Search Results (30)

Disability Certification is an instrument that can contribute to the identification of persons with disabilities who are potential beneficiaries of social protection programmes. In Colombia, the disability certification process was changed in 2020 to include a human rights perspective. However, little information exists on how far the process aligns with the recommendations made by the Convention on the Rights of Persons with Disabilities or to what extent it provides useful information for the operation of the country’s social protection system. This study aims to analyse how the changes implemented in 2020 have contributed to the identification and determination of persons with disabilities in social protection programmes in Colombia. This research uses an analytical-descriptive design, in which legal documents related to the social protection programme and disability certification were analysed. In addition, we conducted semi-structured interviews in Colombia with people with disabilities, professionals conducting the certification, and with key stakeholders, and we analysed the information using thematic analysis. Colombia changed its certification process in 2020, moving from a capacity-to-work assessment to a process of assessing functioning capacity and participation limitations following the International Classification of Functional Disability and Health. However, the new certification process has not provided an instrument to contribute to determining persons with disabilities who should be prioritised or receive social benefits in Colombia. The certification does not establish the support needs of people with disabilities, does not recommend reasonable adjustments to support their participation in society, and has not been used systematically in social protection programmes. Finally, individuals with disabilities commented that the disability certification is a process that does not open up opportunities to receive social benefits and social transfers, and in most cases, it is an expensive and lengthy process. Disability certification in Colombia is not an instrument that determines the needs of people with disabilities, nor the reasonable accommodations that they require in order to participate in society. Full article

Hyperledger Fabric (HLF) is a leading permissioned blockchain platform designed for enterprise applications. However, it faces significant security risks from Denial-of-Service (DoS) attacks targeting its core components. This study systematically investigated network-level DoS attack vectors against HLF, with a focus on threats to its ordering service, Membership Service Provider (MSP), peer nodes, consensus protocols, and architectural dependencies. In this research, we performed experiments on an HLF test bed to demonstrate how compromised components can be exploited to launch DoS attacks and degrade the performance and availability of the blockchain network. Key attack scenarios included manipulating block sizes to induce latency, discarding blocks to disrupt consensus, issuing malicious certificates via MSP, colluding peers to sabotage validation, flooding external clients to overwhelm resources, misconfiguring Raft consensus parameters, and disabling CouchDB to cripple data access. The experimental results reveal severe impacts on the availability, including increased latency, decreased throughput, and inaccessibility of the ledger. Our findings emphasize the need for proactive monitoring and robust defense mechanisms to detect and mitigate DoS threats. Finally, we discuss some future research directions, including lightweight machine learning tailored to HLF, enhanced monitoring by aggregating logs from multiple sources, and collaboration with industry stakeholders to deploy pilot studies of security-enhanced HLF in operational environments. Full article

To improve safety through design, the state can take the initiative in building certification. In this study, we systematically review and review the Barrier-Free (BF) certification evaluation for barrier-free design by implementing information modeling. We developed and applied a BIM-based evaluation template to the evaluation items derived from IPA analysis. As a result of the application, we were able to construct an efficient evaluation sheet by utilizing BIM tools. The results of the study showed that there is a need to improve the BF certification criteria and develop evaluation-related items utilizing BIM functions. This study can be utilized in the future for the development of BIM-based certification criteria for the disabled and the development of evaluation sheets. Full article

Background/Objectives: Spinal cord injury (SCI) is a disabling condition prevalent worldwide, requiring rehabilitation services from injury through community living. This study, conducted by representatives of the World Rehabilitation Alliance (WRA), aims to identify strategies for strengthening SCI rehabilitation services globally, with particular attention to settings where resources are limited. Methods: Three focus groups were held between 2023 and 2024 with WRA representatives specializing in SCI rehabilitation. Discussions focused on four key areas: workforce and education, health policy and systems research, primary care, and emergency response. Perspectives were developed taking into account frameworks from the World Health Organization (WHO). Results: Key insights into SCI rehabilitation services emphasize workforce and education as critical areas, underscoring the importance of specialized training, certification, and ongoing support to build capacity. In health systems and policy research, significant gaps in evidence-based practices were highlighted, emphasizing the need for comprehensive data collection and national registries to guide policy and align SCI care with global standards. The integration into primary care systems is recommended to improve access and address common complications in low- and middle-income countries (LMICs). For emergency response, this study stresses the importance of preparedness and establishing multi-disciplinary teams capable of managing SCI cases in resource-limited settings, reducing preventable complications, and improving patient outcomes. Conclusions: SCI rehabilitation services are essential to global health, with a need for workforce development, research, national registries, and integration into primary and emergency care. Such efforts should improve accessibility and align with global best practices, ensuring comprehensive and accessible rehabilitation for all. Full article

Research has shown that general educators may lack the competencies to effectively include students with disabilities, thus widening the gaps in outcomes between students with disabilities and their peers. In this study, we outline the development and implementation of a competency-based continuing education program, designed to equip general educators to effectively include students with disabilities (SWDs) and earn special education certification. This paper presents the results of a program evaluation conducted using both validated measures and author-developed instruments. Participants included general education teachers, instructional coaches, and those in similar roles. Results indicated that participants significantly increased their knowledge of professional standards, demonstrated knowledge in high-leverage practices, and showed high levels of self-efficacy to implement inclusive practices. We discuss these results, emphasizing the timeliness of this nontraditional approach and its implications for teacher preparation, research, and policy amid the troubling national special education teacher shortage. Namely, this approach epitomizes a model that allows leaders to strategically utilize their existing workforce to address vacancies in special education and emphasizes that the responsibility to support SWDs rests squarely upon all educators. Full article

Access to dental services for young disabled patients is challenging and expensive, often necessitating treatment under general anesthesia. Additionally, ensuring accuracy during impression-taking procedures can be very difficult or outright impossible using traditional methods. Newly developed systems for capturing three-dimensional images of the oral cavity can facilitate the treatment of patients with disabilities. The research aimed to assess the timing of intraoral scanning using a scanner in orthodontic treatment, comparing disabled patients undergoing clear aligner therapy with their healthy counterparts. Scanning times were compared in two patient groups. Group I comprised patients with a certificate of disability, while Group II (control) consisted of patients without a certificate of disability. Maxillary and mandibular scans, as well as bite registration, were performed with the intraoral scanner. The mean scanning time in study Group I was 8.59 min, while in control Group II, it was 5.71 min. The results demonstrated statistical significance, reaching a significance level of p < 0.001. The scanning of disabled patients proved to be more challenging and time-consuming compared to patients in the control group. Consequently, doctors must consider the need to allocate more time to a disabled person during a visit. Despite the difficulties, disabled patients accepted this method of bite scanning. There was no need to carry out such a procedure under general anesthesia. This confirms that scanning should be the preferred method in orthodontic treatment for disabled patients. Full article

The binocular Esterman visual field test (EVFT) of 120 points was the first method to quantify the defects in the binocular visual field. It is used in many parts of the world as a standard test to determine whether an individual has the visual capabilities to drive safely. In Japan, it is required for the grading and issuance of visual disability certificates. The purpose of this study was to determine the reliability of the EVFT results. We studied 104 patients who had undergone the binocular EVFT at Mie University Hospital. Their mean age was 68.0 ± 11.4 years, and the best-corrected visual acuity of the better eye was 0.18 ± 0.38 logMAR units. The EVFT was performed twice on the same day, and the results of the first and second tests were compared. The mean Esterman scores for the first and second test were 89.3 ± 30.5 and 89.1 ± 30.2, respectively, and the test times were 338.9 ± 86.8 and 336.7 ± 76.4 s, respectively. The differences were not significant (p = 0.69 and p = 0.33). In the Bland–Altman analyses (second–first test) of the Esterman scores, the mean difference was 0.38 without significant fixed errors (p = 0.20) or proportional errors (p = 0.27). The limits of agreement within the 1.96 standard deviation were −8.96 to +9.45 points. The agreement rate for the most peripheral 24 test points was significantly lower than the agreement rate for the other 96 test points (p < 0.01). The agreement rate of the upper visual field was significantly lower than that of the lower field (p < 0.01). The overall reliability rate of the EVFT is acceptable, but the peripheral and upper test points have relatively low reliability rates. These findings are important for interpretations of the EVFT results. Full article

The brain and its health are essential for our (physical mental, social, and spiritual) wellbeing, for being able to realize our potential as individuals, and also for a fair, well-functioning, and productive society. However, today the world is facing a healthcare crisis related to the very high (and increasing) burden of brain disorders. As a response to this crisis, the “Swiss Brain Health Plan” (SBHP) was conceptualized in the context of other initiatives launched to value, promote, and protect brain health over the entire life course. In the first section of this position paper, the following fundamental considerations of the SBHP are discussed: (1) the high (and increasing) burden of brain disorders in terms of prevalence (>50% of the population suffers from a brain disorder), disability, mortality, and costs; (2) the prevention of brain disorders; (3) the operational definition of brain health; (4) determinants of brain health; (5) international initiatives to promote brain (including mental) health including the World Health Organization (WHO) intersectorial global action plan on epilepsy and other neurological disorders (NDs) (IGAP) and the WHO comprehensive mental health action plan. In the second section of the paper, the five strategic objectives of the SBHP, which has the vision of promoting brain health for all across the entire life course, are presented: (1) to raise awareness; (2) strengthen cross-disciplinary and interprofessional training/educational programs for healthcare professionals; (3) foster research on brain health determinants and individualized prevention of brain disorders; (4) prioritize a holistic (non-disease-specific), integrated, person-centered public health approach to promote brain health and prevent brain disorders through collaborations across scientific, health care, commercial, societal and governmental stakeholders and insurance providers; (5) support, empower, and engage patients, caregivers, and patient organizations, and reduce the stigma and discrimination related to brain disorders. In the third section of the paper, the first (2024) steps in the implementation of the SHBP, which will be officially launched in Zurich on 22 November 2023, are presented: (1) a definition of the overall organization, governance, specific targets, and action areas of the SBHP; (2) the patronage and/or co-organization of events on such specific topics as brain research (Lausanne), dementia (Geneva), stroke (Basel), neurohumanities (Bellinzona), sleep (Lugano), and psychiatry (Zurich); (3) the conduction of a new study on the global burden of brain disorders in Switzerland; (4) the launching of an international Certificate of Advanced Studies (CAS) on Brain Health at the University of Bern. In the fourth section of the paper, there is a concise executive summary of the SBHP. Full article

In today’s digital age, mobile applications have become invaluable tools for enhancing accessibility and inclusivity, especially for individuals with disabilities. This study focuses on the landscape of accessibility apps designed to facilitate inclusivity for disabled individuals in buildings. By investigating current trends, strengths, weaknesses, and their impact on independence and quality of life, the research aims to shed light on the state of these apps and identify areas for future development. To achieve these objectives, a multi-faceted approach was employed, encompassing a literature review and app categorization. The study emphasizes the necessity for a common evaluation and certification framework to ensure consistency, reliability, and transparency in assessing the effectiveness of accessibility apps in the built environment. Such a framework would instill user trust, support informed decision-making, and stimulate innovation in this field. The findings of this research contribute to the advancement of inclusive design practices, serving as a valuable resource for developers, policymakers, and disabled individuals seeking effective tools to enhance accessibility. By fostering an inclusive society where disabled individuals can fully navigate and participate, this study aligns with the broader goal of creating a more inclusive and equitable world. Full article

Land registration programs on a large scale aimed at strengthening the land rights of farm households in Ethiopia have been executed in different degrees across different regions since 1998. This study investigates the contribution of land registration on the perceived tenure security of farmers, farmer confidence, women and marginalized groups, and sustainable land-management practice after receiving a land holding certificate in the dryland areas of East Gojjam Zone, Ethiopia. Face-to-face interviews were conducted with 385 households selected by using stratified random sampling techniques. Furthermore, focus group discussions and key informants are primary data sources. According to an investigation of qualitative and quantitative data, 163 households have a mean of 0.40 ha of agricultural land on steep slope areas, and approximately 26% of households are afraid of land redistribution and farm loss in the next five years. Moreover, 22% of households fear the government taking their farm plot at any time. Respondents, on the other hand, believe that land registration has reduced the landlessness of women, the disabled, and the poorest of the poor while increasing the landlessness of youths. After land registration, household participation in land-management practices increased by 15%. Despite this, the difference in the mean of major crop yields per household is insignificant, except for wheat, which decreased significantly at the p < 0.1 level. The study determined household head age, household size, land management training and advice, livestock holdings, and the mean distance from farm to settlement as influential factors for increasing construction of water-harvesting systems. Land registration, in general, enhances land tenure security, land-management practice, and land rights of women and marginalized groups of societies, but did not improve crop productivity. The findings should persuade policymakers to address potential sources of insecurity, such as future land redistribution issues. Full article

The aim of this study was to identify the factors that determined the participation of people aged 60 years and older in physical activity (PA) at least once or more frequently in the year before the survey. The analysis included sociodemographic variables, any certificate of disability, level of physical fitness, and declared sports skills. The study used data from the “Participation of Poles in Sports and Physical Recreation in 2012” survey (designed and conducted by Statistics Poland). Questionnaires from 2724 people qualified for analysis. An analysis of frequency and odds ratio (followed by logistic regression analysis) was used to evaluate the determinants of participation of older adults in PA. Participation in PA was declared by 23.7%, most often by older adults aged 60–64 years (chi² = 67.72; p < 0.001). With age, the likelihood of participation in PA declined until the age of 75, when the percentage of active participants increased to 27.4%. Of the variables analyzed (logistic regression model), only very good (p < 0.001) and good (p = 0.002) levels of self-rated physical fitness, secondary (p = 0.014) or tertiary (p = 0.003) education, and a higher number of declared sports skills (p < 0.001) had a favorable effect on the frequency of participation in PA. The low PA of Poles aged 60 years and over (especially those entering retirement age) requires social intervention. Instead of focusing sports policy on increasing the number of participants, it seems more reasonable to focus on individuals living in rural areas with lower socio-professional status and physical fitness. It is necessary to use an individual approach (according to abilities, skill level, and needs) and create systems of interrelations that would provide older adults with support (including the use of social resources). Full article

Birth defects (BDs) are an important cause of abortion, stillbirth, and infant mortality that may cause lifelong disability. The defects can be caused by genetics, environmental exposure, or maternal chronic diseases. We conducted a study to analyze the association between maternal chronic diseases and BDs and to evaluate the effect of decreasing the prevalence of maternal chronic diseases on reducing BDs. The data of newborns and their mothers were concatenated and analyzed from three national population databases: the National Health Insurance Research Database, the Birth Certificate Application, and the Birth Registration Database in Taiwan during the period of 2005 to 2014. Codes 740-759 of the International Classification of Diseases 9th Revision—Clinical Modification (ICD-9-CM) were used as the diagnosis of BDs. The prevalence of BDs was 2.72%. Mothers with cardiovascular diseases, hypertension, anemia, genitourinary tract infections, renal diseases, neurotic or psychotic disorders, gestational diabetes mellitus (DM), and pregestational type 1 or type 2 DM had a significantly higher prevalence of BDs. The population attributable risk percent (PAR%) of BDs was 1.63%, 0.55%, 0.18%, 1.06%, 0.45%, 0.22%, 0.48%, and 0.24% for maternal hypertension, cardiovascular disease, renal disease, genitourinary infection, anemia, neurotic and psychotic disorders, gestational DM, and pregestational type 1 or type 2 DM, respectively. The percentage change (−1%, −5%, and −10% of prevalence in 2034 compared with the prevalence in 2005–2014) of maternal disease and the predicted number of live births was used to estimate the decrease in the number of newly diagnosed BDs in 2034. By using the middle-estimated number of live births in 2034, we predicted that the number of BDs would decrease by 302, 102, 33, 196, 83, 41, 89, and 44 with a −5% prevalence of maternal hypertension, cardiovascular disease, renal disease, genitourinary infection, anemia, neurotic and psychotic disorders, gestational DM, and pregestational type 1 or type 2 DM, respectively. We conclude that mothers with chronic diseases, including cardiovascular diseases, hypertension, anemia, genitourinary tract infections, renal diseases, neurotic or psychotic disorders, gestational DM, and pregestational type 1 or type 2 DM, have a significantly higher (p < 0.01) prevalence of having offspring with BDs. Mothers with chronic diseases are associated with BDs. It is very important to set up a policy to decrease the prevalence of these maternal chronic diseases; then, we can reduce the incidence of BDs. Full article

This study aims to investigate the factors of care-level deterioration in older adults with mild and moderate disabilities using nationally standardized survey data for care-needs certification. We enrolled people aged 68 years or older, certified as support levels 1–2 (mild disability) or care levels 1–2 (moderate disability) with no cancer. The outcome was care-level deterioration after two years. The possible factors were physical and mental functions which were categorized as the following five dimensions according to the survey for care-needs certification: body function, daily life function, instrumental activities of daily living (IADL) function, cognitive function, and behavioral problems. A multivariate logistic regression analysis was conducted after stratifying the care level at baseline. A total of 2844 participants were included in our analysis. A low IADL function was significantly associated with a risk of care-level deterioration in all participants. In addition, low cognitive function was linked to care-level deterioration, except for those with support level 1 at baseline. Participants with more behavioral problems were more likely to experience care-level deterioration, except for those with care level 2 at baseline. Our study showed the potential utility of the care-needs certification survey for screening high-risk individuals with care-level deterioration. Full article

This study aimed to review evidence on future long-term care associated with pre-existing factors among community-dwelling Japanese older adults. We systematically searched cohort and nested case–control studies published between 2000 and 2019 that assessed long-term care certification using the PubMed, CINAHL, and EMBASE databases. The relationship between long-term care insurance information and risk factors was investigated. The protocol was registered with the Open Science Framework. We extracted 91 studies for synthesis, including 84 prospective cohort studies, 1 retrospective cohort study, and 6 nested case–control studies. Certification for long-term care was classified into two endpoints: onset of functional disability and dementia. There were 72 studies that used long-term care certification as a proxy for functional disability, and 22 used long-term care information to indicate the onset of dementia. Common risk factors related to functional disability were physical function, frailty, and oral condition. Motor function and nutritional status were common risk factors for dementia. We found consistent associations between premorbid risk factors and functional disability and dementia. The accumulation of evidence on the incidence of long-term care and associated factors can aid the development of preventive measures. Future studies should aim to integrate this evidence. Full article

Environmental factors are crucial determinants of disability in schizophrenic patients. Using data from the 2014–2018 Certification of Disability and Care Needs dataset, we identified 3882 adult patients (46.78% females; age, 51.01 ± 13.9 years) with schizophrenia. We found that patients with severe schizophrenia had lower capacity and performance than those with moderate schizophrenia. The chances of having an access barrier to environmental chapter 1 (e1) products and technology in moderate schizophrenic patients and in severe schizophrenic patients were 29.5% and 37.8%, respectively. Logistic regression analyses demonstrated that the performance score was related to accessibility barriers in the categories described in e1, with adequate fitness of models in category e110 for personal consumption, e115 for personal usage in daily living activities, and e120 for personal outdoor and indoor mobility and transportation. Furthermore, the capacity-performance discrepancy was higher in moderate schizophrenic patients with accessibility barriers in the e110, e115, and e120 categories than that in moderate schizophrenic patients without accessibility barriers. However, severe schizophrenic patients with category e120 accessibility barriers were prone to a lower discrepancy, with institutional care a potentially decreasing factor. In conclusion, providing an e1 barrier-free environment is necessary for patients with schizophrenia to decrease their disability. Full article