Healthy Lifestyles for People with Disabilities

People with disabilities are more susceptible to compromised health status and preventable secondary conditions. A Healthy Lifestyles curriculum was developed as a health promotion program for people with disabilities. Using the curriculum, ten free 2½-day workshops were provided for people with various disabilities in Oregon and Southwest Washington. Workshops were conducted in collaboration with local entities such as Centers for Independent Living. The workshops took an integrated approach to health, addressing connections among physical, social, emotional, and spiritual health, and health through meaningful activities. During workshops, the participants obtained health information and experienced healthy activities such as yoga and non-impact aerobics, both tailored for people with disabilities. At the end of the workshop, each participant identified two healthy lifestyle goals to work toward. Progress and/or barriers in accomplishing those goals were shared in support groups for 6-9 months. Preliminary results indicate early and sustained improvements in health behaviors and health-related attitudes. The Healthy Lifestyles program offers a promising approach to promoting health among people with disabilities

Persons With Disabilities as an Unrecognized Health Disparity Population

Disability is an emerging field within public health; people with significant disabilities account formore than 12% of the US population. Disparity status for this group would allow federal and state governments to actively work to reduce inequities. We summarize the evidence and recommend that observed differences are sufficient to meet the criteria for health disparities: population-level differences in health outcomes that are related to a history of wide-ranging disadvantages, which are avoidable and not primarily caused by the underlying disability. We recommend future research and policy directions to address health inequities for individuals with disabilities; these include improved access to health care and human services, increased data to support decision-making, strengthened health and human services workforce capacity, explicit inclusion of disability in public health programs, and increased emergency preparedness

Using the international classification of functioning, disability and health to expand understanding of paralysis in the United States through improved surveillance

Background: Surveillance on paralysis prevalence has been conceptually and methodologically challenging. Numerous methods have been used to approximate population-level paralysis prevalence estimates leading to widely divergent prevalence estimates. Objective/hypotheses: To describe three phases in use of the International Classification of Functioning, Disability and Health (ICF) as a framework and planning tool for defining paralysis and developing public health surveillance of this condition. Methods: Description of the surveillance methodology covers four steps: an assessment of prior data collection efforts that included a review of existing surveys, registries and other data collection efforts designed to capture both case definitions in use and prevalence of paralysis; use of a consensus conference of experts to develop a case definition of paralysis based on the ICF rather than medical diagnostic criteria; explanation of use of the ICF framework for domains of interest to develop, cognitively test, validate and administer a brief self-report questionnaire for telephone administration on a population; and development and administration of a Paralysis Prevalence and Health Disparities Survey that used content mapping to back code items from existing national surveys to operationalize key domains. Results: ICF coding led to a national population-based survey of paralysis that produced accurate estimates of prevalence and identification of factors related to the health of people in the U.S. living with paralysis. Conclusions: The ICF can be a useful tool for developing valid and reliable surveillance strategies targeting subgroups of individuals with functional disabilities such as people with paralysis and others.Keywords: Surveillance, Paralysis, ICF, Functional definition of disabilit

Disability Inclusion in 4-H: Aligned with the Mission, Stopped Short by Methods

Quality out-of-school programs can significantly improve youth development outcomes. Youth with disabilities and special health care needs, who represent 19% of all youth, are less likely than their typically developing peers to participate in out-of-school activities. This qualitative study explored factors that influence the inclusion of youth with disabilities in one state’s 4-H program. Factors that facilitated inclusion were personal attitudes and subjective norms, but lack of knowledge and limited resources led to reactive problem solving rather than proactive, organizational planning. By identifying both the factors that facilitate inclusion and those that prevent it or are perceived as barriers, youth development professionals can target areas of focus to improve inclusion of youth with disabilities in 4-H and potentially other youth development programs

KrahnGloriaPHHSUsingInternationalClassification.pdf

Background: Surveillance on paralysis prevalence has been conceptually and methodologically challenging. Numerous methods have been used to approximate population-level paralysis prevalence estimates leading to widely divergent prevalence estimates. Objective/hypotheses: To describe three phases in use of the International Classification of Functioning, Disability and Health (ICF) as a framework and planning tool for defining paralysis and developing public health surveillance of this condition. Methods: Description of the surveillance methodology covers four steps: an assessment of prior data collection efforts that included a review of existing surveys, registries and other data collection efforts designed to capture both case definitions in use and prevalence of paralysis; use of a consensus conference of experts to develop a case definition of paralysis based on the ICF rather than medical diagnostic criteria; explanation of use of the ICF framework for domains of interest to develop, cognitively test, validate and administer a brief self-report questionnaire for telephone administration on a population; and development and administration of a Paralysis Prevalence and Health Disparities Survey that used content mapping to back code items from existing national surveys to operationalize key domains. Results: ICF coding led to a national population-based survey of paralysis that produced accurate estimates of prevalence and identification of factors related to the health of people in the U.S. living with paralysis. Conclusions: The ICF can be a useful tool for developing valid and reliable surveillance strategies targeting subgroups of individuals with functional disabilities such as people with paralysis and others.Keywords: ICF, Paralysis, Surveillance, Functional definition of disabilit

Health Surveillance and People with Intellectual Disabilities

In this chapter we use three case studies (from the USA, Canada, and England) to frame a discussion of key conceptual and methodological issues associated with health-surveillance programs for people with intellectual disabilities. These include the challenges associated with (1) identifying people with intellectual disabilities in administrative databases; (2) identifying people with intellectual disabilities in population-based surveys through data linkage and cognitive testing and self- or informant report; (3) sampling issues; (4) the use of specific intellectual disability surveys; and (5) challenges in measuring health. We conclude with a discussion of the relationship between health surveillance and health policy

How much are we spending? The estimation of research expenditures on cardiovascular disease in Canada

Abstract Background Cardiovascular disease (CVD) is a leading cause of death in Canada and is a priority area for medical research. The research funding landscape in Canada has changed quite a bit over the last few decades, as have funding levels. Our objective was to estimate the magnitude of expenditures on CVD research for the public and charitable (not-for profit) sectors in Canada between 1975 and 2005. Methods To estimate research expenditures for the public and charitable sectors, we compiled a complete list of granting agencies in Canada, contacted each agency and the Canadian Institutes of Health Research (CIHR), and extracted data from the organizations’ annual reports and the Reference Lists of health research in Canada. Two independent reviewers scanned all grant and fellowship/scholarship titles (and summary/key words, when available) of all research projects funded to determine their inclusion in our analysis; only grants and fellowships/scholarships that focused on heart and peripheral vascular diseases were selected. Results Public/charitable sector funding increased 7.5 times, from close to $13 million (in constant dollars) in 1975 to almost$96 million (in constant dollars) in 2005 (base year). The Medical Research Council of Canada (MRCC)/CIHR and the Heart & Stroke Foundation of Canada have been the main founders of this type of research during our analysis period; the Alberta Heritage Foundation for Medical Research and the Fonds de la recherche en santé du Quebec have played major roles at the provincial level. The Indirect Costs Research Program and Canada Foundation for Innovation have played major roles in terms of funding in the last years of our analysis. Conclusion Public/charitable-funded research expenditures devoted to CVD have increased substantially over the last three decades. By international standards, the evidence suggests Canada spends less on health-related research than the UK and the US, at least in absolute terms. However, this may not be too problematic as Canada is likely to free-ride from research undertaken elsewhere. Understanding these past trends in research funding may provide decision makers with important information for planning future research efforts. Future work in this area should include the use of our coding methods to obtain estimates of funded research for other diseases in Canada