Disabling Health Condition Research Articles

Compliance with COVID-19 government guidance and rules by disabled people and people from minoritised ethnic groups: Qualitative findings from the CICADA study.

Within the 2020/21 CICADA (Coronavirus Intersectionalities: Chronic Conditions or Disabilities and Migrants and other Ethnic minorities) study, we explored full, partial or noncompliance with government COVID-19 infection-containment measures by people from minoritised ethnic groups with a disabling health condition or impairment. We used an assets-based intersectional approach and purposive sampling, included non-disabled and White British comparators, and trained community co-researchers to help us reach undocumented migrants and asylum seekers. We undertook 271 semi-structured qualitative interviews, followed by participatory workshops with interviewees to explore data and changes in experiences five and 10 months after the interviews. Perceiving their vulnerability to COVID-19, most participants quickly and often zealously adopted infection-containment behaviours, and continued this after restrictions were lifted. This could reduce mental wellbeing, especially in community-facing cultures, and could create family conflict. Various structural inequities impeded compliance. Many, especially undocumented migrants, felt imprisoned. The intersection of gender, citizenship, socioeconomic status and culture impacted disclosures of COVID-19 infection, support seeking and use. Many were unclear what was safe as well as unsafe. People complained that disability and cultural considerations were omitted from policymaking. Participants mostly had taken the COVID-19 vaccine by October 2022, but ethnic minority participants needed time to deliberate and trusted, community-embedded information whereas White British participants were mostly influenced by mass media. The intersection of health condition or impairment, poverty, and living alone led to more non-compliance with general rules, and more vaccine hesitancy than did misinformation spread through ethnic community channels. Many participants were reluctant to reintegrate in May 2022 because of continued perceived vulnerability to COVID-19 but by September 2022 = seemed more concerned about the economic crisis. We add two new 'types' to existing compliance typologies: deliberators (who eventually decide to follow the rules), and 'necessity-driven non-compliers' who are totally unable to comply because of their disabilities.

Validity, reliability, and responsiveness of the Brazilian version of the instrument World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with obstructive sleep apnoea

BackgroundObstructive sleep apnoea (OSA) is a disabling health condition, and there is no disease-specific patient-reported outcome instrument to assess individuals with OSA. ObjectivesTo evaluate the psychometric properties of the Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) in individuals with OSA. MethodsOne hundred individuals with OSA responded to the WHODAS 2.0 version of 36 items, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the 12-item health survey (SF-12). Internal consistency, convergent and discriminative validity, and responsiveness to continuous positive airway pressure (CPAP) were the psychometric properties tested. ResultsCronbach's α values indicate good internal consistency (0.91 – 0.73), except for the self-care domain (α = 0.52). Convergent validity indicated an excellent correlation (r = -0.80) between the domains of functioning and quality of life. Discriminative validity showed no association between OSA severity and functioning (p = 0.90). The responsiveness to CPAP treatment showed a large effect size (r = 0.82; p < 0.05) ConclusionsThe WHODAS 2.0 instrument is valid, reliable, and responsive for assessing individuals with OSA.

What do we know about Indigenous Peoples with low back pain around the world? A topical review.

Low back pain (LBP) represents a worldwide burden with rising disability, especially in low- and middle-income countries. Indigenous Peoples are exposed to many risk factors for LBP and seem to have overall worse health and higher mortality compared to non-Indigenous. This article aims to provide a topical overview of LBP in Indigenous Peoples. A comprehensive search was done using the keywords "Indigenous" and "back pain." Secondly, a cross-reference search of the citations list of the included articles was conducted. LBP is a prevalent, disabling health condition among Indigenous Peoples that impacts activities of daily living, emotional well-being, and cultural identity. Indigenous Peoples face numerous and unique barriers to obtain Western health care. LBP in Indigenous Peoples is partly iatrogenic and available health care lacks a culturally secure setting. In combination with racism and discrimination by health care providers, this leads to miscommunication, frustration, and poor outcome in Indigenous patients around the world. Contextual considerations and interpretation of findings within the appropriate cultural context are needed in future research and treatment of LBP in Indigenous Peoples. However, our literature analysis exhibits disproportionate representation with the scarcity of studies of Indigenous Peoples of Asia and Africa. Addressing this gap in the literature could provide significant scientific value. Indigenous Peoples should not be forgotten in reducing the global burden for LBP.

High-definition transcranial infraslow pink noise stimulation for chronic low back pain: protocol for a pilot, safety and feasibility randomised placebo-controlled trial

IntroductionChronic low back pain (CLBP) is a common disabling health condition. Current treatments demonstrate modest effects, warranting newer therapies. Brain imaging demonstrates altered electrical activities in cortical areas responsible for...

Adverse Childhood Experiences and Teen Behavior Outcomes: The Role of Disability.

To examine associations between adverse childhood experiences (ACEs) and teen behavior outcomes and whether the presence of disability moderates this relationship. We conducted a secondary analysis of population-based data from the Fragile Families & Child Wellbeing Study urban birth cohort. Disability status included physical/developmental/behavioral conditions (ages 1-5) using mother-reported child health conditions and cognitive disability (age 9), measured by the Peabody Picture Vocabulary Test (PPVT), an assessment of receptive vocabulary. We investigated whether either disability type moderates the relationship between ACEs occurring between ages 5 to 9 and behavior outcomes at age 15, specifically, standardized scales of caregiver-reported externalizing and youth-reported internalizing and delinquent behaviors. Associations were examined using multivariate linear regression models, including interaction effects of ACEs with low PPVT score and disability conditions to assess for potential moderation. Of the 3038 children included, 15% had a cognitive disability and 24% had a disabling health condition. The presence of 2 or more ACEs (compared to none) is associated with more externalizing (by 0.34 standard deviations [SD]), internalizing (0.18 SD), and delinquent (0.18 SD) behaviors. Cognitive disability exacerbates this association for externalizing behaviors and delinquent behaviors while other disabling health conditions do not. ACEs were associated with more behavior problems among urban youth. Cognitive disability, but not other disabling health conditions, compounded this association for externalizing and delinquent behaviors, indicating these children may be particularly vulnerable to the effects of trauma and adversity. Targeted assessment and resources for youth with cognitive disability are critical.

Association Between Cardiometabolic Factors and Dizziness in African Americans: The Jackson Heart Study.

Balance dysfunction is a complex, disabling health condition that can present with multiple phenotypes and etiologies. Data regarding prevalence, characterization of dizziness, or associated factors is limited, especially in an African American population. The aim of the study is to characterize balance dysfunction presentation and prevalence in an African American cohort, and balance dysfunction relationship to cardiometabolic factors. The study design is descriptive, cross sectional analysis. The study sample consist of N = 1,314, participants in the Jackson Heart Study (JHS). JHS participants were presented an initial Hearing health screening questionnaire (N = 1,314). Of these, 317 participants reported dizziness and completed a follow-up Dizziness History Questionnaire. Descriptive analysis was used to compare differences in the cohorts' social-demographic characteristics and cardiometabolic variables to the 997 participants who did not report dizziness on the initial screening questionnaire. Based on questionnaire responses, participants were grouped into dizziness profiles (orthostatic, migraine, and vestibular) to further examine differences in cardiometabolic markers as related to different profiles of dizziness. Logistical regression models were adjusted for age, sex, education, reported noise exposure, and hearing sensitivity. Participants that reported any dizziness were slightly older and predominantly women. Other significant complaints in the dizzy versus nondizzy cohort included hearing loss, tinnitus, and a history of noise exposure (p < 0.001). Participants that reported any dizziness had significantly higher prevalence of hypertension, blood pressure medication use, and higher body mass index (BMI). Individuals with symptoms alluding to an orthostatic or migraine etiology had significant differences in prevalence of hypertension, blood pressure medication use, and BMI (p < 0.001). Alternatively, cardiometabolic variables were not significantly related to the report of dizziness symptoms consistent with vestibular profiles. Dizziness among African Americans is comparable to the general population with regards to age and sex distribution, accordingly to previously published estimates. Participants with dizziness symptoms appear to have significant differences in BMI and blood pressure regulation, especially with associated orthostatic or migraine type profiles; this relationship does not appear to be conserved in participants who present with vestibular etiology symptoms.

Workforce participation of parents of children and youth with mental health difficulties: the impact of community services and supports

ABSTRACT This study explored the effects of demands related to caring for children and youth with mental health difficulties and of resources in community ecologies including health services, schools, neighborhoods, and social supports, on parental workforce participation. Through secondary analysis of U.S. data from the 2016 National Survey of Children’s Health, we found that when children’s mental health issues were more severe, parents experienced frustration with their ability to get services and spent more time providing health care, they were less likely to be employed. Community factors were critical: employed parents reported more frequent contact from the school system, and fewer days that their child missed school. When family members spent more time providing and arranging for health care, were frustrated in their attempts to get services, and reported children missing more school, they cut back their work hours or stopped working. We concluded that parent workforce disengagement patterns were related to demands of exceptional care and to the lack of available community resources. As employers struggle to retain talented workforces, the diversity of employees raising a child or youth with a disabling health condition must be acknowledged, and community supports strengthened.

A classification-based approach to low back pain in primary care \u2013 protocol for a benchmarking controlled trial

BackgroundGuidelines recommend a biopsychosocial framework for low back pain (LBP) management and the avoidance of inappropriate imaging. In clinical practice, care strategies are often inconsistent with evidence and guidelines, even though LBP is the most common disabling health condition worldwide. Unhelpful beliefs, attitudes and inappropriate imaging are common. LBP is understood to be a complex biopsychosocial phenomenon with many known multidimensional risk factors (symptom- and lifestyle-related, psychological and social) for persistent or prolonged disability, which should be identified and addressed by treatment. The STarT Back Tool (SBT) was developed for early identification of individual risk factors of LBP to enable targeted care. Stratified care according SBT has been shown to improve the effectiveness of care in a primary care setting. A biopsychosocially-oriented patient education booklet, which includes imaging guidelines and information, is one possible way to increase patients’ understanding of LBP and to reduce inappropriate imaging. Premeditated pathways, education of professionals, written material, and electronic patient registry support in health care organizations could help implement evidence-based care.MethodsWe will use a Benchmarking Controlled Trial (BCT) design in our study. We will prospectively collect data from three health care regions before and after the implementation of a classification-based approach to LBP in primary care. The primary outcome will be change in PROMIS (Patient-Reported Outcomes Measurement Information System) (short form 20a) over 12-month follow-up.DiscussionThe implementation of a classification-based biopsychosocial approach can potentially improve the care of LBP patients, reduce inappropriate imaging without increasing health-care costs, and decrease indirect costs by reducing work disability. Using the BCT we will be able to evaluate the effectiveness of the improvement strategy for the entire care pathway.Trial registrationISRCTN,ISRCTN13273552, retrospectively registered 13/05/2019.

INCLUSIVE HIGHER EDUCATION: SOCIO-PSYCHOLOGICAL WELL-BEING OF STUDENTS

Introduction. Nowadays, substantial intensification of inclusive processes in educational system (especially in higher education) identifies the need for thorough research of psycho-pedagogical foundations for the development of inclusive education culture.The aimof this research was to identify and compare the levels and factors of social-psychological well-being of healthy students, students with disabilities and students of inclusive groups.Methodology and research methods. At the methodological level, the research was based on the proposition that inclusive education assumes the formation and support of such an integrative socio-psychological space, in which neither students with disabilities nor healthy students feel anxiety in the course of interaction in the classroom or out-of-class situation. As the main methodological tool,a specially designed questionnaire was used for fixing the socio-emographic characteristics of the respondents, as well as for clarifying the problematic experiences of students and their attitudes to using social support resources, for identifying the characteristics of students’ assessments of the conditions of higher education, their satisfaction and involvement in student life and attitudes towards inclusive education. The received results of monitoring were processed by means of the following qualitative and quantitative methods of the analysis: the content analysis; the analysis of percentage with the use of the Pearson’s chi-squared test (χ2); comparative analysis with the use of Student’s t-test; the median test and one-factorial dispersive analysis; correlation and factorial types of the analysis. The statistical software packages Statistica 7.0 were employed for the calculation of the results.Results and scientific novelty. The authors clarified the patterns of formation of the barrier-free socio-psychological environment of the university, which implements the concept of inclusive education. It was established that there are no global differences in the parameters of socio-psychological well-being between students with disabilities and students without disabilities. This determines the favourable social and psychological prerequisites for development of inclusive higher education. Belonging to the same socio-typological and age group and the same leading activity cause the similar experience (e.g. similar problems and difficulties) of both groups of students. The type of disabling health condition, i.e. a disabled student with the defined particular nosological group determines only the specifics of the difficulties, which might be faced in higher school. The conclusion was drawn that successful inclusion of students with disabilities in educational process and social space of university contributes to positive students’ perception of the high school environment.Practical significance. The research outcomes might be used to define the content, directions and forms of work to support students in the conditions of inclusive education. Thus, it is recommended to further develop the system of inclusive education through the following actions: to optimise social conditions of disabled students; to hold rehabilitational and psychological training sessions focused on communication; to organise educational work in order to raise students’ awareness of special technical means of inclusive education; to involve inner circle of people (parents, friends, fellow students) close to disabled students in the process of socio-psychological support.

The Relationship Between PSG and Morning/Evening Emotional Parameters in Patients With Insomnia Disorder and Good Sleepers.

Objectives and Introduction: It is as yet unclear how polysomnographically determined sleep parameters determine emotional well-being both generally and particularly in patients with Insomnia Disorder (ID). ID is a frequent and disabling health condition associated with both day- and nighttime hyperarousal, linked to negative sleep-related ruminations as a cognitive component. Information on the immediate influence of objective sleep quality on emotional parameters is important for therapeutic approaches.Methods: The relationship between objective sleep parameters and two emotional questionnaire items obtained both for evening and morning, relaxation and emotional balance, was determined for both sleep lab nights in 161 ID patients and 161 age and gender matched good sleepers (retrospective sample from the Freiburg data base, 98 female, 63 male in each group, age ID: 42.16 ± 11.55, GSC: 41.91 ± 11.30 years). Multivariate mixed effects analysis, corrected for global influences of group, age and first/second night, was employed to determine between- and within-subject influences of sleep and emotional parameters.Results: Main effects: Within-subject, relaxation in the evening was strongly associated with sleep efficiency, REM latency and low arousal index in NREM sleep. No such influence was significant for emotional balance. Also between subjects, evening relaxation was related to increased sleep efficiency. Group interactions: Patients with larger relaxation values in the evening showed a larger reduction of the number of wake periods and the awakening index in NREM sleep than GSC subjects.Discussion: Unexpectedly, no general influence of emotional balance on sleep was found. The subjective feeling of relaxation, however, was associated with sleep efficiency, REM latency and low NREM sleep arousal index. While the first association may be obvious, a direct link to REM latency and NREM arousal index has not previously been shown. We could also directly observe that the number of wake periods in the PSG is more strongly influenced by evening relaxation in ID patients than in good sleepers, asserting the importance of sleep perception and attitude toward sleep in the therapeutic process.

PMH27 - Age Disparities in Off-Label Use of Antipsychotics Among Wa Medicare-D Beneficiaries

Medicare, which covers all adults over age 65 and younger adults with work disabilities, is the largest public health insurance program in the US. Program drug costs have risen dramatically in the past two decades, due in part to a jump in prescribing of psychiatric medications. This study analyzes patterns of antipsychotic use among Washington state Medicare beneficiaries in 2013. We used Medicare claims data to ascertain the program enrollment status of Medicare beneficiaries, omitting decedents and beneficiaries who added or dropped drug coverage during the 12 month observation period. Our preliminary study sample consisted of all living WA adults (over age 21) continuously enrolled in Medicare Part D or Medicare Advantage in 2013 (N=614,632). We then used the Part D Drug Event file to identify beneficiaries within this subgroup who filled one or more antipsychotic prescriptions (N=39,541). About 6.4% of WA residents continuously enrolled in Medicare Part D or Medicare Advantage received one or more antipsychotic prescriptions. Younger Medicare beneficiaries (aged 21-64) were prescribed antipsychotics at nearly six times the rate of those over age 65 or older (20.0% vs. 3.4%). The majority of antipsychotic users (51.2%) did not appear to have an FDA indicated diagnosis of schizophrenia, major depression, or bipolar and manic disorders. Use for nonindicated diagnoses was more common in older age groups. For example, 84% of antipsychotic users over age 75 do not have an indicated diagnosis, but 51.9% have Alzheimer’s or another dementia. Most WA Medicare beneficiaries who use antipsychotics are under age 65. This group receives early Medicare coverage because they are unable to work due to a disabling health condition, and psychiatric conditions are a very common cause of work disability. Consequently, most younger beneficiaries use antipsychotics for indicated diagnoses.

Why wait to address high-risk cases of acute low back pain? A comparison of stepped, stratified, and matched care.

1. IntroductionAcute low back pain (LBP) is a prevalent and often short-lived pain condition, but it can linger or recur. For approximately 10% of people with acute LBP, it becomes chronic,23 with modest treatment results35 making LBP the most disabling health condition currently.59 Accordingly, pre

Infant Health and Future Childhood Adversity.

Objective To investigate the extent to which disabling infant health conditions are associated with adverse childhood experiences at age 5. Methods We conducted a secondary analysis of data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort. We estimated logistic regression models of associations between the presence of a disabling infant health condition and the child's ACE exposures at age 5, controlling for factors that preceded the child's birth, including the mother's sociodemographic characteristics, physical health, mental illness, and substance abuse and the parents' criminal justice system involvement and domestic violence or sexual abuse. ACEs included 4 categories of child maltreatment (physical, sexual, psychological abuse, neglect) and 5 categories of household dysfunction (father absence, substance use, mental illness, caregiver treated violently, incarceration). Results 3.3% of the children were characterized as having a disabling health condition that was likely present at birth. Logistic regression estimates indicate that having a disabling infant health condition was associated with 83% higher odds of the child experiencing 2 or more ACEs (AOR 1.83, CI 1.14-2.94) and 73% higher odds of the child experiencing 3 or more ACEs (AOR 1.73, CI 1.07-2.77) at age 5. Conclusions for Practice The finding of strong links between disabling infant health conditions and ACEs at age 5 suggests that child health and ACEs play intertwining and mutually reinforcing roles during the early lifecourse and highlights the critical importance of investing in systems that simultaneously promote optimal child development and address childhood adversity.

Neuroprotection in Hypoxic-Ischemic Brain Injury Targeting Glial Cells.

Brain injury constitutes a disabling health condition of several etiologies. One of the major causes of brain injury is hypoxia-ischemia. Until recently, pharmacological treatments were solely focused on neurons. In the last decades, glial cells started to be considered as alternative targets for neuroprotection. Novel treatments for hypoxia-ischemia intend to modulate reactive forms of glial cells, and/or potentiate their recovery response. In this review, we summarize these neuroprotective strategies in hypoxia-ischemia and discuss their mechanisms of action.

Children with disabilities and trajectories of parents' unsecured debt across the life course

Prior research shows that having a child with a disability is economically burdensome for parents but we know little about whether this burden extends to unsecured debt. In this study, we examine the link between having a child with a disability that manifests between birth and age 4 and subsequent trajectories in unsecured household debt. We have three key findings. First, we find that having a child with an early-life disabling health condition is associated with a substantial increase in indebtedness in the years immediately following the child's birth, and that this association persists net of a range of potential confounders. Second, we find that parents do not quickly repay this debt, such that parents of a child with a disabling health condition have different trajectories of unsecured debt across the life course than do parents of children without a disabling health condition. Third, we find that the association between early-life child disability and debt is stronger for more severe conditions, such as those that require ongoing medical treatment. The results of this study are informative for understanding an important aspect of economic functioning—indebtedness—for parents of children with disabilities, as well as the causes and correlates of rising unsecured debt in the U.S.

Body dissatisfaction in older adults with a disabling health condition.

Existing findings on body dissatisfaction in older adults are sparse. In addition, research suggests that chronic illness may elevate risk for body dissatisfaction. Accordingly, this study examined predictors of body dissatisfaction in 274 older adults with a disabling health condition. Most participants reported dissatisfaction with their weight, shape, and/or appearance. Higher body mass index and negative impact of health on appearance predicted body dissatisfaction. Gender comparisons revealed that depressed mood may fuel body dissatisfaction in women. Somatic symptoms predicted body dissatisfaction in men, despite men reporting lower somatic symptoms. Overall, results indicate substantial incidence of and unique risk factors for body dissatisfaction in this population.

Postoperative cognitive dysfunction after liver transplantation

ObjectivePostoperative cognitive dysfunction (POCD) in liver transplant (LT) recipients is defined as a “more than expected” postoperative deterioration in cognitive domains, including short-term and long-term memory, mood, consciousness and circadian rhythm. It is diagnosed, after exclusion of other neurological complications, by using specific neuropsychological tests that need preoperative baseline. The aim of this systematic review was to assess the prevalence of POCD after LT and to analyze patients’ symptoms, type and timing of assessment used. MethodsPubMed, MEDLINE and The Cochrane Li-brary were searched up from January 1986 to August 2014. Study eligibility criteria are as follows: prospective and retrospective studies on human adult subjects describing prevalence of POCD and/or its sequelae after LT episodes were included. ResultsEighteen studies were identified. The timing of testing for POCD may vary between different studies and within the single study, ranging from 0.5 to 32weeks. POCD occurs in up to 50% of LT recipient. ConclusionFuture studies should be focused on detecting preoperative and intraoperative factors associated to POCD in order to carry out appropriate strategies aimed at reducing this disabling health condition. Relationship between POCD and long-term outcome needs to be investigated.

Food Insecurity in US Families with Children with Limiting Health Conditions

Food insecurity in US households with children with limiting health conditions was compared to households with children without limiting health conditions, controlling for demographic variables. Multivariable logistic regression was used to calculate the odds ratios. Data from the 2008-2011 Making Connections Survey (N = 1940) of households with children in seven high poverty communities in the US were used. Having a child with a limiting health condition made a household’s odds 1.41 times (95% C.I., 1.110, 1.790) more likely to be food insecure. When there are two or more children with limiting conditions in the household, the odds of food insecurity are 1.67 times (95% CI, 1.16, 2.40), higher than a family with no children with a disabling health condition. Families with children with limiting health conditions in high poverty communities are especially at risk of experiencing food insecurity, which can complicate health conditions. Nutrition assistance programs are vital to keep children and families food secure.

Negative Affectivity, Emotion Regulation, and Coping in Migraine and Probable Migraine: A New Zealand Case–Control Study

Migraine is a prevalent and disabling health condition. While there have been some suggestions that personality may be linked to migraine incidence, dose-response links to disability or impact are yet to be conducted and multivariate analyses are uncommon. The purposes of this study are to evaluate the personality characteristics differentiating migraine and probable migraine sufferers from matched controls in multivariate models and assess the possibility of a dose-response relationship. Fifty migraine sufferers and 50 age-, sex-, and ethnicity-matched controls in New Zealand completed personality measures including negative affectivity, coping, and monitoring-blunting. Logistic regressions indicated that migraine status was concurrently predicted by Type D negative affectivity, more frequent venting and planning coping, and lower monitoring. There was little evidence to suggest a consistent dose-response type effect of personality on migraine; lower impact and disability were associated with greater openness to experiences, acceptance, and behavioural disengagement. A personality profile characterised by moderate levels of negative emotion and irritability together with failures in inhibitory self-regulation may be associated with an increased risk of strict and probable migraine.

Multimodal evoked potentials in chronic migraine

Background and objectives Chronic migraine (CM) is a disabling health condition. The exact pathophysiological mechanisms are not completely clarified, but a crucial role was attributed to central sensitization. When still episodic, migraine is characterized by a deficient habituation to any kind of sensorial stimulations between attacks, and by an ictal EPs normalization. Less is known about how central sensitization alter this electrocortical profile in CM. Materials & Method – Fifteen episodic and 14 chronic migraine patients underwent median-nerve somatosensory (SSEPs) (right stimulation, 500 sweeps, 4.4 repetition rate, 1.2 motor threshold) and visual (VEPs) evoked potentials (right eye stimulation, 600 sweeps, 3.1 repetition rate, 15 min of arc check) randomly during the same recording session. Patients groups were compared to a group of 22 healthy volunteers (HV) of comparable age and gender distribution. Habituation was calculated as the slope of the linear regression between block 1 to 3 for SSEPs or between block 1 to 6 for VEPs.