Disability and public health research in Australia

The risk of repeated suicidal presentations following residential treatment for substance use disorders: A recurrent event analysis using linked administrative data

BACKGROUND

Individuals seeking alcohol and other drug (AOD) treatment consistently experience higher rates of suicidal behaviours and death by suicide when compared to the general population. By linking residential AOD treatment data to administrative healthcare and death datasets, we aimed to examine suicide-related behaviours and identify risk and protective factors for these events following discharge from residential treatment.

METHODS

Participants included 1056 individuals aged 18-69 (M = 32.06, SD = 9.55, male = 696,65.9 %) admitted to three residential treatment facilities in Queensland, Australia from January 1, 2014 to December 31, 2016. Treatment data was linked to administrative hospital, emergency department (ED), mental health service, and Registry of Deaths data 2-years post-discharge. ICD-10 codes were used to identify and analyse suicide-related events.

RESULTS

Within 2-years post-discharge, 175 (16.6 %) individuals had a suicide-related event (n = 298 episodes). The highest proportion of episodes (11.1 %) occurred within 1-month of discharge. Higher risk of a recurrent suicide-related event was associated with receiving a Disability Support Pension (aHR = 1.69 (95%CI:1.10,2.59), two or more previous episodes of residential AOD treatment (aHR = 1.49 (95%CI:1.30,2.15). Completing residential treatment was associated with a lower risk of suicide-related events (aHR = 0.54 (95%CI:0.35,0.83).

LIMITATIONS

The amalgamation of suicidal ideation, attempts, and death into a single outcome oversimplifies their complex nature and interplay. The exclusive focus on one service provider limits generalisability, and data constraints and missingness preclude many analyses.

CONCLUSIONS

Understanding suicidal behaviours and critical risk periods following discharge from residential treatment is crucial for improving continuing care, developing effective suicide prevention, and implementing targeted interventions among this high-risk population.

How does the subjective well-being of Australian adults with a congenital corpus callosum disorder compare with that of the general Australian population?

PURPOSE

Very little is known about the subjective well-being (SWB) of adults with a congenital corpus callosum disorder (CCD), the extent to which they feel satisfied with their lives, and what might be helpful in improving their SWB and quality of life. This study measured SWB among Australian adults with a CCD and compared the results with normative data for the wider Australian adult population.

METHODS

Online surveys were completed independently by 53 Australian adults with a CCD. Data included demographic profiles and answers to questions about satisfaction with life, employing the Personal Wellbeing Index (PWI) and one open ended question. Domains measured included life as a whole, standard of living, health, achieving in life, personal relationships, safety, community connectedness and future security. The PWI results were statistically analysed and means compared with Australian normative data. The qualitative data were analysed using deductive thematic analysis.

RESULTS

Australian adults with a CCD responded with ratings significantly below what might be expected of the adult Australian population in all domains except for standard of living and safety. Quantitative analysis results were supported by qualitative thematic analysis, expressing particular challenges and barriers to feeling satisfaction with life as a whole, personal relationships, achieving in life, health and future security.

CONCLUSION

Evidence from the PWI and accompanying qualitative responses indicate that SWB of Australian adults with CCD is significantly reduced compared with the general population. Further research is needed to examine the lived experience and explore solutions for support of this community.

Assessment of Oral Health Conditions Among Physically Disabled Patients in Saudi Arabia

OBJECTIVES

This study was undertaken to assess the oral health status among physically disabled Saudi patients.

METHODS

Recruitment took place in the Armed Forces Centre for Health Rehabilitation in Taif, Saudi Arabia. 124 patients living with a physical disability were enrolled and divided into three groups: hemiplegia, paraplegia and quadriplegia. Data was collected on demographics and different oral indices, including the Decayed Missing Filled Teeth (DMFT) index, the Mean Decayed Teeth score, the Community Periodontal Index (CPI), the Community Periodontal Index of Treatment Needs (CPITN), and the Simplified Oral Hygiene Index (OHI-S).

RESULTS

High DMFT was observed among the hemiplegia group (mean = 22.61; P-value = .008) with no difference in the Mean Decayed Teeth. All groups showed signs of gingivitis in the form of gingival bleeding. The most compromised periodontal health in the form of pockets 6 mm or deeper was found in the hemiplegia group (53.7%; P-value = .001). This was also reflected in the CPITN (39.0%; P-value = .001), indicating the need for complex treatments in the same group. Regarding oral hygiene, all groups showed a "fair" oral hygiene condition (OHI-S < 3.0), with significantly poorer hygiene (mean = 2.49; P-value = .042) and greater debris accumulation (mean = 1.52; P-value = .024) among the quadriplegia group. In the regression analysis, both age and gender had significant effects on some indices, while disability type showed borderline effects.

CONCLUSION

The findings indicate poor oral health in these individuals, mainly due to physical limitations, hindering effective self-care practices.

CLINICAL SIGNIFICANCE

Oral health is a critical aspect in people with physical disabilities, as it is intrinsically linked to overall health and well-being. Recognizing the clinical importance of oral health among physically disabled patients is essential to improve access and affordability of dental care for this vulnerable group of the population.

Biopsychosocial determinants of physical activity and healthy eating for people with disability living in supported accommodation: A systematic review of qualitative research

BACKGROUND

People with disability living in supported accommodation experience ongoing health disparities. Physical activity and dietary quality are factors that may minimise the risk of chronic disease, however this population may experience a range of biopsychosocial barriers to physical activity and healthy eating.

OBJECTIVE

The aim of this review was to synthesise the biopsychosocial determinants of physical activity and healthy eating for people with disability living in supported accommodation, as reported by existing qualitative research.

METHODS

A systematic review of qualitative evidence was conducted according to the JBI's methodological guidance. In September 2023, five academic databases were searched for relevant literature published since database inception. A secondary analysis of the results of included studies was guided by the International Framework for Functioning, Disability, and Health (ICF), using the ICF Linking Rules.

RESULTS

A total of 31 articles were included. The analysis identified 154 determinants of physical activity and 112 determinants of healthy eating. Determinants were most prominently representative of environmental factors that captured the health promoting role and attitudes of staff, alongside the influence of the organisational context.

CONCLUSION

This review provided evidence for the complex interactions between body functions and structures, activities and participation, personal factors, and the environment that influence physical activity and healthy eating within supported accommodation. Although there is a limited body of evidence to guide practice, the findings highlight the multifactorial nature of interventions that can be utilised by direct care professionals and adapted to the individual needs and interests of people with disability.

Identifying priorities for Australian disability research using Q methodology

BACKGROUND

Globally, there are over an estimated one billion people with disability. Research priorities with a focus on diagnosis and treatment of conditions or policy and service initiatives, traditionally decided by researchers, may not align with priorities of those with lived experience of disability.

OBJECTIVE

To explore and inform disability research for Australia, including perspectives of people with disability.

METHODS

As part of a research program, we used Q methodology to explore "what should guide the Australian research agenda?" People with disability, their families, community organizations and researchers were purposively recruited and sorted 25 statements, developed iteratively using data collated from systematic research mapping and a prior consultation process. The sorting grid ranged from -4 to +4, according to "Which topics should guide disability research the least to the most?" Factor analysis revealed four distinct but interrelated participant viewpoints.

RESULTS

52 participants (65 % female, aged 18-65+ years, 37 % people living with disability), sorted the statements. Viewpoint 1 - design and delivery of services across the lifespan. Viewpoint 2 - understanding the diverse experience of those with disability. Viewpoint 3 - designing systems to address impacts of disability for the individual, their families and society. Viewpoint 4 - addressing mental health for those with disability no matter where they live.

CONCLUSION

These viewpoints focused on design and delivery of services to address the impacts of disabling environments and attitudes on individuals living with impairments, their families and society. The four viewpoints provide a framework for future disability research in consultation with those with lived experience.

Cardiopulmonary resuscitation and basic life support for people with atypical chest shapes and wheelchair users: Toward supplemented education and emergency management plans

This article explores current practice issues in basic life support (BLS) and cardiopulmonary resuscitation (CPR) delivery for people with disability and poses recommendations for development of education and training where specialist nurses and other health professionals can facilitate BLS and CPR techniques catering for people with atypical chest shapes wheelchair users and people at high risk of choking. People with a disability are at higher risk of premature and unexpected death. At present there is a significant gap in knowledge about how to deliver optimal BLS or CPR to people with atypical chest shapes wheelchair users and people at high risk of choking. This leave carers to augment guidelines during emergency situations. Introduction of supplemented BLS and CPR together with development of emergency care plans for people with disability could reduce the number of people with disability dying premature or preventable deaths.

Barriers and enablers to the implementation of healthy lifestyle interventions for people with disability living in supported accommodation: A systematic review using the consolidated framework for implementation research

BACKGROUND

People with disability living in supported accommodation often experience significant health disparities, despite the availability of additional support. Healthy lifestyle interventions have been identified as one key health promotion strategy. Implementation science offers an opportunity to explore the factors that influence the efficacy and sustainability of these interventions, yet its application in this context has been underutilized.

OBJECTIVE

This systematic review synthesized the barriers and enablers to the implementation of healthy lifestyle interventions delivered to people with disability living in supported accommodation settings.

METHODS

A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search for relevant literature published between January 2011 and November 2021 was conducted across six databases. The findings of included studies were coded and analyzed according to the domains and constructs of the Consolidated Framework for Implementation Research (CFIR) via deductive content analysis.

RESULTS

Five studies were included, and their findings were mapped to 21 out of 38 constructs under the CFIR. Interventions from each study delivered health promotion education and training to staff and/or people with disability. The most prominent determinants that influenced implementation success included an intervention's relevance and its flexibility to adapt to the needs of people with disability, alongside organizational resourcing, and stakeholder endorsement in supporting implementation.

CONCLUSIONS

The CFIR provided a systematic approach to explore the implementation of healthy lifestyle interventions. However, further research that is grounded in and guided by implementation science theories is warranted. Despite the scarcity of literature, several compelling, yet preliminary recommendations were drawn from the findings.

Prevalence and sociodemographic factors associated with vision difficulties in Ghana, Gambia, and Togo: a multi-country analysis of recent multiple Indicator cluster surveys

Background

The sense of sight is one of the important human sensory abilities that is required for independent functioning and survival. The highest burden of sight-related problems is recorded in low-and middle-income countries, especially in sub-Saharan Africa. Despite the burden, nationally representative analyses to understand the prevalence and determinants of vision difficulties are hard to find. Therefore, this study addressed this knowledge gap by estimating the prevalence of vision difficulties and its correlates in gender-stratified models in three West African countries: Ghana, Gambia, and Togo.

Methods

The study used the most recent Multiple Indicator Cluster Surveys of Ghana (2017–2018), Gambia (2018), and Togo (2017). Summary statistics were used to describe the participants and logistic regression was used to perform the bivariate and multivariate analyses. The analyses were performed using Stata version 14 and the complex survey design of the datasets was accounted for using the ‘svyset’ command.

Results

Gendered differences were observed for vision difficulties. More women than men reported vision difficulties in Ghana (men: 14.67% vs women: 23.45%) and Togo (men: 14.86% vs women: 23.61%), but more men than women reported vision difficulties in Gambia (men: 11.64% vs women: 9.76%). We also observed gender differences in how age, education, marital status, and region of residence were significantly associated with reported vision difficulties. The direction and magnitude of these relationships were different among men and women across the survey data in Ghana, Gambia, and Togo.

Conclusion

The findings imply the need to tackle the existing gender inequities that are associated with vision difficulties to promote the quality of life of individuals, especially among older adults.