Health Disability Research Articles

The Involvement of the Ventral Tegmental Area in the Electroacupuncture Alleviation of Anxiety-Like Behaviors Induced by Chronic Restraint Stress in Mice.

Emotional stress is a significant environmental risk factor for various mental health disabilities, such as anxiety. Electroacupuncture (EA) has been demonstrated to have pronounced anxiolytic effects. However, the neural mechanisms underlying these effects and their contribution to behavioral deficits remain poorly understood. Here, we addressed these issues using a classical mouse anxiety model induced by chronic restraint stress (CRS).Anxiety-like behaviors were evaluated with the open field test and elevated plus maze. Neuronal activation in various brain regions was marked using c-Fos, followed by calculations of interregional correlation to characterize a network that became functionally active following EA at the HT7 acupoint (EA-HT7). We selected the hub regions and further investigated their functions and connections in regulating anxiety-like behaviors by using a combination of chemogenetic manipulations and behavioral testing. CRS exposure induced anxiety-like behaviors. Interestingly, EA-HT7 mitigated these behavioral abnormalities. The c-Fos expression in 30 brain areas revealed a vital brain network for acupuncture responsiveness in naïve mice. Neural activity in the NAcSh (nucleus accumbens shell), BNST (bed nucleus of the stria terminalis), VMH (Ventromedial Hypothalamus), ARC (arcuate nucleus), dDG (dorsal dentate gyrus), and VTA (ventral tegmental area) was significantly altered following acupuncture. Notably, both c-Fos immunostaining and brain functional connectivity analysis revealed the significant activation of VTA following EA-HT7. Interestingly, blocking the VTA eliminated the anxiolytic effects of EA-HT7, whereas chemogenetic activation of the VTA replicated the therapeutic effects of EA-HT7. EA-HT7 has demonstrated benefits in treating anxiety and enhances brain functional connectivity. The VTA is functionally associated with the anxiolytic effects of EA-HT7.

Evaluating an Expanded Health Action Process Approach Model of Health Promotion to Predict Physical Activity Levels of Individuals With Chronic Health Conditions and Disabilities

Physical activity is associated with reduced stress, anxiety, and depression. This study evaluated autonomous motivation and social support for exercise in addition to the Health Action Process Approach (HAPA) model as predictors of physical activity among people with chronic health conditions and disabilities. This is secondary data analysis. Participants were 982 U.S. individuals with chronic health conditions and disabilities. Hierarchical regression analysis (HRA) was used to assess variable impact sequentially, and a serial multiple mediation analysis (SMMA) was utilized to test mediation effect. The HAPA model constructs, autonomous motivation, and social support for exercise accounted for 35% of the variance in physical activity scores, a large effect size. Commitment was the strongest predictor, followed by autonomous motivation and self-efficacy. SMMA results indicated that autonomous motivation was associated with self-efficacy and commitment, and these factors were significantly associated with physical activity. Self-efficacy and commitment significantly mediated the relationship between autonomous motivation and physical activity. Autonomous motivation thus plays an important role in predicting the physical activity levels of adults with disabilities, warranting the inclusion of an autonomy construct in the HAPA model.

A UK-wide survey of community forensic services for adults with intellectual disability and/or autism.

Specialist forensic community teams for people with intellectual disability and/or autism have been developed, but little is known about their extent and delivery. To describe specialist forensic community teams for people with intellectual disability and/or autism across the UK. An online survey was sent to representatives of each UK Trust/Health Board providing adult mental health and/or intellectual disability services. Questions covered the availability, structure and activities of specialist community forensic services. Quantitative data were summarised and associations between access to specialist forensic teams and care were tested with Chi-squared tests. Thematic analysis of free-text survey responses was used to understand the challenges of providing community forensic mental health services for this group. A total of 49 out of 78 (63%) eligible Trusts/Health Boards responded, of which 25 (51%) had access to a specialist forensic community team. Teams operated either as part of a single Trust/Board (n = 13) or over a larger regional footprint (n = 12). The availability of specialist forensic community teams was associated with better access to offence-related interventions (χ2 = 15.1002, P < 0.005) and co-production of patient care plans (χ2 = 7.8726, P = 0.005). Respondents reported a wide variation in availability, expertise and perceived quality of community services. The availability of secure and generic in-patient beds, commissioning and legal barriers were also significant challenges in providing appropriate care. Coverage of specialist community forensic teams is not universal. There are indications that such teams are associated with improved care processes, but further work is needed to establish longer-term outcomes and the optimal model of care.

Debate: Should Parents Should Be Able to Request Non-Resuscitation for All Extremely Premature Newborn Infants?

AbstractInfants who are born extremely prematurely can survive if they receive intensive medical treatment. However, they also have a high chance of dying, and a proportion of survivors have long-term health problems and disabilities. In many parts of the world, if parents request it, an extremely premature infant can receive palliative care rather than active survival-focused care at birth. But there are variations between countries as to whether or when this is permitted. To help inform ethical debates across Asia and more widely, we present two contrasting views about parental discretion and the treatment of extremely preterm infants. In questions of this nature, disagreement and dissensus are inevitable. Differences in the outcomes of treatment, the resources available, and the values of society mean that we should not expect a uniform approach. We identify points of potential consensus and compromise despite disagreement.

Chronic health conditions and disability are prevalent among community users of a digital mental health service: a scoping survey

Objectives: Digital interventions can offer accessible and scalable treatment for chronic conditions, though often focus separately on physical or mental health. People accessing digital health services may live with multiple conditions or experience overlapping symptoms. This study aimed to describe the breadth and characteristics of chronic health conditions and self-reported disability among routine users of a digital mental health service, and to examine related motivations to engage with digital mental health interventions. Methods: A cross-sectional survey of adults registered with a digital mental health service in the Australian community (THIS WAY UP) was conducted. Participant demography, chronic health conditions, self-reported disability and motivations for accessing digital treatment were collected and analyzed descriptively. Results: 366 participants responded (77% female, mean age 50 ± 15 years). 71.6% of participants (242/338) reported ≥1 chronic health condition and one-third reported multimorbidity (112/338, 33.1%). Chronic pain, musculoskeletal and connective tissue disorders were most common. 26.9% of respondents (90/334) reported a disability, most commonly physical disabilities. 95% of those with chronic conditions reported negative mental health effects and 46% reported heightened interest in digital mental health treatments because of their condition. Primary motivations for digital service use were receiving a recommendation from a health professional and service accessibility. Discussion: People who access digital mental health services in routine care report high rates of heterogenous chronic illness and related disability. There is interest in accessible digital treatments to support mental health at scale among people who live with varied chronic conditions and disabilities.

The prevalence and influencing factors of remunerative employment in people with chronic spinal cord injury in a middle-income country: Analysis of the Thai International Spinal Cord Injury Community Survey database

BACKGROUND: Remunerative employment (RE) is one of the optimal rehabilitation goals for people with spinal cord injury (SCI). However, there has been no study systematically determine the RE status and its related factors in Thais with chronic SCI. OBJECTIVE: To cross-sectionally determine RE statuses and their influencing factors in Thais with chronic SCI. METHODS: Data from a Thai arm of the International Spinal Cord Injury Community Survey (InSCI) were analyzed. The prevalence of RE and related work status were described. RESULTS: Of 223 individuals with chronic SCI whose age was less than 60 years included in this study, 79 (35%) were remunerative employed. Most of them (41, 54%) were self-employed. The most common reason for unemployment was related to health conditions or disabilities. Education year, attending vocational rehabilitation service, and admission≥2 times per year were independent influencing factors of RE with an odds ratio of 1.090, 2.534, and 0.418, respectively. CONCLUSION: Since education and vocational rehabilitation were the modifiable positive influencing factor of employment, educational and vocational rehabilitation programs should be formally established and universally applied together with medical rehabilitation to increase the prevalence of RE in people with SCI in Thailand.

State LGBTQ policy environments and the cancer burden insexual and gender minoritized communities in the United States.

Our objective was to assess the association between state policies related to sexual orientation and gender identity (SOGI) and cancer prevalence and survivorship indicators in a sexual and gender minoritized (SGM) population in the United States. Data from the 2017-2021 Behavioral Risk Factor Surveillance System were used to measure cancer diagnosis, physical and mental health, and substance use for SGM adult cancer survivors. A state policy Z-score, ranging from most restrictive to most protective state policies related to SOGI, was computed from data available from the Movement Advancement Project. Survey-weighted logistic regression was used to test the relationship between state policies and cancer-related outcomes for SGM people. More protective state policies were associated with lower odds of a cancer diagnosis (adjusted odds ratio [AOR]: 0.92; 95% confidence interval [CI]: 0.87-0.97). Among SGM cancer survivors, increasing protective state policies were associated with lower odds of poor physical health (AOR: 0.83; 95% CI: 0.74-0.94), lower odds of difficulty walking or climbing stairs (AOR: 0.90; 95% CI: 0.80-1.00), and lower odds of difficulty concentrating or remembering (AOR: 0.87; 95% CI: 0.78-0.98). No significant associations were found between state policies and mental health, depression, substance use, diabetes, or cardiovascular disease among SGM cancer survivors. SGM people diagnosed with cancer are more likely to live in restrictive policy states, and survivors in those states have worse physical health and cognitive disability. Additional research should investigate potential causal relationships between state policies and SGM cancer outcomes.

Best Practices and Lessons Learned From the Public Health Disability Specialists Program: Addressing the Needs of People With Disabilities During COVID-19.

The Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO) applied funding issued by the US Centers for Disease Control and Prevention (CDC) to implement the Public Health Disability Specialists Program, part of a project to address the needs of people with disabilities during the COVID-19 pandemic. Disability specialists (subject matter experts) were embedded within state, territorial, and city/county health departments to help ensure disability inclusion in emergency planning, mitigation, and recovery efforts. To evaluate the success of the Disability Specialists Program in improving emergency response planning, mitigation, and recovery efforts for people with disabilities within participating jurisdictions. Disability specialists worked with their assigned jurisdictions to conduct standardized baseline health department needs assessments to identify existing gaps and inform development and implementation of improvement plans. CDC, ASTHO, and NACCHO implemented a mixed methods framework to evaluate specialists' success. State, territorial, and local health departments across 28 jurisdictions between January 2021 and July 2022. Average number of categories of gaps addressed and qualitative documentation of strategies, barriers, and promising practices. Specialists identified 1010 gaps (approximately 36 per jurisdiction) across eight needs assessment categories, most related to mitigation, recovery, resilience, and sustainability efforts (n=213) and communication (n=193). Specialists addressed an average of three categories of gaps identified; common focus areas included equitable COVID-19 vaccine distribution and accessible communications. Specialists commonly mentioned barriers related to limited health agency capacity (eg, resources) and community mistrust. Promising practices to address barriers included sharing best practices through peer-to-peer networks and building and strengthening partnerships between health departments and the disability community. Embedding disability specialists within state, territorial, and local health departments improved jurisdictional ability to meet evolving public health needs for the entire community, including people with disabilities.

Experiences of loneliness and isolation among people with visual impairment: A review of literature (2016–2023)

According to the UK Government, people with a disability or long-term health condition are more likely to experience chronic loneliness than the general population. However, government figures do not disaggregate data on loneliness among different types of health conditions or disabilities, and it remains unclear how this affects people with visual impairment (VI). This review examines experiences of loneliness and isolation among people with VI. Six databases (CINAHL, PubMed, Scopus, Sage, APA Psycharticles, and Psychology and Behavioural Sciences Collection) were searched using a Population, Interest and Outcome (PIO) framework, yielding a total of 2476 articles. A total of 29 articles were selected and appraised for quality using JBI appraisal tools. These articles represented studies from 14 countries. Relevant Government and voluntary sector organisation websites were also considered. Findings showed widespread experiences of isolation and exclusion among people with VI, but subjective experiences of loneliness did not necessarily align with this. Further research is needed to gain a better understanding of the relationship between VI and loneliness and experiences of loneliness for people with VI within both LGBTQ+ communities and within Black, Asian, and Ethnically Minoritised communities, where research remains notably scant. Studies about the impact of the COVID-19 pandemic showed its heightened effect on isolation and loneliness among the VI community. Further research is needed to understand the long-term effects of this. While technology holds promise in mitigating loneliness and isolation among individuals with VI, accessibility issues persist. Future research is needed to understand how technology-based interventions might address loneliness and isolation for individuals with VI and the accessibility barriers associated with the implementation of these. For loneliness and isolation to be minimised, recognising the diversity within the VI population is imperative for tailoring interventions and initiatives effectively.

Acute kidney injury is associated with soluble vascular cell adhesion molecule 1 levels and short-term mortality in patients with ischemic stroke

BackgroundThe mechanisms that modulate the onset of acute kidney inlury (AKI) after ischemic stroke (IS) and valuable biomarkers to predict the occurrence and prognosis of AKI among patients with IS are missing. ObjectiveTo evaluate the frequency of AKI and the prognostic validity of clinical and laboratory biomarkers in predicting AKI and short-term mortality after the IS. MethodsNinety-five patients with IS were enrolled. Baseline IS severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and disability was determined after three-month follow-up using the modified Rankin Scale. Patients with IS were also categorized as survivors and non-survivors after the follow-up. Baseline data and laboratory biomarkers were obtained up to 24 h of the admission. ResultsFifteen (15.7 %) patients with IS presented AKI. The proportion of patients with vitamin D deficiency and the mortality were higher among those with AKI than those without AKI (p=0.011 and p-0.009, respectively). Patients with AKI showed higher disability and higher increased soluble vascular cellular adhesion molecule-1 (sVCAM-1) than those without AKI (p=0.029 and p=0.023, respectively). Logistic regression analysis showed that only sVCAM-1 was associated with the occurrence of AKI after IS [odds ratio (OR): 2.715, 95 % confidence intereval (CI): 1.12–6.67, p=0.027]. When both AKI and NIHSS were evaluated as explanatory variables, this panel showed an OR of 5.782 (95 % CI: 1.09–30.43, p<0.001) and correctly classified 83.6 % of cases. ConclusionIn conclusion, sVCAM-1 levels showed a potential useful for prediction of AKI after IS.

Health equity via inclusive communications: self-censorship of marginalized health needs in qualitative research

ABSTRACT Based on a multi-phase study conducted on the World Health Organization’s (WHO) age-friendly cities program, healthy-cities program, and global sustainable-cities initiatives, this paper assesses how older adults – particularly those living with chronic health conditions and disabilities – discuss mobility challenges in qualitative research. Initial results indicate that demobilizing levels of travel cost and travel risk are implied, with older adults refraining from direct discussion. Reflective analysis is performed on marginalized older adults’ conceptual associations, ideologies, and response to social norms, to identify sources of pressure which may lead to downplaying or self-censorship on transport disadvantage. Results highlight that inequalities may arise from both the built environment and how research trainees communicate in research. Despite literature which suggests severe impacts of transport disadvantage, older adults may face difficulties in voicing their needs when research trainees adhere to the following social norms. First, physical access and feasibility may be minimized as mere matters of convenience to the able-bodied individual; second, overcoming transportation barriers may be seen as based on one’s effort – as opposed to the disabling effects of the built environment; third, health and fitness in general may be also associated with one’s effort, and increasingly also to one’s commitment to environmental-sustainability; fourth, older adults may feel pressure to align perspectives with more privileged stakeholders, or with the general public; fifth, money and income may be delegitimized as apt research topics, regardless of how inability to overcome travel costs may impact daily-wellbeing. Implications for educating future gerontology-research trainees conclude the study.

Norwegian Health Professionals’ Attitudes Toward Addressing Sexual Health with People with Intellectual Disabilities

Abstract Introduction Staff working with individuals with intellectual disabilities face challenges addressing sexual health. Professionals in this context have diverse backgrounds and education, and little is known about their attitudes and skills in providing support for a healthy sexual life and preventing abuse. Moreover, this topic has not been explored in the Norwegian context. The current study examined health professionals’ attitudes toward addressing sexual health with individuals with intellectual disabilities in Norwegian municipal health and care services. Methods A cross-sectional study was conducted using the Norwegian version of the professionals’ attitudes toward addressing sexual health among 72 health professionals working in municipal services for people with intellectual disabilities in Mid-Norway. The data was collected from November 2022 to January 2023. Results The professionals reported feeling partially comfortable and prepared to address sexual health issues with clients. They consistently expressed a need for more basic knowledge about sexual health and training in communicating about sexuality. Attitudes toward addressing sexual health varied based on the professionals’ education, gender, age, and work experience. Conclusions More targeted training on sexual health is needed within the educational programmes in health and social sciences. Sexual health should also be continuously addressed in the workplace and among colleagues. The differences in attitudes between professionals indicate that the composition of the staff benefits from diversity. Policy Implications Healthcare managers are responsible for ensuring greater openness and reflection on attitudes toward sexuality among individuals with intellectual disabilities in workplaces. Educational institutions must provide the necessary skill development and training in communication about sexual health for this client group.

Mental and Behavioral Health, and Crisis Services for People with Intellectual and Developmental Disabilities in Medicaid Home- and Community-Based Services.

People with intellectual and developmental disabilities (IDD) often have higher rates of comorbid mental health conditions compared to the general population. Yet, many people with IDD also have unmet needs for mental and behavioral health services. The aim of this study was to examine how states provided mental and behavior health, and crisis services to people with IDD in their Home- and Community-Based Services (HCBS) programs, the largest funding mechanism for Long-Term Services and Supports (LTSS) for people with IDD in the United States. We analyzed fiscal year (2021) Medicaid HCBS waivers for people with IDD from across the United States to examine if and how they provided mental and behavior health, and crisis services. States projected spending $968.9million for mental and behavior health, and crisis services for 190,299 people with IDD. Applied behavior analysis services were provided at greater rates than positive behavior supports and other forms of behavior interventions. While most states provided mental and behavior health, and crisis services in their waivers, there were vast inconsistencies in how they did so, across states, waivers, and services. HCBS are a crucial safety net to ensure people with IDD, especially those who also have mental health disabilities, can live and thrive in their communities.

Resveratrol as an Antiaging Drug: A Review of articles

Abstract In recent decades, progressions in care of health have increased the average lifespan, resulting in an increase in old age population. Unfortunately, this has led to an increase in periods of health problems or disabilities, and multiple diseases that associated with aging are responsible for the largest health problems in the majority of developing nations. Many anti-aging approaches such as healthy life styles and medical therapies aimed for reducing the prevalence of bad health conditions and the age associated disease as Alzheimer disease, cardiovascular disease, renal impairment, and cancer. Grapes, peanuts, and blueberries are just a few examples of the many foods that contain resveratrol, numerous reports have shown its importance in antiaging therapy that decreases oxidative stress, lowers inflammation, enhances mitochondrial activity and controls apoptosis. Throughout this review, we will describe the possible antiaging mechanisms of resveratrol and its effect on extension of life span and on many aging-related diseases.

Differences between subjective and disability health expectancies across ages in older adults

Health expectancies (HEs) have become a key indicator for monitoring healthy aging. So far, they have mainly been calculated based on functional rather than subjective health measures. Yet, by integrating several dimensions (medical, social, and cultural), subjective health is also an important measure of an older person’s health status. In this study, we first estimated HEs using self-rated health (SRH), by age and sex. Second, we compared these results to those obtained when using a disability measure. We used pooled data from three prospective population-based cohorts including adults aged 65 years and over, living in Southwestern France (N = 4468). SRH was assessed using a single question and disability was measured using the Lawton scale. Healthy/Unhealthy Life Expectancies (HLE/UHLE) and Disability/Disability-Free Life Expectancies (DLE/DFLE) were estimated using the Interpolated Markov Chain program (IMaCh), separately in men and women. Women lived longer than men, with similar HLE but longer UHLE at all ages. The proportion of HLE in total LE decreased with age for both sexes and for women, it became smaller than the proportion of UHLE from age 73 onward. In both sexes, while the DLE was shorter than the UHLE in the youngest, a reversal was observed with advancing age. This change occurred earlier in women. Our study supports that SRH and disability showed different aging patterns, with sex and age differences. From a public health perspective, SRH and disability indicators appeared not interchangeable as they uncovered complementary but different information on the needs of aging people.

Chronic Health Conditions, Disability, and Physical and Cognitive Limitations Among LGBTQ+ Cancer Survivors.

Cancer survivors are at high risk for chronic health conditions and physical and cognitive limitations. However, few studies have explored these outcomes among LGBTQ+ survivors. We used pooled, weighted Behavioral Risk Factor Surveillance System data from 23 states that completed two specific modules from 2020-2022. We calculated age-adjusted prevalence for heart disease, asthma, COPD, depressive disorders, myocardial infarction, kidney disease, stroke, diabetes, hearing disability, vision disability, cognitive limitations, and difficulty walking, dressing, and running errands in LGBTQ+, lesbian, gay, or bisexual (LGB), transgender or gender non-conforming (TGNC), and non-LGBTQ+ cancer survivors. Four multivariable logistic regression models controlling for different factors were run for each outcome. Of 40,990 cancer survivors, 1,715 were LGBTQ+. LGBTQ+ survivors had significantly higher age-adjusted prevalence of all outcomes. The prevalence of all outcomes was highest among TGNC survivors except for depressive disorders and cognitive limitations. LGBTQ+ survivors had higher odds of reporting asthma (aOR: 1.5, 95%CI:1.2-1.9), depressive disorders (aOR: 1.9, 95%CI:1.6-2.4), kidney disease (aOR: 1.5, 95%CI:1.1-2.1), stroke (aOR: 1.7, 95%CI:1.3-2.3), diabetes (aOR: 1.3, 95%CI:1.0-1.6), vision disability (aOR: 1.6, 95%CI:1.2-2.2), cognitive limitations (aOR: 2.3, 95%CI:1.8-2.9), difficulty walking (aOR: 1.7, 95%CI:1.3-2.0), dressing (aOR: 2.0, 95%CI:1.5-2.7), and running errands (aOR: 1.6, 95%CI:1.3-2.1). In TGNC models, TGNC cancer survivors had increased odds of most outcomes. LGBTQ+ cancer survivors have an elevated burden of all chronic health conditions, disabilities, and limitations assessed. TGNC cancer survivors experience even higher burden of the same outcomes. Findings highlight substantial disparities regarding the health of LGBTQ+ cancer survivors.

Micro-analysis of earnings and its determinants in eastern cape province of South Africa

Earnings disparities in South Africa, and specifically the Eastern Cape region are influenced by a complex interplay of historical, socio-economic, and demographic factors. Despite significant progress since the end of apartheid, persistent disparities in earnings continue to raise questions about the effectiveness of policies aimed at reducing inequality and promoting equitable social system. Individual-level dataset from the 2021 South African general household survey were subjected to exploratory analysis, while Heckman selection model was used to investigate the determinants of earnings disparities in the study area. The results showed that majority of the population are not working for a wage, commission or salary, which also pointed to the gravity of unemployment situation in the area of study. Most of the working population (both male and female) are lowest earners (R ≤ 10,000), and this also cuts across all age-group categories. Majority of working population have no formal education, are drop out, or have less than grade-12 certificate, and very few working populations with higher education status were found in the moderate and relatively high earnings categories. While many of the working population are engaged in the informal sector, those in the formal sector are in the lowest earners group. Compared to any other race, the Black African group constituted the majority of non-wage earners, and most in this group were found in the lowest earners group. Some of the working population who were beneficiaries of social grants and medical aids scheme were found in the lowest, low, and moderate earnings categories. The findings significantly isolated the earnings-effect of age, marital status, gender, race, education, geographic indicators, employment sector, and index of health conditions and disabilities. The study recommends interventions addressing racial, gender, and geographic wage gaps, while also emphasizing the importance of equitable access to education, health infrastructure, and skills development.

Development and validation of a nomogram to predict the depressive symptoms among older adults: A national survey in China

BackgroundDepressive symptoms (DS) have become a global public health problem. However, a risk prediction model for DS in the elderly population has not been established. The purpose of this study was to develop and validate a predictive nomogram to screen for DS in the elderly population. MethodsA cross-sectional data of 3396 participants aged 60 and over were obtained from the China Health and Retirement Longitudinal Study 2018 (CHARLS). Participants were divided into the development and validation set. Predictive factors were selected through a single-factor analysis, and then a predictive model nomogram was established. The discrimination, calibration, and clinical validity were evaluated using the receiver operating characteristic (ROC) curves, Hosmer-Lemeshow tests, and decision curve analyses (DCA). ResultsA total of 2379 and 1017 participants were included in the development and validation set, respectively. The analysis found that gender, residence, dyslipidemia, self-rated health, and ADL disability were risk factors for DS in older adults, and were included in the final model. This nomogram showed an acceptable predictive performance as evaluated by the area under the ROC curve with values of 0.684 (95 % confidence interval (CI): 0.663–0.706) and 0.687 (95 % CI: 0.655–0.719) in the development and validation set, respectively. The calibration curve indicated that the model was accurate, and DCA demonstrated a good clinical application value. ConclusionFive factors were selected to establish a nomogram for predicting DS in older adults. The nomogram has a good evaluation performance and can be used as a reliable tool to predict DS among older adults.

Traumatic Brain Injury and Posttraumatic Stress Disorder Are Associated with Physical Health Burden among Post-9/11 Women Veterans.

Background: Little research focuses on physical health outcomes of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) among post-9/11 women veterans (WVs). This study examined lifetime TBI, current PTSD, and their associations with biomarkers of cardiometabolic health, sleep, pain, and functional disability among post-9/11 WVs. Methods: WVs (n = 90) from the Translational Research Center for TBI and Stress Disorders longitudinal cohort study were included in this study. Gold standard clinician administered interviews assessed lifetime TBI (Boston Assessment of TBI-Lifetime) and current PTSD symptoms (Clinician-Administered PTSD Scale-IV). Objective measures of health included waist-hip ratio (WHR) and fasted blood biomarker (high density lipoprotein [HDL], low density lipoprotein [LDL], blood glucose, triglycerides) levels. Self-reported surveys assessed sleep, pain, and functional disability. Results: Just under two-thirds (58.9%) of WVs experienced a lifetime TBI, and just over half (53.3%) of this sample had a current PTSD diagnosis at the time of testing. Lifetime TBI was significantly associated with higher WHR, triglycerides levels, and worse pain and sleep (ps = <0.01 to 0.02; ds = 0.01 to 1.12). Current PTSD was significantly associated with higher WHR, lower HDL, and worse pain and sleep (ps = <0.01 to 0.02; ds = 0.009 to 1.19). PTSD was significantly associated with lower total functioning and each of its subdomains (βs = -0.58 to 0.63; ps = <0.001 to 0.02). Lifetime TBI was significantly associated with total functioning, mobility, and life/work (βs = -0.20 to 0.30; ps = <0.01 to 0.02). Conclusions: These findings highlight the importance of screening for lifetime TBI and cardiovascular disease for WVs and support transdiagnostic treatment approaches targeting physical health outcomes.

Are children with disabilities more likely to be malnourished than children without disabilities? Evidence from the Multiple Indicator Cluster Surveys in 30 countries

IntroductionA key Sustainable Development Goal target is to eliminate all forms of malnutrition. Existing evidence suggests children with disabilities are at greater risks of malnutrition, exclusion from nutrition programmes and...