Criterios de referencia y barreras para la atención de personas con baja visión en Santander / Criteria for referral and barriers to care for people with low vision in Santander

Objetivo: Identificar criterios de derivación y barreras percibidas por los optómetras para la rehabilitación de personas con baja visión en Santander. Métodos: Estudio de corte transversal que incluyó 82 optómetras de municipios de Santander, seleccionados mediante muestreo intencionado. Se diseñó un cuestionario con 36 preguntas para recolectar los datos que son reportados empleando estadística descriptiva. Resultados: El 47,5 % de los profesionales tiene claro el nivel de agudeza visual para clasificar a una persona con baja visión. Las principales barreras identificadas para el acceso a servicios de baja visión fueron: el proceso de derivación dentro del sistema de salud es engorroso (74,39 %), falta de servicios cerca (57,31 %) y considerar que los pacientes no pueden pagar las ayudas (48,78 %). Discusión: Es necesario fortalecer la formación de los optómetras para mejorar los procesos de identificación, atención y rehabilitación. Conclusiones: Es importante ubicar como prioritaria la discapacidad visual en Santander, para así robustecer la red de atención en salud.

Objective: To identify referral criteria and barriers perceived by optometrists for the rehabilitation of people with low vision in Santander. Methods: Cross-sectional study, which included 82 optometrists from municipalities of Santander, selected by purposive sampling. A questionnaire with 36 questions was designed to collect data that are reported using descriptive statistics. Results: A total of 47.5% of the professionals are clear about the level of visual acuity to classify a person with low vision. The main barriers identified for access to low vision services were: the referral process within the health system is cumbersome (74.39%), lack of services nearby (57.31%) and considering that patients cannot afford the aids (48.78%). Discussion: It is necessary to strengthen the training of optometrists to improve the processes of identification, care and rehabilitation. Conclusions: It is important to prioritize visual impairment in Santander in order to strengthen the health care network.

Can a disability studies-medical sociology rapprochement help re-value the work disabled people do within their rehabilitation?

This paper draws attention to the health-related work that disabled people do when engaging with rehabilitation services. Medical sociology has a rich history of looking at the 'illness work' that patients do, while disability studies scholars have explored the cultural value placed upon paid work and the effects on social status of being unable to work. Yet, a longstanding froideur between these two disciplines, which have fundamentally opposed ontologies of illness and disability, means that neither discipline has attended closely to the rehabilitation-related work that disabled people do. The concept of 'adjusting' to illness highlights seemingly irreconcilable disciplinary differences. Yet this article argues that the notion of 'adjustment work' can elucidate the socio-political character of the work disabled people do in their rehabilitation, which could create a more substantial and sustainable dialogue on this subject between disability studies and medical sociology. To make this case, we discuss interview data from the Rights-based Rehabilitation project, which sought to explore disabled people's lived experiences of rehabilitation.

Epistemic injustice as a bridge between medical sociology and disability studies.

This paper explores the potential of the perspective of epistemic injustice to reconcile medical sociology's attention to the micro level of experience and interpersonal exchange, and disability studies' focus on the macro level of oppressive structures. The first part of the paper provides an overview of the concept of epistemic injustice and its key instances-testimonial, hermeneutical, and contributory injustice. We also consider previous applications of the concept in the fields of health care and disability, and we contextualise our investigation by discussing key features of postsocialism from the perspective of epistemic injustice. In the second part, we explore specific epistemic injustices experienced by people who use disability support by drawing on interviews and focus groups conducted with parents of disabled children in present-day Bulgaria. In our conclusion, we revisit our methodological and theoretical points about the potential of epistemic injustice to facilitate mutually beneficial exchanges between medical sociology and disability studies.

Working it out: Will the improved management of leaky bodies in the workplace create a dialogue between medical sociology and disability studies?

This article focuses on the workplace as a significant site of convergence between the disciplines of medical sociology and disability studies. As disability remains on the margins of sociological exploration and theorising relating to health and work, disabled workers remain on the margins of the workforce, subject to disproportionate rates of unemployment, under employment and workplace mistreatment. The article focuses on the experiences of people with 'leaky bodies', focussing specifically on employees who experience troubling menstruation and/or have gynaecological health conditions. It brings together data from three studies conducted between 2017 and 2020; interviews with disabled academics (n = 75), university staff with gynaecological health conditions (n = 23), and key stakeholders in universities (n = 36) (including university executives, line managers and human resources staff). These studies had separate, but linked foci, on the inaccessibility of workplaces, managing gynaecological health conditions at work and supporting disabled people at work respectively. Drawing on the Social Relational Model of disability and theories of embodiment, we explore the experiences and management of workers with leaky bodies in UK University workplaces. Data illustrates how workplace practices undermine embodied experiences of workers with 'leaky' bodies by maintaining workplaces which ignore their material reality. We highlight that addressing embodied needs alongside acknowledging disabled people as an oppressed political category represents a theoretical meeting point for disability studies and medical sociology.

Exploring the intersection of critical disability studies, humanities and global health through a case study of scarf injuries in Bangladesh.

This article puts critical disability studies and global health into conversation around the phenomenon of scarf injury in Bangladesh. Scarf injury occurs when a woman wearing a long, traditional scarf called an orna rides in a recently introduced autorickshaw with a design flaw that allows the orna to become entangled in the vehicle's driveshaft. Caught in the engine, the orna pulls the woman's neck into hyperextension, causing a debilitating high cervical spinal cord injury and quadriplegia. The circumstances of the scarf injury reveal the need for more critical cultural analysis than the fields of global health and rehabilitation typically offer. First, the fatal design flaw of the vehicle reflects different norms of gender and dress in China, where the vehicle is manufactured, versus Bangladesh, where the vehicle is purchased at a low price and assembled on-site-a situation that calls transnational capitalist modes of production and exchange into question. Second, the experiences of women with scarf injuries entail many challenges beyond the injury itself: the transition to life with disability following the rehabilitation period is made more difficult by negative perceptions of disability, lack of resources and accessible infrastructure, and cultural norms of gender and class in Bangladesh. Our cross-disciplinary conversation about women with scarf injuries, involving critical disability studies, global health and rehabilitation experts, exposes the shortcomings of each of these fields but also illustrates the urgent need for deeper and more purposeful collaborations. We, therefore, argue that the developing subfield of global health humanities should include purposeful integration of a humanities-based critical disability studies methodology.

A legacy of silence: the intersections of medical sociology and disability studies.

Disability remains on the margins of the social sciences. Even where disability is foregrounded as a category of analysis, accounts regularly emerge in silos, with little interdisciplinary dialogue acknowledging the potential intersections and points of convergence. This discord is particularly acute within medical sociology and disability studies, yet there is mostly a legacy of silence about the relationship between the two disciplines. Drawing upon data from a qualitative study with parents of disabled children in the UK, I show the value of meshing ideas and tropes from medical sociology and disability studies to make sense of parents' lived experiences. They described the challenges of living with 'impairment' and a need to readjust expectations. At the same time, parents were keen to not align with a deficit framing of their lives. They talked in affirmative terms about their children as sources of joy and vitality, perceived themselves as 'normal', and described convivial, even unremarkable, interactions in public spaces. Yet, parents encountered difficulties when navigating institutional settings and bureaucratic arrangements, or what was commonly referred to as 'the system'. Their troubles were not located in their children's bodies, but in-as per a disability studies sensibility-cultural and structural systems preventing their capacity to live well I argue that both disability studies and medical sociology offer something to the analysis, thereby recognising the gains of not simply buying into the tradition of one worldview. I conclude by imploring for more concrete conversations between both disciplines.

Virtual reality hope machines in a curative imaginary: recommendations for neurorehabilitation research from a critical disability studies perspective.

PURPOSE: This paper provides recommendations for neurorehabilitative research informed by insights from critical disability studies (CDS) and a research study that tested an augmented neurorehabilitative technology prototype. METHODS: The methodology combines critical reflection, feminist science studies and CDS to analyze how neurorehabilitation and disability studies conceptualize notions of disability and cure. It offers recommendations for reconciling the conflicting ideologies of cure that operate within neurorehabilitative research. RESULTS: The prototype acted as a kind of virtual reality hope machine that tapped into different emotions and language games regarding disability and cure. The result is five recommendations about the ways that a CDS perspective might inform neurorehabilitation research: (I) ensure clarity in recruitment materials to account for dominant social views on disability and the possibility of cure; (II) build "strong objectivity" into research methods through attention to social context and multiple meanings of terms; (III) engage in critical reflection about research processes and findings; (IV) incorporate principles of crip technoscience; and (V) include CDS perspectives in neurorehabilitation education. CONCLUSIONS: Bridging a conversation between neurorehabilitative research and CDS can address the discrepancies between ideologies of cure, and situate rehabilitation within the wider concerns of social determinants of health and disability justice.Implications for rehabilitationBridging connections between rehabilitation studies and critical disability studies can generate productive insights that open up conversations with disabled people and a commitment to disability justice.Disability and cure are social constructs and may have different meanings for patients and rehabilitation professionals.Clinicians should be mindful of the conflicting ideological constructs and socio-political dimensions of disability and cure that are operating below the surface in the rehabilitation profession and in interactions between clinicians and patients.As technology continues to transform clinical rehabilitation care through virtual reality and other innovative paradigms, rehabilitation clinicians should recognize the potential for these technologies to become "hope machines," generating patient expectations that are idealized constructions of hoped-for outcomes of returning to a previous state or level of functionality rather than predictive expectations of likely results.

Disability Orientation of Occupational Therapy Practitioners in Physical Rehabilitation Settings: Tension Between Medical and Social Models in Theory and Practice.

IMPORTANCE: To date, little is known about the extent to which occupational therapy practitioners have adopted the core insights of disability studies. OBJECTIVE: To examine the degree to which occupational therapy practitioners endorse the medical model of disability versus the social model of disability in theory and in practice. DESIGN: Cross-sectional study. SETTING: Physical rehabilitation facilities, ranging from hospital to community settings. PARTICIPANTS: One hundred two Israeli occupational therapy practitioners. Outcomes and Measures: The Orientation toward Disability Scale, constructed for this study, has two dimensions that distinguish between the medical and social models of disability: locus of intervention (the person or environment) and client involvement (extent to which the practitioner fosters the client's autonomy in the rehabilitation process). Each dimension addresses both theoretical and practical endorsements. RESULTS: Greater support for the social model of disability was mostly evident in the client involvement dimension, whereas support for the medical model of disability was mostly evident in the locus of intervention dimension. Over both dimensions, the medical model of disability was significantly more endorsed in practice than in theory. Work setting and prior exposure to the social model of disability were found to affect practitioners' disability orientation. CONCLUSIONS AND RELEVANCE: Occupational therapy practitioners working in physical rehabilitation are still relatively far from fully adopting the critical insights of the social model of disability. This finding is especially relevant when their actual practice, rather than their theoretical views, is considered and when rehabilitation takes place in out-of-home settings. What This Article Adds: This study offers unique insight into the disability orientation of occupational therapy practitioners, showing a need for more training programs to expose students to the social model of disability. These programs should use critical discussions of the challenges that this model presents to the profession and barriers to implementing it in practice.

"A Legitimate Place in the Profession": Author Reflections on the 2005 Disability Studies Special Issue.

IMPORTANCE: In 2005, the American Journal of Occupational Therapy published a special issue focused on disability studies. Contributing authors challenged readers to reflect on their practices and recommended ways to change the field, yet literature on the current state of the integration of disability studies into occupational therapy is scarce. OBJECTIVE: To engage the original authors of the 2005 special issue in an examination of perspectives on how disability studies perspectives have contributed to changes within occupational therapy and what work remains. DESIGN: The research team conducted semistructured interviews with 11 authors who published an article in the special issue. Interview transcripts were analyzed using thematic analysis. Triangulation of coders, multiple phases of data analysis, and member checking were used to establish trustworthiness. RESULTS: Five themes emerged from the data: (1) exposure to disability and disability studies, (2) impact of the special issue on occupational therapy, (3) changes observed in occupational therapy beyond the special issue, (4) challenges integrating disability studies into occupational therapy, and (5) disability studies-informed recommendations for occupational therapy. CONCLUSIONS AND RELEVANCE: Although the original contributing authors acknowledged the transformative impact of disability studies on their own practice and scholarship, the results suggest that disability studies remains outside mainstream occupational therapy scholarship. Exploring the connections and divergence between disability studies and fields such as occupational science could improve understanding of how disability studies concepts are defined and used in theory and practice. What This Article Adds: Since the publication of the original special issue in 2005, the field of disability studies has continued to influence occupational therapy, although more often in individual than in systemic ways. Work is needed to embrace a disability studies-informed critical and intersectional foundation for the profession and explore the ways in which occupational therapy can better partner with populations through a disability studies lens.

Disability Studies and Occupational Therapy: Renewing the Call for Change.

Disability studies (DS) is an interdisciplinary field grounded in a minority studies philosophy that approaches disability as a socially constructed phenomenon. The first special issue of the American Journal of Occupational Therapy on DS was published in 2005. The present issue serves as a follow-up to highlight opportunities for and examples of DS integration into occupational therapy education, research, and practice. Studies in this special issue reflect a DS approach to research that prioritizes lived experiences, critical approaches, and participatory methodologies. Reported interventions focus on changing societal barriers rather than remediating individual impairments and acknowledge instrumental activities of daily living often neglected by traditional research. Studies on educational practices in occupational therapy have found persistent issues around negative attitudes toward disability and many opportunities to better infuse disabilities studies into curricula. Revisiting DS as it applies to occupational therapy has shown that many of the issues and considerations raised in 2005 remain in the field today. Recommendations across articles in this special issue highlight that advocacy and working for broader social change are essential for occupational therapy practitioners, given ongoing occupational injustices for people with disabilities. Infusing DS ideas into occupational therapy can promote greater alignment with priorities of disability communities and spur professional change to dismantle oppressive structures and ideologies.

Queering gendered disabilities.

This project defines gendered disabilities broadly, including chronic illnesses that involve the uterus, ovaries, and other body parts traditionally classified as "female." I interrogate the usage of language such as women's health and gynecological using endometriosis, a common chronic illness that can cause severe pain, fatigue, system-wide effects, and infertility. It affects at least ten percent of cisgender women as well as unmeasured numbers of cisgender men and transgender and gender nonconforming people, occurring more commonly than migraines or Crohn's disease. Endometriosis symptoms are often debilitating and can lead to un-/under-employment, reduced quality of life, and even suicide. Once nearly invisible, endometriosis has enjoyed recent public discussion, as major news outlets have reported the individual and social costs of endometriosis, and public figures have spoken out about their experiences. However, increased public spotlight has led to the proliferation of a narrative that endo is primarily a reproductive disease, a myth begun in medical literature nearly a century ago, which overlooks significant medical evidence and drives interventions that have high rates of failure and often cause further impairment. This paper examines locations where queerness meets gendered ableism, arguing that imagining endo as a gendered disability would be a first step toward decoupling compulsory heterosexuality from compulsory able-bodiedness. I also articulate gender-neutral ways to discuss endo and recommendations for more inclusive and accurate language and practices.

Contribuições do modelo feminista nos estudos da deficiência para uma perspectiva de prática inclusiva educacional baseada na interdependência / Contributions of the feminist model in disability studies to an inclusive educational practice perspective based on interdependence / Contribuciones del modelo feminista en los estudios de discapacidad a una perspectiva de práctica educativa inclusiva basada en la interdependencia

Este trabalho visa problematizar a relação entre deficiência e educação, a partir dos processos de construção de uma Educação Inclusiva. A pesquisa foi realizada com educadoras(es) que atuam na interface da Educação "Especial" e da Educação para Jovens e Adultos (EJA), com os(as) quais exercitamos práticas de conversa na Formação Continuada no município de Vitória/ES. Trata-se de uma pesquisa-intervenção de caráter participativo. Como interlocutores, destacamos as contribuições do Modelo Feminista para os Estudos da Deficiência, buscando observar a diretriz ética do lema "nada sobre nós, sem nós" e o princípio da interdependência. Por fim, ao discutirmos com táticas de trabalho cotidianas, esta pesquisa aponta para o exercício ético-político que envolve o cultivo da interdependência como modos de acesso e afirmação de práticas inclusivas.

This study aims to problematize the relation between disability and education, analyzing the process of building an Inclusive Education. The subjects of this study were educators who work with Special Education in the context of Adult and Youth Education, and agreed to participate in conversations that took place during their professional development meetings in the county of Vitória/ES. It is a participatory research-intervention. The research had as it interlocutors the contributions of the Feminist Model to the Disability Studies, seeking to observe the ethical guideline of the motto "nothing about us, without us" and the interdependence principle. Finally, when discussing with daily work tactics, this research indicates that the ethical-political exercise involves the harvesting of interdependence as the main way to access and affirm the inclusive practices.

Este artículo tiene como objetivo problematizar la relación entre discapacidad y educación, a partir de los procesos de construcción de una Educación Inclusiva. La investigación se realizó con educadores que trabajan en la interface de Educación "Especial" y Educación de Jóvenes y Adultos / EJA, y con quienes practicamos prácticas de conversación en Educación Continua en la ciudad de Vitória / ES. Es una investigación-intervención participativa. Como interlocutores, destacamos las contribuciones del Modelo Feminista y los Estudios de Discapacidad, buscando observar una conducción ética del lema "nada sobre nosotros sin nosotros" y el principio de interdependencia. Finalmente, cuando se discute con tácticas de trabajo diarias, esta investigación apunta para el ejercicio ético-político que involucra el cultivo de la interdependencia como formas de acceso y afirmación de prácticas inclusivas.

Educational goals for college students diagnosed with disabilities: from individualist to transformative activist agenda / Metas educacionais para universitários diagnosticados com deficiência: de uma proposta individualista à ativista transformadora / Metas educacionales para estudiantes universitarios diagnosticados con discapacidad: de una propuesta individualista a una activista transformadora

Due to the legal protections and the effects of inclusive reforms introduced in the U.S. in the last decades, the number of students diagnosed with disabilities (SDWD) entering post-secondary education in the country has steadily increased. Nevertheless, SDWD remain significantly underrepresented among the college student population and their graduation rates are lower than those of their able-bodies peers'. Common explanations of unequal outcomes of SDWD in college have invoked issues related to students' transitioning from high school to college and inadequate provision of diversified and adequate support. In this paper, I critically examine the scholarship on academic success of SDWD in higher education that shape institutional discourses and practices around educational and life goals for SDWD. My analysis reveals that narrowly individualistic notions of personal responsibility, autonomy, self-determination and self-advocacy skills dominate such practices and discourses. My contention is that a focus on achieving independence as the ultimate educational goal for SDWD reproduces ableistic assumptions and ultimately disempowers those students. Merging insights from critical disability studies with the Vygotskian socio-historical theory expanded by the Transformative Activist Stance, I propose a radical reconceptualization of developmental goals for SDWD away from the notion of independence of individual learners toward focusing on interdependence, reciprocity, relationality, connectedness and collective agency.

Devido às proteções legais e aos efeitos das reformas inclusivas introduzidas nos EUA nas últimas décadas, o número de alunos diagnosticados com deficiência (SDWD) ingressando no ensino superior no país tem aumentado constantemente. Entretanto, o aluno diagnosticado com deficiência permanece significativamente sub-representado e apresenta taxas de graduação menores entre a população de estudantes universitários. Explicações comuns de desfechos desiguais de alunos com deficiência na faculdade têm invocado questões relacionadas à transição dos alunos do ensino médio para a faculdade e a oferta inadequada de apoio adequado e diversificado. Neste artigo, examina-se criticamente a bolsa de estudos e o sucesso acadêmico dos alunos com deficiência no ensino superior, que molda discursos institucionais e práticas em torno das metas educacionais e de vida para os alunos com deficiência. A análise revela que noções estritamente individualistas de responsabilidade pessoal, autonomia, autodeterminação e habilidades de autodefesa dominam tais práticas e discursos. Discute-se que o foco em alcançar a independência como o objetivo educacional final para o aluno com deficiência reproduz discriminações; em última instância, descapacita esses alunos. Unindo a abordagem de estudos críticos de incapacidade com a teoria sócio histórica vygotskiana expandida pelo Posicionamento Ativista Transformador, propõe-se uma reconceitualização radical dos objetivos de desenvolvimento para o aluno com deficiência, longe da noção de independência dos alunos individuais para focar na interdependência, reciprocidade, conectividade e na importância das relações e ações coletivas.

Debido a las protecciones legales y a los efectos de la reformas inclusivas introducidas en los EE.UU en las últimas décadas, el número de estudiantes diagnosticados con discapacidades que ingresan en la educación superior en el país ha aumentado constantemente. Sin embargo, el número de estudiantes diagnosticados con discapacidad sigue siendo muy pequeño entre la población de estudiantes universitarios y, sus notas de graduación son mas bajas que que las de sus compañeros sin discapacidad. Las explicaciones comunes de esta disparidad entre los estudiantes con discapacidades e sus compañeros sin discapacidad en la universidad han planteado problemas relacionados con la transición de la secundaria a la universidad y la provisión inadecuada de suporte diverso y adecuado. Este artículo examina críticamente los estudios sobre el éxito académico de las personas con discapacidades en la educación superior que respaldan los discursos y prácticas institucionales en torno a las metas educacionales y de vida de los estudiantes diagnosticados con discapacidad. El análisis revela que estas comunicaciones y prácticas son el resultado de una "estrecha" noción individualista de responsabilidad personal, autonomía, autodeterminación y habilidades de autodefensa que dominan tales discursos y prácticas. Se argumenta que el enfoque en el logro de la independencia como objetivo educativo último para los estudiantes con discapacidad reproduce la discriminación; en última instancia, fragiliza a estos estudiantes. Uniendo el enfoque de los estudios críticos de la discapacidad con la teoría socio histórica vygotskiana ampliada por la Postura Activista Transformadora, proponemos una reelaboración radical de los objetivos de desarrollo para los estudiantes diagnosticados con discapacidad, lejos de la noción de independencia de el alumno individualmente, para enfocarse en la interdependencia, reciprocidad, conectividad y la importancia de las relaciones y acciones colectivas.

Exploring Factors Contributing to Race Differences in Poststroke Disability.

Background and Purpose- Cross sectional analyses have found large race differences in poststroke disability, yet these analyses do not account for prestroke disability, hospitalization factors, postacute care, transitions, or mortality. In this context, we explore mortality, nursing home placement, and disability in a longitudinal analysis of older stroke survivors who survived at least 90 days poststroke. Methods- A prospective cohort of black or white stroke survivors from the National Health and Aging Trends Study (2009-2016) linked to Medicare were used. Disability was assessed during in-person interviews with validated scales (0-7). We used cox proportional hazards models to separately assess mortality and nursing home admission adjusting for age, sex, sociodemographics (marital status, education, income, insurance status, social network size), comorbidities, hospitalization factors, postacute care, and 90-day readmissions. To estimate racial differences in disability, we used a multilevel linear regression model initially adjusting for age and sex and then compared with a model adjusted for sociodemographics, comorbidities, hospitalization factors, postacute care, and 90-day readmissions. Results- There were 282 stroke survivors, of which 76 (12.6%) were black. There were no race differences in long-term mortality (hazard ratio for black, 1.2 [95% CI, 0.7-2.2]; P=0.5) or nursing home placement (hazard ratio for black, 0.7 [95% CI, 0.2-2.4]; P=0.5). The largest race differences in disability were observed immediately prestroke, estimated age- and sex-adjusted activity limitations were (2.6 [2.0-3.2] in blacks versus 1.4 [1.0-1.8] in whites, mean difference, 1.2 [0.5-1.9], P<0.001) and immediately poststroke (2.6 [2.0-3.3] in blacks versus 1.7 [1.2-2.1] in whites, mean difference, 1.0 [0.2-1.7], P<0.01). Full adjustment did not substantially change the associations between race and disability. Conclusions- Race differences in nursing home placement, long-term mortality, sociodemographics, comorbidities, hospitalization factors, postacute care, and readmissions are unlikely to be large contributors to race differences in poststroke disability. Further research is needed to understand the drivers of race differences in poststroke disability.

El modelo médico como generador de discapacidad / The Medical Model as a Disability Generator / O modelo médico como gerador de deficiência

Resumen: La discapacidad ha tenido diferentes conceptualizaciones, incluyendo aportes religiosos, científicos, médicos y sociales. El modelo médico es fundamental en la prevención y la rehabilitación adecuada, sin embargo, es también un gran generador de discapacidad. El objetivo de este trabajo es presentar la relación del modelo médico de discapacidad y el enfoque biomédico como generadores de discapacidad y proponer una aproximación teórica a nuevos modelos y enfoques que permitan un abordaje ético-ontológico. El presente es un artículo de exposición en dos etapas: en la primera se hizo una revisión de literatura sobre discapacidad. En la segunda, se presentan los resultados de la discusión entre los autores para comparar e identificar argumentos y contraargumentos de los modelos tradicionales, con respecto a las nuevas formas de análisis con una visión desde la bioética. Una de las principales conclusiones de este análisis es que el modelo médico ha hecho aportes fundamentales en la conceptualización y clasificación de la discapacidad; sin embargo, el enfoque mono -causal positivista termina favoreciendo la medicalización, la discapacidad y demanda más recursos. La discapacidad es un asunto en evolución en el que interactúan las deficiencias individuales y las barreras personales y ambientales, por lo que es necesario superar el paradigma médico y fortalecer el biopsicosocial.

Abstract: Disability has had different conceptualizations, which have included religious, scientific, medical and social contributions. The medical model is fundamental for appropriate prevention and rehabilitation. The goal of this paper is to show the relationship of the disability medical model and the biomedical approach as generators of disability and to propose a theoretical approach to new models and perspectives that allow for an ethical-ontological approach. This is an expository article presented in two stages: in the first one a literature review on disability was carried out. In the second one, the results of the discussion are presented amongst the authors to compare and identify arguments and counterarguments of the traditional models, with regards to the forms of analysis with a view from bioethics. One of the main conclusions of this analysis is that the medical model has made fundamental contributions to the conceptualization of disability; however, the positivistic monocausal approach ends up favoring medicalization, disability and it demands more resources. Disability is a subject in evolution where the individual deficiencies and the personal and environmental barriers interact, therefore it is necessary to overcome the medical paradigm and to strengthen the biopsychosocial.

Resumo: O conceito de deficiência recebeu diferentes contribuições, incluindo as religiosas, científicas, médicas e sociais. O modelo médico é fundamental na prevenção e reabilitação adequada, no entanto, é também um grande gerador de deficiências. O objetivo deste trabalho é apresentar a relação do modelo médico de deficiência e do enfoque biomédico como geradores de deficiência e propor uma aproximação teórica para novos modelos e enfoques que permitam uma abordagem ético-ontológica. Trata-se de um artigo de exposição em duas etapas: na primeira, foi feita uma revisão da literatura sobre deficiência. Na segunda, são apresentados os resultados da discussão entre os autores para comparar e identificar argumentos e contra-argumentos dos modelos tradicionais, no que diz respeito às novas formas de análise a partir da bioética. Uma das principais conclusões dessa análise é que o modelo médico fez contribuições fundamentais na conceituação e classificação da deficiência. No entanto, o enfoque monocausal positivista acaba favorecendo a medicalização e a deficiência, além de demandar mais recursos. A deficiência é uma questão em evolução, na qual as carências individuais e as barreiras pessoais e ambientais interagem, sendo necessário superar o paradigma médico e fortalecer o biopsicossocial.

Considerações sobre a discussão da revisão do esquema da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) / Thoughts on the discussion about the revision of the International Classification of Functioning, Disability and Health (ICF) scheme

A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) apresenta uma abordagem inovadora ao funcionamento: o modelo biopsicossocial. Desde então, a estrutura da CIF e seu esquema explicativo têm sido utilizados em muitos contextos, incluindo saúde, previdência social e educação. Recentemente, surgiram algumas críticas e surgiram propostas a respeito de suas revisões. Objetivos: Este artigo discute propostas anteriores de revisões do esquema da CIF e apresenta sugestões de uma nova. Métodos: Descrevemos algumas das sugestões de esquemas de funcionamento alternativo da CIF e apresentamos algumas de suas características. Resultados: Também propomos nosso próprio esquema, destacando suas vantagens sobre os antecessores. Em nossa proposta, os componentes atuais do esquema são mantidos e dispostos equidistantemente ao longo de uma estrutura tridimensional de "casco de bola" conectada por setas de duas pontas. Nosso esquema é inovador, pois não apresenta nenhum componente como central, permitindo que o esquema seja mais adaptável à realidade de cada perfil funcional. Também é dinâmico, girando em 3 eixos, possibilitando o posicionamento central do componente mais importante. As esferas para cada componente podem ser ampliadas, demonstrando a magnitude de cada componente. Conclusão: Esperamos contribuir para a discussão atual sobre o esquema da CIF e sua revisão.

The International Classification of Functioning, Disability and Health (ICF) presents an innovative approach to functioning: the biopsychosocial model. Since then, the ICF framework and its explanatory scheme has been used in many settings, including health, social security, and education. Recently, some criticism has arisen and proposals have ensued regarding its revisions. Objective: This paper discusses previous proposals for revisions to the ICF scheme and present suggestions of a new one. Methods: We outline some of the suggestions of ICF alternative functioning schemes, and present some of their features. Results: We also propose our own scheme, highlighting its advantages over predecessors. In our proposal, current scheme components are kept and arranged equidistantly along a three dimension 'ball shell' structure connected by double-headed arrows. Our scheme is innovative in that it does not present any component as central, allowing the scheme to be more adaptable to the reality of each functioning profile. It is also dynamic, by rotating on 3 axes, making possible the central positioning of the most important component. The spheres for each component can be enlarged, demonstrating ​​the magnitude of each component. Conclusion: We hope to contribute to the current discussion on ICF scheme and its revision.

Assessment of Prevention Research Measuring Leading Risk Factors and Causes of Mortality and Disability Supported by the US National Institutes of Health.

Importance: No studies to date have examined support by the National Institutes of Health (NIH) for primary and secondary prevention research in humans and related methods research that measures the leading risk factors or causes of death or disability as outcomes or exposures. Objective: To characterize NIH support for such research. Design and Setting: This serial cross-sectional study randomly sampled NIH grants and cooperative agreements funded during fiscal years 2012 through 2017. For awards with multiple subprojects, each was treated as a separate project. Study characteristics, outcomes, and exposures were coded from October 2015 through February 2019. Analyses weighted to reflect the sampling scheme were completed in March through June 2019. Using 2017 data from the Centers for Disease Control and Prevention and 2016 data from the Global Burden of Disease project, the leading risk factors and causes of death and disability in the United States were identified. Main Outcomes and Measures: The main outcome was the percentage of the NIH prevention research portfolio measuring a leading risk factor or cause of death or disability as an outcome or exposure. Results: A total of 11 082 research projects were coded. Only 25.9% (95% CI, 24.0%-27.8%) of prevention research projects measured a leading cause of death as an outcome or exposure, although these leading causes were associated with 74.0% of US mortality. Only 34.0% (95% CI, 32.2%-35.9%) measured a leading risk factor for death, although these risk factors were associated with 57.3% of mortality. Only 31.4% (95% CI, 29.6%-33.3%) measured a leading risk factor for disability-adjusted life-years lost, although these risk factors were associated with 42.1% of disability-adjusted life-years lost. Relatively few projects included a randomized clinical trial (24.6%; 95% CI, 22.5%-26.9%) or involved more than 1 leading cause (3.3%; 95% CI, 2.6%-4.1%) or risk factor (8.8%; 95% CI, 7.9%-9.8%). Conclusions and Relevance: In this cross-sectional study, the leading risk factors and causes of death and disability were underrepresented in the NIH prevention research portfolio relative to their burden. Because so much is already known about these risk factors and causes, and because randomized interventions play such a vital role in the development of clinical and public health guidelines, it appears that greater attention should be given to develop and test interventions that address these risk factors and causes, addressing multiple risk factors or causes when possible.

The state of global research on social work and disability.

Two paradigms are used to define disability. On the one hand, the biological paradigm, which attends to a person's deficiencies and difficulties. And, on the other hand, the social, which does not treat disability as a pathology, but rather places the focus of interest on the deficient tools that society has to consider the capabilities of everyone. This article analyzes the scientific production on disability and social work, using bibliometric techniques and algorithms for the detection of communities, taking into account the current state of research worldwide. This analysis offers a holistic view of the characteristics of the work carried out in the world on this subject.