Barriers, facilitators, and access for wheelchair users: substantive and methodologic lessons from a pilot study of environmental effects.

We undertook a month-long intensive pilot study of a sample of adult wheelchair-users in Boston, Massachusetts and Durham, North Carolina, USA. The study had four objectives; to: (1) measure experiences of reaching and failing to reach specific destinations; (2) measure encounters with environmental facilitators and barriers, including both those overcome and not overcome; (3) determine the frequencies of destinations, facilitators, and barriers, and (4) test for consistency between daily reports and retrospective reports. Full participation entailed baseline and exit telephone interviews, and 28 daily telephone contacts. Participants reported reaching a wide range of destinations, most notably, banks, stores and shops, friends' and relatives' homes and health professionals' offices. There was a smaller range of destinations that they could not reach, despite trying; most notably, religious buildings, friends' and relatives' homes and work-places. They encountered an array of barriers, some of which they were able to overcome and others they could not overcome. Reported barriers included personal, interpersonal, and environmental barriers. The 25 subjects completing the study reported a wide range of human, environmental, and technologic support. In general, the consistency among daily, baseline, and exit interviews was high. This study has both substantive and methodologic implications. It suggests that efforts to facilitate social participation by wheelchair-users should focus not only on the built environment, but also on interventions in personal assistance and assistive technology, health promotion and fitness, and programs that improve civility. Methodologically, the data suggest that it is possible to make reliable measures of environmental encounters without the administrative and respondent burden associated with daily interviews.

Disability as a public health issue: findings and reflections from the Massachusetts survey of secondary conditions.

Public health researchers and practitioners have begun to recognize the dynamic nature of disability, promote the health of people with disabilities, and develop strategies to prevent secondary conditions among them. To understand the epidemiology of secondary conditions, the authors developed the Massachusetts Survey of Secondary Conditions, a longitudinal study of adults with major disabilities (n = 656) based on a conceptual framework linking disability, mediating factors, and health outcomes. This paper reports baseline data on the number of secondary conditions experienced by survey respondents. Respondents experienced a mean of 5.3 of 17 secondary conditions. More numerous secondary conditions were associated with fair or poor general health and number of days unable to do routine activities. Factors amenable to public health interventions included difficulty with weight and exercise maintenance, tobacco and marijuana use, and experiencing assault. Disability should be a focus in all public health research, policy, and programs.

Famine relief and imperial policy in early modern Morocco : The political functions of public health

There has been no systematic ethnology nor comparative history of public health. In fact, there has been a broad consensus that prior to the arrival of missionaries and colonial health authorities there was no indigenous public health. These assumptions apply to only some settings and do not reflet the general history of public health. The present study concerns public health in the first century of Alawi rule in Morocco,ca. 1670-1790. The early Alawi sultans undertook public health programs, most of which concerned the prevention and relief of mass starvation. Goals of the programs were consistent with other features of their public policies. Effectiveness of the programs was limited partly by technical and scientific factors, but more by political constraints, especially the sultans higher priorities for political stability than public welfare and public helth. These data provide important insights not only into Moroccan social and political history , but also into the more general problem of the political nature of public health(AU)