Disability and Health Journal最新文献

Background: Long COVID, characterized by persistent symptoms following SARS-CoV-2 infection, poses substantial challenges to individuals' physical and mental health, yet its impact on life satisfaction remains underexplored.

Objective: This study aimed to investigate variations in life satisfaction among individuals with Long COVID and identify associated predictors using a mixture model approach.

Methods: Participants (N = 212) were recruited via Prolific and completed surveys assessing life satisfaction, stress, resilience, social support, and hope. A mixture model analysis categorized participants into two clusters based on the relationship between life satisfaction and contributing factors (e.g., social support).

Results: Cluster 1 (n = 153) exhibited lower life satisfaction scores, while Cluster 2 (n = 59) reported higher scores. Social support emerged as a significant predictor of life satisfaction in Cluster 2 (p < .001), with correlations indicating its positive association with life satisfaction and negative association with stress levels. However, social support was not significantly associated with life satisfaction in Cluster 1.

Conclusions: The findings highlighted the heterogeneous nature of life satisfaction among individuals with Long COVID. Social support, particularly from family and friends, was identified as a critical factor influencing well-being outcomes. Tailored interventions focusing on enhancing social support networks could mitigate the adverse impacts of Long COVID and improve overall quality of life for individuals with Long COVID.

Background: Deaf adolescents and other young people with sensory disabilities are at elevated risk of sexual violence victimisation. However, there is scant published evidence on the epidemiology of sexual violence victimisation among deaf adolescents from African countries, including Ghana.

Objective: To describe the 12-month prevalence and associated factors of sexual violence victimisation among school-going deaf adolescents in Ghana.

Methods: This is a cross-sectional self-report survey involving a nationally representative sample of 422 school-going deaf adolescents. Multivariable logistic regression was used to examine the sociodemographic, personal-level, family-related, school-based, and interpersonal-level factors associated with sexual violence victimisation.

Results: The 12-month prevalence estimate of sexual violence victimisation was 17.4% (95% confidence interval [CI] = 14.0-21.3%). Comparable estimates were found between females (16.6%; 95%CI = 11.3-23.0%) and males (17.9%; 95%CI = 13.6-23.0%). Deaf adolescents from polygynous families, those who did paid work, those having a single-parent caretaker, those whose primary caretakers were unemployed, and those in romantic relationships were at increased odds of sexual violence victimisation. Family-related factors such as parental divorce, and conflict with parents were also associated with increased odds of sexual violence victimisation. No (putative protective) factors were identified to be associated with reduced odds of sexual violence victimisation.

Conclusions: The prevalence estimates and associated factors of sexual violence victimisation among school-going deaf adolescents in the current study are comparable to what is known about in-school hearing adolescents in Ghana. The evidence highlights the need to strengthen preventive efforts against the offence in both deaf and hearing adolescents.

Background: Disabled people are more likely to be physically inactive than non-disabled people, yet limited research has explored the types of physical activities that disabled people participate in.

Objectives: This study describes the types of physical activities that disabled people participate in, and compares activity frequency and duration to non-disabled people.

Methods: Using cross-sectional data from the 2018/19 Sport England Active Lives survey, participants were categorised into three groups (disability - substantial effect on daily activities; disability - non-substantial effect on daily activities; no disability), and activity types were grouped into 17 categories including athletic, leisure, and swimming. Chi-squared tests and multivariable linear regression were used to compare participation in each activity category across the sub-groups.

Results: Of 158,995 participants, 18% (n=29,057) had a disability that had a substantial effect on daily activities, 21% (n=33,004) had a disability with a non-substantial effect on daily activities, and 61% (n=96,934) had no disability. Leisure was the most frequently reported activity type and of longest duration (median (interquartile range) mins/day: disability - substantial effect on daily activities: 315 (120-700); disability - non-substantial effect on daily activities: 390 (180-750); no disability: 375 (165-750)). Whilst activity duration was typically higher among people with no disability, artistic activities and swimming were higher for people with a disability that had a substantial effect on daily activities.

Conclusions: Activity choices were similar among sub-groups, however participation rates and activity duration were typically lower among disabled people. Reducing inequalities in physical activity participation will require improved access, opportunities, and support.

Background: Sexually transmitted infections (STIs) are prevalent in the general population. Autistic individuals, both with and without intellectual disability (ID), are potentially at increased risk due to gaps in sexual health education, increased vulnerability to sexual abuse, victimization, and disparities in access to primary and reproductive health care.

Objective: This study aims to identify the prevalence of STIs and HIV among a national sample of Medicaid-enrolled autistic individuals and their peers, identifying opportunities for intervention.

Methods: Characteristics of autistic Medicaid beneficiaries with and without ID were stratified to compare individuals with and without chlamydia, gonorrhea, syphilis, and HIV. Period prevalence of outcomes among Medicaid enrollees with autism spectrum disorder (ASD) only, ID only, and both (ASD and ID) were compared.

Results: Among autistic individuals, the prevalence of STIs and HIV was highest in the 22-30 age group and among Black enrollees, underscoring the importance of prioritizing their care through screening and preventive health measures.

Conclusions: The results emphasize gaps in addressing the sexual and reproductive health needs of autistic individuals. Policymakers should prioritize funding for clinician training and increased healthcare access to address the sexual health needs of this population, especially those from additionally marginalized communities. It is vital to provide inclusive care that addresses the unique challenges faced by autistic individuals in accessing appropriate sexual health resources.

Background: The associations between physical activity and various social determinants with quality of life (QoL) among teenagers with cerebral palsy (CP) are inconclusive.

Objective: To explore associations between perceived QoL among teenagers with CP in Sweden and participation in physical leisure activity and physical education in school, as well as sex, gross motor function, pain and bother, caregivers' birth country and socioeconomic status.

Methods: A cross-sectional study with teenagers who have CP, aged 15-18 years. The survey, including the assessment form Cerebral Palsy Quality of Life-teenager (CP QoL-teen), was sent to all youths in the national patient registry held by the Swedish National Board of Health and Welfare (n = 900). Survey data was complemented with data from other national health registries containing information on demographics, physical leisure activity, physical education, and gross motor function. Multivariable linear- and quantile regression analyses were performed.

Results: The survey was answered by 149 participants. Physical leisure activity was positively associated with the QoL-domain Communication and physical health. Gross motor function was associated with domains referring to physical function and participation; more severe motor difficulties indicated lower QoL. Pain was negatively associated with all QoL domains. Low caregiver educational levels were associated with higher social well-being domain.

Conclusion: Minimizing pain and facilitating physical activity may enhance QoL for teenagers who have CP. To improve participation for teenagers with severe disabilities, with non-Nordic caregivers, and caregivers without postgraduate education, targeted measures to facilitate participation are needed.

Background: The gross motor function classification system (GMFCS) is a well-established measurement of function specific to cerebral palsy (CP) and likely offers prognostic ability for disease trajectories. However, other emerging measurements may be more directly aligned with assessing disease risk for adults with CP, such as the Whitney Comorbidity Index (WCI).

Objective: To expand the methodological menu for prognostic model research, this study assessed whether GMFCS or WCI served as a better prognostic factor of 5-year risks of mortality and 21 relevant morbidity outcomes among adults with CP.

Methods: This retrospective cohort study used medical records from 01/01/2012-06/01/2024 from adults ≥18 years old with CP. A 1-year baseline ascertained the WCI score. Logistic regression estimated and compared the c-statistic of each outcome between: (1) base model (age, sex, race, smoking status, insurance, year of start date) + GMFCS and (2) base model + WCI. Multiple imputation was used for missing GMFCS data to address sample selection bias.

Results: In the complete case analysis with no missing GMFCS data (n = 923), 14 of 21 morbidity outcomes were similarly predicted by base + GMFCS and base + WCI models and 7 were predicted better by base + WCI model, while the mortality outcome was predicted better by base + GMFCS. Using the full cohort after multiple imputation (n = 2601), 18 morbidity outcomes were similarly predicted by both models and 3 were predicted better by base + WCI model, while the mortality outcome was predicted better by base + GMFCS.

Conclusions: This study suggests that while GMFCS was superior for mortality prediction, the WCI had similar-to-superior prediction for most morbidity outcomes.

Background: The dearth of disability-focused education in United States residency programs fuels health care disparities faced by persons with disabilities (PWD). However, it has yet to be demonstrated that physicians-in-training feel less comfortable managing disability-specific health concerns than they do other medical conditions.

Objective or hypothesis: To assess Internal Medicine (IM) residents' level of comfort in managing disability-specific versus general internal medical (GIM) concerns. We hypothesized that: 1) IM residents are less comfortable managing disability-specific health conditions than other GIM conditions; 2) IM residents feel increasingly comfortable handling GIM conditions over the course of their training, but not in addressing disability-specific concerns, and; 3) prior exposure to PWD improves IM residents' comfort in managing disability-specific conditions.

Methods: An exploratory study utilizing a Likert Scale-based survey assessing IM residents' level of comfort in managing GIM and disability-focused conditions was developed then distributed through 3 IM programs. Main measures included residents' level of comfort in managing a variety of medical conditions, including those pertaining to the care of PWD. Data analysis included descriptive statistics, ANOVAs, and independent sample t-tests.

Results: The survey was distributed to 298 residents and 127 completed it (response rate of 42.6 %). Participants were less comfortable providing disability-focused care than GIM care. Upper-level residents were more comfortable than first-year residents in managing GIM conditions, but not in providing disability-focused care.

Conclusions: Internal medicine residents are inadequately trained to provide care for PWD. There is a need to incorporate disability-specific learning objectives into graduate medical program requirements and curricula.

Background: Women with disability face more stressors around the time of pregnancy than women without disability. Limited research exists on stressors experienced due to the COVID-19 pandemic among pregnant and postpartum women with and without disability.

Objective: Examine the association between disability status and experiencing certain COVID-19 stressors among women with a recent live birth.

Methods: We analyzed Pregnancy Risk Assessment Monitoring System data from 14 jurisdictions implementing the Disability and Maternal COVID-19 Experiences supplement surveys among women with a live birth from June-December 2020. We examined the prevalence of 12 individual stressors and seven stressor types (any stressor, economic, housing, childcare, food insecurity, mental health, and partner-related), by disability status. For each stressor type, we calculated adjusted prevalence ratios (aPRs) using logistic regression to determine if women with disability were more likely to experience particular stressor types, controlling for respondent age, education, race and ethnicity, marital status, and payment at delivery.

Results: Among 5961 respondents, 6.3 % reported a disability. Compared with women without disability, those with disability were more likely to experience any stressor (aPR 1.19, 95 % CI 1.14-1.24), including economic (aPR 1.38, 95 % CI 1.23-1.56), housing (aPR 1.56, 95 % CI 1.09-2.24), childcare (aPR 1.32, 95 % CI 1.11-1.58), food insecurity (aPR 2.18, 95 % CI 1.72-2.78), mental health (aPR 1.49, 95 % CI 1.37-1.62), and partner-related stressors (aPR 2.00, 95 % CI 1.55-2.58).

Conclusions: Findings highlight the challenges experienced by pregnant and postpartum women with disability during public health emergencies and considerations for this population in preparedness planning.

Background: Individuals with Down syndrome (DS) typically exhibit lower cardiorespiratory fitness and reduced moderate-to-vigorous physical activity (MVPA) compared to persons without disability. Approximately 50-55 % of individuals with DS have congenital heart disease (CHD), which is associated with cardiopulmonary deficiencies and reduced MVPA participation in non-DS populations. It is unknown if CHD related comorbidities compound with DS associated deficits in physical activity and fitness.

Objective: To compare physical activity, cardiorespiratory fitness, and cardiovascular function, of persons with DS with and without CHD.

Methods: Baseline data were used from a 12-month randomized controlled physical activity intervention of adults with DS. Participants with DS were age and sex matched based on presence of CHD. Measures of physical activity through accelerometry (n = 42; CHD, n = 21), cardiorespiratory fitness (VO_2peak; n = 34, CHD n = 17), and cardiovascular function (anaerobic threshold, chronotropic index, O₂ pulse; n = 34, CHD n = 17) were compared by CHD status using Wilcoxon rank sum tests.

Results: There were no differences in VO_2peak between those with and without CHD (CHD 20.3 ml/kg/min; no CHD 21.3 ml/kg/min, p = 0.44). MVPA was lower for those with CHD vs. without CHD (10.0 vs 13.3 min/week, p = 0.05). There were no differences in cardiovascular function by group.

Conclusion: Fitness and physical activity were low regardless of CHD status. Adults with DS and CHD may engage in less physical activity than those without CHD, however fitness and cardiovascular function were not further impaired by CHD. Given the prevalence of CHD in DS, it is important to include those with CHD in work increasing physical activity and fitness.