What some physicians say about caring for patients with disability: Responses to open-ended question to nationwide physician survey.

BACKGROUND: For over 50 years, federal disability civil rights laws have mandated that patients with disability receive equitable health care. However, disabled patients continue to experience health care disparities. OBJECTIVE: To explore physicians' views, in their own words, about caring for patients with disability. METHODS: Review of responses to open-ended question at the end of a nationally representative survey of 714 outpatient physicians about their experiences caring for adult disabled patients. The open-ended question asked for additional comments participants wanted to share. Only 108 (15.1 %) survey participants provided responses suitable for analysis (e.g., legible, complete thought). All issues reported here reflect comments from ≥5 participants. RESULTS: Common concerns involved high costs, too little time, insufficient space, inadequate training, and lack of adequate mental health services to care for disabled patients. Many physicians appeared frustrated by legal requirements that they cover accommodation costs. Multiple physicians described as "unfair" having to pay for sign language interpreters, especially since interpreter costs generally exceed reimbursements for patients' visits. Physicians also commented on high costs and space demands of accessible exam tables, especially for small practices, and on challenges accommodating patients with severe obesity, including concerns that patients with severe obesity could damage their exam tables. Some participants suggested that disabled patients require advocates to get good quality care. CONCLUSIONS: Albeit limited by the small number of responses, these open-ended comments from our nationwide survey of physicians suggest some doctors view certain accessibility requirements as unfair to them or infeasible in their practice environments.

An Italian Survey and Focus Groups on Fibromyalgia Impairment: Impact on Work and Possible Reasonable Accommodations.

Fibromyalgia symptoms affect the sufferers' working life; however, through reasonable accommodations in workplaces, they can continue to work satisfactorily. There are no Italian studies on factors that facilitate or hinder fibromyalgia-affected people's working life. Our objective was to explore, in a pre-pandemic setting, the quality of working life of fibromyalgia sufferers and reasonable accommodations to improve it. Quantitative and qualitative methods were applied; a survey-questionnaire, participatory-developed, was online-administered to a sample of self-reported FM sufferers (N = 1176). Then, two Focus Groups (FGs), involving 15 fibromyalgia-affected women, were held. Data were analyzed by a thematic analysis approach. Among survey-respondents, 20% were unemployed and only 14% went to work gladly. Variability of pain (84%) and fatigue (90%) were the most perceived reasons for difficulties at work. Negative relationships at work were reported by most participants. The FGs' discussions addressed different strategies for overcoming the main obstacle of "not being believed by colleagues and employers" and reasonable accommodations. However, a negative hopeless attitude towards the solution of problems at work was also apparent. Different critical issues in the workplace emerged from the survey and the FGs. Coordinated actions, according to a transdisciplinary approach, are needed to manage fibromyalgia-induced difficulties in the workplace.

Inviabilidad de un régimen legal especial para la tenencia compartida de niños y niñas con discapacidad en el Perú / Unviability of a special legal regime for the shared custody of children with disabilities in Perú / Inviabilidade de um regime legal especial para a guarda compartilhada de meninos e meninas com incapacidade no Peru

En materia de Derecho de familia, la legislación peruana contempla la posibilidad de una tenencia compartida, regulada expresamente en el Código de los Niños y Adolescentes, sin establecer precisiones sobre las condiciones y formas de aplicación, lo que es similar en el Derecho comparado. Sustentado en principios bioéticos y jurídicos, en el presente artículo se analiza la posibilidad de generar una regulación especial para la tenencia compartida, enfocada en la necesidad de establecer criterios especiales que puedan tener en cuenta los jueces en los casos concretos que involucren a niños y niñas. Estos criterios deben partir de un modelo social dirigido a quebrar las barreras impuestas, dotando de las condiciones más adecuadas para un desarrollo integral y pleno. En esa línea de pensamiento, es fundamental el interés superior del niño, el compromiso de los progenitores y la implementación de ajustes razonables.

In terms of family law, Peruvian legislation contemplates the possibility of shared custody, expressly regulated in the Code of Children and Adolescents, without establishing details on the conditions and forms of application, which is similar in comparative law. Based on bioethical and legal principles, this article analyses the possibility of generating a special regulation for shared custody, focusing on the need to establish special criteria that judges can take into account in specific cases involving children. These criteria should be based on a social model aimed at breaking down the barriers imposed, providing the most appropriate conditions for an integral and full development. In this line of thought, the best interests of the child, the commitment of the parents and the implementation of reasonable accommodations are fundamental.

Em matéria de Direito de família, a legislação peruana contempla a possibilidade de uma guarda compartilhada, regulada expressamente no Código das Crianças e Adolescentes, sem estabelecer especificações sobre as condições e formas de aplicação, o que é similar no Direito comparado. Apoiado em princípios bioéticos e jurídicos, no presente artigo se analisa a possibilidade de gerar uma regulação especial para a guarda compartilhada, focada na necessidade de estabelecer critérios especiais que juízes possam ter em conta nos casos concretos que envolvem meninos e meninas. Esses critérios devem partir de um modelo social dirigido a quebrar as barreiras impostas, dotando as condições mais adequadas para um desenvolvimento integral e pleno. Nessa linha de pensamento, é fundamental o interesse superior da criança, o compromisso dos pais e a implementação de ajustes razoáveis.

Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings.

Autistic people experience significant health disparities and reduced life expectancy. Barriers to accessing healthcare are associated with adverse health outcomes. Autism training and healthcare professionals' knowledge about autism is variable, and heterogeneity among autistic people leads to additional educational and clinical complexities. Autism remains nebulous for many practitioners, who are unclear about communication differences, access needs or life experiences common to autistic people. Healthcare environments can be challenging for all patients but autistic people may require specific accommodations to allow equitable access. The authors have developed a simple framework which may facilitate equitable clinical services at all points of access and care, using the acronym 'SPACE'. This encompasses five core autistic needs: Sensory needs, Predictability, Acceptance, Communication and Empathy. Three additional domains are represented by physical space, processing space and emotional space. This simple yet memorable framework encompasses commonalities shared by autistic people.

Accommodating hearing loss in outpatient physician offices in the U.S.

BACKGROUND: Approximately 16.2 million Americans ages 18 and older (5.7%) report being deaf or having serious difficulty hearing. Hearing loss impedes effective communication during clinical encounters putting patients' safety at risk. A large fraction of Americans with Disabilities Act lawsuits addresses whether providers offered auxiliary aids and services required to ensure effective communication. OBJECTIVE: Examine use of different hearing accommodations for deaf or hard of hearing patients by U.S. physicians. METHODS: We surveyed randomly selected physicians nationwide representing 7 specialties about their reported use of 8 types of accommodations when communicating with adult outpatients who are deaf or have significant difficulty hearing, even with hearing aids (overall weighted response rate = 61.0%). We performed a descriptive analysis of responses, using survey sampling weights. RESULTS: Among the 526 physicians in this analysis, most were male, white, urban, and practiced in community-based practices. Overall, 81.5% (SE = 1.9) reported that patients with significant hearing limitations get worse quality health care than others. Among participants, 49.8% (2.4) reported never using an in-person sign language interpreter hired by the practice, and 63.2% (2.4) never use video remote interpreting. In contrast, 30.7% (2.1) always and 29.8% (2.2) usually speak louder and slower to patients with significant hearing limitations. None of the 8 accommodations were always or usually used by 8.9% (1.3) of participants. CONCLUSIONS: More than 32 years after the Americans with Disabilities Act, most physicians do not offer accommodations sufficient to ensure effective communication with adult outpatients with significant hearing limitations.

A Workshop on Supporting Students with Developmental Disabilities 2023 / 医学教育

With the enactment of the amended Anti-Discrimination Act, which mandates the provision of reasonable accommodations, the urgent task for all health professional education institutions is to establish a support system for students with developmental disabilities. On the other hand, they are also required to fulfill their social accountability through quality assurance in education, such as the implementation of outcome-based education curriculum. In order to consider how to balance reasonable accommodations for students with developmental disabilities, quality assurance in education, and social accountability in undergraduate medical education, Professionalism Subcommittee held a workshop on April 22, 2023. The participants engaged in active discussions during the workshop.　Through a post-workshop survey, educational needs and challenges in supporting students with developmental disabilities were clarified, providing insights for future Subcommittee activities.

Breast cancer survivorship and employment in Ireland: Legislative systems and the return to work of women with breast cancer.

BACKGROUND: Breast cancer is the most common invasive cancer in females worldwide. While work is important for well-being, 84% of women in Ireland temporarily or permanently cease working up to six months post-breast cancer diagnosis. Under Irish law, there is a right to reasonable work accommodations, however paid sick leave has only recently been state-mandated. Legislation internationally varies across nations. OBJECTIVE: The aim of this study was to explore the experiences of women who have had breast cancer returning to, and/or remaining in work, in the context of employment legislation. METHODS: Fifteen women with breast cancer, fifteen healthcare professionals, and nine employers nationwide participated in a qualitative-descriptive design, using semi-structured interviews. Interviews were audio-recorded, transcribed, and data analysed using thematic analysis. RESULTS: Thirty-nine participants were recruited. A prominent theme from interviews was that most women with breast cancer and healthcare professional cohorts were not aware of employment rights in the context of cancer diagnoses. This is in contrast to employers. Experiences of sick leave and pay entitlements varied amongst women with breast cancer with financial pressure and expediated the return to work evident for some participants. Most women did not report any discrimination on returning to the workplace, although there were examples of indirect discrimination where unfair expectations were being placed on women by colleagues. CONCLUSIONS: Education and awareness on employment rights and entitlements during and after cancer treatment is warranted. This could be incorporated into work-focused interventions to support those living with and beyond cancer to transition back into the workplace.

Serendipity and Social Justice: How Someone with a Physical Disability Succeeds in Clinical Bioethics.

Trainees with disabilities in health-related professions are often subjected to structural ableism in medicine: the discriminatory manifestation of lowered expectations towards people with disabilities by medical professionals. In this case study, I reflect on my experiences as the first individual with significant disabilities to be offered a postdoctoral fellowship in clinical bioethics at the National Institutes of Health. I focus on the following question: What arrangements need to be in place in order for someone with my level of disability to thrive as a clinical bioethicist? By telling my story, I show how the process of accommodating trainees with disabilities often requires creative problem-solving and a considerable amount of institutional resources. I also describe the team-based method that my mentors and I developed to enable me to complete rotations on the NIH's bioethics consultation service. If more trainees with disabilities are to succeed in clinical bioethics trainee programs, the field will have to grapple with how to develop an infrastructure for providing disability-related support across training programs. This article is the beginning of a dialogue about how to build such an infrastructure.

The Use of Distance Learning and E-learning in Students with Learning Disabilities: A Review on the Effects and some Hint of Analysis on the Use during COVID-19 Outbreak.

Even if the use of distance learning and E-learning has a long tradition all over the world and both have been used to keep in contact with students and to provide lessons, support and learning materials, there is an open debate on the balance between advantages and disadvantages in the use of distance learning. This debate is even more central in their use to support students with Learning Disabilities (LDs), an overarching group of neurodevelopmental disorders that affect more than 5% of students. The current COVID-19 outbreak caused school closures and the massive use of E-learning all over the world and it put higher attention on the debate of the effects of E-learning. This paper aims to review papers that investigated the positive and negative effects of the use of Distance Learning and E-learning in students with LDs. We conducted a literature review on the relationship between Distance Learning, E-learning and Learning Disabilities, via Scopus, Eric and Google Scholar electronic database, according to Prisma Guidelines. The findings are summarized using a narrative, but systematic, approach. According to the data resulting from the papers, we also discuss issues to be analyzed in future research and in the use of E-learning during the current pandemic of COVID-19.

Exploring people with disabilities' perspectives on the availability of appropriate work that fits their capabilities in Jordan.

BACKGROUND: There is a lack of information regarding the availability of work and the appropriateness of work to people with disabilities (PWD) in Jordan. Therefore, this research was initiated and it was hypothesized that work is available and it is appropriate to PWD abilities. OBJECTIVES: To explore the availability of work and the appropriateness of working conditions to PWD abilities. METHOD: Thirty-five individuals completed the "People with Disabilities Working Condition Scale" (PWDWCS). Descriptive and nonparametric statistical analyses including Chi square, Pearson correlation, Mann-Whitney U and Kruskal Wallis tests were used, and content analysis was used for the open-ended questions section to identify the availability of work in terms of opportunities and competition as well as to identify the work fitness to PWDs' abilities. RESULTS: Sixty percent of the participants had difficulties finding a job, with a high competition on the available ones. Several work conditions do not fit PWDs' abilities including improper fitness of work assignment to their capabilities and relatively inappropriate wages. In addition, a higher percentage of the participants reported: A) availability of written job descriptions and procedure manuals B) lack of work-related training and continuing education (CE) programs C) PWD are not being promoted D) availability of relative social acceptance at work E) a relatively comfortable work environment F) finally, work areas which require several modifications to boost accessibility. CONCLUSION: Initial hypotheses could not be confirmed. Several challenges face PWD in Jordan pertaining to the availability and fitness to work. Rehabilitation for all sectors of work is necessary as well as for PWD to improve their employability and work appropriateness to PWD abilities.

The Implementation of Extended Examination Duration for Students With ADHD in Higher Education.

OBJECTIVE: Recently, research indicated that extended examination duration was perceived as effective by students with ADHD. However, the objective effectiveness of this accommodation has not been researched extensively. This study addresses this gap in literature. METHOD: A total of 30 students with ADHD and 30 matched typically developing controls (TDC) participated in a simulation of a real-life examination. They filled in three parallel versions of a paper-and-pencil test in three time conditions: 1 hr (+0%), 1 hr 20 min (+33%), and 1 hr 30 min (+50%). RESULTS: When granted extended examination duration, students with ADHD and TDC use extra time but their performance does not increase. In addition, test-taking strategies were altered to a limited extent, and strategies that are perceived as effective (e.g., marking key words) were rarely used by the students. CONCLUSION: It is concluded that extended examination duration is not objectively effective in an experimental design. Limitations and guidelines for future research are formulated.

Feasibility of electronic peer mentoring for transition-age youth and young adults with intellectual and developmental disabilities: Project Teens making Environment and Activity Modifications.

BACKGROUND: There is a need for mentoring interventions in which transition-age youth and young adults with intellectual and/or developmental disabilities (I/DD) participate as both mentors and mentees. Project TEAM (Teens making Environment and Activity Modifications) is a problem-solving intervention that includes an electronic peer-mentoring component. METHODS: Forty-two mentees and nine mentors with I/DD participated. The present authors analysed recorded peer-mentoring calls and field notes for mentee engagement, mentor achievement of objectives and supports needed to implement peer mentoring. RESULTS: Overall, mentees attended 87% of scheduled calls and actively engaged during 94% of call objectives. Across all mentoring dyads, mentors achieved 87% of objectives and there was a significant relationship between the use of supports (mentoring script, direct supervision) and fidelity. CONCLUSIONS: Transition-age mentees with I/DD can engage in electronic peer mentoring to further practice problem-solving skills. Mentors with I/DD can implement electronic peer mentoring when trained personnel provide supports and individualized job accommodations.

Development and implementation of a clinical needs assessment to support nursing and midwifery students with a disability in clinical practice: part 1.

Equality and disability legislation, coupled with increasing numbers of students with a disability, and inadequate supports in clinical practice, acted as catalysts to explore how best to support undergraduate nursing and midwifery students on clinical placements. Historically, higher education institutions provide reasonable accommodations for theoretical rather than clinical modules for practice placements. This paper describes the development and implementation of a Clinical Needs Assessment designed to identify the necessary supports or reasonable accommodations for nursing and midwifery students with a disability undertaking work placements in clinical practice. The existing literature, and consultation with an expert panel, revealed that needs assessments should be competency based and clearly identify the core skills or elements of practice that the student must attain to achieve proficiency and competence. The five Domains of Competence, advocated by An Bord Altranais, the Nursing and Midwifery Board of Ireland, formed the framework for the Clinical Needs Assessment. A panel of experts generated performance indicators to enable the identification of individualised reasonable accommodations for year 1 nursing and midwifery students in one Irish University. Development and implementation of the Clinical Needs Assessment promoted equality, inclusion and a level playing field for nursing and midwifery students with a disability in clinical practice.

Evaluation of a clinical needs assessment and exploration of the associated supports for students with a disability in clinical practice: part 2.

Engagement and successful completion of nursing and midwifery programmes may be predicated on the identification and implementation of reasonable accommodations to facilitate clinical learning for students with a disability. This qualitative study aims to evaluate a clinical needs assessment for students with a disability and explore their experiences of support in clinical practice. A purposive sample of year one undergraduate students was used. Four students consented to participate and undertook an individual interview. Their disabilities were categorised as specific learning disability (dyslexia) (n = 3) and mental health (n = 1). Data analysis revealed two main themes 'students' experiences of disclosure' and 'receiving support'. Findings revealed that all students disclosed on placement, however, the extent of disclosure was influenced by personal and environmental factors. Students used the clinical needs assessment to highlight accommodations to clinical staff on placement. Issues of concern that arose, included communication between all key stakeholders, negative staff attitudes and the need to improve the provision of accommodations. This preliminary evaluation indicates that the Clinical Needs Assessment bridges the gap in provision of student support between higher education and healthcare institutions. Findings suggest that competence based needs assessments can identify individualised reasonable accommodations for students undertaking clinical placements.

Structural barriers at the workplace for employees with vision and locomotor disabilities in New Delhi, India.

BACKGROUND: India, a signatory to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), has 2.21% of people with disabilities to the total population of which 26% are employed (Census 2011 and 2001). Accessibility was introduced for the first time in 1995 under The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act. Article 9 of UNCRPD promotes barrier-free environment on an equal basis with others. Despite the legislation and the UN convention, structural barriers continue to be one of the largest barriers posing concern for PwDs at their workplace. OBJECTIVE: To identify various physicall barriers limiting accessibility of PWDs in the formal sector in Delhi. METHOD: Quantitative descriptive research design. Random sample was drawn. RESULT: Structural barriers create difficulty in accessing basic amenities such as canteens, toilets etc. CONCLUSION: Disability is a human rights issue. An employee with disability is entitled to dignified life. Effective implementation of Article 9 and 27 of UNCRPD will pave a way for removing structural barriers at workplace.

Addressing the employment-related needs of cancer survivors.

BACKGROUND: Increasingly, people diagnosed with cancer are surviving and continuing to participate in the work force. This trend brings with it new issues regarding survivors' employment-related needs. OBJECTIVE: The research team's objective is to explore cancer survivors' employment-related needs and supports with the ultimate goal of developing a training intervention for them. METHODS: Data were collected via an online survey. This article reports on the findings from the pilot stage of the study, which included 32 respondents. RESULTS: Many cancer survivors experience cancer symptoms at work, but do not tend to seek reasonable accommodations. Levels of awareness of possible programmatic and legal supports are low. Respondents reported that neither employers nor medical practitioners are primary sources of information regarding their individual employment-related concerns. Instead, they relied on general information from cancer advocacy organizations. CONCLUSIONS: Survivors, employers, and practitioners who treat cancer patients could benefit from training resources about how survivors might address their employment-related needs.

Job retention and breast cancer: employee perspectives and implications for rehabilitation planning.

The article presents four case studies of employed women who have had breast cancer. Specifically, the authors examine respondents' career maintenance concerns in the areas of (a) worksite accessibility, (b) performance of essential job functions, (c) job mastery, and (d) job satisfaction. Post-employment strategies are presented to assist rehabilitation professionals in meeting the on-the-job needs of women with breast cancer.

Employment of individuals with deaf-blindness: Necessary skills and prevocational assessments.

The purpose of this paper is to discuss skills necessary for individuals with deaf-blindness to attain and retain employment, as well as identify prevocational assessments for this population. Activities of daily living including functional communication, socialization, and mobility are examined as necessary skills in relation to employment. Reasonable accommodations which promote better communication, socialization, and mobility for individuals with deaf-blindness in the work place are discussed. A case study is included to illustrate successful employment of an individual with deaf-blindness through the evaluation and assessment of necessary skills and personal interests, accompanied by reasonable accommodations. Due to the low incidence of this disorder, an introduction to the etiology and demographics of deaf-blindness is also provided.