The emerging story of disability associated with lymphatic filariasis: a critical review

Globally, 40 million people live with the chronic effects of lymphatic filariasis (LF), making it the second leading cause of disability in the world. Despite this, there is limited research into the experiences of people living with the disease. This review summarises the research on the experiences of people living with LF disability. The review highlights the widespread social stigma and oppressive psychological issues that face most people living with LF-related disability. Physical manifestations of LF make daily activities and participation in community life difficult. The findings confirm the need for the Global Programme to Eliminate Lymphatic Filariasis (GPELF) to support morbidity management activities that address the complex biopsychosocial issues that people living with LF-related disability face.     

Supporting persons with developmental disability--a new model

The way we think about and care for people with developmental disability has changed. Twenty-five years ago, society believed that caregivers always knew what was best for their individual and that he or she must be shielded, even shut away from, the harms that could occur in society. Now, people with disability participate in all aspects of community life. They are educated in local schools, live at home or in their own home, and compete with others in the job market. Caregiving for people with developmental disability is no longer modeled on medicine or stigmatizing labels. Instead, caregivers have become support persons who focus on identifying community resources and making the environment friendlier and safer for persons with disability.     

De lichamelijke en psychische dimensie van kwaliteit van leven van fragiele ouderen

Frail older people have an increased risk of limitations in performing activities of daily living, hospitalization, nursing home admission, and premature death. In this study we determined the difference in experiencing quality of life between frail and non-frail older people. We also investigated the associations between physical, psychological and social components of frailty and the physical and mental dimensions of quality of life. 374 people of 75 years and older filled in a questionnaire, the Senioren Barometer. This questionnaire contained the Tilburg Frailty Indicator (TFI) to assess frailty and the SF-12 for assessing quality of life. The study showed that frail older people on average experience a lower quality of life than non-frail older people. A considerable part of the variance of the physical and mental dimensions of quality of life could be explained by the fifteen components of frailty, after controlling for the background characteristics of the respondents, 33.2% and 36.5%, respectively. The frailty components physical inactivity, physical tiredness, and depressive symptoms were associated with the physical dimension as well as the mental dimension of quality of life. The results confirm the importance of multidimensional assessment of frailty. In addition, they provide a direction to healthcare and welfare professionals in performing interventions with the aim of increasing the quality of life of older people.     

“I Try and Smile,I Try and Be Cheery,I Try Not to Be Pushy. I Try to Say ‘I'm Here for Help’ but I Leave Feeling… Worried”: A Qualitative Study of Perceptions of Interactions with Health Professionals by Community-Based Older Adults with Chronic Pain

Background

Over 50% of community-dwelling older adults experience chronic pain, which threatens their quality of life. Of importance to their pain management is older people''s interaction with health professionals that, if unsatisfactory, may impair the outcome.

Aims

To add to the limited research specific to older people living with chronic pain in the community, we explored how they perceive their experiences of interacting with health professionals, seeking factors that might optimise these interactions.

Methods

Purposive sampling was used to recruit men and women >65 years with self-reported musculoskeletal chronic pain. Qualitative individual interviews and one group interview were undertaken with 23 participants. Data were transcribed verbatim and underwent Framework Analysis.

Results

Three themes were identified. Seeking help illustrates issues around why older people in the community may or may not seek help for chronic pain, and highlights the potential involvement of social comparison. Importance of diagnosis illustrates the desire for professional validation of their condition and an aversion to vague explanations based on the person''s age. Being listened to and being heard illustrates the importance of empathic communication and understanding expectations, with due respect for the person''s age.

Conclusions

In common with people of all ages, an effective partnership between an older person in pain and health professionals is essential if pain is to be reported, appropriately assessed and managed, because of the subjective nature of pain and its treatment responses. For older people with pain, perception about their age, by both parties in the partnership, is an additional factor that can unnecessarily interfere with the effectiveness of this partnership. Health professionals should engage with older adults to clarify their expectations about pain and its management, which may be influenced by perceptions about age; and to encourage expression of their concerns, which may also be affected by perceptions about age.     

Health-related quality of life and associated factors among Onchocerciasis patients in southeast Nigeria: A cross-sectional comparative study

IntroductionOnchocerciasis, a neglected tropical disease of public health importance, causes chronic morbidity and severe disability that may impact on health-related quality of life (HRQoL) of the infected people. This study assessed the HRQoL and associated factors among onchocerciasis patients in southeast Nigeria.MethodsThis was a community-based cross-sectional comparative study. Using a multistage sampling technique, 340 onchocerciasis patients were selected and matched for age and gender with the healthy population in the same neighbourhood. The respondents were interviewed using the short-form-36 (SF-36) questionnaire to determine their HRQoL. WHO Disability Assessment Schedule 2.0 tool (WHODAS 2.0) was used to assess disability in persons with onchocerciasis. Means were compared with independent student t-test while Chi-square test was used to compare proportions. Also, correlation analysis and logistic regression were used in the analyses.ResultsA significantly lower proportion of people living with onchocerciasis had a good quality of life when compared with the healthy subjects (69.4% vs 93.5%, p<0.001). Also, an inverse relationship was seen between disability and quality of life in the onchocerciasis group (r = -0.647, p<0.001). Predictors of poor quality of life among respondents with onchocerciasis were: respondents aged ≥48 years (AOR = 2.5, 95% CI: 1.4–5.0), those with some disability associated with onchocerciasis (AOR = 3.33, 95%CI: 1.4–5.0) and respondents who perceived themselves as a burden to people (AOR = 10, 95%CI: 2.5–20).ConclusionOnchocerciasis impacted negatively on HRQoL of persons with onchocerciasis when compared with the healthy population. The quality of life of persons affected with onchocerciasis reduces with increasing disability. There is the need to increase community awareness on onchocerciasis to ensure early diagnosis and prompt treatment as this will reduce disability among those affected with the disease thus enhancing their HRQoL.     

Successful Aging,Social Support,and Ownership of a Companion Animal

Studies consistently find that higher levels of social support improve the psychological and physiological health of older people, but findings from empirical research are mixed regarding the presence of a “pet effect”— the idea that living with an animal can improve human health, psychological wellbeing, and longevity. We examined the assocations among social support, dog and cat ownership, and successful aging in a panel of 5,688 people between the ages of 50 and 74 years. Utilizing GLM, we tested for the presence of a complement (independent or additive effects) and/or hydraulic (interactive effect) association of pets and human support on four indicators of successful aging (pain, functional ability, chronic illnesses, and subjective successful aging). Supporting the hydraulic hypothesis, we found that having a dog was associated with fewer chronic illnesses, higher functional ability, and higher levels of subjective success when people lack human support. Similarly, having both a dog and a cat was associated with higher functional ability, less pain, and higher levels of subjective success when people lack human support. Supporting the complement hypothesis, we found that having a cat was associated with more chronic illnesses and lower levels of subjective successful aging. Findings carry practical implications for supporting pet ownership of older people, suggesting that dogs have a positive association with successful aging.     

Gender Differences in Health Expectancies across the Disablement Process among Older Thais

Objectives

To estimate health expectancies based on measures that more fully cover the stages in the disablement process for the older Thais and examine gender differences in these health expectancies.

Methods

Health expectancies by genders using Sullivan’s method were computed from the fourth Thai National Health Examination Survey conducted in 2009. A total of 9,210 participants aged 60 years and older were included in the analysis. Health measures included chronic diseases; cognitive impairment; depression; disability in instrumental activities of daily living (IADL); and disability in activities of daily living (ADL).

Results

The average number of years lived with and without morbidity and disability as measured by multiple dimensions of health varied and gender differences were not consistent across measures. At age 60, males could expect to live the most years on average free of depression (18.6 years) and ADL disability (18.6 years) and the least years free of chronic diseases (9.1 years). Females, on the contrary, could expect to live the most years free of ADL disability (21.7 years) and the least years free of IADL disability (8.1 years), and they consistently spent more years with all forms of morbidity and disability. Finally, and for both genders, years lived with cognitive impairment, depression and ADL disability were almost constant with increasing age.

Conclusion

This study adds knowledge of gender differences in healthy life expectancy in the older Thai population using a wider spectrum of health which provides useful information to diverse policy audiences.     

Obesity among People with and without Mental Retardation across Adulthood

Objective: This study was designed to explore obesity during adulthood and the likelihood of moving out of obesity among 1809 adults without disability and 680 adults with mental retardation who received care at the same primary care practices during the period of 1990 to 2003. Research Method and Procedures: A retrospective observational design using medical records first identified patients with mental retardation (MR) and age‐matched controls without disabilities. Data on BMI collected during each primary care visit allowed exploration of obesity at three levels. Moving out of obesity was defined as having a BMI <25 kg/m². We also abstracted data on age, sex, race, and other medical conditions. Results: For adults 20 to 29 years of age, 33.1% of patients without disability and 21% of patients with MR had a BMI >30 kg/m². Between the ages of 50 and 59 years, 40.5% of the patients without disability and 35.2% of the patients with MR had a BMI >30 kg/m². Patients with mild MR had similar prevalence rates of obesity and patients with severe MR had significantly lower prevalence of obesity compared with the patients without disability through 50 years of age. Throughout the period from 20 to 60 years of age, between 15% and 40% of individuals with and without MR, who were previously obese, were not currently obese. Discussion: Throughout the adult years, an increasing proportion of individuals with and without MR are obese. However, obesity is not a chronic state; many people transition back to a normal body weight.     

Physiotherapy in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic and painful clinical condition that leads to progressive joint damage, disability, deterioration in quality of life, and shortened life expectancy. Even mild inflammation may result in irreversible damage and permanent disability. The clinical course according to symptoms may be either intermittent or progressive in patients with RA. In most patients, the clinical course is progressive, and structural damage develops in the first 2 years. The aim of RA management is to achieve pain relief and prevent joint damage and functional loss. Physiotherapy and rehabilitation applications significantly augment medical therapy by improving the management of RA and reducing handicaps in daily living for patients with RA. In this review, the application of physiotherapy modalities is examined, including the use of cold/heat applications, electrical stimulation, and hydrotherapy. Rehabilitation treatment techniques for patients with RA such as joint protection strategies, massage, exercise, and patient education are also presented.     

Impact of Multimorbidity on Disability and Quality of Life in the Spanish Older Population

Background

Population aging is closely related to high prevalence of chronic conditions in developed countries. In this context, health care policies aim to increase life span cost-effectively while maintaining quality of life and functional ability. There is still, however, a need for further understanding of how chronic conditions affect these health aspects. The aim of this paper is to assess the individual and combined impact of chronic physical and mental conditions on quality of life and disability in Spain, and secondly to show gender trends.

Methods

Cross-sectional data were collected from the COURAGE study. A total of 3,625 participants over 50 years old from Spain were included. Crude and adjusted multiple linear regressions were conducted to detect associations between individual chronic conditions and disability, and between chronic conditions and quality of life. Separate models were used to assess the influence of the number of diseases on the same variables. Additional analogous regressions were performed for males and females.

Results

All chronic conditions except hypertension were statistically associated with poor results in quality of life and disability. Depression, anxiety and stroke were found to have the greatest impact on outcomes. The number of chronic conditions was associated with substantially lower quality of life [β for 4+ diseases: −18.10 (−20.95,−15.25)] and greater disability [β for 4+ diseases: 27.64 (24.99,30.29]. In general, women suffered from higher rates of multimorbidity and poorer results in quality of life and disability.

Conclusions

Chronic conditions impact greatly on quality of life and disability in the older Spanish population, especially when co-occurring diseases are added. Multimorbidity considerations should be a priority in the development of future health policies focused on quality of life and disability. Further studies would benefit from an expanded selection of diseases. Policies should also deal with gender idiosyncrasy in certain cases.     

Physical Activity and Welfare of Guide Dogs and Walking Activity of Their Partners

ABSTRACT

Appropriate physical activity is beneficial for physical and psychosocial wellbeing, and it is recommended for people to have 30 minutes of activity on most days of the week, to yield 150 minutes per week. Getting sufficient physical activity particularly challenges people with visual disabilities, and few health-promotion interventions have focused on adults with this disability. Recently, dog walking has been promoted in communities as a way to increase people's physical activity. We surveyed guide-dog partners to assess whether their guide dogs facilitated walking. We also assessed the welfare of these dogs, including their physical activity and social interactions with other dogs and people, especially as there is some concern that these dogs have too little freedom. For comparison, we assessed large and small companion dogs and their handlers, as well. A web-based survey was conducted among people living with guide dogs or companion (pet) dogs: large companion dogs (51 lb or more) and small companion dogs (50 lb or less). Guide-dog partners walked significantly more than handlers of either small or large companion dogs (Guide-dog partners met the healthy standard of 150 min per week of walking, at a level 10 times more than owners of large companion dogs). Guide dogs walked with their partners more frequently and for longer durations per day than owners of companion dogs. Guide dogs with their handlers met more people outside of their homes than did owners of companion dogs, but the groups did not differ in the number of dogs they greeted outside of the house. The frequencies of going to off-leash areas did not differ among the three groups. The findings indicate that having a dog as a guide can lead to a higher amount of walking among guide-dog partners, and that guide dogs have a higher quality of life, in terms of quantity of physical activity and social interactions, compared with large or small companion dogs.     

The embodied liminalities of occupational overuse syndrome: Medical anthropology quarterly

Drawing on interviews with sufferers of OOS (occupational overuse syndrome) in Aoteraoa/New Zealand, this article explores the liminalities associated with OOS and the ways in which this liminality is embodied. While successful rehabilitation could lead back to employment, the respondents' fragility while living with OOS and its accompanying social stigma render such rehabilitation both literally and symbolically "out of reach". Their situations reveal social isolation, loss of identities, pain, and functional disability that have been incorporated into renegotiated identities and biographies in which respondents have become exquisitely self-absorbed, exercising constant bodily surveillance and discipline in order to manage their symptoms. We suggest that this problematic extends beyond biographical disruption to encompass the concept of injury to an embodied sense of integrity for people who were notable prior to their affliction for their reputations as extremely competent and conscientious workers. The embodied meaning of OOS in this environment is not so much to have fallen "out of culture" as Hilbert (Ewan et al. 1991) suggests, but to be liminal in Turner's sense of "threshold people" (Turner 1969:56) "ground down to a uniform condition to be fashioned anew."     

Mortality among People with Severe Mental Disorders Who Reach Old Age: A Longitudinal Study of a Community-Representative Sample of 37892 Men

Background

Severe mental illnesses are leading causes of disability worldwide. Their prevalence declines with age, possibly due to premature death. It is unclear, however, if people with severe mental disorders who reach older age still have lower life expectancy compared with their peers and if their causes of death differ.

Methods and Findings

Cohort study of a community-representative sample of 37892 Australian men aged 65–85 years in 1996–1998. Follow up was censored on the 31st December 2010. Lifetime prevalence of schizophrenia spectrum, bipolar, depressive and alcohol-induced disorder was established through record linkage. A subsample of 12136 consented to a face-to-face assessment of sociodemographic, lifestyle and clinical variables. Information about causes of death was retrieved from the Australian Death Registry. The prevalence of schizophrenia spectrum, bipolar, depressive and alcohol-induced disorders was 1.2%, 0.3%, 2.5% and 1.8%. The mortality hazard for men with a severe mental disorder was 2.3 and their life expectancy was reduced by 3 years. Mortality rates increased with age, but the gap between men with and without severe mental disorders was not attenuated by age. Cardiovascular diseases and cancer were the most frequent causes of death. The excess mortality associated with severe mental disorders could not be explained by measured sociodemographic, lifestyle or clinical variables.

Conclusions

The excess mortality associated with severe mental disorders persists in later life, and the causes of death of younger and older people with severe mental disorders are similar. Hazardous lifestyle choices, suboptimal access to health care, poor compliance with treatments, and greater severity of medical comorbidities may all contribute to this increased mortality. Unlike young adults, most older people will visit their primary care physician at least once a year, offering health professionals an opportunity to intervene in order to minimise the harms associated with severe mental disorders.     

西安地区空军老干部患病现况及其相关因素研究

目的:调查西安地区老年空军人群慢性病患病情况及其生活评价的现况,分析其相关因素的影响。方法:采用整群抽样的方法对西安地区310名老年空军进行体格检查和使用生活综合评价调查表进行问卷调查。结果:在本次研究的老年空军人群中,慢性病患病率100%。同时患两种病及以上的占91.29%。患病率由高到低排名前10位的慢性病依次为高血压、冠心病、高脂血症、老年性白内障、脑血管疾病、前列腺疾病、糖尿病、慢性支气管炎、慢性胃肠道疾病、胆囊和胆道疾病。舒张压异常、体检白细胞指标异常的人群患脑血管疾病的优势比分别是2.16、3.95(P<0.05);甘油三脂异常的人群患高脂血症的优势比是4.74(P<0.001);在健康自评和心理卫生评定中、差的人群患冠心病的优势比分别是1.85、1.64(P<0.001);体能检查中、差的人群惠老年性白内障的优势比是1.48(P<0.05);生活功能、社会交往和活动强度中、差的人群患脑血管疾病的优势比分别是3.40、2.22、2.92(P<0.001)。结论:应有针对性、有重点地开展危险因素的早期干预,促进预防和医疗两大系统的协作,才能有效地控制老年人慢性病的发生。     

Pet companionship and depression: Results from a United States Internet sample

Abstract

Using Internet survey data from 2,291 respondents from the United States, we examined socio-demographic predictors of living with a cat or dog. Logistic regressions showed that, for men, being married, living with children, being Midwestern and non-urban increased odds of living with a pet. For women, being White, having a high income, living with children, and living in a rural setting increased odds for pet ownership. Multivariate analyses examining influences of gender, marital status, and pet ownership on depression (CES-D) scores, adjusting for potential confounders, revealed that unmarried women who live with a pet have the fewest depressive symptoms, and unmarried men who live with a pet have the most. These findings suggest that single women benefit from pet companionship, whereas single men may be burdened by it.     

Food Access and Diet Quality Are Associated with Quality of Life Outcomes among HIV-Infected Individuals in Uganda

Background

Food insecurity is associated with poor nutritional and clinical outcomes among people living with HIV/AIDS. Few studies investigate the link between food insecurity, dietary diversity and health-related quality of life among people living with HIV/AIDS.

Objective

We investigated whether household food access and individual dietary diversity are associated with health-related quality of life among people living with HIV/AIDS in Uganda.

Methods

We surveyed 902 people living with HIV/AIDS and their households from two clinics in Northern Uganda. Health-related quality of life outcomes were assessed using the Medical Outcomes Study (MOS)-HIV Survey. We performed multivariate regressions to investigate the relationship between health-related quality of life, household food insecurity and individual dietary diversity.

Results

People living with HIV/AIDS from severe food insecurity households have mean mental health status scores that are 1.7 points lower (p<.001) and physical health status scores that are 1.5 points lower (p<.01). Individuals with high dietary diversity have mean mental health status scores that were 3.6 points higher (p<.001) and physical health status scores that were 2.8 points higher (p<.05).

Conclusions

Food access and diet quality are associated with health-related quality of life and may be considered as part of comprehensive interventions designed to mitigate psychosocial consequences of HIV.     

Violence against People with Disability in England and Wales: Findings from a National Cross-Sectional Survey

Background

The recent World Report on Disability highlighted violence as a leading cause of morbidity among disabled people. However, we know little about the extent to which people with disability experience different violence types, and associated health/economic costs. The recent introduction of disability measures into the England&Wales victimization survey provided an opportunity to address this gap.

Methods and Findings

Analysis of the 2009/10 British Crime Survey (BCS), a nationally representative cross-sectional survey of 44,398 adults living in residential households in England&Wales. Using multivariate logistic regression, we estimated the relative odds of being a victim of past-year violence (physical/sexual domestic or non-domestic violence) in people with disability compared to those without, after adjusting for socio-demographics, behavioural and area confounders. 1256/44398(2.4%) participants had one or more disabilities including mental illness (‘mental illness’) and 7781(13.9%) had one or more disabilities excluding mental illness (‘non-mental disability’). Compared with the non-disabled, those with mental illness had adjusted relative odds (aOR) of 3.0(95% confidence interval (CI) 2.3–3.8) and those with non-mental disability had aOR of 1.8(95% CI: 1.5–2.2) of being a victim of past-year violence (with similar relative odds for domestic and non-domestic violence). Disabled victims were more likely to suffer mental ill health as a result of violence than non-disabled victims. The proportion of violence that could be attributed to the independent effect of disability in the general population was 7.5%(CI 5.7–9.3%), at an estimated cost of £1.51 billion. The main study limitation is the exclusion of institutionalised people with disability.

Conclusions

People with disability are at increased risk of being victims of domestic and non-domestic violence, and of suffering mental ill health when victimized. The related public health and economic burden calls for an urgent assessment of the causes of this violence, and national policies on violence prevention in this vulnerable group.     

Work-related low back pain: secondary intervention.

A review of the literature indicates that non-specific low back pain is basically an age-related disorder that is affected by differences in occupation, genetics and personal behavior. The cause of low back pain is unknown in most cases, and most of the treatments in routine use are ineffective. There is no evidence that low back pain has decreased in recent years. Consequently, there are a growing number of investigators who believe that efforts at preventing low back pain are futile; that low back pain is an unavoidable consequence of life that will afflict two thirds of the adult population at some point in their lives. These investigators believe that programs aimed at reducing low back disability are likely to be more effective and less costly. Only a small percentage of people with low back pain become disabled, but this small percentage consumes most of the cost. The literature pertaining to the reduction of low back disability is reviewed and discussed. It is concluded that low back disability can be reduced, and that management (not the health care provider) has the primary responsibility for reducing disability.