Extreme Disabilities Research Articles

Gender-Based Frequency and Associated Disability of Rheumatoid Arthritis: A Cross-Sectional Study

Objective: To determine the frequency and associated disability of rheumatoid arthritis in male and female patients Methodology: This was a cross sectional survey conducted at the National Institute of Rehabilitation Science, Pakistan Institute of Medical Science and Pakistan Railways Hospital for one year from February 2019 to February 2020. Study includes diagnosed cases of both genders with ages between 30 to 60 years and fulfilling the 1987 American College of Rheumatology (ACR) criteria. Patients with disabilities due to other reasons were excluded. Sample size of the study was calculated to be 143 using Epi-tool. Sampling technique was non-probability purposive sampling technique. For this study WHODAS-2.0 screening tool was used. Results: Out of 143 patients, 52 (36.4%) were males and 91(63.6%) were females. The mean age of both males and females was 43.41 ± 8.605 SD. We found that 18 (34.6%) male patients presented with mild disability. While in females, 54 (59.3%), 32 (35.16%), 5 (5.49%), and 0 (0%) patients out of 91, reported with mild, moderate, severe, and extreme disabilities respectively. Conclusion: RA is more prevalent in females than in males with the majority of the patients reporting mild disability and more female patients disabled than men.

Post-retrenchment and Retirement of Mineworkers: A Poor Quality of Life in Transkei Region of South Africa

Background: Former mineworkers are sandwiched between scare resources and little hope of getting re-employment. They do not have enough savings to maintain their families. The expenditure is at its highest when they return from the mines, as the children are grown up and are in secondary or senior secondary school. Many are not re-employable because of poor health, and some are disabled.Objective: To highlight the problem of retrenched mineworkers in the Transkei region of South Africa.Method: The case histories of these mineworkers were recorded either at Benefit Examination Clinic (BEC) or at the forensic pathology laboratory which is situated in the chest section of the Mthatha Hospital, Mthatha.Results: There were 2027 former mineworkers examined at BEC between 1997 and 2000. Of these, 172 (8.48%) were re-examined and only 51 (2.5%) received compensated over the period of four years. The examination of mineworkers has decreased from 1997 (29.6%) to 2000 (3.94%). There were 55 (2.71%) died before they received their benefit of examination.Conclusion: Retrenched mineworkers are frequently under psychosocial pressure, including their families and the community. Extreme poverty, sickness, and disabilities co-exist among these retrenched, retired mineworkers in the Transkei region of South Africa.

Older adults with disability in extreme poverty in Peru: How is their access to health care?

BackgroundDisability rates increase with age. In 2012, Peruvian older adults (≥ 65 years) represented 9% of the population. Additionally, older population reported disabilities at about 5 times the rate of Peruvians between 36 and 64 years old, and 30% of older population lived in poverty. Peruvian seniors living in extreme poverty experience disabilities and the extent of their access to healthcare is unknown.ObjectiveThis study assesses associations between disability and access to healthcare among Peruvians older individuals living in extreme poverty.MethodsSecondary analysis of a national representative population based survey that utilizes information from Peru’s 2012 survey Health and Wellbeing in Older Adults (ESBAM), which includes older adults living in extreme poverty. We define disability in terms of the Activities of Daily Living (ADL disability) framework. Healthcare access was assessed as having any of Peru’s available health insurance schemes combined with preventive health services (vision assessment, influenza vaccination, blood pressure assessment, diabetes screening, and cholesterol assessment). Poisson robust regression models were used to evaluate the associations among relevant variables. Prevalence Ratios and 95% confidence intervals (95%CI) were reported.ResultsData from 3869 individuals (65 to 80 years old), of whom 1760 (45.5%) were females, were analyzed. The prevalence of ADL disability was 17.3% (95%CI: 16.0%-18.4%). In addition, more than 60% had never received any of the preventive measures evaluated, except for the blood pressure assessment. In the adjusted model, people with ADL disability had 63% less probability of having extensive insurance, compared to those without disability (p<0.05).ConclusionsThis study shows that this Peruvian older population living in extreme poverty has limited access to healthcare services. Although there was no consistent association between ADL disability and the healthcare access, there is an urgent need to reduce the inequitable access to healthcare of this poor Peruvian older population.

The National and Regional Prevalence Rates of Disability, Type, of Disability and Severity in Saudi Arabia-Analysis of 2016 Demographic Survey Data.

The prevalence of disability varies between countries ranging from less than 1% to up to 30% in some countries, thus, the estimated global disability prevalence is about 15%. However, it is unknown what the current estimate of disability and its types and severity are in Saudi Arabia. Thus, the objective of this study is to estimate national and regional prevalence rates of any disability, types of disability, and their severity among Saudi populations. Data on disability status were extracted from the national demographic survey conducted in 2016 as reported by the General Authority for Statistics, Saudi Arabia (N = 20,064,970). Prevalence rates per a population of 100,000 of any disability, type of disability, and its severity were calculated at the national level and in all 13 regions. Out of 20,064,970 Saudi citizens surveyed, 667,280 citizens reported disabilities, accounting for a prevalence rate of 3326 per a population of 100,000 (3.3%). Individuals aged 60 years and above (11,014) and males (3818) had a higher prevalence rate of disability compared with females (2813). The Tabuk region has the highest rate of reported disability, at 4.3%. The prevalence rates of extreme disabilities in mobility and sight were higher in Madinah (57,343) and Northern border (41,236) regions, respectively. In Saudi Arabia, more than half a million Saudi citizens (1 out of every 30 individuals) reported the presence of disability during the year 2016. A higher prevalence rate of disability was seen among those aged 60 years and above, and males. Targeted efforts are required at the national and regional levels to expand and improve rehabilitation and social services for all people with disabilities.

Disability and Quality Of Life among People Living With HIV/AIDS in Ibadan, Nigeria

Background: Improvements in medical and pharmacologic management of HIV/AIDS has led to increased life expectancy for the afflicted individuals. Hence, the focus of management for People Living With HIV/AIDS (PLWHA) has shifted to issues relating to function and Quality of Life (QoL). Information is scarce on disability issues and quality of life among people living with HIIV/AIDS in Nigeria. This was the premise of this study that assessed the level of disability and how it related to quality of life among people living with HIV/AIDS in Ibadan, the largest city in Nigeria.&#x0D; Methods: 360 PLWHA (274 females; 86 males) aged 37.79±9.37 years participated in this study. They were recruited from the anti-retroviral clinics of one secondary and one tertiary healthcare facilities in Ibadan, Nigeria. Disability and QoL were assessed using the 12-item WHO Disability Assessment Schedule (WHODAS 2.0) and the WHOQOL_HIV Bref respectively. Data were analysed using Chi square and Kruskal Wallis test at p = 0.05.&#x0D; Results: Almost a quarter (23.6%) reported being currently ill, with HIV/AIDS-related symptoms accounting for the highest perceived illness (42.5%). Majority of these participants (71.1%) had mild to extreme disabilities. There were no significant associations (p &gt; 0.05) between disability and each of age, sex and employment status. Disability was however, significantly associated with level of education, alcohol use, CD4 count, history of tuberculosis and QoL (p &lt;0.01).&#x0D; Conclusion: Disability was relatively high among people living with HIV/AIDS in Ibadan, Nigeria. Although mostly rated mild, disability was associated with poor QoL. This underscores the need for early identification of disability in people living with HIV/AIDS to minimise its impact on their QoL.

Is WHODAS 2.0 Useful for Colorectal Cancer Survivors?

ObjectiveTo compare the disability level of colorectal cancer survivors with and without stoma by using the Korean version of the 12-item, interview-administered World Health Organization Disability Assessment Schedule 2.0 (Korean version of WHODAS 2.0).MethodsThis is a multicenter (five tertiary university hospitals and the Korea Ostomy Association) and cross-sectional survey. Colorectal cancer survivors with and without stoma were interviewed. Survey measured disability level using the Korean version of WHODAS 2.0 and health-related quality of life using the SF-36.ResultsA significant difference was observed between patients with and without a stoma in two subdomains: getting around (31.1 vs. 20.3; p=0.013) and participation in society (32.3 vs. 22.2; p=0.028). After adjusting for age, gender, and time since surgery, having a stoma was associated with severe to extreme disabilities in participation (OR=2.72, p=0.045). The Korean version of WHODAS 2.0 showed satisfactory internal consistency (r=0.96) and convergent validity.ConclusionPatients with stoma participated less in society than those without stoma. The Korean version of WHODAS 2.0 is a reliable and valid instrument for measuring disability in Korean colorectal cancer patients.

Atomic force microscopy analysis of central nervous system cell morphology on silicon carbide and diamond substrates

Brain machine interface (BMI) devices offer a platform that can be used to assist people with extreme disabilities, such as amyotrophic lateral sclerosis (ALS) and Parkinson's disease. Silicon (Si) has been the material of choice used for the manufacture of BMI devices due to its mechanical strength, its electrical properties and multiple fabrication techniques; however, chronically implanted BMI devices have usually failed within months of implantation due to biocompatibility issues and the fact that Si does not withstand the harsh environment of the body. Single crystal cubic silicon carbide (3C-SiC) and nanocrystalline diamond (NCD) are semiconductor materials that have previously shown good biocompatibility with skin and bone cells. Like Si, these materials have excellent physical characteristics, good electrical properties, but unlike Si, they are chemically inert. We have performed a study to evaluate the general biocompatibility levels of all of these materials through the use of in vitro techniques. H4 human neuroglioma and PC12 rat pheochromocytoma cell lines were used for the study, and polystyrene (PSt) and amorphous glass were used as controls or for morphological comparison. MTT [3-(4,5-Dimethylthiazol-2-Yl)-2,5-Diphenyltetrazolium Bromide] assays were performed to determine general cell viability with each substrate and atomic force microscopy (AFM) was used to quantify the general cell morphology on the substrate surface along with the substrate permissiveness to lamellipodia extension. 3C-SiC was the only substrate tested to have good viability and superior lamellipodia permissiveness with both cell lines, while NCD showed a good level of viability with the neural H4 line but a poor viability with the PC12 line and lower permissiveness than 3C-SiC. Explanations pertaining to the performance of each substrate with both cell lines are presented and discussed along with future work that must be performed to further evaluate specific cell reactions on these substrates.

The million visual analog scale: its utility for predicting tertiary rehabilitation outcomes.

A longitudinal cohort study involving 1749 patients with chronically disabling spine disorder (CDSD) who underwent tertiary rehabilitation investigated the relation between the Million Visual Analog Scale (MVAS) score and treatment outcome. To determine whether the pretreatment MVAS rating of disability severity is associated with the ability to complete functional restoration rehabilitation, and to determine whether pre- or posttreatment MVAS disability perception is associated with 1-year posttreatment socioeconomic outcomes. The relation of the MVAS to pre- and posttreatment psychosocial measures and physical performance levels also was evaluated. The MVAS yields a total functional disability score ranging from 0 to 150. Like other "disability inventories," the MVAS differs from a "pain inventory" in that the focus is on disability and function, as opposed to self-reported pain. The MVAS may currently be the most powerful functional rating scale because all its questions relate to the patient's ability to perform activities of daily living. It also has the advantage of a visual analog format, which typically is considered more effective than other commonly used self-report formats. A large cohort of 1749 patients with CDSD who underwent tertiary rehabilitation was divided into groups by their severity of disability, rated on the MVAS, both at pre- and posttreatment assessment. The patients were divided into groups ranging from "no reported disability" (MVAS = 0) to "extreme disability" (MVAS = 131-150). The distribution into the six groups was assessed on both pre- and posttreatment MVAS ratings. The patients underwent a 3-week functional restoration program consisting of daily quantitatively directed exercise progression and multimodal disability management. Physical capacity and psychosocial assessments, performed before and after treatment, were correlated with the MVAS scores. A 1-year posttreatment clinical interview obtained information on socioeconomic outcomes, which also were correlated with the MVAS ratings. Mantel-Haenszel linear analyses showed a number of relations between demographic variables and both pre- and posttreatment MVAS scores. Most importantly, the findings showed that severe pretreatment MVAS scores were associated with a lower program completion rate (94% vs 89%; P < 0.001) and a higher rate of postrehabilitation health care use from a new provider (12% vs 41%; P < 0.001). Prerehabilitation scores also were linearly related to lower levels of pretreatment physical performance and higher rates of pretreatment depression. More severe posttreatment MVAS scores were associated linearly with a drop in the work return rate from 93% to 63%, a drop in the work retention rate 1 year after rehabilitation from 86% to 44%, and a drop in the financial settlement rate from 94% to 79% (P < 0.001). A linear trend also was found in the rate of postrehabilitation surgeries, with the percentages rising from 0% in the group with no reported disabilities to 12% in the group with extreme disabilities (P < 0.001). The current study represents the first large-scale examination of the relation between MVAS ratings and treatment outcomes in a CDSD population. These results demonstrate the effectiveness of a simple disability rating scale, such as the MVAS, for systematic disability assessment in potentially predicting treatment outcomes in patients with CDSD. Despite the popularity of other questionnaires, the MVAS is the first disability inventory with demonstrated effectiveness for this purpose in a large CDSD population.

Matriliny, Marxism, and the Birth of the Communist Party in Kerala, 1930–1940

AbstractWhy has communism flourished in some parts of Asia and not in others? Examining the case of Kerala, this paper argues that, in India at least, social dislocation is the crucial ingredient when added to poverty, landlessness, and literacy. In Kerala, the matrilineal family system of caste-Hindus and the attendant system of extreme disabilities enforced against the low castes collapsed in the early twentieth century. The social upheaval was greater than anywhere else in India. Adéracinégeneration of caste-Hindus was forced to seek remedies for-the disruption and misery that daily confronted it, while increasing numbers of low castes refused to submit to the restrictions that traditional society sought to impose. This situation of social turmoil, similar in some ways to that prevailing in China and Vietnam, contributed crucially to the establishment of Kerala's vigorous, broad-based Communist party in the late 1930s.