Independent Life Research Articles

An Assessment of Collaborations Between Centers for Independent Living and Vocational Rehabilitation Agencies Around Transition-Age Youth

Centers for independent living (CILs) and vocational rehabilitation (VR) agencies offer transition services that many youth with disabilities could benefit from, but little is known about the existence of and potential for collaborations between these agencies. In this study, we examined data from VR agencies to assess their relationships with CILs involving transition-age youth at the national and state levels, focusing on two types of collaborations: referrals from CILs to VR agencies and VR youth’s use of CIL services. Although many CILs and VR agencies do work together, their relationships vary, and these collaborations reflect only a small fraction of VR youth who are transition age. Further, for each collaboration type, the VR youth involved in these collaborations differ from other people who apply for or use VR services in terms of their characteristics and service use patterns. The findings point to opportunities for greater collaboration between CILs and VR agencies. They also indicate a need for more research to understand the optimal formats and contexts for such collaborations and the criteria for effectively promoting them at the person and agency levels.

Safety profile of hypnotics or sedatives on community-dwelling older adults aged 75 or older in Japan: A retrospective propensity-matched cohort study.

The purpose of the study is to assess if daily use of hypnotics increases mortality, aspiration pneumonia and hip fracture among relatively healthy individuals aged 75years or older who lead independent lives in the community. Of the adults aged 75years or older residing in Hokkaido prefecture of Japan (n=705,538), those who did not meet several exclusion criteria were eligible for generating propensity score-matched cohorts (n=214,723). Exclusion criteria included co-prescribed medications acting on the central nervous system, diagnoses of malignant neoplasm, dementia, depression, etc. We compared 33,095 participants who were prescribed hypnotics for daily use (hypnotic group) with a propensity score-matched cohort without a prescription (control group). Participants were followed for more than 42months. During the 42-month follow-up period, the incidence of the three outcome measures in the hypnotics group was significantly higher than that in the control group (aspiration pneumonia p<0.001, hip fracture p=0.007, and all-cause mortality p<0.001). Sensitivity analyses utilizing inverse probability weighting demonstrated hazard ratios of 1.083 [1.023-1.146] for mortality, 1.117 [1.014-1.230] for aspiration pneumonia, and 1.720 [1.559-1.897] for hip fracture. Meanwhile, the attribute risk differences were 2.7, 1.5, and 1.0 per 1000 patient-years, respectively. Although daily use of hypnotics increased the risk of three events, their attribute risk differences were fewer than 3.0 per 1000 patient-years. The results will help provide guidance on whether it is reasonable to prescribe hypnotics to geriatric population aged 75 or older leading independent lives in the community. UMIN-CTR UMIN000048398.

Relationship between Childhood Trauma and Depression in Youths in the Transition to Independent Living: The Mediating Effect of Disconnection-Rejection Schemas Moderated by Out-of-Home Care Types

Background: This study explored the relationship between childhood trauma, disconnection-rejection schemas, and depression among youths in the transition to independent living. Additionally, this study examined whether the impact of childhood trauma on depression, mediated by disconnection-rejection schemas, was moderated by the type of out-of-home care (residential care centers, group homes, and foster homes).Methods: A survey questionnaire measuring childhood trauma, disconnection-rejection schemas, and depression was administered to 201 participants.Results: Mistrust-abuse and defectiveness-shame schemas mediated the relationship between childhood trauma and depression. In all types of out-of-home care, both the mistrust-abuse and defectiveness-shame schemas mediated the relationship between childhood trauma and depression. There were no significant differences in mediating effects based on the type of out-of-home care.Conclusions: The findings of this study can be applied to the treatment of depression during the transition to independent living in individuals who have experienced childhood trauma.

The Role of Non-Profit Organizations in Solving the Problem of Homelessness

The relevance of the problem is due to the lack of official statistics on persons without a fixed place of residence, the need to consider the characteristics of social problems in order to find the most effective technologies and methods for effectively providing social assistance, as well as the need to consider factors limiting the effectiveness of social work in providing assistance to this category of citizens. As an object of social work, people without a fixed place of residence represent a complex social group. At the same time, social support and rehabilitation of persons without a fixed place of residence remains one of the most important social problems in our country. Technologies of social work with persons without a fixed place of residence have been systematized, and recommendations have been developed for solving identified problems. A comparative description of social assistance aimed at persons without a fixed place of residence is presented. There is state and non-state assistance to persons without a fixed place of residence. The main technologies of social work with persons without a fixed place of residence are technologies of social prevention and rehabilitation. The role of socially oriented non-profit organizations in solving the problem of homelessness is shown. The theoretical data are supported by the opinion of the leaders of non-profit organizations: with a long history of homelessness, a person’s desire to work becomes dull. It can be concluded that the return of persons without a fixed place of residence to independent life is difficult.

The Accumulative Effect of Intravenous Prostaglandin E1 over Nineteen Years to Treat the Ocular Ischemia in High Myopia Keywords: Ocular ischemia, high myopia, prostaglandin E1 (PGE1), extreme choroidal thinning Prostaglandin E1 in High Myopia.

The purpose of this paper is to present the clinical history of the use of intrarvenous (IV) prostaglandin E1(PGE1), a potent vasodilator of the peripheral vascular system, to treat the ischemia in high myopia. This was originally reported in 2009. Three patients with high myopia and progressive visual loss were seen. They all had documented ocular ischemia and were placed under treatment with IV PGE1 for the ischemia. All 3 had central and peripheral visual improvement which initially lasted from 10-14 days after each treatment. PGE1 was well tollerated by all 3. One abbandoned treatment after 4 months because she did not want to be part of an experiment. A second patient had irregular treatments which became ineffective after 15 years. The third has had regular treatments for the last 19 and 1/2 years maintaining a good visual acuity allowing an independent life. He has been able to extend the intervals between treatments to 3- 4 months. He had occasional hypotensive episodes when the medicine was increased especially during the summer. High myopia can be associated with severe central and/or peripheral visual loss. This can be due to ischemia and can lead to NLP in severe cases if not treated. The author presents the use of IV PGE1 as a possible treatment which could be tried in these cases.

ANALYSIS OF SCHOOL CURRICULA IN TERMS OF REFLECTION ON THE DEVELOPMENT OF SELF-CARE SKILLS TO MENTALLY RETARDED SCHOOL CHILDREN

A focus on self-care skills fosters an environment where all children, regardless of ability, can participate and contribute to the classroom community. The formation and development of self-care skills for children with mental retardation during school years is an important and integral part of the overall system of preparing them for study in inclusive settings, independent life and work to the possible extent.&#x0D; At the same time, literature data, work experience of teachers and special educators working in inclusive schools, as well as our observations show that for children with mental retardation, especially in the lower grades, the acquisition of theoretical knowledge and practical skills and self-care skills in various types of daily activities (game, educational, work, etc.) presents significant difficulties. The possession of these skills is important for these children not only during school but also after graduation.&#x0D; The significance of the problem under study also increases because today in Armenia the shift to inclusive education is a reality and children with various needs study together. This requires children's independence, sufficient social behavior skills, spatial orientation skills, high-quality performance and many other self-care skills in a wide variety of areas of activity. The level of development of these skills largely determines the success of inclusion and adaptation of these children among their classmates.&#x0D; Considering the above mentioned, it becomes important to study and analyze school curricula for various disciplines in grades I-IV in terms of how they reflect issues of education and the development of self-care skills for children with mild and moderate mental retardation. This will help to clarify the positive and negative aspects of these programs, the degree of their direct or indirect connection with the issues of developing self-service skills in these children, and to develop appropriate proposals for their improvement.

Human behavior in philosophical and legal understanding: children's aspects during military actions

The article examines the origin of the concept of human behavior. It was found that human behavior became the subject of study in various fields of knowledge. The origins of the formation of the concept of human behavior go back to Antiquity, which can be traced in the works of famous philosophers and thinkers. In this period, the concept of justice and coexistence of members of society was considered. It was established that Christianity had a significant influence on human behavior, which became the starting point in the formation of human behavior, worldview and, as a result, the creation of formal rules that gradually spread to all spheres of human existence. Historical events that were important for changing paradigmatic ideas about human behavior can also be traced during the First and Second World Wars, because it was during these tragic times that the very value of a person and his life, health, honor and dignity acquired a different color, which also influenced behavior and its interpretation. Human behavior can be considered based on age, value, social, moral, somatic, economic, labor, political markers, etc. The formation of human behavior begins at an early age, and parents are primarily agents of the child's socialization and guides to an independent life and in the process of the child's initial learning of his own reaction to events and the differentiation of positive and negative behavior, which builds the basic framework for his further interaction with the surrounding world. All these components affect the further formation of certain standard patterns in a person, which he subconsciously uses as a reaction to the surrounding world. Considerable changes that took place in the post-war period and in the postmodern period are studied. Attention is focused on the change in human behavior in the present.&#x0D; The impact of the war on the behavior of children and youth, which underwent significant changes, was analyzed.

Six elements test vs D-KEFS: what does "Ecological Validity" tell us?

Extensive research shows that tests of executive functioning (EF) predict instrumental activities of daily living (IADLs) but are nevertheless often criticized for having poor ecological validity. The Modified Six Elements Test (MSET) is a pencil-and-paper test that was developed to mimic the demands of daily life, with the assumption that this would result in a more ecologically valid test. Although the MSET has been extensively validated in its ability to capture cognitive deficits in various populations, support for its ability to predict functioning in daily life is mixed. This study aimed to examine the MSET's ability to predict IADLs assessed via three different modalities relative to traditional EF measures. Participants (93 adults aged 60 - 85) completed the MSET, traditional measures of EF (Delis-Kaplan Executive Function System; D-KEFS), and self-reported and performance-based IADLs in the lab. Participants then completed three weeks of IADL tasks at home, using the Daily Assessment of Independent Living and Executive Skills (DAILIES) protocol. The MSET predicted only IADLs completed at home, while the D-KEFS predicted IADLs across all three modalities. Further, the D-KEFS predicted home-based IADLs beyond the MSET when pitted against each other, whereas the MSET did not contribute beyond the D-KEFS. Traditional EF tests (D-KEFS) appear to be superior to the MSET in predicting IADLs in community-dwelling older adults. The present results argue against replacing traditional measures with the MSET when addressing functional independence of generally high-functioning and cognitive healthy older adult patients.

Hispanic/Latino Ethnicity and Loss of Post-Surgery Independent Living: A Retrospective Cohort Study from a Bronx Hospital Network.

Black race is associated with postoperative adverse discharge to a nursing facility, but the effects of Hispanic/Latino ethnicity are unclear. We explored the Hispanic paradox , described as improved health outcomes among Hispanic/Latino patients on postoperative adverse discharge to nursing facility. A total of 93,356 adults who underwent surgery and were admitted from home to Montefiore Medical Center in the Bronx, New York, between January 2016 and June 2021 were included. The association between self-identified Hispanic/Latino ethnicity and the primary outcome, postoperative adverse discharge to a nursing home or skilled nursing facility, was investigated. Interaction analysis was used to examine the impact of socioeconomic status, determined by estimated median household income and insurance status, on the primary association. Mixed-effects models were used to evaluate the proportion of variance attributed to the patient's residential area defined by zip code and self-identified ethnicity. Approximately 45.9% (42,832) of patients identified as Hispanic/Latino ethnicity and 9.7% (9074) patients experienced postoperative adverse discharge. Hispanic/Latino ethnicity was associated with lower risk of adverse discharge (relative risk [RR adj ] 0.88; 95% confidence interval [CI], 00.82-0.94; P < .001), indicating a Hispanic Paradox . This effect was modified by the patient's socioeconomic status ( P -for-interaction <.001). Among patients with a high socioeconomic status, the Hispanic paradox was abolished (RR adj 1.10; 95% CI, 11.00-1.20; P = .035). Furthermore, within patients of low socioeconomic status, Hispanic/Latino ethnicity was associated with a higher likelihood of postoperative discharge home with health services compared to non-Hispanic/Latino patients (RR adj 1.06; 95% CI, 11.01-1.12; P = .017). Hispanic/Latino ethnicity is a protective factor for postoperative adverse discharge, but this association is modified by socioeconomic status. Future studies should focus on postoperative discharge disposition and socioeconomic barriers in patients with Hispanic/Latino ethnicity.

A Recent History of Activism for Accessibility in Japan (1981–2006)

In this article, I consider how Japanese activists for accessibility localized concepts born out of American and European advocacy, reinterpreted them in light of domestic conditions, and then used them to pass policies for some physically disabled communities between 1981 and 2006. My analysis, which examines newspapers, magazines, state records, and documents from disability organizations, highlights how Japanese activists negotiated global understandings of Independent Living and capitalized on local concerns about the nation’s aging population to convince policy makers to promote the creation of barrier-free facilities and implementation of Universal Design. I conclude that the study of disability in Japan and other parts of the world must include the study of successes and failures of activism for accessibility in differing cultural contexts, and that further research on Japan is needed to continue improving the inclusivity of our increasingly global society.

Retrospective Analysis of Circumstances of Falls and Related Injuries across Levels of Care in Older Adult Retirement Home Facilities.

Towards developing more effective interventions for fall-related injuries, this study analysed a novel database from six retirement home facilities over a 4-year period comprising 1,877 fallers and 12,445 falls. Falls were characterized based on location, activity, injury site, and type, and the database was stratified across four levels of care: Independent Living, Retirement Care, Assisted Care, and Memory care. Falls most occurred within the bedroom (62.8%), and during unknown (38.1%), walking (20.2%), and transfer tasks (14.6%). Approximately one in three (37%) of all falls resulted in an injury, most commonly involving the upper limb (31.8%), head (26.3%), and lower limb (22.2%), resulting in skin tears (35.3%), aches/pains (29.1%), or bruises (28.0%). While fall location, activity, and injury site were different across levels of care, injury type was not. The data from this study can assist in targeting fall-related injury prevention strategies across levels of care within retirement facilities.

결혼이주여성의 디지털 정보 활용 역량, 사회자본, 삶의 만족도 관계

The purpose of this study is to verify the mediating effect of social capital in the relationship between marriage immigrant women's digital information utilization capabilities and life satisfaction. To achieve this research objective, the responses of 563 women among marriage immigrants in the “2022 Digital Information Gap Survey” data were used using SPSS 25.0 and AMOS 24.0 statistical packages, with digital information utilization capabilities as the independent variable and life satisfaction as the dependent variable. It was set to . In addition, the hypothesis was tested using a structural equation model using social capital, which is expected to play a mediating role in their relationship, as a mediating variable. As a result, first, the impact of marriage immigrant women's digital information utilization capabilities on life satisfaction was not statistically significant. Second, marriage immigrant women's ability to use digital information had a positive effect on social capital. Third, the social capital of married immigrant women was found to have a positive (+) effect on life satisfaction. Fourth, as a result of confirming statistical significance through bootstrapping of the impact of digital information utilization capabilities on life satisfaction through social capital, the confidence interval did not include 0 and was statistically significant. As a result, it was confirmed that marriage immigrant women's social capital fully mediated the relationship between their digital information utilization capabilities and life satisfaction. Based on these research results, practical and policy efforts to improve the life satisfaction of married immigrant women were suggested.

Sociodemographic and psychosocial risk factors of railway suicide a mixed-methods study combining data of all suicide decedents in the Netherlands with data from a psychosocial autopsy study

BackgroundRailway suicide has profound implications for the victims and their family, and affects train drivers, railway personnel, emergency services and witnesses. To inform a multilevel prevention strategy, more knowledge is required about psychosocial and precipitating risk factors of railway suicide.MethodsData from Statistics Netherlands of all suicides between 2017 and 2021 (n = 9.241) of whom 986 died by railway suicide and interview data from a psychosocial autopsy of railway suicide decedents (n = 39) were integrated. We performed logistic regression analyses to identify sociodemographic predictors of railway suicide compared to other methods of suicide. The Constant Comparative Method was subsequently employed on interview data from the psychosocial autopsy to identify patterns in psychosocial risk factors for railway suicide.ResultsThe strongest predictors of railway suicide compared to other suicide methods were young age (< 30 years old), native Dutch, a high educational level, living in a multi-person household (especially living with parents or in an institution), living in a rural area and a high annual household income of > 150.000 euros. Several subgroups emerged in the psychosocial autopsy interviews, which specifically reflect populations at risk of railway suicide. These subgroups were [1] young adult males with autism spectrum disorder who strived for more autonomy and an independent life, [2] young adult females with persistent suicidal thoughts and behaviours, [3] middle-aged males with a persistent mood disorder who lived with family and who faced stressors proximal to the suicide in personal and professional settings, [4] male out-of-the-blue suicides and [5] persons with psychotic symptoms and a rapid deterioration.Conclusionsbased on our findings we propose and discuss several recommendations to prevent railway suicide. We must continue to invest in a safe railway environment by training personnel and installing barriers. Additionally, we should adopt prevention strategies that align the needs of subgroups at increased risk, including young females who have attempted other methods of suicide and young males with autism spectrum disorder. Future research should determine the cost-effectiveness and feasibility of low-maintenance, automated interventions near crossings and psychiatric facilities.

The Case for Early Transition-Planning for Students With Significant Support Needs: Implications for Policy and Practice

The period in which young adults transition from high school is accompanied with complexities they need to navigate, such as further education and training, independent living, developing their career, and achieving meaningful employment. All of these set the stage for a successful and independent life. The significance of this transition is paramount; however, in research and practice, we continue to see poor outcomes for students with disabilities, especially those with the most significant support needs. Transition planning, mandated by the Individuals with Disabilities Education Act, must begin no later than a child turning 16. Some states mandate transition activities to start as early as 14, but should we consider an even earlier age? Within this paper, we discuss the need for changes within policy and practice to begin transition activities during children’s early education years.

Getting out of My Room and Independent Living

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Resistance exercise snacks improve muscle mass in female university employees: a prospective, controlled, intervention pilot-study.

Although resistance training (RT) is essential to preserve musculoskeletal fitness and maintain a healthy, independent life into old age, few women perform RT. We investigated whether resistance exercise snacking (RES) could be an efficient training approach for the workplace health promotion (WHP) to minimize barriers for participation and facilitate RT in women in order to improve musculoskeletal fitness. This pilot-study followed a prospective, controlled intervention design. Female employees with sedentary occupations doing RT on less than 2 days/week before study participation were included. Participants self-selected for either intervention (IG) or control group (CG). While the IG [N = 15, mean age 42.1 (SD = 11.1) years] did 10 min of RES on working days for 12 weeks, the CG [N = 15, mean age 49.9 (SD = 9.7) years] was instructed to maintain their habitual physical activity. Primary endpoint was change in muscle mass. Secondary endpoint was change in maximum isometric strength. Balance, cardiovascular fitness, perceived health, and general life satisfaction was assessed for exploratory purpose. Measurements were taken before and after the intervention. 12 participants of IG and 14 of CG completed the study. Muscle mass improved significantly more in the IG [+0.42 (SD = 0.54) kg] compared to the CG [-0.16 (SD = 0.51) kg] (p = 0.01, ƞ2p = 0.24). Strength did not change significantly between groups. Nevertheless, there was a trend for greater improvements in the IG compared to the CG for trunk extension, trunk flexion, and upper body push but not upper body pull. Regarding exploratory endpoints, no significant between-group changes were found. Despite their poor fitness, both groups perceived their health as good and had high life satisfaction before and after the intervention. RES could be an effective approach for the WHP to promote RT in inactive women with sedentary occupations and improve their muscle mass.

Comparison of Educational Development Trends in Ukraine and the World

The article examines the trends in the development of the educational system in recent years in Ukraine and the world in the context of neuropedagogy. Particular attention is paid to the factors that have influenced the strengthening of the role of education in the world, in particular, the strengthening of the state's interest in financing education. The article updates the inextricable connection between the country's economy and the level and quality of education. The author points out the advantages of education support systems in some advanced countries of the world, which can be used as a model experience for domestic educational reform, in particular due to the use of neuropedagogy. The most important trends in the development of education in the world educational space are analyzed. The author notes that the quarter-century experience of the 21st century civilization determines a number of trends according to which it should develop in the future. Among them, for example, the transition of most nations and cultures to market relations is leading in the economy; in politics - to democracy; in social communication - to tolerance; in the general organization of life activities - to an open society and models of sustainable human development, etc. Because education (and science), which prepares a person for independent life, shapes his view on the future development of civilization.

Stressful Life Events and Reward Processing in Adults: Moderation by Depression and Anhedonia

Background. Exposure to acute stress is associated with reduced reward processing in laboratory studies in animals and humans. However, less clear is the association between reward processing and exposure to naturalistic stressful life events. The goal of the current study was to provide a novel investigation of the relation between past 6-month stressful life events and reward processing, and the extent to which this relation was moderated by depression diagnostic status and state symptoms of anhedonia. Methods. The current study included a secondary analysis of data from 107 adults (37 current-depressed, 25 past-depressed, 45 never-depressed; 75% women) drawn from two previous community studies. Past 6-month stressful life events were assessed with a rigorous contextual interview with independent ratings. Response to monetary reward was assessed with a probabilistic reward task. Results. Among current-depressed participants, and among both current- and past-depressed participants with high levels of anhedonia, greater exposure to independent life events outside of individuals’ control was significantly associated with poorer reward learning. In direct contrast, among those with low levels of anhedonia, greater exposure to independent life events was significantly associated with a greater overall bias toward the more frequently rewarded stimulus. Conclusions. Results suggest that depression and anhedonia are uniquely associated with vulnerability to blunted reward learning in the face of uncontrollable stressors. In contrast, in the absence of anhedonia symptoms, heightened reward processing during or following independent stressful life event exposure may represent an adaptive response.

Nerve Transfers in Children with Non-traumatic Amyoplasia

The treatment of obstetric brachial plexus palsy through primary reconstruction and nerve transfers has been established in the past decades. In the case of non-traumatic diseases that lead to flaccid paralysis and the inability to move the extremities, such as transverse myelitis (TM) or arthrogryposis multiplex congenita (AMC), which can have a wide variety of causes, the focus has been on rehabilitative therapy so far, while surgical interventions have been used to a lesser extent, e. g., in the form of osteotomies or muscle transfers. Our aim is to establish nerve transfers as a surgical option to improve mobility in non-traumatic amyoplasia. This work presents the needs-adapted treatment of a total of 23 patients (aged 4 months to 64 months, 18 with AMC and 5 with TM) using nerve transfers on the upper extremity. We were able to show that early nerve transfers in the upper extremity enabled the reanimation of muscles in both AMC and TM. This work shows that the treatment of non-traumatic amyoplasia in children with selective nerve grafts is a successful method. Nerve transfers allow patients to gain or regain important functions for managing independent everyday life. The surgical methods have been established in the treatment of traumatic nerve injuries. They are well-known and can be carried out safely. We believe that this is an important treatment option for paediatric patients with paralysis associated with TM or AMC, which should also be known to the treating physicians.

Striving Towards Independent Living: The Trials and Tribulations of Institutionalised Adolescents in Malaysia

This phenomenological study explores how five institutionalised Malay adolescents used adaptive strategies towards independent living upon being released from welfare institutions. Five 17-year-old Malay Muslim adolescents, three males and two females, were recruited via purposive sampling for a focus group discussion to gather insights into their plans and strategies to cope with life challenges after being released from their respective welfare institutions. Thematic analysis of the FGD data extracted six themes that portrayed the adolescents’ adaptive strategies for facing challenges in life. The themes include making personal preparations, acquiring personal strengths, setting a career direction, exploring the support of friends and outsiders, feeling of being complete, searching for personal necessities and having a sense of responsibility. The findings highlight the need for developing a comprehensive life skills intervention for institutionalised adolescents and psychoeducation counselling modules to alleviate the adolescents’ uncertainties in going through the adjustment phase outside welfare institutions.