Disability and Health Journal最新文献

Background: Women with disabilities encounter unique social and structural barriers that hinder their access to quality reproductive healthcare, particularly in rural settings. These barriers are often exacerbated by societal stigma, discrimination, and inadequate disability-inclusive services.

Objective: The objective of this qualitative study is to explore the reproductive experiences of women with disabilities in rural Türkiye, focusing on the pregnancy, childbirth, and postpartum periods. The study aims to identify the social and systemic barriers these women face in accessing and navigating maternal health services in these settings.

Methods: This qualitative research was conducted in a rural district in southern Türkiye between May and July 2024. Semi-structured, in-depth interviews were carried out with 19 women aged 18-49 with various types of disabilities. Data were analyzed using thematic analysis techniques.

Results: Four central themes emerged from the participants' narratives: (1) experiences of social judgment and emotional distress during pregnancy, (2) contrasting birth experiences influenced by the presence or absence of inclusive care, (3) mixed experiences of support during the postpartum period, and (4) identified expectations and encountered social barriers in motherhood. Many participants reported encountering significant stigma, prejudice, and emotional mistreatment from family, community, and healthcare providers. Conversely, the presence of supportive, disability-aware midwives played a vital role in positive maternal experiences, promoting resilience among participants.

Conclusion: The reproductive journeys of disabled women in rural communities are significantly impacted by stigma and systemic inadequacies. Enhancing disability-focused education for healthcare providers, improving postpartum support systems, and addressing social stigma through public education are crucial steps toward achieving reproductive equity.

Background: Affordable housing provides a critical foundation for children's health. Yet little is known about how households of children with disabilities engage in federal rental assistance programs.

Objective: This study examines the rates of participation in HUD rental assistance programs among households of children with disabilities in 2023 and assesses the odds of these households residing in specific HUD rental assistance programs.

Methods: This paper engages a population level cross-sectional analysis of HUD-assisted households using HUD household and member data files. The sample included all households receiving HUD rental assistance in 2023 that were led by an adult between the ages 18-61 and included at least one child (n = 1,558,711). Participation in HUD rental assistance programs was quantified and characterized through descriptive statistics and multinomial logistic regression.

Results: Eight percent (n = 134,628; 1 in 12) of HUD-assisted households with children included at least one child with a disability. Compared to HUD-assisted households with a child without a disability, HUD-assisted households with a child with a disability had higher odds of participating in a Housing Choice Voucher Program than in Multifamily Housing by a factor of 2.6 and higher odds of participating in Public Housing than Multifamily Housing by a factor of 2.2.

Conclusions: HUD rental assistance programs serve a substantial share of households with children with disabilities, with notable variation in participation by program type. This study provides the most comprehensive national estimates to date of HUD participation among households with children with disabilities, offering a critical foundation for future research.

Background: Limited evidence exists on the sexual health of individuals with severe visual impairment.

Objective: To assess a broad range of sexual health indicators among 15-89-year-old Danes with severe visual impairment.

Methods: Baseline data were sourced from a nationally representative cohort study on sexual health in the Danish population. Participants reporting (N = 631) and not reporting (N = 60,482) severe visual impairment were compared. Binary and polytomous logistic regression analyses provided demographically weighted, confounder-adjusted odds ratios (aORs) with 95 % confidence intervals (CIs) for associations between visual impairment and sexual health outcomes.

Results: Several disparities emerged. Men with visual impairment were less likely to be sexually experienced (aOR: 0.52; CI: 0.30-0.91), to have been sexually active in the past year (aOR: 0.72; CI: 0.51-0.99), to rate their current sex life as good/very good (aOR: 0.74; CI: 0.55-0.99), and to have masturbated in the past year (aOR: 0.74; CI: 0.55-0.99). They were more likely to have had unsafe sex in the past year (aOR: 1.61; CI: 1.13-2.31) and to have experienced sexual assault (aOR: 2.34; CI: 1.17-4.72). Women with visual impairment were more likely to report sexual victimization (aOR: 1.73; CI: 1.23-2.44), same-sex sexual experiences (aOR: 1.83; CI: 1.25-2.68), and identifying as non-heterosexual (aOR: 1.79; CI: 1.24-2.58).

Conclusions: The study underscores significant sexual health challenges among individuals with severe visual impairment, notably victimization (both genders) and unsafe sex (men). Additionally, higher rates of same-sex sexual experiences and non-heterosexual identities were observed among visually impaired women.

Background: People with disabilities experience substantial disparities in perinatal health and outcomes that may be impacted by inequities in health care.

Objective: This study assesses how receipt and content of perinatal care varies by extent of disability.

Method: We analyzed 2019-2021 PRAMS data from 22 sites that included the Washington Group Short Set of Questions (n = 43,567). We examined association of extent of disability (none, some, a lot) with pre-pregnancy, prenatal, and postpartum health care using multivariable Poisson regression to calculate state-adjusted prevalence ratios (PRs) and sociodemographic-adjusted prevalence ratios (aPRs). Among individuals who received each care type, we calculated PRs and aPRs for content of care, including topics pertaining to maternal health, pregnancy prevention, and preparing for a healthy pregnancy.

Results: Compared to those with no difficulty, respondents with some difficulty were less likely to receive pre-pregnancy care from an OB/GYN (PR = 0.93; 95 %CI 0.6, 0.98) or a postpartum checkup (PR = 0.98; 95 %CI 0.98, 0.99); respondents with a lot of difficulty were less likely to receive pre-pregnancy care from an OB/GYN (PR = 0.86; 95 %CI 0.74, 1.00), adequate prenatal care (PR = 0.92; 95 %CI 0.90, 0.95), or a postpartum checkup (PR = 0.94; 95 %CI 0.90, 0.95). Respondents with any level of difficulty were at least as likely as those with no difficulty to receive education on maternal health topics and pregnancy prevention but less likely to receive care addressing desire for children or preparing for a healthy pregnancy.

Conclusions: Disabled women, particularly those with a lot of difficulty, receive differential perinatal health care. Our findings highlight the need for comprehensive and equitable care.

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.