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      Factors associated with environmental barriers of people with disabilities in Mexico

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          ABSTRACT

          OBJECTIVE:

          To examine the associations between sociodemographic, health and disability-related factors and the perception of environmental barriers outside the home environment by individuals with permanent disabilities in Mexico.

          METHODS:

          In this cross-sectional, population-based study, we used data from the 2010 National Survey of Perceptions of Disability in the Mexican Population of 2,041 participants older than 18 with permanent disability. The perceptions of barriers take into consideration the challenges of getting around and using transportation outside the home environment. The covariates consisted of sociodemographic, health-related and disability-related factors. Multivariate logistic regression was used.

          RESULTS:

          The perception of environmental barriers outside the home environment was associated with being a woman, living in an urban area, speaking an indigenous language, experiencing emotional symptoms, having walking/movement, visual or self-care disabilities, having severe/extreme disability, having disability caused by illness, using physical devices, and receiving assistance and care in the home environment.

          CONCLUSIONS:

          This information is valuable for the design of public policies and programs that promote the participation of individuals with permanent disabilities, a high-priority issue in low- and middle-income countries.

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          Most cited references30

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          Health disparities among adults with developmental disabilities, adults with other disabilities, and adults not reporting disability in North Carolina.

          The purposes of this study were (1) to identify disparities between adults with developmental disabilities and non-disabled adults in health and medical care, and (2) to compare this pattern of disparities to the pattern of disparities between adults with other disabilities and adults without disabilities. The authors compared data on health status, health risk behaviors, chronic health conditions, and utilization of medical care across three groups of adults: No Disability, Disability, and Developmental Disability. Data sources were the 2001 North Carolina Behavioral Risk Factor Surveillance System and the North Carolina National Core Indicators survey. Adults with developmental disabilities were more likely to lead sedentary lifestyles and seven times as likely to report inadequate emotional support, compared with adults without disabilities. Adults with disabilities and developmental disabilities were significantly more likely to report being in fair or poor health than adults without disabilities. Similar rates of tobacco use and overweight/obesity were reported. Adults with developmental disabilities had a similar or greater risk of having four of five chronic health conditions compared with non-disabled adults. Significant medical care utilization disparities were found for breast and cervical cancer screening as well as for oral health care. Adults with developmental disabilities presented a unique risk for inadequate emotional support and low utilization of breast and cervical cancer screenings. Significant disparities in health and medical care utilization were found for adults with developmental disabilities relative to non-disabled adults. The National Core Indicators protocol offers a sound methodology to gather much-needed surveillance information on the health status, health risk behaviors, and medical care utilization of adults with developmental disabilities. Health promotion efforts must be specifically designed for this population.
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            Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-incomecountries: results from the WHO Study on global AGEing and adult health (SAGE)

            Background In 2010 falls were responsible for approximately 80 % of disability stemming from unintentional injuries excluding traffic accidents in adults 50 years and over. Falls are becoming a major public health problem in low- and middle-income countries (LMICs) where populations are ageing rapidly. Methods Nationally representative standardized data collected from adults aged 50 years and over participating in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, the Russian Federation and South Africa are analysed. The aims are to identify the prevalence of, and risk factors for, past-year fall-related injury and to assess associations between fall-related injury and disability. Regression methods are used to identify risk factors and association between fall-related injury and disability. Disability was measured using the WHO Disability Assessment Schedule Version 2.0 (WHODAS 2.0). Results The prevalence of past-year fall-related injuries ranged from 6.6 % in India to 1.0 % in South Africa and was 4.0 % across the pooled countries. The proportion of all past-year injuries that were fall-related ranged from 73.3 % in the Russian Federation to 44.4 % in Ghana. Across the six countries this was 65.7 %. In the multivariable logistic regression, the odds of past-year fall-related injury were significantly higher for: women (OR: 1.27; 95 % CI: 0.99,1.62); respondents who lived in rural areas (OR: 1.36; 95 % CI: 1.06,1.75); those with depression (OR: 1.43; 95 % CI: 1.01,2.02); respondents who reported severe or extreme problems sleeping (OR: 1.54; 95 % CI: 1.15,2.08); and those who reported two or more (compared with no) chronic conditions (OR: 2.15; 95 % CI: 1.45,3.19). Poor cognition was also a significant risk factor for fall-related injury. The association between fall-related injury and the WHODAS measure of disability was highly significant (P<0.0001) with some attenuation after adjusting for confounders. Reporting two or more chronic conditions (compared with none) was significantly associated with disability (P<0.0001). Conclusions The findings provide a platform for improving understanding of risk factors for falls in older adults in this group of LMICs. Clinicians and public health professionals in these countries must be made aware of the extent of this problem and the need to implement policies to reduce the risk of falls in older adults. Electronic supplementary material The online version of this article (doi:10.1186/s12916-015-0390-8) contains supplementary material, which is available to authorized users.
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              Mobility disability and the urban built environment.

              Research on the effects of the built environment in the pathway from impairment to disability has been largely absent. Using data from the Chicago Community Adult Health Study (2001-2003), the authors examined the effect of built environment characteristics on mobility disability among adults aged 45 or more years (n = 1,195) according to their level of lower extremity physical impairment. Built environment characteristics were assessed by using systematic social observation to independently rate street and sidewalk quality in the block surrounding each respondent's residence in the city of Chicago (Illinois). Using multinomial logistic regression, the authors found that street conditions had no effect on outdoor mobility among adults with only mild or no physical impairment. However, among adults with more severe impairment in neuromuscular and movement-related functions, the difference in the odd ratios for reporting severe mobility disability was over four times greater when at least one street was in fair or poor condition (characterized by cracks, potholes, or broken curbs). When all streets were in good condition, the odds of reporting mobility disability were attenuated in those with lower extremity impairment. If street quality could be improved, even somewhat, for those adults at greatest risk for disability in outdoor mobility, the disablement process could be slowed or even reversed.
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                Author and article information

                Journal
                Rev Saude Publica
                Rev Saude Publica
                rsp
                Revista de Saúde Pública
                Faculdade de Saúde Pública da Universidade de São Paulo
                0034-8910
                1518-8787
                2019
                27 March 2019
                : 53
                : 27
                Affiliations
                [I ]Instituto Nacional de Geriatría, Subdirección de Investigación Epidemiológica Geriátrica. Departamento de Epidemiología Demográfica y Determinantes Sociales. Ciudad de México, México
                [II ]Instituto Mexicano del Seguro Social. Unidad de Investigación en Epidemiología Clínica. Hospital de Especialidades. Coordinación de Investigación en Salud. Ciudad de México, México
                [III ]Secretaría de Gobernación. Subsecretaría de Prevención y Participación Ciudadana. Ciudad de México, México
                [IV ]Universidad Nacional Autónoma de México. Facultad de Medicina. Centro de Investigación en Políticas, Población y Salud. Ciudad de México, México
                Author notes
                Correspondence: Marcela Agudelo-Botero, Universidad Nacional Autónoma de México, Facultad de Medicina, Centro de Investigación en Políticas, Población y Salud Circuito Cultural s/n Ciudad Universitaria, Ciudad de México C.P. 04510 E-mail: magudelo@ 123456comunidad.unam.mx

                Authors’ Contribution: Design and planning of the study: LGR, MAB. Collection, analysis, and interpretation of data: LGR, MAB, JCM. Preparation or proofreading of the study: LGR, MAB, DML. Approval of the final version: LGR, MAB, DML. Public responsibility for the contents of the article: LGR, MAB.

                Conflict of Interest: The authors declare no conflict of interest.

                Author information
                http://orcid.org/0000-0001-6541-865X
                http://orcid.org/0000-0002-5144-2728
                http://orcid.org/0000-0001-8868-8687
                http://orcid.org/0000-0002-4489-4224
                Article
                00223
                10.11606/S1518-8787.2019053000556
                6474753
                30942269
                dbfbd679-e66d-4dc2-8c53-f23aa187a506

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 01 November 2017
                : 18 April 2018
                Page count
                Figures: 0, Tables: 3, Equations: 0, References: 36
                Categories
                Original Article

                disabled people,self-assessment,activities of daily living,environmental design,socioeconomic factors,cross-sectional studies

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