Background According to the Americans with Disabilities Act, an individual with a disability has a physical or mental impairment that substantially limits one or more major life activities (ADA, 2014). A large body of literature indicates a strong relationship between disability and poor health. Adults with disabilities are more likely to suffer from chronic conditions than adults with no limitations. Thus, this vulnerable population with disabilities should be targeted for health promotion efforts. Healthy People 2020 calls for the inclusion of people with disabilities in U.S. health promotion efforts (Dixon, 2014). According to the Center for Disease Control and Prevention (CDC), individuals with disabilities that begin during the developmental period and last throughout their lifetime causing impairment in physical, learning, language, or behavior areas, are defined as having developmental disabilities (DD) (CDC, 2014). Despite the increasing prevalence of DD in the US, there is little known about the association of DD and chronic health conditions such as obesity, cancer, hypertension and diabetes mellitus. Developmental disability can impact healthy eating habits and physical activity; thus, people living with DD are a vulnerable population at risk of becoming overweight and/or obese and developing a multitude of chronic diseases. Emerging research supports an association between childhood obesity and ASD, one type of DD, documenting that the problem of overweight/obesity in children with ASD is at least as common, if not higher, than in the general pediatric population (Curtin, Anderson, Must, & Bandini, 2010). Although there are some studies that document the association of chronic diseases and intellectual disability among adults (Bhaumik, Watson, Thorp, Tyrer, & McGrother, 2008; de Winter, Bastiaanse, Hilgenkamp, Evenhuis, & Echteld, 2012b; de Winter, Magilsen, van Alfen, Penning, & Evenhuis, 2009; Melville, Hamilton, Hankey, Miller, & Boyle, 2007; Morin, Merineau-Cote, Ouellette-Kuntz, Tasse, & Kerr, 2012; Reichard & Stolzle, 2011; Rimmer & Wang, 2005), limited research has examined whether adults diagnosed with DD are more likely to become obese or have other chronic diseases. This is increasingly important as most recent data suggest that approximately 1 in 6 children in the U.S. have been diagnosed with a DD, ranging from mild disabilities such as speech and language impairments to more pervasive DDs, such as intellectual disability, cerebral palsy, and autism spectrum disorder (ASD) (CDC, 2014). Based on the paucity of research examining the relationship between DDs, including ASD, and chronic diseases that emerge during adolescence and adulthood, the purpose of this study is to examine these relationships, and to provide information about the health status of children and adolescents with DDs as they transition into adulthood. In order to achieve this purpose, an evaluation project was adopted that examined a health promotion program for adults with DDs that aimed to improve or maintain current health status, increase knowledge about healthy food and exercise choices and improve overall health behavior of adults with DDs.

Context: Modifiable risk factors in older methadone maintenance treatment (MMT) patients may put them at a greater risk of acquiring chronic diseases. The paucity of literature regarding the well-being and service needs of older MMT patients required investigation to determine whether these patients are treated for and adhere to chronic disease medications(s) comparably to those not on MMT. Objective: This study compared the proportion of MMT patients to a matched control group treated with first-line medications for four chronic diseases: hypertension, chronic obstructive pulmonary disease (COPD), diabetes mellitus and depression. As a secondary outcome measure, this study also examined the adherence comparability between the two groups. Method: This case control study used prescription claims data from the BC Ministry of Health’s PharmaNet database from October 1, 2008 to December 31, 2009. Each MMT patient was individually matched with a control subject in terms of age, sex, social assistance coverage and local health area. Both groups consisted of 143 men and 56 women for a total of 400 participants. Persons 50 years of age and older, residents of BC, and had prescriptions filled during October 1, 2008 to December 31, 2009, were randomly selected from the PharmaNet database. Results: Odds ratios (ORs) were calculated to compare the odds of MMT patients to non-MMT patients on a first-line medication for each chronic disease under investigation. ORs were 0.865 for hypertension (ns), 0.738 for diabetes (ns) and 4.176 for depression (p <0.001). For COPD the OR could not be calculated as no controls were treated for COPD; however, 11.6% of the MMT group were prescribed COPD medications which was significantly higher than the controls (p<.001). Adherence was calculated using continuous measures of medication availability (CMA) “by patient” and “by medication class” during patients’ persistent periods (continuous use periods) CMA(1), as well as the entire study period CMA(2). By patient, the mean CMA(1) showed no difference between the groups (non-MMT group: 91.9%, SD=15.8, CI=95% vs MMT group: 89.7%, SD=22.2, CI=95%). The mean CMA(2) was statistically different (p<0.05) between the groups (non-MMT group: 70.5%, SD=25.3, CI=95% vs MMT group: 60.8%, SD=29.1, CI=95%). By medication class, CMA(1) was 80-100% for most medication classes for both groups except for insulins and inhalers in the MMT group which fell between 40-79%. The CMA(2) for most medication classes was 60-86% in the non-MMT group and 30-76% in the MMT group. However, the differences between the groups were not statistically significant. Conclusion: Odds ratios for the treatment of all four chronic diseases differed. Therefore, looking at each chronic disease separately may be worthwhile to suggest potential targets for intervention. Disease-specific tailored interventions related to lifestyle risk factors, comorbid medical conditions, and adherence to chronic medications could potentially improve the overall health of older MMT patients. However, development of appropriate interventions and treatments requires research that properly recognizes the physical and mental health problems faced by older MMT patients (Rosen, Hunsaker, Albert, Cornelius, & Reynolds III, 2010). / Graduate

Shaken Baby Syndrome (SBS) is a potentially lethal form of child abuse. Primary prevention efforts have been targeted towards educating the general population, especially pregnant women and new parents, about the dangers of shaking. It is hypothesized that there are identifiable perinatal risk fadors for children that make them more at risk for injury from SBS than other forms of Abusive Head Trauma (AHT). All hospitalized children with suspected AHT (n=206) over a 14-year period who were referred to a multidisciplinary child protection center, were identified. The records of 24 children were not included in the study because they were not available for review, the child did not have a primary head injury, or the child was adopted and birth records were not available. Nonaccidental injury was confirmed in 116 of the remaining children. These included 72 (62%) children fitting SBS criteria, and 44 (38%) children identified as having other AHT. Case analysis included review of hospital and multidisciplinary child protection center records. The SBS and AHT groups were compared to separate perinatal risk fadors that might assist in identifying children at increased risk for SBS. Results of the analysis demonstrated that there was no significant difference between groups evident in the perinatal history. These preliminary findings support the follOWing conclusion that in contrast to many published reports, the perinatal information on the child did not provide significant pre-injury risk identifiers. It was concluded that changes in early educational programs and media campaigns are needed to reduce the sequalae of head trauma in infants and children. Programs must focus on AHT in general, rather than only SBS.

Thesis (Ph. D.)--Victoria University (Melbourne, Vic.), 2006. / Includes bibliographical references.

Thesis (Ph.D.)--University of Western Australia, 2007.

Thesis (Ph. D.)--University of Chicago, Dept. of Economics, August 1997. / Includes bibliographical references. Also available on the Internet.

Thesis (M. Nursing)--Montana State University--Bozeman, 2004. / Typescript. Chairperson, Graduate Committee: Clarann Weinert. Includes bibliographical references (leaves 64-70).

Thesis (Ph.D.)--Drexel University, 2009. / Includes abstract and vita. Includes bibliographical references (leaves 59-64).

Thesis (Ph. D.)--University of Florida, 1984. / Description based on print version record. Typescript. Vita. Includes bibliographical references (leaves 135-146).

No description available.