RESUMO
The present paper describes the conceptual basis of evidence-based classification of para-athletes with intellectual impairment (II). An extensive description of the theoretical and conceptual foundation of the system as currently conceived is provided, as are examples of its applications in the three sports included in the Paralympic programme for II-athletes in 2020 (i.e., athletics, swimming and table tennis). Evidence-based classification for II-athletes is driven by two central questions: i. How can intellectual impairment be substantiated in a valid and reliable way, and ii. Does intellectual impairment limit optimal sport proficiency? Evolution of the system and current best practice for addressing these questions are described, and suggestions for future research and development are provided. Challenges of understanding and assessing a complex (multifaceted and intersectional) impairment in the context of sport also are considered.
Assuntos
Desempenho Atlético/classificação , Paratletas/classificação , Pessoas com Deficiência Mental/classificação , Esportes para Pessoas com Deficiência/classificação , Desempenho Atlético/psicologia , Função Executiva , Humanos , Deficiência Intelectual/diagnóstico , Testes de Inteligência , Internacionalidade , Paratletas/psicologia , Pessoas com Deficiência Mental/psicologia , Desempenho Físico Funcional , Esportes para Pessoas com Deficiência/psicologia , Natação/classificação , Tênis/classificação , Atletismo/classificaçãoRESUMO
The purpose of para sport classification systems is to minimize the impact of impairment on competition outcome. Currently, athletes with intellectual impairment (II) compete in one class, regardless of the extent of activity limitation resulting from their impairment. Consequently, athletes with II that cause relatively minor difficulty in sport have a competitive advantage over athletes who have intellectual impairments that cause more significant advantage. This research investigated the efficacy of a measure of health-related functional impairment, derived from the World Health Organization International Classification of Functioning, Disability, and Health (ICF), as a tool to classify athletes with intellectual impairments (II) into groups with impairments that cause similar activity limitation. The first study used a Delphi technique to identify the most relevant codes within the ICF from which a measure of impairment presence and severity was derived. The second study investigated whether the measure could discriminate between groups of II athletes organized into three competition groups, and whether these groups could be predicted by ICF score. The ICF-based questionnaire shows promise as a conceptual approach and as a tool in this context, but this is a preliminary step before establishing a sport-specific approach to classification.
Assuntos
Desempenho Atlético/classificação , Deficiência Intelectual/classificação , Paratletas/classificação , Pessoas com Deficiência Mental/classificação , Inquéritos e Questionários , Adulto , Comitês Consultivos/organização & administração , Temperatura Corporal/fisiologia , Comorbidade , Técnica Delphi , Avaliação da Deficiência , Feminino , Humanos , Deficiência Intelectual/fisiopatologia , Testes de Inteligência , Internacionalidade , Masculino , Limitação da Mobilidade , Paratletas/psicologia , Índice de Gravidade de Doença , Distúrbios Somatossensoriais/fisiopatologia , Esportes para Pessoas com Deficiência/classificação , Natação/classificação , Tênis/classificação , Atletismo/classificação , Organização Mundial da SaúdeRESUMO
BACKGROUND: People with severe and profound levels of intellectual disability (ID) are frequently examined as a single group in research. However, these two groups may be significantly different, particularly in the area of emotional and behavioural difficulties. METHOD: The Developmental Behaviour Checklist (DBC) was completed by parents and caregivers of 107 people with severe ID and 22 people with profound ID at four time periods across 12 years. Regression analyses were used to examine trends in sub-scale scores across time and groups. RESULTS: Significant differences between the groups of people with severe and profound ID were found. People with profound ID had significantly lower scores across all sub-scales except Social Relating. This was usually related to fewer items being selected as present for people with profound ID, as opposed to the scores being attributable to lower item severity scores. CONCLUSIONS: There are significant differences between groups of people with severe and profound ID in scores on the DBC, indicating differences in behavioural and emotional problems. Caution should be exercised by researchers treating these two disparate groups as a single group, and by practitioners translating such findings into practice.
Assuntos
Sintomas Comportamentais/psicologia , Grupos Diagnósticos Relacionados/normas , Deficiência Intelectual/classificação , Transtornos Mentais/complicações , Pessoas com Deficiência Mental/classificação , Adolescente , Adulto , Idoso , Sintomas Comportamentais/classificação , Sintomas Comportamentais/complicações , Cuidadores/psicologia , Criança , Pré-Escolar , Estudos de Coortes , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Feminino , Humanos , Deficiência Intelectual/complicações , Deficiência Intelectual/enfermagem , Deficiência Intelectual/psicologia , Estudos Longitudinais , Masculino , Transtornos Mentais/classificação , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Pessoas com Deficiência Mental/psicologia , Índice de Gravidade de Doença , Adulto JovemRESUMO
Since 1991, the Minimum Data Set 2.0 (MDS 2.0) has been the mandated assessment in US nursing homes. The Resource Utilization Groups III (RUG-III) case-mix system provides person-specific means of allocating resources based on the variable costs of caring for persons with different needs. Retrospective analyses of data collected on a sample of 9707 nursing home residents (2.4% had an intellectual disability) were used to examine the fit of the RUG-III case-mix system for determining the cost of supporting persons with intellectual disability (intellectual disability). The RUG-III system explained 33.3% of the variance in age-weighted nursing time among persons with intellectual disability compared to 29.6% among other residents, making it a good fit among persons with intellectual disability in nursing homes. The RUG-III may also serve as the basis for the development of a classification system that describes the resource intensity of persons with intellectual disability in other settings that provide similar types of support.
Assuntos
Grupos Diagnósticos Relacionados/economia , Recursos em Saúde/economia , Casas de Saúde/economia , Pessoas com Deficiência Mental , Idoso , Grupos Diagnósticos Relacionados/classificação , Feminino , Recursos em Saúde/classificação , Recursos em Saúde/estatística & dados numéricos , Humanos , Masculino , Casas de Saúde/classificação , Casas de Saúde/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/economia , Pessoas com Deficiência Mental/classificação , Estudos RetrospectivosRESUMO
The article describes in an original way the concept of self-determination, including an analysis of its components and effects. The authors detail two groups of disorders of self-determination: subjective dissipation and subjective alienation. They sustain that this theoretical framework explains more fully the clinics of Intellectual Disability (DSM's Mental Retardation) and is more useful than IQ to orient teaching, therapeutic and rehabilitative interventions. The authors propose that the level and profile of self-determination of a person with intellectual disability should be utilized to sub-classify people with mental retardation diagnose, replacing the ranges of IQ traditionally used, and criticized as well, for useless.
Assuntos
Avaliação da Deficiência , Autonomia Pessoal , Pessoas com Deficiência Mental/classificação , HumanosRESUMO
OBJECTIVE: Adults with mental retardation have histories of cognitive and adaptive deficits posing unique ethical challenges for research consent assessment. This study examined the capacity of persons with mental retardation to consent to participate in randomized clinical trials. METHOD: A total of 150 adults (50 each with mild and moderate mental retardation and 50 comparison subjects without mental retardation) responded to a set of consent questions for a hypothetical randomized clinical trial testing a medication for aggressive disorders. Intelligence, adaptive behavior, medical treatment history, and consent history were evaluated. Univariate and multivariate methods were used to compare performance across and within groups. RESULTS: Comparison subjects scored significantly higher on measures of consent capacity than participants with mild mental retardation, who scored higher than those with moderate mental retardation. Most subjects with mental retardation were able to make a participation choice, and many understood research methods and appreciated the protagonist's disorder and the consequences of participation. Almost half of those with mild mental retardation understood human subject protections. Performance was weakest on understanding the purpose of research and reasoning about whether to participate, suggesting vulnerability to the therapeutic misconception. Psychiatric and experiential factors did not predict consent capacity. CONCLUSIONS: While adults with mental retardation as a group showed consent deficits, many attained consent capacity scores comparable to those of comparison subjects. Investigators should consider individual differences and a consent format suited to deficits in language, memory, and attention before restricting consent opportunities for persons with mental retardation.
Assuntos
Consentimento Livre e Esclarecido/normas , Competência Mental/normas , Pessoas com Deficiência Mental/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto/ética , Adulto , Idoso , Comportamento de Escolha , Compreensão/ética , Feminino , Humanos , Consentimento Livre e Esclarecido/ética , Masculino , Pessoa de Meia-Idade , Participação do Paciente , Direitos do Paciente , Seleção de Pacientes/ética , Pessoas com Deficiência Mental/classificação , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The SF-36 and the shorter SF-12 are widely used in clinical research and increasingly so in practice. Scoring is complex and the validity of a brief scorer for the SF-12 in a community and a clinic sample was examined. METHOD: The sample comprised respondents with complete data on the SF-12 from the community sample in the 1997 Australian National Survey of Mental Health and Well-being (n = 10,641) and from a clinical sample from the Clinical Research Unit for Anxiety and Depression (n = 1,725). Each SF-12 was scored by the standard method (using weights to five decimal places) or by the brief method (using weights that are integers only). RESULTS: Scores generated by the standard scorer correlated almost perfectly with the brief scorer in both the community and clinic samples. Means and standard deviations were similar and no individual scores deviated by more than 2.89 in the community sample or by 3.06 in the clinical sample. IMPLICATIONS: The brief, rounded integer scorer for the SF-12 is an appropriate substitute for the standard scorer when hand scoring is an advantage.
Assuntos
Indicadores Básicos de Saúde , Saúde Mental , Pessoas com Deficiência Mental/classificação , Ansiedade , Austrália , Serviços de Saúde Comunitária/estatística & dados numéricos , Depressão , Medicina de Família e Comunidade , Pesquisa sobre Serviços de Saúde , Humanos , Ambulatório Hospitalar/estatística & dados numéricos , Pessoas com Deficiência Mental/psicologiaRESUMO
During the planning stages of deinstitutionalization, the importance of nursing services must be recognized and given priority consideration in the community placement of persons with serious developmental disabilities. The objective of this study was to survey the medical and nursing profile of a group of nonambulatory, institutionalized individuals with profound mental retardation in anticipation of their nursing and medical needs in the community. Data were collected from the Individual Habilitation Plans of 55 individuals who had resided in a residential facility for individuals with mental retardation and were scheduled for community placement Serious medical problems in decreasing frequency were constipation (96%), seizure disorder (70%), poor dental hygiene (67%), cerebral palsy (62%), scoliosis (61%), contractions (41%), aspiration (44%), skin lesions (40%), and dysphagia (22%). Considering the complexity of health issues encountered in this population, adequate nursing and medical planning are critical to the wellness and successful community placement of a population with special needs.
Assuntos
Enfermagem em Saúde Comunitária , Desinstitucionalização , Deficiência Intelectual/enfermagem , Avaliação das Necessidades , Avaliação em Enfermagem , Pessoas com Deficiência Mental/reabilitação , Adulto , District of Columbia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pessoas com Deficiência Mental/classificaçãoRESUMO
As part of caseload management for community learning disability teams (CLDTs), it would appear reasonable that services would have a mechanism for prioritizing referrals and discharge planning. However, any formal mechanism in relation to these two aspects apparently is lacking within the literature. This theoretical article attempts to illustrate this evidence-base need, and demonstrate how a prioritization and/or discharge planning system would aid CLDTs. In light of the scarcity of material for the learning disability sector, information has been examined from other health domains such as mental health. The paper also presents a discussion on whether rationing of services is best done via explicit or implicit means. Issues related to setting referral criteria and the allocation of referrals are also considered. Although suggestions have been made for CLDTs, it is difficult to do so whilst the evidence base for this sector is so lacking.
Assuntos
Administração de Caso , Serviços Comunitários de Saúde Mental/organização & administração , Deficiência Intelectual/reabilitação , Deficiências da Aprendizagem/reabilitação , Equipe de Assistência ao Paciente , Alta do Paciente , Pessoas com Deficiência Mental/classificação , Medicina Baseada em Evidências , Prioridades em Saúde , Humanos , Encaminhamento e Consulta/organização & administração , Reino UnidoAssuntos
Avaliação da Deficiência , Crianças com Deficiência/classificação , Classificação Internacional de Doenças/classificação , Transtornos Mentais/diagnóstico , Pessoas com Deficiência Mental/classificação , Adolescente , Criança , Crianças com Deficiência/reabilitação , Alemanha , Humanos , Transtornos Mentais/classificação , Programas Nacionais de Saúde , Pessoas com Deficiência Mental/reabilitação , Organização Mundial da SaúdeAssuntos
Atitude Frente a Saúde , Pessoas com Deficiência/psicologia , Adaptação Psicológica , Cultura , Pessoas com Deficiência/classificação , Humanos , Pessoas Mentalmente Doentes/classificação , Pessoas Mentalmente Doentes/psicologia , Pessoas com Deficiência Mental/classificação , Pessoas com Deficiência Mental/psicologia , Autoimagem , Isolamento SocialAssuntos
Pessoas com Deficiência Mental , Terminologia como Assunto , Formação de Conceito , Humanos , Transtornos Mentais/classificação , Pessoas com Deficiência Mental/classificação , Pessoas com Deficiência Mental/legislação & jurisprudência , Pessoas com Deficiência Mental/reabilitação , Organização Mundial da SaúdeAssuntos
Transtornos Mentais/classificação , Pessoas com Deficiência Mental/classificação , Psiquiatria , Terminologia como Assunto , Psiquiatria Comunitária/organização & administração , Reforma dos Serviços de Saúde , Humanos , Serviços de Saúde Mental/organização & administração , Psiquiatria/organização & administração , SuéciaAssuntos
Serviços de Saúde Mental/história , Pessoas com Deficiência Mental/história , Psiquiatria/história , Eugenia (Ciência)/história , História do Século XIX , História do Século XX , Hospitais Psiquiátricos/história , Humanos , Casas de Saúde/história , Pessoas com Deficiência Mental/classificação , Pessoas com Deficiência Mental/psicologia , Instituições Residenciais/história , Esterilização Reprodutiva/história , SuéciaRESUMO
BACKGROUND AND AIMS: Samples of nursing homes in Tuscany (Italy) classify their residents and determine their case-mix according to the Resource Utilization Groups System, Version III (RUG-III). METHODS: A large sample of nursing homes was selected, based on willingness to participate, representation of both public and private institutions, and wide geographic representation. Two registered nurses assessed all residents using the RUG questionnaire. The information collected was then used to group residents into 44 RUGs, and facility-specific case-mix indices were calculated using the RUG-specific weights previously validated in Italy. RESULTS: A total of 3981 residents from 93 nursing homes were assessed. Most residents were over 75 years old (87.4%) and women (68.6%). A large percentage was classified into RUGs within the following primary categories: reduced physical function (33.6%), impaired cognition (17.6%) and clinically complex (17.6%). The resulting nursing home case-mix indices ranged from 0.627 to 1.108 (mean 0.807+/-0.110). No significant association was found between type of facility, level of fees, or extent of staff in the nursing homes and their case-mix indices. CONCLUSIONS: RUGIII can provide information on types of nursing home residents and their care needs. This is useful for monitoring and evaluating long-term care services for the elderly, and allows for more effective planning and allocation of staffing and financial resources.
Assuntos
Grupos Diagnósticos Relacionados/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Pacientes/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos , Pessoas com Deficiência/classificação , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Idoso Fragilizado/estatística & dados numéricos , Nível de Saúde , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Pacientes/estatística & dados numéricos , Pessoas com Deficiência Mental/classificação , Pessoas com Deficiência Mental/estatística & dados numéricos , Qualidade da Assistência à Saúde , Alocação de RecursosRESUMO
People with intellectual disabilities make up about 1% of the population of Europe. As trends toward community life advance, they have become more visible and more likely to access generic health systems. Yet evidence suggests that there are striking disparities between the health of this group and that of the general population. Increased longevity means that adults in this group expect to live longer lives and thus to encounter age-related risks for various health conditions. The 'Pomona' project, funded by the EU Health Monitoring Unit, aims to develop a set of health indicators for people with intellectual disabilities. It will build on the work accomplished by the team developing ECHI--European Community Health Indicators. This article outlines the rationale for the project, key elements in its implementation and expected outcomes.
Assuntos
Planejamento em Saúde , Indicadores Básicos de Saúde , Deficiência Intelectual/epidemiologia , Pessoas com Deficiência Mental/estatística & dados numéricos , Vigilância da População/métodos , Demografia , Europa (Continente)/epidemiologia , União Europeia , Humanos , Deficiência Intelectual/classificação , Cooperação Internacional , Expectativa de Vida , Pessoas com Deficiência Mental/classificação , Projetos Piloto , Informática em Saúde Pública , Qualidade de VidaAssuntos
Pessoas Mentalmente Doentes , Pessoas com Deficiência Mental/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Adulto , Cristianismo , Feminino , Reforma dos Serviços de Saúde , Humanos , Masculino , Pessoas com Deficiência Mental/classificação , Reino UnidoRESUMO
Se hace una revisión de los conceptos básicos sobre discapacidad mental, su etiología, prevalencia, clasificación, diagnóstico, manejo y prevención y se presenta un estudio de casos en 84 jóvenes pacientes de la Fundación General Ecuatoriana, haciendo incapié en las causas que originaron la condición.