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Shenk M, Hicks B, Quiñones A, Harrati A. Racial Disparities in COVID-19 Experiences Among Older Adults With Disabling Conditions. J Aging Health 2024; 36:320-336. [PMID: 37392162 PMCID: PMC10315517 DOI: 10.1177/08982643231185689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
OBJECTIVES This paper examines the health, work, and financial experiences of older adults with disabling conditions during the COVID-19 pandemic. It also explores the role of county- and state-level conditions in these experiences. METHODS Using data from the 2020 Health and Retirement Study, we estimated regression models to assess differences in outcomes between those with and without disabling conditions and by race/ethnicity. We used multilevel modeling to assess whether and how county or state factors might be associated with the differences in these effects. RESULTS Older adults with disabilities were more likely to report experiencing financial hardships, delaying health care, and experiencing effects on work than those without disabilities; these differences are heighted between race and ethnicity. Older adults with disabilities were more likely to live in counties with greater social vulnerability. DISCUSSION This work underscores the importance of developing a robust, disability-inclusive public health response that protects older adults.
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Affiliation(s)
| | | | - Ana Quiñones
- Oregon Health and Science University, Portland, OR, USA
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Fivian E, Harris-Fry H, Offner C, Zaman M, Shankar B, Allen E, Kadiyala S. The Extent, Range, and Nature of Quantitative Nutrition Research Engaging with Intersectional Inequalities: A Systematic Scoping Review. Adv Nutr 2024; 15:100237. [PMID: 38710327 PMCID: PMC11180316 DOI: 10.1016/j.advnut.2024.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/10/2024] [Accepted: 05/01/2024] [Indexed: 05/08/2024] Open
Abstract
Addressing malnutrition for all requires understanding inequalities in nutrition outcomes and how they intersect. Intersectionality is increasingly used as a theoretical tool for understanding how social characteristics intersect to shape inequalities in health outcomes. However, little is known about the extent, range, and nature of quantitative nutrition research engaging with intersectional inequalities. This systematic scoping review aimed to address this gap. Between 15 May 2021 and 15 May 2022, we searched 8 databases. Studies eligible for inclusion used any quantitative research methodology and aimed to investigate how social characteristics intersect to influence nutrition outcomes. In total, 55 studies were included, with 85% published since 2015. Studies spanned populations in 14 countries but were concentrated in the United States (n = 35) and India (n = 7), with just 1 in a low-income country (Mozambique). Race or ethnicity and gender were most commonly intersected (n = 20), and body mass index and overweight and/or obesity were the most common outcomes. No studies investigated indicators of infant and young child feeding or micronutrient status. Study designs were mostly cross-sectional (80%); no mixed-method or interventional research was identified. Regression with interaction terms was the most prevalent method (n = 26); 2 of 15 studies using nonlinear models took extra steps to assess interaction on the additive scale, as recommended for understanding intersectionality and assessing public health impacts. Nine studies investigated mechanisms that may explain why intersectional inequalities in nutrition outcomes exist, but intervention-relevant interpretations were mostly limited. We conclude that quantitative nutrition research engaging with intersectionality is gaining traction but is mostly limited to the United States and India. Future research must consider the intersectionality of a wider spectrum of public health nutrition challenges across diverse settings and use more robust and mixed-method research to identify specific interventions for addressing intersectional inequalities in nutrition outcomes. Data systems in nutrition must improve to facilitate this. This review was registered in PROSPERO as CRD42021253339.
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Affiliation(s)
- Emily Fivian
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Helen Harris-Fry
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claudia Offner
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michele Zaman
- Department of Medicine, Queen's University, Ontario, Canada
| | - Bhavani Shankar
- Department of Geography, The University of Sheffield, Sheffield, United Kingdom
| | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Xie QW, Fan XL, Luo X, Chang Q. Mechanisms underlying the relationship between the intersectionality of multiple social identities with depression among US adults: A population-based study on the mediating roles of lifestyle behaviors. J Affect Disord 2024; 349:384-393. [PMID: 38211749 DOI: 10.1016/j.jad.2024.01.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Despite substantial efforts to investigate the inequalities in mental health among people with marginalized identities, most research has concentrated on single social identities rather than complete persons. The current study aimed to explore the mechanisms underlying the relationship between the intersectionality of multiple social identities with depression among US adults. METHODS Data for this study came from the National Health and Nutrition Examination Survey waves between 2015 and 2018, including a total of 11,268 US adults. A latent class analysis (LCA) was conducted to identify latent subpopulations based on sex, race/ethnicity, immigrant status, disability, household income, employment status, and education level. Interclass differences in lifestyle factors and depression were examined. Multiple mediation analysis was used to examine the mediating roles of lifestyle behaviors. RESULTS LCA identified four potential subpopulations: "least marginalized", "immigrant minorities", "disabled, less-educated non-workers", and "low-income minorities" groups. There was enormous heterogeneity in mental health among immigrant minority individuals. The "disabled, less-educated non-workers" group had the highest rates of depression; in contrast, the "immigrant minorities" group had the best mental health, even better than that of the "least marginalized" group. Distributions of lifestyle factors followed a similar pattern. In addition, lifestyle behaviors significantly mediated the relationship between intersectional social identities and depression. LIMITATIONS The cross-sectional design prevented establishment of the causality of relationships. CONCLUSIONS This study suggests that applying a person-centered approach is important when examining intersectional inequalities in mental health and highlights the effects of structural social hierarchies on individuals' health behaviors and mental health.
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Affiliation(s)
- Qian-Wen Xie
- Department of Social Welfare and Risk Management, School of Public Affairs, Zhejiang University, Hangzhou, China; Research Center for Common Prosperity, Future Regional Development Laboratory, Innovation Center of Yangtze River Delta, Zhejiang University, Jiaxing, China; Center of Social Welfare and Governance, Zhejiang University, Hangzhou, China; Institute for Common Prosperity and Development, Zhejiang University, Hangzhou, China
| | - Xu Li Fan
- Department of Social Welfare and Risk Management, School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Xiangyan Luo
- Department of Social Welfare and Risk Management, School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Qingsong Chang
- School of Sociology and Anthropology, Xiamen University, Xiamen City, China.
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Fuentes K, Hsu S, Patel S, Lindsay S. More than just double discrimination: a scoping review of the experiences and impact of ableism and racism in employment. Disabil Rehabil 2024; 46:650-671. [PMID: 36724368 DOI: 10.1080/09638288.2023.2173315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/21/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Research has shed light on the employment barriers faced by individuals with disabilities, and by racialized people. The challenges faced by people belonging to both marginalized groups are less well-understood. The purpose of this scoping review was to examine existing research on labour market and workplace experiences of racialized people with disabilities, and to identify how ableism and racism intersect to shape employment experiences and outcomes. METHODS Seven international databases were searched, covering the period from 2000 to April 2022. Four reviewers independently conducted the screening, and data extraction and analysis were performed on 44 articles that met our inclusion criteria. RESULTS The findings highlighted rates of workplace ableism and racism (including discrimination allegations and perceived discrimination); types and forms of experiences arising from the intersection of ableism and racism (including unique individual stereotyping and systemic and institutional discrimination); and the role of other demographic variables. The intersection of ableism and racism impacted labour market outcomes, well-being in the workplace, and career/professional advancement. CONCLUSIONS Our review highlights the need for greater in-depth research focusing explicitly on the intersection of ableism and racism (and of other forms of discrimination), to better understand and address the barriers that racialized people with disabilities face in employment.IMPLICATIONS FOR REHABILITATIONThe experiences of racialized people with disabilities have been under explored, and clinicians and rehabilitation specialists should consider incorporating intersectionality into their practices to better understand and serve these populations.Ableism and racism do not operate in isolation, and clinicians and other professionals need to be aware that racialized people with disabilities may face unique challenges and barriers as a result.Service providers should aim to address gaps and inequities in services faced by racialized people with disabilities which may prevent them from finding and/or maintaining meaningful employment.
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Affiliation(s)
- Kristina Fuentes
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Shaelynn Hsu
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Stuti Patel
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Psychology, University of Toronto Mississauga campus, Mississauga, Canada
| | - Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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Murdock ME, Cruz GJ, Derby L, Ellis J, Kronish IM, Edmondson D, Birk JL. Health insurance, perceived threat, and posttraumatic stress after suspected acute coronary syndrome. Health Psychol 2024; 43:34-40. [PMID: 37917470 PMCID: PMC10841455 DOI: 10.1037/hea0001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Threat perceptions during evaluation for acute coronary syndrome (ACS) in the emergency department (ED) predict posttraumatic stress symptoms (PSS). It is unknown how health insurance status affects threat perceptions. We tested whether lacking health insurance is associated with higher threat perceptions and PSS in patients with suspected ACS in the ED and whether threat perceptions mediate associations between lack of health insurance and subsequent PSS. METHOD Patients in the Columbia University Irving Medical Center ED with suspected ACS enrolled in an observational cohort study of psychological and cardiovascular outcomes. A multivariable linear regression model tested health insurance status as the predictor of ED threat perceptions and PSS 1-month posthospitalization, adjusting for age, gender, education, Charlson Comorbidity Index, and Global Registry of Acute Coronary Events risk score. A bootstrapped mediation model tested health insurance status as the predictor, PSS 1-month posthospitalization as the outcome, and ED threat perceptions as the mediator, with the same covariates. RESULTS Of 1,741 patients with suspected ACS in the ED (Mage = 61.01 years, SD = 13.27; 47.1% women), a plurality identified as "Other" race (36.1%), Black (23.9%), and White (22.4%), and 10.3% of patients were uninsured. Lack of health insurance was associated with greater threat perceptions, b = -0.16, 95% CI [-0.26, -0.06], p = .002. Threat perceptions mediated the association between lack of health insurance and higher 1-month PSS, indirect effect = -1.04, 95% CI [-1.98, -0.17]. CONCLUSIONS Lacking health insurance may heighten threat perceptions during ACS evaluation, which may put patients at risk of developing PSS. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Margaret E. Murdock
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Gaspar J. Cruz
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Lilly Derby
- Department of Clinical Psychology, Rutgers University
| | - Julia Ellis
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Ian M. Kronish
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Donald Edmondson
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Jeffrey L. Birk
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
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Robinson-Whelen S, Hughes RB, Alhusen JL, Beers L, Minard CG, Davidson D. Health information seeking in the digital age: a national survey of women with disabilities. Disabil Rehabil 2023; 45:2751-2760. [PMID: 35916449 PMCID: PMC9892349 DOI: 10.1080/09638288.2022.2105960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Access to high quality and accessible online health information (OHI) is critical for reducing disparities, overcoming barriers, and improving the health of women with disabilities. This study aimed to understand women with physical disabilities' use of the Internet to access OHI, most often searched health topics, perceived usefulness of OHI, and self-reported eHealth literacy and challenges in OHI seeking. METHODS We conducted a national online survey with 508 women with physical disabilities who used the Internet. RESULTS Respondents utilized a wide variety of OHI resources. They searched a broad array of health and disability-related topics, with bowel/bladder and finding a physician the most highly searched topics. They generally had confidence in their eHealth literacy skills and ability to understand statistics in OHI. Nevertheless, although our sample consisted of a majority of highly educated internet-users, a sizeable percentage found OHI seeking difficult and frustrating, did not find the information very helpful, and had concerns about the quality of information. CONCLUSIONS This study serves as a call to action to disability and rehabilitation scientists, health care providers, and other health professionals to enhance the availability and accessibility of OHI critical to empowering women with physical disabilities to make well-informed health decisions. Implications for rehabilitationAccess to high quality online health information (OHI) is critical for reducing disparities, overcoming barriers, and improving the health of women with disabilities.Many of the women with disabilities in our study found OHI seeking difficult and frustrating, did not find the information very helpful, and had concerns about the quality of the information.Disability and rehabilitation scientists, health care providers, and public health and health policy professionals need to do more to enhance the availability and accessibility of OHI and resources critical to empowering women with physical disabilities to make well-informed health decisions.Physical medicine and rehabilitation scientists are encouraged to develop and improve assistive technologies needed for accessing OHI, which in turn can promote the independent functioning of people with disabilities.
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Affiliation(s)
- Susan Robinson-Whelen
- Baylor College of Medicine, Center for Research on Women with Disabilities, TIRR Memorial Hermann, Spinal Cord Injury and Disability Research, Houston, TX 77030, USA, 281-467-2349
| | - Rosemary B. Hughes
- University of Montana, Rural Institute for Inclusive Communities and Department of Psychology, Missoula, MT, USA
| | | | - Leanne Beers
- University of Montana, Rural Institute for Inclusive Communities, Missoula, MT, USA
| | - Charles G. Minard
- Baylor College of Medicine, Institute for Clinical and Translational Research, Houston, TX, USA
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Dorsey Holliman B, Stransky M, Dieujuste N, Morris M. Disability doesn't discriminate: health inequities at the intersection of race and disability. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1075775. [PMID: 37484601 PMCID: PMC10357509 DOI: 10.3389/fresc.2023.1075775] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 06/02/2023] [Indexed: 07/25/2023]
Abstract
Objectives Given the prevalence of discrimination experienced by racial and ethnic minorities living with disabilities, it is likely that racism experienced by Black, Indigenous, and people of color (BIPOC) is compounded by the ableism experienced by people with disabilities, widening disparities in health and healthcare outcomes. To address this, we described unmet healthcare needs of a sample of Black, non-Hispanic, and Hispanic adults with and without disabilities. The following research question was examined exploratively: Are Black and Hispanic adults with disabilities at increased risk of unmet healthcare needs compared to Black and Hispanic adults without disabilities according to the 2018 National Health Interview Survey? Methods Survey data was examined from the 2018 National Health Interview Survey (NHIS), a nationally representative survey of community-dwelling adults in the United States. Results Black and non-Hispanic adults most commonly reported mobility only disabilities. People with disabilities were significantly more likely to delay or forego care than their peers without disabilities within each racial/ethnic group. Among non-Hispanic Black and Hispanic adults, nearly 30% of people with disabilities forewent services due to cost compared to persons without disabilities. Conclusions Black and Hispanic adults with disabilities experience greater disparities in access to healthcare than Black and Hispanic adults without disabilities. Therefore, health disparities experienced by racial and ethnic minorities living with disabilities is likely influenced by the dual systemic factors of racism and ableism.
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Affiliation(s)
- Brooke Dorsey Holliman
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, United States
| | - Michelle Stransky
- Department of Medicine, Boston Medical Center, Boston, MA, United States
| | - Nathalie Dieujuste
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, United States
- Department of Psychology, University of Denver, Denver, CO, United States
| | - Megan Morris
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, United States
- Department of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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Filippone PL, Hernandez Trejo Y, Witte SS. Demonstrating the Feasibility of an Economic Empowerment and Health Promotion Intervention among Low-Income Women Affected by HIV in New York City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085511. [PMID: 37107793 PMCID: PMC10138409 DOI: 10.3390/ijerph20085511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/31/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
Women of color in the U.S. face systematic exclusion from the labor market, work protections, and employer-based benefits. Women's economic vulnerability increases their susceptibility to health-related issues, including HIV transmission and substance use, which are work-restricting disabilities, by constraining their capacity to effectively reduce risk. The Women's Economic Empowerment pilot examined the feasibility of a structural intervention, implemented at a neighborhood agency, combining both health promotion and economic empowerment components as a pathway to accessing an urban job market for low-income women with work-restricting disabilities, including living with HIV. Ten women clients from a partner agency in New York completed four health promotion sessions, six financial literacy sessions, and a concurrent opportunity to match savings; some also followed with up to 24 vocational rehabilitation sessions. Interviews captured self-reported data on health promotion and financial outcomes at pre-/post-intervention and 3-month follow-up. Qualitative analysis of recorded group sessions and field notes demonstrate that women express improved HVI/STI knowledge and problem-solving strategies for risk reduction, a shared optimism for the future due to group participation, enhanced social support through relationship-building, a heightened sense of empowerment regarding financial decision making, and a desire to re-engage in the labor force. Findings suggest an empowering approach to re-engage women impacted by poverty, unemployment, and disabilities, including living with HIV, into the workforce may be implemented in a community setting.
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Affiliation(s)
- Prema L. Filippone
- Silver School of Social Work, New York University, New York, NY 10012, USA
- Correspondence:
| | | | - Susan S. Witte
- School of Social Work, Columbia University, New York, NY 10027, USA
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Reid MR, Danguecan AN, Colindres I, Witherspoon D, Rubinstein TB, Drenkard C, Knight AM, Cunningham NR. An ecological approach to understanding and addressing health inequities of systemic lupus erythematosus. Lupus 2023; 32:612-624. [PMID: 36922154 DOI: 10.1177/09612033231164637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Systemic Lupus Erythematosus (SLE) is a complex chronic autoimmune disease disproportionally afflicting women and, in particular, American Indian/Alaska Native, Black, and Hispanic women. These groups of women have significantly worse SLE-related health outcomes which are partially attributable to their exposure to marginalizing and interconnecting social issues like racism, sexism, economic inequality, and more. Although these groups of women have higher rates of SLE and though it is well known that they are at risk of exposure to marginalizing social phenomena, relatively little SLE literature explicitly links and addresses the relationship between marginalizing social issues and poor SLE-health outcomes among these women. Therefore, we developed a community-engaged partnership with two childhood-SLE diagnosed women of color to identify their perspectives on which systemic issues impacted on their SLE health-related outcomes. Afterward, we used Cochrane guidelines to conduct a rapid review associated with these identified issues and original SLE research. Then, we adapted an ecological model to illustrate the connection between systems issues and SLE health outcomes. Finally, we provided recommendations for ways to research and clinically mitigate SLE health inequities.
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Affiliation(s)
- Mallet R Reid
- Department of Family Medicine, College of Human Medicine, 3078Michigan State University, Grand Rapids, MI, USA
| | - Ashley N Danguecan
- Division of Rheumatology, 7979The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Tamar B Rubinstein
- Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY, USA
| | | | - Andrea M Knight
- Division of Rheumatology, 7979The Hospital for Sick Children, Toronto, ON, Canada
| | - Natoshia R Cunningham
- Department of Family Medicine, College of Human Medicine, 3078Michigan State University, Grand Rapids, MI, USA
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Slayter EM, Kattari SK, Yakas L, Singh RCB, Goulden A, Taylor S, Wernick LJ, Simmons LD, Prince D. Beyond Ramps, Curb Cuts, and Captions: A Call for Disability Justice in Social Work. SOCIAL WORK 2022; 68:89-92. [PMID: 36409996 DOI: 10.1093/sw/swac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 06/16/2023]
Affiliation(s)
- Elspeth M Slayter
- PhD, MSW, MA is professor, School of Social Work, Salem State University, 352 Lafayette Street, Salem, MA 01970, USA
| | - Shanna K Kattari
- PhD, MEd, is associate professor, School of Social Work and Department of Women's and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - Laura Yakas
- PhD, MSW, MA, is lecturer, School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Rose C B Singh
- MSW, is a PhD candidate Memorial University of Newfoundland and Labrador, St. John's, Newfoundland, Canada
| | - Ami Goulden
- PhD, MA, MSW, is assistant professor, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland, Canada
| | - Sarah Taylor
- PhD, MSW, is professor and department chair, Department of Social Work, California State University, East Bay, Hayward, CA, USA
| | - Laura J Wernick
- PhD, MSW, MPA, MA, is associate professor, School of Social Service, Fordham University, New York, NY, USA
| | - Lamont D Simmons
- PhD, MA, MSW, is assistant professor, School of Social Work, Salem State University, Salem, MA, USA
| | - Dana Prince
- PhD, MPH, is assistant professor, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
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Ames JL, Morgan EH, Giwa Onaiwu M, Qian Y, Massolo ML, Croen LA. Racial/Ethnic Differences in Psychiatric and Medical Diagnoses Among Autistic Adults. AUTISM IN ADULTHOOD 2022; 4:290-305. [PMID: 36601333 PMCID: PMC9807255 DOI: 10.1089/aut.2021.0083] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Racial/ethnic disparities in access to diagnostic services are pervasive for autistic children. However, a few studies have examined racial/ethnic health disparities among autistic adults, who commonly experience higher rates of health conditions than non-autistic adults. We aimed at examining the intersection of autism and race/ethnicity in association with psychiatric and medical diagnoses. Methods The study population included adult members of Kaiser Permanente Northern California enrolled from 2008 to 2012. We ascertained 1507 adults who had an autism diagnosis documented in their electronic medical records. We sampled a matched control group of adults without an autism diagnosis (N = 15,070) at a 10:1 ratio. Our sample was 46% White, 17% Hispanic, 16% Asian, 7% Black, and 14% other race/ethnicity. We compared health diagnoses (a) between autistic and non-autistic adults within strata of race/ethnicity and (b) across race/ethnicity within strata of autistic and non-autistic adults. Lastly, we examined the interaction between autism and race/ethnicity on both multiplicative and additive scales. Results Autistic adults were more likely to be diagnosed with most medical and psychiatric conditions compared with their non-autistic counterparts of the same race/ethnicity. Among autistic adults, Black, Hispanic, and Asian adults were less likely to be diagnosed with psychiatric conditions and Black and Hispanic autistic adults were more likely to be diagnosed with obesity than their White counterparts. In interaction models, we found that adults who were Black and autistic were disproportionately less likely to be diagnosed with psychiatric conditions and autoimmune disease and more likely to be diagnosed with hypertension than expected. Conclusion Health vulnerabilities may be compounded at the intersection of autism and race/ethnicity. Future research should continue to apply an intersectional lens toward understanding and addressing these disparities. Our findings likely underestimate the health disparities that exist in uninsured autistic adults and those living in other parts of the United States.
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Affiliation(s)
- Jennifer L. Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Address correspondence to: Jennifer L. Ames, PhD, MS, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612-5190, USA
| | - Elizabeth H. Morgan
- College of Education California State University Sacramento, Sacramento, California, USA
| | - Morénike Giwa Onaiwu
- Center for the Study of Women, Gender, and Sexuality, Rice University, Houston, Texas, USA
| | - Yinge Qian
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Maria L. Massolo
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Havercamp SM, Bonardi A. Special Issue Introduction: Addressing Healthcare Inequities in Intellectual Disability and Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:449-452. [PMID: 36454611 DOI: 10.1352/1934-9556-60.6.449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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Sharpe JA, Miller R, Cook CE, Hastings SN, Rethorn TJ, Allen KD, Rethorn ZD. Social Risk Factors Are Associated With Disability Prevalence - Results From 17 States in the 2017 Behavioral Risk Factor Surveillance System. Am J Health Promot 2022; 37:453-463. [PMID: 36194861 DOI: 10.1177/08901171221132390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Determine the association between incremental increases in the number of social risk factors and the prevalence of any disability and disability type. DESIGN The cross-sectional analysis was conducted using 2017 Behavioral Risk Factor Surveillance System data from states whose surveys included items about social risk factors. SETTING Respondents from 17 US states. SUBJECTS Respondents included 136 432 adults. MEASURES Dichotomized social risk factors included food, housing, and financial insecurity, unsafe neighborhood, and healthcare access hardship. ANALYSIS Weighted χ2 and logistic regression analyses adjusted for demographic characteristics, measures of socioeconomic position, and comorbid health conditions were used to examine differences in the prevalence of disability by social risk factor and via a social risk index created by summing the social risk factors. RESULTS Compared to those reporting 0 social risk factors, respondents reporting ≥4 had more than thrice the odds of reporting a cognition ((adjusted odds ratio [AOR]=3.37; 95%CI [2.75-4.13]), independent living (AOR=3.24 [2.52-4.15]), self-care (AOR=3.33 [2.55-4.34]), or any disability (AOR=3.90 [3.24-4.70]); more than twice the odds of reporting a vision (AOR=2.61 [1.93-3.52]) or mobility (AOR=2.72 [2.16-3.41]) disability; and more than 1.5 times the odds of reporting a hearing disability (AOR=1.59 [1.22-2.07]). CONCLUSIONS Incremental increases in the number of social risk factors were independently associated with higher odds of disability. Intervention efforts should address the social context of US adults with disabilities to improve health outcomes.
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Affiliation(s)
- Jason A Sharpe
- 584122VA Center of Innovation to Accelerate Discovery and Practice Transformation Medical Center, Durham, NC, USA
| | - Rachel Miller
- Doctor of Physical Therapy Division, 3065Duke University, Durham, NC, USA
| | - Chad E Cook
- Doctor of Physical Therapy Division, 3065Duke University, Durham, NC, USA.,Department of Population Health Sciences, 3065Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, 3065Duke University, Durham, NC, USA
| | - Susan N Hastings
- 584122VA Center of Innovation to Accelerate Discovery and Practice Transformation Medical Center, Durham, NC, USA.,Department of Population Health Sciences, 3065Duke University Medical Center, Durham, NC, USA.,Department of Medicine, 3065Duke University Medical Center, Durham, NC, USA.,Geriatrics Research Education and Clinical Center, 20054Durham VA Health Care System, Durham, NC, USA.,Center for the Study of Aging, 3065Duke University School of Medicine, Durham, NC, USA
| | - Timothy J Rethorn
- School of Health and Rehabilitation Sciences, 2647The Ohio State University, Columbus, OH, USA
| | - Kelli D Allen
- 584122VA Center of Innovation to Accelerate Discovery and Practice Transformation Medical Center, Durham, NC, USA.,Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Zachary D Rethorn
- 584122VA Center of Innovation to Accelerate Discovery and Practice Transformation Medical Center, Durham, NC, USA.,Doctor of Physical Therapy Division, 3065Duke University, Durham, NC, USA
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14
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Bixby L, Bevan S, Boen C. The Links Between Disability, Incarceration, And Social Exclusion. Health Aff (Millwood) 2022; 41:1460-1469. [PMID: 36190886 PMCID: PMC10335036 DOI: 10.1377/hlthaff.2022.00495] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Disabled people are disproportionately incarcerated and segregated from society through a variety of institutions. Still, the links between disability and incarceration are underexplored, limiting understanding of how carceral institutions punish and contribute to the social exclusion of disabled people. Using data from the 2016 Survey of Prison Inmates, we estimated disability prevalence in state and federal prisons, assessing disparities by race, ethnicity, and sex, and we examined inequities in previous residence in other "punitive" and "therapeutic" institutions. Sixty-six percent of incarcerated people self-reported a disability, with Black, Hispanic, and multiracial disabled men especially overrepresented in prisons. Compared with nondisabled incarcerated people, disabled incarcerated people were more likely to have previously resided in other institutions, such as juvenile detention facilities and psychiatric hospitals. Together, our findings advance the understanding of disability in carceral institutions, highlighting the need for policy interventions redressing the mechanisms contributing to the high incarceration risks of disabled people and the disabling nature of prisons and other carceral institutions.
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Affiliation(s)
- Laurin Bixby
- Laurin Bixby , University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Burns SD, Baker EH, Sheehan CM. Disability and self-rated health: Exploring foreign- and U.S.-born differences across adulthood. J Migr Health 2022; 6:100112. [PMID: 35620793 PMCID: PMC9126965 DOI: 10.1016/j.jmh.2022.100112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
There is limited inquiry regarding how immigrant status intersects with disability to influence health across adulthood. As the U.S. population continues to age, especially immigrants, understanding how disability influences health is imperative. Using 2010-2018 National Health Interview Survey data (n = 461,010) and logistic regression models, we investigate how differences in reporting Activity of Daily Living (ADL) disability influence reports of self-rated health (SRH) between foreign- and U.S.-born respondents (ages 25+) by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian) by age group (25-64 and 65+). Among those ages 25-64, foreign-born respondents generally report lower or similar rates of fair/poor SRH and ADL disability when compared to their U.S.-born peers. Among those ages 65+, we find that foreign-born respondents are at greater risk of fair/poor SRH compared to their U.S.-born peers. Additionally, while having ADL disability greatly increases the likelihood of fair/poor SRH, the impact of this association differs by race/ethnicity/nativity and age. Among those 25-64, having ADL disability appears to be especially, negatively impactful for SRH among foreign-born groups, particularly Hispanics and non-Hispanic Whites. However, among those ages 65+, having ADL disability is less impactful on the SRH of foreign-born respondents, especially non-Hispanic Blacks and Hispanics. Our findings shed new light on marginalization-related diminished returns by showing how ADL disability influences SRH differently between foreign-born groups across adulthood.
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Affiliation(s)
- Shane D. Burns
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., Room 219A, Los Angeles, California 90089, United States
| | - Elizabeth H. Baker
- Department of Sociology, University of Alabama at Birmingham | Rm. 460, 1401 University Blvd, Birmingham, Alabama 35233, United States
| | - Connor M. Sheehan
- School of Social and Family Dynamics, Arizona State University, P.O. Box 873701, Tempe, Arizona 85287, United States
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16
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Su CJ, Cyr PEP. Accessible Medical Education & TIC: Increasing Equitable Care for Disabled Patients. HARVARD PUBLIC HEALTH REVIEW (CAMBRIDGE, MASS.) 2022; 44:https://hphr.org/edition-44-su/. [PMID: 36176338 PMCID: PMC9518008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
An estimated 1 in 4 U.S. adults has a disability, and this number continues to increase. Disabled individuals face significant healthcare inequities, including but not limited to inaccessibility and mistreatment. Our current healthcare system is ill-equipped to provide equitable care to this population. There is a lack of accessibility in healthcare environments, lack of accessible medical training to enable disabled people to become healthcare providers serving their own community, and lack of thorough medical education that encompasses care for disabled patients. Furthermore, the increased risk of trauma, as well as increased risk of medical trauma specifically, endured by disabled people puts them at greater risk of long-lasting adverse effects. In this commentary, we analyze three key areas: 1) the current state of healthcare for disabled patients, 2) disability in medical education & physician workforce, and 3) the relationship between trauma and disability. We argue that the road to more equitable care for disabled patients involves changes to medical education that address all three of these areas. Medical training should expose trainees to disability early and throughout their training, should be made more accessible to support disabled physicians, and finally, should be trauma-informed in a manner that explicitly includes caring for disabled patients and their other intersecting identities.
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17
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Harden JK, Blauwet C, Silver JK, Sholas MG, Rasheed Z, Verduzco-Gutierrez M. Health and Healthcare Disparities Related to Rehabilitation and COVID-19. PM R 2022; 14:273-279. [PMID: 35077011 DOI: 10.1002/pmrj.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Jeannie K Harden
- Department of Rehabilitation Medicine, Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio, University Hospital - University Health, San Antonio, TX, United States
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Brigham and Women's Hospital, Spaulding Rehabilitation Hospital
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, Brigham and Women's Hospital, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Maurice G Sholas
- Sholas Medical Consulting, LLC, New Orleans, Louisiana, United States
| | - Zainab Rasheed
- Central Michigan College of Medicine, Mt. Pleasant, Michigan, United States
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio, University Hospital - University Health, San Antonio, TX, United States
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18
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Jashinsky TL, King CL, Kwiat NM, Henry BL, Lockett-Glover A. Disability and COVID-19: Impact on Workers, Intersectionality With Race, and Inclusion Strategies. THE CAREER DEVELOPMENT QUARTERLY 2021; 69:313-325. [PMID: 35463739 PMCID: PMC9015546 DOI: 10.1002/cdq.12276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/28/2021] [Accepted: 06/16/2021] [Indexed: 11/25/2022]
Abstract
This article discusses the impact of the COVID‐19 pandemic on workers with disabilities. Given that most employment‐related literature about COVID‐19 does not include people with disabilities, an in‐depth exploration of the impact of COVID‐19 on this population is warranted. Additionally, this article discusses the unique issues this population is facing during the pandemic, including the intersectionality of disability, race, and economic disadvantage. Suggestions for supporting people with disabilities in counseling and career‐related activities, both during the COVID‐19 pandemic and postpandemic, are provided.
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19
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Omotayo AO, Olagunju KO, Omotoso AB, Ogunniyi AI, Otekunrin OA, Daud AS. Clean water, sanitation and under-five children diarrhea incidence: Empirical evidence from the South Africa's General Household Survey. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:63150-63162. [PMID: 34226996 DOI: 10.1007/s11356-021-15182-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/24/2021] [Indexed: 04/16/2023]
Abstract
Sufficient supply of potable water, hygiene facilities, and sanitation are major factors enhancing healthy living. Using the dataset from the 2018 South Africa General Household Survey, this study employed the logistic regression model to examine the effects of accessibility to potable water and sanitation on the incidence of diarrhea among under-five children. The findings from the research reveal that the majority of children have access to safe drinking water, although a substantial percentage (32%) of the households had to pay for access. The results of the logistic regression model show that households with access to clean water, to improved toilet facilities, and to water within their residence are less likely to record incidence of diarrhea among under-five children. Moreso, the likelihood of reporting diarrhea among the children decreases with the age of children and the age of household heads. Therefore, to contribute to the designing policies targeted at reducing the incidence of diarrhea among children, this study emphasized that the availability and accessibility of clean water, water-storage facilities, and improved fecal discharge facilities among the South African households are key.
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Affiliation(s)
- Abiodun Olusola Omotayo
- Food Security and Safety Niche Area, Faculty of Natural and Agricultural Sciences, North-West University, Private Bag X2046, Mmabatho, North West Province, 2745, South Africa.
| | - Kehinde Oluseyi Olagunju
- Economics Research Branch, Agri-Food and Biosciences Institute (AFBI), 18a Newforge Lane, Belfast, BT9 5PX, UK
| | | | - Adebayo Isaiah Ogunniyi
- International Food Policy Research Institute (IFPRI), Oro-Ago Crescent Garki II, Abuja, 901101, Nigeria
| | - Olutosin Ademola Otekunrin
- Department of Agricultural Economics and Farm Management, Federal University of Agriculture, (FUNAAB), Abeokuta, Nigeria
| | - Adebola Saidat Daud
- Oyo State College of Agriculture and Technology, P.M.B. 10, Igboora, Oyo State, Nigeria
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20
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Deierlein AL, Antoniak K, Chan M, Sassano C, Stein CR. Pregnancy-related outcomes among women with physical disabilities: A systematic review. Paediatr Perinat Epidemiol 2021; 35:758-778. [PMID: 34431112 DOI: 10.1111/ppe.12781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/21/2021] [Accepted: 05/02/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Disability among women of reproductive age is common; many of these women desire children and do not have impaired fertility. OBJECTIVES To examine the epidemiological literature on perinatal health outcomes among women with physical disabilities. DATA SOURCES We searched Medline and CINAHL for articles published January 2009-April 2020 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. STUDY SELECTION AND DATA EXTRACTION Eligible studies were observational, quantitative, and reported on physical disabilities in association with prenatal, perinatal, postpartum, and/or infant health outcomes. We included studies that grouped physical and non-physical disabilities, such as surveys that queried only about general daily life limitations. We excluded case reports, descriptive studies without comparison groups, and studies conducted in low- or middle-income countries. Data extraction was done using predefined data fields. SYNTHESIS All authors were involved in screening activities, data extraction, and/or quality assessment (rating and areas for bias). RESULTS A total of 2650 articles were evaluated, of which sixteen met inclusion criteria (8 cross-sectional studies and 8 retrospective cohort studies). Assessments of disability status and perinatal outcomes widely varied across studies. Studies were rated as poor (n = 8) or fair quality (n = 8). Findings suggested that women with physical disabilities were at risk of several adverse outcomes, including caesarean delivery, infections, preterm complications, and maternal post-delivery hospitalisations, while their infants may be at risk of low birthweight and small-for-gestational age. Women classified as having complex/severe disabilities were often observed to be at higher risk of adverse outcomes compared to women with less severe disabilities. CONCLUSIONS Research assessing how physical, functional, and medical restrictions influence health outcomes among women with physical disabilities, from preconception through postpartum, is limited. Longitudinal studies with comprehensive data collection that accurately identify women with physical disabilities are critical to understanding their reproductive health risks and outcomes.
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Affiliation(s)
| | | | - Melany Chan
- School of Global Public Health, New York University, New York, NY, USA
| | - Caprice Sassano
- School of Global Public Health, New York University, New York, NY, USA
| | - Cheryl R Stein
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at New York University, New York, NY, USA
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21
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Reid N, Weerasekera S, Hubbard RE, Gordon EH. Frailty in ethnic minority women. Maturitas 2021; 152:26-31. [PMID: 34674805 DOI: 10.1016/j.maturitas.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
In majority populations in high- and middle-income countries, women live longer yet experience higher levels of frailty than men of the same age. It is unclear whether this 'sex-frailty paradox' is present in ethnic minority populations. In this narrative review, we explore biological, behavioural and social factors associated with mortality, morbidity and frailty in women, particularly ethnic minority women. We ascertain that natural menopause occurs earlier in women of particular ethnicities. Ethnic minority women (living in high-income countries) have more children and higher rates of chronic disease and disability, all of which are associated with frailty. In some ethnic minorities, women are less likely to engage in deleterious health behaviours such as smoking and alcohol consumption. However, in others the reverse is true. Women from migrant ethnic minorities tend to have lower levels of physical activity. With time, they can also adopt adverse behavioural patterns of the majority population. Although the evidence is sparse, sex differences in health reporting and social assets, as well as gender roles, are likely to contribute to sex differences in frailty in ethnic minorities. Overall, ethnic minority women are a particularly vulnerable group, but the majority of risk factors for frailty appear to be mutable rather than fixed. Future research may examine interventions that target frailty in different races and ethnicities at individual, population and global levels.
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Affiliation(s)
- Natasha Reid
- Faculty of Medicine, The University of Queensland, Queensland, Australia.
| | - Shavini Weerasekera
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Queensland, Australia; School of Medicine, Griffith University, Queensland, Australia
| | - Ruth E Hubbard
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Queensland, Australia
| | - Emily H Gordon
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Queensland, Australia
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22
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Eisenberg Y, Vanderbom KA, Harris K, Herman C, Hefelfinger J, Rauworth A. Evaluation of the Reaching People with Disabilities through Healthy Communities Project. Disabil Health J 2021; 14:101061. [PMID: 33516725 DOI: 10.1016/j.dhjo.2021.101061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND People with disabilities experience disparities in chronic diseases, such as obesity, heart disease, and diabetes, in disproportionate numbers. Research suggests that healthy communities initiatives that work to implement policy, systems and environmental (PSE) changes can help reduce these disparities by improving access to healthy choices for community residents with disabilities. However, healthy communities efforts to implement PSE changes are often not inclusive of people with disabilities. OBJECTIVE The purpose of this paper is to evaluate the implementation of an Inclusive Healthy Communities Model that was designed to reach people with disabilities through inclusive PSE changes. METHODS Professionals from local public health agencies and disability organizations in 10 diverse communities worked to infuse disability inclusion into PSE changes promoting healthy living. Data on PSE implementation was collected and coded into categories to describe the nature of the inclusive PSEs. RESULTS Communities implemented 507 inclusive PSEs, 466 of which were environmental changes, 25 systems changes, and 16 policy changes. A large majority of PSEs were related to improving the built environment to facilitate access to public spaces, such as parks, playgrounds, and community gardens. Many communities also implemented policy and systems changes related to the addition of inclusion into existing policies, community plans, and ongoing training of staff. CONCLUSION Integrating disability inclusion into traditional healthy communities efforts can facilitate improved access and opportunity for healthy living among people with disabilities. This pilot project has implications for public health workforce training, current practices, and PSE development with interdisciplinary teams and multisectoral coalitions.
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Affiliation(s)
- Yochai Eisenberg
- Department of Disability and Human Development, University of Illinois at Chicago, 1640 W. Roosevelt Rd. M/C 626, Chicago, IL 60608, USA.
| | - Kerri A Vanderbom
- University of Alabama at Birmingham/Lakeshore Research Collaborative, 4000 Ridgeway Dr., Birmingham, AL 35209, USA.
| | - Karma Harris
- National Association of Chronic Disease Directors, 325 Swanton Way, Atlanta, GA 30030 USA.
| | - Casey Herman
- National Center on Health Physical Activity and Disability/Lakeshore Foundation, 4000 Ridgeway Dr., Birmingham, AL 35209, USA
| | - Jennie Hefelfinger
- National Association of Chronic Disease Directors, 325 Swanton Way, Atlanta, GA 30030 USA.
| | - Amy Rauworth
- National Center on Health Physical Activity and Disability/Lakeshore Foundation, 4000 Ridgeway Dr., Birmingham, AL 35209, USA.
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23
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Lee MS, Peart JR, Armin JS, Williamson HJ. A Scoping Review of Barriers and Facilitators to Pap Testing in Women with Disabilities and Serious Mental Illnesses: Thirty Years After the Americans with Disabilities Act. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2021; 14:25-56. [PMID: 38550304 PMCID: PMC10978025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/01/2024]
Abstract
Background Thirty years after the Americans with Disabilities Act (ADA) was passed, promising equal access to health services for people with disabilities and serious mental illness, research on Pap testing continues to uncover health disparities among women with disabilities and women with serious mental illnesses, including those that identify as an ethnic/racial minority. Aim The purpose of this paper is to describe and present the literature on the barriers and facilitators women with disabilities and women with serious mental illnesses face with receiving a Pap test using the social ecological model. We also examined the degree to which racial/ethnic minority women were included in these articles. Method A scoping review was conducted where the research team searched United States academic literature from 1990 through February 2020 in PubMed, Medline, and CINAHL using general subject headings for disability, mental illness, and Pap testing. Results Thirty-two articles met inclusion criteria. More barriers than facilitators were mentioned in articles. Barriers and facilitators are organized into three groups according to social ecological model and include individual (e.g., socioeconomic status, anxiety, education), interpersonal (e.g., family, living environment), and organizational factors (health care provider training, health care system). Participant's race/ethnicity were often reported but minoritized populations were often not the focus of articles. Conclusions More articles discussed the difficulties that women with disabilities and women with serious mental illnesses face with receiving a Pap test than facilitators to Pap testing. Additional research should focus on the intersectionality race/ethnicity and women with disabilities and women with serious mental illnesses in relation to Pap testing.
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Affiliation(s)
- Michele Sky Lee
- The Institute for Human Development, Northern Arizona University
| | | | - Julie S Armin
- Department of Family and Community Medicine, College of Medicine-Tucson, The University of Arizona
| | - Heather J Williamson
- Center for Health Equity Research and Department of Occupational Therapy, Northern Arizona University
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24
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Jesus TS, Kamalakannan S, Bhattacharjya S, Bogdanova Y, Arango-Lasprilla JC, Bentley J, Gibson BE, Papadimitriou C. People with Disabilities and Other Forms of Vulnerability to the COVID-19 Pandemic: Study Protocol for a Scoping Review and Thematic Analysis. Arch Rehabil Res Clin Transl 2020; 2:100079. [PMID: 32839757 PMCID: PMC7438226 DOI: 10.1016/j.arrct.2020.100079] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To develop a protocol for a scoping review mapping as well as thematically analyzing the literature on the effect of, and responses to, the coronavirus disease 2019 (COVID-19) pandemic, focused on people with disabilities with other layers of individual vulnerability or social disadvantage. METHODS We will search scientific databases (Medline/PubMed, Web of Science, Scopus, AgeLine, PsycINFO, CINAHL, ERIC) and preprint servers (MedRxiv, SocArXiv, PsyArXiv). Google searches, snowballing, and key-informant strategies were also used, including a focus on the gray literature (eg, official reports). Peer-reviewed and preprint publications will be covered in 6 languages, and the gray literature in English. Publications will be included if they address individuals with disabilities; the COVID-19 pandemic or subsequent socioeconomic or occupational effects; and individual or social vulnerabilities, including any form of discrimination, marginalization, or social disadvantage. Two independent reviewers will perform eligibility decisions and key data extractions. Beyond mapping the literature, the results will thematically analyze any disproportionate risks people with disabilities and other forms of vulnerability experience in terms of being infected by COVID-19, having severe health consequences, and facing negative socioeconomic effects. Actions taken or recommended to reduce identified inequalities will also be synthesized. Our entire research team, with diverse backgrounds, will be involved in the synthesis. CONCLUSIONS This review, which we plan to expedite, aims to inform policy makers, health authorities, disability advocates, and other stakeholders regarding the needs and ways to promote equity and disability-inclusive responses to the COVID-19 pandemic and the resultant socioeconomic shockwaves.
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Affiliation(s)
- Tiago S. Jesus
- Global Health and Tropical Medicine and WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
- Department of Occupational Therapy, College of Health & Rehabilitation Sciences, Sargent College, Boston University, Boston, MA
| | - Sureshkumar Kamalakannan
- Public Health Foundation of India, South Asia Centre for Disability Inclusive Development and Research, Indian Institute of Public Health–Hyderabad, Hyderabad, India
| | - Sutanuka Bhattacharjya
- Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA
| | - Yelena Bogdanova
- Physical Medicine & Rehabilitation Service, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Juan Carlos Arango-Lasprilla
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Jacob Bentley
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Barbara E. Gibson
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Christina Papadimitriou
- School of Health Sciences, Departments of Interdisciplinary Health Sciences, and Sociology, Oakland University, Rochester, MI
| | - Refugee Empowerment Task Force, International Networking Group of the American Congress of Rehabilitation Medicine
- Global Health and Tropical Medicine and WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
- Department of Occupational Therapy, College of Health & Rehabilitation Sciences, Sargent College, Boston University, Boston, MA
- Public Health Foundation of India, South Asia Centre for Disability Inclusive Development and Research, Indian Institute of Public Health–Hyderabad, Hyderabad, India
- Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA
- Physical Medicine & Rehabilitation Service, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, Leioa, Spain
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- School of Health Sciences, Departments of Interdisciplinary Health Sciences, and Sociology, Oakland University, Rochester, MI
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25
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Rubenstein E, Ehrenthal DB, Mallinson DC, Bishop L, Kuo HH, Durkin M. Pregnancy complications and maternal birth outcomes in women with intellectual and developmental disabilities in Wisconsin Medicaid. PLoS One 2020; 15:e0241298. [PMID: 33108397 PMCID: PMC7591078 DOI: 10.1371/journal.pone.0241298] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/12/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Women with intellectual and developmental disabilities (IDD) may face greater risk for poor pregnancy outcomes. Our objective was to examine risk of maternal pregnancy complications and birth outcomes in women with IDD compared to women without IDD in Wisconsin Medicaid, from 2007-2016. METHODS Data were from the Big Data for Little Kids project, a data linkage that creates an administrative data based cohort of mothers and children in Wisconsin. Women with ≥1 IDD claim the year before delivery were classified as having IDD. Common pregnancy complications and maternal birth outcomes were identified from the birth record. We calculated risk ratios (RR) using log-linear regression clustered by mother. We examined outcomes grouped by IDD-type and explored interaction by race. RESULTS Of 177,691 women with live births, 1,032 (0.58%) had an IDD claim. Of 274,865 deliveries, 1,757 were to mothers with IDD (0.64%). Women with IDD were at greater risk for gestational diabetes (RR: 1.28, 95% CI: 1.0, 1.6), gestational hypertension (RR: 1.22, 95% CI: 1.0, 1.5), and caesarean delivery (RR 1.32, 95% CI: 1.2, 1.4) compared to other women. Adjustment for demographic covariates did not change estimates. Women with intellectual disability were at highest risk of gestational hypertension. Black women with IDD were at higher risk of gestational hypertension than expected under a multiplicative model. CONCLUSIONS Women with IDD have increased risk of pregnancy complications and adverse outcomes in Wisconsin Medicaid. Results were robust to adjustment. Unique patterns by IDD types and Black race warrant further exploration.
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Affiliation(s)
- Eric Rubenstein
- Waisman Center, University of Wisconsin Madison, Madison, WI, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Deborah B. Ehrenthal
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - David C. Mallinson
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Center for Demography and Ecology, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Lauren Bishop
- Waisman Center, University of Wisconsin Madison, Madison, WI, United States of America
- Sandra Rosesnbaum School of Social Work, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Hsiang-Huo Kuo
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Maureen Durkin
- Waisman Center, University of Wisconsin Madison, Madison, WI, United States of America
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
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High prevalence of disability and HIV risk among low socioeconomic status urban adults, 17 U.S. cities. Disabil Health J 2019; 13:100834. [PMID: 31427202 DOI: 10.1016/j.dhjo.2019.100834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/06/2019] [Accepted: 08/09/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND In the United States, approximately 10% of adults 18-64 years are disabled. However, there is scarce literature on the associations between disability and HIV risk. OBJECTIVE To assess disability prevalence and its associations to health and HIV risk factors among low socioeconomic status (SES) (≤high school education or ≤ poverty guidelines) urban adults. METHODS We assessed disability prevalence from a cross-sectional sample of low SES urban heterosexually active adults at risk for HIV participating in the 2016 National HIV Behavioral Surveillance (NHBS) and calculated crude and adjusted prevalence ratios and 95% confidence intervals of disability for health and HIV risk behaviors. RESULTS In the NHBS sample, 39.6% of participants reported any disability. Disability was associated with health care utilization and risk behaviors, even when adjusting for demographics. Participants with disabilities were more likely to have condomless sex with a casual partner and engage in exchange sex. CONCLUSIONS Low SES urban heterosexually active adults reported high prevalence of disabilities and differences in health, health care utilization, and risk factors. Disability might contribute to sexual risk behaviors that increase the likelihood of HIV infection. Further investigations into the intersection of disability and HIV risk are needed, especially in poor communities often excluded from national assessments.
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Heidinger M, Simonnet E, Karippadathu SF, Puchinger M, Pfeifer J, Grisold A. Analysis of Social Determinants of Health and Disability Scores in Leprosy-Affected Persons in Salem, Tamil Nadu, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2769. [PMID: 30563301 PMCID: PMC6313506 DOI: 10.3390/ijerph15122769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 12/05/2022]
Abstract
A consistent relationship has been found between leprosy and inequities in social determinants of health. It, however, remains unclear which aspect of these social determinants contributes most to the risk of infection, and even less clear are the risk factors for the development of leprosy-related disabilities. The objective of this study was to elicit the differential impact of social determinants of health in leprosy-affected persons, and determine whether structural inequities in accessibility to societal resources and lower socioeconomic parameters correlated with higher severity of disabilities. This analysis was based on a sampled population affected by leprosy in Salem, Tamil Nadu, India. Persons enrolled in the study were covered by a nongovernmental lifelong care program, had completed a multidrug therapy for leprosy and/or were slit-skin-smear negative, and showed Grade 1 or higher disabilities due to leprosy. Multiple stepwise linear regression analysis was performed. The Eyes-Hands-Feet (EHF) score was the outcome variable, and gender, age, time after release from treatment, monthly income, and living space were explanatory variables. There were 123 participants, comprised of 41 (33.33%) women and 82 (66.67%) men. All study participants belonged to India's Backward classes; 81.30% were illiterate and the average monthly income was 1252 Indian rupee (INR) (US$19.08 or €17.16). The average EHF score was 7.016 (95% CI, 6.595 to 7.437). Stepwise multiple linear regression analysis built a significant model, where F(2, 120) = 13.960, p ≤ 0.001, effect size (Cohen's f2) = 0.81, explaining 18.9% of the variance in EHF scores (R² = 0.189). Significant predictors of a higher EHF score in persons affected by leprosy were found to be higher age (beta = 0.340, 95% CI, 0.039 to 0.111, p < 0.001), as well as less living space (beta = -0.276, 95% CI, -0.041 to -0.011, p = 0.001). Our results suggest that inequalities in social determinants of health correspond to higher disability scores, which indicates that poor living standards are a common phenomenon in those living with leprosy-related disabilities. Further research is needed to dissect the exact development of impairments after release from treatment (RFT) in order to take targeted actions against disability deterioration.
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Affiliation(s)
- Martin Heidinger
- Global Health and Development, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
| | - Elisa Simonnet
- Global Health and Development, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
| | - Sr Francina Karippadathu
- Doctor Typhagne Memorial Charitable Trust, S.M.M.I. Convent Staff Quarters, St. Mary's Hospital Campus, Arisipalayam, Salem, Tamil Nadu 636009, India.
| | - Markus Puchinger
- Research Unit for Medical Engineering and Computing, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
| | - Johann Pfeifer
- Global Health and Development, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
- Department of General and Visceral Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
| | - Andrea Grisold
- Global Health and Development, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
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Managing the Social Determinants of Health: Part I: Fundamental Knowledge for Professional Case Management. Prof Case Manag 2018; 23:107-129. [PMID: 29601423 DOI: 10.1097/ncm.0000000000000281] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES PRIMARY PRACTICE SETTING(S):: Applicable to health and behavioral health settings, wherever case management is practiced. FINDING/CONCLUSION The SDH pose major challenges to the health care workforce in terms of effective resource provision, health and behavioral health treatment planning plus adherence, and overall coordination of care. Obstacles and variances to needed interventions easily lead to less than optimal outcomes for case managers and their health care organizations. Possessing sound knowledge and clear understanding of each SDH, the historical perspectives, main theories, and integral dynamics, as well as creative resource solutions, all support a higher level of intentional and effective professional case management practice. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Those persons and communities impacted most by the SDH comprise every case management practice setting. These clients can be among the most vulnerable and disenfranchised members of society, which can easily engender biases on the part of the interprofessional workforce. They are also among the costliest to care for with 50% of costs for only 5% of the population. Critical attention to knowledge about managing the SDH leverages and informs case management practice, evolves more effective programming, and enhances operational outcomes across practice settings.
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Palmera-Suárez R, López-Cuadrado T, Fernández-Cuenca R, Alcalde-Cabero E, Galán I. Inequalities in the risk of disability due to traffic injuries in the Spanish adult population, 2009-2010. Injury 2018; 49:549-555. [PMID: 29433800 DOI: 10.1016/j.injury.2018.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/21/2017] [Accepted: 02/06/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although traffic injuries (TIs) are an important cause of disability the related factors are little known. We aimed to estimate the differences in risk of TI-related disability according to individual characteristics that might generate health inequalities. METHODS Cross-sectional study using a representative Spanish population sample drawn from the European Health Interview Survey 2009/2010. We calculated traffic crashes in the preceding year which resulted in injuries. Disability was measured using the Global Activity Limitation Indicator and four indicators of limitations (sensory, physical functional, self-care and domestic activities). Principal socio-demographic and behavioural/lifestyle variables were studied. We used multivariate logistic regression to estimate the risk (ORs) of TI-related disability in the sample as whole and disability-related factors in persons who had experienced TIs. RESULTS Persons with TIs had a higher risk of global disability (OR = 1.61; 95%CI:1.17-2.20), physical functional limitations (OR = 1.96; 95%CI:1.33-2.89) and self-care limitations (OR = 1.73; 95%CI:0.98-3.05). Among persons with TIs, GALI-related risk was higher in women (OR = 3.06, p = 0.002) and persons aged over 30 years (OR31-45years = 6.81, p < 0.001; OR46-64years = 5.96, p = 0.011; OR>64years = 4.54, p = 0.047). Lower risk was observed among persons with a higher educational level (OR = 0.22, p = 0.003). The risk of disability among persons with TIs who consumed illegal drugs was OR = 3.9 (p = 0.023). CONCLUSIONS Traffic injuries in the preceding year are associated with higher risk of disability, which is unevenly distributed. Individual (women and persons over 30 years), socio-economic (lower educational level) and behavioural (illegal drug use) factors are involved. Actions aimed at changing the unequal risk among vulnerable subgroups and providing health, social and protective services should be implemented.
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Affiliation(s)
- Rocío Palmera-Suárez
- Department of Epidemiological Analysis and Health Status, National Centre for Epidemiology, Carlos III Institute of Health, Calle Monforte de Lemos 5, Pabellón 12, PC 28029, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), National Centre for Epidemiology, Carlos III Institute of Health, Calle Monforte de Lemos 5, Pabellón 12, PC 28029, Madrid, Spain.
| | - Teresa López-Cuadrado
- Department of Epidemiological Analysis and Health Status, National Centre for Epidemiology, Carlos III Institute of Health, Calle Monforte de Lemos 5, Pabellón 12, PC 28029, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Autonomous University of Madrid/IdiPAZ (Instituto de Investigación del Hospital Universitario La Paz/La Paz University Teaching Hospital Research Institute), Calle del Arzobispo Morcillo 4, PC 28029, Madrid, Spain.
| | - Rafael Fernández-Cuenca
- Department of Epidemiological Analysis and Health Status, National Centre for Epidemiology, Carlos III Institute of Health, Calle Monforte de Lemos 5, Pabellón 12, PC 28029, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), National Centre for Epidemiology, Carlos III Institute of Health, Calle Monforte de Lemos 5, Pabellón 12, PC 28029, Madrid, Spain.
| | - Enrique Alcalde-Cabero
- Department of Applied Epidemiology, National Centre for Epidemiology, Carlos III Institute of Health, Calle Monforte de Lemos 5, Pabellón 12, PC 28029, Madrid, Spain.
| | - Iñaki Galán
- Department of Applied Epidemiology, National Centre for Epidemiology, Carlos III Institute of Health, Calle Monforte de Lemos 5, Pabellón 12, PC 28029, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Autonomous University of Madrid/IdiPAZ (Instituto de Investigación del Hospital Universitario La Paz/La Paz University Teaching Hospital Research Institute), Calle del Arzobispo Morcillo 4, PC 28029, Madrid, Spain.
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Cervantes A, Singh RG, Pendharkar SA, Bharmal SH, Petrov MS. Profile of Gut Hormones, Pancreatic Hormones and Pro-inflammatory Cytokines in New Zealand Maori. Gastroenterology Res 2018; 11:280-289. [PMID: 30116427 PMCID: PMC6089586 DOI: 10.14740/gr1042w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/28/2018] [Indexed: 12/11/2022] Open
Abstract
Background Maori, indigenous people of New Zealand, have at least two times higher prevalence of obesity and diabetes in comparison with the general population in the country. Gut and pancreatic hormone profile differences as well as pro-inflammatory milieu may contribute to this disparity. The aim was to investigate the differences in gut hormones, pancreatic hormones and pro-inflammatory cytokines between Maori and non-Maori individuals. Methods This was a cross-sectional study. Fasting blood samples were collected to measure cholecystokinin, ghrelin, gastric inhibitory peptide, glicentin, glucagon-like peptide-1 and -2, oxyntomodulin, secretin, amylin, C-peptide, glucagon, insulin, pancreatic polypeptide, somatostatin, interleukin-6, monocyte chemoattractant protein-1 and tumour necrosis factor-α. Binary logistic regression analysis was conducted in one unadjusted and four adjusted statistical models adjusting for patient-, metabolic- and pancreatitis-related factors. Results A total of 8 Maori and 85 non-Maori individuals were included. Circulating levels of ghrelin, pancreatic polypeptide and interleukin-6 levels were significantly higher in Maori (P = 0.005, P = 0.003 and P = 0.011, respectively) in both unadjusted and all the four adjusted analyses. Other signaling molecules did not show consistently significant associations with ethnicity. Conclusion Profile of gut hormones, pancreatic hormones and pro-inflammatory cytokines appears to differ between Maori and non-Maori individuals, independent of obesity, diabetes and other covariates. This may go some way to explain the increased propensity to obesity and diabetes in the Maori population.
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Affiliation(s)
- Aya Cervantes
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Ruma G Singh
- School of Medicine, University of Auckland, Auckland, New Zealand
| | | | - Sakina H Bharmal
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Maxim S Petrov
- School of Medicine, University of Auckland, Auckland, New Zealand
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Papas MA, Stolz N, Orsega-Smith E, Sparling E, Freedman B. The Importance of Inclusion for Cardiovascular Health Promotion Programs in Delaware. Health Promot Pract 2017; 19:256-266. [PMID: 28573871 DOI: 10.1177/1524839917704209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Individuals with disabilities experience greater rates of cardiovascular disease than individuals without disabilities. This increase can be attributed to decreased levels of physical activity, poor eating habits, and increased levels of diabetes, smoking, and obesity. Individuals with disabilities are often excluded from surveillance, treatment, and prevention efforts. Consequently, there is little known about their participation rates in health promotion and disease prevention programs. The aims of this investigation are (1) to examine time trends in cardiovascular disease and risk factors over a 10-year period by disability status and (2) to assess the inclusiveness of health promotion programs in Delaware. The percentage of individuals with disabilities increased from 18% in 2001 to 28% in 2011. Individuals with disabilities had higher rates of cardiovascular disease (t = 80.45; degrees of freedom [df] = 198; p < .0001) and obesity (body mass index > 30 kg/m2) than individuals without disabilities (t = 33.0; df = 198; p < .0001). They also reported less physical activity (t = 44.21; df = 198; p < .0001) and worse diet quality (t = 4.70; df = 198; p < .0001). There was a consistent lack of information about inclusion and participation of individuals with disabilities in health promotion programs. Making adaptations within cardiovascular disease prevention programs in Delaware is imperative to improving the health of individuals with disabilities. Ensuring cardiovascular disease programs are accessible and provide disability-specific trained staff will reduce barriers to participation so that all individuals can benefit.
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