Disability and Health Journal最新文献_第2页

Disability severity and risk of new or recurrent intimate partner violence – Evidence from a cohort study in rural Pakistan 残疾严重程度与新的或经常性亲密伴侣暴力风险--来自巴基斯坦农村地区一项队列研究的证据

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.dhjo.2024.101673

Amanda Collins MSPH , Joanna Maselko ScD , Ashley Hagaman PhD , Lisa Bates PhD , Sarah C. Haight MPH , Aparna G. Kachoria MPH , Sugandh Gupta MA , Sonia Bhalotra PhD , Siham Sikander PhD , Amina Bibi MPH

Background

People with disabilities are more likely to experience intimate partner violence (IPV) than those without. Most research examining the relationship between disability and IPV, however, is cross-sectional and approaches disability as a binary variable. This relationship is also important to consider in a South Asian context, where it may be affected by cultural norms surrounding IPV, and resources for people with disabilities.

Objective

To estimate the degree to which disability severity increases the risk of subsequent IPV among a cohort of mothers living in rural Pakistan.

Methods

Mothers from the Bachpan study (N = 869) with data for at least two consecutive waves between 1-, 2-, 3-, and 6-years postpartum were included in this study. Modified Poisson regression models were used to estimate the relationship between disability level in the preceding wave and psychological, physical, and sexual IPV in the following wave.

Results

For psychological IPV, the risk ratio (RR) for medium severity was 1.27 (95 % CI: 1.10, 1.46) and the RR for high severity was 1.23 (95 % CI: 1.02, 1.48), relative to low severity. Physical IPV had a medium severity RR of 1.44 (95 % CI: 1.00, 2.06) and high severity RR of 1.60 (95 % CI: 1.02, 2.53). For sexual IPV, the medium severity RR was 1.35 (95 % CI: 1.05, 1.75) and the high severity RR was 1.53 (95 % CI: 1.11, 2.10).

Conclusions

This study supports that, in a low-income, rural South Asian context, mothers with disabilities are particularly susceptible to future psychological, physical, and sexual IPV.

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引用次数: 0

Age, sex, and multi-morbidity stratified mortality risk estimates for adults with cerebral palsy to inform clinical decision making 对成年脑瘫患者的年龄、性别和多病分层死亡率风险估计，为临床决策提供依据。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.dhjo.2024.101683

Daniel G. Whitney PhD , Lillian C. Min MD , Edward A. Hurvitz MD

Background

While research has provided key insights into mortality rates and risks for individuals with cerebral palsy (CP), clinically useable mortality risk estimates remain unreported for adults with CP, especially by key patient-level factors.

Objective

The objective of this study was to generate clinically useable mortality risk estimates among adults with CP to inform clinical decision making.

Methods

This retrospective cohort study, using a fee-for-service Medicare database, identified adults ≥18-years-old with CP from 01/01/2008-12/31/2010 and followed through 12/31/2019 for death. Mortality risk at 1-, 3-, 5-, and 9-year intervals were selected based on common clinical length of time to reasonably benefit from preventive care. Sex-stratified analyses assessed risk estimates by narrow age group (18–25/26-34/35–44/45-54/55–64/65-74/≥75 years old) and multi-morbidity group (Whitney Comorbidity Index score 0–2/3/4–6/≥7).

Results

Of 24,767 adults with CP, n = 12,962 were men (mean [SD] age = 48.3 [15.0] years) and n = 11,805 were women (age = 49.7 [15.8] years). Loss to follow-up was rare. 1-year risk was similar between men and women (3.4 % vs. 3.3 %), but increased slightly more for men than women through 9-years (30.1 % vs. 28.0 %). As expected, the mortality risk increased with older age and higher WCI scores. The probability of death (and survival) is presented per age and multi-morbidity group for men and women with CP.

Conclusions

Mortality risk estimates were reported at clinically relevant intervals by age, sex, and multi-morbidity status. This information can be used to weigh harm-to-benefit ratios of screening and treatment strategies based on mortality expectancy estimates.

背景：尽管研究已提供了有关脑性瘫痪（CP）患者死亡率和风险的重要见解，但临床上可用的成年 CP 患者死亡率风险估计值仍未报告，特别是根据患者水平的关键因素进行的估计值：本研究旨在得出临床上可用的成年脑瘫患者死亡风险估计值，为临床决策提供依据：这项回顾性队列研究利用医疗保险付费服务数据库，对 2008 年 1 月 1 日至 2010 年 12 月 31 日期间≥18 岁的 CP 成人患者进行了鉴定，并对其死亡情况进行了跟踪调查，直至 2019 年 12 月 31 日。根据从预防性护理中合理获益的常见临床时间长度，选择了1年、3年、5年和9年间隔的死亡率风险。性别分层分析评估了狭义年龄组（18-25/26-34/35-44/45-54/55-64/65-74/≥75 岁）和多病症组（惠特尼多病症指数评分 0-2/3/4-6/≥7）的风险估计值：在 24,767 名成年 CP 患者中，男性 12,962 人（平均 [SD] 年龄 = 48.3 [15.0] 岁），女性 11,805 人（年龄 = 49.7 [15.8] 岁）。很少有人失去随访。男性和女性的 1 年风险相似（3.4% 对 3.3%），但 9 年后男性的风险略高于女性（30.1% 对 28.0%）。正如预期的那样，死亡风险随着年龄的增长和 WCI 分数的提高而增加。结论：结论：按年龄、性别和多病状态报告了临床相关间隔的死亡风险估计值。这些信息可用于权衡基于预期死亡率估计值的筛查和治疗策略的危害与收益比。

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引用次数: 0

Racial-ethnic differences in the associations between functional disabilities and subsequent depression among community-dwelling midlife and older adults in the US 美国居住在社区的中老年人中功能性残疾与随后抑郁之间的种族和族裔差异。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.dhjo.2024.101709

Debasree Das Gupta PhD , Uma Kelekar PhD , Kallol Kumar Bhattacharyya PhD , Sidney Carl Turner PhD

Background

The intersection of race/ethnicity with disability is a critical dimension of mental health outcomes in later ages that remains under-investigated.

Objective

We examined the role of race-ethnicity in moderating the associations between functional disabilities and subsequent depression among Americans 51 and older and stratified into the two age-groups of midlife (51–64) and older adults (≥65).

Methods

Using a nationally representative sample of community-dwelling Americans (≥51; n = 7475) in the 2016–2018 Health and Retirement Study, we conducted bivariate and multivariable regression analyses. Racial-ethnic groups included non-Hispanic (NH) Black, Hispanic, and NH White and a binary (0/1) outcome defined subsequent depression in 2018. The total number of difficulties on the Nagi, Lawton, and Katz disability scales represented baseline (2016) functional disabilities with a secondary four-level (no/mild/severe with assistance/severe without assistance) disability indicator incorporated to examine the role of assistance with daily living.

Results

Across age-groups, subsequent depression was significantly more prevalent among NH Whites with functional disabilities compared to counterparts reporting no disabilities. Compared to NH Black and Hispanic counterparts, midlife NH Whites were three times more likely to report subsequent depression with each unit increase in the functional disability score, after adjusting for covariates. However, we observed no such racial-ethnic differences among older adults. Among the 51+ severe with no assistance group, adjusted odds of subsequent depression among NH Whites was 2.5 times higher than minority counterparts.

Conclusion

Health programs and environmental adaptations supporting functional care needs in later ages could be beneficial for improving mental health of adults with disabilities.

背景：种族/民族与残疾的交叉是晚年心理健康结果的一个关键维度，但对这一维度的研究仍然不足：我们研究了种族/民族在调节 51 岁及以上美国人中功能性残疾与后续抑郁之间的关联方面所起的作用，并对中年（51-64 岁）和老年人（≥65 岁）这两个年龄组进行了分层：我们利用 2016-2018 年健康与退休研究（Health and Retirement Study）中具有全国代表性的社区居住美国人样本（≥51 岁；n = 7475），进行了双变量和多变量回归分析。种族-族裔群体包括非西班牙裔（NH）黑人、西班牙裔和NH白人，二元（0/1）结果定义了2018年的后续抑郁症。纳吉（Nagi）、劳顿（Lawton）和卡茨（Katz）残疾量表上的困难总数代表了基线（2016年）功能性残疾，同时纳入了二级四级（无/轻度/有辅助严重/无辅助严重）残疾指标，以考察日常生活辅助的作用：在各个年龄组中，有功能性残疾的新罕布什尔州白人与没有残疾的白人相比，随后患抑郁症的比例明显更高。与新罕布什尔州黑人和拉美裔白人相比，在对共变量进行调整后，中年新罕布什尔州白人的功能性残疾得分每增加一个单位，其随后报告抑郁症的可能性就会增加三倍。然而，我们在老年人中没有观察到这种种族-族裔差异。在 51 岁以上严重无助组中，调整后的新罕布什尔州白人继发抑郁症的几率是少数民族的 2.5 倍：结论：支持晚年功能性护理需求的健康计划和环境调整可能有益于改善残疾成年人的心理健康。

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引用次数: 0

“I'm completely off base here on what this child is capable of”: A qualitative analysis of how medical ableism manifests in PICU clinicians' care of children with severe neurological impairment "我完全不了解这个孩子的能力"：对重症监护病房（PICU）临床医生在护理患有严重神经损伤的儿童时如何表现出医疗能力歧视的定性分析。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.dhjo.2024.101691

Ellie Oslin BA , Roberto E. Montenegro MD, PhD , Stephanie A. Kraft JD , Alisa Van Cleave MD , Jori Bogetz MD

Background

Children with severe neurological impairment (SNI) are at heightened risk of experiencing medical ableism from clinicians in the pediatric intensive care unit (PICU), where barriers such as time scarcity and heavy workloads limit clinicians’ ability to provide personalized care.

Objective

To examine medical ableism and strategies to support PICU clinicians in understanding the lives of children with SNI and their families.

Methods

This US-based, single-center, qualitative study included PICU clinicians identified by the parents/caregivers of a child with SNI. Semi-structured 1:1 60-min interviews about the challenges of caring for children with SNI were conducted virtually. Coded data were extracted, thematically analyzed, and further conceptualized using the Dual Process Theory (DPT) bias reduction framework.

Results

Nineteen PICU clinicians participated. Three major themes emerged: 1) assumptions and misconceptions about children with SNI and their families, 2) barriers to providing personalized care, and 3) clinician-suggested strategies to honor the lives of children with SNI. These themes aligned with the DPT framework. As outlined in the DPT, system 1 “fast thinking” errors occur when quick observations inform decisions (e.g., snap judgments about a child's capabilities). Second, barriers (e.g., insufficient time for meaningful interactions) may prevent clinicians from providing unbiased care. Third, system 2 “slow thinking,” where complex decision-making occurs, and can be enhanced through personalization strategies (e.g., viewing visuals of the child at baseline health).

Conclusions

Increasing clinician awareness of their potential implicit biases and utilizing bias reduction strategies to mitigate medical ableism in care are critical areas for future research.

背景：在儿科重症监护病房（PICU）中，严重神经损伤（SNI）患儿遭受临床医生医疗能力歧视的风险很高，因为时间紧、工作量大等障碍限制了临床医生提供个性化护理的能力：目的：研究医疗能动性和策略，以支持 PICU 临床医生了解 SNI 患儿及其家人的生活：这项定性研究以美国为基地，由患有自闭症儿童的父母/监护人确认的 PICU 临床医生参与。研究人员通过虚拟方式进行了 1:1 60 分钟的半结构化访谈，探讨了护理 SNI 患儿所面临的挑战。对编码数据进行提取、主题分析，并使用双重过程理论（DPT）减少偏差框架进一步概念化：结果：19 名 PICU 临床医生参加了此次活动。结果：19 名 PICU 临床医生参加了此次活动，他们提出了三大主题：1）对 SNI 患儿及其家庭的假设和误解；2）提供个性化护理的障碍；3）临床医生建议的尊重 SNI 患儿生活的策略。这些主题与 DPT 框架相一致。如 DPT 所述，系统 1 "快速思考 "错误发生在快速观察做出决定时（例如，对儿童能力的快速判断）。其次，障碍（如没有足够的时间进行有意义的互动）可能会阻碍临床医生提供无偏见的护理。第三，系统 2 的 "慢速思维 "会导致复杂的决策，可以通过个性化策略（例如，查看儿童基线健康状况的视觉效果）来提高决策效率：结论：提高临床医生对其潜在隐性偏见的认识，并利用减少偏见的策略来减轻医疗护理中的医疗能动主义，是未来研究的关键领域。

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引用次数: 0

Peer mentor contributions to an early intervention vocational rehabilitation specialist service following trauma: A qualitative study 同伴导师对创伤后早期干预职业康复专家服务的贡献：定性研究。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.dhjo.2024.101680

L. Barclay PhD, MOT, BAppSci(OT) , G. Hilton PhD, MPH, BOT , E. Fossey PhD, MSc, DipCOT , J. Ponsford PhD , M. Downing PhD, BBSc(Hons) , P. Analytis PhD , P. Ross PhD, BAppSci(OT)

Background

Peer mentors have a role in facilitating the participation, health and well-being of people who have had a traumatic injury. Few studies have explored the involvement of peer mentors in an early intervention vocational rehabilitation (EIVR) service following trauma.

Objective

This study aimed to explore the experience of implementing peer support within the context of an EIVR service from the perspectives of the peer mentors themselves, the vocational therapists supervising them, and the patients that received peer mentoring.

Methods

Semi-structured interviews were conducted with twenty participants from three groups: peer mentors (n = 4); vocational therapists (n = 3); and patients who received the EIVR intervention (n = 24). Data were thematically analysed.

Results

Three themes were identified: The value of peer input in an EIVR service, The facilitators impacting the value of peer involvement as part of the EIVR service, The challenges impacting peer input as part of an EIVR service.

Conclusions

The inclusion of peer mentors early after major traumatic injury was a unique and valuable addition to the EIVR service. Offering peer support early on in rehabilitation enabled patients to gain a sense of hope for their future, and the expectation that returning to work was a realistic option. The careful selection of peer mentors, and ensuring they receive adequate preparation and ongoing supervision are vital to support their well-being during the intervention. Aiming to match peer mentors with similar injuries and work backgrounds to patients is an important contributor to the likely ongoing engagement of the mentee with the mentor.

背景：同伴辅导员在促进创伤患者的参与、健康和幸福方面发挥着作用。很少有研究探讨了同伴指导者参与创伤后早期干预职业康复（EIVR）服务的情况：本研究旨在从同伴指导者、指导他们的职业治疗师以及接受同伴指导的患者的角度，探讨在早期干预职业康复服务中实施同伴支持的经验：对以下三组 20 名参与者进行了半结构式访谈：同伴指导者（4 人）、职业治疗师（3 人）和接受 EIVR 干预的患者（24 人）。对数据进行了主题分析：结果：确定了三个主题：结果：确定了三个主题：EIVR 服务中同伴参与的价值、影响 EIVR 服务中同伴参与价值的促进因素、影响 EIVR 服务中同伴参与的挑战：结论：在重大创伤后早期纳入同伴指导是对 EIVR 服务的独特而有价值的补充。在康复早期提供同伴支持使患者对未来充满希望，并期望重返工作岗位是一个现实的选择。精心挑选同伴指导者，并确保他们做好充分准备和接受持续监督，这对支持他们在干预期间的身心健康至关重要。将具有与患者相似伤情和工作背景的同伴指导者与患者相匹配，这对被指导者与指导者之间的持续互动非常重要。

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引用次数: 0

Reviewer appreciation - 2024

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.dhjo.2024.101724

引用次数: 0

Understanding disability benefits decision-making among adults with self-reported work disabilities: A qualitative study 了解自述有工作残疾的成年人的残疾福利决策：定性研究。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.dhjo.2024.101681

Lila Rabinovich M.Phil (Social Science Researcher), Doerte Junghaenel Ph.D. (Associate Professor), Tabasa Ozawa M.P.H. (Project Specialist)

Background

Take-up gaps in safety net programs, long documented in the US, are an important policy problem as non-take up compromises the equity objectives and efficacy of programs. The Social Security Disability program is an example of this: more than 20 million adults report a work disability, but only around 11 million currently receive disability benefits through the Social Security Disability Insurance or Supplemental Security Income programs.

Objectives

We examine decision-making around benefits application among adults with self-reported work disability who have never applied for disability benefits.

Methods

We conducted 39 interviews with work-disabled adults who have never applied for disability benefits. Thematic analysis identified key barriers and inhibitors to disability application.

Results

High transaction costs involved in disability applications coupled with the widespread perception of low approval rates was mentioned as a critical deterrent. Uncertain and lengthy medical processes after disability onset were also frequently reported as a key deterrent. Stigma about receiving disability benefits did not emerge as a factor in application behavior, although a change in self-concept involving an adjustment to benefit-receiving, work-disabled status was cited as a barrier to claiming.

Conclusion

Our results broadly align with those of other research that examined the information, transaction, and social costs of applying for benefits. Nevertheless, the qualitative data afford a more in-depth, grounded understanding of the primary factors affecting application decisions, and how those interact. These insights are important to inform targets for interventions to reduce barriers to take-up of benefits among potentially eligible adults with disabilities.

背景：在美国，安全网计划的领取差距是一个长期存在的重要政策问题，因为不领取会损害计划的公平目标和效率。社会保障残疾计划就是一个很好的例子：2000 多万成年人报告有工作残疾，但目前只有约 1100 万人通过社会保障残疾保险或补充保障收入计划领取残疾津贴：我们研究了自我报告有工作残疾但从未申请过残疾津贴的成年人在申请津贴时的决策情况：我们对从未申请过残疾津贴的工作残疾成年人进行了 39 次访谈。主题分析确定了残疾申请的主要障碍和抑制因素：申请残障福利所涉及的高昂交易成本以及普遍认为的低批准率是阻碍申请的关键因素。残疾发生后不确定和冗长的医疗程序也经常被报告为主要阻碍因素。领取伤残津贴的耻辱感并没有成为影响申请行为的一个因素，但自我概念的改变，包括调整到领取津贴、工作残疾的状态，被认为是申请的一个障碍：我们的研究结果与其他研究结果基本一致，这些研究考察了申请福利的信息成本、交易成本和社会成本。然而，定性数据使我们对影响申请决定的主要因素以及这些因素之间的相互作用有了更深入、更全面的了解。这些见解对于确定干预目标，减少可能符合条件的成年残疾人领取福利的障碍非常重要。

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引用次数: 0

Perinatal mental health and risk of severe maternal morbidity in women with physical disabilities, Massachusetts 2003-2015. 2003-2015年马萨诸塞州身体残疾妇女围产期心理健康和严重孕产妇发病率风险。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.dhjo.2024.101772

Anne Valentine, Ilhom Akobirshoev, Jiangying Zhang, Tiffany A Moore Simas, Monika Mitra

Background: Perinatal mental health and substance use disorders contribute to adverse maternal outcomes. Women with disabilities experience increased risk for severe maternal morbidity (SMM). No studies have examined the association between perinatal mental health and SMM risk in women with physical disabilities.

Objective: To examine the association between perinatal mental health and substance use disorders and SMM risk in women with physical disabilities.

Methods: We analyzed delivery hospitalizations from 2003 to 2015 from the Massachusetts Pregnancy to Early Life Longitudinal (PELL) data system. We identified physical disability using International Classification of Diseases, Ninth Revision codes. Perinatal mental health status was based on the presence of at least one emergency department visit, observational, or in-patient stay attributed to a mental health or substance use disorder anytime from gestation to delivery. We used modified Poisson regressions to obtain risk ratios (RR) for SMM in women with either a physical disability or no disability by perinatal mental health status. Non-disabled women with no perinatal mental health or substance use disorder visit served as the referent group.

Results: Deliveries in women with no physical disability and a perinatal mental health visit were not associated with risk of SMM. Compared to the referent group, women with a physical disability and a perinatal mental health or substance use disorder visit had greater risk of both SMM (RR = 1.84, 95 % CI:1.32-2.56), and nontransfusion SMM (RR = 2.35 1.52, 3.64), after adjusting for demographic and socioeconomic characteristics.

Conclusions: Increased attention should be paid to perinatal mental health status in women with physical disabilities.

背景：围产期心理健康和物质使用障碍会导致不良的产妇结局。残疾妇女患严重产妇疾病（SMM）的风险增加。没有研究调查围产期心理健康与身体残疾妇女患SMM风险之间的关系。目的：探讨身体残疾妇女围生期心理健康与物质使用障碍和SMM风险的关系。方法：我们分析2003年至2015年马萨诸塞州妊娠至早期生命纵向（PELL）数据系统的分娩住院情况。我们使用国际疾病分类第九次修订代码确定身体残疾。围产期精神健康状况是基于从妊娠到分娩的任何时间因精神健康或物质使用障碍至少一次急诊就诊、观察或住院。我们使用修正泊松回归来获得围生期心理健康状况下有身体残疾或无残疾的女性发生SMM的风险比（RR）。没有围产期精神健康或物质使用障碍就诊的非残疾妇女作为参照组。结果：没有身体残疾的妇女分娩和围产期心理健康检查与SMM的风险无关。与参照组相比，在调整人口统计学和社会经济特征后，身体残疾和围产期精神健康或物质使用障碍就诊的妇女发生SMM （RR = 1.84, 95% CI:1.32-2.56）和非输血SMM （RR = 2.35 1.52, 3.64）的风险更高。结论：应重视身体残疾妇女的围生期心理健康状况。

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引用次数: 0

Adverse childhood experiences in adults with chronic traumatic brain injury: Support for a life course approach to brain injury rehabilitation 慢性脑外伤成人的不良童年经历：支持脑损伤康复的生命过程方法。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.dhjo.2024.101714

Umesh M. Venkatesan PhD , Shannon B. Juengst PhD

Background

Adverse childhood experiences (ACEs) confer greater risk for adult traumatic brain injury (TBI), but little is known about their effects on post-injury outcomes.

Objective

To determine the prevalence and correlates of conventionally defined ACEs (occurring within household/in private; e.g., physical abuse) and community-level ACEs (e.g., bullying) after TBI.

Methods

Participants were 85 Philadelphia-area TBI Model System participants with chronic (>1 year post-injury) TBI. We examined cross-sectional associations between total conventional and community ACEs reported (out of 21) before age 18, mental health symptoms, and health-related quality of life (HRQoL), as well as relationships between ACEs and neighborhood deprivation (census-derived neighborhood socioeconomic status).

Results

The median number of total ACEs was 3 (range: 0–17). Emotional abuse, physical abuse, and alcohol abuse in the household were the most common conventional ACEs (each at 36.5 %). Witnessing violence (45 %) was the most common community ACE. Black individuals (n = 32) reported more community ACEs (p < .001) than White individuals (n = 45). Community ACEs were significantly associated with greater neighborhood deprivation, though this relationship was confounded by race. Total ACEs was significantly related to more severe mental health symptoms (p < .001) and poorer HRQoL (p = .005), even after covariate adjustment. A fully-adjusted path model supported mental health as a mediator between total ACEs and HRQoL.

Conclusions

Results of this preliminary study reveal an appreciable prevalence and potential far-reaching consequences of conventional and community ACEs among those with chronic TBI. The results underscore the value of trauma-informed and life course approaches to research and clinical care in TBI.

背景：童年不良经历（ACEs）会增加成人创伤性脑损伤（TBI）的风险，但人们对其对伤后结果的影响知之甚少：目标：确定创伤性脑损伤后传统定义的 ACE（发生在家庭/私人内部；如身体虐待）和社区层面的 ACE（如欺凌）的发生率和相关性：参与者为费城地区 TBI 模型系统的 85 名慢性（受伤后 1 年以上）TBI 患者。我们研究了 18 岁前报告的常规和社区 ACE（共 21 项）总数、心理健康症状和健康相关生活质量（HRQoL）之间的横截面关联，以及 ACE 与邻里贫困（人口普查得出的邻里社会经济状况）之间的关系：ACE总数的中位数为3（范围：0-17）。家庭中最常见的传统 ACE 是情感虐待、身体虐待和酗酒（各占 36.5%）。目睹暴力（45%）是最常见的社区 ACE。黑人（n = 32）报告了更多的社区 ACE（p 结论：黑人报告的社区 ACE 更多：这项初步研究的结果显示，在慢性创伤性脑损伤患者中，传统和社区 ACE 的发生率相当高，并可能产生深远的影响。这些结果凸显了创伤知情和生命历程方法在创伤性脑损伤研究和临床治疗中的价值。

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引用次数: 0

The language of inclusion: A randomized trial of how DEI statements influence hiring practices for people with visible and invisible disabilities 包容的语言：一项随机试验，研究 DEI 声明如何影响有形和无形残疾人士的招聘实践。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.dhjo.2024.101717

Mason Ameri Ph.D., Terri R. Kurtzberg Ph.D.

Background

Companies are increasingly motivated to ensure that they are effective at hiring people with disabilities, but bias in the process remains a challenge. While Diversity, Equity, and Inclusion (DEI) statements are generally crafted as external-facing signaling devices, little is known about their potential effect on the employees themselves with regard to internal decisions, such as hiring.

Objective

This study aims to explore whether various DEI statements may encourage more positive hiring decisions for job candidates with both visible and invisible disabilities.

Methods

An experiment with a 2 × 4 × 2 design was used (DEI Language: legal/traditional or heartfelt; Disability Type: none, visible, and two types of invisible disabilities; Candidate's Tone: warm or overconfident). Quantitative and qualitative items measured general reactions to the candidate as well as perceptions about his employability, degree of risk as a new hire, skills at negotiating for his salary, and integrity. Statistical tests include analyses of variance and z-tests for proportions.

Results

Heartfelt statements improved ratings of candidates with disabilities in general, and more so for those with invisible disabilities. In addition, the two types of invisible disability were distinct from each other, with the mental health disability more stigmatized than the neurological one.

Conclusions

These results suggest that the DEI language that a company uses is an important signaling device not just for external constituents but also for internal employees. In addition, it is among the first to demonstrate differences in types of invisible disabilities, indicating that more nuance is needed to understand bias in this context.

背景：公司越来越有动力确保有效聘用残障人士，但这一过程中的偏见仍是一个挑战。虽然多元化、公平与包容（DEI）声明通常是作为面向外部的信号装置而制定的，但人们对其在内部决策（如招聘）方面对员工本身的潜在影响却知之甚少：本研究旨在探讨各种公平与平等（DEI）声明是否会鼓励有可见和不可见残疾的求职者做出更积极的招聘决定：方法：采用 2 × 4 × 2 设计进行实验（残疾人就业指数语言：合法/传统或发自内心；残疾类型：无残疾、可见残疾和两种隐形残疾；求职者语气：热情或过度自信）。定量和定性项目测量的是对候选人的一般反应，以及对其就业能力、作为新员工的风险程度、薪酬谈判技巧和诚信度的看法。统计检验包括方差分析和比例 Z 检验：真心话普遍提高了残疾应聘者的评分，隐形残疾应聘者的评分则更高。此外，两种类型的隐形残疾彼此不同，心理健康残疾比神经残疾更受鄙视：这些结果表明，公司所使用的 DEI 语言是一种重要的信号装置，不仅对于外部选民，对于内部员工也是如此。此外，这也是首次证明隐形残疾类型的差异，表明要了解这方面的偏见还需要更多的细微差别。

{"title":"The language of inclusion: A randomized trial of how DEI statements influence hiring practices for people with visible and invisible disabilities","authors":"Mason Ameri Ph.D., Terri R. Kurtzberg Ph.D.","doi":"10.1016/j.dhjo.2024.101717","DOIUrl":"10.1016/j.dhjo.2024.101717","url":null,"abstract":"<div><h3>Background</h3><div>Companies are increasingly motivated to ensure that they are effective at hiring people with disabilities, but bias in the process remains a challenge. While Diversity, Equity, and Inclusion (DEI) statements are generally crafted as external-facing signaling devices, little is known about their potential effect on the employees themselves with regard to internal decisions, such as hiring.</div></div><div><h3>Objective</h3><div>This study aims to explore whether various DEI statements may encourage more positive hiring decisions for job candidates with both visible and invisible disabilities.</div></div><div><h3>Methods</h3><div>An experiment with a 2 × 4 × 2 design was used (<em>DEI Language</em>: legal/traditional or heartfelt; <em>Disability Type</em>: none, visible, and two types of invisible disabilities; <em>Candidate's Tone</em>: warm or overconfident). Quantitative and qualitative items measured general reactions to the candidate as well as perceptions about his employability, degree of risk as a new hire, skills at negotiating for his salary, and integrity. Statistical tests include analyses of variance and z-tests for proportions.</div></div><div><h3>Results</h3><div>Heartfelt statements improved ratings of candidates with disabilities in general, and more so for those with invisible disabilities. In addition, the two types of invisible disability were distinct from each other, with the mental health disability more stigmatized than the neurological one.</div></div><div><h3>Conclusions</h3><div>These results suggest that the DEI language that a company uses is an important signaling device not just for external constituents but also for internal employees. In addition, it is among the first to demonstrate differences in types of invisible disabilities, indicating that more nuance is needed to understand bias in this context.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"18 1","pages":"Article 101717"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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