotes several ideas that can be, in turn, interpreted in quite different ways. Thus the concept of person-centredness in rehabilitation has multiple meanings. The conceptual history indicates that person-centredness has diverse meanings and that it has been used in a variety of contexts somewhat unrelated to disability and rehabilitation. Moreover, there does not seem to be any strict relationship between person-centredness as it is used in the context of rehabilitation and these prior uses and meanings. CONCLUSION: Person-centredness has an ancient pedigree, but its application in the field of rehabilitation raises both practical and theoretical difficulties. It may be that rehabilitation might get a better sense of what it should be and should do by focusing less on the rhetoric of person-centredness and by putting more emphasis on the investigation and operationalization of its key conceptual components.

Abstract: Using contributions from the fields of interactionist sociology and narrative studies and the results of an empirical study, in this article we examine the subject's mediation between life events and state of health. Examining narratives focusing on significant life events from 26 men and women aged between 51 and 73 from the administrative region of Ile de France, we suggest that dimensions of meaning and coherence of self need not be taken as internal dispositions, but rather as the product of sociocognitive work on self-narration. The characterisation of the types of causal relationships that the narrators establish between significant events and other events, situations or periods in their lives, opens up avenues for the development of a methodological tool to replace traditional ways of measuring sense of coherence and meaning/purpose in life using psychometric methods. This alternative perspective based on a conception of the self as narrative might provide a remedy for certain conceptual and methodological difficulties that are found within the field of coping research.

Abstract: BACKGROUND: In France, epidemiological data on immigrant population are limited since characterization of immigrants is viewed as a sensitive issue. The Histoire de Vie survey has enabled the description of the association of immigration characteristics and two health indicators. METHODS: Health-related functional limitations and overweight status (BMI> or =25 kg/m(2)) were studied among 18 to 64 years old using indirect age standardization. Immigration status was characterized in four different ways: via the migratory pathways of interviewees and their parents (French born to two French-born parents, second-generation, immigrated at the age of 15 or younger, immigrated at the age of 16 or older), citizenship (French by birth, French by naturalisation, non French), geographical origin (France, Europe, outside Europe) and language(s) spoken at home (French mother tongue, French for persons who do not have French as mother tongue, French and another language, another language). The analyses were conducted separately in men and in women and stratified by occupational status (upper and lower). For functional limitations, the analysis was repeated excluding participants whose limitations occurred before the age of 19, which was the average age of immigration, to assess a possible healthy migrant effect. RESULTS: Compared to French men born to two French parents, an increased rate of functional limitations was observed among men born in Europe and/or who had at least one parent born in Europe (SMR: 1.4; 95% CI: 1.06-1.81) and a reduced rate among participants born outside Europe or who had at least one parent born outside Europe (SMR: 0.63; 95% CI: 0.46-0.86); these differences remained when social status was taken into account. Among women, a tendency towards a lower rate of functional limitations was found in lower social status groups among those who immigrated as adults, among non French citizens and among non Europeans. Restricting the analysis to individuals free of limitations at the age of 19 did not suggest a healthier migrant effect. Among men, the risk of being overweight did not differ according to immigration characteristics. Women who immigrated in their adult life (SMR: 1.42; 95% CI: 1.18-1.74), who had foreign citizenship (SMR: 1.44; 95% CI: 1.18-1.74) and who still spoke their mother tongue at home (SMR: 1.53; 95%CI: 1.23-1.88) were more likely to be overweight than non migrant women. These results were observed in lower social groups but not in upper social groups. CONCLUSION: These results demonstrate a heterogeneous relationship between immigration status and health, according to age at immigration, gender and origin while the migrant second-generation appears quite close to the population born French to two French-born parents. Further studies are needed to provide data on a wider range of health indicators. In the future, health surveys should document detailed information to allow for a full characterisation of the migrant population.

Abstract: PURPOSE: To throw light upon the dynamic processes which may or may not lead persons with severe motor disability to employment. METHOD: A qualitative approach to the chronology of both the professional and non-professional occupations of wheelchair users between acquisition of the disability and the interview; this approach focuses upon actions and meanings, thus allowing the authors to identify the diverse factors which help build the occupation situation at the time of the study. The narratives of 36 wheelchair users of working age were used. The objective of the analysis was to reconstitute the occupation trajectories of the participants and hence to suggest a typology. This involved pinpointing the various actors, the external and cognitive contexts of their decisions and actions, and their consequences and related feelings. RESULTS: The wide diversity found in the trajectories forced the authors to go beyond any simple notion of 'work versus non-work' and to focus on the quality of the individual's process of occupation appropriation. Indeed, it is possible to successfully appropriate both work and non-work situations, just as, inversely, it is possible for a person to fail to appropriate either type of situation. Analysis of this process allows one to pinpoint different types of trajectory. On the one hand, trajectories within which people appropriate their occupations--gradual, intermittent, through rupture and successive adjustment--and, on the other hand, unstable or endured occupation trajectories. CONCLUSIONS: The findings suggest that with regard to rehabilitation practices, we should be focussing as much on the appropriation process as on return to work.

Abstract: Research shows that lifetime socioeconomic circumstances are associated with adult health. Yet most studies to date have focused on mortality and additional data on morbidity outcomes are needed. Additionally, most research in this area has been conducted in Northern European countries or in the United States, and less is known about the extent of socioeconomic inequalities in health in other industrialized countries with different health and labour market characteristics. In this study, we examined the relationship between the socioeconomic trajectory from childhood to adulthood and functional limitations in midlife in France. We used data from a nationally-representative sample of French men and women conducted in 2002-2003 (the Life History survey). Participants (n = 4798) were 35-64 years of age at the time of the survey. standardized morbidity ratios (SMRs) associated with different lifelong trajectories were estimated using indirect age standardization. Overall, the socioeconomic trajectory from childhood to adulthood was associated with functional limitations in midlife in both men and women. The experience of lifelong socioeconomic disadvantage was associated with SMRs of 1.44, p < 0.0001 in men and 1.21, p = 0.0207 in women. In men, the prevalence of functional limitations was low among those who experienced upward intergenerational mobility and high among those who experienced a downward trajectory during the course of their professional career. Additionally, the prevalence of functional limitations was elevated among men and women who experienced unemployment. These findings indicate that in French men and women, lifetime socioeconomic circumstances are associated with functional limitations in midlife. Understanding the mechanisms that underlie these health disparities will require additional studies of specific health outcomes.

Abstract: The question of returning to work after the onset of severe impairment is inseparable from the biographical work that disabled people need to achieve. Qualitative analysis of interviews I carried out among people who had become paraplegic and among rehabilitation professionals offered the following insights: * During a period extending beyond rehabilitation, interviewees were absorbed by the work of coming to terms with their impairment and delegated the question of occupation to the professionals. At a later date, some of them manage to recast their biographies and gain ownership of their occupations and activities for themselves. An open environment, which offers negotiable opportunities and space for relationships to form, encourages the development of biographical work. Nowadays, the question of exclusion would appear to dominate the domain of rehabilitation. The belief that prolonged inactivity engenders marginalisation has led professionals to develop a doctrine whereby they encourage their patients to plan for their professional activities from a very early stage. Struggling with different time demands (for example, lengthy administrative procedures and reduced rehabilitation time) professionals organise their work around a new time frame which conflicts with their expertise and is difficult to reconcile with the trajectories of disabled people.

Abstract: This article presents a study of the identity of persons with motor impairments with regard to the community of disabled persons. The authors used the Tetrafigap survey on the long-term outcome of Tetraplegic Spinal-cord-injured (TSCI) persons, in France, to study the sense of belonging to the community of disabled persons among 1356 TSCI persons in relation to factors of social participation (both sociological and disability-related) and subjective factors (subjective well-being, social perception of disability, perceived disability). The results show that 44% of TSCI persons felt that disabled persons do not constitute a community (the "no-community" group). Of those who recognised the existence of such a community, 34% said they belonged to it (the "in-community" group) and 22% declared they did not (the "out-community" group). People in the "no-community" group tended to be more socially integrated, whilst those in the "in-community" group tended to have greater social and clinical difficulties. The "out-community" group was more diverse, being made up of both autonomous persons and dependent persons suffering from complications. Factors related to the sense of community belonging were identified using bivariate analysis and multiple logistic regression. Subjective well-being appeared to be independent of any sense of community belonging. However, the authors found a gender difference: women in the "in-community" group described themselves as having a poorer level of well-being than women in the other two groups. The results are discussed in terms of two views on the social treatment of disabilities: universalism and assimilation vs. particularism and positive identity and the growth of the disability movement.

Abstract: The purpose of the research described in this article is to study the effects of severe motor impairments on a person's well-being, by attempting to throw light upon the inconsistencies found in the previous literature, which are due to problems of a conceptual and methodological nature. The data were gathered during the Tetrafigap survey on the long-term outcome of tetraplegic persons in France. This survey involved 1668 tetraplegic spinal cord injured people. We examine the relationships between the overall assessment of well-being as expressed by the people interviewed, and a range of clinical, social and psycho-social factors. A progressive approach, along with the use of adjustments via linear regressions, has allowed us to identify certain confounding factors, and to analyse the respective effects of the different types of variables studied. Thus current age, the age at which the impairment occurred and having or not having a professional activity do not have any direct links with the assessment of well-being, whereas the existence of pain and the subjective assessment of one's own independence and of the severity of one's disability are predictive factors. The functional independence indicators are only linked to well-being when they relate to situations in which the dependence creates embarrassment due to socio-cultural taboos. The loss of autonomy only affects well-being in as much as it imposes limits to social activity, whether they be relational or occupational. Living as a couple is a negative predictive factor if the couple were together prior to the impairment occurring. The overall results demonstrate the importance of moving beyond any conception of the impact of the impairments on well-being that is too exclusively focused on the individual, and of integrating the socio-cultural meanings of handicap situations and the dynamics of the interactions which take place therein.

Abstract: A number of studies focus on factors that might explain the low level of employment of persons with paraplegia without questioning the social representations connected to work. Being employed is considered a priori as beneficial, constituting an important objective for rehabilitation. However sociologists have recently pointed out that work, as a means of self fulfilment, is a 'constructed' rather than a 'natural' category. The comparisons of the representations of work given by two groups: persons with paraplegia (n = 350), and non-disabled persons (n = 327) show that persons with paraplegia are more likely than non-disabled persons to consider work as a source of personal fulfilment and social recognition and less likely to positively value the fact of not-working. In addition, a demonstrated satisfaction with not working, among persons of working age, is clearly more significant among non-disabled persons than among persons with paraplegia. Among these, some of them who have generally made up their mind about not working declare that they feel satisfied being unoccupied. This satisfaction is explained, in part, by expressed representations of work. The authors suggest a reflection on the place of work in rehabilitation programmes.

Abstract:

Abstract: This research was undertaken to determine whether or not disabled persons are at a disadvantage when seeking employment. An experimental design--mailing unsolicited job applications to employers--in a natural social setting allowed a study of employer's behaviour under naturalistic conditions. A randomized comparative study was conducted on a representative sample of 2228 branches of French companies, stratified as a function of their size. Four different profiles of applications were constituted by crossing two independent variables: the presence or absence of mention of a physical deficiency (paraplegia, with a wheelchair) in the job application, and high or low level of qualification. Using random sampling, the investigators sent each company an application for a job using one of these four profiles. Two experimental groups of companies were constituted (each of which received an application with either high or low qualification and mention of disability) with two control groups (applications with high/low qualification, without mention of disability). It was found that highly qualified able-bodied applicants were 1.78 times more likely to receive a favorable response than their disabled counterparts, and modestly qualified able-bodied applicants were 3.2 times more likely to receive a positive response. As well, discrimination became more marked as company size increased. In comparison with laboratory experiments, the results of this research permit a more objective assessment of discriminatory behaviour by companies confronted by disabled job applicants, and show a significant amount of discrimination towards individuals with a physical disability.

Abstract: The objective of this study was to evaluate the consequences of facioscapulohumeral muscular dystrophy (FSH MD) using two different but complementary procedures: an analysis based on the three different dimensions of disablement developed by the WHO--impairment, disability, and handicap--and a study of the psychological repercussions on social identity. Sixty-eight individuals with FSH MD, with 68 members of a control group, responded to a battery of psychosocial questions. Individuals with muscular dystrophy were also studied with reference to the dimensions of impairment, disability and handicap. The results showed that there are close correlations among measures of the three dimensions of disablement. Evaluations made by people with muscular dystrophy of the seriousness of their own disablement are strongly linked to objective measures of impairment. Furthermore, we found that having muscular dystrophy does have certain consequences for an individual's self-identity, although the degree to which one's self-image is validated is to some extent independent of the seriousness of the illness.

Abstract: Starting from two relatively independent trends of research in psychosociology, that of perception by others and that of social identity, the authors try to demonstrate the relationship between the social representation in France of physically disabled people and social identity as expressed by the members of this group. They ask physically disabled and non-handicapped subjects to evaluate themselves by means of a questionnaire consisting of pairs of antonyme adjectives; and they compare their results to those of former research which demonstrated special social representation of physically disabled persons. The results indicate that, even if in a general way the disabled do not perceive themselves as being different from the non-disabled, they manifest, nevertheless, on certain items a clear tendency to see themselves as they are perceived by others. The discussion poses the problem of the origin of this social representation of disabled people and of its possible impact on the social identity of members of that group.

Abstract: Continuing the study of social representation of the physically handicapped, the authors of this article study the influence of income and family situation on the evaluation of a fictive handicapped person. In creating twelve portraits by crossing the modalities of these variables, they arrive at a factorial plan which allows them to prove the effect of income and family situation as well on the positive adjectives marked on a list of personality traits as on the evaluations given by means of a scale ranging from "has overcome his handicap very poorly" to "has overcome his handicap very well". Although the evaluations are in general favorable and in spite of the fact that only little information was given to the subjects, the responses are significantly different. In addition, the relation between the number of positive adjectives attributed and the values received on the scale make it evident that the notion of having well or poorly "overcome one's handicap" is socially evaluated. Finally, the interaction observed between the two studied variables shows that the fact of having a professional occupation is clearly more important if the described person is unmarried than if he is married.