Poster 310 Bowel Issues in Adults with Cerebral Palsy: Type, Frequency and Their Impact on Quality...
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parental separation/divorce) occurring before age 18. ACE count sums number of positive ACE categories (range 0-8). Results: The prevalence of 0, 1, 2, 3, and 4 ACEs was 35%, 20%, 14%, 10%, and 21%, respectively, in those with disabilities and 45%, 23%, 12%, 7% and 12% in those without. Those with disabil- ity had a higher prevalence of every ACE category: Abuse: sexual (18.7 vs. 9.3), physical (23.6 vs. 13.2), emotional (35.4 vs. 24.0); Family dysfunction: domestic violence (21.1 vs. 13.6), prison (8.6 vs. 5.7), mental illness (23.1 vs. 15.3), substance abuse (33.1 vs. 24.4), and separation/divorce (26.3 vs. 23.2). Logistic regression analysis was used to adjust for potentially confounding demo- graphic factors (age, sex, race, income, education), and the adjusted OR of any ACE for those with disability was 1.8 (1.7-2.0) compared to no disability (Wald 2. 0.001). Compared to those with no disability, those with disability had a higher adjusted odds of reporting abuse [2.1 (1.9-2.3)] than family dysfunction [1.6 (1.5- 1.8)]. Conclusions: People with disabilities have higher rates of ACEs. Since other studies have found that ACEs increase health risk behaviors, prevalence of chronic diseases and premature mortality, childhood adversity may impact health disparities in those with disability. Poster 309 Adverse Childhood Experiences and Disability: A “Double Hit” for Health-Risk Behaviors. C. Miryam Schussler-Fiorenza, MD, PhD (Thomas Jeffer- son University, Philadelphia, PA, United States); Marga- ret Stineman, MD; Dawei Xie. Disclosures: C. Schussler-Fiorenza, No Disclosures. Objective: To characterize health-risk behaviors in those with disabilities and to examine the impact of adverse childhood experi- ences (ACEs) on health-risk behaviors in persons with disabilities. Design: Analysis of Behavioral Risk Factor Surveillance System data, a random-digit-dialed population-based telephone survey. The Adverse Childhood Experience (ACE) Module asks about abuse (physical, sexual, emotional) and family dysfunction (exposure to domestic violence, living with a mentally ill, substance abusing, or incarcerated family member, parental separation/divorce) occurring before age 18. Disability was defined as self-reported health-related activity limitation and/or use of an assist device. Setting: Fourteen states and the District of Columbia. Participants: Community-dwelling adults ages 18 (total n 81,184) with disability (n 23, 738). Interventions: Not Applicable. Main Outcome Measures: Health-risk behaviors: current smoking, HIV risk-behaviors (under age 65 only), heavy and binge drinking. Results: Persons with disabilities had a higher prevalence of one or more ACEs (65.1% vs. 54.2%) and 4 ACEs (21.7% vs. 12.1%) compared to those with no disability. They also had a higher age-adjusted prevalence of current smoking (29.6 vs. 18.6) and HIV-risk behaviors (6.0 vs. 3.0). Those with disability who reported one or more ACEs had higher rates of current smoking (29.2 vs. 15.1), HIV risk behaviors (5.4 vs. 1.2), heavy drinking (5.1 vs. 2.7), and binge drinking (11.7 vs. 6.5) than those with disability without ACEs. In logistic regression analyses adjusting for age, sex, race education marital status and income, the adjusted odds of HIV-risk behaviors, heavy and binge drinking (three separate models) was 3.5 (1.8-6.9), 1.8 (1.3-2.5), 1.5 (1.1-2.1), respectively, in those with one or more ACEs compared to no ACE. Compared to those with no ACE, the adjusted odds of current smoking for those with one or more ACEs and 4 ACEs was 1.5 (1.3-2.0) and 2.3 (1.8-3.0), respectively. Conclusions: People with disability have higher rates of certain health-risk behaviors, particularly smoking. They also have in- creased rates of childhood adversity which further increases their rates of health-risk behaviors. Inquiring about and addressing the long-term effects of childhood adversity may help efforts to reduce such behaviors in those with disability. Poster 310 Bowel Issues in Adults with Cerebral Palsy: Type, Frequency and Their Impact on Quality of Life. Christina M. Marciniak, MD (Rehabilitation Institute of Chicago, Chicago, IL, United States); Erik J. Beltran, MS; Justin Burton, MD; Diane Dudas-Sheehan, Nursing Doc- torate; Deborah J. Gaebler-Spira, MD; Michael Jessel- son; Jungwha Lee, PhD, MPH; Sarah A. O’Shea, BA. Disclosures: C. M. Marciniak, Research grants: Allergan, Acorda, Ipsen, Merz, Takeda; Consulting fees: Merz, Shionogi, Allergen. Objective: To examine the problems that adults with cerebral palsy (CP) experience with bowel function, including their relation- ship to gross motor classification and quality of life. Design: Cross-sectional study. Setting: Outpatient physiatry clinic. Participants: 91 adults with CP (46 males, 45 females; mean age 36 years [range 18-79]). Interventions: Not applicable. Main Outcome Measures: International Consultation on In- continence Questionnaire-Anal Incontinence Symptoms (ICIQ-B) and a constipation questionnaire using the Rome 3 criteria for constipation. Results: 81% had an issue with bowel pattern. 84% had at least one issue with bowel control; 46% reported moderate to severe issues with control. Difficulties controlling watery or loose stool leakage reported in 43%; 24% reported having no control. Difficul- ties controlling formed or solid stool leakage reported in 41%; 25% reported having no control. Bowel accidents occurred in 25%. Patients with Gross Motor Function Classification System (GMFCS) level 4 or 5 were more likely to report issues with bowel control than GMFCS level 1, 2 or 3. 65% met the Rome 3 symptomatology criteria for constipation. Moderate to severe pain/discomfort due to constipation was reported by 23%. In assessing quality of life, 19% reported their bowels interfere with their everyday lives and 12% stay home at least some of the time because of their bowels. 25% reported having the possibility of a bowel accident on their mind at least some to all of the time. 29% reported being embarrassed by their bowels at least some to all of the time. Conclusions: Bowel issues identified included pain with evac- uation, control problems such as leakage, and constipation. At least one bowel issue was present in the majority of the patients (81%). These bowel issues affect quality of life and may limit participation in activities outside the home environment. S295 PM&R Vol. 4, Iss. 10S, 2012
Transcript of Poster 310 Bowel Issues in Adults with Cerebral Palsy: Type, Frequency and Their Impact on Quality...
parental separation/divorce) occurring before age 18. ACE countsums number of positive ACE categories (range 0-8).Results: The prevalence of 0, 1, 2, 3, and 4� ACEs was 35%, 20%,14%, 10%, and 21%, respectively, in those with disabilities and45%, 23%, 12%, 7% and 12% in those without. Those with disabil-ity had a higher prevalence of every ACE category: Abuse: sexual(18.7 vs. 9.3), physical (23.6 vs. 13.2), emotional (35.4 vs. 24.0);Family dysfunction: domestic violence (21.1 vs. 13.6), prison (8.6vs. 5.7), mental illness (23.1 vs. 15.3), substance abuse (33.1 vs.24.4), and separation/divorce (26.3 vs. 23.2). Logistic regressionanalysis was used to adjust for potentially confounding demo-graphic factors (age, sex, race, income, education), and the adjustedOR of any ACE for those with disability was 1.8 (1.7-2.0) comparedto no disability (Wald �2. � 0.001). Compared to those with nodisability, those with disability had a higher adjusted odds ofreporting abuse [2.1 (1.9-2.3)] than family dysfunction [1.6 (1.5-1.8)].Conclusions: People with disabilities have higher rates of ACEs.Since other studies have found that ACEs increase health riskbehaviors, prevalence of chronic diseases and premature mortality,childhood adversity may impact health disparities in those withdisability.
Poster 309Adverse Childhood Experiences and Disability: A“Double Hit” for Health-Risk Behaviors.C. Miryam Schussler-Fiorenza, MD, PhD (Thomas Jeffer-son University, Philadelphia, PA, United States); Marga-ret Stineman, MD; Dawei Xie.
Disclosures: C. Schussler-Fiorenza, No Disclosures.Objective: To characterize health-risk behaviors in those withdisabilities and to examine the impact of adverse childhood experi-ences (ACEs) on health-risk behaviors in persons with disabilities.Design: Analysis of Behavioral Risk Factor Surveillance Systemdata, a random-digit-dialed population-based telephone survey.The Adverse Childhood Experience (ACE) Module asks about abuse(physical, sexual, emotional) and family dysfunction (exposure todomestic violence, living with a mentally ill, substance abusing, orincarcerated family member, parental separation/divorce) occurringbefore age 18. Disability was defined as self-reported health-relatedactivity limitation and/or use of an assist device.Setting: Fourteen states and the District of Columbia.Participants: Community-dwelling adults ages � 18 (total n �81,184) with disability (n � 23, 738).Interventions: Not Applicable.Main Outcome Measures: Health-risk behaviors: currentsmoking, HIV risk-behaviors (under age 65 only), heavy and bingedrinking.Results: Persons with disabilities had a higher prevalence of one ormore ACEs (65.1% vs. 54.2%) and 4� ACEs (21.7% vs. 12.1%)compared to those with no disability. They also had a higherage-adjusted prevalence of current smoking (29.6 vs. 18.6) andHIV-risk behaviors (6.0 vs. 3.0). Those with disability who reportedone or more ACEs had higher rates of current smoking (29.2 vs.15.1), HIV risk behaviors (5.4 vs. 1.2), heavy drinking (5.1 vs. 2.7),and binge drinking (11.7 vs. 6.5) than those with disability withoutACEs. In logistic regression analyses adjusting for age, sex, raceeducation marital status and income, the adjusted odds of HIV-risk
behaviors, heavy and binge drinking (three separate models) was3.5 (1.8-6.9), 1.8 (1.3-2.5), 1.5 (1.1-2.1), respectively, in those withone or more ACEs compared to no ACE. Compared to those with noACE, the adjusted odds of current smoking for those with one ormore ACEs and 4� ACEs was 1.5 (1.3-2.0) and 2.3 (1.8-3.0),respectively.Conclusions: People with disability have higher rates of certainhealth-risk behaviors, particularly smoking. They also have in-creased rates of childhood adversity which further increases theirrates of health-risk behaviors. Inquiring about and addressing thelong-term effects of childhood adversity may help efforts to reducesuch behaviors in those with disability.
Poster 310Bowel Issues in Adults with Cerebral Palsy: Type,Frequency and Their Impact on Quality of Life.Christina M. Marciniak, MD (Rehabilitation Institute ofChicago, Chicago, IL, United States); Erik J. Beltran, MS;Justin Burton, MD; Diane Dudas-Sheehan, Nursing Doc-torate; Deborah J. Gaebler-Spira, MD; Michael Jessel-son; Jungwha Lee, PhD, MPH; Sarah A. O’Shea, BA.
Disclosures: C. M. Marciniak, Research grants: Allergan, Acorda,Ipsen, Merz, Takeda; Consulting fees: Merz, Shionogi, Allergen.Objective: To examine the problems that adults with cerebralpalsy (CP) experience with bowel function, including their relation-ship to gross motor classification and quality of life.Design: Cross-sectional study.Setting: Outpatient physiatry clinic.Participants: 91 adults with CP (46 males, 45 females; mean age36 years [range 18-79]).Interventions: Not applicable.Main Outcome Measures: International Consultation on In-continence Questionnaire-Anal Incontinence Symptoms (ICIQ-B)and a constipation questionnaire using the Rome 3 criteria forconstipation.Results: 81% had an issue with bowel pattern. 84% had at leastone issue with bowel control; 46% reported moderate to severeissues with control. Difficulties controlling watery or loose stoolleakage reported in 43%; 24% reported having no control. Difficul-ties controlling formed or solid stool leakage reported in 41%; 25%reported having no control. Bowel accidents occurred in 25%.Patients with Gross Motor Function Classification System (GMFCS)level 4 or 5 were more likely to report issues with bowel control thanGMFCS level 1, 2 or 3. 65% met the Rome 3 symptomatologycriteria for constipation. Moderate to severe pain/discomfort due toconstipation was reported by 23%. In assessing quality of life, 19%reported their bowels interfere with their everyday lives and 12%stay home at least some of the time because of their bowels. 25%reported having the possibility of a bowel accident on their mind atleast some to all of the time. 29% reported being embarrassed bytheir bowels at least some to all of the time.Conclusions: Bowel issues identified included pain with evac-uation, control problems such as leakage, and constipation. Atleast one bowel issue was present in the majority of the patients(81%). These bowel issues affect quality of life and may limitparticipation in activities outside the home environment.
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