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Background Class and social disadvantage have long been identified as significant factors in the etiology and epidemiology of psychosis. Few studies have explicitly examined the impact of intersecting social disadvantage on long-term employment and financial independence. Methods We applied latent class analysis (LCA) to 20-year longitudinal data from participants with affective and non-affective psychosis (n = 256) within the Chicago Longitudinal Research. LCA groups were modeled using multiple indicators of pre-morbid disadvantage (parental social class, educational attainment, race, gender, and work and social functioning prior to psychosis onset). The comparative longitudinal work and financial functioning of LCA groups were then examined. Results We identified three distinct latent classes: one comprised entirely of White participants, with the highest parental class and highest levels of educational attainment; a second predominantly working-class group, with equal numbers of Black and White participants; and a third with the lowest parental social class, lowest levels of education and a mix of Black and White participants. The latter, our highest social disadvantage group experienced significantly poorer employment and financial outcomes at all time-points, controlling for diagnosis, symptoms, and hospitalizations prior to baseline. Contrary to our hypotheses, on most measures, the two less disadvantaged groups did not significantly differ from each other. Conclusions Our analyses add to a growing literature on the impact of multiple forms of social disadvantage on long-term functional trajectories, underscoring the importance of proactive attention to sociostructural disadvantage early in treatment, and the development and evaluation of interventions designed to mitigate ongoing social stratification. [ABSTRACT FROM AUTHOR]

In 2016 WHO launched the priority assistive products list (APL) consisting of 50 products and recommended that using this as a reference, countries should develop their own contextually relevant national APLs. This paper describes the development of Malawi's APL. Two hundred and ninety-six persons with disabilities participated in a rapid Assistive Technology Assessment (rATA) survey. Six focus group discussions (FGDs) with people with various types of disabilities were conducted. The rATA questionnaire and FGDs collected data on assistive products (APs) participants used, APs they needed and the challenges they experienced. Data collection was done in six districts spread across the three regions in Malawi. All age groups were included in the survey. Persons with disabilities aged less than 18 participated but went with their guardians. All persons who participated in this study provided consent. Survey and FGDs results were presented at an APL consensus meeting with policymakers, service providers, disabled peoples' organizations and development partners in the disability sector. Based on the results and further discussions, a consensus was reached on the priority APs for Malawi. More than a third of respondents used wheelchairs (32%), followed by auxiliary crutches (25%), walking sticks (13%), reading glasses (11%), prosthesis (10%), elbow crutches (9%) and orthosis (8%). There is also a high demand for products such as pull-up underwear (incontinence products) (79%), hearing aids (70%), reading glasses (59%) and diapers (63%). After intensive discussions during a consensus meeting, an agreement was reached on the 22 priority APs for Malawi. There is a wide range of APs being used by people with different functional limitations in Malawi. There is also a demand for APs that are not readily available. When developing an APL, the list should include products in use, those in demand, and those recommended by service providers. Following the development of the priority assistive products list (APL) by WHO, member states should develop their own contextually based APL. The development of the APL should be based on research evidence. All key stakeholders including persons with disabilities and other functional limitations, government, and development partners should participate in this process. The APL should be part of the national health system or community services. The Department of Disability and Elderly Affairs in the Ministry of Gender, Community Development, being the Government of Malawi line ministry coordinating disability issues participated actively in this study including inviting participants in the stakeholders' validation workshop. [ABSTRACT FROM AUTHOR]

Policy development and implementation are key to improving access to Assistive Technology (AT). In this paper, we describe a strength-based framework for doing this at national level. We used an action research approach, with the United Nations Conventions on the Rights of Persons with Disability (UNCRPD) as the primary frame of reference. Primary data were collected using the World Health Organisation's rapid Assistive Technology Assessment (rATA). We describe the process of applying our emergent framework and how our findings support it. We identified seven guiding principles for effective policy process: Participatory, Resource aware, Outcomes focused, Collaborative, Evidence-informed, supporting good practices, and System strengthening – which can be summarized by the acronym PROCESS. Five crucial building blocks for effective AT policy development emerged: Identification of the assistive technology ecosystem, Demography of disability and AT use, Evaluation of inclusion and participation in existing policy, Alignment with UNCRPD and Sustainable Development Goals (SDGs), and Locality of implementation – which can be summarized with the acronym IDEAL. The IDEAL PROCESS incorporates key content building blocks and core process principles, constituting a systematic framework for guiding the development of context sensitive AT policy and a strength-based pathway to improving access AT. [ABSTRACT FROM AUTHOR]

Assistive technologies (ATs) promote participation and inclusion in society, and support access to health, social services, education, work and other important life experiences for persons with disabilities, older people and those with chronic conditions. The Global Report on Assistive Technology, launched in May 2022 by WHO and UNICEF, calls for concrete actions to improve access to AT globally, and recognizes AT as both a means to, and an end itself, in the achievement of rights of persons with disabilities. The UN Convention on the Rights of Persons with Disabilities (CRPD, 2006) is the most widely ratified human rights convention, affirming the right to participation in society on an equal basis with others. In this paper, we highlight examples of how AT may play a role in realizing each of the fundamental rights affirmed in the UNCRPD. We conducted an indicative literature search for relevant literature to each of the substantive articles of the CRPD. Assistive technology plays a critical role in achieving the rights affirmed by the Convention on the Rights of Persons with Disabilities. Ensuring adequate provision of AT by states parties is critical to the progressive realization of the rights of persons with disabilities and to fulfilling commitments made by states parties upon ratification of the CRPD. Assistive technology (AT) is critical to enable full participation of persons with disability in society and the achievement of rights affirmed by the Convention on the Rights of Persons with Disabilities. Governments and other key stakeholders should endeavour to improve access to AT through inclusive, evidence-informed programs and services. Advocacy is required to improve access to AT through universal health coverage. [ABSTRACT FROM AUTHOR]

Global population growth and increasing longevity means that the need for Assistive Technology (AT) will continue to increase. The level of unmet need for AT is greatest in low-income settings. The aim of this study is to identify age-related increase in impairment and to estimate the AT needs. We analysed secondary data from the 2018 Malawi Population and Housing Census (MPHC) based on the Washington Group on Disability Statistics (WG) short-set of questions. Out of the 1,556,670 persons with one or more functional limitations or disabilities identified in the census, self-reported difficulties in all domains were markedly higher from age 40 and above. The proportion reporting one functional limitation is higher compared to two or more limitations, but at age 78–80 the proportion reporting two or more functional limitations increased above those reporting one functional limitation. Although 60.9% (60.7–61.0) and 63.5% (63.3–63.6) of those who reported difficulty in seeing and hearing were using glasses and hearing aids respectively, the estimated total need for glasses and hearing aids in this group was 98.9% (98.0–99.0) and 98.4% (98.3–98.5) respectively. The unmet need for glasses and hearing aids were therefore 38.1% and 34.9% respectively. The differential slope of impairment curves against age is a guide to the increasing demand for AT across the life course and across different domains of functioning. Country specific analysis of impairment across age and domains is essential to understand and plan for the growing need for AT globally. It is important to estimate and plan for impairment across life course to address the age-related increase in impairment and the increasing need for AT with age. The Zomba curves show the cumulative nature of impairment with age and the need for age and need specific provision of AT across the life course through proactive policy level actions. The significant high unmet need for glasses and hearing aids attests to similar need for other assistive products and the need for setting specific interventions to address needs of affected persons. The differential slope of impairment curves against age is a guide to the differing and increasing demand for assistive technology across the life course and across different domains of functioning [ABSTRACT FROM AUTHOR]

Assistive technology is the products and services used by individuals with functional limitations to enable participation in society and realisation of rights afforded by the United Nations Convention on the Rights of Persons with Disabilities. The Assistive Product List is a comprehensive list of products identified as essential for access through universal health coverage. Key stakeholders, including organisations of persons with disabilities, civil service organisations, academic organisations and government ministries are collaborating to integrate assistive technology into policy and develop a priority assistive products list for Malawi. To understand the organisational characteristics of, and assistive products provided by, key stakeholders working in AT in Malawi. Online survey of representatives from key stakeholder organisations. We surveyed representatives of key stakeholder organisations to gather information regarding assistive technology product and service provision in Malawi. Responses were analysed using counts for closed-ended questions, and conventional content analysis for open-ended questions. A total of 36 of the 50 APL products were provided by eight organisations. Related services were provided for 36 of the 50 APL products by twelve organisations. Five organisations reported providing both products and services. Products and services are largely funded by donation and provided free to those who require them. A range of organisations in Malawi play a role in assistive product delivery and related services. Coordinated AP delivery and service provision is required at a national level which is sustainable and inclusive, and is based on identified needs of the Malawian population. Policies supporting assistive product and service provision must acknowledge the contextual needs of the communities where they are implemented. Coordination is required for assistive product and service provision at the national and subnational level. Existing and potential gaps in service provision must be addressed when implementing a national assistive products list. [ABSTRACT FROM AUTHOR]

To address the data gap on efforts to assess use of assistive technology among children with disability in sub-Saharan Africa. Contribute towards efforts examining access to assistive technologies in sub-Saharan Africa. The paper uses data from the 2017 survey on Living conditions among persons with disabilities in Malawi and the 2015-16 Malawi Demographic and Health survey to address the objective of the study. The two datasets were statistically matched through random hot deck technique, by integrating the two datasets using randomly selected units from a subset of all available data donors. Results indicate that statistical matching technique produces a composite dataset with an uncertainty value of 2.2%. An accuracy assessment test of the technique also indicates that the marginal distribution of use of assistive technology in the composite dataset is similar to that of the donor dataset with an Overlap index value of close to 1 (Overlap = 0.997). The statistical matching procedure does enable generation of good data in data constrained contexts. In the current study, this approach enabled measurement of access to assistive products among children with disabilities, in situations where the variables of interest have not been jointly observed. Such a technique can be valuable in mining secondary data, the collection of which may have been funded from different sources and for different purposes. This is of significance for the efficient use of current and future data sets, allowing new questions to be asked and addressed by locally based researchers in poor settings. In resource-poor settings, the technique of statistical matching can be used to examine factors that predict the use of assistive technology among persons with disabilities. The statistical matching technique is of significance for the efficient use of current and future datasets, allowing new questions to be asked and addressed by locally based researchers. [ABSTRACT FROM AUTHOR]

People with diabetes will have some coexisting mental illness most of the time and its evaluation and management are essential for the well-being of the person. With this background, the Global Mental Health Assessment Tool (GMHAT) app was used to screen for mental illness among type 2 diabetes mellitus patients attending a tertiary care hospital in Mysore, India. Methods: A cross-sectional study was conducted on 100 patients who were on treatment for type 2 diabetes for at least 6 months from the Out-Patient Department of KR Hospital, Mysore. Interviews were conducted using a structured GMHAT. Data were entered in MS Excel and analysed using SPSS version 21.0. Chi-square, Independent T-test/Mann--Whitney tests were used to investigate associations between the variables. Results: The mean age of the study participants was 48.8 ± 11.6 years. Among the 100 diabetic patients, 39% (n = 39) had mental illness and among the 39 subjects, 21% had depression, 14% had anxiety disorder and 4% suffered from organic disorder. Apart from diabetes, 29, 17, 13, 27, 23 and 20% had hypertension, chronic kidney disease, liver disease, retinopathy, neuropathy and nephropathy, respectively, as comorbid conditions. Conclusion: There is a higher prevalence of mental illness in patients with diabetes mellitus. The prevalence rate increases with an increase in the chronicity of diabetes. The use of the GMHAT app could help in rapid assessment and accurate diagnoses. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted all segments of society, but it has posed particular challenges for the inclusion of persons with disabilities, those with chronic illness and older people regarding their participation in daily life. These groups often benefit from assistive technology (AT) and so it is important to understand how use of AT may be affected by or may help to mitigate the impacts of COVID-19. Objective: The objectives of this study were to explore the how AT use and provision have been affected during the initial stages of the COVID-19 pandemic, and how AT policies and systems may be made more resilient based on lessons learned during this global crisis. Methods: This study was a rapid, international online qualitative survey in the 6 United Nations (UN) languages (English, French, Spanish, Russian, Arabic, Mandarin Chinese) facilitated by extant World Health Organization (WHO) and International Disability Alliance networks. Themes and subthemes of the qualitative responses were identified using Braun and Clarke's 6-phase analysis. Results: Four primary themes were identified in in the data: Disruption of Services, Insufficient Emergency Preparedness, Limitations in Existing Technology, and Inadequate Policies and Systems. Subthemes were identified within each theme, including subthemes related to developing resilience in AT systems, based on learning from the pandemic. Conclusion: COVID-19 has disrupted the delivery of AT services, primarily due to infection control measures resulting in lack of provider availability and diminished one-to-one services. This study identified a need for stronger user-centred development of funding policies and infrastructures that are more sustainable and resilient, best practices for remote service delivery, robust and accessible tools and systems, respond to pandemic and other crisis situations. [ABSTRACT FROM AUTHOR]