Disability and Health Journal最新文献_第9页

One-year employment outcome prediction after traumatic brain injury: A CENTER-TBI study 脑外伤后一年的就业结果预测：CENTER-TBI 研究。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-10-10 DOI: 10.1016/j.dhjo.2024.101716

Helena Van Deynse , Wilfried Cools , Viktor-Jan De Deken , Bart Depreitere , Ives Hubloue , Ellen Tisseghem , Koen Putman

Background

Traumatic brain injury (TBI) can come with long term consequences for functional outcome that can complicate return to work.

Objectives

This study aims to make accurate patient-specific predictions on one-year return to work after TBI using machine learning algorithms. Within this process, specific research questions were defined: ¹ How can we make accurate predictions on employment outcome, and does this require follow-up data beyond hospitalization? ² Which predictors are required to make accurate predictions? ³ Are predictions accurate enough for use in clinical practice?

Methods

This study used the core CENTER-TBI observational cohort dataset, collected across 18 European countries between 2014 and 2017. Hospitalized patients with sufficient follow-up data were selected for the current analysis (N = 586). Data regarding hospital stay and follow-up until three months post-injury were used to predict return to work after one year. Three distinct algorithms were used to predict employment outcomes: elastic net logistic regression, random forest and gradient boosting. Finally, a reduced model and corresponding ROC-curve was created.

Results

Full models without follow-up achieved an area under the curve (AUC) of about 81 %, which increased up to 88 % with follow-up data. A reduced model with five predictors achieved similar results with an AUC of 90 %.

Conclusion

The addition of three-month follow-up data causes a notable increase in model performance. The reduced model - containing Glasgow Outcome Scale Extended, pre-injury job class, pre-injury employment status, length of stay and age - matched the predictive performance of the full models. Accurate predictions on post-TBI vocational outcomes contribute to realistic prognosis and goal setting, targeting the right interventions to the right patients.

背景：创伤性脑损伤（TBI）会对功能结果造成长期影响，从而使重返工作岗位变得更加复杂：本研究旨在利用机器学习算法，针对特定患者的创伤性脑损伤后一年重返工作岗位情况做出准确预测。在此过程中，确定了具体的研究问题：1 我们如何才能准确预测就业结果，这是否需要住院后的随访数据？2 要进行准确预测，需要哪些预测因子？3 预测的准确性是否足以用于临床实践？本研究使用的是核心 CENTER-TBI 观察队列数据集，该数据集在 2014 年至 2017 年期间收集自欧洲 18 个国家。本次分析选择了有足够随访数据的住院患者（N = 586）。住院时间和伤后三个月前的随访数据被用来预测一年后的重返工作情况。预测就业结果使用了三种不同的算法：弹性净逻辑回归、随机森林和梯度提升。最后，建立了简化模型和相应的 ROC 曲线：没有跟踪数据的完整模型的曲线下面积（AUC）约为 81%，有了跟踪数据后，曲线下面积增加到 88%。包含五个预测因子的简化模型也取得了相似的结果，AUC 为 90%：结论：增加三个月的随访数据可显著提高模型性能。简化模型包含格拉斯哥结果量表扩展项、受伤前工作类别、受伤前就业状况、住院时间和年龄，与完整模型的预测性能相当。对创伤后职业结果的准确预测有助于做出切合实际的预后和目标设定，从而为合适的患者提供正确的干预措施。

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引用次数: 0

The effects of poor housing conditions on depressive symptoms in persons with disabilities: Do neighborhood resources and residence type matter? 恶劣的住房条件对残疾人抑郁症状的影响：邻里资源和居住类型重要吗？

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-10-05 DOI: 10.1016/j.dhjo.2024.101712

Gum-Ryeong Park, Saud Haseeb, Eun Ha Namkung

Background: Poor housing conditions pose significant risks to the health of persons with disabilities. However, it is not well understood how and for whom the relationship between housing conditions and health is more pronounced.

Objective: This study aims to estimate the association between poor housing conditions and psychological health, and to explore whether residential characteristics, such as residence type and proximity to community resources, mitigate these risks for community-dwelling adults with disabilities.

Methods: Data were obtained from three waves of the Disability and Life Dynamic Panel (n = 5,058), a nationally representative study of individuals with disabilities in Korea. Our sample were limited to those aged 20 or older for the purpose of this study. Individual-level fixed effect analyses were conducted to assess the longitudinal association between poor housing conditions and depressive symptoms, accounting for individual-level heterogeneity. We also tested the moderating effects of the residential characteristics, including proximity to community resources and residence type.

Results: Poor housing conditions, characterized by structural unsafety and inadequate ventilation, lighting, and noise protection, were associated with increased depressive symptoms among adults with disabilities. The negative impact of poor housing conditions on depressive symptoms was less pronounced for those living close to community services or in apartment complexes where housing conditions are professionally managed.

Conclusions: The study indicates that the quality of housing and neighborhood environments affect the psychological health of adults with disabilities. These findings support for the need for place-based interventions aimed at improving the residential environments of community-dwelling adults with disabilities.

背景：恶劣的住房条件对残疾人的健康构成重大风险。然而，人们并不十分清楚住房条件与健康之间的关系如何以及对哪些人而言更为明显：本研究旨在估算不良住房条件与心理健康之间的关系，并探讨居住特征（如居住类型和与社区资源的接近程度）是否能减轻居住在社区的成年残疾人的这些风险：数据来源于韩国残疾人和生活动态小组的三次调查（n = 5,058），这是一项针对韩国残疾人的具有全国代表性的研究。为本研究之目的，我们的样本仅限于 20 岁或以上的人群。我们进行了个体水平的固定效应分析，以评估恶劣住房条件与抑郁症状之间的纵向联系，并考虑了个体水平的异质性。我们还测试了居住特征的调节作用，包括是否靠近社区资源和居住类型：结果：以结构不安全、通风、照明和噪音防护不足为特征的恶劣住房条件与成年残疾人抑郁症状的增加有关。住房条件差对抑郁症状的负面影响对于那些居住在社区服务机构附近或居住在住房条件有专业管理的公寓区的人来说并不明显：研究表明，住房和邻里环境的质量会影响成年残疾人的心理健康。这些研究结果表明，有必要采取以场所为基础的干预措施，以改善居住在社区的成年残疾人的居住环境。

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引用次数: 0

Physical activity as a mediator in the relationship between health locus of control and health-related quality of life in multiple sclerosis patients with different disease duration. 体育锻炼是不同病程的多发性硬化症患者健康控制点与健康相关生活质量之间关系的中介。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-10-01 Epub Date: 2024-05-01 DOI: 10.1016/j.dhjo.2024.101638

Maciej Tomczak, Małgorzata Walczak, Waldemar Brola, Aleksandra Walczak, Magdalena Koper, Bartosz Chmielewski, Maciej Wilski

Background: The importance of undertaking physical activity for functioning of patients with multiple sclerosis (MS) has been repeatedly highlighted. However, the research on the role of physical activity in shaping the quality of life of patients with different disease duration is scarce.

Objective: The aim of this study was to identify the mediating role of physical activity in the relationship between health locus of control (HLoC) and health-related quality of life in MS patients with varying disease duration.

Methods: The study included 339 patients with MS from rehabilitation centers. The Multiple Sclerosis Impact Scale (MSIS-29) was used to measure health-related quality of life, physical activity was assessed by the Godin Leisure Time Exercise Questionnaire (GLTEQ) and the Health Locus of Control Questionnaire was used to measure HLoC.

Results: Physical activity has been shown to be a mediator in the relationship between intrinsic HLoC and health-related quality of life particularly in patients with longer disease duration. Intrinsic HLoC was positively associated with engaging in physical activity, which in turn was positively associated with the physical component of quality of life in patients with longer (indirect effect: β = -0.077, p < 0.05) and moderate (β = -0.040, p < 0.05) duration of illness.

Conclusion: The results highlight the importance of psychological resources for undertaking quality-of-life-related physical activity by MS patients with long disease duration. Particularly important here is the internal HLoC, which promotes physical activity that increases the chance of a high quality of life.

背景：进行体育锻炼对多发性硬化症（MS）患者的功能的重要性已被反复强调。然而，关于体育锻炼在不同病程患者的生活质量中的作用的研究却很少：本研究旨在确定体育锻炼在不同病程的多发性硬化症患者的健康控制点（HLoC）与健康相关生活质量之间的关系中的中介作用：研究纳入了 339 名来自康复中心的多发性硬化症患者。多发性硬化影响量表（MSIS-29）用于测量与健康相关的生活质量，体力活动通过戈丁休闲时间运动问卷（GLTEQ）进行评估，健康控制点问卷用于测量健康控制点：结果：研究表明，体育锻炼是内在 HLoC 与健康相关生活质量之间关系的中介因素，尤其是在病程较长的患者中。内在 HLoC 与从事体育活动呈正相关，而体育活动又与病程较长患者的生活质量中的体育部分呈正相关（间接效应：β = -0.077，p 结论：在病程较长的患者中，内在 HLoC 与从事体育活动呈正相关，而体育活动又与病程较长患者的生活质量中的体育部分呈正相关：研究结果强调了心理资源对病程较长的多发性硬化症患者进行与生活质量相关的体育活动的重要性。其中尤为重要的是内部 HLoC，它能促进体育锻炼，从而增加获得高质量生活的机会。

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引用次数: 0

Transportation for people with intellectual and developmental disabilities in Home- and Community-Based Services. 家庭和社区服务中智力和发育障碍人士的交通问题。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-09-19 DOI: 10.1016/j.dhjo.2024.101708

Carli Friedman

Background: Transportation can help improve the health, quality of life, and community integration of people with intellectual and developmental disabilities (IDD). Yet, transportation is one of people with IDD's most common unmet needs.

Objective: The aim of this study was to examine if, and, how, states provide non-medical transportation to people with IDD in their Medicaid HCBS programs.

Methods: Using content analysis and descriptive statistics, this study analyzed fiscal year (FY) 2021 Medicaid HCBS 1915(c) waivers for people with IDD from across the nation to examine how they allocated transportation.

Results: In FY 2021, all 44 states and the District of Columbia with HCBS waivers for people with IDD provided transportation services. Transportation was included either by providing a stand-alone service that exclusively provided transportation, or by being embedded within another service. Transportation was embedded within 896 different HCBS services for people with IDD, most commonly within residential habilitation services (26.70 %), supported employment services (19.44 %), and day habilitation (18.44 %). Thirty-three states (73.33 %) also provided 145 different stand-alone transportation services in their programs for people with IDD, to increase community integration and help people gain access to waiver services. A total of $781.78 million of spending was projected for stand-alone transportation services for 261,109 people with IDD (30.32 % of waiver recipients).

Conclusions: HCBS waivers are an important resource for providing transportation for people with IDD. However, significant variation in how states do so may result in disparities or unmet needs.

背景：交通有助于改善智力和发育障碍（IDD）患者的健康、生活质量和社区融合。然而，交通是智障人士最常见的未满足需求之一：本研究旨在探讨各州是否以及如何在其医疗补助 HCBS 计划中为 IDD 患者提供非医疗交通服务：本研究采用内容分析法和描述性统计法，分析了全美各州 2021 财年（FY）针对 IDD 患者的医疗补助 HCBS 1915（c）减免计划，以研究各州如何分配交通服务：结果：2021 财年，所有 44 个州和哥伦比亚特区都为 IDD 患者提供了 HCBS 减免计划，其中包括交通服务。提供交通服务的方式有两种，一种是专门提供交通服务的独立服务，另一种是将交通服务嵌入到其他服务中。有 896 项针对智障人士的不同 HCBS 服务中包含了交通服务，其中最常见的是居住适应训练服务（26.70%）、辅助就业服务（19.44%）和日间适应训练（18.44%）。有 33 个州（73.33%）还在其针对智障人士的计划中提供了 145 种不同的独立交通服务，以加强社区融合并帮助人们获得豁免服务。预计为 261 109 名 IDD 患者（占减免者的 30.32%）提供独立交通服务的总支出为 7.8178 亿美元：结论：HCBS 减免计划是为 IDD 患者提供交通服务的重要资源。然而，各州在提供交通服务的方式上存在很大差异，这可能会导致差异或需求得不到满足。

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引用次数: 0

Author Information 作者信息

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-09-11 DOI: 10.1016/S1936-6574(24)00144-4

引用次数: 0

Still Missing 仍然失踪

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-08-16 DOI: 10.1016/j.dhjo.2024.101686

Margaret A. Turk MD , Monika Mitra PhD

引用次数: 0

Inequities in medicaid home- and community-based services waiver enrollment among people with intellectual and/or developmental disabilities: A nationwide claims-based analysis. 智力和/或发育障碍人士在医疗补助居家和社区服务豁免注册方面的不平等：基于索赔的全国性分析。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-08-02 DOI: 10.1016/j.dhjo.2024.101676

A Alex Levine, Megan B Cole, Amy Lynn Michals, Na Wang, Eric Rubenstein

Background: States use Medicaid 1915(c) waiver programs to enable access to home- and community-based services for people with intellectual and/or developmental disabilities (I/DD). However, enrollment rates and potential inequities are not well documented, impeding efforts to improve care access and quality for waiver program enrollees, especially for racially minoritized beneficiaries experiencing compounded barriers to services and supports.

Objective: To characterize year-by-year 1915(c) waiver program enrollment among Medicaid-enrolled adults with I/DD from 2016 to 2019 and to analyze population-level inequities by type of I/DD and racial/ethnic group.

Methods: Our data source was 2016-2019 Medicaid Transformed Medicaid Statistical Information System Analytic Files Demographic and Eligibility files for beneficiaries with Down syndrome, autism, and intellectual disability. We used generalized estimating equation linear models to estimate the associations of type of I/DD and racial/ethnic group with the probability of 1915(c) waiver program enrollment and reported (1) unadjusted estimates and (2) estimates adjusted for demographics with state and year fixed effects.

Results: From 2016 to 2019, across all types of I/DD and racial/ethnic groups, unadjusted 1915(c) waiver program enrollment rates ranged from 40 to 60 % nationwide. We found modest growth in 1915(c) I/DD waiver program enrollment but persistent inequities over time. Compared to beneficiaries with intellectual disabilities, beneficiaries with autism were less likely to enroll while beneficiaries with Down syndrome were more likely. While some racial/ethnic groups had higher unadjusted mean enrollment, after adjustment, racially minoritized beneficiaries were 3.66-12.0 percentage points less likely to enroll compared to white non-Hispanic beneficiaries.

Conclusions: Given extensive waiting lists for 1915(c) waiver programs, Medicaid programs should evaluate existing enrollment and authorization processes and consider alternative HCBS program authorities.

背景：各州利用医疗补助 1915（c）减免计划为智力和/或发育障碍（I/DD）患者提供家庭和社区服务。然而，该计划的注册率和潜在的不公平现象并没有得到很好的记录，这阻碍了改善减免计划注册者，尤其是那些在服务和支持方面面临重重障碍的少数种族受益者获得护理的机会和质量的努力：目的：描述 2016 年至 2019 年 I/DD 成人医疗补助计划（Medicaid）1915(c) 减免计划的逐年注册情况，并按 I/DD 类型和种族/族裔群体分析人口层面的不平等现象：我们的数据来源是 2016-2019 年医疗补助转型医疗补助统计信息系统分析档案中唐氏综合症、自闭症和智障受益人的人口统计和资格档案。我们使用广义估计方程线性模型来估计 I/DD 类型和种族/族裔群体与 1915(c) 减免计划注册概率之间的关联，并报告了（1）未调整的估计值和（2）根据人口统计学因素和州及年份固定效应调整后的估计值：从 2016 年到 2019 年，在所有类型的 I/DD 和种族/族裔群体中，全国范围内未经调整的 1915（c）减免计划注册率介于 40% 到 60% 之间。我们发现，1915(c) I/DD 减免计划的注册率略有增长，但长期存在不公平现象。与智障受益人相比，患有自闭症的受益人的注册率较低，而患有唐氏综合症的受益人的注册率较高。虽然一些种族/族裔群体的未调整平均注册率较高，但经过调整后，与白人非西班牙裔受益人相比，少数种族受益人的注册率要低 3.66-12.0 个百分点：鉴于 1915（c）豁免计划的候选者众多，医疗补助计划应评估现有的注册和授权程序，并考虑替代性的 HCBS 计划授权。

{"title":"Inequities in medicaid home- and community-based services waiver enrollment among people with intellectual and/or developmental disabilities: A nationwide claims-based analysis.","authors":"A Alex Levine, Megan B Cole, Amy Lynn Michals, Na Wang, Eric Rubenstein","doi":"10.1016/j.dhjo.2024.101676","DOIUrl":"https://doi.org/10.1016/j.dhjo.2024.101676","url":null,"abstract":"<p><strong>Background: </strong>States use Medicaid 1915(c) waiver programs to enable access to home- and community-based services for people with intellectual and/or developmental disabilities (I/DD). However, enrollment rates and potential inequities are not well documented, impeding efforts to improve care access and quality for waiver program enrollees, especially for racially minoritized beneficiaries experiencing compounded barriers to services and supports.</p><p><strong>Objective: </strong>To characterize year-by-year 1915(c) waiver program enrollment among Medicaid-enrolled adults with I/DD from 2016 to 2019 and to analyze population-level inequities by type of I/DD and racial/ethnic group.</p><p><strong>Methods: </strong>Our data source was 2016-2019 Medicaid Transformed Medicaid Statistical Information System Analytic Files Demographic and Eligibility files for beneficiaries with Down syndrome, autism, and intellectual disability. We used generalized estimating equation linear models to estimate the associations of type of I/DD and racial/ethnic group with the probability of 1915(c) waiver program enrollment and reported (1) unadjusted estimates and (2) estimates adjusted for demographics with state and year fixed effects.</p><p><strong>Results: </strong>From 2016 to 2019, across all types of I/DD and racial/ethnic groups, unadjusted 1915(c) waiver program enrollment rates ranged from 40 to 60 % nationwide. We found modest growth in 1915(c) I/DD waiver program enrollment but persistent inequities over time. Compared to beneficiaries with intellectual disabilities, beneficiaries with autism were less likely to enroll while beneficiaries with Down syndrome were more likely. While some racial/ethnic groups had higher unadjusted mean enrollment, after adjustment, racially minoritized beneficiaries were 3.66-12.0 percentage points less likely to enroll compared to white non-Hispanic beneficiaries.</p><p><strong>Conclusions: </strong>Given extensive waiting lists for 1915(c) waiver programs, Medicaid programs should evaluate existing enrollment and authorization processes and consider alternative HCBS program authorities.</p>","PeriodicalId":49300,"journal":{"name":"Disability and Health Journal","volume":" ","pages":"101676"},"PeriodicalIF":3.7,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890619","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

Unmet needs for long-term services and supports and associations with health outcomes. 未满足的长期服务和支持需求以及与健康结果的关联。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-07-30 DOI: 10.1016/j.dhjo.2024.101678

Joseph Caldwell, Elad Daniels, Kaitlin Stober

Background: The availability of population-level data on unmet needs for long-term services and supports (LTSS) is limited at state and national levels. Data on unmet LTSS needs can improve our understanding of disparities and relationships with health outcomes.

Objective: 1) Explore differences in unmet LTSS needs by socio-demographic characteristics, including age, sex, race/ethnicity, metropolitan status, sexual orientation, and socio-economic status; and 2) Examine associations between unmet LTSS needs and health/preventative healthcare outcomes.

Methods: We used the 2021 Behavioral Risk Factor Surveillance System (BRFSS) core survey and state-added LTSS questions to analyze a sample of adults with LTSS needs in Texas (N = 1232). We compared socio-demographic characteristics between adults with and without unmet LTSS needs. We conducted modified-Poisson regressions to estimate unadjusted and adjusted risk ratios (with 95 % confidence intervals) for each health/preventative healthcare outcome among adults with unmet LTSS needs. Health outcomes included health status, healthy days-physical health, healthy days-mental health, suicide ideation, and multiple chronic conditions. Preventative healthcare outcomes included routine check-up and flu vaccine.

Results: Among adults with LTSS needs, those with unmet LTSS needs were statistically significantly more likely to be younger (age<65), female, higher educational attainment, and non-straight sexual orientation. After controlling for socio-demographic variables, having unmet needs for LTSS was significantly associated with poorer physical and mental health outcomes and suicide ideation.

Conclusions: Improved data collection on unmet needs LTSS can assist policymakers, particularly at the state level in guiding reforms to reduce disparities in access to home and community-based services (HCBS) and improve health outcomes.

背景：在州和国家层面，有关未满足的长期服务和支持（LTSS）需求的人口级数据十分有限。关于未满足的长期服务和支持需求的数据可以提高我们对差异以及与健康结果之间关系的认识。目标：1）根据社会人口特征（包括年龄、性别、种族/民族、大都市地位、性取向和社会经济地位）探讨未满足的长期服务和支持需求的差异；2）研究未满足的长期服务和支持需求与健康/预防性医疗保健结果之间的关联：我们使用 2021 年行为风险因素监测系统（BRFSS）核心调查和州附加的 LTSS 问题，对德克萨斯州有 LTSS 需求的成年人样本（N = 1232）进行了分析。我们比较了有和没有未满足 LTSS 需求的成年人的社会人口特征。我们进行了修正的泊松回归，以估计未满足 LTSS 需求的成年人中每种健康/预防性医疗保健结果的未调整和调整风险比（含 95 % 置信区间）。健康结果包括健康状况、健康天数（身体健康）、健康天数（心理健康）、自杀倾向和多种慢性疾病。预防性保健结果包括常规体检和接种流感疫苗：结果：在有长期医疗服务需求的成年人中，有长期医疗服务需求但未得到满足的人在统计上更有可能更年轻（年龄）：改进有关未满足的 LTSS 需求的数据收集工作有助于政策制定者，尤其是州一级的政策制定者指导改革，以减少在获得家庭和社区服务（HCBS）方面的差距并改善健康状况。

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引用次数: 0

Additive interaction of disability with chronic conditions on mortality risk in middle-aged and older adults in Spain 残疾与慢性病对西班牙中老年人死亡风险的叠加作用。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-07-20 DOI: 10.1016/j.dhjo.2024.101672

Roberto Pastor-Barriuso PhD , Iñaki Galán MD, PhD , Javier Damián MD, PhD

Background

Disability and chronic diseases are prevalent conditions associated with mortality, but little information is available on their potential synergistic effects.

Objective

This study aimed to describe additive interactions between disability and chronic diseases on mortality risk in middle-aged and older adults.

Methods

A representative cohort of 22,800 community-dwelling Spanish people aged 50 years or older were interviewed for disability with the Global Activity Limitation Indicator and specific chronic diseases in the 2011–12 and 2014 National Health Surveys and subsequently followed up for mortality. Five-year all-cause mortality risks were standardized in each disability-by-comorbidity category through inverse probability weighting. We computed interaction contrasts as the departure of the standardized risk difference for people with both conditions from the sum of the standardized risk differences for those with any single condition.

Results

The baseline prevalence of disability was 35.1 % (95 % confidence interval [CI] 34.4 %, 35.9 %). There was compelling evidence of synergistic effects of disability with chronic liver disease, heart diseases other than myocardial infarction, cancer, and cerebrovascular disease, with large positive interaction contrasts (95 % CIs) of 106.7 (−16.4, 229.9), 45.7 (6.9, 84.5), 45.1 (−15.0, 105.2), and 42.9 (−41.0, 126.9) excess deaths per 1000 persons. Less clear synergistic responses were observed for other comorbidities. We found some evidence of antagonism for osteoporosis, with a negative interaction contrast of −18.0 (95 % CI −82.2, 46.2) deaths per 1000 persons.

Conclusion

Given the high mortality risk in people with disability, the study of its synergistic effects with target comorbidities can provide relevant information regarding preventive measures.

背景：残疾和慢性病是与死亡率相关的普遍情况，但有关它们潜在协同效应的信息却很少：本研究旨在描述残疾和慢性病对中老年人死亡风险的叠加作用：在 2011-12 年和 2014 年的全国健康调查中，对 22800 名 50 岁或以上居住在社区的西班牙人进行了具有代表性的队列研究，以全球活动受限指标和特定慢性病为依据对其残疾情况进行了调查，随后对其死亡率进行了随访。通过反概率加权法对每个残疾-并发症类别的五年全因死亡风险进行了标准化。我们计算了交互对比，即同时患有两种疾病的人的标准化风险差异与患有任何一种单一疾病的人的标准化风险差异之和的偏差：基线残疾发生率为 35.1%（95% 置信区间 [CI] 34.4%，35.9%）。有令人信服的证据表明，残疾与慢性肝病、心肌梗死以外的心脏病、癌症和脑血管疾病之间存在协同效应，每 1000 人中有 106.7（-16.4，229.9）、45.7（6.9，84.5）、45.1（-15.0，105.2）和 42.9（-41.0，126.9）例超额死亡的巨大正交互对比（95 % 置信区间）。在其他合并症方面，协同反应不太明显。我们发现了骨质疏松症的一些拮抗证据，每 1000 人的负交互对比为-18.0（95 % CI -82.2，46.2）例死亡：鉴于残疾人的高死亡风险，研究其与目标合并症的协同效应可为预防措施提供相关信息。

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引用次数: 0

Time in childhood extracurricular activity and mental health of young adults with developmental disability 童年课外活动时间与发育障碍青少年的心理健康。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-07-05 DOI: 10.1016/j.dhjo.2024.101671

Background

People with developmental disability have higher rates of mental health problems such as anxiety, depression, psychological distress, or a limited sense of belonging to a community. Extracurricular activity can help children and adolescents build social connections beyond family, increasing social capital, which may promote mental health in the transition into adulthood. Little is known about such associations among people with developmental disability.

Objective

To examine associations of childhood extracurricular activity with mental health in young adulthood among people with and without developmental disability.

Methods

Data: Panel Study of Income Dynamics (PSID, 1968–2017), its Child Development Supplement (1997, 2002, 2007) and its Transition into Adulthood Supplement (2005–2019) (n = 2801). Time diaries measured time in activity. Outcomes were psychological distress (Kessler K6) and flourishing (Mental Health Continuum-Short Form). Adjusted linear regressions modeled associations.

Results

In nationally representative results, 9.6 % (95 % confidence interval, CI 7.8, 11.4) had a disability. Children without disability reported more average weekly time in group activity, 125.1 min (CI 113.2, 136.9) vs. 93.6 (CI 55.1, 132.0; not significant at conventional levels). In adjusted results, “some” group activity (0–180 weekly minutes) was associated with greater flourishing for those with developmental disability (0.89; CI 0.16, 1.61).

Conclusion

Among people with developmental disability, group activity in childhood was associated with greater flourishing in young adulthood. More research is needed to understand the complex nature of activity participation for children with developmental disabilities.

背景：发育障碍者的心理健康问题发生率较高，如焦虑、抑郁、心理困扰或对社区的归属感有限。课外活动可以帮助儿童和青少年建立家庭以外的社会联系，增加社会资本，从而在向成年过渡的过程中促进心理健康。但人们对发育障碍者的这种关联知之甚少：研究发育障碍者和非发育障碍者童年课外活动与成年后心理健康的关系：方法：数据：方法：数据：《收入动态面板研究》（Panel Study of Income Dynamics，PSID，1968-2017 年）及其《儿童发展补充研究》（1997 年、2002 年、2007 年）和《成年过渡期补充研究》（2005-2019 年）（n = 2801）。时间日记测量活动时间。结果为心理困扰（Kessler K6）和蓬勃发展（心理健康连续简表）。调整后的线性回归建立了相关模型：具有全国代表性的结果显示，9.6%（95% 置信区间，CI 7.8-11.4）的儿童患有残疾。无残疾儿童每周参加集体活动的平均时间更长，为 125.1 分钟（CI 113.2，136.9）对 93.6 分钟（CI 55.1，132.0；在常规水平上无显著性差异）。在调整后的结果中，"一些 "集体活动（每周 0-180 分钟）与发育障碍人士的更大繁荣程度相关（0.89；CI 0.16，1.61）：结论：在发育障碍患者中，童年时期的集体活动与他们成年后的更大发展相关。要了解发育障碍儿童参与活动的复杂性，还需要进行更多的研究。

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引用次数: 0