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It is pointed out in the initial theoretical considerations that comparatively few studies can be found in the pertinent literature that address the issue of younger non-disabled children's attitudes and behaviour toward children with physical disablement. The present study had comprised 23 second-year primary school-children (8 male, 15 female), age 7.6 to 8.6, from a community with a population of approx. 6000. At the time of our investigation, the subject of "disability" had not been explicitly dealt with at school, and the children moreover reported that they had not previously come into contact with disabled children either. The interviews were administered individually, using an interviewing structure of 19 questions pertaining to 7 different topics. Along with the findings for these 7 areas, the following can be summarized: The findings permit the conclusion that the majority of the children interviewed do not encounter disabled children in terms of an already manifest prejudiced behaviour. Restrictive opinions primarily have to do with functional limitations assumed to affect disabled children's abilities in play, are however unrelated to dimensions of the personality or a social behaviour that could entail rejection of the disabled child. On the other hand it was found that non-disabled children do anticipate the negative views held by others in their environment toward children with disabilities.
In a total sample of 141 mentally retarded adults the quality of social relationships was assessed by the newly developed "Interview for Social Support in Mentally Retarded Adults". Severely mentally retarded persons have close and intimate relationships to a consistently lesser extent than mildly retarded persons. This holds also true for the residents of relatively large institutions compared--under control of the degree of mental retardation--to those of small community based facilities. Social support is not related to age and sex.
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Within a general framework of handicap signalling it was proposed that threat displays are handicaps, they can work only if they put the signaller at a disadvantage, which is only acceptable to honest signallers. The aim of the present article is to investigate this proposal with the help of a simple game-theoretical model. It was found: (1) that the use of cost-free signals is an ESS against the invasion of handicapped signals even if cheating is played as part of a mixed strategy in the population; (2) that the use of handicaps may be an ESS against cost-free signals but only if we assume that the invading cost-free signal is not accepted by weak individuals as a signal of strength; (3) that the establishment of a handicapped signal in the first place is an unresolved problem, because both cost free signals and negative-handicaps are evolutionarily stable against the invasion of handicaps; (4) that in contrast to handicaps the use of negative-handicaps can invade a population using cost-free signals (a negative-handicap is a signal which may serve other functions as well); (5) that negative-handicaps are ESS against cost-free signals as well as against handicaps; and (6) thus, the most likely evolutionary end point is that the biggest negative-handicap would be used as a threat display. This is a posture, which prepares the animal most efficiently to fight; hence, most probably it is the initial position of the fighting technique of the given species. (7) Finally, the investigation of the threat displays of well-studied taxa (great tit, cats, dogs, and hoofed mammals) confirms that threat displays are indeed negative-handicaps. They do not put the user into a disadvantaged position, instead the initial position of the species specific fighting technique is used as a threat display as predicted by the present model.
Nonhandicapped people often report discomfort and uncertainty when interacting with handicapped individuals. The three studies reported here investigated a possible tactic that handicapped people could use to reduce a fellow interactant's discomfort and uncertainty. Nonhandicapped subjects watched two videotapes of handicapped individuals being interviewed. Each subject then chose the handicapped person with whom he would prefer to work on a cooperative task. Results of all three studies supported the hypothesis that a handicapped person acknowledging his handicap will be preferred to a handicapped person who does not acknowledge his handicap. In Study 1, subjects significantly preferred a handicapped person who acknowledged his handicap to a handicapped person who did not disclose anything personal. In Study 2, subjects significantly preferred an acknowledging person over one who made a personal disclosure other than about his handicap. In Study 3, subjects preferred the individual acknowledging a handicap over one who disclosed something else personal even when the acknowledging individual was clearly nervous about doing so. These results suggest that acknowledging the handicap may be a promising tactic.
A human handicap is defined as a broad, hard and long lasting restriction of the mental development and the social integration. Groups of handicapped persons can be divided into mentally, psychologically, physically, sensory (blind, deaf) handicapped as well as into multiple disabled and chronically sick persons and those in need of care (old). New groups with demands for aid are among others people suffering from AIDS, psychologically sick (old) and people getting old as well as mentally, physically und multiple handicapped persons, people suffering from cancer, severely ill and dying people. For all handicapped people should be demanded the possibility of living almost normal lives. For all persons directly concerned as well as their families such a normal life should include: the right of self-determination and autonomy, the demand for complex styles of living and nearby care/support, the providing of respective infrastructures such as barrier free living and access to public institutions, access to public transport and homes fitting for handicapped persons, the demand for out-patient treatment by a complex range of various possibilities of support and finally, the providing of alternative forms of living in contrast to the traditional way of life of handicapped people like families or homes. Three important living areas can be derived from these ideas, namely: living conditions, education/professional and working field, social life/social environment. These important living areas require preventive measures, mainly advice and information centres, places to go early recognition and early promotion of handicapped people and those in risk of a handicap (especially children) as well as medical, professional and social rehabilitation or integration. Concerning the spectrum of support, aid and care in the homely area up to now already exists a variety of offers by out-patient services (information services, social units, mobile support services/organized neighbourhood assistance, individual care of severely sick persons, food services, laundry services, social psychiatric services for chronic mentally sick persons, cancer advice/care, hospital aid, care of persons suffering from AIDS, family relieving services for family members of mentally disabled persons, supervised living) partial treatment of indoor-patients such as daily care units, daily nursing or daily clinics others like nursing families, living communities, short-time care/accommodation, homes for sick people. Moving forces of these offers are mainly charitable organizations such as organisation of social welfare and churches. Besides, aid for handicapped people is also realized by state and local community authorities (Social Welfare and Public Health Department) and private initiatives. In spite of these offers there exist numerous problems und gaps. With regard to the problems one should mention predominantly the financing of measures, specific problems concerning the home care of persons (among others, asking for help too late, less preventive orientation of the services, low orientation of the services with regard to the needs of the handicapped persons and their families, few coordination or cooperation among the services, nursing crisis, few persons engaged in community services) as well as problems in the field of living and living environment (non existence of handicapped-fit or specially furnished homes, lacking infrastructure, public transport not sufficiently equipped for handicapped people, practices of physicians, pharmacies or shops not accessible for handicapped persons). Gaps in the offers are among others the long-time care, crisis intervention/emergencies particularly for singles as well as the nursing possibilities of partial treatment.
BACKGROUND AND PURPOSE: Knowledge of patterns of handicap after stroke and of the relationship among handicap, disability, perception of recovery, and stroke subtype is limited. The aim of this study was to assess handicap 3 and 12 months after first-ever stroke in a community-based study. METHODS: All strokes occurring in a population of 133 816 people were found and assessed. Patients were classified as having cerebral infarction (CI) or intracerebral hemorrhage (ICH) according to imaging or autopsy findings. Cases of CI were categorized using the Oxfordshire stroke classification. Handicap, disability, and perception of recovery were assessed 3 and 12 months after stroke using the London Handicap Scale, Barthel Index, and the question "Have you made a complete recovery from your stroke?" The association between disability and handicap was examined using Pearson's correlation. Differences in handicap among subtypes of CI were evaluated using one-way ANOVA. RESULTS: There were 264 cases of CI or ICH. Of surviving patients, 113 (59%) were assessed at 3 months and 107 (64%) at 12 months. The domains of handicap most affected were physical independence and occupation. Only half the variance in handicap was due to disability. Of patients without disability, those who claimed complete recovery were less handicapped than those who claimed incomplete recovery. Patients with total anterior circulation infarction were more handicapped at 3 and 12 months than those with other subtypes of CI. CONCLUSIONS: Stroke patients were handicapped across many domains. Handicap is only partly explained by disability. Stroke subtype should be considered in the interpretation of outcome data.
OBJECTIVE: To determine the incidence of tinnitus and associated handicap after unilateral sudden sensorineural hearing loss (SSNHL); in addition, to determine the hearing handicap experienced as a consequence of such a loss. STUDY DESIGN: Identification of patients and determination of demographic and audiologic data by retrospective case review; determination of handicap and distress by postal questionnaire. SETTING: Teaching hospital department of otolaryngology. PATIENTS: Thirty-eight patients were identified as having been treated for a unilateral sudden sensorineural hearing loss in the period 1988 through 1997. Of those, 21 (55.3%) replied to the questionnaire. MAIN OUTCOME MEASURES: Audiometric data at admission and at 4-week follow-up, Tinnitus Handicap Inventory (THI), visual analogue scales of tinnitus loudness and distress, Hearing Handicap Inventory in Adults (HHIA). RESULTS: The questionnaire responder group did not significantly differ from the questionnaire nonresponder group on demographic nor audiometric variables, and hence were considered to be a representative sample. Tinnitus was present in 14 patients (67%). Hearing handicap was found in 86% of patients (of the 21 questionnaire responders) and tinnitus handicap in 57% (of the 14 with tinnitus). Correlations were found between tinnitus loudness, distress, and handicap. There was no correlation between time elapsed since SSNHL and tinnitus or hearing handicap, nor was there a correlation between the extent of audiometric loss and hearing or tinnitus handicap. A strong negative correlation was, however, found between recovery in audiometry in the first 4 weeks after onset and tinnitus and hearing handicap. The audiometric status of the contralateral ear correlated with hearing handicap. CONCLUSIONS: A majority of patients after unilateral SSNHL have a perceived handicap associated with tinnitus and hearing. Although this condition is an otologic emergency, careful thought should be given to the audiologic rehabilitation of this patient group.
The purpose of this study was to quantify and partition the expected years of life with and without handicap for the Chinese population according to various types of handicaps, age-sex groups and regions. A large-scale sample survey on handicapped persons conducted in 1987, and the 1990 population census constitute the basis for computing the expected years of life free of handicapped condition using the method proposed by Sullivan. The expected years of life with handicap for the Chinese population in childhood (0-14 y), working ages (15-64 y) and the elderly (65 y+) were 0.40, 1.78, and 3.44 for males and 0.34, 1.69, and 4.55 for females. For the Chinese males over 65 y of age, there were about 1.83 expected years of life with aural handicap and 0.59 expected years of life with ocular handicap. For the Chinese females over 65 y of age, there were about 1.87 expected years of life with aural handicap and 1.16 expected years of life with ocular handicap. The burden of living with handicap is greater for females and the elderly. This general pattern hold for all types of handicap except for skeletal handicap. The expected years of life with handicap for the Chinese population provide useful information for setting public health policies, despite the difficulty in making comparisons with the similar data in other countries.
This study compares self-perceived assessment of hearing handicap with audiometrically derived measures of hearing handicap in a sample of elderly persons. Subjects were evaluated by traditional audiometric tests, the Speech Perception in Noise test, and the Hearing Handicap Inventory for the Elderly, a self-assessment questionnaire. Hearing handicap was also calculated by the audiometrically derived American Academy of Otolaryngology (1979) method. Our results are consistent with other studies that indicate a low correspondence between audiometric measures of hearing handicap and self-assessment of hearing handicap. Furthermore, if the Hearing Handicap Inventory for the Elderly is considered the true measure of hearing handicap, our data indicate that the American Academy of Otolaryngology method tends to overestimate handicap among persons with no self-perceived hearing handicap and underestimates handicap among persons with significant self-perceived hearing handicap.
The purpose of this study was to investigate the impact of maternal prepregnancy and pregnancy-related risk factors, complicated delivery, and perinatal morbidity on subsequent handicaps in children. We surveyed a birth cohort of 4102 mothers and 4138 children in Frederiksborg County, Denmark. Maternal risk factors were defined according to guidelines published by the Danish National Board of Health, and perinatal morbidity and handicaps according to World Health Organization guidelines. The incidence of handicaps: (cerebral palsy, mental retardation [mild and severe], epilepsy, severe defects of vision and hearing); was 44 of 4038 children (twins and neonatal deaths were excluded). A combination of three or more maternal risk factors was found to be a predictor of risk for children with later handicaps; the incidence of handicaps was 11 times higher than in mothers with no risk factors. Eleven percent of all mothers had three or more risk factors and they had 43% of the handicapped children. Multiparity increased the risk in all risk categories. Of complications at delivery, intrapartum asphyxia, as evident from Apgar scores of less than 7 at 1 minute and less than 10 at 10 minutes in particular, was a strong predictor of a later handicap. Premature rupture of membranes for more than 24 hours was also significantly associated with later handicaps. Perinatal morbidity was correlated with a later handicap. The perinatal complication most strongly associated with later handicaps was low birthweight. Forty-eight percent of the affected children had a birthweight of less than 2500 gm and were small for gestational age. We conclude that the incidence of handicaps could possibly be reduced if the causes of the following maternal risk factors were identified and, if possible, eliminated: previous delivery of a child with a birthweight less than 2500 gm, previous delivery of a stillborn child, repeated abortions, severe infection during pregnancy, intrauterine growth retardation, and preterm delivery. Improved intrapartum diagnosis and prevention of asphyxia and treatment of children born with low Apgar scores would reduce the incidence of handicaps, as would intervention to prevent premature rupture of the membranes of more than 24 hour's duration.
In order to find the prevalence of dental caries and physique in handicapped children, 5 schools for physically handicapped or mentally retarded children in Fukuoka city were examined. The subject was 430 handicapped children (283 boys and 147 girls) aged 6-14 years. As control data, the same aged children in the report on the survey of school health in 1986 (National survey) were used in relation to the physique of handicapped children. In addition, the same aged 338 normal children were compared with 80 handicapped as to the degree of their flat feet. The report on the survey of dental diseases in 1981 (National survey) was adopted to compare with dental caries of the handicapped. The results were shown as follows: 1. Concerning the growth of constitution, height, weight and girth of the chest in handicapped children were lower than the values in the National survey. 2. The rate of children with flat feet in the handicapped children was more than that of normal children, and the rate of serious cases was outstanding in the former. 3. The prevalence of dental caries of deciduous and permanent teeth in handicapped children was lower than that in normal children. But the rate of difference was plausible due to the decrease of dental caries with the increase in age. 4. The average number of present teeth in handicapped children was lower than that in the normal children in the National survey. The eruption time was delayed from 6 months to 1 year in handicapped children. 5. The consideration was done to clarify the cause of the lower incidence of dental caries from the view point of the delay of the teeth eruption time in handicapped children when compared with normal children.
BACKGROUND: 'Handicap' is the disadvantage for an individual that results from ill-health. It represents an important outcome in chronic disabling disease, but has proved difficult to measure until recently. The strength of association between handicap and other health status measures, and the relative contributions of health and socioeconomic variables to handicap have not been studied previously. METHODS: We undertook a cross-sectional survey of all people > 65 years old in a defined geographical area of North London. The interview was based on the short-CARE psychiatric survey tool, and in addition included measures of physical health and disability, the London Handicap Scale, income, social support and housing. In all, 654 residents (74%) from a register of 889 were interviewed. A random sample of 225 had additional data collected which are reported in this analysis. RESULTS: Strength of association with handicap scores increased progressively from diagnosis to impairment to disability. Variation in handicap with diagnosis was explained by impairment, and variation with impairment was mostly explained by disability. Age, housing quality, social support and income were associated with handicap score, but confounding by these did not explain the association between handicap and other aspects of disablement. Disease-associated variables explained quantitatively much more variation in handicap than socioeconomic variables. CONCLUSIONS: The most potent influences on handicap are disease and disability, justifying the high priority given by health services to detection, treatment and rehabilitation. Where this is not possible handicap may be reduced to some extent through socioeconomic intervention.
BACKGROUND AND PURPOSE: Handicap, although more relevant to the patient than impairment or disability, has received little attention in people with stroke. The aim of this study was to identify, in an unselected population, factors determining handicap at 2 years after stroke. METHODS: All first-ever cases of stroke in a population of 306 631 over a 1-year period were assessed. Stroke severity, comorbidity, and demographic information was recorded. Among survivors, 2-year poststroke handicap was assessed with the London Handicap Scale. Disability, physical impairment, depression, anxiety, living arrangements, and recurrent stroke at 2 years were documented. If necessary, proxy assessments were obtained, except for mood. Linear regression analyses were performed to identify factors independently associated with handicap. First, all assessments (proxy and nonproxy) were examined; then, the nonproxy assessments were used to examine the effects of mood. RESULTS: Of 266 patients with incident stroke who were alive at 2 years, 226 (85%) were assessed. Significant determinants of handicap on univariable analysis were age, female sex, socioeconomic status, alcohol intake, stroke subtype, initial stroke severity; 2-year physical impairment, disability, depression and anxiety scores; institutionalization; and recurrent stroke. On multivariable analysis, the independent determinants of handicap were age and 2-year physical impairment and disability. In analysis restricted to nonproxy data, depression and anxiety were also independently associated with handicap. CONCLUSIONS: Age, concurrent disability, and physical impairment were more important determinants of handicap than other demographic factors or initial stroke severity. Because depression and anxiety were independently associated with handicap, their treatment may potentially reduce handicap in stroke patients.
AIM: The aim of this study was to analyse possible intra- and postoperative complications and long-term results in combined orthodontic-orthognathic treatment of mentally handicapped patients compared with a control group of patients without handicap. PATIENTS AND METHODS: A group of 20 mentally handicapped patients (male = 7, female = 13) and of 102 non-handicapped patients (male = 36, female = 66) were evaluated retrospectively. The results of the two point-discrimination sensory test and the cephalometric findings of both groups were assessed. Complications during and after the operation, the results of nerve function tests and relapse rates were reported. The statistical analysis was carried out using binary logistical regression analysis with adjustment according to the diagnosis and the type of operation (p < 0.05) RESULTS: No significant differences could be found between the mentally handicapped and the non-handicapped patients. Only the nerve function test immediately postoperatively revealed differences between the two patient groups. The relapse rate in mentally handicapped patients was similar to non-handicapped patients. Forty-seven months after the operation, relapse (change in the ANB angle of more than 0.5 degrees ) was observed in four patients only (handicapped patients). CONCLUSION: Orthognathic surgical procedures in mentally handicapped patients can be carried out with a similarly high success rate as in mentally healthy patients.