Visual Gesture-Based Character Recognition Systems for Design of Assistive Technologies for People With Special Necessities

In the present scenario, around 15% of the world's population experience some form of disability. So, there has been an enormous increase in the demand for assistive techniques for overcoming the restraints faced by people with physical impairments. More recently, gesture-based character recognition (GBCR) has emerged as an assistive tool of immense importance, especially for facilitating the needs of persons with special necessities. Such GBCR systems serve as a powerful mediator for communication among people having hearing and speech impairments. They can also serve as a rehabilitative aid for people with motor disabilities who cannot write with pen on paper, or face difficulty in using common human-machine interactive (HMI) devices. This chapter provides a glimpse of disability prevalence around the globe and particularly in India, emphasizes the importance of learning-based GBCR systems in practical education of differently-abled children, and highlights the novel research contributions made in this field.

Prevalence and correlates of disability in Latin America and the Caribbean: Evidence from 8 national censuses

We estimate disability prevalence rates and gaps in social conditions in eight Latin America and the Caribbean (LAC) countries and project current and future disability prevalence rates in the region. Using data from representative samples of the population in eight countries, we find that reported disability prevalence varies widely across countries, ranging between 4.5 percent in Trinidad and Tobago (2011) to 24.9 percent in Brazil (2010). Differences in surveying approaches and demographic structures likely explain a part of this variation. We find marked sociodemographic gradients for disability. We also report significant disability gaps: people living with disabilities have lower educational attendance and completion rates and lower employment rates. We use age and sex-specific disability rates from our sample of countries and information on the current and future demographic structures in LAC countries to project disability prevalence for the whole region. We project that the total number of people with disabilities in this region will increase by approximately 60 million between 2020 and 2050. Our projections suggest that countries need to systematically plan and implement inclusion policies to adequately address the growing population of people with disabilities in the years to come.

Prevalence, Pattern, and Factors Associated With Self-reported Disability Among the Bhutanese Population: A Secondary Data Analysis of Population and Housing Census

We analyzed the Population and Health Census of Bhutan (PHCB) 2017 to assess the prevalence and pattern of self-reported disability among people aged ≥15 years and the associated factors. The PHCB 2017 used the Washington Group Short Set on Functioning questionnaire to assess the disability (“lot of difficulty” or “cannot do at all”) in seeing, hearing, mobility, cognition, self-care, and communication. Of the 536 443 persons included in the analysis, 384 101(71.6%) were aged <45 years, 283 453(52.8%) were men, and 206 103(38.4%) were from the rural area. The prevalence of any self-reported disability was 2.8%, among whom 34.2% reported multiple disabilities. The disability prevalence (any) was significantly higher among people aged ≥65 years, illiterate, economically inactive, permanent residents, residing in a rural area, and from central and eastern regions of the country compared with their respective counterparts. Further research on access to rehabilitation and linking with social protection schemes for the disabled is required in this country.

An approach to identifying young children with developmental disabilities via primary care records

Background: Preschool aged children with developmental disabilities frequently receive a diagnosis of an indicator of disability, such as developmental delay, some time before receiving a definitive diagnosis at school age, such as autism spectrum disorder. The absence of a definitive diagnosis potentially underestimates the need for support by families with young disabled children, also delaying the access of families to condition-specific information and support. Our aim was to develop a strategy to identify children with probable and potential developmental disabilities before the age of five in primary care records for a UK birth cohort, considering how the identification of only probable or potential developmental disability might influence prevalence estimates. Methods: As part of a study of the effects of caring for young children with developmental disabilities on mothers’ health and healthcare use, we developed a two-part strategy to identify: 1) children with conditions associated with significant disability and which can be diagnosed during the preschool period; and 2) children with diagnoses which could indicate potential disability, such as motor development disorder. The strategy, using Read codes, searched the electronic records of children in the Born in Bradford cohort with linked maternal and child sociodemographic information. The results were compared with national and Bradford prevalence estimates. Results: We identified 83 children with disability conditions and 394 with potential disability (44 children had a disability condition and an indicator of potential disability). Combined they produced a developmental disability prevalence of 490 per 10,000 which is above the UK estimate for developmental disabilities in children under five (468 per 10,000) and within the 419-505 per 10,000 prevalence estimated for Bradford (for children aged 0-18). Conclusions: When disability prevalence is estimated only using conditions diagnosed as developmental disabilities, most young children with developmental disabilities likely to be diagnosed at later ages will be missed.

Prevalence, severity, and risk factors of disability among adults living with HIV accessing routine outpatient HIV care in London, United Kingdom (UK): A cross-sectional self-report study

ObjectivesMeasure the prevalence and severity of disability, and examine disability risk factors among adults living with HIV in London, United Kingdom (UK).MethodsWe conducted a quantitative cross-sectional study. The following self-reported questionnaires were administered: World Health Organization Disability Assessment Schedule 2.0 (WHODAS), HIV Disability Questionnaire (HDQ), a disability item using the Equality Act disability definition (EADD), and demographic and HIV questionnaire. We calculated the proportion (95% Confidence Interval; CI) of “severe” and “moderate” disability as measured using EADD and WHODAS scores ≥2 respectively. We measured disability severity with HDQ domain severity scores. We used demographic and HIV characteristic questionnaire responses to assess potential risk factors of “severe” (EADD) and “moderate” (WHODAS scores ≥2) disability using logistic regression analysis, and HDQ severity domain scores using linear regression analysis.ResultsOf 201 participants, 176 (87.6%) identified as men, with median age 47 years, and 194 (96.5%) virologically suppressed. Severe disability prevalence was 39.5% (n=79/201), 95% CI [32.5%, 46.4%]. Moderate disability prevalence was 70.5% (n=141/200), 95% CI [64.2%, 76.8%]. Uncertainty was the most severe HDQ disability domain. The HIV characteristic of late HIV diagnosis was a risk factor for severe disability [Odds Ratio (OR) 2.71; CI 1.25, 5.87]. The social determinants of health economic inactivity [OR 2.79; CI 1.08, 7.21] and receiving benefits [OR 2.87; CI 1.05, 7.83] were risk factors for “severe” disability. Economic inactivity [OR 3.14; CI 1.00, 9.98] was a risk factor for “moderate” disability. Economic inactivity, receiving benefits, and having no fixed abode were risk factors (P≤0.05) across HDQ disability domains; physical, mental and emotional, difficulty with day-to-day activities, and challenges to social participation. Personal factors of identifying as a woman and being aged <50 years were risk factors (P≤0.05) for HDQ disability domains; mental and emotional, uncertainty, and challenges with social participation.ConclusionsPeople living with well-controlled HIV in London UK experienced multi-dimensional and episodic disability. Results help to better understand the prevalence, severity, and risk factors of disability experienced by adults living with HIV, identify areas to target interventions, reduce disability, and optimise health and function.

177Physical functional limitations and psychological distress in people with and without colorectal cancer

Background This study aims to quantify physical disability and psychological distress in people with and without colorectal cancer (CRC). Methods Questionnaire data (2006-2009) from 267,153 Australian general population members aged ≥45 years participating in the 45 and Up Study (n = 213,231 following exclusions) were linked to cancer registry and hospital admission data, to ascertain CRC status. Modified Poisson regression estimated adjusted prevalence ratios (PRs) for physical disability and psychological distress in participants with versus without CRC. Results Compared with participants without CRC (n = 210,836), CRC survivors (n = 2,395) had significantly higher disability prevalence (11.9% versus 19.5%, respectively): PR = 1.11 (95%CI=1.03-1.20); and a similar prevalence of distress (23.1% versus 20.2%): PR = 1.03 (0.94-1.20). Adverse outcomes were associated with certain clinical characteristics. Compared to participants without CRC, CRC survivors diagnosed 5-&lt;10 and ≥10 years, with regional spread and without recent cancer treatment had similar outcomes; survivors with metastatic CRC and recent treatment had 30-60% higher prevalence of disability and distress. Compared to participants with neither CRC nor disability, PRs for distress were 4.71 (4.22-5.26) for those with disability and CRC and 4.22 (4.13-4.31) for those with disability without CRC. Conclusions Physical disability is elevated in CRC survivors. Psychological distress is elevated 4- to 5-fold with disability, regardless of CRC diagnosis, with lesser increases around diagnosis and treatment. Key message CRC survivors with less advanced disease and who have not been recently diagnosed or treated have physical disability and psychological distress comparable to the general population. Survivors with disability are at particularly high risk of distress.

Interrogating and Reflecting on Disability Prevalence Data Collected Using the Washington Group Tools: Results from Population-Based Surveys in Cameroon, Guatemala, India, Maldives, Nepal, Turkey and Vanuatu

The Washington Group (WG) tools capture self-reported functional limitations, ranging from 6 domains in the Short Set (SS) to 11 in the Extended Set (ESF). Prevalence estimates can vary considerably on account of differences between modules and the different applications of them. We compare prevalence estimates by WG module, threshold, application and domain to explore these nuances and consider whether alternative combinations of questions may be valuable in reduced sets. We conducted secondary analyses of seven population-based surveys (analyses restricted to adults 18+) in Low- and Middle-Income Countries that used the WG tools. The prevalence estimates using the SS standard threshold (a lot of difficulty or higher in one or more domain) varied between 3.2% (95% Confidence Interval 2.9–3.6) in Vanuatu to 14.1% (12.2–16.2) in Turkey. The prevalence was higher using the ESF than the SS, and much higher (5 to 10-fold) using a wider threshold of “some” or greater difficulty. Two of the SS domains (communication, self-care) identified few additional individuals with functional limitations. An alternative SS replacing these domains with the psychosocial domains of anxiety and depression would identify more participants with functional limitations for the same number of items. The WG tools are valuable for collecting harmonised population data on disability. It is important that the impact on prevalence of use of different modules, thresholds and applications is recognised. An alternative SS may capture a greater proportion of people with functional domains without increasing the number of items.

Self-reported disability in rural Malawi: prevalence, incidence, and relationship to chronic conditions

Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve understanding of prevalence and correlates of disability in this low-income setting in Malawi. Methods: This study is nested in the Karonga Health and Demographic Surveillance Site in Malawi; the Washington Group questions were added to the annual survey in 2014. We used cross-sectional data from the 2014 survey to estimate the current prevalence of disability and examine associations of disability with certain chronic conditions. We then reviewed the incidence and resolution of disability over time using panel data from the 2015 survey. Results: Of 10,863 participants, 9.6% (95% CI 9.0-10.1%) reported disability in at least one domain. Prevalence was higher among women and increased with age. Diabetes and obesity were associated with disability among women, and diabetes was also associated with disability among men. Neither hypertension nor HIV were associated with disability. Participants reporting “no difficulty” or “can’t do at all” for any domain were likely to report the same status one year later, whereas there was considerable movement between people describing “some difficulty” and “a lot of difficulty”. Conclusions: Disability prevalence is high and likely to increase over time. Further research into the situation of this population is crucial to ensure inclusive policies are created and sustainable development goals are met.

Associations of Health Conditions and Health-Related Determinants with Disability among New York City Adult Residents

Introduction: Population-based disability prevalence estimates are limited for New York City (NYC). We examined the associa­tion of several health and health-related measures with disability among NYC resi­dents aged 20-64 years.Methods: We used information from 1,314 adults who participated in the 2013-2014 NYC Health and Nutrition Examination Sur­vey (HANES). We categorized survey partici­pants as having a disability if they reported a physical, mental, and/or emotional problem preventing work or if they reported difficulty walking without special equipment because of a health problem. We used log-binomial regression to quantify the association of each exposure with disability before and after adjustment for select covariates.Results: Overall, 12.4% of the study’s NYC residents aged 20-64 years had a disabil­ity. After adjustment, disability prevalence was significantly greater among those who reported having unmet health care needs (prevalence ratio [PR] = 1.75, 95% CI: 1.18-2.57) and those who reported fair/ poor general health (PR = 2.33, 95% CI: 1.68-3.24). The probability of disability was greater among NYC residents with arthritis (PR = 2.66, 95% CI: 1.85-3.98) and hy­pertension (PR = 1.48, 95% CI: 1.04-2.11) when compared with those without these conditions. Disability was also associated with depression (PR = 2.96, 95% CI: 2.06- 4.25), anxiety (PR = 2.89, 95% CI: 2.15- 3.88), and post-traumatic stress disorder (PR = 2.55, 95% CI: 1.66-3.91). Disability, however, was not associated with diabetes.Conclusion: Disability is more prevalent among those with unmet health care needs, fair/poor general health, arthritis, hyperten­sion, depression, anxiety, and PTSD in these NYC residents, aged 20-64 years. These findings have implications for NYC’s strate­gic planning initiatives, which can be better targeted to groups disproportionately affect­ed by disability.Ethn Dis. 2021;31(3):445- 452; doi:10.18865/ed.31.3.445

Lessons from Disability Counting in Ecuador, with a Contribution from Primary Health Care

Disability data are essential for policy. Yet, the predominant use of disability prevalence for service planning reflects dichotomous counting, increasingly less compatible with current disability thinking. Difficulties relate to variations in rates, the lack of matching with needs, and the use of prevalence to compare disability situations. From the perspective of Primary Health Care (PHC), we explore methods for disability counting regarding the usefulness of prevalences in identifying persons with disabilities and meeting their needs with local service implementation. First, we analyze the methods and results of six national cross-sectional studies in Ecuador. Then, we present a case about an exploratory needs-driven method for disability counting in a local PHC setting. The analysis of variations in rates focuses the attention on reasons for and risks of a priori exclusion of persons with disabilities from services. Longitudinal disability counting as a collateral result of meeting needs in the PHC setting yields local disability data worthy of further exploration. Thinking about disability counting from a PHC scope in a developing country prompted reflection on the comparison of prevalences to evaluate disability situations. Findings invite further exploration of the needs-driven counting method, its contributions to planning local services, and complementarity with cross-sectional disability counting.