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1.

Background

Previous literature suggests that individuals with disabilities have increased rates of obesity and decreased participation in physical activity contributing to overall higher incidence of secondary health conditions compared to the general population without disabilities.

Objective/hypothesis

The purpose of this research study was to examine the differences in physical activity rates for college students with Attention Deficit Hyperactivity Disorder (ADHD) and Learning Disabilities (LD).

Methods

A secondary analysis was utilized to examine differences in physical activity rates based on disability, gender, and factors influencing participation in physical activity. The 2011 Fall National College Health Assessment was used as the reference group with a sample of 27,774 students. Multiple independent samples t-tests were utilized in this research.

Results

The results of this study indicated that physical activity for college students with disabilities does not have significant variations compared to those without disabilities. However, gender influences participation in physical activity for this population.

Conclusions

This research helps in narrowing the research gap in this topic through analysis of the college population with ADHD and LD. This paper concludes with implications that could benefit the health status of this population.  相似文献   

2.

Background

To implement appropriate programs for promoting physical activity (PA) in people who are Deaf, it is important to have valid instruments for assessing PA in this population.

Objective

The main purpose of this study was to examine the criterion validity of the short form of the International Physical Activity Questionnaire (IPAQ-S) in Deaf adults.

Method

This study included 44 adults (18–65 years) of both genders (63.6% were females) who met the inclusion criteria. Objective measures of PA were collected using accelerometers, which were worn by each participant during one week. After using the accelerometer, the IPAQ-S was applied to assess participants' physical activity during the last 7 days.

Results

There was no significant correlation between the average time spent in moderate to vigorous physical activity (MVPA) as measured by the accelerometer (40.1 ± 24.5 min/day) and by the IPAQ-S (41.3 ± 57.5 min/day). The IPAQ-S significantly underestimated the time spent in sedentary behavior (7.6 ± 2.7 h/day vs. 10.1 ± 1.6 h/day). Sedentary behavior and MVPA as measured by the accelerometer and the IPAQ-S showed limited agreement.

Conclusions

Our results show some limitations on the use of IPAQ-S for quantifying PA among adults who are Deaf. The IPAQ-S tends to overestimate the MVPA and to underestimate sedentary behavior in adults who are Deaf.  相似文献   

3.

Background

While it is commonly accepted that disparities in unmet need for care vary by age, race/ethnicity, income, education, and access to care, literature documenting unmet needs experienced by adults with different types of disabilities is developing.

Objective

The main objective was to determine whether subgroups of people with disabilities are more likely than people without disabilities to delay/forgo necessary care, in general and among the insured.

Methods

We used pooled Medical Expenditure Panel Survey data (2004–2010) to examine delaying or forgoing medical, dental, and pharmacy care among five disability subgroups (physical, cognitive, visual, hearing, multiple) and the non-disabled population. Logistic regression was conducted to examine delayed/forgone care, controlling for sociodemographic, health, and health care factors.

Results

Over 13% of all working-age adults delayed/forwent necessary care; lack of insurance was the strongest predictor of unmet needs. Among the insured, disability subgroups were greater than two times more likely to report delayed/forgone care than adults without disabilities. Insured working-age adults with multiple chronic conditions and those with ADL/IADL assistance needs had higher odds of delayed or forgone care than their peers without these characteristics. Reasons related to affordability were most often listed as leading to unmet needs, regardless of disability.

Conclusion

Although insurance status most strongly predicted unmet needs for care, many people with insurance delayed/forewent necessary care. Even among the insured, all disability subgroups had significantly greater likelihood of having to delay/forgo care than those without disabilities. Differences also existed between the disability subgroups. Cost was most frequently cited reason for unmet needs.  相似文献   

4.

Background

Comorbid depression is highly prevalent in geriatric patients and associated with functional loss, frequent hospital re-admissions, and a higher mortality rate. Cognitive behavioral psychotherapy (CBT) has shown to be effective in older depressive patients living in the community. To date, CBT has not been applied to older patients with acute physical illness and comorbid depression.

Objectives

To evaluate the effectiveness of CBT in depressed geriatric patients, hospitalized for acute somatic illness.

Design

Randomized controlled trial with waiting list control group.

Setting

Postdischarge intervention in a geriatric day clinic; follow-up evaluations at the patients’ homes.

Participants

A total of 155 randomized patients, hospitalized for acute somatic illness, aged 82 ± 6 years and suffering from depression [Hospital Anxiety and Depression Scale (HADS) scores >7]. Exclusion criteria were dementia, delirium, and terminal state of medical illness.

Intervention

Fifteen, weekly group sessions based on a CBT manual. Commencement of psychotherapy immediately after discharge in the intervention group and a 4-month waiting list interval with usual care in the control group.

Measurements

HADS depression total score after 4 months. Secondary endpoints were functional, cognitive, psychosocial and physical status, resource utilization, caregiver burden, and amount of contact with physician.

Results

The intervention group improved significantly in depression scores (HADS baseline 18.8; after 4 months 11.4), whereas the control group deteriorated (HADS baseline 18.1; after 4 months 21.6). Significant improvement in the intervention group, but not in the control group, was observed for most secondary outcome parameters such as the Barthel and Karnofsky indexes. Intervention effects were less pronounced in patients with cognitive impairment or acute fractures.

Conclusions

CBT is feasible and highly effective in geriatric patients. The benefits extend beyond effective recovery and include improvement in physical and functional parameters. Early diagnosis, good access to psychotherapy, and early intervention could improve care for depressive older patients.

Clinical Trial Registration

www.germanctr.de German Trial Register DRKS 00004728  相似文献   

5.

Background

Children with disabilities are often the target of prejudice from their peers. The effects of prejudice include harmful health consequences. The Contact Hypothesis has previously shown to promote positive attitudes towards a range of social groups.

Objective

To conduct a systematic review and meta-analysis on the effectiveness of school-based interventions for improving children's attitudes towards disability through contact with people with disabilities.

Methods

A comprehensive search was conducted across multiple databases. Studies were included if it evaluated an intervention that aimed to improve children's attitudes towards disability and involved either direct (in-person) or indirect (e.g., extended) contact with people with disabilities. Data were synthesised in a meta-analysis.

Results

Twelve studies met the inclusion criteria. Of these, 11 found significant effects: six used direct contact, two used extended contact, two used parasocial (media-based) contact and one used guided imagined contact. One parasocial contact intervention found no significant effects. Three meta-analyses showed direct contact (d = 0.55, 95% CI 0.20 to 0.90) and extended contact (d = 0.61, 95% CI 0.15 to 1.07) improved children's attitudes; there was no evidence for parasocial contact (d = 0.20, 95% CI -0.01 to 1.40).

Conclusions

Direct, extended, and guided imagined contact interventions are effective in improving children's attitudes towards disability; there was no evidence for parasocial contact.  相似文献   

6.
7.

Objectives

Pneumonia is a frequent condition in older people. Our aim was to examine the total healthcare cost related to pneumonia in nursing home (NH) residents over a 1-year follow-up period.

Design

This was a prospective, longitudinal, observational, and multicenter study that was a part of the Incidence of Pneumonia and related Consequences in Nursing Home Resident study.

Setting

Thirteen NHs located in Languedoc Roussillon and Midi-Pyrénées regions in France were included.

Participants

Resident in NH, older than 60 years and had a group iso-resource score ranging from 2 to 5.

Measurements

Pneumonia events were characterized according to the Observatoire du Risque Infectieux en Geriatrie criteria. Direct medical and nonmedical costs were assessed from the French health insurance perspective. Healthcare resources was retrospectively gathered from the French Social Health Insurance database and valued using the tariffs reimbursed by the French health insurance. Sociodemographic variables, clinical factors, vaccinations, cognition, depression, functional status, frailty index, as well as group iso-resource score were also recorded.

Results

Among the 800 patients initially included in the Incidence of Pneumonia and Related Consequences in Nursing Home Resident study, 345 which were listed in the database of the French Social Health Insurance were included in this economic study. Among them, 64 (18%) experienced at least 1 episode of pneumonia during the 1-year follow-up period. Mean annual total additional cost for a patient who experienced at least 1 episode of pneumonia during the 1 year follow-up period is 2813€. On average, total annual costs increased by 60% to 93% when a patient experienced at least 1 episode of pneumonia.

Conclusions

NH-acquired pneumonia has a great impact on total cost of care for NH residents. Our results suggest the potential economic savings that could be achieved if pneumonia could be prevented in NHs.  相似文献   

8.

Background

Homebound status is associated with poor health, comorbidity, and mortality and represents a major challenge for health systems. However, its prevalence among people with disabilities in the basic activities of daily living (ADLs) is unknown.

Objectives

The objectives were to: (1) examine the prevalence of the homebound status among middle-aged and older adults with disabilities in ADLs, and (2) identify its clinical, functional, and environmental determinants.

Methods

This study included 221 community-dwelling subjects, aged ≥50 years, who applied for long-term care services at the Office for Legal Certification of Long-term Care Need of Coruña (Spain). Each subject had a disability in ADLs and was interviewed by a trained examiner in the subject's home. The participants were considered homebound if they remained inside their home during the previous week.

Measures

Demographic, clinical, functional, and environmental factors. Multiple logistic regression was used to determine the factors associated with homebound status.

Results

The prevalence of homebound status was 39.8%. A multivariate analysis revealed that the presence of architectural barriers at the home entrance (stairs [OR: 6.67, p < 0.001] or a heavy door [OR: 2.83, p = 0.023]), walking ability limitations (OR: 3.26, p = 0.006), and higher age (OR: 1.05, p = 0.04) were associated with homebound status.

Conclusions

Homebound status is a highly prevalent problem among middle-aged and older adults with disabilities in ADLs. Architectural factors in the home and walking ability limitations seem to be important predictors, suggesting that health care interventions should target home adaptations and mobility skills as a means to preventing or decreasing homebound status.  相似文献   

9.

Background

The elevated risk of suicide in people with disability has been suggested in the previous studies; however, the majority of study results have been limited to specific disability types, and there is a lack of research comparing the risk of suicide in people with disability in general.

Objectives

To examine the hazard ratio of suicide according to the presence and the types of disability and identify patterns in the results.

Methods

In this study, we used National Health Insurance Service-National Sample Cohort data on 990,598 people, and performed analysis on the cause of death from 2003 through 2013. A Cox proportional hazard model was used to estimate the hazard ratio of suicide associated with disability and its types.

Results

The hazard ratio of suicide among people with disability was 1.9-folds higher compared to people without disability. The risk of suicide among different disability types was higher in mental disorder, renal failure, brain injury and physical disability. The hazard ratio of suicide in people with disability was not varied by income. The time to death by suicide for people with disability from the onset of their disability was 39.8 months on average.

Conclusions

Our findings suggest that when the government plans suicide prevention policies, early and additional interventions specific to people with disability are needed. Disability due to mental disorder, renal failure should be given priority.  相似文献   

10.

Objectives

A simple and inexpensive tool for screening of sarcopenia would be helpful for clinicians. The present study was performed to determine whether the SARC-F questionnaire is useful in screening of patients with cardiovascular disease (CVD) for impaired physical function.

Design

Cross-sectional study.

Setting

Single university hospital.

Participants

A total of 235 Japanese patients ≥65 years old admitted to our hospital for CVD.

Measurements

SARC-F, handgrip strength, leg strength, respiratory muscle strength, standing balance, usual gait speed, Short Physical Performance Battery (SPPB) score, and 6-minute walking distance were measured before discharge from hospital. The patients were divided into 2 groups according to SARC-F score: SARC-F < 4 (nonsarcopenia group) and SARC-F ≥ 4 (sarcopenia group).

Results

The sarcopenia prevalence rate was 25.5% and increased with age (P trend < .001). The sarcopenia group (SARC-F score ≥ 4) had significantly lower handgrip strength, leg strength, and respiratory muscle strength, poorer standing balance, slower usual gait speed, lower SPPB score, and shorter 6-minute walking distance compared to the nonsarcopenia group (SARC-F score < 4). Patients in the sarcopenia group had consistently poorer physical function even after adjusting for covariates.

Conclusion

The SARC-F questionnaire is a useful screening tool for impaired physical function in elderly CVD patients. These findings support the use of the SARC-F for screening in hospital settings.  相似文献   

11.

Background

Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric syndromes (frailty, sarcopenia, anorexia of aging, and cognitive decline) will delay or avert the development of disability.

Objectives

To identify simple screening programs available for primary health professionals to identify geriatric syndromes.

Data sources

PubMed for the last 5 years and study authors.

Results

A number of screening programs for early detection of geriatric syndromes have been developed for use by primary care health providers, for example, EasyCare, Gérontopôle Frailty Screening Tool, the Rapid Geriatric Assessment, the Kihon Checklist, and others.

Limitations

This is an evolving area with limited information on the outcomes of intervention and possible harms.

Conclusion

Validated screening programs exist but more work is required to determine their utility in improving outcomes of older persons.  相似文献   

12.

Background

To investigate the impact of the Great East Japan Earthquake on preschool children's physical growth in the disaster-affected areas, the three medical universities in Iwate, Miyagi, and Fukushima Prefectures conducted a health examination survey on early childhood physical growth.

Methods

The survey was conducted over a 3-year period to acquire data on children who were born in different years. Our targets were as follows: 1) children who were born between March 1, 2007 and August 31, 2007 and experienced the disaster at 43–48 months of age, 2) children who were born between March 1, 2009 and August 31, 2009 and experienced the disaster at 19–24 months of age, and 3) children who were born between June 1, 2010 and April 30, 2011 and were under 10 months of age or not born yet when the disaster occurred. We collected their health examination data from local governments in Iwate, Miyagi, and Fukushima Prefectures. We also collected data from Aomori, Akita, and Yamagata Prefectures to use as a control group. The survey items included birth information, anthropometric measurements, and methods of nutrition during infancy.

Results

Eighty municipalities from Iwate, Miyagi, and Fukushima Prefectures and 21 from the control prefectures participated in the survey. As a result, we established three retrospective cohorts consisting of 13,886, 15,474, and 32,202 preschool children.

Conclusions

The large datasets acquired for the present survey will provide valuable epidemiological evidence that should shed light on preschool children's physical growth in relation to the disaster.  相似文献   

13.

Objective

Person-centered care (PCC) is meant to enhance nursing home residents' quality of life (QOL). Including residents' perspectives is critical to determining whether PCC is meeting residents’ needs and desires. This study examines whether PCC practices promote satisfaction with QOL and quality of care and services (QOC and QOS) among nursing home residents.

Design

A longitudinal, retrospective cohort study using an in-person survey.

Setting

Three hundred twenty nursing homes in Kansas enrolled or not enrolled in a pay-for-performance program, Promoting Excellent Alternatives in Kansas (PEAK 2.0), to promote PCC in nursing homes.

Participants

A total of 6214 nursing home residents in 2013-2014 and 5538 residents in 2014-2015, with a Brief Interview for Mental Status score ≥8, participated in face-to-face interviews. Results were aggregated to the nursing home level.

Measurements

My InnerView developed a Resident Satisfaction Survey for Kansas composed of 32 questions divided into QOL, QOC, QOS, and global satisfaction subdomains.

Results

After controlling for facility characteristics, satisfaction with overall QOL and QOC was higher in homes that had fully implemented PCC. Although some individual measures in the QOS domain (eg, food) showed greater satisfaction at earlier levels of implementation, high satisfaction was observed primarily in homes that had fully implemented PCC.

Conclusion

These findings provide evidence for the effectiveness of PCC implementation on nursing home resident satisfaction. The PEAK 2.0 program may provide replicable methods for nursing homes and states to implement PCC systematically.  相似文献   

14.

Objectives

Identify contextual and implementation factors impacting the effectiveness of an organizational-level intervention to reduce preventable hospital readmissions from affiliated skilled nursing facilities (SNFs).

Design

Observational study of the implementation of Interventions to Reduce Acute Care Transfers tools in 3 different cohorts.

Setting

SNFs.

Participants

SNFs belonging to 1 of 2 corporate entities and a group of independent SNFs that volunteered to participate in a Quality Improvement Organization (QIO) training program.

Intervention

Two groups of SNFs received INTERACT II training and technical assistance from corporate staff, and 1 group of SNFs received training from QIO staff.

Measurements

Thirty-day acute care hospital readmissions from Medicare fee-for-service claims, contextual factors using the Model for Understanding Success in Quality framework.

Results

All 3 cohorts were able to deliver the INTERACT training program to their constituent facilities through regional events as well as onsite technical assistance, but the impact on readmission rates varied. Facilities supported by the QIO and corporation A were able to achieve statistically significant reductions in 30-day readmission rates. A review of contextual factors found that although all cohorts were challenged by staff turnover and workload, corporation B facilities struggled with a less mature quality improvement (QI) culture and infrastructure.

Conclusions

Both corporations demonstrated a strong corporate commitment to implementing INTERACT II, but differences in training strategies, QI culture, capacity, and competing pressures may have impacted the effectiveness of the training. Proactively addressing these factors may help long-term care organizations interested in reducing acute care readmission rates increase the likelihood of QI success.  相似文献   

15.

Objectives

Hospitalizations among nursing facility residents are frequent and often potentially avoidable. A number of initiatives and interventions have been developed to reduce excessive hospitalizations; however, little is known about the specific approaches nursing facilities use to address this issue. The objective of this study is to better understand which types of interventions nursing facilities have introduced to reduce potentially avoidable hospitalizations of long-stay nursing facility residents.

Design

Cross-sectional survey.

Setting

236 nursing facilities from 7 states.

Participants

Nursing facility administrators.

Measurements

Web-based survey to measure whether facilities introduced any policies or procedures designed specifically to reduce potentially avoidable hospitalizations of long-stay nursing facility residents between 2011 and 2015. We surveyed facilities about seven types of interventions and quality improvement activities related to reducing avoidable hospitalizations, including use of Interventions to Reduce Acute Care Transfers (INTERACT) and American Medical Directors Association tools.

Results

Ninety-five percent of responding nursing facilities reported having introduced at least one new policy or procedure to reduce nursing facility resident hospitalizations since January 2011. The most common practice reported was hospitalization rate tracking or review, followed by standardized communication tools, such as Situation, Background, Assessment, Recommendation (SBAR). We found some variation in the extent and types of these reported interventions.

Conclusions

Nearly all facilities surveyed reported having introduced a variety of initiatives to reduce potentially avoidable hospitalizations, likely driven by federal, state, and corporate initiatives to decrease hospital admissions and readmissions.  相似文献   

16.
17.

Objectives

To investigate the prevalence and factors associated with the use of medications of questionable benefit throughout the final year of life of older adults who died with dementia.

Design

Register-based, longitudinal cohort study.

Setting

Entire Sweden.

Participants

All older adults (≥75 years) who died with dementia between 2007 and 2013 (n = 120,067).

Measurements

Exposure to medications of questionable benefit was calculated for each of the last 12 months before death, based on longitudinal data from the Swedish Prescribed Drug Register.

Results

The proportion of older adults with dementia who received at least 1 medication of questionable benefit decreased from 38.6% 12 months before death to 34.7% during the final month before death (P < .001 for trend). Among older adults with dementia who used at least 1 medication of questionable benefit 12 months before death, 74.8% remained exposed until their last month of life. Living in an institution was independently associated with a 15% reduction of the likelihood to receive ≥1 medication of questionable benefit during the last month before death (odds ratio 0.85, 95% confidence interval 0.88–0.83). Antidementia drugs accounted for one-fifth of the total number of medications of questionable benefit. Lipid-lowering agents were used by 8.3% of individuals during their final month of life (10.2% of community-dwellers and 6.6% of institutionalized people, P < .001).

Conclusion

Clinicians caring for older adults with advanced dementia should be provided with reliable tools to help them reduce the burden of medications of questionable benefit near the end of life.  相似文献   

18.

Background

The transition to adulthood, the gradual change in roles and responsibilities, is identified as a challenging time for adolescents and young adults with physical disabilities, including those with cerebral palsy. Health care, education, employment, independent living, and community engagement have been identified as areas of concern. However, relatively little research has been done to understand the experiences, perceptions, and needs of individuals with cerebral palsy as they transition toward adulthood.

Objective

The objective of this study was to explore the transition experiences, perceptions, and needs of young adults with cerebral palsy living in one state in the southeastern United States.

Methods

Focus groups with nine young adults with cerebral palsy (19–34 years) were conducted. The focus group interview explored the preparation for transition and experiences navigating adulthood. The audio-recorded groups were transcribed and analyzed using thematic analysis.

Results

Young adults with cerebral palsy identified numerous challenges associated with navigating adulthood. The main themes were: 1) being thrust into adulthood; 2) navigating systems and services; 3) understanding and managing my body; and 4) dealing with stereotypes and prejudice.

Conclusions

The findings highlight the need for a holistic approach to transition with a focus on building capacity and empowerment. To navigate complex systems of care, “navigators” or “facilitators” are needed. Additionally, practitioners and service providers in adult systems need further education about cerebral palsy.  相似文献   

19.

Objectives

This study aimed to examine the effects of introducing participatory action research (PAR) within the nursing home (NH) on residents’ quality of life (QoL) and NH experience and participation, and to explore their experiences with PAR.

Design

A mixed methods design was chosen, including a clustered randomized controlled trial (RCT) and qualitative interviews.

Setting

For the RCT, 3 NHs were randomly allocated to 3 conditions: an intervention (weekly PAR activity), an active control (weekly reminiscence-activity), or passive control (care as usual). The qualitative study took place in the intervention NH.

Participants

Within the RCT, about 30 residents were recruited for assessments per NH, including 9 PAR participants and 10 reminiscence participants. Qualitative interviews were held with all PAR participants (residents and internal moderator).

Intervention

PAR is a method to structurally involve residents in the NH operation. Weekly PAR sessions were held with 9 residents and 2 moderators. Here, residents critically analyzed and discussed the NH operation, identified possible problems, suggested improvements, which were further implemented by the NH and monitored by the PAR group.

Measurements

Residents’ NH experience (NH Active Aging Survey), QoL (Anamnestic Comparison Self-Assessment), and experienced participation (Impact on Participation and Autonomy) were measured in the RCT at pre-test, post-test (6 months), and follow-up (12 months). The qualitative study took into account interviews with the PAR stakeholders after 6 months.

Results

The RCT showed residents’ QoL improving more between pre-test and follow-up in the intervention and active control NH compared with the passive control NH. No other effects were observed. The qualitative data revealed a positive PAR experience. Participants enjoyed the activity and indicated various positive influences. Still, there was room for improvement, including communication toward other residents and between staff.

Conclusions

Notwithstanding the modest quantitative effects, PAR led to positive experiences and can have a future in the NH when solving some limitations.  相似文献   

20.

Objectives

Cognitive frailty, a condition describing the simultaneous presence of physical frailty and mild cognitive impairment, has been recently defined by an international consensus group. We estimated the predictive role of a “reversible” cognitive frailty model on incident dementia, its subtypes, and all-cause mortality in nondemented older individuals. We verified if vascular risk factors or depressive symptoms could modify this predictive role.

Design

Longitudinal population-based study with 3.5- and 7-year of median follow-up.

Setting

Eight Italian municipalities included in the Italian Longitudinal Study on Aging.

Participants

In 2150 older individuals from the Italian Longitudinal Study on Aging, we operationalized reversible cognitive frailty with the presence of physical frailty and pre-mild cognitive impairment subjective cognitive decline, diagnosed with a self-report measure based on item 14 of the Geriatric Depression Scale.

Measurements

Incidence of dementia, its subtypes, and all-cause mortality.

Results

Over a 3.5-year follow-up, participants with reversible cognitive frailty showed an increased risk of overall dementia [hazard ratio (HR) 2.30, 95% confidence interval (CI) 1.02–5.18], particularly vascular dementia (VaD), and all-cause mortality (HR 1.74, 95% CI 1.07–2.83). Over a 7-year follow-up, participants with reversible cognitive frailty showed an increased risk of overall dementia (HR 2.12, 95% CI 1.12–4.03), particularly VaD, and all-cause mortality (HR 1.39, 95% CI 1.03–2.00). Vascular risk factors and depressive symptoms did not have any effect modifier on the relationship between reversible cognitive frailty and incident dementia and all-cause mortality.

Conclusions

A model of reversible cognitive frailty was a short- and long-term predictor of all-cause mortality and overall dementia, particularly VaD. The absence of vascular risk factors and depressive symptoms did not modify the predictive role of reversible cognitive frailty on these outcomes.  相似文献   

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