Adaptation and validation of UNICEF/Washington group child functioning module at the Iganga-Mayuge health and demographic surveillance site in Uganda.

BACKGROUND: The UNICEF/Washington Group Child Functioning Module (CFM) assesses child functioning among children between 5 and 17 years of age. This study adapted and validated the CFM at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Uganda. METHODS: This cross-sectional study was conducted between September 2018-January 2019 at the IM-HDSS. Respondents were caregivers of children between 5 and 17 years of age who were administered modified Washington Group short set (mWG-SS) and CFM. The responses were recorded on a 4-point Likert scale. Descriptive analysis was conducted on child and caregiver demographic characteristics. Exploratory factor analysis (EFA) assessed underlying factor structure, dimensionality and factor loadings. Cronbach's alpha was reported as an assessment of internal consistency. Face validity was assessed during the translation process, and concurrent validity of CFM was assessed through comparison with disability short form. RESULTS: Out of 1842 caregivers approached, 1439 (78.1%) participated in the study. Mean age of children was 11.06 ± 3.59 years, 51.4% were males, and 86.1% had a primary caregiver. Based on EFA, vision, hearing, walking, self-care, communication, learning, remembering, concentrating, accepting change, behavior control, and making friends loaded on factor 1 - "Motor and Cognition," while anxiety and depression loaded on factor 2 - "Mood". Cronbach's alpha for the overall CFM was 0.899 (good internal consistency). Cronbach's alpha for each extracted factor was excellent, motor and cognition (0.904), and mood (0.902). CFM had acceptable face validity. Spearman's rank correlation between scores of CFM and modified WG short set was 0.51 (p-value < 0.001). The overall mean CFM score was 2.47 ± 3.82 out of 39. The mean score for Mood (1.35 ± 1.42 out of 6) was higher compared to Motor and Cognition (1.12 ± 3.06 out of 33). Comparing modified WG short set and CFM Likert responses, the percent agreement was greatest for "cannot do at all." CONCLUSION: CFM is a two-factor, valid and reliable scale for assessing disability in Uganda and can be applied to other similar settings to contribute towards disability data from the region. It is an easy-to-administer tool that can help in deeper understanding of context-specific burden and extent of disability in children between 5 and 17 years of age.

Understanding child disability: Factors associated with child disability at the Iganga-Mayuge Health and Demographic Surveillance Site in Uganda.

INTRODUCTION: There is scarcity of data on children with disabilities living in low-and-middle-income countries, including Uganda. This study describes disability prevalence and explores factors associated with different disability categories. It highlights the value of using a standardized, easy-to-use tool to determine disability in children and contextualizing disability in children in light of their developmental needs. METHODS: A cross-sectional study was conducted between September 2018-January 2019 at the Iganga-Mayuge Health and Demographic Surveillance Site in Uganda. Respondents were caregivers of children between 5-17 years and were administered an in-depth Child Functioning Module (CFM). The outcome variable, disability, was defined as an ordered categorical variable with three categories-mild, moderate, and severe. Generalized ordered logit model was applied to explore factors associated with disability categories. RESULTS: Out of 1,842 caregivers approached for the study, 1,439 (response: 78.1%) agreed to participate in the study. Out of these 1,439, some level of disability was reported by 67.89% (n = 977) of caregivers. Of these 977 children with disability, 48.01% (n = 692) had mild disability and 15.84% (n = 228) had moderate disability, while 3.96% (n = 57) had severe disability. The mean (SD) score for mild disability was 2.22±1.17, with a median of 2. The mean and median for moderate disability was 5.26±3.28 and 4 (IQR:3-6), and for severe disability was 14.23±9.51 and 12 (IQR:6-22). The most common disabilities reported were depression (54.83%) and anxiety (50.87%). Statistically significant association was found for completion of immunization status and school enrollment when controlled for a child's age, sex, having a primary caregiver, age of mother at child's birth, family system, family size and household wealth quintile. CONCLUSION: This study suggests association between incomplete immunization status and school enrollment for children with disability. These are areas for further exploration to ensure inclusive health and inclusive education of children with disabilities in Uganda.

Measuring disability and monitoring the UN Convention on the Rights of Persons with Disabilities: the work of the Washington Group on Disability Statistics.

The Washington Group on Disability Statistics is a voluntary working group made up of representatives of over 100 National Statistical Offices and international, non-governmental and disability organizations that was organized under the aegis of the United Nations Statistical Division. The purpose of the Washington Group is to deal with the challenge of disability definition and measurement in a way that is culturally neutral and reasonably standardized among the UN member states. The work, which began in 2001, took on added importance with the passage and ratification of the UN Convention on the Rights of Persons with Disabilities since the Convention includes a provision for monitoring whether those with and without disabilities have equal opportunities to participate in society and this will require the identification of persons with disabilities in each nation. The International Classification of Functioning, Disability and Health (ICF) developed by the World Health Organization provided a framework for conceptualizing disability. Operationalizing an ICF-based approach to disability has required the development of new measurement tools for use in both censuses and surveys. To date, a short set of six disability-related questions suitable for use in national censuses has been developed and adopted by the Washington Group and incorporated by the United Nations in their Principles and Recommendations for Population and Housing Censuses. A series of extended sets of questions is currently under development and some of the sets have been tested in several countries. The assistance of many National and International organizations has allowed for cognitive and field testing of the disability questionnaires in multiple languages and locations. This paper will describe the work of the Washington Group and explicate the applicability of its approach and the questions developed for monitoring the UN Convention on the Rights of Persons with Disabilities.

Measuring child functioning: Assessing correlation and agreement between caregiver and child responses at the Iganga-Mayuge health and demographic surveillance site in Uganda.

INTRODUCTION: Empirical data is scare on assessment of concordance between caregiver-child responses on child functioning. OBJECTIVE: To assess correlation and agreement between children (11-17 years old) and their caregivers' responses to the UNICEF/Washington Group Child Functioning Module (CFM) at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Uganda. METHODS: CFM with 24-questions corresponding to 13 domains of functioning was administered to children between 11 and 17 years of age and their caregivers. Descriptive analyses of the child/caregiver responses were conducted. Correlation and agreement between caregiver and child responses were assessed. RESULTS: Of the 217 caregiver/child pairs eligible for this study, 181 pairs agreed to participate (83.4%). The mean age of children was 13.9 ± 1.9 years, and 56.4% were males. Cronbach's alpha was 0.892 and 0.886 for the caregiver and child versions of CFM respectively, showing good internal consistency in both. There was a significant overall agreement between mean score of caregiver (5.36 ± 5.63 out of 39) and child (5.45 ± 5.34) pairs. Spearman's rank correlation between the pairs was 0.806 (strong positive correlation). Bland-Altman plots for CFM scores showed greater agreement between caregiver and child at lower scores. Percentage agreement between the pairs for overall disability was greater for mild (83.53%) and moderate (79.37%) categories as compared to the severe (66.67%) category. There was substantial agreement (kappa 0.623) for overall disability between the pairs. CONCLUSION: This study indicates that there is significant correlation and agreement between self-reported caregiver-child pair responses, opening the way for considering children as CFM respondents, when possible.

Population-based prevalence of CDKN2A and CDK4 mutations in patients with multiple primary melanomas.

The presence of multiple primary cutaneous melanomas (MPM) has been advocated as guidance to identifying melanoma families. Frequencies of CDKN2A mutations in materials of sporadic MPM cases from pigmented lesion clinics vary between 8 and 15%. Patients with MPM have therefore been regarded as good candidates for CDKN2A mutational screening. We describe a population-based study where all persons in Norway diagnosed with MPM between 1953 and 2004 (n = 738 alive per April 2004) were invited to participate. Three-hundred-and-ninety patients (52.8%) responded confidentially. Mutations in CDKN2A were found in 6.9% of the respondents. Eighty-one MPM patients (20.8%) reported that they belonged to melanoma families, and 17 (21.0%) of these harboured a CDKN2A mutation, compared to 3.2% of the nonfamilial cases. The probability of finding a CDKN2A mutation increased when the patients had three or more melanomas, or a young age of onset of first melanoma. We identified five novel CDKN2A variants (Ala57Gly, Pro81Arg, Ala118Val, Leu130Val, and Arg131Pro) and four that previously have been reported in melanoma families (Glu27X, Met53Ile, Arg87Trp, and Ala127Pro). A large deletion (g.13623_23772del10150) encompassing exon 1alpha and the 5' part of exon 2 was detected in six patients with a family history of melanoma. Three patients, belonging to the same family, had the CDK4 Arg24His mutation. The frequency of CDKN2A mutations was lower than previously reported in other studies, an observation which probably is due to the population-based design of our study.

Exploring ICF components in a survey among Xhosa speakers in Eastern & Western Cape, South Africa.

PURPOSE: To contribute to the testing and development of the ICF model by exploring the relationship between activity limitations, participation restrictions and environmental barriers. METHOD: Structured questionnaire-based interviews were carried out among a convenience sample of 950 households counting 4917 individuals in Eastern and Western Cape, South Africa. Approximately half of the households had at least one individual with disability, while the other half represented controls in the study. Activity limitations, participation restrictions and environmental barriers were operationalized by means of questions drawn directly from the ICF checklist. RESULTS: Principal component analyses supported a four-component solution for the activity and participation variables, and a two-component solution for the barrier variables. Scales for each sub-component were produced by adding the individual items under each sub-component. Male respondents are more restricted than females when it comes to social activities, individual care, education and mobility barriers. While respondents in Western Cape scored higher (more limitations and restrictions) on the activity and participation sub-scales individual care, daily activities and education, Eastern Cape respondents scored higher on both the environmental barrier sub-scales. CONCLUSIONS: A viable structure of sub-components under the broader ICF concepts has been demonstrated. The study has provided some support to viewing activity limitations and participation restrictions as two independent dimensions, but also invites further studies and refinement of the model.

The development and testing of a module on child functioning for identifying children with disabilities on surveys. I: Background.

This is the first of three papers that will document the development of a survey module on child functioning developed by UNICEF in collaboration with the Washington Group on Disability Statistics (WG), and demonstrate - both conceptually and through test results - the strengths of that module compared with alternative tools for identifying children with disabilities in household surveys. This first paper in the series sets the background and reviews the literature leading to the development of the UNICEF/WG Child Functioning Module (CFM) and presents the WG Short Set of questions (WG-SS) and the Ten Question Screening Instrument (TQSI) as precursors, outlining some of their shortcomings and how the UNICEF/WG CFM was designed to meet those challenges. Subsequent articles will summarize results from the cognitive and field testing of the CFM including comparisons with results derived from the TQSI and the WG-SS.

The development and testing of a module on child functioning for identifying children with disabilities on surveys. III: Field testing.

BACKGROUND: A module on child functioning developed by UNICEF and the Washington Group on Disability Statistics (WG) for use in censuses and surveys reflects current thinking around disability measurement and is intended to produce internationally comparable data. The Child Functioning Module (CFM) was developed in response to limitations of the Ten Question Screening Instrument (TQSI) for use in surveys and builds on the WG Short Set (WG-SS) of questions that was designed to capture disability in censuses, particularly among the adult population. OBJECTIVE: This paper documents the testing of the module and summarizes its results, including a description of prevalence levels across countries using different cut-offs, and comparisons with prevalence levels obtained using the TQSI and the WG-SS. METHODS: Field tests were conducted in Samoa as part of the 2014 Demographic and Health Survey and in Mexico as part of the 2015 National Survey of Boys, Girls and Women. The module was also implemented in Serbia as part of a dedicated survey conducted in the province of Vojvodina, in February 2016. RESULTS: Using the recommended cut-offcut-off, the percentage of children reported as having functional difficulty ranges from 1.1% in Serbia to 2% in Mexico among children aged 2-4 years, and from 3.2% in Samoa to 11.2% in Mexico among children aged 5-17 years. Across all three countries, the prevalence of functional difficulty was highest in the socio-emotional domains. A comparison of the prevalence levels obtained using the WG-SS and the CFM shows that, except for the question on cognition/learning, the WG-SS and the CFM are relatively close for children aged 5-17 years for the domains that are included in both question sets, but the WG-SS excludes many children identified by the CFM in other domains. The comparison between the TQSI and the CFM shows that, while the prevalence estimates are similar for seeing and hearing, significant differences affect other domains, particularly cognition/learning and communication. CONCLUSIONS: The CFM addresses a full range of functional domains that are important for child development. The module represents an improvement on the TQSI in that it allows for scaled responses to determine the degree of difficulty, and so can separate out many potential false positives. The module is also preferred over the WG-SS for collecting data on children, first, because most of the questions in the WG-SS are not suitable for children under the age of 5 years, and second, because the WG-SS leaves out important functional domains for children aged 5-17 years, namely those related to developmental disabilities and behavioural issues.

Field testing a draft version of the UNICEF/Washington Group Module on child functioning and disability. Background, methodology and preliminary findings from Cameroon and India.

BACKGROUND: Global child disability data are generally non-comparable, comprising different tools, methodologies and disability definitions. UNICEF and The Washington Group on Disability Statistics (WG) have developed a new tool on child functioning and disability to address this need. AIMS: The aim of this paper is to describe the development of the new module, and to present an independent field test of the draft module in two contrasting settings. METHODS: UNICEF and the WG developed a parent-reported survey module to identify children aged 2-17 years with functional difficulties in population-based surveys through: review of existing documentation, consultation with experts and cognitive testing. A field test of the draft module was undertaken in Cameroon and India within a population-based survey. Functional limitation in each of 14 domains was scored on a scale comprising "no difficulty", "some difficulty", "a lot of difficulty" and "cannot do". RESULTS: In all, 1713 children in Cameroon and 1101 children in India were assessed. Sixty-four percent of children in Cameroon and 35% of children in India were reported to have at least some difficulty in one or more domain. The proportion reported to have either "a lot of difficulty" or "cannot do" was 9% in Cameroon and 4% in India. There were no significant differences in reported functional difficulties by sex but children aged 2-4 were reported to have fewer functional difficulties of any kind compared with older children in both countries. CONCLUSION: Comparable estimates were generated between the two countries, providing an initial overview of the tool's outputs. The continued development of this standardised questionnaire for the collection of robust and reliable data on child disability is essential.

CONTEXTE: Les données globales sur les enfants handicapés sont difficiles à comparer étant donnée la variété des outils, des méthodologies et des définitions du handicap utilisées. L'UNICEF et le Washington Group (WG) ont développé un nouvel outil pour documenter le fonctionnement et le handicap de l'enfant. OBJECTIFS: L'objectif de cette note de recherché vise à décrire le développement de ce nouvel outil et à présenter un test du module provisoire qui a été fait de manière indépendante sur deux terrains différents. MÉTHODES: L'UNICEF et le WG ont développé pour l'enquête un module dans lequel des parents sont interrogés afin d'identifier les enfants âgés de 2 à 17 ans ayant des difficultés fonctionnelles dans les enquêtes en population : examen de la documentation existante, consultation d'experts et tests cognitifs. Le module provisoire a été testé sur le terrain au Cameroun et en Inde dans des enquêtes en population. Les limitations fonctionnelles dans chacun des 14 domaines ont été mesurées avec une échelle allant de « aucune difficulté ¼, « quelques difficultés ¼, « beaucoup de difficultés ¼ à « ne peux pas faire ¼. RÉSULTATS: Au total, 1713 enfants ont été évalués au Cameroun et 1101 en Inde à partir de ce module. Soixante-quatre pour cent des enfants au Cameroun et 35 % des enfants en Inde ont rapporté avoir au moins quelques difficultés dans un ou plusieurs domaines. La proportion d'enfants ayant déclaré « beaucoup de difficultés ¼ ou « ne peux pas faire ¼ était de 9 % au Cameroun et de 4 % en Inde. Il n'y avait pas de différences significatives selon le sexe dans les difficultés fonctionnelles déclarées mais les enfants âgés de 2 à 4 ans ont déclaré moins de difficultés fonctionnelles de manière générale par rapport aux enfants plus âgés dans les deux pays. CONCLUSION: Des estimations comparables ont été produites dans les deux pays, fournissant un premier aperc¸ u des potentialités de l'outil. La poursuite du développement de ce questionnaire standardisé pour collecter des données robustes et fiables sur le handicap de l'enfant est essentielle.

[Treatment of asthma--an analysis of clinical judgment among general practitioners]. / Behandling av astma--en klinisk beslutningsanalyse blant allmennpraktikere.

BACKGROUND: The asthma patient's symptoms, use of drugs, and peak expiratory flow rates dictate treatment of asthma according to the guidelines. Our aim was to examine which information influenced the decisions of general practitioners. MATERIAL AND METHODS: Out of 100 general practitioners attending a course on asthma management, 75 responded to several constructed patient cases on asthma treatment. They decided whether or not to give oral steroids in case of an acute exacerbation and judged the quality of pharmacological treatment. Age, symptoms, body temperature, peak expiratory flow measurement and the dose of beta-2 agonists and inhaled steroids varied from patient to patient. Their attitudes to the use of oral steroids and to the usefulness of measuring peak expiratory flow were evaluated. RESULTS: Among the doctors, 52% evaluated only one characteristic of the patients when deciding upon treatment with oral steroids. The use of drugs was evaluated by one quarter of the doctors when they judged the quality of treatment. Respectively, 81% and 73% were influenced by objective measurements in these decisions. The majority of doctors applied oral steroids and measured peak expiratory flow in asthmatics. INTERPRETATION: This study indicates that general practitioners focus mainly on measured peak expiratory flow rate. The patient's symptoms ought to be given more consideration in the treatment of asthma. The patient's use of anti-asthmatics is emphasised in guidelines, but was of only limited importance to the doctors in this study.

Psychological and physical functioning difficulties associated with complex activity limitations among U.S. adults.

BACKGROUND: There is limited research that assesses psychological functioning categorically as a predictor of complex activity limitations either alone or in conjunction with physical functioning. OBJECTIVES: This paper assesses the impact of psychological and/or physical functioning difficulties as predictors of complex activity limitations among U.S. adults, using data from a national survey. METHODS: Data come from the 2006-2010 National Health Interview Survey among U.S. adults 18 or older (n = 124,337). We developed a combined physical/psychological exposure variable with six categories: 1) no/low psychological distress (LPD) and absence of physical functioning difficulties, 2) moderate psychological distress (MPD) only, 3) serious psychological distress (SPD) only, 4) physical functioning difficulty only, 5) MPD and physical functioning difficulties, and 6) SPD and physical functioning difficulties. Selected complex activity limitations include daily living, social and work limitations. RESULTS: Compared to adults with LPD and absence of physical functioning difficulties, the results demonstrated a clear and significant gradient of increasing risk of complex activity limitations beginning with MPD only, SPD only, physical functioning difficulty only, both MPD and physical functioning difficulties, and SPD and physical functioning difficulties. CONCLUSIONS: The data suggest a stronger risk of complex activity limitations when increasing psychological functioning difficulties coexist with physical functioning difficulties, leading to potential interference with a person's ability to accomplish major life activities measured in this study. The sizeable contribution of psychological distress to the prevalence of basic actions difficulty implies that the mental health component of functional limitations is important in the overall assessment of health and well-being.

Comments on Sabariego et al. Measuring Disability: Comparing the Impact of Two Data Collection Approaches on Disability Rates. Int. J. Environ. Res. Public Health, 2015, 12, 10329-10351.

In the article, Measuring Disability: Comparing the Impact of Two Data Collection Approaches on Disability Rates, in Volume 12 of the Journal International Journal of Environmental Research and Public Health, Carla Sabariego et al. [1] raise several issues regarding the use of the short set of questions developed by the Washington Group on Disability Statistics (WG) as compared with the approach to disability measurement proposed through the Model Disability Survey (MDS). We address these below. [...].

Suicidal ideation and attempts in Norwegian police.

Studies on suicide among police show inconsistent results, thereby contributing to considerable speculation regarding why police officers commit suicide. The present paper is the first nationwide study on suicidal ideation and attempts among police. 3,272 Norwegian police completed Paykel's Suicidal Feelings in the General Population questionnaire. Lifetime prevalence of specific questionnaire items ranged from 24% for the feeling that life was not worth living, 6.4% for having seriously considered suicide, and 0.7% for attempted suicide. Independent predictors of serious suicidal ideation were marital status, subjective health complaints, reality weakness, anxiety, and depression. Serious suicidal ideation was mainly attributed to personal and family problems.

Is there a specific relationship between childhood sexual and physical abuse and repeated suicidal behavior?

OBJECTIVE: Studies show that childhood sexual and physical abuse predict repeated suicide attempts and self-mutilation. Little is known about the importance of sexual and physical abuse when compared to other severe childhood adversities with respect to chronic suicidal behavior. METHOD: Seventy-four subjects, 65% of whom were women, consecutively admitted to a general hospital after having made a suicide attempt, were interviewed as part of the intake interview about prior suicide attempts and self-mutilation and received DSM-IV diagnoses. Sexual abuse, physical abuse, neglect, antipathy from parents, loss of parents, and severe discord in the family before the age of 18, were covered by the Childhood Experience of Care and Abuse (CECA) interview schedule. RESULTS: The prevalence of severe sexual abuse was 35%, severe physical abuse 18%, neglect 27%, antipathy 34%, loss of caregiver 37% and exposure to family violence 31%. Physical and sexual abuse were independently associated with repeated suicide attempts when controlling for the effects of the other childhood adverse factors. No other childhood adversity was related to chronic suicidal behavior. The odds ratio of exposure to sexual or physical abuse was highest among those who both repeated suicide attempts and self-mutilated. CONCLUSION: Physical and sexual abuse are significantly and independently associated with repeated suicidal behavior.

Methods to improve international comparability of census and survey measures of disability.

PURPOSE: To describe the methods used by the Washington Group on Disability Statistics (WG) to develop internationally comparable questions on disability that can be used worldwide. METHOD: The WG approach to developing disability measures included careful consideration of the theoretical and conceptual issues associated with disability, translating disability concepts into measurement tools, and mixed-method evaluations of the proposed questions using both cognitive and field interviewing methodologies. RESULTS: Disability is a complex construct the measurement of which presents considerable challenges for survey methodologists. The Washington Group on Disability Statistics (WG), a UN Statistical Commission sponsored city group, was established to address the methodological and measurement challenges that have characterized disability statistics and to develop questions for use worldwide that will provide comparable, valid and reliable disability statistics. The WG used a variety of methods to meet these objectives and has finalized a short set disability measure for use in censuses worldwide. CONCLUSIONS: The methodologies adopted by the WG have resulted in question sets that greatly improve the international comparability of disability statistics and will advance our understanding of disability worldwide.

Assessing injury-related movement difficulties: A method for analyzing the association between functional limitations and social participation.

BACKGROUND: The conceptualization of disability has shifted from a medical to a social model with a consequent focus away from impairments and toward activities and participation. The International Classification of Functioning, Disability and Health (ICF) provides a common point of reference and a common language in a developing disability discourse. OBJECTIVES: We sought to apply a model for the measurement of disability based on the activity and participation constructs of the ICF to persons with movement difficulty as a result of injury-related causes. METHODS: Data from sample adults aged 18 years and over in the 2001-2006 National Health Interview Survey (NHIS) were used for analysis. Disability among adults with injury-related movement difficulty was assessed through measures of difficulty performing basic actions (movement, sensory, emotional, and/or cognitive functioning); and limitations of complex activities (defined through measures of self-care, social participation, and work participation). SUDAAN 9.0 was used in all analyses to account for the complex sampling design and weighting of the NHIS data. RESULTS: Approximately 16% of noninstitutionalized adults who reported movement difficulty mentioned injury as a cause. On average, between 2001 and 2006, about 7.6 million adults had injury-related movement difficulty in the United States. Overall, 50% of adults who experienced injury-related movement difficulty also experienced some complex activity limitation. CONCLUSIONS: Using NHIS data, we have demonstrated the applicability of an approach using basic actions difficulty and complex activity limitations to measure functioning and participation in individuals with a specific type and cause of difficulty: injury-related movement difficulty. The operationalization of these constructs provides a possible tool to monitor progress toward the attainment of the equalization of opportunities among people with injury-related movement difficulty.

Mood disorders and physical functioning difficulties as predictors of complex activity limitations in young U.S. adults.

BACKGROUND: There is established research that shows associations between basic physical functional difficulties and complex activity limitations. In addition, there is some research that shows associations between mood disorders and complex activity limitations. However, there is limited research looking at the joint association between mood disorders and physical functioning and complex activity limitations. Furthermore, because mood disorders and physical functioning limitations increase with age, there is a lack of information available on younger adults. OBJECTIVES: We assess the impact of mood disorders and physical function difficulties as predictors of complex activity limitations in young U.S. adults, using data from a national survey. METHODS: We use data from the Third National Health and Nutrition Examination Survey (NHANES III) among young U.S. adults 17 to 39 years of age. Selected basic actions difficulties include physical functioning difficulties (motor, visual, or hearing difficulties) and mood disorders (major depressive disorder, dysthymia, or bipolar disorder). Selected complex activity limitations include limitations in activities of daily living (ADLs) (walking inside the home, standing from a chair, getting into and out of bed, eating, and dressing), instrumental activities of daily living (IADLs) (doing chores around the house, preparing meals, and managing money), and/or specific major life activities (limitations in the kind or amount of work or housework they could perform, or being limited in any way because of an impairment or health problem). RESULTS: The prevalence of basic actions difficulty (physical functioning and/or mood disorder difficulties) among young adults is 34%. Among the young adults with basic actions difficulty, nearly 39% have mood disorders. The prevalence rates for ADL/IADL, major life activities, and any complex activity limitation are 8.6%, 8.1%, and 13.6%, respectively. Compared with young adults with no basic actions difficulties, the results showed that young adults with mood disorders alone had elevated adjusted odds ratios (2.5) for limitations in ADLs and/IADLs. For all the complex activity limitations analyzed, compared to those with no basic actions difficulties, young adults with physical functioning difficulties alone had substantially higher adjusted odds ratios (5.4-8.7) and young adults with comorbid mood disorder and physical functioning difficulties had the highest observed odds ratios (9.7-14.0). CONCLUSIONS: The data suggest a stronger risk of complex activity limitations when mood disorders coexist with physical functioning difficulties, leading to potential interference with a person's ability to accomplish the ADLs/IADLs or major life activities measured in this study. Given the magnitude of basic actions difficulty prevalence, and particularly the substantial contribution of mood disorders to this prevalence, further examination of the mental health component of basic actions difficulty is warranted. A possible area for future research could explore coordinated efforts to reduce physical and mental difficulties and facilitate the accomplishment of complex activities.

Functional difficulties among school-aged children: United States, 2001-2007.

OBJECTIVE: This report presents estimates of basic actions difficulty, which includes difficulties related to sensory, motor, cognitive, and emotional or behavioral functioning, in U.S. children aged 5-17 years based on questions from the National Health Interview Survey (NHIS). Selected estimates are shown for the educational and health care service use of children with and without basic actions difficulty. METHODS: Estimates of basic actions difficulty were derived from the Family Core and the Sample Child Core questionnaires of the 2001-2007 NHIS. Estimates were generated and compared using SUDAAN, a statistical package that adjusts for the complex sample design of NHIS. RESULTS: Approximately 18% of children aged 5-17 had basic actions difficulty in one or more of the following domains of functioning: sensory, movement, cognitive, or emotional or behavioral. The percentage of children with difficulty in specific domains varied: 3% had sensory difficulty, 2% movement difficulty, 9% cognitive difficulty, and 10% emotional or behavioral difficulty. From 2001 through 2007, the percentage of children aged 5-17 with basic actions difficulty remained stable at about 18%. Children with and without basic actions difficulty differed greatly in their use of both educational and health care services. One-third of children with basic actions difficulty used special education services compared with 2% of children without basic actions difficulty. A substantially higher percentage of children with basic actions difficulty used health care services, including mental health care, other types of therapy, and prescription medication, than children without basic actions difficulty.