Identifying developmental disability in national surveys: Addressing the knowledge gap with special education histories

BackgroundIn the United States nearly 20% of children ages 12–17 have developmental disorders. Some attain population-based developmental milestones after a delay, or increase functioning through special education, medication, technology, or therapy. Others have severe lasting impairments. An indicator identifying those groups in surveys of adults could help shape policies to improve lives.HypothesesWe hypothesized that survey histories of special education could indicate functional status levels.MethodsData were from the nationally representative Panel Study of Income Dynamics (1997–2017, n = 2745). With measures of diagnoses, behaviors, functional status, service use, and adult outcomes, we tested three special education groups as indicators of: (1) no impairment (no special education), (2) disorders, developmental diagnoses that adversely affect educational performance, but with development after a period of delay or only moderate disability, indicated by transfer from special education; and (3) severe lasting disability, the diagnoses combined with life-long needs for supports or services, with limitations in areas including self-care, mobility, and capacity for independent living, indicated by special education in the individual's final year of school.ResultsAcross the special education groups, from no impairment to severe lasting disability, there were trends of: increasing severe and lasting disability (respectively 4.8%, 35.6%, 76.4%); increasing special services use (13.5%, 43.1%, 83.7%); increasing severe emotional disorders (2.3%, 11.3%, 17.9%); lower percentages attaining at least an associate's degree by age 25 (42.1%, 20.7%, and 8.9%); and more chronic diseases.ConclusionsSpecial education histories provide a useful indicator of developmental disability impairment levels in adults.     

The intracorrelation of family health insurance and job lock

This paper tests for the presence of job lock and “health insurance plan lock” stemming from the health shock of a child family member. Using the onset of an acute, unanticipated health shock, I estimate a 7–14 percent decreased likelihood of all family members leaving their current health insurance network and health plan within one year of the emergency. This corresponds to a reduced one-year job mobility rate of approximately 13 percent for the health plan’s primary policyholder. Furthermore, the non-portability of health insurance products may contribute to the observed job and health plan lock.     

Tedium vitae in stroke survivors: a comparative cross-sectional study

Objectives: Suicide is best studied by deconstructing the psychological experiences preceding suicidal death. We assessed the characteristics of tedium vitae (feeling tired of life) after first ever stroke in Nigerian survivors.

Methods: Using the Schedule for Clinical Assessment in Neuropsychiatry, tedium vitae was assessed in 130 stroke survivors attending rehabilitation in a large Nigerian university hospital. Global cognitive and executive dysfunctions were evaluated, respectively, using the Mini Mental State Examination and the modi?ed Indiana University Token test. All participants had their index stroke 3 to 24 months before recruitment into the study. We also examined a comparative group of 130 age, gender, and education matched apparently normal persons who were unrelated to the stroke survivors. Associations were explored using univariate and multivariate logistic regression analyses.

Results: Tedium vitae was experienced by 16 (12.3%) stroke survivors compared with 5 (3.9%) in the comparative group (O. R = 3.5, 95% C. I = 1.3–9.9, p = 0.018). Among stroke survivors, those who were retired were more likely to experience tedium vitae (56.2%, p = 0.045). In analyses adjusting for the effect of systemic hypertension, cognitive dysfunction, retirement and marital separation, there was a 3.5-fold increase in the odds of experiencing tedium vitae after surviving a stroke (O. R = 3.5, 95% C. I = 1.1–11.6, p = 0.042).

Conclusions: Tedium vitae is a common suicidal experience after stroke and may be among the earliest perceptible pointer to impending poststroke suicide. It is easy to assess and may be less costly to obtain an adequate sample size in studies aiming to understand the phenomenon of suicide in the stroke population.     

Traditional Food Practices,Attitudes, and Beliefs in Urban Alaska Native Women Receiving WIC Assistance

Objective

To identify practices, attitudes, and beliefs associated with intake of traditional foods among Alaska Native women.

Vaccinations in prison settings: A systematic review to assess the situation in EU/EEA countries and in other high income countries

IntroductionIn 2016, more than 600,000 persons were being held in EU/EEA correctional facilities on a given day. People in prison may be at risk of vaccine-preventable diseases. While vaccination recommendations for people in prison exist, little is known on coverage and implementation options.MethodsWe performed a systematic review on existing evidence on vaccination in prison settings in the EU/EEA. We searched peer-reviewed and grey literature following international methodology and reporting standards, to gather records published between 1980 and 2016 in all languages. We analysed quantitative (acceptance, uptake, cost-effectiveness) and qualitative (barriers) outcomes.ResultsOut of 7041 identified records, 19 full-text articles were included from peer-reviewed literature and two from grey literature. Of these, 18 reported on hepatitis A and/or B virus (HAV/HBV), two on influenza and one on MMR vaccination. Two studies on HAV vaccine reported varying acceptance (5–91%) and uptake rates (62.9–70.5%). Seven studies reported on HBV vaccination. A comparative study showed a significantly higher uptake of the third HBV vaccine dose with the very rapid (63%) compared to the standard schedule (20%). HBV vaccination was generally well accepted (54–100%), whereas uptake was variable (dose 1:23–100%, dose 2:48–92%, dose 3:19–80%). One study on the combined HAV/HBV vaccine reported an acceptance rate of 34%, and declining uptake following dose 1. One study on influenza vaccine showed an uptake of 42–46%, while another reported a MMR vaccine acceptance of 80% and an uptake of 74%. Overall, main reasons for non-vaccination included release from/or transfer between prisons, and refusal.ConclusionsThis systematic review highlighted important knowledge gaps and operational challenges for vaccination in prison settings. Vaccination is an effective measure that warrants comprehensive and tailored implementation to reduce the preventable disease burden, avoid risks of large outbreaks of vaccine-preventable diseases, and contribute to health equity for people in prison.