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The world, today, recognizes the increasing importance of assistive technology (AT) that can reduce the functional limitations of persons with disabilities, individuals with chronic debilitating diseases, and elders. This indicates that at some point, everyone, either temporary or permanent, will require AT to improve their physical and functional abilities, thus contributing to independent living, social inclusion, and education. Besides this, the need for AT will be growing with a majority from low-middle-income countries. The same is true for India though we are not sure how many people have met a need, and unmet need for AT to date, but the requirement will continue to increase. There is a significant gap between needs and access to AT. Recently, the WHO has led many initiatives related to AT services after the 71st World Health Assembly's resolution in 2018, to improve access to AT for its member states. The UN Sustainable Development Goals (SDGs) have pledged that no one should be left behind irrespective of personal characteristics. India, a ratified member state, needs to align with various initiatives undertaken by the WHO and the UN. Despite many challenges, India needs to formulate evidence-based AT policy, planning within the purview of the healthcare delivery system in collaboration with various government and nongovernment sectors, including industries. This article explores the need, access, and potential challenges associated with AT services in India. Finally, we discussed various initiatives on AT in the country and possible recommendations to improve AT services across.

There is an increasing awareness among researchers and others that marginalized and vulnerable groups face problems in accessing health care. Access problems in particular in low-income countries may jeopardize the targets set by the United Nations through the Millennium Development Goals. Thus, identifying barriers for individuals with disability in accessing health services is a research priority. The current study aimed at identifying the magnitude of specific barriers, and to estimate the impact of disability on barriers for accessing health care in general. A population based household survey was carried out in Sudan, Namibia, Malawi, and South Africa, including a total of 9307 individuals. The sampling strategy was a two-stage cluster sampling within selected geographical areas in each country. A listing procedure to identify households with disabled members using the Washington Group six screening question was followed by administering household questionnaires in households with and without disabled members, and questionnaires for individuals with and without disability. The study shows that lack of transport, availability of services, inadequate drugs or equipment, and costs, are the four major barriers for access. The study also showed substantial variation in perceived barriers, reflecting largely socio-economic differences between the participating countries. Urbanity, socio-economic status, and severity of activity limitations are important predictors for barriers, while there is no gender difference. It is suggested that education reduces barriers to health services only to the extent that it reduces poverty. Persons with disability face additional and particular barriers to health services. Addressing these barriers requires an approach to health that stresses equity over equality.

Children and adolescents are increasingly susceptible to issues related to anxiety and depression symptoms. The literature does not present a consensus on the composition of indicators that make predictions, prognostic algorithms, or management strategies in mental health promotion and prevention. Most studies primarily focus on the consequences observed in adulthood. This study develops a multidimensional representation of the propensity of children and adolescents to have difficulties in the field of anxiety and depression. The Ordered Weighted Averaging (OWA) operator was used to create a composite indicator, and three quality tests validated the results. For this, it uses information about different dimensions associated with adversity in childhood and adolescence from 54 countries sourced from UNICEF’s Multiple Indicator Cluster Surveys to compare the values of proposed dimensions across continents. The generated composite indicator reveals that, on average, countries in Africa show a higher propensity for children and adolescents to present difficulties in the anxiety and depression fields. In the opposite position, the Americas have the lowest average propensity for these mental health conditions. The validation of the results through quality tests reinforces confidence in the direction indicated by the findings, enhancing the decision-making process when dealing with multidimensional phenomena.

Uganda is among the first to use the Washington Group Short Set of Questions on Disability to identify persons with disabilities in its Demographic and Health Survey. In this paper, we review the HIV Knowledge, Attitudes and Behaviour component of the 2011 Ugandan Demographic and Health Survey, analysing a series of questions comparing those with and without disabilities in relation to HIV/AIDS knowledge, attitudes and practices. We found comparable levels of knowledge on HIV/AIDS for those with and those without disabilities in relation to HIV transmission during delivery (93.89%, 93.26%) and through breastfeeding (89.91%, 90.63%), which may reflect increased attention to reaching the community of persons with disabilities. However, several gaps in the knowledge base of persons with disabilities stood out, including misconceptions of risk of HIV infection through mosquito bites and caring for a relative with HIV in own household (34.39%, 29.86%; p<0.001; 91.53%, 89.00%; p = 0.001, respectively). The issue is not just access to appropriate information but also equitable access to HIV/AIDS services and support. Here we found that persons with multiple disabilities were less likely than individuals without disabilities to return to receive results from their most recent HIV test (0.60[0.41-0.87], p<0.05). HIV testing means little if people do not return for follow-up to know their HIV status and, if necessary, to be connected to available services and supports. Additional findings of note were that persons with disabilities reported having a first sexual encounter at a slightly younger age than peers without disabilities; and persons with disabilities also reported having a sexually transmitted disease (STD) within the last 12 months at significantly higher rates than peers without disabilities (1.38[1.18-1.63], p<0.01), despite reporting comparable knowledge of the need for safer sex practices. This analysis is among the first to use HIV/AIDS-related questions from Demographic Health Surveys to provide information about persons with disabilities in Uganda in comparison to those without disabilities. These findings present a more complex and nuanced understanding of persons with disabilities and HIV/AIDS. If persons with disabilities are becoming sexually active earlier, are more likely to have an STD within the preceding 12 month period and are less likely to receive HIV test results, it is important to understand why. Recommendations are also made for the inclusion of disability measures in Uganda's AIDS Indicator Survey to provide cyclical and systematic data on disability and HIV/AIDS, including HIV prevalence amongst persons with disabilities.

Background To ensure that women with disabilities (WwD) have access to essential maternal health services, understanding their service utilization within the continuum of care (CoC) framework is vital. However, the influence of women’s disability status on maternal CoC has not been fully explored. Hence, this paper examines the completion level and inequality of basic maternal CoC, as well as its association with women’s disability status. Methods We conducted analyses on demographic and health survey data of nine low- and middle-income countries collected between 2016 and 2022. Disability among reproductive-age women was assessed using the Washington Group Short Set questionnaires. The maternal CoC was defined to include receiving four or more antenatal visits, skilled birth attendance and obtaining timely postnatal care. Concentration indices were used to measure wealth-related inequalities in completing CoC. Multivariable logistic regression was used to identify factors associated with inequalities in the CoC completion. Results A total of 14.0% of women had a disability of at least some difficulty in one domain of function. Among women who made their first antenatal care contact, only 35.8% completed CoC; this percentage was lower among women with disability (32.7%). The odds of completing CoC was lower among WwD (AOR = 0.89, 95% CI: 0.83–0.95). Higher maternal education (AOR = 1.63–2.27), female-headed household (AOR = 1.14, 95% CI: 1.07–1.22), currently working (AOR = 1.29, 95% CI:1.22–1.37) and wealth quintile (increasing from poor to the richest (AOR = 1.24–2.18) were positively associated with higher odds of completing the CoC. We found overall pro-rich inequality in CoC completion (CI 0.27: 95%CI: 0.26–0.29). Higher inequalities were observed in countries with lower coverage of maternal healthcare services. Conclusion Maternal CoC completion was lower among WwD, especially those with lower socioeconomic status. Effective strategies that ensure disability-friendly maternal health care services will play a pivotal role. Maternal health service programs should prioritize women’s disability status alongside other key socioeconomic factors and address health care barriers to ensure more equitable and comprehensive maternal health care.

Machine learning has increasingly gained prominence in the healthcare sector due to its ability to address various challenges. However, a significant issue remains unresolved in this field: the handling of imbalanced data. This process is crucial for ensuring the efficiency of algorithms that utilize classification techniques, which are commonly applied in risk management, monitoring, diagnosis, and prognosis of patient health. This study conducts a comparative analysis of techniques for handling imbalanced data and evaluates their effectiveness in combination with a set of classification algorithms, specifically focusing on stroke prediction. Additionally, a new approach based on Particle Swarm Optimization (PSO) and Naive Bayes was proposed. This approach was applied to the real problem of Chagas disease. The application of these techniques aims to improve the quality of life for individuals, reduce healthcare costs, and allocate available resources more efficiently, making it a preventive action.

There is international evidence that people with disabilities face barriers when accessing primary healthcare services and that there is inadequate information about effective interventions that work to improve the lives of people with disabilities, especially in low-income and middle-income countries. Poor rural residents generally experience barriers to accessing primary healthcare, and these problems are further exacerbated for people with disabilities. In this study, we explore the challenges faced by people with disabilities in accessing healthcare in Madwaleni, a poor rural Xhosa community in South Africa. Purposive sampling was done with 26 participants, using semi-structured interviews and content analysis to identify major themes. This study showed a number of barriers to healthcare for people with disabilities. These included practical barriers, including geographical and staffing issues, and attitudinal barriers. It is suggested that although there are practical barriers that need to be addressed, attitudinal barriers could potentially be addressed more easily and cost effectively.

Chronic illnesses, such as Rheumatoid Arthritis (RA), are a growing burden on health care systems worldwide. Self-management emphasises the patient's central role in managing their illness. This is pertinent given the majority of care is provided by the individual themselves; yet how individuals make sense of self-management in everyday life is largely unseen. The purpose of this study was to capture the strengths and concerns of individuals with RA in self-managing their illness, raise awareness of their lived experience and spark a dialogue among stakeholders. A community-based participatory approach, Photovoice, was adopted. A purposive sample of participants were tasked with taking photographs to represent the challenges and solutions to living with RA. Group workshops and semi-structured interviews were conducted to facilitate reflection, dialogue and analysis. Data analysis followed Braun and Clarke's thematic analysis. Public exhibitions were held throughout the Autumn of 2019. Eight women and three men (n = 11) across suburban and urban regions of Ireland were recruited (mean age 57 years, disease duration 4-21 years). Participants identified four main themes which reflected the lived experience of self-managing RA: (i) I'm Here but I'm Not, (ii) Visible Illness, (iii) Medicine in All its Forms, (iv) Mind Yourself. These themes captured the challenge of reduced agency, limited contribution and participation, and a complex relationship between visible and invisible illness. Solutions focused on improving psychological and emotional resilience, particularly through personal reflection and increased agency. Our findings suggest that RA is experienced as a fluid relationship between states of masking and surfacing of illness shaped by contextual and situational factors. Photovoice was a highly effective tool to capture and communicate this complexity. Supporting increased agency among individuals with RA to control the (in)visibility of illness and disability can inform the development of future self-management support.

This study proposes a novel approach to constructing composite indicators, utilizing discriminant analysis to identify the determining factors for the diagnosis of multidimensional depression and to provide an index that represents the multidimensionality of this construct. By focusing solely on factors that significantly correlate with the diagnosis of multidimensional depression, this method provides a more precise and objective representation of the problem. The application of the method to the 2019 Brazilian Health Survey data demonstrated its effectiveness, resulting in a composite indicator that separates individuals who self-declare as having depression from individuals who self-declare as not having depression. The results highlight individuals who have a limiting chronic condition, high levels of education, less support from friends and family, perform unhealthy work, and are male. In contrast, individuals with the opposite characteristics are associated with a negative multidimensional depression diagnosis. The proposed composite indicator not only improves the measurement accuracy but also offers a new means of visualizing and understanding the multidimensional nature of depression diagnosis, providing valuable information for the formulation of targeted public health policies aimed at reducing the time for which people show symptoms of depression.

This paper explores differences in experienced environmental barriers between individuals with and without disabilities and the impact of additional factors on experienced environmental barriers. Data was collected in 2011-2012 by means of a two-stage cluster sampling and comprised 400-500 households in different sites in South Africa, Sudan Malawi and Namibia. Data were collected through self-report survey questionnaires. In addition to descriptive statistics and simple statistical tests a structural equation model was developed and tested. The combined file comprised 9,307 participants. The Craig Hospital Inventory of Environmental Factors was used to assess the level of environmental barriers. Transportation, the natural environment and access to health care services created the biggest barriers. An exploratory factor analysis yielded support for a one component solution for environmental barriers. A scale was constructed by adding the items together and dividing by number of items, yielding a range from one to five with five representing the highest level of environmental barriers and one the lowest. An overall mean value of 1.51 was found. Persons with disabilities scored 1.66 and persons without disabilities 1.36 (F = 466.89, p < .001). Bivariate regression analyses revealed environmental barriers to be higher among rural respondents, increasing with age and severity of disability, and lower for those with a higher level of education and with better physical and mental health. Gender had an impact only among persons without disabilities, where women report more barriers than men. Structural equation model analysis showed that socioeconomic status was significantly and negatively associated with environmental barriers. Activity limitation is significantly associated with environmental barriers when controlling for a number of other individual characteristics. Reducing barriers for the general population would go some way to reduce the impact of these for persons with activity limitations, but additional and specific adaptations will be required to ensure an inclusive society.