The importance of cultural factors in the planning of rehabilitation services in a remote area of Papua New Guinea

Purpose: The aim of this study in the Middle Ramu, Papua New Guinea, was to gain a better understanding of how cultural factors work to influence the lives of persons with disability in a remote area. The study also explores how this information can be used for the planning of rehabilitation services.

Method: Two phase screening identified persons with disability in the study area and questionnaires were completed for all those identified. Information documented included the nature of the disability, a biomedical cause (where appropriate), the perceived cause of the disability, as well as some indication as to where help had been sought for the disability. In depth interviews were later done with disabled individuals and their families, to determine how they explained their disability.

Results: Thirty-two per cent of persons with disability and their families attributed disability to sorcery or other supernatural causes, a greater proportion than for any other category of perceived aetiology. There was widespread acceptance of Western medicine, although help was more likely to be sought from sources in the community for disabilities believed to have a supernatural origin.

Conclusions: This study demonstrates that an understanding of cultural factors is fundamental to implementing rehabilitation services that are culturally appropriate and address the social dimension of disability.     

Swedish women's satisfaction with medical and emotional aspects of antenatal care

AIM: This paper reports a study to investigate how satisfied Swedish women are with their antenatal care. BACKGROUND: Medical care is of high priority, but other aspects, such as psychosocial support are also important for women during pregnancy. Identifying women who are dissatisfied with their antenatal care could help us to improve this. Methods. A national cohort of 2746 Swedish-speaking women completed a questionnaire in early pregnancy and at 2 months postpartum. The data were collected in 1999-2000. RESULTS: The majority of participants were satisfied with their antenatal care, but 23% were dissatisfied with the emotional aspects and 18% with the medical aspects. The strongest predictors of dissatisfaction were women's opinions that midwives had not been supportive and had not paid attention to their partners' needs. If the women believed that there were not enough antenatal visits or had met three or more midwives during their antenatal visits, they were more likely to be dissatisfied with the care received. Those with low levels of education were more likely to be dissatisfied with both medical and emotional aspects of antenatal care. CONCLUSIONS: Midwives working in antenatal care should support pregnant women and their partners in a professional and friendly way in order to increase satisfaction with care. Organizing teamwork with no more than two midwives taking care of a woman during a normal pregnancy could make women feel more supported by their midwives.     

Mothers' and fathers' responses to their child's pain moderate the relationship between the child's pain catastrophizing and disability

Preliminary evidence suggests that pain catastrophizing in children may be important in understanding how parents respond to their child’s pain. However, no study has investigated whether parental responses, in turn, moderate the impact of child’s catastrophizing upon pain outcomes. The present study was designed to address this, and investigated the association of the child’s catastrophizing with different types of parental responses (ie, solicitousness, discouragement and coping promoting responses) and the extent to which parental responses moderate the association between the child’s catastrophizing and disability. Participants were 386 school children and their parents. Analyses revealed significant associations between the child’s pain catastrophizing and parental responses, but with mothers and fathers evidencing different patterns; ie, higher levels of the child’s catastrophizing were significantly associated with lower levels of solicitousness by fathers, and with higher levels of discouragement by mothers. Moderation analyses indicated that father’s solicitiousness moderated the association between catastrophizing and disability; the positive association between catastrophizing and the child’s disability was further strengthened when fathers reported low levels of solicitousness, but became less pronounced when fathers reported high levels of solicitousness. Findings also revealed a moderating impact of mothers’ and fathers’ promotion of their child’s well behaviour/coping. Specifically, the detrimental impact of child catastrophizing upon disability was less pronounced when parents reported high promotion of their child’s well behaviours/coping. The findings of the present study suggest the importance of assessing and targeting parental responses to their child’s pain to alter the adverse impact of the child’s pain catastrophizing on pain outcomes.     

Potential contributions to disability theorizing and research from positive pyschology

Purpose. Within the context of taking the perspectives of disabled individuals themselves more seriously, it is imperative that researchers and practitioners accord due primacy to the experiential worlds and everyday lived experiences of individuals with disabilities. Based on the premise that theoretical groundedness (along with methodological rigour) is integral to sound research, it is argued that the existing body of knowledge regarding the lived experiences of individuals with disabilities may be complemented by a conceptual placing of understandings of disability in relation to a prominent theoretical pathway at the moment, namely, the interdisciplinary emphasis on human strengths and wellness.

Method. A critical engagement with key conceptualizations of disability entailed a focus on the development, strengths, and challenges of medical, social and psychologically based conceptualizations of disability.

Results and conclusion. The existing body of knowledge around disability may be extended and complemented by key concepts regarding human health/wellness from the field of Positive Psychology. Positive Psychology's keynote contribution to the study of disability and rehabilitation entails directing researchers and practitioners to the aim of building, reinforcing and extending disabled individuals' strengths and capacities in order to optimize their functioning in all areas of life, and thereby promote wellness.     

Potential contributions to disability theorizing and research from positive pyschology

Purpose.?Within the context of taking the perspectives of disabled individuals themselves more seriously, it is imperative that researchers and practitioners accord due primacy to the experiential worlds and everyday lived experiences of individuals with disabilities. Based on the premise that theoretical groundedness (along with methodological rigour) is integral to sound research, it is argued that the existing body of knowledge regarding the lived experiences of individuals with disabilities may be complemented by a conceptual placing of understandings of disability in relation to a prominent theoretical pathway at the moment, namely, the interdisciplinary emphasis on human strengths and wellness.

Method.?A critical engagement with key conceptualizations of disability entailed a focus on the development, strengths, and challenges of medical, social and psychologically based conceptualizations of disability.

Results and conclusion.?The existing body of knowledge around disability may be extended and complemented by key concepts regarding human health/wellness from the field of Positive Psychology. Positive Psychology's keynote contribution to the study of disability and rehabilitation entails directing researchers and practitioners to the aim of building, reinforcing and extending disabled individuals' strengths and capacities in order to optimize their functioning in all areas of life, and thereby promote wellness.     

Rethinking disability: the social model of disability and chronic disease

Disability is commonly viewed as a problem that exists in a person’s body and requires medical treatment. The social model of disability, by contrast, distinguishes between impairment and disability, identifying the latter as a disadvantage that stems from a lack of fit between a body and its social environment. This paper describes the social model of disability and then considers how it might deal with chronic disease or impairment and why medical professionals should learn about disability perspectives to improve their practice.     

学习障碍护理研究进展及启示

英国学习障碍护理距今已有一百多年的历史,在其发展过程中经历了许多困难和革新,同时也积累了丰富的经验。该文主要对英国学习障碍护理的发展概况、护士角色职责和工作内容、人才培养和管理制度、面临的挑战及其应对进行介绍,并提出中国学习障碍护理发展的建议,旨在为护理服务模式的创新及护理服务体系的完善提供新视角,为护士引领健康服务提供借鉴。     

Functioning and disability analysis by using WHO Disability Assessment Schedule 2.0 in older adults Taiwanese patients with dementia

Background: To analyse the disability status of elderly Taiwanese dementia patients by using the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). Methods: We enrolled 12 126 disabled elderly (>65 years) patients with dementia during July 2012–January 2014 from the Taiwan Data Bank of Persons with Disability. Trained interviewers evaluated the standardised scores in the six WHODAS 2.0 domains. Student’s t test was used for comparing WHODAS 2.0 scores of male and female dementia patients with different age groups. Results: The study population comprised 12 126 patients; 7612 were women and 4514 were men. The WHODAS 2.0 scores showed that the dementia patients had global activity limitation and participation restriction in all domains. Dementia-induced disability was prominent in male patients in all of the domains of the WHODAS 2.0. The domains of life activities, getting along with people and cognition were more strongly affected than the other domains. However, women experienced more rapid functional decline than men did as they aged. Conclusion: The data analysed in this large-scale, population-based study revealed crucial information on dementia-induced disability in elderly patients on the basis of the WHODAS 2.0 framework.

• Implications for rehabilitation

• Dementia patients have global functional disability in all domains of WHODAS 2.0 and multidisciplinary team is needed for rehabilitation programme intervention for these patients.

• When considering the rehabilitation resource and strategy, the domains of cognition, activities of daily living and life activities should be focussed.

• When dementia patients aged 65–75 years old, male patients got more restriction of function than female and more medical resource allocation for disabled male patients is recommended.

• With ageing, female dementia patients exhibited more rapid functional decline than male patients did and more budget about rehabilitation for maintain functional and dementia progression is crucial for female patients.

     

Using the ICF to code and analyse women's disability narratives

Purpose. This article describes the use of the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) as a conceptual framework for processing and analyzing the narratives of 50 community-dwelling women with a spinal cord injury. The women were participants in a federally-funded study of stress and coping over the life course.

Method. The paper describes the development of a coding scheme and data reduction techniques used to process qualitative data.

Results. The initial results of three phases of data analysis are then presented: (i) the construction of matrices to display data so as to permit pattern finding; (ii) the mapping of specific ICF codes to text to produce a more finely grained analysis of environment-related stressors, and (iii) a thematic analysis of text depicting the dynamics of person-environment interaction.

Conclusions. Of potential value to the further elaboration of the ICF is a fleshing out of the personal factors component of the ICF and the provision of a context-driven, process view of person-environment interaction. It is hoped that this article will stimulate continued discussion of person-level factors. The concept of coupling suggests also a need to focus research attention on the bi-directional and ever evolving linkages connecting person to environment.     

Using the ICF to code and analyse women's disability narratives

PURPOSE: This article describes the use of the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) as a conceptual framework for processing and analyzing the narratives of 50 community-dwelling women with a spinal cord injury. The women were participants in a federally-funded study of stress and coping over the life course. METHOD: The paper describes the development of a coding scheme and data reduction techniques used to process qualitative data. RESULTS: The initial results of three phases of data analysis are then presented: (i) the construction of matrices to display data so as to permit pattern finding; (ii) the mapping of specific ICF codes to text to produce a more finely grained analysis of environment-related stressors, and (iii) a thematic analysis of text depicting the dynamics of person-environment interaction. CONCLUSIONS: Of potential value to the further elaboration of the ICF is a fleshing out of the personal factors component of the ICF and the provision of a context-driven, process view of person-environment interaction. It is hoped that this article will stimulate continued discussion of person-level factors. The concept of coupling suggests also a need to focus research attention on the bi-directional and ever evolving linkages connecting person to environment.     

Amygdala responses to nonlinguistic emotional vocalizations

Whereas there is ample evidence for a role of the amygdala in the processing of visual emotional stimuli, particularly those with negative value, discrepant results have been reported regarding amygdala responses to emotional auditory stimuli. The present study used event-related functional magnetic resonance imaging to investigate cerebral activity underlying processing of emotional nonlinguistic vocalizations, with a particular focus on neural changes in the amygdala. Fourteen healthy volunteers were scanned while performing a gender identification task. Stimuli, previously validated on emotional valence, consisted of positive (happiness and sexual pleasure) and negative (sadness and fear) vocalizations, as well as emotionally neutral sounds (e.g., coughs). Results revealed bilateral amygdala activation in response to all emotional vocalizations when compared to neutral stimuli. These findings suggest that the generally accepted involvement of the amygdala in the perception of emotional visual stimuli, such as facial expressions, also applies to stimuli within the auditory modality. Importantly, this amygdala response was observed for both positive and negative emotional vocalizations.     

Pattern of disability among patients attending Taif Rehabilitation Center, Saudi Arabia

Purpose. Despite the growing awareness of the community about the economic, psychological and medical impact of disability, limited research has been carried out to determine the pattern of disabilities in Saudi Arabia.

Methods. This is a cross-sectional study of hospital records of patients who were admitted to Armed Forces Rehabilitation Center, Taif, Saudi Arabia, during the period from 1999 - 2005. A total of 850 patient records were reviewed. Data were collected on age, sex, nationality, data of admission and discharge and type of disability. Univariate and multivariate logistic regression analyses were performed to determine predictors of long stay at the hospital.

Results. Trauma as an etiology of disability was more common than non-traumatic incidents among male and middle age patients (16 - 45 years). Traumatic accidents mostly result in quadriplegia (72.8%). Male, single, less than 45 years old, patients with traumatic accidents and patients with paralytic types of disability were significantly more likely to stay longer at the hospital (≥6 months).

Conclusions. The home care program should be expanded to minimize duration of stay at the rehabilitation centers with lower cost as well as health education of the public would help in encouraging disabled patients to adapt to daily life activities.     

Pattern of disability among patients attending Taif rehabilitation center,Saudi Arabia

Purpose. Despite the growing awareness of the community about the economic, psychological and medical impact of disability, limited research has been carried out to determine the pattern of disabilities in Saudi Arabia.

Methods. This is a cross-sectional study of hospital records of patients who were admitted to Armed Forces Rehabilitation Center, Taif, Saudi Arabia, during the period from 1999 – 2005. A total of 850 patient records were reviewed. Data were collected on age, sex, nationality, data of admission and discharge and type of disability. Univariate and multivariate logistic regression analyses were performed to determine predictors of long stay at the hospital.

Results. Trauma as an etiology of disability was more common than non-traumatic incidents among male and middle age patients (16 – 45 years). Traumatic accidents mostly result in quadriplegia (72.8%). Male, single, less than 45 years old, patients with traumatic accidents and patients with paralytic types of disability were significantly more likely to stay longer at the hospital (≥6 months).

Conclusions. The home care program should be expanded to minimize duration of stay at the rehabilitation centers with lower cost as well as health education of the public would help in encouraging disabled patients to adapt to daily life activities.     

Counting disability: global and national estimation

Purpose: How many people with disabilities are in the world? How is disability defined? How can we measure disability in an accurate and comparable way? These are some of the key questions which the recently published World Bank/WHO World Report on Disability (WRD) addresses.

Method: Multiple data sources and methods were used by WHO and the World Bank to estimate a global figure, with the ICF as the underlying data standard. Key international data sources were the World Health Survey of 2002–2004 and the 2004 updates from the Global Burden of Disease study. The World Report on Disability also includes a compilation of country-reported prevalence from census and surveys. This paper presents and discusses key findings of the Irish National Disability Survey (2006) to illustrate the value of the ICF framework for disability statistics and most especially the environmental factors component.

Results: The World Report estimates that globally one billion people or 15% of the world’s population experience disabilities. Between 110–190 million people (2% of the world’s population) experience severe or extreme difficulties in functioning. Definitions and measures of disability vary widely across countries. The Irish Disability Survey shows the substantial impact of environmental factors on people’s functioning. For example, attitudes, and the presence or absence of facilitating equipment, support services, flexible working arrangements and transport significantly affect participation of people with disabilities in Irish society.

Conclusions: To improve the quality of disability information, the World Report recommends the use of a common definition and concepts of disability based on WHO’s International Classification of Functioning Disability and Health (ICF). Furthermore, disability measurement needs to apply a multidimensional approach, in particular, measuring disability in terms of the level of difficulty a person is experiencing in multiple areas of life, rather than head counting severe impairment types in a dichotomous way. Environmental factors have significant effects on individual functioning and should be considered as an integral part in disability measurement.

Implications for Rehabilitation

• Rehabilitation practitioners and researchers can be part of the international work towards an epidemiology of functioning and disability, by using a common language and frame of reference – the ICF – and by gathering and sharing information and statistics as recommended by the World Report on Disability.

• Better comparability between clinical or case based data and population data will also enable analyses which serve to improve the health of populations globally.

• Environmental factors – physical, social and attitudinal – must be recorded or measured as part of the context which influences the experience and level of functioning and can offer useful information to guide positive interventions.

     

脑卒中失能患者延续性护理方案的构建

目的:构建脑卒中失能患者延续性护理方案,为脑卒中失能患者出院后延续性护理提供指导。方法:基于文献分析初步编制服务方案,检索CNKI、万方、维普中文数据库、PubMed、Cochrane Library、Ovid数据库进行检索,检索时限截至2019年10月31日。在文献检索与分析的基础上,初步拟定专家咨询问卷,遵循知情同...     

The Loss Inventory: preliminary reliability and validity data for a new measure of emotional and cognitive responses to disability

Purpose:?To examine the utility, reliability and validity of a new scale, The Loss Inventory (LI) for measuring symptoms unique to grief following disablement.

Methods:?Prospective survey study in which two self-report measures, the LI and Zung Self-Rating Depression Scale, were administered to 103 hospitalized rehabilitation patients. Correlational analyses, t tests, t score conversions of raw data, and analysis of variance used to determine reliability (internal consistency) of the LI and compare means of scores across several variables.

Results:?Cronbach's Alpha?=?0.90 for the LI. The Zung and the LI correlated 0.59 but study subjects were significantly (p?<?0.001) more likely to score higher on the LI than on the Zung. Certain LI items were significantly more frequently endorsed by depressed patients. Significant gender and ethnic differences were found.

Conclusions:?Rehabilitation patients sampled in this study were no more likely to be depressed than most people. Grief symptoms reported following functional losses are similar to those reported by persons who have experienced the death of someone close. The Loss Inventory reliably measures these grief symptoms. Gender and ethnicity affect the manner in which grief symptoms are reported. The LI may improve mental health clinicians' diagnostic accuracy in rehabilitation and medical settings.     

The Loss Inventory: preliminary reliability and validity data for a new measure of emotional and cognitive responses to disability

PURPOSE: To examine the utility, reliability and validity of a new scale, The Loss Inventory (LI) for measuring symptoms unique to grief following disablement. METHODS: Prospective survey study in which two self-report measures, the LI and Zung Self-Rating Depression Scale, were administered to 103 hospitalized rehabilitation patients. Correlational analyses, t tests, t score conversions of raw data, and analysis of variance used to determine reliability (internal consistency) of the LI and compare means of scores across several variables. RESULTS: Cronbach's Alpha=0.90 for the LI. The Zung and the LI correlated 0.59 but study subjects were significantly (p<0.001) more likely to score higher on the LI than on the Zung. Certain LI items were significantly more frequently endorsed by depressed patients. Significant gender and ethnic differences were found. CONCLUSIONS: Rehabilitation patients sampled in this study were no more likely to be depressed than most people. Grief symptoms reported following functional losses are similar to those reported by persons who have experienced the death of someone close. The Loss Inventory reliably measures these grief symptoms. Gender and ethnicity affect the manner in which grief symptoms are reported. The LI may improve mental health clinicians' diagnostic accuracy in rehabilitation and medical settings.