Chronic Health Impairments Research Articles

The effects of chronic unpredicted mild stress on maternal negative emotions and gut microbiota and metabolites in pregnant rats.

Chronic long-term stress is associated with a range of disorders, including depression and a variety of other chronic illnesses. It is well known that maternal exposure to psychosocial stress during pregnancy significantly increases the likelihood of adverse pregnancy outcomes. The gut microbiota has been a popular topic, it is a key mediator of the gut-brain axis and plays an important role in human health; changes in the gut microbiota have been related to chronic stress-induced health impairment, however, the relationship between maternal negative emotions and abnormal gut microbiota and its metabolites during maternal exposure to chronic stress during pregnancy remains unclear. Pregnant rats were subjected to chronic unpredicted mild stress (CUMS) to establish the rat model of chronic stress during pregnancy. The behavioral changes were recorded using sucrose preference test (SPT) and open-field test (OFT), plasma corticosterone levels were determined by radioimmunoassay, and a comprehensive method combining 16S rRNA gene sequencing and gas chromatography-mass spectrometry (GC-MS) metabolomics was used to study the effects of stress during pregnancy on the function of intestinal microbiota and its metabolites. Chronic stress during pregnancy not only increased maternal plasma corticosterone (P < 0.05), but also caused maternal depression-like behaviors (P < 0.05). Chronic stress during pregnancy changed the species composition at the family level of maternal gut microbiota, the species abundance of Ruminococcaceae in the stress group (23.45%) was lower than the control group (32.67%) and the species abundance of Prevotellaceae in the stress group (10.45%) was higher than the control group (0.03%) (P < 0.05). Vertical locomotion and 1% sucrose preference percentage in pregnant rats were negatively correlated with Prevotellaceae (r=-0.90, P<0.05). Principal component analysis with partial least squares discriminant analysis showed that the integration points of metabolic components in the stress and control groups were completely separated, indicating that there were significant differences in the metabolic patterns of the two groups, and there were seven endogenous metabolites that differed (P < 0.05). The negative emotional behaviors that occur in pregnant rats as a result of prenatal chronic stress may be associated with alterations in the gut microbiota and its metabolites. These findings provide a basis for future targeted metabolomics and gut flora studies on the effects of chronic stress during pregnancy on gut flora.

The Student Voice: Recommendations for Supporting the Success of Graduate Students with Disabilities in Online Courses

ABSTRACT This article offers recommendations for online graduate students, instructors, and universities to better meet the needs of students with disabilities who increasingly participate in online courses. Using semi-structured interviews, researchers asked what recommendations participants from respective disability categories have for supporting them in their pursuit of a graduate education in an online environment. Thirteen graduate participants represented five disability classifications including learning disabilities, attention deficit disorder/attention deficit hyperactivity disorder, psychological disorders, chronic health impairments, or visual impairments. Interview transcripts were analyzed to identify disability-specific recommendations through constant comparison of individual data sets. Recommendations for students, instructors, and universities focused on instructor-student communication and relationships, online course design, and a changing and active role of institutional support services. The collaborative efforts of all are emphasized.

Do Others Care about me and Encourage me to be Myself? A Propensity-Score Analysis on the Effect of Chronic Health Impairments on Work-Related Perceived Inclusion

Our study evaluated the effect of chronic health impairments on work-related perceived inclusion. Using an online questionnaire, we collected data on employees' perceived inclusion (1807 with and 540 without impairments) and identified matched pairs based on propensity scores. Employees with impairments perceived themselves as less included than their matched pairs without impairments, but only if they regarded themselves as severely limited in their work activities or if they regarded their impairment as severely stigmatized. Limitations and stigmata were found to be independent negative predictors of perceived inclusion. Our findings suggest a need for measures to improve the work-related perceived inclusion of people with chronic health impairments. Such measures should aim at optimising workplace accommodations as well as changing performance-related social norms in organisations and stereotypical assumptions about employees with chronic health impairments.

Case Challenge: Repeated Falls, Muscle Weakness, and Dizziness in an 80-Year-Old Patient

Accurate assessment and management of older adult patients with a history of repeated falls are critical to their overall health status. In older adults, falls are a sign of frailty, immobility, and chronic or acute health impairment. A detailed comprehensive geriatric assessment and medication review are essential for a successful diagnosis and treatment plan.

Chronic pain, mental health and functional impairment in adult refugees from Syria resettled in Norway: a cross-sectional study

BackgroundLimited research exists on pain and especially the co-occurrence of pain and mental ill health in general refugee populations. The present study aimed to approximate the prevalence of chronic pain (CP) among adult refugees from Syria resettled in Norway; investigate the association between CP and mental ill health; and explore how CP and mental ill health associate with both perceived general health and functional impairment. Gender as potential effect modifier in these associations was also examined.MethodsCross-sectional, postal survey questionnaire. Inclusion criteria: ≥ 18 years old; refugee from Syria; and arrived in Norway between 2015 and 2017. Study sample was randomly drawn from full population registries, and n = 902 participated (participation rate ≈10%). CP was measured with 10 items on pain lasting for ≥ 3 consecutive months last year. Symptoms of anxiety, depression and PTSD were measured with the HSCL and HTQ scales, respectively. Ordered and binomial logistic regressions were used in analyses. Gender was tested as effect modifier with Wald test for interaction.ResultsIn the sample overall, the proportion of participants who reported severe CP was 43.1%. There was strong evidence that anxiety, depression and PTSD were associated with higher levels of CP. In fully adjusted regression models, including both CP and mental health variables, CP was strongly associated with poor perceived general health whereas mental health showed much weaker associations. The association between mental health (anxiety and PTSD) and functional impairment was highly gender specific, with strong associations in men but not in women. CP was strongly associated with functional impairment with no difference across gender.ConclusionThe study shows a high burden of CP in a general population of adult refugees from Syria with likely substantial adverse consequences for daily functioning. The strong association between CP and mental ill health suggests personnel working with refugees’ health should be attuned to their co-occurrence as both problems may need to be addressed for either to be effectively mitigated. A clear mismatch exists between the burden on health caused by pain in general refugee populations and the amount of available evidence to guide mitigating strategies.Trial registrationNCT03742128.

P028 Impact of Juvenile Idiopathic Arthritis on schooling

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and is one of the major causes of morbidity and physical disability. Due to frequent absences, children with chronic health impairments are also often confronted with educational difficulties. The aims of this study were to assess the impact of JIA on children’s schooling and to determine the factors that influence their school level. Methods This is a cross-sectional study including patients with JIA (ILAR criteria). A detailed questionnaire was completed for each participant by interviewing them or their parents as well as by information obtained from their medical records. Collected data included age, sex, subtype of JIA, disease duration, level of disability according to the Childhood Heath Assessment Questionnaire (CHAQ), visual analogue scale for patient’s overall assessment of disease activity (VASOA), duration of morning stiffness, tender joint counts (TJCs), swollen joint counts (SJCs), erythrocyte sedimentation rate (ESR), C-Reactive Protein (CRP), Disease Activity Score (DAS28) for polyarticular and oligoarticular JIA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for Enthesitis-related arthritis. Medications used for JIA treatment were also documented. Data on the school performance of patients and their siblings were obtained using telephone interviews (educational level, absenteeism, school delay by repetition, drop-out). Results A total of 43 patients with JIA were included, 25 female and 18 male, with a mean age of 26 years [12–51] and a mean disease duration of 237 months (5–496). The average age of the onset of the disease was 7.4 years [1.5–16]. The most common subtype was rheumatoid factor-positive polyarthritis (n = 18) followed by systematic (n = 8), oligoarticular (n = 8), rheumatoid factor-negative polyarthritis (n = 5) and Enthesitis-related arthritis (n = 4). The mean DAS28 was 3.02 [0.76 – 5.55] and the median CHAQ was 0.66 [0–3]. Twenty-nine of the children were receiving corticosteroid. Disease-modifying anti-rheumatic drugs were used by 38 of the 43 patients: methotrexate (n = 27), sulfasalazine (n = 8), leflunomide (n = 7), biotherapies (n = 16). Twenty patients had complications: Hip arthritis (n = 18), growth stunting (n = 14), uveitis (n = 5). Joint replacement was required in 11 cases. Four patients were illiterate, 14 had dropped out of school, 24 reported repeated absences due to illness. A year of schooling was repeated by 50.85% of patients. Eleven out of 32 patients over the age of 20 had an university level. Almost 80% of patients were exempted of physical education. There were no significant associations between the school-related problems, the socio-demographic characteristics and the various parameters of clinical and biological activity studied. Conclusion Our study suggested that JIA negatively affects schooling of children. More studies, with a larger sample of children, are needed to identify the variables associated with school failure in order to ensure the proper management of these patients and to increase their academic performance.

The BCG disaster, Lübeck, 1930: An Oral History Project of the ‘Calmette Children’ and their Survivorship

Objectives Today Bacillus Calmette Guérin (BCG) is the most common agent used in the intravesical treatment of non- muscle invasive (NMIBC) bladder cancer but originally was used as a vaccine against the widespread scourge of tuberculosis. The public acceptance of this vaccination was, at least in Germany, delayed by an infamous 1930 medical event in which 251 infants were accidentally inoculated with a batch of BCG vaccine contaminated with live mycobacterial cultures. The accident itself was comprehensively investigated but those affected were forgotten. For this oral history project, adult survivors of the 1930 BCG disaster were interviewed in order to document their biographical outcomes and personal perspectives. Methods We conducted personal, recorded interviews with identified survivors of the 1930 BCG accident and relatives. We analyzed contemporary news articles and accounts and secondary sources from German medical and popular literature. Results Of the survivors, a total of 8 patients and 8 family members of patients were interviewed. In addition, two interviews were also conducted with relatives of the presiding judge from the 1931/2 trial and of an involved physician. The 18 biographies make up the dataset for this study. Interviewed survivors, the so called ‘Calmette Kinder’ (Ger.”Kinder”: Children), recounted years of illness and chronic health impairments. The supportive measures taken after the accident by the town of Lübeck were extensive and ranged from medical care and health promoting measures such as additional food for the vaccinated infants to the establishment of an arbitration court for the compensation of the ‘Calmette Kinder’. Conclusions The Lübeck Disaster was a landmark event in the history of biomedical safety, ethics and informed consent. The decades-long consequences of a failed vaccination effort for infants still urges a cautious, measured approach to medical progress today. Lessons learned were critical for the establishment of the modern approach to public vaccination efforts so well-illustrated in the fight against CoVid 19 and other microbiological threats.

Mitochondrial DNA Instability Is Common in HIV-Exposed Uninfected Newborns.

Worldwide, one million HIV-exposed uninfected (HEU) children are born yearly, and chronic health impairments have been reported in these children. Mitochondrial DNA (mtDNA) instability and altered mtDNA content have been evidenced in these children, but an exhaustive characterization of altered mitochondrial genomes has never been reported. We applied deep mtDNA sequencing coupled to the deletion identification algorithm eKLIPse to the blood of HEU neonates (n = 32), which was compared with healthy controls (n = 15). Dried blood spots (DBS) from African HEU children were collected seven days after birth between November 2009 and May 2012. DBS from French healthy controls were collected at birth (or <3 days of life) in 2012 and in 2019. In contrast to the absence of mtDNA instability observed at the nucleotide level, we identified significant amounts of heteroplasmic mtDNA deletions in 75% of HEU children and in none of controls. The heteroplasmy rate of the 62 mtDNA deletions identified varied from 0.01% to up to 50%, the highest rates being broadly compatible with bioenergetic defect and clinical expression. mtDNA integrity is commonly affected in HEU neonates. The nature of the deletions suggests a mechanism related to aging or tumor-associated mtDNA instability. This child population may be at risk of additional mtDNA genetic alterations considering that they will be exposed to other mitotoxic drugs including antiretroviral or anti-tuberculosis treatment.

Leveraging the Biology of Adversity and Resilience to Transform Pediatric Practice.

Advances in science are fundamentally changing the way we understand how inextricable interactions among genetic predispositions, physical and social environments, and developmental timing influence early childhood development and the foundations of health and how significant early adversity can lead to a lifetime of chronic health impairments. This article and companion article illustrate the extent to which differential outcomes are shaped by ongoing interactive adaptations to context that begin at or even before conception and continue throughout life, with increasing evidence pointing to the importance of the prenatal period and early infancy for the developing brain, the immune system, and metabolic regulation. Although new discoveries in the basic sciences are transforming tertiary medical care and producing breakthrough outcomes in treating disease, this knowledge is not being leveraged effectively to inform new approaches to promoting whole-child development and preventing illness. The opportunity for pediatrics to serve as the leading edge of science-based innovation across the early childhood ecosystem has never been more compelling. In this article, we present a framework for leveraging the frontiers of scientific discovery to inform new strategies in pediatric practice and advocacy to protect all developing biological systems from the disruptive effects of excessive early adversity beyond providing information on child development for parents and enriched learning experiences for young children.

Older Adults’ Subjective Age as a Potential Psychological Resource in Clinical Management of Chronic Illnesses

Subject age is predictive of future morbidity and mortality and can be potentially viewed as a psychological resource. However, there seems to be a reciprocal relationship between subjective age and health. In a series of analyses, we demonstrated that various measures of health status such as number of chronic illnesses, self-rated health and sensory impairment have an adverse association with older adults’ subjective age. Specifically, chronic illnesses seem to have a period effect and age effect. Living with chronic illness over a period of time seems to attenuate its association with subjective age. Similarly, the association between chronic illnesses and subjective age gets weaker with increase in older adults’ chronological age. Therefore, asking those living with chronic health conditions and specifically younger older adults about their subjective age and providing appropriate resources, counseling and reassurance about chronic illness management may prevent the downstream negative health effects of increased subjective age.

Participation of young people with disabilities and/or chronic conditions in low- and middle-income countries: a scoping review.

The purpose of this scoping review was to describe and map the literature available on the participation of young people (0-21y) with disabilities and/or chronic conditions living in low- and middle-income countries (LMICs). A systematic search and selection process identified 78 publications. Descriptive data were extracted using a data-charting form, and studies were mapped using the family of participation-related constructs framework. The findings demonstrated that, although the published evidence is steadily increasing, the participation research on this vulnerable population is still either absent or very scarce in the majority of LMICs, and very little is known about the participation of children with chronic health conditions. Most studies included in this review focused on attendance or 'being there'. Although attendance is an important aspect, more needs to be done to understand children's experiences or involvement while attending, thus capturing both dimensions of participation. There is an increasing trend in research on participation patterns of children with disabilities in low- and middle-income countries. Most research focuses on children's attendance, or 'being there'. We know very little about children's involvement, or experience, while attending daily activities.

Examining the effects of light versus moderate to vigorous physical activity on cognitive function in African American adults

Background Physical activity (PA) recommendations for older adults often endorse participation in moderate to vigorous intensity (MVPA). However, health disparities are evident such that African Americans engage in lower levels of MVPA, have a higher prevalence of chronic health and cognitive impairments. The purpose of this cross-sectional study was to examine the role of light PA in addition to MVPA and their associations with measures of executive function among African American older adults. Methods One hundred and ten participants (mean age = 64.78 ± 5.7, males = 14) completed measures of cognitive functioning, including the Trail making, Flanker and the N-back tasks. Additionally, participants completed a 6-minute walk test to estimate their cardiovascular fitness and were given an Actigraph accelerometer for 7-days to objectively assess their light and MVPA. Results Regression analyses controlling for age, fitness and education showed that higher levels of light PA but not MVPA predicted better cognitive performance on the incongruent flanker reaction time (β=-.24), trails B (β=-.24) and 1-back accuracy (β=.28). Both light PA and MVPA predicted faster reaction times on the 1-back and 2-back conditions of the n-back (light PA: β’s=-.22-.23; MVPA: β’s=-.28). Conclusions Light PA demonstrated similar or better associations than MVPA with cognitive functions which are known to decline with age. Designing and promoting light PA interventions in African American older adults maybe more feasible given the prevalence of disability and functional health disparities. Intervention studies testing the efficacy and effectiveness of light PA are needed and could have a significant public health impact among aging African Americans.

Critter quest: an inclusive physical activity app for children - a feasibility study

Purpose: The current paediatric population are not reaching targeted government's guidelines of physical activity. This can lead to serious implications to children's health and wellbeing. Furthermore children with chronic health conditions and/or impairments participate in activity less than the general population. Activity apps have been shown to support positive behavioural change. Although many apps exist, promoting physical activity, an opportunity to design an app inclusive and accessible for children with challenging health conditions and disabilities was identified.

Investigating the relationships between social capital, chronic health conditions and health status among Australian adults: findings from an Australian national cohort survey

BackgroundSocial capital is a collective attribute of communities that determines health and well-being of populations. The collective resources in a high social capital community have been reported to result in better health outcomes. While evidence supports the links between social capital and various health outcomes, it is not clear about underlying mechanisms connecting multiple dimensions of social capital to health.MethodsUsing the two-wave data from a nationally representative cohort study of Australian adults (N = 16,637), this study examined the effects of two dimensions of social capital (i.e., structural and cognitive social capital) on physical and mental health in the Australian adult population. Based on prior literature and theoretical reasoning, it was anticipated that the structural and cognitive social capital would influence self-assessed health status (physical and mental health). Additionally, these two dimensions of social capital were hypothesized to moderate the relationships between chronic health conditions and these two aspects of health status.ResultsAnalyses showed that the effects of chronic health conditions on mental health status were moderated by the structural social capital (β = .652, SE = .249, p = .009). Additionally, it was found that perceived community cohesion was predictive of mental health (β = .295, SE = .103, p = .004). Our analysis also indicated that perceptions of disadvantaged neighbourhood environment contributed to poorer mental health status (β = −.461, SE = .144, p = .001). However, none of the social capital variables significantly predicted physical health status.ConclusionsFindings suggest that the structural dimension of social capital would function as a buffer against the malicious effects of chronic health conditions, impairments and disabilities. Specifically, community participation (structural social capital) is indispensable to develop an effective community-based program to improve health and well-being of those with chronic health conditions or disabilities, as increasing active participation may generate beneficial effects in this vulnerable population. Subjective perceptions about communities can also play an important role in improving better health outcomes. Further research is needed to examine underlying mechanisms linking the multiple dimensions of social capital to health outcomes among individuals who are vulnerable to external stressors.

Socioeconomic Adversity, Negativity in the Parent Child-Relationship, and Physiological Reactivity: An Examination of Pathways and Interactive Processes Affecting Young Children's Physical Health.

We tested the hypothesis that socioeconomic status (SES) would predict children's physical health problems at the end of kindergarten among children whose parent reported greater parent-child relationship (PCR) negativity and/or who exhibited greater parasympathetic (RSA) reactivity. We also tested whether RSA and PCR negativity mediated the SES-health association. Data were collected from 338 children (mean [SD] age, 5.32 [.32] years) and their primary caregivers (87% biological mothers) during the fall and subsequent spring of kindergarten. In the fall, parents reported income and education level (SES) and PCR negativity, and RSA reactivity was assessed via a standardized challenge protocol for young children. In the fall and then spring, parents reported children's chronic medical conditions and physical health impairments. Multivariate regression was conducted within a structural equation-modeling framework to test hypotheses. Significant interactions were found between SES and PCR negativity (b = -0.074, p = .035) and between SES and RSA reactivity (b = 0.169, p = .019) as predicts children's spring health impairment, adjusting for health in the preceding fall. Lower SES was associated with greater health impairment among children whose parents reported more PCR negativity (b = -0.110, p = .024) and children who showed greater RSA reactivity (b = -0.106, p = .011). Socioeconomic status was unrelated to physical health at low PCR negativity or RSA reactivity. Mediation models were not supported. Parent-child relationship quality and individual differences in stress reactivity may modulate the influence of SES on physical health in childhood.

Study on the Strategy of GHS System in Taiwan

The “Globally Harmonized System of Classification and Labeling of Chemicals” (GHS) not only provides a unified system for dealing with the labeling of intrinsic materials and compound chemicals but also furnishes hazard information to the contingency personnel, work site workforce, transportation workforce and consumers for the prevention of acute and chronic health impairments as well as ecological hazards. Since 2008, the GHS has gradually been observed internationally to substitute the classification and labeling of hazardous substances, the Material Safety Data Sheet (MSDS), and relevant regulations on hazardous chemicals which are currently used by many countries; substantial influences have been seen in Taiwan's chemical manufacturing industry, import/export trades, the recognition of labor safety and protection against chemical hazards, as well as the governmental management over chemicals and national legislation and enforcement of the relevant statutes. The study takes safety and health related topics--Management of Chemical Hazards--proposed in the 18th World Congress on Safety and Health at Work convened 2008 at Seoul as the main subject, with questionnaires and interviews carried out against focal groups and experts, for verifying the priority in these safety and health issue.

131: Health and Quality of Life Outcomes for a Cohort of Children with Severe Traumatic Brain Injury

The Multiattribute Health Status Classification System (MHSCS) is a parent/proxy administered tool including a series of health-specific domains that give levels of functioning between 1 (normal health) to 4 or 5 (most severe). Previous studies have used the MHSCS to document chronic health impairment and child morbidity (Gemke et al., 1995; 1996; Feeny et al., 1992; 1993; Saigal et al., 1994). There is a high inter-rater reliability exceeding 70% between caregivers and physiatrists with sensitivity and specificity from acute injury predictors at 75% and 70% (Robertson et al., 2001). The MHSCS is a useful parent-report surveillance tool to audit outcome after severe Traumatic Brain Injury (TBI). To assess the post-injury health outcomes of young children sustaining a severe TBI using the MHSCS. This is a retrospective chart review of children who sustained severe TBI before 12 years of age & were followed in the Brain Injury program. Severe TBI was defined as Glasgow Coma Scale =<8/15. Ethics approval was granted. Demographic variables were collected and expressed as mean (± SD) (range). A multivariate analysis of variance was conducted to compare scores on the MHSCS. A total of 18 children (10 male, eight female) mean age 6.84±3.4 years, (range 1.5 to 11.8 years) were reviewed at three years (n=8) or ≥5 years (n=10) post-injury. An independent t test indicated no significant difference between the Total scores at three and ≥5 years (P=0.23) (Chart 1). The overall difference across subscales was not significantly different (Chart 2). The Cognition Subscale scores increased significantly between three and ≥5 years (P=0.038) and the Emotional Subscale scores increased marginally (P=0.073). Outcomes of severe TBI persist beyond the acute recovery stages. Children experience significantly more difficulties with cognition and emotion at ≥5 years post injury than at three years. This may reflect emerging deficits as they face more complex material at school. Children also experience marginally more emotional difficulties at ≥5 years than at three years. This may reflect developmental maturity making them more aware of their TBI-related limitations. Although it was not significantly different, there was a trend towards lower scores for Mobility and Self-Care Subscales. The MHSCS was a useful parent-report surveillance tool to audit outcome after severe TBI.

British adults with chronic health conditions or impairments face significant barriers to accessing health services

To quantify the extent to which adults with chronic health conditions or impairments in Great Britain experience barriers to accessing health services in comparison to adults without impairments. Secondary analysis of cross-sectional population-based survey data from the Life Opportunities Survey. The Life Opportunities Survey interviewed a nationally representative sample of 37,513 individuals age 16 or older from 19,951 households. A subset of questions addressed disability status, health conditions and impairments, and participation restrictions in accessing public services. Simple bivariate and multivariate logistic regression (controlling for age, gender, and ethnicity) analyses were undertaken to estimate the risk that specific condition/impairment types were associated with barriers to accessing health care. Individuals with chronic health conditions or impairments were significantly more likely to report difficulties accessing health care services. Additionally, individuals in each condition/impairment group had significantly higher odds of experiencing a variety of barriers, including discrimination by healthcare staff, inexperienced or unhelpful staff, lack of help with communication, lack of information, problems with transportation, difficulty getting into buildings, difficulty using facilities, and lack of confidence or anxiety. Individuals with chronic health conditions or impairments are significantly more likely than their non-impaired peers to experience barriers in accessing health care. These barriers are likely to exacerbate disability and may increase the likelihood of developing additional preventable health conditions. As a result, they may contribute towards the health inequalities experienced by disabled people. The existence of these barriers also suggests that health care provision in Great Britain is failing to meet its statutory requirement to provide 'reasonable adjustments' to ensure equality of access for disabled adults.

Review of intrinsic factors related to fall risk in individuals with visual impairments.

Abundant information in the geriatric literature emphasizes the factors relevant to maintenance of independent mobility and reduction of fall risk. However, while some researchers have attempted to identify the relationship between chronic health and visual impairment, few studies have systematically explored the impact of physical interventions that aim to remediate reduced health and function in adults with visual impairments. This review identifies intrinsic physical factors that negatively affect health and independence in adults with visual impairments. By highlighting these factors, we hope to provide a basis for future exercise interventions that will target reductions in the rate of physiological decline while preserving and potentially restoring independent functioning. Because the aging population is increasing and the basis for and subsequent formulation of exercise programs for maintaining mobility and quality of life have not been definitively ascertained for individuals with declining vision, exploring the intrinsic physical factors most amenable to physical rehabilitation becomes relevant.

The effect of a Disability-awareness Program via e-Learning on Enhancing the Self-evaluation, Knowledge and Attitude of Elementary School Studens toward Students with Chronic Health Impairments

The effect of a Disability-awareness Program via e-Learning on Enhancing the Self-evaluation, Knowledge and Attitude of Elementary School Studens toward Students with Chronic Health Impairments