Awareness of driving disability in people with stroke tested in a simulator

The aim of this study was to explore and describe awareness of driving disability in people with driving difficulties after stroke. The study comprised a consecutive sample of 38 participants with stroke who showed difficulties in a technically advanced, interactive driving simulator. Driving ability in the simulator was measured using Performance Analysis of Driving Ability (P-Drive). Awareness of driving disability was measured using a modified version of Assessment of Awareness of Disability (AAD), measuring the discrepancy between observed driving actions and self-reported disability after a driving evaluation in a simulator. A majority of the participants (n=36) demonstrated driving ability that was below the cut-off criterion for P-Drive. Furthermore, a majority of the items measuring awareness of driving disability were scored low, indicating that participants with stroke who did not pass a driving evaluation also had limited awareness of driving disability. A General Linear Model analysis indicated that awareness of driving disability and cognitive screening outcome explained 74% of the variance in driving ability. This study indicated that a majority of the people with stroke who fail a driving evaluation also have limited awareness of their disability, which indicates the need to address awareness in driving evaluations.     

Intravenous magnesium sulphate does not improve survival or disability outcomes in people with stroke

QuestionDoes intravenous magnesium sulphate improve survival or disability outcomes if given within 12 hours of stroke onset?Study designMulticentre randomised controlled trial.Main resultsIntravenous magnesium sulphate did not significantly improve survival or disability outcomes at 90 days compared with placebo in people with stroke (see Table 1).     

3.

The impact of stroke on psychological and physical function outcomes in people with long-term physical disability     

《Disability and health journal》2020,13(4):100919

BackgroundAn increased number of people who have a long-term physical disability (LTPD) are aging. Similar to older adults without previous disability, individuals with LTPD may experience age-related comorbidities secondary to aging. A leading cause of disability in the United States among older adults is stroke. Limited evidence supports that individuals with LTPD are at higher risk of a stroke compared to those without disability. Stroke may negatively impact physical, cognitive, and/or psychosocial function. For those who have lived longer with LTPD, the impact of stroke may differ.ObjectiveTo determine the impact of stroke on health outcomes in people with LTPD.MethodsThirty-three individuals with both LTPD and self-reported stroke were identified in a national purposive sample of adults reporting physical disability associated with LTPD (Group A). Group A was compared to an age matched sample of 33 individuals with the same conditions but no stroke (Group B). Group A participants were also compared to national norms based on age cohort from a national sample of 182 stroke survivors (Group C).ResultsAge range of all participants = 65–74 years. Combine sample among three groups = 248. Group A did not differ from Group B. However, Group A reported significantly higher pain interference (p < .001), fatigue (p = .003), and decreased physical function (p < .001) than Group C.ConclusionsThe study informs how the impact of acquiring another condition after living with a LTPD differs among a general stroke population and those who are living with LTPD.     

4.

Measuring disability after a stroke.   总被引：3，自引：0，他引：3       下载免费PDF全文

S Ebrahim  F Nouri    D Barer 《Journal of epidemiology and community health》1985,39(1):86-89

A ranked activities of daily living (ADL) scale has been developed for stroke patients, on which an individual's score predicts his/her overall function ability. With an unranked scale the same total score can be obtained from different combinations of items and gives little idea of the patient's general pattern or degree of disability. The items in the scale are easy to assess on both inpatients and outpatients, and accepted criteria for valid ranking are fulfilled. A strong relation was found between scale score one month post-stroke and length of stay in hospital. Low scores at one month were also associated with high mortality during the subsequent five months. "Formal" and "informal" methods of ADL assessment were compared, and only small and unimportant differences were found. Assessments by postal questionnaire were also evaluated and agreed well with formal assessments carried out by visiting the patients' homes. Use of some or all of these methods would help to simplify and standardise follow up records for both routine care and research.     

5.

Qualitative research with people with intellectual disability     

Gwynnyth Llewellyn 《Occupational therapy international》1995,2(2):108-127

Qualitative research methods are gaining popularity in disability research, in particular as a way to explore the personal experience of disability. However, using these methods can be problematic with people traditionally regarded as vulnerable in the research relationship. People with intellectual disability are often so regarded. This paper discusses ethical concerns and issues of research credibility in qualitative research with this group of disabled people. An ethnographic study about the parenting experience of parents with intellectual disability is used to illustrate strategies to achieve credibility in qualitative studies in intellectual disability research.     

6.

Doctor-patient communication with people with intellectual disability - a qualitative study     

Magda Wullink  Wemke Veldhuijzen  Henny MJ van Schrojenstein Lantman - de Valk  Job FM Metsemakers  Geert-Jan Dinant 《BMC family practice》2009,10(1):1-10

Background

Patients' priorities and views on quality care are well-documented in Western countries but there is a dearth of research in this area in the East. The aim of the present study was to explore Chinese patients' views on quality of primary care consultations in Hong Kong and to compare these with the items in the CARE measure (a process measure of consultation quality widely used in the UK) in order to assess the potential utility of the CARE measure in a Chinese population.

Methods

Individual semi-structured interviews were conducted on 21 adult patients from 3 different primary care clinics (a public primary healthcare clinic, a University health centre, and a private family physician's clinic). Topics discussed included expectations, experiences, and views about quality of medical consultations. Interviews were typed verbatim, and a thematic approach was taken to identify key issues. These identified issues were then compared with the ten CARE measure items, using a CARE framework: Connecting (Care Measure items 1–3), Assessing (item 4), Responding (items 5,6), and Empowering (items 7–10).

Results

Patients judged doctors in terms of both the process of the consultation and the perceived outcomes. Themes identified that related to the interpersonal process of the consultation fitted well under the CARE framework; Connecting and communicating (18/21 patients), Assessing holistically (10/21 patients), Responding (18/21 patients) and Empowering (19/21 patients). Patients from the public clinic, who were generally of lower socio-economic status, were least likely to expect holistic care or empowerment. Two-thirds of patients also judged doctors on whether they performed an adequate physical examination, and three-quarters on the later outcomes of consultation (in terms of relief or cure and/or side-effects of prescribed drugs).

Conclusion

These findings suggest that Chinese patients in Hong Kong value engaged, empathic primary care doctors and judge the quality of consultations largely on these human skills and the attitudes and values that underpin them, as well as on the perceived outcomes of treatment. The match between themes relating to consultation process and the CARE Measure items suggests utility of this measure in this population, but further quantitative validation is required.     

7.

Vitamin D and people with intellectual disability     

Vanlint S  Nugent M  Durvasula S 《Australian family physician》2008,37(5):348-351

     

8.

Medicare, Medicaid and people with disability     

Master RJ  Taniguchi C 《Health care financing review》1996,18(2):91-97

     

9.

The labelling of people with an intellectual disability     

Robyn Hayes 《Australian Occupational Therapy Journal》1995,42(1):35-39

The issue of ‘disablist’ language has been raised by people with disabilities and their supporters. They are concerned that labels such as mental retardation suggest negative stereotypes which dominate a person's social identity. This paper reviews the existing guidelines for intellectual disability-related labels, their historical precedents, the opinions of interested parties and empirical evidence on the impact of labelling. It is concluded that communication about disability-related issues should use terminology which is consistent, least likely to be used as a form of abuse and is most widely acceptable to the people it describes. At the moment, people first terminology best fits those criteria for communication about all people who presently bear labels such as schizophrenic, arthritic or the handicapped.     

10.

The main signs of ageing in people with intellectual disability          下载免费PDF全文

Stuart Wark PhD  Rafat Hussain PhD  Helen Edwards PhD 《The Australian journal of rural health》2016,24(6):357-362

     

11.

Preventing stroke in people with atrial fibrillation: a cross-sectional study     

de Lusignan S  van Vlymen J  Hague N  Thana L  Dzregah B  Chan T 《Journal of public health (Oxford, England)》2005,27(1):85-92

BACKGROUND: The annual stroke rate in atrial fibrillation is around 5 per cent with increased risk in those with hypertension, diabetes, left ventricular dysfunction and other cardiovascular risk factors. This study set out to identify the patients with atrial fibrillation and modifiable risk factors for stroke. METHOD: Analysis of practice computer data taken from eight general practices (81 811 patients) in the south of England. 944 patients with a diagnosis of atrial fibrillation, of whom 782 (82.8 percent) were aged 65 years and over. RESULTS: The age standardised prevalence of diagnosed atrial fibrillation was 1.23 per cent (1.28 percent for men and 1.18 percent for women). It was much more prevalent in the older population, 8.28 percent and 6.66 percent for males and females over 65, respectively. Cardiovascular co-morbidities were more frequent with increasing age. Blood pressure (BP) was recorded in over 95 per cent of patients with atrial fibrillation though there was scope for improving control; 25 per cent of men and 31 per cent women had a BP over 150/90. Inconsistent recording of ECG and echocardiography made it hard to identify patients with left ventricular dysfunction. Forty six percent of men and 37 percent of women were either being prescribed Warfarin, or had contraindications to its use; of those on Warfarin 75.9 percent have an international normalized ratio in range. Forty four per cent were treated with aspirin. People at high risk of stroke were no more likely to be treated with Warfarin or aspirin than those at moderate risk. CONCLUSIONS: The rate of use of Warfarin remains low, and there is scope for better recording and management of risk factors particularly BP.     

12.

Services for people with stroke.          下载免费PDF全文

D T Wade 《Quality in health care》1993,2(4):263-266

     

13.

The COVID-19 pandemic and people with disability     

《Disability and health journal》2020,13(3):100944

     

14.

Health problems in people with intellectual disability in general practice: a comparative study     

van Schrojenstein Lantman-De Valk HM  Metsemakers JF  Haveman MJ  Crebolder HF 《Family practice》2000,17(5):405-407

In a GP database, 318 people with intellectual disability (ID) appeared to have 2.5 times more health problems than people without ID. This short report deals with the nature of the health problems. Consequences for health care policy are discussed.     

15.

Behavioural concerns--assessment and management of people with intellectual disability     

Woods R 《Australian family physician》2011,40(4):198-200

     

16.

Knowledge translation and the health of people with disability     

Margaret A. Turk  Suzanne McDermott 《Disability and health journal》2018,11(2):169

     

17.

Invisible populations: parallels between the health of people with intellectual disability and people of a refugee background     

Brolan CE  Ware RS  Lennox NG  Gomez MT  Kay M  Hill PS 《Australian journal of primary health》2011,17(3):210-213

When considering the delivery of primary health care in the community, some populations remain virtually invisible. While people with intellectual disability might seem to share few characteristics with refugees and humanitarian entrants, there are a number of difficulties that both groups share when accessing and receiving primary health care. Commonalities include communication barriers, difficulties accessing past medical records and the complexity of health needs that confront the practitioner providing health care. These issues and additional systemic barriers that prevent the delivery of optimal health care to both groups are explored. Integrated multidisciplinary care is often required for the delivery of best practice care; however, such care can be difficult for each group to access. In May 2010, the specific Medicare Health Assessment Item numbers for both of these groups were incorporated into a group of more generic Item numbers. This has resulted in a lost opportunity to enhance the evidence surrounding health care delivery to these vulnerable populations. This paper recognises the importance of health policy in leading affirmative action to ensure these populations become visible in the implementation of the National Primary Health Care Strategy.     

18.

Sexual abuse and intellectual disability: Awareness for a better intervention     

《Sexologies》2014,23(4):e91-e97

     

19.

Metabolic syndrome in 25% of older people with intellectual disability     

de Winter CF  Magilsen KW  van Alfen JC  Willemsen SP  Evenhuis HM 《Family practice》2011,28(2):141-144

     

20.

The reality of disability: Multidimensional poverty of people with disability and their families in Latin America     

Mónica Pinilla-Roncancio 《Disability and health journal》2018,11(3):398-404

Background

Disability and poverty are interconnected and although this relationship has been recognised, there is a lack of empirical evidence to support any possible causal relationship in this topic, particularly in the context of Latin America (LA).

Hypothesis

This study tests the hypothesis “Disability increases the risk of multidimensional poverty of people living with disabilities and their families”.

Methods

Using national census data from Brazil, Chile, Colombia, Costa Rica and Mexico, the Global Multidimensional Poverty Index (Global MPI) was calculated with the aim of measuring and comparing the levels of multidimensional poverty of people living in households with and without disabled members in the five countries.

Results

We found that in the five countries people with disabilities and their families had higher incidence, intensity and levels of multidimensional poverty compared with people living in other households. Their levels of deprivation were also higher for all the indicators included in the Global MPI and the contribution of this group to the national MPI was higher than their share of the population, thus people with disabilities and their families are overrepresented in those living in multidimensional poverty.

Conclusions

People with disabilities and their families are in worse conditions than poor households without disabled members and social policies should aim to reduce their high levels of multidimensional poverty and deprivation.     

The impact of stroke on psychological and physical function outcomes in people with long-term physical disability

BackgroundAn increased number of people who have a long-term physical disability (LTPD) are aging. Similar to older adults without previous disability, individuals with LTPD may experience age-related comorbidities secondary to aging. A leading cause of disability in the United States among older adults is stroke. Limited evidence supports that individuals with LTPD are at higher risk of a stroke compared to those without disability. Stroke may negatively impact physical, cognitive, and/or psychosocial function. For those who have lived longer with LTPD, the impact of stroke may differ.ObjectiveTo determine the impact of stroke on health outcomes in people with LTPD.MethodsThirty-three individuals with both LTPD and self-reported stroke were identified in a national purposive sample of adults reporting physical disability associated with LTPD (Group A). Group A was compared to an age matched sample of 33 individuals with the same conditions but no stroke (Group B). Group A participants were also compared to national norms based on age cohort from a national sample of 182 stroke survivors (Group C).ResultsAge range of all participants = 65–74 years. Combine sample among three groups = 248. Group A did not differ from Group B. However, Group A reported significantly higher pain interference (p < .001), fatigue (p = .003), and decreased physical function (p < .001) than Group C.ConclusionsThe study informs how the impact of acquiring another condition after living with a LTPD differs among a general stroke population and those who are living with LTPD.     

Measuring disability after a stroke.

A ranked activities of daily living (ADL) scale has been developed for stroke patients, on which an individual's score predicts his/her overall function ability. With an unranked scale the same total score can be obtained from different combinations of items and gives little idea of the patient's general pattern or degree of disability. The items in the scale are easy to assess on both inpatients and outpatients, and accepted criteria for valid ranking are fulfilled. A strong relation was found between scale score one month post-stroke and length of stay in hospital. Low scores at one month were also associated with high mortality during the subsequent five months. "Formal" and "informal" methods of ADL assessment were compared, and only small and unimportant differences were found. Assessments by postal questionnaire were also evaluated and agreed well with formal assessments carried out by visiting the patients' homes. Use of some or all of these methods would help to simplify and standardise follow up records for both routine care and research.     

Qualitative research with people with intellectual disability

Qualitative research methods are gaining popularity in disability research, in particular as a way to explore the personal experience of disability. However, using these methods can be problematic with people traditionally regarded as vulnerable in the research relationship. People with intellectual disability are often so regarded. This paper discusses ethical concerns and issues of research credibility in qualitative research with this group of disabled people. An ethnographic study about the parenting experience of parents with intellectual disability is used to illustrate strategies to achieve credibility in qualitative studies in intellectual disability research.     

Doctor-patient communication with people with intellectual disability - a qualitative study

Background

Patients' priorities and views on quality care are well-documented in Western countries but there is a dearth of research in this area in the East. The aim of the present study was to explore Chinese patients' views on quality of primary care consultations in Hong Kong and to compare these with the items in the CARE measure (a process measure of consultation quality widely used in the UK) in order to assess the potential utility of the CARE measure in a Chinese population.

Methods

Individual semi-structured interviews were conducted on 21 adult patients from 3 different primary care clinics (a public primary healthcare clinic, a University health centre, and a private family physician's clinic). Topics discussed included expectations, experiences, and views about quality of medical consultations. Interviews were typed verbatim, and a thematic approach was taken to identify key issues. These identified issues were then compared with the ten CARE measure items, using a CARE framework: Connecting (Care Measure items 1–3), Assessing (item 4), Responding (items 5,6), and Empowering (items 7–10).

Results

Patients judged doctors in terms of both the process of the consultation and the perceived outcomes. Themes identified that related to the interpersonal process of the consultation fitted well under the CARE framework; Connecting and communicating (18/21 patients), Assessing holistically (10/21 patients), Responding (18/21 patients) and Empowering (19/21 patients). Patients from the public clinic, who were generally of lower socio-economic status, were least likely to expect holistic care or empowerment. Two-thirds of patients also judged doctors on whether they performed an adequate physical examination, and three-quarters on the later outcomes of consultation (in terms of relief or cure and/or side-effects of prescribed drugs).

Conclusion

These findings suggest that Chinese patients in Hong Kong value engaged, empathic primary care doctors and judge the quality of consultations largely on these human skills and the attitudes and values that underpin them, as well as on the perceived outcomes of treatment. The match between themes relating to consultation process and the CARE Measure items suggests utility of this measure in this population, but further quantitative validation is required.     

The labelling of people with an intellectual disability

The issue of ‘disablist’ language has been raised by people with disabilities and their supporters. They are concerned that labels such as mental retardation suggest negative stereotypes which dominate a person's social identity. This paper reviews the existing guidelines for intellectual disability-related labels, their historical precedents, the opinions of interested parties and empirical evidence on the impact of labelling. It is concluded that communication about disability-related issues should use terminology which is consistent, least likely to be used as a form of abuse and is most widely acceptable to the people it describes. At the moment, people first terminology best fits those criteria for communication about all people who presently bear labels such as schizophrenic, arthritic or the handicapped.     

Preventing stroke in people with atrial fibrillation: a cross-sectional study

BACKGROUND: The annual stroke rate in atrial fibrillation is around 5 per cent with increased risk in those with hypertension, diabetes, left ventricular dysfunction and other cardiovascular risk factors. This study set out to identify the patients with atrial fibrillation and modifiable risk factors for stroke. METHOD: Analysis of practice computer data taken from eight general practices (81 811 patients) in the south of England. 944 patients with a diagnosis of atrial fibrillation, of whom 782 (82.8 percent) were aged 65 years and over. RESULTS: The age standardised prevalence of diagnosed atrial fibrillation was 1.23 per cent (1.28 percent for men and 1.18 percent for women). It was much more prevalent in the older population, 8.28 percent and 6.66 percent for males and females over 65, respectively. Cardiovascular co-morbidities were more frequent with increasing age. Blood pressure (BP) was recorded in over 95 per cent of patients with atrial fibrillation though there was scope for improving control; 25 per cent of men and 31 per cent women had a BP over 150/90. Inconsistent recording of ECG and echocardiography made it hard to identify patients with left ventricular dysfunction. Forty six percent of men and 37 percent of women were either being prescribed Warfarin, or had contraindications to its use; of those on Warfarin 75.9 percent have an international normalized ratio in range. Forty four per cent were treated with aspirin. People at high risk of stroke were no more likely to be treated with Warfarin or aspirin than those at moderate risk. CONCLUSIONS: The rate of use of Warfarin remains low, and there is scope for better recording and management of risk factors particularly BP.     

Health problems in people with intellectual disability in general practice: a comparative study

In a GP database, 318 people with intellectual disability (ID) appeared to have 2.5 times more health problems than people without ID. This short report deals with the nature of the health problems. Consequences for health care policy are discussed.     

Invisible populations: parallels between the health of people with intellectual disability and people of a refugee background

When considering the delivery of primary health care in the community, some populations remain virtually invisible. While people with intellectual disability might seem to share few characteristics with refugees and humanitarian entrants, there are a number of difficulties that both groups share when accessing and receiving primary health care. Commonalities include communication barriers, difficulties accessing past medical records and the complexity of health needs that confront the practitioner providing health care. These issues and additional systemic barriers that prevent the delivery of optimal health care to both groups are explored. Integrated multidisciplinary care is often required for the delivery of best practice care; however, such care can be difficult for each group to access. In May 2010, the specific Medicare Health Assessment Item numbers for both of these groups were incorporated into a group of more generic Item numbers. This has resulted in a lost opportunity to enhance the evidence surrounding health care delivery to these vulnerable populations. This paper recognises the importance of health policy in leading affirmative action to ensure these populations become visible in the implementation of the National Primary Health Care Strategy.     

The reality of disability: Multidimensional poverty of people with disability and their families in Latin America

Background

Disability and poverty are interconnected and although this relationship has been recognised, there is a lack of empirical evidence to support any possible causal relationship in this topic, particularly in the context of Latin America (LA).