Trends in U.S. adult chronic disability rates over time

BackgroundTrends in the patterns and prevalence of chronic disability among U.S. residents carry important implications for public health and public policies across multiple societal sectors.ObjectivesTo examine trends in U.S. adult population rates of chronic disability from 1998 to 2011 using 7 different disability measures and examining the implications of trends in population age, race and ethnicity, and body mass index (BMI).MethodsWe used National Health Interview Survey data on civilian, non-institutionalized U.S. residents ages ≥18 from selected years between 1998 and 2011. We used self-reported information on functional impairments, activity/participation limitations, and expected duration to create 7 chronic disability measures. We used direct standardization to account for changes in age, race/ethnicity, and BMI distributions over time. Multivariable logistic regression models identified associations of disability with sociodemographic characteristics.ResultsWithout adjustment, population rates of all 7 disabilities increased significantly (p < 0.0001) from 1998 to 2011. The absolute percentage change was greatest for movement difficulties: 19.3% in 1998 and 23.3% in 2011. After separate adjustments for trends in age, race/ethnicity, and BMI distributions, 6 disability types continued to show increased rates over time (p < 0.01), except for sensory disabilities. Over time, poor education, poverty, and unemployment remained significantly associated with disability.ConclusionsIf these trends continue, the numbers and proportions of U.S. residents with various disabilities will continue rising in coming years. In particular, the prevalence of movement difficulties and work limitations will increase. Furthermore, disability will remain strongly associated with low levels of education, employment, and income.     

State-specific estimates of complete smoke-free home rules among postpartum women, 2010

BackgroundSecondhand smoke exposure increases an infant's risk of morbidity and mortality. We provide state-specific estimates for and characterize postpartum women with complete smoke-free home rules.MethodsData were analyzed from 26 states and New York City (n = 37,698) from the 2010 Pregnancy Risk Assessment Monitoring System, a population-based survey of women who recently delivered live-born infants. We calculated state-specific estimates of complete rules and assessed associations between complete rules and selected characteristics.ResultsOverall, 93.6% (95% CI: 93.1–94.1) of women with recent live births had complete smoke-free home rules (86.8% [West Virginia] to 98.6% [Utah]). Demographic groups with the lowest percentage of rules were women who smoked during pregnancy/postpartum (77.6%), were non-Hispanic Black (86.8%), never initiated breastfeeding (86.8%), < 20 years of age (87.1%), < $15,000 annual income (87.6%), < 12 years of education (88.6%), unmarried (88.6%), initiated prenatal care late/had no prenatal care (88.8%), had Medicaid coverage (89.7%), had an unintended pregnancy (90.3%), and enrolled in WIC (90.6%).ConclusionsPrevalence of complete smoke-free home rules was high among women with recent live births; however, disparities exist by state and among certain sub-populations. Women, particularly smokers, should be educated during and after pregnancy about secondhand smoke and encouraged to maintain 100% smoke-free homes.     

How long does it take to complete outpatient substance use disorder treatment? Disparities among Blacks,Hispanics, and Whites in the US

This research investigates racial and ethnic disparities in outpatient substance use disorder treatment completion and duration in treatment, for different substances, across the US, using the national 2014 Treatment Episode Dataset-Discharge (TEDS-D) data set. Moderated fixed effects logistic regression models assessed effects of race/ethnicity on length of stay in treatment and treatment completion for different substances of use. Moderated models also assessed the differential effect of length of stay on treatment completion among Blacks, Hispanics, and Whites. While Blacks and Hispanics both have significantly lower treatment completion rates than Whites, treatment duration is substantially similar across the three groups. Blacks and Hispanics generally take longer to complete treatment than Whites, though this varies by substance for Hispanics. Disparities in treatment completion persist even after controlling for treatment duration. These results indicate that observed racial and ethnic disparities in treatment completion are not due to differences in length of stay in treatment. Economic, cultural, accessibility, or, potentially, discriminatory, factors may suppress the likelihood of treatment completion for minorities and result in longer treatment durations required for completion. Recognition by treatment providers of the unique challenges to treatment completion faced by minorities may enhance treatment outcomes for minorities in the US.     

Development and psychometric properties of the tobacco and nicotine consequences scale (TANCS) to screen for cigarette and e-cigarette misuse in community settings

IntroductionTo date, there are no existing measures of tobacco or nicotine misuse (i.e., negative consequences). The goal of the present study was to develop and test the psychometric properties of a novel scale, the Tobacco and Nicotine Consequences Scale (TANCS) to assess tobacco and nicotine misuse among cigarette smokers and e-cig users.MethodsThis cross-sectional study collected data using an anonymous survey to assess tobacco and nicotine use expectancies, behaviors, and negative consequences of use. Of the 607 participants who attempted the survey, 491 participants (80.8%) completed the TANCS items. A split-half validation method was used to assess the structure and validity of the TANCS using exploratory and confirmatory factor analysis.ResultsThe exploratory factor analysis produced a five-factor solution, and the confirmatory factor analysis supported the factor structure with results providing an excellent fit to the data (CFI = 0.995, TLI = 0.994, RMSEA = 0.015, SRMR = 0.052). A total of 17 items were retained. The overall scale showed excellent reliability (α = 0.91) with subscale alphas between 0.68 and 0.90.The scale was significantly correlated to nicotine dependence and smoking expectancies, measured by the Fagerstrom Test Cigarette Dependence and Smoking Effects Questionnaire, respectively, suggesting the TANCS is a valid measure of tobacco and nicotine misuse. Total and subscale scores differed between participants preferring cigarettes or e-cigarettes.ConclusionsThe TANCS is a brief, reliable measure of tobacco and nicotine misuse that is correlated to tobacco and nicotine expectancies, use, and dependence. Future work should explore the test-retest reliability and incremental validity of the scale for tobacco use disorder.     

Can the loco-check be used as a self-check tool for evaluating fall risk among older subjects? A prospective study

BackgroundJapan has now become a super-aged society. Notably, as the Japanese society ages, the prevalence of falls, which represent an aging-related problem, has increased. Locomotive syndrome (LS) is a condition of decreased mobility due to locomotive organ disorder. The loco-check is simple tool to detect early-stage LS. The loco-check comprises seven items relating to daily activities. Higher numbers of affirmative answers in the loco-check are negatively associated with physical functions. The purpose of this study was to examine the potential correlation between the number of affirmative answers given on the “loco-check” survey and the likelihood of experiencing at least one fall during the following one-year period.MethodsThis prospective study included 154 cases (35 men, 119 women), all aged 65 years or older, answered the loco-check at baseline. As part of their normal treatment process, the participants made monthly visits to the out-patient department; thus, at each of these visits for the following 12 months a medical doctor interviewed each patient to determine whether they had experienced a fall during the previous month.ResultsThe mean age of the sample was 77.3 years, and the median number of affirmative answers given was 2.0. The number of affirmative answers significantly correlated with the cases which had a fall event within the follow-up period. Specifically, an increase in one “yes” answer on the loco-check increased the relative risk of fall (odds ratio: 1.32; 95% Confidence interval (CI): 1.03–1.70). In addition, the risk of fall was high in cases which showed the number of affirmative answers given on the loco-check ≥4 (odds ratio: 9.26; 95% CI: 1.05–81.7).ConclusionThe number of affirmative answers given on the loco-check is positively correlated with a fall event within the following year.     

The intervention priorities of parents of children with autism spectrum disorders in Iran

When designing and implementing evidence-based programs for children with an autism spectrum disorder, the intervention priorities of parents are important criteria. Although studies in developed countries have explored parents’ intervention priorities, there is a paucity of this kind of research in developing countries. This research explores the intervention priorities of 207 Iranian parents for their children with autism in Tehran, the capital of Iran. Participants with children between 2 to 21 years of age were asked to rate their intervention priorities from among 10 main categories. In addition, correlations between children’s difficulties and parental intervention priorities were examined.The results indicate that building social communication skills was the highest intervention priority for parents of Iranian children with autism, a contrast to typical current service provision in Iran. The results also substantiated that presence of social communication difficulties and challenging behaviors in children are typically correlated with parents' intervention priorities.     

Use of the double-paddle anterolateral thigh flap for locally advanced tongue carcinoma requiring second site reconstruction

BackgroundAdvanced oral tongue carcinoma can present with extension beyond the oral cavity. Operative defects after resection may involve multiple anatomical sites and significantly impact speech and swallowing. Dependence on long-term enteral feeding is not uncommon for these patients. The anterolateral thigh (ALT) flap is one of the most reliable and flexible flaps used in the reconstruction of total and subtotal tongue defects. The double-paddle flap modification may be a more suitable option for complex oral tongue defects after advanced tumor ablation.MethodsCase series of 31 patients with oral tongue squamous cell carcinoma that were classified as stage IV. The age of patients ranged from 32 to 63 years. We designed the double-paddle ALT flaps to reconstruct the two-site surgical defects (tongue defect and pharynx or neck skin defect). Postoperative viability of the flap was checked by clinical observation. The last examination was performed at 3-months after the completion of adjuvant chemoradiotherapy. The functional capacity of our patients was evaluated by three physicians (Head and Neck Surgeon, Radiation Oncologist, and Physiatrist) using a Speech Intelligibility Score and the Functional Oral Intake Scale.ResultsA total of 31 patients with surgical defects after total or subtotal tongue resection for cancer underwent double-paddle ALT flaps for reconstruction from March 2018 to December 2019. The dimension of flaps from 8 × 12 cm to 10 × 18 cm were divided into double-paddle from 8 × 5 cm to 10 × 10 cm. There was one case of pedicle thrombosis, one case of postoperative bleeding, three cases of neck infection, and six cases of salivary fistula. Our patients were seen in follow up from 6 to 36 months, with median follow-up of 23.5 months. The survival rate of ALT flap was 100%. All of our patients achieved an oral diet by 9 months after surgery. The mean score speech intelligibility was 2.74 ± 0.68 (4-point ordinal scale). The 2-year disease-free survival rate was 61.3%.ConclusionsThe double-paddle ALT flap is a reliable flap suitable for oral defects involving multiple subsites after ablative procedures. The majority of patients demonstrated acceptable functional rehabilitation.Clinical question/ level of evidenceTherapeutic, IV.