COVID-19 vaccination hesitancy among Americans with disabilities aged 18-65: An exploratory analysis

BackgroundIt is important for people with disabilities to be vaccinated against COVID-19 because, as a group, they are at increased risk of severe outcomes. While there are multiple vaccines available to prevent COVID-19, a considerable proportion of Americans report some hesitancy to becoming vaccinated, including people with disabilities.ObjectiveWe conducted a study to explore what factors may contribute to COVID-19 vaccination hesitancy among Americans with disabilities.MethodsWe used Amazon's Mechanical Turk to survey 439 people with disabilities (ages 18+) about their concerns of the COVID-19 disease, vaccines, and hesitancy toward vaccination to learn more about factors that influence vaccination hesitancy. Concerns about vaccines were analyzed as a composite variable representing different dimensions such as: side effects, too new, developed too quickly, influenced by politics, and effectiveness.ResultsResults from a logistic regression indicate that concern about vaccines was the most significant predictor of hesitancy, even after considering demographic, economic, and geographic factors. Concerns about getting COVID-19, getting tested for COVID-19, trust in experts, education, and being a Democrat were negatively associated with hesitancy.ConclusionsThese findings indicate that some groups of individuals may be more vaccination hesitant because they are more concerned about vaccine safety than COVID-19 infection. Public health messaging that focuses on the risks of vaccines relative to the risks of COVID-19 might be one strategy to reduce hesitancy and increase vaccination uptake. Messaging should also be tailored to specific disabilities (i.e. physical, mental, sensory), written in plain language, and disseminated in accessible formats.     

Parental experiences of adopting healthy lifestyles for children with disabilities living with overweight and obesity

BackgroundChildren with disabilities present with high obesity rates.ObjectiveThis study explored the parental experience of adopting healthy lifestyle choices, for children with disabilities, who received dietetic weight management advice.MethodsSemi-structured qualitative interviews were carried out with eight parents/carers in their own homes or healthcare setting in an inner London locality, or by telephone. Data was analyzed using an interpretative phenomenological analysis (IPA) approach.ResultsFive superordinate themes emerged: 1. Strategies to promote healthy lifestyles: encouraging physical activity, limiting access to food and taking a gradual approach to making lifestyle changes. 2. Challenges to adopting healthy lifestyles: selective eating patterns, the high cost of healthy foods and parental/carer lack of time. 3. The role of healthcare professionals (HCPs): revealed that not all parents/carers received advice or support, prior to dietetic referral, when managing their child's weight. Feeling reassured by HCPs was valued. Parents/carers reported a positive experience of seeing the dietitian, as they appreciated receiving practical and individualized advice. 4. Support needs: family support and support from families with children with disabilities was explored. 5. Parent/carer wellbeing: such as stress was found to have a detrimental impact on parents making healthy lifestyle changes.ConclusionsAdopting a healthy lifestyle involved a variety of strategies and challenges, some of which are specific to this population group and should be considered by HCPs, when having weight-related discussions and offering advice. Parental/carer support needs and wellbeing should also be taken into consideration when planning weight management services for this population group.     

Complications following hysterectomy in women with intellectual and developmental disabilities

BackgroundLimited data exist on complications following hysterectomy among women with intellectual and developmental disabilities (IDD).ObjectiveThe objective was to assess the frequencies of postoperative complications in women with IDD following hysterectomy.MethodsThe National Inpatient Sample from 2014 to 2017 was queried using codes from the International Classification of Disease 9th and 10th revisions to identify women over 15 years of age with a diagnosis of an IDD undergoing hysterectomy. Comparisons were made to women without IDD undergoing the same procedure. Logistic regression analysis was performed to examine between group differences in the frequency of clinical post-surgical complications while adjusting for potential confounding variables.ResultsOf eligible women undergoing hysterectomy, 1,370 were identified as having IDD and 624,700 did not. Compared to controls, women with IDD were significantly younger (45 vs. 50 years, p < 0.001). Women with IDD were also more likely to have had governmental health insurance (83% vs. 34%, p < 0.001), an open hysterectomy approach (78% vs. 69%, p = 0.002), and longer hospital stays (4 vs. 3 days, p < 0.001). After adjusting for potential confounders, women with IDD had greater odds of postoperative urinary complications (OR 3.74, 95% CI 1.18–11.83) and complications related to decubitus ulcer formation (OR 8.97, 95% CI 2.10–38.36).ConclusionsWomen with IDD have increased odds having urinary and decubitus ulcer complications following hysterectomy, compared to women without IDD. These results inform surgical decision-making and anticipatory guidance for these women and their caregivers.     

Understanding medical students' attitudes towards and experiences with persons with disabilities and disability education

BackgroundIn the United States, approximately one quarter of individuals are living with disabilities and receiving healthcare services. The undergraduate medical school curriculum provides an opportunity to improve the attitudes and skills of physicians working with persons with disabilities (PWD).Objective/hypothesisThe purpose of this study was to gain an understanding about fourth-year medical students’ self-reported attitudes towards and experiences with PWD and disability education. We hypothesized that medical students would recall having education about disabilities, would be able to identify a pivotal disability education experience, and would report being less comfortable working with PWD than persons without disabilities.MethodsThis mixed methods observational study was conducted via an online survey distributed to medical students during Winter 2020/2021. It contained an adapted instrument and a few short answer questions.ResultsOur survey had 44 respondents, a 28% response rate. Though 98% of students reported receiving disability education during one or more courses, 80% felt their disability education during medical school has been inadequate. Additionally, 64% reported having an influential learning experience involving PWD. Despite their attitudes, education, and experiences, respondents reported feeling less comfortable obtaining a history, performing a physical exam, and establishing a differential diagnosis when working with PWD.ConclusionsThis study highlights the need for continued development of disability curricula, which likely extends beyond the studied institution. Additional educational elements could be added to humanities sessions, as well as other courses and clerkships.     

Reaching for equitable care: High levels of disability-related knowledge and cultural competence only get us so far

BackgroundAchieving equitable medical care for people with disabilities is a complex challenge with emphasis often placed on the need for improved physician knowledge and cultural competence. Physical medicine and rehabilitation (PM&R) is a specialty dedicated to maximizing patient function, where a focus on working with and learning from patients with complex disabilities informs physician training and patient care.ObjectiveThe purpose of this study was to assess barriers to equitable care in PM&R clinics through a structural checklist and semi-structured interviews with clinic staff and physicians.MethodsWe used qualitative analysis with a grounded theory approach to develop a unified explanation of how existing clinic processes and provider attitudes affect equitable access to medical care.ResultsWe found physicians comfortable with and respectful of patient differences who described leveraging unpaid time and creativity to navigate structural, resource, and awareness barriers. Staff and physicians described current barriers as negatively affecting quality of care, clinic efficiency, and, in some cases, patient and staff safety.ConclusionOur results suggest that high levels of physician disability-related knowledge and cultural competence may be insufficient to the challenge of achieving equitable care.     

The association between disability and risk of exposure to peer cyber victimisation is moderated by gender: Cross-sectional survey

BackgroundLittle is known about the exposure of youth with disability to cyber victimisation.Objective/Hypothesis: To estimate the prevalence of peer cyber and non-cyber victimisation in a nationally representative sample of 14-year-old adolescents with and without disability and to determine whether gender moderates the relationship between disability and exposure to victimisation.MethodsSecondary analysis of data collected in Wave 6 of the UK's Millennium Cohort Survey on 11,726 14-year-old adolescents living in the UK.ResultsAdolescents with disability had higher prevalence of cyber and non-cyber victimisation than those with no disability. For cyber victimisation there was a statistically significant interaction between gender and disability, with evidence of increased cyber victimisation for adolescents with disability compared to those with no disability among girls, but not boys. For non-cyber victimisation there was no evidence of an interaction between gender and disability.ConclusionsThe prevalence of both cyber and non-cyber victimisation was higher among adolescents with disability than those with no disability. The association between disability and risk of exposure to peer cyber victimisation appears to be moderated by gender.     

中国中老年人共病发展轨迹及其对新发失能的影响

目的 探索我国中老年人共病发展轨迹及其对新发失能的影响,以识别具有相似共病发展历程的同质群体,为我国中老年人群的失能风险干预提供依据。方法 基于中国健康与养老追踪调查2011-2018年4期数据,采用组基轨迹模型拟合共病发展轨迹,进而采用含时间依存协变量Cox回归模型分析其对新发失能的影响。结果 共纳入8 580名中老年人,依据中老年共病发展轨迹趋势,可分为无共病型（2 136人,24.90%）、新发-发展型（3 758人,43.80%）、适度-发展型（2 270人,26.45%）和严重-发展型（416人,4.85%）4种类型。适度-发展型和严重-发展型人群中女性、自评健康差、超重/肥胖、单身、居住在农村、家庭年人均支出水平高、发生新发失能的占比较高。调整人口学、行为学协变量后,与新发-发展型相比,严重-发展型（HR=3.132,95%CI：1.884~5.207）的失能风险最高,适度-发展型（HR=1.400,95%CI：1.026~1.909）次之,无共病型（HR=0.631,95%CI：0.424~0.938）最低。结论 我国中老年人的共病发展轨迹存在异质性,共病发展轨迹的失能风险随共病水平的升高而增加,提示共病发展轨迹升高是发生失能的危险因素。     

1990—2019年中国痛风疾病负担研究

目的 分析1990—2019年中国痛风疾病负担变化,为痛风的防控提供理论依据。方法 检索2019年全球疾病负担数据库中国痛风的患病数、患病率、发病数、发病率、伤残调整寿命年（DALYs）、DALYs率,统计分析中国1990—2019年痛风的疾病负担年龄、性别分布及其变化趋势,并对疾病进行危险因素归因分析。结果 2019年中国痛风患病人数为16161324例,标化患病率为1136.24/10万,发病人数为1041329例,标化发病率为213.82/10万,DALYs为510485人年,标化DALY率为35.89/10万。与1990年相比,各指标均持续增长。痛风疾病负担与性别和年龄相关,男性高于女性,男性在50~54岁达高峰,女性在65~69岁达高峰。高BMI和肾功能不全是痛风的主要危险因素,2019年高BMI的PAF为22.55%,肾功能不全的PAF为9.11%,分别较1990年增长了126.18%和34.96%。结论 1990—2019年中国痛风疾病负担呈升高趋势,应加强痛风的预防和诊治,降低其对社会造成的负担。     

中国中老年人失能状况公平性与影响因素

目的 分析中国50岁及以上中老年人失能状况和失能状况公平性,并探究中老年人失能状况不公平的主要影响因素。方法 利用全球老龄化与成人健康研究(Study on Global Ageing and Adult Health,SAGE)中国2007—2010年第一轮调查数据,计算集中指数和集中曲线,并对集中指数进行分解。结果 中国中老年人失能评估量表平均分为7.32,中老年男性平均分为6.37,女性平均分为8.21。中老年人失能状况集中指数为-0.190 9,中老年男性为-0.184 4,中老年女性为-0.196 1。对集中指数进行分解后,社会经济地位对中老年人失能状况不公平的贡献较高,包括经济水平、受教育程度和工作类型,贡献率分别为66.41%、16.45%和13.10%。与社会结构因素相比,中老年人吸烟、饮酒和身体活动情况等个人生活方式因素的贡献率较低。结论 中国存在中老年人失能状况不公平,较好的健康状况集中在经济水平较好的中老年人群中。中老年男性失能状况较女性更轻,且失能状况不公平程度更小。经济水平、受教育程度和工作类型是对中国中老年人失能状况不公平贡献率较高的主要因素,提示仅通过促进中老年人健康生活方式不能够有效减少失能状况在经济水平较好和较差的中老年人群中的差异。政府需要在重视促进中老年人健康的基础上,进一步加强和完善适宜的社会和医疗保障措施,将减少中老年人健康不公平作为政策重点,尤其应该向发展相对滞后、中老年人相对聚集的地区重点分配医疗卫生和其他相关社会资源,同时应该加大对中老年人健康和健康公平相关研究的支持,为积极应对人口老龄化和制定政策收集证据。     

Feasibility,acceptability and effects of dance therapy in stroke patients: A systematic review

IntroductionStroke is the leading cause of non-traumatic disability in adults, with balance and gait disturbances representing the main limitations of body functions. Dance therapy (DT) has shown positive effects in older adults and in patients with neurological pathologies. This systematic review aims to examine the feasibility, acceptability and effects of DT in stroke rehabilitation, specifically on functional gains of gait and balance.MethodsA systematic search was carried out for articles published in the MEDLINE, PEDro, Web of Science, Scopus and CINHAL in February 2021 and updated in April 2021. Results: Eight studies were included (2 clinical cases, 5 case series and 1 randomized controlled trial), 7 of them in patients with chronic stroke and only 1 in subacute stroke phase. The most widely used dance modality was tango and ballet, with sessions ranging from 30 to 110 min. DT seems to show positive effects on post-stroke body functions and activities such as gait and balance. Reported dropout rates are inconsistent, no adverse effects were reported, and participant satisfaction was high.ConclusionGiven the heterogeneity and uneven quality of the included studies, strong conclusions cannot be put forward on the effectiveness of DT in post-stroke body function and activities. Nevertheless, DT seems to be safe and acceptable therapy for patients, and no adverse effects have been reported. More studies with a high level of evidence and feasibility are needed to determine the patient profile, the characteristics of the intervention, the participation rate and the role of the rehabilitation professional most likely to generate optimal benefit.