Recognizing and Responding to the Health Disparities of People with Disabilities

Health status is critically important to experiencing quality of life, self-sufficiency, and full participation in society. For the 54 million Americans with disabilities, maintaining health and wellness is especially important to reduce the impact of impairment on functioning in these critical life areas. Yet, people with disabilities may be the largest underserved subpopulation demonstrating health status disparities that stem from preventable secondary conditions. Healthy People 2010, the nation’s blueprint for improved health, addresses this problem in its objectives. In 2002 and 2005, the U.S. Surgeon General asked for public health efforts to improve the health and wellness of persons with disabilities. This article examines the concepts of health and wellness, summarizes currently available information documenting disparities in health for people with disabilities, and provides a framework for policy recommendations to reduce health disparities among people with disabilities

Inclusion of Youths with Disabilities in 4-H: A Scoping Literature Review

The Journal of Extension serves as a conduit for the dissemination of current research and practices within Extension and 4-H. We conducted a review of Journal of Extension articles published since passage of the Americans with Disabilities Act of 1990. Our purpose was to determine what practices, programs, and studies have occurred regarding inclusion in 4-H of youths with disabilities or special health care needs. The review resulted in detailed examination of 16 articles and revealed information about Extension professionals\u27 attitudes toward inclusion, strategies and program approaches related to inclusion, and specific areas that need to be addressed further to increase inclusion

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

Age at disability onset and self-reported health status

Background: The critical importance of improving the well-being of people with disabilities is highlighted in many national health plans. Self-reported health status is reduced both with age and among people with disabilities. Because both factors are related to health status and the influence of the age at disability onset on health status is unclear, we examined the relationship between disability onset and health status. Methods: The U.S. 1998–2000 Behavioral Risk Factor Surveillance system (BRFSS) provided data on 11,905 adults with disability. Bivariate logistic regression analysis modeled the relationship between age at disability onset (based on self-report of duration of disability) and fair/poor self-perceived health status, adjusting for confounding variables. Results: Key variables included demographics and other measures related to disability and general health status. Disability onset after 21 years of age showed significant association with greater prevalence of fair/poor health compared to early disability onset, even adjusting for current age and other demographic covariates. Compared with younger onset, the adjusted odds ratios (OR) were ages 22–44: OR 1.52, ages 45–64: OR 1.67, and age ≥65: OR 1.53. Conclusion: This cross-sectional study provides population-level, generalizable evidence of increased fair or poor health in people with later onset disability compared to those with disability onset prior to the age of 21 years. This finding suggests that examining the general health of people with and those without disabilities might mask differences associated with onset, potentially relating to differences in experience and self-perception. Future research relating to global health status and disability should consider incorporating age at disability onset. In addition, research should examine possible differences in the relationship between age at onset and self-reported health within specific impairment groups.This is the publisher’s final pdf. The published article is copyrighted by BioMed Central Ltd. and can be found at: http://www.biomedcentral.com/bmcpublichealth

Wellness Promotion in Persons With Disabilities: Physicians\u27 Personal Behaviors, Attitudes, and Practices

Objective: To examine physicians\u27 attitudes, personal wellness behaviors, and wellness promotion practices with their patients who were living with a disability. Design and Participants: A 20-item survey was mailed to 1,200 physicians from a national stratified random sample. Responses were received from 417 physicians (34.8% response rate). Results: Physicians who reported engaging in high levels of wellness promotion with their patients with disabilities rated wellness promotion as more important and reported feeling more competent and responsible. Several barriers and incentives to wellness promotion were reported. Conclusions: Physicians\u27 attitudes and perceived competencies may influence their wellness promotion activities with their patients with disabilities. Medical training modules and other methods may increase physicians\u27 wellness promotion activities

Investigating Mycobacteriophage-Host Protein Interactions

Mycobacteriophages are viruses that infect bacterial cells of the genus Mycobacterium. They possess a multitude of unfamiliar or novel genes – genes encoding protein sequences that do not resemble any previously studied proteins – and thus encode products with functions not readily predicted. We hypothesized that some of those genes encode products that interfere with the normal metabolism of the host cell, possibly through specific phage-host protein-protein interactions, and thus have a role in enabling phage infection. Further, we predicted that those gene products when expressed alone in host cells would still be toxic and impair cell growth. We have investigated unfamiliar genes in two genetically distinct mycobacteriophages, Pumpkin and Vix, and have identified 4 single genes (Pumpkin_115, Pumpkin_119, Pumpkin_142, Vix_80) and several small genomic regions (Pumpkin gene segment 130-133 and Vix gene segments 65-66, 68-72, 87-88) that are cytotoxic to M. smegmatis. We are taking a multi-prong approach to further identify the specific functions associated with these genes and their products and to determine their roles in the infection process: 1) we have identified mutants of M. smegmatis that are resistant to the expression of those genes, 2) we are using E. coli- expressed phage genes to screen for interacting host proteins, 3) we are collecting microscopy data that could identity phage interruption of normal cellular function, and 4) we are in the process of deleting these genes from the phage genome to determine the effect on infection. 24-hour expression of individual cytotoxic phage genes in M. smegmatis resulted in a significant increase in mean host cell length and some subtle effects on cell shape. Ongoing analysis of the mutants has identified a common mechanism of resistance to distinct phage gene expression, while protein-protein interaction studies have not yet identified a potential host target involved in translation