The impact of the Fundamental Critical Course on knowledge acquisition in Rwanda

Background Emerging critical care systems have gained little attention in low- and middle-income countries. In sub-Saharan Africa, only 4% of the healthcare workforce is trained in critical care, and mortality rates are unacceptably high in this patient population. Objectives We sought to retrospectively describe the knowledge acquisition and confidence improvement of practitioners who attend the Fundamental Critical Care Support (FCCS) course in Rwanda. Methods We conducted a retrospective study in which we assessed survey data and multiple-choice question data that were collected before and after course delivery. The purpose of these assessments at the time of delivery was to evaluate participants’ perception and acquisition of critical care knowledge.Results Thirty-six interprofessional clinicians completed the training. Performance on the multiple-choice questions improved overall after the course (mean score pre-course of 56.5% to mean score post-course of 65.8%, p-value <0.001) and improved in all content areas with the exception of diagnosis and management of acute coronary syndrome and acute respiratory failure/mechanical ventilation. Both physicians and nurses improved their scores significantly (68.9% to 75.6%, p-value = 0.031 and 52.0% to 63.5%, p-value <0.001, respectively). Self-reported confidence in level of knowledge also increased in all areas. Survey respondents indicated on open-answer questions that they would like the course offerings at least annually, and that further dissemination of the course in Rwanda was warranted. Conclusion Deploying the established FCCS course improved Rwandan healthcare provider knowledge and confidence across most critical care content areas. Therefore, this course represents a good first step in bridging the gaps noted in emerging critical care systems. Contributions of the study Critical care education in sub-Saharan Africa is limited and few staff have formal training. The aim of the study was to determine whether a focused course delivered in Rwanda on critical care management improved knowledge in key areas. Our retrospective study on results from a multiple choice question test and survey indicate that short courses may improve knowledge of critical care management.     

常州市0～6岁残疾儿童的流行病学调查

目的掌握目前常州市残疾儿童的患病率及致残原因。方法参照2001年全国0～6岁残疾儿童抽样调查所采用的方法对市区5个街道0～6岁儿童5102人进行了各类残疾的流行病学调查。结果确诊各类残疾共44人,患病率为8.62‰,各类残疾共57人次,残疾发生率为1.12%,其中智力残疾27人次,肢体残疾18人次,精神残疾7人次,视力残疾3人次,听力残疾2人次,残疾发生率分别为5.29‰、3.53‰、1.37‰、0.59‰、0.39‰。结论常州市残疾儿童的患病率较1987年有明显下降,但残疾儿童的康复现状仍不容乐观。     

A comparative review of measurement instruments to inform and evaluate effectiveness of disability inclusive development

Abstract

Purpose: A review of existing measurement instruments was conducted to examine their suitability to measure disability prevalence and assess quality of life, protection of disability rights and community participation by people with disabilities, specifically within the context of development programs in low and middle-income countries. Methods: From a search of PubMed and the grey literature, potentially relevant measurement instruments were identified and examined for their content and psychometric properties, where possible. Criteria for inclusion were: based on the WHO’s International Classification of Functioning Disability and Health (ICF), used quantitative methods, suitable for population-based studies of disability inclusive development in English and published after 1990. Characteristics of existing instruments were analysed according to components of the ICF and quality of life domains. Results: Ten instruments were identified and reviewed according to the criteria listed above. Each version of instruments was analysed separately. Only three instruments included a component on quality of life. Domains from the ICF that were addressed by some but not all instruments included the environment, technology and communication. Conclusion: The measurement instruments reviewed covered the range of elements required to measure disability-inclusion within development contexts. However no single measurement instrument has the capacity to measure both disability prevalence and changes in quality of life according to contemporary disability paradigms. The review of measurement instruments supports the need for developing an instrument specifically intended to measure disability inclusive practice within development programs.

• Implications for Rehabilitation

• Surveys and tools are needed to plan disability inclusive development.

• Existing measurement tools to determine prevalence of disability, wellbeing, rights and access to the community were reviewed.

• No single validated tool exists for population-based studies, uses quantitative methods and the components of the ICF to measure prevalence of disability, well-being of people with disability and their access to their communities.

• A measurement tool that reflects the UNCRPD and addresses all components of the ICF is needed to assist in disability inclusive development, especially in low and mid resource countries.

     

The level and time course of disability: Trajectories of disability in adults and young elderly

Objectives. The objectives of this study were: (i) to identify trajectories in the level and time course of disability, (ii) to determine the relative frequency of each trajectory, and (iii) to assess the relationship of these trajectories with age, sex and the presence of four chronic diseases (asthma/chronic obstructive pulmonary disease (COPD), heart disease, severe low back complaints and diabetes mellitus).

Methods. We used six measurements of disability and information on mortality from a longitudinal study in Dutch persons aged 15 – 74. We used cluster analyses to group persons with similar levels and time courses of disability into disability trajectories. Deaths were classified into a separate trajectory. Multinomial regression was used to assess the relationship of the trajectories with age, sex and the four chronic diseases. Information on disability in the last year(s) prior to death was used to examine disability prior to death.

Results. Nine trajectories of disability were identified, while all deaths were classified into a separate trajectory; 74% was entirely non-disabled. The size of the other trajectories varied from 10% (permanently mildly disabled) to 0.5% (severely disabled with large increase in disability). Significant associations were found with age and, correcting for age and sex, with asthma/COPD, heart disease and low back complaints, but not with diabetes. The ORs were generally highest for trajectories characterized by severe disability, although disease-specific associations were also found. Among the deaths, 41% of the trajectories were associated with disability prior to death. Disability prior to death was more prevalent among persons with heart disease, back complaints, and asthma/COPD.

Conclusions. These findings suggest that disability is a dynamic process, and that important differences exist within the ‘disabled’ population. This is important for assessing the need for care and shows the limitations of modeling disability change based on two measurements only.     

Elderly recipients of home nursing services: pain, disability and functional competence

Despite increasing evidence that pain is a problem with which many in their later years must contend, little is known about the experience of community-dwelling seniors who require the assistance of home nursing services to remain independent and functional in their homes. This study investigated the prevalence and experience of pain among seniors who were recipients of home nursing services. The study was guided by the World Health Organization Classification of Impairment, Disability and Handicap. Face to face interviews were conducted with 66 individuals who reported whether they were often troubled by pain and/or had experienced pain of a noteworthy nature within the 2 weeks prior to the interview. In addition, they responded to standardized questions about their pain experience and their levels of disability and functional competence. Findings revealed that although three-quarters of respondents reported pain, there was no association between pain and measures of disability. Findings, however, revealed an association between pain and measures of funtional competence, more specifically, global function, level of depressive symptomatology, sleep impairment and satisfaction with life. Implications for nursing include the need for a heightened awareness of the prevalence of pain in community-dwelling older adults and the development of assessment and intervention strategies that support their quality of life.     

Health promotion needs of physically disabled individuals with lower limb amputation in Rwanda

Purpose. The objectives of the study were to identify the health-related behaviors among physically disabled individuals with lower limb amputation resident in Rwanda, the factors that influenced these behaviors, and the major issues that should be targeted in health promotion programs for physically disabled individuals with lower limb amputation.

Method. A cross-sectional survey, utilizing a self-administered questionnaire, was carried out among 334 lower limb amputees who volunteered to take part in the study. In addition, a sub-sample of 15 participants was purposively selected for in-depth face-to-face interviews.

Results. Many participants did not engage in physical exercises (64.7%). Others abused alcohol on daily basis (14.4%), smoked 11 - 20 cigarettes daily (13.2%), and used recreational drugs such as marijuana, opium and cocaine (9.6%). There were significant associations between the age group of the participants and participation in exercises (P = 0.001), and consuming alcohol, tobacco and recreational drugs (P = 0.001). In-depth interviews revealed factors influencing the behavior of participants.

Conclusions. Participants were found to be at risk of secondary complications because of poor lifestyle choices. There is a need to develop and promote wellness-enhancing behaviors in order to enhance the health status of physically disabled individuals in Rwanda who have lower limb amputations.     

Rethinking the relationships between disability,rehabilitation, and society

This paper provides a critical review of contrasting ways of thinking about the nature of disability in society. It highlights the dominance of the medical model of disability whereby medical and rehabilitative professionals and practitioners tend to conceive of disability as an individual physiological and/or medical condition requiring the afflicted individual to be given appropriate medical and/or rehabilitative support. As the paper suggests, such perspectives are problematical because they reduce the understanding of disability to the conditions of the individual ‘patient’ and ignore wider social and environmental influences in engendering a state of disability. Thus, the paper highlights other perspectives on disability and society which suggest that social, attitudinal, and environmental barriers in society are an important component in disabling people with physical and/or mental impairments. In this sense, breaking down disabling social practices against people with disabilities might be as important, if not more so, than seeking to cure physical and/or mental impairments.     

Health promotion needs of physically disabled individuals with lower limb amputation in Rwanda

Purpose.?The objectives of the study were to identify the health-related behaviors among physically disabled individuals with lower limb amputation resident in Rwanda, the factors that influenced these behaviors, and the major issues that should be targeted in health promotion programs for physically disabled individuals with lower limb amputation.

Method.?A cross-sectional survey, utilizing a self-administered questionnaire, was carried out among 334 lower limb amputees who volunteered to take part in the study. In addition, a sub-sample of 15 participants was purposively selected for in-depth face-to-face interviews.

Results.?Many participants did not engage in physical exercises (64.7%). Others abused alcohol on daily basis (14.4%), smoked 11?–?20 cigarettes daily (13.2%), and used recreational drugs such as marijuana, opium and cocaine (9.6%). There were significant associations between the age group of the participants and participation in exercises (P?=?0.001), and consuming alcohol, tobacco and recreational drugs (P?=?0.001). In-depth interviews revealed factors influencing the behavior of participants.

Conclusions.?Participants were found to be at risk of secondary complications because of poor lifestyle choices. There is a need to develop and promote wellness-enhancing behaviors in order to enhance the health status of physically disabled individuals in Rwanda who have lower limb amputations.     

The progression of disability among older adults in Mexico

Purpose: This paper seeks to document the progression of disability in a developing country and to examine gender differences in this process.

Methods: The data come from the Mexican Health and Aging Study (MHAS), a nationally representative sample of older adults. An ordinal logistic regression (n?=?3283) is used to measure the progression of disability that considers: (1) no disability, (2) mobility problems, (3) mobility problems with IADLs limitations, (4) mobility problems with ADLs limitations, (5) combinations of the latter three and (6) death.

Results: Approximately 43% of the sample remained in the same level of disability after 2 years. The patterns of progression with two disabilities differ for men and women.

Conclusions: Our model reflects the importance of separating ADLs and IADLs in the study of disability progression in Mexico. Varying risk profiles and cultural differences might influence the divergent disability paths followed by each gender.

• Implications for Rehabilitation

• The disablement process involving transitions from mobility impairments to IADL and ADL limitations seen in developed countries differs for older adults in Mexico.

• Cultural differences may influence the progression from non-disabled to becoming disabled in different ways for females in developing countries like Mexico.

• One-fifth of individuals showed greater function and independence over time, suggesting that the disablement process is reversible. This finding highlights the need to focus on improving mobility, ADL, and IADL skills to facilitate successful aging.

• Although disability is often conceptualised as a combination of ADL and IADL limitations, gender differences seen in Mexico indicate the need to separate ADL and IADL when developing approaches to prevent or ameliorate disability.

     

High prevalence of early onset mental disorders among long-term disability claimants

Purpose: To provide information on prevalence, comorbidity, age-of-onset and severity of mental disorders among persons claiming disability after long-term sickness absence. Method: Cross-sectional analysis of a cohort of Dutch disability claimants (n?=?346). Composite International Diagnostic Interview (CIDI) 3.0 was used to generate DSM-IV classifications of mental disorder, age-of-onset and severity; registry data were used on demographics and ICD-10 classifications of somatic disorder. Results: The mean age of respondents was 49.8 (range 22–64). The most prevalent broad categories of mental disorders were mood and anxiety disorder with a 12-month prevalence of 28.6% and 32.9%, respectively. Mood and most anxiety disorders had ages of onset in adolescence and early adulthood. The phobias start at school age. Of all respondents, 33.7% had ≥1 12-month mental disorder. Co-occurrence of substance use disorders, phobias and depression/anxiety disorders is frequent. Urogenital and gastrointestinal diseases, and cancer coincide with 12-month mental disorder in 66.7%, 53.9% and 51.7% of cases, respectively. More than two out of three specific mental disorders are serious in terms of disability and days out of working role. Conclusions: Disability claimants constitute a vulnerable population with a high prevalence of serious mental disorder, substantial comorbidity and ages-of-onset in early working careers. More research is needed to help prevent long-term sickness absence and disability of claimants with mental health problems.

• Implications for Rehabilitation

• This study shows common mental disorders, such as mood and anxiety disorders, to be highly prevalent among persons claiming disability benefit after long-term sickness absence, to have early onsets and to often co-occur with somatic disorders.

• Professionals in primary and occupational health care should assess need for treatment of workers at risk, while at the same time being careful not to medicalize normal life problems.

• Insurance physicians assessing disability benefit claims should identify factors that caused claimants to call in sick and start interventions to promote return to work.

     

The specialist learning disability nurse in Wales

Fisher M. International Journal of Nursing Practice 1997; 3: 188–190
The specialist learning disability nurse in Wales
This paper reflects on the development of services for people with learning disabilities within the United Kingdom and focuses on the role of the specialist nurse. The nurse's contribution to the care of this client group has been the subject of debate and controversy for a number of years. Developments within the learning disability field in Wales in particular are explored, with the All Wales Strategy for People with Learning Disabilities providing the background and context for these developments. An example of how specialist nurses from around Wales came together in order to share good and best practice is discussed. The conclusion is that the specialist learning disability nurse has a great deal to offer, but must be prepared to work together with other professionals as well as service users and their families.     

Models of disability

This paper critically reviews medical approaches to the identification and treatment of disability. The medical model locates disability within individuals. By contrast, this paper argues that disability cannot be understood outside its social context. As such, some of the assumptions about normality and difference which underpin traditional approaches to the diagnosis and treatment of disabled people are challenged. If it is accepted that disability is located not solely within the mind or body of an individual, but rather in the relationship between people with particular bodily and intellectual differences and their social environment, then greater focus may be placed on ameliorating disability through changes in social policy, culture and institutional practices.     

Constructive Functional Diversity: A new paradigm beyond disability and impairment

Aims of the paper. This article presents a more dynamic and constructive paradigm than the current dominant ones (for example medical or social models), to describe and change the impact of impairment and disability. The reflections contained are inspired by personal and professional frustration with the existing polarized ideology of human function, which fails to adequately describe the diversity of physiological and psychosocial function amongst people. It aims to provoke and inspire dialogue about our current paradigm of human function in relation to value and capacity.

Key findings and implications. Within this paper: I critique society's biases regarding of functional deficit relative to the subconscious fear of losing function; I question the polarity of the negatively framed language of impairment and disability; I offer constructive, creative ‘solutions’ to describe the experience of atypical function. In so doing, an entirely new language of diverse human function and a concept of Constructive Functional Diversity (CFD) is proposed, which includes a complex yet logical array of modes and outcomes of function.

Conclusions and recommendations. Finally I suggest the benefits of a more dynamic paradigm of functional change in enhancing rehabilitative outcomes, including client-directed practice.