Disability and Health Journal

The challenges of the scholarship in the field of disability and health

2011-12-30

The volume this year marks our fifth anniversary of publication for Disability and Health Journal. In this time the Journal has enjoyed significant accomplishments, and we the Editors are grateful for the support and enthusiasm of authors, reviewers, readers, the Editorial Board, the American Association on Health and Disability (AAHD), and the Publishers. In the past 4 years we have:

Parental psychological distress and quality of life after a prenatal or postnatal diagnosis of congenital anomaly: A controlled comparison study with parents of healthy infants

Ana Fonseca, Bárbara Nazaré, Maria Cristina Canavarro — 2011-12-30

Abstract: Background: Parental early adjustment to a prenatal or postnatal diagnosis of congenital anomaly has been studied mainly within a pathological and deterministic perspective, giving us an inadequate view of the impact of the diagnosis.Objectives: Adopting a comprehensive approach on parental adjustment, we aimed to characterise the impact of the diagnosis on psychological distress and quality of life, in the early postdiagnosis stage. The effects of gender and the timing of the diagnosis were also examined.Methods: In this cross-sectional study, 42 couples with healthy infants and 42 couples whose infants were prenatal or postnatally diagnosed with a congenital anomaly responded to the Brief Symptom Inventory-18 and to the World Health Organization Quality of Life–Brief instrument.Results: In the early postdiagnosis stage, parents whose infants were diagnosed with a congenital anomaly presented higher levels of psychological distress than did the parents of healthy infants (F2,79 = 6.23, p = .003), although they displayed similar levels of quality of life (F4,78 = 0.62, p = .647). Mothers reported more adjustment difficulties than fathers in both groups. Receiving the diagnosis in the prenatal period was associated with higher maternal psychological quality of life (Z = –2.00, p = .045).Conclusion: The occurrence of a diagnosis of congenital anomaly during the transition to parenthood adds to an accumulation of stress-inducing events and manifests itself in psychopathological symptoms. Maintaining a positive evaluation of well-being may be understood as a parental resource to deal with the diagnosis. The importance of adopting a comprehensive perspective on parental adjustment is highlighted.

Tax subsidization of personal assistance services

Steven Mendelsohn, William N. Myhill, Michael Morris — 2012-01-30

Abstract: Background: Personal assistance services (PAS) is the term used to describe the range of assistance, services, and supports many people with disabilities and older Americans need to remain in their homes and communities. The Americans with Disabilities Act requires that people with disabilities receive essential services in the communities of their choice rather than in institutional settings. PAS availability often determines whether persons with disabilities become institutionalized or remain in their communities. PAS, however, are not inexpensive or broadly available. Strategies are needed to improve their availability to people with disabilities and the elderly. We sought to analyze 8 provisions of the Internal Revenue Code for their utility to make PAS more affordable and available.Methods: The authors conducted a legal analysis of 8 statutory provisions, as interpreted by regulations, court decisions, and other authoritative sources.Results: Each of the tax provisions analyzed covers some PAS expenses incurred by an individual or family. Favorable tax treatment is impacted by the nature and amount of expenses and by the location and conditions of services. The current limitations and complexities of legal interpretations and the fact that many individuals with disabilities are uninformed about these tax provisions present challenges and opportunities.Conclusions: As the need for PAS grows, reform of tax policy is an important complement to health care and long-term services and supports for people with disabilities. To increase utilization of current beneficial tax provisions that subsidize the cost of PAS, individuals with disabilities and tax preparers must become better informed about using these provisions.

Built environment instruments for walkability, bikeability, and recreation: Disability and universal design relevant?

Jennifer A. Gray, Jennifer L. Zimmerman, James H. Rimmer — 2012-04-01

Abstract: Background: Despite a plethora of instruments that measure the built environment with respect to its effect on potential physical activity, little is known about how relevant these instruments are for people with disabilities (PWDs).Objective: This review comprises an in-depth review of instruments related to the built environment and physical activity, as well as an examination of such instruments to determine their applicability for PWDs.Methods: In this paper, the term “built environment” refers to human-made structures (e.g., urban and rural design characteristics, recreational structures) that may facilitate or impede an individual’s ability to be physically active. A content analysis was conducted on 95 instruments measuring walkability, bikeability, and recreation with respect to disability and universal design (UD) relevance. Instruments were also cataloged according to other dimensions, including psychometric properties, data collection modalities, and impact or use.Results: Roughly one third of all instruments include some disability-specific items, and only a few UD principles are consistently demonstrated across all instruments. Psychometric information is available for approximately one half of the instruments. Most instruments use objective/audit methods of data collection, with less using subjective/perceived and Geographic Information System (GIS) methods. With respect to instrument impact/use, just over one half of the instruments have articles cited in the peer-reviewed literature.Conclusions: Recommendations for new and revised built environment instruments include more focus on specific disability populations, incorporation of all UD principles, as well as attention to psychometric quality and measurement specificity.

Physical ill health, disability, dependence and depression: Results from the 2007 national survey of psychiatric morbidity among adults in England

2012-04-01

Abstract: Background: The relationship between physical ill health, disability, and depression is not straightforward. Both cross-sectional and longitudinal studies have clearly shown that medical illness and physical disability are strongly associated with depression.Objective: To test the hypothesis that disability is associated with an increased prevalence of depression irrespective of physical health problems and that this is proportionate to the severity of disability (measured in terms of the number of difficulties in daily activities and the degree of dependence on others).Methods: Using a random probability sample design, 7460 respondents were interviewed for the third national survey of psychiatric morbidity of adults in the private household population in England. Fieldwork was carried out throughout 2007. The prevalence of depression was established by the administration of the revised Clinical Interview Schedule (CIS-R), while disability was measured by reported difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL).Results: Disability was associated with depression even after adjustment for physical ill health. The number of ADL/IADL difficulties was directly related to the likelihood of respondents having depression. Dependence on others was not associated with depression once severity of disability had been accounted for.Conclusion: All ADL/IADL limitations are significantly associated with depression and there seems to be a cumulative effect irrespective of whether the limitation is in personal care or in instrumental activities such as mobility problems.

Association of total serum cholesterol with functional outcome following home care rehabilitation in Italian patients with stroke

Maria Concetta Cataldo, Maria Luisa Calcara, Giuseppe Caputo, Caterina Mammina — 2011-12-30

Abstract: Background: Stroke is a disabling disease. In elderly populations, stroke is the third leading cause of death and the primary cause of reduction in or loss of functional ability and personal autonomy. Possible associations between levels of total serum cholesterol (TC) and both incidence of stroke and functional outcomes after rehabilitation are still under study.Objective: To detect positive and negative prognostic factors associated with functional outcomes in first-time stroke patients admitted to an integrated home care rehabilitative program.Methods: This study enrolled 141 patients with a first-time stroke who were admitted to a home care rehabilitation program. Primary outcome measures were the Barthel activities of daily living (ADL) and mobility indices at the beginning and end of the rehabilitative treatment. The impact of TC and other demographic and clinical variables was analyzed using bivariate and multivariate logistic regression analyses.Results: Age and Short Portable Mental Status Questionnaire (SPMSQ) score were negatively associated with functional outcome. In contrast, elevated TC was positively associated with a better home rehabilitative treatment outcome. Barthel index score at admission was negatively associated with outcomes assessed by the Barthel ADL index and age with outcomes assessed by the Barthel mobility index. In a multivariate logistic regression analysis, SPMSQ score and elevated TC were significantly associated with outcome. Specifically, higher SPMSQ scores were negatively associated with better rehabilitative treatment outcomes, whereas elevated TC was positively associated.Conclusions: Elevated TC seems to be associated with better functional outcomes in patients with first-time stroke.

What barriers to physical activity do individuals with a recent brain injury face?

Simon Driver, Alison Ede, Zane Dodd, Laurel Stevens, Anne Marie Warren — 2011-12-30

Abstract: Background and Objective: Traumatic brain injury (TBI) is a serious public health issue that challenges professionals to develop effective health promotion strategies to meet individual’s diverse and unique needs. One effective health promotion strategy is physical activity (PA), although barriers to activity frequently prevent participation. Thus, there is a need to identify the barriers to participation, amount of weekly PA completed, and readiness to be active if effective health promotion programs are to be implemented.Methods: A convenience sample of 28 outpatients with a TBI completed a questionnaire before discharge from a comprehensive outpatient program and descriptive statistics were reported. In addition independent t tests and effect sizes were calculated between amount of PA and stage of change.Results: Our results indicated that participants only faced an average of 2.25 barriers (range 0-9), completed a mean of 46 minutes of PA each week, and reported being in the “action” stage of PA participation. Individuals in the action and maintenance stage completed significantly more PA (21.67; t [25] = −15.43; p < .001; Cohen’s D effect size = 4.39) than precontemplators or contemplators.Conclusions: Individuals with a TBI face many different barriers that prevent them from being active, placing them at further risk of experiencing secondary and chronic conditions. Practitioners should acknowledge that each individual faces a unique set of barriers emphasizing the importance of individualized health promotion programs.

Editorial Board