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PubMed1992

Posttraumatic disablement: a prospective study of impairment, disability, and handicap.

This study was designed to evaluate both the frequency and the course of impairments, disabilities, and handicaps resulting from trauma. It was conducted in Aquitaine, France, on a sample of 1005 trauma patients (mean ISS, 10.5 +/- 0.3) in which severe trauma (ISS > 25) was rather overrepresented (169 of 1005). A prospective follow-up of disablement according to the WHO classification was based on medical examinations performed 6 and 12 months after the trauma. Of 664 survivors reviewed at 6 months, the findings were cross tabulated with Injury Severity Score (ISS) and age. There was a good relationship between ISS and the mean length of stay in the hospital (r = 0.46; p < 0.001), the duration of rehabilitation, and the time away from work or school. Out of this sample of 1005 patients with rather major injuries, 73% of the survivors suffered from at least one impairment, with a consistently lower frequency in children whatever the severity. At least one disability was encountered in 52.3% of these patients depending on both ISS and age. Handicap was noted in at least 26% of the cases. Between the sixth month and the end of the first year, the minimal handicap regression was 35.8%, whereas the minimal regression of the disability rate was 19.5%. The best improvement was observed essentially in the low ISS categories. Whereas for minor trauma the course of disablement seems to be fixed 1 year after the injury, such is not the case for severe trauma.

Absenteeism↗
PubMedDate not supplied

The Americans with Disabilities Act: more rights for people with disabilities.

Another milestone in the quest for equal rights for people with disabilities occurred with the passage of PL101-336, the Americans with Disabilities Act. Though some controversy surrounded the passage of this legislation, the bill had clear bipartisan endorsement, as well as the support of President George Bush. The basis of the law was introduced in the Senate May 9, 1989, as Bill S933 by Senator Thomas Harkin (D-IA). A similar bill, HR2273, was introduced the same day in the House of Representatives by Rep. Anthony Coehlo (D-CA). The process by which the House and Senate bills became the final Americans with Disabilities Act was lively. Understanding the law and its provisions is important for rehabilitation nurses who are healthcare providers in frequent contact with people with disabilities.

Civil Rights↗
PubMed1992

Diabetes and disability among Mexican Americans: the effect of different measures of diabetes on its association with disability.

The association of non-insulin-dependent diabetes mellitus and disability was evaluated in a population of Mexican Americans from the southwest U.S. using data from the Hispanic Health and Nutrition Examination Survey. Among the total sample of persons who completed a clinical examination, 14.6% reported a limitation of job performance, the inability to complete housework, or the inability to perform activities of daily living. Among the subsample who completed the clinical examination and reported having diabetes, 31.6% claimed similar disability. In those respondents who also completed an oral glucose tolerance test (OGTT) or who were currently receiving insulin, the prevalence of disability was 25% in persons with an abnormal OGTT and 40.2% in those who were receiving insulin compared with 14.9% in those with a normal OGTT. Self-reported diabetes was positively associated with functional impairment in the examined population after adjusting for demographic variables and comorbidity; however, diabetes confirmed by OGTT was not significantly associated with disability after adjustment for other factors. Differences in pre-existing health status between persons who completed the OGTT and those who did not are discussed in relation to these results.

Activities of Daily Living↗
PubMed1992

The Americans With Disabilities Act of 1990 expands employment opportunities for persons with developmental disabilities.

The primary purpose of the ADA is the full inclusion of persons with disabilities within their communities. The ADA prohibits discrimination on the basis of disability in the areas of employment, transportation, public accommodations, telecommunications, and state and local government agencies. The person described in this report encountered some of this discrimination. He successfully obtained paid community-integrated employment only after overcoming major obstacles and barriers, the greatest being transportation. In our highly mobile society, reliable transportation is essential for the acquisition and maintenance of community-integrated employment. The participant was repeatedly denied access to public transportation on the basis of his disability. To help overcome this barrier, Transition Services had to provide needed transportation at great expense, which delayed opportunities for the participant to gain control of this aspect of his life. Enactment of the ADA makes it more difficult for public transportation agencies to deny services to persons with disabilities by claiming inconvenience or lack of accessible vehicles. When publicly funded transportation programs assume their full responsibility for transportation to the public, agencies like Transition Services can focus on individualized employment and training issues rather than on providing transportation. In the workplace, the employer's willingness to work cooperatively with the participant and the staff of Transition Services resulted in several low-cost and reasonable accommodations based on the participant's needs and abilities. A simple rearrangement of work space allowed the participant to perform his job while benefiting the other workers in the crowded restaurant kitchen.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1975

[The problem complex of the disabled and the marginal group theory - socio-scientific approaches designed to explain the social discrimination of the disabled (author's transl)].

The position of disabled people in societies such as the Federal Republic of Germany, is characterised by the status of marginal groups in the sense of social discrimination. As can be demonstrated by the discrimination shown towards the disabled in employment, there are two different paradigms of the socio-scientific marginal group theory suitable for explaining this fact. According to the socio-psychological approach, vocational discrimination is understood as a sort of social punishment for the violation of norms and values. The socio-economic approach, on the contrary, considers the unfavourable job situation of the disabled a by-product of a general development towards underemployment and the de-manning programme in capitalistic systems. In some respect, the theoretical approach seems to be more resonable, but to comprehend adequately the marginal group status of the disabled, it is necessary to integrate both the socio-economic and socio-psychological theory components.

Persons with Disabilities↗
PubMed1978

[Reactions vis-a-vis the disabled. Critical comments on G. H. Neumann's article: prejudices and negative attitudes towards the disabled--their origin and methods of elimination from the viewpoint: of behavioural science and biology (author's transl)].

Neumann's opinion that prejudices towards the disabled are decisively determined by inborn reactions, i.e., the reaction towards outsiders and the fear reaction towards strangers, is put to question. Ethological and ethnological research results demonstrate that the studies of human and animal behaviour towards the "disabled" are still in an elementary stage and that hitherto available results only permit the conclusion that animals as well as human beings display a very complex and differentiated behaviour vis-a-vis the disabled. In connection with human beings this complexity is seen as evidence of the outstanding significance of societal factors--in their broadest sense--for the formation of prejudices towards the disabled. The necessity of a goal-oriented elimination of these prejudices is stressed. Furthermore, attention is drawn to terminological problems and the difficulties or comparisons between human beings and animals.

Animals↗
PubMed1992

Dental fellowships in developmental disabilities help broaden care of disabled.

Continuation of the national trend toward deinstitutionalization and community placement for persons with developmental disabilities, physical handicaps and other medical problems will mean increased demand for dentists trained to care for this segment of the population. The New York State Office of Mental Retardation and Developmental Disabilities now offers dental fellowships in developmental disabilities to help fill the learning gap.

Academic Medical Centers↗
PubMed1992

Medical expenditures for disability and disabling comorbidity.

Disability and disabling comorbidity place a disproportionately large burden on the health care system. National Medical Care Utilization and Expenditure Survey data show that medical care expenditures for noninstitutionalized persons amounted to $154 billion ($691 per capita) in 1980. The medical expenditure per capita for people reporting two or more disabling chronic conditions ($2456) was 5 times the amount incurred by those with no limiting conditions ($486) and more than 1.5 times the amount incurred by those with one limiting condition.

Adolescent↗
PubMed1991

Play deprivation in children with physical disabilities: the role of the occupational therapist in preventing secondary disability.

Self-initiated free play experiences are vital for the normal growth and development of all children. In this paper, children with physical disabilities who are deprived of normal play opportunities are viewed as having a second disability that hinders their potential for independent behavior and performance. Physical, social, personal, and environmental barriers that may limit the play experiences of children with physical disabilities are delineated. Studies of the interactions of these children during play are discussed, and a case is made for the promotion of active, free play in the home, the school, and the community. As facilitators of this process, occupational therapists must consider a variety of factors, including the unique capabilities of the child, the influence of parent-child and peer relationships, the role of other caregiving adults, the adaptation of toys and materials, and the impact of the environment and setting.

Caregivers↗
PubMed1992

Coping with disability. Nurse administrators' obligations under the Americans with Disabilities Act.

Many nurses who have disabilities view the Americans with Disabilities Act of 1990 as a piece of legislation that will have significant implications for nurse administrators and managers at all levels. This legislation becomes fully operational in July 1992, and little has been written in nursing literature about its implications. As a nurse administrator, are you ready to "cope with disability?"

Adaptation, Psychological↗
PubMed1992

American Academy of Pediatrics Committee on Children with Disabilities: American Association for Pediatric Ophthalmology and Strabismus, and American Academy of Ophthalmology: Learning disabilities, dyslexia, and vision.

Dyslexia and other related learning disabilities are serious problems. The American Academy of Pediatrics, through its Committee on Children with Disabilities and the Section on Ophthalmology, the American Academy of Ophthalmology, and the American Association for Pediatric Ophthalmology and Strabismus strongly support the need for early diagnosis and educational remediation. There is no known eye or visual cause for dyslexia and learning disabilities, and no effective visual treatment. Multidisciplinary evaluation and management must be based on proven procedures demonstrated by valid research.

Child↗
PubMed1991

The effects of sampling conditions on sentence production in normal, reading-disabled, and language-learning-disabled children.

This study explored the effects of contextual support, discourse genre, and the listener's knowledge of information on syntactic and phonologic production and fluency. Subjects were language-learning-disabled, reading-disabled, and normal primary school children. Clause structure complexity, fluency, and grammatical and phonemic accuracy tended to be highest when children were discussing absent referents, providing explanations and stories, and giving unshared information. These effects were generally the same across all groups, although some effects were significant for only the language-learning-disabled children. Several explanations for these findings are considered.

Child↗
PubMed1990

Making non-discriminatory fitness-for-duty decisions about persons with disabilities under the Rehabilitation Act and the Americans with Disabilities Act.

This article describes an assessment role performed by clinical psychologists in the employment context, and examines how it has been evaluated by the courts from the standpoint of discrimination against persons with disabilities. Guidelines are offered for making fitness-for-duty decisions which are legally defensible, and examples of the decision-making process are provided. Data-based limitations on professional expertise are articulated, and conclusions drawn are aimed at practicing psychologists and the courts dealing with these uncertainties. Issues are analyzed principally in courts dealing with these uncertainties. Issues are analyzed principally in relation to Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA), which has been passed by both houses of Congress.

Adult↗
PubMed1992

Respiratory disability. The uncoupling of oxygen consumption and disability.

In the past it was believed that respiratory disability could be objectively assessed by comparing the measured O2 consumption requirement of the job with the subjects' measured or estimated maximal oxygen consumption. More recently, it has become clear that this "classic" paradigm does not completely apply to all situations. This article reviews recent aspects of respiratory disability assessment.

Asthma↗
PubMed1992

Mortality, disability, and falls in older persons: the role of underlying disease and disability.

BACKGROUND: Falls are prevalent in older persons and can have serious consequences. METHODS: Data from the Longitudinal Study on Aging were analyzed to study the relationship between falls and both mortality and functional status in 4270 respondents age 70 and over. The effects of demographic traits, chronic conditions, and disability present at baseline were controlled for by means of multivariable analyses. RESULTS: Risk of death within 2 years was greater for both single fallers (crude odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-2.0) and multiple fallers (crude OR, 2.2; 95% CI, 1.7-2.8). This excess risk was dissipated when selected covariates were added to the model. No crude or adjusted association was evident between single falls and functional impairment; however, multiple falls were an independent risk factor (adjusted OR, 1.6; 95% CI, 1.2-2.0). CONCLUSIONS: Multiple falls in older persons increase risk of functional impairment and may indicate underlying conditions that increase risk of death.

Accidental Falls↗
PubMed1992

[Problems and disability pension in back and spinal diseases in occupational disability insurance].

In the German disability insurance, exclusion clauses are the dominating approach to the underwriting of low back pain. This is due to a lack of clear prognostic factors, the nonexistence of severity classifications and the strong impact of individual and psychological circumstances. Considering various clinical, individual and psychological indicators, a new system is introduced to allocate the prognosis of lower back pain to four levels of severity. This approach makes it possible to use extra ratings instead of exclusion clauses of mild and moderate low back pain.

Back Pain↗