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1.
Phys Rev Lett ; 125(7): 070603, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32857528

RESUMO

We propose a thermodynamic refrigeration cycle which uses indefinite causal orders to achieve nonclassical cooling. The cycle cools a cold reservoir while consuming purity in a control qubit. We first show that the application to an input state of two identical thermalizing channels of temperature T in an indefinite causal order can result in an output state with a temperature not equal to T. We investigate the properties of the refrigeration cycle and show that thermodynamically, the result is compatible with unitary quantum mechanics in the circuit model but could not be achieved classically. We believe that this cycle could be implemented experimentally using tabletop photonics. Our result suggests the development of a new class of thermodynamic resource theories in which operations are allowed to be performed in an indefinite causal order.

2.
Phys Rev Lett ; 125(11): 117401, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32975978

RESUMO

We report the observation of a mode associated with a topological defect in the bulk of a 2D photonic material by introducing a vortex distortion to a hexagonal lattice analogous to graphene. The observed modes lie midgap at zero energy and are closely related to Majorana bound states in superconducting vortices. This is the first experimental demonstration of the Jackiw-Rossi model [R. Jackiw and P. Rossi, Nucl. Phys. B190, 681 (1981)NUPBBO0550-321310.1016/0550-3213(81)90044-4].

3.
J Appl Res Intellect Disabil ; 31(6): 983-998, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29947444

RESUMO

BACKGROUND: The review examined the effectiveness of Active Support (RQ1) and stakeholders' experiences of the model (RQ2). METHOD: Data were meta-analysed (RQ1; studies = 14) and synthesized narratively (RQ2; studies = 10). RESULTS: By follow-up (6 months post-training), effect sizes (RQ1) for resident total activity engagement were significant and ranged from small (d = 0.33, 95% CIs: 0.10-0.50) to large (Tau-U = 0.95, 95% CIs: 0.64-1.25) depending on study design. Follow-up changes in staff assistance were moderate (d = 0.56, 95% CIs: 0.23-0.89; Tau-U 0.63, 95% CIs: 0.32-0.93) and large for quality of support (d = 1.03, 95% CIs: 0.61-1.44). Other outcomes did not change. CONCLUSIONS: Active Support was more effective following complete staff training, in larger settings, at lower staff-to-resident ratios and with less experienced staff. Active Support training and outcomes were valued by staff and residents (RQ2), and staff experienced increased job satisfaction. Lower staff turnover and organizational readiness appear crucial for maintaining implementation.


Assuntos
Deficiência Intelectual/reabilitação , Relações Interpessoais , Avaliação de Resultados em Cuidados de Saúde , Assistência Centrada no Paciente/métodos , Instituições Residenciais , Apoio Social , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Adulto Jovem
4.
Am J Med Genet A ; 167(7): 1493-500, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25820775

RESUMO

As part of a wider study to investigate the behavioral phenotype of a national sample of girls and women with Rett syndrome (RTT) in comparison to a well-chosen contrast group and its relationship to parental well-being, the development, clinical severity, current abilities and health of 91 participants were analyzed in relation to diagnostic, clinical and genetic mutation categories. Early truncating mutations or large deletions were associated with greater severity. Early regression was also associated with greater severity. All three were associated with lower current abilities. Epilepsy and weight, gastrointestinal and bowel problems were common co-morbidities. Participants with classic RTT had greater health problems than those with atypical RTT. A substantial minority of respondents reported fairly frequent signs of possible pain experienced by their relative with RTT. Overall, the study provides new data on the current abilities and general health of people with RTT and adds to the evidence that the severity of the condition and variation of subsequent disability, albeit generally within the profound range, may be related to gene mutation. The presence of certain co-morbidities represents a substantial ongoing need for better health. The experience of pain requires further investigation.


Assuntos
Epilepsia/patologia , Trato Gastrointestinal/patologia , Nível de Saúde , Proteína 2 de Ligação a Metil-CpG/genética , Síndrome de Rett/epidemiologia , Síndrome de Rett/genética , Síndrome de Rett/patologia , Peso Corporal/fisiologia , Feminino , Humanos , Mutação/genética , Estatísticas não Paramétricas , Inquéritos e Questionários
5.
J Appl Res Intellect Disabil ; 27(3): 200-11, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24030888

RESUMO

BACKGROUND: People with intellectual disabilities experience disparities in their health and health care. Annual health checks are intended to counter such disparity by improving access to primary health care. However, little is known about their experience of having a health check or other types of contact with primary care services. MATERIALS AND METHODS: The findings of two studies which used focus groups were combined. 102 people with intellectual disabilities participated in the focus groups. RESULTS: Participants' experiences of primary care services generally, and health checks in particular, were positive. However, unanimity was rare on any of the topics discussed and a number of areas of dissatisfaction emerged. CONCLUSIONS: Further studies with larger and more representative samples are necessary as feedback from people with intellectual disabilities about their experience of contact with primary care staff might help to enhance GP knowledge about their health requirements.


Assuntos
Medicina Geral/normas , Deficiência Intelectual/reabilitação , Atenção Primária à Saúde/normas , Adulto , Comportamento do Consumidor , Grupos Focais , Humanos , Relações Profissional-Paciente , País de Gales
6.
Br J Psychiatry ; 203(3): 288-96, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23520220

RESUMO

BACKGROUND: Many people with intellectual disabilities find it hard to control their anger and this often leads to aggression which can have serious consequences, such as exclusion from mainstream services and the need for potentially more expensive emergency placements. AIMS: To evaluate the effectiveness of a cognitive-behavioural therapy (CBT) intervention for anger management in people with intellectual disabilities. METHOD: A cluster-randomised trial of group-based 12-week CBT, which took place in day services for people with intellectual disabilities and was delivered by care staff using a treatment manual. Participants were 179 service users identified as having problems with anger control randomly assigned to either anger management or treatment as usual. Assessments were conducted before the intervention, and at 16 weeks and 10 months after randomisation (trial registration: ISRCTN37509773). RESULTS: The intervention had only a small, and non-significant, effect on participants' reports of anger on the Provocation Index, the primary outcome measure (mean difference 2.8, 95% CI -1.7 to 7.4 at 10 months). However, keyworker Provocation Index ratings were significantly lower in both follow-up assessments, as were service-user ratings on another self-report anger measure based on personally salient triggers. Both service users and their keyworkers reported greater usage of anger coping skills at both follow-up assessments and keyworkers and home carers reported lower levels of challenging behaviour. CONCLUSIONS: The intervention was effective in improving anger control by people with intellectual disabilities. It provides evidence of the effectiveness of a CBT intervention for this client group and demonstrates that the staff who work with them can be trained and supervised to deliver such an intervention with reasonable fidelity.


Assuntos
Ira , Terapia Cognitivo-Comportamental/métodos , Deficiência Intelectual/terapia , Psicoterapia de Grupo/métodos , Adaptação Psicológica , Adulto , Análise por Conglomerados , Terapia Cognitivo-Comportamental/economia , Custos e Análise de Custo , Feminino , Humanos , Deficiência Intelectual/economia , Deficiência Intelectual/psicologia , Masculino , Pessoa de Meia-Idade , Psicoterapia de Grupo/economia , Resultado do Tratamento
7.
J Appl Res Intellect Disabil ; 26(1): 63-70, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23255379

RESUMO

AIM: To explore the experience of 'lay therapists' of a group-based cognitive behaviour therapy (CBT) anger management intervention. BACKGROUND: Staff employed in daytime opportunity services for adults with intellectual disabilities took on the role of 'lay therapist' to facilitate CBT groups. METHODS: They were trained and supervised by clinical psychologists and interviewed 2-6 weeks after the last group session. Their experiences were explored by means of a qualitative approach, interpretative phenomenological analysis (IPA). RESULTS: Several key themes emerged from the interview data such as 'hopes and fears', 'having a framework', 'making it work', 'observing progress', 'ingredients of success', 'the therapist role' and 'taking the group forward'. CONCLUSIONS: These themes indicate that participants' experiences had been perceived as positive for themselves, the service users as well as the relevant organization although initially the therapist role had appeared daunting.


Assuntos
Ira , Atitude do Pessoal de Saúde , Terapia Cognitivo-Comportamental/métodos , Deficiência Intelectual/terapia , Papel Profissional/psicologia , Psicoterapia de Grupo/organização & administração , Adulto , Competência Clínica , Feminino , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Acessibilidade aos Serviços de Saúde , Humanos , Deficiência Intelectual/psicologia , Masculino , Pessoa de Meia-Idade , Pessoas com Deficiência Mental/psicologia , Pesquisa Qualitativa , Desenvolvimento de Pessoal , Adulto Jovem
8.
J Appl Res Intellect Disabil ; 26(5): 410-9, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23925964

RESUMO

BACKGROUND: Many people with intellectual disabilities display high levels of anger, and cognitive-behavioural anger management interventions are used routinely. However, for these methods to be used optimally, a better understanding is needed of different forms of anger assessment. The aim of this study was to investigate the relationship of a range of measures to self- and carer reports of anger expression, including instruments used to assess mental health and challenging behaviour. METHOD: Adults with intellectual disabilities, who had been identified as having problems with anger control, their key-workers and home carers all rated the service users' trait anger, using parallel versions of the same instrument (the Provocation Inventory). In addition, service users completed a battery of mental health assessments (the Glasgow Depression Scale, Glasgow Anxiety Scale and Rosenberg Self-Esteem Scale), and both groups of carers completed a battery of challenging behaviour measures (the Hyperactivity and Irritability domains of the Aberrant Behavior Checklist and the Modified Overt Anger Scale). RESULTS: Participants had high levels of mental health problems (depression: 34%; anxiety: 73%) and severe challenging behaviour (26%). Hierarchical linear regression analysis was used to explore the extent to which anger ratings by the three groups of respondents were predicted by demographic factors, mental health measures and challenging behaviour measures. Older service users rated themselves as less angry and were also rated as less angry by home carers, but not by key-workers. More intellectually able service users were rated as more angry by both sets of carers, but not by the service users themselves. Significantly, mental health status (but not challenging behaviour) predicted service users' self-ratings of anger, whereas challenging behaviour (but not mental health status) predicted carers' ratings of service users' anger. CONCLUSIONS: Service users and their carers appear to use different information when rating the service users' anger. Service users' self-ratings reflect their internal emotional state and mental health, as reflected by their ratings of anxiety and depression, whereas staff rate service users' anger on the basis of overt behaviours, as measured by challenging behaviour scales.


Assuntos
Ira/fisiologia , Deficiência Intelectual/psicologia , Transtornos Mentais/psicologia , Autorrelato/normas , Adulto , Fatores Etários , Cuidadores/psicologia , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Escalas de Wechsler
9.
J Appl Res Intellect Disabil ; 25(1): 60-70, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22473949

RESUMO

BACKGROUND: Increased provision of out-of-family residential support is required because of demographic changes within the intellectual disabilities population. Residential support now has to be provided in a climate requiring both financial constraint and high quality service outcomes. The aim was to evaluate the quality of life consequences of living with less intensive staff support, resulting from the introduction of more targeted staff allocation coupled with telecare. METHODS: The study comprised 91 participants who lived in 33 settings. The targeted support/telecare intervention was implemented at staggered intervals in 25 of these settings (63 participants). Data on a range of participant and setting descriptors, quality of care, and a range of objective lifestyle indicators were collected at four points in time over 2 years. Impact of the intervention was evaluated using within-group comparisons over time. RESULTS: Comparison between pre- and post-intervention showed that staffing levels were significantly reduced by 23%, whereas they were constant in the absence of intervention. One health indicator improved in the absence of intervention and another improved following intervention. There were no significant changes in any other lifestyle indicators (safety, money, social and community activity, independence or choice). CONCLUSIONS: A combination of targeted support and telecare had no adverse short-term affect on participants' quality of life, but reduced staff input so it seems that they have a role to play in the strategic development of out-of-family placements for adults with intellectual disabilities. Further research is needed to explore in more detail how efficiency is achieved in practice.


Assuntos
Cuidadores/organização & administração , Lares para Grupos/organização & administração , Estilo de Vida , Pessoas com Deficiência Mental/reabilitação , Telemedicina/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores/economia , Feminino , Seguimentos , Lares para Grupos/economia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Telemedicina/economia , Telemedicina/instrumentação , Recursos Humanos , Adulto Jovem
10.
Epilepsia ; 52(7): 1223-30, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21453357

RESUMO

PURPOSE: No study to date has prospectively investigated the impact of epilepsy on psychiatric disorders among adults with an intellectual disability (ID). This study aimed to determine prospectively the influence of epilepsy on the development of psychiatric disorders in adults with ID. METHOD: Psychiatric symptoms were measured prospectively over a 1-year period among 45 adults with ID and active epilepsy and 45 adults with ID without epilepsy, matched on level of ID. The 1-year incidence rate (IR) of commonly occurring Axis 1 psychiatric disorders was compared with and without controlling for possible confounding factors. Total psychiatric symptom scores over the period were compared between the two groups using repeated-measures analysis of covariance. KEY FINDINGS: Adults with epilepsy and ID had a more than seven times increased risk for developing psychiatric disorders, particularly depression and unspecified disorders of presumed organic origin, including dementia, over a 1-year period compared to those with ID only. Comparison of the psychiatric scores showed the epilepsy group to have significantly higher unspecified disorder and depression symptom scores. SIGNIFICANCE: The findings point to an increased risk of depression and unspecified disorders, including dementia, among adults with ID and epilepsy. Further exploration of the nature and treatment of these unspecified disorders may help the care of people with epilepsy and ID.


Assuntos
Epilepsia/complicações , Deficiência Intelectual/complicações , Transtornos Mentais/etiologia , Adulto , Análise de Variância , Transtornos de Ansiedade/etiologia , Estudos de Casos e Controles , Intervalos de Confiança , Transtorno Depressivo/etiologia , Epilepsia/psicologia , Feminino , Humanos , Deficiência Intelectual/psicologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores de Risco
11.
Seizure ; 18(4): 279-84, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19084433

RESUMO

PURPOSE: To investigate the efficacy and safety of levetiracetam in adults with intellectual disabilities who have uncontrolled partial or generalised epilepsy. METHODS: An open label prospective study compared seizure frequency, adverse effects, participant challenging behaviour, carers' concerns about epilepsy and perceived participant quality of life between a baseline observation prior to the use of levetiracetam and follow-up observations at 3, 6, 9 and 12 months afterwards. Challenging behaviour, carers' concerns about epilepsy and perceived quality of life were assessed using standardized measures. RESULTS: Recruitment was low (n=42). Six participants did not enter the trial. Two participants withdrew at initiation of treatment, one with seizures worsening and one with a rash, and a further one later on with a rash; all were felt to be drug related. Three other participants withdrew for independent reasons. Twelve months follow-up was achieved for 26 participants (62%) and at least 6 months follow-up for 30 participants (71%). Median seizure frequency reduced from baseline levels of 4.2 per week to average post-intervention levels of 2.2 for the 30 participants (z=-2.53, p<.05). No overall change in challenging behaviour was found, although increases in behaviour problems were reported for a minority. Patient concerns about seizures and medical treatment declined and perceived quality of life relating to seizure severity improved whilst that related to behaviour deteriorated. Increased adverse effects were reported immediately after initiation of levetiracetam but declined towards baseline levels by study completion. DISCUSSION: Conclusions must remain tentative due to methodological weaknesses. Further investigation of the possible changes found here within a controlled study is merited.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Deficiência Intelectual/complicações , Deficiência Intelectual/tratamento farmacológico , Piracetam/análogos & derivados , Adulto , Idoso , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Levetiracetam , Masculino , Pessoa de Meia-Idade , Piracetam/uso terapêutico , Estudos Prospectivos , Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
Am J Ment Retard ; 113(2): 87-101, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18240878

RESUMO

In a matched-groups design, costs and quality of life outcomes for adults with intellectual disabilities with relatively low support needs were compared between those in fully staffed group homes (n = 35) and in semi-independent living (n = 35). Data were collected on participant characteristics, setting organization, various lifestyle outcomes, and costs. There were no differences in the majority of lifestyle outcome measures. Fully staffed participants had better outcomes in money management and some health indicators. Semi-independent living participants had better outcomes for choice and community activities undertaken without staff support. Costs for semi-independent living were less. On balance, semi-independent living could offer certain cost-effective lifestyle advantages provided that sufficient attention is given to health, living, and financial well-being.


Assuntos
Atividades Cotidianas , Serviços Comunitários de Saúde Mental/economia , Lares para Grupos/economia , Deficiência Intelectual/economia , Estilo de Vida , Qualidade de Vida/psicologia , Atividades Cotidianas/psicologia , Adulto , Comportamento do Consumidor , Análise Custo-Benefício , Hospital Dia/economia , Inglaterra , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Deficiência Intelectual/psicologia , Deficiência Intelectual/reabilitação , Masculino , Análise por Pareamento , Avaliação de Processos e Resultados em Cuidados de Saúde , Ajustamento Social , Meio Social , Apoio Social , País de Gales
13.
Orphanet J Rare Dis ; 13(1): 185, 2018 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-30359268

RESUMO

BACKGROUND: It is well documented that mothers of children with intellectual disabilities or autism experience elevated stress, with mental health compromised. However, comparatively little is known about mothers of children with rare genetic syndromes. This study describes mental health and well-being in mothers of children with 13 rare genetic syndromes and contrasts the results with mothers of children with autism. METHODS: Mothers of children with 13 genetic syndromes (n = 646; Angelman, Cornelia de Lange, Down, Fragile-X, Phelan McDermid, Prader-Willi, Rett, Rubenstein Taybi, Smith Magenis, Soto, Tuberous Sclerosis Complex, 1p36 deletion and 8p23 deletion syndromes) and mothers of children with autism (n = 66) completed measures of positive mental health, stress and depression. Using Bayesian methodology, the influence of syndrome, child ability, and mother and child age were explored in relation to each outcome. Bayesian Model Averaging was used to explore maternal depression, positive gain and positive affect, and maternal stress was tested using an ordinal probit regression model. RESULTS: Different child and mother factors influenced different aspects of mental well-being, and critically, the importance of these factors differed between syndromes. Maternal depression was influenced by child ability in only four syndromes, with the other syndromes reporting elevated or lower levels of maternal depression regardless of child factors. Maternal stress showed a more complex pattern of interaction with child ability, and for some groups, child age. Within positive mental health, mother and child age were more influential than child ability. Some syndromes reported comparable levels of depression (SMS, 1p36, CdLS) and stress (SMS, AS) to mothers of children with autism. CONCLUSIONS: Bayesian methodology was used in a novel manner to explore factors that explain variability in mental health amongst mothers of children with rare genetic disorders. Significant proportions of mothers of children with specific genetic syndromes experienced levels of depression and stress similar to those reported by mothers of children with autism. Identifying such high-risk mothers allows for potential early intervention and the implementation of support structures.


Assuntos
Transtorno Autístico , Saúde Mental , Mães/psicologia , Doenças Raras , Adolescente , Adulto , Teorema de Bayes , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Fatores de Risco , Adulto Jovem
15.
Dev Neurorehabil ; 20(5): 261-265, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27019123

RESUMO

PURPOSE: There is an emerging research literature on the experiences of family members of girls and women with Rett syndrome (RTT), but a lack of longitudinal data. METHODS: Fifty mothers whose daughters had RTT were surveyed 16-17 months after an earlier cross-sectional study. Measures completed at both time points focused on maternal positive and negative psychological well-being and their daughters' behavioral and emotional problems and RTT behavioral phenotype severity. RESULTS: Maternal stress, anxiety, and depression demonstrated at least moderate levels of stability. Maternal positive perceptions were also moderately stable over 16-17 months. Longitudinal analyses suggested that their daughters' behavioral and emotional problems rather than RTT behavioral phenotype severity predicted later maternal well-being. CONCLUSION: Mothers with RTT daughters experience chronic stress (persisting over time) but also ongoing positive perceptions. Practitioners should recognize positive perceptions and also consider targeted behavioral parent training to reduce behavior problems in individuals with RTT.


Assuntos
Mães/psicologia , Síndrome de Rett/psicologia , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Criança , Feminino , Humanos , Pessoa de Meia-Idade , Estresse Psicológico/psicologia , Inquéritos e Questionários
16.
Health Technol Assess ; 21(47): 1-92, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28857740

RESUMO

BACKGROUND: Data suggest that approximately 50,000 adults with learning disabilities (LDs) in England and Wales are currently prescribed antipsychotic medication. Illness in this population is common, including significant rates of challenging behaviour and mental illness, but there is particular concern over the use of antipsychotics prescribed for reasons other than the treatment of psychosis. Control of challenging behaviour is the primary reason why such medications are prescribed despite the absence of good evidence for any therapeutic effect for this purpose. OBJECTIVES: To assess the feasibility of recruitment and retention and to explore non-efficacy-based barriers to a blinded antipsychotic medication withdrawal programme for adults with LDs without psychosis compared with treatment as usual. A secondary objective was to compare trial arms regarding clinical outcomes. DESIGN: A two-arm individually randomised double-blind placebo-controlled drug reduction trial. SETTING: Recruitment was through community learning disability teams (CLDTs) in south Wales and south-west England. PARTICIPANTS: Adults with LDs who are prescribed risperidone for treatment of challenging behaviour with no known current psychosis or previous recurrence of psychosis following prior drug reduction. INTERVENTION: A double-blind drug reduction programme leading to full withdrawal within 6 months. Treatment in the intervention group was gradually reduced over a 6-month period and then maintained at the same level for a further 3 months, still under blind conditions. In the control group, the baseline level of medication was maintained throughout the 9-month period. The blind was broken at 9 months, following final data collection. MAIN OUTCOME MEASURES: Feasibility outcomes were (1) the number and proportion of general practices/CLDTs that progressed from initial approach to recruitment of participants and (2) the number and proportion of recruited participants who progressed through the various stages of the study. Trial arms were also compared regarding clinical outcomes, the Modified Overt Aggression Scale, the Aberrant Behaviour Checklist, the Psychiatric Assessment Schedule for Adults with Developmental Disability checklist, the Antipsychotic Side-effect Checklist, the Dyskinesia Identification System Condensed User Scale, the Client Service Receipt Inventory, use of other interventions to manage challenging behaviour, use of as-required (pro re nata) medication and level of psychotropic medication use. RESULTS: Of the 22 participants randomised (intervention, n = 11; control, n = 11), 13 (59%) achieved progression through all four stages of reduction. Follow-up data at 6 and 9 months were obtained for 17 participants (intervention, n = 10; and control, n = 7; 77% of those randomised). There were no clinically important changes in participants' levels of aggression or challenging behaviour at the end of the study. There were no expedited safety reports. Four adverse events and one serious adverse event were reported during the trial. LIMITATIONS: Recruitment was challenging, which was largely a result of difficulty in identifying appropriate persons to consent and carer concerns regarding re-emergence of challenging behaviour. Reduced recruitment meant that the full trial became an exploratory pilot study. CONCLUSIONS: The results indicate that drug reduction is possible and safe. However, concerns about taking part were probably exacerbated by limited availability of alternative (behavioural) interventions to manage behaviour; therefore, focused support and alternative interventions are required. The results of the qualitative study provide important insights into the experiences of people taking part in drug reduction studies that should influence future trial development. FUTURE WORK: We recommend that further work focuses on support for practitioners, carers and patients in reducing antipsychotic medication. TRIAL REGISTRATION: Current Controlled Trials ISRCTN38126962. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 47. See the NIHR Journals Library website for further project information.


Assuntos
Antipsicóticos/efeitos adversos , Análise Custo-Benefício , Deficiências da Aprendizagem/psicologia , Adulto , Agressão/psicologia , Antipsicóticos/uso terapêutico , Escalas de Graduação Psiquiátrica Breve , Método Duplo-Cego , Inglaterra , Feminino , Humanos , Masculino , Projetos Piloto , Pesquisa Qualitativa
17.
Br J Gen Pract ; 56(523): 93-8, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16464321

RESUMO

BACKGROUND: Adults with a learning disability frequently have unmet health needs. The cause for this is complex and may be related to difficulties in accessing usual primary care services. Health checks have been widely recommended as a solution to this need. AIM: To determine the likelihood that a structured health check by the primary care team supported by appropriate education would identify and treat previously unrecognised morbidity in adults with an intellectual disability. DESIGN OF STUDY: Individuals were identified within primary care teams and a structured health check performed by the primary care team. This process was supported by an educational resource. Face-to-face audit with the team was performed 3 months following the check. SETTING: Forty general practices within three health authorities in south and mid-Wales participated. They had a combined registered patient population of 354 000. METHOD: Health checks were conducted for 190 (60%) of 318 identified individuals; 128 people moved, died, withdrew from the study, or refused to participate. RESULTS: Complete data were available on 181 health checks; 51% had new needs recognised, of whom 63% had one health need, 25% two health needs, and 12% more than two. Sixteen patients (9%) had serious new morbidity discovered. Management had been initiated for 93% of the identified health needs by the time of audit. This study is the first to identify new disease findings in a primary care population and the likelihood that such disease will be treated. CONCLUSIONS: The findings reflect a concern that current care delivery leaves adults with an intellectual disability at risk of both severe and milder illness going unrecognised. Health checks present one mechanism for identifying and treating such illness in primary care.


Assuntos
Deficiência Intelectual/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Deficiência Intelectual/complicações , Masculino , Serviços de Saúde Mental/provisão & distribuição , Pessoa de Meia-Idade , Avaliação das Necessidades , País de Gales
19.
J Dev Phys Disabil ; 28: 425-441, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27340365

RESUMO

The aim was to observe the behaviour of a sample of females with RTT and explore how it was organized in relation to environmental events. Ten participants, all with a less severe form of classic (n = 9) or atypical (n = 1) Rett syndrome (RTT), were filmed at home and at school or day centre. Analysis used real-time data capture software. Observational categories distinguished engagement in social and non-social pursuits, hand stereotypies, self-injury and the receipt of attention from a parent, teacher or carer. Associations between participant behaviour and intake variables and receipt of attention were explored. Concurrent and lagged conditional probabilities between behavioural categories and receipt of attention were calculated. Receipt of adult attention was high. Engagement in activity using the hands was associated with a less severe condition and greater developmental age. Engagement in activity, whether using the hands or not, and social engagement were positively associated with receipt of support. The extent of hand stereotypies varied greatly across participants but was independent of environmental events. Six participants self-injured. There was some evidence that self-injury was related to adult attention. Participants appeared to experience a carer and attention rich environment and their levels of engagement seemed high as a result. As in the more general literature, engagement in activity was related to personal development and to social support. Self-injury contrasted with hand stereotypies in having possible environmental function.

20.
Am J Ment Retard ; 110(2): 121-35, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15762822

RESUMO

There is evidence of considerable variability in the quality of residential services and a tendency for residents' quality of life to co-vary with ability level. Quality of life of 154 people living in 47 small community residences was assessed using 14 subjective and objective indicators. Information on setting structure, processes, and staff working methods was collected. Factors associated with resident choice, activity, and social and community well-being were modeled using multivariate regression, which controlled for the confounding effect of ability level. Few factors associated with subjective quality of life were found. Resident ability and staff attention to residents had a strong effect across objective measures. Number of residents and staff had little explanatory power. Staff working methods had an inconsistent impact.


Assuntos
Serviços Comunitários de Saúde Mental , Lares para Grupos , Deficiência Intelectual/reabilitação , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autonomia Pessoal , Satisfação Pessoal , Qualidade de Vida , Tratamento Domiciliar/normas , Comportamento Social , Inquéritos e Questionários , Resultado do Tratamento
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