The Impact of Hearing Loss on Health Care Access During the COVID-19 Pandemic

Individuals with hearing loss are at increased risk of having poor access to health care compared with hearing peers. The impact of the COVID-19 pandemic on health care access for adults with hearing loss in the United States was investigated through weighted analyses of the 2021 National Health Interview Survey. The association of hearing loss and disruptions to health care use during the pandemic was examined using multivariable logistic regression controlling for demographic characteristics including sex, race/ethnicity, education, socioeconomic status, insurance status, and medical comorbidities. Adults with hearing loss had significantly higher odds of reporting receiving no medical care (odds ratio [OR] = 1.63, 95% confidence interval [CI]: 1.46-1.82, p < .001) or delayed medical care (OR = 1.57, 95% CI: 1.43-1.71, p < .001) due to the pandemic. Individuals with hearing loss did not have higher odds of COVID-19 diagnosis or vaccination. Strategies should be developed to support adults with hearing loss to improve their access to care during public health emergencies.

Physical Disability and Psychedelic Therapies: An Agenda for Inclusive Research and Practice

Over the past decade, there has been an increase in the number of clinical trials for psychedelic therapies as treatments for a wide range of psychiatric conditions. We are concerned that research organizations overseeing these trials have neglected the inclusion of individuals with physical and sensory disabilities. We suggest that psychedelic research organizations should prioritize and plan for the inclusion of individuals with physical and sensory disabilities to address the mental health burdens they confront. Not doing so risks reinforcing structural ableism in healthcare: the discriminatory manifestation of lowered expectations toward people with disabilities on the part of medical providers. Drawing on scholarship from disability studies and medical ethics, we offer four recommendations for disability inclusion in research. We recognize particular populations shoulder significant mental health burdens; these populations deserve priority and should be given a range of accommodations. We emphasize the need for extensive disability awareness training for those facilitating psychedelic therapies and encourage psychedelic researchers and therapists to exercise cultural humility toward individuals with physical and sensory disabilities. This article should be the impetus for further scholarship and debate about how psychedelic research and therapies can be made accessible to members of disability communities who might benefit.

Neurodevelopment at 2 years and umbilical artery Doppler in cases of very preterm birth after prenatal hypertensive disorder or suspected fetal growth restriction: EPIPAGE-2 prospective population-based cohort study

OBJECTIVE

To investigate the association between absent or reversed end-diastolic flow (ARED) on umbilical artery Doppler ultrasound and poor neurological outcome at 2 years of age after very preterm birth associated with suspected fetal growth restriction (FGR) or maternal hypertensive disorders.

METHODS

The study population comprised all very preterm (22-31 completed weeks) singleton pregnancies delivered because of suspected FGR and/or maternal hypertensive disorders that had umbilical artery Doppler and 2-year follow-up available included in EPIPAGE-2, a prospective, nationwide, population-based cohort of preterm births in France in 2011. Univariate and two-level multivariable logistic regression analyses were used to assess the association of ARED in the umbilical artery, as compared with normal or reduced end-diastolic flow, with severe or moderate neuromotor and/or sensory disability and with an Ages and Stages Questionnaire (ASQ) score below a threshold. This was defined as a score more than 2 SD below the mean in any of the five domains, at age 2, adjusting for gestational age at delivery. ASQ is used to identify children at risk of developmental delay requiring reinforced follow-up and further evaluation. Descriptive statistics and bivariate tests were weighted according to the duration of the inclusion periods.

RESULTS

The analysis included 484 children followed up at 2 years of age, for whom prenatal umbilical artery Doppler ultrasound was available. Among them, 8/484 (1.6%) had severe or moderate neuromotor and/or sensory disability, and 156/342 (45.4%) had an ASQ score below the threshold. Compared with normal or reduced end-diastolic flow in the umbilical artery (n = 305), ARED (n = 179) was associated with severe or moderate neuromotor and/or sensory disability (adjusted odds ratio (OR), 11.3; 95% CI, 1.4-93.2) but not with an ASQ score below the threshold (adjusted OR, 1.2; 95% CI, 0.8-1.9).

CONCLUSION

Among children delivered before 32 weeks of gestation due to suspected FGR and/or maternal hypertensive disorder who survived until 2 years of age, prenatal ARED in the umbilical artery was associated with a higher incidence of severe or moderate neuromotor and/or sensory disability. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Extramural Oral Health Educational Program Involving Individuals With Disabilities: Impact on Dental Students' Professionalism

Context

Oral health inequalities experienced by patients, including people with disabilities (PWD), have been related to dentists' lack of professionalism and inadequate experience in managing patients with special needs.

Aims

This study investigated the impact of an extramural program involving PWD on dental students' professionalism and students' perception of training in managing patients with special needs.

Materials and Methods

A group of 165 undergraduate dental students (year 1 to year 5) participated in a voluntary program, involving 124 visually impaired children, at a special education school in Kuala Lumpur, Malaysia. A dedicated module in oral health was developed by specialists in special care dentistry, pedodontics, and medical sciences. Dental students then participated in a semi-structured focus group interview survey to discuss perceptions of their learning experiences. Qualitative data were analyzed via thematic analysis.

Results

The program had positive impact on various aspects categorized into four major domains: professional knowledge (e.g., understanding of oral-systemic-social-environmental health interaction and understanding of disability), professional skills (e.g., communication and organizational skills), professional behavior (e.g., empathy and teamwork), and value-added learning (e.g., photography and information technology skills). Students showed improved willingness to manage, and comfort in managing PWD, and expressed support for future educational programs involving this patient cohort.

Conclusion

Improved knowledge, skills, attitudes, and personal values, as well as support for future programs, indicate the positive impact of extramural educational activities involving PWD in developing professionalism in patient care, while providing an opportunity for students to be exposed to managing patients with special needs.

Research Trends and Recommendations for Physical Activity Interventions Among Children and Youth With Disabilities: A Review of Reviews

This scoping review synthesized reviews of physical activity (PA) interventions for children and youth with disabilities to highlight promising elements of effective interventions, research methodological limitations, and research priorities. Twenty studies were eligible and underwent three rounds of review by an expert panel. Rich and diverse PA programs derived potential short-term benefits toward health, function, and PA. Strategies to increase sample sizes included embedding programs in the community and using information communication technology to deliver exercise programs. Methodological limitations of interventions included a lack of generalizability, transferability, and scientific rigor. Three research priorities were identified: develop and report precision-based intervention strategies, identify strategies that promote both long-term and sustainable PA participation and outcomes, and develop scalable interventions and recruitment strategies. If addressed, these areas could enhance the impact of PA interventions for children and youth with disabilities.

An interesting case of systemic lupus erythematosus in a patient with Moebius syndrome

Moebius' syndrome (MS) is characterized by a nonprogressive facial palsy associated with impairment in eye abduction, which can be uni- or bilateral. Some authors raise the possibility that patients with MS may suffer from social stigmatism due to their facial dysmorphism and that constant teasing and bullying perpetrated by people in the same social circle are adjuvants in the development of low self-esteem, behavioral problems, and even psychiatric disorders. Psychological stress, anxiety, and depression are factors contributing to both development and impairment of autoimmune diseases, such as systemic lupus erythematosus (SLE). The objective of this work is to report the case of a patient with MS who developed SLE. In the present case report, we have emphasized the importance of both clinical dental examination and surgeon-dentist in the early diagnosis of systemic diseases by considering that these conditions can affect both syndromic and normoreactive patients.

Disability discrimination in healthcare services and employment

This article discusses the meaning and philosophical basis of disability discrimination in health care. It focuses on aspects of language that influence discourse about disability and affect the experiences of people with disabilities. Reference is made to the experiences of those who have an autism spectrum condition, with a specific focus on three NHS employees with Asperger syndrome, in relation to disability discrimination. The implications for nurses and nursing are discussed. Recommendations are made for awareness raising and training.

"It's just so bloody hard": recommendations for improving health interventions and maternity support services for disabled women

PURPOSE

Little is known about the barriers and facilitators to pregnancy, birth and motherhood for disabled women within the New Zealand context. Our study explored this deficit with the aim of improving health care interventions and support for disabled mothers.

METHODS

This paper reports on the third phase of a mixed-methods study. The first two phases used semi-structured individual and focus group interviews with disabled women, and health professionals, involved in maternity and postnatal care and has been reported elsewhere. Phase 3 utilised a modified Delphi technique with both groups of participants to seek consensus on the prioritisation of recommendations from the study. This article focuses on the disabled women's recommendations.

RESULTS

In all, 20 disabled women took part in the Delphi phase of the study (28% of the cohort from Phase 1). In total, 11 key recommendations were identified by the disabled women, with the top seven discussed in detail here.

CONCLUSIONS

Health professionals and health systems could, and arguably should, utilise a matrix of these recommendations to facilitate a review of service responsiveness to disabled women. Implications for Rehabilitation Becoming a mother is a potentially relevant and important rehabilitation issue for women of childbearing age who come into contact with rehabilitation services. Disabled women encounter a range of economic, attitudinal and knowledge barriers in relation to becoming mothers. Centralised sites/sources of information have potential to provide accessible and useful information for disabled women and health professionals.