Disability and Health Journal最新文献

Background: Little is known about the longitudinal relationship between the prevalence of childhood medical conditions or disabilities (MCoD) lasting at least six months and associated excess healthcare costs to the public payer (Medicare).

Objective: To determine the additional federally funded Medicare costs for children who have a long-term medical condition or disability and to investigate whether these costs rise due to the recurring presence of the conditions over time.

Methods: This study utilised data from the nationally representative Longitudinal Study of Australian Children, comprising Birth (B) and Kindergarten (K) cohorts, involving 9,224 children. Based on Medicare data linkage, the analysis included 54,285 observations longitudinally. Generalised linear models with a log link and gamma distribution were employed to estimate the impact of childhood MCoD on Medicare costs over 14 years for the B cohort and 12 years for the K cohort. All models were adjusted for demographic, socioeconomic, and selected child medical characteristics.

Results: On average, children with long-term MCoD incurred excess Medicare costs ranging from A$494 to A$784 biennially, in the different age groups of 0-1 to 16-17 years, compared to children without such conditions. Nationally, this translates to an estimated total additional Medicare expenditure of A$313.0 million for a cohort of children from age 0-1 year to 16-17 years.

Conclusion: The findings highlight the significant excess public Medicare costs associated with childhood MCoD in Australia. These results will be beneficial for future cost-effectiveness analysis and for improving public health planning aimed at improving support for children with long-term medical conditions or disabilities.

Cerebral palsy (CP) is a lifelong condition that affects 1.5-3.4 per 1000 children worldwide. As they grow older, these children must transition from pediatric to adult healthcare services. This transition comes with stress and uncertainty for a population that is already at a higher risk of poor mental health. This paper discusses what is known about mental health in youth with CP and its impact on their transition within the medical system. It also uses a biopsycho-ecological framework to understand how transition impacts several domains of their life including family structure and social participation. Actionable guidance for medical providers and caregivers is given to promote a healthier transition process.

Background: Disability is experienced by approximately 1.3 billion individuals worldwide. Therefore, people with disabilities (PWD) are part of every physician's patient base, regardless of specialty. Specific educational programs are needed, as medical students and physicians still report discomfort in taking histories, performing clinical examinations and making differential diagnoses when dealing with PWD.

Objective: We hypothesized that participation in a one-week disability awareness training, including theoretical sessions, practical workshops with PWD, and 3-day immersive training courses, would significantly improve the quantitative and qualitative outcomes of medical students toward PWD.

Methods: We conducted a monocentric prospective mixed-methods study targeting 3rd year medical students, using quantitative measurements through repeated synchronous surveys, evaluating disability attitudes in health care (DAHC) scores and performed qualitative explorations through individual semidirected interviews, evaluating students' feelings and attitudes toward PWD.

Results: A total of 218 students (mean age: 21.1 ± 1.4 years) were included in the study. While 60 % of the participants reported no prior working experience with PWD, there was a significant improvement in paired-DAHC scores 3 months after the training (+1.32, p = 0.003). Improvements were predominantly observed in comfort levels during interaction and in discriminatory attitudes. This practical experience was positively reported in the semidirected interviews, in which a facilitated transition from unfamiliarity to informed empathy and knowledge was reported.

Conclusions: The implementation of disability awareness trainings in compulsory medical curricula should be prioritized to improve future physician's skills and attitudes when caring for PWD.

Background: People with intellectual disabilities (ID) frequently experience poorer health and lower treatment coverage compared to those without ID, yet differences in hypertension prevalence and treatment coverage remain unclear.

Objective: To estimate the pooled prevalence ratio (PR) of hypertension and hypertension treatment coverage comparing adults with and without ID.

Methods: We searched MEDLINE, Embase, PsychINFO, Global Health and Global Index Medicus on June 6, 2024. We included observational and intervention studies that estimated the prevalence of hypertension and/or treatment coverage. The risk of bias was assessed using the Newcastle-Ottawa Scale tool. We undertook a random-effects meta-analysis to estimate the pooled PR with 95 % confidence intervals (CI). Sources of heterogeneity were explored through sensitivity and subgroup analyses, and meta-regression.

Results: 21 studies from 10 countries across three regions were included. The pooled PR were 0.71 (95 % CI: 0.47-1.05) for hypertension and 0.61 (95 % CI: 0.47-0.81) for hypertension treatment coverage. Only one study adjusted for age; most reported unadjusted estimates, making them prone to confounding. 14 studies were rated as high risk of bias. Subgroup analysis and meta-regression revealed variability in the methods used to diagnose ID, with sample size emerging as the primary source of variability in the effect estimates.

Conclusions: This systematic review showed that adults with ID have a similar prevalence of hypertension, but lower hypertension treatment coverage compared to those without disabilities. However, these results should be interpreted with caution due to the lack of adjustment for confounding in the association and variability in the diagnosis of ID.