Panoramic radiographs and dental patients with Down syndrome: A scoping review.

INTRODUCTION: Life expectancy for people with Down syndrome (DS) has increased to 60 years, although poor oral health affects their quality of life. Panoramic radiographs (PRs) are usually well-tolerated by people with DS and can provide valuable diagnostic data for treatment planning and research. Methods A scoping review of peer-reviewed articles published between 1971and 2021 was conducted in accordance with the PRISMA extension for scoping reviews to determine the scope of use of PRs for people with DS. RESULTS: 937 papers were screened, and 52 papers were included and charted into seven categories in this review. A high prevalence of tooth agenesis (TA) and other anomalies were reported in 45% of papers. Severe periodontal disease was considered characteristic of DS in the 1970s-80s and the benefit of time-consuming treatment was questioned. Since 2000 case reports illustrate that improved oral care, orthodontic treatment, and dental implants under local or general anaesthetic can improve the quality of life for people with DS. CONCLUSION: PRs play an important role in the diagnosis of anomalies, periodontal disease, and implant planning for patients with DS. This review highlights the gaps in research of caries, pathology, TMJ, systemic disease indicators, and guidelines for dentists. Systematic PR viewing, with a knowledge of characteristic features of DS, will assist diagnosis of pathology and improve comprehensive dental care treatment planning for children and adults with DS.

Outdoor areas of Australian residential aged care facilities do not facilitate appropriate sun exposure.

OBJECTIVE: The aim of the present study was to assess whether the outdoor areas of residential aged care facilities used for a sunlight intervention trial had the design features that encouraged participants' use of these spaces. METHODS: The design principles recommended in the 'Vitamin D and the Built Environment in Victoria' guidelines were used to assess the outdoor spaces of residential aged care facilities that were used in a randomised controlled trial (RCT) of sunlight exposure. Attendance rates in the sunlight RCT were analysed in relation to global impression scores of the facilities using one-way analysis of variance. RESULTS: Thirty-six outdoor areas of 31 facilities were assessed. The facilities met the guidelines for sun exposure, and were generally safe and accessible. However, many lacked privacy, security and aesthetic appeal. Most of the outdoor spaces were not used for regularly scheduled activities. Attendance rates were higher in those facilities with the highest global impression scores compared with those with the lowest scores (F(2,367) = 3.262, P = 0.039). CONCLUSIONS: The physical environment of the outdoor areas of residential aged care facilities was associated with their use for sunlight exposure. Suitably designed or modified spaces have the potential to encourage their greater use, and residential aged care facilities should also plan regular activities in those areas. These measures can facilitate safe sun exposure, as well as physical activity and social interaction in older people.

Vitamin D response of older people in residential aged care to sunlight-derived ultraviolet radiation.

UNLABELLED: The aim of this study was to determine the vitamin D response to sunlight ultraviolet radiation in older people. Increases in vitamin D depended on the season of exposure, but the changes were small. Natural sun exposure is not a practical intervention for vitamin D deficiency in this population. PURPOSE: The purpose of this study is to measure the ultraviolet radiation (UVR) exposure of those in residential aged care in an earlier trial of sunlight exposure and to determine its effect on their vitamin D response. METHODS: Attendance data, demographic, clinical and biochemical variables for 248 participants were used for a secondary analysis of a previous cluster randomized trial of sunlight exposure and falls. The ambient solar UV Index data were used to calculate the participants' UVR dose. Multiple linear regression was used to test if UVR exposure over 6 months, as measured by the standard erythemal dose (SED), was a predictor of vitamin D response, controlling for age, gender, BMI, calcium intake, baseline vitamin D and season of exposure. RESULTS: The median 25-hydroxyvitamin D (25OHD) was 32.4 nmol/L at baseline and 34.6 nmol/L at 6 months (p = 0.35). The significant predictors of 25OHD at 6 months were UVR exposures in spring-summer (coefficient = 0.105, 95 % confidence interval (CI) 0.001-0.209, p = 0.05) and autumn-winter (coefficient = 0.056, 95 % CI 0.005-0.107, p = 0.03) and baseline vitamin D (adjusted coefficient = 0.594, 95 % CI 0.465-0.724, p = 0.00). In those starting sunlight sessions in spring, an increase of 1 unit in log SED was associated with 11 % increase in 25OHD. CONCLUSIONS: Natural UVR exposure can increase 25OHD levels in older people in residential care, but depends on the season of exposure. However, due to inadequate sun exposure, 25OHD did not reach optimal levels. Nevertheless, where sun exposure is encouraged in this group, the focus for the start of exposure should be in the months of spring or autumn, as this timing was associated with a vitamin D response.

Influence of the environment on participation in social roles for young adults with down syndrome.

BACKGROUND: The concept of disability is now understood as a result of the interaction between the individual, features related to impairment, and the physical and social environment. It is important to understand these environmental influences and how they affect social participation. The purpose of this study is to describe the social participation of young adults with Down syndrome and examine its relationship with the physical and social environment. METHODS: Families ascertained from the Down syndrome 'Needs Opinion Wishes' database completed questionnaires during 2011. The questionnaires contained two parts, young person characteristics and family characteristics. Young adults' social participation was measured using the Assessment of Life Habits (LIFE-H) and the influences of environmental factors were measured by the Measure of the Quality of the Environment (MQE). The analysis involved descriptive statistics and linear and logistic regression. RESULTS: Overall, participation in daily activities was higher (mean 6.45) than in social roles (mean 5.17) (range 0 to 9). When the physical and/or social environment was reported as a facilitator, compared to being no influence or a barrier, participation in social roles was greater (coef 0.89, 95%CI 0.28, 1.52, coef 0.83, 95%CI 0.17, 1.49, respectively). The relationships between participation and both the physical (coef 0.60, 95% CI -0.40, 1.24) and social (coef 0.20, 95%CI -0.47, 0.87) environments were reduced when age, gender, behavior and functioning in ADL were taken into account. CONCLUSION: We found that young adults' participation in social roles was influenced more by the physical environment than by the social environment, providing a potentially modifiable avenue for intervention.

Relationship between family quality of life and day occupations of young people with Down syndrome.

PURPOSE: To explore relationships between family quality of life, day occupations and activities of daily living (ADL) of young persons with Down syndrome. METHOD: Data were collected from 150 families with a young person with Down syndrome aged 16-30 years participating in the Down syndrome "Needs Opinions Wishes" database. Data described the young person's characteristics (including functional abilities, behaviour and day occupations) and family characteristics (including income, family and community supports and quality of life). RESULTS: Compared to families of young people attending open employment, families of young people participating in sheltered employment tended to report poorer family quality of life, after adjusting for personal characteristics, behaviour and income (coeff -6.78, 95 % CI -14.38, 0.81). Family supports reduced this relationship (coeff -6.00, 95 % CI -12.76, 0.76). Families of young people with greater functioning in ADL reported better family quality of life regardless of personal and environmental factors (coeff 0.45, 95 % CI 0.05, 0.85) and inclusion of family factors such as family supports reduced this association (coeff 0.29, 95 % CI -0.10, 0.67). CONCLUSIONS: Participation of young people with Down syndrome in open employment may positively influence family quality of life. Services that facilitate functioning in ADL and assist the families in accessing suitable family supports have the potential to positively influence family quality of life.

From diminished men to conditionally masculine: sexuality and Australian men and adolescent boys with intellectual disability.

Men and boys with intellectual disability represent a unique group who have hitherto been overlooked by researchers and theorists exploring men and masculinities. Qualitative data from an Australian ethnographic study focused on the sexual health needs of men and adolescent boys with moderate to profound intellectual disability. Findings suggest that masculinity for this group of men is more a biopsychosocial phenomenon than a social construct organised around heteronormative ideals. The conditional masculinity of the men participating in the study was based instead on a number of intrinsic and external factors, which are described in detail.

Gendered service delivery: a masculine and feminine perspective on staff gender.

Despite acknowledgement that paid caregivers have a significant impact on the lives of people with intellectual disability, the subjective experience of staff gender is rarely considered in research. Qualitative data from a study on the sexual health needs of men and boys with intellectual disability is presented. We designed this study to determine what impact staff gender has on the sexual health needs of men and boys with intellectual disability. Findings suggest that although staff traverse the same geographies of care, they do it in uniquely gendered ways. Staff gender is an important consideration when dealing with sexual health matters and can enhance the type and quality of relationships between people with intellectual disability.

A masculine perspective of gendered topics in the research literature on males and females with intellectual disability.

BACKGROUND: A focus on male social pathologies may have evolved within parts of the intellectual disability research literature. This article explores this notion and makes some connections between mainstream gender theory about hegemonic masculinity and the current gendered discourse in intellectual disability research. METHOD: We conducted a thematic analysis of all journal article titles from four prominent intellectual disability journals where "man," "woman," "men," "women," "male," "female," "girl," and "boy" were mentioned in the title. RESULTS: Thematic differences were identified between articles that focused on males or females, with less research attention on male health compared with female health. A strong focus was evident on problematised male sexual behaviour. CONCLUSIONS: There is a distinct difference evident between articles that problematise males and articles for females encouraging health promotion that suggests a disparate focus on male social pathologies. A deeper contextual analysis of unique sex differences in research is proposed.

Service and support needs of Australian carers supporting a family member with disability at home.

BACKGROUND: As part of an international, multicentre project, the service and support needs of Australian family carers were investigated. METHOD: A sample of 1,390, 448 family carers completed a self-report survey, including an adaptation of the Family Needs Survey (FNS) and several open-ended questions. A mixed method design was used, employing quantitative and qualitative analyses. RESULTS: On the FNS the most frequently endorsed items were those relating to the need for information about services and, in particular, future, out-of-home accommodation. Similarly, the need for respite services was endorsed by over 80% of respondents. Comments indicated that access to and the quality of respite, day support, and therapy programs were a priority. CONCLUSIONS: Participants expressed the need for greater access to information. Access to appropriate respite options, together with quality day support and therapy services, remain a priority for family carers.

The present, past and future of the study of intellectual disability: challenges in developing countries.

There is strong evidence that socio-cultural factors largely determine what is seen as competent behaviour. Within western high income countries, driven by the values of utilitarian individualism, the construct of intellectual disability has been largely determined to meet the needs of urban, industrialised societies. In contrast, competence in non-industrialised societies may be more reflected in collaborative, interpersonal problem solving skills such as those found among Nigerian students labelled as intellectually disabled. However, people who are judged to be incompetent or "obtrusive" in countries deficient in support services, are often neglected and consigned to a life in poorly managed segregated institutions, as is the case in China, Russia and some countries in Eastern Europe. Non western countries that have a long history of a globalised economy, such as Taiwan and Japan also remain committed to segregated institutional provisions for people with an intellectual disability, despite a notional acceptance of inclusionary policies enunciated by the United Nations Declarations and Conventions. In this paper is concluded that it must be recognised that the population of people with an intellectual disability, regardless of how the condition is defined and classified, is quite heterogeneous. Their needs are also varied and not at all dissimilar to those of the general population. As developing countries adopt western style consumer-driven economies, there is an extreme danger that they, too, will follow the same trajectory of exclusion and impose the culture of "otherness" for a group whose contribution to that society will be devalued. Good science is futile unless it benefits all peoples.

The present, past and future of the study of intellectual disability: challenges in developing countries: [review]

There is strong evidence that socio-cultural factors largely determine what is seen as competent behaviour. Within western high income countries, driven by the values of utilitarian individualism, the construct of intellectual disability has been largely determined to meet the needs of urban, industrialised societies. In contrast, competence in non-industrialised societies may be more reflected in collaborative, interpersonal problem solving skills such as those found among Nigerian students labelled as intellectually disabled. However, people who are judged to be incompetent or "obtrusive" in countries deficient in support services, are often neglected and consigned to a life in poorly managed segregated institutions, as is the case in China, Russia and some countries in Eastern Europe. Non western countries that have a long history of a globalised economy, such as Taiwan and Japan also remain committed to segregated institutional provisions for people with an intellectual disability, despite a notional acceptance of inclusionary policies enunciated by the United Nations’ Declarations and Conventions. In this paper is concluded that it must be recognised that the population of people with an intellectual disability, regardless of how the condition is defined and classified, is quite heterogeneous. Their needs are also varied and not at all dissimilar to those of the general population. As developing countries adopt western style consumer-driven economies, there is an extreme danger that they, too, will follow the same trajectory of exclusion and impose the culture of "otherness" for a group whose contribution to that society will be devalued. Good science is futile unless it benefits all peoples.

Existe amplia evidencia de que los factores socioculturales determinan en gran medida la percepción de conducta competitiva. En los países occidentales de altos ingresos, dominados por los valores del individualismo utilitario, las necesidades de las sociedades urbanas industrializadas han sido el principal determinante del concepto de discapacidad intelectual. A diferencia de esto, en las sociedades no industrializadas, la competencia puede verse mejor reflejada en las habilidades colaborativas, interpersonales para la resolución de problemas, tales como las que se encuentran entre estudiantes nigerianos considerados como intelectualmente discapacitados. Sin embargo, en los países deficientes en servicios de apoyo, a las personas consideradas incompetentes o "impertinentes" con frecuencia se les descuida y se les obliga a vivir en instituciones segregadas pobremente administradas, como por ejemplo en China, Rusia y en algunos países de Europa Oriental. Otros países no occidentales que tienen una larga historia de economía globalizada, como Taiwan y Japón permanecen igualmente fieles al modelo de instituciones segregadas para las personas con discapacidad intelectual, a pesar de una aceptación nominal de las políticas inclusivistas enunciadas por las declaraciones y convenciones de las Naciones Unidas. En este artículo se concluye que se debe reconocer la heterogeneidad que existe entre la población con discapacidad intelectual independientemente de cómo se defina y clasifique la condición. Sus necesidades son asimismo variadas y no disímiles respecto de las de la población general. En la medida en que los países en desarrollo adoptan economías de estilo occidental, orientadas hacia el consumo, existe un gran riesgo de que sigan también la misma trayectoria de exclusión y le impongan la cultura de la "otredad" a un grupo cuya contribución a esa sociedad sería devaluada. A menos que beneficie a todos la buena ciencia es inútil.

The relationship between neurobehavioural problems of severe traumatic brain injury (TBI), family functioning and the psychological well-being of the spouse/caregiver: path model analysis.

This study used a modern theory of stress as a framework to strengthen the understanding of the relationship between neurobehavioural problems of TBI, family functioning and psychological distress in spouse/caregivers. The research was an ex post facto design utilising a cross-sectional methodology. Path analysis was used to determine the structural effect of neurobehavioural problems on family functioning and psychological distress. Forty-seven female and 17 male spouse/caregivers of partners with severe TBI were recruited. Spouse/caregivers who reported partners with TBI as having high levels of behavioural and cognitive problems experienced high levels of unhealthy family functioning. High levels of unhealthy family functioning were related to high levels of distress in spouse/caregivers, as family functioning had a moderate influence on psychological distress. Furthermore, indirect effects of behavioural and cognitive problems operating through family functioning intensified the level of psychological distress experienced by spouse/caregivers. Additionally, spouse/caregivers who reported high levels of behavioural, communication and social problems in their partners also experienced high levels of psychological distress. This study was significant because the impact of TBI on the spouse/caregiver from a multidimensional perspective is an important and under-researched area in the brain injury and disability field.