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OBJECTIVE: To identify and quantify ability bias in generative artificial intelligence large language model chatbots, specifically OpenAI's ChatGPT and Google's Gemini. DESIGN: Observational study of language usage in generative artificial intelligence models. SETTING: Investigation-only browser profile restricted to ChatGPT and Gemini. PARTICIPANTS: Each chatbot generated 60 descriptions of people prompted without specified functional status, 30 descriptions of people with a disability, 30 descriptions of patients with a disability, and 30 descriptions of athletes with a disability (N=300). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Generated descriptions produced by the models were parsed into words that were linguistically analyzed into favorable qualities or limiting qualities. RESULTS: Both large language models significantly underestimated disability in a population of people, and linguistic analysis showed that descriptions of people, patients, and athletes with a disability were generated as having significantly fewer favorable qualities and significantly more limitations than people without a disability in both ChatGPT and Gemini. CONCLUSIONS: Generative artificial intelligence chatbots demonstrate quantifiable ability bias and often exclude people with disabilities in their responses. Ethical use of these generative large language model chatbots in medical systems should recognize this limitation, and further consideration should be taken in developing equitable artificial intelligence technologies.

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PURPOSE: Despite existing employment-related legislation and governmental programs, people with disabilities continue to face significant barriers to competitive employment. These obstacles are partially due to biases among employers regarding the contributions of people with disabilities and perceptions about accommodation costs, which can affect their hiring decisions. Existing research on employment barriers and facilitators often treats people with disabilities homogenously and focuses mainly on large companies. This study helps to fill these gaps by exploring the motivations and challenges small employers face when hiring people with disabilities and how their attitudes and willingness to hire vary based on disability type. METHODS: We surveyed business owners and decision-makers at companies with fewer than 100 employees resulting in a sample of 393 company respondents. Through descriptive analyses, we examined variations in respondents' willingness to hire and the prevailing attitudes among the company leaders sampled. We explored how employer attitudes can either hinder or support the hiring of people with disabilities. We conducted multivariate analysis to explore the connections among attitudinal barriers, facilitators, and willingness to hire individuals with various disabilities, reflecting disability's heterogeneous nature. RESULTS: Our findings reveal that, in terms of hiring people with disabilities, the most important concerns among employers are: inability to discipline, being unfamiliar with how to hire and accommodate, and uncertainty over accommodation costs. These concerns do not differ between employers covered by the Americans with Disabilities Act (ADA) and non-covered employers. However, ADA-coverage may make a difference as ADA-covered employers are more likely to say they would hire an applicant with a disability. We find that for small companies (less than 15 employees), the positive effect of the facilitators (positive perceptions about workers with disabilities) almost completely offsets the negative effect of the barriers. However, for the larger companies, the marginal effect for an additional barrier is significantly more predictive than for an additional facilitator. Among the disabilities we examined, employers are least likely to hire someone with blindness, followed by mental health disabilities, intellectual disabilities, deafness, and physical disabilities, underscoring that employers do not view all types of disabilities as equally desirable at work. CONCLUSIONS: Understanding small employers' underlying concerns and effectively addressing those factors is crucial for developing effective intervention strategies to encourage small employers to hire and retain people with different disabilities. Our results suggest greater openness among ADA-covered employers to hiring people with disabilities, but the perceived barriers indicate a need for ongoing information on effective intervention strategies to increase disability hiring among all small employers.

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This article takes as its starting point the recent case of Crowter, which challenged the law permitting provision of abortion on the grounds of fetal anomaly. It begins by briefly locating the case within a longer 'biography' of the Abortion Act 1967, casting important light on the issue raised within it. It then focuses in detail on the claims made in Crowter, exploring how important moral, social and political concerns with disability discrimination were refracted through an anti-abortion lens as they were translated into legal argument. As a result, the legal remedies sought were simultaneously disproportionate and insufficient to address the harms described. Whilst agreeing that the Abortion Act reflects anachronistic and discriminatory understandings of disability and is overdue reform, the article argues that a response that fully reflects modern ethical values will require more radical change than envisaged in Crowter, and that this must refuse an opposition between the rights of pregnant and disabled people.

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BACKGROUND: Lifting of masking restrictions at key periods during the COVID-19 pandemic may have disproportionately negatively impacted the mental health of individuals with disabilities. OBJECTIVE: This study examines the prevalence of depression-related symptoms in individuals with and without disabilities preceding and following the US rollback of COVID-19 masking mandates. METHODS: Pandemic-era data on reported symptoms of depression from the federal Household Pulse Survey from dates surrounding two major announcements on masking relaxations were analyzed. Possible interactions between disability status and type, age grouping, educational attainment, race/Hispanic ethnicity, and sex variables were considered. RESULTS: Following relaxation of major masking restrictions, people with disabilities experienced elevation in depression symptom presence while people without disabilities experienced lessening in these symptoms. Differences between people with and without disabilities were significant. CONCLUSIONS: Direct causation between masking mandate relaxations and changes in symptoms of depression cannot be drawn from the available data. However, when considered with greater vulnerabilities to COVID-19 experienced by many individuals with disabilities and dismissive rhetoric surrounding masking decisions, negative feelings arising from mandate changes may have led to elevations in symptoms of depression in people with disabilities in sharp contrast to people without disabilities who may have felt relief. Findings indicate future public health decision making, even in times of crisis, should be undertaken with as much caution as possible regarding and in partnership with populations already at risk.

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OBJECTIVE: This study aimed to investigate the feasibility and validity of measuring implicit attitudes towards dementia in adults and older adults and evaluate the impact of dementia-friendly education using virtual reality (VR) on implicit attitudes. METHODS: This study was a secondary analysis of data from a randomised controlled trial. Community members in Tokyo aged 20-90 years participated in dementia-friendly education with or without VR. At the end of the dementia-friendly education programs, implicit attitudes towards dementia were measured using the Implicit Relational Assessment Procedure (IRAP). RESULTS: Of the 145 participants, 89 (61%) started the IRAP, and 21 (15%) completed it. Lower age was significantly associated with the start/completion of the IRAP, and the age thresholds at which 50% of participants would not start/complete it were estimated to be 72.3/44.8 years, respectively. Those who had experience interacting with people with dementia other than family members had lower IRAP scores than those who had no such experience. The intervention group participating in the VR program had lower IRAP scores than the control group (p = .09). CONCLUSIONS: Although measuring implicit attitudes using IRAP is deemed not feasible for people in their 70s and older, the differences in interaction experience would be evidence supporting the validity of the measurements of implicit attitudes towards dementia. The results suggest that dementia-friendly education, using VR, improves implicit attitudes towards dementia.

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PURPOSE: The aim of this study was to gain an understanding of employers' attitudes to, knowledge about, and policies relating to employing someone with a spinal cord injury (SCI). METHODS: Semi-structured interviews were conducted with nine employers located in Australia from a range of backgrounds and different sized businesses. The interviews were thematically analysed. RESULTS: Three themes were identified: Organisational policies (sub-themes: Recruitment - inherent requirements of the role vs risk mitigation; Recruitment strategies and targets; Disclosure; Accommodations needed or offered); Barriers & facilitators (sub-themes: Lack of knowledge about SCI; Physical accessibility; Workplace culture); Personal attitudes (sub-themes: Personal attitudes don't align with organisational policy; Personal experiences informed understanding). CONCLUSIONS: Organisational policies and practices of the employers' organisations, and workplace culture impact the likelihood of someone with a SCI being employed, particularly in relation to recruitment, employment targets, and available accommodations. Individual staff attitudes and knowledge also influence this process. Multi-faceted approaches are needed to increase the employment of people with SCI.

Barriers to employing someone with spinal cord injury (SCI) include lack of knowledge about SCI, and lack of knowledge about workplace lawsOrganisational policies and practices of organisations impact the likelihood of someone with an SCI being employedIndividual staff attitudes influence employment of people with SCIEmployers' knowledge about and confidence in employing people with SCI, is an important area to target interventions.

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State prescription drug monitoring programs (PDMPs) use proprietary, predictive software platforms that deploy algorithms to determine whether a patient is at risk for drug misuse, drug diversion, doctor shopping, or substance use disorder (SUD). Clinical overreliance on PDMP algorithm-generated information and risk scores motivates clinicians to refuse to treat-or to inappropriately treat-vulnerable people based on actual, perceived, or past SUDs, chronic pain conditions, or other disabilities. This essay provides a framework for challenging PDMP algorithmic discrimination as disability discrimination under federal antidiscrimination laws, including a new proposed rule interpreting section 1557 of the Affordable Care Act.

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OBJECTIVE: While depression associated with disability has been extensively studied, how depression could differ depending on whether the disability is congenital or acquired remains to be investigated. The objective of this study was to compare depression and its related factors among people with congenital and acquired physical disabilities. METHODS: We used the 2016 Panel Survey of Employment for the Disabled in Korea, a population-based survey for people with disability registered with the Korean government. Among 4577 participants, a total of 2128 participants with physical disability were analyzed using Chi-square test and binary logistic regression analysis. RESULTS: The prevalence of depression was 12.9% in those with congenital physical disability and 16.0% in those with acquired physical disability. Stress due to disability and family relationship satisfaction were associated with higher and lower odds of depression, respectively, in both disability groups. Discrimination due to disability, divorce, social participation, and subjective social status were significant predictors of depression only in people with acquired disability. CONCLUSIONS: Compared to those with congenital disability, individuals with acquired disability can be more susceptible to issues relating to social relationship, social standing and discrimination. Findings of this study suggest that acquired disability and adapting to changes associated with it can be a source of mental distress in addition to living with it. More efforts are needed to address discrimination, provide supportive social relationships, and provide supportive living conditions in order to reduce depression in persons living with disability, especially those with acquired disability.

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Introducción. La discapacidad se ha interpretado bajo diferentes puntos de vista a medida que pasan los años, convirtiéndose en un punto clave la mirada global para una correcta integración dentro de la sociedad, especialmente desde el punto de vista de la Kinesiología. Objetivo. analizar la población con discapacidad en Chile con respecto a las variables sociodemográficas (sexo y edad), en su estado de dependencia y discriminación desde el 2015 al 2021. Métodos. Estudio cuantitativo, descriptivo, en donde se identificaron y contrastaron dichas variables de las bases de datos secundarias ENDISC (II Estudio Nacional de la Discapacidad del 2015), CASEN (Encuesta de Caracterización Sociodemográfica del 2017) y EBS (Encuesta de Bienestar Social del 2021). Resultados. Existe mayor prevalencia de discapacidad en el género femenino entre los 18 a 34 años, mostrando relación entre el nivel de dependencia con edad y sexo en el 2015 y 2017 con mayor prevalencia hacia la independencia. Además, se establece relación entre la autopercepción de discriminación en personas con discapacidad de acuerdo con el sexo y la edad en el 2017 y 2021, mayor prevalencia al "No" sentirse discriminado. Discusión: A medida que aumenta la edad, aumenta con ella la discapacidad de la persona, sumado a la percepción de discriminación en diferentes esferas sociales, que limitan aún más el desarrollo de las personas con discapacidad. Conclusión. Es necesario de un estudio más enfocado en variables vinculadas con la discapacidad, de esta manera tener información estadística para lograr entablar diferentes políticas públicas en beneficio de la situación de discapacidad.

Background. Disability has been interpreted from different points of view as the years go by, with a global perspective becoming a key point for correct integration within society, especially from the point of view of Kinesiology. Aim. analyze the population with disabilities in Chile with respect to sociodemographic variables (sex and age), in their state of dependency and discrimination from 2015 to 2021. Methods. Quantitative, descriptive study, where these variables from the secondary databases ENDISC (II National Disability Study of 2015), CASEN (Sociodemographic Characterization Survey of 2017) and EBS (Social Wellbeing Survey of 2021) were identified and contrasted. Results. There is a higher prevalence of disability in women between 18 and 34 years of age, showing a relationship between the level of dependency with age and sex in 2015 and 2017 with a greater prevalence towards independence. In addition, a relationship is established between the self-perception of discrimination in people with disabilities according to sex and age in 2017 and 2021, a greater prevalence of "No" feeling discriminated against. Discussion. As age increases, the person's disability increases with it, added to the perception of discrimination in different social spheres, which further limit the development of people with disabilities. Conclusion. It is necessary to study more focused on variables linked to disability, in this way to have statistical information to establish different public policies to benefit the disability situation.

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BACKGROUND: Cybervictimization of people with long-term conditions is a disturbing phenomenon with a documented impact on health and well-being. These experiences are primarily examined using quantitative methods, focusing on children and young people. However, research centered on the cybervictimization of adults with chronic conditions is scarce, with limited qualitative input from the victims as experts in their own experiences. OBJECTIVE: This study aims to understand the impact of cybervictimization on the self-management of long-term conditions among adults with chronic conditions and disabilities in the United Kingdom. METHODS: This paper reports the findings from the qualitative phase of a phenomenologically informed mixed methods study. The biographical disruption concept was used to conceptualize the study. In-depth semistructured interviews were conducted with 13 participants with chronic conditions who experienced cybervictimization. A codebook was developed, and a zigzag approach to thematic analysis was used to define and refine themes. Ethical considerations and risk assessment were ongoing during the research process because of the sensitivity of the topic and cases of harassment. RESULTS: Cybervictimization has direct and indirect impacts on the self-management of chronic conditions. This impact was verified across 6 overarching themes that emerged from this study. First, biomedical events included overall health deterioration because of existing conditions, new diagnoses, and subjective physical complaints. Second, the impact on mental health was perceived through psychological consequences and psychiatric disorders that developed after or during this traumatic experience. Third, the multilevel impact theme focused on disrupting the strategies for coping with health conditions and involved unplanned changes to victims' health management priorities. Fourth, the impact of complexity reflected the perceived uniqueness in each case, intersectionality, struggle to obtain formal support, and subsequent health complications. Fifth, social network involvement comprised the effects of social isolation, victim blaming, and deception. Finally, the disability discrimination theme focused on prejudice, issues on inclusion, and hostility in society, with subsequent effects on well-being. CONCLUSIONS: People with long-term conditions experienced different forms of cybervictimization, all disruptive with various effects on health. Disability discrimination was a prominent finding to be further investigated. This paper reports the impact as themes to guide further research and practice, with the recognition that long-term conditions and impairments are not a homogeneous group. Despite the devastating consequences, there are positive points that strengthen potential interventions. Awareness-raising campaigns, training of support channels, and multidisciplinary research are recommended to tackle this issue and initiate change.

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This article examines Bey v. City of New York - a recent Second Circuit case where four Black firefights suffering from Pseudofolliculitis Barbae (a skin condition causing irritation when shaving which mostly affects Black men) challenged the New York City Fire Department's Clean Shave Policy - with an intersectional approach utilizing legal theories of racial, disability, and religious discrimination.

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This article offers a glimpse of the Americans with Disabilities Act ("ADA") of 1990, as amended by the ADA Amendments Act of 2008 ("ADAAA"), at its 30th anniversary. It considers current issues before the courts, primarily legal cases from 2020 and 2021, and new questions in light of the COVID-19 pandemic, such the latitude of the ADA's antidiscrimination protections and its definition of disability. It provides a quick primer on the basics of the ADA: employment discrimination under Title I, antidiscrimination mandates for state and local governments under Title II, and commands to places of accommodation offering services to the public under Title III. The ADA at 30 remains a beacon for a future in which all people, regardless of individual difference, will be welcomed as full and equal members of society.

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In a recent case before the High Court of England and Wales, Crowter v Secretary of State for Health and Social Care, three claimants challenged the disability ground for abortion contained in section 1(1)(d) of the Abortion Act 1967. It was argued on behalf of the claimants that this provision was incompatible with a number of rights protected by the European Convention on Human Rights. Among the arguments made was a claim that this provision perpetuates discriminatory attitudes and negative stereotypes towards disabled people. While the case was rightly unsuccessful, as restricting or removing section 1(1)(d) would only force pregnant people to continue pregnancies in difficult circumstances, the claim around discrimination carries some weight. The High Court rejected this line of argument, missing an opportunity to consider the ways in which the Abortion Act is both inadequate in relation to access to abortion and perpetuates stigma towards disabled people. However, the reform required to address this must take place in Parliament and cannot be done by the courts.

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OBJECTIVES: Disability discrimination is linked with poorer well-being cross-sectionally. The aim of this study was to explore prospective associations between disability discrimination and well-being. DESIGN: Prospective cohort study. SETTING: The United Kingdom Household Longitudinal Study. PARTICIPANTS: Data were from 871 individuals with a self-reported physical, cognitive or sensory disability. PRIMARY OUTCOME MEASURES: Depression was assessed in 2009/10. Psychological distress, mental functioning, life satisfaction and self-rated health were assessed in 2009/10 and 2013/14. RESULTS: Data were analysed using linear and logistic regression with adjustment for age, sex, household income, education, ethnicity and impairment category. Perceived disability discrimination was reported by 117 (13.4%) participants. Cross-sectionally, discrimination was associated with depression (OR=5.40, 95% CI 3.25 to 8.97) fair/poor self-rated health (OR=2.05; 95% CI 1.19 to 3.51), greater psychological distress (B=3.28, 95% CI 2.41 to 4.14), poorer mental functioning (B=-7.35; 95% CI -9.70 to -5.02) and life satisfaction (B=-1.27, 95% CI -1.66 to -0.87). Prospectively, discrimination was associated with increased psychological distress (B=2.88, 95% CI 1.39 to 4.36) and poorer mental functioning (B=-5.12; 95% CI -8.91 to -1.34), adjusting for baseline scores. CONCLUSIONS: Perceived disability-related discrimination is linked with poorer well-being. These findings underscore the need for interventions to combat disability discrimination.

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Despite an elaborated framework on reasonable accommodations in the UN Convention on the Rights of Persons with Disabilities (UN CRPD), persons with mental disabilities continue to face significant limitations to employment in East Africa. The aim of our study is to explore legal provisions related to reasonable accommodations in the employment-related laws regarding persons with mental disabilities in East Africa, and to suggest ways to bridge the gap between principles of international law and provisions of domestic laws. The disability, labour and human rights laws of 18 East African countries were accessed from the database of WHO MiNDbank and the International Labour Organisation. These laws were reviewed in the light of the framework of Article 27 of the UN CRPD. We found that 15 (83%) of the countries in East Africa have ratified the UN CRPD, and 12 (67%) have formulated an explicit definition of disability that includes mental illness. Eleven countries (61%) have explicit laws mandating employers to provide reasonable accommodations for persons with a mental disability. Eight countries (44%) have submitted a state report to the CRPD Committee. Lack of clear and specific definition of reasonable accommodations or the existence of vague definitions create challenges. If persons with a mental disability are to exercise their right to inclusive and gainful employment, there is a need for legal reforms that guarantee access to inclusive employment practices.

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Background: measures of population health, like the Disability Adjusted Life Year (DALY), are important for health policy and planning. Some worry, however, that these measures discriminate against the disabled. Methods: This paper provides an analysis of the disability discrimination problem. Then, adapting a fixed-plus-variable framework proposed in welfare economics to the case of health measurement, it proposes a novel measure called the Ethically Adjusted Life Year (EALY). Results: The EALY, in at least some formulations, can avoid discriminating against the disabled. It is different from, and has some advantages over, alternative ways of avoiding discrimination. Conclusions: There is reason to consider using the EALY in measuring health burden and the impact of health interventions.

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This article discusses the meaning and philosophical basis of disability discrimination in health care. It focuses on aspects of language that influence discourse about disability and affect the experiences of people with disabilities. Reference is made to the experiences of those who have an autism spectrum condition, with a specific focus on three NHS employees with Asperger syndrome, in relation to disability discrimination. The implications for nurses and nursing are discussed. Recommendations are made for awareness raising and training.

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This article critically examines the 25 June 1998 decision by the House of Lords regarding the psychiatric admission of a man with autism. Mr L was able neither to consent to, nor refuse, that admission and the disposition of his case illuminates the current debate regarding best interests of vulnerable adults by the judiciary and the psychiatric profession. This article begins with the assumption that hospitalisation was not the optimum response to Mr L's condition, provides alternative approaches to the interpretation of best interest and examines principles of liberty, anti-discrimination, and equal protection.

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OBJECTIVES: To gather empirical evidence on any discrimination based on genetic information shown by the insurance industry in the United Kingdom and to assess how society is likely to handle future genetic information from tests for polygenic multifactorial conditions. DESIGN: Postal questionnaire survey. SUBJECTS: Sample (n=7000) of members from seven British support groups for families with genetic disorders and a representative sample (n=1033) of the general public who answered questions on applying for life insurance as part of an omnibus survey. MAIN OUTCOME MEASURES: Subjects were asked about their experiences with insurers, the medical profession, employers, and social services. Experiences with insurers are reported here. RESULTS: Altogether 33.4% of the study group had problems when applying for life insurance compared with 5% of applicants in the omnibus survey. Thirteen per cent of study respondents from subgroups who represented no adverse actuarial risk on genetic grounds reported that their treatment by insurers seemed to represent unjustified genetic discrimination. CONCLUSIONS: Life insurers may not be operating a consistent policy for assessing genetic information or acting in accord with the actuarial risks brought to them. The inconsistency suggests error rather than a corporate policy of discrimination based on genetic characteristics. Any future proposals for genetic testing for common or multifactorial disorders should be examined carefully.

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