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PubMed2003

Can disability studies and psychology join hands?

Although the field of disabilities studies incorporates psychology within its interdisciplinary purview, it embodies a distinct perspective consonant with the new paradigm of disability. This perspective is contrasted with that of psychology, and the place of disability within psychology is examined. Although psychology has begun to embrace diversity, disability has remained marginalized. Four areas are presented in this article: (a) the foundational ideas of disability studies, (b) training in disability within psychology, (c) the paradigms of disability reflected in research on disability, and (d) future research directions.

Humans↗

PubMed2001

Needs of carers of severely disabled people: are they identified and met adequately?

OBJECTIVE: To examine the unmet needs of informal carers of community dwelling disabled people and to compare their perspectives to those of disabled people and nominated professionals. It was hypothesised that a poor recognition of carers' needs could have implications for carers' well- being and thus their ability to maintain their caring role. Need was defined as a service or a resource that would confer a health or rehabilitation gain. DESIGN: Face to face interviews with carers and disabled participants, telephone interviews with professionals (Southern England). Disabled participants had been selected randomly from two disability registers. MAIN OUTCOME MEASURES: The Southampton Needs Assessment Questionnaire (carers version), SF-36 (carers' health status). RESULTS: Carers experienced similar health status to people in the general population. The most frequently carer-reported unmet needs were for short breaks, domestic help and respite care. Carers who had reported unmet need for short breaks had significantly poorer levels of mental health and vitality (SF-36) than carers who had not reported this. Similar numbers of unmet carers' needs were reported by disabled participants, professionals and carers themselves. In terms of type of unmet needs, poor concordance between carers and disabled participants occurred in 52% of cases: carers reported more unmet needs than disabled participants for short breaks and domestic help. Poor concordance scores between carers and professionals occurred in 59% of cases: carers reported more unmet needs for short breaks than professionals and professionals reported more unmet needs for formal respite care. CONCLUSION: In line with recent legislation, carers' needs must be independently addressed and services, especially for flexible community support such as short break services, must be developed specifically to meet the needs of carers. Further research is warranted to evaluate whether recent legislation for carers has any effect on carers' well-being and ability to cope with their caring role.

Adolescent↗

PubMed2002

Religious and secular students' sense of self-efficacy and attitudes towards inclusion of pupils with intellectual disability and other types of needs.

BACKGROUND: The aim of the present study was to investigate whether Judaism's positive attitudes toward people with disabilities would influence greater willingness towards inclusion of such people in regular classes and a greater sense of self-efficacy in working with them. METHODS: The present authors compared religious (n = 175) and secular (n = 420) Jewish students at a teacher's college with regard to these variables. The authors used the Regular Education Initiative questionnaire, which investigates teachers' self-efficacy and attitudes towards including pupils with different types of disabilities in regular education. They analysed the results according to the college students' major and the type of disability (five types at three levels of severity). RESULTS: The results indicate that religious students are more willing than non-religious students to consider the inclusion of people with four types of disabilities and have a greater sense of efficacy for dealing with all types of disabilities. The hypothesis that the milder the disability, the higher would be the teacher's sense of self-efficacy and her/his willingness for such children to be included in a regular class was sustained. The religious special education students were the only ones who exhibited willingness to include pupils with intellectual disability, and moderate and severe emotional disturbances. Students who majored in special education scored higher than all their counterparts on both measures. The results also sustain the hypothesis that there would be a positive correlation between both measures. CONCLUSIONS: To facilitate inclusive education amongst teachers and students, the present authors recommend an intervention programme designed to help students acquire knowledge and strategies about inclusion. They also suggest enriching this programme with Jewish religious sources, which reflect positive attitudes toward people with disabilities.

Adult↗

PubMed2000

Teaching medical students about disability and rehabilitation: methods and student feedback.

The predicted increase in the prevalence of chronic and disabling diseases in the population over the next 30 years calls for a more effective approach to educating medical students about the assessment and management of disability. The introduction of a new postgraduate medical course at Flinders University of South Australia in 1996 allowed the development of a new topic on disability and rehabilitation. Over a 4-week period, students undertake four activities. First, they follow a particular patient in an inpatient rehabilitation setting and learn about the multidisciplinary approach to rehabilitation. Secondly, they each visit two people with a disability living in the community and assess their physical, mental, functional and social status. Thirdly, they each visit a service which supports those people in the community. Finally, they simulate having a disability which is randomly allocated to them. During these 4 weeks, students also participate in problem-based learning (PBL) and have 27 h of associated sessions or lectures. The PBL cases and associated sessions have a 'chronic disease' theme. We developed a questionnaire to obtain student feedback on this new topic in the first 2 years of its delivery. A 69% response rate has been obtained. Overall, the topic was well-received, and as a result most students felt more comfortable in dealing with disabled people. They were enthusiastic about ward work, and enjoyed learning about aspects of multidisciplinary team care. Exercises involving simulation of disability were largely acceptable. We believe that this topic helps our students to deal better with the problems of disabled people.

Australia↗

PubMed1998

Causes of locomotor disability and need for orthopaedic devices in a heavily mined Taliban-controlled province of Afghanistan: issues and challenges for public health managers.

We conducted a locomotor disability survey on a heavily mined Taliban-controlled province of Afghanistan to document the problem of locomotor disability and to assess the need for orthopaedic rehabilitation devices in a study population of 12065. Global prevalence of locomotor disability was 23/1000 (95% CI: 20-26). )War-related injuries were the leading cause of disability, affecting almost exclusively adult males. Leading causes of disability among women and children were medical and poliomyelitis. Devices most needed were lower limb ortheses (8.2 devices/1000 people; 95% CI: 5.9-10.4) and orthopaedic shoes (6.0/1000; 95% CI:4.1-8.0). The need for lower limb prostheses was less frequent (2.0/1000; 95% CI: 1.1-2.8). Most lower limb amputees (mainly victims of landmine injuries) were fitted with an artificial leg, while rehabilitation needs for other types of disability remained largely unmet. We estimated that it would take at least 3 years to provide enough orthopaedic shoes and 10 years for ortheses, whereas the need for lower limb prostheses could be met in less than 4 months. None of the 27 women with lower limb disability were equipped with an orthopaedic device, although this was the case for 31 of 89 men (35%). The problem of landmines should not divert attention from other causes of disability such as poliomyelitis or from other rehabilitation requirements. Immunization programmes and restoration of the public health infrastructure should be given high priority; rehabilitation services are largely insufficient and should be developed. Extreme gender difference in needs coverage is a matter of concern. Researching culturally sensitive strategies to tackle this problem should be a priority for donors and implementing agencies.

Adolescent↗

PubMedDate not supplied

Migraine frequency and intensity: relationship with disability and psychological factors.

BACKGROUND: Migraine can be disabling, but it varies greatly in frequency and intensity between individuals. It is not clear which clinical features have the greatest impact on a migraineur's quality of life. OBJECTIVE: To determine the influence of headache intensity and frequency on headache-related disability. METHODS: Patients who were referred to a headache clinic and given a diagnosis of migraine with or without aura or transformed migraine (n = 115) were divided into different groups based on headache frequency and mean headache intensity. Headache frequency was determined from patient diaries. Headache intensity also was assessed from patient diaries and from scores on the pain severity scale of the Multidimensional Pain Inventory (MPI). Headache-related disability was assessed with the Headache Disability Inventory and by scores on the activity interference scale of the MPI. The degree of depression present was assessed with the Beck Depression Inventory, and emotional distress was measured by scores on the affective distress scale of the MPI. RESULTS: In our patient population, higher mean headache intensity levels were associated with higher levels of headache-related disability. Our results also suggested that increased headache intensity is associated with higher levels of depression and emotional distress, although this correlation was statistically significant in only 1 of 4 comparisons. Headache frequency did not correlate with disability, depression, or emotional distress. CONCLUSIONS: For a headache referral population, headache intensity appears to be a major determinant of headache-related disability, and it also correlates, to some extent, with the degree of depression and emotional distress present. Headache frequency was not clearly related to disability or psychological factors.

Adult↗

PubMed2000

Factors predicting stroke disability at discharge: a study of 793 Chinese.

OBJECTIVE: To identify factors predicting stroke disability at discharge in a Chinese population. DESIGN: Retrospective analysis of data collected from stroke patients. SETTING: A 25-bed stroke rehabilitation unit in Hong Kong. PARTICIPANTS: A total of 793 Chinese patients with acute stroke consecutively admitted for inpatient rehabilitation. INTERVENTIONS: All patients received traditional rehabilitation therapies including physical, occupational, and speech therapies when appropriate. MAIN OUTCOME MEASURES: Disability was measured with the Barthel index (BI), and mild disability at discharge was defined as a BI score of > or =15. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. RESULTS: Logistic regression analysis revealed that a BI score of > or = 15 points at admission strongly predicted that the patient's BI at discharge would be > or =15. For those whose BI score at admission was less than 15, these factors correlated negatively with a discharge BI of 15: BI at admission of <5 (OR .08, CI .04-.17); National Institutes of Health stroke scale at admission of >7 (OR .23, CI .12-.43); urinary incontinence at admission (OR .35, CI .21-.60); age > or =65 years (OR .44, CI .25-.77); and abbreviated mental test at admission of <7 (OR .56, CI .33-.94). CONCLUSIONS: For Chinese stroke patients, the disability at admission is the most important predictor for disability at discharge. Patients with very severe disability, severe neurologic impairment, urinary incontinence, old age, and impaired cognition at admission are less likely to recover to mild disability at discharge. Although hemorrhagic stroke is more common among Chinese populations, it is not an independent predictor for disability at discharge.

Aged↗

PubMed2002

Medical students' attitudes toward persons with disability: a comparative study.

OBJECTIVES: To investigate first-year medical students' attitudes toward persons with disability and to examine whether gender and a background in disability determine attitudes toward persons with disability. DESIGN: A cross-sectional survey. SETTING: University settings in the United States and Canada. PARTICIPANTS: Ninety first-year medical students (US, n=46; Canada, n=44) were surveyed. INTERVENTION: Medical students given 3 surveys. MAIN OUTCOME MEASURES: Attitude Toward Disabled Persons (ATDP) Scale, Scale of Attitudes Toward Disabled Persons (SADP), and Rehabilitation Situations Inventory (RSI). RESULTS: There were no differences between the medical student groups from the United States and Canada. Compared with norms, medical students overall have more positive attitudes on the ATDP. Their attitudes were less positive on the SADP and on its optimism-human rights subscale. On the RSI, they were less comfortable with sexual situations and depression. Male medical students held poorer attitudes as scored than female medical students. Those with a background in disability were more comfortable dealing with challenging rehabilitation situations. Comfort with challenging rehabilitation situations showed significant differences across levels of experience but not gender. The more positive medical students' attitudes are toward persons with disability, the more likely they are to be comfortable with challenging rehabilitation situations. CONCLUSION: First-year medical students from the United States and Canada held similar attitudes and had less positive attitudes than SADP norms. Gender and background in disability influenced attitudes. Male medical students were more likely to hold negative attitudes. Specific educational experiences need to promote more positive attitudes.

Adult↗

PubMed2000

Neurologic and developmental disability after extremely preterm birth. EPICure Study Group.

BACKGROUND AND METHODS: Small studies show that many children born as extremely preterm infants have neurologic and developmental disabilities. We evaluated all children who were born at 25 or fewer completed weeks of gestation in the United Kingdom and Ireland from March through December 1995 at the time when they reached a median age of 30 months. Each child underwent a formal assessment by an independent examiner. Development was evaluated with use of the Bayley Scales of Infant Development, and neurologic function was assessed by a standardized examination. Disability and severe disability were defined by predetermined criteria. RESULTS: At a median age of 30 months, corrected for gestational age, 283 (92 percent) of the 308 surviving children were formally assessed. The mean (+/-SD) scores on the Bayley Mental and Psychomotor Developmental Indexes, referenced to a population mean of 100, were 84+/-12 and 87+/-13, respectively. Fifty-three children (19 percent) had severely delayed development (with scores more than 3 SD below the mean), and a further 32 children (11 percent) had scores from 2 SD to 3 SD below the mean. Twenty-eight children (10 percent) had severe neuromotor disability, 7 (2 percent) were blind or perceived light only, and 8 (3 percent) had hearing loss that was uncorrectable or required aids. Overall, 138 children had disability (49 percent; 95 percent confidence interval, 43 to 55 percent), including 64 who met the criteria for severe disability (23 percent; 95 percent confidence interval, 18 to 28 percent). When data from 17 assessments by local pediatricians were included, 155 of the 314 infants discharged (49 percent) had no disability. CONCLUSIONS: Severe disability is common among children born as extremely preterm infants.

Cohort Studies↗

PubMed1981

Preschool children's understanding of children with orthopedic disabilities and their expectations.

The present study investigated whether preschool children (N = 121) had a realistic understanding of the limitations imposed by various orthopedic disabilities. The results have indicated that the preschoolers were aware that orthopedic disabilities may impose some physical limitations. Ss tended to perceive able-bodied children more capable in performing various tasks than disabled children. This evaluative judgment does not necessarily mean that the preschoolers were discriminating against the disabled children, but it may be a reflection of a sense of realism that the able-bodied children have less trouble in doing these tasks than their disabled counterpart. It was suggested that, with increased understanding of the realistic limitations imposed by orthopedic disabilities, children may be come less biased toward their disabled peers. This change in attitude would have significant impact on the self-concepts of disabled children.

Attitude↗

PubMed2002

Attitudes of individuals with acquired brain injury towards disability.

OBJECTIVE: To describe the relationships between acceptance of disability, attitudes towards disability, quality of life, functional ability, community integration, and demographic markers, in individuals with acquired brain injuries. METHOD: Forty subjects completed four self-report instruments, including the Attitudes Towards Persons with Disabilities Scale O-Version, the Acceptance of Disability Scale, the Rand-36 Health Status Inventory, and the Community Integration Questionnaire. An observer completed the Functional Independence Measure and the Functional Assessment Measure as a measure of the subject's level of disability. RESULTS: Significant correlations appeared between positive regard for one's own and other's disabilities and one's acceptance of disability, as well as both higher health status and community integration. No significant correlations appeared between positive attitudes and either physical functioning, age, age of onset, or time since injury. CONCLUSION: Situational factors, such as community integration, can be manipulated to potentially influence the attitude of an individual with acquired brain injury towards themselves and towards others with disabilities.

Activities of Daily Living↗

PubMed2001

The epidemiology of disability and occupation handicap resulting from major traumatic injury.

PURPOSE: To assess the prevalence of disability and handicap among survivors of major traumatic injury (injury severity score > 15) using a prospective population based cohort study design. The study was set in the former Yorkshire Health Region. SUBJECTS/METHODS: A cohort of 367 individuals identified as having received and survived major traumatic injury during the 12 month period October 1988-September 1989. OPCS disability scores and employment status at 5 years post injury were established through structured face-to-face interviews. RESULTS: Three hundred and four (84% response. 89% adjusted response) individuals were interviewed. Seventy-seven percent of these were male and they had a mean age (SEM) of 30.8 (1.06) years. Injuries were caused by road traffic accidents in 68% of the cases and were primarily orthopaedic and neurological in nature. At 5 years post injury 81.2% of individuals had some form of measurable disability principally relating to locomotion, behaviour, continence and intellectual functioning consistent with injury type. A third had an OPCS disability score of 5 or greater and approximately 1 in 12 were in the most severe categories of OPCS scores of 9-10 necessitating dependency on formal or informal carer assistance. Whilst five of the eight sub-scales of the SF36 showed correlation in severity proportion, general health perception and energy/vitality were higher in those with increasing disability as measured by the OPCS scale. Of those between the ages of 16-64 nearly half (49%) were not in paid employment at the time of follow up. CONCLUSION: A high prevalence of severe permanent disability, work disability and occupation handicap has been identified in a cohort of mainly young adult males following major traumatic injury resulting from road traffic accidents. Progress in accident prevention, injury reduction and the management of patients with serious injuries should be measured not only in terms of reduced mortality from such events but also in the long term disability and quality of life sequelea of survivors.

Adolescent↗

PubMed2003

The coping responses of the adolescent siblings of children with severe disabilities.

PURPOSE: There is a paucity of literature conducted on adolescents' perceptions of their siblings with severe disabilities. The period of adolescence is characterized by personal and emotional conflicts resulting from teenagers' search towards self-identity and autonomy and exploration of the boundaries of parental support. The study attempts to describe the coping responses of these adolescent siblings in their adjustment to the family stressor of having a sibling with a disability; and the adolescents' available coping resources. METHOD: This study is qualitative in nature and open-ended, structured interviews were conducted with 19 adolescents between the ages of 12 and 15 years who had a sibling with severe disabilities. The interviews were then analysed according to categories using an editing analysis style. RESULTS: The results indicated that the subjects reported limited family interaction and were often reticent in expressing their feelings about their sibling with a disability. In addition, they expressed guilt feelings regarding their siblings with disabilities. Furthermore, siblings of children with severe disabilities received limited information and guidance regarding their sibling's disability. CONCLUSION: The need for professional support to facilitate adolescents' coping with the disability and its consequences as well as the establishment of strong support networks for these adolescents became evident.

Adaptation, Psychological↗

PubMed2004

Barriers to accessing safe motherhood and reproductive health services: the situation of women with disabilities in Lusaka, Zambia.

PURPOSE: To ascertain how well health services in Lusaka, Zambia currently meet the safe motherhood and reproductive health care needs of women who have physical impairment leading to disability. METHODS: A qualitative study was conducted in Lusaka, Zambia. In-depth tape-recorded interviews were conducted with 24 purposively selected women with disabilities and with 25 safe motherhood/reproductive public sector health service providers. Qualitative analysis was conducted using NVivo software. RESULTS: Women with disabilities encounter various social, attitudinal and physical barriers to accessing safe motherhood and reproductive health (RH) services in this particular setting. The strong desire for children and affection can increase vulnerability to sexual exploitation. At the same time, a generalized assumption among reproductive health service providers that women with disabilities will not be sexually active, and not require RH services, leads to increased vulnerability to sexually transmitted infection including HIV. Once pregnant, traditional beliefs about transmission of disabilities can create barriers to integration in ante-natal clinics. Nurse-midwives' fear of delivery complications in women with physical impairments can also result in routine over-referral to a tertiary maternity facility which is outside the locality and harder for women with mobility limitations to get to. CONCLUSION: Greater understanding of the influences underpinning societal attitudes towards sexuality and disability in this setting, and more extensive communication between health care staff and women with disabilities would facilitate positive action towards improving safe motherhood and reproductive health services for women with disabilities.

Adult↗

PubMed2006

Neighborhood social participation, use of anxiolytic-hypnotic drugs, and women's propensity for disability pension: a multilevel analysis.

AIMS: The increasing number of people on disability pension in Sweden is of concern for Swedish policy-makers, and there is a need for a better understanding of the mechanisms behind disability pension. We investigated (i) whether women living in the same neighborhood have a similar propensity for disability pension that relates to neighborhood social participation, and (ii) whether there is an association between anxiolytic-hypnotic drug (AHD) use and disability pension in women that is modified by the neighborhood context. METHODS: We used multilevel logistic regression with 12,156 women aged 45 to 64 (first level) residing in 95 neighborhoods (second level) in the city of Malmö (250,000 inhabitants), Sweden, who participated in the Malmö Diet and Cancer Study (1991-96). RESULTS: Both AHD use (OR = 2.09, 95% CI 1.65, 2.65) and neighborhood rate of low social participation (OR = 11.85, 95% CI 5.09, 27.58) were associated with higher propensity for disability pension. The interval odds ratio indicated that the influence of neighborhood social participation was large compared with the unexplained variance between the neighborhoods. The association between AHD use and disability pension was not modified by the neighborhood context. The median odds ratio was 1.44 after adjusting for individual characteristics and 1.27 after the additional adjusting for neighborhood social participation. CONCLUSIONS: Women living in the same neighborhood appear to have a similar propensity for disability pension, beyond individual characteristics, and this contextual effect seems largely explained by neighborhood social participation. In addition, AHD use might increase the propensity for disability pension in women.

Anti-Anxiety Agents↗

PubMed2005

Intimate partner violence and disabilities among women attending family practice clinics.

PURPOSE: To estimate the frequency and type of disabilities preventing work among those experiencing intimate partner violence (IPV) compared with those never experiencing IPV. METHODS: We used a large cross-sectional survey of women, ages 18-65, attending family practice clinics from 1997 through 1998. Participation included a 5-10-minute in-clinic survey assessing IPV experience and a longer telephone survey assessing health status and chronic disabilities that prevented work outside the home or housework. RESULTS: Of 1,152 eligible women surveyed, 54% experienced some type of IPV, and 24% were currently in a violent relationship. Women who had ever experienced IPV were more than twice as likely to report a disability (adjusted odds ratio [aOR] = 2.2, 95% confidence interval [CI] 1.6, 3.0). The most commonly reported disabilities were those associated with heart or circulatory disease (4.9%), followed by back problems (3.5%), chronic pain (3.4%), arthritis (3.0%), nerve system damage (2.4%), asthma or another respiratory problem including emphysema (1.7%), and either depression (1.6%) or another mental illness (1.0%). Women ever experiencing IPV were more likely to report a disability due to generalized chronic pain (aOR = 2.5, 95% CI 1.5, 4.3) and mental illness (aOR = 4.5, 95% CI 1.5, 13.1). IPV-related injuries were associated in a dose-dependent manner with having any disability and with disability from chronic pain, asthma and other respiratory diseases, mental illness, and chronic diseases. CONCLUSIONS: Primary care-based efforts to screen for IPV and effectively intervene to reduce the impact of IPV on women's lives must be a public health priority to reduce the shortterm and long-term health effects, including disabilities.

Adult↗

PubMed2004

Socio-demographic correlates of mobility disability in older Brazilians: results of the first national survey.

INTRODUCTION: Socio-economic differences in mobility disability prevalence in old age have been reported from the US and Europe. Brazil is characterised by gross socio-economic inequalities, but there have been no previous national data on disability prevalence. AIM: This study aimed to estimate disability rates and explore associations identifying the most significant socio-economic markers associated with mobility disability prevalence in old age in Brazil. SUBJECTS AND METHODS: A nationally representative sample of 28,943 people aged 60 years or over was interviewed, in the 1998 National Household Survey (PNAD), conducted by the Brazilian Institute of Geography and Statistics. RESULTS: The prevalence rates of markers of mild, moderate and severe disability were higher in women than men, and increased with age. Prevalence rates of difficulty with personal care and medium distance walking were broadly similar to England, but far more Brazilians reported difficulty climbing stairs. In logistic regression analyses, the strongest markers associated with increased mobility disability prevalence were age, gender, lack of education and low income. Rural residence was also associated with reduced prevalence. Limited differences by region were present, and there were mixed effects for self-reported racial group for women. CONCLUSIONS: Disability in the older population of Brazil shows familiar prevalence patterns by age and gender. Disparity in income and educational attainment in Brazil are the most important markers associated with group differences in mobility disability prevalence in old age.

Aged↗

PubMed2006

Low serum carotenoids and development of severe walking disability among older women living in the community: the women's health and aging study I.

OBJECTIVE: to determine whether low serum carotenoid levels, an indicator of low intake of fruits and vegetables, are associated with the progression of disability in older women. DESIGN: longitudinal analysis in a population-based cohort. SETTING: moderately-severely disabled women, >or=65 years, living in the community in Baltimore, Maryland (the Women's Health and Aging Study I). PARTICIPANTS: 554 women without severe walking disability (inability to walk or walking speed <0.4 m/s) at baseline. MAIN OUTCOME MEASURE: incidence of severe walking disability assessed every 6 months over 3 years. RESULTS: 155 women (27.9%) developed severe walking disability during follow-up. Rates of development of severe walking disability per 100 person-years among women in the lowest and in the three upper quartiles of total carotenoids were, respectively, 13.8 versus 10.9 (P=0.0017). Adjusting for confounders, women in the lowest quartile of total carotenoids were more likely to develop severe walking disability (hazards ratio 1.57, 95% confidence interval 1.24-2.00, P=0.0002) compared with women in the three upper quartiles. CONCLUSION: low serum carotenoid levels, an indicator of low intake of fruits and vegetables, are independent predictors of the progression towards severe walking disability among older women living in the community.

Aged↗