An inquiry based on statistical data concerning rheumatic diseases in seven European countries was performed. The data reported were based on the ICD (8th revision, 1965). The time of reference was the period 1968-78. The countries concerned (Czechoslovakia, Finland, France, the GDR, Poland, Sweden and the United Kingdom) reported data on the following 'measures of frequency': rates of hospital discharge; rates of spells of sickness and incapacity for work; incidences of disability pension due to rheumatic disorders. The main results are threefold: The social importance of rheumatic diseases has been increasing in several European countries in the late 1960s and 1970s, though the situation differs from one country to another. There is sufficient evidence to assume a true increase in the occurrence of clinical symptoms among persons afflicted with 'degenerative arthropathy', i.e. osteoarthrosis and vertebrogenic pain. The increasing social importance of 'degenerative arthropathy' ought to stimulate a process of rethinking of the traditionally established priorities in rheumatological research and practice.
A project group of the Medical Advisory Board of the German Federal Rehabilitation Council (BAR) developed fundamental joint principles on experts' opinions according to the social law code no. IX (SGB IX). The principles aim at medical experts working in different social organisations and statutory health care insurance. It was intended to create a "sociomedical language" which should be used as jointly as possible by experts in rehabilitation and social medicine and which is based on the ICF (International Classification of Functioning, Disability and Health, WHO 2001). Its stringent application will increase the utility of medical expertise across different institutions. The authors recommend to evaluate whether this model could provide a tool in the communication and cooperation between different sectors of the health system. Part I describes the theoretical model, Part II its application to a virtual individual case history.
The International Classification of Impairments, Disabilities, and Handicaps (ICIDH), a manual of disease consequences issued by WHO, at present exists in two versions. ICIDH-1, issued in 1980, has been under revision since 1993. This revision process will result in a more sophisticated and more comprehensive ICIDH-2 in 2001. The ICIDH, based on the biopsychosocial disease model, describes disease consequences in three dimensions: Structural and functional body impairments. Disabilities (ICIDH-1) or restrictions of activities (ICIDH-2) in activities of daily living. Handicaps (ICIDH-1) or participation limitations (ICIDH-2) in social integration. In the field of geriatrics ICIDH is also helpful as a coherent conceptual framework and reference manual to determine and code the disabilities and handicaps with regard to daily living competence. Geriatric assessment instruments are no alternative, but complementary to the ICIDH. In view of the high frequency of geriatric patients with multimorbidity, i.e. multiple impairments, disabilities, and handicaps, the utility of the ICIDH in geriatric care is highly dependent on the flexible application of this classification system.
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