Search

Objectives: The association between loneliness and disability is a growing public health priority. While the University of California Los Angeles Loneliness Scale (UCLA-LS) has been internationally used as an indicator for assessing loneliness, its optimal cutoff point in relation to disability occurrence has not yet been examined. Therefore, we aimed to determine the optimal cutoff point of the UCLA-LS regarding future disability., Methods: This longitudinal cohort study was conducted in Tokai City, Aichi Prefecture, Japan. Overall, 4536 community-dwelling older adults (age: 73.8 ± 5.5 years; females: 55.2%) were followed up for 2 years. The area under the curve of the receiver operating characteristic analysis was calculated to evaluate the optimal cutoff point of the UCLA-LS in relation to future disability occurrence using the Youden index, which maximized the sensitivity and specificity of the UCLAS-LS. A survival analysis was conducted to test this cutoff value's external validity, using the presence or absence of disability occurrence as the dependent variable., Results: The cutoff score of the UCLA-LS in relation to future disability was 44 points. An association was found between new disability occurrence and loneliness based on this cutoff value (hazard ratio: 1.67, 95% confidence interval: 1.29-2.16)., Conclusions: Although cultural context should be taken into account, the optimal cutoff scores for the loneliness scale related to disability identified in this study may be a useful indicator for early recognition of loneliness as a global public health problem and for promoting social participation as one of the disability prevention strategies., (© 2024 John Wiley & Sons Ltd.)

For many disabled people, violence can become an unwanted, yet ordinary part of everyday life. Often, these crimes are attributed to understandings of disabled people as vulnerable and largely, passive victims. Attending to the aims of this special issue, this paper aims to dismantle these stereotypes and attend to the unique ways that disabled people can resist and respond to hate crime through creative and collaborative research practices. Building upon this, I argue that there is a pressing need for hate studies researchers to work "with" and not "on" those who have experienced targeted violence. Working in this way builds upon long-standing efforts of disabled activists and disabilities studies researchers to challenge reductive research practices by working in more collective and inclusive ways. To demonstrate this, I reflect upon a project working in partnership with disabled people to create a disability hate crime toolkit. The toolkit, now published, shares accessible and informative resources that can be used to raise awareness about disability hate crime. While the focus of this paper is disability, I consider methods of collaboration, co-production and participation that can be drawn upon by researchers to respond to hate crime and interpersonal violence more broadly., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Disability studies have been successfully focusing on individuals' lived experiences, the personalization of goals, and the constitution of the individual in defining disease and restructuring public understandings of disability. Although they had a strong influence in the policy making and medical modeling of disease, their framework has not been translated to traditional naturalistic accounts of disease. I will argue that, using new developments in evolutionary biology (Extended Evolutionary Synthesis [EES] about questions of proper function) and behavioral ecology (Niche conformance and construction about the questions of reference classes in biostatistics accounts), the main elements of the framework of disability studies can be used to represent life histories at the conceptual level of the two main "non-normative" accounts of disease. I chose these accounts since they are related to medicine in a more descriptive way. The success of the practical aspects of disability studies this way will be communicated without causing injustice to the individual since they will represent the individuality of the patient in two main naturalistic accounts of disease: the biostatistical account and the evolutionary functional account. Although most accounts criticizing the concept of disease as value-laden do not supply a positive element, disability studies can supply a good point for descriptive extension of the concept through inclusion of epistemic agency., (© 2024. The Author(s).)

It has been determined that quality of life in epilepsy is closely related to the perceived disability experienced by individuals with the diagnosis. However, this measure is seldom considered in healthcare processes. The objective of the present study is to establish the psychometric properties of the Perceived Disability Questionnaire in individuals diagnosed with epilepsy within a Latin American context. A cross-sectional, analytical study was conducted involving 325 participants, aged 12 years and older (M 40.42 years), individuals diagnosed with epilepsy in Colombia. The main psychometric properties of the instrument were explored to account for its factorial validity and reliability. The Perceived Disability Questionnaire exhibits high reliability (α = 0.878) and the three subscales comprising the final version of the questionnaire (Dissatisfaction, Pessimism, and Self-Disdain) explain 45.393 % of the total variance in relation to beliefs of disability associated with the diagnosis of epilepsy; the questionnaire significantly correlates with the Quality of Life in Epilepsy Inventory (QOLIE-10). Adequate psychometric properties of the instrument are found, which allows for its proposal as a tool in epilepsy care processes within the Colombian context., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

People living with cognitive impairments face new forms of disablement in the context of transport digitalisation, an issue recently catalysed by controversies regarding rail ticket office closures. Transport can dramatically impact the lives of people diagnosed with dementia, who often find their mobility suddenly and dramatically impaired. Unfortunately, sociological analysis of cognitive disability has traditionally been undermined by under-theorisation. One solution can be found in classic bioethical work on hypercognitivism-the veneration of cognitive acuity-and its disabling consequences. A hypercognitive approach can nurture an attentiveness to the specificities of digital disablement. Here, disability does not emerge from digitalisation inherently, but is instead intensified by the implementation of digitalisation in line with value commitments. A more robust sociology of cognitive disability could better represent the interests of people with cognitive impairments and resist the new forms of disability that current digitalisation risks spreading., (© 2024 The Authors. The British Journal of Sociology published by John Wiley & Sons Ltd on behalf of London School of Economics and Political Science.)

We aimed to calculate disability-adjusted life expectancy (DALE) for Korean older adults based on their sex, educational attainment, and residential region across their cognitive status. We included 3,854 participants (aged 65-91 years) from the Korean Longitudinal Study of Aging's seventh survey data. The participant's cognitive function status (normal, moderately impaired, or severely impaired) was determined based on cognitive examination and physical function independence, which was used to calculate their DALE. Females with normal cognition had higher DALE (7.60 years, Standard Deviation (SD) = 3.88) than males (6.76, SD = 3.40); however, both sexes had comparable DALE for cognitive impairment. In contrast, the DALE values increased with higher educational achievements. Regarding residential areas, the DALE value for participants with normal cognition and moderate impairment was the highest among urban dwellers, while DALE for participants with severely impaired cognitive function was highest among rural dwellers; however, there were no statistically significant differences based on residential conditions. Our findings suggest that demographic characteristics should be considered when developing health policies and treatment strategies to meet the needs of the aging population in Korea., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

We investigated whether attachment insecurity (anxiety and avoidance) moderated the association between satisfaction with social support and pain disability. We also tested whether the relationship between insecure attachment and pain disability was serially mediated by pain catastrophising and psychological inflexibility. A large-scale cross-sectional correlational design was employed. Data were collected using an online survey. Correlation, serial mediation and moderated regression analyses were used. Data from 894 people with self-reported chronic pain were analysed. Based on correlations, age, depression, and pain intensity were included as covariates. No direct effect of satisfaction with social support on pain disability was observed in the moderation. Attachment anxiety was positively associated with pain disability (b = 1.20, t = 2.03, p < .05), but attachment avoidance was not (b = -0.08, t = -0.13, p = .90). The association between attachment anxiety and pain disability was partially mediated by pain catastrophising and psychological inflexibility (c = 1.21, t = 4.37, p < .001; a1db2 = 0.33, t = 5.15, p < .001). The relationship between attachment avoidance and pain disability was fully mediated by pain catastrophising and psychological inflexibility (c = 0.15, t = 0.54, p = .59; a1db2 = 0.13, t = 2.24, p < .05). This study provided initial evidence that pain catastrophising and psychological inflexibility mediate the association between insecure attachment and pain disability. Follow-up research using a longitudinal design is recommended., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: To examine how the level of perceived work ability and its changes over time are associated with the risk of full disability pension (DP) among those receiving partial DP., Methods: We retrieved survey data on perceived work ability and covariates (sociodemographic factors and health behaviors) from a cohort study of Finnish public sector employees at two time points: 2008 and 2012 and linked them with register data on DP obtained from the Finnish Centre for Pensions up to the end of 2018. Participants had begun receiving partial DP in 2008 and responded to either the 2008 survey (n = 159) or both surveys (n = 80). We used Cox regression for the analyses., Results: During the follow-up, 61 (38%) of those receiving partial DP transitioned to full DP. Those with perceived poor work ability were at a higher risk of full DP (HR 1.93; 95% CI 1.11-3.38) than those with at least moderate work ability, after adjustment for covariates. During four years of receiving partial DP, perceived work ability decreased among 36% of the participants, and remained unchanged or improved among 64%. Change in work ability was not associated with a risk of full DP., Conclusion: Among those receiving partial DP, perceived poor work ability was a risk factor for full DP. Our findings highlight the importance of monitoring the level of perceived work ability of those receiving partial DP to enable identifying individuals at an increased risk of full DP., (© 2023. The Author(s).)

Purpose: Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) are understudied conditions characterized by hallmark hypermobility and chronic pain. Disease manifestations lead to significant disability. Understanding predictors of disability, over and above the univariate construct of pain severity, is necessary to tailor treatment. Thus, the current study examined the impact of the Fear-Avoidance Model [FAM] on disability in hEDS/HSD. Fear of falling was included as a novel fear-avoidance factor impacting disability., Methods: A total of 168 individuals with hEDS/HSD answered a cross-sectional online survey regarding FAM constructs, fear of falling, disability, and clinical-demographic factors. A hierarchical regression analysis was used to assess whether FAM constructs and fear of falling significantly predicted disability, over and above pain severity and age., Results: Pain catastrophizing, anxiety, and fear of falling contributed significant unique predictive relations, above age and average pain severity. Pain severity and fear of falling were the strongest unique predictors of disability., Conclusions: This is the first study to assess the relations among FAM constructs, pain severity, and disability in hEDS/HSD, and introduces fear of falling as a novel fear-avoidance factor specific to this population. Future research should apply these findings towards individualized interventions to improve disability in hEDS/HSD.

Background: Understanding the self-rated health of industrially disabled individuals is an important variable that significantly affects their quality of life, satisfaction, and return to work after an industrial accident. Since the health of people with industrial disabilities is affected by various environments and variables, interventions and policies that are suitable for their characteristics are needed., Objectives: This study aimed to identify changes in self-rated health among industrially disabled individuals, distinguish between different latent classes, and verify predictive factors for each latent class., Methods: Four time-point datasets from the 2018-2021 panel study of Korean workers' compensation insurance were used. Using the latent growth curve model, an overall trajectory of self-rated health of industrially disabled individuals was confirmed, and the number and characteristics of different trajectories were identified using the latent class growth model. Multinomial logistic regression analysis was used to identify the predictive factors for each class., Results: Four classes of self-rated health trajectories were identified: low-decreasing (21.7%), moderate-increasing (15.7%), high-decreasing (56.1%), and low-stable (6.5%) classes. A multinomial logistic regression analysis revealed that significant determinants (age, capacity, type of industrial accident, grade of disability, mental activity, outdoor activity, and social relationships) were different for each latent class. Capacity level affected all potential class classifications., Conclusions: To improve the self-rated health of industrially disabled individuals, it is necessary to develop an appropriate strategy that considers the characteristics of the latent class., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study employed a cross-sectional, qualitative individual interview methodology to explore South African women with physical disabilities' experiences of intimate partner and sexual violence, inclusive of non-consensual and coerced sexual intercourse. For the participants, disability was a factor that intersected with gender norms to create vulnerability to abuse, and that patriarchal ideologies constructing how women should perform their gendered roles in marriage or sexual partnerships, as well as disability stigma, exacerbated this vulnerability. It is important to develop understandings of the different risk factors for violence - at the individual level and in the context of dyadic relationships - to develop programming to better support women., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: The primary objective of this study was to explore individuals' perspectives on the factors, situations or events that contributed to their perceptions of injustice following occupational injury., Materials and Methods: The study sample consisted of 30 participants (18 women, 12 men) who had submitted a time-loss claim for a work-related musculoskeletal injury. Participants with elevated scores on a measure of perceived injustice were interviewed about the factors that contributed to their sense of injustice. A thematic analysis was conducted to identify the broad classes of situations or events that participants experienced as unjust in the weeks following occupational injury., Results: Three dominant themes emerged from the interviews: (1) Invalidation, (2) Undeserved suffering and (3) Blame. Inductively derived subthemes reflected specific dimensions of post-injury experiences that contributed to participants' sense of injustice., Conclusions: Given that suffering and invalidating communication are potentially modifiable factors, there are grounds for optimism that intervention approaches can be developed to prevent or reduce perceptions of injustice in the aftermath of debilitating injury. The development of intervention approaches that are effective in preventing or reducing perceptions of injustice holds promise of contributing to more positive recovery outcomes in individuals who have sustained debilitating work injuries., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Ensuring the wellness of older individuals with disabilities requires prioritising the care needs of their carers. However, current practice lacks validated tools to measure the needs of carers in home environments. Thus, this study aimed to create and test a questionnaire on the care needs of family carers of older people with disabilities in China., Methods: We used a standard development process to generate the questionnaire. The pilot testing included cognitive interviews to ensure interpretation as intended. Furthermore, we used a cross-sectional study method to conveniently select 640 Chinese family carers of older people with disabilities from August 1, 2022, to June 11, 2023, for face-to-face investigation. Exploratory factor analysis (EFA) aided in project reduction and factor estimation, with 30 participants undergoing retest evaluations every two weeks. Confirmatory factor analysis (CFA) assessed the model's structural validity, while internal consistency and retest reliability validated its accuracy., Results: These tests established the model: content validity, item analysis and EFA. Six factors extracted from the initial analysis explained 62.891% of the observation variance. CFA showed good model fit, and the questionnaire had good reliability and validity. The final questionnaire included 21 items focusing on six dimensions: care assistance (three items), care environment (three items), care information (three items), formal support (four items), care ability (six items) and self-development (two items)., Conclusion: The care needs questionnaire effectively evaluates the needs of family carers in their caring activities., (© 2024. The Author(s).)

Parenting with a physical disability often brings with it a range of challenges. Occupational therapists are well positioned to support parents to address these challenges, yet occupational therapy research and practice around parenting is relatively scarce. This paper addresses the questions: (1) How should occupational therapists support parenting occupations for people with physical disability? (2) How do parents with physical disability experience occupational therapy? An anonymous survey of 62 parents, primarily mothers, with physical disability about their experiences with parenting challenges and occupational therapy was analysed using both quantitative and qualitative techniques. Parents experienced challenges in engaging in a range of parenting tasks with children over a range of age groups. Parents reported that support was often needed and indicated that occupational therapy could assist them directly with specific parenting goals as well as the more usual biomechanical goals that influence parenting. Yet less than half of participants who received occupational therapy services reported that parenting tasks were addressed, and only one-fifth reported that their goals had been fully met. The data also indicated that the knowledge, skills, and attitudes of occupational therapists with regard to working with parents with disability can be improved. Findings suggest a need to better incorporate parenting occupations in standard occupational therapy training to increase occupational therapists' comfort and competence in working with clients on parenting issues., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Anne Honey et al.)

Audio description improves access to visual culture for people who are unable to fully participate in it due to visual impairments. Because of this direct benefit to disabled people, it is usually defined as an accommodation or inclusion service. Rather than adopting this view, we see disability as a creative force, arguing that it can engender a new dimension of art: audio description as a form of cinematic ekphrasis. This claim is made by drawing on the 2017 movie Radiance , by Japanese director Naomi Kawase. This movie puts audio description in the spotlight and stimulates discussion on this underdeveloped and under-recognised art. Radiance is structured around the process of making the audio description, thus offering good insight into the artistry and main challenges of this process. Between the words of this meditation on the art of audio description, Kawase also challenges the dominant ocular normative narrative on blindness as a deficiency and provokes a discussion on the contribution that blindness-with its different, still culturally unexplored modes of perception-could make to the interpretation of visual arts. Radiance can thus be treated as an artful argument for the greater recognition of disabled people's right to participate in cultural life., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Leprosy and lymphatic filariasis (LF) are among the most disabling neglected tropical diseases (NTDs) that affect the citizens of Mozambique, especially in the Northern provinces. The irreversible impairments caused by these NTDs often lead to psychosocial consequences, including poor mental wellbeing, stigma and reduced social participation. Limited data on these consequences are available for Mozambique, which are urgently needed to better understand the true disease burden and support advocacy for scaling up interventions., Methods: A cross-sectional mixed-methods study was conducted. Mental distress was assessed with the Self Reporting Questionnaire (SRQ-20), participation restriction was assessed with the Participation Scale Short (PSS) and perceived stigma was assessed with the Explanatory Model Interview Catalogue affected persons stigma scale (EMIC-AP). Additionally, semi-structured interviews were conducted with persons affected by leprosy or LF., Results: In total, 127 persons affected by leprosy and 184 persons affected by LF were included in the quantitative portion of the study. For the qualitative portion, eight semi-structured interviews were conducted. In both disease groups, mental distress was found in 70% of participants. Moreover, 80% of persons affected by leprosy and 90% of persons affected by LF perceived stigma. Moderate to extreme participation restriction was found in approximately 43% of persons affected by leprosy and in 26% of the persons affected by LF. Persons affected by leprosy and LF felt excluded from society and experienced financial problems. More severe disabilities were associated with more severe outcomes for mental wellbeing, participation restriction and stigma. By contrast, participation in a self-care group was suggested to have a positive impact on these outcomes., Conclusion: The findings provide evidence that persons affected by leprosy and LF must not only confront physical impairments but also experience significant disability in the psychosocial domain, including mental distress, participation restriction and stigma. These challenges must be urgently addressed by NTD programmes to promote the inclusion and wellbeing of persons affected by NTDs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 van Wijk et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: Middle-aged and older adults smoking for years are afflicted by smoking-related diseases and functional limitations; however, little is known about the effect of smoking on nonfatal conditions in middle and later life. This study aims to investigate the impact of smoking on both total life expectancy (TLE) and disability-free life expectancy (DFLE) and the variations in such effects by educational level in China., Methods: Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), 2011-2018, with a total sample of 16,859 individuals aged 45 years or older involved in the final analysis. The Activities of Daily Living (ADL) scale was used to measure disability, and the population-based multistate life table method was used to estimate the differences in TLE and DFLE by smoking status and educational attainment., Results: At baseline, 28.9% of participants were current smokers, 8.5% were former smokers, and 62.6% never smoked. Approximately 5.6% were identified with ADL disability. Both current smokers and former smokers experienced lower TLE and DFLE than never smokers, and such differences were particularly prominent among men. Intriguingly, former smokers manifested a lower DFLE for both sexes and a lower TLE among women, though a longer TLE among men, compared with current smokers. Similar differences in TLE and DFLE by smoking status were observed for groups with different levels of education., Conclusion: Never smokers live longer and healthier than current smokers and persons who quit smoking. Smoking was associated with greater reductions in TLE and DFLE among men. However, educational attainment might not moderate the adverse effect of smoking on both fatal and nonfatal conditions in the context of China. These findings have implications for disability prevention, aged care provision and informing policies of healthy aging for China and elsewhere., (© 2024. The Author(s).)

Introduction: Based on the data from the China Health and Retirement longitudinal study (CHARLS), we aimed to investigate the bidirectional relationship between depressive symptoms and functional disability., Methods: Data were collected across 3 waves from 2013 to 2018. The activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) scales were used to measure functional disability and the CESD-10 was used to measure depressive symptoms. Cross-lagged models were performed to examine cross effect between depressive symptoms and functional disability across three waves., Results: Data on 10,092(mean [SD] age, 61.98[8.44] years; 3764 females [37.30%]) and 10,180 participants (mean [SD] age, 62.01[8.46] years; 3788 females [37.21%]) in IADL sample and ADL sample were included in the analyses. For IADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes in CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08-0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09-0.10). For ADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes of CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08-0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09-0.10)., Discussion: Study findings underscore a significant bidirectional between depressive symptoms and functional disability in older adults. Thus, simultaneous intervention should be taken to manage the mutual development of functional disability and depression., (© 2024. The Author(s).)

Background: An essential aspect of human well-being is positive sexual health outcomes. However, the issue of adverse sexual health outcomes continues to be a major public health concern, particularly for women with disabilities in sub-Saharan Africa (SSA). Therefore, this current scoping review mapped studies conducted in the last twenty-nine years on the sexual health of women with disabilities from these five dimensions: sexual activity, contraceptive use, sexual autonomy, sexual violence and risky sexual behaviour, whilst seeking to identify the current state of knowledge and address the study gaps in SSA., Methods: This current scoping review was informed by the methodological framework proposed by Arksey and O'Malley. Exploratory searches were conducted in PubMed, Web of Science, African Journals Online, etc., to identify studies conducted in SSA that focus on sexual activity, contraceptive use, sexual autonomy, sexual violence and risky sexual behaviour among women with disabilities in SSA since the inception of the International Conference on Population and Development in 1994 to 30th of March 2024. This process resulted in the inclusion of seventeen (17) studies., Results: Of the 1362 identified through various databases, 34 studies were included for the full-text retrieval and screening; only 17 studies met the inclusion criteria. The eligible studies were conducted across six countries in SSA and published between 2008 and 2023. Eight studies used quantitative study type, six utilised qualitative approach, and three employed mixed-methods analysis. Two studies were conducted on sexual activity, ten were conducted on contraceptive use, four were conducted on sexual violence, and one study was conducted on risky sexual behaviour, whilst no study on sexual autonomy met the inclusion criteria., Conclusion: This review showed that there were few or scarce studies on sexual activity, contraceptive use, sexual autonomy, sexual violence and risky sexual behaviour among women with disabilities in SSA and even where the studies were substantial (contraceptive use), the majority of the studies were conducted in a country. Future studies should consider examining dimensions of sexual health, such as sexual autonomy, sexual activity and risky sexual behaviour of women with disabilities that were not available or were scarce in the literature., (© 2024. The Author(s).)

Background and Aims: Disability, an important aspect of disease burden in patients with inflammatory bowel disease [IBD], has been suggested as a valuable clinical endpoint. We aimed to investigate how disease acceptance and perceived control, two psychological predictors of subjective health, are associated with IBD-related disability., Methods: In this cross-sectional study, adult IBD patients from the University Hospitals Leuven received a survey with questions about clinical and demographic characteristics, disease acceptance and perceived control [Subjective Health Experience model questionnaire], and IBD-related disability [IBD Disk]. Multiple linear regressions assessed predictors of IBD-related disability in the total sample and in the subgroups of patients in clinical remission or with active disease., Results: In the total sample (N = 1250, 54.2% female, median [interquartile range: IQR] age 51 [39-61] years, 61.3% Crohn's disease, 34.9% active disease), adding the psychological predictors to the model resulted in an increased explained variance in IBD-related disability of 19% compared with a model with only demographic and clinical characteristics [R2adj 38% vs 19%, p <0.001]. The increase in explained variance was higher for patients in clinical remission [ΔR2adj 20%, p <0.001] compared with patients with active disease [ΔR2adj 10%, p <0.001]. Of these predictors, disease acceptance was most strongly associated with disability in the total sample [β = -0.44, p <0.001], as well as in both subgroups [β = -0.47, p <0.001 and β = -0.31, p <0.001 respectively]. Perceived control was not significantly associated with disability when accounting for all other predictors., Conclusions: Disease acceptance is strongly associated with IBD-related disability, supporting further research into disease acceptance as a treatment target., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

This study investigates the state of inclusivity in Ukrainian universities, focusing on the perceptions of university staff amid the country's ongoing sociopolitical transformations. Here we report on the perceptions of 820 staff members from various professional roles, including academic, management, and support positions, this research explored inclusivity through diverse lenses, encompassing work experience, interactions with students with disabilities, and self-identification with vulnerable groups. Most respondents assessed a moderate to high level of inclusivity, indicating a positive overall outlook on inclusive practices within these institutions. Notably, perceptions of inclusivity vary slightly across different professional roles, with academic staff expressing a marginally lower level of perceived inclusivity than their counterparts. However, these variations are not statistically significant, suggesting a uniform perception across staff categories. Furthermore, the study revealed that personal experience in working with students with disabilities does not substantially alter staff perceptions of inclusivity. Similarly, self-identification with vulnerable groups only marginally influences these perceptions. This suggests that while individual experiences and identities are factors in inclusivity perceptions, their impact is not profoundly different. This research contributes to understanding inclusivity in higher education, particularly within environments undergoing significant social and political changes., (© 2024. The Author(s).)

Introduction: We present a relationship-centred shared-decision-making (RCSDM) process model to explicate factors that shape decision-making processes during physical medicine and rehabilitation (PMR) encounters among patients, their care partners and practitioners. Existing shared decision-making (SDM) models fall short in addressing the everyday decisions routinely made regarding persons with chronic disabilities who require high levels of support, their care partners and rehabilitation practitioners. In PMR, these everyday decisions are small scale, immediate and in service to a larger therapeutic goal. They can be thought of as micro-decisions and involve multiple practitioners, care partners and patients. How micro-decisions are made in this context is contingent on multiple roles and relationships among these relevant parties. Our model centres on micro-decisions among patients, their care partners and practitioners based on our disorders of consciousness (DoC) research., Methods: To develop our model, we examined peer-reviewed literature in SDM in PMR, chronic disability and person-centeredness; formed collaborations and co-created our constructs with rehabilitation practitioners and with care partners who have lived experience of caring for persons with DoC; analysed emerging empirical data and vetted early versions with expert scientific and clinical audiences. Our model builds from the core tenets of relational autonomy, and scholarship and activism of disability advocates., Findings: Our model conceptualizes four non-hierarchical levels of analysis to understand the process of micro-decision-making in chronic disability and medical rehabilitation: social forces (historical and sociological); roles and relationships (multiple and intersecting); relational dimensions (interactional and contextual) and micro-decision moments (initiation, response and closure)., Discussion: Relationships among patients, their care partners and practitioners are the intersubjective milieu within which decisions are made. Our conceptual model explicates the process of micro-decision-making in PMR., Patient or Public Contribution: Care partners (or caregivers) and rehabilitation practitioners are active members of our team. We work together to develop research projects, collect, analyse and disseminate data. The conceptual model we present in this manuscript was co-created-input from care partners and practitioners on previously collected data became the impetus to develop the RCSDM process model and share co-authorship in this manuscript., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Aim: This study explores and compares the impact of in-person and online versions of a Research-based Theatre production named "Alone in the Ring," aimed at increasing knowledge and fostering positive attitudes towards persons with disabilities in healthcare professions. The study examines changes in attitudes towards disabled persons in healthcare professions, levels of engagement in the play and knowledge about the experiences and challenges of disabled individuals in healthcare professions. It also investigates possible actions to increase inclusion for disabled persons in healthcare education and practice., Background: Disabled students face numerous barriers in healthcare education and practice, many of which are rooted in stigma and negative attitudes. Research-based Theatre promotes experiential learning to address these attitudes and stereotypes. The performance "Alone in the Ring" is based on a comprehensive study of the experiences of disabled students and clinicians in health professions, aiming to promote inclusion for students with disabilities in these fields., Design: This study uses a pre-test and post-test design with two comparison groups., Method: The study employed an explanatory sequential mixed method design to explore the impact of online versus in-person Research-based Theatre teaching in healthcare education. Participants were graduate health students (N = 198); 100 watched the in-person version and 98 watched the online version. Surveys were administered before and after the performance. Participants were also invited to share their experiences in semi-structured interviews and their responses were analyzed using thematic analysis., Results: Results indicated that students generally felt more comfortable with disabled persons in healthcare professions in the post-survey compared to the pre-survey, with online participants reporting greater comfort and higher engagement than those in-person. Knowledge of disabled persons' experiences and challenges, as well as possible actions to increase belonging and inclusion, improved significantly for both groups from pre- to post-performance, with online participants showing a greater change. Qualitative data revealed that online theatre was perceived as authentic and beneficial for accessibility, engagement and emotional impact on students, though challenges included potential distractions and technological issues. Positive correlations were found between changes in knowledge, positive attitude and engagement, suggesting that increased engagement and a shift in attitudes can promote knowledge and awareness of the inclusion of disabled persons in healthcare professions., Conclusion: These results support the use of online theatre-based academic teaching that experientially engages students, increases empathy and can promote more inclusive healthcare educational settings for disabled persons., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background People with Multiple Sclerosis (MS) have unique housing and support needs that are essential for maintaining independence at home; however, there is limited research to guide the design of community living options for this population. The aim of this study was to examine housing and support needs and preferences of people with MS with the intention to inform the planning of a co-designed intervention based on the study's findings. Methods Using the Knowledge to Action (KTA) framework, quantitative (n =79) and qualitative (n =6) data from people with MS were extracted and integrated from projects completed by the research team that explored the housing and support needs and preferences of people with disability. Results were synthesised and presented to a reference group for validation, contextualisation, and adaptation to the Australian context. Results High physical support needs were common across participants. People most commonly required home modifications to improve accessibility, such as ramps, equipment such as heating and cooling, and assistive technology. Many people required more than 8 hours per day of paid support. Moving into individualised housing facilitated independence and community reintegration. People reported gaps between what they wanted from support workers and what they received, citing individual and systemic barriers. Conclusion People with MS have support needs that require proactive and responsive funding arrangements, housing design and support provision. In line with KTA principles, findings will inform the planning of a co-designed intervention that involves people with lived experience of MS and other stakeholders to influence policy and improve home and living outcomes for this population.

Background: Patients with multiple sclerosis (MS) face a wide range of symptoms, including physical disability, imbalance, motor disorders, and acute and chronic pain. The psychosocial consequences of these symptoms may limit social well-being and quality of life in these patients., Purpose: The aim of the study was to assess self-perceived social isolation among patients with MS and its relationship with pain intensity and disability status., Methods: This cross-sectional study was conducted on 200 patients with MS referred to neurology wards and clinics, the MS Association, and rehabilitation centers. Data collection tools used included a demographic information form, Numeric Pain Rating Scale, Expanded Disability Status Scale, and Social Isolation Questionnaire., Results: The mean scores of 4.66 ( SD = 1.15) for disability and 4.18 ( SD = 2.22) for pain intensity both indicated moderate levels of both. Of the sample, 21.5% (43 patients) reported no pain, 22.5% ( n = 45) reported mild pain, 35% ( n = 70) reported moderate pain, and 21% ( n = 42) reported intense pain. The average social isolation score was 63.52 ( SD = 3.32), which is higher than the theoretical average. Of the sample, 44.5% reported low social isolation, whereas 55.5% indicated high social isolation. Gender, duration of MS, economic status, disability status, and pain intensity were all found to be significantly associated with social isolation in patients with MS (all p s < .05)., Conclusions: Based on the findings, comprehensive support plans are necessary to improve psychosocial well-being, social life, and quality of life in patients with MS., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: Research on health-related quality of life (HRQoL) trajectory patterns for people with disabilities (PwD) is scant. Understanding the HRQoL trajectory patterns for PwDs and investigating their relationship with disability types and socioeconomic factors can have important implications for Australia's welfare policy., Methods: We analysed data from waves 11 to 21 of the Household, Income and Labour Dynamics in Australia (HILDA) survey of respondents aged 15 + years of the PwDs. The analytic sample consists of 3724 self-reported disabled individuals and 34,539 observations in total. The SF-6D utility score is our HRQoL measure. Group-based trajectory modelling was utilised to identify trajectory groups, and multinomial logistic regression was employed to determine the baseline factors associated with trajectory group membership., Results: The study identified four distinct types of HRQoL trajectories (high, moderate improving, moderate deteriorating and low HRQoL trajectories). Psychosocial disability types followed by physical disability types had a high Relative Risk Ratio (RRR) in the low group compared with high trajectory group membership of PwDs (psychosocial: 6.090, physical: 3.524). Similar, results followed for the moderate improving group albeit with lower RRR (psychosocial: 2.868, Physical: 1.820). In the moderate deteriorating group, the disability types were not significant as this group has a similar profile to high group at the baseline. Compared with males, females had a higher RRR in low and moderate versus high improving HRQoL trajectories (low: 1.532, moderate improving: 1.237). Comparing the richest class to the poorest class, socioeconomic factors (income and education) predicted significantly lower exposure for the richer class to the low and medium HRQoL trajectories groups (RRR < 1)., Conclusion: Different forms of disability, demographic and socioeconomic factors have distinct effects on the HRQoL trajectories of disabled individuals. Healthcare and economic resource efficiency might be improved with targeted government policy interventions based on disability trajectories., (© 2024. Crown.)

Background: The need to improve spinal motor behaviour in chronic low back pain (CLBP) rehabilitation remains unclear. The objective of this study was to test if changes in spinal motor behaviour were associated with changes in disability after an interdisciplinary rehabilitation program (IRP) in patients with CLBP., Methods: Seventy-one patients with CLBP participating in an IRP were included. Spinal motor behaviour was assessed with biomechanical (lumbar angular amplitude and velocity, erector spinae muscle activity and duration of the task), cognitive-emotional (task-specific fear [PRF]) and pain-related (movement-evoked pain [MEP]) measures during a lifting task before and after the IRP. Disability was measured before and after the IRP, and at 3-month and 1-year follow-ups., Results: After adjusting for confounders, changes in disability were significantly associated with MEP changes (β adj. = 0.49, p < 0.001) and PRF changes (β adj. = 0.36, p = 0.008), but not with changes in any of the biomechanical measures. MEP at the end of IRP was also associated with disability at 3 months (β adj. = 0.37, p = 0.001) and 1 year (β adj. = 0.42, p = 0.01). Biomechanical measures at the end of the IRP were not associated with disability, except for the duration of the task that was significantly associated with reduction of disability at 3 months (β non-adj = 0.5, p < 0.001)., Conclusions: Pain-related and cognitive-emotional measures of spinal motor behaviour were associated with reduction in disability following an IRP. Future research is needed to further investigate causal relationships between spinal motor behaviour and disability., Significance Statement: This study supports a multidimensional understanding and analysis of spinal motor behaviour, integrating the cognitive-emotional, pain-related and biomechanical domains. It also supports the consideration of spinal motor behaviour as a potentially important treatment target in chronic low back pain management. Moreover, it suggests that reducing movement-evoked pain and task-specific fear may have more influence on disability than changing lumbar amplitude, lumbar angular velocity or erector muscle activity, which may have important implications for rehabilitation., (© 2024 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.)

Purpose: The aim of this review was to synthesise qualitative literature on physical activity experiences of community-dwelling older adults with physical disabilities., Methods: We conducted a scoping review of peer-reviewed, qualitative studies on physical activity with community-dwelling older adults with physical disabilities. We analysed eligible studies identified through electronic database searches (CINAHL Complete, MEDLINE, SPORTDiscus) and manual searches undertaken up to June 2023., Results: Twenty-eight articles with 306 participants were included. As regard the experience of physical activity, although physical activity could elicit pleasure and enjoyment, many reported that physical activity sometimes produced pain. Various outcomes of physical activity were reported, with several physical, psychological, social, and lifestyle benefits prominent. Analyses of barriers and facilitators demonstrated how intrapersonal, interpersonal, environmental, and systems and programme factors influenced physical activity participation among older adults with physical disabilities., Discussion: Our findings contribute to literature on physical activity in older adults with physical disabilities by synthesising qualitative research on physical activity experiences, outcomes, barriers, and facilitators in this population. Findings demonstrate the need for knowledgeable and supportive healthcare and exercise professionals, environments that support physical activity, and activities that promote pleasure and social connections.Implications for RehabilitationPhysical activity is perceived to have wide-ranging benefits for community-dwelling older adults with physical disabilities.Various intrapersonal, interpersonal, environmental, and systems and programme barriers constrain physical activity in physically disabled people.Knowledgeable and supportive healthcare and exercise professionals, accessible environments, and activities that promote pleasure and social connections could enhance engagement in physical activity.

Background: Although numbers of youth with disabilities (YWD) are increasing, this population continues to be poorly represented in psychological and developmental research. There is a demonstrated need to better understand identity development in YWD., Objective: The purpose of this review was to determine the applicability of a contemporary developmental model, positive youth development (PYD), for YWD. PYD describes six "Cs" that contribute to thriving in youth: competence, confidence, connection, character, caring/compassion, and contribution. We explored which "Cs" contribute to identity development in YWD, what appears to be unique, and how PYD could be adapted to better include this population., Method: Through a qualitative metasynthesis, we explored how PYD emerged across the qualitative literature from psychology and related fields for YWD. We coded 18 qualitative articles according to the original definitions of the "Cs" of PYD and tracked emerging constructs across included studies., Results: Findings reveal evidence for four out of six of the original "Cs" in YWD. Two emerging "Cs," coping and constraints, may be unique to this population., Conclusions: PYD may be applicable for YWD, but an expanded version may be more relevant to this group. The addition of newly defined "Cs" could contribute to a better understanding of positive development in YWD and other marginalized populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Australians with a psychosocial disability (PSD) and a National Disability Insurance Scheme (NDIS) plan may at times require emergency care due to the fluctuating nature of their physical and mental health conditions or when their supports have become insufficient. This nationwide study investigated the experiences of people presenting to an emergency department (ED) who have a PSD and an NDIS plan. The objective was to understand current care and communication practices and to provide recommendations for service integration. Twenty-four interviews were conducted with people who had a PSD and an NDIS plan. Participants were asked semi-structured questions about their experiences when engaging with NDIS processes and when engaging with the ED as an NDIS recipient and how communication practices could be improved between the two services. A qualitative, descriptive thematic analysis approach was used. A lived experience advisory group participated in the research and provided commentary. The findings of this study indicate that the NDIS, as a personalised budget scheme, presents challenges for people with complex PSD and physical needs. ED clinicians appear to be unclear about what the NDIS provides and communication between the two systems is fragmented and inconsistent. The themes identified from the analysed transcripts are: (a) People with PSD experience distress when dealing with the NDIS; (b) There's a blame game between the ED and the NDIS; and (c) Inadequate service integration between the ED and NDIS. Recommendations to assist with service integration include building service capacity, providing overlapping care and bridging the diverse biomedical, psychosocial and disability care services., (© 2024 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

Introduction: Previous research has demonstrated that children lacking knowledge about genetic disorders may have harmful attitudes toward people with disabilities, but disability awareness can successfully modify these attitudes. We explored adolescents' implicit and explicit attitudes toward peers with genetic conditions to determine whether improved genetics/genomics literacy can mitigate the impact of ableism in this population., Methods: English-speaking adolescents (10-18 years) from British Columbia were invited to complete a Disability Attitudes Implicit Association Test (DA-IAT) and participate in a semi-structured focus group centering on a fictionalized vignette about an adolescent with Down syndrome. We used pragmatism as an analytical paradigm. Descriptive and inferential statistics were used to analyze DA-IAT and sociodemographic data; phronetic iterative analysis with constant comparison as a coding strategy for transcripts; and interpretive description to develop a conceptual model., Results: Twenty-two adolescents completed the DA-IAT and participated in one of four focus groups. Participants had a statistically significant implicit preference for non-disabled people (D-score = 0.72, SD = 0.44; t = 7.18, p < .00001). They demonstrated greater diversity in their explicit attitudes during the focus groups. Although participants articulated a positive attitude toward improved genetics education, results demonstrate their belief that social and personal interactions with disabled peers would be essential to address negative perceptions., Conclusions: This study lays important groundwork to understand, explain, and influence the negative attitudes of adolescents toward individuals with disabilities. Findings will be used to inform the design of interventions that address biased perceptions of people with genetic disorders, with the goal of reducing prejudices and improving social interactions., (© 2024 The Authors. Journal of Adolescence published by Wiley Periodicals LLC on behalf of Foundation for Professionals in Services to Adolescents.)

Diagnostic genetic testing and non-invasive prenatal testing (NIPT) for conditions associated with disability are becoming increasingly available to consumers. This genetic information can be used in the disability setting to inform factors such as prognosis, management, and reproductive decision-making. Genetic counselors (GCs) play an important role in the provision of genetic testing and NIPT, and their attitudes toward disability can influence how genetic information is communicated and shape patients' responses. This study aimed to evaluate and describe Australasian GCs' experience with and attitudes toward disabilities to identify potential biases and training needs. A cross-sectional survey was distributed to 400 GCs registered with the Human Genetics Society of Australasia. Of the 106 respondents (participation rate: 26%), a significantly greater proportion were more comfortable interacting with individuals with physical disability as compared to intellectual disability (p < 0.001). GCs with personal experiences with disabilities reported significantly greater comfort interacting with people with intellectual disability than those without experience (p = 0.012). Qualitative analysis revealed discomfort was less reflective of bias than inexperience and apprehension about communicating disrespectfully. GCs believed people with disabilities experience discrimination and that having a disability could make a person stronger, wiser, and more motivated. Most GCs viewed prenatal testing for disabilities positively as it allowed for decisions regarding continuing the pregnancy and/or provided opportunity to prepare. Challenges identified for prenatal counseling included negative societal attitudes and the low visibility of disability. GCs felt that 'personal beliefs' was the primary factor influencing the decision to terminate a pregnancy affected by disability. These findings highlight important education and training needs for GCs to improve preparedness and comfort when communicating with people with a disability., (© 2023 The Authors. Journal of Genetic Counseling published by Wiley Periodicals LLC on behalf of National Society of Genetic Counselors.)

Purpose of the Article: This article describes a conceptual and methodological approach to integrating functional information into an ontology to categorize mental functioning, which to date is an under-developed area of classification, and supports our work with the United States (U.S.) Social Security Administration (SSA)., Design and Methodological Procedures: Conceptualizing and defining mental functioning was paramount to develop natural language processing (NLP) tools to support our use case. The International Classification of Functioning, Disability, and Health (ICF) was the framework used to conceptualize mental functioning at the activities and participation level in clinical records. To address challenges that arose when applying the ICF as to what should or should not be classified as mental functioning, a mental functioning domain ontology was developed that rearranged, reclassified and incorporated all ICF key components, concepts, classifications, and their definitions., Conclusions: Challenges emerged in the extent to which we could directly align components in the ICF into an applied ontology of mental functioning. These conceptual challenges required rearrangement of ICF components to adequately support our use case within the social security disability determination process. Findings also have implications to support future NLP efforts for behavioral health outcomes and policy research.

Purpose: To explore the lived experience of physical exertion for persons living with advanced multiple sclerosis (MS)., Method: An interpretive (hermeneutic) phenomenological approach was undertaken with 8 persons living with advanced MS. Interviews were conducted with exploratory questions that explored participants' experiences of physical exertion. Data was analysed using phenomenological methods and the findings presented as hermeneutic stories., Results: Participants conveyed physical exertion as a means of influencing their connection with the world. Interpretation identified four subthemes; Lived Body, Sense of Self, Purpose of exertion, and Attributes of the World and an overarching superordinate theme Body-World engagement. Hermeneutic stories illuminated the intertwined relationship between the themes and the idiographic nature of physical exertion., Conclusion: The experience of physical exertion was meaningfully related to participants' sense of self, agency, and 'being in the world'.

Purpose: This study aims to examine the transformative learning experiences of medical students participating in home visits to persons living with disabilities in rural areas of South Africa, in order to explore the potential of such experiences to shape their beliefs about their professional development and clinical practice., Methods: Qualitative data was collected from the students through written reflections and semi-structured interviews. The data were analyzed thematically using a phenomenological approach guided by Mezirow's theory of transformative learning., Results: The findings reveal a three-stage process of transformative learning for the students. Firstly, students held predominantly negative views towards the learning activity, prior to the home visits. Secondly the role of critical reflection facilitated a change in students' perspectives. Finally, there was a change in perspective towards a predominantly positive valuing of the activity to their learning and approach to clinical practice., Discussion: This study highlights the significance of incorporating home visits and structured critical reflection into undergraduate medical curricula. It underscores the need for further research in this area and contributes to the understanding of transformative learning in healthcare education. The findings emphasize the potential of community-based activities to shape inclusive practices and foster holistic patient care.

Purpose/objective: The acquisition of a disability impacts one's corporeality and has been found to destabilize one's sense of personal and social identity. The article explores the psychological and behavioral adaptation strategies that are employed in response to resisting, incorporating, and/or integrating disability into one's identity. We refer to a study that considered factors that facilitate and/or impede disability identification, aiming to investigate the trajectory that the process of identity (re)construction takes., Research Method/design: Seven individual, in person, semistructured interviews were conducted with adults with acquired physical and sensory disabilities. Data underwent thematic analysis. To encapsulate the intrapersonal as well as interpersonal dynamics inherent in identity (re)construction, the analysis was guided by an interpretative phenomenological lens and social identity theory (SIT)., Results: Disability identification is a complex and contradictory phenomenon, with strategies of resistance, incorporation, and/or integration fluctuating by setting and circumstance. These findings represent a significant departure from SIT literature-participants rather made use of more collectivist as opposed to individualistic adaptation strategies. Arguably, progress is being made with regard to disability pride, opening up a space for more positive and affirming disabled identities. Furthermore, disability identification is largely facilitated by greater opportunities for political advocacy and social support-online and in the disabled community. However, stigma-internalized and external-is still a major inhibitory factor to disability identification., Conclusions/implications: Recommendations for rehabilitation programs and psychological professionals working with acquired physical and sensory disability are proposed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Abstract: Students with physical disabilities are underrepresented in medicine, driven in part by ableist beliefs about the ability of individuals with disabilities to complete procedure-based or surgically oriented clerkships, including obstetrics and gynecology (Ob/Gyn). There is a growing commitment to disability inclusion by medical and specialty training associations. Yet published case studies and accommodation protocols for medical student wheelchair users navigating an Ob/Gyn clerkship are absent in the literature. This article describes successful disability inclusion for an Ob/Gyn clerkship, including accommodations for medical student wheelchair users. The authors share mechanisms to address and combat ableist assumptions and facilitate access for future medical students by working collaboratively with student and key stakeholders to develop an inclusive and accessible training experience.These recommendations are shared through the story of a third-year medical student who rotated through the longitudinal clerkships at the Cleveland Clinic Lerner College of Medicine. The student, an individual with osteogenesis imperfecta who uses a power wheelchair with a seat elevator, completed third-year rotations and thrived in her clinical experiences. The authors describe her journey through a robust 4-week Ob/Gyn clerkship, in which she fulfilled the required clinical core conditions and observation skills with reasonable accommodation. Given the high acuity, surgery, and outpatient demands in Ob/Gyn-and the transferrable skills to other clerkships-the student's experience is an excellent exemplar for demonstrating disability inclusion and reasonable accommodation.Ob/Gyn clerkship directors and clinical faculty can broadly use the recommended timelines and communication protocols to create accessible training environments. With student input, minor scheduling adjustments, ongoing communication, reasonable accommodations, and an open mind, medical students on the clinical wards who are wheelchair users can successfully navigate the required expectations of medical training., (Copyright © 2024 the Association of American Medical Colleges.)

Background: Psychosocial rehabilitation in forensic psychiatric services requires sound measurement of patient and staff perceptions of psychosocial function. The recommended World Health Organisation Disability Assessment Schedule 2.0 (WHODAS), designed for this, has not been examined with offender patients., Aims: To examine patient and staff WHODAS ratings of secure hospital inpatients with psychosis, any differences between them and explore associations with other clinical factors., Methods: Seventy-three patients self-rated on the WHODAS after 3 months as inpatients. An occupational therapist interviewed the patient's primary nurse and care team at about the same time (staff ratings). Scores were calculated according to the WHODAS manual. WHODAS scores and interview-rated symptom severity, cognitive measures, daily antipsychotic dose and duration of care were compared., Results: Patient ratings indicated less disability than staff ratings for total score and for the domains of understanding and communicating, getting along and life activities. Self-care and participation ratings were similar. Patients were more likely to rate themselves as disabled in getting around (mobility). Only one-fifth of patient- and staff- ratings (16, 22%) were similar, while for nearly a third of the patients (23, 32%) self-ratings were higher than staff ratings. More severe positive symptoms were associated with higher self-rated WHODAS disability after accounting for treatment duration, negative symptoms, cognitive score and antipsychotic dose. No variable accounted for the staff/patient differences in ratings., Conclusion: Our mean WHODAS score findings echoed those in other patient samples-of patient underestimation of disability, linked to severity of symptoms. In this study using the WHODAS for the first time in a forensic mental health secure inpatient service, however, we found that, by comparing individuals, half of the patients reported equivalent or greater disability than did staff. Future research should focus on elucidating from patients what contributes to their self-ratings. Understanding their thought processes in rating may enhance rehabilitation planning., (© 2024 The Author(s). Criminal Behaviour and Mental Health published by John Wiley & Sons Ltd.)

Background: This study aims to identify disability classes among people with schizophrenia spectrum disorder, depression, anxiety or diabetes via the WHODAS 2.0; investigate the invariance of disability patterns among the four diagnostic groups; and examine associations between disability classes and sociodemographic variables., Methods: Patients seeking treatment for schizophrenia spectrum disorder, depression, anxiety or diabetes (n=1076) were recruited. Latent class analysis was used to identify disability classes based on WHODAS 2.0 responses. Measurement invariance was tested using multi-group latent class analysis. Associations between classes and sociodemographic variables were tested via multinomial logistic regression., Results: A five-class solution was identified; examination of model invariance showed that the partially constrained five-class model was most appropriate, suggesting that class structure was consistent while class membership differed across diagnostic groups. Finally, significant associations were found between class membership and ethnicity, education level, and employment status., Conclusions: The results show the feasibility of using the WHODAS 2.0 to identify and compare different disability classes among people with mental or physical conditions and their sociodemographic correlates. Establishing a typology of different disability profiles will help guide research and treatment plans that tackle not just clinical but also functional aspects of living with either a chronic psychiatric or physical condition., (© 2024. The Author(s).)

Background: Adolescents with disability have lower vaccination rates than the general population, including HPV vaccination. Understanding the multi-level influences on vaccination in specialist schools is crucial to achieve optimal vaccination coverage and vaccination experiences for adolescents living with disability., Objective: To identify and improve understanding of the facilitators and barriers of HPV vaccination among adolescents with intellectual disabilities or autism in Victorian specialist schools to inform strategies to increase vaccination acceptance and uptake., Methods: Qualitative interviews with key stakeholders (adolescents with disabilities, parents, school and council immunisation staff) from six specialist schools in Victoria, Australia. Data were analysed thematically. Inductively derived themes were then deductively mapped across the UNICEF 'Journey to Immunization' model., Results: 32 interviews were conducted with stakeholders (2 adolescents, 7 parents, 13 school staff, 10 council staff). Trust in vaccines was high, but knowledge of the HPV vaccine was limited. Barriers included lack of accessible information for parents, the consent process, behavioural challenges and vaccine-related anxiety among students. The immunisation program in special schools was perceived as convenient, however preparing students for vaccination day and catering to individual student needs were key. Participants expressed a need for more parent information about options and additional support for vaccination outside of the school program., Conclusions: Our study identified a range of facilitators and barriers to the school immunisation program for students with disabilities in specialist schools. The next phase of this work will use co-design workshops to build on the suggestions for improvement and opportunities that could be leveraged to improve vaccination uptake., (© 2024. The Author(s).)

Objectives: to identify and synthesize, from the literature, the impacts of physical disability caused by leprosy on the quality of life of individuals receiving care within the Health Care Network., Methods: this is a scoping review conducted following the JBI recommendations. The databases used in the search included the Medical Literature Analysis and Retrieval System Online, Cochrane Library, Web of Science, Lilacs, Cumulative Index to Nursing and Allied Health Literature, Scopus, Embase, Leprosy Information Services, and Google Scholar., Results: 1690 documents were identified, of which 36 were included in the review. Physical disability caused by leprosy affects the quality of life in the areas of daily activities, socioeconomic aspects, psychological well-being, pain, and overall well-being., Conclusions: we identified the impairments caused by physical disability in the quality of life, highlighting the need for prevention, promotion, and rehabilitation actions, such as screening, case management, and health education.

Aim: Depression and disability in activities of daily living (ADL) are common in middle-aged and older adults. This study investigated the bidirectional relationship between depression and disability in ADL in Chinese middle-aged and older adults., Methods: Data from a baseline study of 17,596 participants from the China Health and Retirement Longitudinal Study (CHARLS) and two follow-up visits at 4 and 7 years were included. We designed Study A and Study B to explore the interaction between depression and disability in ADL in middle-aged and older people., Results: Individuals with disability in ADL at baseline had adjusted odds ratios (ORs) of 1.331 (1.118, 1.584) and 1.969 (1.585, 2.448) for developing depression compared with those without disability in ADL at the 4- and 7-year follow-ups, respectively. Individuals with depression at baseline had adjusted ORs of 1.353 (1.127, 1.625) and 1.347 (1.130, 1.604), respectively, for developing disability in ADL 4 and 7 years later., Conclusions: There was a bidirectional relationship between depression and disability in ADL. Depression increased the risk of disability in ADL, but this risk did not increase with time, whereas the effect of disability in ADL on depression increased with time., (© 2024. The Author(s).)

Background: There is a consensus among scholars, policymakers, and implementers that addressing the complex nature of intimate partner violence (IPV) requires a collaborative response. However, there is limited literature on how various professionals work collaboratively to address the needs of women with disabilities who experience IPV. This study combines the perspectives of women with disabilities and those of professionals to understand collaboration in providing IPV services to women with disabilities., Methods: Twenty-nine in-depth interviews were conducted with 18 IPV service providers and 11 women with disabilities. The data were analyzed using reflective thematic analysis., Results: The findings are presented under three themes: the first shows a consensus among different IPV service providers and disabled women on the importance of collaboration when supporting victims of IPV with disabilities; the second depicts the common ways in which collaboration occurs when supporting women with disabilities; and the third illuminates the critical elements that boost effective collaboration., Conclusion: Supporting IPV victims with disabilities requires active collaboration at both an internal and external level. Strengthening collaboration among different actors requires trust, specified roles, and the allocation of adequate resources., (© 2024. The Author(s).)

Background: As societal evolution unfolds in China, individuals with physical disabilities are increasingly provided opportunities in higher education, particularly in the field of medicine. However, these medical students often encounter bias in their work environments, including during internships, which fosters self-stigma and impedes their experience for workplace well-being (WWB). Such a decrease in WWB detrimentally affects not only their mental health in the workplace but also hinders their sense of personal worth and assimilation into broader society. This study aims to examine the challenges faced by medical students with physical disabilities in China as they aspire to achieve WWB, and to explore potential intervention strategies., Methods: Leveraging cognitive consistency theory (CCT), we introduces a conceptual framework to examine the relationships among self-stigma, perceived discrimination, and WWB. It also investigates the role of trait mindfulness as a potential mitigating factor in this dynamic. We employed the Internalized Stigma of Mental Illness Scale (ISMIS), Discrimination Perception Questionnaire (DPQ), Workplace Well-being Subscale (WWBS), and Mindful Attention Awareness Scale (MAAS) to survey 316 medical students with physical disabilities. Statistical analyses, including correlation, regression, and moderated mediation effect assessments, were conducted using SPSS 22.0 and AMOS 24.0., Results: A notable negative correlation exists between self-stigma and WWB (r = -0.56, p < 0.01). Perceived discrimination partially mediates the relationship between self-stigma and WWB. The direct effect of self-stigma and its mediating effect through perceived discrimination account for 60.71% and 21.43% of the total effect, respectively. Trait mindfulness moderates the latter part of this mediating pathway. Moderation models indicate that trait mindfulness has a significant negative moderating effect on the impact of perceived discrimination on WWB (β = -0.10, p < 0.001)., Conclusions: Self-stigma adversely affects the positive work experiences of medical students with physical disabilities by eliciting a heightened sensitivity to discriminatory cues, thereby undermining their WWB. Trait mindfulness can effectively counter the detrimental effects of perceived discrimination on WWB. Consequently, this study advocates for the systematic incorporation of mindfulness training into educational services and workplace enhancement programs for medical students with disabilities, aiming to foster an inclusive and supportive external environment., (© 2024. The Author(s).)

Medicalization represents an increasingly significant form of social control. Emergent evidence suggests that workplace managers take up medicalized practices and discourses to produce a compliant labor force, but this phenomenon has received limited sociological attention. This paper extends prior theories of medicalization to investigate therapeutic management in the low-wage workplace. I draw upon eight months of ethnographic fieldwork in Disability Works, a nonprofit job training program for people with mental illnesses, and interviews with other providers and advocates within this field. Disability Works harnesses therapy, psychiatry, and "softer" therapeutic practices such as mindfulness meditation, sleep hygiene, and positive affirmations to produce its workforce. This paper identifies two dimensions of therapeutic management: (1) it aims to inculcate work norms at the level of client-workers' embodied dispositions, and (2) it aims to transform structural problems into individual ones. Findings illuminate therapeutic management as an emergent workplace regime and may guide future research on its effects., (Copyright © 2024 The Author. Published by Elsevier Ltd.. All rights reserved.)

Introduction: There is growing research evidence on bodily discourses and body image issues of women with disabilities. Within the art-based intervention repertoire for persons with disabilities, dance and movement-based therapies and interventions are gaining prominence. The aim of this study was to examine the impact of dance sessions (delivered online) on body image, body satisfaction/dissatisfaction, and wellbeing of women with disabilities., Method: A quasi-experimental waitlist control design study was conducted with data collected at two time points: baseline or pre-test and five-months later or post-test. Outcomes were measured using the Body Image Scale and the WHO-5-Wellbeing Index., Results: The dance sessions were effective (Hedges' g = -0.56 -0.88; p < 0.01) and post-test body dissatisfaction scores were lower and wellbeing scores were higher for participants with a college degree or postgraduate degree, self-employed or students, and whose intervention compliance was above threshold (>50% dance sessions attended and corresponding homework sessions completed). Tobit regression models indicated that it was possible to estimate post-test outcomes due to dance sessions alone, controlling for significant socio-demographics., Discussion: The domain knowledge of non-pharmacological art-based interventions for persons with disabilities, particularly women, is supported., Conclusions: Findings commend dance sessions as effective psychotherapeutic mechanisms to mitigate body dissatisfaction, improve body image and wellbeing of women with disabilities. Future research may focus on large-scale cross-sectional trials, variations in the repertoire for women with different disability types and histories, and qualitative narratives., Competing Interests: Declaration of competing interest There are no conflicts of interest to report for this submission., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to examine reciprocal and dynamic associations between Social Isolation (SI), loneliness, and disability among Chinese older adults., Design: This is a prospective cohort study., Setting and Participants: The global trend of population aging has resulted in a significant rise in the prevalence of disabilities, SI, and loneliness among older adults. These factors can severely impact the health and well-being of older adults. Therefore, it is crucial to implement more efficient interventions aimed at reducing disabilities, addressing SI, and combating loneliness among older adults in order to improve their overall health and well-being., Methods: Using a large, nationally representative sample spanning 16 years, we employed the general cross-lagged panel model to explore the relationships among 50,348 older adults with a mean age of 81.83 at baseline. Disability was measured by a comprehensive index tool that incorporated multiple dimensions. SI was measured using an SI index, and loneliness was evaluated using a single-item measure., Results: SI emerged as a stronger predictor of disability than loneliness. Longitudinal analysis revealed accumulative disadvantages in the association between SI and disability. Additionally, disability was found to contribute to increased SI and loneliness. However, our study did not detect any variance in the strength of the cross-lagged effects between social isolation and disability., Conclusions and Implications: The findings suggest that reducing SI is crucial for reducing disability among older adults. Initiating early interventions to minimize initial SI could aid in preventing later-life disability. Additionally, addressing disabilities may positively impact the reduction of loneliness and SI within this population., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Stigma looms over the disability community., Objective or Hypothesis: The aim of this paper is to gain a deeper understanding of how societal stigma impacts depression among wheelchair users., Methods: Mixed research methods were used on a sample of sixty full-time wheelchair users (M age = 43.78, SD = 15.50) whose disability was either acquired (n = 32) or congenital (n = 28). Data was collected via an anonymous Qualtrics survey. Qualitative and quantitative content analyses were performed., Results: Three major themes were identified from the qualitative analysis, including pity, discomfort, and invisibility which demonstrated that our participants felt frequently stigmatized in public. Several participants noted how assumptions were made about their competence, intellect, ability, and the entire disability experience based on the physical representation of their wheelchair. The quantitative results demonstrated a positive correlation between The Major Depression Index and the Able Privilege Scale-Revised, a scale constructed to examine personal power and privilege in relation to society depending on disability type., Conclusions: Wheelchair users feel stigmatized by members of society, which is associated with increased levels of depression and perceived pity, discomfort, and invisibility., Competing Interests: Declaration of competing interest The authors report no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)