COVID-19 Pandemic and Disability: Essential Considerations

People with disabilities have greater healthcare needs and are more likely to experience poor health, however, their access to healthcare remains compromised compared to people without disabilities. Despite this well recognised need, people with disabilities often face  barriers to accessing healthcare and they face additional risks to their well-being, because of the ongoing COVID-19 pandemic. In this paper, we posit that people with disabilities are vulnerable in the context of the COVID-19 pandemic. We demonstrate this vulnerability through briefly highlighting eight key considerations, as they relate to disability and COVID-19. We conclude that both inaccessible healthcare systems and the presence of underlying health conditions put people with disabilities at additional risk. Further, vulnerability to severe illness and death, post-contracting COVID-19, is exacerbated by the interaction between impairments and personal and environmental barriers existing at different levels, resulting in a disproportionately negative impact for people with disabilities. It is thus not sufficient to look only at underlying medical conditions as an indicator of risk for contracting COVID-19. Additionally, the challenge posed by not routinely collecting data on disability renders potential difficulties in linking disability to COVID-19 deaths/infections. More research is needed on disability and COVID-19 to inform disability-inclusive pandemic responses

Effects of the Environment on Physical Activity in New Zealand Children

Childhood obesity rates have risen steadily in recent decades along with increased urbanisation that has changed where children can play and roam freely, potentially reducing their daily energy expenditure. The relationship between aspects of the built environment and children's physical activity has therefore been identified as a public-health issue. This thesis represents a review, two studies that examined built-environment effects on children's activity, one play intervention study and two studies that investigated issues with accelerometer measurement of physical activity. Chapter two addresses the need for a quantitative review of the effects of objectively measured built-environment factors on children's objectively measured physical activity. The review included studies that used geographical information systems (GIS) or street audits to quantify the built environment with physical activity quantified by accelerometers, pedometers or global positioning systems. A key insight was that danger from vehicle traffic appears to underlie the association between physical activity and some measures of the built environment. There was inadequate research on effects of neighbourhood walkability and on the confounding effects of weather, compliance and the intensity threshold for moderate-vigorous activity. In Study 1, habitual physical activity of 227 children living in 48 residential neighbourhoods within four cities was measured with accelerometers and related to built-environment factors defined using GIS analysis and street-audit measures. Disparate built-environment effects on children’s physical activity were rationalised by classifying neighbourhoods as either safe for children’s walking or play or those where traffic danger constrained activity, which suggests that unsafe neighbourhoods need redesigning. In Study 2 the same data were analysed with a particular focus on children’s daily pattern of accelerometer steps at light and moderate-vigorous intensities. It was revealed that reductions in moderate-vigorous activity were associated with poor weather, darkness and non-school days. These reductions might be offset by interventions that encourage children to self-select outdoor or indoor activities at step cadences of ~80 per minute. Modifying the built environment is a long-term health strategy towards developing child-walkable neighbourhoods where children can roam and play independently to increase their daily physical activity. A short-to-medium term intervention plan was implemented in Study 3, a crossover design for promoting children’s increased physical activity through self-determined play during a supervised play period before school (08:00-09:00) with free access to play equipment. There were no clear changes in total activity, but during the play intervention there were trivial-small reductions in girls’ body-mass index (BMI) while boys’ BMI remained constant when normally BMI would be expected to increase. Reasons for excluding data from analysis in the intervention study were investigated in Study 4 and it was found that non-compliance and discomfort with wearing accelerometers along with monitor failure excluded half of the children from providing activity data for analyses. In the final study, the effect of accelerometer-count thresholds on the amount of activity classified as moderate-vigorous intensity was investigated and thresholds from published articles are recommended rather than manufacturer thresholds. In conclusion, future studies should investigate the effects of neighbourhoods designed to increase safety to encourage children’s habitual activity. Measurement of physical activity should be undertaken by continuously wearing accelerometers (and global positioning system watches) and analysed using published count thresholds

Congregational bonding social capital and psychological type : an empirical enquiry among Australian churchgoers

This study explores the variation in levels of bonding social capital experienced by individual churchgoers, drawing on data generated by the Australian National Church Life Survey, and employing a five-item measure of church-related bonding social capital. Data provided by 2065 Australian churchgoers are used to test the thesis that individual differences in bonding social capital are related to a psychological model of psychological types (employing the Jungian distinctions). The data demonstrated that higher levels of bonding social capital were found among extraverts (compared with introverts), among intuitive types (compared with sensing types) and among feeling types (compared with thinking types), but no significant differences were found between judging types and perceiving types

Not fitting in and getting out : psychological type and congregational satisfaction among Anglican churchgoers in England

Listening to the motivations reported by individuals for ceasing church attendance and becoming church leavers, Francis and Richter identified high on the list the sense of "not fitting in". Drawing on psychological type theory, several recent studies have documented the way in which some psychological types are over-represented in church congregations and other psychological types are under-represented. Bringing these two observations together, the present study tested the hypothesis that church congregations have created type-alike communities within which individuals displaying the opposite type preferences are more likely to feel marginalised and to display lower levels of satisfaction with the congregations they attend. Data were provided by 1867 churchgoers who completed a measure of psychological type, together with measures of frequency of attendance and congregational satisfaction. These data confirmed that congregations were weighted towards preferences for introversion, sensing, feeling and judging, and that individuals displaying the opposite preferences (especially intuition, thinking and perceiving) recorded lower levels of congregational satisfaction. The implications of these findings are discussed for promoting congregational retention by enhancing awareness of psychological type preferences among those who attend

A mixed methods approach to evaluating community drug distributor performance in the control of neglected tropical diseases

BACKGROUND: Trusted literate, or semi-literate, community drug distributors (CDDs) are the primary implementers in integrated preventive chemotherapy (IPC) programmes for Neglected Tropical Disease (NTD) control. The CDDs are responsible for safely distributing drugs and for galvanising communities to repeatedly, often over many years, receive annual treatment, create and update treatment registers, monitor for side-effects and compile treatment coverage reports. These individuals are 'volunteers' for the programmes and do not receive remuneration for their annual work commitment. METHODS: A mixed methods approach, which included pictorial diaries to prospectively record CDD use of time, structured interviews and focus group discussions, was used to triangulate data on how 58 CDDs allocated their time towards their routine family activities and to NTD Programme activities in Uganda. The opportunity costs of CDD time were valued, performance assessed by determining the relationship between time and programme coverage, and CDD motivation for participating in the programme was explored. RESULTS: Key findings showed approximately 2.5 working weeks (range 0.6-11.4 working weeks) were spent on NTD Programme activities per year. The amount of time on NTD control activities significantly increased between the one and three deliveries that were required within an IPC campaign. CDD time spent on NTD Programme activities significantly reduced time available for subsistence and income generating engagements. As CDDs took more time to complete NTD Programme activities, their treatment performance, in terms of validated coverage, significantly decreased. Motivation for the programme was reported as low and CDDs felt undervalued. CONCLUSIONS: CDDs contribute a considerable amount of opportunity cost to the overall economic cost of the NTD Programme in Uganda due to the commitment of their time. Nevertheless, programme coverage of at least 75 %, as required by the World Health Organisation, is not being achieved and vulnerable individuals may not have access to treatment as a consequence of sub-optimal performance by the CDDs due to workload and programmatic factors

The psychological-type profile of lay church leaders in Australia

A sample of 845 lay church leaders (444 women and 401 men) from a range of 24 different denominations and movements (including house churches and independent churches) completed the Francis Psychological-Type Scales within the context of the 2006 Australian National Church Life Survey. The psychological-type profiles of these lay church leaders were almost identical to the type profiles of 1527 Australian churchgoers (936 women and 591 men) published in an earlier study by Robbins and Francis. The predominant types among female lay church leaders were ISFJ (21%), ESFJ (21%), and ISTJ (18%). The predominant types among male lay church leaders were ISTJ (28%), ISFJ (17%), ESTJ (13%), and ESFJ (12%). The SJ temperament accounted for 67% of the female lay church leaders and for 70% of the male lay church leaders. The strengths and weaknesses of the SJ leadership style are discussed

Haptoglobin Phenotype, Preeclampsia Risk and the Efficacy of Vitamin C and E Supplementation to Prevent Preeclampsia in a Racially Diverse Population

Haptoglobin's (Hp) antioxidant and pro-angiogenic properties differ between the 1-1, 2-1, and 2-2 phenotypes. Hp phenotype affects cardiovascular disease risk and treatment response to antioxidant vitamins in some non-pregnant populations. We previously demonstrated that preeclampsia risk was doubled in white Hp 2-1 women, compared to Hp 1-1 women. Our objectives were to determine whether we could reproduce this finding in a larger cohort, and to determine whether Hp phenotype influences lack of efficacy of antioxidant vitamins in preventing preeclampsia and serious complications of pregnancy-associated hypertension (PAH). This is a secondary analysis of a randomized controlled trial in which 10,154 low-risk women received daily vitamin C and E, or placebo, from 9-16 weeks gestation until delivery. Hp phenotype was determined in the study prediction cohort (n = 2,393) and a case-control cohort (703 cases, 1,406 controls). The primary outcome was severe PAH, or mild or severe PAH with elevated liver enzymes, elevated serum creatinine, thrombocytopenia, eclampsia, fetal growth restriction, medically indicated preterm birth or perinatal death. Preeclampsia was a secondary outcome. Odds ratios were estimated by logistic regression. Sampling weights were used to reduce bias from an overrepresentation of women with preeclampsia or the primary outcome. There was no relationship between Hp phenotype and the primary outcome or preeclampsia in Hispanic, white/other or black women. Vitamin supplementation did not reduce the risk of the primary outcome or preeclampsia in women of any phenotype. Supplementation increased preeclampsia risk (odds ratio 3.30; 95% confidence interval 1.61-6.82, p<0.01) in Hispanic Hp 2-2 women. Hp phenotype does not influence preeclampsia risk, or identify a subset of women who may benefit from vitamin C and E supplementation to prevent preeclampsia

Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle

Summary The International Osteoporosis Foundation (IOF) Capture the Fracture Campaign aims to support implementation of Fracture Liaison Services (FLS) throughout the world. Introduction FLS have been shown to close the ubiquitous secondary fracture prevention care gap, ensuring that fragility fracture sufferers receive appropriate assessment and intervention to reduce future fracture risk. Methods Capture the Fracture has developed internationally endorsed standards for best practice, will facilitate change at the national level to drive adoption of FLS and increase awareness of the challenges and opportunities presented by secondary fracture prevention to key stakeholders. The Best Practice Framework (BPF) sets an international benchmark for FLS, which defines essential and aspirational elements of service delivery. Results The BPF has been reviewed by leading experts from many countries and subject to beta-testing to ensure that it is internationally relevant and fit-for-purpose. The BPF will also serve as a measurement tool for IOF to award ‘Capture the Fracture Best Practice Recognition’ to celebrate successful FLS worldwide and drive service development in areas of unmet need. The Capture the Fracture website will provide a suite of resources related to FLS and secondary fracture prevention, which will be updated as new materials become available. A mentoring programme will enable those in the early stages of development of FLS to learn from colleagues elsewhere that have achieved Best Practice Recognition. A grant programme is in development to aid clinical systems which require financial assistance to establish FLS in their localities. Conclusion Nearly half a billion people will reach retirement age during the next 20 years. IOF has developed Capture the Fracture because this is the single most important thing that can be done to directly improve patient care, of both women and men, and reduce the spiralling fracture-related care costs worldwide.</p