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This is a systematic review of systematic reviews of secondary health conditions, health promotion interventions, and employment in people with intellectual disabilities. Articles were included if they reported a systematic review of health and employment, secondary health conditions, and health promotion interventions for people with intellectual disabilities. The methodological quality of the included reviews was reviewed using the A MeaSurement Tool to Assess systematic Reviews quality rating system, a measurement tool to assess systematic reviews. Twenty-five systematic reviews were included. There was evidence that people with intellectual disabilities (ID) were at elevated risk for secondary health conditions, health promotion interventions can improve physical and mental health conditions, and employment is associated with better health-related quality of life. Health promotion intervention to help people with ID engage in health promoting behaviors can improve health and their ability to find and maintain employment.
Multiple sclerosis (MS) is a central nervous system disorder that impacts more than 400,000 people in the U.S. The disease results in multiple functional impairments that are diverse and varied across individuals. Additonally, MS has a profound impact on community participation which, like other rehabilitation outcomes, cannot be explained on the basis of functional limitations alone. The purpose of this study was to develop and evaluate a model of community participation for people living with MS using the World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF) framework. The model focused on the roles that personal factors have as predictors of community participation, while also serving as mediators and moderators for the relationship between activity limitation and participation. Results from the hierarchical regression analysis indicated that demographic characteristics (i.e. MS type), personal factors (i.e. core self-evaluations (CSE), MS self-management, resilience, and social skills), and activity limitations accounted for 64% of the variance in participation. Further, mediation analysis indicated that CSE mediated the relationship between activity limitation and community participation. Finally, moderation analysis indicated an interaction effect between educational attainment and MS self-management. Implications for future research in rehabilitation and clinical application are discussed.
In a global society experiencing an increasing shortage of qualified workers and the recognition that individuals with autism spectrum disorder (ASD) can be effective employees, there is an uptick in private sector initiatives to address employment needs through the recruitment of workers with ASD. A case study methodology with consensual qualitative research analysis was used to gain a rich understanding of employment of people with ASD at a medium-sized clothier in collaboration with a service provider for people with ASD. Perceptions of implementation and effectiveness were collected. Results suggest the hiring of people with ASD was positively perceived by employees. Components of this success included changes to the physical work environment, diversity training specific to individuals with disabilities, and a company climate of engaging and supporting employees with ASD. This research suggests that the collaborative initiative may prove a meaningful model for other companies interested in employing people with ASD.
The relationship between the subtypes of psychotic experiences (PEs) and common mental health symptoms remains unclear. The current study aims to establish the 12-month prevalence of PEs in a representative sample of community-dwelling Chinese population in Hong Kong and explore the relationship of types of PEs and common mental health symptoms.
This is a population-based two-phase household survey of Chinese population in Hong Kong aged 16–75 (N = 5719) conducted between 2010 and 2013 and a 2-year follow-up study of PEs positive subjects (N = 152). PEs were measured with Psychosis Screening Questionnaire (PSQ) and subjects who endorsed any item on the PSQ without a clinical diagnosis of psychotic disorder were considered as PE-positive. Types of PEs were characterized using a number of PEs (single v. multiple) and latent class analysis. All PE-positive subjects were assessed with common mental health symptoms and suicidal ideations at baseline and 2-year follow-up. PE status was also assessed at 2-year follow-up.
The 12-month prevalence of PEs in Hong Kong was 2.7% with 21.1% had multiple PEs. Three latent classes of PEs were identified: hallucination, paranoia and mixed. Multiple PEs and hallucination latent class of PEs were associated with higher levels of common mental health symptoms. PE persistent rate at 2-year follow-up was 15.1%. Multiple PEs was associated with poorer mental health at 2-year follow-up.
Results highlighted the transient and heterogeneous nature of PEs, and that multiple PEs and hallucination subtype of PEs may be specific indices of poorer common mental health.
Maternal and child health are intrinsically linked. With accumulating evidence over the past two decades supporting the developmental origins of health and diseases hypothesis, it is now widely recognised that nutrition in the first 1000 d sets the foundation for long-term health. Maternal diet before, during and after pregnancy can influence the developmental pathways of the fetus and lead to health consequences later in life. While maternal and infant mortality rates have declined significantly in the past two decades, the growing burden of obesity and chronic non-communicable diseases in women of reproductive age and children is on a rapid rise worldwide, in developed and developing countries. A key contributory factor is malnutrition, which is a consequence of consuming poor quality diets. Suboptimal macronutrient balance and micronutrient inadequacies can lead to undesirable maternal body composition and metabolism, in turn influencing the health of the mother and leading to longer-term metabolic and cognitive health consequences in the infant. The GUSTO (Growing Up in Singapore Towards healthy Outcomes) study, a mother–offspring multi-ethnic cohort study in Singapore, has contributed to this body of evidence over the past 10 years. This review will illustrate how nutritional epidemiological research through a birth cohort has illuminated the importance and urgency of maternal and child nutrition and health in a modern, industrialised setting. It underscores the importance of a number of critical nutrients during pregnancy, in combination with healthy dietary patterns and appropriate meal timing, for optimal maternal and child health.
Recent evidence suggests that synchronizing eating-fasting schedules with body's circadian rhythms or day-night cycles is important for metabolic health. Besides food quantity and quality, food timing may contribute to weight regulation. However, it is unclear if this factor during pregnancy can influence maternal weight retention after childbirth. Using data from a prospective cohort, the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study, we examined the associations of maternal circadian eating pattern and diet quality in pregnancy with substantial postpartum weight retention (PPWR) at 18 months. We assessed 687 pregnant women for their circadian eating pattern (night-eating, night-fasting and eating episodes) and diet quality (Healthy Eating Index) based on information derived from 24-h dietary recall at 26–28 weeks’ gestation. Night-eating was defined as > 50% of total energy intake during 1900–0659 h; night-fasting duration was determined based on the longest fasting interval between consumption of a calorie-containing food or beverage during 1900–0659 h; eating episodes were defined as events that provided ≥ 210 kJ with time intervals between eating episodes of ≥ 15 min; diet quality was ascertained using the Healthy Eating Index which measures adherence to the Singapore dietary guidelines for pregnant women. PPWR was calculated by subtracting the weight at the first antenatal clinic visit from weight at 18-month postpartum. Substantial PPWR was defined as weight retention of 5 kg or more. Adjusting for maternal age, ethnicity, education, parity, night shift, mood, body mass index and total energy intake, multivariable binary logistic regression analysis was performed to estimate odds ratio (OR) of substantial PPWR in relation to circadian eating pattern and diet quality. Of 687 women, 110 (16%) had substantial PPWR. After confounders adjustment, night-eating (OR 1.95; 95% confidence interval 1.05, 3.62) and lower diet quality (1.91; 1.17, 3.10) were independently associated with higher odds of substantial PPWR. No associations with substantial PPWR were observed for night-fasting duration and number of eating episodes. During pregnancy, women with higher caloric consumption at night and lower diet quality had a greater likelihood of substantial PPWR. These findings suggest that aligning eating time with day-night cycles and adherence to dietary guidelines during pregnancy may help to alleviate overweight and obesity risk in postpartum life. There is a possibility that these eating patterns persist beyond pregnancy and pose implications for long-term obesity development. Further investigation on this area is required.
Seasonal influenza virus epidemics have a major impact on healthcare systems. Data on population susceptibility to emerging influenza virus strains during the interepidemic period can guide planning for resource allocation of an upcoming influenza season. This study sought to assess the population susceptibility to representative emerging influenza virus strains collected during the interepidemic period. The microneutralisation antibody titers (MN titers) of a human serum panel against representative emerging influenza strains collected during the interepidemic period before the 2018/2019 winter influenza season (H1N1-inter and H3N2-inter) were compared with those against influenza strains representative of previous epidemics (H1N1-pre and H3N2-pre). A multifaceted approach, incorporating both genetic and antigenic data, was used in selecting these representative influenza virus strains for the MN assay. A significantly higher proportion of individuals had a ⩾four-fold reduction in MN titers between H1N1-inter and H1N1-pre than that between H3N2-inter and H3N2-pre (28.5% (127/445) vs. 4.9% (22/445), P < 0.001). The geometric mean titer (GMT) of H1N1-inter was significantly lower than that of H1N1-pre (381 (95% CI 339–428) vs. 713 (95% CI 641–792), P < 0.001), while there was no significant difference in the GMT between H3N2-inter and H3N2-pre. Since A(H1N1) predominated the 2018–2019 winter influenza epidemic, our results corroborated the epidemic subtype.
Low socioeconomic status (SES) is a barrier for cardiovascular disease (CVD) risk screening and a determinant of poor CVD outcomes. This study examined the associations between access to health-promoting facilities and participation in a CVD risk screening program among populations with low SES residing in public rental flats in Singapore.
Data from Health Mapping Exercises conducted from 2013 to 2015 were obtained, and screening participation rates of 66 blocks were calculated. Negative binomial regression was used to test for associations between distances to four nearest facilities (i.e., subsidized private clinics, healthy eateries, public polyclinics, and parks) and block participation rate in CVD screening. We also investigated potential heterogeneity in the association across regions with an interaction term between distance to each facility and region.
The analysis consisted of 2069 participants. The associations were only evident in the North/North-East region for subsidized private clinic and park. Specifically, increasing distance to the nearest subsidized private clinic and park was significantly associated with lower [incidence rate ratio (IRR) = 0.88, 95% confidence interval (CI): 0.80–0.98] and higher (IRR = 1.93, 95%CI: 1.15–3.25) screening participation rates respectively.
Our findings could potentially inform the planning of future door-to-door screenings in urban settings for optimal prioritization of resources. To increase participation rates in low SES populations, accessibility to subsidized private clinics and parks in a high population density region should be considered.
The main objective of this study was to investigate the relationships between motivation and readiness levels for physical activity and exercise behaviour among persons with chronic musculoskeletal pain. Participants were 211 U.S. adults with chronic musculoskeletal pain from online support groups as well as specialty and primary care clinics (females = 86.7%; mean age = 43.4 years, SD = 14.4 years). The participants completed an online survey on their engagement in physical activity and exercise behaviour. Multiple one-way analyses of variance with post-hoc comparisons using the Tukey HSD test revealed significant differences between the readiness stages of change groups of preintenders, intenders, and actors in their motivation for physical activity and exercise behaviour. Specifically, the actor group of behavioural change reported higher levels of motivation beliefs for physical activity and exercise behaviour compared to preintenders and intenders. These findings suggest that people with chronic musculoskeletal pain experiencing increased motivation for physical activity and exercise behaviour are more engaged in desired behaviours than the persons with chronic pain reporting varying degrees of behavioural intentions.
To engage in the community and the workplace requires physical, mental, and social health and wellbeing. Health promotion is a crucial rehabilitation counselling function for the health and wellbeing of people living with chronic illness and disability (CID). This exploratory review seeks to examine theories and models of motivation applicable to health promotion interventions in rehabilitation counselling practice. Although no single theory can address all the potential variables affecting people with CID's health behaviours, Bandura's (1977) concept of self-efficacy and outcome expectancy appear to be the most common factors in the health promotion models we surveyed. Among theories of motivation, only self-determination theory specifically includes a motivation variable, autonomy (internal and external motivation). We developed a diagram to depict a model, including all the theories and models covered in this exploratory review and identify commonalities among their constructs. This diagram can be used by rehabilitation counsellors to apply theories and models of motivation in case conceptualisation, formulating clinical hypotheses, developing treatment plans, and selecting and implementing evidence-based health promotion interventions for their clients.
Early life nutrition and feeding practices are important modifiable determinants of subsequent obesity, yet little is known about the circadian feeding pattern of 12-month-old infants. We aimed to describe the 24-h feeding patterns of 12-month-old infants and examine their associations with maternal and infant characteristics. Mothers from a prospective birth cohort study (n 431) reported dietary intakes of their 12-month-old infants and respective feeding times using 24-h dietary recall. Based on their feeding times, infants were classified into post-midnight (00.00–05.59 hours) and pre-midnight (06.00–23.59 hours) feeders. Mean daily energy intake was 3234 (sd 950) kJ (773 (sd 227) kcal), comprising 51·8 (sd 7·8) % carbohydrate, 33·9 (sd 7·2) % fat and 14·4 (sd 3·2) % protein. Mean hourly energy intake and proportion of infants fed were lower during post-midnight than pre-midnight hours. There were 251 (58·2 %) pre-midnight and 180 (41·8 %) post-midnight feeders. Post-midnight feeders consumed higher daily energy, carbohydrate, fat and protein intakes than pre-midnight feeders (all P<0·001). The difference in energy intake originated from energy content consumed during the post-midnight period. Majority (n 173) of post-midnight feeders consumed formula milk during the post-midnight period. Using multivariate logistic regression with confounder adjustment, exclusively breast-feeding during the first 6 months of life was negatively associated with post-midnight feeding at 12 months (adjusted OR 0·31; 95 % CI 0·11, 0·82). This study provides new insights into the circadian pattern of energy intake during infancy. Our findings indicated that the timing of feeding at 12 months was associated with daily energy and macronutrient intakes, and feeding mode during early infancy.
The objectives of this study were (1) to evaluate the measurement structure of the Perceived Empathic and Social Self-Efficacy Scale amongst 194 individuals with serious mental illness (SMI) and (2) to establish construct validity for the Perceived Empathic and Social Self-Efficacy Scale. Confirmatory factor analysis yielded a two-factor measurement structure of the Perceived Empathic and Social Self-Efficacy Scale, which was positively associated with insight, social support, and life satisfaction. The Perceived Empathic and Social Self-Efficacy Scale is a useful measure to assess social skills amongst individuals with SMI in rehabilitation counselling.
Anxiety disorders are prevalent yet under-recognized in late life. We examined the prevalence of anxiety disorders in a representative sample of community dwelling older adults in Hong Kong.
Data on 1,158 non-demented respondents aged 60–75 years were extracted from the Hong Kong Mental Morbidity survey (HKMMS). Anxiety was assessed with the revised Clinical Interview Schedule (CIS-R).
One hundred and thirty-seven respondents (11.9%, 95% CI = 10–13.7%) had common mental disorders with a CIS-R score of 12 or above. 8% (95% CI = 6.5–9.6%) had anxiety, 2.2% (95% CI = 1.3–3%) had an anxiety disorder comorbid with depressive disorder, and 1.7% (95% CI = 1–2.5%) had depression. Anxious individuals were more likely to be females (χ2 = 25.3, p < 0.001), had higher chronic physical burden (t = −9.3, p < 0.001), lower SF-12 physical functioning score (t = 9.2, p < 0.001), and poorer delayed recall (t = 2.3, p = 0.022). The risk of anxiety was higher for females (OR 2.8, 95% C.I. 1.7–4.6, p < 0.001) and those with physical illnesses (OR 1.4, 95% C.I. 1.3–1.6, p < 0.001). The risk of anxiety disorders increased in those with disorders of cardiovascular (OR 1.9, 95% C.I. 1.2–2.9, p = 0.003), musculoskeletal (OR 2.0, 95% C.I. 1.5–2.7, p < 0.001), and genitourinary system (OR 2.0, 95% C.I. 1.3–3.2, p = 0.002).
The prevalence of anxiety disorders in Hong Kong older population was 8%. Female gender and those with poor physical health were at a greater risk of developing anxiety disorders. Our findings also suggested potential risk for early sign of memory impairment in cognitively healthy individuals with anxiety disorders.
Objective: To evaluate the measurement structure of the Taiwanese Version of the Job Satisfaction of Persons with Disabilities Scale (JSPDS). Design: A quantitative descriptive research design using exploratory factor analysis (EFA). Participants: One hundred and thirty-two gainfully employed individuals from Taiwan with poliomyelitis participated in this study. Results: EFA result indicated a three-factor structure accounting for 54.1 per cent of the total variance. The internal consistency reliability coefficients for the integrated work environment, job quality, and alienation factors were 0.91, 0.77, and 0.59, respectively. Only the integrated work environment and job quality factors showed positive correlations with life satisfaction. People with higher educational attainment also reported higher levels of job satisfaction than people with lower educational attainment. Conclusion: The three-factor measurement structure of the JSPDS appears to be parsimonious, psychologically meaningful, and interpretable, and can be used to improve the comprehensiveness of vocational rehabilitation outcome evaluation.
Little is known about the influence of meal timing and energy consumption patterns throughout the day on glucose regulation during pregnancy. We examined the association of maternal feeding patterns with glycaemic levels among lean and overweight pregnant women. In a prospective cohort study in Singapore, maternal 24-h dietary recalls, fasting glucose (FG) and 2-h postprandial glucose (2HPPG) concentrations were measured at 26–28 weeks of gestation. Women (n 985) were classified into lean (BMI<23 kg/m2) or overweight (BMI≥23 kg/m2) groups. They were further categorised as predominantly daytime (pDT) or predominantly night-time (pNT) feeders according to consumption of greater proportion of energy content from 07.00 to 18.59 hours or from 19.00 to 06.59 hours, respectively. On stratification by weight status, lean pNT feeders were found to have higher FG than lean pDT feeders (4·36 (sd 0·38) v. 4·22 (sd 0·35) mmol/l; P=0·002); however, such differences were not observed between overweight pDT and pNT feeders (4·49 (sd 0·60) v. 4·46 (sd 0·45) mmol/l; P=0·717). Using multiple linear regression with confounder adjustment, pNT feeding was associated with higher FG in the lean group (β=0·16 mmol/l; 95 % CI 0·05, 0·26; P=0·003) but not in the overweight group (β=0·02 mmol/l; 95 % CI −0·17, 0·20; P=0·879). No significant association was found between maternal feeding pattern and 2HPPG in both the lean and the overweight groups. In conclusion, pNT feeding was associated with higher FG concentration in lean but not in overweight pregnant women, suggesting that there may be an adiposity-dependent effect of maternal feeding patterns on glucose tolerance during pregnancy.
Background: Self-determination theory (SDT) has increasingly been used as a theoretical framework for evaluating key elements of the recovery paradigm in rehabilitation and mental health services research and policy-making for people living with severe mental illnesses. Purpose: The purpose of this study was to validate the Behavioral Regulation in Work Questionnaire (BRWQ), an adaptation of the Behavioral Regulation in Exercise Questionnaire-2, as a measure of self-determined work motivation for use in psychiatric rehabilitation settings. Methods: One hundred and twenty-four individuals with severe mental illness were recruited from eight Clubhouse programmes in Hawaii. Factorial validity of the BRWQ was evaluated using exploratory factor analysis. Findings: Principal components analysis of the BRWQ yielded four factors (amotivation, external regulation, introjection and autonomous motivation). The autonomous motivation factor was found to be significantly related to other SDT constructs, including competency, relatedness, outcome expectancy and vocational rehabilitation engagement. Conclusions: The BRWQ is a psychometrically sound SDT measure for assessing self-determined work motivation and could contribute to the use of self-determination as a paradigm for improving recovery and employment outcomes of people with severe mental illness in rehabilitation settings.
This study investigated pain coping profiles using the Coping Strategies Questionnaire-24 (CSQ-24) in a sample of 171 workers’ compensation clients with chronic musculoskeletal pain from Canada. Cluster analysis identified three distinct coping profiles: mixed coping, catastrophising, and positive coping. Multivariate analysis of variance (MANOVA) results revealed that the positive coping group had lower levels of activity interference and depression as well as higher levels of quality of life than the mixed coping and catastrophising groups. Study findings indicate clients with chronic musculoskeletal pain can be categorised according to pain coping strategies, and pain coping strategies used are related to rehabilitation outcomes. The implications of these pain coping profiles for rehabilitation counselling practice are discussed.
The objective of the study was to determine the effect of task-specific self-efficacy on stages of readiness for change among people with substance abuse problems. Participants were 140 men and 33 women with substance abuse problems receiving services in outpatient therapeutic community service programs. The Stages of Change Scale-Substance Abuse (SCS-SA) was the outcome measure. People with substance abuse problems receiving outpatient treatment services can be meaningfully classified into four stages of change groups: (1) Precontemplation, (2) Inactive, (3) Ambivalent-Conforming, and (4) Participation. Readiness for change is related to self-efficacy in work-related skills and risk-avoidance skills. Task-specific self-efficacy is related to stages of change. The findings of this study suggested that providing skill training to enhance task specific self-efficacy can help people with substance abuse problems progress from lower level to higher level of stages of change.
This study examined personality characteristics of undergraduate and graduate students in rehabilitation counselling programs. Cluster analysis of 204 NEO Five-Factor Inventory (NEO-FFI) personality profiles of these students indicated a three-cluster solution as optimal. These three personality clusters were identified as the Therapist Personality cluster, Case Manager Personality cluster, and the Sensitive Personality cluster. Implications for rehabilitation job roles, rehabilitation education, and counselling are discussed.