Severe Disability Research Articles

“What is the point of being able to enter a building if the service or activity is not adapted?”: Leisure opportunities for people with severe disabilities’

Leisure and relationships are crucial for human development, especially in the youth stage, and are recognised rights. Notwithstanding, young people with disabilities encounter many barriers to access these activities, especially those with severe disabilities. We aim to analyse their experiences and those of their families in this area. We conducted a reflexive thematic analysis of 25 interviews held with young people with severe disabilities and/or their guardians from different areas of Aragón (Spain). We detected difficulties, such as access to resources, and the relevance of family support and its impact. Aggravating factors, such as being institutionalised, being a migrant or having multidisability were assessed. After discussing participants’ proposals with current research, we proposed measures to improve social inclusion in the leisure of young people with severe disabilities, such as recognising the leisure assistant figure, the training for and more professionals, or the incorporation of the intersectional perspective into specialised social services.

The Minimal assessment Protocol for Cerebral Stroke 2020 (PMIC2020): a multicenter feasibility study in post-stroke inpatient rehabilitation.

In 2008, a Working Group of the Italian Society of Physical and Rehabilitation Medicine (SIMFER) published the first minimum protocol for assessing stroke patients (PMIC) to define functional needs and outcomes. The recent PMIC revision (PMIC2020) introduces a document for all rehabilitation settings, incorporating updated measurement tools. The aim of this study was to investigate the PMIC2020 feasibility and administration time (AT) in post-stroke inpatients and to examine the influence of demographic and clinical variables on AT. Multicenter prospective observational study. Eight Italian rehabilitation centers for post-acute inpatients. Adult patients consecutively admitted to rehabilitation after ischemic/hemorrhagic stroke, reporting the first event or recurrence, with a modified Barthel Index (mBI)<75 points, without cognitive impairment and clinical instability. PMIC2020 was administered at admission (T0) and discharge (T1), recording AT of each section/ tool. A feasibility questionnaire was administered to assessors. Univariate and multivariate analyses were conducted to investigate the effect of demographics and clinical variables on AT. One hundred fifty-one subjects were enrolled at T0 and 139 at T1; the mean±SD AT (seconds) was 1634±401 at T0 and 1087±360 at T1 (P<0.001). National Institute of Health-Stroke Scale and Mini-Mental State Examination required the highest AT. All but two scales had significantly lower AT at T1 (P<0.05). Severe disability (as measured by mBI) was associated with higher AT than either complete or minimal/absent disability. The feasibility questionnaire showed good PMIC2020 appraisal by assessors without relevant critical issues. PMIC2020 was feasible in post-acute inpatient rehabilitation settings. No relevant critical issue was raised by users. Even though more comprehensive than PMIC, PMIC2020 required only slightly more AT (27 minutes at T0 and 18 minutes at T1, on average); more AT was needed to assess patients with severe disability. The study has immediate transferability for the National Health Service, as PMIC2020 can be routinely implemented in clinical practice and research to assess stroke patients' needs and outcomes. The updated measures allow more immediate comparisons with international data on stroke rehabilitation. Future research should investigate the PMIC2020 feasibility in other rehabilitation settings and its relevance in predicting stroke rehabilitation needs and outcomes.

The Landscape of Randomized Clinical Trial Meta-analyses on Statins for Aneurysmal Subarachnoid Hemorrhage: A Scoping Review.

Aneurysmal subarachnoid hemorrhage (aSAH) is a type of non-traumatic SAH that can have detrimental effects on the central nervous system, resulting in severe disability or death. Early nimodipine is currently the only strongly recommended pharmacological treatment that has shown efficacy in improving neurological/functional outcomes in aSAH patients. Whether statin treatment is of benefit to aSAH patients is an issue that has generated considerable interest and debate. In the present scoping review, we mapped and analyzed the available literature on metaanalyses of randomized clinical trials (RCTs) examining the effect of statins on aSAH. Seventeen meta-analyses of RCTs, published between 2008 and 2023, were identified. Treatments in included meta-analyses were based on various regimens of simvastatin, pravastatin, pitavastatin or atorvastatin for up to 21 days. Eleven of the included reports indicated some beneficial effect of statin treatment, reducing rates of at least one of the following: cerebral vasospasm, delayed cerebral ischemia/delayed ischemic neurologic deficit, mortality or functional/ neurological outcome. In contrast, six meta-analyses, showed no such effects. The limitations reported by several meta-analyses, included low patient numbers or disproportionate representation of patients from certain RCTs, differences in drug treatment, patient diagnostic criteria and outcome evaluation between RCTs, as well as poor data quality or lack of RCTs data. Knowledge of the reported limitations may aid the design of future clinical trials and/or their meta-analyses.

Sex differences in the impact of lower respiratory tract infections on older adults’ health trajectories: a population-based cohort study

BackgroundLower respiratory tract infections (LRTIs) are a major global health concern, particularly among older adults, who have an increased risk of poorer health outcomes that persist beyond the acute infectious episode. We aimed to investigate the mid-term (up to 7 years) and long-term (up to 12 years) effects of LRTIs on the objective health status trajectories of older adults, while also considering potential sex differences.MethodsCohort data of adults aged ≥ 60 years from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K) collected between 2001 and 2016 was analyzed. Information on LRTIs was obtained from the Swedish National Patient Register, and objective health status was assessed using the Health Assessment Tool (HAT) which incorporates indicators of mild and severe disability, cognitive and physical functioning, and multimorbidity. The LRTI-exposed and -unexposed participants were matched using propensity score matching based on an expansive list of potential confounders. Mixed linear models were used to analyze the association between LRTIs and changes in HAT scores.ResultsThe study included 2796 participants, 567 of whom were diagnosed with a LRTI. LRTIs were independently associated with an excess annual decline of 0.060 (95% CI: -0.107, -0.013) in the HAT score over a 7-year period. The associations were stronger among males, who experienced an excess annual decline of 0.108 (95% CI: -0.177, -0.039) in up to 7-years follow-up, and 0.097 (95% CI: -0.173, -0.021) in up to 12-years follow-up. The associations were not statistically significant among females in either follow-up period.ConclusionLRTIs, even years after the acute infectious period, seem to have a prolonged negative effect on the health of older adults, particularly among males. Preventative public health measures aimed at decreasing LRTI cases among older adults could help in preserving good health and functioning in old age.

Disability and intimate partner violence experience among women in rural Samoa: A cross-sectional analysis.

Women with disabilities experience higher rates of intimate partner violence (IPV). Evidence suggests this violence often manifests in more subtle and severe forms over longer periods of time. There is limited evidence on this association in the Pacific Islands region, despite facing one of the highest global prevalences of IPV. Examine the prevalence of disability and the association between disability and types of IPV experience among women in rural Samoa as part of the EVE Project. This study analysed cross-sectional data collected with nine communities in rural Samoa between December 2022 and February 2023. Enumerators collected data with 707 women on tablets using REDCap. IPV was measured using the standardised Demographic and Health Survey (DHS) domestic violence methodology. Disability was assessed using the Washington Group questions. Logistic regression was conducted to examine the association between disability and experiences of IPV (physical, sexual, emotional and economic violence) among women. Having a disability was significantly associated with increased IPV experience among women in this study. When controlling for age and education, women with severe disability were significantly more likely to experience sexual (OR 4.31; p=0.01) and emotional (OR 2.87; p=0.02) IPV, when compared to women with no disability. Our findings point towards a greater vulnerability of women with disabilities to IPV, and particularly sexual and emotional IPV, in rural Samoa. Qualitative research in partnership with women with disabilities is essential to inform the design of measurement tools and prevention programmes that are grounded in the context-specific experiences and needs of all women with disabilities.

Towards a treatment for thyroid hormone transporter MCT8 deficiency: achievements and challenges.

Patients with an inactive thyroid hormone (TH) transporter MCT8 (Allan-Herndon-Dudley Syndrome, AHDS) display severe neurological impairments and motor disabilities indicating an indispensable function of MCT8 in facilitating TH access to the human brain. As a consequence, the CNS of AHDS patients appears to be in a TH deficient state which greatly compromises proper neural development and function. As another hallmark of this disease, patients exhibit elevated serum T3 levels leading to a hyperthyroid situation in peripheral tissues. Several treatment strategies have been developed and evaluated in preclinical mouse models as well as in patients. Here, we discuss these different therapeutic approaches to overcome MCT8 deficiency and summarize the current achievements and challenges in improving brain maturation in the absence of MCT8.

Parents and service providers’ perspectives about social inclusion of people with neurodevelopmental disabilities in Qatar: investigation of financial transactions and personal status laws

The current study aims to explore parents and service providers’ attitudes towards the social inclusion of people with neurodevelopmental disabilities into society, through exercising their rights in various financial transactions and personal status matters in the State of Qatar. Additionally, the study aims to explore any differences in the participants’ attitudes towards social inclusion based on their role, gender and the child’s disability type. Eighty-two service providers (46 Female) and sixty-five parents (40 Female) of children with Intellectual Disability or Autism Spectrum Disorder participated in this study. They completed the Attitudes towards social inclusion of people with disabilities (ASIPD) Scale. Findings showed that the participants believe that the Shari’ah (Islamic law) places a high premium on the social inclusion of the people with neurodevelopmental disabilities and predates various modern theories on the subject. In addition, the Islamic law permits the persons with mild neurodevelopmental disabilities to engage in many contracts in the realms of financial transactions and personal status. Parents and service providers have neutral to positive attitudes towards social inclusion of people with neurodevelopmental disabilities in terms of performing some financial transactions and some personal status rights like marriage and divorce according to severity of disability. Results were discussed and further recommendations were provided.

Self-esteem among People Living with Physical Disability Visting Rehabilitation Centers of Kathamandu, Nepal: An Observational Study

Introduction: Self-esteem is a comprehensive personal evaluation of an individual's worth that involves a person's perception of self, it functions as a defense mechanism that individuals possess to safeguard themselves from psychological harm. This study aims to assess the prevalence of self-esteem and its associated factors among people living with physical disability. Methods: A cross-sectional study was conducted among people living with a physical disability residing inside Kathmandu Valley from August to November 2022 after acquiring ethical approval from institutional review committee of CiST College (Reference number: IRC/161/078/079). A total of 215 samples were taken for the study. A face-to-face interview technique was applied for data collection consisting of the Rosenberg self-esteem scale. Bivariate analysis applying a Chi-squared test and multivariable logistic regression was carried out to identify the factors associated with self-esteem at 95% CI and 5% level of significance (p-value &lt;0.05).Results: It was observed that 71 (33.02%) participants had lower levels of self-esteem. Education, family type, the severity of disability, and family affection were the factors associated with self-esteem in bivariate analysis. In multivariable analysis, informal education (aOR: 3.932; 95% CI 1.129-13.696), poor family relationships were twice (aOR: 2.237; 95% CI 1.029-5.507), perceived severity of disability (aOR: 3.129; 95% CI 1.341-7.300) to be associated with lower self-esteem.Conclusions: The findings reveal that a significant portion of participants, approximately one-third, experience lower levels of self-esteem. Furthermore, factors such as education, family type, severity of disability, and family affection emerged as significant influencers of self-esteem.

Alfacalcidol-Induced Kidney Injury in Patients with Severe Motor and Intellectual Disabilities.

Patients with severe motor and intellectual disabilities (SMID) often experience insufficient physical activity, leading to osteoporosis. The active form of vitamin D is commonly prescribed for the prevention or treatment of osteoporosis. We observed four cases of kidney injury believed to be associated with the administration of 1α-OH vitamin D (alfacalcidol) preparations. This study employed a case series design to investigate change in kidney function in SMID patients following administration or discontinuation of alfacalcidol. We retrospectively analyzed data of 23 SMID patients (sex: 10 males, 13 females; age range: 27 to 74 y), and assessed kidney function, serum calcium, and albumin levels. Data was grouped into A: 16 cases collected both before starting alfacalcidol administration and during alfacalcidol administration; and into B: 11 cases collected during alfacalcidol administration and after discontinuation of alfacalcidol administration. Of the 23 patients, four were assigned into both group A and group B. Of the 16 cases in group A, six showed ≥30% decreased kidney function. Of the 11 cases in group B, the median values of modified Cr-eGFR were 43.0 and 65.1 mL/min/1.73 m2, respectively (p=0.008), indicating a significant improvement in kidney function. It is essential for practitioners to understand that osteoporosis may ordinarily occur in SMID patients due to reduced bone stimulation. Thus caution must be exercised when administering active vitamin D preparations to this population, as they carry a risk of kidney organ damage despite having no direct effect on bone health.

Effectiveness of Transforaminal Epidural Steroid Injection and Lumbar Traction in Lumbar Radiculopathy Due to Intervertebral Disc Herniation: A Comparative Study

Background: Lumbar radiculopathy, commonly caused by intervertebral disc herniation, leads to severe pain and disability. Various non-surgical treatments, including Transforaminal Epidural Steroid Injection (TESI) and lumbar traction, are employed to alleviate pain and improve functionality. Objective: The study aimed to compare the effectiveness of TESI and lumbar traction in managing lumbar radiculopathy. Methods: This study was designed as a prospective, randomized, comparative trial conducted over 12 months at a tertiary care center, involving 100 patients diagnosed with lumbar radiculopathy due to intervertebral disc herniation (IDH). Eligible patients, aged 18 to 65 years with MRI-confirmed disc herniation causing radiculopathy, were randomly assigned to either the TESI group (n=50) or the lumbar traction group (n=50). Exclusion criteria included patients with prior lumbar surgery, spinal infections, or tumors. The TESI group received a single transforaminal epidural steroid injection under fluoroscopic guidance, while the lumbar traction group underwent mechanical traction therapy for 30 minutes per session, three times a week for six weeks. Outcome measures included pain intensity, assessed using the Visual Analog Scale (VAS) at baseline, two weeks, and six months post-intervention, functional outcome using the Oswestry Disability Index (ODI) at the same time points, and patient satisfaction using a five-point Likert scale at six months. Statistical analyses were conducted using SPSS software, with significance set at p-values &lt;0.05. Results: The results of this study demonstrated that both the TESI and lumbar traction groups experienced significant improvements in pain and functional outcomes; however, the TESI group showed more pronounced results. In terms of pain reduction, the TESI group’s mean VAS score decreased from 7.5 at baseline to 3.2 at two weeks and 2.8 at six months, while the lumbar traction group saw a decrease from 7.6 to 5.1 at two ........

A Five-year Study of Spinal Disorders among Patients Presenting to the National Trauma Center of Nepal: An Observational Study

Introduction: Spinal cord injuries result in severe neurological impairments and disabilities. With an estimated 15.4 million cases globally in 2021, spinal cord injuries are more common in low- and middle-income countries, yet research in these areas is limited. This study aimed to find the pattern of spinal injuries and outcomes associated with spine injuries over a five-year duration at a tertiary trauma care center. Methods: This observational cross-section study was conducted at the National Trauma Center, Kathmandu from 2075 to 2080 B.S. with ethical clearance from the Nepal Health Research Council (Reference number: 968). Total-population sampling was used. A structured proforma was employed as the primary data collection tool. Data was analyzed using SPSS. Results: Of the 20843 patients, 2070 (9.93%) had spinal injuries. The median age was 43 (IQR 32-56) years, with 1391 (67.20%) male patients. The median hospital stay was 12 (IQR 7-20) days. Falls accounted for 1221 (58.99%) cases, and road traffic accidents for 195 (9.42%). Spinal fractures were present in 1076 (51.98%) patients with 456 (42.38%) in lumbar vertebra. There were 225 (10.87%) cases of subluxation with 214 (95.11%) in cervical level. Conclusions: The study provides insights into the patterns and outcomes of spinal injuries over five years of time. The mortality rate and cases of patients leaving against medical advice highlight areas for improvement in patient care and follow-up.

Machine learning for predictive AAC: Improving speech and gesture-based communication systems

Augmentative and alternative communication (AAC) systems play a crucial role in supporting individuals with severe communication disabilities by providing accessible means of expression and engagement. However, many conventional AAC devices rely on manual input or basic predictive functions, which can limit communication efficiency and responsiveness. The application of machine learning (ML) to AAC offers new opportunities to enhance these systems, enabling them to provide faster, more accurate, and contextually relevant communication assistance. Advances in ML, particularly in predictive text, speech recognition, and gesture interpretation, allow AAC systems to adapt more intuitively to user needs, predicting intent based on usage patterns and multimodal data, such as voice and gestures. Current research highlights the potential of ML to address key gaps in AAC technology by creating more responsive, personalized systems that align with individual user behaviours. This study proposes a novel ML framework designed to integrate these capabilities, promising improvements in communication speed, user autonomy, and accuracy. By addressing the challenges and limitations of traditional AAC devices, this research aims to advance accessible communication solutions that empower users and improve quality of life.

CPMP rescue of a neonate with severe molybdenum cofactor deficiency after serendipitous early diagnosis, and characterisation of a novel MOCS1 variant

We report the first, and so far, only index patient with neonatal onset MoCD type A who was diagnosed and treated early enough with cPMP to avoid severe brain injury and disability. The child presented with hypoglycemia at the age of 10 h and was diagnosed because of the incidental finding of severely decreased L-cystine in plasma. Due to a high level of awareness and excellent co-operation between metabolic laboratory and clinical services, cPMP substitution could be initiated before severe encephalopathy set in, and the child subsequently had a normal motor development. The child has been continued on daily substitution with cPMP until today (age 7 years) and has shown a satisfying long-term developmental outcome. Long-term follow-up, however, revealed significant communication difficulties and cognitive abilities in the range of mild to moderate learning disability. The severity of the metabolic disease was confirmed by the extent of biochemical abnormalities and further functional characterisation of the underlying genetic variants. This case provides further evidence that cPMP substitution does significantly alter the disease course when applied early enough. Postnatal treatment in this case was not sufficient to enable an entirely normal cognitive development, despite sustained complete normalization of the biochemical abnormalities.

Disease burden among patients with Arginase 1 deficiency and their caregivers: A multinational, cross-sectional survey.

Arginase 1 deficiency (ARG1-D) is an ultrarare, metabolic disease which may cause spastic paraplegia, cognitive deficiency, seizures, and ultimately severe disability. The aim of this study was to assess disease burden in ARG1-D by performing a cross-sectional survey of patients with ARG1-D and their caregivers in four European countries (France, Portugal, Spain, and the United Kingdom). Patients were enrolled at participating clinics and data were collected using a web-based questionnaire. The findings indicate that there is a significant share of patients who experience severe cognitive and mobility impairment but also that there is a considerable variance in symptom severity among patients. Disease management was mostly in line with treatment guidelines and self-reported adherence to treatment was reported to be high among a majority although following diet restrictions was perceived as difficult. However, despite this, since a large share of patients experienced severe cognitive and mobility impairment an unmet need among this patient population is suggested. The introduction of disease-modifying therapies and early identification and diagnosis may help alleviate the disease burden associated with ARG1-D in the future.

Post-operative Mortality Trends for Complicated Appendicitis: Adults with and without Disabilities

Abstract Background Even for the same complicated appendicitis, the prognosis may vary if appropriate post-operative care and follow-up are not provided. We aimed to investigate the 10-year trend of complicated appendicitis mortality among disabilities and non-disabilities peoples in Korea, recognizing potential disparities in post-surgical outcomes and the importance of adequate post-operative care. Methods Patients with complicated appendicitis were classified by severity using DRG codes. Causes of death were categorized into infectious, respiratory, cardiovascular, and digestive diseases using ICD-10 data. Age-adjusted mortality rates were calculated annually from 2008 to 2017 based on disability presence, severity, and type. Factors associated complicated appendicitis mortality were analyzed using multivariate logistic regression models. Results The mortality of complicated appendicitis was 10.2 times (40.8% vs. 413.9%) higher in people with disabilities, especially those with severe disabilities. This difference was more evident in patients with a severe disability (aOR=2.12, 95% CI:1.58-2.86), intellectual or psychological disability (aOR=2.95, 95% CI:1.49-5.85) and internal organ problems (aOR=2.05, 95% CI:1.28-3.28). Conclusions Our findings suggest that insufficient post-operative care among disabled peoples, especially those with severe disabilities, internal organ problems, and intellectual or psychological disabilities, may impact outcomes. This is exacerbated by poor healthcare facilities and limited disability awareness among healthcare workers. Additionally, further research is required to uncover unexplained mortality causes. Funding: This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Education (No. 2022R1I1A3070074) and by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health &amp; Welfare, Republic of Korea (grant number: HC23C0165). Key messages • Complicated appendicitis mortality rates show a stark 10.2-fold disparity between people with and without disabilities. • Severe disabilities, intellectual or psychological disabilities, and internal organ problems heighten the risk, emphasizing the importance of disability-inclusive healthcare practices.

Factors Influencing Quality of Life in the Disabled: Focus on Household Members Mental Health

Abstract Background Household members of the disabled experience various difficulties such as social isolation and the burden of caregiving. These difficulties can lead to mental health problems, which in turn affect the quality of life(QoL) of the disabled. Research on the QoL of the disabled is ongoing, but there are few studies addressing the mental health of household members. We aimed to investigate the impact of household members’ mental health on the QoL of the disabled. Methods We used data from the 2021 Disability and Life Dynamics Panel(nationwide survey). On the base of Patrick’s model of disability health promotion, we analyzed the impact of household members’ mental health on the QoL of the disabled by using correlation analysis and multiple regression analysis adjusted for gender, age, income level, employment status, education level, activities of daily living, participation in social activities, type and severity of disability, presence of multiple disabilities, and health status. Results The level of depression(r=-.316, p&amp;lt;.0001) and self-esteem(r=.248, p&amp;lt;.0001) of household members were found to be significantly correlated with the QoL of the disabled. The level of depression of household members had a significant negative impact on the QoL of the disabled(β=-.153, p&amp;lt;.0001), while self-esteem had a significant positive impact(β=.144, p&amp;lt;.0001). It was found that the level of depression had a greater impact on QoL than self-esteem. Conclusions Lower levels of depression and higher levels of self-esteem of household members are associated with higher QoL for the disabled. Improving the mental health of household members is crucial in improving the QoL of the disabled, enabling them to interact more positively with society. Additionally, as 27% of household members experience depressive issues, enhancing their mental health positively impacts on the overall well-being of families with disabilities. Efforts to enhance household members’ mental health are crucial. Key messages • Household members’ mental health significantly influences the quality of life of the disabled. • To improve the quality of life of the disabled, strengthening programs for promoting the mental health of household members and policy improvements are necessary.

Key Factors Influencing Quality of Life in the Disabled Based on Multifaceted Life Satisfaction

Abstract Background Healthy life of the disabled is considered a global social issue, and enhancing the quality of life (QoL) of the disabled is an important task. The disabled have lower multifaceted life satisfaction due to various daily restrictions, which negatively affects their QoL. Research on the QoL of the disabled is ongoing, but there are few comprehensive studies addressing multifaceted life satisfaction. To enhance the QoL of the disabled, it is essential to understand their multifaceted life satisfaction and investigate key factors influencing their QoL. Methods We used data from the 2021 Disability and Life Dynamics Panel (nationwide survey). On the base of Patrick’s model of disability health promotion, we analyzed the impact of multifaceted life satisfaction of the disabled on their QoL by using multiple regression analysis adjusted for gender, age, education level, daily living activities, type and severity of disability, and presence of multiple disabilities. Results The satisfaction with social relationships(β=.535, p&amp;lt;.0001), income(β=.146, p&amp;lt;.0001), housing environment(β=.132, p&amp;lt;.0001), occupation(β=.130, p&amp;lt;.0001), and health(β=.111, p&amp;lt;.0001) was found to have a significant positive impact on the QoL of the disabled. Particularly, satisfaction with social relationships exerted the greatest impact on their QoL. Conclusions Not only health satisfaction, but also social relations, income, housing environment, occupation had a substantial impact on the QoL of the disabled. These findings can support the government in prioritizing health policy development for the disabled and contribute to improving the QoL for the disabled through a comprehensive and integrated approach. The government should develop health policies to enhance social connections and support networks for the disabled, while also considering aspects for improving income, housing environment, occupation, and health. Key messages • Not only health satisfaction, but also social relations, income, housing environment, occupation had a substantial impact on the QoL of the disabled. • The government should prioritize developing health policies aimed at enhancing social relations for the disabled, while also considering income, housing environment, occupation, and health.

Nationwide trends in the suicide mortality among the disabled in Korea from 2006 to 2017

Abstract Aims The disabled are one of the priority populations at risk of suicide, but there has been no study of the factors influencing suicide mortality among the disabled in South Korea. Methods To analyze age-standardized suicide mortality (ICD-10 Codes, X60-84) for each year according to the presence, severity and type of disability, we linked three population datasets (National Health Insurance Claims Database, Disability Registry, and Deaths by Cause). Our dataset covers the entire population of South Korea, extended over a 12-year period from 2006 to 2017. The analyses were stratified by sex, and hazard ratios for suicide were determined by multivariate logistic regression after adjustment for socio-demographic and clinical variables. Results The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017. The highest suicide rates were observed among intellectual or mental disabled, and severe disabled. In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female. Conclusions Although the disabled people’s suicide is often seen as an individual problem, it actually affects their families, communities and society. Therefore, government must strive to emphasize the broad view of the disabled population - not just the health of individuals, and track suicide trends and identifying risk and protective factors for suicidal behavior. From this information, suicide prevention strategies for the disabled people should be evaluated to identify the most effective interventions. Financial support: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (No. 2022R1I1A3070074, and 2022R1I1A1A01068449), and a grant of Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health &amp; Welfare, Republic of Korea (No. HC23C016500). Key messages • The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017. • In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female.

Implantable cardioverter defibrillators among elderly survivors of out-of-hospital cardiac arrest

Abstract Background Survivors of out-of-hospital cardiac arrest (OHCA) with a shockable rhythm are at increased risk of cardiac arrest, and clinical practice guidelines recommend placement of an implantable cardioverter defibrillator (ICD) in the absence of a reversible cause and an expected meaningful survival of at least one year. Contemporary data on the prevalence of secondary prevention ICD placement among OHCA survivors remain limited. Purpose Examine patterns of secondary prevention ICD implantation in survivors of OHCA due to a shockable rhythm in a large national registry. Methods Using 2013-2019 data from the Cardiac Arrest Registry to Enhance Survival (CARES) linked to Medicare files, we identified 3,226 patients aged &amp;gt;65 years who survived to discharge following OHCA due to an initial shockable rhythm from January 1, 2013 to December 31, 2019. Patients with severe neurological disability, prior history of cancer, and those discharged to hospice were excluded. We calculated cumulative prevalence of ICD implantation at discharge, 90 days, and 6 months post cardiac arrest. Multivariable hierarchical regression models with random hospital effects were used to determine the adjusted association of patient characteristics with ICD implantation and quantify the extent of variation in ICD implantation across sites, using a median odds ratio (OR) and 95% confidence interval (CI). Results Patients’ mean age was 72.2 years; 23.5% were women, 10% were Black and 4% Hispanic. Among 3,226 OHCA patients, 997 (30.9%) received an ICD before discharge; 1,266 (39.2%) received an ICD within 90 days of cardiac arrest, and 1,287 (39.9%) received an ICD by 6 months. After adjusting for differences in demographics and co-morbidities, the odds of receiving an ICD at discharge were significantly lower in patients aged 85 years and older, women, patients with prior history of stroke or diabetes, patients who presented with acute myocardial infarction (P&amp;lt;0.05 for all). There was no significant difference in ICD implantation by race and ethnicity (P=0.94) (Table 1). Even after adjusting for patient demographics, co-morbidities, and presentation with acute myocardial infarction, there was large variation in hospital rate of ICD implantation at discharge, with a median odds ratio of 1.65 (95% CI 1.41-1.86). Conclusion Fewer than 1 in 3 patients with OHCA due to a shockable rhythm are discharged with a secondary prevention ICD. Although implantation of ICD was associated with patient variables, there was no difference in ICD implantation by race and ethnicity. There was large variation across hospitals in ICD implantation even after adjusting for patient variables highlighting an opportunity for improving post-arrest management of cardiac arrest survivors.

4.C. Scientific session: Navigating through complex challenges of responding to outbreaks of multidrug-resistant organisms

Abstract Antimicrobial resistance is one of the top ten global public health threats according to the WHO, contributing to millions of deaths each year. While outbreaks of multidrug-resistant organisms (MDROs) are well studied in hospital and nursing home settings, knowledge gaps exist concerning the complex challenges of outbreaks of MDROs among vulnerable patient populations, such as patients with intellectual disabilities or elderly patients living longer at home with multiple comorbidities. The coordination of such outbreaks requires a multidisciplinary approach as these patients often receive care throughout different healthcare settings, including long-term care and home-based nursing care. We delve into the complexities of coordinating an MDRO outbreak response involving healthcare professionals from various healthcare settings. The challenges inherent to the coordination of multidisciplinary involvement and the use of innovative strategies for outbreak preparedness and surveillance, will be thoroughly examined based on scientific evidence and practice based experiences. Workshop objectives • To exchange experiences on managing cross-institutional outbreaks of MDROs • To foster deeper understanding of the complexities of multidisciplinary involvement during MDRO outbreaks among vulnerable patient populations The workshop structure: - A brief introduction will be provided on the generic challenges in providing long-term care to vulnerable patient populations carrying MDROs. We will subsequently illustrate potential challenges faced during a cross-institutional MDRO outbreak among these patients through a realistic scenario (5 min): A patient with severe intellectual and physical disabilities living in both a long-term care facility as well as with family at home, unexpectedly turns out to be carrying an MDRO after recent hospital admission. As the patient receives nursing care from both from family members and nursing staff in different healthcare settings, a cross-institutional MDRO outbreak has occurred requiring a coordinated response. - Hereafter, individual presenters will address evidence- and experience-based challenges faced in MDRO outbreak responses within the specific healthcare settings covered in the previously presented scenario. We will navigate through the scenario together with the participants, discussing practical and ethical dilemmas, and explore ways for containing the MDRO outbreak while maintaining effective and compassionate healthcare delivery. In addition, we will discuss the use of public health innovations, such as social network analysis as a basis for the development of a stress test exercise to improve preparedness for MDRO outbreaks, and the role of wastewater surveillance in MDRO outbreaks. Discussions will be facilitated by (online) voting tools to invite participants to exchange experiences (40 min). We conclude with an exciting quiz to summarize the key messages of this workshop (10 min). Key messages • Healthcare setting, knowledge, proportionality and well-being of vulnerable patients populations are important to acknowledge during cross-institutional MDRO outbreaks. • Novel stress test exercise and wastewater surveillance are potential methods to improve preparedness and surveillance, respectively, during cross-institutional MDRO outbreak responses.