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The prognosis for individuals on disability retirement. An 18-year mortality follow-up study of 6887 men and women sampled from the general population.

BACKGROUND: Several studies have shown a markedly higher mortality rate among disability pensioners than among non-retired. Since most disability pensions are granted because of non-fatal diseases the reason for the increased mortality therefore remains largely unknown. The aim of this study was to evaluate potential explanatory factors. METHODS: Data from five longitudinal cohort studies in Sweden, including 6,887 men and women less than 65 years old at baseline were linked to disability pension data, hospital admission data, and mortality data from 1971 until 2001. Mortality odds ratios were analyzed with Poisson regression and Cox's proportional hazards regression models. RESULTS: 1,683 (24.4%) subjects had a disability pension at baseline or received one during follow up. 525 (7.6%) subjects died during follow up. The subjects on disability pension had a higher mortality rate than the non-retired, the hazards ratio (HR) being 2.78 (95%CI 2.08-3.71) among women and 3.43 (95%CI 2.61-4.51) among men. HR was highest among individuals granted a disability pension at young ages (HR >7), and declined parallel to age at which the disability pension was granted. The higher mortality rate among the retired subjects was not explained by disability pension cause or underlying disease or differences in age, marital status, educational level, smoking habits or drug abuse. There was no significant association between reason for disability pension and cause of death. CONCLUSION: Subjects with a disability pension had increased mortality rates as compared with non-retired subjects, only modestly affected by adjustments for psycho-socio-economic factors, underlying disease, etcetera. It is unlikely that these factors were the causes of the unfavorable outcome. Other factors must be at work.

Adult↗

Identification of intragenic variants in pediatric patients with intellectual disability in Peru.

BACKGROUND: Intellectual disability in Latin America can reach a frequency of 12% of the population, these may include nutritional deficiencies, exposure to toxic or infectious agents, and the lack of universal neonatal screening programs. In 90% of patients with intellectual disability, the etiology can be attributed to variants in the genome. OBJECTIVE: to determine intragenic variants in patients with intellectual disability between 5 and 18 years old at Instituto Nacional de Salud del Niño. METHODS: It is a descriptive cross-sectional study with convenience sampling. A total of 124 children diagnosed with intellectual disability were selected based on psychological test results and availability for whole exome sequencing. In addition, a chromosomal analysis of 6.55 M was performed on ten patients with a negative result in sequencing. Relative and absolute frequencies and measures of central tendency and dispersion were determined according to their nature. In addition, multiple linear regression and Poisson regression were used to determine the association between some clinical characteristics and the probability of occurrence in patients with positive results. RESULTS: The median age of the patients was 6.3 (IQR = 5.95), males accounted for 57.3%, and 91.9% of the cases had mild intellectual disability. Exome sequencing determined the etiology in 30.6% of patients with intellectual disability, of which 52.6% were autosomal dominant inheritance. The most frequent genes found were MECP2, STXBP1 and LAMA2. A broad genotype-phenotype correlation was identified, highlighting the genetic heterogeneity of intellectual disability in this population. The presence of dermatologic lesions, dystonia, peripheral neurological disorders, and fourth finger flexion limitation were observed more frequently in patients with intellectual disability with "positive results". CONCLUSIONS: This study shows that one-third of patients with intellectual disability exhibit intragenic variants, highlighting the importance of genetic analysis for accurate diagnosis. The identification of genes such as MECP2, STXBP1, and LAMA2 underscores the genetic heterogeneity of intellectual disability in the studied population. These findings emphasize the need for genetic testing in clinical management and the implementation of early detection programs in Peru.

Humans↗

Disease, impairment, disability and social handicap: a community based study of people aged 70 years and over.

The aim of this research was to investigate the prevalence of disability in a total population-based sample aged 70 years and over, the social handicap resulting from the disability and the diseases and impairments contributing to disability in the most disabled subjects. From the initial sample of 856 subjects, 782 (91.4%) participated. Disability in the tasks examined varied from 1.3% of subjects unable to feed themselves to 24.4% unable to carry out housework. In the 74 most disabled subjects comorbidity was common. The major clinical disorders that contributed to impairment and disability were heart failure, osteoarthritis, stroke and dementia. Those who were disabled were considerably more likely to be handicapped than those not disabled (odds ratio 6.65, 95% confidence interval 4.73-9.36). When social support was considered, the estimated risk of handicap associated with disability ranged from 3.19 (95% CI 1.92-5.30) for the subset of subjects who had a spouse, to 52.00 (95% CI 4.03-670.6) for subjects without emotional support.

Activities of Daily Living↗

Nondiscrimination on the basis of disability in state and local government services--Department of Justice. Final rule.

This rule implements subtitle A of title II of the Americans with Disabilities Act, Public Law 101-336, which prohibits discrimination on the basis of disability by public entities. Subtitle A protects qualified individuals with disabilities from discrimination on the basis of disability in the services, programs, or activities of all State and local governments. It extends the prohibition of discrimination in federally assisted programs established by section 504 of the Rehabilitation Act of 1973 to all activities of State and local governments, including those that do not receive Federal financial assistance, and incorporates specific prohibitions of discrimination on the basis of disability from titles I, III, and V of the Americans with Disabilities Act. This rule, therefore, adopts the general prohibitions of discrimination established under section 504, as well as the requirements for making programs accessible to individuals with disabilities and for providing equally effective communications. It also sets forth standards for what constitutes discrimination on the basis of mental or physical disability, provides a definition of disability and qualified individual with a disability, and establishes a complaint mechanism for resolving allegations of discrimination.

Architectural Accessibility↗

Musculoskeletal disabilities among police force personnel of the Islamic Republic of Iran.

Musculoskeletal disorders are among the most common causes of disability in the military population. The objectives of this study were to assess the frequency of musculoskeletal disabilities in police force personnel and to determine the association between disabilities and age, rank, and different job types. The population studied were 2600 Islamic Republic of Iran police force disability cases from March 1997 to March 1998. Ninth revision of International Classification of Diseases was used to indicate diagnoses. The frequency of disabilities related to musculoskeletal disorders was 25.7%. Back disabilities were the most common musculoskeletal problems. Patients with back disabilities were older on average than patients with other musculoskeletal disorders (p < 0.001). Back disabilities were more common in commissioned officers (third lieutenant to colonel) than other police force personnel (p < 0.0001). On the contrary, fractures and dislocations were more common in noncommissioned officers (sergeant to warrant officer) (p < 0.001). There were associations between specific jobs and musculoskeletal disabilities. According to present data, musculoskeletal disorders account for one-quarter of disability cases in police force personnel. Prevention programs, especially in high-risk groups, should be considered.

Adult↗

Early predictors of long-term disability after injury.

BACKGROUND: Improving outcomes after serious injury is important to patients, patients' families, and healthcare providers. Identifying early risk factors for long-term disability after injury will help critical care providers recognize patients at risk. OBJECTIVES: To identify early predictors of long-term disability after injury and to ascertain if age, level of disability before injury, posttraumatic psychological distress, and social network factors during hospitalization and recovery significantly contribute to long-term disability after injury. METHODS: A prospective, correlational design was used. Injury-specific information on 63 patients with serious, non-central nervous system injury was obtained from medical records; all other data were obtained from interviews (3 per patient) during a 2 1/2-year period. A model was developed to test the theoretical propositions of the disabling process. Predictors of long-term disability were evaluated using path analysis in the context of structural equation modeling. RESULTS: Injuries were predominately due to motor vehicle crashes (37%) or violent assaults (21%). Mean Injury Severity Score was 13.46, and mean length of stay was 12 days. With structural equation modeling, 36% of the variance in long-term disability was explained by predictors present at the time of injury (age, disability before injury), during hospitalization (psychological distress), or soon after discharge (psychological distress, short-term disability after injury). CONCLUSIONS: Disability after injury is due partly to an interplay between physical and psychological factors that can be identified soon after injury. By identifying these early predictors, patients at risk for suboptimal outcomes can be detected.

Accidents, Traffic↗

Disablement in society: towards an integrated perspective.

Demographic and morbidity changes have undermined traditional responses to disease and disability. An expanded model of disablement is required, integrating consequences as well as causes. Three main concepts involved are impairment, disability, and handicap. These constitute a continuum ranging from bio-medical phenomena (impairment) through functional limitation and activity restriction (disability) to social disadvantage (handicap). Though complete sequences can occur, analytical and practical problems arise from the fact that their interrelationship is not always straightforward or predictable. From an analysis of available data it is calculated that 34% of the adult population in Great Britain are impaired. A tenth of these are severely disabled. The age structure and underlying causes of disablement challenge prevailing stereotypes: disablement becomes more frequent with age and it is caused in large part by chronic diseases. An attempt to assess handicap direct, rather than as a derivative of disability, displays severe disadvantages among the disabled. The model allows the possibility of gathering information relevant to different aspects of disablement and warns against reductionist or naive responses in health care and social policy.

Chronic Disease↗

New trends in vocational rehabilitation and employment of disabled persons.

This papers outlines new approaches and concepts aimed at creating employment opportunities for disabled persons in a difficult labour market situation. It relates the new trends to interest engendered by the United Nations International Year of Disabled Persons and the recently proclaimed U.N. Decade of Disabled Persons (1983-1992) with greater participation and involvement of community groups, employers' and workers' organisations inrehabilitation activities. Much of the paper is devoted to changing patterns of sheltered employment including a centralised administration for groups of workshops, introduction of modern management techniques and development of profitable production or sub-contract work. The development of the enclave system of sheltered employment is highlighted whereby groups of severely disabled people work together under special supervision in an otherwise ordinary and undifferentiated working environment. Disable persons' co-operatives, a modular method of vocational training and the ergonomic approach to adaptation of jobs as means of creating jobs for the disabled are discussed in detail. The need to make good the acute lack of trained rehabilitation staff and to give higher priority to the employment needs of disabled people in rural areas, is stressed. Suggestions for research into ways and means of expanding employment opportunities for the disabled and for improving existing vocational rehabilitation services are outlined. Finally the paper refers to the newly adopted International Labour Office Convention and Recommendation Concerning Vocational Rehabilitation and Employment (Disabled Persons) which will, it is envisaged, inspire world-wide action in creating wider employment opportunities for disabled persons.

Blindness↗

Midlife hand grip strength as a predictor of old age disability.

CONTEXT: Poor muscle strength, functional limitations, and disability often coexist, but whether muscle strength during midlife predicts old age functional ability is not known. OBJECTIVE: To determine whether hand grip strength measured during midlife predicts old age functional limitations and disability in initially healthy men. DESIGN AND SETTING: A 25-year prospective cohort study, the Honolulu Heart Program, which began in 1965 among Japanese-American men living on Oahu, Hawaii. PARTICIPANTS: A total of 608945- to 68-year-old men who were healthy at baseline and whose maximal hand grip strength was measured from 1965 through 1970. Altogether, 2259 men died over the follow-up period and 3218 survivors participated in the disability assessment in 1991 through 1993. MAIN OUTCOME MEASURES: Functional limitations including slow customary walking speed (< or =0.4 m/s) and inability to rise from a seated position without using the arms, and multiple self-reported upper extremity, mobility, and self-care disability outcomes. RESULTS: After adjustment for multiple potential confounders, risk of functional limitations and disability 25 years later increased as baseline hand grip strength, divided into tertiles, declined. The odds ratio (OR) of walking speed of 0.4 m/s or slower was 2.87 (95% confidence interval [CI], 1.76-4.67) in those in the lowest third and 1.79 (95% CI, 1.14-2.81) in the middle third of grip strength vs those in the highest third. The risk of self-care disability was more than 2 times greater in the lowest vs the highest grip strength tertile. Adding chronic conditions identified at follow-up to the models predicting disability reduced the ORs related to grip strength only minimally. CONCLUSIONS: Among healthy 45- to 68-year-old men, hand grip strength was highly predictive of functional limitations and disability 25 years later. Good muscle strength in midlife may protect people from old age disability by providing a greater safety margin above the threshold of disability.

Activities of Daily Living↗

Gender disparities in the receipt of home care for elderly people with disability in the United States.

CONTEXT: Projected demographic shifts in the US population over the next 50 years will cause families, health care practitioners, and policymakers to confront a marked increase in the number of people with disabilities living in the community. Concerns about the adequacy of community support are particularly salient to women, who make up a disproportionate number of disabled elderly people and who may be particularly vulnerable because they are more likely to live alone with limited financial resources. OBJECTIVE: To address gender differences in receipt of informal and formal home care. DESIGN, SETTING, AND PARTICIPANTS: Nationally representative survey conducted in 1993 among 7443 noninstitutionalized people (4538 women and 2905 men) aged 70 years or older. MAIN OUTCOME MEASURE: Number of hours per week of informal (generally unpaid) and formal (generally paid) home care received by survey participants who reported any activity of daily living (ADL) or instrumental activity of daily living (IADL) impairment (n = 3109) compared by gender and living arrangement and controlling for other factors. RESULTS: Compared with disabled men, disabled women were much more likely to be living alone (45.4% vs 16.8%, P<.001) and much less likely to be living with a spouse (27.8% vs 73.6%, P<.001). Overall, women received fewer hours of informal care per week than men (15.7 hours; 95% confidence interval [CI], 14.5-16.9 vs 21.2 hours; 95% CI, 19. 7-22.8). Married disabled women received many fewer hours per week of informal home care than married disabled men (14.8 hours; 95% CI, 13.7-15.8 vs 26.2 hours; 95% CI, 24.6-27.9). Children (>80% women) were the dominant caregivers for disabled women while wives were the dominant caregivers of disabled men. Gender differences in formal home care were small (2.8 hours for women; 95% CI, 2.5-3.1 vs 2.1 hours for men; 95% CI, 1.7-2.4). CONCLUSION: Large gender disparities appear to exist in the receipt of informal home care for disabled elderly people in the United States, even within married households. Programs providing home care support for disabled elderly people need to consider these large gender disparities and the burden they impose on families when developing intervention strategies in the community.

Activities of Daily Living↗

Obesity among adults with disabling conditions.

CONTEXT: Obesity, a leading cause of preventable death and chronic disease, is associated with disability. Little is known about obesity among adults with specific disabilities. OBJECTIVES: To determine the prevalence of obesity in adults with physical and sensory limitations and serious mental illness. DESIGN, SETTING, AND PARTICIPANTS: The 1994-1995 National Health Interview Survey of 145 007 US community-dwelling respondents, 25 626 of whom had 1 or more disabilities. MAIN OUTCOME MEASURES: Likelihood of being obese, attempting weight loss, and receiving exercise counseling among adults with and without disabilities. RESULTS: Among adults with disabilities, 24.9% were obese vs 15.1% of those without disabilities. After adjusting for sociodemographic factors, adults with a disability were more likely to be obese, with an adjusted odds ratio (AOR) of 1.9 (95% confidence interval [CI], 1.8-2.0). The highest risk occurred among adults with some (AOR, 2.4; 95% CI, 2.3-2.5) or severe (AOR, 2.5; 95% CI, 2.3-2.7) lower extremity mobility difficulties. After further adjustment for comorbid conditions, adults with disabilities were as likely to attempt weight loss as those without disabilities, except for adults with severe lower extremity mobility difficulties, who were less likely (AOR, 0.7; 95% CI, 0.5-0.9]), and adults with mental illness, who were more likely (AOR, 1.4; 95% CI, 1.2-1.8). Physician exercise counseling was reported less often among adults with severe lower extremity (AOR, 0.5; 95% CI, 0.4-0.7) and upper extremity (AOR, 0.7; 95% CI, 0.5-1.0) mobility difficulties. CONCLUSION: Obesity appears to be more prevalent in adults with sensory, physical, and mental health conditions. Health care practitioners should address weight control and exercise among adults with disabilities.

Adult↗

Retirement disability among workers in a natural gas distribution company.

Epidemiological investigations of occupational disability are severely limited because of the inherent difficulties in standardizing definitions of disability and because of the lack of appropriate comparison data. Nevertheless, occupational disability is of great concern to workers. An investigation of disability, defined as permanent retirement due to medical disability, among hourly employees of a natural gas distribution company was undertaken in response to a request by the employees' union. Because of the above limitations, a hypothesis-generating rather than hypothesis-testing approach was taken, utilizing both disability retirement incidence rates and a prevalence survey of the living disabled retirees. It was hypothesized from the analysis that this group of workers did experience an excess of retirement disability for the period 1971-1980 when compared to estimated disability incidence rates of the general Social Security insured population, and that this excess may have been due in part to an excess of musculoskeletal disabilities associated with occupational physical stresses and strains.

Accidents, Occupational↗

Health status, activity limitations, and disability in work and housework among Latinos and non-Latinos with arthritis: an analysis of national data.

OBJECTIVE: To document disparities in health status, activity limitations, and disability in work and housework between Latinos and non-Latino whites with arthritis. We examined whether sociodemographic factors (age, income, and education) account for the disparities between the ethnic groups, and whether comorbid conditions, disease duration, health care utilization, and functional abilities predict health status, activity limitations, and work and housework disability after controlling for sociodemographic variables. METHODS: We analyzed data from the Condition file of the 1994 National Health Interview Survey on Disability, Phase I. RESULTS: The risk of worse health, activity limitations, and work and housework disability was >2 times greater among Latinos compared with non-Latino whites. In the regression models accounting for potential confounders, Latino ethnicity remained significantly associated with poorer health status, but not activity limitations or disability in work or housekeeping. Of the socioeconomic status variables, education had a significant protective effect on work disability and health status. Comorbid conditions and health care utilization increased the likelihood of worse health, activity limitations, and work disability. Limitations in physical function were associated with poorer health and disability in work and homemaking. CONCLUSION: Social status differences between Latinos and non-Latinos may account for disparities in activity limitations and disability in work and housework. Education may provide various health benefits, including access to a range of occupations that do not require physical demands. The findings help to address the great gap in knowledge concerning factors related to the health and disability status of Latinos with arthritis.

Activities of Daily Living↗

Inadequate cardiovascular disease prevention in women with physical disabilities.

Health promotion and screening tests are important in persons with disability to avert secondary conditions that can lead to suboptimal functioning or premature death. Conversely, the existence of a primary disability can increase a person's susceptibility to secondary conditions. Cardiovascular disease (CVD) is the major cause of death in the United States, and its prevalence has been underinvestigated in persons with disability. This descriptive study used survey research to compare the risk of CVD in samples of 100 physically disabled women with 50 nondisabled women in the community. Participants, recruited from health fairs, completed questionnaires that explored the participants' knowledge of CVD risk factors, possession of specific CVD risk factors, and experience with CVD preventive screening procedures. Data revealed that compared with women without disability, women with disability were less knowledgeable about CVD risk factors and experienced marked deficiencies in CVD preventive screening. Body weight measurement, baseline electrocardiograms, family history, and smoking queries were performed less often in women with disabilities than in women without disabilities of similar age. Physical inactivity and postmenopausal status were specific CVD risk factors found to be more prevalent in the sample of women with disability. These findings suggest that risk of CVD is underrecognized and underassessed in women with a physical disability.

Adult↗

Workplace characteristics and work disability onset for men and women.

OBJECTIVES: This paper investigates the association between job characteristics and work disability among men and women in older working ages in the United States. We examine whether the association persists when controlling for major chronic disease experience. We also address whether job characteristics are ultimately associated with the receipt of disability benefits. METHODS: Data are from the Health and Retirement Survey and are nationally representative of noninstitutionalized persons 51-61 in 1992. Disability onset is estimated using a hazard modeling approach for those working at wave 1 (N = 5,999). A logistic regression analysis of disability benefits is based on a risk set of 525 persons who become work-disabled before the second interview. RESULTS: Women's disability onset and health problems appear less related to job characteristics than men's. For men, work disability is associated with stressful jobs, lack of job control, and environmentally hazardous conditions but is not associated with physical demands. Participation in disability benefit programs among those with work disability is unrelated to most job characteristics or health conditions. CONCLUSIONS: Understanding of the differing process to work disability for men and women and the relationship between work and health by gender is important for current policy development.

Persons with Disabilities↗

Disability and the detection of mental disorder in primary care.

INTRODUCTION: Despite the importance of disability associated with common mental disorders, research on the detection of mental disorders in primary care has scarcely explored its relevance. Aims To describe the disability burden of primary care patients with common mental disorders and subthreshold disorders and to examine the association between general practitioner's (GP) recognition of mental disorder and disability. Design Cross-sectional survey of GPs and their patients. Setting General practices in the lower North Island of New Zealand. Method Participants were randomly selected: GPs (n=70) and their patients (n=3414, of whom a subset of 775 from the basis of this paper). Formal DSM-IV diagnoses were made with the Composite International Diagnostic Interview (CIDI), and psychosomatic and psychological symptoms were measured with the Somatic and Psychological Health Report. Disability was measured with the World Health Organisation's Disability Assessment Schedule-version II. GPs independently rated the severity of psychological symptoms and the presence or absence of disorder. Results The principal findings were (1) that disability was associated with both mental disorder and subthreshold disorder with no significant difference in the level of disability between these categories, and (2) that GPs were less sensitive to the presence of mental disorders as defined by the CIDI if there was little concomitant disability, and in subthreshold cases, the presence of disability increased the chance of GPs identifying clinically significant symptoms. Conclusion Studies of GP recognition of mental disorder have almost exclusively adopted the perspective of concepts of disorder as defined by psychiatry. This study provides some insight into the way GPs attend to both symptoms and functioning in their assessments of psychological syndromes. Disability is an important cue to recognition of mental health problems in the primary care setting, including those that are not recognised by standardised psychiatric assessment but which may still be relevant to patient suffering.

Clinical Competence↗

Determinants of sexual disability and dissatisfaction in female patients with rheumatoid arthritis.

Previous research has identified two main problems of sexuality in female rheumatoid arthritis (RA) patients: difficulties in sexual performance and diminution of sexual desire and satisfaction. This study attempts to determine the clinical and psychological factors significantly contributing to sexual disability and dissatisfaction in female RA patients. Ninety consecutive female RA outpatients were assessed by a gynecologist. After excluding patients who were not sexually active and those with genital tract abnormalities, 52 patients were examined and investigated rheumatologically and given questionnaires assessing sexual performance, desire, and satisfaction, as well as demographic variables, pain, disability, anxiety, and depression. Following a correlation analysis, the contributions of demographic, disease, and psychological variables to sexual disability and dissatisfaction were explored by hierarchical and stepwise regression. Thirty-two patients (62%) had difficulties in sexual performance including nine patients (17%) who were totally unable to engage in sexual intercourse because of arthritis. Sexual desire or satisfaction were diminished in 24 patients (46%) and completely lost in 24 patients (46%). Sexual disability was not significantly correlated with any psychodemographic variables, but with parameters of disease activity (p<0.001), Health Assessment Questionnaire (HAQ)-disability (p<0.001), hip (p<0.001) but not knee joint disease, seropositivity (p<0.05), and diminished desire (p<0.05). However, HAQ-disability and hip joint disease were the only independent and significant determinants of sexual disability in the regression model after controlling for the effects of age and disease duration. These variables together explained 64% of the variance of sexual disability. On the other hand, pain (p<0.001), age (p<0.05), and depression (p<0.05) were the significant determinants in the regression model for sexual dissatisfaction, all together contributing 36% of its variance. More than 60% of female RA patients experience variable degrees of sexual disability and diminished sexual desire and satisfaction. Difficulties in sexual performance are related more to overall disability and hip involvement, while diminished desire and satisfaction are influenced more by perceived pain, age, and depression.

Adult↗

Predictive variables on disability and quality of life in stroke outpatients undergoing rehabilitation.

The purposes of this study were: (1) to evaluate the relationship between disability and Quality of Life (QoL) in stroke outpatients undergoing rehabilitation and (2) to determine whether and how demographic and social features of the patient, duration of disease and concomitant diseases influence the disability and QoL of the stroke outpatients. We performed a prospective study using several conventional disability measurements (Barthel Index, Functional Independence Measure, Modified Rankin Scale and Deambulation Index) and a validated patient-oriented measurement of QoL (SF-36). Sixty-eight outpatients were evaluated consecutively. As expected, all disability measurements were related to Physical Function: patients with higher disability, according to the physician's perspective, complained of higher deterioration of physical performance. Unexpectedly, patients with higher disability from the physician's point of view perceive that they were not able to do some daily activities not only because of physical problems but also because of emotional problems, and complained of higher deterioration of mental health. Multivariate analysis showed that higher disability is associated with higher age, depression and lower educational level. Physical Composite Score appeared to be deteriorated in patients with lower educational level who lived with family; on the contrary, Mental Composite Score appeared deteriorated in patients with higher educational level who lived alone. The current study provides interesting data about the relationship, not always expected, between disability and QoL for stroke patients and about the influence of patients' characteristics on disability and QoL. Our results showed that in a rehabilitation programme we should consider not only disability assessment but also QoL, which is more relevant for the patient.

Adult↗