Higher social distress and lower psycho-social wellbeing:examining the coping capacity and health of people with hearing impairment

Abstract
Purpose: The objectives of this paper are as follows: (1) propose an explanatory model as to how hearing disability may impact on health and (2) examine the model’s utility.
Methods: Data were collected on the psycho-social wellbeing, disability and physical health of farmers (n=56) participating in an intervention to manage the social impacts of hearing disability. Two models were proposed and examined using multiple hierarchical linear regression. Model 1 used self-rated quality of life and model 2 used capacity to manage hearing and listening impairments, as dependent variables.
Results: The analyses found that physical measures of hearing impairment (audiograms) were not correlated with physical or mental health outcomes. However, in model 1, self-confidence and self-rated ability to manage hearing impairment were most closely associated with reduced quality of life (anxiety and diastolic blood pressure were positively associated with quality of life). In model 2, higher anxiety and reduced self-confidence were associated with decreasing ability to successfully manage one’s hearing impairment.
Conclusions: The findings support the explanatory model that stress is higher and wellbeing lower when the fit between the person’s coping capacity and environmental demands is poor.

Hearing in athletes with intellectual disabilities : the need for improved ear care

Background The Special Olympics offer the opportunity for athletes with intellectual disabilities to participate in a range of sports at regional, national and international level. A parallel Healthy Athletes programme was introduced to ensure safety at the games but also to collect data on the health needs of those with intellectual disabilities (ID).

Method This study reports on the introduction of a hearing screen for the first time at national games in Great Britain. Given the availability of free local healthcare it was unclear whether the screen would simply duplicate services already accessed locally.

Results Of the 996 athletes who went though the hearing screen 40% were identified with a previously unrecognised hearing loss, 52% required medical ear care and 43% required wax removal. Despite complex competing stimuli within the screening area only 15 of the subjects were unable to complete the full screen. Local clinical services are carried out in more controlled environments therefore it is reasonable to presume that it would be possible for them to provide assessment of ear care and ongoing audiological assessments where needed. It was found that carers and sports coaches were generally unaware of the hearing needs of the athletes, in spite of the fact that they worked so closely with them.

Conclusions The importance of imparting information to carers and coaches, together with the need for access to regular ear care locally is underlined in this study.

Removing barriers to substantive equality : a case study of remedying disability discrimination complaints

Disability discrimination complaints are primarily resolved in the privacy of a conciliation conference. Few complaints reach the courts, so there is very little available information about the outcomes negotiated by the parties or how this type of discrimination is being addressed. Drawing on settlement agreements and decided cases from Queensland, this article examines how disability discrimination across a range of areas is remedied prior to hearing and by the tribunal. The data suggests that complaints are predominantly remedied in an individualised way, mainly with compensation. Although the parties negotiate wider, systemic outcomes on occasion — such as building modifications or better access to premises — courts rarely award remedies of this nature. The law in the United Kingdom takes quite a different approach. This article considers three mechanisms used in the United Kingdom which could be adopted in Australia to strengthen the law’s effectiveness for people with a disability: investing a public agency with enforcement powers; requiring organisations to make reasonable adjustments for people with a disability; and placing a positive duty on public authorities to promote equality for people with a disability.

Population outcomes of three approaches to detection of congenital hearing loss

BACKGROUND: Universal newborn hearing screening was implemented worldwide largely on modeled, not measured, long-term benefits. Comparative quantification of population benefits would justify its high cost.

METHODS: Natural experiment comparing 3 population approaches to detecting bilateral congenital hearing loss (>25 dB, better ear) in Australian states with similar demographics and services: (1) universal newborn hearing screening, New South Wales 2003-2005, n = 69; (2) Risk factor screening (neonatal intensive care screening + universal risk factor referral), Victoria 2003-2005, n = 65; and (3) largely opportunistic detection, Victoria 1991-1993, n = 86. Children in (1) and (2) were followed at age 5 to 6 years and in (3) at 7 to 8 years. Outcomes were compared between states using adjusted linear regression.

RESULTS: Children were diagnosed younger with universal than risk factor screening (adjusted mean difference -8.0 months, 95% confidence interval -12.3 to -3.7). For children without intellectual disability, moving from opportunistic to risk factor to universal screening incrementally improved age of diagnosis (22.5 vs 16.2 vs 8.1 months, P < .001), receptive (81.8 vs 83.0 vs 88.9, P = .05) and expressive (74.9 vs 80.7 vs 89.3, P < .001) language and receptive vocabulary (79.4 vs 83.8 vs 91.5, P < .001); these nonetheless remained well short of cognition (mean 103.4, SD 15.2). Behavior and health-related quality of life were unaffected.

CONCLUSIONS: With new randomized trials unlikely, this may represent the most definitive population-based evidence supporting universal newborn hearing screening. Although outperforming risk factor screening, school entry language still lagged cognitive abilities by nearly a SD. Prompt intervention and efficacy research are needed for children to reach their potential.

Physical disability and sexual esteem

The current study investigated the impact of physical disability on sexual feelings, sexual experiences, and sexual esteem. Thirty-five respondents (18 males and 17 females), with physical disabilities between 19 to 60 years (SD = 10, mean = 38) participated in focus groups where they discussed how their physical disability impacted on their sexuality. They also responded to a series of questions that were designed to examine disability-specific issues in sexual esteem using a four-point Likert-type scale. The data demonstrated that the participants struggled with many social and sexual barriers that were associated with having a physical impairment. This appeared to lead to increased feelings of negativity in many participants, including a belief that they were less sexually desirable than an able-bodied person and that having a disability seriously limited their sexual expression. The implications of these findings for practitioners and suggestions for future research are discussed.

The impact of physical disability on body esteem

The current study investigated the impact of physical disability on body esteem. A total of 35 people (18 males and 17 females) with physical disabilities between 19 to 60 years (mean = 38 years, SD = 10), participated in focus groups where they discussed their feelings about how their disability affected their body esteem. They also responded to a series of questions that were designed to examine disability-specific issues in body esteem using a four point Likert-type scale. The data demonstrated that the body esteem of the participants was commonly affected by physical disability. It also suggested that feedback from the social environment is a likely mediator of body esteem. Suggestions for future research and implications for clinicians are discussed.

Substance abuse by offenders with mild intellectual disability

This study compared the rate of self-reported alcohol and other drug use in a sample of 30 young adults with mild intellectual disability whose offending behaviour had resulted in involvement in the criminal justice system, with a matched comparison group of 30 non-offenders. Performance on an alcohol and other drug knowledge test was also compared. The results indicated that many individuals with mild intellectual disability regularly consumed alcohol and used illicit drugs. Furthermore, the data suggest a possible link between substance abuse and offending behaviour in this population. Individuals who had offended reported greater use of both legal and illicit drugs than their non-offending counterparts and many reported that they had been under the influence of alcohol or illicit drugs at the time of committing the offence that had resulted in their current placement within the criminal justice system. Although deficits in knowledge were apparent in both groups, the offenders demonstrated greater overall knowledge about alcohol and other drugs.

Population based intervention to change back pain beliefs and disability : three part evaluation

Objective To evaluate the effectiveness of a population based, state-wide public health intervention designed to alter beliefs about back pain, influence medical management, and reduce disability and costs of compensation. Design Quasi-experimental, non-randomised, non-equivalent, before and after telephone surveys of the general population and postal surveys of general practitioners with an adjacent state as control group and descriptive analysis of claims database. Setting Two states in Australia Participants 4730 members of general population before and two and two and a half years after campaign started, in a ratio of2:1:1; 2556 general practitioners before and two years after campaign onset. Main outcome measures Back beliefs questionnaire, knowledge and attitude statements about back pain, incidence of workers' financial compensation claims for back problems, rate of days compensated, and medical payments for claims related to back pain and other claims. Results In the intervention state beliefs about back pain became more positive between successive surveys (mean improvement in questionnaire score 1.9 (95% confidence interval 1.3 to 2.5), P<0.001 and 3.2 (2.6 to 3.9), P < 0.001, between baseline and the second and third survey, respectively). Beliefs about back pain also improved among doctors. There was a clear decline in number of claims for back pain, rates of days compensated, and medical payments for claims for back pain over the duration of the campaign. Conclusions A population based strategy of provision of positive messages about back pain improves population and general practitioner beliefs about back pain and seems to influence medical management and reduce disability and workers' compensation costs related to back pain.

The subjective well-being of people caring for a family member with a severe disability at home: a review

This review concerns the life quality of people caring for a relative with a severe disability within their family. It involves the balance between the advantages such care brings to the care recipient and the costs borne by the family. A brief history indicates that the forces that encourage family care are minimally concerned with family welfare. Moreover, an analysis of both qualitative and quantitative data indicates that primary caregivers are at considerable risk of high stress, clinical depression, and abnormally low subjective quality of life. It is concluded that increased public expenditure directed to the care of people with severe disability is urgently required.

Factors that influence employer decisions in hiring and retaining an employee with a disability

This paper is based on results of a national study in Australia. Questionnaires were completed by 643 employers, each of whom had employed a person with a disability between 1996--1998. Employers rated the importance of several factors relevant to decisions to hire and retain a person with a disability. Individual factors were rated most important, with grooming/hygiene and work-performance factors rated highest. Management factors and cost factors were rated moderately important. Social factors were rated least important. Analyses of variance were conducted, identifying several employer differences in ratings. The paper discusses employer values as well as the need to include employers in a partnership approach.

Employer benefits and costs of employing a person with a disability

This paper is based on results of a national study in Australia. Questionnaires were completed by 643 employers, each of whom had employed a person with a disability between 1996-1998. Employers rated the importance of several factors relevant to decisions to hire and retain a person with a disability. Individual factors were rated most important, with grooming/hygiene and work-performance factors rated highest. Management factors and cost factors were rated moderately important. Social factors were rated least important. Analyses of variance were conducted, identifying several employer differences in ratings. The paper discusses employer values as well as the need to include employers in a partnership approach.

Case studies in learning disability: implications for instruction

A significant number of children with learning disabilities may hold negative attributions about themselves which not only impact on their willingness to learn but put themselves at risk of developing depression. A multi-disciplinary assessment team found evidence for the existence of at least two distinct patterns of learning disability. It was concluded that interventions must focus not only on content areas but on the individual attributions the child holds about his or her ability and potential.

Development and validation of the physical disability sexual and body esteem scale

The Physical Disability Sexual and Body Esteem (PDSBE) scale was developed to assess respondents' capacity to feel positive about their sexuality and their body while living with a physical impairment. The current paper presents four studies that were conducted to develop and assess the psychometric properties of the 10 item PDSBE scale. The first study was an exploratory factor analysis involving 348 participants with physical disabilities. The factors were: Sexual Esteem, Attractiveness to Others, and Body Esteem. The second study was a confirmatory factor analysis, with a total of 338 participants. This analysis confirmed the factor structure established in study 1. The third study revealed good test-retest reliability on a total of 47 participants with physical disabilities. The final study was conducted with 748 participants with physical disabilities and showed that the PDSBE had high reliability and good convergent and divergent validity. Mean scores showed that women scored significantly higher than men on the total PDSBE scale and on the Sexual Esteem and Attractiveness to Others subscales. Future applications for the PDSBE scale are discussed.