Factors affecting access to daily oral and dental care among adults with intellectual disabilities.

BACKGROUND/PURPOSE: Accessing oral health care can be more difficult for adults with intellectual disabilities with reports of poorer levels of oral health. This investigation identifies factors influencing engagement in day-to-day oral and dental health care for adults with intellectual disabilities. METHOD: A survey, containing questions about facilitators and barriers to maintaining oral health and hygiene, was completed with adults with intellectual disabilities and their caregivers (N = 372). RESULTS: Data were analysed using thematic network analysis. Two global themes were identified; "Personal and lifestyle influences," mentioned more often as barriers to oral care, included physical, sensory, cognitive, behavioural and affective factors and "social and environmental factors," mentioned more as facilitators, included caregiver support, equipment and adaptations used and oral hygiene routine. CONCLUSIONS: Numerous individual, social and environmental factors influence oral care. A coordinated organisational response is advocated involving collaboration between dental and intellectual disability services and training for caregivers and people with intellectual disabilities.

Healthy lifestyles for adults with intellectual disability: knowledge, barriers, and facilitators.

BACKGROUND: People with intellectual disability (ID) are more likely to have health problems than people without disability. Little previous research has investigated health from the perspective of the people with ID themselves. We aimed to focus on what people with ID understand being healthy to mean and what their experiences are of healthy lifestyles. METHOD: Semistructured interviews were conducted with 13 adults with ID to ask them about their health and healthy lifestyles. Data were analysed thematically. RESULTS: Participants demonstrated understanding of what it means to be healthy, have a healthy diet, the dangers of substance misuse, and the benefits of exercise. Participants demonstrated some knowledge about rationales for engaging in healthy behaviours. The idea of moderation was raised, along with barriers and facilitators to engaging in a healthy lifestyle. CONCLUSIONS: Findings suggest that people with ID demonstrate some understanding of what constitutes being healthy and are aware of healthy lifestyles, the consequences of unhealthy behaviours, and of the need for moderation.

Approaches used to prevent and reduce the use of restrictive practices on adults with learning disabilities: Protocol for a realist review.

INTRODUCTION: The use of restrictive practices has significant adverse effects on the individual, care providers and organisations. This review will describe how, why, for whom, and in what circumstances approaches used by healthcare organisations work to prevent and reduce the use of restrictive practices on adults with learning disabilities. METHODS AND ANALYSIS: Evidence from the literature will be synthesised using a realist review approach - an interpretative, theory-driven approach to understand how complex healthcare approaches work in reducing the use of restrictive practices in these settings. In step 1, existing theories will be located to explore what approaches work by consulting with key topic experts, holding consultation workshops with healthcare professionals, academics, and experts by experience, and performing an informal search to help develop an initial programme theory. A systematic search will be performed in the second step in electronic databases. Further searches will be performed iteratively to test particular subcomponents of the initial programme theory, which will also include the use of the CLUSTER approach. Evidence judged as relevant and rigorous will be used to test the initial programme theory. In step three, data will be extracted and coded inductively and deductively. The final step will involve using a realist logic of analysis to refine the initial programme theory in light of evidence. This will then provide a basis to describe and explain what key approaches work, why, how and in what circumstances in preventing and reducing the use of restrictive practices in adults with learning disabilities in healthcare settings. RESULTS: Findings will be used to provide recommendations for practice and policymaking. REGISTRATION: In accordance with the guidelines, this realist review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 4th December 2019 (CRD42019158432).

Urine screening for clients with learning disabilities.

This article describes a study carried out to explore how common urinary tract infections are among adults with learning disabilities who use continence products. The study also evaluated the use of a product to assist urine sample collection with this client group.

Prevalence of strongyle nematodes in naturally infected ponies of different ages and during different seasons of the year in Louisiana.

One hundred and seventeen ponies were surveyed for the seasonal prevalence of strongyloid parasites, particularly cyathostomes, and for host- and age-related differences in these infections. For 56 ponies, all stages of the cyathostome life cycle, both mucosal and luminal, were enumerated. Total numbers of cyathostomes and percentage of developing larvae (DL) encysted in the mucosa remained constant in all 4 seasons of the year, whereas a significant increase in the percentage of adults in the cyathostome population occurred in fall. In yearling ponies, encysted early third-stage larvae constituted a significantly lower percentage of the cyathostome population, and DL and adults formed a significantly higher percentage, compared with those stages in older ponies, 2-5 yr of age. More species of cyathostomes were present in yearling ponies than in older ponies. Significant differences occurred in fecal egg counts at different seasons of the year, even though adult cyathostome and large strongyle numbers remained constant. Twenty-four species of cyathostomes were found year-round, and 2 rare species were found in only 2 or 3 seasons of the year. Prevalences for these 24 species were not significantly different during any season, although 5 species had significant differences in intensity levels of infection in certain seasons of the year. Three species of large strongyle (strongylinae) adults had significant seasonal variations in intensities. These were Strongylus edentatus and S. vulgaris, which occurred in significantly higher numbers in summer and fall, and Triodontophorus brevicauda, which was more numerous in spring and summer. Fourth- and fifth-stage larvae of S. vulgaris recovered from the mesenteric vasculature were significantly more numerous in winter and spring than in other seasons.

Gastrointestinal helminths of ponies in Louisiana: a comparison of species currently prevalent with those present 20 years ago.

A survey in Louisiana of gastrointestinal helminths recovered at necropsy from 117 ponies with minimal exposure to anthelmintics between 1989 and 2000 is compared with a survey conducted 20 yr earlier in the same region. An objective of this study was to determine whether species diversity has been affected by the advent and use of the macrocyclic lactone (ML) parasiticides and by the increased anthelmintic pressure on the helminth species infecting the general equine population. Twenty-six cyathostome species and 8 strongyle species were recovered. Two cyathostome species that were not found before, Cylicostephanus asymetricus and C. bidentatus, and 1 species of large strongyle, Oesophagodontus robustus, were added to the list of species found in Louisiana. All cyathostome and large strongyle species found previously were still present. But prevalences and intensities were significantly reduced for almost all large and small strongyle species. Prevalences and intensities of Oxyuris equi adults and larvae were reduced, whereas the prevalence of Parascaris equorum remained constant. The tapeworm Paranoplocephala mamillana was added to the list of parasite species found in Louisiana. Anoplocephala perfoliata remained the most common cestode. This species was found at the same level of intensity but increased slightly in prevalence. Anoplocephala magna was found less frequently than previously. The overall diversity of species remained reatively unchanged. The reasons for the differences in intensity and prevalence of strongyles between these 2 periods are unknown but might be related to the development and use of the broad-spectrum ML anthelmintics in the intervening period, a difference in the population of equids surveyed, different techniques used to identify the parasites, or differences in numbers of parasites identified (or to all).

The misdiagnosis of epilepsy in people with intellectual disabilities: a systematic review.

PURPOSE: Epilepsy is common in people with intellectual disabilities. Epilepsy can be difficult to diagnose and may be misdiagnosed in around 25% of cases. A systematic review was conducted to explore: (i) How common the misdiagnosis of epilepsy is amongst people with intellectual disabilities. (ii) Reasons for misdiagnosis of epilepsy. (iii) Implications of misdiagnosis. (iv) Improving diagnosis. METHODS: Primary studies and systematic reviews published in the English language between 1998 and 2008 were identified from electronic databases, experts, the Internet, grey literature, and citation tracking. Included studies were critically appraised by team members using the appraisal tools produced by the Critical Appraisal Skills Programme (CASP) at the Public Health Resource Unit, Oxford. RESULTS: Eight studies were included in the review and critically appraised: six cohort studies and two case studies. Where data was provided in the cohort studies between 32% and 38% of people with intellectual disabilities were diagnosed as not having epilepsy or as having nonepileptic events. The main reason for misdiagnosis was the misinterpretation of behavioural, physiological, syndrome related, medication related or psychological events by parents, paid carers and health professionals. CONCLUSIONS: Those working in epilepsy and intellectual disability services and families must be made more aware of the possibility of misdiagnosis. Future research is needed about the misdiagnosis of epilepsy amongst people with intellectual disabilities and carer knowledge.

Following up fighting fit: the long-term impact of health practitioner input on obesity and BMI amongst adults with intellectual disabilities.

This article presents findings on the long-term impact of health practitioner input to reduce obesity amongst adults with intellectual disabilities. Body mass index (BMI) was measured for an input group (N = 33) and a comparison group (N = 40) 6 years after the input group first received input. Data on BMI were collected at baseline, 6 months, 1 year and 6 years. Mean BMI for the input group reduced steadily over 6 years. Mean BMI in the non-input group rose initially, stabilized and then decreased (although remaining higher than at baseline). The input group demonstrated improvements in obesity levels and lost more weight than the non-input group. However, the differences between groups did not reach statistical significance. This and the improvements in BMI within the non-input group may be due to the relatively small sample size, effect size and the impact of other local initiatives.

Fighting fit? An evaluation of health practitioner input to improve healthy living and reduce obesity for adults with learning disabilities.

People with learning disabilities are at high risk of obesity and consequent health risks. This study aimed to (1) describe levels of obesity for adults supported by learning disability services, and to (2) evaluate the effectiveness of health practitioner input with individuals with learning disabilities. Body mass index (BMI) was measured at 6 month intervals and change in BMI over time was compared between a non-input group and a group receiving practitioner input to improve healthy living. Initially 35 percent of the non-input sample was classified as clinically obese. Mean BMI increased over time for the non-input group at first, but decreased for the group that received practitioner input. The differences in weight change between the two groups reached statistical significance with a greater weight reduction in the input group. Implications for service provision are discussed.