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Background: Little is known about depressive symptoms in podoconiosis despite the independent contribution of depression to worse health outcomes and disability in people with other chronic disorders. Method: Two-hundred and seventy-one individuals with podoconiosis and 268 healthy neighbours (individuals from the nearest household in any direction) were investigated for depressive symptoms using a validated Amharic version of the Patient Health Questionnaire (PHQ-9). The WHO Disability Assessment Schedule II (WHODAS II) tool was used to measure disability. Logistic regression and zero inflated negative binomial regression were used to identify factors associated with elevated depressive symptoms, and disability, respectively. Results: Among study participants with podoconiosis, 12.6% (34/269) had high levels of depressive symptoms (scoring 5 or more points on the PHQ-9, on two assessments two weeks apart) compared to 0.7% (2/268) of healthy neighbours (p<0.001). Having podoconiosis and being older were significantly associated with increased odds of a high PHQ-9 score (adjusted odds ratios [AOR] 11.42; 95% CI 2.44-53.44 and AOR 1.04; 95% CI 1.00- 1.08, respectively). Significant predictors of a higher disability score were having podoconiosis (WHODAS II multiplier value: 1.48; 95% CI 1.39-1.58) and having a high PHQ-9 score (1.07; 95% CI 1.06-1.08). Conclusion: We recommend integrating evidence-based treatments for depression into podoconiosis interventions. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence suggests that illnesses and injuries leading to restricted activity have adverse functional consequences, but whether the two components of restricted activity have comparable effects is unknown. We evaluated whether an illness/injury leading to bed rest represents a more potent exposure than one leading to cutting down on one's usual activities without bed rest.Methods: We prospectively evaluated 754 community-living persons, 70+ years. Telephone interviews were completed monthly for >15 years to assess disability in four basic, five instrumental, and four mobility activities and to ascertain exposure to illnesses/injuries leading to cut down activities and bed rest, respectively. For each of the three functional domains, transitions between no disability, mild disability, and severe disability were evaluated each month.Results: For each domain, cut down activities and bed rest were significantly associated with at least one transition. The associations were consistently stronger, however, for bed rest than for cut down activities. Bed rest was a particularly potent exposure for transitions from no disability to severe disability, with hazard ratios as high as 8.94 (95% CI, 5.69-14.1) for the mobility activities, and for all transitions from severe disability (representing recovery), with hazard ratios as low as 0.25 (0.12-0.54) for the transition to no disability for the basic activities.Conclusions: In the setting of an illness/injury, bed rest was more strongly associated with a set of clinically meaningful transitions in functional status than cut down activities. Prompt medical attention may be warranted when an older person takes to bed because of an illness/injury. [ABSTRACT FROM AUTHOR]

Background. We examined the association between perceived environmental barriers to outdoor mobility and loneliness among community-dwelling older people. In addition, we studied whether walking difficulties and autonomy in participation outdoors affected this association. Methods. Cross-sectional analyses of face-to-face home interview data with 848 people aged 75–90 years (mean age: 80.1 years; 62% women) gathered within the “Life-Space Mobility in Old Age” (LISPE) project. Self-reports of loneliness, environmental barriers to outdoor mobility, and difficulties in walking 2 km were obtained with structured questionnaires. Autonomy in participation outdoors was assessed with the “Impact on Participation and Autonomy” questionnaire. Results. Altogether, 28% of participants reported experiencing loneliness sometimes or often. These participants also reported more difficulties in walking 2 km, restricted autonomy in participation outdoors, and more environmental barriers to outdoor mobility than people not experiencing loneliness. Snowy and icy winter conditions (odds ratio: 1.59 [95% confidence interval: 1.15–2.20]), long distances to services (odds ratio: 1.57 [1.00–2.46]), and hills in the nearby environment (odds ratio: 1.49 [1.05–2.12]) significantly increased the odds for loneliness, even after adjustments for walking difficulties, autonomy in participation outdoors, perceived financial situation, living alone, and health. Path modeling revealed that environmental barriers increased loneliness either through direct association or indirectly through restricted autonomy in participation outdoors. Conclusions. Prospective studies should investigate whether removing environmental barriers to outdoor mobility improves autonomy in participation outdoors and alleviates loneliness among older people. [ABSTRACT FROM PUBLISHER]

The article reports on research conducted to determine the levels of physical activity and to determine the factors related to the physical activity behavior of adults with multiple sclerosis by use of the Physical Activity for People With a Disability (PAD) model. Researchers evaluated 106 people with multiple sclerosis. They found that the the individuals that they evaluated spent an average of 30 hours per week on activities with metabolic equivalents of two on the Expanded Disability Status Scale score. They also found that people with multiple sclerosis were less active if their disease was more severe, if they received a disability pension or had children to care for. INSET: The Bottom Line.

The article discusses the use of Internet resources in disability studies. Teachers can improve a student's understanding of disability studies by incorporating Internet resources into their curriculum. Some students can be intimidated by areas of a library where disability studies resources are kept and many libraries are not open at night whereas the Internet can be used at any time and is both a familiar and friendly atmosphere for students. The American Folklife Center of the Library of Congress hosts the Veterans History Project which is a collection of veterans' histories.

Background and Purpose Although a criterion reference of 10,000 steps per day is recommended for health benefits, a literature search yielded no normative standard for daily steps. Therefore, a meta-analysis was used in estimate the number of pedometer-documented steps that adults take daily. Methods Studies were retrieved using electronic databases and cross-referencing from retrieved studies. A random-effects model and 95% confidence intervals (CIs) were used tor all analyses of daily step data. Results Seventy-one outcomes, representing 6,199 subjects from 42 studies, met the inclusion criteria. Excluding Amish subjects, the daily step count averaged 9,448 (95% CI=8,899-9,996) and was greater in subjects younger than 65 years of age (mean=9,797, 95% CI=9,216-10,377) compared with subjects 65 years of age or older (mean=6,565, 95% CI=4,897-8,233). Discussion and Conclusion This study provides an estimate of the number of daily steps taken by adults. The number is less than the recommended 10,000 steps per day and is especially low in adults 65 years of age or older. [ABSTRACT FROM AUTHOR]

Nearly 20% of US citizens are disabled. Epidemiologic studies have shown that people with physical disabilities have a 1.2- to 3.9-fold increase in obesity prevalence. Obesity is becoming a serious problem in disabled individuals. The mechanisms by which obesity occurs in people with physical disabilities is not clear, but pathophysiological changes of body composition and energy metabolism, physical inactivity, and muscle atrophy all favor the development of obesity. Health professionals should identify disabled patients at risk and provide early prevention guidance. Research is needed to help generate detailed clinical guidelines to promote weight control among people with physical disabilities. [ABSTRACT FROM AUTHOR]

Background. Physical performance measures can predict incident disability, but little research has assessed and compared how these measures predict progressive and rapid-onset (catastrophic) disability. The authors evaluated the ability of upper and lower extremity performance measures to predict progressive and catastrophic disability in activities of daily living (ADL), mobility, and upper extremity function. Methods. The incidence of progressive and catastrophic disability was assessed semiannually during a 3-year period in 884 women participating in the Women's Health and Aging Study I. Four-meter walking speed, balance, and chair stands tests were used to evaluate lower extremity function. The putting-on-blouse test, the Purdue pegboard test, and grip strength were used to assess upper extremity function. Summary performance scores (SPS) for the lower and upper extremities were calculated. Among participants in whom disability developed, those who reported no difficulty in the previous year were defined as cases of catastrophic disability, and those who previously reported little or some difficulty were considered to be cases of progressive disability. Cox proportional hazard regression analyses were used to evaluate the association of performance measures and time to incident disability. The predictive ability of performance measures was compared using receiver-operator characteristic curves. Results. All lower and upper extremity measures, with the exception of grip strength, significantly predicted the onset of progressive ADL disability, but only walking speed was significantly associated with the onset of catastrophic ADL disability. The chair stands test, walking speed, and the lower extremity SPS were significantly associated with the onset of both progressive and catastrophic mobility disability. Only lower extremity individual tests and SPS significantly predicted the onset of both progressive and catastrophic upper extremity disability. The... [ABSTRACT FROM AUTHOR]