Measurement properties of instruments that assess inclusive access to fitness and recreational sports centers: A systematic review

BackgroundExercise is necessary for overall health and well-being for all individuals. For people with disabilities, fitness and recreational sports centers are reported to be generally inaccessible and not user friendly.ObjectiveThis review study aimed to identify instruments that assess access to fitness and recreational sports centers and to appraise the identified instruments' qualitative and quantitative attributes.MethodsWe systematically searched databases (AMED, CINAHL, EMBASE, MEDLINE, SCOPUS, SPORTDiscus and Web of Science for the years spanning 1950 to April 2012) and web-based search engines (Google and Google Scholar) to identify instruments, published in English that objectively assess the accessibility of fitness and recreational sports centers. Identified instruments were critically appraised using the qualitative attributes QAPAQ Checklist Part I and the COSMIN checklist for measurement properties.ResultsSeven instruments were included in this review: ADA Accessibility Guidelines Checklist for Buildings and Facilities (ADAAG); ADA Checklist for Readily Achievable Barrier Removal; Accessibility Instruments Measuring Fitness and Recreation Environments (AIMFREE); Community Health Environment Checklist – Mobility (CHEC-M); Removing Barriers to Health Clubs and Fitness Facilities (RBHCFF); Health Empowerment Zone Environmental Tool Shortened Environmental Checklist: Fitness Centre Survey (HEZEAT-FCS); Community Health Environment Checklist – Exercise Facilities (CHEC-Fit). Only the AIMFREE and CHEC-M have aspects of measurement properties evaluated.ConclusionWe recommend that instrument developers consider conducting full psychometric assessment of their instruments using adequate sample sizes. We also recommend they consider scoring methods and respondent burden to provide scientifically robust instruments that are easy to administer.     

中国不安全母婴保健致残的模式及其预防策略

目的对我国不安全母婴保健（unsafe maternal and child health,UMCH）致残的模式进行探讨,并针对具体分区提出可行的预防策略。方法综合1987年和2006年的残疾与死亡指标,利用SPSS 16.0软件对我国31个省的不安全母婴保健致残的模式进行聚类分析。结果我国31个省UMCH致残的模式可分为以下四类：死亡和残疾并存地区,包括新疆、西藏、甘肃、青海、贵州、云南;死亡向残疾转变的初级阶段地区,包括浙江、湖南、江西、湖北、内蒙古、陕西、四川、安徽、山西、重庆、广西、宁夏;死亡向残疾转变的高级阶段地区,包括江苏、福建、山东、河北、河南、海南、广东、吉林、辽宁、黑龙江;残疾向健康转变地区,包括北京、上海、天津。结论我国20年间UMCH致残情况更加严重。各省的母婴健康状况表现出不同的发展模式,应针对当前母婴健康发展的省际差异优化卫生资源配置。     

公共卫生教育国际化的研究与实践

新型冠状病毒疫情的暴发给全球公共卫生带来了极大的挑战,因此培养高层次、复合型的公共卫生人才对于壮大公共卫生力量具有重要意义。本文概述我国公共卫生人才培养的现况与挑战,提出我国对新时代公共卫生人才的培养需求。高校承担着培养新时代公共卫生人才的重担,对于公共卫生系统的建设至关重要。结合公共卫生教育实践,介绍复旦大学公共卫生教育实践和公共卫生博士（DrPH）学位项目。

     

Routine identification of patients with disabilities in primary care: A mixed-methods study

BackgroundPeople with disabilities experience barriers to receiving healthcare and often have worse health outcomes, but data on disability is rarely routinely collected in a standardized way.ObjectiveThis study examined how patients responded to being asked about disabilities as part of a routine, self-administered sociodemographic survey.MethodsWe conducted a mixed-methods study in a multi-site primary care organization. We compared the characteristics of people who responded to a question about disabilities to those who did not respond using logistic regression. We also compared survey responses to data available in medical charts. In-depth interviews were conducted with a sample of patients following survey completion.ResultsOver 28 months, 15,221 patients were offered the survey and 14,247 (93.6%) responded to at least one question. Of these, 11,275 (79.1%) patients answered the question about disabilities. Older patients, patients who rented their home, and non-White patients were less likely to respond to the question. When comparing survey responses to data from medical charts we identified discrepancies. Patients interviewed reported they had difficulty judging what constituted a disability. Stigma related to mental illness and substance use led them to avoid disclosing those conditions.ConclusionsDirectly asking patients whether they have a disability may be challenging given confusion about what constitutes a disability and stigma associated with certain disabilities. Future research should examine whether asking about barriers faced in accessing health services could adequately identify patients with disabilities and also be used to identify tangible actions an organization could take to lower barriers to care.     

Integration of chronic disease and disability and health state programs in Montana

This paper describes the strategies used in one state, Montana, to improve the health of individuals at risk for or living with chronic conditions associated with disability. These strategies demonstrate capacity to intervene at individual and environmental levels, and reveal opportunities for public health professionals to collaborate with independent living and long term care partners. In this paper we attempt to outline some of the challenges inherent in these collaborations and suggest strategies to overcome them.     

Proxy reliability: Health-related quality of life (HRQoL) measures for people with disability

Objectives: Research and surveillance activities sometimes require that proxy respondents provide key exposure or outcome information, especially for studies of people with disability (PWD). In this study, we compared the health-related quality of life (HRQoL) responses of index PWD to proxies. Methods: Subjects were selected from nursing home, other assisted living residences, and from several clinic samples of PWD. Each index identified one or more proxy respondents. Computer-assisted interviews used a random order of measures. Proxy reliability was measured by intraclass correlation (ICC) and κ statistics. HRQoL measures tested included the surveillance questions of the Behavioral Risk Factor Surveillance System (BRFSS), basic and instrumental activities of daily living (ADLs and IADLs), medical outcomes study short-form 36 and 12 (SF-36 and SF-12). Results: A total of 131 index-proxy sets were completed. In general, agreement and reliability of proxy responses to the PWD tended to be best for relatives, with friends lower, and health care proxies lowest. For example, the ICC for the physical functioning scale of the SF-36 was 0.68 for relatives, 0.51 for friends, and 0.40 for healthcare proxies. There was a tendency for proxies to overestimate impairment and underestimate HRQoL. This pattern was reversed for measures of pain, which proxies consistently underestimated. The pattern among instruments, proxy types, and HRQoL domains was complex, and individual measures vary from these general results. Conclusions: We suggest caution when using proxy respondents for HRQoL, especially those measuring more subjective domains. This revised version was published online in June 2006 with corrections to the Cover Date.     

Reimagining spaces where children play: developing guidance for thermally comfortable playgrounds in Canada

SettingPlanning and designing thermally comfortable outdoor spaces is increasingly important in the context of climate change, particularly as children are more vulnerable than adults to environmental extremes. However, existing playground standards focus on equipment and surfacing to reduce acute injuries, with no mention of potential negative health consequences related to heat illness, sun exposure, and other thermal extremes. The goal of this project was to develop proposed guidelines for designing thermally comfortable playgrounds in Canada for inclusion within the CAN/CSA-Z614 Children’s playground equipment and surfacing standard.InterventionThe project to develop guidance for thermally comfortable playgrounds was initiated with a municipal project in Windsor, Ontario, to increase shade, vegetation, and water features at parks and playgrounds to provide more comfortable experiences amid the increased frequency of hot days (≥30°C). The lack of available information to best manage environmental conditions led to a collaborative effort to build resources and raise awareness of best practices in the design of thermally comfortable playgrounds.OutcomesA group of multidisciplinary experts developed technical guidance for improving thermal comfort at playgrounds, including a six-page thermal comfort annex adopted within a national playground and equipment standard. The annex has been used by Canadian schools in a competition to design and implement green playgrounds.ImplicationsBoth the technical report and the thermal comfort annex provide increased awareness and needed guidance for managing environmental conditions at playgrounds. Thermally safe and comfortable play spaces will help ensure that Canada’s playgrounds are designed to minimize environmental health risks for children.     

The accessibility of health services to young deaf adolescents in Ghana

Quality health care is a fundamental human right, which is enshrined in several international and domestic legislative instruments. In the Ghanaian context, there are reports that adults with disabilities encounter barriers in their attempts to access health care. However, scholarly attention is yet to explore the perspectives of young people and adolescents with disabilities. Therefore, this quantitative study was conducted from the perspective of critical disability studies, where young deaf adolescents (YDAs) were regarded as right bearers, and where they shared their perspectives on health accessibility decisions, barriers, and needs. Sixty‐seven participants, made up of 44 male and 23 female students, took part in this quantitative study. Although many YDAs who took part in this study indicated that it was not difficult to access health facilities, they claim to have encountered communication barriers. Sign language interpreters in health facilities and introduction of sign language courses in health training institutions to improve communication between health professionals and deaf patients have been suggested as ways of addressing the barriers faced by YDAs in Ghana.     

An exploration of healthy eating and physical activity habits of Hmong high-school students by disability status: A pilot study

BackgroundImmigrants are at risk of being obese from obesogenic environments and face factors which limit physical activity and healthy eating. While Hmong immigrants acknowledge the importance of healthy eating and physical activity, to our knowledge no studies have looked at health promoting behaviors among Hmong adolescents with and without disabilities.ObjectiveIn this paper, we seek to provide baseline data about physical activity and healthy eating among Hmong high school students with disabilities in Minnesota.MethodsWe used data from the 2016 Minnesota Student Survey. The study included responses from 1,824 Hmong high school students. We compared physical activity and healthy eating of Hmong high school students by disability status.ResultsApproximately 13% of Hmong had a disability (n = 239). A greater percentage of Hmong high school students with disabilities reported zero days of 60 min of physical activity (20.5% vs 14.8%, p < 0.10) and zero days participation in sports teams outside of school (69.0% vs. 64.3%, p < 0.10). Compared to Hmong students without disabilities, a significantly lower percentage of Hmong students with disabilities reported not receiving free/reduced lunch (66.5% vs 73.1%, p < 0.05) and significantly more likely to skip meals because their family did not have enough money (14.2% vs 9.7%, p < 0.05).ConclusionAdolescent Hmong with disabilities encounter both cultural and disability specific factors which could contribute to poorer health promoting behaviors. This study shines light on the need for social policy that promotes disability inclusive, culturally specific health promotion information and advocacy for immigrant youth with disabilities and their families in schools and communities.     

湖北某矿床开采区居民健康状况心理状态调查

目的 了解具有一般环境生态结局的湖北某矿床开采区居民健康状况及心理状况.方法 采用健康调查问卷、症状自评量表(SCL-90)、状态一特质焦虑问卷(STAI-Form Y)和自行设计的一般状况调查表,选择矿区某村居住10年以上的居民93人为观察组,以居住于同区域、经济状况及生活习惯基本相同、不受矿区生态环境影响的居民101人为对照组,进行流行病学调查,同时收集部分对象尿样和发样,测定其铅、镉、砷、铜、锌含量以及尿总蛋白、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、δ-氨基酮戊酸(8-ALA)水平.结果 观察组铅、镉、砷接触症状发生率明显高于对照组.观察组尿镉、发镉、发砷、发铅水平均高于对照组,差异有统计学意义(P＜0.05).观察组及对照组尿生化指标检查未见明显异常.观察组SCL-90阳性症状调整检出率为8.60%,对照组为0.99%,SCL-90评分中观察组在总分及多项因子得分均明显高于对照组,差异有统计学意义(P＜0.05),表明前者心理卫生状况不及后者;观察组的状态焦虑(S-AI)总体分及分性别S-AI分值高于对照组,差异均有统计学意义(P＜0.05,P＜0.01),表明调查当时观察组焦虑情绪更为明显.观察组的特质焦虑(T-AI)总体分、观察组女性T-AI分值均高于对照组,差异有统计学意义(P＜0.01),表明就人格特质的焦虑倾向来说,观察组尤其是观察组的女性更为明显.结论 矿床开采区居民的心理卫生状况不及非矿区居民,前者焦虑程度比后者高.     

Continuity of primary care and prenatal care adequacy among women with disabilities in Ontario: A population-based cohort study

BackgroundWomen with disabilities experience elevated risks for pregnancy complications and report barriers accessing prenatal care. Emerging evidence highlights the significant role primary care providers play in promoting preventive services like prenatal care.ObjectiveTo examine the relationship between continuity of primary care (COC) and prenatal care adequacy among women with disabilities.MethodsWe conducted a population-based study using health administrative data in Ontario, Canada. The study population included 15- to 49-year-old women with physical (n = 106,555), sensory (n = 32,194), intellectual/developmental (n = 1515), and multiple (n = 6543) disabilities who had a singleton livebirth or stillbirth in 2003–2017 and ≥ 3 primary care visits < 2 years before conception. COC was measured using the Usual Provider of Care Index. Nominal logistic regression was used to compute adjusted odds ratios (aOR) for prenatal care adequacy, measured using the Revised-Graduated Prenatal Care Utilization Index, for women with low versus moderate/high COC, controlling for other social and medical characteristics.ResultsWomen with disabilities with low COC, versus those with moderate/high COC, had increased odds of no (aOR 1.42, 95% CI 1.29–1.56), inadequate (aOR 1.19, 95% CI 1.16–1.23), and intensive prenatal care (aOR 1.22, 95% CI 1.19–1.25) versus adequate. In additional analyses, women with low COC and no/inadequate prenatal care were the most socially disadvantaged among the cohort, and those with low COC and intensive prenatal care had the greatest medical need.ConclusionImproving primary care access for women with disabilities, particularly those experiencing social disadvantage, could lead to better prenatal care access.     

Experiential learning in women's health: medical student reflections

CONTEXT: Reflection on clinical experience is used by medical students to enhance the development of clinical practice skills and professional behaviours in the area of obstetrics and gynaecology. It is applied through small-group reflective tutorials, writing reflective summaries and one-to-one discussion of reflections with staff. OBJECTIVE: To identify the levels of critical reflection achieved and explore the emergent themes in students' written reflections. METHODS: Thematic analysis was undertaken to document the recurring emergent themes on which students chose to reflect and the depth of reflection students achieved. RESULTS: Most students reflected on clinical, communication and reasoning skills, lack of medical knowledge, and the development of their own and others' professional practice. The 4 levels of reflection students demonstrated were: listing, where students only state the clinical experience; describing, where students describe the clinical experience, including what they did well and what they did not; applying, where students discuss what they need to change and how to develop, and integrating, where students apply reflection to future clinical practice. Few respondents demonstrated the ability to reflect to the level of integration except with facilitated discussion. DISCUSSION: The range of experiences on which students reflected was appropriate. The information obtained from the emergent themes has been useful for programme development. At the end of the process students were still not reflecting at the level of integration. This affirms that reflectivity is a skill that develops throughout life. Evaluating the level of reflection achieved and discussing this explicitly with the student may be instrumental in helping the student develop his or her reflective capacity further.     

2019年湖北省中小学校生活与教学环境卫生现状分析

目的 分析湖北省中小学校生活与教学环境卫生现状,为政府部门制定干预策略提供支持.方法 采用分层随机抽样的方法,抽取湖北省30个区县175所中小学校的1 032间教室,统计描述生活与教学环境卫生指标的合格率,使用x2检验比较各组间差异.结果 课桌椅分配合格率仅5.2％,教室人均面积合格率为21.3％,黑板反射比合格率为3...     

Physical activity in persons with late effects of polio: A descriptive study

BackgroundTo promote a healthy and active lifestyle there is a need to increase our knowledge of the level of physical activity (PA) among people with late effects of polio.ObjectivesTo examine PA in people with late effects of polio and to assess the relationship between PA, life satisfaction and various sociodemographic factors.MethodsPA was assessed in 81 persons with late effects of polio using the Physical Activity and Disability Survey (PADS) and by a pedometer. Life satisfaction was assessed with the Life Satisfaction Questionnaire (LiSat-11).ResultsThe amount of PA varied considerably but on average the participants were physically active almost 3 h per day, mostly in household activities. The mean value of the pedometer counts was 6212 steps per day (SD = 3208). Sixty-nine percent of the participants rated themselves as satisfied with life as a whole. The sum of PADS was positively and significantly related to the number of steps (r = 0.39, p < 0.001), increasing age (r = 0.26, p < 0.05) and to the level of global satisfaction with life (rho = 0.23, p < 0.05). The number of steps was also positively and significantly associated with level of global satisfaction with life (rho = 0.37, p < 0.001).ConclusionDespite a progressive physical disability, people with late effects of polio are physically active, but much of the activities are performed as part of their household activities and not as traditional exercise. The relationship between PA, life satisfaction and age further supports the general contention that an active lifestyle is an important factor for perceived well-being among older people.     

我国环境与健康工作主要进展及建议

我国环境污染问题日益突出,环境污染所致人群健康危害已广泛显现并进入高发期。20世纪80年代以来,我国政府开展了大量环境与健康（又称环境卫生）工作,本文对20世纪80年代~2015年间我国环境与健康工作进行了回顾,并对今后一段时期的工作提出了建议。     

Differences in Obesity Rates Between People With and Without Disabilities and the Association of Disability and Obesity: A Nationwide Population Study in South Korea

Objectives

The objective of this study was to identify the differences in obesity rates among people with and without disabilities, and evaluate the relationship between obesity rates and the existence of disabilities or characteristics of disabilities.

Methods

Mass screening data from 2008 from the National Disability Registry and National Health Insurance (NHI) are used. For analysis, we classified physical disability into three subtypes: upper limb disability, lower limb disability, and spinal cord injury. For a control group, we extracted people without disabilities by each subtype. To adjust for the participation rate in the NHI mass screening, we calculated and adopted the weight stratified by sex, age, and grade of disability. Differences in obesity rates between people with and without disabilities were examined by a chi-squared test. In addition, the effect of the existence of disabilities and grade of disabilities on obesity was examined by multiple logistic regression analysis.

Results

People with disabilities were found to have a higher obesity rate than those without disabilities. The obesity rates were 35.2% and 35.0% (people with disabilities vs. without disabilities) in the upper limb disability, 44.5% and 34.8% in the lower limb disability, 43.4% and 34.6% in the spinal cord injury. The odds for existence of physical disability and grade of disability are higher than the non-disabilities.

Conclusions

These results show that people with physical disability have a higher vulnerability to obesity.