Widening disparities in the national prevalence of diabetes mellitus for people with disabilities in South Korea.

OBJECTIVES: In Korea, diabetes mellitus has a high disease burden, based on disability-adjusted life years. However, the disease burden is disproportionately distributed, with people with disabilities (PWD) experiencing higher rates of health disparities. Our study investigated long-term trends in diabetes prevalence and risk according to disability status, grade, and type. STUDY DESIGN: Retrospective cohort study. METHODS: Approximately 10 million individuals aged ≥30 years were included yearly from the National Health Information Database (NHID) and national disability registration data in Korea between 2008 and 2017, corresponding to 40 % of those aged ≥30 years in Korea. In 2017, 12, 975, 757 individuals were included; 5.5 % had disabilities. We estimated annual diabetes age-standardized prevalence and used multiple logistic regression analyses to estimate the odds of having diabetes in 2017, according to disability status, severity, and type. RESULTS: Diabetes age-standardized prevalence consistently increased over 2008-2017 in PWD and people without disabilities. However, the prevalence increased more rapidly and was higher in all years among PWD, with widening disparities based on disability status. Additionally, diabetes prevalence was high in all years for specific subgroups, including women, individuals with intellectual or mental disabilities or autism, and individuals with severe disabilities, suggesting further disparities among PWD. CONCLUSIONS: Our findings reveal health disparities between those with and without disabilities and among PWD subgroups. In addition to timely prevention, diabetes screening and management among PWD is vital. Public investment in improving disparities in the root causes of diabetes is essential, including health behaviours, healthcare utilization, and self-care.

NEEDS AND POSSIBILITIES OF SOCIAL WORK IN IMPLEMENTING SOCIAL INCLUSION WITH THE TOOLS OF ADAPTIVE PHYSICAL ACTIVITY.

OBJECTIVE: Aim: reveal in social work the possibilities of applying adaptive physical activity in the process of social inclusion of persons with disabilities. PATIENTS AND METHODS: Materials and Methods: To obtain factual information, the survey method (questionnaire) and a complex of mathematical statistics methods were used: methods of descriptive statistics and correlation analysis. Statistical analysis was performed using SPSS Statistics 24.0.0. A total of 102 anonymous respondents took part in the focus groups. RESULTS: Results: The connection between adaptive physical activity and the increase in the level of social inclusion of persons with disabilities, in particular, former military personnel and war veterans, was investigated. It was determined that social work professionals can use adaptive physical activity tools to promote the social inclusion of persons with disabilities and other low-mobility population groups. CONCLUSION: Conclusions: It was established that the ways of using adaptive physical activity tools by social workers for the social inclusion of persons with disabilities are most often socio-psychological, physical, professional rehabilitation, social support, and preventive activities. New opportunities for the implementation of social inclusion by means of adaptive physical activity of persons with disabilities as a result of military operations are opened in connection with the introduction of the position of «helper (assistant) of a veteran in the community¼, which will be held by a social worker.

Patterns and predictors of dental hospitalizations in patients with acquired brain injury from pre-injury to acute and post-acute injury.

BACKGROUND: Acquired brain injury (ABI) can cause long-term disability and functional impairment. OBJECTIVE: This study aims to determine the prevalence of dental hospitalizations in an ABI cohort across different phases of injury and identify factors associated with such hospitalizations. METHODS: The cohort comprises patients with ABI (n = 683), traumatic (n = 282) and non-traumatic (n = 401) who were admitted to a neurorehabilitation service in Western Australia between 1991 and 2016. De-identified patient data were linked to the Hospital Morbidity Data Collection. The incidence of dental hospitalizations was calculated per 1,000 person-years (PY), and associated factors were investigated using multilevel mixed-effects logistic regression. RESULTS: Dental hospitalizations significantly increased from pre-injury (3.35/1,000PY) to acute injury (302.65, Δ+299.3) and remained elevated in the post-acute phase (23.98, Δ+20.63). Dental caries had the highest incidence rate among all diagnoses in the pre-injury and post-acute phases (0.68 and 8.93, respectively), followed by gingivitis and periodontal diseases (3.60) in the post-acute phase. Tooth extractions were performed more often than restorative and preventive treatment in the pre-and post-injury phase, p < 0.001. Dental hospitalizations were associated with the type of ABI, age at injury, remoteness, and history of pre-injury hospitalization. CONCLUSION: Implementing comprehensive preventive dental care can reduce potentially preventable dental hospitalization among ABI patients.

Is there a sexual difference in the relationship between sociodemographic information and the unmet dental care needs of disabled adults? An analysis from a national survey on persons with disabilities.

BACKGROUND: Health status and health care utilization in people with disabilities are more likely to be poorer than those without disabilities. Previous studies showed that there were gaps in health-related conditions by sociodemographic information and gender but the association between these factors was not explained. This study aims to analyze the relationship between sociodemographic information and the unmet dental care needs of people with disabilities and explore the effect of sex within this relationship. METHODS: The 2014 national survey on persons with disabilities was used, which separated unmet healthcare needs into medical and dental services. Unweighted samples included 6,824 people with disabilities in total and 6,555 (96.1% of the total, weighted as 6,583) people aged 20 years or older were selected as the study population. Frequency and chi-square tests were conducted to determine differences in the prevalence of unmet dental needs based on socioeconomic information, chronic diseases, and behavioral factors after applying weights. Logistic regressions were performed using an adjusted model with sociodemographic information, chronic diseases, and behavioral variables. All analyses were performed using IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, N.Y., USA). RESULTS: Analysis of the sociodemographic factors related to unmet dental care revealed that they were higher in women and the elderly. In the fully adjusted logistic model, most of the sociodemographic information was significantly associated with unmet dental needs. The lowest group was 4.18 times more likely to have unmet dental care needs than the richest group, and females and middle-school graduates were almost twice as likely to experience unmet dental care needs than males and university graduates. Considering the interaction effect of age on unmet dental needs depending on sex differences, the odds ratio decreased for females with every annual increase in both models. Compared with the younger group, the older group showed a lower risk of having unmet dental needs, especially in females. CONCLUSIONS: The factor most closely related to the unmet dental care needs of disabled people was socioeconomic problems. Its influence also differed by sex and age. Therefore, economic support measures and sexual differences are needed for long-term policy consideration to reduce the unmet dental care needs of disabled people.

Associations Between Opioid Prescriptions and Use of Hospital-Based Services Among US Adults with Longstanding Physical Disability or Inflammatory Conditions Compared to Other Adults in the Medical Expenditure Panel Survey, 2010-2015.

Purpose: To investigate the association of filling opioid prescriptions with healthcare service utilization among a nationally representative sample of adults with disability. Materials and Methods: The Medical Expenditure Panel Survey (MEPS) for 2010-2015, Panels 15-19, was used to identify adults who were prescribed opioids during each two-year period. We examined the data for associations between opioid prescription filling and the number of emergency department (ED) visits and hospitalizations. The participants were grouped as those with inflammatory conditions or with longstanding physical disability, and a comparison group of those without these conditions. Results and conclusions: Opioid prescription filling differed among adults with inflammatory conditions and longstanding physical disability compared to the comparison group (44.93% and 40.70% vs 18.10%, respectively). For both groups of people with disability, the relative rates for an ED visit or hospitalization were significantly higher for those who filled an opioid prescription, compared to adults with the same conditions who did not fill an opioid prescription. People with a longstanding physical disability who filled an opioid prescription had the highest rate ratio of ED use and hospitalization. Results from this investigation demonstrate that opioid prescription filling among persons with inflammatory conditions and longstanding physical disabilities is associated with higher rates of ED visits and hospitalizations.

Prenatal Care Experiences of Childbearing People With Disabilities in Ontario, Canada.

OBJECTIVE: To explore the care experiences of childbearing people with physical, sensory, and/or intellectual/developmental disabilities during pregnancy. DESIGN: Descriptive qualitative. SETTING: Ontario, Canada, where physician and midwifery care during pregnancy are provided at no direct cost to residents. PARTICIPANTS: Thirty-one people with physical, sensory, and/or intellectual/developmental disabilities (who self-identified as cisgender women [n = 29] and trans or nonbinary persons [n = 2]) who gave birth in the last 5 years. METHODS: We recruited childbearing people with disabilities through disability and parenting organizations, social media, and our team's networks. Using a semistructured guide, we conducted in-person and virtual (e.g., telephone or Zoom) interviews with childbearing people with disabilities in 2019 to 2020. We asked participants about the services they accessed during pregnancy and if services met their needs. We used a reflexive thematic analysis approach to analyze interview data. RESULTS: Across disability groups, we identified four common themes: Unmet Accommodation Needs, Lack of Coordinated Care, Ableism, and Advocacy as a Critical Resource. We found that these experiences manifested in unique ways based on disability type. CONCLUSION: Our findings suggest the need for accessible, coordinated, and respectful prenatal care for people with disabilities, with the requirements of such care depending on the needs of the individual person with a disability. Nurses can play a key role in identifying the needs and supporting people with disabilities during pregnancy. Education and training for nurses, midwives, obstetricians, and other prenatal care providers should focus on disability-related knowledge and respectful prenatal care.

Predictive factors associated with trajectory of job satisfaction of workers with physical disabilities: A latent growth curve analysis.

BACKGROUND: Job satisfaction is a highly useful factor in maintaining a successful work life for the disabled. OBJECTIVE: This study aimed to evaluate how job satisfaction among workers with physical disabilities evolves over time, and to identify predictive factors that influence the trajectory of job satisfaction. METHODS: A longitudinal data analysis using the three-year databases of the 2016-2018 Employment Panel Survey for the Disabled (n = 693). A latent growth curve model analysis was conducted to determine the trajectory of the job satisfaction among workers with physical disabilities, as well as the predictive factors affecting it. RESULTS: Job satisfaction among workers with physical disabilities increased over time, and there were substantial individual differences in the trajectory of the job satisfaction. The significant predictors for the job satisfaction over the three years were degree of disability, computer usage ability, employment support services, and experience of discrimination. Gender, educational background, interpersonal relationship/organizational adaptability, convenience facilities for the disabled, job suitability, disability acceptability, and self-esteem had a considerable impact on the intercept of the job satisfaction, but not on the slope. CONCLUSION: The findings would inform healthcare providers to establish mid-to-long-term vocational rehabilitation intervention plans that could increase the job satisfaction among workers with physical disabilities.

Percepção dos usuários de centro especializado em reabilitação física sobre barreiras de acessibilidade e mobilidade urbana / Perception of physical rehabilitation center users about accessibility barriers and urban mobility / Percepción de los usuarios de centros de rehabilitación física sobre las barreras de accesibilidad y movilidad urbana

Objetivo: compreender a percepção dos usuários de programa de reabilitação física sobre suas experiências no enfrentamento de barreiras de acessibilidade e mobilidade urbana para comparecer nos atendimentos em Centro Especializado de Reabilitação. Método:estudo descritivo, abordagem qualitativa, realizado na região Metropolitana I do Rio de Janeiro, Brasil. Dados coletados através de entrevistas semiestruturadas, analisados à luz da análise de conteúdo, abordagem temática. Resultados: da análise emergiram quatro categorias que evidenciaram reiteradas experiências desafiadoras no percurso de suas residências para agendamentos no programa de reabilitação, se deparando com ambientes de mobilidade urbana inadequados à circulação de pessoas com algum tipo de deficiência ou mobilidade reduzida. Considerações Finais: os participantes experimentam situações constrangedoras que os fazem se sentir impotentes, desmotivados, frustrados e com baixa autoestima, requerendo das equipes de reabilitadoras a adoção de estratégias acolhedoras de atendimentos para que não comprometam o alcance de metas planejadas no programa de reabilitação.

Objective: to understand the perception of users of a physical rehabilitation program about their experiences in facing barriers to accessibility and urban mobility to attend consultations at a Specialized Rehabilitation Center. Method: descriptive study, qualitative approach, in the Metropolitan Region I of Rio de Janeiro, Brazil. Data collected through semi-structured interviews, analyzed in the light of content analysis, thematic approach. Results: from the analysis, four categories emerged that showed repeated challenging experiences in the course of their residences for scheduling in the rehabilitation program, facing urban mobility environments unsuitable for the circulation of people with some type of disability or reduced mobility. Final Considerations: participants experience embarrassing situations that make them feel powerless, unmotivated, frustrated and with low self-esteem, requiring rehabilitation teams to adopt welcoming strategies for care so that they do not compromise the achievement of goals planned in the rehabilitation program.

Objetivo: comprender la percepción de los usuarios de un programa de rehabilitación física sobre sus experiencias frente a las barreras de accesibilidad y movilidad urbana para asistir a consultas en un Centro Especializado de Rehabilitación. Método: estudio descriptivo, abordaje cualitativo, realizado en la Región Metropolitana I de Río de Janeiro, Brasil. Datos recolectados a través de entrevistas semiestructuradas, analizados a la luz del análisis de contenido, abordaje temático. Resultados: del análisis surgieron cuatro categorías que evidenciaron reiteradas experiencias desafiantes en el transcurso de sus residencias para la inserción en el programa de rehabilitación, frente a ambientes de movilidad urbana no aptos para la circulación de personas con algún tipo de discapacidad o movilidad reducida. Consideraciones Finales: los participantes viven situaciones bochornosas que los hacen sentir impotentes, desmotivados, frustrados y con baja autoestima, requiriendo que los equipos de rehabilitación adopten estrategias acogedoras de atención para que no comprometan el logro de las metas previstas en el programa de rehabilitación.

Analysis of biomechanics in athletes with disabilities: a systematic and narrative review / Análise da biomecânica em atletas com deficiência: uma revisão sistemática e narrativa

Abstract Introduction Specifically in athletes with disabilities, investigations and biomechanical understanding seem to be even more relevant, as they provide data on how a certain type of disability limits sports practice and also describe parameters that allow the suggestion of relevant adaptations capable of guaranteeing a higher level comfort to practitioners. Objective To describe patterns of biomechanical behavior during exercise in athletes with disabilities, and to discuss possible relationships between the type of disability and the sport practiced. Methods This study performed a search in five electronic databases from the oldest records available until July 2020 using a search strategy that combined terms related to "athletes with disabilities" and "biomechanical analysis." Inclusion criteria: population (amateur or professional athletes with disabilities), intervention (sports practice), study design (observational), outcome (having evaluated biomechanics during sports practice). The biomechanical variables of interest included kinematic, kinetic, or electromyographic outcome measures. Results Tewnty-six articles met the inclusion criteria (n = 705 participants). Biomechanical analysis showed that there is a greater inclination in the angle of the head and an increase in the kinematic variables in blind athletes, which result in less distance, speed, and performance; compensatory body patterns, reduced mooring strength, speed, joint amplitude, and reduced final performance are observed in amputated limbs of amputees; and there was a strong correlation between the subject's functional classification and kinematic parameters in wheelchair athletes, with this being proportional to the level of impairment. Conclusion The outcomes demonstrated that the type of disability and the level of functional limitation are proportionally related to biomechanics in athletes with disabilities.

Resumo Introdução Em atletas com deficiência, as investigações e o entendimento biomecânico parecem ser ainda mais relevantes ao fornecer dados sobre de que modo determinado tipo de deficiência limita a prática esportiva e, ainda, descrever parâmetros que permitam sugestão de adaptações pertinentes capazes de garantir maior nível de conforto aos praticantes. Objetivo Descrever padrões de comportamento biomecânico durante o exercício em atletas com deficiência e discutir possíveis relações entre o tipo de deficiência e o esporte praticado. Métodos Este estudo realizou uma busca em cinco bases de dados eletrônicas a partir dos registros mais antigos disponíveis até julho de 2020, utilizando uma estratégia de busca que combinou termos relacionados a "atletas com deficiência" e "análise biomecânica". Critérios de inclusão: população (atletas amadores ou profissionais com deficiência), intervenção (prática esportiva), desenho do estudo (observacional), resultado (ter avaliado a biomecânica durante a prática esportiva). As variáveis biomecânicas de interesse incluíram medidas de desfecho cinemáticas, cinéticas ou eletromiográficas. Resultados Vinte e seis estudos atenderam aos critérios de inclusão (n = 705 participantes). Os resultados mostraram que há maior inclinação do ângulo da cabeça e aumento das variáveis cinemáticas em atletas cegos, resultando em menor distância, velocidade e desempenho; padrões corporais compensatórios, redução da força de amarração, velocidade, amplitude articular e desempenho final reduzido são observados em membros amputados de amputados; e parece haver relação entre a classificação funcional do sujeito e os parâmetros cinemáticos em atletas de cadeira de rodas, sendo esta proporcional ao grau de comprometimento. Conclusão Os resultados demonstraram que o tipo de deficiência e o nível de limitação funcional estão proporcionalmente relacionados à biomecâ-nica em atletas com deficiência.

Dental care for patients with special needs at a private higher education institute / Atendimento odontológico a pacientes com necessidades especiais em uma instituição privada de ensino superior

Objetivo: Pacientes com necessidades especiais são aqueles indivíduos que necessitam de cuidados especiais por tempo indeterminado ou por toda a vida. O presente estudo tem como objetivo abordar o atendimento odontológico de pacientes com necessidades especiais em uma instituição privada de ensino superior da cidade de São Paulo. Material e Métodos: Foi realizado um estudo descritivo, retrospectivo, para análise de 210 prontuários odontológicos de pacientes com necessidades especiais atendidos no Departamento de Odontologia para Pacientes Especiais da Universidade Cruzeiro do Sul entre 2012 e 2018. Dados sobre sexo, idade, diagnóstico da condição debilitante, motivo da consulta, uso continuado de medicamentos, imagens radiográficas e tratamentos odontológicos prestados foram todos coletados e posteriormente submetidos à análise estatística descritiva e inferencial (teste do qui-quadrado) ao nível de significância de 5%. Resultados: Quanto aos tipos de procedimentos odontológicos avaliados no presente estudo, dos 210 pacientes, 24% necessitaram de tratamentos curativos dentários em que a terapia periodontal foi o tipo mais prevalente, enquanto os tratamentos endodônticos tiveram a menor prevalência, representando apenas 4%. Houve alta prevalência de doenças crônicas sistêmicas, acometendo 56% dos casos, cuja faixa etária era superior a 40 anos. Conclusão: Check-ups odontológicos regulares devem ser priorizados em pacientes com necessidades especiais para evitar intervenções mais invasivas como em nosso grupo (AU)

Objective: Patients with special needs are those individuals who need special care for an undetermined period of time or for lifetime. The present study is aimed to address the dental care of special needs patients at a private higher education institute in the city of São Paulo. Material and Methods: A descriptive, retrospective study was performed for analysis of 210 dental records of special needs patients who were treated at the Dental Department for Special Patients of the Cruzeiro do Sul University between 2012 and 2018. Data on gender, age, diagnosis of the debilitating condition, reason of the consultation, continued use of medications, radiographic images and dental treatments provided were all collected before being submitted to descriptive and inferential statistical analysis (chi-square test) at a significance level of 5%. Results: As for the types of dental procedures assessed in the present study, of the 210 patients, 24% needed dental curative treatments in which periodontal therapy was the most prevalent type, whereas endodontic treatments had the lowest prevalence, representing 4% only. There was a high prevalence of chronic systemic diseases, affecting 56% of the dental records, whose age group was above 40 years old. Conclusion: Regular dental check-ups should be prioritized in patients with special needs to avoid more invasive interventions as found in our group (AU)

Reivindicative occupational practices of activist with disabilities / Práticas ocupacionais reivindicativas de ativistas com deficiência

Abstract Introduction The occupational praxis of activists with disabilities in the Latin America has presented actions of revindication from historically marginalised territories. Objective To explore and describe strategies used by Chilean activist with disabilities. Method Qualitative design via three research techniques: a) 11 in-depth interviews; b) six group chat sessions; c) content analysis of eight social networks belonging to collectives of activists with disabilities in Chile. Results Activists indicate various occupations for revindication as subjects with rights. These trajectories are exemplified with the following dimensions: 1) Interpellate full social participation: demanding justice and citizenship; 2) Showing defective bodies: public mobilisations; 3) Occupying institutional space by placing: bodies in the system. Conclusion Dissident occupational practices intervene and transform the limited comprehension about what human vulnerability and fragility is capable of. This situation is mainly appreciated in the Global South.

Resumo Introdução A práxis ocupacional de ativistas com deficiência na América Latina tem apresentado ações de reivindicação de territórios historicamente marginalizados. Objetivo Explorar e descrever as estratégias utilizadas por ativistas chilenos com deficiência. Método Desenho qualitativo por meio de três técnicas de pesquisa: a) 11 entrevistas em profundidade; b) seis sessões de chat em grupo; c) análise de conteúdo de oito redes sociais pertencentes a coletivos de ativistas com deficiência no Chile. Resultados Os ativistas indicam diversas ocupações para reivindicação como sujeitos de direitos. Essas trajetórias são exemplificadas com as seguintes dimensões: 1) Interpelar a participação social plena: reivindicar justiça e cidadania; 2) Mostrar corpos defeituosos: mobilizações públicas; 3) Ocupar o espaço institucional colocando: os corpos no sistema. Conclusão Práticas ocupacionais dissidentes intervêm e transformam a compreensão limitada sobre do que é capaz a vulnerabilidade e fragilidade humana. Esta situação é apreciada principalmente no Sul Global.

Elaboração de um material educativo digital para cuidadores de pessoas com deficiência / Development of a digital educational material for caregivers of people with disabilities

O presente estudo teve como objetivos: 1. Avaliar a qualidade de um material educativo já publicado na área de Pessoas Com Deficiência (PCD). Para isto foi escolhido, por conveniência, um material educativo em saúde bucal para cuidadores de pessoas com Transtorno do Espectro Autista (TEA), disponibilizado online. Duas cirurgiãs-dentistas aplicaram, de forma independente, neste material, a versão validada para o português do Brasil do Clear Communication Index (BR-CDC-CCI). O material apresentou 100% de conformidade com os critérios exigidos por este instrumento, mostrando-se um excelente material, podendo cumprir seu objetivo de ajudar pais e profissionais nos cuidados à saúde bucal das pessoas com TEA; 2. Elaborar um guia digital para a promoção de saúde bucal para cuidadores de PCD, utilizando-se também como instrumento de validação o BR-CDC-CCI. Foram selecionados por conveniência e de maneira consecutiva, os cuidadores de PCD com 18 anos ou mais, alfabetizados, presentes no Centro de Especialidades Odontológicas (CEO) e da Associação de Pais e Amigos dos Excepcionais (APAE), da cidade de Itaúna, Minas Gerais, que aguardavam consulta. Após aprovação do projeto no Comitê de Ética em Pesquisa, todos foram convidados a participar do estudo e, concordando, assinaram o Termo de Consentimento Livre e Esclarecido (TCLE). Foi aplicado um instrumento validado para língua portuguesa do Brasil de avaliação de alfabetismo em saúde bucal - Rapid Estimate of Adult Literacy in Dentistry (BREALD). Após a avaliação do nível de alfabetismo, um grupo focal foi formado com os voluntários da pesquisa (cuidadores). Nesta etapa, mediante uma abordagem participativa, dialógica e coletiva, foram identificadas dúvidas, dificuldades e necessidades deles em relação à saúde bucal das PCD pelas quais são responsáveis. Neste grupo focal foi utilizado um roteiro preestabelecido para subsidiar o conteúdo do guia com foco nas questões de saúde bucal. Critérios como mensagem principal, indicações visuais, chamadas a ação, palavras de conhecimento do público-alvo, design adequado, fontes confiáveis, recomendações de comportamento, seus riscos e benefícios, foram observados, conforme recomendação Clear Communication Index (BR-CDC-CCI). A versão preliminar do guia foi apresentada para os cuidadores de PCD para avaliação, bem como por grupo de profissionais de saúde experts em educação em saúde. Finalmente, houve necessidade da colaboração de profissionais da área de comunicação, designer gráfico e/ou ilustradores. O guia digital, então, será distribuído para os serviços públicos e redes sociais.

The present study had the following objectives: 1. Assess the quality of an educational material already published in the area of Disable People. For this purpose, an educational material on oral health for caregivers of people with Autism Spectrum Disorder (ASD), available online, was chosen for convenience. Two dentists applied, independently, to this material, the validated version for Brazilian Portuguese of the Clear Communication Index (BR-CDC-CCI). The material presented 100% compliance with the criteria required by this instrument, proving to be an excellent material, able to fulfill its objective of helping parents and professionals in the oral health care of people with ASD; 2. To elaborate a digital guide for the promotion of oral health for people with disabilities caregivers, also using the BR-CDC-CCI as a validation instrument. Caregivers of people with disabilities aged 18 years or older, literate, present at the Dental Specialties Center (DSC) and the Association of Parents and Friends of Exceptional Children (APAE), in the city of Itaúna, Minas Gerais, who were waiting for an appointment, were selected for convenience and in a consecutive manner. After approval of the project by the Research Ethics Committee, all were invited to participate in the study and, in agreement, signed the Written Informed Consent Form (WICF). An instrument validated for the Brazilian Portuguese language was applied to assess oral health literacy- Rapid Estimate of Adult Literacy in Dentistry (BREALD). After evaluating the level of literacy, a focus group was formed with the research volunteers (caregivers). At this stage, through a participatory, dialogical and collective approach, doubts, difficulties and needs were identified in relation to the oral health of the people with disabilities for which they are responsible. In this focus group, a preestablished script was used to support the content of the guide focusing on oral health issues. Criteria such as the main message, visual indications, calls to action, words of knowledge of the target audience, adequate design, reliable sources, recommendations for behavior, its risks and benefits, were observed, as recommended by the Clear Communication Index (BR-CDC-CCI). The preliminary version of the guide was presented to people with disabilities caregivers for evaluation, as well as by a group of health professionals who are experts in health education. Finally, there was a need for the collaboration of communication professionals, graphic designers and/or illustrators. The digital guide will then be distributed to public services and social networks.

Implicações do cuidado informal à saúde de pessoas dependentes assistidas no domicílio pós-alta hospitalar / Implicaciones de la atención informal para la salud de las personasdependientes atendidas en el domicilio tras el alta hospitalaria / Implications of informal health care of dependent people assisted at home after hospital discharge

Objetivo:identificar as implicações do cuidado informal à saúde de pessoas dependentes assistidas no domicílio após a alta hospitalar. Método: estudo transversal realizado com 41 díadescuidadoresinformais-pessoas dependentes que receberam alta para o domicílio. Coletaram-se os dados por meio de questionários. Realizou-se Regressão Logística Binomial. Resultados: deixar as atividades laborais eleva em 55,79 as chances de cuidar de pessoa com lesão por pressão. O uso de medicamentos contínuos associou-se ao desenvolvimento de lesões por pressão (OR=37,80), eventos adversos (OR=40,39) e óbito (OR=54,68). O tempo em horas dedicado ao cuidado reduz a chance de lesão por pressão (OR=0,81), a idade do cuidador diminui os eventos adversos (OR=0,91) e o óbito após a desospitalização (OR=0,91). Conclusão: as implicações foram as lesões por pressão, eventos adversos e o falecimento da pessoa dependente após a alta hospitalar, as quais se associaram ànecessidade de deixar o emprego e ao uso de medicações contínuas

Objective:to identify the implications of informal health care for dependent people assisted at home after hospital discharge. Method:a cross-sectional study carried out with 41 dyads of informal caregivers-dependent people who were discharged home. Data were collected through questionnaires. Binomial Logistic Regression was performed. Results:leaving job activities increases the chances of caring for a person with a pressure injury by 55.79. The use of continuous medication was associated with the development of pressure injuries (OR=37.80), adverse events (OR=40.39) and death (OR=54.68). The time in hours dedicated to care reduces the chance of pressure injury (OR=0.81), the age of the caregiver decreases adverse events (OR=0.91) and death after discharge (OR=0.91). Conclusion:the implications were pressure injuries, adverse events and the death of the dependent person after hospital discharge, which were associated with the need to leave the job and the use of continuous medications.

Objetivo:identificar las implicaciones del cuidado informal de la salud para las personas dependientes asistidas en el domicilio después del alta hospitalaria. Método:estudio transversal realizado con 41 díadas de personas dependientes-cuidadoras informales que fueron dadas de alta domiciliarias. Los datos fueron recolectados a través de cuestionarios. Se realizó Regresión Logística Binomial. Resultados:la salida de las actividades laborales aumenta en un 55,79 las posibilidades de cuidar a una persona con lesión por presión. El uso de medicación continua se asoció con el desarrollo de lesiones por presión (OR=37,80), eventos adversos (OR=40,39) y muerte (OR=54,68). El tiempo en horas dedicado al cuidado reduce la posibilidad de lesión por presión (OR=0,81), la edad del cuidador disminuye los eventos adversos (OR=0,91) y la muerte tras el alta (OR=0,91). Conclusión:las implicaciones fueron las lesiones por presión, los eventos adversos y la muerte de la persona dependiente después del alta hospitalaria, que se asociaron con la necesidad de dejar el trabajo y el uso continuo de medicamentos

Relationships at Work: Integrating the Perspectives of Disability Partners to Enhance a Peer Navigation Intervention.

Objective: The Our Peers-Empowerment and Navigational Support (OP-ENS) community-based participatory research study developed, implemented, and evaluated a peer navigator intervention aimed at improving health and healthcare access among Medicaid beneficiaries with disabilities. Peer navigators are community partners with physical disabilities trained to deliver structured peer support interventions that can address barriers to care. The purpose of this paper is two-fold. First, it explicates the relational work the peer navigators do with peers in delivering the intervention. Second, it illustrates how our community-based participatory approach empowered peer navigators to share their knowledge to refine the intervention. Methods: Clinical coordinator team meeting notes, critical incident documentation reports, peer navigator reflections (n = 20) were analyzed thematically to understand the peer navigators' relational work and intervention refinements. Following Labov's 6-stage approach to personal narratives and a collaborative writing process academic, clinical, and disability partners co-wrote descriptive exemplars to showcase these processes. Findings: Through the manualized OP-ENS intervention process, peer navigators helped peers achieve incremental successes. Peer navigators used their training and personal experiences to engage with peers and forge deep connections and relationships of trust. As a result, peers identified a wide-range of social health concerns, including poverty, social isolation, and racial and disability related discrimination that might otherwise go unaddressed. True to the principles of community-based participatory research, by fostering an equity-focused collaboration and listening to peer navigators, the project team implemented subtle but salient refinements to the intervention. Refinements included an explicit focus on social determinants of health affecting peers' health and wellbeing and supplemental trainings to help peer navigators support peers with significant mental health needs. Conclusion: The peer navigators were intentional and skilled at relationship building, thus complex elements which impact peers' health were addressed. Peer navigators were empowered to communicate their perspectives with the study team, who worked together to strengthen the intervention processes and infrastructure. This atmosphere of trust and collaboration amongst diverse stakeholders was instrumental to OP-ENS' successful implementation. Healthcare systems should consider implementing peer support interventions that are responsive to consumer input to address social determinants of health for persons with disabilities.

Gramáticas do capacitismo: diálogos nas dobras entre deficiência, gênero, infância e adolescência / Grammars of ableism: dialogues in the folds between disability, gender, childhood, and adolescence

Resumo Nesse ensaio teórico assumimos o capacitismo como uma gramática que sustenta diversos duplos que hierarquizam e discriminam corporalidades reputadas dissidentes. Sustentamos esse argumento partindo da violação de direitos à saúde e à vida das pessoas com deficiência, pessoas travestis, transexuais e intersexos e das crianças e adolescentes em práticas de vigilância e correção, que sustentam as instituições de saúde e educação, e a Língua.

Abstract In this theoretical essay, we assume ableism as a grammar that sustains several duplicities that hierarchize and discriminate reputed dissident corporalities. We maintain this argument based on the violation of rights to health and life of disabled people, travestis, trans and intersex people, and children and adolescents, in practices of surveillance and correction, which sustain health and education institutions, and Language as the central point of such enabling.

Aging loneliness: improving the quality of life of disabled wreda residents.

The final process in human life has many changes, commonly referred to as wreda or the aging process. This study aims to find out, describe, and analyze techniques for applying group guidance to improve the quality of life of a person's disability at the Integrated Rehabilitation Centre for Persons with Disabilities. The study uses a qualitative descriptive approach, a research procedure that produces descriptive data from the person or behavior observed. Data validity can be done by triangulation, which directs data collection from various existing sources. The main results of this study stated that guidance techniques could minimize stress wreda disability, evidenced by after completing the activity, facial expressions, more smiles, and enthusiasm in following the next activity. Group guidance techniques improve the quality of life of persons with disabilities at the Integrated Rehabilitation Centre for Persons with Disabilities. Limitations in this study became an obstacle in conducting group guidance, namely the mood of disability wreda ups and downs and different desires of each disability. Therefore, future studies on disability assistance and guidance mastery strategies are needed.

O cuidado na perspectiva de familiares de pessoas com deficiência: revisão integrativa / Caring from the perspective of family members of people with disabilities: an integrative review / El cuidado desde la perspectiva de los familiares de personas com discapacidad: uma revisón integrativa

Esta revisão integrativa tem como objetivo compreender como os familiares cuidadores pensam o cuidado de pessoas com deficiência. A busca pelos estudos foi realizada nas bases de dados Scopus, Web of Science, PsycInfo, INDEXPSI, LILACS, SciELO. Foi estipulado o período de tempo que compreende os últimos dez anos de pesquisa (2010-2020). Após a aplicação dos critérios de inclusão e exclusão foram selecionados 19 artigos. A análise dos dados foi categorizada em cinco grandes temas: (a) O cuidado e suas implicações emocionais, psicológicas, físicas, comportamentais e sociais; (b) O cuidado como solidão; (c) O cuidado e suas demandas práticas; (d) O cuidado e as estratégias de enfrentamento; (e) O cuidado e a representação de deficiência. Os resultados mostraram que o cuidado é compreendido conforme a cultura e crenças a respeito da deficiência, além de ocasionar implicações de diferentes ordens aos cuidadores familiares como, discriminações, ansiedade, depressão, solidão e dificuldades financeiras.

This integrative review aims to understand how family caregivers think about caring for a disabled person. The quest for the studies was performed in the databases Scopus, Web of Science, PsycInfo, INDEXPSI; LILACS and, SciELO. The period that comprises the last ten years of research has been stipulated (2010-2020). After applying the inclusion and exclusion criteria, 19 articles were selected. Data analysis was categorized into five major subjects: (a) Caring and its emotional, psychological, physical, behavioral, and social implications; (b) Caring as solitude; (c) Caring and its practical demands; (d) Caring and coping strategies; (e) Disability caring and representation. The results showed that caring is understood according to the culture and beliefs about the disability, in addition it causes different types of implications for family caregivers, such as discrimination, anxiety, depression, loneliness and, financial difficulties.

Esta revisión integrativa tiene como objetivo comprender qué piensan los familiares cuidadores sobre el cuidado de las personas con discapacidades. La búsqueda de los estudios se realizó en las bases de datos Scopus, Web of Science, PsycInfo, INDEXPSI, LILACS, y SciELO. Se ha estipulado el período de tiempo que comprende los últimos diez años de investigación (2010-2020). Después de aplicar los criterios de inclusión y exclusión, se seleccionaron 19 artículos. El análisis de datos se clasificó en cinco temas principales: (a) El cuidado y sus implicaciones emocionales, psicológicas, físicas, conductuales y sociales; (b) El cuidado como soledad; (c) El cuidado y sus exigencias prácticas; (d) El cuidado y las estrategias de afrontamiento; (e) El cuidado y la representación de personas discapacitadas. Los resultados mostraron que el cuidado se entiende de acuerdo con la cultura y creencias sobre la discapacidad, además de generar implicaciones de diferentes órdenes para los familiares cuidadores, tales como discriminación, ansiedad, depresión, soledad y dificultades económicas.

[Assessment of barriers in people with disabilities with ophthalmopathology and varying degrees of sensory impairment to substantiate the list of support services they need and social protection measures in different areas of life.]

The assessment of barriers in persons older than working age with visual impairment was carried out using the International Classification of Functioning, Disabilities and Health to substantiate the list of necessary support services. An increase in the absolute number of people in older age groups objectively leads to an increase in the number of citizens experiencing difficulties in solving medical, social and psychological problems. Analysis of the results of the study showed that a significant part of people, due to impaired visual functions, experience limitations and barriers in physical environment, emotional sphere, family relationships with close and distant relatives. When assessing environmental barriers that interfere with the full-fledged life of persons with visual impairments, the presence of restrictions in sections D4 «Mobility¼, D5 «Self-service¼, D6 «Household life¼ was revealed. The presence of barriers and restrictions indicates the need to implement social protection measures, including rehabilitation, the need to adjust the list of support services. The use of the International Classification of Functioning, Disability and Health will determine the barriers faced by a disabled person due to visual impairment in various spheres of life and provide targeted assistance, support and assistance, to ensure the objectivity and sufficiency of social protection measures for each disabled person, on a scientific basis.

Physical therapy treatment in a para-powerlifting and para-swimming athlete with achondroplasia. case report

ABSTRACT Introduction: Achondroplasia is an autoso-mal dominant congenital condition caused by a mutation of the fibroblast growth encoding gene, which affects endochondral ossification. It is the most common cause of disproportionate short stature, generating physical disability. In the presence of disability, adapted sport emerges as a strategy designed to generate inclusion and, thereby, improve the quality of life of disabled people. The aim was to develop a physical therapy plan that included recommendations to minimize the risk of injury and prevent loss of functionality as a consequence of sports practice. Case presentation: This is the case of a 27-year-old Colombian athlete diagnosed with achondroplasia who competes in the para-powerlifting and swimming modalities. Physiotherapeutic and physical fitness evaluations were carried out, finding obesity and postural and gait pattern alterations. The available literature does not recommend practicing these sports in this type of patient; however, a training program and recommendations were designed to preserve her functionality and improve her sports performance. The plan was put into practice and tolerated adequately by the athlete. Conclusions: Training plans that promote the maintenance of optimal physical condition in adapted sports participants allow them to continue practicing their sport without compromising their life expectancy or functionality. The analysis of the present case illustrates how physical therapists play a key role in this population to minimize the possible complications derived from training and competitions.

RESUMEN Introducción. La acondroplasia es una condición congênita causada por una mutación del gen codificador de crecimiento del fibroblasto que afecta la osificación endocondral y genera discapacidad estructural; además, es la causa más común de talla baja desproporcionada. Por su parte, el deporte adaptado es una disciplina deportiva que se ajusta al colectivo de personas con discapacidad y una estrategia diseñada para generar inclusión y mejorar la calidad de vida de sus participantes. Se presenta el caso de una paciente con acondroplasia a quien se le diseñó un plan fisioterapéutico de intervención enfocado a minimizar el riesgo de lesiones y prevenir la pérdida de funcionalidad como consecuencia de la práctica deportiva. Presentación del caso. Paciente femenina de 27 años diagnosticada con acondroplasia y practicante de levantamiento de potencia adaptado y natación paralímpica, a quien mediante valoración fisioterapéutica y de la aptitud física se le encontraron alteraciones posturales y en el patrón de marcha. Dado que por su condición de base no es recomendable que practique los deportes en los cuales compite, se le diseñó un programa de entrenamiento y recomendaciones dirigido a preservar su funcionalidad y mejorar su desempeño en la práctica deportiva. El plan fue puesto en práctica y tolerado de forma adecuada por la deportista. Conclusiones. Los planes de entrenamiento que favorezcan el mantenimiento de la condición física óptima de los participantes de deportes adaptados les permiten a estos deportistas realizar su práctica sin afectar su expectativa de vida ni su funcionalidad. El análisis del presente caso muestra cómo el fisioterapeuta desempeña un rol importante en esta población, pues los puede ayudar a disminuir las posibles complicaciones que se deriven de entrenamientos y competencias.

Assessment of health status for the purposes of benefi ts and social security services for people with lung cancer and the economic impact of this disease on social security in the Czech Republic.

BACKGROUND: The paper deals with temporary incapacity for work and newly created first, second or third degree disability in people dia-gnosed with lung cancer (dg. C34). The aim of this study was to describe the economic impacts on the budget in the Czech Republic, spent through the Czech Social Security Administration on temporary incapacity for work and newly created disability pensions due to the disease. For greater completeness of the impact on the budget of the Czech Republic, we have also provided an overview of applications for care allowance and applications for the purpose of granting a disability card. MATERIAL AND METHODS: The starting point for the evaluation was the data provided by the Czech Social Security Administration. The basic research group consisted of people with dg. C34, who applied for an invalidity pension in 2016-2019, due to first, second and third degree invalidities. The disability and temporary incapacity for work is therefore related to a group of people at working age. With the help of quantitative research using content analysis of the text, we performed data evaluation. RESULTS: We found that even though the number of people applying for a disability pension for dg. C34 is declining slightly, the expenditure on these pensions is still high. In the years 2016, 2017, 2018 and 2019, the research groups consisted of 612, 631, 576 and 543 people, respectively. CONCLUSION: The disease associated with lung cancer is not only characterized by high mortality, but is also one of the very common causes of temporary incapacity for work and new disabilities. This fact therefore contributes significantly to the economic costs of the Czech Republic.