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Mobility problems and perceptions of disability by self-respondents and proxy respondents.

BACKGROUND: The Americans With Disabilities Act defines disability on the basis of physical or mental impairments or external perceptions of impairment. OBJECTIVES: The objective of this study was to examine perceptions of disability among people with lower-extremity mobility difficulties. RESEARCH DESIGN: This study used a cross-sectional, nationally representative survey, the 1994 to 1995 National Health Interview Survey-Disability (NHIS-D) supplement. Using SAS-callable SUDAAN for all analyses, we produced national population estimates. SUBJECTS: This study included 142,572 noninstitutionalized, civilian residents of the United States who were > or =18 years of age, with 80,423 self-respondents and 49,883 proxy respondents. MEASURES: We created a 4-level mobility variable using NHIS-D questions about the ability to walk, climb stairs, stand and the use of mobility aids. We examined associations between mobility and answers to 2 questions about self- and external perceptions of disability. RESULTS: The results showed that 3.1% (estimated 5.82 million persons) reported major mobility difficulties, including 3.7% of self-respondents and 2.7% of those with proxy respondents. Among persons with major mobility problems, 70.8% perceived themselves as disabled, whereas 64.8% thought other people see them as disabled. Also, 80.5% of manual wheelchair users saw themselves as disabled. Proxies were somewhat more likely to perceive disability than self-respondents, although differences were not generally statistically significant. In multivariable regressions, mobility level was the strongest predictor of self-perceived disability, followed by general health status. CONCLUSIONS: Mobility problems increase the likelihood that people will see themselves as disabled, but these perceptions are not universal. Although the schematic of wheelchair users has become an international symbol of disability, many people with serious mobility problems do not view themselves as disabled.

Adult↗

A cross-sectional multivariate analysis of children's attitudes towards disabilities.

BACKGROUND: Past research has shown that children can be biased against peers with disabilities, but the association of attitudes with gender, age and disability preferences, as well as interactions between these variables, are unclear. The objectives of this study were to examine these issues in a cross-sectional, split-plot study to clarify: (1) if elementary school children's attitudes towards peers with disabilities are related to age, gender and type of disability; (2) if interactions between these variables exist; and (3) if convergent validity could be achieved across three theoretically linked dependent variables. METHODS: One hundred elementary school children between 4 and 10 years old were assessed for attitudes towards target children with no disability, a physical or an intellectual disability, and a combined intellectual/physical disability. Measures were completed in an interview format. RESULTS: Attitudes towards a target child with physical disabilities and a target child without disabilities did not differ. There was a significant interaction for age and disability. Attitudes towards target children with intellectual and intellectual/physical disabilities were negatively biased, and were negatively associated with age. Results were consistent across measures except for a main effect of gender in one measure and a gender by age interaction in another. CONCLUSIONS: Children's attitudes appear to be associated with several factors, including age and the presence or absence of disability. Gender differences in attitudes may be because of gender-based response biases rather than disability biases. Because of the multifaceted nature of childhood attitudes, cross-sectional designs with several dependent and independent variables provide an opportunity to examine consistency of results across measures and potential interactions between factors that may not be uncovered when variables are examined in isolation.

Age Factors↗

The influence of anxiety on the progression of disability.

OBJECTIVES: To determine the influence of anxiety on the progression of disability and examine possible mediators of the relationship. DESIGN: Community-based observational study. SETTING: Women's Health and Aging Study I, a prospective observational study with assessments every 6 months for 3 years. PARTICIPANTS: One thousand two functionally limited women aged 65 and older. MEASUREMENTS: Anxiety symptoms were assessed using four questions from the Hopkins Symptom Checklist (nervous or shaky, avoidance of certain things, tense or keyed up, fearful). Participants who reported experiencing two or more of these symptoms at baseline were considered anxious. Anxiety as a predictor of the onset of four types of disability was examined using Cox proportional hazards models. Three models were tested: an unadjusted model, a model adjusted for confounding variables (age, race, vision, number of diseases, physical performance, depressive symptoms), and a mediational model (benzodiazepine and psychotropic medication use, physical activity, emotional support). RESULTS: Nineteen percent of women reported two or more symptoms of anxiety at baseline. Unadjusted models indicate that anxiety was associated with a greater risk of worsening disability: activity of daily living (ADL) disability (relative risk (RR)=1.40, 95% confidence interval (CI)=1.10-1.79), mobility disability (RR=1.41, 95% CI=1.06-1.86), lifting disability (RR=1.54, 95% CI=1.20-1.97), and light housework disability (RR=1.77, 95% CI=1.32-2.37). After adjusting for confounding variables, anxiety continued to predict the development of two types of disability: ADL disability (RR=1.41, 95% CI=1.08-1.84) and light housework disability (RR=1.56, 95% CI=1.14-2.14). Finally, benzodiazepine and psychotropic medication use, physical activity, and emotional support were not significant mediators of the effect of anxiety on the development of a disability. CONCLUSION: Anxiety is a significant risk factor for the progression of disability in older women. Studies are needed to determine whether treatment of anxiety delays or prevents disability.

Activities of Daily Living↗

Prevalence and predictors of disability in valued life activities among individuals with rheumatoid arthritis.

OBJECTIVE: To identify the prevalence of disability in a wide range of life activities and identify factors associated with such disability using the Verbrugge and Jette disablement model as a framework. METHODS: Data were from a panel study of 548 individuals with rheumatoid arthritis, interviewed annually by telephone. Valued life activity (VLA) disability was assessed using a 26-item scale rating difficulty in carrying out each activity. Three types of summary measure were calculated: activities unable to perform, activities affected, and mean difficulty. Subscale scores were also calculated, corresponding to obligatory, committed, and discretionary activities, as defined in the disablement model. Disease status measures were examined as predictors of VLA disability using multiple regression analyses. RESULTS: Half the subjects were unable to do at least one VLA. Approximately 2%, 31.3%, and 40.2% were unable to do at least one obligatory, committed, and discretionary activity, respectively. Almost all (95%) reported at least one VLA affected by rheumatoid arthritis; 68.4%, 91.4%, and 92.5% reported at least one obligatory, committed, and discretionary activity, respectively, affected. Disease status measures were robust predictors of VLA disability, accounting for 22-47% of the variation in VLA disability (with one exception). Adding the health assessment questionnaire (HAQ) to these models increased (p<0.0001) all model R2 values. HAQ score mediated the effects of many disease measures, consistent with the disablement model. CONCLUSION: VLA disability was common, with more disability noted in committed and discretionary than obligatory activities. Because VLA disability has been linked to psychological wellbeing in previous studies, identification of factors that may protect against such disability is important.

Activities of Daily Living↗

Disability and health status: ethnic differences among women in the United States.

STUDY OBJECTIVES: There are few data describing disability and health status for ethnic groups. The disablement process involves social influences, which may include minority status. Cross sectional data were examined to investigate the relation of ethnicity to disability. DESIGN: A stratified random digit dialled sample of women aged 40 and older. Disability and health status were measured as functional and activity limitations, work disability, and days of poor physical and mental health. SETTING: United States. PARTICIPANTS: Women interviewed by telephone included 774 white, 749 African-American, 660 Hispanic, and 739 Native American women. MAIN RESULTS: The prevalence of disability was higher among minority women when classified by general health status, and the need for personal care assistance. There was a striking excess of work disability: 3.5% of white women compared with 7.1% to 10.3% for minority women. The differences were reduced when adjusted for other risk factors and socioeconomic status. White and minority women reported more similar disability when it was defined by poor mental and physical health days. CONCLUSIONS: Disability is correlated with social and demographic characteristics as well as medical diagnoses. Ethnicity also is associated with disability and may be part of a social context for disablement. Future research should concentrate on the temporal sequence of disability. Consistent definitions of disability will facilitate this research.

Adult↗

Time frame and predictors of recovery from disability following recurrent ischemic stroke.

OBJECTIVE: To assess the rate, degree, and predictors of recovery from a disabled to nondisabled state in patients disabled after recurrent ischemic stroke. METHODS: Patients with ischemic stroke enrolled in the Management of Atherothrombosis with Clopidogrel in High Risk Patients (MATCH) Study underwent prospective assessment of their modified Rankin score (mRS) at 1, 3, 6, 12, and 18 months after enrollment and after recurrent stroke. Patients disabled (defined as mRS > or = 3) after recurrence were analyzed for recovery (defined as mRS < 3) during the 18 months, and predictors of recovery were sought using a Cox proportional-hazard multiple regression analysis. RESULTS: Three hundred forty-five (54%) of 637 patients were disabled after recurrent ischemic stroke; 115 (33%) patients had been disabled and 230 (66%) nondisabled before stroke recurrence. At recurrence, the degree of disability was moderate (mRS 3) in 135 (39%) patients, severe (mRS 4) in 139 (40%), and very severe (mRS 5) in 71 (21%). After 12 months' median follow-up, 117 (34%, 95% CI: 29 to 39%) had recovered: 68 (50%, 42 to 59%) of 135 moderately disabled, 45 (32%, 25 to 41%) of 139 severely disabled, and 4 (6%, 2 to 14%) of 71 very severely disabled; 70 (20.3%) patients died. From recurrence, median time to recovery was 6 months (mRS 3) and 18 months (mRS 4); 94% with very severe disability had not recovered at 18 months. Independent predictors of recovery were moderate disability at recurrence (mRS 3) compared with severe (mRS 4: hazard ratio [HR] 1.5; 95% CI 1.04 to 2.3) or very severe disability (mRS 5: HR 7.6; 2.7 to 20) and a nondisabled vs disabled state before recurrence (HR 4.0; 2.3 to 6.8). CONCLUSIONS: The rate of recovery from recurrent ischemic stroke was greatest in the first 6 months; one-third of patients recovered within 12 months. The significant predictors of recovery were a nondisabled state before recurrence and increasing severity of the recurrent stroke.

Activities of Daily Living↗

Nonfatal injuries among US children with disabling conditions.

OBJECTIVES: We investigated the risk of nonfatal injury in US children with disabilities. Disability was defined as a long-term reduction in the ability to conduct social role activities, such as school or play, because of a chronic physical or mental condition. METHODS: Among 57 909 children aged 5-17 years who participated in the 2000-2002 National Health Interview Survey, we identified 312 children with vision/hearing disabilities, 711 with mental retardation, 603 with attention-deficit/hyperactivity disorder (ADD/HD), and 403 with chronic asthma. We compared nonfatal injuries in the past 3 months between children with disabling conditions and those without using injury rates and logistic regression analyses. RESULTS: Compared with children without a disability, a higher percentage of children with disabilities reported nonfatal injuries (4.2% for vision disability, 3.2% for mental retardation, 4.5% for attention-deficit/hyperactivity disorder, and 5.7% for asthma vs 2.5% for healthy children). After we controlled for confounding effects of sociodemographic variables, children with disabilities, with the exception of mental retardation, had a statistically significantly higher injury risk than those without disabling conditions. CONCLUSIONS: Children with a disabling condition from vision/hearing disability, ADD/HD, or chronic asthma had a significantly higher risk for nonfatal injuries compared with children without a disabling condition. These data underscore the need to promote injury control and prevention programs targeting children with disabilities.

Adolescent↗

[Longevity, disease, and duration of disability].

Disability and the resulting lowered quality of life are serious issues accompanying increased longevity. Active life expectancy #(8) can be to used to distinguish the number of years without disability from the number with disability; increases were found in both in longevity #(9, 19). With the same rate of age-related new disability in the cohorts between 1970 and 1990, the total disability increased three fold #(11). In elderly patients I showed that 1) the duration of disability of those at a specific age at death (predeath) #(1) increased with age, and it decreased in those who remained without disability, 2) the cumulative number of days of disability for patients who died at a specific age (a convolution function of predeath and mortality) #(2), approached a normal distribution, which is consistent with the central limit theorem, 3) competing risk with chronic disease in a patient greatly affects the incidence and duration of disability, 4) using the central limit theorem we can predict that preventing dementia will retard premature rectangularization of the disability-free survival curve, and will thus reduce the total disability, 5) disability is an example of how variation and selection of chronic diseases (disease Darwinism) can alter population structure. Insights into the evolution of senescence #(14-21), pleiotropy, and slower rates of molecular evolution in the core than at the border #(26, 27), reveal that the central nervous system is relatively robust and conservative for pleiotropy and may senesce relatively slowly, which support a new way of thinking #(3, 4) about old age. To minimize disability, public knowledge and education about an ideal lifestyle and the evolution of senescence is essential.

Aged↗

Factors influencing entry-level occupational therapists' attitudes toward persons with disabilities.

Negative attitudes exhibited by rehabilitation professionals could have adverse consequences for persons with disabilities in their achievement of desired outcomes. Because occupational therapists are in a position to exert considerable influence in the therapeutic relationship, this study explored entry-level occupational therapy practitioners' equal status contact with and attitudes toward persons with disabilities. METHOD. Questionnaires were sent to 402 entry-level occupational therapists. These questionnaires consisted of: a demographic scale, the Disability Social Distance Scale, the Contact With Disabled Persons Scale, and a Similarity Scale (constructed for this study to evaluate the concept of equal status). Data analysis explored the relationship between 172 respondents' equal status perception and contact with persons with disabilities and their attitudes toward persons with disabilities. RESULTS. Respondents exhibited generally positive attitudes toward persons with disabilities. Perceived equality, personal and professional contact, and the majority of demographic factors were not significantly correlated with their attitudes toward persons with disabilities. Respondents who specified working with persons without disabilities in the wellness capacity exhibited more positive attitudes than those working with persons with biomechanical and neurological disabilities. In addition, respondents who had a greater frequency of professional contact with persons with disabilities also appeared to experience more personal contact with persons with disabilities. CONCLUSION. Entry-level occupational therapists' attitudes toward persons with disabilities may not only be influenced by parameters of the contact variable but also by the profession's holistic philosophy, the occupational therapy educational curricula, and the personal characteristics of those who choose to pursue a career in occupational therapy.

Adolescent↗

[Detection mode of leprosy and its disability grading in Khulna City, Bangladesh].

The early case detection followed by WHO/MDT is the most important in leprosy control program not only for the destruction of linkage of infection but also the prevention of disability in leprosy. PIME Sisters leprosy program has been carrying out active case detection for leprosy since 1986 in Khulna, the third biggest metropolitan city in Bangladesh. The relation between several detection modes and their associated disability grading was analyzed in order to see the contribution of each detection mode to disability grading. The disability grading of new registered patients from 1995 to 1997, 1,115 cases in total was analyzed according to its detection mode. Voluntary reporting patients from "out of control area" had both high disability grading of G = 2 (38.0%) and high MB rate (39.3%). On the other hand voluntary reporting patients in control area had less disability grading of G = 2 (12.2%) and less MB rate (25.3%). The number of patients referred by local doctors was still small and had both high disability grading of G = 2 (27.0%) and high MB rate (51.4%). Children detected under school surveillance did not have any marked disability of G = 2 (0%) and were almost PB patients (88.6%). (Prevalence rate of school surveillance was low.) Patients detected under general surveillance had low disability grading of G = 2 (2.6%). The disability grading (G = 2) of voluntary patients from control area (12.2%) was three times as much as that of patients from general surveillance (2.6%). Lastly patients of family contacts who were aware of the first symptoms had relatively less disability grading (5.9%). The small number of patients referred by local doctors (3.3% of total number) with high disability grading meant that there would be still great need of information programs on leprosy for local medical professions to think about leprosy. The high disability grading of patients from "out of control area" meant that the more effective leprosy control program should be done in "out of control area".

Adolescent↗

Occupational back disability in U.S. Army personnel.

Musculoskeletal disorders represent a prevalent source of outpatient visits, lost work time, hospitalization, and disability in the military. Recent research has identified patterns among military occupations, gender, and musculoskeletal disability. Although back disorders accounted for a high percentage of all cases, little is known about the relationship between job type and disability in soldiers. The present study analyzed 41,750 disability cases to determine (1) prevalence of work-related back disability diagnoses, (2) specific jobs associated with greater risk of back disability, and (3) association among gender, job type, and disability. The results indicate that (1) lumbosacral strain and intervertebral disc syndrome represent the most prevalent diagnoses for back disability, (2) certain occupations were associated with higher back disability risk, and (3) specific jobs were identified in which females experienced higher rates of back disability than males. The nature of these high-risk jobs, and recent research on work disability factors in U.S. Army soldiers, suggest that a combination of ergonomic and individual/organizational psychosocial factors may play a role in the development, exacerbation, and maintenance of work disability. Future research that identifies specific job factors contributing to increased back disability risk should assist in the development of empirically based work site prevention programs to improve musculoskeletal health and readiness.

Absenteeism↗

[Prevalence of disabilities of the upper and lower extremities among community-dwelling middle-aged and elderly women].

OBJECTIVE: In order to obtain baseline data for designing programs aimed at promoting physical function among elderly people in Japan, we determined the prevalence of disabilities affecting upper and lower extremities and their impact on function in community-dwelling middle-aged and elderly Japanese women. METHODS: Subjects were 580 women aged 40 years and over, living in Oshima town, Nagasaki, Japan. Information on disabilities affecting all four extremities was collected by questionnaire. Subjects were asked about the extent of disability in each extremity (no disability, some, moderate, cannot or very difficult to use extremity) and the reason for the disability. The functional level was defined using a disability score, calculated by summing the disabilities for upper or lower extremities (no disability, 0; some, 1; moderate, 2; cannot or very difficult to use, 3). Women who scored 0 were classified as 'good', women who scored 1-2 'fair', and who scored 3-6 as 'poor'. RESULTS: Prevalence of disability affecting the upper extremities increased significantly with age (11.9% with some or greater, and 4.3% with moderate or worse). Disabilities of the lower extremities also increased significantly with age (27.2% with some or greater, and 12.9% with moderate or worse), affecting a larger proportion of individuals. With regard to the upper extremities, the women classified a 'fair' and 'poor' increased significantly with age (9.5% with 'fair', and 2.4% with 'poor'), and function decreased (p = 0.003). The same was the case for the lower extremities (19.0% with 'fair', and 8.3% with 'poor') (P < 0.001). The most frequently cited cause of disability was arthritis, both in the upper (20%) and lower (40%) extremities, followed by stroke (10%), fracture (10%) and trauma not associated with fracture (10%). CONCLUSIONS: In middle aged and elderly women, disabilities of the upper and lower extremities become more prevalent and are associated with further functional impairment with aging. Such disabilities are more common in the lower extremities, and arthritis seems to be the most frequent cause.

Adult↗

Prevalence of children with disabilities in central region, Ghana.

A cross sectional survey was conducted in Central Region, Ghana to determine the prevalence of children with disabilities. Forty-seven (1.8%) out of a total of 2,556 children under fifteen years of age had disabilities. About a third, had difficulty with movement of which post poliomyelitis infection disability formed the majority. Twelve children (25.5%) had difficulty with hearing and speech (deaf and dumb). Three children were reported as having epilepsy and 2 others had mental retardation. There was no case of total blindness, however, two children complained of poor vision and three others had a squint. Other disabilities identified, included one child each with kyphosis (hunch back), hydrocephalus (very large head) and extensive facial scars from burns. Disability was more common among children who had not been immunized or who did not have immunization card at the time of interview. The prevalence of disability was higher among female children in the rural community and in children with no formal education. Prevalence of disability increased with age. The prevalence of disability was 14.4 per 1,000 for children (1-5) years, 16.6 per 1000 for children (6-9) years and 3.7 per 1,000 for (10-15) years age group. Younger children had better immunization status and lower disability rates. Thirty percent of the children with disability said they were experiencing discrimination especially among the female children. This study has demonstrated that there is a need to intensify the preventive efforts at reducing the problem of childhood disability and to increase public support to the disabled children by avoiding discrimination and encouraging education and training of the disabled children.

Adolescent↗

Prevalence of neurocognitive dysfunction and other clinical manifestations in disabled patients with systemic lupus erythematosus.

OBJECTIVE: While work disability is common in patients with systemic lupus erythematosus (SLE), it is not known which lupus disease characteristics predispose toward work disability. We examined demographic, clinical, serological, and neuropsychological factors in a group of disabled and nondisabled patients with SLE. METHODS: Fifty patients meeting American College of Rheumatology criteria for SLE were assessed for work status, disease characteristics, fatigue, anxiety, depressive symptoms, and quality of life. All subjects underwent an abbreviated panel of neuropsychological tests. Subjects who had formal work disability (social security or longterm disability, n = 16) and subjects who self-reported work disability without formal recognition (n = 8) were compared to subjects denying work disability from lupus (n = 26). RESULTS: Education level, African-American race, and SLICC Damage Index score were significantly associated with formal work disability relative to other subjects. Neurocognitive impairment (OR 14.44, 95% CI 3.01, 68.20; p = 0.001), nephritis (OR 3.75, 95% CI 1.01, 13.9; p = 0.048), and discoid lupus (OR 19.93, 95% CI 3.51, 113.3; p = 0.001) were all associated with formal disability. Formally disabled patients had higher fatigue and anxiety scores and more impaired quality of life in many domains relative to nondisabled subjects. Subjects with self-reported work disability also had neurocognitive dysfunction, high fatigue scores, and poor quality of life, but in other respects appeared to have milder disease than formally disabled subjects. CONCLUSION: Neurocognitive dysfunction and fatigue are 2 manifestations that may contribute materially to work disability in lupus. Other associated factors include low education levels, SLICC Damage Index scores, discoid lupus, nephritis, and possibly African-American race.

Adult↗

[Prevalence of disability pension related to obesity in Iceland 1992-2004].

OBJECTIVES: To investigate changes in the prevalence of disability pension related to obesity in Iceland from 1992 to 2004. MATERIAL AND METHODS: Data were obtained from the disability register of the State Social Security Institute and Statistics Iceland for the years 1992 and 2004. Prevalence of disability pension related to obesity and of disability pension in general was calculated for both years. Statistical significance was assessed by calculating chi square and standardized risk ratios. RESULTS: From 1992 to 2004 the number of recipients of disability pension with obesity as a primary diagnosis increased from 37 to 111, amounting to 183% increase for females and 263% for males. This increase is significantly greater than the increase in disability pension in general during this period. Age standardized risk ratio showed increased disability related to obesity for both genders. Among males it was greater than the general increase in disability, while among females it was less. There was a significantly greater increase in disability related to obesity in areas outside the capital compared with Reykjavík and surrounding areas among females. The increase in disability related to obesity far surpasses the increase in obesity in the population, according to population surveys, suggesting that severe and morbid obesity may be particularly on the rise. CONCLUSION: There has been a significant increase in the prevalence of disability pension related to obesity in Iceland from 1992 to 2004. It is possible that increased social awareness of obesity during the study period has influenced diagnostic habits of physicians and thus increased the use of obesity as a diagnosis in medical certificates and disability assessment. In all likelihood, however, there has been an increase in disabling obesity in Iceland, indicating that obesity is an increasing public health problem demanding appropriate intervention.

Chi-Square Distribution↗

A profile of children with disabilities receiving SSI: highlights from the National Survey of SSI Children and Families.

This article provides a nationally representative profile of noninstitutionalized children 0 to 17 years of age who were receiving support from the Supplemental Security Income (SSI) program because of a disability. To assess the role of the SSI program in providing assistance to low-income children with disabilities and their families, it is important to obtain detailed information on demographic characteristics, income and assets, health and disabilities, and health care utilization. Yet administrative records of the Social Security Administration do not contain many of the relevant data items, and the records provide only an incomplete picture of the family relationships affecting the lives of children with disabilities. The National Survey of SSI Children and Families fills this gap. This summary article is based on survey interviews conducted between July 2001 and June 2002 and provides some highlights characterizing children with disabilities who were receiving SSI and their families. Most children receiving SSI (hereafter referred to as "SSI children") lived in a family headed by a single mother, and less than one in three lived with both parents. A very high proportion, about half, were living in a household with at least one other individual reported to have had a disability. About 70 percent of children received some kind of special education. SSI support was the most important source of family income, with earnings a close second. On average, SSI payments accounted for nearly half of the income for the children's families, and earnings accounted for almost 40 percent. When all sources of family income were considered, slightly more than half (54 percent) of SSI children lived in families above the poverty threshold, a notable fact given that the federal SSI program guarantees only a subpoverty level of income. However, beyond these averages there was substantial variation, with some children living in families with income well below the poverty threshold and others having income well over 200 percent of the poverty threshold. About one-third of SSI children lived in families owning a home, two-thirds lived with parents or guardians with at least one car, and about 40 percent lived with parents or guardians with zero liquid assets. Less than 4 percent lived with adults who owned stocks, mutual funds, notes, certificates of deposit, or savings bonds. The Social Security Administration's administrative records contain only a limited amount of information about disability diagnoses. The National Survey of SSI Children and Families supplements those records with data from an array of questions on functional limitations, self-reported health, and the perceived severity of disabilities. The data suggest that a great degree of variation in severity exists within the childhood caseload, as reflected in reports of the presence or absence of six functional limitations, perceived overall health status, and perceived impact of disability on the child's ability to do things. Overall, 36 percent of the children were reported to have had disabilities that affected their abilities to do things "a great deal," and for 21 percent their difficulties had very little or no impact. Physical disabilities were most common among children aged 0 to 5, and mental disabilities dominated the picture for the other two age groups: 6 to 12 and 13 to 17. Virtually all SSI children are covered by some form of health insurance, with Medicaid being by far the most common source of health insurance coverage. Just as in the case of the severity of disabilities, substantial variation was reported in health care utilization among SSI children. Almost 30 percent of children had two or fewer doctor visits during the 12 months preceding the interview, and close to 50 percent had five or more doctor visits. About four-fifths of the children had no reported hospitalizations or surgeries during the previous year. More than 40 percent of the children visited an emergency room during the previous year, most of them more than once. Importantly, no out-of-pocket costs associated with medical care were reported for more than two-thirds of the children, and only about 3 percent had annual expenses exceeding $1,000 for physical and mental health care. This finding suggests that SSI payments are not used to cover medical expenses for the overwhelming majority of children. The use of supportive therapies varied widely among SSI children: more than half reported having used physical, occupational, or speech therapy; only 8 percent used respite care for the parents or other family members. An analysis of the perception of the survey respondents shows that more than one-third of children had unmet needs for mental health counseling services, and about three-quarters of families had unmet needs for respite care. In several service categories, the proportion perceived to have had unmet service needs was around 10 percent or less. In the dominant service category of physical, occupational, and speech therapy, only 11 percent perceived to have had unmet service needs.

Adolescent↗

The relative importance of pain and functional disability to patients with rheumatoid arthritis.

OBJECTIVE: Pain and functional disability are 2 major factors influencing the health status of patients with rheumatoid arthritis (RA). To determine the relative importance ascribed to these factors by patients, we examined the relationship of levels of both pain and functional disability to self-reported global arthritis status in patients with RA. METHODS: Pain, disability and global arthritis status were measured prospectively in 305 patients with RA using the Health Assessment Questionnaire, which was completed by patients every 6 months for up to 9.5 years. The relative importance of pain and functional disability was determined by the relative magnitude of their association with global arthritis status, as estimated by pooled time series regression analysis. RESULTS: At study entry, median levels of pain, functional disability, and global arthritis status for the cohort were 1.1 (possible range: 0-3.0), 1.25 (possible range: 0-3.0), and 35 (possible range: 0-100), respectively, indicating moderate arthritis severity. Both pain (p < 0.0001) and functional disability (p < 0.0001) were significantly related to changes in global arthritis status over time. The standardized regression coefficient of pain was 1.2 times larger than that of disability, indicating that patients' ratings of their arthritis status was only slightly more heavily weighted by changes in pain than by changes in functional disability. Pain was a more important feature than disability among nonwhites (pain/disability standardized coefficient ratio = 2.7), while disability appeared to be more important for males (ratio = 0.8). The duration of RA did not influence the relative importance of pain and disability. CONCLUSION: Pain and functional disability were of similar importance to this group of patients with RA, and the relative importance of pain and disability did not vary with the duration of RA.

Adult↗

Functional disability before myocardial infarction in the elderly as a determinant of infarction severity and postinfarction mortality.

BACKGROUND: Functional disability is a common condition among elderly patients. However, to our knowledge, its effect on outcome of myocardial infarction (MI) has not been assessed. Our objectives were to determine whether disability in the activities of daily living measured before MI is a predictor of MI severity and mortality. METHODS: Disability in activities of daily living was measured prospectively in a cohort of 222 patients who were hospitalized with acute MI. Outcome measures were severity characteristics on admission to the hospital (higher Killip class, presence of new Q waves in the first electrocardiogram, and lower systolic blood pressure), and 6-month mortality. RESULTS: Patients with disability before hospitalization were older and had more comorbidity. After adjusting for these factors and for delay in hospital arrival, disability was still significantly associated with clinical severity on admission to the hospital and with mortality (adjusted relative risk of death for patients with disability vs patients without disability, 2.01; 95% confidence interval, 1.23-3.28). Clinical severity and hospital treatment explained the higher mortality of patients with disability. When these factors were added to the previous model, the relative risk of mortality for patients with disability vs patients without disability was 1.24, and the 95% confidence interval was 0.73 to 2.12. CONCLUSIONS: Functional disability in activities of daily living before MI is an important predictor of clinical severity and mortality in elderly patients with MI. This effect is only minimally explained by the older age and higher comorbidity of patients with disability. However, higher clinical severity and lower use of treatment interventions are major determinants of their higher mortality compared with patients without disability.

Activities of Daily Living↗