Disability and Health Journal最新文献

Background: People with cerebral palsy (CP) may have an elevated risk of pneumococcal disease, which is a vaccine-preventable disease, but this has not been studied.

Objective: To compare the initial rate and number of incident pneumococcal disease events up to 9-years between adults with vs. without CP.

Methods: This retrospective cohort study accessed a 20 % random Fee-For-Service Medicare dataset from the Centers for Medicare and Medicaid Services, including claims from adults ≥18 years old with CP and elderly ≥65 years without CP from 01/01/2008-12/31/2019. The incidence rate (IR) per 1000 person-years, IR ratio (IRR), and the number distinct events of all-cause pneumonia, pneumococcal pneumonia, and invasive pneumococcal disease was estimated for each cohort up to 9-years of follow-up.

Results: The IR and IRR of the first event was higher for adults with CP ≥ 18 years old compared to elderly without CP for all-cause pneumonia (IR[95 %CI] = 71.24[69.85-72.63] and 40.10[40.04-40.16], respectively; IRR[95 %CI] = 1.78[1.74-1.81]), pneumococcal pneumonia (IR[95 %CI] = 6.27[5.90-6.64] and 2.44[2.43-2.46], respectively; IRR[95 %CI] = 2.57[2.42-2.72]), and invasive pneumococcal disease (IR[95 %CI] = 0.64[0.52-0.75] and 0.26[0.26-0.27], respectively; IRR[95 %CI] = 2.44[2.04-2.93]). Among those with outcome events, adults ≥18 years old with CP had a higher number of distinct all-cause pneumonia (e.g., 0 and ≥ 7 events, 54.8 % and 1.7 % for men with CP and 71.9 % and 0.1 % for elderly men without CP) and pneumococcal pneumonia (e.g., 0 and ≥ 2 events, 96.1 % and 0.5 % for women with CP and 98.4 % and 0.1 % for elderly women without CP) events compared to elderly without CP. Notably, when stratified by sex and age group, the IR of pneumococcal pneumonia for both men and women with CP was comparable between the youngest age group, 18-25 years old, and elderly ≥75 years old without CP (e.g., 18-25 year old men with CP, IR[95 %CI] = 3.81[2.29-5.33] and ≥75 year old men without CP, 4.01[3.97-4.05]).

Conclusions: Findings suggest the at-risk window for pneumococcal disease begins about 4 decades earlier for CP compared to the general population; prevention efforts may need to consider implementing strategies earlier in the lifespan for this population.

Since 2015, the global health community, through the Sustainable Development Goals (SDGs), has committed to promoting equitable early childhood care and development that fosters inclusive education and lifelong learning for all children under the age of 5. Whereas several global policies on disability-inclusion recommend a twin-track approach to support people with disabilities, the application of this approach for children with disabilities in early childhood is unclear. In this article, we examine the concept of inclusion for children with disabilities in early childhood and how to address the inequalities they face through the globally recommended twin-track approach. We highlight key components of this approach for optimizing school readiness for children with varying severities of disability. We offer recommendations for addressing potential barriers to disability inclusion, based on evidence from multiple sources, and emphasize the need for a globally coordinated strategy to advance the global vision and commitments for children with disabilities.

Background: Prenatal screening and folic acid supplementation have decreased spina bifida (SB) incidence, while advances in multidisciplinary care have increased life expectancy for those born with the condition. Historically, orthopedic outcomes research has focused largely on childhood, as earlier assumptions regarding limited survival into adulthood contributed to the exclusion of adults with SB from longitudinal studies. As a result, knowledge of orthopedic procedures performed on adults with SB may help to guide treatment in childhood and transition to adult care.

Objective: To describe the epidemiology of orthopedic procedures performed on adults with SB.

Methods: The MarketScan database was queried to investigate the frequency of orthopedic procedures among adults with SB. All orthopedic Current Procedural Terminology codes were assessed, as were codes for upper extremity nerve decompression procedures.

Results: A total of 10,869 adults with SB were included. Patients were, on average, 38.1 years ± 14.5 old and female (58.6 %). Patients most commonly underwent application of multi-layer compression below the leg (12.1 %), Unna boot application (6.7 %), and sacroiliac (SI) joint injections (4.7 %). Over one-third (n = 4,036, 37.1 %) of patients underwent casting/strapping procedures. Joint arthroplasty was observed in 1.8 % of patients while lower extremity amputations occurred in 4.4 % of patients. Nerve decompressions (n = 210, 1.9 %) were the most common upper extremity procedures followed by arthroscopic shoulder surgery (n = 151, 1.4 %).

Conclusion: Adults with SB underwent a notable burden of casting/strapping and procedures related to wound care, representing ongoing problems with skin breakdown. Injection of the SI joint was a common procedure. Joint arthroplasty, rotator cuff repair, and nerve decompression, while less frequent, may demonstrate both the long-term sequelae of altered gait mechanics and the upper extremity consequences of prolonged use of assistive mobility devices.

Background: Concern about falling (CaF) can emerge after experiencing a fall or recognizing personal fall risk. High CaF may lead to activity curtailment, greater fall risk, and reduced quality of life and participation in full-time wheelchair/scooter (WC/S) users. Identifying predictors of CaF can help clinicians address CaF in rehabilitation interventions.

Objective: To examine predictors of CaF among individuals living with various health conditions who use WC/S full-time.

Methods: This cross-sectional online survey included adults who used WC/S full-time for at least one year and had experienced at least one fall in the prior three years. Path analysis identified predictors of CaF, measured by the Fall Concerns Scale for people who use WC/S (FCS-WC/S).

Results: 137 people who use WC/S full-time (63 % male, 37 % female) participated. Being younger (p < .05), being male (p <.05), having experienced at least one fall-related injury in the past year (p < .01), having a higher impact of chronic dizziness on physical, emotional, and functional well-being (p < .001), inability to get up from the ground independently (p < .01), and lower burden of depressive symptoms (p < .05) were predictors of increased levels of CaF.

Conclusion: This study's findings suggest that the influences of CaF among people who use WC/S are multifactorial. Awareness of these predictors can help researchers and clinicians develop screenings to better identify people who use WC/S with high levels of CaF and develop treatment plans to effectively manage CaF.

Background: The Supplemental Security Income (SSI) program of the Social Security Administration (SSA) provides an important safety net to families of children with severe disabilities who meet specific income and asset criteria. Despite its importance, there is evidence that around 30 % of potentially eligible children are not enrolled.

Objectives: This qualitative study examines individuals' experiences of barriers and facilitators to enrollment in child SSI.

Methods: We conducted 51 interviews with caregivers of children with severe disabilities, including 36 interviews with individuals who applied for child SSI, and 15 with individuals who have potentially eligible children but who have not applied.

Results: We find that several deterrents to take up may be at play. The perception of high application burden, limited time, cognitive demands of competing household responsibilities, and psychological stress limited caregivers' ability to get through the application's administrative "sludge." Moreover, the stigmatizing or "labeling" effect of SSI enrollment on their children, as well as the perceived compliance costs of child SSI, deterred applications. Finally, our interviews reveal that service providers, most within pediatric healthcare settings, play a critical role in facilitating access to child SSI.

Conclusions: Our findings suggest that more systemic capacity building for service providers could level the playing field for potential applicants in the context of other sources of enrollment variability.

Background: People with physical disabilities (PWD) are at increased risk for obesity compared to people without disability (PWoD). PWD face barriers to physical activity (PA), which is important for weight loss maintenance (WLM) in PWoD. However, the role of PA in WLM has not been evaluated in PWD.

Objective: The purpose of this study was to examine differences in PA between PWD and PWoD and whether PA is associated with WLM success among PWD.

Methods: Data were derived from 536 participants already enrolled in the International Weight Control Registry, which included targeted recruitment of PWD. Physical disability was self-reported via study-designed survey capturing presence and type of disability. PA was assessed using the International Physical Activity Questionnaire, and weight history was self-reported as "Successful" (lost weight and maintained ≥1 year), "Regain," or (Lost but regained within 1 year). PA was compared between PWD and PWoD and among PWD by weight history status using generalized regression models.

Results: PWD (n = 174) reported more sedentary time (β = 0.34; 95 % CI = 0.16-0.52, p < 0.001), and greater odds of reporting zero total physical activity (OR = 5.18, 95 % CI = 2.19-12.24, p < 0.001), zero total leisure physical activity (OR = 2.22, 95 % CI = 1.51-3.26, p < 0.001), and zero leisure vigorous physical activity (OR = 1.87, 95 % CI = 1.15-3.02, p = 0.011). There were no significant differences in PA among PWD based on weight history status.

Conclusions: PA may not be a critical factor influencing weight maintenance in PWD. Even among successful participants, PWD report lower PA than PWoD, highlighting the need for inclusive PA programs.

Background: Although individuals with intellectual disability (ID) experiencing domestic violence (DV) have greater health-care needs than do those without ID, research on the health-care utilization patterns of these individuals is lacking.

Objective: To examine whether ID influences health-care utilization among those who experience DV.

Methods: This retrospective cohort study used nationwide data from Taiwan's Family Violence dataset and National Health Insurance claims data from 2011 to 2022. The primary outcome measures were the frequency of general outpatient and psychiatric visits before and after the DV incident. Generalized estimating equations (GEEs) were used to analyze trends in health-care utilization over time after adjustment for covariates.

Results: The results of an analysis of health-care utilization from 3 months before to 3 months after a DV incident indicated that individuals with ID visited general outpatient and psychiatric clinics more than individuals without ID did. Additionally, GEE analysis results revealed that from the first to the second month following DV, health-care utilization was greater in the ID group, who had 21.23 % more general outpatient visits and 52.05 % more psychiatric visits than did those without ID, indicating prolonged negative health effects associated with DV in these individuals.

Conclusions: Individuals with ID who experience DV have prolonged health-care needs after DV compared with individuals without ID. For sustained recovery and improved long-term results, post-DV support should be responsive to a person's disability status and specific needs.