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Background
Experiences of discrimination lead people from vulnerable groups to avoid medical healthcare. It is yet to be known if such experiences affect people with disabilities (PWD) in the same manner.Objectives
To determine the association between perceived discrimination and healthcare-seeking behavior in people with disabilities and to explore differences of this association across disability types.Methods
We performed a cross-sectional study with data from a national survey of people with disabilities. Perceived discrimination and care-seeking behavior were measured as self-reports from the survey. Dependence for daily life activities, possession of health insurance, and other disability-related variables were included and considered as confounders. We used Poisson regression models and techniques for multistage sampling in the analyses. A stratified analysis was used to explore effects of discrimination across types of disability.Results
Most of PWD were 65 years or older (67.1%). Prevalence of healthcare seeking was 78.8% in those who perceived discrimination, and 86.1% in those who did not. After adjusting for potential confounders, the probability of not seeking care was higher in people who reported perceived discrimination (adjusted PR = 1.15; 95%CI: 1.04–1.28). In a stratified analysis, significant effects of discrimination were found in people with communication disability (adjusted PR = 1.34, 95%CI: 1.07–1.67) and with physical disability (adjusted PR = 1.17, 95%CI: 1.03–1.34).Conclusions
People with disabilities who perceive discrimination are less likely to seek healthcare. This association was higher for people with communication and physical disabilities. These results provide evidence to institutions who attempt to tackle discrimination. 相似文献3.
Magdalena Wrzesińska Anna Lipert Beata Urzędowicz Lucjan Pawlicki 《Disability and health journal》2018,11(1):20-30
Background
Young people with visual impairment (VI) face many environmental barriers that influence physical activity.Objective
The aims of the study were to assess the level of physical activity (PA) in students with VI, with regard to their age, gender, level of VI, body mass index and abdominal obesity (AO), and to identify the percentage of study participants who did not meet the international recommendations for PA.Methods
Anthropometric measurements were taken to assess the body mass index and waist-to-height ratio. The PA level was measured by the International Physical Activity Questionnaire- Long Form. A sample of 122 students with VI aged 15.1–22.7 years were included in the study.Results
The mean total PA was 8514.5 ± 7201.0 Metabolic Equivalents min/week. Students with normal weight and excess weight had much greater total PA scores than those who were underweight (p < 0.05). Students with abdominal obesity had slightly lower total PA than those without AO. Blind students were engaged less in PA in most of the domains than partially-sighted students. Overall, 39.3% of participants did not meet the recommendation of 75 min/week of vigorous PA, and 23.8% did not meet the recommendation of almost 150 min/week of moderate PA. In total, 32.8% of participants did not meet the international recommendations of 420 min/week moderate or vigorous PA.Conclusion
To improve the PA level of students with VI, health promotion initiatives focused on promoting PA during their school days and free time are required, based on innovative methods adjusted to their needs. 相似文献4.
Oscar Castro Kwok Ng Elizaveta Novoradovskaya Grégoire Bosselut Mary Hassandra 《Disability and health journal》2018,11(2):174-183
Background
Despite the strong evidence that physical activity (PA) is a key determinant of health, there is limited knowledge on the content and outcomes of PA promotion interventions among individuals with disabilities.Objective
To conduct a scoping review in order to examine the published literature on PA promotion interventions among adults with disabilities.Methods
A scoping review following the methodological framework provided by Arksey and O'Malley used electronic databases (MEDLINE, PsycINFO, and CINAHL), reference lists, and journals to locate studies. Inclusion criteria were based on study aim, outcome measures, and a disability definition by the WHO International Classification of Functioning, Disability and Health. The Behavior Change Techniques Taxonomy version 1 and Furlan and collaborators' risk of bias assessment were utilized during the data charting stage.Results
Thirty-eight articles met the inclusion criteria. Most of the studies (70%) reported a significant increase in PA behavior immediately following intervention. However, less than half of the studies (46%) examined the maintenance of pre-/post-test differences. The number of identified behavior change techniques was significantly higher for successful PA promotion interventions than for interventions with no effects on PA. Approximately one-third of studies (32%) were rated as having a high risk of bias.Conclusions
Although findings support the idea that PA promotion interventions produce positive changes in PA behavior for a variety of disability conditions, risk of bias assessment calls for prudence. There are opportunities for continued development of the area of PA promotion among individuals with disabilities through systematic reviews and meta-analyses. 相似文献5.
Background
Regular engagement in physical activity can help youth control their weight during childhood while decreasing one's chances of developing chronic diseases (e.g., coronary heart disease, diabetes) throughout the lifespan. While numerous studies have explored physical activity participation and weight status among typically developing children, few epidemiological studies utilizing nationally representative data has focused on children with chronic health problems, illness, or disabilities (CHID).Objective
Thus, the primary purpose of this secondary-data analysis was to examine physical activity participation and the prevalence of overweight/obesity among nine-year-old children with CHID in Ireland.Methods
The weighted nationally-represented data for the obesity analysis (N = 6114) and physical activity analysis (N = 6165) were derived from the Growing up in Ireland national study. Logistic regression analyses were conducted to examine associations between child weight status and likelihood of meeting physical activity guidelines. Children's primary caregiver weight status, child gender, and CHID status were correlates, while estimated household income, reported hours of weekly physical education, and locale were covariates.Results
Children with CHID had significantly higher odds (1.51, 95% CI 1.19–1.91) of being classified as overweight/obese compared to peers without CHID, when controlling for locale, income, and weekly physical education hours. Conversely, having a CHID was not significantly associated with the odds of children meeting recommended physical activity guidelines.Conclusions
Children with CHID had significantly higher odds of being overweight/obese, and these odds increased if the child had a primary caregiver who was overweight/obese. Physical activity levels did not differ between children with and without CHID. 相似文献6.
Background
Emerging research demonstrates that light-intensity physical activity is favorably associated with numerous health outcomes among the general population, even independent of high-intensity physical activity.Objective
To examine the association between accelerometer-assessed light-intensity physical activity and mortality in a national sample of American adults with mobility limitations.Methods
Data from the 2003–2006 National Health and Nutrition Examination Survey were utilized. Participants were followed through 2011. Based on self-report, analyzed participants included those with mobility limitations (N = 1369). Light-intensity physical activity was assessed via waist-mounted accelerometry.Results
For the sample, 108,010 person-months occurred with an all-cause mortality rate of 2.07 per 1000 person-months. After adjustments, for every 60 min/day increase in light-intensity physical activity, participants with mobility limitations had a 14% reduced risk of all-cause mortality (HR = 0.86; 95% CI: 0.75–0.98; P = 0.03).Conclusion
These findings underscore the importance of promoting light-intensity physical activity to those with mobility limitations. 相似文献7.
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8.
Paul D. Loprinzi Megan M. Danzl Elizabeth Ulanowski Calli Paydo 《Disability and health journal》2018,11(1):165-168
Background
Few studies have examined the association between daily physical activity and cognitive function among older adults with Parkinson's disease (PD).Objective
Here we evaluate the association between accelerometer-assessed physical activity and cognition among older patients with PD.Methods
Cognition assessed via the Montreal Cognitive Assessment (MoCA). Moderate-to-vigorous physical activity (MVPA) was assessed via accelerometry over a 1–2 week monitoring period.Results
After adjusting for motor impairment severity, for every 1 min/day increase in MVPA, participants had a 0.09 unit increase in MoCA-determined cognitive function (β = 0.09; 95% CI: ?0.003–0.19; P = 0.05). When further adjusting for motor impairment, age and gender, results were unchanged (β = 0.09; 95% CI: 0.004–0.19; P = 0.04).Conclusion
The present study provides suggestive evidence of a favorable association between daily physical activity behavior and cognitive function among adults with PD. 相似文献9.
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10.
Verena R. Cimarolli Joann P. Reinhardt Jillian Minahan Orah Burack Channing Thomas Regina Melly 《Journal of the American Medical Directors Association》2017,18(11):991.e1-991.e4
Objectives
Use of exercise technologies has benefits for community-dwelling older adults in terms of improved gait and balance. But research on the feasibility of use of exercise technologies in various geriatric health care settings is lacking. Hence, the current study examined the feasibility of implementing an exercise technology intended to augment rehabilitation in patients receiving post-acute care (PAC) in a skilled nursing facility (SNF). We focused on 3 indicators of feasibility: extent of usage (including predictors of more intense use), patients' acceptability of the technology, and limited efficacy.Design
Cross-sectional study with data from patients' electronic medical records (EMR), exercise technology portal, and patient interviews.Setting
SNF.Participants
A sample of post-acute patients (n = 237).Measurements
Sociodemographic and health-related variables, time spent using the technology, and 8 items of the Physical Activity Enjoyment Scale (PACES).Results
Average time spent using the technology varied greatly (range, 1–460 minutes). A regression analysis showed that patients who had a longer length of stay (β = .01, P < .05) and were younger (β = ?0.01, P < .05) spent significantly more time using the technology. Acceptability of technology was high among patients. Finally, patients who used the technology had lower 30-day rehospitalization rates.Conclusion
Exercise technology is feasible to use in supporting rehabilitation in patients receiving PAC in a SNF and seems to have beneficial effects. 相似文献11.
Hiroyuki Shimada Hyuma Makizako Takehiko Doi Hyuntae Park Kota Tsutsumimoto Joe Verghese Takao Suzuki 《Journal of the American Medical Directors Association》2018,19(7):584-591
Importance
Although participation in physical and cognitive activities is encouraged to reduce the risk of dementia, the preventive efficacy of these activities for patients with mild cognitive impairment is unestablished.Objective
To compare the cognitive and mobility effects of a 40-week program of combined cognitive and physical activity with those of a health education program.Design
A randomized, parallel, single-blind controlled trial.Setting
A population-based study of participants recruited from Obu, a residential suburb of Nagoya, Japan.Participants
Between August 2011 and February 2012, we evaluated 945 adults 65?years or older with mild cognitive impairment, enrolled 308, and randomly assigned them to the combined activity group (n?=?154) or the health education control group (n?=?154).Interventions
The combined activity program involved weekly 90-minute sessions for 40?weeks focused on physical and cognitive activities. The control group attended 90-minute health promotion classes thrice during the 40-week trial period.Measurement
The outcome measures were assessed at the study's beginning and end by personnel blinded to mild cognitive impairment subtype and group. The primary endpoints were postintervention changes in scores on (1) the Mini-Mental State Examination as a measure of general cognitive status and memory, (2) the Wechsler Memory Scale-Revised–Logical Memory II, and (3) the Rey Auditory Verbal Learning Test. We applied mobility assessments and assessed brain atrophy with magnetic resonance imaging.Results
Compared with the control group, the combined activity group showed significantly greater scores on the Mini-Mental State Examination (difference?=?0.8 points, P?=?.012) and Wechsler Memory Scale-Revised–Logical Memory II (difference?=?1.0, P?=?.004), significant improvements in mobility and the nonmemory domains and reduced left medial temporal lobe atrophy in amnestic mild cognitive impairment (Z-score difference?=??31.3, P?<?.05).Conclusion
Combined physical and cognitive activity improves or maintains cognitive and physical performance in older adults with mild cognitive impairment, especially the amnestic type. 相似文献12.
Ka Keat Lim William Yeo Joyce S.B. Koh Chuen Seng Tan Hwei Chi Chong Karen Zhang Truls Østbye Tet Sen Howe David Bruce Matchar 《Journal of the American Medical Directors Association》2018,19(11):989-994.e2
Objectives
To examine the associations of 3 measures of prefracture health status (physical function, mental function, and comorbidity count) with trajectories of physical and mental function at 1.5, 3, 6, and 12 months after hip fracture surgery.Design
Single-center observational study.Setting
Singapore General Hospital (an acute hospital).Participants
Patients aged ≥60 years who underwent first hip fracture surgery between June 2011 and July 2016 (N = 928).Intervention
None.Measurements
We used data collected prospectively from the hospital's hip fracture registry. We used the Short Form–36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) as indicators of physical and mental function, respectively, collected at admission and at 1.5, 3, 6, and 12 months after hip fracture surgery. Comorbidity count at admission was the sum from a list of 10 common diseases associated with poorer physical function.Results
Prefracture physical function and prefracture mental function demonstrated time-varying associations (interaction P < .001 and P = .001, respectively) with postfracture physical function; the associations were small initially but increased in strength up to 6 months and stabilized thereafter. In contrast, the strength of the association between comorbidity count and postfracture physical function were time-invariant (?0.52, P = .027). The strength of the associations between all 3 measures of prefracture health status and postfracture mental function were also constant over time (0.09, P = .004, for physical function; 0.38, P < .001, for mental function; ?0.70, P = .034, for comorbidity count).Conclusions/Implications
The time-varying associations between prefracture health status and postfracture physical function suggest that even for patients with good prefracture health status, initial recovery may be slow. Our findings can be useful to clinicians and therapists in their prognostic evaluations and in management of patients’ expectation for recovery. 相似文献13.
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Geeske Peeters Siobhan Leahy Sean Kennelly Rose Anne Kenny 《Journal of the American Medical Directors Association》2018,19(3):248-254.e3
Background
Fear of falling (FoF) is present in 20% to 85% of older adults and may be an early marker of decline in global cognitive functioning (GCF). We tested the hypothesis that FoF is associated with lower levels of GCF (cross-sectional) and greater decline in GCF (prospective) in adults aged 50 and older.Design
Observational cohort study.Setting
The Irish Longitudinal Study on Ageing, a population-based study.Participants
Data were from 4931 participants (mean age 62.9 ± 9.1, range 50–98, 54.3% female).Measurements
FoF was based on self-report in 2010. GCF was measured with the Montreal Cognitive Assessment (MoCA) and Mini Mental Status Examination (MMSE) in 2010 and 2014. The cross-sectional association was examined using linear regression unadjusted and after adjustment for demographic and health factors. The prospective association between FoF and the odds of >1-SD decline in GCF were examined using logistic regression. Interaction with age and mediation by social and physical activities were examined.Results
In 2010, 21.9% of participants reported FoF. In the unadjusted cross-sectional models, those with FoF had lower scores on the MoCA (B ?1.15, 95% confidence interval [CI] ?1.40 to ?0.90) and MMSE (B ?0.52, CI ?0.67 to ?0.37). In the unadjusted prospective models, FoF was associated with a greater odds of decline in MoCA (odds ratio [OR] 1.60, CI 1.26–2.04) and MMSE (OR 1.64, CI 1.29–2.08). After adjustment for covariates, all associations attenuated and were no longer statistically significant, except the association with decline in MoCA (OR 1.32, CI 1.01–1.71). No statistically significant interaction with age was found (P > .37). Additional adjustment for social and physical activity did not change the results.Conclusions
The findings provide weak evidence for FoF as a predictor of cognitive decline. 相似文献15.
Background
According to prior studies, it is possible to consider the emergency care utilization due to ambulatory care sensitive conditions (ACSCs) as a proxy measure of access to primary care but there was no confirmed study among people with disabilities.Objective/Hypothesis
We examined overall emergency department (ED) utilization patterns among people with disabilities compared with the general population and estimated factors affecting ED utilization. Additionally, we examined whether there were any differences in ED visits due to ACSCs according to type and severity of disability.Methods
The nationally representative Korean Health Panel Survey was used. Data from 14,616 individuals who participated in the survey from 2008 to 2012 were analyzed. The frequency and causes of emergency visits were examined between individuals with and without disabilities. A generalized regression model with Poisson distribution was applied to identify factors that affect ED visits.Results
In 2012, people with disabilities were about two times as likely to visit the ED compared to people without disabilities, and people with external disability represented the largest proportion of people with disabilities. According to generalized linear model, disability was a strong predictor of ED visits, along with lower education level, being elderly, having a chronic disease, and being less healthy. Overall, ED visits due to ACSCs were about three times higher in the disabled group than in the non-disabled group.Conclusions
Public health authorities should consider strengthening the primary care system to avoid unnecessary and preventable ED utilization among all Korean people, including people with disabilities. 相似文献16.
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Background
Many young adults, specifically those with a diagnosis of autism spectrum disorder (ASD), do not meet the national physical activity (PA) guidelines. One way to address this problem may be to examine the factors that motivate individuals to engage in PA. However, the majority of current literature does not consider the unique characteristics of individuals with ASD, which may influence their motivation.Objective
The purpose of this research was to examine Self-Determination Theory predictors for PA for young adults with ASD.Methods
Respondents included 143 young adults with ASD who completed a survey pertaining to their motivational process to engage in physical activity, based on self-determination theory variables.Results
Goodness of fit indices reported from a path analysis suggests the current data closely align with the self-determination theory (χ2 (3, N?=?143)?=?11.99, p?>?.01, GFI?=?0.97, NFI?=?0.95, CFI?=?. 96, RMSEA?=?0.15). The three basic psychological needs explained 39% of the variance within respondents' self-determined motivation, and self-determined motivation explained 8% of the variance in PA levels.Conclusions
These findings support utilizing the self-determination theory within health promotion efforts for young adults with ASD. Practitioners should focus on enhancing the perceived basic psychological needs of young adults within physical activity settings. 相似文献18.
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Iván De-Rosende Celeiro Sergio Santos-del-Riego Javier Muñiz García 《Disability and health journal》2017,10(1):145-151
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20.
Anusha M. Vable Alison K. Cohen Stephanie A. Leonard M. Maria Glymour Catherine d.P. Duarte Irene H. Yen 《Annals of epidemiology》2018,28(11):759-766.e5