Disability and Health Journal最新文献_第6页

Intersecting Inequalities: Non-Partner violence against poor women with disabilities in Egypt 交叉不平等：非伴侣暴力侵害埃及贫穷残疾妇女。

IF 3.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-08-05 DOI: 10.1016/j.dhjo.2025.101935

Amr Abdelwahed , Xindong Zhao , Daad Fouad , Ebrahim Amer , Maha Abo Gendia

Background

Non-partner violence (NPV) against women with disabilities remains underexamined, particularly in resource-limited settings like Egypt. Intersecting vulnerabilities—gender, disability, and poverty—amplify risks. Structural inequalities and social marginalization further heighten violence, limit access to support systems, and exacerbate the vulnerabilities of women with disabilities, creating significant gaps in intervention and support.

Objective

This study investigates the prevalence and determinants of NPV among poor women with disabilities in Egypt, with a focus on how sociodemographic and disability-related factors shape risk.

Methods

Using data from the 2020 Violence Against Women With Disability Survey, this cross-sectional study analyzes 5616 women with physical, hearing, visual, or multiple disabilities. Descriptive statistics and logistic regression models were employed to examine lifetime and past-year experiences of NPV and associated characteristics.

Results

Nearly half (47.8 %) of women reported experiencing NPV since age 15, and 25.3 % experienced it in the past year. Higher risk was observed among younger women, unmarried, those living in Upper Egypt, those with early-onset or multiple disabilities, and those with lower educational attainment. Notably, employed women faced increased odds of NPV, possibly reflecting exposure in public or workplace settings.

Conclusions

The findings emphasize the urgent need for disability-sensitive interventions that address structural inequality, stigma, and social exclusion. Interventions should prioritize inclusive legal protections, caregiver oversight, and access to accessible services, especially in underserved and rural regions. Targeted policies are essential to ensure safety, dignity, and justice for women with disabilities in Egypt.

背景：针对残疾妇女的非伴侣暴力（NPV）仍未得到充分研究，特别是在埃及等资源有限的环境中。相互交织的脆弱性——性别、残疾和贫困——放大了风险。结构性不平等和社会边缘化进一步加剧了暴力，限制了获得支持系统的机会，并加剧了残疾妇女的脆弱性，在干预和支持方面造成了巨大差距。目的：本研究调查了埃及贫困残疾妇女NPV的患病率和决定因素，重点关注社会人口统计学和残疾相关因素如何影响风险。方法：利用2020年暴力侵害残疾妇女调查的数据，本横断面研究分析了5616名身体、听力、视觉或多重残疾的妇女。采用描述性统计和逻辑回归模型来检验终生和过去一年的NPV经历及其相关特征。结果：近一半（47.8%）的女性报告自15岁以来经历过NPV， 25.3%的女性在过去一年中经历过。在年轻女性、未婚女性、生活在上埃及的女性、早发性残疾或多重残疾女性以及受教育程度较低的女性中，观察到较高的风险。值得注意的是，就业妇女面临NPV的可能性增加，可能反映了在公共或工作场所的暴露。结论：研究结果强调，迫切需要采取对残疾敏感的干预措施，解决结构性不平等、污名化和社会排斥问题。干预措施应优先考虑包容性法律保护、护理人员监督和可获得服务，特别是在服务不足和农村地区。有针对性的政策对于确保埃及残疾妇女的安全、尊严和正义至关重要。

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引用次数: 0

Editorial transition at DHJO DHJO编辑换届。

IF 3.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-08-05 DOI: 10.1016/j.dhjo.2025.101936

Monika Mitra (DHJO Co-Editor-in-Chief)

引用次数: 0

Incentivizing, enforcing and improving disability accessible health care: Current gaps and potential solutions 激励、执行和改善残疾人可获得的卫生保健：目前的差距和可能的解决办法。

IF 3.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-07-23 DOI: 10.1016/j.dhjo.2025.101933

Megan Morris , Steve Lockhart , Kori Eberle , Jennifer Oshita

Background

Despite federal requirements for health care organizations (HCOs) to provide accessible care to patients with disability, care often remains inaccessible.

Objective

To explore stakeholders’ perspectives of the effectiveness of federal requirements and factors motivating HCOs to provide accessible care to patients with disability.

Methods

We conducted 55 interviews with key informants (e.g., Disability Coordinators, researchers, policymakers, professional organizations, advocates) between May 2019 and August 2020. All interviews were conducted by qualitatively trained researchers and analyzed using content analysis methodology.

Results

We identified 3 themes: 1) existing laws are necessary, but not sufficient; 2) education is needed for health care organizations on disability as an equity issue; 3) health care is motivated by cost, quality and competition.Interview participants reported legal mandates as a major mechanism incentivizing healthcare organizations to invest in accessible care for patients with disability. These mandates, enforced through patient lawsuits and complaints, have been ineffective in driving systemic change.Additionally, organizational leaders lack knowledge on their legal obligations to provide equitable access to healthcare and the needs of patients with disability.

Participants identified a need for research demonstrating that accessible care improves outcomes and costs. Finally, participants expressed a desire for methods to facilitate competition amongst healthcare organizations to encourage provision of accessible care.

Conclusion

Federal requirements are necessary but insufficient in ensuring accessibility. Alternative solutions are needed which educate leadership and align with cost, quality and competition incentives. Diversifying the levers which incentivize accessible care could drive meaningful change in equitable healthcare for patients with disability.

背景：尽管联邦要求卫生保健组织（hco）为残疾患者提供无障碍护理，但护理往往仍然无法获得。目的：探讨利益相关者对联邦要求的有效性和激励hco为残疾患者提供无障碍护理的因素的看法。方法：在2019年5月至2020年8月期间，我们对关键信息提供者（如残疾协调员、研究人员、政策制定者、专业组织、倡导者）进行了55次访谈。所有访谈均由经过定性培训的研究人员进行，并使用内容分析方法进行分析。结果：我们确定了3个主题：1)现有法律是必要的，但还不够；2)卫生保健组织需要将残疾作为一个公平问题进行教育；3)医疗保健的动机是成本、质量和竞争。访谈参与者报告说，法律规定是激励医疗机构投资于残疾人无障碍护理的主要机制。这些通过患者诉讼和投诉来执行的命令，在推动系统性变革方面是无效的。此外，组织领导人对其提供公平获得医疗保健的法律义务和残疾患者的需求缺乏了解。与会者确定有必要进行研究，证明可获得的医疗服务可改善结果并降低成本。最后，与会者表示希望找到促进医疗保健组织之间竞争的方法，以鼓励提供可获得的医疗服务。结论：联邦要求是必要的，但不足以确保可及性。我们需要另一种解决方案，既能培养领导力，又能与成本、质量和竞争激励措施保持一致。使激励无障碍医疗的手段多样化，可以推动残疾患者获得公平医疗保健方面发生有意义的变化。

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引用次数: 0

Unequal impact of housing, food, and healthcare hardships on depression among persons with disabilities: A quantile regression approach 住房、食物和医疗困难对残疾人抑郁症的不平等影响：分位数回归方法。

IF 3.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-07-22 DOI: 10.1016/j.dhjo.2025.101932

Gum-Ryeong Park , Mihi Parikh , Jiya Patel

Background

While material hardships have been widely studied, less is known about whether baseline psychological health mitigates these hardships—or how its role varies by type of essential good or service (e.g., housing, food, healthcare) among persons with disabilities.

Objective

This study examines how different types of material hardship—specifically housing, food, and healthcare hardships—affect psychological health across different points in the depressive symptom distribution among people with disabilities.

Methods

This study used data from the Disability and Life Dynamic Panel (DLDP) survey (2018–2020). Individual level fixed effects models were conducted to estimate within-individual differences in depressive symptoms in relation to housing, food, and healthcare hardships. Quantile regression was used to examine how the effects of material hardships vary across the distribution of depressive symptoms, allowing us to assess whether individuals with relatively better or worse psychological health are differently impacted.

Results

Individuals with mental disabilities and those categorized with brain lesion disorders reported higher levels of depressive symptoms and greater difficulties related to housing, food, and healthcare. Quantile regression results indicate that the association between these material hardships and depressive symptoms is more pronounced among individuals with higher baseline levels of depression.

Conclusions

This study highlights the impact of material hardship on depression in individuals with disabilities, emphasizing the need for policies and support systems that address both material and psychological health needs.

背景：虽然对物质困难进行了广泛的研究，但对基本心理健康是否减轻这些困难，或其作用如何因残疾人的基本商品或服务类型（如住房、食物、医疗保健）而异，所知甚少。目的：本研究探讨不同类型的物质困难-特别是住房，食物和医疗困难-如何影响残疾人抑郁症状分布的不同点的心理健康。方法：本研究使用来自残疾和生活动态小组（DLDP）调查（2018-2020）的数据。采用个体水平固定效应模型来估计与住房、食物和医疗困难有关的抑郁症状的个体内差异。分位数回归用于检查物质困难的影响如何在抑郁症状的分布中变化，使我们能够评估心理健康状况相对较好或较差的个体是否受到不同的影响。结果：患有精神残疾和脑损伤障碍的个体报告了更高水平的抑郁症状，并在住房、食物和医疗保健方面遇到了更大的困难。分位数回归结果表明，这些物质困难与抑郁症状之间的关联在基线抑郁水平较高的个体中更为明显。结论：本研究强调了物质困难对残疾人抑郁症的影响，强调了解决物质和心理健康需求的政策和支持系统的必要性。

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引用次数: 0

Work from home and job Satisfaction: Differences by disability status among healthcare workers 在家工作与工作满意度：医疗工作者残疾状况的差异。

IF 3.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-07-22 DOI: 10.1016/j.dhjo.2025.101931

Yana van der Meulen Rodgers , Lisa Schur , Flora M. Hammond , Renee Edwards , Jennifer Cohen , Douglas Kruse

Background

Many workers with disabilities face negative stereotypical attitudes, pay gaps, and a lack of respect in the workplace, contributing to substantially lower job satisfaction compared to people without disabilities. Work from home may help to increase job satisfaction for people with disabilities.

Objective

This study analyzes how different measures of job satisfaction vary between people with and without disabilities, and the extent to which working from home moderates the relationship between disability and job satisfaction.

Methods

We use multivariable regression analysis to examine if the ability to work from home moderates the relationship between disability and indicators related to job satisfaction. The dataset draws on a novel survey of healthcare professionals.

Results

Results show that people with disabilities have relatively greater turnover intentions, lower sense of organizational commitment and support, weaker perceptions of openness and inclusion in the workplace, and worse relations with management and coworkers. Regressions indicate that working from home helps to improve most perceptions of work experiences but does so more for people without disabilities than for people with disabilities.

Conclusions

The findings suggest that (a) some accommodations typically viewed as exceptions to meet the needs of people with disabilities have even greater benefits for the workforce at large and (b) because workers without disabilities also benefit from remote work, we cannot expect this accommodation to close job satisfaction gaps caused by inequities.

背景：许多残疾工人面临着消极的刻板态度，工资差距，以及在工作场所缺乏尊重，与非残疾人相比，他们的工作满意度大大降低。在家工作可能有助于提高残疾人的工作满意度。目的：本研究分析残疾人士和非残疾人士在工作满意度上的差异，以及在家工作在多大程度上调节残疾与工作满意度之间的关系。方法：我们使用多变量回归分析来检验在家工作的能力是否调节残疾与工作满意度相关指标之间的关系。该数据集借鉴了对医疗保健专业人员的一项新颖调查。结果：残障人士的离职倾向相对较高，组织承诺和支持感较低，工作场所的开放性和包容性较弱，与管理层和同事的关系较差。回归表明，在家工作有助于改善大多数人对工作经历的看法，但对非残疾人的影响比对残疾人的影响更大。结论：研究结果表明：(a)一些通常被视为满足残疾人需求的例外的便利设施对整个劳动力有更大的好处；(b)因为没有残疾的工人也从远程工作中受益，我们不能指望这种便利设施能缩小由不平等造成的工作满意度差距。

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引用次数: 0

The disability squeeze: Out-of-pocket expenses and unmet needs for disability-related goods and services in the U.S. 残障挤压：美国残障相关商品和服务的自付费用和未满足需求

IF 3.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-07-19 DOI: 10.1016/j.dhjo.2025.101930

Zachary A. Morris , Stephanie Rennane , Nanette Goodman , Daniel Mont , Michelle Ballan , Amber Davis , Stephen McGarity , Brooke Ellison , Ghenet Weldeslassie

Background

Few studies have quantified the higher cost of living with a disability and the extent of unmet needs for disability-related goods and services as experienced by adults with disabilities in the U.S.

Objective

To provide national estimates of total annual out-of-pocket disability-related expenditures, their burden, and the prevalence of unmet needs, and to investigate whether persons with disabilities from underserved communities experience disparate impacts from “the disability squeeze.”

Methods

We designed and fielded a survey in June of 2023 to a nationally representative sample of adults with disabilities through the Understanding America Study, an online panel survey. Multivariate regression analyses examine correlates with out-of-pocket expenditures, the financial burden of the expenditures, and unmet needs.

Results

Among 1168 working-age adults with disabilities, mean annual expenditures on disability-related goods and services was $5341 in June 2023, equating to 20 % of household income. Additionally, 67 % of adults with disabilities reported an unmet need. Controlling for sociodemographic characteristics, adults with disabilities with incomes below the federal poverty level reported significantly lower expenditures (p < .05) but greater financial burden from their out-of-pocket expenses (p < .05). Hispanic persons with disabilities also reported significantly lower expenditures (p < .05) but higher rates of unmet need (p < .05).

Conclusion

Adults with disabilities in the U.S. experience considerable financial strain from their disability-related expenses and sustain high rates of unmet needs with disproportionate impacts identified for those from underserved communities.

背景：很少有研究量化了美国成年残疾人较高的生活成本和未满足的残疾相关商品和服务需求的程度。提供全国每年与残疾相关的自费支出总额、负担和未满足需求的普遍程度的估计，并调查来自服务不足社区的残疾人是否受到“残疾挤压”的不同影响。方法：我们在2023年6月设计并实施了一项调查，通过在线小组调查“了解美国研究”，对全国具有代表性的成年残疾人样本进行了调查。多元回归分析检验了与自费支出、支出的经济负担和未满足需求的相关性。结果：在1168名工作年龄的残疾成年人中，2023年6月，与残疾相关的商品和服务的平均年支出为5341美元，相当于家庭收入的20%。此外，67%的成年残疾人报告需求未得到满足。控制社会人口学特征，收入低于联邦贫困水平的残疾成年人报告的支出显着降低(p结论：美国残疾成年人因残疾相关费用而承受相当大的经济压力，并且维持较高的未满足需求率，对那些来自服务不足社区的人产生了不成比例的影响。

{"title":"The disability squeeze: Out-of-pocket expenses and unmet needs for disability-related goods and services in the U.S.","authors":"Zachary A. Morris , Stephanie Rennane , Nanette Goodman , Daniel Mont , Michelle Ballan , Amber Davis , Stephen McGarity , Brooke Ellison , Ghenet Weldeslassie","doi":"10.1016/j.dhjo.2025.101930","DOIUrl":"10.1016/j.dhjo.2025.101930","url":null,"abstract":"<div><h3>Background</h3><div>Few studies have quantified the higher cost of living with a disability and the extent of unmet needs for disability-related goods and services as experienced by adults with disabilities in the U.S.</div></div><div><h3>Objective</h3><div>To provide national estimates of total annual out-of-pocket disability-related expenditures, their burden, and the prevalence of unmet needs, and to investigate whether persons with disabilities from underserved communities experience disparate impacts from “the disability squeeze.”</div></div><div><h3>Methods</h3><div>We designed and fielded a survey in June of 2023 to a nationally representative sample of adults with disabilities through the Understanding America Study, an online panel survey. Multivariate regression analyses examine correlates with out-of-pocket expenditures, the financial burden of the expenditures, and unmet needs.</div></div><div><h3>Results</h3><div>Among 1168 working-age adults with disabilities, mean annual expenditures on disability-related goods and services was $5341 in June 2023, equating to 20 % of household income. Additionally, 67 % of adults with disabilities reported an unmet need. Controlling for sociodemographic characteristics, adults with disabilities with incomes below the federal poverty level reported significantly lower expenditures (p < .05) but greater financial burden from their out-of-pocket expenses (p < .05). Hispanic persons with disabilities also reported significantly lower expenditures (p < .05) but higher rates of unmet need (p < .05).</div></div><div><h3>Conclusion</h3><div>Adults with disabilities in the U.S. experience considerable financial strain from their disability-related expenses and sustain high rates of unmet needs with disproportionate impacts identified for those from underserved communities.</div></div>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":"19 1","pages":"Article 101930"},"PeriodicalIF":3.3,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718963","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}

引用次数: 0

Accessibility and utilisation of reproductive healthcare services among women with disabilities in Lithuania: Insights from a mixed-methods study 立陶宛残疾妇女获得和利用生殖保健服务的情况：来自一项混合方法研究的见解。

IF 3.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-07-19 DOI: 10.1016/j.dhjo.2025.101928

Ugnė Grigaitė , Simona Aginskaitė , Rokas Uscila

Background

Women with disabilities worldwide face barriers to reproductive healthcare, including accessibility challenges and negative attitudes from medical professionals. These issues reflect multiple intersecting forms of discrimination.

Objective

This study aims to examine how women with various disabilities in Lithuania access reproductive healthcare services, evaluate their experiences with these services, and explore the related attitudes of clinicians.

Methods

This cross-sectional study employs a mixed-methods convergent design. Quantitative and qualitative data were collected through an online survey (n = 154) and two focus groups with medical professionals (n = 12). Statistical and thematic analyses were performed using SPSS and MAXQDA.

Results

Over half of the women rated their reproductive healthcare experiences as average to very bad. Issues spanned preventive, general, pregnancy, labour, childbirth, and postpartum care. Participants with hearing, mobility, physical disabilities, and autism reported more issues, often citing inaccessible infrastructure, lack of Sign language interpretation, written consultations, or Easy-to-Read materials. Intellectual disabilities were also associated with reports of negative attitudes from medical professionals, highlighting widespread communication and support inadequacies.

Conclusions

Improving reproductive healthcare for women with disabilities in Lithuania and globally requires educating medical professionals on the human rights-based model of disability and accessibility. Implementing individual accommodations in healthcare is essential and should involve medical staff, administrators, and policymakers. Ensuring access to sex education for women with disabilities and addressing societal stereotypes about their sexuality and motherhood are also vital. Further research with larger sample sizes is needed to evaluate and enhance the accessibility and quality of reproductive healthcare services for women with disabilities.

背景：世界各地的残疾妇女在生殖保健方面面临障碍，包括无障碍挑战和来自医疗专业人员的消极态度。这些问题反映了多种交叉形式的歧视。目的：本研究旨在调查立陶宛不同残疾妇女获得生殖保健服务的情况，评估她们获得这些服务的经历，并探讨临床医生的相关态度。方法：本横断面研究采用混合方法收敛设计。通过在线调查（n = 154）和两个医疗专业人员焦点小组（n = 12）收集定量和定性数据。采用SPSS和MAXQDA进行统计和专题分析。结果：超过一半的妇女认为她们的生殖保健经历一般到非常差。问题包括预防，一般，怀孕，分娩，分娩和产后护理。听力、行动不便、身体残疾和自闭症的参与者报告了更多的问题，通常是缺乏无障碍的基础设施、缺乏手语翻译、书面咨询或易于阅读的材料。智力残疾还与医疗专业人员的消极态度有关，突出表明普遍缺乏沟通和支持。结论：改善立陶宛和全球残疾妇女的生殖保健需要对医疗专业人员进行基于人权的残疾和无障碍模式的教育。在医疗保健中实施个人住宿是必不可少的，应该包括医务人员、管理人员和决策者。确保残疾妇女获得性教育，消除社会对她们的性行为和母性的刻板印象也至关重要。需要进行更大样本量的进一步研究，以评估和提高残疾妇女获得生殖保健服务的机会和质量。

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引用次数: 0

Associations of dynamic versus static disability with experiences of stigma and mental health 动态与静态残疾与污名和心理健康经历的关联。

IF 3.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-07-15 DOI: 10.1016/j.dhjo.2025.101927

Elodie Carel, Ashley C. Woodman, Alexander J. Kellogg, Allecia E. Reid

Background

Prior research recognizes that the visibility of an individual's disability is salient to understanding experiences, such that greater visibility is associated with higher levels of stigma and symptoms of anxiety and depression. Yet, the dynamicity of a disability, defined as the extent to which severity of an impairment fluctuates, has been relatively understudied. We conducted the first known quantitative examination of dynamicity.

Hypotheses

We hypothesized that mental health and chronic illnesses would be most frequently characterized as dynamic. We also expected that dynamicity would be associated with greater symptoms of anxiety and depression, and that these relationships would be mediated by greater experiences with discrimination and microaggressions.

Methods

The sample included 125 participants with disabilities who answered the Ableist Microaggression Scale, the Everyday Discrimination Scale, the Generalized Anxiety Disorder Screener-7, the Center for Epidemiological Studies Depression Scale, and an author-created six-question measure of disability dynamicity.

Results

Mental health conditions were rated by participants as highly dynamic. Consistent with our hypotheses, four linear regressions supported that, above and beyond demographic factors and disability visibility, dynamicity predicted more ableist microaggressions, discrimination, anxiety symptoms, and depressive symptoms. In mediation models, discrimination predicted both depressive and anxiety symptoms, whereas ableist microaggressions did not. Confidence intervals further supported that discrimination, but not microaggressions, mediated the relationship of dynamicity with anxiety and depressive symptoms.

Conclusions

Disability dynamicity appears relevant to understanding stigmatizing experiences and resulting anxiety and depression symptoms. Recognition of this association can contribute to advancement of culturally competent mental health care for people with dynamic disabilities.

背景：先前的研究认识到，个人残疾的可见性对于理解经历是显著的，因此，更大的可见性与更高水平的耻辱和焦虑和抑郁症状相关。然而，残疾的动态性（定义为损害的严重程度波动的程度）的研究相对不足。我们进行了已知的第一次动态定量检验。假设：我们假设心理健康和慢性疾病最常见的特征是动态的。我们还预计，活力会与更严重的焦虑和抑郁症状有关，而这些关系将通过更多的歧视和微侵犯经历来调节。方法：样本包括125名残疾参与者，他们回答了Ableist微攻击量表、日常歧视量表、广泛性焦虑障碍筛查-7、流行病学研究中心抑郁量表和作者创建的六题残疾动态量表。结果：心理健康状况被参与者评价为高度动态的。与我们的假设一致，四个线性回归支持，除了人口因素和残疾可见度之外，动态预测更多的残疾主义微侵犯、歧视、焦虑症状和抑郁症状。在中介模型中，歧视可以预测抑郁和焦虑症状，而残疾主义微侵犯则不能。置信区间进一步支持歧视，而不是微侵犯，介导了动态与焦虑和抑郁症状的关系。结论：残疾动态似乎与理解污名化经历和由此产生的焦虑和抑郁症状有关。承认这种联系有助于为动态残疾者提供符合文化要求的精神卫生保健。

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引用次数: 0

Environmental barriers to participation for people with spinal cord injury. The case of Ecuador 脊髓损伤患者参与的环境障碍。厄瓜多尔的例子。

IF 3.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-07-15 DOI: 10.1016/j.dhjo.2025.101929

Ana Oña , Andrea Pacheco Barzallo , Jaime Toaquiza , Diana Pacheco Barzallo

This study assesses the environmental barriers faced by people with spinal cord injury (SCI) in Ecuador. Using cross-sectional data from the International Spinal Cord Injury Survey (InSCI), we analyzed responses from 510 participants across 23 provinces. We calculated the total environmental barrier index using the Nottwil Environmental Factor Inventory (NEFI) and applied regression analysis to identify key influencing factors. We also examined the severity of barriers by region, comparing rural and urban areas.

Our findings reveal significant disparities. Individuals with lower incomes, those with tetraplegia, and those without a partner reported higher levels of environmental barriers. Rural residents were disproportionately affected. While both urban and rural participants cited long-distance travel and limited public access as top barriers, finances ranked higher in urban settings, whereas home access was more critical in rural areas.

This is the first national study to map modifiable environmental barriers for people with SCI in Ecuador. The results point to clear spatial and economic inequalities, highlighting the need for targeted policies that improve public infrastructure to promote social inclusion.

本研究评估了厄瓜多尔脊髓损伤（SCI）患者面临的环境障碍。利用国际脊髓损伤调查（InSCI）的横断面数据，我们分析了来自23个省份的510名参与者的回答。利用Nottwil环境因子量表（NEFI）计算总环境屏障指数，并运用回归分析方法确定关键影响因素。我们还按地区考察了障碍的严重程度，比较了农村和城市地区。我们的发现揭示了显著的差异。收入较低的人、四肢瘫痪者和没有伴侣的人报告的环境障碍水平较高。农村居民受到的影响尤为严重。尽管城市和农村的参与者都认为长途旅行和公共交通有限是最大的障碍，但在城市环境中，经济状况排在第一位，而在农村地区，家庭交通更为重要。这是厄瓜多尔首个针对脊髓损伤患者可改变的环境障碍进行的全国性研究。研究结果指出了明显的空间和经济不平等，强调需要制定有针对性的政策，改善公共基础设施，促进社会包容。

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引用次数: 0

Employment is associated with manual ability in adults with cerebral palsy – a population-based study 一项基于人群的研究表明，成年脑瘫患者的就业与体力有关。

IF 3.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2025-07-10 DOI: 10.1016/j.dhjo.2025.101926

Jenny Hedberg-Graff , Elisabet Rodby-Bousquet , Anna Lindgren , Evgenia Manousaki , Erika Cloodt , Katina Pettersson

Background

Employment rates are lower in adults with cerebral palsy (CP). Even though reduced manual ability is associated with limitations in daily activities, it is unclear whether employment rates are associated with manual ability in adults with CP.

Objective

To analyze regular employment and employment rates (hours/week) in adults with CP and estimate their associations with manual ability relative to age and sex.

Methods

This was a cross-sectional study of adults with CP, aged 20–64 years, from the combined Swedish CP follow-up program and registry. Manual ability was classified as levels I–V using the Manual Ability Classification System (MACS). Logistic regression analysis was used.

Results

The study included 2304 adults with CP (1271 men; median age 28 years, interquartile range 20–64 years). Fewer than one in five (19 %) were employed, and about half (52 %) of these worked full time. The probability of employment in adults with MACS level II was almost half that of those with level I (OR 0.44; 95 % CI 0.34–0.57) and decreased with each MACS level to OR 0.01 (95 % CI 0.00–0.03) for MACS V. Limited manual ability was associated with a lower probability of working full time: ORs of 0.46 (95 % CI 0.30–0.72) for MACS II and 0.29 (95 % CI 0.16–0.56) for MACS III–V.

Conclusion

Limited manual ability in adults with CP impacts both their likelihood of employment and employment rate. Greater manual ability is associated with a higher probability of regular employment and working full time.

背景：成人脑瘫（CP）患者的就业率较低。尽管体力能力下降与日常活动受限有关，但目前尚不清楚成年CP患者的就业率是否与体力能力有关。目的：分析成年CP患者的正常就业和就业率（每周工作小时数），并估计其与年龄和性别之间的体力能力关系。方法：这是一项横断面研究，年龄在20-64岁之间，来自瑞典CP联合随访计划和登记。使用手工能力分类系统（MACS）将手工能力分为I-V级。采用Logistic回归分析。结果：该研究包括2304名成年CP患者(男性1271名；中位年龄28岁，四分位数范围20-64岁)。不到五分之一（19%）的人有工作，其中约一半（52%）是全职工作。MACS水平为II的成年人的就业概率几乎是水平为I的一半(OR 0.44；对于MACS v，随MACS水平的提高而降低至OR 0.01 （95% CI 0.00-0.03）。有限的手工能力与较低的全职工作概率相关：MACS II的OR为0.46 (95% CI 0.30-0.72)， MACS III-V的OR为0.29 （95% CI 0.16-0.56）。结论：成年CP患者体力活动能力的限制影响其就业的可能性和就业率。更强的体力劳动能力与更大的正常就业和全职工作的可能性有关。

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引用次数: 0