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PubMed1998

Health-care utilization by disabled persons: a survey in rural Bangladesh.

The purpose of the present study was to examine the utilization of health services by disabled persons in rural Bangladesh and to identify associated factors to inform the development of appropriate health services. Household surveys were conducted in two villages of Bangladesh by a trained primary-care specialist who lived in the study area for 4 months. About 81% of the sample had utilized some form of health care with more than half consulting unqualified practitioners of modern medicine. Disabled persons whose families perceived they were disabled were 14 times more likely than others to seek treatment. Being male and in the economically productive age group, having an acquired disability and having some form of belief about disability causation were associated with utilization. The conclusions of the study are that social and cultural barriers prevent certain groups, notably women and demographically dependent age groups, from accessing health care. Those who are economically beneficial to the family usually utilize health services. A combination of educational and economic initiatives such as a disability benefits allowance would strongly promote the health of disabled persons and create a general awareness of disability in Bangladesh. A long-term programme which includes disability training for health-care workers and use of financial institutions and existing local government infrastructure for intensive rehabilitation will improve quality of life for disabled persons and is proposed for urgent implementation.

Adolescent↗

PubMed2005

[Factors affecting subjective satisfaction with verbal communication among the disabled elderly and their family caregivers].

The aims of the present study were to investigate satisfaction with verbal communication among the disabled elderly and their family caregivers; and to find the significantly influential factors of satisfaction with verbal communication. The subjects were 85 disabled elderly and 85 family caregivers. For the disabled elderly, satisfaction with verbal communication, demographic, and physical factors were examined using an interview survey. For the caregivers, satisfaction with verbal communication, demographic factors, and some factors related caregiving were examined using a self-administered questionnaire. In the disabled elderly, 82.4% were satisfied with their verbal communication while 55.3% of family caregivers were satisfied. Satisfaction with verbal communication between the disabled elderly and their caregivers showed low agreement (kappa = 0.17). Bivariate analysis revealed that satisfaction with verbal communication of the disabled elderly was significantly related to ADL (p < 0.01), dysphagia risk (p < 0.05), and ability of comprehension (p < 0.05) while satisfaction with verbal communication of caregivers was significantly related to the gender of the disabled elderly and caregivers' burden. Furthermore, multiple regression analysis showed that the factor most related to satisfaction with verbal communication for the disabled elderly was ability of comprehension (p value = 0.032, odds ratio = 2.960), and the most related factor for their caregivers was the burden evaluated by J-ZBI_8 (p value = 0.004, odds ratio = 0.842). These results suggest that satisfaction with verbal communication of the disabled elderly disagrees with that of the family caregivers, and that some related factors for the disabled elderly are different from those in their family caregivers.

Aged↗

PubMed1994

Running and the development of disability with age.

OBJECTIVE: To determine, by longitudinal study, whether regular vigorous running activity is associated with accelerated, unchanged, or postponed development of disability with increasing age. STUDY DESIGN: 8-year prospective, longitudinal study with yearly assessments. PARTICIPANTS: 451 members of a runners' club and 330 community controls who were initially 50 to 72 years old (also characterized as "ever-runners" [n = 534] and "never-runners" [n = 247], respectively). MEASUREMENTS: The dependent variable was disability as assessed by the Health Assessment Questionnaire and separately validated in these participant cohorts. Covariates included age, sex, body mass index, comorbid conditions, education level, smoking history, alcohol intake, mean blood pressure, initial disability level, family history of arthritis, and radiologic evidence of osteoarthritis of the knee in a subsample. RESULTS: Initially, the runners were leaner, reported joint symptoms less frequently, took fewer medications, had fewer medical problems, and had fewer instances of and less severe disability, suggesting either that the average previous 12 years of running had improved health or that self-selection bias was present. After 8 years of longitudinal study, the differences in initial disability levels (0.026 compared with 0.079; P < 0.001) had steadily increased to 0.071 for runners compared with 0.242 for controls (P < 0.001). The difference was consistent for men and women. The rate of development of disability was several times lower in the runners' club members than in community controls; this difference persisted after adjusting for age, sex, body mass, baseline disability, smoking history, history of arthritis, or other comorbid conditions (slopes of progression of disability for the years 1984 to 1992, after adjusting for covariates: men in the runners' club, 0.004 [SE, 0.002]; community controls, 0.012 [SE, 0.002]; women in the runners' club, 0.009 [SE, 0.005]; community controls, 0.027 [SE, 0.004]; P < 0.002 for both sets of comparisons). In addition to differences in disability, there were significant differences in mortality between the runners' club members (1.49%) and community controls (7.09%) (P < 0.001). These differences remained significant after adjusting for age, sex, body mass, comorbid conditions, education level, smoking history, alcohol intake, and mean blood pressure (P < 0.002, conditional risk ratio for community controls compared with the runners, 4.27; 95% CI, 1.78 to 10.26). CONCLUSIONS: Older persons who engage in vigorous running and other aerobic activities have lower mortality and slower development of disability than do members of the general population. This association is probably related to increased aerobic activity, strength, fitness, and increased organ reserve rather than to an effect of postponed osteoarthritis development.

Aging↗

PubMed2000

An instrumental variables approach to measuring the effect of body weight on employment disability.

OBJECTIVE: To measure the effect of body weight on employment disability. DATA SOURCES: Female respondents to the National Longitudinal Survey of Youth (NLSY), a nationally representative sample of American youth, surveyed from 1979 to 1998, merged with data from the child sample of the NLSY. STUDY DESIGN: A series of probit models and probit models with instrumental variables is estimated with the goal of measuring the effect of body weight on employment disability. The two outcomes of interest are whether a woman reports that her health limits the amount of work that she can do for pay, and whether she reports that her health limits the kind of work that she can do for pay. The models control for factors that affect the probability of health limitations on employment, such as education, cognitive ability, income of other family members, and characteristics of children in the household. Self-reports of height and weight are corrected for reporting error. PRINCIPAL FINDINGS: All else being equal, heavier women are more likely to report employment disability. However, this overall correlation may be due to any or all of the following factors: weight causing disability, disability causing weight gain, or unobserved factors causing both. Instrumental variables estimates provide no evidence that body weight affects the probability of either type of employment disability. CONCLUSIONS: This study finds no evidence that body weight causes employment disability. Instead, the observed correlation between heaviness and disability may be due to disability causing weight gain or unobservable factors causing both disability and weight gain.

Adult↗

PubMed2002

[Medical and non-medical risk factor criteria for disability pension].

BACKGROUND: Non-medical factors may contribute substantially to the risk of becoming disabled, despite the common medically based criteria for disability pension. This study seeks to identify medical and non-medical determinants for the national medically-based disability pension in a Norwegian total population. MATERIAL AND METHODS: The baseline data were obtained through a comprehensive health screening programme, the Nord-Trøndelag Health Study in 1984-86 (HUNT I). Participants were people without disability pension, 20-66 years old in 1984-86. Information on disability pensioning was obtained from the National Insurance Administration database in 1995. Data analysis was performed by life table and Cox regression analysis. RESULTS: The incidence of disability pension showed great variations by age and gender; there was an increase over the follow-up period, especially among people below 50. We found a consistent pattern of increasing risk of disability pension with decreasing socio-economic status and education. Low educational level, low perceived health, occupational related factors, and any long-standing health problem were found to be the strongest independent risk factors for disability pension. INTERPRETATION: Non-medical factors are strong risk factors for disability pension. These factors are usually not addressed by individually based health or rehabilitation programmes. Thus, when it comes to addressing the causes of incidence of disability pension in the population, the results suggest a population approach.

Adult↗

PubMed2003

[Disability-free life expectancy among 60-year-olds in Denmark].

INTRODUCTION: Life expectancy can be expressed as average expected lifetime in different health states. The purpose of the study was to estimate disability-free life expectancy, i.e. average lifetime without disabilities, in Denmark and in the counties of Denmark and evaluate the relation between life expectancy and the proportion of disability-free life expectancy. MATERIAL AND METHODS: Prevalence rates of disability (in terms of walking, walking on stairs, carrying 5 kg, reading, hearing and speaking) derived from the Danish Health Interview Survey 2000 were combined with life-table data and disability-free life expectancy was calculated by Sullivan's method. RESULTS: In 2000 expected lifetime of 60-year-old men and women was 18.8 years and 22.0 years respectively and disability-free life expectancy was 14.7 years for both sexes corresponding to 78.4% and 66.6% of the remaining lifetime for men and women respectively. Differences in disability-free life expectancy between counties ranged from zero to three years. In counties with the highest life expectancy among women they tended to have a higher proportion of life years with disabilities, but there was no correlation between life expectancy and the proportion of disability-free life expectancy for men. DISCUSSION: The results may illustrate theories about the relation between increased lifetime and quality of life in terms of health. Increased total lifetime for women prolongs the proportion of expected lifetime with disability ("expansion of morbidity"), whereas for men no correlation was found ("dynamic equilibrium").

Activities of Daily Living↗

PubMedDate not supplied

Joint damage and disability in rheumatoid arthritis: an updated systematic review.

Joint damage and disability in rheumatoid arthritis (RA) both increase with disease duration but the nature of their relationship is uncertain. This review updates knowledge of the progression and inter-relationship of joint damage and disability in treated RA and provides a synopsis of the main predictive factors for damage and disability. In early RA 39-73% of patients develop one or more erosions in their hands and wrists by 5 years. In established RA the average annual increase in radiological damage scores is 1.9% maximal damage. After 20 years RA patients have on average 43% of maximum possible damage. These data suggests that joint damage progresses constantly over the first 20 years of RA. The average annual increase in HAQ scores is 0.033 per year (1% of possible maximum disability). In the first years of disease there is a "J-shaped" curve with an initial fall in HAQ scores followed by an increase over the next four years. In cross-sectional studies there is either no correlation or a weak correlation between damage and disability in early RA; this absence of correlation is explained by the "J-shaped" curve of disability with disease duration in early RA. As disease duration increases the correlation between damage and disability becomes more obvious; 9 studies show correlation coefficients between 0.31 and 0.75. The most predictive factors of damage and disability are rheumatoid factor status and disease activity. The validity of our conclusions are limited by the potential indirect link between small joint damage and disability, with large joint damage being a more important predictor, and the presence of ceiling effects on X-rays. In conclusion, joint damage accounts for a substantial proportion of the disability associated with the disease.

Adult↗

PubMedDate not supplied

Psychiatric comorbidity and work disability in patients with inflammatory rheumatic diseases.

OBJECTIVE: To determine the relative contribution of psychiatric comorbidity to work disability in patients with inflammatory rheumatic diseases (IRD). Parallel analyses were also performed in a matched control group with no diagnosis of IRD to investigate if predictors of work disability in medical patients are independent from the presence of IRD. METHOD: The patient group with IRD (73.9% female; mean age, 42.7 years) and the control group (73.9% female; mean age, 42.2 years) consisted of 356 outpatients each. Psychiatric comorbidity was diagnosed using the Patient Health Questionnaire (PHQ), functional disability was measured with the 12-item Short-Form Health Survey (SF-12), and severity of illness was assessed by the treating physicians. Stepwise logistic regression analyses were performed to identify independent predictors of work disability controlling for psychiatric comorbidity, functional disability, severity of illness, additional clinical variables, and demographics. RESULTS: Psychiatric comorbidity increased work disability in patients with severe IRD from 25% to 50%, and from 5% to 17% in mild disease. Physical functioning (OR = 0.6; p <.0001), depression severity (OR = 1.6; p =.005), and illness severity (OR = 1.8; p =.006) were identified as independent predictors of work disability in patients with IRD. Similar predictors of work disability were identified in the control group, but depression severity did not meet statistical significance at the 5% level. CONCLUSIONS: This study provides evidence that depression is an independent risk factor of work disability in patients with IRD, but this result cannot be generalized to other medical conditions. Improved diagnosis and treatment of depressive disorders in patients with IRD may help avoid work disability.

Adult↗

PubMed1992

The prevalence of childhood disability and related medical diagnoses in Clarendon, Jamaica.

In a population-based survey in a defined area in the parish of Clarendon, Jamaica, the prevalence of six types of childhood disabilities was sought. All children aged 2-9 years who screened positive for disability, with 8% of children screening negative (out of a total of 5,468 children), were assessed by a physician and a psychologist. Disabilities were categorised by types and levels of severity. The estimated prevalence rate for all types and levels of disabilities was 93.9 per 1,000 children and for serious disability was 24.9 per 1,000. The rates for specific disabilities showed wide variation (cognitive, 81/1,000; speech, 14/1,000; visual, 11/1,000; hearing, 9/1,000; motor, 4/1,000; seizure, 2/1,000). Of the disabled children, 70% had only one disability, 23% had two and 6% had three or four disabilities. If disability is to be seen as a major outcome of a range of interacting factors, then these prevalence rates, taken with the specific aetiologies, would provide a framework for planning preventive and rehabilitative interventions.

Child↗

PubMedDate not supplied

[Disability in childhood. Care and professional training regarding particularly the problems currently seen in long-term control of newborns at risk].

Children with disability are a heterogeneous population distributed between complex conditions including physical disorders, psychomotor and neurodevelopment disorders, social role and school activities limitations. Prenatal, perinatal and neonatal diseases together with disabling chronic conditions may cause childhood disability. Data from literature show a prevalence of childhood disability ranging from 5 to 20% with a wide range of severity level. The social impact of childhood disability is extremely relevant. Children with disabilities frequently require health care services and special education. VLBW (very low birth weight infants, birth weight <1500 gr) have major disabilities (10-15%) while minor disabilities can be found in 20-25% of these subjects. The first step stays in medical prevention but also an oriented training toward these problems for doctors both in pre and post-graduate formation can play a significant role. Support of society in order to understand the complexity and heterogeneity of childhood disability, through social care services, is mandatory. These measures, apparently costly, if correctly done, will be helpful for both the individual subject and the whole society, through a reduction of the disability problems and the final economy cost impact.

Adolescent↗

PubMed1989

Permanent disability in black mineworkers. A critical analysis.

Two-thirds of all occupational permanent disabilities among black workers in South Africa occur in the mining industry. Comparison of compensated permanent disability cases shows that the incidence of permanent disability among black mineworkers is several times higher than that in any other South African industry. Most permanent disabilities sustained in mining fall into the category of 1-5% disability. Trends in the incidence of permanent disability are examined and compensation for disabled black mineworkers is investigated. The basis of workers' compensation legislation involves workers giving up their common-law right to litigate for losses owing to occupational injuries (including pain and suffering) in exchange for guaranteed protection against income losses. However, the evidence suggests that compensation generally does not redress income loss. Most disabled black miners receive compensation payments that are lower than poverty datum levels and high rates of inflation rapidly erode their real value. Since many black workers are repatriated after a disabling accident, the issue of employment becomes crucial. The problems highlighted suggest that compensation legislation requires reform to ameliorate the difficulties faced by disabled black miners and recommendations are made.

Accidents, Occupational↗

PubMed1995

A survey of dentists and the services they provide to disabled people in the Province of Manitoba.

Persons with disabilities occasionally report that dentists are reluctant to provide them with either dental care or necessary services. There is very little information about the kinds of services that Canadian dentists provide to disabled people. To answer this question, a mail survey, following Dillman's Total Design Method, was undertaken in Manitoba. Questionnaires were mailed to all dentists licensed to practise in Manitoba in 1990. A total of 342 surveys were returned, representing a 62 per cent response rate. In all, 259 (76 per cent) of respondents reported regularly providing dental care to disabled people of all ages who were afflicted by a broad range of disabling conditions. The private dental office was the primary location in which this dental care was provided, but 65 dentists (25 per cent) reported providing dental care in hospitals or other institutions such as nursing homes. Forty per cent of the dentists who reported treating disabled people were willing to accept referrals of new patients with disabilities. Dentists reported providing a full range of dental services to disabled people, and using similar modes of pain control for both disabled and non-disabled patients. The primary mechanism of payment was social assistance programs. Dentists reported that they received adequate compensation (defined as their usual and customary fee) in only 50 per cent of the cases in which they provided dental care to disabled patients. However, 27 per cent of the respondents reported always receiving their customary fee, and 52 per cent indicated that they would be willing to attend continuing education courses offered in the area of special patient care.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

Province-based study of neurologic disability of children weighing 500 through 1249 grams at birth in relation to neonatal cerebral ultrasound findings.

BACKGROUND: Adverse neurodevelopmental outcome in premature infants is more common in the presence of certain ultrasonographically detectable intracranial lesions. Present nomenclature and classifications of parenchymal changes in preterm infants of varying gestations have led to some confusion. Descriptive definitions may be clinically useful. Regionalized perinatal and neonatal care enables population-based studies of these lesions and subsequent outcomes. METHODS: Two- to 3-year outcomes of neonates weighing 500 through 1249 g born in Alberta to Alberta residents during 1987 through 1990 were reviewed in relation to neonatal cerebral ultrasound lesions. Odds ratios and confidence limits for disability were calculated. RESULTS: Of 960 live births in this weight group, 669 (70%) survived to 1 year adjusted age; 646 (96.6%) were assessed at follow-up, and 80 (12.4%) of these were disabled: cerebral palsy, 8.7%; vision loss, 2.9%; hearing loss, 1.3%; epilepsy, 0.6%; mental retardation, 4.8%; more than one disability per child, 3.6%; and projected dependent disability, 1.4%. Lesions considered to be predictive of disability on ultrasound (excluding germinal layer hemorrhage) were found in 79 (11.8%), parenchymal lesions in 63 (9.4%) of 1-year survivors: intraventricular hemorrhage (IVH) (n = 59), persistent or transient cerebral ventriculomegaly (n = 50), persistent or transient intraparenchymal periventricular echodensity (n = 29), and cystic periventricular leukomalacia (n = 7). All lesions except isolated IVH were associated with adverse outcome; 37% of disabled children, 61% of multiply disabled children, and all children projected to become dependently disabled had parenchymal lesions with or without IVH. Triple lesions of IVH, cerebral ventriculomegaly, and intraparenchymal periventricular echodensity gave an odds ratio for disability of 50. Transient lesions had significant risk. CONCLUSIONS: This province-based study provides a descriptive scheme of serial neonatal cerebral ultrasound lesions and outcome considered useful for clinicians caring for newborns of lowest gestational ages. The overall incidence of parenchymal lesions was lower than frequently reported. Combinations of lesions were linked to increased incidence, complexity, and severity of childhood disability.

Brain Diseases↗

PubMed1993

Would people with a disability in the highlands benefit from a community-based rehabilitation program?

Community-based rehabilitation for those people with a physical disability is a policy promoted by the World Health Organization. In order to assess whether such a program might be useful to the disabled people of the highlands of Papua New Guinea a survey was conducted which first identified those people with a severe physical disability and then investigated the degree that they were handicapped in terms of their social and physical environment. The survey was performed in the Tari area of the Southern Highlands Province in conjunction with the Papua New Guinea Institute of Medical Research (PNGIMR). By using the PNGIMR demographic surveillance system it was possible to calculate a prevalence level of physical disability (including walking disability, deafness and blindness) of 46 per 10,000 (0.46%). A significant physical disability was identified in 114 people, of whom 54 were given personal interviews to establish their quality of life. The survey found the social and economic situation of disabled people to be generally good although there is a lack of basic material aids for handicapped people. The disabled people and their families do not need extra knowledge about how to care for their disabilities and a formal community-based rehabilitation program would be inappropriate, but they would find mobility aids such as wheelchairs and artificial limbs of enormous help. The regular health care services are widely used although both people with a disability and health service staff are not always aware of the types of treatment which can usefully be provided.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Progression of functional disability in patients with rheumatoid arthritis. Associations with rheumatology subspecialty care.

BACKGROUND: To determine whether patients with rheumatoid arthritis and their physicians make appropriate decisions regarding referral to rheumatologists and the need for continuing rheumatology care, we examined the relationship between the progression of functional disability in these patients and their use of rheumatology subspecialty care over time. METHODS: A cohort of 282 patients with rheumatoid arthritis was followed prospectively for up to 10 years. Participants were categorized into three subgroups based on the pattern of care received from rheumatologists over the study period: patients who were never treated by a rheumatologist; patients treated by a rheumatologist only intermittently; and patients treated by a rheumatologist at least once during each 6-month study period. The outcome was the rate of progression of functional disability, measured using the Health Assessment Questionnaire Disability Index. RESULTS: Among the 52 patients who had not been referred to a rheumatologist, 30 (58%) had rates of progression of functional disability that were stable or improving over time (rate < 0.01 Disability Index units per year), while 22 (42%) had rates that were worsening (rate > or = 0.01 Disability Index units per year). Among patients treated by rheumatologists, the average rate of progression was substantially lower among the 69 patients who were treated regularly by a rheumatologist than among 161 patients treated by rheumatologists intermittently (0.008 Disability Index units per year vs 0.020 Disability Index units per year). This difference was associated with more intensive use of second-line antirheumatic medications, and more frequent joint surgeries, among patients treated by rheumatologists on a regular basis. CONCLUSIONS: Most patients with rheumatoid arthritis in this community cohort were treated by a rheumatologist, but 42% of those not referred had progressively increasing functional disability. Among patients treated by rheumatologists, those who had continuing care from rheumatologists experienced lower rates of progression of functional disability than those who had only intermittent care. These results suggest that use of rheumatology subspecialty care is associated with better health outcomes in rheumatoid arthritis.

Activities of Daily Living↗

PubMed1996

Physical disability in a cohort of persons with AIDS: data from the AIDS Time-Oriented Health Outcome Study.

OBJECTIVE: Physical disability is one of the more important determinants of health-related quality of life in person with AIDS, although little information is available on specific physical functional deficits. The purpose of this study was to document the types, frequency, severity, and correlates of physical disability in persons with AIDS. DESIGN: The design was cross-sectional with assessment of disability at the initial evaluation for the AIDS Time-Oriented Health Outcome Study, an observational community-based cohort of persons with AIDS. METHODS: Disability was measured by the HIV Health Assessment Questionnaire, a self-administered assessment of perceived difficulty in eight functional categories. Additional medical and demographic information was obtained from chart review, in addition to other standardized quality of life measures. RESULTS: The sample consisted of 546 persons, primarily white homosexual men, evaluated a mean of 475 days (SD, 474) after an AIDS-defining diagnosis. Ten to 50% of men reported some degree of activity-specific disability, mostly mild or moderate. Disability scores varied widely and tended to be most severe among those items considered to be high level 'instrumental activities of daily living'. Univariate correlations were strong between disability and number of symptoms, global health status, and the Medical Outcomes Study HIV fatigue index (r = -0.4223 to 0.5115 for men). Correlations between disability and either time from AIDS diagnosis or CD4 T-lymphocyte count were not statistically significant. For men, stepwise multiple regression showed that 26.9% of disability variance was explained by symptoms, 3.7% by the Medical Outcomes Study HIV fatigue index, and 1.8% by total number of opportunistic infections. CONCLUSION: We conclude that physical function is variable among persons with AIDS living in the community, with a substantial number experiencing mild to moderate deficits tending to occur in instrumental activities of daily living. Further studies should address the need for and efficacy of appropriate rehabilitation interventions in persons with AIDS experiencing physical disability.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Disability among Canada's aboriginal peoples in 1991.

In 1991, disability rates among adults were high for Aboriginal people, compared with the total Canadian population: 31% versus 13%. For all ages and levels of education, Aboriginal disability rates were much higher than those of Canadians overall. While most younger Aboriginal persons with a disability were only slightly disabled and did not need help with their daily activities, at age 55 and over, more than half of Aboriginal persons with a disability were either moderately or severely disabled and required such help. Nonetheless, most of the Aboriginal population with disabilities who needed help received it, so only a small proportion of them had unmet needs for assistance. The need for assistance, however, increased with the severity of disability. Recent improvements in survivorship mean that more Aboriginal people will live to older ages, at which disability rates are higher. This has implications for their need for health and social services, and the associated costs. Statistics Canada's 1991 Aboriginal Peoples Survey (APS) was used to examine the prevalence and severity of disability and the degree of dependence in the Aboriginal population. Where possible, these results are compared with data for the total Canadian household population from the 1991 Health and Activity Limitation Survey (HALS).

Adolescent↗

PubMedDate not supplied

Dental hygiene students' attitudes toward treating individuals with disabilities.

In the past, studies have been conducted to determine dental and dental hygiene students' attitudes toward the disabled following their clinical experience. The purpose of this study was to identify how dental hygiene students' attitudes toward treating clients with disabilities changed between the start and the end of their didactic and clinical rotation. Earlier research had examined dental hygiene students' attitudes toward individuals with disabilities following either a limited didactic and clinical course addressing disabilities or at the completion of their dental hygiene education. Few investigations had examined students' attitudes prior to and at the completion of a long-term course on clients with disabilities. The aim of this investigation was to determine if a one-year clinical and didactic course addressing various disabilities would result in a significant change in the students' attitudes and comfort level when treating clients with disabilities. The survey researched the attitudes of 18 senior dental hygiene students in the special care clinic at Baylor College of Dentistry, Texas. The students received a pre- and post-modified survey of the "Dental Students' Attitudes Toward the Handicapped Scale" and were asked to rank their responses from strongly agree (5) to strongly disagree (1). The following areas were assessed: Group 1 (Positive Perceptions of Educational Training); Group 2 (Negative Attitude Toward Treating Persons with Disabilities); Group 3 (Providing Dental Services); Group 4 (Negative Perceptions of Educational Training); and Group 5 (Comfort Level when Treating Persons with Disabilities). There was a significant improvement in the students' attitudes in Groups 1, 2 and 4 with p-values for the questions in these groups ranging between p < 0.001 to p < 0.05. In Group 3, only two out of the five questions yielded a significant change in attitude, p < 0.001 to p < 0.01. Following the rotation, when asked about their comfort level in treating clients with disabilities (Group 5), the students reported being comfortable treating persons with autism p < 0.01, cerebral palsy p < 0.05, quadriplegia and paraplegia p < 0.05.

Adult↗