Showing papers on "Physical disability published in 1998"
01 Nov 1998
TL;DR: Estimates of the overall burden of musculoskeletal pain that combine the results of site specific surveys will be too high, and those that do not adjust for socioeconomic factors will beToo low.
Abstract: BACKGROUND Epidemiologically-based rheumatology healthcare needs assessment requires an understanding of the incidence and prevalence of musculoskeletal disorders in the community, of the reasons why people consult in primary care, and of the proportion of people who would benefit from referral to secondary care and paramedical services. This paper reports the first phase of such a needs assessment exercise. SPECIFIC OBJECTIVE To estimate the relative frequency of musculoskeletal pain in different, and multiple, anatomical sites in the adult population. SETTING Three general practices in the former Tameside and Glossop Health Authority, Greater Manchester, UK, a predominantly urban area. DESIGN Population survey. METHODS An age and sex stratified sample of 6000 adults from the three practices was mailed a questionnaire that sought data on demographic factors, musculoskeletal symptoms (pain in the past month lasting for more than a week), and physical disability (using the modified Health Assessment Questionnaire- mHAQ). The areas of pain covered were neck, back, shoulder, elbow, hand, hip, knee, and multiple joints. The Carstairs index was used as a measure of social deprivation of the postcode sector in which the person lived. RESULTS The response rate after two reminders was 78.5%. Non-responders were more likely to live in areas of high social deprivation. People who lived in more deprived areas were also more likely to report musculoskeletal pain, especially backpain. After adjusting for social deprivation the rates of musculoskeletal pain did not differ between the practices and so their results were combined. After adjustment for social deprivation, the most common site of pain was back (23%; 95% CI 21, 25) followed by knee (19%; 95% CI 18, 21), and shoulder (16%; 95% CI 14, 17). The majority of subjects who reported pain had pain in more than one site. The prevalence of physical disability in the community rose with age. It was highest in those with multiple joint problems but was also high in those with isolated back or knee pain. CONCLUSION Musculoskeletal pain is common in the community. People who live in socially deprived areas have more musculoskeletal symptoms. Estimates of the overall burden of musculoskeletal pain that combine the results of site specific surveys will be too high, those that do not adjust for socioeconomic factors will be too low.
979 citations
TL;DR: A large body of studies show that both children and their mothers, as groups, are at increased risk for psychosocial adjustment problems compared to peers, but that there is considerable individual variation in outcome.
Abstract: Research conducted primarily over the past 5-8 years on the psychosocial effects of pediatric chronic physical disorders on children and their families is reviewed. A large body of studies show that both children and their mothers, as groups, are at increased risk for psychosocial adjustment problems compared to peers, but that there is considerable individual variation in outcome. Since the last review on this topic (Eiser, 1990a), many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children and their mothers. Improvements are noted in the theoretical basis for this work, programmatic nature of some of the research, and efforts at producing clinically relevant information. Evaluations of interventions, however, are lagging. Critical issues and future directions regarding developmental approaches, theory, method, measurement, and intervention are discussed.
714 citations
TL;DR: Assessment and interventions targeting for psychological distress in addition to interventions targeted for impairments appear warranted to effectively reduce the disability associated with facial neuromotor disorders.
Abstract: The relationship between facial neuromotor system impairment, disability, and psychological adjustment is not well understood. This study was designed to explore the relation between impairment and disability and the impact of psychological adjustment on the relation for individuals with disorders of the facial neuromotor system. We studied outpatients (n=48; mean age, 49.0; SD=16.3; range, 18 to 84 years) with a facial neuromotor disorder and acute or chronic facial paralysis. Measures of impairment (Facial Motion Assay, House-Brackmann scale, and Facial Grading System), disability (Facial Disability Index, physical and social well-being subscales), and psychological adjustment (Beck Anxiety Inventory, Beck Depression Inventory) were administered. Bivariate correlations between impairment and disability measures indicated impairment was positively correlated with physical and social disability (r=0.44, p < 0.01; r=0.39, p < 0.05, respectively). Stepwise regression analysis to predict disability indicated physical disability was predicted by impairment and the interaction of impairment and psychological distress (R2=0.425; F=12.57; df=2, 34; p=0.002). Psychological distress, and not impairment and the interaction of impairment and distress, was the single predictor of social disability (R2=0.274; F=13.23; df=1, 35; p=0.001). Psychological distress was a moderator of the relation between impairment and physical disability and a mediator of the relation between impairment and social disability for individuals with facial neuromotor disorders. Assessment and interventions targeted for psychological distress in addition to interventions targeted for impairments appear warranted to effectively reduce the disability associated with facial neuromotor disorders.
460 citations
TL;DR: A strong positive association between percent body fat and disability was observed and could not be explained by age, education, physical activity, smoking, alcohol use, muscle mass, and health status.
Abstract: Background Low muscle mass has been assumed to be associated with disability, but no studies confirming this association have been published High body weight and high body mass index, both rough indicators of body fatness, have been shown to increase the risk for disability; however, the specific role of body fatness has not been studied Methods The relations of skeletal muscle mass and percent body fat with self-reported physical disability were studied in 753 men and women aged 72 to 95 years Cross-sectional data from biennial examination 22 (1992-1993) of the Framingham Heart Study were used Body composition was assessed by dual-energy x-ray absorptiometry Disability was scored as any versus none on a 9-item questionnaire Results Total body and lower extremity muscle mass were not associated with disability in either men or women However, a strong positive association between percent body fat and disability was observed The odds ratio for disability in those in the highest tertile of body fatness was 269 (95% confidence interval 145-500) for women and 308 (122-781) for men compared to those in the lowest tertile The increased risk could not be explained by age, education, physical activity, smoking, alcohol use, estrogen use (women only), muscle mass, and health status Analyses restricting disability to mobility items gave similar results Conclusions In contrast to current assumptions, low skeletal muscle mass was not associated with self-reported physical disability Persons with a high percent body fat had high levels of disability Because it cannot be ruled out that persons with low skeletal muscle mass dropped out earlier in the study, prospective studies are needed to further assess the relationship between body composition and physical disability
257 citations
TL;DR: To determine the prevalence rates of self‐reported sleep complaints and their association with health‐related factors, a large sample of adults in Northern Ireland were surveyed over a 12-month period.
Abstract: OBJECTIVES: To determine the prevalence rates of self-reported sleep complaints and their association with health-related factors.
DESIGN: A cross-sectional study.
SETTING: People living in the community.
PARTICIPANTS: A total of 2398 noninstitutionalized individuals, aged 65 years and older, residing in the Veneto region, northeast Italy.
MEASUREMENTS: Odds ratios for the association of sleep complaints with potential risk factors.
RESULTS: The prevalence of insomnia was 36% in men and 54% in women, with increased risks for women (odds ratio (OR) = 1.69, 95% CI: 1.3–2.1), depression (OR = 1.93, 95% CI, 1.5–2.5), and regular users of sleep medications (OR = 5.58, 95% CI, 4.3–7.3). About 26% of men and 21% of women reported no sleep complaints. Night awakening, reported by about two-thirds of the participants, was the most common sleep disturbance. Women and regular users of sleep medications had significantly increased odds for insomnia and for not feeling rested upon awakening in the morning. Depressive symptomatology was more strongly associated with insomnia and night awakening than with awakening not rested, whereas physical disability was more strongly associated with awakening not rested than with the other two sleep disturbances.
CONCLUSION: Our findings show that sleep complaints, highly common among older Italians, are associated with a wide range of medical conditions and with the use of sleep medications. Further longitudinal studies are needed to investigate the causes and the negative health consequences of sleep disturbances to improve both the diagnosis and treatment.
234 citations
TL;DR: It is revealed that those who reported having musculoskeletal pain were seven times more likely to have some difficulty performing three or more activities listed in the questionnaire, and thorough pain assessment and pain management may be important in the maintenance of independent living.
Abstract: The proportion of people 65 years of age and older who report musculoskeletal pain and physical disability is high. The main objective of this study was to determine whether physical disability was associated with the presence of musculoskeletal pain in a sample of senior citizens. Self-administered questionnaires were sent to a sample of 1306 community-dwelling senior citizens in London, Ontario, Canada between August and October 1995. The questionnaire included questions about pain, difficulty performing activities, depressive symptoms, chronic conditions, and demographic information. A total of 887 seniors completed the questionnaire (70.7% response rate, aged 65–94, 41.2% men, 58.8% women). Logistic regression analysis, without controlling for potential confounding variables, revealed that those who reported having musculoskeletal pain were seven times more likely to have some difficulty performing three or more activities listed in the questionnaire (OR=6.91 95% CI 4.92–9.69). When significant confounding variables were controlled in the analysis, seniors who reported musculoskeletal pain were still three times more likely to have some difficulty with three or more activities (OR=2.93, 95% CI 1.96–4.38). Although no causal relationship can be inferred, thorough pain assessment and pain management may be important in the maintenance of independent living for adults 65 years of age or older.
151 citations
TL;DR: The patterns the authors find in mastery among those individuals in their middle-years suggest to us that disabled and nondisabled individuals may live out their lives with differential opportunities for attainment and that this inequality has implications for their sense of mastery.
Abstract: Are there age differences in the sense of mastery, independent of physical disability? Do age and disability have joint effects on mastery? We propose that both age and disability have independent and synergistic effects on the sense of mastery or control. We analyze data from a large community sample of disabled individuals and a comparison of nondisabled respondents. Our study finds that, indeed, disabled and older respondents report lower levels of mastery. Moreover, the influence of disability on mastery is conditioned by age--and the interaction differs across age groups. In addition, our findings suggest that disabled individuals are disadvantaged in the status variables traditionally associated with greater control. When we adjust for these status variables, we reduce the strength of a quadratic age by disability interaction term considerably. The patterns we find in mastery among those individuals in their middle-years suggest to us that disabled and nondisabled individuals may live out their lives with differential opportunities for attainment and that this inequality has implications for their sense of mastery. Our findings reveal complex nonlinear and synergistic associations among age, disability, and the sense of mastery and raise provocative questions for future research.
129 citations
Journal Article•
TL;DR: Findings indicate that the integration of exercise training into the care of persons with AD is both needed and feasible and that the efficacy of this approach for reducing additional physical disability in these individuals is currently underway.
Abstract: This article provides information on the baseline health and physical function of 30 individuals with Alzheimer's disease (AD); describes a community-based program designed to increase balance, flexibility, strength, and endurance in these persons by the training of caregivers to facilitate and supervise exercise activity; and documents the adherence of these subjects and their caregivers to this intervention. Subjects were recruited from an ongoing, community-based Alzheimer's Disease Patient Registry, and met NINCDS-ADRDA criteria for probable or possible AD. Caregivers were family members living with the demented individuals in the community. Physical performance was measured using walking speed, functional reach, and standing balance. Health status was measured with the Medical Outcomes Study Short Form, the Sickness Impact Profile, and caregiver reports of subject's restricted activity days, bed disability days, falls, and exercise participation. Baseline data indicated that persons with AD were impaired on measures of physical performance and function, compared to published data on nondemented older adults. During a 12-wk treatment period, caregivers were taught to guide their demented charges in an individualized program of endurance activities (primarily walking), strength training, and balance and flexibility exercises. Adherence data indicated that 100% of the subjects were compliant with some exercise recommendations, and one-third completed all assigned exercises during the training period. Caregivers were able to learn and direct subjects during scheduled exercise activities. These findings indicate that the integration of exercise training into the care of persons with AD is both needed and feasible. Further research is currently underway to determine the efficacy of this approach for reducing additional physical disability in these individuals.
100 citations
TL;DR: Improvements in social interaction appear possible through more effective management of certain health conditions and attention to potential sociocultural barriers.
Abstract: 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 healthrelated 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.
94 citations
TL;DR: In this article, the authors review the expanding literature on disability, charting the process by which such studies have become newly significant in the field and suggest possible links to the growing literature on rights, social justice and ethics.
Abstract: Studies of disability have been rare in human geography until a recent blossoming of interest. In this article we review the expanding literature on disability, charting the process by which such studies have become newly significant in the field. Our initial focus is on physical disability after which we move on to issues around mental health and intellectual disability. In the concluding section we evaluate the significance of recent work on disability within human geography as a whole and suggest possible links to the growing literature on rights, social justice and ethics.
94 citations
TL;DR: Time-series analyses showed that depression and disability tended to track together, and most changes occurred within the first 6 months after discharge.
Abstract: The authors examined depression/disability outcomes in hospitalized older medical patients during the year after hospital discharge to assess the pattern and rate of changing depression and disability, the causal relationship between these variables, and to identify patients at greatest risk for poor outcomes. A group of 119 medical patients at Duke Hospital were both depressed and disabled; they were followed for a median of 47 weeks after hospital discharge. Time-series analyses showed that depression and disability tended to track together, and most changes occurred within the first 6 months after discharge. Blacks were more likely to remit from depression despite continued disability and less likely to experience continued depression despite decreased disability. Patients with a history of depression were less likely to experience improvement in depression unless disability improved. Number of medical diagnoses and depression severity independently predicted poorer depression outcomes. Certain characteristics of patients during hospitalization predict depression/disability outcomes after discharge.
TL;DR: Analysis of data from the Weekly Substudy of the Women's Health and Aging Study, a cohort of Baltimore-area women with moderate to severe physical disability, found that the prevalence of self-reported difficulty increased with baseline disability and, to a lesser extent, with age group.
Abstract: The assessment of physical functioning and disability is integral to population-based and clinical research carried out among elderly people. Typically, functional status is measured through self-reported responses to questions of the form "Do you have difficulty [doing a specific task]?" Knowledge of the reliability and validity of these self-report measures is key to the interpretation of many research efforts, but data on these measurement parameters are sparse. This paper addresses this deficiency through analyses of data from the Weekly Substudy of the Women's Health and Aging Study, a cohort of Baltimore-area women aged > or =65 years with moderate to severe physical disability. Self-reported data on 20 activities, obtained weekly over a 6-month period in 1993 or 1994, were analyzed to investigate how time intervals between assessments and a subject's age and baseline level of disability influenced the consistency of self-reports of disability at both the population level and the individual level. The prevalence of self-reported difficulty increased with baseline disability and, to a lesser extent, with age group. Consistency for all items was very high over short time intervals, but it decreased substantially with increasing intervals between responses (although associations between responses remained significant at 24 weeks). Consistency did not vary with age or baseline disability. Graphic techniques and statistical methods for use with repeated binary data are also illustrated.
TL;DR: There was no significant correlation between physical discomfort and somatic symptoms; emotional distress and depression or generalized anxiety; or disability and dependence in activities of daily living in elderly people living in an inner-city area.
Abstract: Measurement of health related quality of life (HQoL) has been developed as a way of describing health states in terms of an individual's perception of his/her position in life. In the UK, the HQoL approach has become a cornerstone of health services research, particularly in relation to the purchaser-provider relationship. For elderly people, it may be particularly relevant when considering whether intervention is of overall benefit. Psychiatric morbidity, physical disability and quality of life were assessed by standardized questionnaire in older people living at home in an inner-city area. Seven-hundred subjects were interviewed. More than 75% of subjects who completed other instruments also completed the IHQL (Index of Health-Related Quality of Life). There was no significant correlation between physical discomfort and somatic symptoms; emotional distress and depression or generalized anxiety; or disability and dependence in activities of daily living . There is a clear need to develop measure...
TL;DR: In this paper, the association between educational level and disability was characterized by a dose-response effect, with the relative odds significantly decreased by about 30%, 60%, and 79% in those with 4 or 5, 6 to 8, and more than 8 years of education, compared to those with 3 or less years.
Abstract: Background Most studies report that people with higher education enjoy better health and longer life. Although it is well known that most risk factors are more common among individuals with a lower level of education, the underlying mechanism of this association is not fully understood. The objective of this study was to assess the association between education, disability, and mortality. Methods We analyzed data on 1,817 men and 1,643 women, aged 65-84 years, to assess the association of educational level with physical disability and mortality adjusting for age, sex, smoking habit, occupation, and major chronic conditions. Results The association between educational level and disability was characterized by a dose-response effect, with the relative odds significantly decreased by about 30%, 60%, and 79% in those with 4 or 5, 6 to 8, and more than 8 years of education, compared to those with 3 or less years of education. Death rates were lower among persons with 4 or more years of education compared to those with less education. However, after adjusting for disability status, education was no longer associated with mortality (RR=0.97, CI=0.65-1.43). Conclusions The strong association of low education with disability found in this study may explain the inverse association with mortality reported in previous studies. Disability, indeed, seems to be the mediator between education and mortality and might be due to the higher severity level of diseases, leading to death, in the lower educated group.
TL;DR: Results indicated that although SCI subjects were more internally oriented than MS subjects, internality was not linked to lower levels of depression or anxiety in either group, although within the SCI group an external LOC was associated with increased depression and physical disability.
Abstract: Purpose: This study examines the role of control cognitions, i.e. locus of control (LOC), in predicting adaptation to two contrasting physically disabling conditions.Method: Locus of control beliefs were investigated in terms of their relationship with psychological distress (anxiety and depression) experienced by people facing either spinal cord injury (SCI) or multiple sclerosis (MS). The role of pain experience was also considered in terms of its impact on psychological distress in both groups.Results: Results indicated that although SCI subjects were more internally oriented than MS subjects, internality was not linked to lower levels of depression or anxiety in either group, although within the SCI group an external LOC was associated with increased depression and physical disability. Conclusions: For people facing a future with the challenge of physical disability, the pattern of progression of disability over time may be of significance in the development of psychological distress.
TL;DR: It is concluded that pain coping has a mediating role in the relationship between pain chronicity and physical disability and less use of "resting" and a physically active lifestyle are independently associated with less physical disability.
Abstract: Objective. To investigate the use of pain coping strategies by community-living older people with pain in the hip or knee and the mediating role of coping with pain in the relationship between the chronicity of pain and physical disability. Methods. A group of 157 people with pain 'in the last month' was identified. Coping with pain was assessed with the Pain Coping Inventory, physical disability with the Sickness Impact Profile, and household and sport activities with a validated structured interview method. Results. People with chronic pain used relatively more 'resting,' and 'reducing demands' as pain coping strategies. Pain chronicity made a significant contribution to physical disability; however, when corrected for other variables in a regression model, no significant partial correlation was found. Conclusion. We conclude that pain coping has a mediating role in the relationship between pain chronicity and physical disability. Less use of 'resting' and a physically active lifestyle are independently associated with less physical disability.
TL;DR: In this paper, the authors examined the courtship experiences of 8 able-bodied women who made postinjury marital commitments to men with a spinal cord injury (SCI), finding that participants described their mates as positively adjusted to their disability and as demonstrating autonomous attitudes which, along with personality variables, were considered important elements of attraction.
Abstract: No previous research seems to have examined why able-bodied women might choose to marry men with a significant, permanent physical impairment. This exploratory study employed a grounded theory methodology to examine the courtship experiences of 8 able-bodied women who made postinjury marital commitments to men with a spinal cord injury (SCI). A tentative model of relationship development integrated salient factors which emerged from the data. Contrary to what one might expect to find based on maladaptive motivations attributed to nondisabled mates by some authors, the present findings suggest a substantial overlap with existing models of courtship. There were evident, though, significant individual factors and external social forces influencing relationship development in the context of disability. Participants described their mates as positively adjusted to their disability and as demonstrating autonomous attitudes which, along with personality variables, were considered important elements of attraction. Participants revealed: an openness to a relationship with a partner with SCI; prior personal experience with disability; flexibility regarding role performance; acceptance of disability and need for assistance; an attitude aimed at fostering their partner's independence; and, resiliency when faced with social disapproval.
TL;DR: People with HIV infection before an AIDS-defining illness demonstrate relatively low levels of physical dysfunction, and perceived disability among the pre-AIDS sample is somewhat higher than that of the general population.
TL;DR: There appears to be a specific and ordered relationship between the level of physical dependence and various types of physical disabilities, which could have implications for therapeutic intervention and health status measures.
Abstract: Objectives. To explore the relationship between disability and physical dependence handicap, and the mediating effect of personal (demographic) and environmental factors as modeled by the International Classification of Impairments, Disability, and Handicaps.
Methods. Data on people with arthritis-associated disabilities were abstracted from a national population survey (n = 16,017). A hierarchical physical dependence variable was formulated. Nominal logistical regression was used to determine predictors of physical dependence related to specific disability, personal characteristics, and environmental adaptation variables.
Results. The risk of physical dependence only increased substantially at age ≥75 years. Specific types of physical disability differentially predicted different levels of physical dependence. The major predictor of physical dependence was disability alone and in conjunction with environmental factors.
Conclusions. There appears to be a specific and ordered relationship between the level of physical dependence and various types of physical disabilities. The findings could have implications for therapeutic intervention and health status measures.
01 Jan 1998
TL;DR: For the purpose of this paper, the term disability will encompass the following impairments: disability that can increase vulnerability to abuse resulting from physical, sensory, or mental impairments, or a combination of impairments.
Abstract: For the purpose of this paper, the term disability will encompass the following impairments: disability that can increase vulnerability to abuse resulting from physical, sensory, or mental impairments, or a combination of impairments; physical disability resulting from injury (e.g., spinal cord injury, amputation), chronic disease (e.g., multiple sclerosis, rheumatoid arthritis), or congenital conditions (e.g., cerebral palsy, muscular dystrophy); sensory impairments consisting of hearing or visual impairments; and mental impairments comprising developmental conditions (e.g., mental retardation), cognitive impairment (e.g., traumatic brain injury), or mental illness. Emotional abuse is being threatened, terrorized, severely rejected, isolated, ignored, or verbally attacked. Physical abuse is any form of violence against one’s body, such as being hit, kicked, restrained, or deprived of food or water. Sexual abuse is being forced, threatened, or deceived into sexual activities ranging from looking or touching to intercourse or rape.
TL;DR: The results highlight the importance of occupational stress as a predictor of disability and the potential utility of addressing this factor in the development of empirically based disability prevention strategies and delineates the biobehavioral mechanisms linking occupational stress to prolonged symptoms and subsequent work disability.
Abstract: Occupational upper-extremity disorders have been associated with prolonged pain and work disability. Using the U.S. Army Physical Disability Agency database, the present case-control studies (n = 434 and n = 342) investigated the contribution of demographic, physical, occupational psychosocial, and individual psychosocial factors to work disability in soldiers with upper-extremity disorders. Age (odds ratio [OR] = 1.11), rank (private E-2: OR = 3.79; private first class: OR = 4.39; specialist or corporal: OR = 2.17), ethnic group (white: OR = 1.54), and occupational stress ("often": OR = 2.46) were found to predict disability. The results highlight the importance of occupational stress as a predictor of disability and the potential utility of addressing this factor in the development of empirically based disability prevention strategies. This investigation also emphasizes the need for research that delineates the biobehavioral mechanisms linking occupational stress to prolonged symptoms and subsequent work disability. Language: en
TL;DR: The impact of coronary heart disease (CHD) on elderly patients' functional abilities is of growing interest because of the increasing number of people that survive the disease as discussed by the authors, and therefore, the authors of this paper aim to assess whether there is an independent association between physical disability and CHD.
Abstract: The impact of coronary heart disease (CHD) on elderly patients' functional abilities is of growing interest because of the increasing number of people that survive the disease. The aim of our study was, firstly, to describe functional abilities among elderly CHD patients and, secondly, to analyze the relationships between physical disability and the severity of chest pain or dyspnea. The third aim was to assess whether there is an independent association between physical disability and CHD. The study was carried out at the health center of the municipality of Lieto, southwestern Finland. From a population of 1196 community-dwelling persons aged > or = 64 years, 89 men and 73 women with CHD (angina pectoris and/or a past myocardial infarction) were selected along with 178 male and 146 female sex- and age-matched controls without CHD. Physical functioning was assessed by means of interviewer-based questionnaires, compared between patients and controls and described in relation to the severity of chest pain and dyspnea among patients. The associations between dependence or difficulties in mobility, ADL (activities of daily living) and IADL (instrumental activities of daily living) and CHD, age, smoking, comorbidities, drug therapy and clinical characteristics were assessed by logistic regression analyses. On items representing mobility and managing in IADL, patients reported more difficulties or dependence than controls. Among female patients, more severe chest pain was associated with poor managing in IADL and tended to be associated with poor mobility. More severe dyspnea was associated with poor mobility among both male and female patients, and with poor managing in IADL among male patients. Logistic regression analyses failed to show that CHD was associated independently with physical disability among the elderly. However, physical disability was associated with the use of cardiovascular drugs in the models among both genders, which probably indirectly indicated an association between physical disability and CHD. Several confounding factors, such as higher age, depression, cancer and the use of psychotropic drugs, contributed to the decline in functional abilities even among persons with CHD. In conclusion, elderly CHD patients have greater limitations in their functional ability than matched controls, which may depend on the severity of the disease. Especially male patients' limitations in physical abilities may be influenced by the fact that men with CHD are more likely to be depressed. Although an independent association between physical disability and CHD was not found, the associations found between physical disability and the use of cardiovascular drugs probably indicate a causal relationship between CHD and physical disability.
TL;DR: McCarthy and Thompson as mentioned in this paper pointed out that outside of the small and specialist field of learning disability work, feminists and feminisms have traditionally not made reference to the experiences of women with learning disabilities, nor sought to make events, materials or ideas accessible to them.
Abstract: Feminist researchers and activists have been criticized by women with physical disabilities for having often overlooked their experiences and contributions (Morris, 1991, 1996). If this is true for physical disability, it is doubly true for learning disabilities,(1) where outside of the small and specialist field of learning disability work, feminists and feminisms have traditionally not made reference to the experiences of women with learning disabilities, nor sought to make events, materials or ideas accessible to them (McCarthy, 1996). Over the past seven years I have been working in learning disability services focusing on sexuality issues with women (see for example McCarthy, 1993, 1994, 1996) as well as carrying out more recent academic research (McCarthy, 1997; McCarthy and Thompson, 1997). The observations and commentary in this article are based on that experience.
TL;DR: In this paper, the authors compare and contrast mothers' perceptions of their family life in three different family environments, those without a child with disability and those families who live with a child having an intellectual or physical disability.
Abstract: This paper describes some features of a study which compares and contrasts mothers’ perceptions of their family life in three different family environments, those without a child with disability and those families who live with a child with an intellectual or physical disability. All families have children in the middle childhood period allowing the mothers to reflect on earlier experiences and changes in their family life. Mothers’ psychological characteristics are explored in terms of the coping resources they utilise when meeting stressful life situations in their family and how their personal resilience and vulnerability is related to these individual coping resources.
Journal Article•
TL;DR: The origins and experiences of the Community Medical Alliance, a Boston-based clinical care system that contracts with the Massachusetts Medicaid program on a fully capitated basis to pay for and deliver a comprehensive set of benefits to individuals with advanced AIDS and individuals with severe disability are discussed.
Abstract: This paper discusses the origins and experiences of the Community Medical Alliance (CMA), a Boston-based clinical care system that contracts with the Massachusetts Medicaid program on a fully capitated basis to pay for and deliver a comprehensive set of benefits to individuals with advanced AIDS and individuals with severe disability. Since 1992, the program has enrolled 818 individuals with either severe disability, AIDS, mental retardation, or general SSI-qualifying disability. Under a fee-for-service system, these two groups had received fragmented care. The capitated CMA program emphasizes patient education and self-management strategies, social support and mental health services, and a team approach to healthcare delivery that has reoriented care to primary care physicians, homes, and communities.
TL;DR: Before they are 2 years old, children are able to recognize that their older brothers and sisters are different, and often imitate the parents' behaviour towards the older child.
Abstract: Pre-school siblings' comments about, and behaviour towards, their older, learning-disabled brothers and sisters are reported. Initially, some of the very young siblings want to be similar, and attempt to imitate their brothers and sisters, particularly if he or she is also physically disabled; this may be because of the immediate visibility of physical disability, which makes it appear interesting and important to the younger child. Before they are 2 years old, children are able to recognize that their older brothers and sisters are different, and often imitate the parents' behaviour towards the older child.
TL;DR: Though limited, the literature on supportive psychotherapy permits consideration of its application in rehabilitation counseling, and rehabilitation case examples that focus on chronic disability and long-term psychological adjustment are presented.
Abstract: Though limited, the literature on supportive psychotherapy permits consideration of its application in rehabilitation counseling. A review of supportive psychotherapy indications and techniques is followed by rehabilitation case examples that focus on chronic disability and long-term psychological adjustment.
01 Jan 1998
TL;DR: In this article, the authors present material relevant for social workers working with lesbians and gay men as adults in their own right, separate from their capacity as carers of children or as offenders.
Abstract: This chapter covers material relevant for social workers working with lesbians and gay men as adults in their own right, separate from their capacity as carers of children or as offenders. They may, as adults, indeed be carers of children and/or offenders, but here this is not the primary focus. Because in this context the term ‘adult’ is so broad, I have had to be selective in what is covered. There are generic themes that are relevant to all interventions with adults, but in addition there are areas that are particularly relevant to lesbian and gay clients/service users, including mental health, chronic sickness, death and bereavement, physical disability, old age, and learning disabilities (those headings not covered include substance misuse (except briefly under mental health in relation to alcohol) and the assessment of adult carers who are lesbians and gay men). With so much to deal with in one chapter, the intention is to offer pointers or to raise questions for further thought, rather than engage in exhaustive discussions.
01 Jan 1998