Disability and Health Journal最新文献_第9页

Impact of COVID-19 on psychoactive medication use among individuals with intellectual and developmental disabilities in Ontario, Canada: A repeated cross-sectional study COVID-19 对加拿大安大略省智力和发育障碍人士使用精神活性药物的影响：重复横断面研究。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-06-12 DOI: 10.1016/j.dhjo.2024.101649

Background

Evidence for worsening mental health among individuals with intellectual and developmental disabilities (IDD) during COVID-19 sparked concerns for increased use of psychoactive medications.

Objective

To examine the impact of COVID-19 on psychoactive medication use and clinical monitoring among individuals with IDD in Ontario, Canada.

Methods

We conducted a repeated cross-sectional study among individuals with IDD and examined weekly trends for psychoactive medication dispensing and outpatient physician visits among those prescribed psychoactive medications between April 7, 2019, and March 25, 2023. We used interventional autoregressive integrated moving average models to determine the impact of the declaration of emergency for COVID-19 (March 17, 2020) on the aforementioned trends.

Results

The declaration of emergency for COVID-19 did not significantly impact psychoactive medication use among individuals with IDD. Provision of clinical monitoring remained relatively stable, apart from a short-term decline in the weekly rate of outpatient physician visits following the declaration of emergency for COVID-19 (step estimate: 21.26 per 1000 individuals [p < 0.01]; ramp estimate: 0.88 per 1000 individuals [p = 0.01]). When stratified by mode of delivery, there was a significant shift towards virtual care (step estimate: 78.80 per 1000 individuals; p < 0.01). The weekly rate of in-person physician visits gradually increased, returning to rates observed prior to the COVID-19 pandemic in January 2023.

Conclusion

Although access to clinical care remained relatively stable, the shift towards virtual care may have negatively impacted those who encounter challenges communicating via virtual mediums. Future research is required to identify the support systems necessary for individuals with IDD during virtual health care interactions.

背景：有证据表明，在 COVID-19 期间，智力和发育障碍（IDD）患者的精神健康状况恶化，这引发了人们对精神活性药物使用增加的担忧：研究 COVID-19 对加拿大安大略省 IDD 患者精神活性药物使用和临床监测的影响：我们在 IDD 患者中开展了一项重复横断面研究，并考察了 2019 年 4 月 7 日至 2023 年 3 月 25 日期间精神活性药物处方配药和门诊医生就诊的每周趋势。我们使用干预性自回归综合移动平均模型来确定 COVID-19 紧急宣布（2020 年 3 月 17 日）对上述趋势的影响：结果：宣布 COVID-19 进入紧急状态并未对 IDD 患者使用精神活性药物产生重大影响。除了在宣布 COVID-19 紧急状态后每周门诊医生就诊率出现短期下降之外，临床监测的提供情况仍保持相对稳定（步骤估计值：每 1000 人 21.26 次[p 结论：虽然临床监测的提供情况保持相对稳定，但在宣布 COVID-19 紧急状态后每周门诊医生就诊率出现短期下降：尽管获得临床治疗的机会相对稳定，但向虚拟治疗的转变可能会对那些在通过虚拟媒介进行交流时遇到困难的人产生负面影响。今后需要开展研究，以确定在虚拟医疗互动过程中 IDD 患者所需的支持系统。

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引用次数: 0

From the “backburner” to the forefront: Qualitative analysis of medical and physician assistant students’ reflections on Crip Camp 从 "后备 "到前沿：定性分析医学和助理医师学生对 Crip 夏令营的反思。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-06-10 DOI: 10.1016/j.dhjo.2024.101652

Background

Disability-focused health professions education must evolve to portray the lives of disabled patients, lived experiences of ableism, and disability history more accurately and authentically. Methods of education that utilize first-person perspectives of disabled people to deliver authentic representations are limited in the current literature.

Objective

To explore first-year medical and physician assistant students' reflections on healthcare access, healthcare providers’ roles, and barriers to health equity for patients with disabilities after watching an exemplar, first-person perspective documentary titled Crip Camp: A Disability Revolution.

Methods

A three-part, student-created disability curriculum “Introduction to Disability and Anti-Ableist Healthcare” was offered as an elective for first-year medical students during the 2021–2022 and 2022–2023 academic years. The disability curriculum was required for first-year physician assistant students during the 2023–2024 academic year. One curricular component was watching Crip Camp: A Disability Revolution and completing a 500-750-word reflective essay. Qualitative thematic analysis was used to organize essay responses.

Results

Seven major themes emerged in the students’ essays highlighting the importance of disability-focused education, the necessity of understanding the historical context and mistreatment of people with disabilities, limitations of health policies and health systems, the role of trainees and providers, and intersectionality. Themes were aligned with the socioecological model and disability consciousness to reflect healthcare delivery and education benefit, respectively.

Conclusion

Crip Camp: A Disability Revolution was an effective educational intervention to provide and apply knowledge in reflecting on healthcare experiences of people with disabilities. The themes have implications for health professions education and health care delivery.

背景：以残障人士为重点的健康专业教育必须不断发展，以更准确、更真实地描述残障病人的生活、残障人士的生活经历以及残障历史。在目前的文献中，利用残疾人的第一人称视角进行真实再现的教育方法非常有限：目的：探讨医学和助理医师专业一年级学生在观看第一人称视角纪录片《瘸子营》（Crip Camp：残疾革命》：在 2021-2022 学年和 2022-2023 学年期间，为医学专业一年级学生开设了一门由三部分组成、由学生自创的残疾课程 "残疾与反歧视医疗简介"，作为选修课。在 2023-2024 学年，残疾课程是一年级助理医师学生的必修课。课程内容之一是观看《瘸子训练营》：残疾革命》，并完成一篇 500-750 字的反思性论文。我们采用定性主题分析法来组织论文答辩：结果：学生们的论文中出现了七大主题，强调了以残疾为重点的教育的重要性、了解历史背景和虐待残疾人的必要性、卫生政策和卫生系统的局限性、受训者和提供者的角色以及交叉性。这些主题与社会生态模式和残疾意识相一致，分别反映了医疗保健服务和教育的益处：结论：瘸子训练营：结论："瘸子夏令营：残疾革命 "是一项有效的教育干预措施，它提供并应用了反思残疾人医疗保健经验的知识。这些主题对卫生专业教育和医疗保健服务具有启示意义。

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引用次数: 0

Pattern of contraceptive use among reproductive-aged women with disabilities in Bangladesh: Evidence from multiple indicator cluster survey 2019 孟加拉国育龄残疾妇女使用避孕药具的模式：来自2019年多指标类集调查的证据。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-06-07 DOI: 10.1016/j.dhjo.2024.101651

Background

Contraception is crucial for reproductive-aged women with disabilities, empowering them to manage reproductive choices and enhancing overall health, autonomy, and well-being.

Objective

The objective of this study was to examine the usage patterns of contraceptive methods among reproductive-aged women with disabilities in Bangladesh.

Methods

We analyzed data from 47,465 reproductive-aged women from the 2019 Bangladesh Multiple Indicator Cluster Survey. Outcome variables included contraceptive usage patterns, grouped into any contraceptive methods, any modern contraceptive methods, and any traditional contraceptive methods. The primary explanatory variable considered was disabilities level (women with no disabilities, women with moderate disabilities, and women with severe disabilities), along with types of disabilities. A multilevel mixed-effects logistic regression model was used to assess associations between outcomes and explanatory variables while accounting for confounding.

Results

The prevalence of any contraceptive methods use was 66.4 %, declining to 54 % among women with severe disabilities. The odd of modern contraception use was 31 % lower (aOR, 0.69, 95 % CI, 0.65–0.73) among women with moderate disabilities and 47 % lower (aOR, 0.53, 95 % CI, 0.47–0.60) among those with severe disabilities, compared to women with no disabilities. Within the individual domains of disabilities, those with vision, walking, cognitive, and self-care-related disabilities reported lower odds of modern contraception uptake than those with no disabilities.

Conclusions

The study highlights that women with disabilities use contraceptives less often, increasing vulnerability to unintended and short interval pregnancies and unsafe abortion. Strengthening family planning and prioritizing women with disabilities for modern contraceptives are vital.

背景：避孕对育龄残疾妇女至关重要：避孕对育龄残疾妇女至关重要，它能增强她们管理生育选择的能力，提高整体健康、自主性和幸福感：本研究旨在调查孟加拉国育龄残疾妇女使用避孕方法的模式：我们分析了来自 2019 年孟加拉国多指标类集调查的 47 465 名育龄妇女的数据。结果变量包括避孕药具使用模式，分为任何避孕方法、任何现代避孕方法和任何传统避孕方法。考虑的主要解释变量是残疾程度（无残疾妇女、中度残疾妇女和重度残疾妇女）以及残疾类型。采用多层次混合效应逻辑回归模型评估结果与解释变量之间的关联，同时考虑混杂因素：任何避孕方法的使用率为 66.4%，重度残疾妇女的使用率降至 54%。与非残疾妇女相比，中度残疾妇女使用现代避孕方法的比例低 31%（aOR，0.69，95% CI，0.65-0.73），重度残疾妇女使用现代避孕方法的比例低 47%（aOR，0.53，95% CI，0.47-0.60）。在各个残疾领域中，视力、行走、认知和自我护理相关残疾的妇女采取现代避孕措施的几率低于非残疾妇女：这项研究强调，残疾妇女使用避孕药具的频率较低，这增加了意外怀孕、短间隔怀孕和不安全人工流产的风险。加强计划生育和优先考虑残疾妇女使用现代避孕药具至关重要。

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引用次数: 0

The hidden crisis: Long COVID's association with housing stability and home accessibility among people with disabilities 隐藏的危机：Long COVID 与残疾人住房稳定性和住房无障碍的关系。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-06-07 DOI: 10.1016/j.dhjo.2024.101650

Background

The COVID-19 pandemic has given rise to the emerging phenomenon known as Long COVID, characterized by persistent symptoms long after the acute infection has passed. However, the relationship of Long COVID on housing stability and home accessibility remains underexplored.

Objective

This manuscript aims to comprehensively examine the association of Long COVID on housing stability and accessibility, identifying challenges faced by people with Long COVID and potential strategies to address them.

Methods

The study employs a cross-sectional mixed-methods approach, combining quantitative and qualitative methods. It analyzes data from 1533 people with disabilities, 514 with Long COVID and 1019 without Long COVID, to compare demographics, housing stability, financial concerns, housing problems, and home accessibility. Qualitative analysis extracts thematic insights from 13 participant narratives.

Results

Individuals with Long COVID exhibit significantly higher rates of housing instability (21.1 % v. 8.1 %, p < 0.001) and financial concerns, such as worries about high rent or mortgage (50.4 % v. 40.0 %, p < 0.001), compared to those without Long COVID. They also report more frequent issues with pests (30.0 % v. 23.5 %, p < 0.01) and mold (22.0 % v. 12.7 %, p < 0.001) in their homes. Qualitative analysis reveals financial setbacks, difficulties in obtaining support, and the challenges of home accessibility.

Conclusions

Associations between Long COVID and challenges related to housing stability and home accessibility highlight the need for systemic changes, financial support, and advocacy. This research contributes to understanding Long COVID's challenges, informing policy development, and promoting compassionate responses, ensuring the well-being of people with Long COVID.

背景：在 COVID-19 大流行中出现了一种被称为 "长 COVID "的新现象，其特点是在急性感染过后很长时间仍有持续症状。然而，Long COVID 与住房稳定性和住房可达性之间的关系仍未得到充分探讨：本手稿旨在全面研究长效 COVID 与住房稳定性和无障碍性的关系，确定长效 COVID 患者面临的挑战以及解决这些问题的潜在策略：本研究采用横断面混合方法，结合了定量和定性方法。研究分析了 1533 名残疾人的数据，其中 514 人患有长期慢性病，1019 人不患有长期慢性病，比较了人口统计学、住房稳定性、财务问题、住房问题和住房可达性。定性分析从 13 位参与者的叙述中提炼出主题见解：结果：长 COVID 患者的住房不稳定性明显更高（21.1% 对 8.1%，p 结论：长 COVID 与住房不稳定性之间的关系与长 COVID 的影响密切相关：长期 COVID 与住房稳定性和住房可达性相关的挑战之间的关联凸显了系统性变革、财政支持和宣传的必要性。这项研究有助于了解长期慢性病患者所面临的挑战，为政策制定提供信息，并促进采取富有同情心的应对措施，从而确保长期慢性病患者的福祉。

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引用次数: 0

“As a parent, I want to do more for my child”: A phenomenological approach to understanding the experiences of parents involved in surgical decision-making for children with congenital hand anomalies "作为父母，我想为我的孩子做得更多"：用现象学的方法了解参与先天性手部异常儿童手术决策的父母的经历。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-06-07 DOI: 10.1016/j.dhjo.2024.101647

Background

A congenital anomaly of the hand can affect both function and appearance, and places a stressful psychological burden on the family, especially parents. Surgery during infancy may prevent later disabilities, but little is known of the importance of parents’ involvement in these decisions in terms of psychological adjustment or treatment satisfaction.

Objective

To understand parents' perceptions of involvement in their child's surgery for limb anomaly, and their preferences for the support of healthcare professionals. Results should lead to recommended interventions to improve familial adjustment to the child's condition.

Methods

Qualitative data was collected from semi-structured confidential self-reported interviews of 35 parents (65.7 % mothers) of children who had received reconstructive surgery for congenital hand anomaly (at age 24.89 ± 9.26 months); interviews were coincident with the 1-month postoperative follow-up. The parents ranged in age, gender, educational background, economic status, and type of anomaly. Data analysis referenced Colaizzi's phenomenological approach.

Results

The concerns of the parents were consolidated into three themes: attitudes toward Parental involvement in surgical decision-making; status of parental involvement in Surgical decision-making; and need for help and support.

Conclusion

Some parents were comfortable leaving surgical decisions entirely to the medical staff, but most preferred active participation and were disappointed at their lack of inclusion. The maximum benefit from surgery for congenital abnormalities in infancy is achieved when the parents and extended families have access to the expertise, skills, encouragement, and psychological support of healthcare providers.

背景：先天性手部畸形会影响功能和外观，并给家庭，尤其是父母带来沉重的心理负担。在婴儿期进行手术可预防日后残疾的发生，但从心理适应或治疗满意度的角度来看，父母参与这些决定的重要性却鲜为人知：目的：了解父母对参与孩子肢体异常手术的看法，以及他们对医护人员支持的偏好。方法：从半问卷调查中收集定性数据：对35名接受过先天性手部异常整形手术（年龄为24.89 ± 9.26个月）患儿的家长（65.7%为母亲）进行了半结构化保密自我报告访谈，收集了定性数据；访谈与术后1个月的随访同时进行。家长的年龄、性别、教育背景、经济状况和畸形类型各不相同。数据分析参考了 Colaizzi 的现象学方法：结果：家长们关注的问题归纳为三个主题：对家长参与手术决策的态度；家长参与手术决策的状况；以及需要帮助和支持：结论：一些家长愿意将手术决策权完全交给医务人员，但大多数家长更希望积极参与，并对自己未能参与其中感到失望。如果父母和大家庭能够获得医护人员的专业知识、技能、鼓励和心理支持，就能从婴儿先天性畸形手术中获得最大益处。

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引用次数: 0

Leisure time physical activity in middle-aged and older adults aging with long-term spinal cord injury: Changes over six years 长期脊髓损伤的中老年人的业余体育活动：六年来的变化

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-06-07 DOI: 10.1016/j.dhjo.2024.101648

Background

Regular leisure time physical activity (LTPA) has beneficial health effects in people with spinal cord injury (SCI). Yet, participation in LTPA is low, and little is known about changes many years after injury.

Objectives

To determine changes in LTPA in middle-aged and older adults with long-term SCI over six years, investigate associations with gender, age, injury characteristics and changes in secondary health conditions and activity limitations, and investigate factors related to being physically active or sedentary.

Methods

Part of the Swedish Aging with Spinal Cord Injury Study (SASCIS). LTPA was assessed twice over a six-year period with the Physical Activity Recall Assessment for people with Spinal Cord Injury (n = 75; 32% women, mean age 67 years, mean time since injury 31 years, injury levels C1-L3, AIS A-D). Changes were assessed with paired t-tests, McNemar test and Wilcoxon signed-rank test, associations with multivariable regression and group comparisons with Mann-Whitney U test and Chi Square test.

Results

On group level participation in LTPA did not change, but the variability was substantial on individual level. There were no significant associations between changes in LTPA and the investigated variables. Among sedentary participants, higher level and severity of injury were overrepresented and the activity limitations were greater.

Conclusion

Our findings indicate stability in LTPA over time, but with a large individual variation. In many participants LTPA was insufficient to reach positive health effects. Promoting participation in LTPA is therefore an important part of the long-term management of middle-aged and older adults aging with long-term SCI.

背景有规律的闲暇时间体育活动（LTPA）对脊髓损伤（SCI）患者的健康有益。目标确定患有长期脊髓损伤的中老年人在六年内的闲暇时间体育活动的变化，调查与性别、年龄、损伤特征以及继发性健康状况和活动限制的变化之间的关系，并调查与体育活动或久坐不动有关的因素。方法瑞典脊髓损伤老年人研究（SASCIS）的一部分。在为期六年的时间里，通过脊髓损伤患者体力活动回顾评估（n = 75；32% 为女性，平均年龄为 67 岁，平均受伤时间为 31 年，受伤级别为 C1-L3，AIS A-D），对长轴活动量进行了两次评估。采用配对 t 检验、McNemar 检验和 Wilcoxon 符号-秩检验对变化进行评估，采用多变量回归对关联进行评估，采用 Mann-Whitney U 检验和 Chi Square 检验对组间比较进行评估。长跑锻炼的变化与调查变量之间没有明显关联。结论我们的研究结果表明，随着时间的推移，LTPA 保持稳定，但个体差异很大。在许多参与者中，LTPA 不足以对健康产生积极影响。因此，促进参与长时运动是对患有长期 SCI 的中老年人进行长期管理的重要组成部分。

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引用次数: 0

Predictors of COVID-19 infection and hospitalization in group homes for individuals with intellectual and/or developmental disabilities 智力和/或发育障碍人士集体之家中 COVID-19 感染和住院治疗的预测因素。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-06-05 DOI: 10.1016/j.dhjo.2024.101645

Background

More than seven million people with intellectual and/or developmental disabilities (ID/DD) live in the US and may face an elevated risk for COVID-19.

Objective

To identify correlates of COVID-19 and related hospitalizations among people with ID/DD in group homes in Massachusetts.

Methods

We collected data during March 1, 2020–June 30, 2020 (wave 1) and July 1, 2020–March 31, 2021 (wave 2) from the Massachusetts Department of Public Health and six organizations administering 206 group homes for 1035 residents with ID/DD. The main outcomes were COVID-19 infections and related hospitalizations. We fit multilevel Cox proportional hazards models to estimate associations with observed predictors and assess contextual home- and organizational-level effects.

Results

Compared with Massachusetts residents, group home residents had a higher age-adjusted rate of COVID-19 in wave 1 (incidence rate ratio [IRR], 12.06; 95 % confidence interval [CI], 10.51–13.84) and wave 2 (IRR, 2.47; 95 % CI, 2.12–2.88) and a higher age-adjusted rate of COVID-19 hospitalizations in wave 1 (IRR, 17.64; 95 % CI, 12.59–24.70) and wave 2 (IRR, 4.95; 95 % CI, 3.23–7.60). COVID-19 infections and hospitalizations were more likely among residents aged 65+ and in group homes with 6+ resident beds and recent infection among staff and residents.

Conclusions

Aggressive efforts to decrease resident density, staff-to-resident ratios, and staff infections through efforts such as vaccination, in addition to ongoing access to personal protective equipment and COVID-19 testing, may reduce COVID-19 and related hospitalizations in people with ID/DD living in group homes.

背景：美国有 700 多万智力和/或发育障碍（ID/DD）患者，他们可能面临 COVID-19 的高风险：目的：确定马萨诸塞州集体之家的 ID/DD 患者中 COVID-19 和相关住院治疗的相关因素：我们在 2020 年 3 月 1 日至 2020 年 6 月 30 日（第 1 次调查）和 2020 年 7 月 1 日至 2021 年 3 月 31 日（第 2 次调查）期间从马萨诸塞州公共卫生部和 6 个组织收集了数据，这些组织管理着 206 个团体之家，其中有 1035 名 ID/DD 居民。主要结果是 COVID-19 感染和相关住院治疗。我们采用多层次考克斯比例危险模型来估计与观察到的预测因素之间的关联，并评估家庭和组织层面的环境影响：与马萨诸塞州居民相比，集体之家居民在第一波（发病率比 [IRR]，12.06；95 % 置信区间 [CI]，10.51-13.84）和第二波（发病率比 [IRR]，12.06；95 % 置信区间 [CI]，10.51-13.84）中的年龄调整后 COVID-19 感染率较高。在第 1 波（发病率比 [IRR]，12.06；95 % 置信区间 [CI]，10.51-13.84）和第 2 波（发病率比 [IRR]，2.47；95 % 置信区间 [CI]，2.12-2.88）中，年龄调整后的 COVID-19 住院率较高（IRR，17.64；95 % 置信区间 [CI]，12.59-24.70）和第 2 波（IRR，4.95；95 % 置信区间 [CI]，3.23-7.60）。在 65 岁以上的居民和拥有 6 张以上居民床位的集体之家中，工作人员和居民近期感染 COVID-19 和住院的可能性更大：结论：除了持续提供个人防护设备和 COVID-19 检测外，通过接种疫苗等措施积极降低住户密度、工作人员与住户的比例和工作人员感染率，可减少住在集体之家的智障/残疾人士感染 COVID-19 和相关的住院治疗。

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引用次数: 0

Document analysis of adaptive sport opportunities at Division-1 universities in the United States 对美国一级大学适应性运动机会的文件分析。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-06-05 DOI: 10.1016/j.dhjo.2024.101646

Background

Individuals with disabilities are less likely to participate in physical activity, with the greatest decline in participation during college years. Despite known health benefits, there are significant barriers that limit sport and exercise participation for students with disabilities, including adaptive access. To our knowledge, there has been no comprehensive review conducted to examine the number of adaptive sport offerings on a collegiate level.

Objective

Assess the availability of adaptive sport opportunities for students at National Collegiate Athletic Association (NCAA) Division-1 Universities to better understand university-affiliated adaptive sport opportunity for students.

Methods

Website document analysis was conducted by systematically querying the general homepage, athletics page, and campus recreation websites of each NCAA Division-1 University in the United States (US). Institutional and sport-related characteristics were recorded.

Results

Of the 358 NCAA Division-1 Universities, 20.4 % (73/358) marketed adaptive sport opportunities (recreational, club, and/or intercollegiate), with 3.9 % (11/358) acknowledging intercollegiate adaptive sport programs on their websites. Five percent (6/121) of private institutions, and 28.3 % (67/237) of public institutions reported adaptive sport opportunities. The Northeast region had the fewest number of institutions reporting adaptive sport offerings (4/67, 6.0 %). The most commonly offered sport was adaptive recreation (36/358, 10.2 %), followed by wheelchair basketball (26/358, 7.4 %).

Conclusion

Over three-quarters of Division-1 Universities in the US lack an online description of adaptive sport opportunity, highlighting the need for expanded resourcing and marketing of adaptive sport at the university level. Future studies are necessary to identify appropriate strategies to effectively promote sport, maximize participation and improve social inclusion.

背景：残疾人参加体育锻炼的可能性较小，大学期间的参与率下降幅度最大。尽管已知对健康有益，但残疾学生参与体育锻炼（包括适应性体育锻炼）仍存在重大障碍。据我们所知，目前还没有对大学提供的适应性体育运动的数量进行全面审查：评估全国大学生体育协会（NCAA）一级大学为学生提供的适应性运动机会，以更好地了解大学附属机构为学生提供的适应性运动机会：方法：通过系统查询美国（US）每所 NCAA Division-1 大学的主页、体育网页和校园娱乐网站，对网站文档进行分析。结果：在 358 所 NCAA Division-1 大学中，20.4%（73/358）的大学在其网站上宣传适应性体育机会（娱乐、俱乐部和/或校际），3.9%（11/358）的大学在其网站上承认校际适应性体育项目。5%的私立院校（6/121）和 28.3%的公立院校（67/237）报告了适应性运动机会。东北地区提供适应性体育项目的院校数量最少（4/67，6.0%）。最常提供的体育项目是适应性娱乐（36/358，10.2%），其次是轮椅篮球（26/358，7.4%）：超过四分之三的美国一级大学缺乏关于适应性体育机会的在线描述，这凸显了在大学层面扩大适应性体育资源和营销的必要性。今后有必要开展研究，以确定适当的战略，有效推广体育运动，最大限度地提高参与率和社会包容性。

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引用次数: 0

Bridging research and policy: The Disability and health journal and the Final Rule of Section 504 of the rehabilitation act of 1973 连接研究与政策：残疾与健康》杂志和 1973 年《康复法》第 504 条的最终规则。

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-05-31 DOI: 10.1016/j.dhjo.2024.101644

Monika Mitra PhD, Margaret A. Turk MD

引用次数: 0

Systemic barriers hinder person-centered home and community based services (HCBS): Perspectives of service users and professionals. 系统性障碍阻碍了以人为本的家庭和社区服务（HCBS）：服务使用者和专业人员的观点。

IF 4.5 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal

Pub Date : 2024-05-28 DOI: 10.1016/j.dhjo.2024.101629

Niveda Tennety, Bridgette M Schram, Jacqueline Kish, Tonie Sadler, Ross Kaine, Katie Kaufman, Steve Lutzky, Allen Heinemann

Background: In response to the 2014 Final Settings Rule issued by the Centers for Medicaid and Medicare Services, home-and-community based services (HCBS) provider organizations strengthened person-centered (PC) planning for HCBS to improve participants' choice and control over their services. Despite the call for widespread adoption of PC services, systemic barriers influence service users' and professionals' experiences in receiving and delivering PC services.

Objective: This study describes the perspectives of HCBS professionals and users on systemic barriers that affect PC HCBS delivery.

Methods: Semi-structured interviews with 20 HCBS users and 22 HCBS professionals explored perspectives on providing and receiving PC HCBS as well as higher level systems challenges to providing PC services. Qualitative analysis focused on participants' perspectives of system-level issues.

Results: Qualitative analysis generated three themes: (1) Workforce considerations; (2) Resources and service access; and (3) Infrastructure for feedback. High direct service provider turnover rates, service-eligibility determination procedures, and waitlists affected service delivery. Participants highlighted a need for increased direct service provider compensation, access to higher-quality training, improved financial resources, and effective feedback infrastructures. Waiver flexibility due to the Covid-19 public health emergency allowed expanded service access and improved quality.

Conclusion: Organizational and system-level issues hinder delivery of PC services. Increased flexibility and resource allocation for service provision, as demonstrated in the Covid-19 public health emergency response, should be sustained. HCBS users' suggestions for service-delivery improvements are consistent with recent state and organizational initiatives. HCBS improvements benefit from user-identified solutions in program development and implementation.

背景：为响应医疗补助和医疗保险服务中心发布的 2014 年《最终设置规则》，家庭和社区服务（HCBS）提供机构加强了以人为本（PC）的家庭和社区服务规划，以改善参与者对其服务的选择和控制。尽管人们呼吁广泛采用 PC 服务，但系统性障碍影响了服务使用者和专业人员在接受和提供 PC 服务时的体验：本研究描述了家庭护理服务专业人员和用户对影响个人护理家庭护理服务提供的系统性障碍的看法：对 20 名社区保健服务使用者和 22 名社区保健服务专业人员进行了半结构式访谈，探讨了他们对提供和接受个人护理社区保健服务的看法，以及提供个人护理服务所面临的更高层次的系统挑战。定性分析侧重于参与者对系统层面问题的看法：定性分析产生了三个主题：（1）劳动力考虑因素；（2）资源和服务获取；以及（3）反馈基础设施。直接服务提供者的高更替率、服务资格确定程序和等待名单影响了服务的提供。与会者强调，需要增加直接服务提供者的报酬、提供更高质量的培训、改善财政资源以及建立有效的反馈基础设施。由于 Covid-19 公共卫生紧急状况而产生的豁免灵活性允许扩大服务范围并提高服务质量：结论：组织和系统层面的问题阻碍了个人护理服务的提供。正如 Covid-19 公共卫生突发事件应对措施所展示的那样，在提供服务方面增加灵活性和资源分配应持续下去。HCBS 用户对服务提供改进的建议与近期州和组织的倡议是一致的。在计划制定和实施过程中，用户确定的解决方案将有助于改善 HCBS。

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