Relative Disability Research Articles

Socio-geographical disparities of obesity and excess weight in adults in Spain: insights from the ENE-COVID study.

In Spain, differences in the prevalence of obesity and excess weight according to sex and sociodemographic factors have been described at the national level, although current data do not allow to delve into geographical differences for these conditions. The aim was to estimate national and regional prevalences of adult obesity and excess weight in Spain by sex and sociodemographic characteristics, and to explore difference sources of inequalities in its distribution, as well as its geographical pattern. ENE-COVID study was a nationwide representative seroepidemiological survey with 57,131 participants. Residents in 35,893 households were selected from municipal rolls using a two-stage random sampling stratified by province and municipality size (April-June 2020). Participants (77.0% of contacted individuals) answered a questionnaire which collected self-reported weight and height, as well as different socioeconomic variables, that allowed estimating crude and standardized prevalences of adult obesity and excess weight. Crude prevalences of obesity and excess weight were higher in men (obesity: 19.3% vs. 18.0%; excess weight: 63.7% vs. 48.4%), while severe obesity was more prevalent in women (4.5% vs. 5.3%). These prevalences increased with age and disability, and decreased with education, census tract income and municipality size. Differences by educational level, relative census income, nationality or disability were clearly higher among women. Obesity by province ranged 13.3-27.4% in men and 11.4-28.1% in women; excess weight ranged 57.2-76.0% in men and 38.9-59.5% in women. The highest prevalences were located in the southern half of the country and some north-western provinces. Sociodemographic characteristics only explained a small part of the observed geographical variability (25.2% obesity). Obesity and overweight have a high prevalence in Spain, with notable geographical and sex differences. Socioeconomic inequalities are stronger among women. The observed geographical variability suggests the need to implement regional and local interventions to effectively address this public health problem.

Years lived with disability of cancer in China: findings from disability weights measurement with a focus on the effect of disease burden

Disability weights are crucial for quantifying health loss associated with non-fatal outcomes and were not well assessed in different countries, especially for specific cancer. Therefore, this study aimed to identify disability weights with a focus on specific cancer in a large Chinese population. Two types of web surveys were conducted, and 254 health states, including 30 new states for specific cancer, were investigated using paired comparison methods. The years lived with disability (YLDs) of cancer were calculated as the sum of the prevalence of each sequela of cancer multiplied by its relative disability weight. In total, 44,069 participants were eligible for the disability weights study. The disability weights of 254 health states were estimated. Among those, the disability weights of 18 specific cancer types varied greatly at diagnosis and primary treatment stage, with the value ranging from 0.619 (95% uncertainty interval (UI) 0.606–0.632) for brain cancer to 0.167 (95% UI 0.158–0.176) for oropharyngeal cancer. The discrepancy in YLDs calculated by different disability weights was high, and the largest gap for all cancer combined was approximately 30.14%. When calculated using the cancer-specific disability weights, a total of 1,967,830 (95% UI 1,928,880–2,008,060) YLDs of cancer were recorded in China. The disability weights of cancer varied greatly among cancer types and populations, which had considerable influence on the estimation of the disease burden. Cancer-specific disability weights could provide a more accurate evaluation of the cancer burden.

Neuroinflammatory Biomarkers for Traumatic Brain Injury Diagnosis and Prognosis: A TRACK-TBI Pilot Study.

The relationship between systemic inflammation and secondary injury in traumatic brain injury (TBI) is complex. We investigated associations between inflammatory markers and clinical confirmation of TBI diagnosis and prognosis. The prospective TRACK-TBI Pilot (Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot) study enrolled TBI patients triaged to head computed tomography (CT) and received blood draw within 24 h of injury. Healthy controls (HCs) and orthopedic controls (OCs) were included. Thirty-one inflammatory markers were analyzed from plasma. Area under the receiver operating characteristic curve (AUC) was used to evaluate discriminatory ability. AUC >0.7 was considered acceptable. Criteria included: TBI diagnosis (vs. OC/HC); moderate/severe vs. mild TBI (Glasgow Coma Scale; GCS); radiographic TBI (CT positive vs. CT negative); 3- and 6-month Glasgow Outcome Scale-Extended (GOSE) dichotomized to death/greater relative disability versus less relative disability (GOSE 1-4/5-8); and incomplete versus full recovery (GOSE <8/ = 8). One-hundred sixty TBI subjects, 28 OCs, and 18 HCs were included. Markers discriminating TBI/OC: HMGB-1 (AUC = 0.835), IL-1b (0.795), IL-16 (0.784), IL-7 (0.742), and TARC (0.731). Markers discriminating GCS 3-12/13-15: IL-6 (AUC = 0.747), CRP (0.726), IL-15 (0.720), and SAA (0.716). Markers discriminating CT positive/CT negative: SAA (AUC = 0.767), IL-6 (0.757), CRP (0.733), and IL-15 (0.724). At 3 months, IL-15 (AUC = 0.738) and IL-2 (0.705) discriminated GOSE 5-8/1-4. At 6 months, IL-15 discriminated GOSE 1-4/5-8 (AUC = 0.704) and GOSE <8/ = 8 (0.711); SAA discriminated GOSE 1-4/5-8 (0.704). We identified a profile of acute circulating inflammatory proteins with potential relevance for TBI diagnosis, severity differentiation, and prognosis. IL-15 and serum amyloid A are priority markers with acceptable discrimination across multiple diagnostic and outcome categories. Validation in larger prospective cohorts is needed. ClinicalTrials.gov Registration: NCT01565551.

Prevalence of Visual Impairment and Coverage of Cataract Surgical Services: Associations with Sex, Disability, and Economic Status in Five Diverse Sites

ABSTRACT Purpose Prevalence of visual impairment (VI) and access to services can vary significantly across and between different population groups. With renewed focus on universal health coverage and leaving no one behind, it is important to understand factors driving inequitable eye health. This paper presents results from five population-based surveys where prevalence of VI and cataract surgical coverage (CSC) were measured and examined for differences by sex, economic-status, and disability. Methods Rapid assessments of avoidable blindness took place in four rural sites: Kalahandi, Jhabua and Sitapur in India; and Singida, Tanzania; and one urban site: Lahore, Pakistan. In addition, the Equity Tool was used to measure economic status and the Washington Group Short Set was used to measure disability. Prevalence of VI and CSC were calculated and associations with sex, disability, and relative wealth examined. Results Prevalence of VI varied from 1.9% in Lahore to 15.0% in Kalahandi. CSC varied from 39.1% in Singida to 84.0% in Lahore. Additional disability was associated with greater levels of VI in all sites and lower CSC in Singida. Being female was associated with higher VI in Kalahandi, Lahore and Singida and lower CSC in Lahore and Singida. Being poorer was associated with higher VI in Singida and lower CSC in Singida and Sitapur. Conclusion Relationships between VI and relative wealth, sex, and disability are complex and variable. Although certain characteristics may be associated with lower coverage or worse outcomes, they cannot be generalized and local data are vital to tailor services to achieve good coverage.

Upper Limb Three-Dimensional Reachable Workspace Analysis Using the Kinect Sensor in Hemiplegic Stroke Patients

A reachable workspace evaluation using the Kinect sensor was previously introduced as a novel upper limb outcome measure in neuromuscular and musculoskeletal conditions. This study investigated its usefulness in hemiplegic stroke patients. Forty-one patients with hemiplegic stroke were included. Kinect-based reachable workspace analysis was performed on both paretic and nonparetic sides. Upper limb impairment was measured using the Fugl-Meyer Assessment and the Motricity Index on the paretic side. Disability was assessed using the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire. Correlations between the relative surface areas, impairment scores, and disability were analyzed. Quadrants 1, 3, and 4 as well as the total relative surface area of the paretic side were significantly reduced compared with the nonparetic side. The total relative surface area of the paretic side correlated with the Fugl-Meyer Assessment scores, the Motricity Index for Upper Extremity, and the Disabilities of the Arm, Shoulder, and Hand questionnaire score. Furthermore, quadrant 3 was the most important determinant of upper limb impairment and disability. A reachable workspace (a sensor-based measure that can be obtained relatively quickly and unobtrusively) could be a useful and alternative outcome measure for upper limb in hemiplegic stroke patients.

The impact of access to prescription drugs on disability in eleven European countries

BackgroundClinical studies have shown that the use of certain drugs can reduce disability. Access to prescription drugs varies across countries. Even when the total number of drugs launched in two countries is similar, the specific drugs that were launched, and the diseases those drugs are used to treat, may differ. Objective/HypothesisWe test the hypothesis that the larger the relative number of drugs for a disease that were launched during 1982–2015 in a country, the lower the relative disability in 2015 of patients with that disease in that country, controlling for the average level of disability in that country and from that disease, and the number of patients with the disease and their mean age. MethodsWe estimate two-way (by country and disease) fixed-effects models of several measures of disability for 31 diseases in eleven European countries using data from the Survey of Health, Ageing and Retirement in Europe and from other sources. ResultsThe estimates imply that drug launches during 1982–2015 reduced the probability of severe limitation in 2015 by 4.9 percentage points, from 21.8% to 16.9%; they reduced the probability of any limitation by 7.7 percentage points, from 61.1% to 53.4%; and they reduced the mean number of Activities of Daily Living limitations by about 29%. Drug launches also yielded a small increase in an index of quality of life and well-being. ConclusionsIn general, the larger the number of drugs for a disease that were launched during 1982–2015 in a country, the lower the average disability in 2015 of patients with that disease in that country, controlling for the average level of disability in that country and from that disease, and the number of patients with the disease and their mean age.

Severity dependent distribution of impairments in PSP and CBS: Interactive visualizations

BackgroundProgressive supranuclear palsy (PSP) -Richardson's Syndrome and Corticobasal Syndrome (CBS) are the two classic clinical syndromes associated with underlying four repeat (4R) tau pathology. The PSP Rating Scale is a commonly used assessment in PSP clinical trials; there is an increasing interest in designing combined 4R tauopathy clinical trials involving both CBS and PSP. ObjectivesTo determine contributions of each domain of the PSP Rating Scale to overall severity and characterize the probable sequence of clinical progression of PSP as compared to CBS. MethodsMulticenter clinical trial and natural history study data were analyzed from 545 patients with PSP and 49 with CBS. Proportional odds models were applied to model normalized cross-sectional PSP Rating Scale, estimating the probability that a patient would experience impairment in each domain using the PSP Rating Scale total score as the index of overall disease severity. ResultsThe earliest symptom domain to demonstrate impairment in PSP patients was most likely to be Ocular Motor, followed jointly by Gait/Midline and Daily Activities, then Limb Motor and Mentation, and finally Bulbar. For CBS, Limb Motor manifested first and ocular showed less probability of impairment throughout the disease spectrum. An online tool to visualize predicted disease progression was developed to predict relative disability on each subscale per overall disease severity. ConclusionThe PSP Rating Scale captures disease severity in both PSP and CBS. Modelling how domains change in relation to one other at varying disease severities may facilitate detection of therapeutic effects in future clinical trials.

The impact of social and psychological consequences of disease on judgments of disease severity: An experimental study

BackgroundThe Global Burden of Disease (GBD) project systematically assesses mortality, healthy life expectancy, and disability across 195 countries and territories, using the disability-adjusted life year (DALY). Disability weights in the DALY are based upon surveys that ask users to rate health states based on lay descriptions. We conducted an experimental study to examine whether the inclusion or removal of psychological, social, or familial implications from a health state description might affect individual judgments about disease severity, and thus relative disability weights.MethodsWe designed a survey consisting of 36 paired descriptions in which information about plausible psychological, social, or familial implications of a health condition was either present or absent. Using a Web-based platform, we recruited 1,592 participants, who were assigned to one of two experimental groups, each of which were asked to assign a value to the health state description from 0 to 100 using a slider, with 0 as the “worst possible health” and 100 as the “best possible health.” We tested five hypotheses: (1) the inclusion of psychological, social, or familial consequences in health state descriptions will reduce the average rating of a health state; (2) the effect will be stronger for diseases with lower disability weights (i.e., less severe diseases); (3) the effect will vary across the type of additional information added to the health state description; (4) the impact of adding information on familial consequences will be stronger for female than male; (5) the effect of additional consequences on ratings of health state descriptions will not differ by levels of completed education and age.ResultsOn average, adding social, psychological, or familial consequences to the health state description lowered individual ratings of that description by 0.78 points. The impact of adding information had a stronger impact on ratings of the least severe conditions, reducing average ratings in this category by 1.67 points. Addition of information about child-rearing had the strongest impact, reducing average ratings by 2.09 points. We found little evidence that the effect of adding information on ratings of health descriptions varied by gender, education, or age.ConclusionsIncluding information about health states not directly related to major functional consequences or symptoms, particularly with respect to child-rearing and specifically for descriptions of less severe conditions, can lead to lower ratings of health. However, this impact was not consistent across all conditions or types of information, and was most pronounced for inclusion of information about child-rearing, and among the least severe conditions.

The Impact of Risk Factors for Coronary Heart Disease on Related Disability in Older Irish Adults.

The aim of this study is to examine the prevalence of coronary heart disease (CHD)-related disability (hereafter also "disability") and the impact of CHD risk factors on disability in older adults in the Republic of Ireland (ROI) and Northern Ireland (NI). Population attributable fractions were calculated using risk factor relative risks and disability prevalence derived from The Irish Longitudinal Study on Ageing and the Northern Ireland Health Survey. Disability was significantly lower in ROI (4.1% vs. 8.8%). Smoking and diabetes prevalence rates, and the fraction of disability that could be attributed to smoking (ROI: 6.6%; NI: 6.1%), obesity (ROI: 13.8%; NI: 11.3%), and diabetes (ROI: 6.2%; NI: 7.2%), were comparable in both countries. Physical inactivity (31.3% vs. 54.8%) and depression (10.2% vs. 17.6%) were lower in ROI. Disability attributable to depression (ROI: 16.3%; NI: 25.2%) and physical inactivity (ROI: 27.5%; NI: 39.9%) was lower in ROI. Country-specific similarities and differences in the prevalence of disability and associated risk factors will inform public health and social care policy in both countries.

Global Burden of Skin Disease: Inequities and Innovations.

We review the current understanding of the burden of dermatological disease through the lens of the Global Burden of Disease project, evaluate the impact of skin disease on quality of life in a global context, explore socioeconomic implications, and finally summarize interventions towards improving quality of dermatologic care in resource-poor settings. The Global Burden of Disease project has shown that skin diseases continue to be the 4th leading cause of nonfatal disease burden world-wide. However, research efforts and funding do not match with the relative disability of skin diseases. International and national efforts, such as the WHO List of Essential Medicines, are critical towards reducing the socioeconomic burden of skin diseases and increasing access to care. Recent innovations such as teledermatology, point-of-care diagnostic tools, and task-shifting help to provide dermatological care to underserved regions in a cost-effective manner. Skin diseases cause significant non-fatal disability worldwide, especially in resource-poor regions. Greater impetus to study the burden of skin disease in low resource settings and policy efforts towards delivering high quality care are essential in improving the burden of skin diseases.

Expanding the phenotype of reciprocal 1q21.1 deletions and duplications: a case series

BackgroundRecurrent reciprocal 1q21.1 deletions and duplications have been associated with variable phenotypes. Phenotypic features described in association with 1q21.1 microdeletions include developmental delay, craniofacial dysmorphism and congenital anomalies. The 1q21.1 reciprocal duplication has been associated with macrocephaly or relative macrocephaly, frontal bossing, hypertelorism, developmental delay, intellectual disability and autism spectrum disorder.MethodsOur study describes seven patients, who were referred to us for developmental delay/intellectual disability, dysmorphic features and, in some cases, congenital anomalies, in whom we identified 1q21.1 CNVs by array-CGH.ResultsOur data confirm the extreme phenotypic variability associated with 1q21.1 microdeletion and microduplication. We observed common phenotypic features, described in previous studies, but we also described, for the first time, congenital hypothyroidism in association with 1q21.1 deletion and trigonocephaly associated with 1q21.1 duplication.ConclusionsThe aim of this study is to contribute to the definition of the phenotype associated with reciprocal 1q21.1 deletions and duplications.

Work disability after road traffic injury in a mixed population with and without hospitalisation

BackgroundStudies addressing work disability after road traffic injury are generally aimed at seriously injured hospital patients, and less is known about the disability burden associated with injuries not requiring hospitalisation. The aim of this study was to describe the distribution and determinants of work disability outcomes for patients with musculoskeletal and orthopaedic traffic injuries, including those not sufficiently severe to require hospitalisation. MethodsPersons injured in road traffic accidents in 2005–2007 claiming compensation via the Transport Accident Commission (Victoria, Australia) were included if they had compensated time off work, and their most serious injury was musculoskeletal or orthopaedic (n=5970). Work disability outcomes were determined from income compensation payments over 17 months following the accident. Logistic regression models were used relating demographic and injury characteristics to work disability. ResultsOf the injuries, 59% required hospitalisation; 15% required hospitalisation of >1 week. Long-term work disability was common with 32% of injuries resulting in work disability ≥6 months after the accident. The duration of work disability increased markedly with length of hospital stay. Those with no hospital stay accounted for 27% of all work disability days; those with ≤7 days in hospital (including no hospital stay) accounted for 71%. Female sex, age ≥35 years and early opioid prescriptions were also risk factors for work disability ≥6 months after the accident. ConclusionThe majority of work disability days were among patients with one week or less in hospital. Because (short) hospitalisation was relatively common after traffic accidents, the relative work disability burden of non-hospitalised injury is not as great as in a mixed injury aetiology population.

Relative weight and disability retirement: a prospective cohort study

The aims of this study were to examine (i) the association of relative weight with subsequent disability retirement due to any diagnosis and also in two major diagnostic groups (ie, musculoskeletal diseases and mental disorders) and (ii) whether diagnosed diseases, physical and mental functioning, and working conditions explain these associations. This prospective study comprised a cohort of 6542 middle-aged employees of the City of Helsinki, Finland. Questionnaire data were linked with register data on disability retirements, with a mean follow-up time of 7.8 years. Adjusting for age, body mass index (BMI) was associated with all-cause disability retirement among men and women, the highest risk being for the severely obese and the obese [hazard ratio (HR) 3.45, 95% confidence interval (95% CI) 2.53-4.69; HR 1.94, 95% CI 1.52-2.46, respectively]. Adjusting for age, relative weight was also strongly associated with the main retirement diagnoses, especially musculoskeletal diseases among the severely obese (HR 4.76, 95% CI 3.06-7.40) and obese (HR 2.35, 95% CI 1.62-3.39). The association was attenuated when adjusting for self-reported diseases and physical and mental functioning at baseline. Working conditions had negligible effects on the associations. Maintenance of normal weight is likely to reduce the risk of disability retirement. Among obese employees, the focus should be on the improvement of physical functioning and the effective treatment of obesity and its co-morbidities to counteract the heightened risk of disability retirement.

The correlation between craniovertebral angle, backpack weights, and disability due to neck pain in adolescents

To investigate the responses of the craniovertebral (CV) angle to backpack loadings in adolescents with and without neck pain and to explore the relationships between CV angle, relative backpack weight, neck pain and disability. A cross-sectional single-blinded study was conducted on 60 adolescents (30 neck pain and 30 non-neck pain) aged from 13 to 18 years old. The verbal analog scale (VAS) and Chinese version of Northwick Park Neck Pain Questionnaire (NPQ) were used to assess neck pain severity and disability respectively. CV angle was measured in neutral and with backpack loadings of 5% to 30% of subject's body weight by using the Head Posture Spinal Curvature Instrument (HPSCI). In both groups, CV angles gradually decreased with increment of backpack loadings and the amount of decreases became significant from 10% body weight onwards (P < 0.05). Although the changes of CV angles did not show any significant differences at any point of comparison between the groups, the neck pain group showed a clinically significant decrease of CV angle (∼ 5°) at 10% relative loading whereas non-neck pain group did it at 15% relative loading. Change of CV angles did not show significant correlations with relative backpack weight, cervical pain and disability (P > 0.05). Our findings suggested a safety limit of 10% relative backpack load for adolescents. The results showed the tendency that the ability of maintaining good head posture in response to backpack loadings by non-neck pain subjects might be better than those with neck pain.

Clinical Usefulness of the Muscle Contracture Test: Time to Reevaluate?

Red Deer Regional Medical Center, Red Deer, Alberta, Canada. ikwetny@hotmail.comIn a recent article, Tautz et al. 1discussed the use of a muscle contracture test for diagnosis of malignant hyperthermia (MH) susceptibility. They correctly noted that there is a 2% chance that contracture testing will incorrectly mislabel an MH-susceptible individual as normal. It is difficult to believe that any of my colleagues will expose a patient to a 2% risk of severe complications by giving triggering anesthetics. In my opinion, the fact that a patient has been evaluated for MH will be a strong indication for using nontriggering anesthesia management. Tautz et al. stated that there is a consensus among experts that a person who has had contracture testing and who is labeled not susceptible can safely receive triggering anesthetics. Unfortunately, they did not provide references to any written guidelines or consensus statements on that issue.Tautz et al. mentioned another reason for using the contractility test: the fact that for certain patients (children, severe asthmatics, and patients with difficult airways) potent inhaled anesthetics are useful. Yes, they are useful. But how safe are they? Is 98% safe enough when we have 100% safe nontriggering alternatives available? Most biopsy centers do not perform these tests for children under 5 yr old.*In the very few situations in which inhalation induction is the safest approach (e.g ., acute epiglottitis or a difficult pediatric airway), the anesthesiologist should be prepared to monitor and treat a possible MH crisis regardless of the patient's test results.I recall consulting one of my own patients regarding contracture testing after an MH crisis.2According to the clinical grading scale, this patient's likelihood of MH was “almost certain.”3The patient and family were informed, and the patient was advised to wear a Medic Alert bracelet. However, I felt uneasy recommending a procedure that was very expensive ($6,000 USD), invasive (need for another anesthesia, relative disability for 3–4 days), and burdensome (3-h flight to nearest biopsy center), with no clear benefits for the patient. In their article, Tauzt et al. wrote: “We cannot fault a clinician who wishes to give a nontriggering anesthetic to a person who has had contracture testing and who is not susceptible to MH.” Thank you for not blaming me for playing it safe! But perhaps we should fault an anesthesiologist who unnecessarily canceled elective procedures because he or she was uncomfortable anesthetizing the patients before their MH status had been established by biopsy. The debate about the usefulness of the muscle contracture test has had a long history.4In our era of evidence-based medicine and cost-effective analyses, should we not also reevaluate muscle biopsy testing for MH?Red Deer Regional Medical Center, Red Deer, Alberta, Canada. ikwetny@hotmail.com

Relative Body Weight and Disability in Older Adults: Results From a National Survey

This study examined the sociodemographic, health, and economic determinants of limitations in performing instrumental activities of daily living (IADL) in Canadians 65 years and older with emphasis on the role of relative body weight. Furthermore, the study examined the relationship between these limitations and the whole range of relative body weight while controlling for the above determinants. This research used data collected in the Canadian Community Health Survey in 2005 on Canadians 65 years and older (N = 21,255). The odds of experiencing IADL limitations were higher for women, the poor, and those not living with a partner. These odds also increased with advancing age and weaker physical health. Controlling for socioeconomic and health characteristics, the odds of experiencing such limitations were significantly elevated in underweight and obese individuals but not in overweight individuals. Prevention and intervention strategies targeting underweight and obese individuals should be a policy priority.

The correlation between craniovertebral angle, backpack weights, and disability due to neck pain in adolescents

To investigate the responses of the craniovertebral (CV) angle to backpack loadings in adolescents with and without neck pain and to explore the relationships between CV angle, relative backpack weight, neck pain and disability. A cross-sectional single-blinded study was conducted on 60 adolescents (30 neck pain and 30 non-neck pain) aged from 13 to 18 years old. The verbal analog scale (VAS) and Chinese version of Northwick Park Neck Pain Questionnaire (NPQ) were used to assess neck pain severity and disability respectively. CV angle was measured in neutral and with backpack loadings of 5% to 30% of subject's body weight by using the Head Posture Spinal Curvature Instrument (HPSCI). In both groups, CV angles gradually decreased with increment of backpack loadings and the amount of decreases became significant from 10% body weight onwards (P < 0.05). Although the changes of CV angles did not show any significant differences at any point of comparison between the groups, the neck pain group showed a clinically significant decrease of CV angle ( approximately 5 degrees ) at 10% relative loading whereas non-neck pain group did it at 15% relative loading. Change of CV angles did not show significant correlations with relative backpack weight, cervical pain and disability (P > 0.05). Our findings suggested a safety limit of 10% relative backpack load for adolescents. The results showed the tendency that the ability of maintaining good head posture in response to backpack loadings by non-neck pain subjects might be better than those with neck pain.

Relative deprivation and incident functional disability among older Japanese women and men: prospective cohort study

Background:A prospective observational study was conducted to test the hypothesis that relative deprivation was associated with incident physical or cognitive disability, independent of absolute income.Methods:Study subjects consist of 9463 non-disabled...

Unruly Bodies: Life Writing by Women with Disabilities (review)

Reviewed by: Unruly Bodies: Life Writing by Women with Disabilities Ananya Mukherjea (bio) Susannah B. Mintz’s Unruly Bodies: Life Writing by Women with Disabilities, Chapel Hill: University of North Carolina Press, 2007 Susannah B. Mintz’s Unruly Bodies provides a much needed discussion of disabled women’s understandings of their own lives, bodies, and identities and of the meanings that their disabilities have and produce in the world—for others who are disabled and for the “able bodied.” As Mintz explains, this book links disability theory with feminist autobiography studies in discussing the illness and disability narratives of eight American women. In his classic work Stigma, sociologist Erving Goffman managed to link the experiences of people with highly visible disabilities (extreme facial disfigurements, missing limbs) with those of people with much more subtle physical anomalies, without diminishing the lives or knowledge of either group. He did so by focusing away from relative physical ability or disability and examining, instead, the concept of social identity and how, in his words, social identity can sometimes be “spoiled” by the body’s failure (refusal?) to conform to the categories and roles that others may expect of it. The disabled body, then, is not so much a determinant of individual value as its presentation, performance, and interpretation are media through which to understand what a society values and how individuals navigate such knowledge. Similarly, Mintz adapts Arthur W. Frank’s ideas that bodies give disability stories their meaning (123) and that the life writing of disabled women are life stories told through the body (9). Mintz writes, “The autobiographers studied in Unruly Bodies are compelling precisely because they write their bodies—their gendered, disabled bodies—as textually produced but also phenomenologically alive” (4). Trinh T. Minh-ha, in Woman, Native, Other, exhorted women of color to resist the seemingly rational, masculinist impartiality of academic discourse by “writing their bodies,” speaking from their own subjectivities, experiences, and practical knowledge as influenced by their physical bodies and the categories and political positions through which those bodies pass. Mintz offers a discussion of the writing of disabled women who do the same. As with Trinh’s work and women of color, the pertinence of this subject and [End Page 315] book, while certainly significant for English language studies and for disability studies, reaches beyond to gender studies, to women’s history, to sociology, and to sexuality studies. While Mintz’s book has much to offer as it studies a spectrum of life writing by contemporary disabled women, it is particularly noteworthy for highlighting the sexual and emotional lives of these writers, aspects of their lives that have been left out of much work in disability studies. Queer disability studies has been one exception to this oversight, but Mintz makes a real contribution by refusing (as do the writers she discusses) to redeem the disabled by presenting them as particularly brave, creative, or wise. Rather, it is in narrating her everyday life that Mintz disavows any need for redemption or constant comparison to the lives of the “normal” or “able bodied.” It is in such mundane reportage that the author is able to “set right” mistakes or misunderstandings from the past; in the case of Denise Sherer Jacobson’s story of parenting her infant son, “The Question of David becomes the arena in which Jacobson can transform submissive . . . behavior into scenes of . . . resolute expression” (148). In discussing Nancy Mairs’s detailed, matter-of-fact writing about her life with multiple sclerosis (MS), her experiences as the mother of adolescents, or her erotic relationship with her husband, Mintz writes, Mairs’s own phenomenology demands reckoning with a degenerative condition whose specific effects . . . force a continual renegotiation of the nature of selfhood. . . . To counteract the essentializing maneuvers of patriarchal discourse, Mairs presents a self both indeterminate and adamantly embodied, capable of becoming unhinged from cultural categories but also defined by the realities of MS. Asking that her readers acknowledge both the ordinariness and radical difference of her “crippled” female self, Mairs exposes the boundaries apparently inherent in [oppositional categories].” (26) Mintz’s focus on life writing as phenomenology and her insistence that the careful reader work hard to strike...

The burden of cardiovascular disease and cancer attributable to low fruit and vegetable intake in the European Union: differences between old and new Member States

To estimate the burden of disease attributable to low fruit and vegetable intake in the 15 countries that were members of the European Union (EU) before May 2004 (EU-15) and the 10 countries that then joined it (EU-10). Data on fruit and vegetable intake, target levels of intake and estimates of relative risks, deaths and disability were combined to obtain the burden of ischaemic heart disease, ischaemic stroke and four types of cancer (lung/bronchus/trachea, stomach, oesophagus, and colon/rectum) attributable to low fruit and vegetable consumption. EU-15 and EU-10 Member States. The number of lives potentially saved annually from the selected outcomes if fruit and vegetable intake increased to 600 g person(-1) day(-1) reached 892,000 and 423,000 in the EU-15 and EU-10, respectively; total disease burden could decrease by 1.9% and 3.6%, respectively. The burden of ischaemic heart disease and stroke could be reduced by up to 17% and 10%, respectively, in the EU-15 and by 24% and 15%, respectively, in the EU-10; potential reductions for the selected cancers varied from 1% to 12% in the EU-15 and from 2% to 17% in the EU-10. The potential health gain of increased fruit and vegetable intake is particularly large in the new Member States, and particularly high for cardiovascular diseases, a main cause of health divide in Europe. This stresses the need for better nutrition programmes and policies that take account of economic, social and cultural specificities.