The experiences of family members of persons with intellectual disabilities who used residential care homes during the COVID-19 pandemic.

BACKGROUND: The global COVID-19 pandemic has shown the vulnerability of some population groups, including persons with intellectual and developmental disabilities (IDD). AIM: The present paper will provide more clarity and understanding of the experiences of family members of persons with IDD housed in residential facilities in Catalonia within the period of maximum restrictions during the COVID-19 pandemic. METHODS AND PROCEDURES: Semi-structured interviews were conducted using an interpretive phenomenological qualitative approach. Study participants consisted of 14 relatives of IDD individuals who were institutionalized in residence facilities or homes. The guiding questions emerged from group discussions with relatives of those with IDD who did not participate in the subsequent interviews. Drawing from this group, the factors that were identified to have had the greatest impact on their lives were later used to guide the interviews. Data collection was carried out in face-to-face individual interviews that were recorded together with the observations of two researchers between February and October 2022. RESULTS: Our analysis identified 4 main themes that developed into additional factors: the decision to stay at home or in the residence, fear, illness, and protocol. Individuals with IDD lost their daily routines, suffered from social isolation, and did not understand the situation. CONCLUSION: The results of this study allow for a better understanding of the experiences of families of persons with IDD in residential centres during the lockdown by identifying their needs and how to better support them in the future. OUTCOMES AND RESULTS: Knowledge and understanding of these events should allow for better management of similar situations in the future.

This study contributes to a growing body of research that examines the experiences of IDD individuals and their families during the early months of the COVID-19 pandemic. A qualitative phenomenological interpretative approach was used following the recommendations of qualitative research practices in health care. Our findings reveal that relatives of persons with IDD who lived in residential care homes felt that the residents were not adequately cared for by the staff, who applied measures for containment and contagion prevention that were disproportionate, resulting in their needs not being considered; these recommended measures had been developed for elderly care homes. Individuals with IDD lost their daily routines, suffered from social isolation, and did not understand the situation. The present findings show that residential care homes for persons with IDD require specific action protocols in crisis situations that are adapted to the needs and characteristics of each centre,thus adopting a model of care based on human rights.

THE RHEOENCEPHALOGRAPHIC STUDY OF THE INTERHEMISPHERIC ASYMMETRY OF CEREBRAL BLOOD FLOW IN HEALTHY AND MENTALLY RETARDED CHILDREN.

Aim - to study functional organization of hemodynamic processes in brain basins of healthy children and children with mild mental retardation depending on the nature of asymmetry and gradient of cerebral blood filling are investigated. The research executed in the scientific laboratory of the special and inclusive education department of the Armenian State Pedagogical University after Kh. Abovyan and Armenian State Institute of Physical Culture and Sport. The study involved children aged 8 to 11 years, a total of 131. 73 of them are healthy schoolchildren and 58 children with a low degree of mental retardation. Each category of subjects was divided into 2 age groups: 8-9 years and 10-11 years. The results of the experimental study of task performance show that interesting data have been obtained which will serve as a basis for the development of necessary means, methods, and conditions for the development of elementary practical orientation in mentally retarded elementary school children. The analysis of the results of the study allows us to highlight the following important points: in the control group, 88% of the examined patients showed a hyperfrontal pattern in terms of RI (rheogramm amplitude). In seven children, the hypermastoidal pattern was observed, and in the two children of the control group, no significant differences between the RI values in the frontal and mastoidal basins were found. The study involved 131 children aged 8 to 11 years old. 73 of them were healthy with normal physical and mental development as well as 58 children with a weak degree of mental retardation. The study was undertaken to determine which sport and physical activity allowed children with mental retardation. Established that the parameter of TPWV in 8-9-year-old and 10-11-year-old schoolchildren of the control group was significantly higher than that of experimental children in the frontal, bimostoidal and hemispheric basins.

Anterior segment indices in mentally retarded children.

To compare the anterior segment indices between mentally retarded and normal children. The current study was conducted as a cohort. In this study, 73 mentally retarded and 76 normal children were selected from normal school and special schools for mentally retarded children using random cluster sampling method. Mental retardation in children was confirmed by a psychologist. Optometry examinations including visual acuity and refraction were performed for all participants, and ultimately, corneal imaging measurements were taken by Pentacam. The mean age of mentally retarded and normal children was of 13.30 ± 1.83 and 13.05 ± 1.82 years, respectively (P = 0.180). A multiple generalized estimating equations model demonstrated that there is a significant association between central corneal thickness (CCT) (coef = 1.011, P < 0.001), corneal diameter (CD) (coef = 0.444, P = 0.046), anterior chamber depth (ACD) (coef = 0.23), P < 0.001) and index of vertical asymmetry (IVA) (coef = 0.12, P < 0.001) and mental retardation. Cerebral palsy children had higher keratoconus index (KI), central keratoconus index (CKI), index of height asymmetry(IHA), and index of height decentration (IHD) compared to those without cerebral palsy (P < 0.05). Children with moderate mental retardation had higher index of surface variance (ISV), IVA, IHA, and IHD than those with mild mental retardation (P < 0.05). The mean and standard deviation of CCT, CD, ACD and IVA index in mentally retarded children were 535.3 ± 46.68 micron, 11.87 ± 0.42 mm, 3.29 ± 0.24 mm and 0.25 ± 0.18 mm, respectively. These indices in the normal group were 525.53 ± 47.52 micron, 11.84 ± 0.38 mm, 3.15 ± 0.28 mm and 0.17 ± 0.05 mm, respectively. The findings of this study showed that some anterior segment indices were different in mentally retarded compared to normal children. Moreover, some keratoconus indicators were worse in cerebral palsy children and children with higher grade mental retardation. So, it is important to consider keratoconus screening in these children.

Supported employment interventions for workplace mental health of persons with mental disabilities in low-to-middle income countries: A scoping review.

OBJECTIVE: To review the evidence of supported employment interventions in low-to-middle income countries, documents their impact for persons with mental disorders in the open labour market and well as support decision making for its wider implementation in the workplace. DESIGN: The scoping review is conducted following guidelines in the Arksey and O'Malley (2005) Framework. DATA SOURCES AND ELIGIBILITY: Eleven databases which are PubMed, Scopus, Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo, SocINDEX, Open Grey and Sabinet were searched for articles published between January 2006 and January 2022. Both peer-reviewed articles and grey literature were eligible if they were on supported employment interventions in low-to-middle income countries. Only articles published in English were included. STUDY APPRAISAL AND SYNTHESIS: Articles were screened at title, abstract and full article levels by two independent teams with the use of Rayyan software. Deductive thematic analysis was used to synthesize evidence on the supported employment interventions implemented in LMICs, capturing evidence of their outcomes for persons with mental disabilities securing competitive work. RESULTS: The search yielded 7347 records and after screening by title and abstract, 188 studies were eligible for full article screening. Eight studies were included in this scoping review. Thematic descriptions of the findings were based on the availability of supported employment interventions within the context, the type of supported employment interventions as well as mental health and vocational outcomes in the workplace. CONCLUSIONS: There is limited evidence of supported employment interventions in low-to-middle income countries despite the promising potential it has as an intervention to address mental health problems in the workplace and facilitate work participation by persons with mental disabilities.

[Dental care and prevention possibilities for the mentally disabled currently]. / Az értelmi fogyatékkal élok fogászati kezelése és prevenciós lehetoségei napjainkban.

INTRODUCTION: In Hungary, dental care and prevention for mentally disabled individuals are becoming increasingly challenging. Currently, there are 100,000 intellectually disabled individuals in the country who require "special medical care". OBJECTIVE: The objective of this study was to develop and modify a relatively simple preventive procedure, adjusted to the mental capabilities of the patients, and implement it within a selected group. The study aimed to assess the results after 3 and 6 months, respectively, and to compare them with the international literature. METHOD: The preventive procedure was introduced to 49 patients admitted to the institute of Csömör Nursing Home and Daycare Institute of the Foundation for Equal Opportunities. To ensure the accuracy of the data, the patients were examined separately by 3 doctors. The program began with dental care training for both patients and nursing staff. The periodontal examinations were carried out by the team's periodontologist. The patients were checked after 3 and 6 months, respectively, and the data were recorded. RESULTS: No changes were registered in terms of the DMF-T index during this short period of time, therefore we applied the restorative index. However, a significant improvement was observed in the periodontal condition. DISCUSSION: The preventive procedure proved to be effective, considering the fact that all patients had periodontal problems due to neglected oral hygiene. As there was a significant improvement in the periodontal condition, an improvement of the DMF-T index dentition of the patients can also be expected in the future. CONCLUSION: Enhanced oral hygiene (advancing towards "normal oral hygiene" from the neglected oral hygiene of the patients) can bring about considerable improvement in the case of patients needing special medical care. To attain positive results, a proper approach and regular motivation are essential for both patients and caregivers. Orv Hetil. 2023; 164(37): 1456-1461.

Could Fixed Implants Be a Viable Treatment Option in Disabled Patients? A Clinical Retrospective Study.

PURPOSE: To verify the survival rates and marginal bone loss (MBL) of implants in patients with different disability types. MATERIALS AND METHODS: Clinical and radiographic assessments were performed in a total of 189 implants for fixed implant prostheses in 72 patients. Data were collected on loaded implants at least 1 year in function, and the mean observation time was 37.3 months. Implant survival was examined, and MBL was observed around the implants of two groups (mental disability vs physical disability) based on age, sex, implant location (anterior vs posterior), and prosthetic connection (internal vs external). RESULTS: Of the 189 implants, 4 failed; the total implant survival rate was 97.8% across a mean of 37.3 months. The cumulative survival rate at 85 months in a Kaplan-Meier survival curve analysis was 94.3% ± 3% in patients with mental disability and 50% ± 35.4% in patients with physical disability, which was a statistically significant difference between the disability groups (P = .006). Fisher exact test showed significant differences in MBL only with age (P < .001). The implant MBL by disability type-adjusted for age and observation period-showed significant differences in multiple linear regression analyses (P = .003). CONCLUSION: The implant survival rates in patients with disability were in line with those reported for nondisabled patients. The MBL of the implants was within the physiologic bone loss after implant loading. Implants in patients with mental disability showed higher cumulative survival rates than in patients with physical disability, but also a higher amount of MBL. Within the limitations of this study, dental implants for patients with disability are viable. These results can establish future implant treatment plans for this population. Int J Oral Maxillofac Implants 2023;38:562-568. doi: 10.11607/jomi.9880.

Tacit knowledge in dyads of persons with profound intellectual and multiple disabilities and their caregivers: An interpretative literature study.

BACKGROUND: Caring for persons with profound intellectual and multiple disabilities (PIMD) demands specific expertise. Tacit knowledge seems to play an important role, but little is known about its nature, including what is necessary for its development and transfer. AIM: To gain understanding of the nature and development of tacit knowledge between persons with PIMD and their caregivers. METHOD: We conducted an interpretative synthesis of literature on tacit knowledge in caregiving dyads with persons with PIMD, persons with dementia or infants. Twelve studies were included. RESULTS: Tacit knowledge is about caregivers and care-recipients becoming sensitive and responsive to each other's cues and together crafting care routines. Learning takes place in a constant process of action and response that transforms those involved. CONCLUSION: Building tacit knowledge together is necessary for persons with PIMD to learn to recognise and express their needs. Suggestions are made for ways to facilitate its development and transfer.

Importance of a multi-tiered treatment approach for intellectually and developmentally disabled patients with hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic, debilitating skin condition that is characterized by painful pustules, nodules, abscesses, and sinus tracts. The complicated and fast-evolving treatment of HS consists of a multi-tiered approach that includes, antibacterial, antihormonal, anti-inflammatory, and surgical options. Studies have demonstrated an earlier age of onset and increased prevalence of HS in patients with intellectual and developmental disability (IDD) compared to patients without IDD. To explore the use of an intensive multi-tiered HS management algorithm that requires monthly office visits, monthly intravenous therapy, and several daily treatment modalities in an HS population with IDD, we conducted an IRB-approved retrospective chart review of HS patients treated at the Albert Einstein College of Medicine-Montefiore HS Center (HSC) with diagnoses of concurrent IDD to investigate their demographic and diagnostic characteristics, as well as the spectrum of therapies employed in this cohort. A total of 22 HS patients with concomitant IDD, including trisomy 21, unspecified intellectual disability, autism spectrum disorder, and trisomy 13 were identified. Therapies utilized in this cohort for HS included topical and oral antibiotics, spironolactone, finasteride, oral contraceptive pills, infliximab, adalimumab, isotretinoin, intralesional and intramuscular triamcinolone injections, and excisional surgery. In conclusion, our findings indicate that despite the practical challenges, daily oral antibiotic regimens, anti-androgen combinations, oral retinoids, infliximab, adalimumab, and surgery collectively play important roles in treating HS patients with IDD. Our cases underscore the importance of utilizing the full range of modalities as the HS treatment algorithm continues to evolve.

Subjective perceptions that affect the continued employment of persons with mental disabilities in Japan: A mixed-methods study.

BACKGROUND: Among people with mental disabilities in Japan, 50.7% have left employment within a year despite the provision of employment support. Their subjective perceptions are likely relevant, as many causes for leaving employment are personal. However, thus far, employment continuity assessment has been based on objective indicators, while subjective evaluation remains underdeveloped. OBJECTIVE: We conducted a mixed-methods study to identify the subjective characteristics that impact the ability of persons with mental disabilities to continue working while receiving employment support. METHODS: In total, 41 participants with mental disabilities in continuous employment were included in the study, and data were collected using a demographic and employment status questionnaire and the Worker's Role Interview. Further, to clarify the constructs related to subjective perceptions of work continuity, the step for coding and theorization (SCAT) method was utilized. RESULTS: The results revealed five overarching superordinate concepts and 12 subordinate concepts of subjective perceptions regarding maintaining the current work and the future for participants who continue to work. These perceptions may be related to the participants' experience and the time course of work continuity. Subjective perceptions of difficulty levels were found to be the most and the least difficult for a reasonable accommodation without specific rules and awareness of the effects of work concepts, respectively. CONCLUSION: This research could facilitate the development of an employment support system based on people with mental disabilities' subjective needs, thus contributing to their continued employment.

The Voluntary Sterilisation Act: Best Interests, Caregivers, and Disability Rights.

How can caregivers' interests be balanced with disability rights in decisions about whether to sterilise an intellectually disabled person? This question is considered in the context of Singapore, a commonwealth country that lacks a test case. Singapore has a lesser-known history of eugenics, and has struck an uneasy compromise between communitarian values and obligations under the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in recent years. This article provides an overview of Singaporean law under the Voluntary Sterilisation Act 1974 and the Mental Capacity Act 2008, and compares this with the law in Canada, England and Wales, and Australia. This article also situates the CRPD in the context of Singapore's dualist view of international law and communitarian approach to disability policy. It argues that CRPD rights to bodily integrity can be presumptively upheld in best interests determinations on sterilisation, while caregivers' interests can be accommodated in a relational understanding of best interests. A decisional framework along these lines is proposed.

"Forwards, Not Backwards": How the U.S. Supreme Court May Save the Plight of Individuals with Mental Disabilities.

When federal district court Judge Carlton Reeves penned his opinion in U.S. v. Mississippi,1 the case that seemed poised to overhaul Mississippi's suffering mental health system, he began with the story of Ms. Melanie Worsham, a mental health patient, also a certified peer support specialist. Ms. Worsham works to help those like herself who suffer with lifelong serious mental illness (SMI) to "overcome the obstacles that might be getting in their way of living the life they want to live." She also assists those with SMI by aiding in "navigating the system, to find resources, and then just being moral support."2.

Parents with intellectual disability reporting on factors affecting their caregiving in the wake of the COVID-19 pandemic: A qualitative study.

BACKGROUND: Parents with intellectual disability are vulnerable to parenting stress and overwhelming life events. The COVID-19 pandemic constitutes a potentially overwhelming event, but there is little knowledge concerning the effects on parents' caregiving. The present study aimed to fill this gap. METHOD: Semi-structured interviews with 10 Swedish parents with intellectual disability were analysed using thematic analysis. RESULTS: One broad caregiving-related theme: increased caregiving demands and reduced resources for coping resulting in strained parent-child interactions and relationships. Four subthemes highlighted influential factors: pandemic information, professional support, social relationships and informal support, and children's school activities. Strained parent-child interactions were particularly common in the absence of adapted pandemic information, if professional and informal support were compromised, and if the parents had dealt with school-related changes. CONCLUSIONS: Findings support contextual models of caregiving and a stress-resources perspective, and emphasise the importance of adapted information and support to parents with intellectual disability during crises.

Effect of Indoor Climbing on Occupational Self-Efficacy and Employability: Results of a 10-Month Randomised Controlled Study of Persons with Intellectual Disability.

(1) Background: Indoor climbing has different effects at various levels, including physical, psychological, and social ones. It is of high interest to assess whether social skills developed through climbing can be transferred to another environment, such as the working environment. This study investigates the effects of indoor climbing on employability and occupational self-efficacy of people with intellectual disability, who possess lower levels of social competences in general. (2) Methods: A randomised controlled study (RCT) experimental study design with three groups was formed-one intervention (IG) and two control groups (CGI&II). For 10 months, the IG went climbing (two times per week), whereas the first CG followed a sports programme and the second CG served as controls. (3) Results: IG participants showed significant improvement in mental and somatic health over time. Regarding occupational self-efficacy, females had a significantly lower mean. Nevertheless, only the IG's female participants mean increased significantly over time. (4) Conclusions: Indoor climbing can be effective for improving occupational health and can be beneficial for specific groups; however, additional research is needed to further specify the influence of indoor climbing on a wider variety of aspects of the life of people with intellectual disability.

The State of Forensic Literature on Persons with Intellectual Disability Who Sexually Offend.

Persons with intellectual disability charged with sexual crimes (PWID/SC) pose a unique challenge for the forensic psychiatrist. They represent a heterogeneous group whose motivations and pathology range from a simple lack of adaptive functioning to more complex comorbid paraphilic disorders. Although there is a growing body of literature on the risk assessment and treatment of PWID/SC, there is a relative lack of guidance and research on the evaluation of these individuals throughout the legal processes that follow being charged with a sexual crime. To address this deficit, this article reviews the literature germane to several key aspects of this process. We first review the current understanding of intellectual disability and sexual pathology. We identify landmark legal decisions that may relate to PWID/SC. We then review the literature related to PWID/SC and competency assessments, defenses involving mental disease or impairment, sexually violent predator evaluations and court-mandated pharmacotherapy. We aim to both bring attention to this unique forensic population and highlight areas for further research and exploration.

The collaborative development through multidisciplinary and advocate consensus of an accessible notice of rights for people with intellectual disabilities in police custody.

Background People with intellectual disabilities are over-represented in the criminal justice system. The United Nations' Convention on the Rights of Persons with Disabilities (UNCRPD) enshrines a right to equal access to justice for persons with disabilities (Article 13, UNCRPD). Accessible information is a key aspect of exercising this right. Yet, many jurisdictions, including Ireland, are yet to develop accessible information for disabled people who may be arrested. Aims This paper describes the collaborative development through multidisciplinary and advocate consensus of an accessible (Easy -to- Read) Notice of Rights (ERNR) for people with intellectual disabilities in police custody in Ireland. Methods Guidelines developed by Ireland's representative organisation for people with intellectual disabilities and examples of international practice were used to develop a draft ERNR by the primary researcher in partnership with an expert from a representative organisation for people with intellectual disabilities. The ERNR was developed thereafter through two focus groups with a view to achieving consensus with a focus on accessibility, accuracy and layout. This included a multidisciplinary focus group with participants from a representative organisation for people with intellectual disabilities, psychology, speech and language therapy, the police force, public health, forensic psychiatry, mental health, law and, subsequently, a focus group of people with lived experience of intellectual disability. Results Progressive development of the ERNR resulted in incremental improvements in textual accuracy as well as the inclusion of more accessible language and imagery. Originality/value This is the first attempt at developing an easy-to-read document relating to the legal rights of suspects in police custody in Ireland and, accordingly, this procedural innovation promises to assist, not just persons with intellectual disabilities, but also those with limited literacy at the point of arrest. The methodology used in the preparation of the document, employing a focus group to achieve consensus with participation from both multiple disciplines and persons with an intellectual disability, is in harmony with the ethos of the UNCPRD. This methodology may usefully be employed by other member states that have ratified the Convention but have yet to develop accessible version of the legal rights and entitlements that extend to arrested persons under their domestic law.

Mental, Neurological, and Somatic Comorbidities and Their Treatment in Persons With Intellectual Disability.

BACKGROUND: Persons with intellectual disability (ID) often suffer from significant comorbidities. As data have been lacking until now, the present report is the first one containing outpatient data on the prevalence of ID in Germany, its comorbidities, and outpatient (drug) treatment. METHODS: This study is based on the nationwide outpatient billing data and drug prescription data of all SHI-insured adults (SHI, statutory health insurance) (age 18-109) who were seen at least once in an outpatient medical practice in 2018. Patients with at least two F70-F79 diagnoses in two quarters were included in the study group (SG) (n = 324 428). A random sample of patients without ID served as the control/comparison group (CG) (n = 648 856). The odds ratios (SG vs. CG) for comorbidities, prescriptions of selected classes of drugs, and involvement of medical specialties were each analyzed by multivariate logistic regression. RESULTS: The prevalence of ID was 0.55%. ID was found to be associated with a variety of comorbidities. The highest odds ratios [OR] were for infantile cerebral palsy (OR: 121.71; 95% confidence interval: [111.67; 132.67]), autism spectrum disorders (OR: 83.85 [75.54; 93.08]), and developmental disabilities (OR: 61.34 [58.86; 63.94]). The most frequently prescribed drug categories (as classified by the anatomic-therapeutic-chemical (ATC) convention) were psychoactive drugs (antipsychotic, anxiolytic, and hypnotic drugs and sedatives) and antiepileptic drugs (OR: 10.40 [10.27; 10.53] and 9.90 [9.75; 10.05], respectively). Both general practitioners (OR: 2.64 [2.59; 2.69]) and medical specialists were consulted by the SG more frequently than by the CG; the type of specialist most commonly consulted was in the neuropsychiatric field, i.e., a neurologist or psychiatrist (OR: 6.85 [6.77; 6.92]). CONCLUSION: A diagnosis of ID frequently appears in outpatient billing data. Future analyses should be devoted to the specific care of people with intellectual disability, who constitute an especially multimorbid and vulnerable patient group.

Representations of Sexuality among Persons with Intellectual Disability, as Perceived by Professionals in Specialized Institutions: A Systematic Review.

The objective of this systematic review is to make an inventory of the representations of the professionals of specialized institutions on the sexuality of persons with intellectual disabilities. The scientific studies were identified according to the PRISMA protocol using 18 databases, with keywords on sexuality and parenthood. Studies were reviewed through a methodological assessment and then a thematic analysis. Twenty-four studies were reviewed and three themes were identified: professionals' representations of gender, sexuality, and consent; professionals' perceptions of their role in supporting people's sexual lives; and the ways in which professionals construct representations of people's sexual lives. This corpus highlights deep paradoxes in the representations of professionals concerning the socio-affective needs and sexuality of people with intellectual disabilities, creating what we could define as a "system of incompatibility" and leading to difficulties in positioning. Support is still too random and subject to control logics in the name of protecting users, who are perceived as vulnerable. Training and new ways of teamwork appear to be central to supporting the evolution of the representations and practices of professionals. Future research anchored in practices and involving users as well as professionals is necessary to better understand the paradoxical aspects of professionals' representations and to draw alternative ways of constructing these representations.