[Social support and accompaniment for patients with disabilities]. / Soutien et accompagnement social des patients en situation de handicap.

The announcement of multiple sclerosis is likely to turn a person's life and plans upside down. Many questions then arise, particularly concerning rights and available assistance. Faced with the multitude of existing organizations and mechanisms, caregivers can direct the patient to a social service assistant. This person will be able to advise and accompany the patient in his or her efforts.

Systematic review of interventions for reducing stigma experienced by children with disabilities and their families in low- and middle-income countries: state of the evidence.

OBJECTIVES: To identify and assess the evidence for interventions to reduce stigma experienced by children with disabilities and their families in low- and middle-income settings. METHODS: Systematic review of seven databases (MEDLINE, EMBASE, Global Health, PsycINFO, Social Policy and Practice, CINAHL, IBSS) for studies of interventions that aimed to reduce stigma for children with disabilities published from January 2000 to April 2018. Data were extracted on study population, study design, intervention level(s) and target group, and type(s) of stigma addressed. A narrative approach was used to synthesise the results. RESULTS: Twenty studies were included. The majority (65%) of interventions targeted enacted stigma (negative attitudes) and the most common intervention approach was education/training (63%). Over half (54%) of interventions were delivered at the organisational/institutional level, and only four studies targeted more than one social level. The most common disability targeted was epilepsy (50%) followed by intellectual impairment (20%). The majority of studies (n = 18/20, 90%) found a reduction in a component of stigma; however, most (90%) studies had a high risk of bias. CONCLUSIONS: This review highlights the lack of quality evidence on effective stigma-reduction strategies for children with disabilities. Validation and consistent use of contextually relevant scales to measure stigma may advance this field of research. Studies that involve people with disabilities in the design and implementation of these strategies are needed.

OBJECTIFS: Identifier et évaluer les données des interventions visant à réduire la stigmatisation subie par les enfants avec des invalidités et leurs familles dans les milieux à revenu faible et intermédiaire. MÉTHODES: Revue systématique de sept bases de données (MEDLINE, EMBASE, Global Health, PsycINFO, Social Policy and Practice, CINAHL, IBSS) pour des études d'interventions visant à réduire la stigmatisation des enfants handicapés publiées de janvier 2000 à avril 2018. Les données ont été extraites sur la population étudiée, la conception de l'étude, le(s) niveau(x) d'intervention et le groupe cible, ainsi que le(s) type(s) de stigmatisation abordé(s). Une approche narrative a été utilisée pour synthétiser les résultats. RÉSULTATS: Vingt études ont été incluses. La majorité (65%) des interventions ciblaient la stigmatisation (attitudes négatives) et l'approche d'intervention la plus courante était l'éducation/la formation (63%). Plus de la moitié (54%) des interventions ont été réalisées au niveau organisationnel/institutionnel et seules quatre études ciblaient plus d'un niveau social. L'invalidité la plus fréquemment ciblée était l'épilepsie (50%) suivie de la déficience intellectuelle (20%). La majorité des études (n = 18/20, 90%) ont trouvé une réduction d'une composante de la stigmatisation, mais la plupart (90%) des études présentaient un risque élevé de biais. CONCLUSIONS: Cette revue met en évidence le manque de données probantes de qualité sur les stratégies efficaces de réduction de la stigmatisation pour les enfants handicapés. La validation et l'utilisation cohérente d'échelles contextuellement pertinentes pour mesurer la stigmatisation pourraient faire avancer ce domaine de recherche. Des études impliquant les personnes avec des invalidités dans la conception et la mise en œuvre de ces stratégies sont nécessaires.

[Chronic chest pain after rib fracture: It can cause a disability?] / La douleur thoracique chronique après fracture de côtes : peut-elle causer une invalidité ?

INTRODUCTION: The rib fractures and instability of the chest wall are the main lesions of closed chest trauma. These lesions can be a source of chronic, often disabling with daily discomfort resulting limitation of some activities. The objective of this study was to assess the prevalence of this phenomenon in order to improve the quality of early care. METHODOLOGY: Through an observational retrospective cohort study on a number of 41 patients supported and monitored for traumatic rib fractures at the Military Hospital of Meknes during the period from October 2010 to March 2016. RESULTS: The circumstances of the accident were dominated by accidents of public roads (86%) and concerned the young adult male. Radiographs have enumerated 165 fracture lines with an average of 4 rib fractures per patient. These were unilateral fractures in 88% of cases, and concerned the means arc in 46% of cases. The rib fracture was undisplaced fracture in 39% of patients, whereas in 2 patients, a flail chest was present. Post-traumatic hemothorax (63% of cases) were the thoracic lesions most commonly associated with rib fractures. The initial management consisted in the use of analgesics systemically in all patients. The retrospective evaluation of pain by the verbal scale was possible in 30 patients. The persistent pain was noted in 60% of cases. This pain was triggered by a simple effort to moderate in 55% of cases, and hard effort in 28% of cases. In 17% of patients, even at rest, the pain occurred intermittently. The impact in terms of disability was mild to moderate in 28% of cases and important in 17%. The neuropathic pain was found in 3 patients. Therapeutically, the first and second levels of analgesics were sufficient to relieve pain. The neuroleptics were required for 2 patients. CONCLUSION: Our study confirms the persistence of chronic painful, sometimes lasting several years after the initial chest trauma. This pain is responsible of disability triggered most often after exercise.

Disability, social functioning and school inclusion among older children and adolescents living with HIV in Zimbabwe.

OBJECTIVE: Increasing numbers of children with HIV are surviving to adolescence and encountering multiple clinical and social consequences of long-standing HIV infection. We aimed to investigate the association between HIV and disability, social functioning and school inclusion among 6- to 16-year-olds in Zimbabwe. METHODS: HIV-infected children receiving antiretroviral therapy from a public-sector HIV clinic and HIV-uninfected children attending primary care clinics in the same catchment area were recruited. Standardised questionnaires were used to collect socio-demographic, social functioning and disability data. Multivariable logistic regression was used to assess the relationship between HIV status and disability and functioning. RESULTS: We recruited 202 HIV-infected and 285 HIV-uninfected children. There was no difference in age and gender between the two groups, but a higher proportion of HIV-infected children were orphaned. The prevalence of any disability was higher in HIV-infected than uninfected children (37.6% vs. 18.5%, P < 0.001). HIV-infected children were more likely to report anxiety (adjusted odds ratio (aOR) 4.4; 95% CI 2.4, 8.1), low mood (aOR 4.2; 2.1, 8.4) and difficulty forming friendships (aOR 14.8; 1.9, 116.6) than uninfected children. Children with HIV also reported more missed school days, repeating a school year and social exclusion in class. These associations remained apparent when comparing children with HIV and disability to those with HIV but no disabilities. CONCLUSIONS: Children with HIV commonly experience disabilities, and this is associated with social and educational exclusion. Rehabilitation and support services are needed to facilitate educational attainment and social participation in this group.

Factors associated with the delay of diagnosis of leprosy in north-eastern Colombia: a quantitative analysis.

OBJECTIVES: To determine the average time in months between the beginning of symptoms and the diagnostic confirmation of leprosy by the health system and to investigate factors associated with diagnostic delay. METHODS: A total of 249 patients older than 15 years diagnosed with leprosy between 2011 and 2015, in 20 endemic municipalities of north-eastern Colombia, provided informed consent and were interviewed face-to-face. Clinical histories from health centres or hospitals where study participants were treated for leprosy were also reviewed. RESULTS: The mean delay in diagnosis of leprosy was 33.5 months. About 14.9% of patients showed a visible deformity or damage (disability grade 2, DG2) at the time of diagnosis. In multivariable regression analysis, five or more consultancies required to confirm the diagnosis and not seeking care immediately after noticing first symptoms were associated with longer diagnostic delay. CONCLUSIONS: Our study found a significant delay in diagnosis of leprosy in north-eastern Colombia, which might explain the continuously high rate of DG2 among new cases being notified in the country. Both patient- and health system-related factors were associated with longer diagnostic delay. Interventions to increase awareness of disease among the general population and timely referral to a specialised health professional are urgently needed in our study setting.

Funcionalidad familiar y afrontamiento en pacientes con incapacidad permanente en una Unidad Médica Familiar / Family function and coping in patients with permanent disability in a Medical Familiar Unit / Funcionamento familiar e de afrontamento em pacientes com deficiência permanente em uma Unidade Médica da Família / Fonctionnalité familiale et adaptation chez les patients ayant une incapacité permanente dans une Unité de Médecine Familiale

Resumen Objetivo: Determinar el afrontamiento y la funcionalidad familiar en pacientes con incapacidad permanente en la Unidad Médica Familiar 39 del Instituto Mexicano del Seguro Social en Tabasco durante 2014 - 2015. Materiales y métodos: Estudio de observación, transversal, analítico, en 65 derechohabientes con Incapacidad permanente, de 18 a 69 años, ambos sexos. Se evaluó la Funcionalidad Familiar (FF-SIL). Para el Afrontamiento se utilizó el CSI (Coping Strategies Questionnaire) Inventario de Estrategias de Afrontamiento, previo consentimiento informado. Se realizó estadística descriptiva y X2 de Pearson. Resultados: Las características del paciente estudiado fueron: edad media 39 años, masculino (89.8%), con pareja (84.7%), alfabetizados (98.3%), religión católica (64.4%), sin ocupación (57.6%), con ingreso mensual entre 3 y 10 mil pesos (67.8%), con promedio de 2 hijos (50.8%), con vivienda propia (76.3%), comorbilidad asociada (30.5%), con familia nuclear (78%), ciclo vital familiar en dispersión (50.8%), con 3 o más dependientes económicos (54.2%), con miembro familiar que trabaja (57.6%), porcentaje en dictamen de incapacidad permanente del 25 a 49% (44.1%), la lesión que provocó la IP fue fractura de miembro inferior (37.3%), tienen con incapacidad permanente de 12 a 18 meses, (25.4%), tipo de riesgo que sufrieron accidente de trabajo (74.6%), la incapacidad permanente dictaminada de tipo parcial (91.5%), pertenecen a una familia funcional. (93.2%), y emplearon un afrontamiento activo al estrés (69.5%). Se observó que las familias funcionales emplearon un afrontamiento activo del estrés en un 66.1%,X 2 = .76, gl:l conp: .001, estadísticamente significativa. Conclusiones: Los pacientes con dictamen de incapacidad permanente presentaron una Funcionalidad Familiar relacionada con la estrategia empleada de afrontamiento activo ante el estrés.

Abstract Objective: To determine the coping and the family functionality in permanent disability in the 39th Medical family Unit of the Instituto Mexicano del Seguro Social (IMSS) in Tabasco during 2014 - 2015. Materials and Methods: An analytical transversal observational Study was made to 65 permanent disability right holder' workers, done in both genders from 18 to 69 years old. The Family Functionality (FF - SIL) was evaluated. A Coping Strategies Questionnaire (CSI) was used for Coping, with prior informed agreement. A descriptive statistic was done and the Pearson X2. Results: the patient's studied characteristics were: media age, 39 years old, (89.8%) male, (84.7%) with couple, (98.3%) literate, (64.4%) Catholic religion, (57.6%) idle, (67.8%) from 3 to 10 thousand pesos monthly income, (50.8%) with 2 children, (76.3%) owned a house, (30.5%) associated comorbidity, (78%) nuclear family, (50.8%) scattered family, (54.2%) with 3 or more economic dependents, (57.6%) with a working family member, (44.1%) from a 25 to a 49% in a permanent disability , (37.3%) the IP provoked injury was in a lower member, (25.4%) has a permanent disability from 12 to 18 months, (74.6%) work accident risk, (91.5%9) permanent partial type declared disability, (9 3.2%) belong to a functional family, (69.5%) applied an active coping stress. It was observed that functional families use an active coping stress in a 66.1%, X 2 =.76, gl;l with p: .001, statistically significan! Conclusions: Patients with a permanent disability report presented a Family Functionality related to the strategy used for active coping with stress.

Resumo Objetivo: Determinar o enfrentamento e funcionamento familiar em pacientes com incapacidade permanente UMF 39, IMSS, Tabasco durante 2014 - 2015. Materiais e métodos: Estudo de observação, transversal, analítico em 65 pessoas com deficiencia permanente, de 18 a 69 anos, de ambos os sexos. Se avaliou a funcionalidade familiar (FF-SIL). Para o afrontamento utilizou-se o CSI (Coping Strategies Questionnaire), a enquete sobre as Estratégias de Afrontamento, após o consentimento informado. Realizou-se estatística descritiva e X2 de Pearson realizada. Resultados: As características dos pacientes estudados foram: idade média de 39 anos, do sexo masculino (89,8%), em casal (84,7%), alfabetização (98,3%), católicos (64,4%), sem ocupação (57,6%), com renda mensal entre 3 e 10 mil pesos (67,8%), com em média 2 criabas (50,8%), com casa própria (76,3%), co-morbidade (30,5%), familia nuclear (78%), ciclo vital em dispersão ( 50,8%), com 3 ou mais dependentes (54,2%), com membro da familia trabalhando (57,6%), porcentagem opiniáo incapacidade permanente de 25 a 49% (44,1%), o prejuízo causado o IP foi quebrado membro inferior (37,3%), com licença de incapacidade permanente de 12 a 18 meses (25,4%), tipo de risco de acídente sofrido (74,6%), deficiencia permanente do tipo parcial (91,5%), pertencem a uma familia funcional. (93,2%), e utilizaram uma tensão ativa (69,5%) de enfrentamento do stress. Observou-se que as familias funcionais utilizaram um afrotnamento ativo do estresse em 66,1%, X2 = 0,76, gl:1 p:,001, estatisticamente significativa. Conclusões: Os pacientes com certidáo de incapacidade permanente tiveram uma funcionalidade familiar relacionadas com estratégia de enfrentamento ativo ao estresse.

Résumé Objectif: Déterminer l'adaptation et le fonctionnement familial chez les patients ayant une incapacité permanente dans l'Unité Médicale Familiale 39 de l'«Instituto Mexicano del Seguro Social¼ (Institut Mexicain de Sécurité Social) de Tabasco, pendant la période 2014 - 2015. Matériaux et méthodes: Étude observationnelle, transversale et analytique, réalisée avec 65 bénéficiaires ayant une incapacité permanente, de 18 a 69 ans, des deux sexes. Le fonctionnement familial a été évalué avec le FF-SIL, et l'adaptation avec le CSI (Coping Strategies Questionnaire), en comptant avec le consentement préalable des participants. Les résultats ont été analysés avec la statistique descriptive et la X2 de Pearson. Résultats: Les caractéristiques principales des patients étudiés ont été les suivantes: age moyen 39 ans, sexe masculin (89,8%), en couple (84,7%), alphabete (98,3%), catholique (64,4%), sans occupation (57,6%), revenu mensuel de 3 a 10 mille pesos (67,8%), 2 enfants en moyenne (50,8%), propriétaire de leur logement (76,3%), avec des comorbidités (30,5%), de famille nucléaire (78%), dans l'étape de dispersion du cycle familiale (50,8%), un minimum de 3 personnes a charge (54,2%), un membre de la famille qui travaille (57,6%), une invalidité permanente évaluée de 25 a 49% (44,1%), une fracture de jambe a l'origine de cette incapacité (37,3%), une incapacité permanente établie depuis 12 a 18 mois (25,4%), un accident de travail a l'origine de l'incapacité (74,6%), une incapacité permanente partielle (91,5%), une famille fonctionnelle (93,2%), utilisation de stratégies actives d'adaptation (69,5%). On a observé que 66,1% des familles fonctionnelles ont utilisées des stratégies actives d'adaptation, X2= .76, gl:1 con p: .001, statistiquement significatif. Conclusions: Les patients ayant une incapacité permanente établie ont une fonctionnalité familiale liée a des stratégies actives d'adaptation au stress.

The Environmental Production of Disability for Seniors with Age-Related Vision Loss.

To date, attention to the environmental production of disability among older adults with age-related vision loss (ARVL) has been limited. This critical ethnographic study aimed to reveal the ways in which environmental barriers produced and perpetuated disability for 10 older adults with ARVL. A modified version of Carspecken's five-stage approach for critical ethnography was adopted with three methods of data collection used, including a narrative interview, a participant observation session, and a semi-structured, in-depth interview. Findings revealed how disability is shaped for older adults with ARVL when they encounter environmental features that are embedded within an ageist and disablist society. These findings are illustrated via presenting analysis of three commonly discussed activities: shopping, eating, and community mobility. Our discussion suggests that addressing the environmental production of disability requires inclusive social policy, advocacy, and a focus on education in order to develop and sustain age and low-vision-friendly environments.

Pain and alcohol consumption among older adults: findings from the World Health Organization Study on global AGEing and adult health, Wave 1.

OBJECTIVE: To investigate cross-sectional associations between self-reported recent pain and alcohol use/abstinence, and previous-day pain and previous-week alcohol consumption in adults aged 50 + in six low- and middle-income countries (LMICs). METHODS: The WHO Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010) in China, Ghana, India, Mexico, Russia and South Africa is the data source. Prevalence of alcohol use/abstinence is reported by previous-day and previous-month pain. Multinomial logistic regressions (crude and adjusted for sex and country) tested associations between recent pain and alcohol use in the pooled multicountry sample. RESULTS: Across the six SAGE countries, about one-third of respondents reported alcohol use, being highest in Russia (74%) and lowest in India (16%). Holding the effects of sex and country constant, compared with abstainers, people with previous-day pain were more likely to be previous-day or other users. With regard to the quantity and frequency of alcohol use, people with previous-day pain were more likely to be non-heavy drinkers. CONCLUSION: Overall, we found that, in this population of older adults in six LMICs, recent pain was associated with moderate use of alcohol, although there were differences between countries. The findings provide a platform for country-specific research to better understand bi-directional associations between pain and alcohol in older adults.

[Clinical course of post-stroke depression in Kinshasa]. / Évolution clinique de la dépression post-accident vasculaire cérébral à Kinshasa.

OBJECTIVES: To describe the evolution of the clinical profile of post-stroke depression over a period of one year and to determine factors associated with changes in post-stroke depression. METHODS: Prospective cohort study with a follow-up of 1year including 30 consecutive eligible patients. The severity of depression was assessed with the patient health questionnaire (PHQ9). RESULTS: The mean age was 55.87±12.67years. Seventy percent of patients were men. The two assessments for neurological status, perceived health status and test results of attention were not statistically different. The rate of depressive symptoms was 26.67% in 2011 and 20% in 2012. Disability and apathy were significantly improved. The average for disability increased from 2.77±1.19 to 2.46±2.19 (P=0.002). From 66.7% in 2011, the proportion of patients able to walk without assistance rose to 93.3% in 2012 (P=0.03). In addition, the proportion of patients apathetic decreased from 43.3% to 13.3% (P=0.01). Greater age, female sex, sleep disorders and post-stroke apathy remained associated with DPAVC between the two assessments, with an increase in the strength of the association for apathy. CONCLUSIONS: The frequency of post-stroke depression is high and remains stable over time. Disability is the clinical feature that evolved more favorably. The association with apathy, present at the beginning, of the study was strengthened one year later.