Disability-related Health Research Articles

Disabled Employees as A Vulnerable Group in the Labor Market and Mobbing: A Qualitative Research in Tokat Province

Out of the vulnerable and disadvantaged groups in the labor market, disabled employees make up one of the segments that is most exposed to mobbing in the workplace. In this study, we investigated mobbing processes against disabled employees and their effects on them. The research was conducted through faceto-face in-depth interviews with 10 disabled employees in the province of Tokat, between November 2019 and December 2020. The obtained data was analyzed using descriptive and content methods. We examined the characteristics of handicapped employees who had been victims of mobbing, the mobbing acts used against them, causes and types of mobbing and their effects on the victims. The findings show that disabled employees are subjected to acts of mobbing including scolding, mockery, shouting, humiliation, backbiting, overloading, disdain, and being given work below their qualifications. Negative prejudices and attitudes towards disability are among the causes of mobbing against disabled employees in the workplace. Mobbing affects the effective and equal participation of disabled people at work and hinders their permanent presence in the labor market. The psychological and physical health of disabled employees who are victims of mobbing worsen and their disability-related health problems deteriorate. Mobbing impairs the physical and mental health of disabled employees and reduces their productivity as well. Mobbing weakens and eventually breaks these people’s ties with the labor market and their working lives.

Disability and the achievement of Universal Health Coverage in the Maldives.

To assess access to general and disability-related health care among people with disabilities in the Maldives. This study uses data from a case-control study (n = 711) nested within a population-based, nationally representative survey to compare health status and access to general healthcare amongst people with and without disabilities. Cases and controls were matched by gender, location and age. Unmet need for disability-related healthcare is also assessed. Multivariate regression was used for comparisons between people with and without disabilities. People with disabilities had poorer levels of health compared to people without disabilities, including poorer self-rated health, increased likelihood of having a chronic condition and of having had a serious health event in the previous 12 months. Although most people with and without disabilities sought care when needed, people with disabilities were much more likely to report difficulties when routinely accessing healthcare services compared to people without disabilities. Additionally, 24% of people with disabilities reported an unmet need for disability-related healthcare, which was highest amongst people with hearing, communication and cognitive difficulties, as well as amongst older adults and people living in the lowest income per capita quartile. Median healthcare spending in the past month was modest for people with and without disabilities. However, people with disabilities appear to have high episodic healthcare costs, such as for disability-related healthcare and when experiencing a serious health event. This study found evidence that people with disabilities experience unmet needs for both disability-related and general healthcare. There is therefore evidence that people with disabilities in the Maldives are falling behind in core components relevant to UHC: availability of all services needed, and quality and affordability of healthcare.

Special Issue Introduction: Addressing Healthcare Inequities in Intellectual Disability and Developmental Disabilities.

Special Issue Introduction: Addressing Healthcare Inequities in Intellectual Disability and Developmental Disabilities.

Childhood Socioeconomic Status and Late-Adulthood Health Outcomes in China: A Life-Course Perspective

The relationship between socioeconomic status and health has been studied widely across many western countries but the relationship is relatively underexplored in China. Using a life-course perspective, this paper examines the associations between six indicators of childhood socioeconomic status with classic late-adulthood health outcomes. The analysis uses logistic and Ordinary Least Square (OLS) regression models with data on life history and data from the most recent wave of CHARLS – a nationally representative survey of people aged 45 and older. The models demonstrate that unfavourable socioeconomic status in childhood is, in general, correlated with poorer health outcomes later in life, whereas a more socioeconomically advantaged childhood is associated with better health outcomes in middle and older age. However, for those individuals who were overweight in childhood, the advantaged socioeconomic status effect appears to increase the probability of remaining overweight when older. Furthermore, the indicators of current socioeconomic status as well as the interaction terms between childhood socioeconomic status and adulthood socioeconomic status were introduced, as most existing research in the world, including China, tends to only focus on the mediation effect of current socioeconomic status. The findings show that, among all the health outcomes in this research, only the associations between disability-related health variables and adulthood socioeconomic status are moderated by childhood socioeconomic status. These results indicate both homogeneity and heterogeneity in the impacts of childhood socioeconomic status on different health outcomes and also inform public policies in China with regard to population health.

Supporting children’s health needs: an analysis of paid leave policies in 193 countries

ABSTRACT The COVID-19 pandemic has highlighted the extent to which national laws and policies shape public health and economic security. Paid leave policies enable parents to meet children’s health needs while maintaining job and income security. These policies matter immensely to children’s health every year. Yet, little is known about the extent to which policies exist to support the full range of childhood health needs. Using a novel dataset constructed from legislative text in 193 countries, this study assesses whether laws in place in 2019 are adequate to support meeting children’s everyday, serious, and disability-related health needs. Globally, only half of the countries guaranteed working parents access to any paid leave that could be used to meet children’s health needs. Only a third addressed everyday health needs, including leave that matters to reducing infectious disease spread. For serious health needs, even when paid leave was available, it was often too short for complex health conditions. Moreover, although all children require parental presence at medical appointments and for serious illness, fewer countries guaranteed paid leave to care for older children than younger. Addressing these gaps is crucial to supporting child health and working families during times of public health crisis and every year.

Associations of Sustainable Development Goals Accelerators With Adolescents' Well-Being According to Head-of-Household's Disability Status-A Cross-Sectional Study From Zambia.

Objectives: We examined associations between accelerators (interventions impacting ≥2 SDG targets) and SDG-aligned well-being indicators among adolescents 16–24 years old in Zambia. Methods: We surveyed adults from 1,800 randomly sampled households receiving social cash transfers. We examined associations between accelerators (social cash transfers, life-long learning, mobile phone access) and seven well-being indicators among adolescents using multivariate logistic regressions. Results: The sample comprised 1,725 adolescents, 881 (51.1%) girls. Mobile phone access was associated with no poverty (adjusted Odds Ratio [aOR] 2.08, p < 0.001), informal cash transfers (aOR 1.82, p = 0.004), and seeking mental health support (aOR 1.61, p = 0.020). Social cash transfers were associated with no disability-related health restrictions (aOR 2.56, p = 0.004) and lesser odds of seeking mental health support (aOR 0.53, p = 0.029). Life-long learning was associated with informal cash transfers (aOR 3.49, p < 0.001) and lower school enrollment (aOR 0.70, p = 0.004). Adolescents with disabled head-of-household reported worse poverty, good health but less suicidal ideation. Conclusions: Social cash transfers, life-long learning, and mobile phone access were positively associated with well-being indicators. Adolescents living with disabled head-of-household benefited less. Governments should implement policies to correct disability-related inequalities.

P004 Non-Invasive Ventilation - Partnering with Paediatric NDIS participants and their families

Abstract To discuss a new funding pathway for Non-Invasive ventilation (NIV) in Paediatrics. Since October 2019, the National Disability Insurance Scheme (NDIS) introduced funding for NDIS participants in the category ‘Disability-related Health Supports - Respiratory Support’. From August 2020, a nursing project was funded by the Hospital Executive to facilitate the transfer of NIV consumable costs to the NDIS. A retrospective review of 256 NIV patients (Bi-Level Positive Airway Pressure (BiPAP) and Continuous Positive Airway Pressure (CPAP)) and the patients NDIS eligibility status. 110 patients were identified as potential NDIS eligible patients by Primary diagnosis and their families contacted and supported to access NDIS funding for NIV device and consumables. By May 2021, 163 patients were NDIS participants on NIV therapy. Formal Assistive Technology (Respiratory ventilation) requests were developed with Key stakeholder input and supplier quotes obtained for machines and consumables. Nursing support, whilst labour intensive has shown to benefit Paediatric patients and their families accessing NDIS funding for NIV therapy in the future. Furthermore, the purchasing of disability-related health supports through NDIS funding is an alternative funding model for NIV in Paediatrics.

1074The role of epidemiology in improving the health of people with disability

Abstract Focus and outcomes for participants The symposium will focus on the role of epidemiologists in building an evidence base to improve the health of the 15% of the world’s population with disability who currently experience vast health inequalities. Participants will be introduced to new ways of conceptualising disability in epidemiology; state of the art approaches to monitoring disability-related socio-economic and health inequalities; methodological challenges and solutions to address the biases due to misclassification, confounding and reverse causation; and the application of causal mediation analysis and natural experiments in identifying potential policy solutions. Participants will gain a greater understanding of how epidemiological methods can be applied to improve the health of people with disability, as well as insights and ideas for their research. A network of epidemiologists interested in this topic will be generated to foster ongoing communication and collaborative opportunities. Rationale for the symposium, including for its inclusion in the Congress The health of disabled people has largely been ignored by epidemiologists. This is despite emerging evidence that people with disability experience poorer health because of factors unrelated to their impairment, including socio-economic disadvantage, discrimination, and violence. However, turning epidemiologists’ efforts to the health of people with disability presents conceptual and methodological challenges, some of which are unique to the content area. Participants will be shown a suite of approaches that can be deployed to address these problems. Participatory methods and innovative graphical and statistical methods for analysing disability-related health inequalities, approaches rarely used in epidemiology, will be covered. The symposium will also concentrate on the application of methods to optimise causal inference in the presence of multiple potential biases, and methods that simulate randomised controlled trial conditions to model policy interventions. Presentation program The presentations are from researchers from the CRE-DH, funded through Australia’s National Health and Medical Research Council organised four themes. Theme 1: Conceptualisation of disability We will present findings from a scoping review of original articles in epidemiology journals and will argue that, while, disability is usually conceptualised in epidemiology as an outcome, reconceiving of disability as an exposure, mediator and/or effect modifier can provide important insights on the determinants of health of people with disability. Theme 2: Monitoring disability-related inequalities We will demonstrate how the CRE-DH has used participatory methods, where people with disability are ‘experts through lived experience’, to develop indicators to monitor disability-related inequalities and design a National Community Attitudes survey. We will demonstrate innovative ways to graphically illustrate prevalence, absolute and relative inequalities simultaneously, and discuss how hierarchical Bayesian methods can be used to overcome inadequate power due to disaggregation and assess inequalities under uncertainty. Theme 3: Approaches to minimising bias We will talk about how biases can affect estimates of disability prevalence and disability-outcome associations, including reverse causation, confounding and misclassification. We will discuss a range of approaches we have used to address these challenges including modelling incident (rather than prevalent) disability, using fixed effects models and propensity score approaches, and approaches to addressing misclassification bias drawing on examples from our program of research. Theme 4: Identification of policy interventions We will discuss methods that can be used to model the impact of policies on the health of people with disability using examples from our research. We will present the results of a causal mediation analysis modelling the impact of different employment policy interventions on mental health outcomes. We will illustrate the value of natural policy experiments for estimating effects of policy changes on employment and health of people with disability using two examples – the 2014 reassessment of Disability Support Pensioners under stricter impairment tables and the introduction of Australia’s National Disability Insurance Scheme. The symposium will conclude with a facilitated discussion focussed on how epidemiologists can come together internationally to grasp the opportunities and address the challenges in research focussed on the health of people with disabilities. Names of presenters Professor Anne Kavanagh, PhD Dr Nicola Fortune, PhD Dr George Disney, PhD Dr Zoe Aitken Dr Samia Badji, PhD

ЗАГАЛЬНІ ЗАСАДИ СТВОРЕННЯ БЕЗБАР’ЄРНОГО СЕРЕДОВИЩА ДЛЯ ЛЮДЕЙ З ІНВАЛІДНІСТЮ

People with disabilities face many different barriers, including physical, social, and economic ones, which prevent them from participating fully and effectively in public life. They do not have equal access to basic resources such as education, employment, health and social and legal security systems, but have a higher mortality rate. Despite this, disability remains largely unnoticed on the general development agenda of many countries. A barrier-free environment is something that allows people with disabilities to move safely, freely and use all structures within the built environment, roads, parks, gardens and other places. The goal of barrier-free design is to create an environment that supports the independent functioning of people so that they can participate in all activities without outside help. Forms of disability can be very different. Some disability-related health disorders lead to poor health and special health needs, while others do not. However, all people with disabilities have the same general needs as all other people, and therefore need access to basic health, social care and services in the first place. Today, accessibility for all is recognized as a basic necessity, and all over the world are trying to ensure it. Measures to overcome barriers and open the door to an inclusive society must be implemented effectively. In the conditions of the country's development and the focus on the socially-oriented society of popularizing the manifestations of humanism, overcoming the phenomenon of segregation of people with disabilities cannot be ignored. The article proves the urgency of creating a barrier-free environment for people with disabilities. Based on the analysis of the National Strategy for Creating a Barrier-Free Space in Ukraine until 2030, the main goals and directions of work are described. The general manifestations of the existing barriers in the life of people with disabilities are described. Proposed measures to overcome them based on the areas of this Strategy. The principles of Universal Design are described. Compliance with which is provided in the development of all measures to create a barrier-free environment for people with disabilities.

Trajectories of unsecured debt and health at midlife

BackgroundUnsecured debt — debt not tied to an asset — is a financial stressor that undermines health, but prior research has not investigated relationships between group-based trajectories of unsecured debt and pain and disability at midlife. MethodsUS respondents of the National Longitudinal Study of Youth-1979 cohort reported unsecured debt and income between ages 28–40. We used these measures to identify group-based trajectories of unsecured debt and unsecured debt-to-income ratio. We then used trajectory membership to predict three pain and disability-related health outcomes at age 50, adjusting for lagged health and other covariates. ResultsGroup-based trajectory models divided the sample of 7850 respondents into 6 unsecured debt trajectories and 5 unsecured debt-to-income trajectories. In fully adjusted unsecured debt models, compared to people with constant low debt, those who paid down debt over time, carried constant debt, experienced debt cycling, or accumulated debt later in life were more likely to report pain interference with activities or joint pain or stiffness at age 50 (pain interference ORs ranging from 1.33 to 1.76; joint pain or stiffness ORs ranging from 1.27 to 1.45). In fully adjusted unsecured debt-to-income models, compared to those with constant low debt, those with constant high debt or accumulating debt later in life were more likely to report pain interference or joint pain or stiffness (pain interference ORs ranging from 1.30 to 1.91; joint pain or stiffness ORs ranging from 1.19 to 1.33). ConclusionThe amount, timing, and duration of unsecured debt accumulation and repayment have important health implications and may exacerbate midlife health inequalities.

THE RIGHT TO THE HIGHEST ATTAINABLE STANDARD OF MENTAL HEALTH IN SELECTED AFRICAN COUNTRIES: A COMMENTARY ON HOW SELECTED MENTAL HEALTH LAWS FARE AGAINST ARTICLE 25 OF THE CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES

Persons with disabilities have an equal right to access health services, including general health services and disability-related health services. In accessing health care, persons with disabilities encounter many barriers. These include stereotypes about disability on the part of health care providers; a lack of appropriately-trained health care staff; imbalanced power relationships between persons with health needs and medical professionals; inaccessible health care facilities; inaccessible health-related information; and a lack of individualised accommodations.1 These barriers are heightened in the circumstances of persons with psychosocial disabilities who face additional challenges, including legally-sanctioned involuntary commitment; forced treatment; and the use of restraints and solitary confinement in mental health care institutions.In addition, certain categories of persons with psychosocial disabilities require particular attention in health care settings. In this regard, the Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment in his 2013 report notes that ‘women living with disabilities, with psychiatric labels in particular, are at risk of multiple forms of discrimination and abuse inhealth-care settings’.2

Health conditions and victimization among incarcerated individuals in U.S. jails

PurposeIndividuals incarcerated in jails across the U.S. suffer from poorer health compared to the general population. This study examines how mental, physical, and disability-related health conditions correspond to theft and assault victimization in jails. MethodsWe analyze a cross-sectional sample of 3650 jail inmates from the 2011–2012 National Inmate Survey (NIS-3) – Jails Alternative Survey. We assess the relationship between chronic conditions, serious mental illness, anxiety disorders, physical disabilities and two types of victimization in a series of logistic regressions. ResultsHaving a physical disability and serious mental illness significantly heighten the risk of theft victimization by another inmate, net of all covariates. Health conditions are not associated with risk of assault by another inmate. The number of co-occurring conditions is associated with an increase in the risk of theft victimization, but not violent assault by another jail inmate. ConclusionsJail inmates suffering from various health conditions are at increased risk for theft victimization. Despite relatively short stays, many of those in jail suffer from mental, physical, or disability-related health issues that appear to heighten their risk for victimization. It is crucial to develop effective policies to protect the particularly vulnerable from victimization while in custody.

Incidence of Cerebral Palsy, Seizure Disorder and Developmental Delay in Newborns with Hypoxic Ischemic Encephalopathy Following Treatment with Hypothermia

Neonatal Hypoxic ischemic encephalopathy (HIE) is a serious condition that can lead to significant neurological problems, developmental delay, and mortality. Fetal oxygen deficiency decreases cardiac output, leading to reduced cerebral blood flow and brain injury. In 2006 the United States spent over 300 billion dollars in disability related health care expenditure. HIE if left untreated leads to poor quality of life, and survivors end up with lifelong disabilities. Therapeutic hypothermia became standard of care in 2002, and evidence has shown it has neuroprotective benefit. We hypothesize that neonates treated with hypothermia will have lower incidence of cerebral palsy (CP), seizure disorder (SD) and developmental delay (DD), compared to neonates diagnosed with HIE prior to the current standard of care. Compared to healthy neonates, neonates treated with hypothermia will have higher incidence of CP, SD, and DD &#x0D; &#x0D; Project Methods: A retrospective chart review will be performed using 200 participants with medical records from Lutheran health network neonate intensive care unit. Historical data from prior to the current standard of care (January 2007 to 2011) will be used for newborns with HIE. Another data set from January 2015 to December 2019 will be used for newborns treated with hypothermia and healthy patients as well. The TIMP test will be used to assess motor performance in early infancy. The Bayley Scales of Infant and Toddler Development third edition will be used to measure cognitive, language and motor development. Cerebral palsy will be assessed using the Gross Motor Function Classification System. &#x0D; &#x0D; Results: We expect that the results of this study will match previous research, which found that neonates treated with hypothermia had better outcomes compared to neonates not treated with hypothermia. &#x0D; &#x0D; Potential Impact: If found to be effective, this intervention may improve the quality and quantity of a patient’s life and reduce the cost of healthcare spending on disability.

Infusing Service-Learning into Allied Health Profession Curriculum: Perceived Enablers and Barriers

Service-learning may offer an innovative perspective in the competing global and national health interests among Philippine universities. This study sought to understand the enablers and barriers of implementing service-learning in the context of a premier private Catholic Philippine allied health profession education. It used an in-depth descriptive qualitative design. Transcripts from interviews, field notes and organizational documents were analyzed using thematic analysis. Data were coded and categorized into perceived barriers and enablers according to The Self-Assessment Rubric for Institutionalization of Service-Learning in Higher Education (SRISL) by Furco (2002). A wide range of enablers and barriers to implementing SL in one of the university’s health-related program were discussed. The results of this study may support further uptake of service-learning as a signature pedagogy in the allied health profession, particularly for its emerging unique professional identity and role in enhancing disability-related health outcomes.

Association between persistent high costs and chronic physical, mental and disability-related health conditions among community-dwelling Medicare-Medicaid dually eligible enrollees

Background: The 11.4 million Americans who receive both Medicare and Medicaid benefits constitute one of the nation’s most vulnerable and costly populations.

Health Burden and Socioeconomic Disparities From Hearing Loss: A Global Perspective.

To characterize the disability-related health burden of hearing loss (HL) at a global level, with a focus on socioeconomic health disparities. The global burden of HL, as calculated by disability-adjusted life years (DALYs) per 100,000 individuals, was evaluated for 184 countries. Data from 5-year intervals encompassing 1990 to 2015 were organized by human development index (HDI) categorizations as specified by the U.N. Development Program (UNDP). Gini coefficients and concentration indices were used to evaluate global inequality in HL burden over this time period. There was a global lack of improvement in hearing loss burden over 25 years. National HL burden, as measured by age-standardized DALYs, had an inverse relationship with successive level of development (p < 0.0001). Global inequalities in HL burden as measured by the concentration index decreased from 1990 to 2005, remained stable between 2005 and 2010, and slightly increased from 2010 to 2015. Central Sub-Saharan Africa, followed by Eastern Sub-Saharan Africa and South Asia, had the greatest rates of disease burden in 2015. To our knowledge, this analysis is the first to investigate socioeconomic-related inequalities in hearing loss burden using statistical tools such as the Gini coefficient and concentration index. Although inequalities have largely decreased in recent decades, the global burden of hearing loss remains high and there are recent signs of increased inequality. These data suggest that a greater distribution of hearing care resources may need to be directed towards developing countries to combat global hearing loss burden. III.

Breastfeeding Among Women With Physical Disabilities in the United States.

The benefits of breastfeeding are well established, and breastfeeding is now widely practiced in the United States. Although increasing numbers of women with physical disabilities are having children, little information is available about breastfeeding practices among these women. Nonetheless, the children of women with physical disabilities should benefit from breastfeeding just as children of nondisabled mothers do. Research aim: This study aimed to explore the facilitators and barriers to breastfeeding among women with physical disabilities. This study involved semistructured telephone interviews with a convenience sample of women ( N = 25) with diverse physical disabilities from across the United States. All participants had given birth within the past 10 years. Interviews were audio-recorded, professionally transcribed, and analyzed using content analysis. Analyses found four broad themes indicating facilitators to breastfeeding: (a) adaptations and equipment, (b) use of breast pump, (c) physical assistance from others, and (d) peer support. We also found five broad themes suggesting barriers to breastfeeding: (a) lack of supports, (b) disability-related health considerations, (c) limited information, (d) difficulties with milk production, and (e) difficulties latching. The need for greater supports for women with physical disabilities who desire to breastfeed as well as information for women and their clinicians about facilitating breastfeeding.

Patient Satisfaction and Prognosis for Functional Improvement and Deterioration, Institutionalization, and Death Among Medicare Beneficiaries Over 2 Years

ObjectiveTo examine how patient satisfaction with care coordination and quality and access to medical care influence functional improvement or deterioration (activity limitation stage transitions), institutionalization, or death among older adults. DesignNational representative sample with 2-year follow-up. SettingMedicare Current Beneficiary Survey from calendar years 2001 to 2008. ParticipantsCommunity-dwelling adults (N=23,470) aged ≥65 years followed for 2 years. InterventionsNot applicable. Main Outcome MeasuresA multinomial logistic regression model taking into account the complex survey design was used to examine the association between patient satisfaction with care coordination and quality and patient satisfaction with access to medical care and activities of daily living (ADL) stage transitions, institutionalization, or death after 2 years, adjusting for baseline socioeconomics and health-related characteristics. ResultsOut of 23,470 Medicare beneficiaries, 14,979 (63.8% weighted) remained stable in ADL stage, 2508 (10.7% weighted) improved, 3210 (13.3% weighted) deteriorated, 582 (2.5% weighted) were institutionalized, and 2281 (9.7% weighted) died. Beneficiaries who were in the top quartile of satisfaction with care coordination and quality were less likely to be institutionalized (adjusted relative risk ratio [RRR], .68; 95% confidence interval [CI], .54–.86). Beneficiaries who were in the top quartile of satisfaction with access to medical care were less likely to functionally deteriorate (adjusted RRR, .87; 95% CI, .79–.97), be institutionalized (adjusted RRR, .72; 95% CI, .56–.92), or die (adjusted RRR, .86; 95% CI, .75–.98). ConclusionsKnowledge of patient satisfaction with medical care and risk of functional deterioration may be helpful for monitoring and addressing disability-related health care disparities and the effect of ongoing policy changes among Medicare beneficiaries.

Medical security and catastrophic health expenditures among households containing persons with disabilities in Korea: a longitudinal population-based study.

BackgroundAlthough persons with disabilities need access to comprehensive and consistent healthcare services, a significant number of the poor with disabilities do not receive Medical-Aid due to the conditions of eligibility. We aimed to compare the financial burden of healthcare services between two groups of poor persons with disabilities: those not enrolled in Medical-Aid and Medical-Aid enrollees.MethodsThis study used the 1st–8th data (2008–2014 year) of Panel Survey of Employment for the Disabled (PSED) conducted by the Korea Employment Agency for the Disabled. We classified adults who did not exceed 100 % of the poverty level into two groups (N = 3,010). The first group consisted of enrollees in Medical-Aid (n = 1,259) and the second group comprised those not enrolled in Medical-Aid (n = 1,325). We applied generalized estimating equations (GEEs) to assess the independent effect of enrollment in Medical-Aid on catastrophic health expenditures (CHE).ResultsWe found that about 4.2 % of the poor not enrolled in the Medical-Aid experienced CHE and the poor not enrolled in Medical-Aid were 2.1 times more likely to experience CHE than Medical-Aid enrollees after applying multivariate models adjusted for several covariates.ConclusionsGiven the additional expenses for treatment and rehabilitation caused by disability-related health problems, persons with disabilities are more likely to face barriers to needed medical services. Thus, policy makers need to expand the number of people receiving Medical-Aid by loosening the strict criteria for those with disabilities.

Pain Assessment: A Relevant Concern to Increase Quality of Life in People with Intellectual Disabilities

Background: Pain is a serious concern in people with intellectual disabilities. They may experience many painful situations because of the lack of management of common medical problems, because of their disability-related health state and because of age-related illnesses. Literature findings: Validated tools are now available to assess pain with accuracy. People with mild and moderate intellectual disabilities are able to understand pain and they know coping strategies. Most treatments of pain relief, including psychological methods are appropriate. Conclusion: There is still room for development in clinical training and to change attitudes to improve pain management in this population.