Medical Disability Research Articles

“This is Not Me” – A Critical Discussion About Methodological Issues Concerning Agency and Participatory Sense-Making in Qualitative Research with Children

Participatory sense-making and agency are important methodological issues in qualitative research, especially that involving children. In this article we investigate and discuss how agency unfolds in three specific situations as recorded in the reflexive notes of two of the authors regarding their research with children with various medical diagnosis and disabilities. Using a combined autoethnographic and enactive phenomenological approach, the authors explore three particular moments where child participants registered disagreement with, or rejection of, the application to them of prevailing notions of ‘disability’. On the basis of the findings, the authors argue that the process of implementing and performing qualitative research implies a process of participatory sense-making in which participants' multi-level agentic capacity is the basis for understanding one another’s gestures and vocal expressions. The article illuminates how different bodies enable different individual embodied, embedded, emotive and enacted agentic expressions, and how power, understood as an extended agentic capacity, circulates in the co-existence between child and researcher in qualitative research. Researchers are urged to develop the willingness and ability to ‘dis-place’ themselves when working with child participants, so as to move towards the child with interest, respect, and openness to learning from them.

Improving Hearing Protection Device Noise Attenuation Through Fit-Testing in an Occupational Health Clinic.

Occupational noise-induced hearing loss (NIHL) is the second most common medical disability for military veterans and accounts for 24% of all hearing loss in the United States. Hearing loss negatively affects health and billions of dollars are spent annually for direct and indirect medical costs and lost work productivity. Proper hearing protection device (HPD) fit can prevent NIHL. Quantitative fit-testing systems to determine personal attenuation rates (PARs) are available, but not widely utilized. Without quantitative testing, validating appropriate fit and attenuation to a permissible exposure level to prevent NIHL is difficult. A quality improvement project measured 100 employees enrolled in a hearing conservation program (HCP) to determine if they obtained a target PAR after inserting the HPDs in their "usual" fashion. Those who did not obtain target PAR (n = 27) received an evidence-based intervention that demonstrated proper HPD fit by a skilled trainer followed by a repeat attempt by the participant to replicate the feel of the demonstrated HPD placement. PAR was subsequently measured to assess for appropriate noise attenuation. Seventy-one percent achieved target PAR (≥ 20 decibels) at baseline testing. After the intervention, 91 of 100 participants had achieved target PAR, a 20% improvement. Findings suggest this evidence-based intervention was an effective strategy for improving HPD fit for employees enrolled in HCPs. This intervention may prevent occupational hearing loss and decrease the health and socioeconomic impacts of NIHL.

Body mass index and 12-year mortality among older Mexican Americans aged 75\u2009years and older

BackgroundThe role of obesity in mortality in the very old and old-oldest Hispanic population has not been studied. The objective of this study was to examine the effect of body mass index (BMI) on 12-year mortality among older Mexican Americans aged 75 years and older.MethodsTwelve year prospective cohort study consisting of a population-based sample of 1415 non-institutionalized Mexican American men and women aged 75 and older from 5 southwestern states: Arizona, California, Colorado, New Mexico, and Texas. Data was from Wave 5 of the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/2005–2016). Socio-demographics, body mass index (BMI), self-reported medical conditions, disability, depressive symptoms, falls, Mini-Mental-State-Examination (MMSE), and Short Physical Performance Battery (SPPB) were assessed at baseline during 2004–2005. BMI (Kg/m2) was classified as underweight (< 18.5), normal weight (18.5 to < 25), overweight (25 to < 30), obesity category I (30 to < 35), and obesity category II/morbid obesity (≥ 35). For assessment of mortality, deaths were ascertained through the National Death Index and report from relatives. Cox proportional hazards regression analysis was performed to estimate the hazard ratio (HR) of 12-year mortality as a function of BMI categories at baseline.ResultsThe mean BMI was 27.5 ± 1.7 with participants classified as 1.8% underweight, 30.8% normal weight, 39.2% overweight, 20.7% obesity category I, and 7.6% obesity category II/morbid obesity. Mexican Americans aged ≥75 years with overweight or obesity category I had a reduced HR of death (0.82, 95% CI = 0.70–0.96 and 0.75, 95% CI = 0.62–0.91, respectively) over 12-years of follow-up. The HR of death for underweight and obesity category II/morbid obesity participants was 1.59 (95% CI = 1.03–2.45) and 1.12 (95% CI = 0.85–1.46), respectively. Female participants and those with high scores in the MMSE and SPPB had decreased risk of death.ConclusionsThis study showed the protective effect of overweight and obesity on mortality in Mexican Americans above 75 years of age, which might have implications when treating older adults with overweight and obesity.

Use of Mobile and Wearable Artificial Intelligence in Child and Adolescent Psychiatry: Scoping Review.

BackgroundMental health disorders are a leading cause of medical disabilities across an individual’s lifespan. This burden is particularly substantial in children and adolescents because of challenges in diagnosis and the lack of precision medicine approaches. However, the widespread adoption of wearable devices (eg, smart watches) that are conducive for artificial intelligence applications to remotely diagnose and manage psychiatric disorders in children and adolescents is promising.ObjectiveThis study aims to conduct a scoping review to study, characterize, and identify areas of innovations with wearable devices that can augment current in-person physician assessments to individualize diagnosis and management of psychiatric disorders in child and adolescent psychiatry.MethodsThis scoping review used information from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of several databases from 2011 to June 25, 2021, limited to the English language and excluding animal studies, was conducted. The databases included Ovid MEDLINE and Epub ahead of print, in-process and other nonindexed citations, and daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; Web of Science; and Scopus.ResultsThe initial search yielded 344 articles, from which 19 (5.5%) articles were left on the final source list for this scoping review. Articles were divided into three main groups as follows: studies with the main focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, and internalizing disorders such as anxiety disorders. Most of the studies used either cardio-fitness chest straps with electrocardiogram sensors or wrist-worn biosensors, such as watches by Fitbit. Both allowed passive data collection of the physiological signals.ConclusionsOur scoping review found a large heterogeneity of methods and findings in artificial intelligence studies in child psychiatry. Overall, the largest gap identified in this scoping review is the lack of randomized controlled trials, as most studies available were pilot studies and feasibility trials.

Cormac McCarthy: A Complexity Theory of Literature

Cormac McCarthy: A Complexity Theory of Literature

Periacetabular Osteotomy in United States Military Personnel: Results From an Interservice Hip Preservation Practice.

Background:Untreated or residual developmental dysplasia of the hip may cause significant morbidity. Periacetabular osteotomy (PAO) allows for surgical reorientation of the acetabulum but requires a significant recovery period. Because of the physical demands of active military service, hip dysplasia or its treatment with PAO may cause a significant impact on the careers of affected personnel.Purpose:To measure the impact of symptomatic acetabular dysplasia and its treatment with PAO on the physical readiness of personnel in the United States Armed Forces.Study Design:Case series; Level of evidence, 4.Methods:Records from an interservice hip-preservation practice were reviewed for all patients who underwent PAO while on active duty from January 2014 through April 2017. Collected information included branch of service, military occupation, preoperative duty restrictions related to the hip, and concomitant surgical procedures. Patients were evaluated for a minimum of 24 months and assessed for their time to return to duty, continued duty restrictions, and referrals to the medical evaluation board.Results:Twenty patients (15 female, 5 male) underwent a PAO while on active duty during the period assessed. The mean patient age at surgery was 25.9 years, and the mean follow-up was 3.3 years (range, 2.3-5.4 years). In the 6 months preceding surgery, 94% of the 17 patients with available records were on duty restrictions specific to their hip (14 temporary, 2 permanent). After PAO, 35% of patients (n = 7) returned to full duty and 85% were able to remain on active duty (n = 12) or complete their military service commitments (n = 5) without noted medical disability. Three patients were medically discharged after PAO, with 1 patient referred due to hip pathology.Conclusion:Acetabular dysplasia significantly affects physical readiness in affected servicemembers, with 94% requiring duty restrictions. PAO allowed 85% of patients to return to military service, and 1 in 3 were able to return to full duty.

Значение использования шкал оценки тяжести состояния при лечении пациентов с политравмой

The problem of treatment of patients with multiple and combined injuries remains one of the most relevant in modern medicine. According to modern statistical data, amount of traumas is growing worldwide, and among the able-bodied population polytrauma is one of the main causes for disablement and death. About 5 million people worldwide are injured every year, of which 15–21% have multiple and associated injuries. To improve the quality of medical care for patients with polytrauma and decrease the level of disablement and deaths, it is necessary to study the problem of rendering medical aid to patients with multiple and combined injuries. The purpose — to assess various scales of the condition severity of patients with polytrauma. Material and methods. A retrospective analysis of 120 patients was carried out, who from 2017 to 2020 were treated at City Clinical Hospital named after A.K. Eramishantsev, of them 66 (55%) women and 54 (45%) men. The age group was 25–75 years old. Results. One of the most adequate methods of assessing the condition severity of patients with polytrauma is a score-based approach, which allows determining the correct treatment tactics. Correct treatment tactics can reduce the time of disability, mortality and disability of patients. In modern traumatology and orthopedics, ISS scale is considered the «gold standard» for assessing the condition severity, but many doctors and authors mark that this scale is insufficiently informative. Our comparative analysis revealed that the NISS scale has greater accuracy in predicting mortality than ISS, especially in critical patients and patients with blunt trauma. Conclusion. A clear definition of the polytrauma concept with a single score assessment system for assessing the condition severity will allow to standardize treatment tactics, conduct an adequate comparative analysis of treatment results, objectively resolve issues of organization and financial provision of medical care to seriously injured patients, improve the quality of medical care, reduce mortality and disability of the able-bodied population, and provide full recovery and return to normal standard of living. The creation of a unified assessment system is difficult, which is associated with the polyphocality of injuries. We believe that further in-depth studies of patients with multiple and combined trauma are needed to develop modern guidelines and clinical recommendations, as well as a unified single-score assessment system.

Reimbursement of Digital Therapeutics: Future Perspectives in Korea.

Digital health is rapidly growing worldwide and its area is expanding from wellness to treatment due to digital therapeutics (DTx). This study compared DTx in the Korean context with other countries to better understand its political and practical implications. DTx is generally the same internationally, often categorized as software as a medical device. It provides evidence-based therapeutic interventions for medical disabilities and diseases. Abroad, DTx support entailed state subsidies and fundraising and national health insurance coverage. In the case of national health insurance coverage, most cases were applied to mental diseases. Moreover, in Japan, DTx related to hypertension will possibly be under discussion for national health insurance coverage in 2022. In overseas countries, coverage was decided only when the clinical effects were equivalent to those provided by existing technology, and in the UK, real usage data for DTx and associated evaluations were reflected by national health coverage determination. Prices were either determined through closed negotiations with health insurance operating agencies and manufacturers or established based on existing technology. Concerning the current situation, DTx dealing with various diseases including hypertension are expected to be developed near in the future, and the demand for use and compensation will likely increase. Therefore, it is urgent to define and prepare for DTx, relevant support systems, and health insurance coverage listings. Several support systems must be considered, including government subsidies, science/technology funds, and health insurance.

Descripción de pacientes colombianos con simulación/magnificación de enfermedad mental, un problema frecuente en psiquiatría laboral

IntroductionOccupational psychiatry evaluates the relationship of manifestations of mental problems with work. The Colombian occupational insurance model provides financial and work-related benefits due to occupational disease, and simulation can therefore become a challenge for the psychiatrist. MethodsWe evaluated 76 patients in a mental health medical board, applying simulation tests (SIMS, TOMM and the Rey 15-item test) and cognitive performance and personality tests. We analysed the results with measures of central tendency and dispersion, Pearson's correlation index, the χ2test, Student's t test and the Mann Whitney U test. We carried out a binary logistic regression model of magnification behaviours using independent clinical, neuropsychological and personality variables. Results71% had suffered work accidents; 84.2% had a psychiatric diagnosis pre-meeting and 27.6% post-meeting; clinical inconsistencies and magnification and simulation of symptoms were demonstrated; 64.5% reported chronic pain and 50% were disabled. All simulation tests positively correlated with each other and the F-K index (MMPI-2), positively correlated with SIMS and schooling. Medical disability and chronic pain increased the risk of magnifying behaviours. ConclusionsThe mental health medical board enables effective identification of illness, simulation and magnification in difficult cases. The simulation and magnification behaviours are associated with medical disability and chronic pain. Our results demonstrate the importance of an adequate diagnosis and early detection of simulation and magnification behaviours.

“Spend your spoons wisely”: Conceptualizations of time, energy and aging invisibly with Crohn’s Disease

An increasing number of people with chronic medical disabilities are living longer and into old age due to the growing medical and technological advancements over the past half century. We used grounded theory to examine the lived experience of aging “with” a disability in a non-elderly population. On average, participants were 37 years of age at the time of interview. The average time since diagnosis was 17 years and ranged from 3 to 34 years. Many worked full-time outside of the home and some held advanced or graduate degrees. Of the 35 participants interviewed, three-quarters expressed worries about the future and aging, specifically related to physical limitations of having CD. The other 25% talked about learning to accept the diagnosis and ‘moving forward’ with their life as they age. All participants described the difficulties of fatigue and energy limitations. Planning of life was limited to 24 hours — a direct consequence of functional limitations of a relapsing-remitting disease. The most prominent theme that emerged from participants’ narratives to explain aging invisibly with a chronic illness was quantifying energy into ‘spoons’, a way of measuring the stock of their energy on any given day. These findings translate into important insights into the process of aging for those who live and age “with” Crohn’s as their everyday lives are immersed in managing the varying whims of this illness.

Mixed-Method Evaluation of the Public Health Questionnaire for Estimating Depression Among Tibetan Buddhist Monastics

Background: Depression is the largest source of global medical disability, highlighting the importance of translating and validating depression screening instruments to improve our understanding of differences in the prevalence of depression in divergent cultures around the world. The aim of this study was to translate and evaluate a widely used depression screening and diagnostic instrument, the Patient Health Questionnaire-9 (PHQ-9), for use with Tibetan populations. A secondary aim was to use the Tibetan-PHQ-9 (T-PHQ-9) to estimate the prevalence of depression symptoms in a population of Tibetan-speaking Buddhist monastic scholars engaging in a 6-year science curriculum in India, the Emory Tibet Science Initiative (ETSI).Methods: Three-hundred-eighty-four monastics (363 monks, 21 nuns) completed the T-PHQ-9. We computed measures of internal consistency and conducted factor analysis to evaluate scale performance. Following this, we evaluated the prevalence of depressive symptoms among the monastic population. We also conducted cognitive interviews with six monastics to explore their thought processes when completing the instrument and when thinking about depression symptoms.Results: The T-PHQ-9 had acceptable reliability and demonstrated a single-factor structure. While having low energy was the most commonly endorsed symptom, monastics did not have overall higher endorsement rates of other somatic symptoms when compared with endorsement rates of emotional symptoms. Over 10% of the monastics scored in the moderately severe to severe range and met criteria for major depressive disorder using standard diagnostic criteria cut-offs. First year monks had the highest mean score, and there was not a significant difference between monks and nuns. Cognitive interviews revealed some variation in the cognitive processes used to complete the instrument, particularly with symptoms related to energy and concentration.Conclusion: These preliminary findings indicate that the Tibetan PHQ-9 is a reliable instrument for assessing depressive symptoms, as evidenced by its ability to inform how symptoms are experienced, interpreted, and communicated among Buddhist monastics. Results from the cognitive interviews may be important for further refining the instrument.

The Cost-Effectiveness of Psychodynamic Therapy: The Obstacles, the Law, and a Landmark Lawsuit

ABSTRACT Psychotherapy, especially dynamic psychotherapy and psychoanalysis, has been poorly supported by insurance although the Mental Health Parity Act mandates benefits for mental health care at parity with other health care and The Affordable Care Act lists mental health care, including psychotherapy, as an Essential Health Benefit. Limiting insurance support for psychotherapy turns away very ill, especially poorer patients who forego treatment and incur increased medical costs and disability. Patients with personality disorders, chronic anxiety depression, chronic illness and comorbidity require extended, often intensive, psychotherapy for optimal recovery. Brief cognitive-behavioral therapy is seen as a “gold standard” and “most evidence-based” although its research protocols study subjects not typical of most patients and who achieve only short-lived improvements. Research finds psychodynamic therapies to be highly cost-effective, equal to other efficacious therapies in improving symptoms, and also superior in improving maladaptive interpersonal relationship patterns, a high-risk factor for mortality. Knowledgeable attorneys and expert witnesses were key to the 2019 successful class action lawsuit against United Behavioral Health for declining to cover research supported generally accepted standards for mental health care and for a subsequent California state law mandating sufficient insurance coverage. To defend it in legal and policy arenas, providers and advocates for psychodynamic psychotherapy should familiarize themselves with its supporting research and the laws that demand its provision.

A Review on Complications of Sleep Apnea

Sleep apnea occurs when the upper airway repeatedly becomes blocked during sleep, reducing or entirely blocking airflow. This is referred to as obstructive sleep apnea. If the brain fails to provide the necessary impulses for breathing, the disease is known as central sleep apnea. Sleep apnea and other sleep breathing problems are a leading cause of medical, social, and occupational disability. Sleep apnea is also linked to pulmonary hypertension, cardiac arrhythmia and other neurocognitive effects, majority of individuals with sleep apnea go undetected, putting them at danger during surgery. It is critical to identify these patients so that relevant steps can be implemented as soon as possible. In this review article, we will discuss about sleep apnea issues and their possible causes.&#x0D; Keywords: Sleep apnea, Bradycardia, Tachycardia, Breathing, Hypercapnia

Are We Able to Determine Differences in Outcomes Between Male and Female Servicemembers Undergoing Hip Arthroscopy? A Systematic Review.

Background:Female servicemembers sustain higher rates of lower extremity injuries as compared with their male counterparts. This can include intra-articular pathology in the hip. Female patients are considered to have worse outcomes after hip arthroscopy for femoroacetabular impingement and for hip labral repair.Purpose:To (1) compare published rates of hip arthroscopy between male and female military servicemembers and (2) determine if there are any sex-based differences in outcomes after hip arthroscopy in the military.Study Design:Systematic review; Level of evidence, 3.Methods:We reviewed the literature published from January 1, 2000, through December 31, 2020, to identify studies in which hip arthroscopy was performed in military personnel. Clinical trials and cohort studies were included. The proportion of women within each cohort was identified, and results of any between-sex analyses were reported.Results:Identified were 11 studies that met established criteria. Studies included 2481 patients, 970 (39.1%) of whom were women. Surgery occurred between January 1998 and March 2018. Despite women accounting for approximately 15% of the active-duty military force, they represented 39.1% (range, 25.7%-57.6%) of patients undergoing hip arthroscopy. In most cases, there were no differences in self-reported outcomes (pain, disability, and physical function), return to duty, or medical disability status based on sex.Conclusion:Women account for approximately 15% of the military, but they made up 40% of patients undergoing hip arthroscopy. Outcomes were not different between the sexes; however, definitive conclusions were limited by the heterogeneity of outcomes, missing data, lack of sex-specific subgroup analyses, and zero studies with sex differences as the primary outcome. A proper understanding of sex-specific outcomes after hip arthroscopy will require a paradigm shift in the design and reporting of trials in the military health system.

Ethical Guidance for Hard Decisions: A Critical Review of Early International COVID-19 ICU Triage Guidelines

This article provides a critical comparative analysis of the substantive and procedural values and ethical concepts articulated in guidelines for allocating scarce resources in the COVID-19 pandemic. We identified 21 local and national guidelines written in English, Spanish, German and French; applicable to specific and identifiable jurisdictions; and providing guidance to clinicians for decision making when allocating critical care resources during the COVID-19 pandemic. US guidelines were not included, as these had recently been reviewed elsewhere. Information was extracted from each guideline on: 1) the development process; 2) the presence and nature of ethical, medical and social criteria for allocating critical care resources; and 3) the membership of and decision-making procedure of any triage committees. Results of our analysis show the majority appealed primarily to consequentialist reasoning in making allocation decisions, tempered by a largely pluralistic approach to other substantive and procedural values and ethical concepts. Medical and social criteria included medical need, co-morbidities, prognosis, age, disability and other factors, with a focus on seemingly objective medical criteria. There was little or no guidance on how to reconcile competing criteria, and little attention to internal contradictions within individual guidelines. Our analysis reveals the challenges in developing sound ethical guidance for allocating scarce medical resources, highlighting problems in operationalising ethical concepts and principles, divergence between guidelines, unresolved contradictions within the same guideline, and use of naïve objectivism in employing widely used medical criteria for allocating ICU resources.

Design of the Spine Pain Intervention to Enhance Care Quality And Reduce Expenditure Trial (SPINE CARE) study: Methods and lessons from a multi-site pragmatic cluster randomized controlled trial

BackgroundLow back and neck pain (together, spine pain) are among the leading causes of medical visits, lost productivity, and disability. For most people, episodes of spine pain are self-limited; nevertheless, healthcare spending for this condition is extremely high. Focusing care on individuals at high-risk of progressing from acute to chronic pain may improve efficiency. Alternatively, postural therapies, which are frequently used by patients, may prevent the overuse of high-cost interventions while delivering equivalent outcomes. MethodsThe SPINE CARE (Spine Pain Intervention to Enhance Care Quality And Reduce Expenditure) trial is a cluster-randomized multi-center pragmatic clinical trial designed to evaluate the clinical effectiveness and healthcare utilization of two interventions for primary care patients with acute and subacute spine pain.The study was conducted at 33 primary care clinics in geographically distinct regions of the United States. Individuals ≥18 years presenting to primary care with neck and/or back pain of ≤3 months' duration were randomized at the clinic-level to 1) usual care, 2) a risk-stratified, multidisciplinary approach called the Identify, Coordinate, and Enhance (ICE) care model, or 3) Individualized Postural Therapy (IPT), a standardized postural therapy method of care. The trial's two primary outcomes are change in function at 3 months and spine-related spending at one year. 2971 individuals were enrolled between June 2017 and March 2020. Follow-up was completed on March 31, 2021. DiscussionThe SPINE CARE trial will determine the impact on clinical outcomes and healthcare costs of two interventions for patients with spine pain presenting to primary care.Trial registration number: NCT03083886

Mental health, substance use disorder, and opioid uses disorder: updates and strategies for treatment

Objective: to describe the main strategies to deal with gaps in the identification, treatment and training regarding substance use disorder (SUD), and opioid uses disorder (OUD). Method: this is a narrative review, based on recent articles and publications on mental health and substance use recognized internationally. Results: a prevalence of co-occurring substance use and mental health/psychiatric disorders continue to rise and are considered complex problems, with multifaceted treatment challenges including medical conditions, disabilities, homelessness, medication noncompliance, and high relapse rates. The treatment for SUD and OUD are complex. The co-occurrence of these two disorders require a multifaceted approach for the diagnosis and treatment. Conclusion: the prevalence of SUD, OUD and their co-occurrence continue to rise and nurses and other health professionals should be prepared to diagnose, treat and/or refer users to assure their adequate care and long term recovery.

Effect of Cognitive Behavioural Therapy in Treatment of Chronic Non-Specific Low Back Pain

Background: Low-back pain is a major health and economical problem that affects populations around the world. Chronic low-back pain, in particular, is a major cause of medical expenses, work absenteeism, and disability. Objective: To explore the effect of adding cognitive-behavioral therapy to physical therapy interventions in patients with chronic non-specific back pain. Patients and methods: 20 male and female patients between 25 and 40 years old diagnosed as chronic non-specific back pain with central sensitization and fear avoidance behaviors symptoms participated in this study. Patients were randomly assigned into two groups. The first group was treated by cognitive behavioral therapy (graded exposure and graded activity) in addition to physiotherapy the second group was treated by physical therapy interventions which was given only 3 times/week for 4 consecutive weeks. Results: Descriptive statistics was used to identify each variable’s mean and standard deviation. A paired t-test was used to compare characteristics of patients between both groups. Pre-treatment results showed no significant difference in both measured variables of Oswestry, and pain in both groups (P > 0.05). On the other hand, post-treatment results showed a significant decrease in the Oswestry, and pain only in group A (the study group). Conclusion: Adding graded exposure and graded activity as an operant cognitive behavioural therapy approach to physical therapy program is more beneficial than physical therapy program alone. More data and follow up needed for this study.

Factors Associated With Online Learning Self-Efficacy Among Students With Disabilities In Higher Education

ABSTRACT This study examined how the prevalence of online learning increases educational outcomes and access for students with disabilities, exploring the factors associated with these learners’ self-efficacy in virtual environment. College students with disabilities (n = 278) were surveyed about their experience with online courses, overall technology competence, and preferred instructional modalities. Online learning self-efficacy (OLSE) was used as the outcome. Factors associated with OLSE were technological competence and delivery preferences. Students with medical disabilities, in comparison to their peers with a psychological and/or learning disability, reported a higher level of OLSE in the virtual environment. These factors collectively accounted for 33.7% of the variance in OLSE (R2 = .36, F = 19.631, p < .001). Improving the accessibility of online learning for students with disabilities will promote best practices in online learning for all students. Accessibility mind-sets have been increasingly called for as higher education institutions are offering online courses.

A legacy of silence: the intersections of medical sociology and disability studies

Disability remains on the margins of the social sciences. Even where disability is foregrounded as a category of analysis, accounts regularly emerge in silos, with little interdisciplinary dialogue acknowledging the...