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Thread starter B2TF
How did you vote:
Labour/Leave
Conservative/Leave
Other/Leave
Labour/Remain
Conservative/Remain
Other/Remain
B2TF
The Moral High Ground
THE MIGHTY SHAYMEN
It's often claimed The Left own the internet, and certainly they do seem to be more than well represented among those willing to express an opinion -and God help anyone who doesn't agree with them. Remainers too, seemed to be everywhere online in the past 4 years. Indeed, if the internet was any guide, there would have been landslides for both Labour and Remain. But not so, and in real life the majorities lay with the other tribes, who mostly only chose to express their view in the quiet of the voting booths. So, mainly for my own interest, please state which side of the lines do you stand on, in this anonymous poll. Oh and, if you're a Labour voting Remainer, please let me know what it's like over there on the WRONG side of history. Thanks.
Railway Blue
I've voted Labour since that late 1960s when I became old enough to vote. I think the advent of Momentum and the pushing to the front of Corbyn (who was completely unsuitable to either lead the party or the country) combined with his hatred of Jews and love for terror groups compelled me to do something that I believed impossible i.e. vote Tory. I did that at the last election. I usually have a Vote Labour sticker in my window and when they knocked on my door before the last election and I told them I wouldn't be voting Labour they were speechless. I cited Momentum as my reason and they couldn't see what my problem was.
Reactions: B2TF
rudebwoyben
Railway Blue said:
Hatred of Jews LMAO...
For the record I'm Jewish and it's clear to me that just about all of the parties throwing accusations of anti-Sémitism don't actually care about Jewish people and are instrumentalising it for their own purposes. The recent Labour leaks have shown that as have the complete ignoring of cases of anti-sémitism from elsewhere.
i agree that Corbyn didn't have the qualities necessary to lead a government, after all he had never been in charge of anything all life but then again it always appears that Labour are judged against a much higher standard than the Tories.
And what is it about Momentum that makes them repellent to you? It just seems that they're a catch-all term of revulsion for many people, a caricature when really they're just an organisation founded to get younger people engaged in politics.
I'm 70 later this month and as long as I can remember (1950s) I've been appalled Jew-HATRED. I visit Israel every two years and support the state of Israel and pro-Israel charities and charities that oppose anti-Semitism.. Momentum are to blame for the past 5 wasted years for the Labour Party in forcing the election of a completely useless leader. Its possible that he will still have decision-making power from the back benches. BTW I don't know what LMAO means?
BTW I don't know what LMAO means?
It's one of those abbreviations Lefties invented to use on the internet, to make (in their view) people feel small. It means Laughing My Arse Off. They have others: Rolling On the Floor Laughing (ROFL), Laughing Out Loud (LOL) , and the nuclear option, Rolling On The Floor Laughing My Arse Off (ROFLMAO). All designed to express their contempt and condescension towards your opinion and their innate superiority over YOU. They're generally just not very nice people.
Keep watching.... ...
Reactions: Railway Blue
24 hours gone, I donl;t think we're going to get any more votes on this:
So we have:
4 Tories
4 Labour
3 Leavers
7 Remainers
I thought there'd be a lot more Labour than that, maybe they're just gobbier than Tories?
As for Remainers, well they were everywhere on social media and out on the streets and the online petitions, both before and after the referendum. Leavers? They did their talking with their pens and pencils in the voting booths, like true democrats. 5 elections and a referendum.
Reactions: Camborne Gills
Camborne Gills
Gillingham, Kent, Miami Dolphins, Castleford
Remainers were gobbier because they were sore losers, like Krankie in Scotland. Anyway, the emptiest vessels make the most noise.
B2TF said:
I think my skin is thick enough now not to be concerned by insults I can't even translate. Thanks B2TF ( which is another one I cant translate).
Back To The Future.
Latest: The Terminator
Latest: Stocky


Barwell boss Law ready for the leaders
TABLE-TOPPERS Market Drayton are the visitors to in-form Barwell on Saturday in what promises to be a pulsating encounter, writes John Harris.
Hinckley Times
Victory for Marcus Law's men, who have two games in hand on most of the teams above them, would mean a promotion charge is very much on the cards.
But it will be one of the sternest test the Canaries have faced this season, especially after just recovering from two FA Vase encounters with Studley which was finally settled on penalties in Barwell's favour.
Law said: "Market Drayton are top for a reason and it will be great to pit our wits against them and see how far we've come.
"They finished third last season, are a good side and it should be an intriguing encounter.
"We prepare for every game as if we're facing top of the league. We have a job to do and hopefully the players can respond to that."
He added: "I will assess the squad at training tonight. We've had two very draining games in the FA Vase on muddy pitches so we'll see how the players are."
Talking of the Studley success, which came on spot-kicks after the team battled out a 3-3 draw last Saturday and then a 2-2 stalemate on Tuesday evening, Law said: "They were two good games. On both occasions they equalised in the sixth minute of injury-time but we've come through and that's the main thing.
"We have three massive weeks of football before the next round so we are not even worrying about that.
"But it's good for the club to get some financial gain and it's a competition we take very seriously and strive to do well in."
Barwell FC
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Dr. Yolanda Page '91 to take over as provost at Savannah State University
Photo: Sabree Hill/Dillard University.
By Eddie Francis, efrancis@dillard.edu
Dr. Yolanda W. Page arrived at Dillard as a first year student in 1987. As is the case for so many other Bleu Devils, Page quickly came to love "Fair Dillard," and that showed throughout her career. She began her academic career as an English instructor at Dillard in 1994. She also served as chair of the English Department and as assistant dean of humanities. After leadership stints at the University of Arkansas at Pine Bluff and the University of Arkansas at Little Rock, Page returned to Dillard in 2013 to serve as vice president for academic affairs. The Shreveport native has announced that she will be moving on from Dillard to take over as provost at Savannah State University, the oldest institution of higher learning in Savannah, Georgia and the oldest public HBCU in the state.
In her new role, Page will be responsible for planning, developing and implementing the overall academic vision and goals for Savannah State. The Georgia HBCU has an enrollment of approximately 3,600 students. Savannah State boasts 30 baccalaureate majors and degrees, five graduate programs, and nearly 150 faculty.
"Dr. Page is a dedicated daughter of Dillard who has made major contributions through accreditation, re-establishing nursing at Dillard, obtaining approval for a master's in nursing, and establishing a strong pre-law program. We wish her well as provost," said Dr. Rochelle L. Ford, president of Dillard.
In the coming weeks, Ford will announce an interim vice president for the Division of Academic Affairs.
Under Page's leadership, Dillard has experienced a number of successes in academics. The University's nursing program experienced improvements after a self-imposed restructuring. As a result the last three cohorts have met the NCLEX pass rate requirement. Most recently, the nursing program announced its plans to offer a Master of Science in Nursing which will be the first graduate program in Dillard's history. The business program achieved national accreditation from the Accreditation Council for Business Schools and Programs. The University also implemented online courses for the first time and now offers its criminal justice degree online. Dillard also reaffirmed its ten-year SACSCOC accreditation through 2030. In addition, since 2013 the Division of Academic Affairs has secured approximately $35 million in state and federal funding. Of that amount, Page secured approximately $4.9 million in external funding through her own grant writing efforts and relationships.
Page has received numerous awards in recognition of her leadership including the Council of Independent Colleges Chief Academic Officer Award in 2020 and Diverse: Issues in Higher Education recognized her as one of 25 Outstanding Women in Higher Education (2017).
"It goes without saying that leaving Dillard is bittersweet," said Page. "I met my husband at Dillard, we were married in Lawless Chapel and my sister is a Dillard nurse, so this is like leaving a part of myself behind."
A 1991 graduate of Dillard, Page served on the Student Government Association and became a member of Alpha Kappa Alpha Sorority, Inc. - Beta Upsilon chapter.
Page will continue to serve at Dillard until she begins at Savannah State on September 6.


Sutton, Bell winners in runoff
Keith Sutton defeated Mayor Kary Story in the Pocahontas mayoral race and Kevin Bell was elected Sheriff of Randolph County in the runoff election Tuesday.
In unofficial returns Sutton received 634 votes or 53.77 percent and Story received 545 or 46.23 percent of the votes. Story was seeking his second term as mayor of Pocahontas. He was elected in 2014. A total of 1,179 votes were cast in the mayoral race.
Sutton also won the general election race on Nov. 6, but failed to receive a majority of votes in that three-way race.


Cristina L. Sadowsky
Kennedy Krieger Institute, United States
Masauso Chirwa
University of Zambia, Zambia
Zhuoying QIU
China Rehabilitation Research Center/WHO Collaborating Center for Family International Classifications, China
Grace Lavelle
King's College London, United Kingdom
What this paper adds:
SYSTEMATIC REVIEW article
Front. Rehabil. Sci., 06 September 2022
Sec. Disability, Rehabilitation, and Inclusion
Volume 3 - 2022 | https://doi.org/10.3389/fresc.2022.904586
Mental health problems among adolescents and young adults with childhood-onset physical disabilities: A scoping review
Shalini Lal1,2,3*, Stephanie Tremblay2,4,5, Danielle Starcevic2, Melina Mauger-Lavigne1,2 and Dana Anaby4,5
1School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
2Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
3PEPP Montreal and ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, QC, Canada
4School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
5Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
Aim: This scoping review aims to better understand the extent and nature of research activity on the topic of mental health problems in young people with childhood-onset physical disabilities. Specifically, we document what has been investigated in terms of the occurrence and experience of mental health problems among young people with childhood-onset physical disabilities, and their access to mental health services.
Methods: We searched four databases (Medline, PsycINFO, CINAHL, Embase) for articles published between 2007 and 2019. Studies were included if they addressed: (1) young people between the ages of 13 and 24 with a childhood-onset physical disability, and (2) mental health assessment, treatment, or service access and use.
Results: We identified 33 peer-reviewed studies that focused mainly on young people with cerebral palsy, juvenile arthritis, and spina bifida. The most common mental health problems investigated were depression and mood related difficulties (73%), anxiety (39%), and social/behavioural issues (33%) and the most common age range was 13 to 17. Ten studies explored access, use, and experiences of mental health services; stigma; caregiver mental health; and value for comprehensive care, using qualitative, quantitative, or mixed methods.
Conclusions: Findings suggest the importance of developing integrated models of service delivery to identify and address the mental health needs of this population, and consensus on best practices for assessment and reporting rates of subclinical symptoms and psychiatric conditions.
• Majority of studies pertained to: cerebral palsy, juvenile arthritis, and spina bifida.
• Most prevalent mental health concerns investigated: depression/mood, anxiety, social/behavioural difficulties.
• Large amount of variation in reported rates of mental health problems.
• Methodological gaps including inconsistencies in mental health assessments used.
• Need for integrated models of service delivery to increase access to peer-to-peer and vocational support services to support youth with physical disabilities in their mental health and well-being.
Childhood-onset physical disabilities such as cerebral palsy, spina bifida, and juvenile arthritis are often associated with restrictions in mobility, self-care, leisure, and community activities (1–3), which can negatively impact mental health and well-being. Indeed, research has shown that physical disabilities in young people have been associated with subclinical mental health problems, including depressive and anxious symptoms (4–6). This is concurrent with epidemiological research demonstrating that, compared to individuals of other age groups, young people in general between the ages of 12–24 have a higher risk of developing a mental illness (7). Having a physical disability during adolescence and young adulthood compounds this risk given that it is a developmental stage when comparisons with peers are common, and awareness of these differences (e.g., reduced mobility) can affect self-esteem (8–10). Students with physical disabilities are twice as likely to report feeling sad or hopeless on a daily basis and three times as likely to report attempting suicide compared to their typically developing peers (11).
Mental health problems and psychiatric conditions in young people with childhood-onset physical disabilities are concerning as these, if left untreated, can often persist or worsen throughout adulthood (12). For this population, adolescence and young adulthood are phases of life characterized by a range of developmental transitions (8) that are coupled with a shift from pediatric to adult care services which is often accompanied by a reduction of health-related services. Additionally, young people with childhood-onset physical disabilities typically receive services in rehabilitation settings with therapists specialized in physical rehabilitation who may have limited awareness and skills needed to identify, assess, and address mental health issues in their clientele.
Thus, understanding the mental health and related needs of adolescents and young adults with physical disabilities and their access and use of mental health services is necessary for identification, prevention and early intervention. Such knowledge can also inform the development of integrated rehabilitation services that can comprehensively address the mental health and well-being of young people with physical disabilities. However, limited efforts have been made to synthesize knowledge about the occurrence of mental health problems in this population and their experiences of accessing and using mental health services.
1.1. Objective
The purpose of this scoping review is to map and synthesize research on mental health problems among young people with congenital and childhood-onset physical disabilities associated with restricted mobility, and their access and use of mental health services.
We used scoping review methodology to address the objectives of this study. Scoping reviews focus on broader topics (e.g., subclinical symptoms versus a specific mental disorder) and may include a multitude of study designs (13). There are four primary reasons why one might complete a scoping review: 1) to map the extent and nature of research activity on a topic; 2) to determine whether a full systematic review can/should be completed; 3) to synthesize and disseminate findings from research; and 4) to identify gaps in the literature (13). In line with reasons 1, 3, and 4, the current scoping review aims to obtain a portrait of the emerging literature in order to identify the extent and nature of the research, synthesize and disseminate findings related to objectives, and identify research gaps.
We developed a scoping review protocol based on the framework proposed by Arksey and O'Malley (13) and additional methodological resources including Levac et al. (14), the Joanna Briggs Institute (15), and the PRISMA-ScR Checklist (16). The protocol was registered online with Open Sciences Framework (17). We also examined the PRISMA-ScR Checklist in relation to the current report to ensure alignment with the latest scoping review reporting guidelines (see Supplementary File Table 1 for the completed PRISMA-ScR Checklist).
2.1. Identifying the research question
Using the PCC framework (Population/Participants, Concept, Context), this review aimed to answer the following research question: In young people recruited from community and clinical settings between the ages of 13 to 24 with congenital and childhood-onset physical disabilities (e.g., cerebral palsy, spina bifida, muscular dystrophies, juvenile idiopathic arthritis, or other conditions that affect movement and mobility), what is known about the occurrence of mental health problems, their experience of these problems, and their access and use of mental health services?
2.2. Identifying relevant studies
2.2.1 Information sources
The search was focused on peer-reviewed, scientific publications. We conducted the search in four electronic databases (Medline, Embase, PsycINFO and CINAHL) that cover a range of research areas including health, psychology, and rehabilitation sciences. In consultation with a university librarian specializing in health and rehabilitation, we developed an initial search strategy for Medline (see Table 1) and adapted the strategy for the other databases. The keyword strategy included the following concepts: physical disability or diagnosis of congenital or childhood-onset physical disability AND mental health diagnosis or symptoms AND adolescents (13 to 18) or young adults (19 to 24). The upper limit for age was set to 24 years old which corresponds with the United Nations Educational, Scientific and Cultural Organization (UNESCO) definition of youth. The keywords for capturing the construct of physical disability (further detailed below) were based on a previous scoping review (18). The results in Medline were restricted to humans, French and English languages, and years of publication from 2007 onwards. Language restrictions were based on the languages the authors are fluent in, the lower limit for the publication year was selected to restrict the number of results (for feasibility) and ensure the historical relevance of information, especially as it pertains to access and use of mental health services. The search was initially implemented December 2016, however given that a small number of papers were found, we were unable to justify a systematic review that addressed the research questions. Therefore, we updated our search strategy in May 2019.
Table 1. Medline search strategy.
2.3. Selecting studies
2.3.1. Selection of sources of evidence
After the search was implemented in all four databases, the results were imported into Endnote X7. Duplicates were identified and removed. First-level screening (based on title and abstract) was completed using the inclusion and exclusion criteria. Studies that did not meet these criteria were removed (first-level screening was split between two reviewers, A2 & A4). Four reviewers then completed second level (full text) screening of the remaining articles using the inclusion and exclusion criteria (A1, A2, A4, A5). Disagreements were resolved through discussion between research team members. Articles that met the eligibility criteria after second level (full text) screening underwent data extraction using Excel software.
2.3.2. Inclusion and exclusion criteria
Cerebral palsy (CP), spina bifida (SB), muscular dystrophies, juvenile idiopathic arthritis (JIA), or other conditions that affect movement and mobility (e.g., Mobius disorder) were the focus of this review given their associated physical disabilities. Cerebral palsy (CP) defines a group of non-progressive neurodevelopmental disorders that affects posture and movement, and individuals can also experience comorbid sensation, perception, cognition, communication, behavior, musculoskeletal impairments and/or epilepsy (19). Spina bifida is a health problem caused by a congenital deformity of the neural tube, and is associated with deformities, impaired sensation, muscle weakness, paralysis, orthopedic problems, bladder and bowel dysfunction and seizure disorders (20). Muscular dystrophy is a group of disorders (the most common being Duchenne's) caused by a genetic irregularity resulting in muscle weakness, hypotonia and atrophy (9). Juvenile idiopathic arthritis (JIA) is an umbrella term for arthritic illnesses that begin before the age of 16 and involve inflammation of one or more joints, alongside other symptoms depending on the type of JIA (21). Other physical disabilities that affect movement and mobility include disorders such as Mobius disorder, a congenital disorder causing partial or complete paralysis of facial nerves, often in conjunction with malformation of upper and/or lower limbs (22).
The following mental health symptoms and conditions were included: psychotic disorder, brief reactive psychosis, schizoaffective disorder, schizophreniform disorder, psychosis, schizophrenia, bipolar disorder, bipolar depression, manic disorder, manic state, mania, bipolar affective psychosis, anxiety, depression, substance abuse, substance-related disorder, eating disorder, and autism spectrum disorder (ASD) or autism, as per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) (23). In addition, studies were included if they focused on behavioral difficulties, such as hyperactivity, aggressivity, and emotional lability. Studies that assessed general psychiatric symptoms were also included, given that the first symptoms or experiences of illness tend to present themselves around adolescence before a formal diagnosis has been given.
The inclusion criteria for the selection of articles were as follows: (1) study population with a mean age between 13 and 24 years old, or at least 50% of the studied sample between ages 13 and 24 with specific results reported about this group, or including the term adolescents, youth, or young adults to describe the population if no age is mentioned; (2) study population including at least 50% of individuals diagnosed with a disability noted above (e.g., cerebral palsy, spina bifida), or mental health data for this population were reported separately; (3) study addressing psychological issues, mental illnesses or symptoms of mental illness; (4) article published in French or English, between 2007 and 2019. In terms of exclusion criteria, literature reviews and grey literature were excluded (reference lists of literature reviews were scanned).
2.4. Charting the data
2.4.1. Data charting process
Using Excel software, a data charting form was developed by adapting a template used in A1′s previous scoping reviews. The research team piloted and finalized the chart at the start of the data extraction process. Articles that were selected for inclusion in the study were read in full to establish familiarity with the data. Data extraction was first conducted by one reviewer (A2 or A4) and audited by another reviewer to confirm the completeness and accuracy of the extracted data (A2 or A3). The data extraction was also audited by A1 and A5 at several stages throughout the process.
2.4.2. Data items
Data selected for extraction included: study characteristics (author, year, title, country), study objective(s), study population and research design, methods and measures, and results. Only data related to the main objectives of the scoping review were extracted (e.g., only measures, methods, and results pertaining to mental health or access or use of mental health services).
2.4.3. Critical appraisal of individual sources of evidence
A critical appraisal of the sources of evidence is an optional step in the conduct of scoping reviews (18). We did not conduct this step due to the large variability of study designs and research approaches within the selected studies and given our primary objective of mapping the evidence.
2.5. Collating, summarizing, and reporting the results
2.5.1. Characteristics of sources of evidence
Counts, proportions, and tables were used to synthesize study characteristics such as country, study design, year, study population characteristics (e.g., type of diagnosis, age), and measures used to assess mental health.
2.5.2. Occurrence of mental health problems
A list of the mental health problems investigated in the selected studies was created and two reviewers (A2, A3) separately counted the number of studies that investigated each mental health problem. The final counts were discussed between the two reviewers, with a third reviewer (A1) resolving any disagreements.
The prevalence rates of mental health problems within the study populations were summarized using frequencies, proportions, means, medians, and ranges. A prevalence rate was defined as the number of participants identified as having a case of a mental health problem divided by the total number of participants in the study (reported either directly by the authors in text or in a table within the selected study or calculated manually by the current scoping review authors). A "case of a mental health problem" was counted if either (a) the authors of the studies identified the concern as a "clinical case" based on the measures and thresholds they used to evaluate mental health, including mild, moderate, or severe mental health concerns, or (b) if a participant (the young person themselves or a parent/guardian) reported, in a self-report measure or clinical interview, that they had or perceived having a mental health problem. If authors reported on the number of "borderline" or "at risk" cases (i.e., scores or symptoms that do not meet clinical thresholds but are beyond the normal range) of a mental health disorder, these were not considered in the current summary of prevalence rates, with the exception of studies that were categorized as "mental health not specified" – given that this is a broader concept. For the rest of the categories, we did not include "borderline" or "at risk" as these items were not consistently defined nor reported across the selected studies. We included self-reported cases given that these reports were used as the only measures of mental health within several of the selected studies. One reviewer (A3) counted the number of studies that reported rates of a problem within each mental health problem category, extracted the rates from the studies, and calculated the mean, median, and range of the rates. A second reviewer (A1) validated the extraction and calculation of rates and any issues identified were resolved by discussion between the two reviewers.
2.5.3. Experience of mental health problems, access and use of mental health services
An inductive content analysis (24) was used to synthesize extracted findings related to access and use of mental health services among the study population. First, the 33 selected studies were reviewed and articles that included qualitative data on access to mental health services among young people with childhood-onset physical disabilities were identified (10 articles based on either a mixed methods design or solely a qualitative methodology). Two reviewers (A2, A3) then separately extracted results from these ten articles and separately coded the results to determine a preliminary list of themes. The final list of themes and subthemes was determined by discussion and consensus between the two reviewers in consultation with a third reviewer (A1). Themes were defined as any thematically-related results that appeared in at least 2 of the studies; subthemes were defined as any thematically-related results that appeared in at least 2 of the studies within the identified theme that were distinct from the other results. Counts, proportions, and tables were used to provide a final summary of these findings.
A total of 2,520 articles were retrieved and imported into Endnote X7, and 2,214 remained after removing duplicates. After first-level screening, 2051 articles were excluded because they did not meet the inclusion and exclusion criteria. Next, 163 articles underwent second-level screening, and 33 documents were included in the current scoping review. The 130 articles that were excluded during the second-level screening were either targeting the wrong population, did not explicitly address a mental health component, or did not include sufficient detail for data extraction. See Figure 1 for an adapted PRISMA flow diagram (25).
Figure 1. PRISMA flow diagram.
3.1. Overview of studies reviewed
Supplementary File Table 2 provides an overview of the 33 studies reviewed (4, 26–57). Articles originated from several different countries, with the largest proportion (13/33) published in the United States (see Table 2). In terms of research design, there were 21 cross-sectional studies, 5 longitudinal studies, 3 case studies, 3 qualitative studies, and 1 retrospective cohort study. All the articles were published between 2007 and 2019, with most appearing after 2010 (see Figure 2). The largest portion of articles focused on cerebral palsy (n = 12), followed by juvenile idiopathic arthritis (n = 8) and spina bifida (n = 8). The other physical disabilities were muscular dystrophies (n = 3) and Mobius syndrome (n = 1), and one article included several types of disabilities.
Figure 2. Number of articles published per year.
Table 2. Number of articles per country.
3.1.2. Methods used to capture mental health
As illustrated in Supplementary File Table 3, we identified 36 methods (majority being measures) used among the 33 studies to assess mental health symptoms or related phenomena such as quality of life and pain. The most common used scales across studies were: Children's Depression Inventory (CDI; n = 7), Strengths and Difficulties Questionnaire (SDQ-25; n = 6), Child Behavior Checklist (CBCL; n = 5), Pediatric Quality of Life Inventory (PedsQL; n = 3), Wechsler Intelligence Scale (n = 3), Child Attitude Towards Illness Scale (CATIS; n = 2), Child Health Questionnaire (CHQ; n = 2), Mental Status Examination (n = 2) and the Mood and Feelings Questionnaire (MFQ; n = 2). The remaining measures (n = 27) were used in only one study each. Measures were a mix of young people and parent reports, and two measures (the General Health Questionnaire and the Social Orientation of Parents with Handicapped Children Questionnaire) served to capture parents' mental health states. Interviews of various types (e.g., open-ended, psychiatric, semi-structured, or structured) were also commonly used (n = 10).
3.1.3. Prevalence of mental health problems and cognitive, physical and functional difficulties among young people with childhood-onset physical disabilities
The most common mental health problems addressed in the studies were depression and mood related difficulties (n = 24), anxiety (n = 13), and social/behavioural difficulties (n = 11). Table 3 synthesizes the mental health problems reported in the studies, and is organized in relation to physical health condition. Table 4 provides a synthesis of the reported rates for each mental health concern, including the number of studies that reported the rates, and the range, mean, and median of the rates. The number of articles reporting rates were: 12 out of 24 for depression and mood related difficulties, 8 out of 13 for anxiety, 5 out of 11 for social/behavioural difficulties, 6 out of 9 for mental health problems not specified, including aggregated rates of mental health problems, 3 out of 6 for attention deficit hyperactivity disorders, 2 out of 3 for autism spectrum disorders, 0 out of 2 for psychosis, 0 out of 1 for self-harm and 1 out of 1 for substance use behaviors. The presence of mental health symptoms found in these studies are further detailed in the sections below. All rates are summarized to 1 decimal point.
Table 3. Number of articles addressing a specific mental health problem (n = 33)a.
Table 4. Studies reporting rates of mental health problems.
3.1.3.1. Depression and mood related (n = 25)
Among the 25 studies that addressed depression and mood-related difficulties, seven were focused on spina bifida (27, 30, 33, 36, 42, 45, 47), eight on juvenile arthritis (4, 26, 32, 37, 40, 43, 44, 46), three on muscular dystrophy (29, 34, 35), five on cerebral palsy (31, 38, 39, 41, 48, 49), and one on other conditions (28). Twelve of these studies reported on rates of depression and mood-related difficulties, which ranged from 7.8% to 53.0%. Specifically, depression and mood-related symptoms in participants with spina bifida, ranged from 13.6% to 53.0% (27, 36, 42, 47); juvenile arthritis, 14.7% to 36.2% (4, 26, 40); muscular dystrophy, 8.5% to 27.6% (29, 34); cerebral palsy, 7.8% to 42.0% (41, 48), and other conditions, 8.3% (28). When comparing the presence of depression and mood-related symptoms in youth with physical disabilities to that of typically developing youth, results were inconsistent across and even within studies, depending on the assessment method. For example, some studies found that youth with physical disabilities had greater levels of mood or depressive symptoms (e.g., [36, 38, 42]), whereas other studies found no differences among the groups in emotional and psychological health (e.g., [40, 45, 48]). An example of within study inconsistency is Russo et al. (40) which found significant differences in the presence of depression or mood related symptoms when using standardized methodology (i.e., no psychopathology found) versus using open ended interviews and clinical observation in a sample of youth with JIA (i.e., 33% presenting with emotional lability).
3.1.3.2. Anxiety (n = 13)
Among the 13 studies that addressed anxiety, three were focused on spina bifida (27, 33, 36) and juvenile arthritis (32, 40, 43), two on muscular dystrophy (29, 34), three on cerebral palsy (48, 49, 50), and two on other conditions (28, 51). Among these 13 studies, 8 reported on rates of anxiety, specifically in relation to spina bifida (27, 36), juvenile arthritis (40), muscular dystrophy (29, 34), cerebral palsy (48), and other conditions (28, 51). Across these conditions, anxiety symptoms were reported to be present in 2.2% to 31.1% of the participants. Specifically, anxiety symptoms in participants with spina bifida, ranged from 20.5% to 31.1% (27, 33, 36); juvenile arthritis, 4% (40); muscular dystrophy, 2.2% to 27.6% (29, 34); cerebral palsy, 30.2% (48), and other conditions, 3.3% to 8.3% (28, 51). When studies compared rates of anxiety in youth with physical disabilities to typically developing youth, results were inconsistent, such that some found youth with physical disabilities had greater levels of anxiety symptoms (e.g., [33, 48]), whereas others found no differences (e.g., [36, 40]).
3.1.3.3. Social/behavioural (n = 11)
Among the 11 studies that addressed social/behavioural difficulties, two were focused on juvenile arthritis (40, 44), one on muscular dystrophy (35), six on cerebral palsy (38, 48, 49, 50, 52, 53), and two on other conditions (28, 51). Among these 11 studies, 5 reported on rates of social/behavioral difficulties; specifically, juvenile arthritis (40), cerebral palsy (48, 53), and other conditions (28, 51), ranging from 16.0 to 27.3%. Specifically, symptoms in participants with juvenile arthritis, 16.0% (22); cerebral palsy, 18.8% to 27.3% (48, 53); and other conditions, 17.3% to 25.0% (28, 51). Several studies compared rates of social/behavioural difficulties in youth with physical disabilities to typically developing youth: some found that youth with cerebral palsy had greater levels of social/behavioural difficulties (e.g., [48, 52, 53]), or lower levels of behavior or conduct problems (38) whereas one study found no significant differences between youth with JIA and typically developing youth in some aspects such as behavioural psychological functioning (40).
3.1.3.4. Mental health problems (not specified) (n = 9)
Among the 9 studies that addressed mental health problems (not specified), three were focused on spina bifida (27, 45, 47), one on juvenile arthritis (40), two on cerebral palsy (38, 54), and three on other conditions (28, 51, 55). Among these 9 studies, 6 reported on rates of mental health problems, specifically spina bifida (27, 47), juvenile arthritis (40), cerebral palsy (38), and other conditions (28, 51), ranging from 16.0% to 69.0%. Mental health problems in participants with spina bifida were 49.2% to 69.0% (27, 47); juvenile arthritis, 41.6% (40); cerebral palsy, 16.0% (38); and other, 32.2% to 50.8% (28, 51). When studies compared rates of mental health problems in youth with physical disabilities to typically developing youth using self-report, they did not find significant differences between groups (40, 45, 54, 55), however one study found that based on parental report, young people with CP have more mental health problems than youth in the general population (54).
3.1.3.5. Attention deficit hyperactivity disorders (n = 6)
Among the six studies that addressed attention deficit hyperactivity disorders (ADHD), one was focused on muscular dystrophy (34), four on cerebral palsy (38, 48, 52, 53), and one on other conditions (51). Among these six studies, three reported on rates of ADHD, specifically muscular dystrophy (34), cerebral palsy (48), and other conditions (51), ranging from 16.7% to 19.7%. Reported symptoms in participants with muscular dystrophy were 16.7% (34); cerebral palsy, 19.5% (48); and other, 19.7% (51). When studies compared rates of ADHD in youth with physical disabilities to typically developing youth, one study found that youth with physical disabilities had lower levels of ADHD-related symptoms (38), one study found that youth with physical disabilities had increased hyperactivity and attentional difficulties (52), and another study did not find any difference in ADHD between the groups (48).
3.1.3.6. Autism spectrum disorders (n = 3)
Among the three studies that addressed autism, one was focused on muscular dystrophy (29), one on cerebral palsy (56), and one on other conditions (51). Among these three studies, two reported on rates of autism symptoms, specifically, muscular dystrophy, 14.9% (29), and other, 3.3% (51), and one reported the rate of CP among people diagnosed with Asperger's syndrome (AS), 0.7% (56). Regarding the latter, Mouridsen et al. (56) did a retrospective study with a nationwide cohort of 4,180 people diagnosed with AS. Over an average observation period of 15 years, the authors discovered that the occurrence of cerebral palsy was 3 times higher for those with AS compared to those with cerebral palsy in the general population.
3.1.3.7. Psychotic disorder (n = 2)
Among the two studies that addressed psychotic disorder, both were case studies focused on cerebral palsy (31, 50). For example, one of the studies described a 15-year-old female with cerebral palsy that was diagnosed with psychotic disorder (not otherwise specified) after experiencing four psychotic episodes within one year (31).
3.1.3.8. Self-harm (n = 1)
Only one study reported on self-harm. It included a sub-sample of youth with spina bifida, and found a rate of 1.4% (57), however there was no higher or lower risk for self-harm associated with having spina bifida.
3.1.3.9. Substance use and other health-risk behaviors (n = 1)
One cross-sectional study examining the prevalence of cigarette smoking, alcohol drinking, excessive drinking and illegal drug use among young adults with spina bifida found rates ranging from 11.0% to 92.0%, depending on the behavior. The authors concluded that substance use behaviors are less prevalent among those with spina bifida, but current alcohol consumption is more frequent in young adults with depressive symptoms (42).
3.1.4. Experience of mental health problems and mental health services
Ten articles addressed the experience of mental health problems and/or mental health services access or use among young people with childhood-onset physical disabilities. Three out of the ten studies (40, 53, 55) used a mixed-methods approach that included qualitative interviews. Six out of the ten studies used qualitative methods only (31, 32, 35, 44, 49, 50), including semi-structured interviews and focus groups, and one study used sociodemographic information pertaining to mental health services received (36). In addition, most of these studies reported data on the entire sample (e.g., 2 papers reported on case studies of a young person with cerebral palsy and psychosis). Four themes were identified through our review of the findings from these studies: (1) access, use, and experiences of mental health services; (2) stigma; (3) mental health of family caregivers; and (4) importance of peer and vocational support services. We have organized the results from these studies in relation to these four themes in Table 5, and present a synthesis below.
Table 5. Experience of mental health problems and mental health services for young people with childhood-onset physical disabilities.
With regards to the theme of access, use, and experiences of mental health services (31, 32, 35, 36, 40, 49, 50, 53, 55), studies highlighted that: few participants (i.e., less than a quarter the sample) that had mental health problems were receiving mental health care; a need for services to address issues such as sexuality, relationships, depression, peer support, and vocational services; a lack of formalized help seeking; delays in help seeking; and delays in receiving care. Studies describing how participants accessed mental health services (31, 40, 50) showed different pathways to care such as: pediatrician, pediatric emergency department clinic, and referral to psychologist. Details on the type of treatment and services that participants received was limited; however, two case studies (31, 50) mentioned medication for psychosis symptom treatment, cognitive behavioral therapy, and supportive directive therapy. Foster et al. (50) also highlighted that parents should be involved in the diagnosis of mental illness among children with cerebral palsy, should be educated about the mental illnesses their child is at risk for, and given tools on how to advocate for their child.
With regards to the theme of stigma (32, 40, 49), studies highlighted the influence of stigma experienced by parents, or the young people themselves, on delay in help-seeking, as well as its contribution to feelings of anxiety and decisions to disclose their disability to others. With regards to the theme of mental health of family and caregivers (44, 49), studies highlighted the importance of having mental health support and services for family members as a component of services for young people with disabilities. Regarding the theme of the importance for peer support and vocational support services (32, 35, 44): peer support was highlighted by clinicians and young people as a potentially helpful resource and a way to reduce isolation for young people with physical disabilities and vocational support was emphasized as being an important component of psychological and social services that young people with physical disabilities receive.
This review sought to better understand the occurrence, experience of mental health problems, and mental health services access and use, among young people with childhood-onset physical disabilities.
4.1. Principal findings
Collectively, there was significant variation in the assessment measures and methods, source of reporting, and conceptualization of mental health problems, making it challenging to synthesize and compare results across studies. For example, we identified 35 separate measures that were used to assess mental health across 33 studies. Moreover, across the studies, authors used different sources of data, methods of data collection (e.g., self/parental report versus clinician report; interview or observation vs. self-report), and clinical cutoff points between measures. There was also variation in how authors approached the phenomenon of mental health problems, with some focusing on specific conditions (e.g., depression) and others used a non-categorical/broad approach (e.g., perceived mental health). Collectively, these factors may explain why we found a large variation in the reported rates of mental health concerns between the studies and even within a study. It may also explain why we found inconsistent results across the few studies that compared the occurrence of mental health problems in young people with childhood-onset physical disabilities to typically developing young people. In addition, differences in the prevalence of mental health concerns may be partly based on various sociodemographic and other clinical factors, such as the severity of physical conditions and related disabilities, which was not consistently detailed in the studies.
The three most common mental health concerns investigated in the literature were depression and mood-related difficulties, anxiety, and social and behavioural difficulties. The focus on depression and anxiety is concomitant with the prevalence of these disorders among young people in the general population (58). Social and behavioral difficulties were also commonly investigated, which may be attributed to the importance of social relationships among young people. Social elements such as belonging and having authentic friendships have been identified as contributing factors to meaningful participation in leisure activities among young people with disabilities (59). It is important to identify social difficulties early on to reduce their impact on participation and, consequently, the well-being of young people. Some of the factors associated with mental illness identified in the selected studies included impairments associated with the physical disability, pain, and family-related challenges. These factors are therefore important to consider when monitoring for symptoms of mental illness among young people with childhood-onset physical disabilities as they may help to identify individuals at risk for developing mental disorders.
We identified several themes from the qualitative data including: access, use, and experience of mental health services; stigma; mental health of family caregivers; and peer-to-peer and vocational support services. The theme of access, use, and experience of mental health services indicate that many young people experiencing mental health concerns (including clinically significant symptoms) are not accessing mental health services, and that young people and their families often experience several unmet psychological and social needs. Unmet mental health needs have been previously found to be higher in children with special healthcare needs that also have chronic emotional, behavioural, or developmental problems compared to children with special healthcare needs that do not have chronic problems of this nature (60). Needs that are unmet by mental health services in a timely manner can put young people at risk of deterioration, which may also impact their transition into adulthood. More research is needed to further understand access and use of mental health services and the reasons for limited access among young people with childhood-onset physical disabilities. For example, concerns around stigma related to the physical condition were highlighted in a few of the included studies (32, 40, 49) and may influence help-seeking. Another factor that may limit access is how services are organized for this population and the potential lack of coordination between physical rehabilitation settings and the mental health care system. Transportation challenges have also been highlighted as specific barriers in research (61). Technology (e.g., e-mental health services) may be able to play a role in removing some of the barriers that young people with physical disabilities face in accessing mental health services (62). The additional themes pertaining to the importance of peer and vocational support services and the mental health of family and caregivers indicate the need for a comprehensive psychosocial approach to providing mental healthcare to young people with childhood onset physical disabilities.
4.2. Identified gaps in current knowledge and future directions for research
Few studies explored the functional limitations stemming from comorbid disorders, therefore additional research on this topic is needed. Indeed, physical impairments have an impact on social roles and daily activities, which in turn affect mental health. While a few studies touched on quality of life, participation in activities were not well-addressed by the studies we reviewed. In addition, the selected articles were mostly cross-sectional studies; different types of study designs could improve the reliability of evidence for these populations. Furthermore, the studies in this review used a wide variety of measures to assess mental health, including non-validated tools. Future research using validated measures to assess mental health problems is warranted. This will not only improve the reliability and validity of results, but also will facilitate knowledge synthesis. Concurrently, guidelines for assessing the mental health status of young people with childhood-onset physical disabilities, including recommendations for multi-method and multi-informant (e.g., parents, youth, others) approaches to assessment, are important avenues for further consideration.
Across the studies, an array of factors was investigated or discussed in relation to mental health concerns among youth with physical disabilities, such as: physical, cognitive, and neurological impairments (27, 30, 31, 33, 36, 38, 49, 51, 52, 57), pain (4, 27, 38, 39, 41, 44, 48, 54), family-related factors, such as parental mental health problems, stress, anxiety, and support (27, 28, 39, 49, 50, 54), negative attitudes and negative attributes (37, 46), health-related quality of life (28, 43), sex (38, 39), social or vocational disability (32, 35), ability to ambulate (34), self-image (49), low birth weight (51), age (28, 53), isolation (44), steroid use (44), access to support for parents (49), social challenges at school (50), verbal status (i.e., being non-verbal) (52), and having spinal lesions of L2 and above (45). It was beyond the scope and objectives of this review to systematically review these factors; however, this is an area for future research attention. Such a review could provide youth, family members and service providers with insights on factors that can contribute to the mental health of young people with physical disabilities. This knowledge could help contribute to earlier identification of mental health problems among this population as well as an increased focus on preventative care.
Although we found a handful of studies examining mental health services access and use among our target population, this is a relatively nascent field that would benefit from more extensive health services research attention. Moreover, while some articles indicated the need for additional mental health (and comprehensive) services for young people with physical disabilities, there was limited attention in these studies on how to organize services for this population. A better understanding of the organizational contexts of various healthcare systems or models of service delivery would be pertinent to ensure the complex needs of this population are met. It is important to consider the needs of this population within the global efforts already underway to transform youth mental health service delivery.
4.3. Strengths and limitations
This review has both limitations and strengths. In terms of limitations, for feasibility purposes, we restricted the search from 2007 onwards, which limits the body of evidence reviewed. A study quality assessment was not done due to the large variability of study designs and research approaches (further detailed below); this is also not a requirement of conducting scoping reviews as the objective is to map the evidence on an emerging topic. Moreover, the summaries of reported mental health prevalence rates should be interpreted with caution, given the variability of study designs, sampling methods, populations, measures, missing information, and the lack of quality assessment. Additionally, calculated means were not weighted based on the study sample sizes; as such, these values are likely skewed due to rates from smaller and larger sample sizes equally contributing to the mean. We also calculated unweighted medians (i.e., median values could be skewed by outliers). We decided to report on the overall mean and median prevalence rates for the purposes of summarizing the data in the context of a scoping review, however, these should not be taken as conclusive estimates. Further, to reduce misclassification of the summarized prevalence rates, we did not consider borderline cases in our summaries (as these were not reported consistently within the selected studies). In addition, the articles about health risk behaviours or risk factors for psychiatric disorders were included, but their contribution was limited to answer the study question.
However they were included as being of interest to present issues that are related to mental and physical health in this population. These articles help to highlight behaviours that should be considered by healthcare professionals when interacting with young people with disabilities. In the majority of the studies, the entire sample included youth with physical disabilities (e.g., cerebral palsy, spina bifida, muscular dystrophy, etc.); however, some studies had a mixed sample or took on a non-categorical approach, which are important to consider when interpreting these results. In addition, the data on lived experiences of mental health problems and mental health services access and use was obtained from a heterogenous range of studies, for example, in terms of clinical population, percentage of sample known to be experiencing mental health problems, and data collection method.
In terms of strengths, we used a comprehensive search strategy to increase the likelihood of identifying relevant studies. For example, given that many mental illnesses develop during young adulthood, and many young people may not have access to formal diagnostic procedures, we used broad eligibility criteria to describe psychological issues, mental illnesses, or symptoms of mental illness. Moreover, the key words for the search strategy were built on a previously published scoping review (18) which helped with the comprehensiveness of the search terms. In addition, minimal exclusion criteria related to study design additionally allowed us to synthesize both quantitative and qualitative data which contributed to our objective of obtaining a portrait of the extent and nature of the literature. To increase the rigor of this review, we collaborated with the rehabilitation school librarian who helped apply a systematic search strategy and based the protocol on well-established guidelines for conducting scoping reviews (14, 15, 16). A data extraction process involving an additional reviewer auditing the data extraction of all articles, and validation of the extracted data by other members of the research team contributed to the rigor of the review. Qualitative synthesis of themes was also validated by an additional reviewer and reviewed with a third member of the team.
This scoping review shows that mental health problems are common in adolescents and young adults with childhood-onset physical disabilities. It also highlights the need for adapting healthcare services to increase accessibility and use of mental health supports, and identifies methodological and research design gaps in the literature. Findings suggest the importance of healthcare professionals being aware of the mental health needs of young people with childhood-onset physical disabilities, and the need for services research on how best to address their access to mental health services.
The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author/s.
SL conceived the original idea for this scoping review, its overall methodology, and supervision of its implementation and reporting in collaboration with DA. SL and MAL drafted the protocol and manuscript report, and all authors contributed to the finalization of both documents. ST, DS, and MAL assisted with data extraction and analysis. SL led the synthesis of the results and revisions to the manuscript. All authors approved the submitted version.
A1 is supported by an award from the Canada Research Chairs program; A2 is supported by a training award from the Fonds de Recherche du Québec - Santé in 2019–2020. A4 is supported by a Research Scholar Award from the Fonds de Recherche du Québec - Santé.
The authors would like to acknowledge and thank Myrian Grondin, who was consulted as a university librarian, for her assistance and support with the development of the search strategy for the current study.
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fresc.2022.904586/full#supplementary-material.
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47. *Wagner R, Linroth R, Gangl C, Mitchell N, Hall M, Cady R, et al. Perception of secondary conditions in adults with spina bifida and impact on daily life. Disabil Health J. (2015) 8(4):492–8. doi: 10.1016/j.dhjo.2015.03.012
48. *Whitney DG, Shapiro DN, Warschausky SA, Hurvitz EA, Peterson MD. The contribution of neurologic disorders to the national prevalence of depression and anxiety problems among children and adolescents. Ann Epidemiol. (2019) 29:81–4. e2. doi: 10.1016/j.annepidem.2018.11.003
49. *Florou A, Widdershoven M-A, Giannakopoulos G, Christogiorgos S. Working through physical disability in psychoanalytic psychotherapy with an adolescent boy. Psychoanal Soc Work. (2016) 23(2):119–29. doi: 10.1080/15228878.2016.1160834
50. *Grody MB, Coffey BJ. Presentation and treatment of acute psychosis in an adolescent girl with cerebral palsy. J Child Adolesc Psychopharmacol. (2012) 22(2):175–8. doi: 10.1089/cap.2012.2223
51. *Yang P, Chen Y-H, Yen C-F, Chen H-L. Psychiatric diagnoses, emotional–behavioral symptoms and functional outcomes in adolescents born preterm with very low birth weights. Child Psychiatry Hum Dev. (2015) 46(3):358–66. doi: 10.1007/s10578-014-0475-1
52. *Adegboye D, Sterr A, Lin J-P, Owen TJ. Theory of mind, emotional and social functioning, and motor severity in children and adolescents with dystonic cerebral palsy. Eur J Paediatr Neurol. (2017) 21(3):549–56. doi: 10.1016/j.ejpn.2017.01.013
53. *Brossard-Racine M, Waknin J, Shikako-Thomas K, Shevell M, Poulin C, Lach L, et al. Behavioral difficulties in adolescents with cerebral palsy. J Child Neurol. (2013) 28(1):27–33. doi: 10.1177/0883073812461942
54. *Ramstad K, Jahnsen R, Skjeldal OH, Diseth TH. Mental health, health related quality of life and recurrent musculoskeletal pain in children with cerebral palsy 8–18 years old. Disabil Rehabil. (2012) 34(19):1589–95. doi: 10.3109/09638288.2012.656794
55. *Woodward JF, Swigonski NL, Ciccarelli MR. Assessing the health, functional characteristics, and health needs of youth attending a noncategorical transition support program. J Adolesc Health. (2012) 51(3):272–8. doi: 10.1016/j.jadohealth.2011.12.016
56. *Mouridsen SE, Rich B, Isager T. Cerebral palsy in individuals with a history of Asperger's syndrome: a Danish nationwide register study based on hospital diagnoses. J Pediatr Neurol. (2013) 11(1):29–34. doi: 10.3233/JPN-120594
57. *Singhal A, Ross J, Seminog O, Hawton K, Goldacre MJ. Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage. J R Soc Med. (2014) 107(5):194–204. doi: 10.1177/0141076814522033
58. Findlay L. Depression and suicidal ideation among Canadians aged 15 to 24. Statistics Canada, Catalogue no. 82-003-X, Health Rep. (2017) 28(1):3–11.
59. Willis C, Girdler S, Thompson M, Rosenberg M, Reid S, Elliott C. Elements contributing to meaningful participation for children and youth with disabilities: a scoping review. Disabil Rehabil. (2017) 39(17):1771–84. doi: 10.1080/09638288.2016.1207716
60. Inkelas M, Raghavan R, Larson K, Kuo AA, Ortega AN. Unmet mental health need and access to services for children with special health care needs and their families. Ambul Pediatr. (2007) 7(6):431–8. doi: 10.1016/j.ambp.2007.08.001
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Keywords: mental health, youth, mental health services, access, disability, systematic review, early intervention, psychiatry
Citation: Lal S, Tremblay S, Starcevic D, Mauger-Lavigne M and Anaby D (2022) Mental health problems among adolescents and young adults with childhood-onset physical disabilities: A scoping review. Front. Rehabilit. Sci. 3:904586. doi: 10.3389/fresc.2022.904586
Received: 25 March 2022; Accepted: 8 August 2022;
Published: 6 September 2022.
Cristina L. Sadowsky, Kennedy Krieger Institute, United States
Grace Lavelle, King's College London, United Kingdom
Zhuoying Qiu, China Rehabilitation Research Center/WHO Collaborating Center for Family International Classifications, China
Masauso Chirwa, University of Zambia, Zambia
© 2022 Lal, Tremblay, Starcevic, Mauger-Lavigne and Anaby. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Shalini Lal shalini.lal@umontreal.ca
Specialty Section: This article was submitted to Disability, Rehabilitation, and Inclusion, a section of the journal Frontiers in Rehabilitation Sciences
Women in Science: Disability, Rehabilitation, and Inclusion


George Clooney will never marry, says sister
WENN.com
Nov 09, 2012 • Last Updated November 9, 2012 • 1 minute read
1/13 ▲
1/13 George Clooney and Stacy Keibler at the 49th Annual New York Film Festival premiere of "The Descendants" on Sunday, October 16, 2011. Ivan Nikolov/(WENN.COM photo) Photo by Mandatory Credit: Ivan Nikolov/WENN.com ▲
1/13 George Clooney at the 49th Annual New York Film Festival premiere of "The Descendants" on Sunday, October 16, 2011. Ivan Nikolov/(WENN.COM photo) Photo by Mandatory Credit: Ivan Nikolov/WENN.com ▲
George Clooney's sister is convinced her famous brother will never get married and have children because he is too dedicated to his career.
The Ocean's Eleven star, who is currently romancing former wrestler Stacy Keibler, has been a serial dater since 1993, when he split from his wife of four years, Talia Balsam.
And Clooney's older sibling Adelia Zeidler is convinced the 51 year old won't walk down the aisle again and start a family because he won't want to leave a wife and kids behind while he goes off to make movies.
She tells the New York Daily News, "I would say he probably will not get married... If he was going to get married he would want to be a husband and be somebody who would be there, who would have the time and the ability to focus on the family and the home and all of that. And in the business that he is in, he has to be able to get up and go.
"The majority of actors don't really make their marriages work... If he had children, when he was with them, he would be concerned about his career and if he was working he would be concerned about the children. And he doesn't think it would be fair to split his focus."


Vinh Long Travel Guide
Located in the Mekong Delta of southern Vietnam, Vinh Long, the same capital name, covers the area of 1,475 km2 and also is the homeland of 1,023,400 people. The province is bounded by Tien Giang to the north, Ben Tre to the east, Tra Vinh to the eastern south, Can Tho to the west and Dong Thap to the western north.
To access Vinh Long, roadway and waterway are all available. The total length of roadway is 260km, including 5 national highways (No.1, 53, 54, 57, 80) and 5 provincial roadways (No.902, 903, 905, 906). Besides, thanks to the system of 342km waterway with 13 main rivers and many channels, connects between Vinh Long and other provinces are being more and more convenient.
Vinh Long is rich in culture which is the high potentiality for tourism with 450 relics, including 10 relics known as national relics of culture and history and 32 provincial relics of culture and history. Some can be listed such as Cong Than, That Thu temple, Thanh Tinh Ngoc Son Quang, ancient pagodas in Tra On, Tan Hoa communal house, An Binh isle etc.
Vinh Long is characterized as a flat region with the large area of alum soil which is more fertile than the soil in other surrounding provinces. The alluvial here is built by Tien and Hau rivers. With the abundance in quantity and quality of alluvial, the cultivation has more than two paddy crops annually. Also, this brings full benefits in many sizable fruit orchards in this area. It is not surprising that the name Vinh Long is translated to 'eternal prosperity'.
If visitors plan for a day trip to Mekong Delta, Vinh Long should be put in your booklet as a must-come place. Coming to there, visitors have a chance to walk among the trees, relax in hammocks, try all kinds of delicious tropical fruits in the gardens of An Binh and Binh Hoa Phuc islands. Some popular places are Mr.Sau Giao's Flower Garden, Mr. Muoi Day's Stilt-House and Mr. Hai Hoang's Old House.
Vinh Long Weather
Like other provinces in Mekong Delta, the best time to travel to Vinh Long is from September to December. It is the floating season here, thus, you can enjoy a pleasant climate, go fishing, and sample mouth-watering fish dishes.
Weather in Vinh Long
Getting to Vinh Long
Vinh Long is 70 km from Mytho, 34km from Can Tho and 136km from Ho Chi Minh city. There are always buses from Vinh Long to Ho Chi Minh City, Can Tho, My Tho, Long Xuyen, Sa Dec, Rach Gia and other Mekong Delta destinations and vice versa. Within the province, the bus system is 5km long from the center of Vinh Long. Apart from buses, there are boats to some surrounding destinations and Tam Nong in Dong Thap, Cho Lach in Ben Tre, Cai Be in Tien Giang, and Song Doc in Ca Mau on your tour to Southern Vietnam.
What to See in Vinh Long
Don Ca Tai Tu Show
Vinh Long is featured as the province of both tangible and intangible heritage. The most popular intangible value is Don Ca Tai Tu show, which is a not-to-be-missed activity of most travelers when traveling to Vietnam.
'Don ca tai tu' is a typical and traditional form of music performance in Southern Vietnam in general and in Vinh Long province in particular. It has also been recognized as UNESCO Intangible Cultural Heritage. To implement the Government policy, the local committee has been conducting many measures to preserve and utilize heritage values for socio-economic development, particularly in tourism and culture. Through years, 'Don ca tai tu' has been proving its powerful vitality as the major part in local people's daily lives. The show has been performed at big events, like death anniversaries, birthday celebrations, weddings, and public gatherings. To perform this type of music, the instruments are used to accompany singers who perform many tones of emotion through beautiful and tormenting rhythms.
An Binh Island
An Binh is a top choice among many domestic and international tourists looking for a tropical getaway. You will have an opportunity to contemplate the gentle beauty from natural landscapes and discover the uniqueness of indigenous people.
Hiring a small boat to float on the system of the interlaced river, you find yourself lost in the fruit orchards with both sides of deep blue rows of willow. The soil here is very fertile and populous with fresh water which benefits many types of fruit such as rambutan, mango, longan, durian, and sapodilla, etc. Coming here, all the noise, hurry and bustle of the urban life will be dispelled to be replaced by the smooth, soft and comfortable feelings from watching peaceful sceneries in the countryside water. There are some suggested gardens for tourists to come such as Mr. Sau Giao garden, Mr. Muoi Day's house on stilts, Mr. Hai Hoang ancient house. Besides, tourists can also find other gardens to relax under 'homestay' tourism. For example, Mr. Nam Thanh homestay, Mr. Tam Tien homestay, Mr. Ba Linh homestay, etc. Here, the hosts are very willing to invite you to have a meal with typical dishes of water regions such as fried gourami with pieces of fish rolling with basil, star fruit, banana dipped in chili garlic fish sauce, crispy fried spring rolls, etc. and live with the friendly and hospitable locals.
Eco-Tourism zone – Vinh Sang Farm
From An Binh island, tourists can pay a visit to Vinh Sang tourist area to join in exciting activities, namely riding ostriches running on the sand, going fishing crocodile, walking in the unique monkey bridges, cycling around the village, slapping ditch for fishing, spreading the nets, experiencing grass sleds, kayaking along the river, etc.
Vinh Sang Farm
Vinh Sang farm was built in 2004 by local government with the total investment capital of 12 billion VND and over 2.2ha of raising area. Ostrich-raising zone is the most attractive area for most tourists. Mr. Vinh – the farm's owner announces that 'Tourists come here mainly to try such a new game which firstly emerged in the West. Children are the first ones attracted by this game. Some of them even shout out 'Hugo riding ostriches' even when they are riding on the real ostriches." Every year, this farm attracts thousands of tourists, of which international tourists take up from 15-20%.
Vinh Long Temple of Literature and Saints
Vinh Long Temple of Literature and Saints is located on the wide area along Long Ho River, which is one of the three Confucian Temple of literature constructed in southern Vietnam in the 19th century.
Built from 1864 to 1866 by Phan Thanh Gian, a mandarin of the Nguyen Dynasty, the name of the temple, Van Thanh Mieu, stands for 'a temple worshiping the holy literary genius'. The person referred to in the name conferred upon Confucius, who is widely known as 'the eternal teacher'.
The scenery inside the temple brings tourist a pretty feeling of silence and holiness in mind. The spacious area with a straight asphalted road decorated by two lines of old trees and the ancient statues of talented intellectuals on the grounds of the temple puts visitors at ease to contemplate. In March 1991, it was recognized as a national historical relic by the Ministry of Culture and Information.
What to Eat in Vinh Long
Vinh Long is the homeland of various fruits and some serious delicious foods. Followings are some special famous dishes in Vinh Long:
Grapefruit in Vinh Long
This kind of fruit is very rich in nutrition. It's big, sweet and sour, has a lot of meat. You can enjoy grape with the local type of salt mix with dried shrimp.
Travelers may feel weird or even scary when being introduced to this food. But do not ever miss the chance to enjoy cicada. According to Oriental medicine, the cicada is used to cure fever, seizures, etc.
Ut fish soup
Appetizers find the best way to enjoy Ut fish is to cook them with spinach growing at fields. This kind of vegetables is self-generated, no need for extra nutrition. Fish meat is fatty, soft. You can enjoy fish with salt, pepper to feel the delicious taste in each bite.
Luc Si Rice paper
There are many diverse types of rice paper upon their using methods such as rice paper rolls, dipped rice paper, sweet rice papers rolls, and baked rice paper. This is 100% handmade product from rice flour without using any chemicals. Appetizers can feel soft and a little salty when tasting this kind of food. For most visitors, rice paper wrapped with shrimp, meat, vegetables, rice noodles, and sauce or soy sauce is the best-served dish ever.
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Cheese, nutrient, rich, tasty ...
Lifestyle, Health
Cheese, nutrient, rich, tasty but to consume in small portions.
Published Oct 6, 2017, 1:08 pm IST | Updated Oct 6, 2017, 1:08 pm IST
"Cheese does contain some important nutrients, including calcium and protein, along with vitamin B12 and zinc. However, the calories can add up quickly if you aren't mindful," said Kelly Pritchett, a registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics.
Softer cheeses tend to have fewer calories than hard cheeses: an ounce of whole-milk ricotta (approximately 2 tablespoons) has about 50 calories, an ounce of feta has 75 calories, and an ounce of whole-milk mozzarella has 85 calories. But an ounce of Swiss (one slice) has 108 calories, and an ounce of cheddar has 114 calories .
For the same calories, you can have a cup of black bean soup and probably feel just as full. Cheese is also high in saturated fat, which is known to increase LDL cholesterol, the "bad" cholesterol. In fact, cheese is one of the biggest sources of saturated fat in the US diet. Some research suggests that full-fat cheeses don't seem to negatively affect LDL cholesterol as would be predicted based on its saturated fat content.
"It is not clear exactly why this is the case but may have to do with other nutrients in cheese, like calcium or protein, modifying the way the fat is absorbed or metabolized," said Gregory D. Miller, chief science officer for the National Dairy Council. Still, when it comes to fat content, some cheeses are lighter than others and the higher the fat, the higher the calories.
Cottage cheese has the least amount of fat, with 1 gram per ounce. Ricotta has 4 grams of fat per ounce, and feta and mozzarella have 6 grams each. Parmesan, Swiss and cheddar are higher in fat, with 7, 8 and 9 grams of fat per ounce, respectively.
"Using soft cheeses like mozzarella versus cheddar can be helpful if you are looking for ways to cut calories," Pritchett said. Interestingly, despite its higher calorie content, hard cheese like cheddar can be beneficial for your teeth. Aside from getting calcium and other minerals from it, consuming hard cheese generates saliva, which helps make your mouth less acidic and your teeth less prone to cavities.


Erasing Intersex: Christian Theology and Sexual Empire
Susannah Cornwall
susannah.cornwall@manchester.ac.uk
Speaking in 1996, Heidi Walcutt, who had gathered with other intersex people at a retreat organized by the Intersex Society of North America in California, said,
In this mad rush to 'correct' this 'freak of nature', doctors are currently performing genocide. They are eliminating a race of people who are born different than others. And, I mean, people get up in arms when they talk about the genocide of Hitler and the insane bullshit that Napoleon did, and . . . Idi Amin, and just listing all of these mean, evil dictators who were really corrupt. We need to take a look at what's happening in our own back yards. At the people who are being silenced and eliminated not so much by being put to death but by having something removed from their bodies that sets them apart as being different (Walcutt 1996).
Walcutt is not the only person to have described the surgical normalization of intersex bodies as a form of genocide, though some commentators suggest that this kind of imagery is unhelpful, detracting from the specific horror of the systematic elimination of a people group. Receiving surgical intervention, however undesired or unwarranted, counter critics, is not on the same plane as being executed.
But even if corrective surgery may not unproblematically be figured as genocide, it might otherwise be figured as a kind of imperial imposition. Academics writing about intersex conditions, where individuals are born with bodies that have both male and female physical characteristics, sometimes suggest that early "corrective" intervention is a form of colonization of these unusual bodies. Hilary Malatino (2009), Morgan Holmes (2009), and Lena Eckert (2009) are among those scholars of intersex who understand corrective genital surgery in infancy as repeating colonial-type modes of normality, in which only certain types of bodies are sanctioned, and "problematic" ones have external discourses of pathology and desirability imposed on them. Intersex children's bodies, it has been suggested, are "disappeared" by being made to fit into a more typical pattern—and some intersex adults believe this has had a negative impact on their wellbeing, gender identity, and sense of self, as well as their capacity to enjoy sexual relationships because of the damage to their genitals. Doctors, suggest some critics, are imposing narrow patterns of normality and health on intersex people, which erase variation and enforce a strictly binary model of human sex.
Furthermore, suggests Eckert, early anthropological work on intersex in communities outside Europe sometimes figured it as primitive, atavistic, or something beyond which more "civilized" races had developed (Eckert 2009: 45-6). This heightened the characterization of intersex bodies as "other" than "good," typical white Western bodies, ethnically as well as sexually and culturally. Even well-respected work by anthropologists such as Gilbert Herdt on intersex in Papua New Guinea and the Dominican Republic may have risked repeating colonizing discourses by examining non-Western cultures solely via a Western model of gender and sex (Eckert 2009: 49).
Of course, doctors do not practice medicine in a vacuum; parents, too, often assume that there is no way their intersex child could grow up healthy and happy unless their unusual bodies are altered. Doctors and parents, like the rest of us, inhabit societies in which norms of sex and gender determine from an early age how a child is to be named, reared, and socialized, and in which most people assume that one must have a clearly and unambiguously sexed male or female body in order to promote one's psychological wellbeing.
Intersex bodies may be "colonized" by anthropologists who have caricatured them and surgeons who have inscribed sexed meaning onto them, but the Church exists as another colonizing body (this time, an institutional body) in the area of intersex. Although Christian denominations have done very little in the way of specific discussion of intersex (touching on it only in the context of discussions about transgender and homosexuality), the broader norms of sex, gender, and sexuality repeated and disseminated by them means that it is difficult to see where intersex bodies fit into the stories about personhood and embodiment that the Church tells. Even in what are sometimes described as post-Christian societies, such as Britain, theological assumptions about decent and good embodiment and configurations of sex, gender, and sexuality continue to be influenced by models of binary sex with Christian theological underpinnings.
To colonize the bodies of intersex people means to limit their possibilities, to determine on their behalves what their futures must be. Marcella Althaus-Reid wrote of the limitations imposed on Latin American societies by the conquistadors, delineating which paths and routes could and could not be taken in the indigenous inhabitants' own surroundings. By analogy, she noted, colonizing theologies have also imposed their own "paths," figuring others as illegitimate. But reclaiming alternate theological paths is crucial, she suggested, given that the "main roads" of Christianity inevitably lead those who walk them straight back to alliances with empire (Althaus-Reid 2003: 31-2). It seems to me that Christianity's "main roads" also continue to influence at least some medical practitioners working with intersex children: Alice Dreger, Ellen Feder, and Anne Tamar-Mattis (2012) note that at least one influential paediatric endocrinologist in the USA endorses the use of dexamethasone, a controversial steroid drug, in the treatment of intersex baby girls with large clitorises and small vaginal openings on the grounds that it will increase their chances of growing up to be heterosexual wives and mothers. Even if the link is not explicit, I believe that Christian discourses about masculinity and femininity underlie this kind of understanding of heterosexuality and motherhood as particularly desirable for women. Christian denominations have done too little in the way of pointing out alternative possibilities, or endorsing multiplicities of embodiment as good and bearing the image of God.
However, as churches come to consider their responses to intersex in more detail, they might learn much from moves made by postcolonial theologians and biblical interpreters in recent years. They might employ suspicious, interrogative modes of reading and interpretation in interaction with their own traditions as well as others with which they engage. They might seek to "read otherwise," giving special attention to counter-interpretations made by those who have formerly been excluded from discourse. They might ask whose stories and experiences have been erased and elided in mainstream theologies of sex, gender, sexuality, and embodiment—that is, whose voices are and are not being heard. My own research with intersex Christians in Britain has begun to show that at least some of them feel absent or invisible in existing denominational accounts of the significance of human sex (Cornwall 2013). Decolonizing theologies of intersex will therefore also resist any tendency to make final or complete claims about the significance of human sex in imaging relationships between God and humanity, or to pronounce on which sexes do and do not reflect God's intention for human beings.
In the nearly two decades since Heidi Walcutt described surgical intervention for intersex as genocide on the part of doctors, the medical profession has begun to respond to intersex individuals and to take seriously their post-surgery experiences and warnings about the possible negative consequences of early intervention. Many medical teams now routinely ensure that parents of intersex infants are put in touch with intersex support groups and made aware of the diversity of opinion surrounding medical protocols. But most Christian denominations have, thus far, been less responsive to the reality of intersex and its implications for their teachings about sex, gender, sexuality, and embodiment. As a result, churches risk, consciously or otherwise, continuing in the service of empire: an empire of sexual hegemony (Cornwall 2012) in which unambiguous maleness and femaleness are so over-imbued with cosmic significance and consequent social importance that intersex bodies, bodies with unusual sex, are presented as distorted, deviant, disordered, or—yet more crushingly—as simply unspeakable.
Althaus-Reid, Marcella. 2003. The Queer God. London: Routledge.
Cornwall, Susannah. 2012. "'From a Remote Rural Village in Limpopo': Colonized Bodies, Hybrid Sex and Postcolonial Theology." In Gendering Christian Ethics, ed. Jenny Daggers, 147-167. Newcastle: CSP.
Cornwall, Susannah. 2013. "British Intersex Christians' Accounts of Intersex Identity, Christian Identity and Church Experience." Practical Theology 6.2: 134-150.
Dreger, Alice, Ellen K. Feder and Anne Tamar-Mattis. 2012. "Prenatal Dexamethasone for Congenital Adrenal Hyperplasia: An Ethics Canary in the Modern Medical Mine." Journal of Bioethical Inquiry 9: 277-294.
Eckert, Lena. 2009. "'Diagnosticism': Three Cases of Anthropological Research into Intersexuality." In Critical Intersex, ed. Morgan Holmes, 41-71. Aldershot: Ashgate.
Holmes, M. Morgan. 2009. "Introduction: Straddling Past, Present and Future." In Critical Intersex, ed. Morgan Holmes, 1-12. Aldershot: Ashgate.
Malatino, Hilary. 2009. "Situating Bio-Logic, Refiguring Sex: Intersexuality and Coloniality." In Critical Intersex, ed. Morgan Holmes, 73-94. Aldershot: Ashgate.
Walcutt, Heidi. 1996. Speaking in Hermaphrodites Speak! (video), ISNA (Intersex Society of North America). Petaluma, CA: Intersex Society of North America.
Dr. Susannah Cornwall is Postdoctoral Research Associate at the Lincoln Theological Institute, Department of Religions and Theology, University of Manchester, UK, a partner institute of Postcolonial Networks. She leads the Intersex, Identity, Disability: Issues for Public Policy, Healthcare and the Church project (http://lincolntheologicalinstitute.com/intersex-identity-disability) and teaches Postcolonial Christian Theology. She has a PhD in Theology from the University of Exeter, UK.
Jason Craige Harris2015-09-25T16:41:01+00:00July 13th, 2013|Archive blog, Culture, Gender/Sexuality, Plural Space, Politics, Religion|


In this Jan. 11, 2006, file photo, a gas-lit flame burns on a natural gas stove. (AP Photo/Thomas Kienzle, File)
Federal agency considering ban on gas stoves: report
by: Dana Casullo, Allison Shinskey
(WPRI) — Cooking with a gas stove could soon be a thing of the past.
A federal agency is considering a ban on gas stoves due to concerns about indoor pollution being linked to childhood asthma, according to a report from Bloomberg News.
In the December 2022 study, a U.S. Consumer Product Safety Commissioner told Bloomberg that using gas stoves has a "hidden hazard."
Researchers say the chemicals emitted from the appliances while in use are a "significant trigger," saying that nitrogen dioxide (NO2), in particular, is known to cause respiratory distress and asthma attacks.
Nationally, researchers say gas stoves are a contributor to asthma at a rate of 13%.
About 35% of households in the U.S. use a gas stove, which is causing some controversy.
Consumer safety board to weigh regulations on gas stoves
Dozens of local governments, including Los Angeles and New York, are already mandating new homes and businesses run on electric rather than gas appliances, while about 20 states responded by forbidding such bans.
"Obviously getting rid of a gas stove and replacing it with another technology eliminates the source, but you can do quite a bit with ventilation," said Dr. Jon Levy, with the Boston University of Public Health.
Levy said ventilation isn't the final answer for every kitchen with a gas stove, especially if it's a smaller home.
Previous Stanford University research found leaks from gas stoves alone produce planet-warming pollution equal to half a million gas-powered cars each week.
For those considering switching to an electric stove, President Joe Biden's Inflation Reduction Act includes rebates to help switch from gas to electric.
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