An international study of public contact with people who have an intellectual disability.

BACKGROUND: People with intellectual disability (ID) are often socially isolated, and many experience stigma and discrimination. Increased contact with the general public is thought to overcome prejudices. This large-scale international study had three main aims: to determine the type and frequency of contact that the general public has with people with ID; to identify the personal characteristics of those who have greater contact; and to examine the public's level of comfort at the prospect of having contact with people with ID. METHOD: Self-completed online questionnaires were administered to nationally representative panels of respondents in 17 countries; totally 24 504 persons. Multivariate analyses were used to identify respondents more likely to have had frequent personal contact with persons with ID from those with infrequent or no contact and those respondents who were most comfortable at meeting a person with ID. RESULTS: Internationally around one in four of the general population reports having frequent personal contact with people who have an ID although this varied from 7% in Japan to 46% in Panama. The principal forms of contact were through friendships, neighbours or extended family members. Over all countries, volunteering and engagement with Special Olympics were the two main predictors of frequent personal contact followed by employment in the education, health or social care field, being a parent of children under 18 years, playing sports and being employed. People who reported frequent personal contact were also more comfortable at meeting a person with ID. CONCLUSIONS: This international dataset provides a baseline against which public contact can be compared across countries and changes monitored over time. The findings suggest ways in which greater contact can be promoted and making the public more comfortable at meeting people with ID.

Prevalence and risk of Down syndrome in monozygotic and dizygotic multiple pregnancies in Europe: implications for prenatal screening.

OBJECTIVE: To determine risk of Down syndrome (DS) in multiple relative to singleton pregnancies, and compare prenatal diagnosis rates and pregnancy outcome. DESIGN: Population-based prevalence study based on EUROCAT congenital anomaly registries. SETTING: Eight European countries. POPULATION: 14.8 million births 1990-2009; 2.89% multiple births. METHODS: DS cases included livebirths, fetal deaths from 20 weeks, and terminations of pregnancy for fetal anomaly (TOPFA). Zygosity is inferred from like/unlike sex for birth denominators, and from concordance for DS cases. MAIN OUTCOME MEASURES: Relative risk (RR) of DS per fetus/baby from multiple versus singleton pregnancies and per pregnancy in monozygotic/dizygotic versus singleton pregnancies. Proportion of prenatally diagnosed and pregnancy outcome. STATISTICAL ANALYSIS: Poisson and logistic regression stratified for maternal age, country and time. RESULTS: Overall, the adjusted (adj) RR of DS for fetus/babies from multiple versus singleton pregnancies was 0.58 (95% CI 0.53-0.62), similar for all maternal ages except for mothers over 44, for whom it was considerably lower. In 8.7% of twin pairs affected by DS, both co-twins were diagnosed with the condition. The adjRR of DS for monozygotic versus singleton pregnancies was 0.34 (95% CI 0.25-0.44) and for dizygotic versus singleton pregnancies 1.34 (95% CI 1.23-1.46). DS fetuses from multiple births were less likely to be prenatally diagnosed than singletons (adjOR 0.62 [95% CI 0.50-0.78]) and following diagnosis less likely to be TOPFA (adjOR 0.40 [95% CI 0.27-0.59]). CONCLUSIONS: The risk of DS per fetus/baby is lower in multiple than singleton pregnancies. These estimates can be used for genetic counselling and prenatal screening.

The impact on Iranian mothers and fathers who have children with an autism spectrum disorder.

BACKGROUND: To date, most research with families who have a child with autism spectrum disorder (ASD) has been undertaken in English-speaking countries. Increased levels of stress allied with poorer health have been commonly reported for mothers, with less attention paid to fathers. This study aimed to document the personal impact on Iranian mothers and fathers and identify the correlates of increased stress and poorer emotional well-being. METHOD: In all, 103 parents (58 mothers and 45 fathers) from 74 families who had a child with ASD volunteered to take part in the study. Each participant completed through interview, standardised rating scales of parenting stress, emotional well-being and family functioning as well as rating their child's autistic symptoms, including stereotyped behaviours. RESULTS: Mothers had significantly higher scores than fathers on measures of stress and emotional well-being. Although these variables were highly correlated, binary logistic regression identified that the poorer health was also associated with lower educational levels of the parents, more behavioural problems with the child and fewer autistic symptoms overall. A similar regression analysis of stress scores identified no gender differences but found that lower stress was associated with mothers and fathers who were joint caregivers and when the family lived with relatives. CONCLUSIONS: Iranian parents experience broadly similar responses to parents in other countries, which suggests that the impact of ASD outweighs any cultural differences that might otherwise be present in parental responses to caring for children. In common with families internationally, these parents are likely to benefit from opportunities to become better informed about ASD and the management of their child at home allied with increased support from families and friends.

Obesity and overweight in intellectual and non-intellectually disabled children.

BACKGROUND: Few studies have compared overweight and obesity in intellectually disabled (ID) and non-intellectually disabled (N-ID) children. This research compared the prevalence of overweight and obesity between a sample of 218 ID and 229 N-ID school pupils in Northern Ireland (NI). Comparison of the physical activity and dietary behaviour of the two groups of school pupils were also undertaken. METHODS: Each pupil completed (assisted if required) a food intake and physical activity questionnaire. Following this body mass index (BMI) and waist circumference were measured and recorded. RESULTS: Significantly more ID pupils (72, 33%) were overweight/obese compared with 55 (24%) of the N-ID pupils in accordance with their BMI. ID pupils also had significantly higher waist circumferences. Over a quarter of foods consumed by the pupils were fatty and sugary foods and close to 30% of these foods were eaten by the ID children. Pupils spent most of their time engaging in low levels of activity such as reading, watching TV, on games consoles and listening to music. Pupils with an ID spent fewer hours on moderate and high levels of activities compared with those children with N-ID. CONCLUSIONS: Results of this study found higher levels of overweight and obesity in this sample than in international published research. Additionally significantly higher numbers of ID pupils were overweight and obese indicating the need for future research and public health to focus on this issue.

Trends in the prevalence, risk and pregnancy outcome of multiple births with congenital anomaly: a registry-based study in 14 European countries 1984-2007.

OBJECTIVE: To assess the public health consequences of the rise in multiple births with respect to congenital anomalies. DESIGN: Descriptive epidemiological analysis of data from population-based congenital anomaly registries. SETTING: Fourteen European countries. POPULATION: A total of 5.4 million births 1984-2007, of which 3% were multiple births. METHODS: Cases of congenital anomaly included live births, fetal deaths from 20 weeks of gestation and terminations of pregnancy for fetal anomaly. MAIN OUTCOME MEASURES: Prevalence rates per 10,000 births and relative risk of congenital anomaly in multiple versus singleton births (1984-2007); proportion prenatally diagnosed, proportion by pregnancy outcome (2000-07). Proportion of pairs where both co-twins were cases. RESULTS: Prevalence of congenital anomalies from multiple births increased from 5.9 (1984-87) to 10.7 per 10,000 births (2004-07). Relative risk of nonchromosomal anomaly in multiple births was 1.35 (95% CI 1.31-1.39), increasing over time, and of chromosomal anomalies was 0.72 (95% CI 0.65-0.80), decreasing over time. In 11.4% of affected twin pairs both babies had congenital anomalies (2000-07). The prenatal diagnosis rate was similar for multiple and singleton pregnancies. Cases from multiple pregnancies were less likely to be terminations of pregnancy for fetal anomaly, odds ratio 0.41 (95% CI 0.35-0.48) and more likely to be stillbirths and neonatal deaths. CONCLUSIONS: The increase in babies who are both from a multiple pregnancy and affected by a congenital anomaly has implications for prenatal and postnatal service provision. The contribution of assisted reproductive technologies to the increase in risk needs further research. The deficit of chromosomal anomalies among multiple births has relevance for prenatal risk counselling.

Promoting social inclusion through Unified Sports for youth with intellectual disabilities: a five-nation study.

BACKGROUND: Although the promotion of social inclusion through sports has received increased attention with other disadvantaged groups, this is not the case for children and adults with intellectual disability who experience marked social isolation. The study evaluated the outcomes from one sports programme with particular reference to the processes that were perceived to enhance social inclusion. METHOD: The Youth Unified Sports programme of Special Olympics combines players with intellectual disabilities (called athletes) and those without intellectual disabilities (called partners) of similar skill level in the same sports teams for training and competition. Alongside the development of sporting skills, the programme offers athletes a platform to socialise with peers and to take part in the life of their community. Unified football and basketball teams from five countries--Germany, Hungary, Poland, Serbia and Ukraine--participated. Individual and group interviews were held with athletes, partners, coaches, parents and community leaders: totalling around 40 informants per country. RESULTS: Qualitative data analysis identified four thematic processes that were perceived by informants across all countries and the two sports to facilitate social inclusion of athletes. These were: (1) the personal development of athletes and partners; (2) the creation of inclusive and equal bonds; (3) the promotion of positive perceptions of athletes; and (4) building alliances within local communities. CONCLUSIONS: Unified Sports does provide a vehicle for promoting the social inclusion of people with intellectual disabilities that is theoretically credible in terms of social capital scholarship and which contains lessons for advancing social inclusion in other contexts. Nonetheless, certain limitations are identified that require further consideration to enhance athletes' social inclusion in the wider community.

A longitudinal study of the intra-country variations in the provision of residential care for adult persons with an intellectual disability.

BACKGROUND: Small-scale community accommodation is the preferred alternative internationally to the institutional and congregated services that previously dominated residential care for persons with intellectual disability. The strategies required for changing to new service models are not well researched. METHOD: The National Intellectual Disability Database in Ireland provided the data to explore the changes in provision that occurred over a 10-year period and the extent of the intra-country variation across eight administrative areas for health services. Data were extracted for 2 years, 1999 and 2009, for over 7000 adult persons resident in either congregated or community-based accommodation. Comparative indicators were calculated for the eight areas as well as nationally. In addition, over 4000 persons living in congregated settings were tracked over the 10 years to ascertain relocations as well as gathering information on the numbers of people newly admitted to each type of accommodation. RESULTS: Marked variations across the eight areas were found in the overall numbers of people in residential accommodation, the proportion of persons living in congregated settings and the extent of changes in the numbers of people in each type of accommodation. Moreover, fewer than 15% of people had relocated nationally from congregated settings over the 10-year period and the number of new admissions to this form of provision remained high in certain areas. CONCLUSIONS: The implementation of new forms of provision was not uniform across Ireland and possible reasons are proposed. Among the wider lessons internationally is the need for robust systems to monitor service provision nationally and locally if equity of access is to be achieved.

The role of support staff in promoting the social inclusion of persons with an intellectual disability.

BACKGROUND: Past studies have found that people supported in more individualised housing options tend to have levels of community participation and wider social networks than those in other accommodation options. Yet, the contribution of support staff in facilitating social inclusion has received relatively scant attention. METHODS: In all 245 staff working in either supported living schemes, or shared residential and group homes, or in day centres completed a written questionnaire in which they rated in terms of priority to their job, 16 tasks that were supportive of social inclusion and a further 16 tasks that related to the care of the person they supported. In addition staff identified those tasks that they considered were not appropriate to their job. RESULTS: Across all three service settings, staff rated more care tasks as having higher priority than they did the social inclusion tasks. However, staff in supported living schemes rated more social inclusion tasks as having high priority than did staff in the other two service settings. Equally the staff who were most inclined to rate social inclusion tasks as not being applicable to their job were those working day centres; female rather than male staff, those in front-line staff rather than senior staff, and those in part-time or relief positions rather than full-time posts. However, within each service settings, there were wide variations in how staff rated the social inclusion tasks. CONCLUSIONS: Staff working in more individualised support arrangements tend to give greater priority to promoting social inclusion although this can vary widely both across and within staff teams. Nonetheless, staff gave greater priority to care tasks especially in congregated service settings. Service managers may need to give more emphasis to social inclusion tasks and provide the leadership, training and resources to facilitate support staff to re-assess their priorities.

Using personal goal setting to promote the social inclusion of people with intellectual disability living in supported accommodation.

The social exclusion of persons with intellectual disability is more marked in congregated than in individualised supported accommodation. Goal setting was used as a means of increasing individuals' choices and engaging support staff in personalised planning. Method People living in four different housing and support options were invited to identify up to three 'social inclusion' goals they wanted to achieve in the coming months. Nine months later, a review was undertaken to see if their goals had been attained and also to identify what had helped or hindered individuals in doing this. The goal selection was then repeated and reviewed again after a further 9 months. Results The most commonly chosen goals were around social activities with other people and over half the participants were reported to have attained at least one of their goals within 9 months, particularly those in supported living arrangements that had greater hours of individual staff support. In the second 9-month period, fewer people chose goals, although the same proportion as before were successful. The main reason given for goal attainment was the information and support provided by staff. Conclusions Goal setting seems a suitable way of promoting social inclusion as it can be tailored to the needs and aspirations of individuals, although extra efforts may be needed to implement and sustain it with staff across all accommodation options.

Meeting the training needs of community-based service personnel in Africa through video-based training courses. Leonard Cheshire Foundation International.

PURPOSE: This paper describes the development of a new training model: namely one which is local and open to everyone; in which people learn through seeing and doing; with the focus on information that is practical and relevant to them. A package of video and workbooks enables the courses to be presented by local tutors who have taken part in a training workshop to prepare them for the task. METHOD: This model was applied to an eight unit course on working with children who have cerebral palsy. It was presented in 13 locations by 19 tutors in four southern African countries to over 150 participants within a 6 month period. A developmental approach was adopted which involved working with partners to identify training needs, develop and field test the video course. Tutors and participants evaluated the course separately using quantitative and qualitative methods. RESULTS: Overall tutors and participants rated the course positively. They identified elements which they found particularly useful along with those which were considered less useful. Course results and outcomes are discussed. CONCLUSIONS: The findings indicated that the training model was effective and five further courses have been developed about disability issues. These are described in the Appendix.

Nursing inputs to special schools in N. Ireland.

Children attending special schools often have healthcare needs that require ongoing medical and nursing care. Two postal surveys were undertaken of 47 special schools in N. Ireland to determine the type of contact they had with nurses and the functions they fulfilled. Responses were received from 42 school principals and from the 11 Health and Social Service Trusts responsible for nursing services. It was found that nurses were based in nine of 42 schools while the remaining schools depended on a range of different visiting nurses. The nurses were involved in 'hands-on' tasks as well as giving advice and training to school personnel. Further research needs to define more closely the nursing needs of these pupils as well as evaluating the differential benefits of various nursing services to schools and how their inputs can be coordinated with those of other health professionals.

Home-based learning programmes for mentally handicapped people in rural areas of Zimbabwe.

This paper describes the operation of a community-based rehabilitation programme specifically for mentally handicapped children and young adults living with their families in rural areas of Zimbabwe. Details are given of the clients enrolled in the programme and the teaching goals used with them. Evaluation data on the programme's effectiveness is also presented. Three features are identified as being central to the programme's success, 1) partnership with existing agencies in the area, 2) the training and monitoring that is provided by specialist staff in mental handicap, and 3) the provision of resource materials -- forms, cards, videos -- which are tailored to the cultural, linguistic and literacy needs of the recipients. The efficient use of specialist staff is highlighted as are future areas for research and development.

Play activities of mentally handicapped children at home and mothers' perception of play.

Reviewers have frequently commented on the meagre literature that is available on the play of mentally handicapped children, especially play at home. This study involved 67 families with a moderately or severely handicapped child aged mainly between 2 and 12 years, living in Dublin city. Details were obtained on who the children played with; the activities they engaged in and aspects of the home environment conducive to play. Furthermore mothers' perception of play are reported along with their reactions to playing with their child. It was found that the children's play was immotive and lacking in variety and that it invariably occurred within the family. Mothers viewed play as very important and saw it as an enjoyable and beneficial experience for themselves as well as the child. It is argued that parents should be given opportunities to learn how best they could nurture their child's development through play.

The recreational pursuits of mentally handicapped adults.

The parents or care-givers of over 200 mentally handicapped adults, living at home in the city of Dublin, were interviewed as to how their son or daughter spent their leisure time. The picture that emerged was of a sheltered existence within the community. Mostly their activities were passive and solitary in nature - watching T. V.; listening to radio or records. Nearly half of the sample did not take part in any activity outside of the family; only one third took part in the community activity and only one fifth were reported to have non-handicapped friends. It would appear that parents are willing for this to continue, in that they had few suggestions for new activities; they felt their son or daughter was not interested and most thought that recreational activities should be supervised. It is argued that services should teach leisure skills in the same systematic and structured way as for other areas of the curriculum. This should reassure parents and help to ensure that mentally handicapped people not only live in the community but that they can participate in community activities.

A training strategy for personnel working in developing countries.

Throughout the world a common consensus has emerged that community based services offer the best prospect of meeting the needs of people with disabilities and their families. However the shift away from specialist centres and institutions has not been accompanied as yet by a reappraisal of the training required by personnel working in these new forms of services. This paper describes the training strategy which has been developed by the Community Based Rehabilitation Programme in Guyana, South America. This has three components. First, the identification of training needs of families and support workers, second, the production of video-based training packages on specific topics and third, the utilisation of available personnel to act as local tutors. This strategy has resulted in over 7000 CBR volunteers, health workers, teachers in mainstream schools, families and villagers having access to information and skills which otherwise they would be denied. An immediate priority in developing countries is to nurture the human resources required to develop and sustain this sort of training strategy and proposals for doing this are outlined.

Health conditions and support needs of persons living in residential facilities for adults with intellectual disability in Western Cape Province.

BACKGROUND: Intellectual disability (ID) is a relatively high-incidence disability, with an increased risk of poor physical and mental health. Persons with ID also have lifelong support needs that must be met if they are to achieve an acceptable quality of life. Little is known about these health conditions and support needs in the African context. This study examines persons over the age of 18 years with ID in residential facilities in Western Cape Province. OBJECTIVE: To analyse the health conditions and support needs of persons with ID in Western Cape Province. METHOD: A survey of residents' health conditions and support needs was conducted in face-to-face interviews with the managers of 37 out of 41 identified facilities. RESULTS AND CONCLUSION: The survey comprised 2 098 residents (54% of them female), representing less than 2% of the estimated population of persons with ID in the province. The survey suggests that such persons experience a wide range of health conditions (notably mental health and behavioural issues) but have limited access to general health care and rehabilitation services. Furthermore, the daily living supports required for an acceptable quality of life are limited. The findings highlight the need for better health and support provision to persons with ID.