Disability and Health Journal最新文献

Background: Adolescents with intellectual and developmental disabilities (IDD) often demonstrate lower physical fitness than their typically developing (TD) peers. Physical fitness is influenced by factors such as body size, physical activity, ethnicity, and environmental conditions; however, large-scale studies in Asian populations remain limited.

Objective: This study aimed to assess physical fitness in Japanese adolescents with IDD, accounting for height, weight, and physical activity levels.

Methods: Data were obtained from Japan's 2023 National Survey on Physical Fitness, Athletic Ability, and Exercise Habits. Participants included 2,216 adolescents with IDD attending special support schools and 921,297 TD students. Variables included height, weight, total weekly physical activity time, and eight physical fitness tests: handgrip strength, sit-ups, sit-and-reach test, repetitive side jump, 20-m shuttle run, 50-m run, standing long jump, and handball throw. After propensity score matching by sex, Mann-Whitney U tests and ordinal logistic regression analyses were performed.

Results: After adjusting for height, weight, and physical activity level, adolescents with IDD showed consistently lower performance across all test items than their TD peers, regardless of sex (effect sizes r = 0.35-0.74). Longer total weekly physical activity time was positively associated with better comprehensive evaluations. The IDD group had approximately twice the prevalence of obesity and significantly less weekly physical activity time.

Conclusions: Japanese adolescents with IDD demonstrate lower physical fitness, higher obesity rates, and reduced physical activity than TD peers. Targeted interventions, including increased physical activity, are needed to improve health and functional outcomes in this population.

Background: Obesity disproportionately affects children with disabilities as compared to their nondisabled peers. This is particularly concerning due to challenges with ambulation, transfer, and reliance on caregivers. The degree to which obesity in children with spina bifida (SB) impacts ambulatory status is unknown. The purpose of this study was to determine factors associated with a decline in ambulatory status among children and young adults living with SB.

Methods: The National Spina Bifida Patient Registry was used to identify patients at least 5 years of age, who were community ambulators and experienced a decline in ambulation at subsequent visits following enrollment into the registry. A Cox regression model was run to test the association between the time to decline in ambulation and change in BMI with BMI used as a time-varying covariate. Additional variables included were age at enrollment, patient demographics, functional level of lesion (FLOL), diagnosis, and surgical history.

Results: 353 of 3032 (11.6 %) patients who were originally identified as community ambulators experienced a decline in ambulation. Median follow up was 3.0 years (inter-quartile range 1.7,4.8). Increase in BMI was significantly associated with decline in ambulation (HR 1.03, 95 % CI 1.01-1.04, p = 0.002) as well as more proximal level of lesion (p < 0.001), myelomeningocele diagnosis (p = 0.001), greater number of surgeries (p = 0.0013), and older age at enrollment (p = 0.0038).

Conclusion: A small percentage of individuals with SB experienced a decline from community ambulation status during the period observed. There are identifiable and potentially modifiable risk factors associated with this loss, including increased BMI.

Background: There is emerging evidence that people with disabilities are at a higher risk of suicide than those without disabilities. However, variations in suicide risk among individuals with disabilities are not well understood.

Objective: This study was performed to explore trends in suicide mortality between people with and without disabilities through a serial cross-sectional analysis.

Methods: We analysed data covering the entire population of South Korea over a 12-year period from 2006 to 2017. Suicide mortality risks were assessed yearly according to the presence, severity, and type of disability, with analyses stratified by sex. Multivariate logistic regression was used to calculate odds ratios for suicide, adjusting for sociodemographic and clinical factors.

Results: Throughout the study period, suicide risks remained approximately twice as high among individuals with than without disabilities. While suicide risks among non-disabled individuals continued to decrease, there has been a rise in suicide risks among those with mild disabilities since 2015. Among the five types of disabilities, the highest suicide risks were observed in individuals with developmental or psychological disabilities and those with major internal disorders. Adjusting for sociodemographic characteristics and mental health factors substantially reduced the odds ratios for suicide risk among individuals with disabilities.

Conclusion: Addressing suicide as an extreme manifestation of social disadvantage faced by individuals with disabilities requires a multifaceted approach beyond individual healthcare. Public health efforts should integrate suicide prevention for people with disabilities into the broader healthcare agenda, addressing factors at the individual, family, community, and societal levels.

Background: As neurodevelopmental disabilities emerge in early childhood, reporting them as the underlying cause of death in mortality statistics effectively establishes the cause of death at birth. This hampers efforts to address causes of premature mortality and improve life expectancy for this population.

Objective: To quantify the reporting of neurodevelopmental disabilities as the underlying cause of death in Australian data and determine whether it is due to death certification practices or statistical coding rules.

Methods: Our observational study analysed Australian death data (2007-2022). We identified ICD-10 codes for neurodevelopmental disabilities and determined whether these were documented on death certificates as a direct or contributing cause and whether, following statistical coding, they were reported as an underlying or associated cause of death.

Results: ICD-10 codes for neurodevelopmental disabilities were present in 9878 deaths. For 40% of these, neurodevelopmental disability was reported as the underlying cause. This varied by disability type - from 8% for intellectual disability to 61% for Down syndrome. We found this was not always due to certifier practices. For 29% of deaths with a neurodevelopmental disability reported as the underlying cause, the corresponding condition was correctly recorded by the certifying practitioner as a contributing cause.

Conclusions: Neurodevelopmental disabilities are being reported as the underlying cause of death in Australian mortality statistics, due to both medical practitioners' assessments and statistical coding. To ensure mortality statistics better inform efforts to reduce premature mortality in people with neurodevelopmental disabilities, both education for certifying practitioners and a change to statistical coding rules are required.

Background: People with traumatic brain injury (TBI) experience poor long-term health and participation outcomes, and current rehabilitation approaches fail to robustly improve these outcomes. An intervention aimed at enhancing social support may be an effective approach to promoting greater participation and improving long-term health outcomes among people with TBI.

Objective: We conducted a Delphi study involving a series of iterative consensus-building surveys to finalize a set of intervention elements likely to yield a sustainable and effective support relationship that aligned with the values of people with lived experience of brain injury and was likely to be feasible for implementation in community settings.

Methods: We enrolled participants with TBI (n = 4), their family members (n = 3), TBI rehabilitation providers (n = 4), and TBI rehabilitation researchers (n = 4), who each completed three iterative surveys.

Results: Through this Delphi study, we selected four essential intervention elements (communication strategies, shared goals and activities, reciprocal psychosocial support, and problem-solving), and one active, but non-essential element (intermittent peer mentorship) to be included in future intervention development studies.

Conclusions: Despite varied perspectives on the value of peer mentorship, we were able to finalize a set of intervention elements by adjusting the focus and model of peer mentorship to fit the values and priorities of participants. Future research is needed to refine and test this approach with people with TBI and their family members to optimize acceptability and feasibility.

Background: Disability is typically measured in surveys using functional limitation questions rather than asking respondents to self-identify as having a disability. Little is known about the characteristics of those who self-identify with a disability and how they compare with those identified via functional limitation questions.

Objective: To compare the prevalence and characteristics of people with disabilities measured by both functional and self-identification measures, and to assess the overlap between these populations.

Methods: Using nationally representative survey data from 2023, we conduct bivariate comparisons of demographic, health, functional characteristics and financial needs between populations captured by self-identification question, the Washington Group Short Set on Functioning (WG-SS) and the American Community Survey Six (ACS-6) Questions. We estimate a multivariable regression to explore predictors of self-identification.

Results: Adding a self-identification question doubles the population with disabilities relative to measuring disability with the WG-SS alone, and increases the population by 30 % relative to the ACS-6 alone. People who self identify are less likely to be female or Hispanic/Latinx, are in worse physical health and more likely to be LGBTQIA + compared to those identified only by functional measures. The group identified by both the self-identification and either functioning question set are in the worst health and are more likely to participate in disability programs.

Conclusion: Including a self-identification question in addition to functioning questions expands the prevalence of disability to varying degrees depending on which functional questions are used, but use of functioning and self-identification questions together enhances identification of the subgroup with highest needs.

Background: People with disabilities disproportionately use cannabis compared to those without a disability; however, little is known about reasons for use among people with disabilities.

Objective: The purpose of this study was to assess the prevalence and reasons for cannabis use among people with disabilities.

Methods: Data from Wave 5 (2023-2024) of the National Survey on Health and Disability (n = 1919), a national online survey of adults aged 18+ who self-identify as living with a disability, were used to estimate the prevalence and reasons for cannabis use among those with any disability and six self-reported limitations (cognitive, hearing, independent living, mobility, self-care, vision). Open-ended responses were analyzed using an inductive content analysis to create themes.

Results: The prevalence of current cannabis use among survey respondents was 21.9 % and people with cognitive disabilities reported the highest proportion (28.7 %). The most prevalent common reasons for current cannabis use across all domains were to help with pain (71.9 %) and to relax or relieve tension (60.2 %). Analysis of open-ended responses for cannabis use reasons yielded three main themes: medicinal reasons, contextual reasons, and primarily as sensory moderator. Specific medical reasons for using cannabis included assistance with health-related conditions such as migraines, nausea, muscle spasms, seizures, mental health concerns, and sleep disturbances.

Conclusions: Cannabis use is prevalent across disability domains and the majority of respondents note they use cannabis to help with pain and to relax or relieve tension. Findings highlight the need to monitor cannabis use for pain relief among this population.

Background: Caring for children with disabilities can impose additional burdens that negatively affect caregivers' physical health. Although this issue has been widely studied, findings remain inconsistent.

Objective: This study aimed to examine differences in physical health between caregivers of children with and without disabilities through a systematic review and meta-analysis. A secondary aim was to explore whether specific factors moderated these differences.

Methods: A systematic search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the narrative synthesis, physical health differences between groups were manually compared. For the meta-analysis, outcomes were categorized as either Likert scale scores or odds ratios. Hedges' g was calculated for Likert-scale studies, while pooled odds ratios were computed for studies reporting odds ratios. Moderator variables included disability type, measurement type, parental age, and type of physical health outcome.

Results: Twenty-eight studies were included, yielding 36 independent groups. Of these, 30 reported significantly poorer physical health among caregivers of children with disabilities. A random-effects model (n = 9, k = 12) revealed a significant pooled effect size (g = -.38, p = .003, 95 % CI [-.63, -.13]). Another model (n = 8, k = 11) showed a significant pooled odds ratio (OR = 1.30, 95 % CI [1.05, 1.60], p < .001). Type of physical health significantly moderated the association, with musculoskeletal outcomes showing stronger effects (Q(1) = 3.61, p = .04).

Conclusions: Caregivers of children with disabilities consistently exhibit poorer physical health. Future research should identify mechanisms contributing to this disparity.