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1.
Ryan R. Bailey Allison Phad Ryan McGrath Debra Haire-Joshu 《Disability and health journal》2019,12(2):323-327
Background
History of stroke increases cardiometabolic risk, which can be exacerbated by the presence of unhealthy lifestyle factors. Population-based estimates of lifestyle risk factors in people with stroke are lacking but could be used to inform research, policy, and healthcare practice.Objective
To compare population-based estimates of the prevalence of five lifestyle risk factors—low fruit and vegetable consumption, insufficient physical activity, smoking, heavy alcohol consumption, and overweight/obesity—among U.S. adults with and without stroke.Methods
Representative data from noninstitutionalized adults aged ≥18 years (stroke, n?=?37,225; no stroke, n?=?851,607) from the 2015 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) were used to estimate prevalence of individual and total number of risk factors. Logistic regression models were used to determine the odds of lifestyle risk factors in adults with stroke, adjusting for sex, age, ethnicity, marital status, education, income, and disability.Results
Prevalence and adjusted odds ratios (AOR) were higher in individuals with stroke compared to those without stroke for insufficient physical activity (56.5% vs. 49.5%, AOR: 1.14) and smoking (30.1% vs. 16.6%, AOR: 1.16), but lower for heavy alcohol consumption (5.4% vs. 6.1%, AOR: 0.76). Prevalence for low fruit and vegetable consumption (51.7% vs. 46.0%) and overweight/obesity (70.2% vs. 64.5%) was higher among adults with stroke, but differences were attenuated by demographic characteristics. Additionally, clustering of 4–5 lifestyle risk factors was higher in adults with stroke (9.0% vs. 5.3%, AOR: 1.12).Conclusion
Additional research and healthcare interventions are needed to improve lifestyle risk factors in adults with stroke. 相似文献2.
Anne C. Wheeler Amanda Wylie Adrienne Villagomez Ellen Bishop Melissa Raspa 《Disability and health journal》2019,12(2):269-277
Background
Previous research suggests that individuals with intellectual or developmental disabilities (IDD) may experience challenges accessing quality health care.Objective/Hypothesis
This study explored parent perceptions of access and quality of health care services for children with fragile X syndrome (FXS), the leading hereditary cause of intellectual/developmental disabilities.Methods
Nearly 600 primary caregivers of at least one child with FXS completed an online survey on access, barriers, and quality of health care for their family member with FXS (N?=?731).Results
In a convenience sample of well-educated and affluent caregivers, the majority did not report experiencing difficulties with access to services. Caregivers of younger children and those with lower family incomes reported greater challenges with health care access. Nearly 40% of caregivers indicated that their child's PCP was not as knowledgeable about FXS-related needs as they would prefer, indicating a possible knowledge gap on the part of providers.Conclusions
These factors represent potential barriers to quality health care for individuals with FXS, with potential lifelong effects ranging from delayed age of diagnosis to difficulty accessing a PCP in adulthood. 相似文献3.
Gretchen A. Benson Abbey Sidebottom Joy Hayes Michael D. Miedema Jackie Boucher Marc Vacquier Arthur Sillah Safa Gamam Jeff J. VanWormer 《Journal of the Academy of Nutrition and Dietetics》2019,119(4):585-598
Background
Clinical care for type 2 diabetes has improved but remains suboptimal. Collaborative, team-based models that maximize skills of different disciplines may improve care for individuals with diabetes, but few have been tested using rigorous research designs.Objective
To investigate the efficacy of a registered dietitian nutritionist–led telemedicine program compared with that of a control group in terms of diabetes optimal care goals.Design
A randomized controlled trial in which participants were assigned to a control or intervention group.Participants/setting
One hundred eighteen adults with type 2 diabetes (mean age, 60 years; 45% female) participated in the study between April 2016 and December 2017. Participants were recruited from separate primary care clinics in two rural Minnesota communities.Intervention
For those assigned to the intervention, registered dietitian nutritionists used a treatment protocol to initiate and titrate therapies for blood glucose, hypertension, and lipid levels in addition to providing medical nutrition therapy; telemedicine visits supplemented usual care.Main outcome measures
Primary outcomes included composite and individual diabetes optimal care goals: hemoglobin A1c, blood pressure, not using tobacco, and taking a statin and aspirin (as appropriate). Secondary measures included physical activity, breakfast, fruits and vegetables, whole grains, body mass index, low-density lipoprotein, and medication adherence.Statistical analysis
Mixed-model regression was used to examine outcomes between baseline and 1-year follow-up.Results
A modest but significantly greater improvement in the number of diabetes optimal care measures met at follow-up was found in the intervention group (3.7 vs 3.2 in the control group [P=0.017]). Among individual measures, the intervention group had significantly greater medication use, with 2.5 and 2.2 higher odds (compared with the control group) of taking a statin [95% CI, 1.0 to 6.24]) and aspirin [95% CI, 0.90 to 5.19] as appropriate, respectively.Conclusions
ENHANCED (diEtitiaNs Helping pAtieNts CarE for Diabetes) findings suggest that registered dietitian nutritionists following medication treatment protocols can effectively improve care for adults with type 2 diabetes and can serve an instrumental role as part of the health care team in providing evidence-based, patient-centered care. 相似文献4.
Background
There is a need to examine health care utilization of individuals with the rare conditions muscular dystrophies, spina bifida, and fragile X syndrome. These individuals have a greater need for health care services, particularly inpatient admissions. Prior studies have not yet assessed 30-day all-cause readmission rates.Objective
To estimate 30-day hospital readmission rates among individuals with three rare conditions.Hypothesis
Rare conditions patients will have a higher 30-day all-cause readmission rate than those without.Methods
Data from three sources (2007–2014) were combined for this case-control analysis. A cohort of individuals with one of the three conditions was matched (by age in 5 year age groups, gender, and race) to a comparison group without a rare condition. Inpatient utilization and 30-day all-cause readmission rates were compared between the two groups. Logistic regression analyses compared the odds of a 30-day all-cause readmission across the two groups, controlling for key covariates.Results
A larger proportion in the rare condition group had at least one inpatient visit (46.1%) vs. the comparison group (23.6%), and a higher 30-day all-cause readmission rate (Spina Bifida-46.7%, Muscular Dystrophy-39.7%, and Fragile X Syndrome-35.8%) than the comparison group (13.4%). Logistic regression results indicated that condition status contributed significantly to differences in readmission rates.Conclusions
Higher rates of inpatient utilization and 30-day all-cause readmission among individuals with rare conditions vs. those without are not surprising, given the medical complexity of these individuals, and indicates an area where unfavorable outcomes may be improved with proper care coordination and post discharge care. 相似文献5.
Chong-Han Kua Vivienne S.L. Mak Shaun Wen Huey Lee 《Journal of the American Medical Directors Association》2019,20(3):362-372.e11
Objectives
Deprescribing is effective in addressing concerns relating to polypharmacy in residents of nursing homes. However, the clinical outcomes of deprescribing interventions among residents in nursing homes are not well understood. We evaluated the impact of deprescribing interventions by health care professionals on clinical outcomes among the older residents in nursing homes.Design
Systematic review and meta-analysis of randomized controlled trials. CINAHL, International Pharmaceutical Abstracts, MEDLINE, EMBASE, and Cochrane Library were searched from inception until September 2017; manual searches of reference lists of systematic reviews identified in the electronic search; and online trial registries for unpublished, ongoing, or planned trials. (PROSPERO CRD42016050028).Setting and Participants
Randomized controlled trials in a nursing home setting that included participants of at least 60 years of age.Measures
Falls, all-cause mortality, hospitalization, and potentially inappropriate medication were assessed in the meta-analysis.Results
A total of 41 randomized clinical studies (18,408 residents) that examined deprescribing (defined as either medication discontinuation, substitution, or reduction) in nursing were identified. Deprescribing interventions significantly reduced the number of residents with potentially inappropriate medications by 59% (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.19–0.89). In subgroup analysis, medication review–directed deprescribing interventions reduced all-cause mortality by 26% (OR 0.74, 95% CI 0.65–0.84), as well as the number of fallers by 24% (OR 0.76, 95% CI 0.62–0.93).Conclusions
Compared to other deprescribing interventions, medication review–directed deprescribing had significant benefits on older residents in nursing homes. Further research is required to elicit other clinical benefits of medication review–directed deprescribing practice. 相似文献6.
Paolo Dionigi Rossi Sarah Damanti Carolina Nani Mauro Pluderi Giulio Bertani Daniela Mari Matteo Cesari Dario Consonni Diego Spagnoli 《Journal of the American Medical Directors Association》2019,20(3):373-376.e3
Objectives
To evaluate the effects of repeated cerebrospinal fluid (CSF) tap procedures in idiopathic normal pressure hydrocephalus (iNPH) patients ineligible for surgical treatment.Design
Prospective, monocentric, pilot study.Setting
University hospital.Participants
Thirty-nine patients aged 75 years and older, ineligible for shunting surgical intervention.Intervention
Repeated CSF taps.Measurements
All patients underwent a comprehensive geriatric assessment before and after each CSF tap. Adverse events were recorded.Results
No major side effect was reported. Eleven patients showed no response to the first CSF tap test and were excluded. In the remaining 28 patients, all physical and cognitive functions improved after the drainage procedures, except for continence (which seemed poorly influenced). According to clinical judgment, the mean time frame of benefit between CSF taps was 7 months. Patients withdrawing from the protocol during the clinical follow-up showed a worsening of functional and cognitive performances after the interruption.Conclusions/Implications
Periodic CSF therapeutic taps are safe, allow a better control of iNPH symptoms, and prevent functional decline in geriatric patients. 相似文献7.
Colleen M. Heflin Claire E. Altman Laura L. Rodriguez 《Disability and health journal》2019,12(2):220-226
Background
Households with a disabled adult are disproportionately food insecure, yet the mechanisms linking food insecurity to disability are under-specified.Objective
To develop and empirically examine a model of the potential pathways connecting specific types of disability with food insecurity.Methods
With pooled, repeated cross-sectional National Health and Nutrition Examination Survey data (1999–2014) including 38,354 participants, we ran probit models to estimate the probability of being food insecure as a function of different sets of disability measures and our control variables. We explored the extent to which these patterns differed for prime-aged individuals (19–59) from those age 60 and older.Results
Work-limiting disabilities, functional limitations, and trouble managing money were associated with an increased likelihood of food insecurity for both prime-aged and older individuals, net of other forms of disability. Mobility limitations, trouble seeing, and trouble hearing increased the likelihood of food insecurity for prime-aged individuals only.Conclusion
These findings suggest that disabilities are associated with food insecurity through multiple pathways. Revised public health and policy solutions are needed to address the high rates of food insecurity among those with disabilities. 相似文献8.
Nicole Fran Kahn Chirayath M. Suchindran Carolyn Tucker Halpern 《Disability and health journal》2019,12(2):155-163
Background
Timing of first sex has important implications for later sexual health, but little research has considered this in populations with physical disabilities.Objective
The purpose of this paper was to examine timing of sexual experiences among populations with physical disabilities in the United States from adolescence to early adulthood, and how timing varies by biological sex, race/ethnicity, and sexual orientation. We hypothesized that those with physical disabilities would exhibit earlier initiation of each type of sexual activity compared to those without disabilities, but the degree of differences would depend on disability severity. We further hypothesized that these associations would be moderated by biological sex, race/ethnicity, and sexual orientation.Methods
Data were from 13,458 respondents to Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health. Cox proportional hazards models assessed differences in timing of vaginal, oral, anal, and first sex by disability severity.Results
Populations with the most severe physical disabilities had a significantly slower progression to first vaginal sex, oral sex, and their first sexual experience compared to those without disabilities (aHR: 0.74–0.77). Timing also differed by biological sex, race/ethnicity, and sexual orientation, though the direction and degree of these differences varied by disability severity.Conclusions
Results fill an important gap in the literature by considering variations in sexual timing among populations with physical disabilities using a longitudinal, nationally representative sample. Future research should continue to promote inclusion of populations with disabilities to inform future policies and programs for healthy sexual development. 相似文献9.
Juliana P. Antonio Roberta A. Sarmento Jussara C. de Almeida 《Journal of the Academy of Nutrition and Dietetics》2019,119(4):652-658
Background
The overall diet quality of individuals and populations can be assessed by dietary indexes based on information from food surveys. Few studies have evaluated the diet quality of individuals with type 2 diabetes or its potential associations with glycemic control.Objective
To evaluate the relationship between diet quality and glycemic control.Design
Cross-sectional study with consecutive enrollment from 2013 to 2016.Participants
Outpatients with type 2 diabetes treated at a university hospital in southern Brazil.Main outcome measures
Dietary information was obtained by a quantitative food frequency questionnaire validated for patients with diabetes. Overall diet quality was evaluated by the Healthy Eating Index 2010. Glycemic control was assessed by fasting plasma glucose and glycated hemoglobin.Statistical analyses
A receiver operating characteristic curve was constructed to find the optimal Healthy Eating Index cutoff point to discriminate diet quality, considering good glycemic control as glycated hemoglobin level <7%. Patients were then classified as having lower vs higher diet quality, and the two groups were compared statistically. Logistic regression models were constructed with glycated hemoglobin level ≥7% as the dependent variable, adjusted for age, current smoking, diabetes duration and treatment, physical activity, body mass index, high-density lipoprotein cholesterol level, and energy intake.Results
A total of 229 patients with type 2 diabetes (median age=63.0 years [interquartile range=58.0 to 68.5 years]; diabetes duration=10.0 years [interquartile range=5 to 19 years]; body mass index 30.8±4.3; and glycated hemoglobin=8.1% [interquartile range=6.9% to 9.7%]) were evaluated. A Healthy Eating Index score >65% yielded the best properties (area under the receiver operator characteristic curve=0.60; sensitivity=71.2%; specificity=52.1%; P=0.018). Patients with lower-quality diets were younger and more likely to be current smokers than patients with higher-quality diets. After adjusting for confounders, patients with lower-quality diets had nearly threefold odds of poorer glycemic control (2.92; 95% CI 1.27 to 6.71; P=0.012) than those in the higher-quality diet group.Conclusions
Lower diet quality, defined as an Healthy Eating Index 2010 score <65%, was associated with poor glycemic control in this sample of outpatients with type 2 diabetes. 相似文献10.
Background
This research deals with the way people create discourses around disability, which shape the community's concept of disability.Objective
The purpose of this article is to find out how the community configures "disability", in particular by understanding the ideas, needs and strategies that the community uses towards people with disabilities. Specifically, different roles have been involved, such as professionals, volunteers, family members and citizens. The final aim is intervening on the discourses that can contrast the full personal fulfilment of people with disabilities and social inclusion.Methods
This paper relates to discursive psychology's theoretical references and makes use of the Methodology of Textual Analysis. The tools we used include investigation protocols specially designed to detect text both through manual "pencil and paper" and computerized denominations.Results
The results show that those who are in direct contact with people with disabilities (volunteers and family members) are more exposed to treating them as disabled, making the deficit coincide with the person and also have a more judgemental approach.Conclusions
From the results obtained we can see which practices can be activated to facilitate the network between the various roles in order to implement inclusive interventions and help those more exposed to prejudices. 相似文献11.
Susan M.H. Gills Garry Auld Ann Hess Susan S. Baker 《Journal of the Academy of Nutrition and Dietetics》2019,119(3):500-506
Background
The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded, community nutrition education program that assists the low-income population in acquiring knowledge and skills related to nutrition, food safety, food resource management, food security, and physical activity. Evaluation of EFNEP includes a 24-hour dietary recall (24HDR) administered by paraprofessional educators, yet protocols for most large-scale nutrition research studies employ registered dietitian nutritionists (RDNs) or individuals with educational backgrounds in nutrition or related fields to collect dietary recalls.Objective
To compare 24HDRs collected by trained paraprofessional educators with recalls collected by an RDN.Design
Exploratory cross-over study comparing same-day 24HDR in a one-on-one setting collected by paraprofessional educators and an RDN. Paired recalls were separated by at least 1 hour.Participants and setting
The participants (n=41) were volunteer women who were eligible for participation in EFNEP in two states.Main outcome measures
The 24HDRs were compared for energy, macronutrients, micronutrients, and food groups.Statistical analysis performed
Mixed-model analysis to account for repeated measures. Intraclass correlation and Spearman correlation coefficients to determine interrater agreement.Results
No difference in 24HDR was seen when compared by interviewer (paraprofessional vs RDN) or by site (Colorado vs North Carolina). There were significant differences in four components (energy, total fat, saturated fat, and solid fats-added sugar) based on recall order, with a higher intake in the second recall compared with the first.Conclusion
The results of this preliminary study suggest that a well-trained paraprofessional educator using a valid methodology can collect a 24HDR that is similar to a recall collected by an RDN. The paraprofessional educator can be employed for dietary data collection, allowing the RDN to focus on more advanced aspects of scope of practice, such as data evaluation and program development. 相似文献12.
Cristina Reverberi Francesco Lombardi Mirco Lusuardi Alessandra Pratesi Mauro Di Bari 《Journal of the American Medical Directors Association》2019,20(4):470-475.e1
Objectives
Patients with acquired brain injuries (ABIs) often need tracheostomy because of dysphagia. However, many of them may recover over time and be eventually decannulated during post-acute rehabilitation. We developed the Decannulation Prediction Tool (DecaPreT) to identify, early in the post-acute course, patients with ABIs who can be safely decannulated.Design
Nonconcurrent cohort study.Setting and Participants
Patients with ABI, as well as with dysphagia and tracheostomy, were retrospectively selected from the database of a neurorehabilitation unit in Correggio, Reggio Emilia, Italy.Measures
Potential bivariate predictors of decannulation were screened from variables collected on admission during clinical examination, conducted by an expert speech therapist. Multivariable prediction was then obtained in 2 separate random subsamples to develop and validate the logistic regression model of the DecaPreT.Results
Of 463 patients with ABI (mean age 52.2 years) selected, 73.0% could be safely decannulated before discharge. After bivariate screening, multivariable predictors of decannulation were identified in the development subsample and confirmed in the validation subsample, each with its odds ratio and 95% confidence interval as follows: age tertile (1.77, 1.08–2.89; P = .024), no saliva aspiration (3.89, 1.73–8.64; P = .001), pathogenesis of ABI (trauma vs other causes vs stroke vs anoxia: 2.23, 1.41–3.54; P = .001), no vegetative status (8.47; 2.91–24.63; P < .001), and coughing score (voluntary and reflex vs voluntary vs reflex vs neither voluntary nor reflex cough: 2.62, 1.70–4.05; P < .001). In the validation subsample, the predicting equation obtained an area under the receiver operating characteristics curve of 0.836.Implications
The DecaPreT predicts safe decannulation in patients with dysphagia and tracheostomy, using simple clinical variables detected early in the post-acute phase of ABI. The tool can help clinicians choose timing and intensity of rehabilitation interventions and plan discharge. 相似文献13.
Christina Chauvenet Molly De Marco Carolyn Barnes Alice S. Ammerman 《Journal of the Academy of Nutrition and Dietetics》2019,119(3):416-424.e2
Background
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program is an important intervention for prevention and treatment of obesity and food insecurity, but participation has dropped among eligible populations from 2009 to 2015. Program satisfaction is integral to participant retention, and the retail experience is a vital component of program satisfaction.Objective
This article applies behavioral economics principles to explore the retail experience of WIC participants and ways in which it may be improved.Design
The authors designed and conducted semistructured interviews and focus groups with WIC participants.Participants/setting
A convenience sample of WIC participants aged 18 years and older were recruited through WIC clinics in Texas, North Carolina, Oregon, and Illinois (n=55, 27 participants from four focus groups and 28 individual interviews).Statistical analysis conducted
Responses were analyzed qualitatively using principles of content analysis.Results
Challenges in identifying WIC-allowable items throughout the store as well as perceived stigmatization during the checkout process were the chief complaints. Study participants described a learning curve in successful use of WIC in retail environments over time. Study participants also reported acceptance of restrictions, such as a requirement to purchase the least expensive brand.Conclusions
Dissatisfaction with the retail experience may lead to the underutilization of WIC benefits or program exit. Behavioral economics strategies that facilitate a better shopping experience, such as creating a section for WIC items in the store or improving in-store education, may improve the retail experience for WIC customers. Further research is needed to ensure such strategies are effective and do not contribute to stigma. 相似文献14.
Lauren E. Au Courtney Paolicelli Klara Gurzo Lorrene D. Ritchie Nancy S. Weinfield Kaela R. Plank Shannon E. Whaley 《Journal of the Academy of Nutrition and Dietetics》2019,119(3):435-448
Background
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides supplemental foods to assist participants in meeting their dietary needs. Few studies have described the extent to which WIC-eligible foods contribute to the overall diet of children who were enrolled in WIC prenatally or in early infancy.Objective
Our aims were to examine commonly consumed foods and estimate the proportion of dietary intake contributed by WIC-eligible foods among 13- and 24-month-old children, and to assess differences by WIC participation status at 24-months.Design
This was a national observational study.Participants/setting
Children participating in the WIC Infant and Toddler Feeding Practices Study-2 were included (13 months old [n=2,777] and 24 months old [n=2,450]) from 2013 to 2016.Main outcome measures
Dietary intakes were assessed using 24-hour dietary recalls at 13 and 24 months. The 10 most commonly consumed foods were described using the What We Eat in America food category classification system. WIC-eligible foods were defined as meeting the WIC nutrient criteria set forth in the Federal regulation.Statistical analyses performed
The estimated proportion (mean±standard error) of WIC-eligible foods to total daily intake was calculated for energy, macronutrients, and select micronutrients. Multiple linear regression, adjusted for confounders, was conducted to compare the estimated proportion of nutrient intake from WIC-eligible foods by WIC participation at 24 months.Results
At 13 and 24 months, most (60% and 63%, respectively) of the commonly consumed foods were eligible for purchase as part of the child WIC food package. WIC-eligible foods provided >40% of calories and close to 50% or more of other nutrients, and the contribution of WIC-eligible foods to overall micronutrient intake increased between 13 and 24 months. Children still on WIC at 24 months obtained a larger proportion of calories and most other nutrients from WIC-eligible foods than children no longer on WIC.Conclusions
WIC-eligible foods could contribute to the overall diet of toddlers who were enrolled in WIC prenatally or in early infancy. Further, there may be additional nutritional benefits of staying on the program through 24 months. 相似文献15.
16.
Angela R. Fertig Katie A. Loth Amanda C. Trofholz Allan D. Tate Michael Miner Dianne Neumark-Sztainer Jerica M. Berge 《Journal of the Academy of Nutrition and Dietetics》2019,119(5):818-830
Background
Interest in initiatives that promote home cooking has been increasing, but no studies have examined whether home cooking is associated with dietary quality using longitudinal data on meals served in a diverse sample of families.Objective
The present study examined data on multiple meals per family in diverse households to determine whether home-cooked meals are more likely to contain nutritious ingredients than pre-prepared meals.Design
Data for the study came from the National Institutes of Health–funded Family Matters Study. As part of this study, between 2015 and 2016, 150 families provided ecological momentary assessment data on 3,935 meals over an 8-day observation window.Participants/setting
In this study, investigators followed 150 families with children aged 5 to 7 years old from six racial/ethnic groups (n=25 each non-Hispanic white, non-Hispanic black, Hispanic, Native American, Hmong, and Somali families). Recruitment occurred through primary care clinics serving low-income populations in Minnesota.Main outcome measures
The main outcomes were participants’ self-reports of whether they served fruits, vegetables, and whole grains at a meal, and reports were made within hours of the meal.Statistical analyses performed
Within-group estimator methods were used to estimate the associations between meal preparation and types of food served. These models held constant time-invariant characteristics of families and adjusted for whether the meal was breakfast, lunch, dinner, or a snack and whether it was a weekend meal.Results
For all racial/ethnic and poverty status groups, meals that were fully or partly home-cooked were more likely to contain fruits and vegetables than pre-prepared meals (P<0.001). Meals that were partly home-cooked were the most likely to contain whole grains (P<0.001). Restaurant meals were more likely to contain vegetables than pre-prepared meals (P<0.001) but were equally likely to contain fruits and/or whole grains as pre-prepared meals.Conclusions
Interventions or initiatives that encourage fully or partly home-cooked meals may help families incorporate nutritious foods into their diets. In addition, evaluations of potential strategies to increase the likelihood of supplementing pre-prepared and restaurant meals with nutritious meal ingredients warrants further investigation. 相似文献17.
18.
The relation of abuse to physical and psychological health in adults with developmental disabilities
Rosemary B. Hughes Susan Robinson-Whelen Dora Raymaker Emily M. Lund Mary Oschwald Marsha Katz Albert Starr Elesia Ashkenazy Laurie E. Powers Christina Nicolaidis 《Disability and health journal》2019,12(2):227-234
Background
People with developmental disabilities are at disproportionately high risk of abuse. Although considerable evidence exists on the health-related consequences of abuse in the general population, little is known about those consequences in people with developmental disabilities.Objective
To examine the relation of abuse with psychological and physical health outcomes in adults with developmental disabilities.Methods
We used an accessible audio computer-assisted self-interview to collect anonymous data on demographic and disability characteristics, childhood and adult abuse experiences, and physical and psychological health from 350 women and men with developmental disabilities. Abuse experience was reflected by five factor scores consisting of three child abuse factors (childhood sexual abuse, childhood physical abuse, childhood disability-related abuse) and two adult abuse factors (adult sexual abuse, adult mixed abuse). We examined each of four health outcomes (depression, post trraumatic stress disorder, physical health symptoms, secondary health conditions) separately to determine the extent to which childhood and adult abuse experiences uniquely predicted psychological and physical health outcomes above and beyond demographic and disability-related characteristics.Results
All five abuse factor scores were significantly related to all four health outcomes. When examined simultaneously, childhood disability-related abuse and adult mixed abuse accounted for unique variance in outcomes. Exploratory analyses revealed no difference in the impact of abuse by gender.Conclusions
In this study, childhood disability-related abuse and adult mixed abuse significantly predicted lower levels of psychological and physical health in a sample of adults with developmental disabilities. Our findings highlight the importance of addressing abuse and its sequalae in the developmental disabilities community. 相似文献19.
Teresa Botigué Olga Masot Jèssica Miranda Carmen Nuin Maria Viladrosa Ana Lavedán Sandra Zwakhalen 《Journal of the American Medical Directors Association》2019,20(3):317-322
Objective
The aim of this study was to determine the prevalence of low fluid intake in institutionalized older residents and the associated factors.Design
This was a cross-sectional study.Setting and Participants
The study was carried out at a nursing home with a capacity for 156 residents, all of whom were older than 65 years.Measures
Data were collected on the fluids consumed by each resident over a period of 1 week. Information relating to sociodemographic variables and to residents' health, nutrition, and hydration status was also collected.Results
Of 53 residents, 34% ingested less than 1500 mL/d. The factors with the greatest correlation associated with low fluid intake were cognitive and functional impairment, the risk of suffering pressure ulcers, being undernourished, a texture-modified diet, dysphagia, impaired swallowing safety, and BUN:creatinine ratio.Conclusions/Implications
The results obtained highlight the scale of low fluid intake in nursing homes and also aid to identify and understand the factors associated with this problem. The findings could help us to develop specific strategies to promote the intake of liquids and thereby reduce the incidence of dehydration in nursing homes. 相似文献20.