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PubMed1998

Physical disability and social interaction: factors associated with low social contact and home confinement in disabled older women (The Women's Health and Aging Study).

OBJECTIVES: This study examines the association of disability and social interaction, measured as in-person contact with non-household members and home confinement, and identifies sociodemographic, socioeconomic, and health-related factors that modify this relationship. METHODS: Participants were 1,002 moderately to severely disabled community-dwelling women aged 65 and older from the Women's Health and Aging Study, identified by screening an age-stratified random sample of Medicare beneficiaries in Baltimore, Maryland. Logistic regression models were used to estimate the odds of low social interaction associated with disability and each independent modifier. RESULTS: In a typical week, 23% did not visit with anyone residing outside their households and 17% did not leave their homes. In addition to and independent of disability level, older age, not completing high school, having a driver in the home, hearing difficulties and incontinence were associated with low social contact; older age and African American race were related to home confinement. African American women living alone are especially vulnerable to home confinement. DISCUSSION: Physical disability is not necessarily socially disabling, as many of the most severely disabled in our study had at least daily social interaction. Improvements in social interaction appear possible through more effective management of certain health conditions and attention to potential sociocultural barriers.

Activities of Daily Living↗

PubMed2004

Lateralization of temporal lobe epilepsy and learning disabilities, as defined by disability-related civil rights law.

PURPOSE: Epilepsy research has identified higher rates of learning disorders in patients with temporal lobe epilepsy (TLE). However, most studies have not adequately assessed complex functional adult learning skills, such as reading comprehension and written language. We designed this study to evaluate our predictions that higher rates of reading comprehension, written language, and calculation disabilities would be associated with left TLE versus right TLE. METHODS: Reading comprehension, written language, and calculation skills were assessed by using selected subtests from the Woodcock-Johnson Psycho-Educational Tests of Achievement-Revised in a consecutive series of 31 presurgical patients with TLE. Learning disabilities were defined by one essential criterion consistent with the Americans with Disabilities Act of 1990. Patients had left hemisphere language dominance based on Wada results, left or right TLE based on inpatient EEG monitoring, and negative magnetic resonance imaging (MRI), other than MRI correlates of mesial temporal sclerosis. RESULTS: Higher rates of reading comprehension, written language, and calculation disabilities were associated with left TLE, as compared with right TLE. Nearly 75% of patients with left TLE, whereas fewer than 10% of those with right TLE, had at least one learning disability. CONCLUSIONS: Seizure onset in the language-dominant hemisphere, as compared with the nondominant hemisphere, was associated with higher rates of specific learning disabilities and a history of poor literacy or career development or both. These results support the potential clinical benefits of using lateralization of seizure onset as a predictor of the risk of learning disabilities that, once evaluated, could be accommodated to increase the participation of patients with epilepsy in work and educational settings.

Adult↗

PubMed2001

Mental illness and changing definitions of disability under the Americans With Disabilities Act.

The Americans With Disabilities Act (ADA) prohibits employment discrimination on the basis of disability. Originally, an assessment of whether a person had a disability and thus was protected by the ADA examined the person's impairment in its uncorrected state. Thus it was comparatively easy for people with mental illness to meet the threshold requirement for having a disability. However, in 1999 the U.S. Supreme Court issued three decisions holding that, for the purposes of the ADA, disability had to be assessed in its corrected state. Since those decisions were issued, the courts have increased the burden on individuals, including people with mental illness, to prove that they have a disability. In several cases, courts ruled that people with serious mental illnesses do not have a disability and are not protected by the ADA. This article discusses these cases and their implications for people with mental illness and for practitioners.

Adult↗

PubMed1994

Occupational impairment and disability among applicants for Social Security disability benefits in Pennsylvania.

OBJECTIVE: The study goal was to assess the extent of workplace-related disease and injury among Social Security Disability Insurance applicants. METHODS: A convenience sample of 240 consecutive applicants to the Pennsylvania Bureau of Disability Determination was studied to assess the prevalence of work-related disorders. An applicant had a work-related condition if there was a clear statement of a workplace illness or injury associated with the impairment, or if the applicant had worked at an occupation with a high likelihood of exposures known or suspected to contribute to the condition of interest. RESULTS: Of the 240 applicants, 166 (69%) were awarded disability insurance benefits; a total of 27 (11%) had work-related conditions, including 14 of the 166 (8%) who were found to be disabled. Forty percent of the 27 had a disorder that was musculoskeletal in origin. Of 59 applicants with cancer, 10.2% had some work-related etiological component. Of an estimated 71,680 adult disability insurance applicants in Pennsylvania in 1990, 5134 new insurance beneficiaries had a projected occupationally related disability. CONCLUSIONS: A substantial number of applicants for disability insurance benefits suffer from an impairment caused or exacerbated by prior workplace exposures. These individuals may serve as sentinel events for initiating follow-up surveillance and prevention activities.

Accidents, Occupational↗

PubMed1992

A multiple-source method for studying the prevalence of developmental disabilities in children: the Metropolitan Atlanta Developmental Disabilities Study.

The Metropolitan Atlanta Developmental Disabilities Study is the first US, population-based epidemiologic study of the prevalence of mental retardation, cerebral palsy, hearing impairment, and visual impairment among school-age children. The study population consisted of children who were 10 years of age between 1985 and 1987 and whose mothers were residents of the five Georgia counties of Clayton, Cobb, DeKalb, Fulton, and Gwinnett at the time of the child's birth. Since children with developmental disabilities are identified by and receive services from various health, social service, and education systems, a multiple-source case identification method was used. This study is unique in that individual school records were used to identify children with the four disabilities. Use of a multiple-source method made it possible to confirm specific conditions and to classify subtypes of disabilities. About 95% of the children with one or more of these four disabilities were initially identified through the school systems. This approach is much less costly than conducting medical and psychologic assessments on populations of children. In addition, this method made it possible to estimate accurately the "administrative prevalence" of these disabilities (ie, the number of children previously identified with these disabilities for the purpose of providing services). The prevalence rates found in this study, per 1000 10-year-old children, were as follows: mental retardation, 10.3; cerebral palsy, 2.0; hearing impairment, 1.0; and visual impairment, 0.6.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral Palsy↗

PubMed2005

The impact of function on work status for community dwelling disabled persons with arthritis: an analysis of the National Health Interview Survey Disability Supplement.

Arthritis is one of the most common diseases and a leading cause of disability in adults. Returning injured workers to work and preventing work disability is the primary mission of occupational health professionals. The purpose of this study was to identify risk factors associated with work disability and intervention strategies. This study is a retrospective cohort analysis of secondary individual level data. The data for the study were collected by the National Health Interview Survey, Disability Supplement (NHIS-D) 1995. Community dwelling disabled persons with functional limitations due to arthritic conditions were included in this analysis. A total of 286 records were available for logistic regression analysis. The outcome variable was work status, either working or not working. The significant predictors of working status were ability to lift 10 pounds (OR = 1.64), college education (OR = 0.21), age (OR = 1.03), and less than high school education (OR = 2.48). Thirty-four percent of the variance in working status was explained by the model that also included health status, difficulty standing, difficulty walking up steps, difficulty walking 1/4 mile, ethnicity, and gender. Younger disabled persons with arthritis, who have little difficulty lifting 10 pounds, and have some college education have better odds of working. Occupational health professionals need to look for ways to improve the educational status and functional lifting ability of disabled individuals with arthritis.

Adolescent↗

PubMed1998

The Americans with Disabilities Act, mental disability, and employment practices.

This research examines the response of employers to the Americans with Disabilities Act (ADA), with a specific focus on the employment of those with mental disabilities. A telephone survey was completed in a metropolitan area in the southern United States with a random sample of 117 businesses. In terms of specific practices that indicated compliance with the ADA, 15% had specific policies for hiring those with mental disabilities, and 37.6% had indeed hired such individuals. Companies that had complied with the ADA were more likely to be large and to have specific policies for the hiring of minorities and those with physical disabilities. Employers also did not believe that employment of those with mental disabilities was their responsibility, and supported increased efforts by the rehabilitation community to improve employment opportunities for individuals with mental disabilities Mental health services providers need to work more closely with employers in their regions and educate them about the capabilities of individuals with mental disabilities, and inform employers that the types of accommodations necessary are neither costly nor difficult to implement.

Attitude to Health↗

PubMed2005

[Evaluation of the attitude towards disabled persons of 3rd and 4th year medical students using the "Attitude towards disabled persons" questionnaire. Effect of courses and rotations in physical medicine and rehabilitation departments].

UNLABELLED: Modifications of the medical curriculum have included a compulsory course on disability. OBJECTIVE: To determine whether attendance in a course on disability and/or rotations in physical medicine and rehabilitation departments modify the attitude of medical students towards disabled people. METHODS: All third- and fourth-year students completed a translated version of the ATDPb. This questionnaire rates items evaluating attitude towards disabled people on a 6-point scale (minimum 0; maximum 180). Retro-translation was performed to control the translation. During the second year, all students had attended a general course in ethics. Fourth-year students had attended a 17 hours course on disability, and 21 of 78 had spent 9 weeks in the physical medicine and rehabilitation department. The study compares fourth-year students to third-year students, considered as controls, and students having spent a rotation in the physical medicine and rehabilitation department to others. RESULTS: The mean score of all students was 108.86+/-15.84 (73-160) on the ATDP scale. Males and females did not differ significantly, and the score did not change from that before the course on disability (109.95+/-14.98 vs 107.6+/-16.65, P=0.23) nor after a rotation in the physical medicine and rehabilitation department (113.52+/-11.42 vs 108.54+/-16.03, P=0.14). CONCLUSION: Development and validation of scores that would fit better to the European cultural context would be useful. The present method of theoretical courses and rotations do not improve the attitude of students towards disabled people and should be modified if this objective is to be achieved.

Attitude to Health↗

PubMed2006

Impact of the timing, type and severity of disability on the subjective well-being of individuals with disabilities.

Despite the existence of a large volume of literature on subjective well-being (SWB) of the general population, very few studies have focused on individuals with disabilities. The present study uses data on 24,036 Canadians with disabilities to investigate factors affecting their SWB. It found that SWB, measured here by level of happiness, decreases with severity of disability but is independent of the type of physical disability. Those born with a disability are likely to be happier as compared to those disabled later on in life. Per capita family income has no effect on happiness. However, unemployment decreases happiness. Happiness is found to be U shaped in age, bottoming out around 40 years of age. Some of these results vary when the sample is split according to the timing, type or severity of disability.

Activities of Daily Living↗

PubMed2003

Women are more disabled in basic activities of daily living than men only in very advanced ages: a study on disability, morbidity, and mortality from the Kungsholmen Project.

OBJECTIVE: We explored the effect of morbidity, mortality, and occurrence of new disability on gender differences in activities of daily living (ADL) functioning in different age groups in the elderly population. METHODS: All 77+-year-old members of a community-based cohort were clinically examined by physicians, assessed by psychologists, and interviewed by nurses at baseline and after a 3-year interval. Diseases were diagnosed according to ICD-9 and the DSM-III-R criteria for dementia. The Katz index of ADL was used to measure basic functional status. RESULTS: After adjustment for socio-demographic characteristics, the oldest women (90+ years) had higher disability prevalence and a tendency for higher long-term disability incidence. Women aged 85+ years also had higher morbidity prevalence. Mortality among disabled subjects was similar for both genders, whereas higher mortality was found in younger nondisabled men (77-84 years). CONCLUSION: We conclude that gender differences in disability, morbidity, and mortality vary with age in the elderly population. Gender differences in morbidity and basic functional dependence were evident only in the oldest old. Based on current and previous findings, we speculate that more women may be at higher risk of developing severe disability than men in the advanced ages due to longer survival with slight disability earlier in adult life.

Activities of Daily Living↗

PubMed2001

[Restructuring of the specialized job market for people with disabilities through legislative reform of the Rehabilitation Act--consequences for the workshops for the disabled].

The legal basis for employment of people with disabilities in sheltered Workshops for the Disabled (Werkstätten für Behinderte, WfB) had hitherto been shaped by the 1961 Federal Social Assistance Act, the 1969 Employment Promotion Act, the 1974 Severely Disabled Persons Act with the related Workshop Ordinances of 1980 and 1996. The Act on Combating Unemployment of Severely Disabled Persons, effective as of Oct. 1, 2000 has now created a new legal foundation, which also is aimed at enhancing Workshop employees' horizontal mobility into the general job market, inter alia providing for access to Supported Employment arrangements and for availability of selective placement and support services (Integrationsfachdienste, IFD) throughout Germany. These Services also are intended as points of contact in the counselling of severely disabled school leavers in relation to placement opportunities in competitive jobs and/or integration projects or firms. Discussed from a legal perspective are the differences in sociolegal respects between such projects for severely disabled persons and employment in Workshops for the Disabled, as well as implications for the Workshops' own economic activity, also making reference to the forthcoming Book 9 of the Social Code.

Persons with Disabilities↗

PubMedDate not supplied

Medicine, gender, and disability: disabled women's health care encounters.

In this article I examine the intersection of gender and disability in the medical arena by considering disabled women's experiences of receiving health care in the United Kingdom. Drawing on the "social model of disability," I focus on the attitudes and practices of doctors. I use two sources of qualitative data: (i) 68 disabled women's narratives gathered in the United Kingdom in 1996-1997; (ii) interviews with 17 disabled women regarding their reproductive experiences in the United Kingdom. I suggest that disabled women health service users are at risk of experiencing oppressive medical practices because two forces of oppression appear to be frequently, and interactively, in play: patriarchy and disablism.

Attitude of Health Personnel↗

PubMed2001

Abuse assessment screen-disability (AAS-D): measuring frequency, type, and perpetrator of abuse toward women with physical disabilities.

An interview questionnaire was presented to a multiethnic sample of 511 women, age 18-64 years, at public and private specialty clinics to determine the frequency, type, and perpetrator of abuse toward women with physical disabilities. The four-question Abuse Assessment Screen-Disability (AAS-D) instrument detected a 9.8% prevalence (50 of 511) of abuse during the previous 12 months. Using two standard physical and sexual assault questions, 7.8% of the women (40 of 511) reported abuse. The two disability-related questions detected an additional 2.0% of the women (10 of 511) as abused. Women defining themselves as other than black, white, or Hispanic (i.e., Asian, mixed ethnic background) were more likely to report physical or sexual abuse or both, whereas disability-related abuse was reported almost exclusively by white women. The perpetrator of physical or sexual abuse was most likely to be an intimate partner. Disability-related abuse was attributed equally to an intimate partner, a care provider, or a health professional. This study concludes that both traditional abuse-focused questions and disability-specific questions are required to detect abuse toward women with physical disabilities.

Adolescent↗

PubMed1999

Hand-grip strength predicts incident disability in non-disabled older men.

OBJECTIVES: To verify if hand-grip performance in older men is a predictor of disability. DESIGN: Population-based prospective study. SETTING: A sample from the Italian rural cohorts of the FINE study (Finland, Italy, Netherlands Elderly), representative of the general population of elderly men surveyed in 1991 and 1995. PARTICIPANTS: 140 men aged 71-91 years who reported no disability in performing activities of daily living (ADLs), instrumental activity of daily living (IADLs) and mobility activities at baseline examination and provided information on their functional status at follow-up 4 years later. MEASUREMENTS: Disability was defined as needing help in performing ADLs, IADLs and mobility. Hand-grip strength was evaluated at baseline by a mechanical dynamometer. RESULTS: After adjusting for potential confounding variables, a lower concentration of high-density lipoprotein cholesterol was the only factor predicting disability in men aged 76 years or younger and only reduced hand-grip strength predicted incident disability in men 77 years or older. CONCLUSION: Poor hand strength as measured by hand-grip is a predictor of disability in older people. The hand-grip test is an easy and inexpensive screening tool to identify elderly people at risk of disability.

Activities of Daily Living↗

PubMed1997

Black-white differences in risk of becoming disabled and recovering from disability in old age: a longitudinal analysis of two EPESE populations.

This study compared the odds of becoming disabled and recovering from disability among blacks and whites aged 65 years and over in two sites of the Established Populations for Epidemiologic Studies of the Elderly (EPESE) project. The authors examined the influence of mortality differences, socioeconomic status, and health-related factors on racial differences in risk of disability and recovery. A Markov model was employed using nine waves of data from the New Haven, Connecticut, site (529 blacks, 2,219 whites) and seven waves of the North Carolina (Piedmont) site (2,260 blacks, 1,876 whites), collected between 1982 and 1992. Blacks below age 75 years had an increased risk of developing disability relative to whites in New Haven (odds ratio (OR) at age 65 years = 3.33, 95% confidence interval (CI) 2.13-5.22) as well as in North Carolina (OR at age 65 years = 1.58, 95% CI 1.25-1.99). This excess risk diminished with increasing age, and crossed over in New Haven (OR at age 85 years = 0.45, 95% CI 0.22-0.95), but not in North Carolina (OR at age 85 years = 1.22, 95% CI 0.98-1.51). Adjustment for socioeconomic and health-related factors only partially reduced the excess disability risk among blacks below age 75 years in New Haven, but eliminated the difference in disability risk between blacks and whites in North Carolina. Blacks below age 75 years also had higher mortality risks at both sites. There were no consistent racial differences in recovery from disability.

Black or African American↗

PubMed1978

Measuring attitudes toward the physically disabled: testing the 'Attitude Towards Disabled Persons' scale (A.T.D.P. Form O) on social work and non-social work students.

The aim of the study was to test the U.S.A. Validated 'Attitude Towards Disabled Persons' Inventory (A.T.D.P. Form O) on a British student population to establish norms. The objectives were to test specific hypotheses related to the sex of the respondent, contact with physically disabled people and whether social work students had different attitude scores than non social work students. In addition, a comparison was made between the British and U.S.A. 'norms'. The student population of four specific British Universities comprised the sampling frame. The sample was a non probability accidental sample of social work and non social work students. Standardised A.T.D.P. Form Os were administered in group situations. Each form was accompanied by a letter explaining the study, together with a short questionnaire eliciting the sex of respondent and type and extent of any contact with disabled people. The findings demonstrated that there are probably differences between U.S.A. and British norms but that there are general similarities between the two countries. In both countries females, scored higher than males, which by interpretation indicates possibly a more favourable attitude. Contact with the disabled is also a contributing factor in higher scores. Social work students also tended to score more highly than non social work students. The implications of these findings are discussed with regard to the possible development of professional attitudes for those who work with the disabled. It is postulated that 'idealisation' may be reflected in attitudes of students who intend to work with the disabled which, after general and professional life experience gives way to less favourable attitudes. Closeness of contact of respondents to disabled people is a factor which needs further exploration in connection with changing attitude scores.

Adult↗

PubMed2005

Disability as a "family affair": parental disability and childhood immunization.

BACKGROUND: There is a substantial body of research focusing on the health and healthcare utilization of individuals with a disability but less has been done to examine the impact of disability on nondisabled family members. OBJECTIVE: We sought to investigate the influence of parental disability on children's healthcare as measured by the timely receipt of childhood immunizations. RESEARCH DESIGN: Observations on 11,997 children between the ages 2 and 5 years were obtained from the 1994 and 1995 United States National Health Interview Surveys representing 27,534,841 children when weighted. Children are determined to be in compliance with the Centers for Disease Control immunization protocol at age 24 months if they have received 4 DTP, 3 polio, and 1 MMR vaccine dose. Disability is characterized using the activity and personal care scales from the National Health Interview Surveys. The data were analyzed using logistic regression controlling for factors identified in prior research to be related to timely receipt of immunization. RESULTS: Children living with a parent who is unable to provide his or her own personal care are 65% less likely (odds ratio = 0.35; 95% confidence interval = 0.17-0.70) to be immunized on time than children who live with parent(s) who do not have a disability. Children of parents who are limited in their personal care, and children of parents who have work limitations, are not less likely than children of nondisabled parents to receive immunizations on time. CONCLUSIONS: The impact of a parent's severe disability extends to the health care of dependent children. These findings argue for research to investigate the full scope of the effects of parental disability on children's health and for policies that address this impact.

Activities of Daily Living↗

PubMedDate not supplied

A comparison of opinions from parents of disabled and non-disabled children on behavior management techniques used in dentistry.

The purposes of this study were to compare the acceptance of pediatric dental behavioral management techniques by 40 parents of children with disabilities with that of 40 parents whose children were not disabled and to determine the effect of prior information on the level of acceptance for both groups of parents. An instrument containing a demographic questionnaire and using a visual analog scale asked parents to indicate acceptance level of hand-over mouth, sedation, restraint using Papoose board, and general anesthesia for either a check-up/cleaning, dental filling, or treatment of a toothache. One half of each parent group received a written description and rationale for the behavior management technique prior to rating acceptance, and the other half did not. Although differences were found between parents of the disabled and non-disabled and between those informed and not informed, only one technique and procedure (restraint for check-up/cleaning) was significantly different for acceptability (p < or = 0.05), and that was between uninformed parents of non-disabled children and informed parents of disabled children. We conclude that having a disabled child or receiving a prior rational for pediatric behavior management techniques was not significantly related to differences in acceptance of the techniques for the procedures described.

Adult↗