The role of psychosocial factors in explaining socio-economic differences in mobility decline in a chronically ill population: results from the GLOBE study

In chronically ill patients, mobility develops more unfavorably in persons with low socio-economic status (SES) than in their better-off counterparts. Using longitudinal data from the Dutch GLOBE study (a study of health and living conditions in Eindhoven and its surroundings), the present study examines whether psychosocial factors can explain socio-economic differences in mobility decline, independent of disease severity, co-morbidity, and health-related behavior in a chronically ill population. Data were from 1384 men and woman, aged 15-74 years, suffering from at least one of the four chronic diseases: asthma/COPD, heart disease, diabetes mellitus, and low back pain. Three indicators of SES were used: education, occupational class, and income. Change in physical mobility between 1991 and 1997 was measured with the Nottingham Health Profile (NHP). Psychosocial factors were measured extensively and included life events, long-term difficulties, coping styles, social support, and personality characteristics. Low occupational level and low income predicted an increased risk of mobility decline in comparison to people with a higher occupational level and income, even after controlling for sociodemographics, disease severity, co-morbidity, and health-related behavior. Additional adjustment for psychosocial factors hardly reduced the SES-related odds ratios of mobility decline. We conclude that psychosocial factors (and also health-related behaviors, disease severity and co-morbidity) cannot explain socio-economic differences in mobility decline in a chronically ill population. Our findings will not give us new tools for prevention and intervention strategies in order to reduce physical disability and particularly the SES differences therein.     

Socioeconomic inequalities in mobility decline in chronic disease groups (asthma/COPD, heart disease, diabetes mellitus, low back pain): only a minor role for disease severity and comorbidity

OBJECTIVE: This study examined the association between socioeconomic status and mobility decline and whether this could be explained by disease severity and comorbidity in four different chronic disease groups (asthma/COPD, heart disease, diabetes mellitus, and low back pain). It is not clear, whether the adverse course of physical functioning in persons with a low socioeconomic status can be explained by a higher prevalence of more severe disease or comorbidity in these persons. DESIGN: Dutch GLOBE study: prospective cohort study. SETTING: Region of Eindhoven (south east of the Netherlands). PARTICIPANTS: 1384 persons suffering from at least one of the four chronic diseases were selected. The number of respondents in each group was: asthma/COPD 465, heart disease 788, diabetes mellitus 137, and low back pain 707. There were 580 respondents who suffered from more than one condition. MAIN RESULTS: Odds ratios of mobility decline between 1991 and 1997, adjusted for age, sex, marital status, and baseline mobility, were significantly higher in low socioeconomic groups in comparison with high socioeconomic groups. Only very little of this association could be explained by the higher disease severity and comorbidity in these patients. Findings were similar in patients with asthma/COPD, heart disease, diabetes mellitus, and chronic low back pain. CONCLUSION: These findings indicate that to reduce physical disabilities and particularly the socioeconomic differences therein, it may not be sufficient to solely intervene upon the risks of severe disease and comorbidities.     

Visual, hearing, and physical disability: prevalence and associated factors in a population-based study

The aim of this study was to describe the prevalence of disabilities according to demographic and socioeconomic characteristics, as well as to determine the main causes. The research used data from two population-based health surveys in S?o Paulo State, Brazil, in 2002 and 2003, designed with complex sampling techniques. Interviewees that reported disabilities comprised the study sample, according to the database variables. Prevalence of any disability was 110.8; visual disability, 62; hearing disability, 44; and physical disability, 13.3. Prevalence rates for disabilities varied according to age, gender, and schooling. Prevalence of hearing and physical disability was higher among men. The principal cause of disabilities was the disease itself. External causes were also one of the causative factors in disabilities. Disabilities increased with age and were more prevalent among women and persons with less schooling, and the principal causes were diseases and injuries.     

Morbidity Experiences and Disability Among Canadian Women

HEALTH ISSUE: Women are more frequently affected by chronic conditions and disability than men. Although some of these sex differences have been in part attributed to biological susceptibility, social determinants of health and other factors, these gaps have not been fully explained in the current literature. This chapter presents comparisons of hospitalization rates, and the prevalence of chronic conditions and physical disability between Canadian women and men and between various subgroups of women, adjusting for selected risk factors. The Canadian Hospital Morbidity Database (2000-2001) and Canadian Community Health Survey (2000-2001) were used to examine inpatient hospital morbidity, prevalence of chronic conditions and disability. KEY FINDINGS: Hospitalization rates were 20% higher among women than men. This was due to the large number of hospitalizations for pregnancies and childbirth. When "normal" deliveries were excluded, hospitalization rates remained higher among women. Women had slightly lower rates of hospitalizations for ambulatory-care sensitive conditions than men. Prevalence of activity limitation (mild and severe) was higher among women than men, and differences remained after adjusting for age, chronic conditions, socio-economic status, and smoking. Women who reported a disability were less likely than men to be in a partnered relationship, have less tangible social support, and have lower income and employment rates. DATA GAPS AND RECOMMENDATIONS: The impact of morbidity and disability on Canadian women is substantial. These results identify areas for interventions among more vulnerable subgroups, and point to the need for further research in the area of risk factors for the prevention of morbidity and disability in the population.     

State-specific prevalence of obesity among adults with disabilities--eight states and the District of Columbia, 1998-1999

The national health objectives for 2010 rank obesity among the top ten leading health indicators. Obesity increases the risk for type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, respiratory problems, certain cancers, gallstones, osteoarthritis, and lowered life expectancy. The estimated annual cost attributable to obesity-related diseases is approximately $100 billion. Obesity among adults in the general U. S. population increased from 12.0% in 1991 to 17.9% in 1998. Little is known about the national or state prevalence of obesity among persons with disabilities. Obesity is not measured routinely or reported among persons with disabilities. To determine the prevalence of obesity among persons with and without disabilities, CDC analyzed data from the 1998 and 1999 Behavioral Risk Factor Surveillance System (BRFSS) for eight states and the District of Columbia (DC). The findings indicate that obesity rates are significantly higher among persons with disabilities, especially among blacks and persons aged 45-64 years. The findings suggest that public health messages and interventions should be targeted to persons with disabilities who are likely to become obese and to obese persons who are likely to become disabled.     

中国少数民族残疾人的现况调查

目的 了解中国少数民族人口残疾现患率的流行特征.方法 以全国为总体,自治区、直辖市为次总体,利用多阶段分层整群概率比例抽样方法抽取2 526 145人,其中少数民族297 761人,由专业医生进行残疾相关问题询问、诊断和残疾等级评定.结果 中国少数民族和汉族人口残疾现患率分别为6.24%(95%CI:6.16%～6.51%)和6.41%(95%CI:6.38%～6.51%).少数民族和汉族人口标化残疾现患率为7.04%和5.98%,少数民族高于汉族.少数民族人口标化残疾率男性高于女性(7.31%vs.6.75%).少数民族人口肢体残疾现患率水平最高,为1.90%(95%CI:1.89%～1.91%),其次是听力残疾1.34%(95%CI:1.33%～1.35%)、多重残疾1.14%(95%CI:1.13%～1.15%)、视力残疾0.99%(95%CI:0.97%～1.01%)、精神残疾0.38%(95%CI:0.37%～0.40%)、智力残疾0.38%(95%CI:0.37%～0.39%)、言语残疾0.12%(95%CI:0.11%～0.13%).遗传、中耳炎、脑瘫、脑疾病(除去原因不明)、智力低下(除去原因不明)是少数民族儿童视力、听力、肢体、智力和言语残疾发生最重要的致残原因.老年性白内障、老年性耳聋、骨关节病、脑血管病和脑梗死是导致少数民族老年人口五类残疾的最重要原因.白内障、中耳炎(除去原因不明)、其他外伤、脑疾病(除去原因不明)是少数民族劳动年龄人口残疾最重要因素.中耳炎造成的儿童听力残疾和不良社会文化因素造成的智力残疾仍然是少数民族人口主要致残因素,其他主要致残因素及其顺位与汉族残疾人口相类似.结论 少数民族人口残疾现患率高于汉族人口,在不同年龄阶段,应针对主要致残因素预防和降低少数民族人群的残疾发生.     

Explaining Disability Trends in the U.S. Elderly and Near‐Elderly Population

Objective

To examine disability trends among U.S. near-elderly and elderly persons and explain observed trends.

Data Source

1996–2010 waves of the Health and Retirement Study.

Study Design

We first examined trends in Activities of Daily Living and Instrumental Activities of Daily Living limitations, and large muscle, mobility, gross motor, and fine motor indexes. Then we used decomposition analysis to estimate contributions of changes in sociodemographic composition, self-reported chronic disease prevalence and health behaviors, and changes in disabling effects of these factors to disability changes between 1996 and 2010.

Principal Findings

Disability generally increased or was unchanged. Increased trends were more apparent for near-elderly than elderly persons. Sociodemographic shifts tended to reduce disability, but their favorable effects were largely offset by increased self-reported chronic disease prevalence. Changes in smoking and heavy drinking prevalence had relatively minor effects on disability trends. Increased obesity rates generated sizable effects on lower-body functioning changes. Disabling effects of self-reported chronic diseases often declined, and educational attainment became a stronger influence in preventing disability.

Conclusions

Such unfavorable trends as increased chronic disease prevalence and higher obesity rates offset or outweighed the favorable effects with the result that disability remained unchanged or increased.     

Disability among lesbian, gay, and bisexual adults: disparities in prevalence and risk

Objectives. We used population-based data to comprehensively examine disability among lesbian, gay, and bisexual adults.Methods. We estimated prevalence of disability and its covariates and compared by sexual orientation by utilizing data from the Washington State Behavioral Risk Factor Surveillance System (n = 82 531) collected in 2003, 2005, 2007, and 2009. We used multivariate logistic regression to examine the relationship between disability and sexual orientation, after we controlled for covariates of disability.Results. Findings indicated that the prevalence of disability is higher among lesbian, gay, and bisexual adults compared with their heterosexual counterparts; lesbian, gay, and bisexual adults with disabilities are significantly younger than heterosexual adults with disabilities. Higher disability prevalence among lesbians and among bisexual women and men remained significant after we controlled for covariates of disability.Conclusions. Higher rates of disability among lesbian, gay, and bisexual adults are of major concern. Efforts are needed to prevent, delay, and reduce disabilities as well as to improve the quality of life for lesbian, gay, and bisexual adults with disabilities. Future prevention and intervention efforts need to address the unique concerns of these groups.Disability is a critical and growing public health issue that must be addressed as part of this nation''s blueprint to improve health.1 Public health data reveal that the number of adults living with disabilities continues to increase.2 Nearly 50 million American adults aged 18 years and older are affected by disabilities,3 with more than 10 million persons living with physical or mental disabilities necessitating ongoing assistance with day-to-day or other instrumental activities.4 Costs exceed more than $300 billion annually as a result of medical care and lost productivity related to disabilities.3 Although disabilities can have a major impact on health, quality of life, and full participation in society, people with disabilities remain one of the most underserved populations in the United States.5The Centers for Disease Control and Prevention''s (CDC''s) Health Disparities and Inequalities Report—United States, 2011 identifies disparities related to disability and sexual orientation as the 2 main gaps in current health disparities research.6 To date, existing research has not comprehensively examined the prevalence and covariates of disability among lesbian, gay, and bisexual (LGB) adults. Multiple health-related behaviors such as smoking, lack of exercise, obesity, health conditions (including arthritis and asthma), and mental distress have been found to be associated with limitations in physical functioning and disabilities among the general population.7–12 Previous studies have also consistently found that LGB adults experience disparities in smoking.13,14 Furthermore, higher rates of asthma, arthritis, and obesity among lesbians and bisexual women and frequent mental distress among LGB adults are of concern.14–19 A few studies examining correlates of poor health among LGB adults have documented that, compared with their heterosexual counterparts, these groups may be more likely to experience some physical limitations.16,17 Although such findings suggest that LGB adults may be at an elevated risk for disability, the prevalence and covariates of disability within these groups have not been comprehensively examined with population-based data.Adults living with disabilities are also at risk for health disparities because they tend to receive fewer preventive health services and have poorer health than do those without disabilities.2 Because LGB adults are a health-disparate population1 and those living with disabilities often do not have access to adequate health care services, LGB adults with disabilities may face multiple and serious health risks. The early detection and identification of the most at-risk groups will enable public health initiatives to expand the reach of strategies and interventions to prevent the progression to disability as well as to tailor disability management programs to meet the unique needs of such diverse populations.We analyzed disability among LGB adults by utilizing standardized measures developed by the CDC and assessed in the Behavioral Risk Factor Surveillance System (BRFSS). We disaggregated data (n = 82 531) from the Washington State BRFSS by gender and examined patterns of disability by sexual orientation. Based on this population-based sample, we examined the following: (1) prevalence of disability by sexual orientation; (2) the age-adjusted relationship between sexual orientation and covariates of disability, including chronic health conditions, health risk behaviors, and physical and mental health status; and (3) the relationship between disability and sexual orientation after we controlled for covariates of disability.     

Factors relating to high psychological distress in Indigenous Australians and their contribution to Indigenous–non‐Indigenous disparities

Objective: To explore factors associated with high psychological distress among Aboriginal and non‐Aboriginal Australians and their contribution to the elevated distress prevalence among Aboriginal people. Methods: Questionnaire data from 1,631 Aboriginal and 233,405 non‐Aboriginal 45 and Up Study (NSW, Australia) participants aged ≥45 years were used to calculate adjusted prevalence ratios for high psychological distress (Kessler‐10 score ≥22) for socio‐demographic, health and disability‐related factors, and to quantify contributions to differences in distress prevalence. Results: While high‐distress prevalence was increased around three‐fold in Aboriginal versus non‐Aboriginal participants, distress‐related risk factors were similar. Morbidity and physical disability had the strongest associations; high distress affected 43.8% of Aboriginal and 20.9% of non‐Aboriginal participants with severe physical limitations and 9.5% and 3.9% of those without limitations, respectively. Differences in distress prevalence between Aboriginal and non‐Aboriginal participants were essentially attributable to differences in SES, morbidity, disability/functional limitations and social support (fully‐adjusted PR 1.19 [95% 1.08, 1.30]); physical morbidity and disability explained the bulk. Conclusions: The markedly elevated prevalence of high distress among older Aboriginal Australians appears largely attributable to greater physical morbidity and disability. Implications for public health: Addressing upstream determinants of physical morbidity and improved integration of social and emotional wellbeing care into primary care and chronic disease management are essential.     

A community-based evaluation of disability resources and inclusion practices in rural Botswana

BackgroundCommunity-based approaches to enhance the inclusion of persons with disabilities have proven effective; however, not much is known about cultural and contextual factors that influence the capacity of policy implementation and inclusion practices in rural Botswana.ObjectiveThe study evaluated local disability education and health resources in rural Botswana to develop a deeper understanding of cultural and contextual factors impacting inclusion practices.MethodResearchers used socio-demographic and qualitative research methods to conduct a comprehensive community-based needs assessment. Sampling techniques included maximum variation and snowball sampling. Thirty-two individuals participated in the study. Data were collected between June and August of 2019 through participant observation, in-depth interviews, and focus group discussions. An inductive thematic analysis was conducted by examining participants’ attitudes, perceptions, and experiences of community members with disabilities.ResultsFour primary themes emerged identifying factors that affect people living with disabilities in the rural community: (1) culture of vulnerability, (2) determinants of disability, (3) educational resources for persons with disabilities, and (4) effective systems integration. Findings suggested that while policies associated with disability at the government level are in place, disparities among rural communities’ hindered local responses to managing the needs of persons with disabilities.ConclusionsSocial, environmental, and physical barriers prevent the full implementation of policies that advocate for the rights of persons with disabilities in Botswana's rural settings. Increasing awareness of cultural and contextual factors may help community stakeholders facilitate inclusive practices in Botswana.     

Environmental barriers to health care among persons with disabilities--Los Angeles County, California, 2002-2003

In 2002, an estimated 51.2 million persons in the United States (approximately 18.1% of the population) had a disability. Recent data suggest that substantial disparities in health behaviors and overall health status exist between persons with and without disabilities. Nonetheless, when they have access to adequate health care, persons with disabilities can lead healthy lives. The World Health Organization's International Classification of Functioning, Disability, and Health stresses the importance of environment (e.g., physical environment, attitudes of others, or policies) as either a barrier or facilitator in the daily activities of persons with disabilities. In addition, increasing access to health and wellness treatment programs for persons with disabilities and reducing the proportion of persons with disabilities who report environmental barriers to participation in daily activities are goals of Healthy People 2010 (objectives 6-10 and 6-12). However, few population-based studies have explored how environment affects the lives of those with disabilities. To determine the prevalence of disability among persons in Los Angeles County, California, and assess the effects of environmental barriers on these persons, residents were surveyed during 2002-2003. The results of that survey suggested that persons with physical or sensory disabilities experienced several environmental barriers and that the prevalence of barriers varied by demographic characteristics, household income, and severity of disability. To improve quality of life among persons with disabilities, public and private health agencies should implement measures to remove environmental barriers to health care and other services.     

Self-reported short sleep duration among US adults by disability status and functional disability type: Results from the 2016 Behavioral Risk Factor Surveillance System

BackgroundShort sleep duration is associated with an increased risk of chronic disease and all-cause death. A better understanding of sleep disparities between people with and without disabilities can help inform interventions designed to improve sleep duration among people with disabilities.ObjectiveTo examine population-based prevalence estimates of short sleep duration by disability status and disability type among noninstitutionalized adults aged ≥18 years.MethodsData from the 2016 Behavioral Risk Factor Surveillance System were used to assess prevalence of short sleep duration among adults without and with disabilities (serious difficulty with cognition, hearing, mobility, or vision; any difficulty with self-care or independent living). Short sleep duration was defined as <7 h per 24-h period. We used log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) while adjusting for socioeconomic and health-related characteristics.ResultsAdults with any disability had a higher prevalence of short sleep duration than those without disability (43.8% vs. 31.6%; p < .001). After controlling for selected covariates, short sleep was most prevalent among adults with multiple disabilities (PR 1.40, 95% CI: 1.36–1.43), followed by adults with a single disability type (range: PR 1.13, 95% CI: 1.03–1.24 [for independent living disability] to PR 1.25, 95% CI: 1.21–1.30 [for mobility disability]) compared to adults without disability.ConclusionsPeople with disabilities had a higher likelihood of reporting short sleep duration than those without disabilities. Assessment of sleep duration may be an important component in the provision of medical care to people with disabilities.     

中国人口六类残疾流行现状

目的 了解2006年中国人口视力、听力、言语、肢体、智力和精神残疾的流行现状.方法 参照<第二次全国残疾人抽样调查残疾标准>,于2006年4月1日0时在31个省、自治区、直辖市抽取2 526 145人进行全国第二次残疾人抽样调查,对6类残疾的流行现状进行分析.结果 (1)全国总现患率为6. 39%,与1987年的4.90%相比,升高1.49个百分点.其中肢体残疾现患率最高,为2.34%;言语残疾最低,为0.53%.(2)全国一、二级重度残疾人占29.49%,三、四级的中度和轻度残疾占70.51%,言语残疾一、二级的重度残疾人所占比例超过65%,精神残疾该比例超过45%,为6类残疾中重度残疾比例最高的两类残疾.(3)年龄、性别、居住地均与6类残疾相关,有统计学意义(P＜0.001).(4)在各类残疾中,先天因素对言语残疾、智力残疾中的作用最大,分别占22.67%和22.41%.结论 从数据分析结果来看,2006年中国残疾人具有以下特点:老年残疾人比例高;残疾等级以中轻度为主,但重度残疾比例不低;农村残疾人比例高和致残原因多元化.     

Estimating health needs: the impact of a checklist of conditions and quality of life measurement on health information derived from community surveys

BACKGROUND: Prevalence estimates of chronic disease vary according to the technique used. Questionnaire surveys may be susceptible to inaccuracies, which may be overcome by addition of a checklist of conditions. This paper presents SF-36 scores and NHS consultation rates for people reporting individual chronic diseases or disabilities in two questionnaire surveys, one of which employed a checklist and one of which did not. We aimed to document differences in estimates of disease prevalence, and to determine whether or not subjective impact on quality of life is the same in people recruited by a checklist as in those who volunteer that they have a chronic disease or disability without the prompt of a checklist. We use these data to estimate the contribution that different chronic diseases and disabilities make to the burden of disease in the community. METHODS: Data were collected in two postal questionnaire surveys conducted in 1991 and 1997 with response rates of 72 per cent and 64 per cent. Both questionnaires included a question on long-standing illness, disability or infirmity, together with the SF-36 health status measure. Respondents to the 1991 survey were asked to specify their illness in a free text response, whereas the 1997 survey offered a checklist of conditions. Prevalence rates of each condition were calculated, together with an 'escalation factor' representing the increase in reporting of specific diseases between the surveys. SF-36 domain and component summary scores were calculated overall and for the groups reporting individual chronic diseases or disabilities. Disease-specific NHS consultation rates were calculated for both surveys. RESULTS: The overall reported rate of chronic disease and disability increased from 28 per cent in 1991 to 42 per cent in 1997. Reported levels of mental health problems and of conditions with a perceived psychosomatic element increased substantially, whereas rates of well-defined conditions were similar. The pattern of SF-36 scores for those reporting chronic disease or disability was similar in the two surveys in spite of very different prevalence rates, and respondents reporting chronic disease had similar levels of health service use. This suggests that they were reporting conditions with similar levels of impact on quality of life. Heart disease, arthritis and mental health problems had the greatest impact on quality of life, and asthma and hypertension the least. CONCLUSIONS: Evidence from SF-36 scores and NHS consultation rates suggests that addition of a checklist of conditions to this community health survey encouraged reporting of illnesses by the genuinely ill and not merely by those who are less severely affected by their disease. This method appears to give a more accurate reflection of health needs than information derived from routine data sources. The combination of prevalence data combined with subjective assessment of quality of life allows an alternative perspective of health needs. This approach highlights the relative importance of musculo-skeletal problems, particularly back pain, and mental health problems to the burden of disease, and the relative lack of importance of conditions such as asthma. It presents a contrast to studies based on other methods of health needs assessment.     

浙江省0~14岁残疾儿童流行病学调查

【目的】 了解浙江省0~4岁视力、智力、听力、言语、精神、肢体及多重残疾的流行特征。 【方法】 依据《中国残疾人实用评定标准》利用多阶段分层整群概率比例抽样方法抽取浙江省0~14岁儿童15 787,采用三阶段筛查程序进行调查。由专业医生进行残疾相关问题询问、诊断和残疾等级评定。 【结果】 总检出率为10.95‰, 其中智力残疾检出率最高,为4.37‰, 其次为多重残疾3.55‰、精神残疾1.20‰、肢体残疾1.08‰、言语残疾0.95‰、视力残疾0.44‰ 、听力残疾0.38‰。男性残疾检出率高于女性,农村高于城市,差异具有统计学意义(χ²=5.86,5.97,P均<0.05)。各年龄段残疾检出率比较,差异无统计学意义(χ²=1.04,P>0.05)。多重及听力残疾以重度以上为主,其他残疾以中轻度为主。遗传、发育异常是致残的主要原因。 【结论】 浙江省0~14岁残疾检出率低于全国平均水平,针对致残因素,预防和降低儿童残疾的发生。     

Workers with a chronic disease and work disability

The prevalence of chronic diseases in the age group 18–65 years is high. Cardiometabolic conditions and musculoskeletal diseases are the most frequent chronic diseases. Depending on disease and comorbidity, the employment rates are considerably lower than for healthy individuals. Chronically ill workers may have problems in meeting job demands, they may experience physical, cognitive or sensory limitations, have fatigue or pain complaints or other disease symptoms. Psychological distress, depressive feelings, feelings of shame or guilt, lack of coping or communicative skills, and non-supportive colleagues and supervisors may add to work-related problems. The ICF Model (International Classification of Functioning, Disability and Health) of the WHO offers a framework for understanding and considering health-related problems at work and finding solutions. Interventions to prevent problems in functioning, sickness absence and work disability may focus on the worker, the workplace, or health care. Multidisciplinary vocational rehabilitation, exercise therapy, cognitive behavioural interventions, workplace interventions and empowerment are interventions with at least some evidence of effectiveness. Future policy could focus more on promotion of workers’ health and future research should include the interests and motivations of employers concerning disability management, skills of line managers, the feasibility of interventions to prevent work disability and the context sensitivity of study outcomes.     

Prevalence and correlates of family dysfunction and poor adjustment to chronic illness in specialty clinics

This study estimated the prevalence of poor adjustment and family dysfunction among three chronically ill clinic patient populations and assessed the biological, situational, social and psychological variables which most explained poor adjustment. Recently referred subjects were approached and 216 chronically ill subjects (from oncology, rheumatology and gastroenterology clinics) completed a Meaning of Illness Questionnaire, the McMaster Family Assessment Device, and the Psychosocial Adjustment to Illness Self-report Scale. In addition, information describing their biological, disease and socioeconomic status was obtained from the clinic record. Respondents were generally representative of other new referrals to the clinics (ineligible for the subsequent trial) in disease characteristics but uniformly came from a more advantaged socioeconomic situation and were better adjusted to illness. Subjects from the three clinics were comparable on meaning, family function and adjustment variables. The proportion of subjects with family dysfunction was 30% and with poor adjustment to illness was 36%, high by community standards. Nevertheless, healthy family functioning and high levels of positive adjustment to chronic illness prevailed and were remarkably similar across clinic settings. Severity or type of disease was not related to adjustment outcomes nor to the level of observed disability. Rather, as hypothesized, meaning given the illness, followed by family function, and disability variables combined to explain 57% of the variance in adjustment outcomes. An intervention designed to improve family function and the meaning given illness was judged suitable.     

Prevalence of disabilities and associated health conditions among adults--United States, 1999

In the United States, the number of persons reporting disabling conditions increased from 49 million during 1991-1992 to 54 million during 1994-1995. During 1996, direct medical costs for persons with disability were $260 billion. Surveillance of disability prevalence and associated health conditions is useful in setting policy, anticipating the service needs of health systems, assisting state programs, directing health promotion and disease prevention efforts, and monitoring national health objectives. The U.S. Bureau of the Census and CDC analyzed data from the Survey of Income and Program Participation (SIPP) to determine national prevalence estimates of adults with disabilities and associated health conditions. This report summarizes findings of that analysis, which indicate that disability continues to be an important public health problem, even among working adults, and arthritis or rheumatism, back or spine problems, and heart trouble/hardening of the arteries remain the leading causes. Better health promotion and disease prevention may reduce the prevalence of disability-associated health conditions.     

Peer Reviewed: Obesity and Overweight Prevalence Among Adolescents With Disabilities

Introduction

We examined overweight and obesity prevalence among adolescents with disabilities by disability type (physical vs cognitive) and demographic factors (sex, age, race/ethnicity).

Methods

Parents (N = 662) of adolescents aged 12 to 18 years with disabilities from 49 states responded to an online survey from September 2008 through March 2009.

Results

Prevalence of obesity among adolescents with physical and cognitive disabilities (17.5%) was significantly higher compared with that among adolescents without disabilities (13.0%). Obesity prevalence was higher among males, 18-year-olds, and youths with cognitive disabilities than among females, younger adolescents, and youths with physical disabilities.

Conclusion

The higher prevalence of obesity among youths with disabilities compared with nondisabled youths, particularly in certain subgroups, requires further examination in future surveillance research.     

老年人慢性病对日常生活功能的影响

目的：研究贵阳市城区老年慢性病人日常生活功能（ＡＤＬ和ＬＡＤＬ）的影响。方法：通过问卷问和体格检查相结合，对贵阳市我９６６名≥６０岁的老年人进行了慢性病和日常生活功能调查。运用非条件Ｌｏｇｉｓｔｉｃ回归分析有关慢性病对老年人日常生活功能损害原作用大小。结果：慢性病患病率为５７．８％，ＡＤＬ损害率为９．４％，ＩＡＤＬ损害率为２３．２％。对ＡＤＬ损害影响显著的疾病依次为脑血管疾病、白内障、慢性阻塞性肺