Search Results (15)

This article documents and explores the history of the e-scooter ban in Toronto, Ontario, Canada as a pathway to examining broader issues concerning the eradication of accessibility barriers in public spaces for pedestrians with disabilities and respectful uses of consultation to develop disability-inclusive regulations. The use of e-scooters poses a particular dilemma to accessibility for persons with disabilities. On the one hand, the concept of disability contemplates attitudinal and environmental barriers, as noted, for example, in the Preamble of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD). Attitudinal and environmental barriers have traditionally stemmed from interests that are inherently opposed to the collective interests of disabled persons. Examples include attitudes that project stigma against persons with disabilities or a focus on seeking to preserve historical features of the built environment for their aesthetics, without consideration for their accessibility or functionality for disabled persons. They have also generally originated in periods of historical marginalization or exclusion of persons with disabilities. By contrast, e-scooter debates and connected debates regarding the regulation of micromobility vehicles, contain at least one dimension that could very well be shared with persons with disabilities—that is, the preservation of the environment. E-scooters are also a phenomenon of contemporary disability exclusion: policies concerning environmental sustainability, including those promoting e-scooters, are being developed contemporaneously with growing international and national legal recognition of disability rights. These factors render arguments over appropriate regulation of the use of public spaces more complex as, within those arguments, one sees two competing positive policy directions that need to be addressed: the rights of pedestrians with disabilities and environmental sustainability. This article concludes with theoretical and practical suggestions for strengthening regulatory policymaking to address these and other complex intersectional issues of accessibility policy design. Full article

Arts and culture are central to the political struggles of people with disabilities and have the potential to transform how societies relate to disability and to realize the human rights model of disability enshrined in the Convention on the Rights of Persons with Disabilities. Yet, low levels of participation in arts by people with disabilities are reported in many countries. We also lack research to support policy making that promotes positive measures. This article presents some of the findings from a large qualitative study across 28 European countries addressing factors perceived as facilitative of cultural participation by people representing organizations of people with disabilities. Identifying these factors is a step in supporting the deployment of policies aiming to end the exclusion of people with disabilities from the cultural sphere both as audiences and artists and to realize the human rights model of disability. In particular, findings point to the need to change the knowledge base and ethos of cultural bodies and to reform, amongst other issues, funding mechanisms, governance structures, and consultation processes. We argue that making disability inclusion more intrinsic to cultural policy has the potential to enhance diversity and ultimately to foster the participation of people with disabilities in society more broadly. Full article

Background: Evaluating the predictors of unfavorable outcomes in patients with ankle fractures is crucial for identifying high-risk patients and implementing personalized treatment strategies. This study aimed to analyze factors that influence quality of life in patients with ankle fractures. Methods: Four databases were consulted. The main outcomes were functionality and quality of life scales combined using the standard mean difference (SMD) (Review Manager 5.4). Results: Eight studies with 2486 patients were included. A significant correlation was found between female sex and worse functionality scores (beta 4.15, 95% CI 1.84–6.46). Additionally, older age was correlated with worse functionality scores (beta −0.24, 95% CI −0.29 to −0.19). Patients with diabetes or metabolic syndrome also had worse outcomes (SMD 0.27, 95% CI 0.18–0.36). High BMI and obesity were also associated with worse quality of life scores (beta 2.62, 95% CI 0.77–4.48). Smokers had greater disability in the analyzed scales (SMD 0.22, 95% CI 0.05–0.39). No significant differences were observed with respect to syndesmotic involvement. Conclusions: Age, sex, diabetes, high BMI, and smoking negatively impact functional outcomes and quality of life in patients with ankle fractures. Full article

The quality of life is one of the key factors in assessing the health status of HIV-positive individuals, with its improvement considered an important goal of treatment. Assessment of the quality of life helps accurately evaluate the impact of diseases and treatment on the patient’s life. The aim of this study was to assess the quality of life of HIV-positive people in Poland using the example of patients treated in the Observation and Infection Clinic with the Subunit for HIV/AIDS Patients of the University Clinical Hospital in Bialystok, based on the evaluation of HIV-positive status acceptance in HIV patients as well as sociometric variables such as age, gender and marital status. A total of 147 patients participated in this study, including 104 men (70.7%) and 43 women (29.3%). This study was conducted between May 2019 and January 2020 in the Observation and Infection Clinic with the Subunit for HIV/AIDS Patients with the Consultation and Diagnostic Centre at the Teaching Hospital of the Medical University of Bialystok. This study used a diagnostic survey method with a modified questionnaire “Psychosocial Situation of People Living with HIV/AIDS in Poland” by Dr. Magdalena Ankiersztejn-Bartczak and the following standardised psychometric tools: the World Health Organization Quality of Life (WHOQOL-BREF), Short-Form Health Survey (SF-36), Acceptance of Illness Scale (AIS) and Satisfaction with Life Scale (SWLS). The majority of respondents (60%) reported no significant changes in their lives as a result of HIV infection. Gender was not a differentiating factor in the quality of life of people living with HIV. The variation in psychometric measures within the female and male groups was far greater than the difference between them. Marital status clearly differentiated the quality of life. The following conclusions were drawn from this study: The surveyed HIV patients presented a moderate level of quality of life, which was mainly determined by marital status. Higher quality of life was presented by married persons. Duration of infection was not correlated with quality of life. The level of acceptance of HIV infection was relatively high among respondents. A higher level of HIV acceptance was associated with a higher quality of life. The respondents presented a relatively poor level of satisfaction with life. Changing jobs, going on disability, relationship breakdown, not having a family of their own and losing friends were the key HIV-related changes in the lives of the respondents. Full article

The ongoing transformation of mobility, including new services such as on-demand mobility, raises the question of how services need to be designed so that everyone can use them. The number of persons with mobility impairments is increasing as a result of demographic change, and with the current amendment of the law, it will be mandatory in Germany to take these person’s needs into due consideration. After all, a transport provider’s success relies on sufficient demand in society (including persons with and without disabilities). Due to changing mobility routines, increased comfort, and other individual personal requirements, vehicles smaller than conventional buses are necessary for passenger transportation. The following investigation is a research study, which is based on an intensive literature review and expert interview study. The goal of this work is to evaluate the current status quo of the German public transport system with respect to inclusive on-demand services and their satisfaction with user requirements. Therefore, guideline-oriented interviews with experts from the mobility sector were consulted and analyzed. For this purpose, the procedure of the qualitative analysis was used. Furthermore, user analysis and methodological processes were conducted in order to strategically establish necessary measures. On the one hand, the current initial situation is addressed and initial experience with these new services is reported. The current focus is on the automation and electrification of these vehicles. In order to make them accessible to all potential customers, ergonomic requirements should be considered from the beginning. The previous experiences with other vehicle classes as well as the legal framework conditions are to serve as a benchmark. On the other hand, existing challenges will be discussed, and necessary steps will be worked out. A result of this situational analysis shows that the currently available vehicle concepts do not fulfill all requirements. It is important to consider the vehicle and the barrier-free mobility chain (booking and paying for the journey or vehicle, as well as boarding, traveling, and alighting). Overall, the design of barrier-free mobility systems requires a process of both political and social rethinking in order to succeed. Full article

Israel is not isolated from the global migration process. It is required to provide a medical, educational, and socio-cultural response to the integration of tens of thousands of African asylum seekers. This qualitative-phenomenological study collected data from 15 educators as a primary source and learned about their actions to mediate health and educational issues for African asylum seekers. The findings reveal four categories: (1) a healthy lifestyle; (2) emotional-behavioral; (3) learning disabilities and special needs; (4) diseases, vaccines, and medical treatments. It seems that educators are forced to take on roles traditionally entrusted to the state, and they have become agents of socialization who mediate between parents and the Israeli health and education system through personal relationships and individual conversations. This study reveals a dual reality: on the one hand, African asylum seekers experience alienation, exclusion, and violence; on the other hand, they gain a positive point of view when parents see the educators as loyal partners and sources of knowledge who can be consulted to receive help in routine times and during the coronavirus pandemic, a time in which they lost their livelihood, health insurance, and ability to understand the new rules of the lockdowns. Full article

Headache is the first cause of consultation in neurology, and one of the most frequent reasons for consultation in general medicine. Migraine is one of the most common, prevalent, and socioeconomically impactful disabling primary headache disorders. Neuroticism can be conceptualized as a disposition to suffer anxiety and emotional disorders in general. Neuroticism has been associated with various mental and physical disorders (e.g., chronic pain, depression), including migraine. With the aim to explore in depth the relationship between migraine and neuroticism, and contribute to the understanding of this relation in order to provide a better treatment for migraine patients based on a personalized and more comprehensive approach, a scoping review was performed using PubMed, Scopus, and Web of Science. Databases were searched independently by the two researchers, reaching a final set of 18 articles to be included. The search terms were: migraine and neuroticism. Neuroticism seems to be highly prevalent in migraine patients. Findings reveal that migraine patients with comorbid depression and anxiety showed higher levels of neuroticism. Depression has been associated with an increased risk of transformation from episodic to chronic migraine whereas neuroticism might be a mediator factor. Neuroticism also might be a mediator factor between childhood maltreatment and migraine. The revision conducted confirms that: (1) Migraine patients usually have a higher level of neuroticism and vulnerability to negative affect, compared to non-migraineurs and tension-type headache patients. (2) Neuroticism is associated with migraine. Nonetheless, more research is needed to clarify potential moderators of this relationship and the role of neuroticism itself in this disease. This knowledge might be useful in order to promote a better management of negative emotions as part of intervention programs in migraine. Full article

(1) Background: Disability is a dynamic interaction between a person’s health conditions and personal and environmental factors. Disability is an evolving concept, which can be improved by intervening in the barriers that prevent disabled people from functioning in their daily life and enjoying a satisfactory sexual life. Sexuality is an important dimension of life that affects people’s well-being. The aim was to describe and understand the experiences of primary care nurses regarding care for the sexuality of persons with disabilities. (2) Methods: A descriptive qualitative study was designed. Twenty-one in-depth interviews were conducted with nurses. A thematic analysis was used to analyse the data. (3) Results: three main themes emerged: (1) Initial assessment of the patient: competencies for a nurse-patient therapeutic relationship; (2) A comprehensive approach to nursing care for persons with disabilities: the importance of sexuality; and (3) Sex counselling in nursing consultations. (4) Conclusions: Nurses have the skills to develop a good therapeutic relationship with patients. Planning of nursing interventions is required in order to promote individual coping, emotional support, and sex education. Sex counselling is essential to promote autonomy, with the figure of the sex therapist emerging for this purpose. Full article

The participation of organisations of persons with disabilities (OPDs) is crucial at each stage of policy processes at the local, regional, and international levels. However, decision-making mechanisms have traditionally excluded OPDs, failing to consult with them on decisions that impact on their daily lives. The overall aim of this study was to examine the participation of persons with disabilities and OPDs in development programmes and policies by exploring recommendations from a sample of OPDs on ways to strengthen their participation with government and the UN. Secondary data analysis was conducted using a global survey on the participation of OPDs, administered by the International Disability Alliance to OPD representatives. Two open-ended items were analysed, which explored participants’ recommendations on ways to strengthen their participation with government and the UN. Data were analysed using the descriptive and interpretive qualitative methods. Respondents provided recommendations on how to strengthen their participation with their national government and the UN, focusing on several issues including accessibility, human rights, and the need for inclusion of all OPDs and all groups of persons with disabilities. The synergy between the Convention on the Rights of Persons with Disabilities and the Sustainable Development Goals presents opportunities for OPDs to increase their participation in development policies and programmes. It is vital, however, to dismantle the barriers to participation in decision-making by OPDs and persons with disabilities. Full article

People with disabilities may be disproportionally affected by the COVID-19 pandemic. We synthesize the literature on broader health and social impacts on people with disabilities arising from lockdown-related measures. Methods: Scoping review with thematic analysis. Up to mid-September 2020, seven scientific databases and three pre-print servers were searched to identify empirical or perspective papers addressing lockdown-related disparities experienced by people with disabilities. Snowballing searches and experts’ consultation also occurred. Two independent reviewers took eligibility decisions and performed data extractions. Results: Out of 1026 unique references, 85 addressed lockdown-related disparities experienced by people with disabilities. Ten primary and two central themes were identified: (1) Disrupted access to healthcare (other than for COVID-19); (2) Reduced physical activity leading to health and functional decline; (3) From physical distance and inactivity to social isolation and loneliness; (4) Disruption of personal assistance and community support networks; (5) Children with disabilities disproportionally affected by school closures; (6) Psychological consequences of disrupted routines, activities, and support; (7) Family and informal caregiver burden and stress; (8) Risks of maltreatment, violence, and self-harm; (9) Reduced employment and/or income exacerbating disparities; and (10) Digital divide in access to health, education, and support services. Lack of disability-inclusive response and emergency preparedness and structural, pre-pandemic disparities were the central themes. Conclusions: Lockdown-related measures to contain the COVID-19 pandemic can disproportionally affect people with disabilities with broader impact on their health and social grounds. Lack of disability-inclusive response and emergency preparedness and pre-pandemic disparities created structural disadvantages, exacerbated during the pandemic. Both structural disparities and their pandemic ramifications require the development and implementation of disability-inclusive public health and policy measures. Full article

A Sexual Outlook Questionnaire (SOQ) that can apply to a wide range of Korean populations, including disabled people, was necessary for comprehensive research on improving clinical practice of sexual education and developing sex-related intervention programs. We developed the SOQ and tested its validity with exploratory and confirmatory factor analysis and multi-trait/-item matrix analyses. Internal consistency was assessed using Cronbach’s α coefficient for item total correlations. We studied a total of 334 married or previously married adults with no cognitive impairment in the community settings. The eleven survey items were included in the final SOQ. Three factors were found: The first, “personal benefit”, was devoted to the impact of one’s sexual life and included four questions about the health-promoting effects and their recognition of healthiness, youth, and vitality as benefits of their sexual life. The second, “relational value”, included four questions about sex as an expression of love and means of communication, and its effect on the improvement of their relationship with their spouse (partner). The third, “sexual endeavor”, included three questions about the handling of sex-related problems, consulting with an expert, and sexual education. The questionnaire can briefly measure the sexual outlook of any married or previously married adult, regardless of disability. Full article

Disability-inclusive development is important because there are a billion people with disabilities, and they often fall behind in income, education, health, and wellbeing. More and better evidence is needed on the effectiveness of how development interventions include and target people with disabilities. This review outlines some of the methodological challenges facing impact evaluations of disability-inclusive development interventions. Identifying people with disabilities is complex. Most approaches focus on impairment or functional limitations. They may or may not recognise environmental or personal factors, which influence the experience of disability. The Washington Group Short Set is widely endorsed for disability assessment; the addition of anxiety and depression items may enhance this tool further. The appropriate outcomes for the impact evaluation should be selected based on the aims and target audience of the intervention, the availability of appropriate tools, and after consultation with people with disabilities. New and better tools are needed to measure the range of impacts that may occur with greater accuracy, including impacts that are direct/indirect, proximal/distal, intended/unintended, and positive/negative. Disaggregation of data by impairment type is recommended to understand the effectiveness of interventions for different groups where the sample size is sufficient to allow meaningful comparisons. The inclusion of people with disabilities throughout the research process will improve the quality and acceptability of the study conducted. Full article

The article highlights how the strategic use of the Convention on the Rights of Persons with Disabilities (CRPD) by disabled people’s organizations (DPOs) in Iceland has produced a shift in the balance of power with regard to how, and by whom, disability legislation and policy in Iceland is developed. The article draws on a study examining the last stages of a consultative process between representatives of DPOs and policymakers in Iceland leading up to the adoption, in May of 2018, of core disability legislation, Laws pertaining to services for disabled people with long-term support needs (No. 38/2018). It examines the process from the perspective of representatives of DPOs through in-depth interviews and document analysis. This article draws on critical theory and the human rights approach in its analysis, with a particular emphasis on the roadmap to the coproduction of policy provided by the CRPD and the UN CRPD Committee through the issuance of guidance to States Parties to the Convention. It draws attention to the DPOs’ ongoing refocusing of their strategies, and their emphasis on harnessing the rights contained in the CRPD to gain recognition of their right to participation in the coproduction of policy and in changing process norms. Full article

Stroke is the leading cause of disability and death. Nowadays, clinical benefits of stroke units and thrombolysis in ischemic stroke are evidence-based. Also the benefit of endovascular treatment for acute ischemic stroke has been established. Telemedicine has been used to improve access to care by allowing a neurologist at a remote location to interact with the patient and their family members. Prior studies have shown that the use of telemedicine for acute ischemic stroke is not only safe and effective, but it also increases the utilization of tPA, improving patient outcomes. This study aimed to investigate the diffusion of telemedicine in Italian stroke networks with an online questionnaire to assess: type of stroke care setting, Volume of thrombolysis- thrombectomy/year, access to stroke care between different hospitals, the presence of imaging sharing protocols within the network or patients dispatchment screening; type of network solutions. We have interviewed 24 Italian neurologists, working in large urban areas, from north southward, including Italian islands. In particular, these neurologists represented 14 different regions and 20 countries. A majority of neurologists replying to the survey (47.83%) worked in large general hospitals or smaller general hospitals (26%) and a smaller number of physicians (17.3%) were committed in University Hospital or (8.7%) independent foundation hospitals. The 60.87% of stroke networks involved in the survey had a low thrombolysis/year volume while the 30.43% had a thrombolysis/year volume above 100. According to the survey a local stroke network was established in 87.50% of cases. In the 45.83% of cases, the hospitals care is not homogeneous within the network. A network for the consultation of neuroimaging between hospitals is available in 33.33% of cases. Whitin those describing an active network for Teleconsult the 57.14% used personal devices, while only the 25 % use professional teleconference system, and in 25% of cases used medical devices. Our findings demonstrated a relevant diffusion of Teleconsult in Italian stroke networks. The systems adopted are mostly individual solutions not integrated in protocolled pathways. These findings may encourage a systematization of Telemedicine medical curricula to increase larger access to neurological consults. Full article

(1) Background: Recent reforms in Australia, providing people with disability and older people with choice and control over allocated funding, have altered consumer expectations and transformed the landscape of assistive technology (AT) service provision. The purpose of this study is to report on the routine AT outcomes of people who accessed an AT consultation service and examine how well these capture the impact of AT on their lives; (2) Methods: This study, which uses mixed methods for concurrent triangulation of the data, reports on the outcomes for 127 people who acquired a range of assistive technology in 2015 and examines the adequacy of an existing service outcome framework in capturing the true value of these technologies to AT users. Outcome data was routinely collected by a community service 2–4 months following an AT consultation. A telephone or face-to-face interview gathered demographic information as well as AT outcomes, using two standardized tools, the Individualized Prioritised Problem Assessment (IPPA) and the EATS 6D. Qualitative comments relating to the impact of the AT on the person’s life were also documented; (3) Results: The acquired AT generally met or exceeded expectations of the person using the AT and the attending health professional. Overall, people experienced decreased difficulty and increased feelings of autonomy, with most of the reported improvements identified in mobility and usual activities; (4) Conclusion: Routine outcome data provide some evidence of the value of AT in addressing concerns as identified by clients. Qualitative data, which captured the impact of AT on people’s lives, suggest that the empowering and transformative aspects of AT are not currently being captured by existing measures. Full article