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PubMedDate not supplied

Disease, impairment, disability and social handicap: a community based study of people aged 70 years and over.

The aim of this research was to investigate the prevalence of disability in a total population-based sample aged 70 years and over, the social handicap resulting from the disability and the diseases and impairments contributing to disability in the most disabled subjects. From the initial sample of 856 subjects, 782 (91.4%) participated. Disability in the tasks examined varied from 1.3% of subjects unable to feed themselves to 24.4% unable to carry out housework. In the 74 most disabled subjects comorbidity was common. The major clinical disorders that contributed to impairment and disability were heart failure, osteoarthritis, stroke and dementia. Those who were disabled were considerably more likely to be handicapped than those not disabled (odds ratio 6.65, 95% confidence interval 4.73-9.36). When social support was considered, the estimated risk of handicap associated with disability ranged from 3.19 (95% CI 1.92-5.30) for the subset of subjects who had a spouse, to 52.00 (95% CI 4.03-670.6) for subjects without emotional support.

Activities of Daily Living↗
PubMedDate not supplied

An empirical investigation of the 'Biopsychosocial Disease Consequence model': psychological impairment, disability and handicap in chronic pain patients.

The purpose of this study is to emphasize the meaningfulness of a global, functional rather than a narrow medical view in the efficacy evaluation of chronic pain treatment. Therefore, the 'Biopsychosocial Disease Consequence (BPSDC) model' to assess function more globally than before, is presented in this article. The model is based on two theories: (1) the biopsychosocial approach and (2) WHO's classification of impairments, disabilities and handicaps. In addition to the presentation of the conceptual model, the development of the hypothetical criteria and assessment models for psychological impairments, disabilities and handicaps, and the validity testing of the psychological assessment axis are described. Within each of the three classes, i.e. psychological impairments, disabilities and handicaps, the results supported the independence of the hypothetical criteria from each other. On the other hand, results suggested that some changes to the hypothetical assessment models for some of the criteria might be valuable. It was concluded that although the most adequate psychological assessment models for function, found in this study, can be considered as robust and recommendable as one set of tools for functional assessment, the main aim of this article is to encourage multidisciplinary team efforts to develop and systematize the assessment procedures of function in patients suffering from chronic diseases.

Adult↗
PubMedDate not supplied

Using the handicap code of the ICIDH for classifying patients by intensity of nursing care requirements.

An 11-class patient classification system (PCS) has been built on a recode of two dimensions of the handicap code of the ICIDH: physical independence and mobility handicaps. The proposed system, called MAC XI, explains 78% of the variance of nursing care hours required by nursing-home residents and extended-care hospital patients. This percentage of variation is higher than the one explained by traditional dependency grids such as the Exton-Smith, Murphy, Kuntzmann and SMAF. MAC XI, based on two dimensions of the handicap code, is thus a powerful tool for predicting intensity of nursing care for staffing and budgeting purposes in long-term care institutions.

Activities of Daily Living↗
PubMed1997

Management of impairment, disability, and handicap due to multiple sclerosis.

In this article, we update management measures for patients with multiple sclerosis (MS) that can improve or prevent impairment, disability, and handicap and include those factors that a primary-care physician can implement or facilitate. The medical literature since 1989 was reviewed. Although new drug trials hold promise to decrease impairment from MS, well-coordinated interdisciplinary care to minimize disability and handicap most profoundly affect the quality of life for patients with MS. MS is usually not severely disabling, and appropriately timed intervention can prevent secondary impairment and reduce disability and handicap. Pharmacologic, physical, and psychosocial issues--ranging from spasticity, pain, weakness, and tremor to neurogenic bowel management and sexuality--are addressed. General wellness measures remain important. The influence of the Americans With Disabilities Act is discussed, and specific adaptive equipment and social resources are outlined. The ultimate goals of management of patients with MS are functional independence and efficient use of medical and community resources: a focus on "ability" rather than "disability." Although impairment can limit function, wellness and adjustment have no boundaries.

Activities of Daily Living↗
PubMed1979

Dear Ivor...: Having spent my last four years in the NHS working for the mentally handicapped.

An administrator who has been promoted out of the field of mental handicap writes an open letter to one of his recent patients in the mental handicap sector of Brentry Hospital. Aware of the deficiencies of the 1959 Mental Health Act and with deep reservations about any real improvements resulting from the Jay committee's recommendations, Winston Tayler, states the case, as he sees it, for the mentally handicapped.

Humans↗
PubMed1983

Nondiscrimination on the basis of handicap--Office of the Secretary, HHS. Interim final rule.

The interim final rule modifies existing regulations to meet the exigent needs that can arise when a handicapped infant is discriminatorily denied food or other medical care. Three current regulatory provisions are modified to allow timely reporting of violations, expeditious investigation, and immediate enforcement action when necessary to protect a handicapped infant whose life is endangered by discrimination in a program or activity receiving federal financial assistance. Recipients that provide health care to infants will be required to post a conspicuous notice in locations that provide such care. The notice will describe the protections under federal law against discrimination toward the handicapped, and will provide a contact point in the Department of HHS for reporting violations immediately by telephone.

Congenital Abnormalities↗
PubMed1985

In-service training in therapeutic recreation for persons with severe handicaps.

The majority of persons with severe handicaps have been excluded from most therapeutic recreation programs because they are less skill proficiency and more difficult to involve. In many cases recreation leaders are neither trained nor prepared to work with severely disabled individuals. The described in-service training project was successful in increasing recreation leaders' competency for working with persons who have severe handicaps. The project consisted of lectures, audio-visual presentations, simulations, role playing, and group discussion. It was found that the participants' self ratings of their competency in assessment, task analysis, writing individualized recreational objectives, using a behavioral approach, data collection, and program reevaluation were significantly increased (P less than .01). Their overall self evaluation was also increased. This in-service project was effective in promoting staff training and increasing opportunities for therapeutic recreation for persons with severe handicaps.

Persons with Disabilities↗
PubMed1985

Special adaptive recreation as intervention in vocational and transitional services for handicapped youth.

Increased concern for rising costs of disability-related programs, coupled with various manpower and economic projections, have resulted in major shifts in federal program priorities. The shift from institutional support to "self-help programs" mandates service providers to demonstrate the extent to which their programs promote independent living skills among the handicapped. As a result of recent and projected trends, leisure service providers must begin to articulate and justify their roles as essential to vocational training and successful placement of handicapped individuals within the community. The purpose of this article is to present a Special Adaptive Recreation Support Systems Model, which demonstrates the utilization of special recreation programs as a supportive service to educational, vocational, transitional, and community programs for the handicapped.

Adolescent↗
PubMed1989

Playing God in the NICU. Ethical guidelines focus on what seems best for the handicapped infant--Saint Vincent Health Center, Erie, PA.

Physicians, nurses, and administrators of Saint Vincent Health Center, Erie, PA, embarked on a project to refine ethical standards regarding the treatment of severely handicapped infants to meet current government regulations and to express the hospital's Catholic ethical ideals. The guidelines they developed do not lead to precise conclusions; rather, they direct the search for right decisions. Complicating the development of guidelines are psychological considerations, medical ambiguities, and economics. One reaction to the attempt to establish guidelines for decision making for very ill and handicapped infants is predictable: What right does anyone have to decide who will live and who will die? Who can play God? But healthcare providers must all play God because they have no alternative. If playing God means making life-and-death decisions, then being stewards of human life involves just such a responsibility. Medical professionals working with severely handicapped infants know they cannot avoid this responsibility. Caring human beings simply have to decide for helpless others. The guidelines developed by the Pediatrics Ethics Committee at Saint Vincent Health Center focus on what seems to be best for the dependent and helpless infant, who rightly has a claim on our support, care, love, and concern.

Congenital Abnormalities↗
PubMed1999

Hand-eye dominance in a population with mental handicaps: prevalence and a comparison of methods.

BACKGROUND: The primary purpose of this study was to investigate hand-eye dominance in a population with mental handicaps and how the distribution compared with the general population. In addition, this study investigated the correlation between two methods of hand-eye dominance testing. METHODS: Two methods were used to determine eye dominance: the hole-in-the-hand method and the eye dominance wand. Hand dominance was determined by the subject's choice of accepting hand. The sample was comprised of a population of 421 athletes participating in the 1997 Special Olympic Games in Toronto. All subjects unable to give a dominant hand or unable to perform either of the ocular dominance tests were eliminated from analysis. Athletes who demonstrated strabismus or a difference in visual acuity between the two eyes of greater than 1 line were separated in the analysis, reducing the sample population to 191. RESULTS: The hole-in-the-hand method of eye dominance showed that 40.3% of this population exhibited crossed dominance. The eye dominance wand found crossed dominance in 36.6% of this population. The eye dominance wand demonstrated moderate agreement with the hole-in-the-hand method; however, there was some crossover of eye dominance between tests, when the tests were compared on a case-by-case basis. CONCLUSIONS: The prevalence rate of this population of persons with mental handicaps agrees with the prevalence rates found by Robison et al., in which 41% of a general nonhandicapped population demonstrated crossed dominance. The results suggest that persons with mental handicaps have prevalence rates of crossed dominance similar to those found in the general population.

Adolescent↗
PubMed2000

Articulation index and hearing handicap.

This investigation examined the relationship between perceived hearing handicap and the Articulation Index (AI) and the extent to which this relationship was influenced by the variables age, gender, degree of hearing loss, and audiometric slope. Subject age, gender, pure-tone thresholds, and scores for the Self-Assessment of Communication (SAC) and the Significant Other Assessment of Communication (SOAC) were extracted retrospectively from 373 patient files (194 males, 179 females). Correlation analysis revealed a significant (p < .01) negative relationship between AI values and both measures of hearing handicap, and also indicated that SAC/SOAC total scores correlated significantly (p < .01) with each other. Partial correlation analyses revealed that degree of hearing loss was the only variable under study that had substantial influence on the strength of AI/hearing handicap correlations.

Adolescent↗
PubMed2000

Modeling a two-mile run age and body weight handicap for men and women.

PURPOSE: To develop a weight and age handicap model for Two-Mile Run Test (2MRT) performance for adult men and women using dimensional analysis and recent empirical data. METHODS: Models of the body composition- and physical activity-adjusted effect of age on VO2max and the allometric model of body size and 5 K run time for men and women (adjusted for the 2MRT distance) were employed. RESULTS: Two tables were developed, one for each gender. Each provides a simple index (sec) of run time based on body weight and age, that are subtracted from actual 2MRT time to yield adjusted run time. CONCLUSION: Such a handicap model, which grants a handicap based only on the independent effects of age and weight (not fatness or lack of physical conditioning, for example), is the first to be based on physiologically sound theory and empirical data. It may prove useful for military fitness testing particularly in situations where higher achievement is rewarded and/or control for age and weight differences in warranted.

Adult↗
PubMed2000

Nutritional status of patients in a long-stay hospital for people with mental handicap.

OBJECTIVE: To investigate the general nutritional status of patients in Alexandra Hospital, Cape Town, and to determine whether dietary copper deficiency was causing anaemia in hospital patients. DESIGN: Descriptive and cross-sectional analytical studies. SETTING: A long-stay hospital for people with mental handicap. SUBJECTS: Information was obtained from the total hospital population. In addition, groups of 15 patients were selected from each of two specific wards, one with active and the other inactive patients. To determine whether copper deficiency was causing anaemia, a sample of 30 patients, divided into three groups (a hypochromic microcytic, a normochromic anaemic and a non-anaemic group) was studied. MAIN OUTCOME MEASURES: Body mass indices (BMI) and daily dietary intakes were compared with Recommended Daily Allowance (RDA) values. Serum copper and serum caeruloplasmin levels were used to detect possible copper deficiency. RESULTS: A considerable number of patients were found to be underweight (32% of males and 26% of females had BMIs < 20). A smaller number were obese (6% of males and 17% of females had BMIs > 30). Poor nutrition was more common in severely handicapped patients and those with acquired causes of their mental handicap. Subjects with Down syndrome were generally well nourished and occasionally obese. Poor dietary intakes of biotin, pantothenic acid, vitamin D and copper were encountered. The serum copper and caeruloplasmin values were found to be within normal limits. Patients with hypochromic, microcytic anaemia had higher serum copper and caeruloplasmin levels than those with normochromic anaemia and the control group. CONCLUSIONS: A number of nutritional problems among the inpatient population were found. Many were undernourished, while a smaller number of patients were overweight. In both the active and inactive wards macronutrient intakes were generally within normal limits. However, some micronutrient nutritional deficiencies were encountered. We were unable to establish that dietary copper deficiency was the cause of anaemia in our patients. Elevated serum copper and caeruloplasmin levels found in hypochromic, microcytic patients were thought to result from the existence of low-grade infection, associated with elevation of the acute-phase protein, caeruloplasmin.

Adult↗
PubMed2001

Prevalence of impairments, disabilities, handicaps and quality of life in the general population: a review of recent literature.

OBJECTIVE: To determine the prevalence rates of morbidity in the general population through bibliographic research. METHODS: Articles relating to impairment, disability, handicap, quality of life and their prevalence in the general population, published between January 1990 and March 1998, were selected on the MEDLINE database. FINDINGS: The 20 articles retained out of 433 used 41 different indicators. Indicators of impairment, disability, handicap and low quality of life showed prevalence rates of 0.1-92%, 3.6-66%, 0.6-56% and 1.8-26% respectively, depending on age and the accuracy of indicators. The heterogeneity of the conceptual framework and insufficient recognition of the importance of indicator accuracy, the age factor and the socioeconomic characteristics of the studied populations impede reliable international comparison. CONCLUSION: Further standardization of indicators is therefore required. The revision of the International Classification of Impairments, Disabilities and Handicaps may make it possible to resolve some of the difficulties encountered.

Adolescent↗
PubMed2002

Hearing loss, hearing handicap, and functional health status between African American and Caucasian American seniors.

This investigation examined the relations among hearing loss, handicap perception, and functional health status of 152 African American and Caucasian American seniors ranging in age from 60 to 89 years. Subjective measures were obtained from self-report scores on the Hearing Handicap Inventory for the Elderly (HHIE), the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and demographic profiles. Results indicated the following: (1) both subject groups exhibited nearly identical degrees of sensorineural hearing loss consistent with presbyacusis; (2) African American seniors reported significantly lower levels of completed education than did Caucasian American seniors; (3) differences between groups in self-report scores of hearing handicap (HHIE) were not statistically significant; (4) differences across groups in self-report scores of functional health status (SF-36) were not statistically significant; and (5) increasing levels of hearing loss produced significantly higher HHIE scores and significantly lower SF-36 scores in each group. These findings are discussed.

Acoustic Impedance Tests↗
PubMed2000

The school-to-work transition of people with mental handicap in Hong Kong.

The purpose of this study was to examine the school-to-work experience of people with mental handicap in Hong Kong. Fourteen young adults with mild mental handicap participated in in-depth interviews. An interview guide was utilized which included topics related to the participants' vocational preferences, work motivation and post-school placements. Data were analyzed according to a constant comparative method and content analysis. Three-quarters of the participants expressed job preferences. Three-quarters of the participants had taken a vocational training program unrelated to their job preferences. Half of the participants who had taken up open employment had not obtained their preferred jobs. None of the participants who had completed vocational training obtained job placements that matched their vocational training programs. All of the participants except five were not involved in making independent decisions regarding employment. The need to improve the quality of vocational services and empower people with mental handicap to take up self-determining roles are discussed.

Journal Article↗
PubMed2003

Screening for handicapping hearing loss in the elderly.

OBJECTIVE: To compare 2 screening methods for unrecognized handicapping hearing loss in the elderly. STUDY DESIGN: Cross-sectional study. POPULATION: Five hundred forty-six older individuals who underwent audiometry at biennial examination 22 of the Framingham Heart Study and who took the Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) questionnaire. OUTCOMES MEASURED: The 2 screening methods were the 10-item HHIE-S and 1 global question: "Do you have a hearing problem now?" The gold standard was an audiogram showing a pure tone threshold of 40 dB HL or higher at 1 and 2 kHz in one ear or at 1 or 2 kHz in both ears. Both screening methods were compared with the gold standard in terms of sensitivity, specificity, and predictive values. The 10-item screening version of the HHIE-S (cutoff score between 8 and 10) had a sensitivity of 35% and a specificity of 94% for detecting the criterion hearing loss. The global subjective measure had greater sensitivity (71%) but lower specificity (71%) than the HHIE-S. Combining the global question and the HHIE-S items failed to improve the specificity of the global question or the sensitivity of the HHIE-S. CONCLUSIONS: The global measure of hearing loss was more effective than the detailed questionnaire in identifying older individuals with unrecognized handicapping hearing loss. Primary care physicians are encouraged to ask their patients whether they have a hearing problem and refer patients who do for formal hearing testing.

Activities of Daily Living↗
PubMed1999

Is there a gender difference in coping, perceived disability and handicap in patients with noise-induced hearing loss?

Gender differences in coping strategies and self-rated disability and handicap were explored in individuals with noise-induced hearing loss. The study group consisted of 60 male and 33 female patients, consecutively presenting at the hearing clinics in two hospitals in the western part of Sweden. The females were older and had worse average hearing thresholds over the low frequencies (0.5, 1 and 2 kHz) in the better ear than the males. However, all subjects rated their hearing loss as "moderate" to "severe". The patients responded to the Communication Strategies Scale, CSS, measuring "maladaptive behaviour", "verbal strategies" and "non-verbal strategies" and the Hearing Disability and Handicaps Scale, HDHS, which is composed of four factorially derived subscales: "speech perception", "non-speech sounds", "interpersonal distress" and "threat to the self-image". Pure-tone audiometry and sociodemographic data was also assessed. Despite differences in pure-tone audiometry, there were no significant differences between gender in perceived disability or handicap. Significant gender differences in coping were found. The women used "maladaptive behaviour" and "verbal strategies" significantly more often than the men. This is in agreement with results of an interview-study of women with NIHL, showing that the perceived emotional temperature in a specific situation guided the choice of coping strategy. The gender difference in coping could also be related to, and explained by, the conversational goal (transactional or interactional).

Journal Article↗