Model of Intellectual Disability and the Relationship of Attitudes Towards the Sexuality of Persons with an Intellectual Disability

The following article discusses the relationship between the model of intellectual disability and the attitudes towards sexuality of people with disabilities. This correlation has been verified during the author’s own research conducted on students of several medical faculties such as nursing, public health, emergency medical services and physiotherapy. Tools of the author’s design have been used in the research. Likert-type scale “Perspective of intellectual disability” has been used to determine the model of disability seen from the medical (individual) or social perspective. To examine the attitudes towards sexuality two tools of the author’s own design have been used: a Likert-type scale “The essence of sexuality in persons with an intellectual disability” which has been used to analyze the cognitive aspect of the attitudes, and a semantic differential with notions concerning physical and psychosocial aspects of sexuality including the affective-evaluative aspect. As expected, significant correlations have been found between the model and the attitudes both in the cognitive and the affective-evaluative aspect. Higher scores for the individual model correlated with: (a) lover scores for most aspects of sexuality of people with intellectual disability, (b) perceiving them as asexual, (c) biological determinism in the sexual sphere. The social model concurred with positive values given to sexuality of people with intellectual disability and its normalization in the sphere of its determinants and symptoms.     

Revision of the ICIDH Severity of Disabilities Scale by data linking and item response theory

The Severity of Disabilities Scale (SDS) of the ICIDH reflects the degree to which an individual's ability to perform a certain activity is restricted. This paper describes the application of two models from item response theory (IRT), the graded response model and the partial credit model, in order to derive a tentative proposal for a revised SDS. The key ingredient of the approach is to scale existing disability items obtained in different studies on a common scale by exploiting the overlap. Both IRT models are fitted to a linked data set containing items for measuring walking disability. Based on these solutions, a tentative SDS is constructed. The paper concludes with a discussion of the implications, limitations and advantages of the approach.     

Depressive symptoms in relation to physical health and functioning in the elderly

The associations between depressive symptoms and functional disability and chronic conditions are examined in an elderly cohort of 2,806 noninstitutionalized men and women living in New Haven, Connecticut who were interviewed in 1982 as a part of the Yale Health and Aging Project. The aim is to explore several potential sources of invalidity in using the Center for Epidemiologic Studies-Depression scale (CES-D) to measure depressive symptoms in elderly populations. In particular, the authors are concerned with the possibility that prevalent physical illnesses and disabilities may cause the older person to report many somatic complaints, a major component of most measures of depressive symptomatology, and thereby inflate his or her CES-D score. Mean CES-D scores are 4.86 for those without any disabilities and range to 13.51 for those with major functional disabilities. However, physical disability is significantly associated with virtually every item on the CES-D scale not just those somatically-oriented items. The addition of functional disability to a multivariate model including age subfactor analysis of responses from this elderly sample produces results almost identical to those reported by earlier investigators who studied younger and middle-aged adults. The authors conclude that physical disabilities among the elderly do not appear to be a major threat to the validity of the CES-D scale and that the strong associations between physical and mental health should be rigorously investigated.     

Interobserver variation in the application of 2 disability scales in heart patients]

OBJECTIVE. To examine the use of the Rankin scale for the assessment of disability in patients with ischaemic heart disease. SETTING. University Hospital Utrecht. DESIGN. Prospective interobserver study. PATIENTS AND METHODS. Fifty-two outpatients with heart disease (previous myocardial infarction, angina or both) were separately interviewed by four physicians (residents or specialists), viz., two cardiologists and two neurologists. The degree of disability was recorded by each observer on two different scales: the modified Rankin scale, a six-point scale developed from a neurological background, and the four-point scale developed by the New York Heart Association (NYHA). The agreement rates for the observers (23 in all) were corrected for chance (kappa-statistics; maximum 1.0). RESULTS. Total agreement on both scales was found for six of the participating 51 patients and for 10 and 11 patients when the Rankin scale and the NYHA scale were considered separately. Kappa values were 0.21 for the Rankin scale and 0.24 for the NYHA scale. The weighted kappa values were 0.56 and 0.47, respectively. The agreement among neurologists and cardiologists was comparable. CONCLUSION. The agreement rates of cardiologists and neurologists in the use of the Rankin scale and the NYHA scale in outpatients with heart disease are at best satisfactory. The good results of an earlier study with the Rankin scale in stroke patients were not achieved. This study indicates that the Rankin scale may be useful for the assessment of disability from heart disease particularly in patients with neurological disease, but there is room for further improvement.     

Perceptions towards disability among social work students in Israel: Development and validation of a new scale

Over the last decades, the disability movement has been advocating for a paradigmatic shift in how disability is perceived and managed: from a medical or individual perspective focusing on the person's body and mind to a social perspective emphasizing the context and barriers of disability. However, we still know little about the perceptions of helping professionals, particularly social workers who work closely with disabled people. Thus, the aim of the current study is to develop and validate a scale—Perceptions Toward Disability Scale (PTDS)—to measure how social workers view disability: as an individual or social category. This paper describes the three phases of the scale's construction. First, scale items were formulated and its content validity was examined. Next, a pilot of 30 social workers completed a questionnaire and an initial exploratory factor analysis was conducted. In the third and main phase, the final draft was completed in 2016 by 565 Israeli social work students to assess its psychometric properties. Both exploratory and confirmatory factorial validity and discriminant validity analyses were conducted. The results of a confirmatory factor analysis revealed two distinct factors: an individual perspective of disability comprised of eight items (α = 0.77) and a social perspective of disability comprised of ten (α = 0.66). Subsequent analyses supported the scale's discriminant validity as indicated by the lack of an association between the Attitude Toward Disabled Persons Scale (ATDP) and the social model subscale (r = .13, p = .19) and by the weak negative relation with the individual model subscale (r = ?.25, p = .01). These findings show that the PTDS possesses promising construct validity and provide support for its utility. This easy‐to‐administer instrument offers several practical benefits and can serve as a framework for further empirical research regarding social work practice with disabled people.     

Medical disability assessment of the back pain patient for the Social Security Administration: the weighting of presenting clinical features

We investigated how physicians use history and physical findings when assessing disability for low back pain. Thirty-six North Carolina physicians, either practitioners experienced in disability determinations (26) or employees of the Social Security disability agency (10), responded to 48 clinical vignettes. They rated each case on a scale of 0 to 1.0, according to their degree of certainty that the patient was disabled. All combinations of five patient variables were presented in the vignettes: pain (mild or severe), physical examination (normal, reflex loss or muscular weakness), mobility (normal or restricted), X-rays (normal or osteoarthritis), and occupational history (normal or light work). The mean certainties for the individual vignettes ranged from 0.08 to 0.43. Mean certainty estimates across physicians ranged from 0 to 0.61, indicating substantial variability in how physicians assess disability. Practicing physicians had higher certainty of patients' disability than did physicians employed by Social Security, 0.37 vs 0.07 (p less than 0.01). Degree of pain was not associated with certainty of disability. All other clinical factors were highly significant predictors of physician assessment of certainty of disability. The emphasis on physical and radiographic findings over history places disability evaluation distinctly apart from other medical assessments.     

How good is Sullivan''s method for monitoring changes in population health expectancies?

STUDY OBJECTIVE: To compare health expectancies calculated by Sullivan's method and the multistate life table method in order to identify the magnitude of the bias in Sullivan's method and assess how seriously this limits its use for monitoring population health expectancies. DESIGN: A simulation model was used to compare health expectancies calculated using Sullivan's method and the multistate life table method under various scenarios for the evolution of disability over time in populations. The simulation model was based on abridged cohort life tables using data on French mortality from 1825-90 and disability prevalence data from the 1982 French health survey. MAIN RESULTS: The Sullivan method could not detect a sudden change in disability transition rates, but the simulations suggested that it provides a good estimate of the true multistate value if there are smooth and relatively regular changes in disability prevalence over the longer term. When disability incidence rates are increasing or decreasing smoothly over time, the absolute bias in the Sullivan estimate of disability free life expectancy is relatively constant with age. The relative bias thus increases at older ages as disability free life expectancy decreases. CONCLUSIONS: The difference between the estimates produced by the two methods was small for realistic scenarios for the evolution of population health and Sullivan's method is thus generally acceptable for monitoring relatively smooth long term trends in health expectancies for populations.     

A dynamic analysis of disability and labour force participation in Ireland 1995-2000

This paper aims to analyse the effect of disability on participation in the labour force, using the Irish component of the European Community Household Panel Survey 1995-2000. A range of panel models are considered, but to allow for any unobserved influences or state dependence in labour force participation, our preferred model is a dynamic panel model. We show how the estimates of current disability are changed once we control for the effect of past disability and previous participation. We compare base estimates of disability with those controlling for unobserved heterogeneity and past participation. The results suggest that the base effect of disability is overestimated by between 40-60% for men and by 5-10% for women.     

上海市嘉定区社区老年人的失能现状及其影响因素

目的 了解上海市嘉定区老年人的失能现状并分析其影响因素,为老年人失能防控和健康老龄化建设提供科学依据。方法 采用多阶段随机抽样方法,选取≥60岁的嘉定区户籍老年人群作为调查对象,采用世界卫生组织研发的自报健康调查量表测量老年人失能情况;应用多因素Logistic回归分析模型及列线图分析老年人失能的影响因素。结果 共调查老年人4 773人,其中失能老人495人,失能率为11.4%,女性的失能率(13.6%)高于男性(8.9%)。老年人自我评价在认知记忆、视力辨认、疼痛不适、睡眠及活动行走这五方面存在更多的失能,失能率分别为31.7%、23.0%、21.6%、20.4%和13.6%。多因素分析结果显示,年龄大、自评健康较差、患2种及以上慢性病的老年人失能率较高(均有P<0.05);每周体育锻炼、饮酒的老年人失能率较低(均有P<0.05)。结论 嘉定区社区老年人失能率较高。应加强慢性病管理,关注老年人的不同照护需求,开展针对性的早期预防和干预。     

Dynamics of functional aging based on latent-class trajectories of activities of daily living

PurposeThis study sought to identify and characterize major patterns of functional aging based on activities of daily living (ADL).MethodsWe followed 754 community-living adults aged 70 years or older monthly for ADLs, instrumental ADLs, hospitalization and restricted activity over 10 years. A generalized growth mixture model was used to identify trajectories of ADL disability across seven 18-month intervals. Cumulative burdens of disability and morbidity from different trajectories were examined using a generalized estimating equation Poisson model.ResultsFive distinct trajectories emerged. The predominant trajectory maintained ADL independence, with membership probability being 61.6%. The remaining trajectories either stayed at low (1 or 2 ADLs, 13.6%) or high (3 or 4 ADLs, 7.0%) levels of disability or declined gradually toward low (11.2%) or high (6.5%) disability. The independent trajectory was associated with the lowest burdens of disability and morbidity and a decreasing time trend of restricted activity, whereas the high disability trajectory demonstrated opposite trends. About 31% of the cohort remained in the same trajectory throughout the follow-up period.ConclusionsThe course of functional aging is heterogeneous and dynamic. Although most older adults maintain functional autonomy, some may experience persistent disability or progress toward severe disability with substantial morbidity.     

Aggregated measures of functional disability in a nationally representative sample of disabled people: analysis of dimensionality according to gender and severity of disability

Objective To determine (i) the dimensional invariance of instrumental and basic activities of daily living (IADL/ADL) by gender subgroups, and (ii) the extent to which ADL dimensionality varies with the inclusion or exclusion of nondisabled people. Methods Data were taken from the 1999 Spanish Survey on Disability, Impairment and State of Health. The analysis focussed on 6,522 people aged over 65 years who received help to perform or were unable to perform IADL/ADL items. Unidimensional and multidimensional item response theory (IRT) models were applied to this sample. Results In the female sample, IADL/ADL items formed a scale with sufficient unidimensionality to fit a two-parameter logistic IRT model. In the male sample, the structure was bidimensional: self-care and mobility, and household activities. When the sample was composed of IADL/ADL disabled people, ADL items formed a unidimensional scale; when it was composed only of ADL disabled people, they formed a bidimensional structure: self-care and mobility. Conclusions IADL/ADL items can be combined in a single scale to measure severity of functional disability in females, but not in males. Separate aggregated scores must be considered for each subdomain, basic mobility and self-care, in order to measure the severity of ADL disability.     

Validity and reliability of the Disabilities of Arm,Shoulder, and Hand scale in dental students: A transnational study

This study aimed to evaluate the validity and reliability of the Disabilities of Arm, Shoulder, and Hand (DASH) scale in Brazilian and American dental students and assess the influence of demographic variables on disability in them. A cross-sectional observational study was conducted with a nonprobabilistic sample. The sample was composed of students of both genders from the School of Dentistry of Araraquara, State University of São Paulo (UNESP) (n = 288), and students from Stony Brook University, New York, NY, USA (n = 149). The disabilities of the upper limbs were estimated using the DASH scale. The samples were characterized by collecting information on gender, academic year, and sports and work activities. The refined bifactorial model presented goodness-of-fit indices for both countries. There was a significant effect of the variables gender and academic year for the Brazilian sample and the variable sports practices for the American sample. The refined bifactorial model was valid and reliable for the Brazilian and American populations. In this model, the removal of item 17 for the Brazilian sample and items 3, 13, and 23 for the American sample was necessary. Demographic variables such as gender, academic year, and sports practice contributed significantly to the level of disability in the study populations.     

The Impact of Physical Disability on Body Esteem

The current study investigated the impact of physical disability on body esteem. A total of 35 people (18 males and 17 females) with physical disabilities between 19 to 60 years (mean = 38 years, SD = 10), participated in focus groups where they discussed their feelings about how their disability affected their body esteem. They also responded to a series of questions that were designed to examine disability-specific issues in body esteem using a four point Likert-type scale. The data demonstrated that the body esteem of the participants was commonly affected by physical disability. It also suggested that feedback from the social environment is a likely mediator of body esteem. Suggestions for future research and implications for clinicians are discussed.     

Disability studies and health care curriculum: the great divide

Models or paradigms of disability are used to guide health care professionals' perceptions so that they can serve people with disabilities, enhance their futures, and facilitate the resources they need. Health care curricula, which in essence train students to make such decisions, are influenced by these models. The medical model, which locates disability within the individual, assumes the individual with a disability is a victim who must be cured or made more normal. The functional-limitation paradigm expands on the medical model, focusing on the interaction of physical or mental limitations with social and environmental factors. The economic model, based on the concept of employability, emphasizes a health-related inability (or limited ability) to work rather than physical functioning of the individual. The sociopolitical model views disability as a policy and civil rights issue. Health care professionals face a dilemma as the disability rights movement demands a shift in social power from the paternalistic view of the medical model to the autonomist view of the sociopolitical model. The question is asked if curricula are preparing our future health care professionals to distinguish how to view each situation and each individual through the lens of the appropriate model.     

Disability Prevention

Occupational back pain is a widespread self-limited but recurring disease that generates major societal costs and impairs workplace productivity. However, this societal impact is mostly accounted for by a small fraction of patients with back pain who have prolonged absence from work, i.e. prolonged disability.Evidence from research from the past 2 decades has progressively shown that most efforts to prevent or cure the disease have limited results, explaining the expanding number of disability cases from back pain. However, recent evidence has also shed light on the causes of disability that are not only due to the patients’s personal characteristics (physical and psychosocial), but also stem from the patients’s environment in the disability problem — the workplace, the compensation system and even the healthcare delivery system.In addition, successful intervention studies have used an approach to disability prevention through patient reassurance and interventions linked to the workplace, instead of using a medical model of back pain treatment. It is evident that the present disease treatment paradigm should be replaced by a disability prevention paradigm for patients with subacute or chronic back pain to avoid unnecessary evolution towards prolonged disability.We propose a disability prevention management model to encourage clinicians, employers, unions and insurers, as well as researchers in the field, to work within the perspective of the disability paradigm.     

Antecedents of work disability absence among young people: a prospective study

PURPOSE: This study examined the relative contribution of individual factors, job characteristics, and temporal factors to the likelihood of lost days of work due to a work-related disability or illness among Canadians 16 to 24 years old. METHODS: Using a prospective Canadian survey with up to 6 years of follow-up, the job-based analyses included 45,125 job episodes generated from a representative sample of young workers. A hazard model on work disability absence included the following predictors: age, gender, physical demands of the job (manual, nonmanual, and mixed), hours worked, highest education achieved, multiple concurrent job, job tenure, school activity, and living in a rural or urban area. RESULTS: The overall 1-week work disability absence rate was 0.78 per 1000 person-months. In the multivariate model, young workers holding manual jobs were 2.65 times more likely to have a work disability absence compared with young workers with nonmanual jobs. Also, those with less than a high school education were almost 3 times more likely to have a work disability absence. Other demographic factors such as gender were not independently associated with work disability absences. CONCLUSIONS: This prospective study finds that job characteristics are the predominant risk factors for work disability absences for young workers. Young workers with less education appear to be particularly vulnerable, possibly because of inadequate job skills or particularly dangerous job tasks.     

Joint association of obesity and hypertension with disability in the elderly—A community-based study of residents in Shanghai,China

Background

Although both obesity and hypertension are known risk factors for disability, the joint association of obesity and hypertension with risk of disability is unknown. This paper is aim to examine the joint association of obesity and hypertension with risk of disability.

Methods

Cross-sectional study with 8060 elderly community-dwelling individuals participating in the survey initiated by Shanghai Health and Family Planning Commission from March to September 2013. Obesity was measured using the body mass index (BMI) in World Health Organization (WHO) Asia criteria. Hypertension, based on the doctor’s diagnosis, was obtained through face-to-face interview. Disability was measured using the self-reported physical self-maintenance scale (PSMS) and the instrumental activities of daily living (IADL) scale developed by Lawton and Brody.

Results

A total of 8.97% of participants reported ADL disability, and 15.18% for IADL disability. After adjusting social demographics and chronic conditions, the risk of ADL disability was progressively greater in obese persons with hypertension (OR=1.40, 95% CI=1.05-1.89), underweight persons without hypertension (OR=2.05, 95% CI=1.29-3.25), and underweight persons with hypertension (OR=2.14, 95% CI=1.36-3.36). For IADL disability, only underweight persons with hypertension were significantly associated (OR=1.65, 95% CI=1.23-2.21).

Conclusions

Low or extremely high BMI, independent of its metabolic consequences, is a risk factor for disability among the elderly. Simple hypertension wasn’t significantly associated with disability. In addition, having hypertension significantly increased the risk of ADL disability in obese individuals and IADL disability in underweight individuals.

     

The Framingham Disability Study: relationship of various coronary heart disease manifestations to disability in older persons living in the community.

The relation between coronary heart disease and disability was examined in 2,576 community-dwelling women and men ages 55-88 years. These Framingham Study participants were originally recruited in 1948-51 for an examination of cardiovascular disease. Twenty-seven years later, remaining members of the cohort were interviewed to ascertain physical abilities, and a score on a disability scale was assigned. Multivariate logistic analyses examined disability in relation to uncomplicated angina pectoris (AP), complicated AP, and coronary heart disease other than AP, controlling for possible confounders. In younger and older women and men, uncomplicated and complicated AP were associated with disability. Coronary heart disease other than AP was associated with disability only in the younger men. Congestive heart failure predicted disability only in the women. These results suggest that onset of AP should be recognized as a critical point in the development of disability and that AP is a better predictor of disability than is myocardial infarction or coronary insufficiency.     

What does ‘disability’ mean for medical students? An exploration of the words medical students associate with the term ‘disability’

CONTEXT: Disability teaching is a core theme in undergraduate medical education. Medical students bring a range of experiences of disability to their medical training. AIM: The principal aim of this study was to explore the words that medical students associate with the term "disability" and to consider how the resulting information could inform teaching. A secondary aim was to see if a short disability course changed the word associations. METHODS: Students were asked to write down 2 words that came to mind when they heard the word "disability", before and after a 4-day course in disability. Words from 4 cohorts were analysed by frequency and the following word dichotomies: visual icons/personal attributes; loss/enabling, and medical model/social model. A random sample of students took part in focus groups at the beginning and end of the course. RESULTS: A total of 381 students provided 667 before-course words and 189 students provided 336 after-course words. Before the course, words denoting visual icons of disability, and loss were prominent, accounting for 85% of the words, and 74% of the words describing personal attributes were negative. Focus group responses at this stage reflected an eagerness to help but patronising terms were prominent, along with concern about political correctness. Students also expressed nervousness about encountering disabled people. In response, teaching was adapted to make it more learner-focused, to offer a safe environment in which students can test out their language, to build on the positive associations and to develop a range of pre-course creative activities with disabled people. After the course a considerable and significant shift in emphasis was observed, with a reduction in the use of visual icon words, an increase in words denoting enablement, and an increase in words relating to the social model of disability and to positive personal attributes (P < 0.001). Focus group participants at this stage reported greater confidence in approaching disabled people but continued to question political correctness. CONCLUSIONS: Medical students associate disability predominantly with depersonalised or negative words. A short disability course appears to change these associations. Reasons for this and implications for teaching are discussed.     

我国60岁及以上老年人失能情况及相关因素分析

目的 了解我国老年人失能情况并分析失能的相关因素。方法 以2014年中国老年社会追踪调查（CLASS）数据为基础,利用Barthel指数量表评价60岁及以上老年人的失能情况。应用logistic回归模型分析我国老年人失能的相关因素。 结果 共选取样本6 182例,其中失能老年人1 517例,失能率为24.5%,轻、中、重度和完全失能比例分别为21.2%、2.1%、0.7%、0.6%。二分类logistic回归分析结果显示,年龄、自评健康、担心记忆力、慢性病数量、生活事件、社会交往、认知能力、老化态度、抑郁情况、社区活动场所配备和参加社区活动与老年人失能密切相关。结论 中国老年人失能率较高,家庭、社会、机构、政府等应有效整合预防老年人失能的发生,同时关注失能老人的心理状态,提高其生活质量。