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Rodríguez M, Camacho JA. Rural-urban differences in the perceived impact of COVID-19 on mental health by European women. Arch Womens Ment Health 2024; 27:547-555. [PMID: 38347220 PMCID: PMC11230959 DOI: 10.1007/s00737-024-01443-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 02/05/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE Many studies have documented an adverse impact of the pandemic on women´s mental health. This cross-sectional study aims to explore associations between women's perceived impact of lockdowns and curfews on their mental health and their residential location, along with other contextual and individual factors. METHODS Using data from the Flash Eurobarometer 2712 "Women in times of COVID-19", conducted between January 25 and February 3, 2022, across the 27 Member States of the European Union (n = 23,671), this study applied bivariate tests and stratified models based on respondent location (rural areas, small or medium-sized towns and urban areas). The exploration sought predictors influencing the perceived mental health impact, encompassing five individual characteristics (age, disability, employment status, educational attainment, and household type), perceptions of violence against women, and country of residence. The dependent variable was assessed subjectively, measured on a scale from 1 (minor negative impact) to 5 (major negative impact). RESULTS Women living in urban areas generally reported a higher perceived negative impact on mental health compared to women in rural areas or in small/medium-sized towns. Age and disability were significantly linked to perceiving a negative impact on mental health. Similar adjusted odds ratios for age were observed across rural areas (aOR 0.97, 95% CI = 0.97-0.98), small or medium-sized towns (aOR 0.98, 95% CI = 0.97-0.98), and urban areas (aOR 0.97, 95% CI = 0.97-0.98). In terms of disability, the odds were higher in rural areas (aOR 1.44, 95% CI = 1.20-1.73) than in urban ones (aOR 1.36, 95% CI = 1.15-1.62). Among women residing in urban areas, those in childless couples were less likely to perceive a negative impact on mental health (aOR 0.89, 95% CI = 0.80-0.99) compared to women in couples with children. Respondents perceiving increased violence against women due to COVID-19 were more likely to perceive a negative impact on mental health, with higher odds ratios in rural areas (aOR 1.56, 95% CI = 1.40-1.74) compared to urban areas (aOR 1.29, 95% CI = 1.17-1.41). Differences across countries were also found. CONCLUSION The perceived impact of lockdowns and curfews on mental health exhibited variance between urban and rural areas. These disparities were influenced by individual characteristics such as age, disability, or household type, as well as the effects of COVID-19 on violence against women and contextual variables like country of residence.
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Affiliation(s)
- Mercedes Rodríguez
- Institute of Regional Development, University of Granada, Calle Rector López Argüeta. Edificio Centro de Documentación Científica, 3ª Planta, 18071, Granada, Spain.
| | - José A Camacho
- Institute of Regional Development, University of Granada, Calle Rector López Argüeta. Edificio Centro de Documentación Científica, 3ª Planta, 18071, Granada, Spain
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Mackwood M, Pashchenko O, Leggett C, Fontanet C, Skinner J, Fisher E. Telehealth Trends and Hypertension Management Among Rural and Medicaid Patients After COVID-19. Telemed J E Health 2024; 30:e1677-e1688. [PMID: 38457122 PMCID: PMC11296195 DOI: 10.1089/tmj.2023.0628] [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: 11/20/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 03/09/2024] Open
Abstract
Objective: Examine the associations between rurality and low income with primary care telehealth utilization and hypertension outcomes across multiple years pre- and post-COVID-19 pandemic onset. Methods: We compiled electronic health record data from the mixed rural/urban Dartmouth Health system in New Hampshire, United States, on patients with pre-existing hypertension or diabetes receiving primary care in the period before (January 2018-February 2020) and after the transition period to telehealth during the COVID-19 Pandemic (October 2020-December 2022). Stratifying by rurality and Medicaid enrollment, we examined changes in synchronous (office and telehealth visits, including audio/video use) and asynchronous (patient portal or telephone message) utilization, and control of mean systolic blood pressure (SBP) <140. Results: Analysis included 46,520 patients, of whom 8.2% were Medicaid enrollees, 42.7% urban residents. Telehealth use rates were 12% for rural versus 6.4% for urban, and 15% for Medicaid versus 8.4% non-Medicaid. The overall postpandemic telehealth visit rate was 0.29 per patient per year. Rural patients had a larger increase in telehealth use (additional 0.21 per year, 95% CI, 0.19-0.23) compared with urban, as did Medicaid (0.32, 95% CI 0.29-0.36) compared with non-Medicaid. Among the 38,437 patients with hypertension, SBP control worsened from 83% to 79% of patients across periods. In multivariable analysis, rurality corresponded to worsened control rates compared with urban (additional 2.4% decrease, 95% CI 2.1-2.8%); Medicaid and telehealth use were not associated with worsened control. Conclusions: Telehealth expansion enabled a higher shift to telehealth for rural and low-income patients without impairing hypertension management.
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Affiliation(s)
- Matthew Mackwood
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, New Hampshire, USA
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Oleksandra Pashchenko
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Full Circle Health Family Medicine Residency, Boise, Idaho, USA
| | - Christopher Leggett
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | - Jonathan Skinner
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Economics, Dartmouth College, Lebanon, New Hampshire, USA
| | - Elliott Fisher
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Asdaq SMB, Alshehri S, Alajlan SA, Almutiri AA, Alanazi AKR. Depression in persons with disabilities: a scoping review. Front Public Health 2024; 12:1383078. [PMID: 38779421 PMCID: PMC11110534 DOI: 10.3389/fpubh.2024.1383078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
Individuals with disabilities are more vulnerable to depression development than the general population. This study sought to map the evidence on current knowledge of depression, intervention strategies, and assessment tools among people with disabilities. This review was conducted following Arksey and O'Malley's scoping review methodology framework. An electronic search was performed on four English databases: PubMed, Cochrane Library, PsycINFO, and Web of Science. The original search returned 1802 results, with 1,116 from Web of Science, 626 from PubMed, 25 from Cochrane, and 35 from PsycINFO. After removing duplicates, 786 articles were chosen for the title and abstract screening processes. Finally, 112 full-text publications were deemed eligible, with 41 papers being included in this scoping review for analysis. A large proportion (32; 78.04%) of the studies chosen were cross-sectional, 14 (34.14%) of them reported general disability, 12 (29.26%) used a patient health questionnaire (PHQ-9) to measure depression, and 14 (34.14%) had interventions, including cognitive behavioral therapy, psychological counseling, social support, and physical activity. All interventions successfully reduced the severity of the depression. Cognitive behavioral therapies and psychological counseling were widely used interventions that had a significant impact on reducing depression. More randomized controlled trials are required, and they should focus on individuals with specific disabilities to provide disability-specific care that can improve the quality of life for disabled individuals.
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Valdez A. Understanding Disability and Ableism in Nursing Continuing Education. J Contin Educ Nurs 2024; 55:210-211. [PMID: 38687100 DOI: 10.3928/00220124-20240411-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
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Sahyoun L, Chen K, Tsay C, Chen G, Protiva P. Clinical and socioeconomic determinants of survival in biliary tract adenocarcinomas. World J Gastrointest Oncol 2024; 16:1374-1383. [PMID: 38660666 PMCID: PMC11037051 DOI: 10.4251/wjgo.v16.i4.1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/16/2023] [Accepted: 02/01/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Despite advances in detection and treatments, biliary tract cancers continue to have poor survival outcomes. Currently, there is limited data investigating the significance of socioeconomic status, race/ethnicity, and environmental factors in biliary tract cancer survival. AIM To investigate how socioeconomic status and race/ethnicity are associated with survival. METHODS Data from the Surveillance, Epidemiology, and End Results database for biliary and gallbladder adenocarcinomas were extracted from 1975 to 2016. Socioeconomic data included smoking, poverty level, education, adjusted household income, and percentage of foreign-born persons and urban population. Survival was calculated with Cox proportional hazards models for death in the 5-year period following diagnosis. RESULTS Our study included 15883 gallbladder, 11466 intrahepatic biliary, 12869 extrahepatic biliary and 7268 ampulla of Vater adenocarcinoma cases. When analyzing county-specific demographics, patients from counties with higher incomes were associated with higher survival rates [hazard ratio (HR) = 0.97, P <0.05]. Similarly, counties with a higher percentage of patients with a college level education and counties with a higher urban population had higher 5-year survival rates (HR = 0.96, P = 0.002 and HR = 0.97, P = 0.004, respectively). CONCLUSION Worse survival outcomes were observed in lower income counties while higher income and education level were associated with higher 5-year overall survival among gallbladder and biliary malignancies.
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Affiliation(s)
- Laura Sahyoun
- Department of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY 10065, United States
| | - Kay Chen
- Gastroenterology Section, Jennifer Moreno VA San Diego Healthcare System, San Diego, CA 92161, United States
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA 92093, United States
| | - Cynthia Tsay
- Department of Gastroenterology and Hepatology, John Hopkins Hospital, Baltimore, MD 21287, United States
| | - George Chen
- Department of Digestive Diseases, Yale New Haven Hospital, New Haven, CT 06520, United States
| | - Petr Protiva
- Department of Digestive Diseases, Yale New Haven Hospital, New Haven, CT 06520, United States
- Department of Gastroenterology, VA Connecticut Health Care System, West Haven, CT 06516, United States
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Campos L, Costa D, Donato H, Nunes B, Cruz EB. Implementation of digital health in rural populations with chronic musculoskeletal conditions: A scoping review protocol. PLoS One 2023; 18:e0291638. [PMID: 38134049 PMCID: PMC10745161 DOI: 10.1371/journal.pone.0291638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Musculoskeletal conditions are a major source of disability worldwide, and its burden have been rising in the last decades. Rural areas, in particular, are associated with higher prevalence of these conditions as well as higher levels of disability, which is likely related to other determinants that affect these communities. Although digital health has been identified as a potential solution to mitigate the impact of these determinants, it is also known that these populations may face barriers that limit the implementation of these interventions. Therefore, the aim of this scoping review is to comprehensively map the evidence regarding the implementation of digital health interventions in rural populations with chronic musculoskeletal conditions. We will include studies published from the year 2000; that report the use of digital interventions that promote prevention, treatment or monitoring of any chronic musculoskeletal condition or chronic pain from musculoskeletal origin, in patients that live in rural areas. This protocol follows the methodological framework for scoping reviews proposed by Arksey and O'Malley, as well as the Joana Briggs Institute (JBI) approach. We will conduct the search on Medline (PubMed), EMBASE, Web of Science and Scopus, as well as grey literature databases. Two independent reviewers will screen titles and abstracts followed by a full-text review to assess the eligibility of the articles. Data extracted will include the identification of the digital interventions used, barriers and enablers identified by the patients or healthcare providers, the patient-level outcomes measured, and the implementation strategies and outcomes reported. By mapping the evidence on the implementation of digital health interventions in rural communities with musculoskeletal conditions, this scoping review will enhance our understanding of their applicability in real-world settings.
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Affiliation(s)
- Lara Campos
- ESS, Polytechnic Institute of Setúbal, Setúbal, Portugal
- National School of Public Health, NOVA University of Lisbon, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Lisboa, Portugal
| | - Daniela Costa
- Comprehensive Health Research Center (CHRC), Lisboa, Portugal
| | - Helena Donato
- Documentation and Scientific Information Service, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Baltazar Nunes
- National School of Public Health, NOVA University of Lisbon, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Lisboa, Portugal
- Epidemiology Department, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | - Eduardo B. Cruz
- ESS, Polytechnic Institute of Setúbal, Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), Lisboa, Portugal
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Pirlog BO, Jacob AP, Rajan SS, Yamal JM, Parker SA, Wang M, Bowry R, Czap A, Bratina PL, Gonzalez MO, Singh N, Zou J, Gonzales NR, Jones WJ, Alexandrov AW, Alexandrov AV, Navi BB, Nour M, Spokoyny I, Mackey J, Silnes K, Fink ME, Pisarro Sherman C, Willey J, Saver JL, English J, Barazangi N, Ornelas D, Volpi J, Pv Rao C, Griffin L, Persse D, Grotta JC. Outcomes of patients with pre-existing disability managed by mobile stroke units: A sub-analysis of the BEST-MSU study. Int J Stroke 2023; 18:1209-1218. [PMID: 37337357 DOI: 10.1177/17474930231185471] [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] [Indexed: 06/21/2023]
Abstract
BACKGROUND Few data exist on acute stroke treatment in patients with pre-existing disability (PD) since they are usually excluded from clinical trials. A recent trial of mobile stroke units (MSUs) demonstrated faster treatment and improved outcomes, and included PD patients. AIM To determine outcomes with tissue plasminogen activator (tPA), and benefit of MSU versus management by emergency medical services (EMS), for PD patients. METHODS Primary outcomes were utility-weighted modified Rankin Scale (uw-mRS). Linear and logistic regression models compared outcomes in patients with versus without PD, and PD patients treated by MSU versus standard management by EMS. Time metrics, safety, quality of life, and health-care utilization were compared. RESULTS Of the 1047 tPA-eligible ischemic stroke patients, 254 were with PD (baseline mRS 2-5) and 793 were without PD (baseline mRS 0-1). Although PD patients had worse 90-day uw-mRS, higher mortality, more health-care utilization, and worse quality of life than non-disabled patients, 53% returned to at least their baseline mRS, those treated faster had better outcome, and there was no increased bleeding risk. Comparing PD patients treated by MSU versus EMS, 90-day uw-mRS was 0.42 versus 0.36 (p = 0.07) and 57% versus 46% returned to at least their baseline mRS. There was no interaction between disability status and MSU versus EMS group assignment (p = 0.67) for 90-day uw-mRS. CONCLUSION PD did not prevent the benefit of faster treatment with tPA in the BEST-MSU study. Our data support inclusion of PD patients in the MSU management paradigm.
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Affiliation(s)
- Bianca O Pirlog
- Department of Neuroscience, County Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Asha P Jacob
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Suja S Rajan
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jose-Miguel Yamal
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephanie A Parker
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mengxi Wang
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ritvij Bowry
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alexandra Czap
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Patti L Bratina
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michael O Gonzalez
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Noopur Singh
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jinhao Zou
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicole R Gonzales
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William J Jones
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne W Alexandrov
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrei V Alexandrov
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Babak B Navi
- Feil Family and Brain Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - May Nour
- Department of Neurology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Ilana Spokoyny
- Department of Neurology, Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - Jason Mackey
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kelly Silnes
- University of Buckingham Medical School, Buckingham, UK
| | - Matthew E Fink
- Feil Family and Brain Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Carla Pisarro Sherman
- Feil Family and Brain Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Josh Willey
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey L Saver
- Department of Neurology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Joey English
- Department of Neurology, Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - Nobl Barazangi
- Department of Neurology, Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - David Ornelas
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jay Volpi
- Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA
| | - Chethan Pv Rao
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | | | - David Persse
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - James C Grotta
- Mobile Stroke Unit, Memorial Hermann Texas Medical Center, Houston, TX, USA
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Choi SL, Carr D, Namkung EH. Telehealth Use Among Older Adults With Sensory, Cognitive, and Physical Impairments: A Substitute or Supplement to Traditional Care? J Gerontol B Psychol Sci Soc Sci 2023; 78:1735-1746. [PMID: 37422799 DOI: 10.1093/geronb/gbad098] [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: 01/07/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVES Telehealth use flourished during the COVID-19 pandemic, as older patients faced obstacles to seeking in-person care. Heavy reliance on telehealth may continue postpandemic, due to increased Medicare investments in its use. However, it is unclear if older adults with disabilities face obstacles to effective telehealth use. We evaluate (a) how sensory, physical, and cognitive impairments affect older adults' use of telehealth only, traditional in-person care only, neither, or both (i.e., combined care); and (b) whether these patterns differ on the basis of socioeconomic and social resources that may facilitate telehealth use. METHOD Data are from the Self-Administered Questionnaire in the 2020 wave of the Health and Retirement Study (n = 4,453). We estimated multinomial logistic regression models to evaluate associations between impairments and health care service use and tested 2-way interaction terms to evaluate moderation effects. RESULTS Persons without impairments were most likely to use combined care, considered the optimal form of care. Persons with vision or cognitive impairment were more likely to use telehealth or traditional care only, whereas persons with 3 or more physical limitations were least likely to use telehealth alone, relative to combined care. Patterns did not differ significantly on the basis of any of the potential moderators. DISCUSSION We discuss implications for health care policy and practice, in light of reimbursement changes proposed by the Centers for Medicare and Medicaid Services for telehealth services. These proposals include the elimination of voice-only services which may be particularly beneficial to vision-impaired older adults.
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Affiliation(s)
- Shinae L Choi
- Department of Consumer Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Deborah Carr
- Department of Sociology and Center for Innovation in Social Science, Boston University, Boston, Massachusetts, USA
| | - Eun Ha Namkung
- Department of Social Welfare, Ewha Womans University, Seoul, South Korea
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Hameed W, Asim M, Saleem S, Avan BI. Inequalities in utilisation of essential antenatal services for women with disabilities in Pakistan: analysis of a cross-sectional demographic and health survey of Pakistan 2017-2018. BMJ Open 2023; 13:e074262. [PMID: 37487675 PMCID: PMC10373668 DOI: 10.1136/bmjopen-2023-074262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVES Although the number of disabled women entering motherhood is growing, there is little quantitative evidence about the utilisation of essential antenatal care (ANC) services by women with disabilities. We examined inequalities in the use of essential ANC services between women with and without disabilities. DESIGN, SETTING AND ANALYSIS A secondary analysis of cross-sectional data from recent Demographic and Health Survey of Pakistan 2017-2018 was performed using logistic regression. PARTICIPANTS A total weighted sample of 6791 ever-married women (age 15-49) who had a live birth in the 5 years before the survey were included. OUTCOME MEASURES Utilisation of ANC: (A) antenatal coverage: (1) received ANC and (2) completed four or more ANC visits and (B) utilisation of essential components of ANC. RESULTS The percentage of women who were at risk of disability and those living with disability in one or more domains was 11.5% and 2.6%, respectively. The coverage of ANC did not differ by disability status. With utilisation of essential ANC components, consumption of iron was lower (adjusted OR, aOR=0.6; p<0.05), while advice on exclusive breast feeding (aOR=1.6; p<0.05) and urine test (aOR=1.7; p<0.05) was higher among women with disabilities as compared with their counterparts. Similarly, the odds of receiving advice on maintaining a balanced diet was higher (aOR=1.3; p<0.05) among women at risk of any disability as opposed to their counterparts. Differences were also found for these same indicators in subgroup analysis by wealth status (poor/non-poor) and place of residence (urban-rural). CONCLUSION Our study did not find glaring inequalities in the utilisation of ANC services between women with disabilities and non-disabled women. This was true for urban versus rural residence and among the poor versus non-poor women. Some measures, however, should be made to improve medication compliance among women with disabilities.
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Affiliation(s)
- Waqas Hameed
- Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Muhammad Asim
- Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | - Sarah Saleem
- Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Bilal Iqbal Avan
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Feng J, Beheshti M, Philipson M, Ramsaywack Y, Porfiri M, Rizzo JR. Commute Booster: A Mobile Application for First/Last Mile and Middle Mile Navigation Support for People With Blindness and Low Vision. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2023; 11:523-535. [PMID: 38059065 PMCID: PMC10697290 DOI: 10.1109/jtehm.2023.3293450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/02/2023] [Accepted: 07/04/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE People with blindness and low vision face substantial challenges when navigating both indoor and outdoor environments. While various solutions are available to facilitate travel to and from public transit hubs, there is a notable absence of solutions for navigating within transit hubs, often referred to as the "middle mile". Although research pilots have explored the middle mile journey, no solutions exist at scale, leaving a critical gap for commuters with disabilities. In this paper, we proposed a novel mobile application, Commute Booster, that offers full trip planning and real-time guidance inside the station. METHODS AND PROCEDURES Our system consists of two key components: the general transit feed specification (GTFS) and optical character recognition (OCR). The GTFS dataset generates a comprehensive list of wayfinding signage within subway stations that users will encounter during their intended journey. The OCR functionality enables users to identify relevant navigation signs in their immediate surroundings. By seamlessly integrating these two components, Commute Booster provides real-time feedback to users regarding the presence or absence of relevant navigation signs within the field of view of their phone camera during their journey. RESULTS As part of our technical validation process, we conducted tests at three subway stations in New York City. The sign detection achieved an impressive overall accuracy rate of 0.97. Additionally, the system exhibited a maximum detection range of 11 meters and supported an oblique angle of approximately 110 degrees for field of view detection. CONCLUSION The Commute Booster mobile application relies on computer vision technology and does not require additional sensors or infrastructure. It holds tremendous promise in assisting individuals with blindness and low vision during their daily commutes. Clinical and Translational Impact Statement: Commute Booster translates the combination of OCR and GTFS into an assistive tool, which holds great promise for assisting people with blindness and low vision in their daily commute.
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Affiliation(s)
- Junchi Feng
- Department of Biomedical EngineeringTandon School of EngineeringNew York UniversityBrooklynNY11201USA
- Center for Urban Science and Progress, Tandon School of EngineeringNew York UniversityBrooklynNY11201USA
| | - Mahya Beheshti
- Department of Mechanical and Aerospace EngineeringTandon School of EngineeringNew York UniversityBrooklynNY11201USA
- Department of Rehabilitation MedicineNYU Langone HealthNew YorkNY10016USA
| | | | | | - Maurizio Porfiri
- Department of Biomedical EngineeringTandon School of EngineeringNew York UniversityBrooklynNY11201USA
- Center for Urban Science and Progress, Tandon School of EngineeringNew York UniversityBrooklynNY11201USA
- Department of Mechanical and Aerospace EngineeringTandon School of EngineeringNew York UniversityBrooklynNY11201USA
| | - John-Ross Rizzo
- Department of Biomedical EngineeringTandon School of EngineeringNew York UniversityBrooklynNY11201USA
- Department of Rehabilitation MedicineNYU Langone HealthNew YorkNY10016USA
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Lu H, Wang Y, Liu Y, Holt JB, Okoro CA, Zhang X, Zhang QC, Greenlund KJ. County-Level Geographic Disparities in Disabilities Among US Adults, 2018. Prev Chronic Dis 2023; 20:E37. [PMID: 37167553 DOI: 10.5888/pcd20.230004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Local data are increasingly needed for public health practice. County-level data on disabilities can be a valuable complement to existing estimates of disabilities. The objective of this study was to describe the county-level prevalence of disabilities among US adults and identify geographic clusters of counties with a higher or lower prevalence of disabilities. METHODS We applied a multilevel logistic regression and poststratification approach to geocoded 2018 Behavioral Risk Factor Surveillance System data, Census 2018 county-level population estimates, and American Community Survey 2014-2018 poverty estimates to generate county-level estimates for 6 functional disabilities and any disability type. We used cluster-outlier spatial statistical methods to identify clustered counties. RESULTS Among 3,142 counties, median estimated prevalence was 29.5% for any disability and differed by type: hearing (8.0%), vision (4.9%), cognition (11.5%), mobility (14.9%), self-care (3.7%), and independent living (7.2%). The spatial autocorrelation statistic, Moran's I, was 0.70 for any disability and 0.60 or greater for all 6 types of disability, indicating that disabilities were highly clustered at the county level. We observed similar spatial cluster patterns in all disability types except hearing disability. CONCLUSION The results suggest substantial differences in disability prevalence across US counties. These data, heretofore unavailable from a health survey, may help with planning programs at the county level to improve the quality of life for people with disabilities.
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Affiliation(s)
- Hua Lu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Population Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS S107-6, Atlanta, GA 30341
| | - Yan Wang
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James B Holt
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Catherine A Okoro
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xingyou Zhang
- Office of Compensation and Working Conditions, US Bureau of Labor Statistics, Washington, District of Columbia
| | - Qing C Zhang
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Residential trajectories across the life course and their association with cognitive functioning in later life. Sci Rep 2022; 12:17004. [PMID: 36220827 PMCID: PMC9553870 DOI: 10.1038/s41598-022-18501-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/12/2022] [Indexed: 12/29/2022] Open
Abstract
Previous work has found that later life urban-rural differences in cognitive health can be largely explained by indicators of cognitive reserve such as education or occupation. However, previous research concentrated on residence in limited, specific, periods. This study offers a detailed investigation on the association between urban (vs. rural) residence from birth, and cognitive functioning in older age. Using data from the Survey of Health Ageing and Retirement in Europe we created residential trajectories from birth to survey enrolment with a combination of sequence and cluster analysis. Using mixed-effects models, we investigated the association between residential trajectories in early, mid, and later life and three cognitive functioning outcomes: immediate recall, delayed recall, and verbal fluency. In a sample of 38,165 participants, we found that, even after accounting for differences related to education and occupation, rural (vs. urban) residence in early life remained associated with poorer cognitive performance later in life. This suggests that growing up in rural regions leads to a long-term disadvantage in cognitive functioning. Thus, public health policies should consider that urban-rural inequalities in early life may have long-lasting associations with inequalities in cognitive health in old and very old age.
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13
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Chapman SA, Greiman L, Bates T, Wagner LM, Lissau A, Toivanen-Atilla K, Sage R. Personal Care Aides: Assessing Self-Care Needs And Worker Shortages In Rural Areas. Health Aff (Millwood) 2022; 41:1403-1412. [DOI: 10.1377/hlthaff.2022.00483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Susan A. Chapman
- Susan A. Chapman , University of California San Francisco, San Francisco, California
| | - Lillie Greiman
- Lillie Greiman, University of Montana, Missoula, Montana
| | - Timothy Bates
- Timothy Bates, University of California San Francisco
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14
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Aguillard K, Gemeinhardt G, McCurdy S, Schick V, Hughes R. "Helping Somebody Else Has Helped Me Too": Resilience in Rural Women With Disabilities With Experiences of Interpersonal Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP15594-NP15619. [PMID: 33993781 DOI: 10.1177/08862605211016356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The concept of resilience, the ability to "bounce back," from adversity, can inform interpersonal violence interventions and victim assistance services. Unfortunately, though women with disabilities (WWD) experience high rates of all forms of violence and multiple layers of adversity, existing resilience research overlooks this populations' experiences, perspectives, and resilience strategies. The impairment, socially misperceived as a personal tragedy, precludes individuals with disabilities from being considered resilient; rather, they are designated almost universally as "at risk" or "vulnerable." This study aims to remedy this gap in understanding and scholarship. This qualitative study engaged 33 rural women with diverse disabilities who experienced violence to learn about how they cultivated resilience to support recovery and growth after experiencing abuse. Women described key personal qualities and supportive networks and services, such as internal drive, connectedness, dedication, healthy and helpful outlets, and an evolution of thoughts and behaviors. Counter to prevailing perceptions of WWD as dependent and helpless, women described how living with a disability honed strengths fundamental to their resilience. Women also described an "altruism born of suffering" wherein their experiences of violence contributed to a desire to give back and help others in difficult circumstances.Women's insights help to build a more comprehensive understanding of effective strategies and supports to bolster WWD's resilience. These findings inform interventions and promote approaches to build on women's strengths and resourcefulness.
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15
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Mahmood S, Hameed W, Siddiqi S. Are women with disabilities less likely to utilize essential maternal and reproductive health services?-A secondary analysis of Pakistan Demographic Health Survey. PLoS One 2022; 17:e0273869. [PMID: 36037199 PMCID: PMC9423668 DOI: 10.1371/journal.pone.0273869] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/16/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND People with disabilities deal with widespread exclusion from healthcare services, including sexual and reproductive health (SRH) rights. Studies analyzing the relationship between disability and key SRH utilization outcomes have often reported mixed findings. In Pakistan, very little to no literature is available on this topic, therefore we aim to determine inequalities in the utilization of essential maternal and reproductive health services between women with and without disabilities in Pakistan. METHODS This was a secondary analysis of Pakistan Demographic Health Survey 2017-18 performed on a weighted sample of 6,711 women aged 15-49 years with a live birth in the 5 years preceding the survey. Six types of disabilities were assessed i.e. vision, hearing, communication, cognition, walking and self-care. Utilization of essential maternal and reproductive health services was assessed through a set of four outcome variables: (i) modern contraceptive use; (ii) skilled antenatal care (ANC); (iii) skilled birth attendance (SBA); and (iv) skilled postnatal care (PNC). Multivariate Cox regression analysis was performed to determine the association between dependent and independent variables. Data were analyzed using Stata MP Version 16.0. RESULTS A total of 6,711 women were included out of which 14.1% (n = 947) live with at least one form of disability. Mean age was 29.4 (S.E = 0.13) years. The most prevalent form of disability was vision (7.0%), followed by walking (4.8%), cognition (4.8%) and hearing (1.8%). Women with disabilities were comparatively less educated, belonged to older age group, and had higher parity than their non-disabled counterparts. With the exception of modern contraceptive use, which was more prevalent in the group with disabilities, women with disabilities were less likely to utilize skilled ANC, SBA and PNC in bivariate analysis. However, these associations turned insignificant in the adjusted model. Overall, no statistically significant differences were observed in the utilization of essential reproductive health services between women with and without disabilities after adjusting for important covariates. CONCLUSION Our analyses did not find any statistically significant differences in the utilization of essential maternal and reproductive health services between women with and without disabilities. In-depth research utilizing qualitative or mixed methods is required to understand how well the healthcare system in Pakistan is responsive to the different needs of disabled women.
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Affiliation(s)
- Shafaq Mahmood
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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16
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Feiss R, Corrigan JD, Ding K, Beaulieu CL, Bogner J, Yang J. Lifetime history of TBI with loss of consciousness and disability among Appalachian and rural residents: 2016–2019 Ohio BRFSS. Inj Epidemiol 2022; 9:25. [PMID: 35965339 PMCID: PMC9377055 DOI: 10.1186/s40621-022-00390-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background While lifetime history of traumatic brain injury (TBI) is associated with increased risk of disabilities, little is known about disability and TBI among Appalachian and other rural residents. This study aimed to examine if the relationship between lifetime history of TBI with loss of consciousness (LOC) and disability differs by location of living (Appalachian vs. non-Appalachian; rural vs. urban). Methods We obtained data on lifetime history of TBI with LOC, location of living, and six sources of disability (auditory, visual, cognitive, mobility, self-care related, and independent living-related impairments) from the 2016–2019 Ohio Behavioral Risk Factor Surveillance System. We modeled the disability outcomes with Appalachian living (or rural living), lifetime history of TBI with LOC, and their interaction as independent variables. Results Of the 16,941 respondents included, 16.9% had a lifetime history of TBI with LOC, 19.5% were Appalachian residents and 22.9% were rural residents. Among Appalachian residents, 56.1% lived in a rural area. Appalachian (ARR = 1.92; 95%CI = 1.71–2.13) and rural residents (ARR = 1.87; 95%CI = 1.69–2.06) who had a lifetime history of TBI with LOC were at greater risk for having any disability compared to non-Appalachian and urban residents without lifetime history of TBI with LOC, respectively. Conclusions Appalachian and rural living and lifetime history of TBI with LOC are risk factors for disability. Future research and health policies should address mechanisms for this risk as well as access to healthcare services following a TBI among Appalachian and rural residents.
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17
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Mann S, Christini K, Chai Y, Chang CP, Hashibe M, Kepka D. "Vaccine hesitancy and COVID-19 immunization among rural young adults". Prev Med Rep 2022; 28:101845. [PMID: 35669235 PMCID: PMC9159780 DOI: 10.1016/j.pmedr.2022.101845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 05/23/2022] [Accepted: 05/28/2022] [Indexed: 11/18/2022] Open
Abstract
Rural young adults may be more averse to receiving a COVID-19 immunization than urban young adults. We aimed to assess differences in COVID-19 vaccine hesitancy for rural, compared with urban, young adults and characterize modifiable factors. This cross-sectional online survey collected demographic data, vaccination attitudes, and COVID-19 impacts from 2937 young adults, ages 18-26 years, across the western U.S. from October 2020 to April 2021. Rurality was determined by participants' zip code and classified using the rural and urban continuum codes (RUCC). Multivariable logistic regression described adjusted (age, gender, race and ethnicity, being a current student, and month of survey) odds of self-reported intent to receive the COVID-19 vaccination by rurality. Mediation analysis was used to decompose total effects into average direct effects and average causal mediation (indirect) effects. Rural participants had 40% lower odds than urban participants of intending to receive the COVID-19 vaccine after adjustments (adjusted odds ratio, 0.62 [95% CI, 0.50-0.76]). The direct effect remained (P<0.001), but was mediated by both education (8.3%, P<0.001) and month in which the survey was taken (23.5%, P<0.001). We observed a divergence after December 2020 in vaccination intent between rural and urban young adults that widened over time. Hesitancy to receive the COVID-19 vaccine was greater among rural, compared with urban young adults, and grew disproportionally after December 2020. Mediation by whether one was a current student or not suggests differences in sources of information for vaccination decision-making, and highlights areas for addressing vaccine hesitancy.
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Affiliation(s)
- Sara Mann
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kaila Christini
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Corresponding author at: 2000 Circle of Hope, Rm 4144, Salt Lake City, UT 84112, USA.
| | - Yan Chai
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Chun-Pin Chang
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Mia Hashibe
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Deanna Kepka
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- University of Utah College of Nursing, Salt Lake City, UT, USA
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18
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Portero de la Cruz S, Cebrino J. Rural-Urban Differences in Common Mental Disorders, Functional Limitation and Social Support among Adults with Cancer: A Population-Based Study in Spain. J Clin Med 2022; 11:jcm11102742. [PMID: 35628871 PMCID: PMC9146103 DOI: 10.3390/jcm11102742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 12/10/2022] Open
Abstract
The psychological, physical and social well-being components may differ for cancer patients living in urban vs. rural zones. This study aimed to examine the common mental disorders (CMDs), functional limitation (FL) and perceived social support (PSS) of rural and urban Spanish cancer patients from 2006 to 2017, to compare sociodemographic variables, health-related determinants and use of healthcare resources and to identify which sociodemographic and health-related factors were related to CMDs, FL and PSS. We performed a cross-sectional study among cancer patients using data from the Spanish National Health Surveys (2006, 2011 and 2017). A total of 698 of the subjects resided in rural areas and 1824 in urban areas. Binary logistic and multiple linear regressions were performed to determine the factors related to CMDs, FL and PSS. Rural residents visited their general practitioners more frequently than the city dwellers (61.03% vs. 56.63%, p = 0.04). A decreased prevalence of CMDs was observed among urban individuals over time (2006: 39.13%, 2011: 38.87%, 2017: 34.30%; p for trend = 0.04). Among rural residents, FL was associated with age, educational level and self-perceived health status, while among city dwellers, PSS was linked to marital status, nationality, having chronic conditions and self-perceived health status.
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Affiliation(s)
- Silvia Portero de la Cruz
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba, Avda. Menéndez Pidal, S/N, 14071 Córdoba, Spain;
- Research Group GC12 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, 14071 Córdoba, Spain
| | - Jesús Cebrino
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Avda. Doctor Fedriani, S/N, 41009 Seville, Spain
- Correspondence: ; Tel.: +34-954-551-771
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19
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Armstrong NM, Vieira Ligo Teixeira C, Gendron C, Brenowitz WD, Lin FR, Swenor B, Deal JA, Simonsick EM, Jones RN. Associations of dual sensory impairment with incident mobility and ADL difficulty. J Am Geriatr Soc 2022; 70:1997-2007. [PMID: 35343588 DOI: 10.1111/jgs.17764] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a dearth of studies examining the associations of objectively measured dual sensory impairment (DSI) with incident mobility and activities of daily life (ADL) difficulty longitudinally. METHODS Cox proportional hazards models were used to examine the associations of DSI and single sensory impairment (hearing, vision) with incident mobility difficulty (many problems or inability to walk ¼ mile and/or climb 10 steps) and ADL difficulty up to six years of follow-up among 2020 participants of the Health, Aging, and Body Composition Study, a cohort of older adults aged 70-79 years from Pittsburgh, PA and Memphis, TN. Vision impairment (VI) was defined as impaired visual acuity (20/50 or worse on Bailey-Lovie distance test) and contrast sensitivity (<1.3 log units on Pelli-Robson test), and hearing impairment (HI) was defined as pure-tone average in better-hearing ear >25 decibels. Models were adjusted by age, race, sex, education, diabetes, depressive symptoms, hypertension, gait speed from 20-meter walk, global cognition score, prevalent cardiovascular disease, and body mass index. RESULTS There were 23% with DSI (n = 459). DSI was associated with increased risk of both incident report of mobility (hazard ratio [HR] = 2.25, 95% confidence interval [CI]: 1.47, 3.43), and ADL difficulty (HR = 2.26, 95% CI: 1.50, 3.40). Neither VI nor HI alone was associated with risk of either outcome. CONCLUSIONS DSI is associated with increased risk of incident mobility and ADL difficulty. Rehabilitation and adaptive environmental changes for individuals living with DSI may be important to maximize mobility and daily function.
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Affiliation(s)
- Nicole M Armstrong
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Colby Gendron
- Department of Economics, Brown University, Providence, Rhode Island, USA
| | - Willa D Brenowitz
- Department of Psychiatry and Behavioral Sciences and Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bonnelin Swenor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins Disability Health Research Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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20
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Aguillard K, Hughes R, Gemeinhardt GL, Schick V, McCurdy S. "They Didn't Ask." Rural Women With Disabilities and Experiences of Violence Describe Interactions With the Healthcare System. QUALITATIVE HEALTH RESEARCH 2022; 32:656-669. [PMID: 34978225 DOI: 10.1177/10497323211059142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Women with disabilities are at risk of experiencing multiple forms of severe and prolonged violence, yet guidelines for screening this population are unclear, screening rates are historically low, and screening tools may be inadequate to capture disability-related aspects of abuse. We conducted qualitative in-depth interviews with 33 rural women in the United States with diverse disabilities and experiences of violence. They described overarching healthcare provider and system factors that influenced their trust and confidence in healthcare delivery as an avenue to support their safety. Women described interactions with the healthcare system during their experience of violence as a missed opportunity for identifying and responding to their abuse and connecting them with resources. We conclude with policy and practice recommendations based on women with disabilities' perspectives and insights.
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Affiliation(s)
| | | | | | - Vanessa Schick
- 12340University of Texas School of Public Health, Houston, TX, USA
| | - Sheryl McCurdy
- 12340University of Texas School of Public Health, Houston, TX, USA
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21
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Nuako A, Liu J, Pham G, Smock N, James A, Baker T, Bierut L, Colditz G, Chen LS. Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system. PLoS One 2022; 17:e0263718. [PMID: 35143583 PMCID: PMC8830640 DOI: 10.1371/journal.pone.0263718] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 01/25/2022] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The objective of this study is to identify how predisposing characteristics, enabling factors, and health needs are jointly and individually associated with epidemiological patterns of outpatient healthcare utilization for patients who already interact and engage with a large healthcare system. METHODS We retrospectively analyzed electronic medical record data from 1,423,166 outpatient clinic visits from 474,674 patients in a large healthcare system from June 2018-March 2019. We evaluated patients who exclusively visited rural clinics versus patients who exclusively visited urban clinics using Chi-square tests and the generalized estimating equation Poisson regression methodology. The outcome was healthcare use defined by the number of outpatient visits to clinics within the healthcare system and independent variables included age, gender, race, ethnicity, smoking status, health status, and rural or urban clinic location. Supplementary analyses were conducted observing healthcare use patterns within rural and urban clinics separately and within primary care and specialty clinics separately. FINDINGS Patients in rural clinics vs. urban clinics had worse health status [χ2 = 935.1, df = 3, p<0.0001]. Additionally, patients in rural clinics had lower healthcare utilization than patients in urban clinics, adjusting for age, race, ethnicity, gender, smoking, and health status [2.49 vs. 3.18 visits, RR = 0.61, 95%CI = (0.55,0.68), p<0.0001]. Further, patients in rural clinics had lower utilization for both primary care and specialty care visits. CONCLUSIONS Within the large healthcare system, patients in rural clinics had lower outpatient healthcare utilization compared to their urban counterparts despite having potentially elevated health needs reflected by a higher number of unique health diagnoses documented in their electronic health records after adjusting for multiple factors. This work can inform future studies exploring the roots and ramifications of rural-urban healthcare utilization differences and rural healthcare disparities.
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Affiliation(s)
- Akua Nuako
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States America
| | - Jingxia Liu
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States America
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States America
| | - Giang Pham
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States America
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States America
| | - Aimee James
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States America
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States America
| | - Timothy Baker
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States America
| | - Laura Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States America
| | - Graham Colditz
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States America
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States America
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States America
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States America
- * E-mail:
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22
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Clark S, Lawrence EM, Monnat SM. Support from Adult Children and Parental Health in Rural America. JOURNAL OF RURAL SOCIAL SCIENCES 2022; 37:2. [PMID: 36299915 PMCID: PMC9595110] [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
Adult children are a primary source of care for their aging parents. Parents in rural areas, however, live further from their adult children than parents in urban areas, potentially limiting the support they receive and compromising their health and ability to age in place. We use two waves of the Panel Study of Income Dynamics (2013 and 2017) to investigate the relationships among geographic proximity, adult children's instrumental and financial support, and parental health. Rural parents live further from their adult children and receive less financial support, but they are more likely to receive instrumental assistance. In addition, rural parents have worse health and more functional limitations than urban parents, and these differences persist after controlling for proximity to and support from adult children. Our findings indicate that factors beyond proximity influence the complex relationships between spatial and social boundaries and their consequences for older adults' health and well-being.
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23
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Ridenhour BJ, Sarathchandra D, Seamon E, Brown H, Leung FY, Johnson-Leon M, Megheib M, Miller CR, Johnson-Leung J. Effects of trust, risk perception, and health behavior on COVID-19 disease burden: Evidence from a multi-state US survey. PLoS One 2022; 17:e0268302. [PMID: 35594254 PMCID: PMC9122183 DOI: 10.1371/journal.pone.0268302] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
Early public health strategies to prevent the spread of COVID-19 in the United States relied on non-pharmaceutical interventions (NPIs) as vaccines and therapeutic treatments were not yet available. Implementation of NPIs, primarily social distancing and mask wearing, varied widely between communities within the US due to variable government mandates, as well as differences in attitudes and opinions. To understand the interplay of trust, risk perception, behavioral intention, and disease burden, we developed a survey instrument to study attitudes concerning COVID-19 and pandemic behavioral change in three states: Idaho, Texas, and Vermont. We designed our survey (n = 1034) to detect whether these relationships were significantly different in rural populations. The best fitting structural equation models show that trust indirectly affects protective pandemic behaviors via health and economic risk perception. We explore two different variations of this social cognitive model: the first assumes behavioral intention affects future disease burden while the second assumes that observed disease burden affects behavioral intention. In our models we include several exogenous variables to control for demographic and geographic effects. Notably, political ideology is the only exogenous variable which significantly affects all aspects of the social cognitive model (trust, risk perception, and behavioral intention). While there is a direct negative effect associated with rurality on disease burden, likely due to the protective effect of low population density in the early pandemic waves, we found a marginally significant, positive, indirect effect of rurality on disease burden via decreased trust (p = 0.095). This trust deficit creates additional vulnerabilities to COVID-19 in rural communities which also have reduced healthcare capacity. Increasing trust by methods such as in-group messaging could potentially remove some of the disparities inferred by our models and increase NPI effectiveness.
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Affiliation(s)
- Benjamin J. Ridenhour
- Institute for Modeling for Collaboration and Innovation, University of Idaho, Moscow, ID, United States of America
- Department of Mathematics and Statistical Science, University of Idaho, Moscow, ID, United States of America
- * E-mail:
| | - Dilshani Sarathchandra
- Institute for Modeling for Collaboration and Innovation, University of Idaho, Moscow, ID, United States of America
- Department of Culture, Society and Justice, University of Idaho, Moscow, ID, United States of America
| | - Erich Seamon
- Institute for Modeling for Collaboration and Innovation, University of Idaho, Moscow, ID, United States of America
| | - Helen Brown
- Institute for Modeling for Collaboration and Innovation, University of Idaho, Moscow, ID, United States of America
- Department of Movement Science, University of Idaho, Moscow, ID, United States of America
| | - Fok-Yan Leung
- Department of Culture, Society and Justice, University of Idaho, Moscow, ID, United States of America
| | - Maureen Johnson-Leon
- Department of Integrative Biology, University of Texas–Austin, Austin, TX, United States of America
| | - Mohamed Megheib
- Institute for Modeling for Collaboration and Innovation, University of Idaho, Moscow, ID, United States of America
| | - Craig R. Miller
- Institute for Modeling for Collaboration and Innovation, University of Idaho, Moscow, ID, United States of America
- Department of Biological Sciences, University of Idaho, Moscow, ID, United States of America
| | - Jennifer Johnson-Leung
- Institute for Modeling for Collaboration and Innovation, University of Idaho, Moscow, ID, United States of America
- Department of Mathematics and Statistical Science, University of Idaho, Moscow, ID, United States of America
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24
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John PS, Menec V, Tate R, Newall N, O'Connell M, Cloutier D. Functional status in rural and urban adults: The Canadian Longitudinal Study on Aging. J Rural Health 2022; 38:679-688. [PMID: 33886143 PMCID: PMC9787669 DOI: 10.1111/jrh.12578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To document the prevalence of functional impairment in middle-aged and older adults from rural regions and to determine urban-rural differences. METHODS We have conducted a secondary analysis using data from an ongoing population-based cohort study, the Canadian Longitudinal Study on Aging (CLSA). We used a cross-sectional sample from the baseline wave of the "tracking cohort." The definition of rurality was the same as the one used in the CLSA sampling frame and based on the 2006 census. This definition includes rural areas, defined as all territory lying outside of population centers, and population centers, which collectively cover all of Canada. We grouped these into "Urban," "Peri-urban," "Mixed" (areas with both rural and urban areas), and "Rural," and compared functional status across these groups. Functional status was measured using the Older Americans Resource Survey (OARS) and categorized as not impaired versus having any functional impairment. Logistic regression models were constructed for the outcome of functional status and adjusted for covariates. FINDINGS No differences were found in functional status between those living in rural, mixed, peri-urban, and urban areas in unadjusted analyses and in analyses adjusting for sociodemographic and health-related factors. There were no rural-urban differences in any of the individual items on the OARS scales. CONCLUSIONS We found no rural-urban differences in functional status.
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Affiliation(s)
- Philip St. John
- Department of Geriatric MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Verena Menec
- Department of Community MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Robert Tate
- Department of Community Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Nancy Newall
- Department of PsychologyBrandon UniversityBrandonManitobaCanada
| | - Megan O'Connell
- Department of PsychologyUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Denise Cloutier
- Department of GeographyUniversity of VictoriaVictoriaBritish ColumbiaCanada
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Rimmer JH, Wilroy J, Galea P, Jeter A, Lai BW. Retrospective evaluation of a pilot eHealth/mHealth telewellness program for people with disabilities: Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR). Mhealth 2022; 8:15. [PMID: 35449508 PMCID: PMC9014229 DOI: 10.21037/mhealth-21-34] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/23/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND People with disabilities have few options to participate in wellness programs that are tailored to their health, functional level, specific interests/needs, and available in the comfort of their home. To address this need, we evaluated a mobile health wellness program for people with physical disabilities. METHODS Retrospective pilot evaluation of MENTOR (Mindfulness, Exercise, and Nutrition To Optimize Resilience), an 8-week, 40-hour online telewellness program adapted from the peer reviewed literature on wellness. The three core wellness domains-mindfulness, exercise, and nutrition-were delivered via Zoom to groups of participants with a disability. Each group met weekly with an assigned health coach who responded to Q&A about the program and presented new material on several additional wellness domains that could impact their health (e.g., relationships, contribution to society/community, spending outdoor time in nature). Pre/post measures included the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and the UAB/Lakeshore Wellness Assessment (LWA). Participants were also interviewed and provided feedback after the program, which was thematically analyzed. RESULTS A total of 154 people from 15 states enrolled in the MENTOR program and 135 completed it (87.7% completers). Data were analyzed from a subset of participants (n=53) who were asked to complete a pre/post assessment and had complete data. Participants who were physically inactive at baseline improved their GLTEQ total activity (P=0.002; effect size =0.56) and moderate-to-vigorous activity scores (P=0.005; effect size =0.53). LWA results demonstrated that participants increased their exercise behavior (P=0.006; effect sizes =0.39) and contribution to society/community (P=0.013; effect size =0.37). Participants with low overall wellness (mental, physical & emotional health) at baseline had statistically significant improvements in exercise, nutrition, sleep, core values, self-care, hobbies, contribution to society/community, relationships, and overall wellness (all P<0.05 with effect sizes ranging from 0.43 to 1.07). Resultant qualitative themes were: (I) lifestyle transformation occurred through new positive experiences, physical and mental health benefits, and adoption of healthy behaviors; and (II) engagement through accessible online bonding through enjoyable and professional experiences. CONCLUSIONS A pilot telewellness program for people with disabilities is feasible and potentially effective in improving several domains of wellness. There is a need for precision-based mobile health (mHealth) programs that are tailored for people with disabilities and that can be accessed from various portable devices including their phone and/or tablet.
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Affiliation(s)
- James H. Rimmer
- Dean’s Office, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- Lakeshore Foundation, Homewood, AL, USA
| | - Jereme Wilroy
- Lakeshore Foundation, Homewood, AL, USA
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pierre Galea
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Byron W. Lai
- Lakeshore Foundation, Homewood, AL, USA
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
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Figliozzi M, Unnikrishnan A. Exploring the impact of socio-demographic characteristics, health concerns, and product type on home delivery rates and expenditures during a strict COVID-19 lockdown period: A case study from Portland, OR. TRANSPORTATION RESEARCH. PART A, POLICY AND PRACTICE 2021; 153:1-19. [PMID: 34511746 PMCID: PMC8423846 DOI: 10.1016/j.tra.2021.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 08/18/2021] [Accepted: 08/22/2021] [Indexed: 05/20/2023]
Abstract
E-commerce volumes and home deliveries have experienced steady growth in the last two decades. Strict COVID-19 lockdowns made home delivery an essential service and a lifeline for many households that, for travel restrictions or health concerns, were not able to utilize traditional shopping methods. This research studies the impact of socio-demographic variables and e-commerce attitudes on household deliveries for seven product categories (groceries, meals, electronics, household and office goods, recreational items, and fashion, beauty and personal care products, and medicine/health-related products) during the lockdown period in the greater Portland metropolitan region. To understand these impacts, exploratory factor analysis and choice models with latent variables are estimated utilizing data collected from an online survey representing the population in the greater Portland metropolitan region. The results indicate that each factor has a unique profile in terms of significant socio-demographic variables. A novel contribution of this research is to study the impact on home deliveries of non-traditional variables like health and safety concerns and the presence of household members with disabilities during a pandemic. The results show that health concerns are very influential and that there are substantial differences across factors on delivery rate and expenditure levels. Key findings and perspectives regarding future delivery rates and implications for transportation agencies and logistics companies are discussed.
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Affiliation(s)
- Miguel Figliozzi
- Department of Civil and Environmental Engineering, Transportation Technology and People Lab, Portland State University, P.O. Box 751-CEE, Portland, OR 97207, USA
| | - Avinash Unnikrishnan
- Department of Civil and Environmental Engineering, Transportation Technology and People Lab, Portland State University, P.O. Box 751-CEE, Portland, OR 97207, USA
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27
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Assessing factors associated with social connectedness in adults with mobility disabilities. Disabil Health J 2021; 15:101206. [PMID: 34489203 DOI: 10.1016/j.dhjo.2021.101206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND People with mobility disabilities are likely to report limitations in community participation and social connectedness for a variety of reasons, including inaccessible physical environments, health issues, transportation barriers, and limited financial resources. Improving social connectedness is a public health issue and research shows its relation to overall health and life expectancy. OBJECTIVE The purpose of this study was to (1) assess social activity, isolation, and loneliness among people with mobility disabilities compared to those with non-mobility disabilities and (2) understand factors associated with social connectedness among people with mobility disabilities. METHODS An observational, cross-sectional analysis was conducted using data from Wave 2 of the National Survey on Health and Disability (NSHD) to test for differences between adults age 18-64 with mobility disabilities (n = 621) and those with other disabilities (n = 1535), in addition to tests within the mobility disability group. RESULTS Adults with mobility disabilities were less likely than respondents from other disability groups to report feeling isolated (30.2% versus 35.2%), but these groups did not differ on measures of social activity or loneliness. Within the mobility disability group, being unemployed and in fair or poor health were predictive of greater loneliness, more isolation, and less satisfaction with social activity. CONCLUSIONS Social connectedness is an important public health issue. This research helps to inform service providers and medical professionals about the personal factors affecting social connectedness among people with mobility disabilities.
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Córdoba J, Bagnato MJ. Characterization of People with Functional Limitations from ICF Components Using the Longitudinal Social Protection Survey (ELPS) of Uruguay. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158012. [PMID: 34360305 PMCID: PMC8345411 DOI: 10.3390/ijerph18158012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022]
Abstract
Characterising people with disabilities at the population level using the ICF approach is a challenge, as it implies that researchers are able to identify variables that can account for the components that make up the multidimensional definition of disability. The purpose of this study is to generate updated information on disability in Uruguay, as there has been no in-depth analysis of how this population lives, how they access the services and benefits that affect their quality of life, and what the significant differences are between those who make up this population. A quantitative analysis was applied to the target population, consisting of participants in the Longitudinal Survey of Social Protection (2016) who reported at least one limitation in performing ADLs and who were in the age range of 18–64 years. Significant differences were found between the different groups in terms of their reported limitations in relation to obtaining necessary services due to their health condition, dropping out of education before completing the compulsory level, low labour market insertion, feelings of loneliness, and low participation. More research needs to be done as it is clear that people with disabilities do not have access to the support they need, which leads to even greater exclusion.
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Annaswamy TM, Chandan P, Houtrow AJ. Health care for people with disabilities: Need for systemic change. PM R 2021; 13:1193-1195. [PMID: 34029454 DOI: 10.1002/pmrj.12647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Thiru M Annaswamy
- Department of PM&R, UT Southwestern Medical Center, PM&R Service, VA North Texas Health Care System, Dallas, Texas, USA
| | - Priya Chandan
- Division of Physical Medicine & Rehabilitation, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Amy J Houtrow
- Division of Pediatric Rehab Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Lin SW, Chiu TY, Liou TH, Yen CF, Chen HG. The Relationship of Urbanization and Performance of Activity and Participation Functioning among Adults with Developmental Disabilities in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207553. [PMID: 33080804 PMCID: PMC7589366 DOI: 10.3390/ijerph17207553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/04/2020] [Accepted: 10/13/2020] [Indexed: 12/22/2022]
Abstract
Developmental disability is likely to be lifelong in nature and to result in substantial activity and societal participation limitations. The performance of individuals is related to the environment, supports, and urbanization of living cities. Most of the surveys for people with disabilities have not discussed the relationship between the cognitive impairment properties and performance of participation and activities functioning, and most cognitive impairments are regarded as having similar performance. The location of residence in childhood is mainly influenced by parents and main caregivers, but the factors related to the preferences of adults with cognitive impairment in the location of residence are more complicated. Objective(s): The aim was to explore and compare the relationships of the urbanization degree of their living cities and the functioning performance of daily living in various domains among adults with intellectual disability (ID), autism, and concomitant communicative impairment (CCI). Method: The cross-sectional study was applied, and the data was collected face-to-face by professionals in all authorized hospitals in Taiwan. The participants were 5374 adults with ID (n = 4455), autism (n = 670), CCI (n = 110) and combination disabilities (n = 139) which were according to the International Statistical Classification of Diseases 9th Revision (ICD-9) from a total of 167,069 adults with disabilities from the Disability Eligibility System (DES) in Taiwan between July 2012 and October 2013. The authors used the World Health Organization Disability Assessment Schedule 2.0–36 item version of WHO (WHODAS 2.0-36 items) to measure performance and capability of daily living. Results and Conclusions: There were significant differences in age, gender, disabled severity, and the urbanization between all subgroups (p < 0.05). After adjusting the age of all participators, the degree of urbanization just significantly affected the functioning score distribution in domain 1: cognition for an adult with ID, autism, and CCI; in domain 2, mobility for an adult with CCI and combination disability; in domain 3, self-care; domain 4, independent domains for ID (p < 0.05). There were no significant differences between urbanization degree and functioning scores in all domains for adults with autism. All in all, only in groups with combination disability did we find that the worse the degree of impairment was, the lower the degree of urbanization of their place of residence was, and there was no such phenomenon in adults with autism and ID in our study.
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Affiliation(s)
- Shyang-Woei Lin
- Department of Natural Resources and Environmental Studies, National Dong Hwa University, Hualien 97401, Taiwan;
| | - Tzu-Ying Chiu
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien City 97005, Taiwan;
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan;
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien City 97004, Taiwan;
- Correspondence:
| | - Hui-Guan Chen
- Department of Public Health, Tzu Chi University, Hualien City 97004, Taiwan;
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Auriemma CL, Molinero AM, Houtrow AJ, Persad G, White DB, Halpern SD. Eliminating Categorical Exclusion Criteria in Crisis Standards of Care Frameworks. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:28-36. [PMID: 32420822 PMCID: PMC7387214 DOI: 10.1080/15265161.2020.1764141] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift-to some degree-from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by "crisis standards of care," but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities.
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