Nondisabled Group Research Articles

Obesity and Physical Activity Characteristics of Schoolchildren with Intellectual and Learning Disability

Previous studies indicated that schoolchildren with intellectual and learning disability have higher prevalence of obesity than those without disability. However, the role of physical activity on obesity in schoolchildren with intellectual and learning disability is still unclear. The purpose of this study was to investigate the prevalence of obesity in children with or without intellectual and learning disability, and to distinguish the relationship with their physical activity levels. The data for the study were extracted from the Taipei School Children Physical and Mental Health Survey, a population based, cross-sectional epidemiological study of elementary schoolchildren of Taipei city. Based on the data, schoolchildren were divided into non-disability (ND) and intellectual/learning disability (ILD) groups. We found that gender- and age-adjusted body mass index (BMI) were higher in ILD than ND as analyzed by ANCOVA. Height and sedentary behavior times (watching TV and using computer) and physical activity levels were lower in ILD compared to ND group. Data adjusting for covariates in multinomial logistic regression showed that intellectual/learning disabilities were associated with obesity, exercise time below suggestion, and proportion of tendency was not to find the partner for exercise. The present study findings concluded that the high prevalence of obesity appears to be associated with physical activity level in schoolchildren with intellectual/learning disabilities. Moreover, we also found that ＂people support＂ plays an important role in exercise participation of elementary schoolchildren with intellectual/learning disability.

Importance of locus of control in offenders with intellectual disability

Purpose – Locus of control (LOC) is the manner in which one attributes their ability to make change in life. This could be through others, fate or chance (externalised), or through oneself (internalised). An internalised LOC results in greater self-belief in the ability to change one's behaviour. Non-disabled offenders with an internalised LOC are more likely to benefit from treatment through therapy and in turn have reduced rates of re-offending. The relationship between LOC and response to treatment is only understood in a limited way for offenders with intellectual disability (ID) who participate in treatment programmes. The paper aims to discuss these issues. Design/methodology/approach – To better understand LOC for offenders with ID, this paper investigates its role in community-based therapy outcomes along with its use as a common pre-/post-measure of treatment success in mainstream offender populations. Drawing upon these findings information more specific to people with ID will be discussed. Findings – This paper will then explore the importance of LOC in treating offenders with ID through a review of the current published literature, which generally indicates offenders with ID demonstrate a tendency towards an external LOC in comparison with non-disabled or non-offender groups. Originality/value – Given the negative implications for treatment that external LOC may play, several significant therapeutic strategies that can contribute to development of internalised LOC are discussed, in addition to a consideration of other possible variables separate from ID that may play a role in both developing or perpetuating an external LOC.

Higher risk of violence exposure in men and women with physical or sensory disabilities: results from a public health survey.

The World Health Organization has declared that violence is a global public health problem. The prevalence of violence exposure among adults with intellectual and unspecific disabilities has been demonstrated in several studies, whereas only a few articles on people with sensory disabilities have been published. The aim of this study was to investigate the prevalence and risk for exposure to physical violence, psychological offence, or threats of violence in people with physical and/or sensory disabilities, compared with people with no such disabilities, controlling for socioeconomic data. Data from a public health survey were analyzed. A nationally representative sample of women and men aged 16 to 84 years had answered a questionnaire. In the present study, the whole sample, comprised of 25,461 women and 21,545 men, was used. Women with auditory disabilities were generally more often violence exposed than non-disabled women, whereas men with physical disabilities were more often violence exposed than non-impaired men. Some age groups among both women and men with visual disabilities had higher prevalence rates than women and men without disabilities. The adjusted odds ratios (ORs) were significantly higher among the auditory impairment group for exposure to physical (OR = 1.4, confidence interval [CI] = [1.1, 1.9]) and psychological (OR = 1.4, CI = [1.1, 1.8]) violence among women. Men with physical disabilities had raised odds ratios for physical violence (OR = 1.7, CI = [1.2, 2.4]) and psychological violence (OR = 1.4, CI = [1.0, 2.0]) compared with the non-disabled group. Both men and women with a physical or sensory disability showed higher odds of being exposed to violence than men and women without a disability. The results indicated that socioeconomic situation, smoking, and hazardous drinking strengthened the association between impairment and violence.

Predicting psychosocial outcomes using a brief measure of quality of life in a sample of people with spinal cord injury.

Spinal cord injury (SCI) significantly impacts an individual's quality of life (QOL). A brief and subjective measure of QOL is necessary to monitor the progress and outcomes of SCI rehabilitation. To determine whether this measure of QOL was associated with clinically important physical and psychosocial outcomes in a sample of people with SCI, to determine how people with SCI scored on this measure of QOL, and to determine whether people with SCI scored differently than nondisabled individuals on the QOL scale. Participants were 134 people with SCI (65% male; 35% female) and 227 nondisabled people (35% male; 65% female). Participants were assessed on a number of psychosocial and physiological variables at a large urban university and rehabilitation center. Variables examined were QOL, life satisfaction, depression, social interaction, pain, fatigue, and level of functioning. Participants with SCI reported more low QOL scores and fewer high QOL scores than the nondisabled group. For participants with SCI, QOL was positively related to life satisfaction and social interaction and negatively related to pain, fatigue, and depression. Participants with SCI scored lower on the QOL measure than those without a disability, although the difference was not clinically significant. QOL was unrelated to level of functioning; people may still experience a high QOL despite their physical limitations. Depression and social interaction were significantly related to QOL and should be secondary targets for intervention following SCI rehabilitation.

Posttraumatic Stress Disorder and Substance Use Disorder Comorbidity Among Individuals With Physical Disabilities:Findings From the National Comorbidity Survey Replication

Co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) affects multiple domains of functioning and presents complex challenges to recovery. Using data from the National Comorbidity Study Replication, a national epidemiological study of mental disorders (weighted N = 4,883), the current study sought to determine the prevalence of PTSD and SUD, the symptom presentation of these disorders, and help-seeking behaviors in relation to PTSD and SUD among individuals with physical disabilities (weighted n = 491; nondisabled weighted n = 4,392). Results indicated that individuals with physical disabilities exhibited higher rates of PTSD, SUD, and comorbid PTSD/SUD than nondisabled individuals. For example, they were 2.6 times more likely to meet criteria for lifetime PTSD, 1.5 times more likely for lifetime SUD, and 3.6 times more likely for lifetime PTSD/SUD compared to their nondisabled peers. Additionally, individuals with physical disabilities endorsed more recent/severe PTSD symptoms and more lifetime trauma events than nondisabled individuals with an average of 5 different trauma events compared to 3 in the nondisabled group. No significant pattern of differences was noted for SUD symptom presentation, or for receipt of lifetime or past-year PTSD or SUD treatment. Implications of these findings and recommendations for future research are discussed.

Women with disability: the experience of maternity care during pregnancy, labour and birth and the postnatal period.

BackgroundIt has been estimated that 9.4% of women giving birth in the United Kingdom have one or more limiting longstanding illness which may cause disability, affecting pregnancy, birth and early parenting. No large scale studies on a nationally representative population have been carried out on the maternity experiences of disabled women to our knowledge.MethodSecondary analysis of data from a survey of women in 2010 by English National Health Service Trusts on behalf of the Care Quality Commission was undertaken. 144 trusts in England took part in the postal survey.Women self-identified with disability and were excluded if less than 16 years of age or if their baby had died. The 12 page structured questionnaire with sections on antenatal, labour and birth and postnatal care covered access, information, communication and choice. Descriptive and adjusted analyses compared disabled and non-disabled groups. Comparisons were made separately for five disability subgroups: physical disability, sensory impairment, mental health conditions, learning disability and women with more than one type of disability.ResultsDisabled women comprised 6.14% (1,482) of the total sample (24,155) and appeared to use maternity services more than non-disabled women. Most were positive about their care and reported sufficient access and involvement, but were less likely to breastfeed. The experience of women with different types of disability varied: physically disabled women used antenatal and postnatal services more, but had less choice about labour and birth; the experience of those with a sensory impairment differed little from the non-disabled women, but they were more likely to have met staff before labour; women with mental health disabilities also used services more, but were more critical of communication and support; women with a learning disability and those with multiple disabilities were least likely to report a positive experience of maternity care.ConclusionThis national study describes disabled women’s experiences of pregnancy, child birth and postnatal care in comparison with non-disabled women. While in many areas there were no differences, there was evidence of specific groups appropriately receiving more care. Areas for improvement included infant feeding and better communication in the context of individualised care.

Compendium on Best Practices (2012-2013)

Social exclusion has become one of the important themes in contemporary social policy all over the world. While there is a considerable debate about the precise meaning of the term and some of the most useful definitions have sought to emphasize that social exclusion is concerned with the ‘inability to participate effectively in economic, social, and cultural life and, in some characteristics, alienation and distance from mainstream society. In contrast to poverty and unemployment which focus on individuals or households, social exclusion is primarily concerned with the relationship between the individual and society, and the dynamics of that relationship. In fact, in many ways, it appears useful to emphasize similarities between the debates about social exclusion and the debates about the barriers generated by disability. In the latter case, it is well recognized that some physical or mental disability can generate a powerful barrier to the ability to interact with society and that the state has some obligation to reduce or remove these barriers. In a similar way, one can see social exclusion among non-disabled groups as socially generated barriers that reduce the ability of the excluded individuals to interact with society. Applying ‘social exclusion’ to children necessitates further considerations. Since children are citizens who are entitled to rights and capabilities in their own right, ‘social exclusion’ is an issue violating their rights and capabilities directly, which is recognized in the Convention of the Rights of the Child and national legislation governing the rights of children (UNICEF, 1989; BMFSFJ, 1998). At the same time, since children are growing to be adults, and decisions, choices, and opportunities in childhood will crucially affect their position as adults, the impact of their economic, social, educational, and psychological development on their status as adults will have to be examined as well. The armed conflict in Kashmir from the last 22 years has resulted in about 100,000 orphans who are confronted with a range of issues like deprivation of education, livelihood, health care and above all stigma attached to being an orphan. The condition of orphans whose fathers were militants have to face a lot of discrimination in getting support in comparison to other orphans. The orphans are only discriminated and deprived of their rights because their fathers or other relatives were militants. This is due to lot of reasons, the primary ones being that government does not provide much support to orphans who are children of militants and government of Jammu and Kashmir provides some ex gratia relief to dependents of people who get killed in the armed conflict but in the case militants the family of the deceased suffers a lot. The armed conflict has also taken a heavy toll on the mental health of people particularly women and children. In 1980, 8-10 patients per year on an average visited the Government Psychiatric Hospital for the treatment of depression, but the number rose to 18,000 in 1994 and to about 50,000 in 2008. There is an enormous stigma attached to any mental illness in the Kashmiri society. The stigma is even more with girls who are unmarried as the parents think taking the girl to psychiatrists is inviting unwanted questions from the society. People with mental illness are secluded and treated with much contempt. A mere visit to Psychiatric hospital is associated with a lot of questioning from the people. The number of children with mental health issues is high but due to the stigma and to avoid to get secluded from the society the parents ignore such illness. There are also a sizeable number of children who are disabled owing to the direct exposure to armed violence and they are subjected to neglect, exploitation and discrimination not only at the hands of the society at large but from parents as well.

The Impact of Setting Accommodation on Large-scale Assessment of English Language Learners with and without Learning Disabilities: Balanced vs. Unbalanced Data in Latent Class Analyses

This exploratory study examined the effect of setting accommodation on Grade 6 students’ number sense and numeration skill in relation to whether they speak a language other than English at home, have a learning disability, and received setting accommodation for a large-scale math assessment. A set of latent class analyses was conducted to investigate students’ response patterns and latent class memberships in both balanced and unbalanced data; three- and two-way ANOVA were also performed to examine the effect. The results suggest that a 4-class model with a covariate and indirect effects have better model fit to the balanced and unbalanced data. Percentage correct and missing response rate in two datasets were also compared and discussed. The results indicate that number sense and numeration skill of accommodated Grade 6 students with LD was comparable to their non-accommodated peers with LD when their response patterns were taken into account. For non-disabled groups, non-accommodated Grade 6 students outperformed their accommodated counterparts. The language spoken at home by students was not a significant indicator of the effect. The implication for data design of latent class analysis and parametric statistics for large-scale data was also discussed in this paper.

Bilateral coordination and gait symmetry after body-weight supported treadmill training for persons with chronic stroke

BackgroundLocomotor interventions are commonly assessed using functional outcomes, but these outcomes provide limited information about changes toward recovery or compensatory mechanisms. The study purposes were to examine changes in gait symmetry and bilateral coordination following body-weight supported treadmill training in individuals with chronic hemiparesis due to stroke and to compare findings to participants without disability. MethodsNineteen participants with stroke (>6months) who ambulated between 0.4 and 0.8m/s and 22 participants without disability were enrolled in this repeated-measures study. The stroke group completed 24 intervention sessions over 8weeks with 20minutes of walking/session. The non-disabled group served as a comparison for describing changes in symmetry and coordination. Bilateral 3-dimensional motion analysis and gait speed were assessed across 3 time points (pre-test, immediate post-test, and 6-month retention). Continuous relative phase was used to evaluate bilateral coordination (thigh–thigh, shank–shank, foot–foot) and gait symmetry was assessed with spatiotemporal ratios (step length, swing time, stance time). FindingsSignificant improvements in continuous relative phase (shank–shank and foot–foot couplings) were found at post-test and retention for the stroke group. Significant differences in spatiotemporal symmetry ratios were not found over time. Compared to the non-disabled group, changes in bilateral coordination moved in the direction of normal recovery. Most measures of continuous relative phase were more responsive to change after training than the spatiotemporal ratios. InterpretationsAfter body-weight supported treadmill training, the stroke group made improvements toward recovery of normal bilateral coordination. Bilateral coordination and gait symmetry measures may assess different aspects of gait.

Muscle activity during stance phase of walking: Comparison of males with transfemoral amputation with osseointegrated fixations to nondisabled male volunteers

A recent development in prosthetics is the osseointegrated fixation (OF), with improvements in comfort, fatigue, hip movement, and ease of prosthetic attachment reported. However, little information is available regarding muscle function. This study reports on selected gait parameters of the residual limb during the stance phase of level overground walking, focusing on muscle activity. Five males with transfemoral amputation (TFA) with OFs were recruited. Ground reaction force (GRF), lower-limb kinematics, and surface electromyography (sEMG) from residual-limb muscles were recorded. sEMG data were also collected from a group of 10 nondisabled male subjects. Interstance variability of gait parameters was assessed by coefficient of multiple correlations. Repeatability of GRF and hip kinematics was high, whereas repeatability of the sEMG was low for four of the five individuals with TFA. Interstance variability of the sEMG for gluteus medius (GMED) was significantly greater in the group with TFA. The main difference in sEMG between the groups was the phase, with GMED and adductor magnus displaying greater differences than their counterparts in the nondisabled group. Results demonstrate that muscles in the residual limb retain aspects of their previous functional pattern.

Touch screen performance by individuals with and without motor control disabilities

Touch technology is becoming more prevalent as functionality improves and cost decreases. Therefore, it is important that this technology is accessible to users with diverse abilities. The objective of this study was to investigate the effects of button and gap size on performance by individuals with varied motor abilities. Participants with (n = 38) and without (n = 15) a motor control disability completed a digit entry task. Button size ranged from 10 to 30 mm and gap size was either 1 or 3 mm. Results indicated that as button size increased, there was a decrease in misses, errors, and time to complete tasks. Performance for the non-disabled group plateaued at button size 20 mm, with minimal, if any gains observed with larger button sizes. In comparison, the disabled group's performance continued to improve as button size increased. Gap size did not affect user performance. These results may help to improve accessibility of touch technology.

Effects of body-weight supported treadmill training on kinetic symmetry in persons with chronic stroke

BackgroundThe purpose was to examine changes in kinetic symmetry in persons with chronic stroke immediately and 6-months after body-weight supported treadmill training. MethodsFifteen participants at least six-months post stroke and able to ambulate between 0.4 and 0.8m/s and 20 participants without neurological conditions completed all phases of the study and were included in the analysis. The non-disabled group served as a comparison for describing changes in kinetic symmetry. The stroke group completed 24 sessions of body-weight supported treadmill training over 8-weeks with 20minutes of total walking per session. Bilateral 3-dimensional motion analysis and gait speed were assessed 1-week before training (pre-test), 1-week after training (post-test) and 6-months after training (retention) in a repeated measures design. Relative propulsion of the paretic leg and relative positive work of the hip, knee and ankle joints of both legs were calculated to evaluate symmetry of kinetic forces. FindingsStatistically significant differences in relative propulsion and positive joint work within the paretic and non-paretic legs were not found over time. The stroke group significantly improved gait speed from pre- to post-test (p=.001) and pre-test to retention (p=.008). In comparison to the non-disabled group, forces produced by the stroke group were asymmetrical demonstrating compensatory adaptation. InterpretationAlthough the participants with chronic stroke walked faster after body-weight supported treadmill training, the relative percentages of propulsion and positive work remained unchanged. These findings suggest that the increase in speed was likely due to strengthening existing compensatory strategies rather than through recovery of normal kinetic symmetry.

Reading motivational differences among groups: Reading disability (RD), attention deficit hyperactivity disorder (ADHD), RD + ADHD, and typical comparison

This study assessed the reading motivation of 133 students at individual grade levels (2nd–5th), who were divided in subgroups with and without reading disabilities/difficulties (RD) and with and without attention deficit hyperactivity disorder (ADHD). Major findings were that students in the RD subgroup had lower reading motivation (intrinsic, extrinsic, and self-efficacy) and read less for enjoyment than the nondisability (ND) group; students in the combined group (ADHD+RD) showed these motivational deficits in earlier grade levels. However, students with ADHD did not differ from the ND group in reading motivation, and children with RD (with and without ADHD) were equivalent to ND in social motivation up to the 5th grade. Implications of these findings were (a) social reading is an instructional pathway for both groups of students with RD, (b) assessments of reading motivation, in addition to reading skill, may be important in assessing responses to intervention, and (c) motivational interventions should be implemented early before motivational responses become a motivational style.

AFDC/TANF exits and re-entries for families raising children with educational disabilities

Having a child with a disability is considered a barrier to self-sufficiency among welfare recipients. This study examines the impact of children's educational disability on single-mother families' welfare exits and re-entries for a cohort of children in a metropolitan region in Missouri, who were born between 1982 and 1994, and received AFDC/TANF at least once from 1990 through 2008 (N=4,928). A semiparametric proportional hazards model for recurrent events is used to analyze the relationship between a child's educational disability and family welfare exit and re-entry. Results show that families with children with disabilities (the disability group) are less likely to exit and more likely to re-enter the welfare system than families with children without disabilities (the nondisability group). After the 1996 welfare reform, the welfare exit rate increases more for the disability group than for the nondisability group, while the welfare re-entry rate decreases less for the disability group than for the nondisability group.

Effect of Touch Screen Button Size and Spacing on Touch Characteristics of Users With and Without Disabilities

The aim of this study was to investigate the effect of button size and spacing on touch characteristics (forces, impulses, and dwell times) during a digit entry touch screen task. A secondary objective was to investigate the effect of disability on touch characteristics. Touch screens are common in public settings and workplaces. Although research has examined the effect of button size and spacing on performance, the effect on touch characteristics is unknown. A total of 52 participants (n = 23, fine motor control disability; n = 14, gross motor control disability; n = 15, no disability) completed a digit entry task. Button sizes varied from 10 mm to 30 mm, and button spacing was 1 mm or 3 mm. Touch characteristics were significantly affected by button size. The exerted peak forces increased 17% between the largest and the smallest buttons, whereas impulses decreased 28%. Compared with the fine motor and nondisabled groups, the gross motor group had greater impulses (98% and 167%, respectively) and dwell times (60% and 129%, respectively). Peak forces were similar for all groups. Button size but not spacing influenced touch characteristics during a digit entry task. The gross motor group had significantly greater dwell times and impulses than did the fine motor and nondisabled groups. Research on touch characteristics, in conjunction with that on user performance, can be used to guide human computer interface design strategies to improve accessibility of touch screen interfaces. Further research is needed to evaluate the effect of the exerted peak forces and impulses on user performance and fatigue.

Upper-extremity H-reflex measurement post-stroke: Reliability and inter-limb differences

ObjectiveTo establish test–retest reliability of flexor carpi radialis (FCR) H-reflexes in non-disabled and stroke participants. We also investigated inter-limb differences and effects of chronicity post-stroke compared to non-disabled group and age-related effects in the non-disabled group. MethodsSixteen chronic stroke and twenty-two non-disabled participants were recruited. Bilateral FCR H-reflexes were tested on two separate days by stimulating the median nerve and recording surface electromyography responses. FCR recruitment curves were plotted for H-reflex (H) and motor (M) waves and normalized as a percentage of maximal M-wave (ordinate) and motor threshold (abscissa). StatisticsIntraclass correlation coefficients [two-way mixed model-ICC (1, 2)], one-way ANOVA, Bland–Altman plots, standard error of measurement (SEM), and smallest real difference (SRD). ResultsICCs ranged from 0.55 to 0.95 (stroke) and 0.69–0.88 (non-disabled). SEM% (% of the mean) ranged from 9% to 24% (stroke) and 18–38% (non-disabled); SRD% ranged from 18% to 66% (stroke) and 6% to 50% (non-disabled). H-reflex amplitude and slope were greater in the paretic vs. non-paretic arm post-stroke (p=0.07 and 0.01, respectively) and the paretic arm vs. non-disabled participants (p=0.007 and 0.002, respectively). Stroke participants with longer chronicity (mean 9.4years) revealed a significantly greater Hslp/Mslp on the paretic side compared to shorter chronicity (2.5years; p=0.05). Mean Hslp/Mslp was significantly greater in the young (mean 29years) compared to the older group (62years; p=0.045). ConclusionsThese results establish reliability of FCR H-reflexes in stroke and non-disabled participants. SEM and SRD measurements can be used to interpret recovery patterns and longitudinal effects of therapeutic interventions. SignificanceFCR H-reflex amplitude and slope can be reliably measured and used to investigate neurophysiological mechanisms of motor recovery post-stroke.

Work Disability, Mortgage Default, and Life Satisfaction in the Economic Downturn

The study examined the relationship between work disability and mortgage default in the latest economic downturn in the United States and further assessed the associations of work disability and mortgage default with life satisfaction. Work disability was measured by self-reported health-related work limitations. Mortgage default was defined as delaying home mortgage payment for more than 30 days in the study. The data were obtained from the 2007 and 2009 Panel Study of Income Dynamics, and logistic regression was used to test research questions. Of the 2,361 homeowners who had a mortgage, nearly 6% had mortgage default in 2009, and 14.5% of householders or their spouses had work disabilities in 2007. The disability group was significantly more likely than the non-disability group to have mortgage default, AOR = 1.80, 95% CI = (1.02, 3.16). Both work disability and mortgage default had significant and negative associations with life satisfaction. Results suggest that mortgage assistance services should be provided for individuals with work disabilities and their families to prevent housing distress and improve quality of life.

Disparities in short-term and long-term all-cause mortality among Korean cancer patients with and without preexisting disabilities: a nationwide retrospective cohort study

This study was conducted in order to determine whether a gap exists between cancer patients with disabilities and those without disabilities with regard to short-term and long-term all-cause mortality in Korea. The National Health Insurance claims database and the National Disability Database were used for performance of analyses. We identified 93,758 cancer patients (age, >20 years) who were diagnosed as cancer according to ICD-10 and who underwent treatment between January 1, 2000 and December 31, 2000. To distinguish between short-term and long-term survivorship outcomes, we performed survival analysis of short-term (<5 years) all-cause mortality for cancer patients and then confined our analysis to 5-year cancer survivors in order to assess the impacts of disability on long-term all-cause mortality. All analyses were performed according to gender, type of cancer, and type of disability, respectively, when cell sizes were large enough. Compared with the nondisability group, neither male nor female cancer patients with disabilities showed higher short-term (<5 years) all-cause mortality. When we confined our analysis to 5-year cancer survivors, both male (hazards ratio (HR), 1.48; 95% confidence interval (CI), 1.33-1.66) and female (HR, 1.53; 95% CI, 1.28-1.83) patients with prediagnosis disability had higher long-term all-cause mortality than those in the nondisability group. Male patients with impaired communication (HR, 1.24; 95% CI, 1.07-1.44) and female patients with internal disability (HR, 2.20; 95% CI, 1.42-3.42) had higher short-term (<5 years) all-cause mortality than those without these disabilities. Among both male (HR, 1.56; 95% CI, 1.38-1.75) and female (HR, 1.54; 95% CI, 1.28-1.86) 5-year cancer survivors, impaired mobility showed a significant association with a higher long-term mortality. This study raises concerns with regard to disability-related disparities in cancer outcome among long-term cancer survivors. Further attention and effective collaborative efforts are required for improvement of survival and quality of care for long-term cancer survivors.

Disability, more than multimorbidity, was predictive of mortality among older persons aged 80 years and older

Objective In this study, we evaluate the impact of disability and multimorbidity on the risk of all-cause death in a population of frail older persons living in community. Study Design and Setting We analyzed data from the Aging and Longevity Study in the Sirente geographic area, a prospective cohort study that collected data on all subjects aged 80 years and older ( n = 364). The main outcome measure was all-cause mortality over 4-year follow-up. Results A total of 150 deaths occurred. Sixty-seven subjects (44.6%) died in the nondisabled group compared with 83 subjects (55.3%) in the disabled group ( P < 0.01). Thirty-nine subjects (31.7%) died among subjects without multimorbidity compared with 111 subjects (46.0%) with two or more diseases ( P < 0.01). When examining the combined effect of multimorbidity and disability, the effect of disability on the risk of death was higher than that of multimorbidity. After adjusting for potential confounders, relative to those without disability and multimorbidity, disabled subjects showed an increased risk of death when multimorbidity was associated (hazard ratio [HR] = 3.91; 95% confidence interval [CI] = 1.53–10.00) and in absence of multimorbidity (HR = 2.36; 95% CI = 0.63–8.83). Conclusion Our results show that disability exerts an important influence on mortality, independently of age and other clinical and functional variables.

Work disability in ankylosing spondylitis: differences among working and work-disabled patients

Ankylosing spondylitis (AS) is a systemic chronic inflammatory disease primarily affecting the axial skeleton. Work disability can be one of the major consequences of AS, and the knowledge about the burden of AS to the patient and society is not well-established yet. The objective of this study was to investigate work disability among patients with AS in the national service and to put forward the related factors and differences among disabled and nondisabled groups. A total of 121 male AS patients were included in the study. Patient demographics and duration of disease were noted, and employment status and disability were questioned. Measures of functionality, axial mobility, health-related quality of life, and depression were used. It was found that 38 patients (31.4%) continued their work lives with no change, 54 patients (44.6%) changed to a lighter job, and 29 patients (24%) were retired due to AS. Differences in age at onset of the disease, time since the diagnosis, C-reactive protein (CRP) levels, and hip involvement were statistically significant. The mean retirement age of the patients was 36 +/- 4.2 years. Frequency of hip involvement was higher in the work-disabled group. Spine was evidently affected more seriously, and CRP values were higher in the work-disabled group. Older age at onset, longer time since the diagnosis, longer diagnosis delay, and some physical impairments like decrease in spinal mobility and hip involvement may preclude AS patients from leading a productive work life.