Objectives: To assess the occurrence and prognostic factors for the ability to maintain paid work in patients with rheumatoid arthritis (RA). Setting: Inception cohort of patients with RA recruited from rheumatology d...
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Objectives: To assess the occurrence and prognostic factors for the ability to maintain paid work in patients with rheumatoid arthritis (RA). Setting: Inception cohort of patients with RA recruited from rheumatology departments in nine NHS Hospital Trusts in England. Patients: All consecutive patients with RA of less than two years' duration, before any second line (disease modifying) drug treatment, and followed up for five years. Methods: Clinical, laboratory, and radiological assessments, and all treatments were recorded prospectively using a standardised format at presentation and yearly. Outcome measures: Changes in, and loss of paid work by five years' follow up. Results: 732 patients completed the five year follow up. 353/721 (49%) were gainfully employed at the onset of RA, 211 (60%) were still working at five years, 104 (29%) stopped because of the disease, and 31 (9%) retired for reasons other than RA. Work disability at five years was more likely in manual workers (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.4 to 3.8) and worse baseline Health Assessment Questionnaire (HAQ>1.5, OR 2.26, 95% Cl 1.38 to 3.7). In combination with other baseline variables (erythrocyte sedimentation rate, sex, age of onset, and radiological erosions), employment outcome was predicted in 78% using multivariate analysis. Conclusions: Nearly half of the patients with RA were in paid employment at onset, work disability was an adverse outcome for a third of these patients by five years, and manual work and high baseline HAQ were important predictors for this. These details are likely to be useful to clinicians, health professionals, and patients in order to plan medical, orthopaedic, and remedial treatments in early RA. Future disease modifying treatments could be compared with this cohort of patients who were treated with conventional second line drugs.
Objective. This study examines the extent that older persons experience patterns of health service use that vary by race. Methods. Using the 1989 NLTCS database, researchers estimate ten binomial logistic regressions ...
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Objective. This study examines the extent that older persons experience patterns of health service use that vary by race. Methods. Using the 1989 NLTCS database, researchers estimate ten binomial logistic regressions of community medical service use by disabled White and Black older persons. Chow tents and Oaxaca decomposition analysis inform why racial differences continue to exist, although most elderly persons have Medicare. Results. With similar medical conditions. Blades are less likely to use services, particularly prescription medications and physician services. Use of some medical services is more likely for elderly Black persons who live in rural areas. small cities. and Western states, or who have more IADLs. joint and breathing problems, and broken parts. An Oaxaca decomposition indicates that differences in personal characteristics (e.g., income and health) do not fully explain racial differences in use of prescriptions and physician services. Discussion. For reasons that are unrelated to financial assets, blacks remain vulnerable in their ability to access services commonly used by older persons. To remedy racial disparities in medical utilization, public policy must expand its focuses beyond health finance issues and consider differences in availability, accessibility, and acceptability.
Purpose: Few research studies have sought to examine the health promotion needs of young people with disabilities. This paper reports the association between self-reported disability and various health behaviours (tob...
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Purpose: Few research studies have sought to examine the health promotion needs of young people with disabilities. This paper reports the association between self-reported disability and various health behaviours (tobacco and alcohol use, physical activity, sedentary activities) psyche-social outcomes and school satisfaction. Method: Cluster stratified random sampling was combined with a cross-sectional descriptive design to obtain 3918 school students attending year 6 (primary school), year 8 and year 10 (high school throughout New South Wales Australia), to complete a self-administered questionnaire. Results: The: prevalence of self-reported disability among this student sample was 5.8%. The most frequently reported disabilities were physical, sensory and teaming disabilities. Students with disabilities reported similar health and educational outcomes as their able-bodied peers. However, they also reported lower levels of school satisfaction, greater voluntary absenteeism and were more likely to get drunk or smoke cigarettes. Students with disabilities reported higher levels of psycho-social distress. They were also as physically active as other students. but also spent more time engaged in sedentary activities. Conclusion: students with self-reported disabilities exhibit attitudes and behaviours that are consistent with studies of students who are alienated from their school communities. Community-based health promotion interventions are required to address these Issues in order to prevent the onset of secondary disease processes or additional disability.
作者：
Flower, JWirz, SUCL
Inst Child Hlth Ctr Int Child Hlth London WC1N 1EH England
User involvement in planning is now well established in the fields of both health and development. This study looks at one particular client group, namely disabled people, and addresses the question: How do selected E...
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User involvement in planning is now well established in the fields of both health and development. This study looks at one particular client group, namely disabled people, and addresses the question: How do selected European-based international non-governmental organizations (INGOs) facilitate the participation of disabled people in their planning process? The study was exploratory in nature, using both quantitative and qualitative methods to answer the research question. Data were collected using a self-administered questionnaire with 18 INGOs, which was supported by five semi-structured interviews and 20 'e-mail dialogues' with key informants. The findings indicate that the INGOs involve disabled people's organizations (DPOs) in their planning of services and projects in a variety of ways. Most commonly this is through sharing information with them, bur consulting them, including them in decision-making or supporting action initiated by them are other less frequent methods of involvement. INGOs with a specific disability focus involve disabled people in the ways described above more frequently than other INGOs. Although most INGOs regularly provide information and consult DPOs, if there is no assurance that ideas raised will be implemented, then there is no guarantee of DPOs' participation in the planning process of these INGOs. The focus of an INGO and the nature of its projects affect how disabled people are involved in planning, whereas the size of an INGO has little effect. INGOs thus far have failed to match their expressed intentions about participation, but as they help to strengthen DPOs, encourage their formation and move to make disability an issue that cuts across sectoral boundaries, INGOs are changing. There is still a lot of rhetoric about participation, but the participation of disabled people in the planning process of INGOs is a growing reality.
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 h...
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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.
Objectives. This article used a new data source to examine the issue of disability trends among elderly persons and examined the potential implications of these trends on future health and long-term care needs. Method...
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Objectives. This article used a new data source to examine the issue of disability trends among elderly persons and examined the potential implications of these trends on future health and long-term care needs. Methods. We used the 1992-1996 Medicare Current Beneficiary Survey to examine time trends in rates of activities of daily living and instrumental activities of daily living disability and physical limitation among Medicare beneficiaries aged 65 and over. We used multinomial logit and least squares regression techniques to produce trend estimates that held the age, sex, race, and educational distributions constant and projected these trends into the future. Finally, we estimated the potential impact of disability decline on per capita Medicare spending on elderly persons. Results. We found that disability among elderly persons is declining and that the trend toward a more educated elderly cohort explains some, but not all, of this decline. In the absence of downward disability trends, per capita Medicare expenditures would have grown even faster than they have. Discussion. Although the decline in disability prevalence in recent years appears real, whether it continues has enormous implications for the size of the disabled population in the future and for the ability of the society to care for its disabled elderly members.
Background, Few population studies have investigated the functional disabilities that accompany specific psychiatric diagnoses. This study assesses the nature and strength of current and residual impairments in variou...
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Background, Few population studies have investigated the functional disabilities that accompany specific psychiatric diagnoses. This study assesses the nature and strength of current and residual impairments in various functional domains of life. Methods. Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective study in the Dutch general population aged 18 to 64 (N = 7147). Psychiatric diagnoses were based on the Composite International Diagnostic Interview;functional disability was assessed on the basis of the Short-Form-36 and the number of disability days. Results. Psychopathology was associated with increased disability in social, emotional and physical domains of life. Disability levels varied by psychiatric diagnosis, with mood disorders showing the poorest levels of functioning, especially for vitality and social functioning;alcohol-related disorders were associated with few disabilities. Co-morbidity strongly aggravated the disability. The effect of contextual factors on disability was limited, although somatic ill health, unemployment and adverse youth history increased the likelihood of functional disability. The findings indicate that psychopathology can also have residual debilitating effects. Conclusions. Mental health care providers should be aware that the extent and the type of disability may vary with the different types of disorders and among different groups within the population. Since recovery from functional limitations may not be complete or may take more time than the remission of the psychiatric symptomatology, non-psychiatric follow-up care is needed. The high number of lost work days is relevant from an economic perspective. There is a need for illness-specific disability assessment instruments.
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