A Pioneer Tool to Reduce Restrictive Practices toward People with Intellectual and Developmental Disabilities.

Reducing restrictive practices toward individuals with intellectual and developmental disabilities is a globally recognized imperative and human rights priority. This paper presents a novel tool called LibRe for assessing and reducing restrictive practices. This tool involved an instrumental multistage design and collaboration between professionals, individuals with disabilities, family members, and experts from different fields. It addresses diverse restrictive practices in five key domains: physical or mechanical, chemical or pharmacological, structural, relational, and practices related to contexts and supports. It addresses practices that are pertinent to the Spanish context and that existing tools have not covered. Embedded as a step within an organizational approach, LibRe fosters organizational transformation and provides resources to achieve outcomes within reduction plans for restrictive practices. In total, 156 teams comprising 585 professionals, 64 people with disabilities, and 44 family members responded to the tool. In terms of evidence for internal structure validity, the oblique five-factor model exhibited an adequate fit through confirmatory factor analysis, along with satisfactory reliability indices, according to ordinal alpha and omega. Users positively appraised the tool's usefulness and identified its strengths and challenges. Although further research is needed, preliminary evidence frames LibRe as a useful resource for practice and research.

Impact of COVID-19 on the burden of care of families of people with intellectual and developmental disabilities.

AIM: This study analysed the impact that COVID-19 and the response measures implemented by the Spanish Government have had on families of individuals with intellectual and developmental disabilities. METHOD: Data on 323 family members (M = 52.3 years old; SD = 10.5) were collected through an online survey, which was focused on analysing difficulties experienced and service provision during lockdown. RESULTS: Many families (66.3%) have seen their level of stress increased during lockdown because of, among other reasons, a greater burden of care. Difficulties were associated with the closure and changes in disability-related services. Families of people with extensive support needs have generally experienced greater difficulties. CONCLUSION: Support services should have been considered essential services during lockdown. The failure to receive support has resulted in excessive burden on families, who had to assume a multitude of roles to support their family member with intellectual and developmental disability.

Supports for people with intellectual and developmental disabilities during the COVID-19 pandemic from their own perspective.

BACKGROUND: Individuals with intellectual and developmental disabilities (IDD) represent a particularly vulnerable group to the threats posed by COVID-19. However, they have not yet been given a voice on how their living conditions have been affected by COVID-19. AIMS: This study aims to report the impact on people with IDD of COVID-19 and the response measures applied in Spain during the lockdown. METHOD: Data on 582 individuals with IDD were collected through a survey. Seven open questions were included to capture the perspectives of people with IDD on COVID-19 and its consequences. Content analysis was performed to identify themes and categories across participant responses. Chi-square tests were used to analyze the relationship between reporting a specific category and participants' characteristics. RESULTS: Supports have been conditioned by the living context. People living in specific settings had fewer natural supports, while those living with their family relied heavily on it. Participants also lacked supports considered necessary. It is worth stressing that persons with IDD have also provided support to others. CONCLUSIONS: Although people with IDD have generally received the assistance they need during the lockdown, it must be ensured that appropriate supports are provided regardless of the context in which they live.

[The dentist's role in the child abuse: diagnosis and report]. / O papel do médico dentista no diagnóstico e sinalização do abuso de crianças.

Child Abuse is a frequent problem worldwide that surpasses ethnicity, religion, culture, economic and social classes. In the United States of America child protective services account, per year, over one million cases of child abuse or neglect. In Portugal, the incidence of the problem is unknown but each year thousands of abused children are accompanied by the Commissions for the Protection of Children and Youth at Risk. This abuse threatens children's physical, emotional and intellectual development, as well as their dignity, security, well-being and even their own lives. The body regions most frequently affected in physical abuse, are the cranium, neck and orofacial region, in fact, about 50% of the injuries arising from child abuse occur in the orofacial region. These data place the dentist in a privileged position to make the detection, diagnosis and report of child abuse. Therefore, these professionals must be prepared to recognize, diagnose and report their suspicions to the appropriate authorities, which play a key role in victims protection and criminal investigation. This review intends to stress the important role of the dentist in the detection, diagnosis and report of child abuse, systematizing child abuse risk factors and indicators essential to the intervention of these professionals. This problem's approach is multidisciplinary, involving particularly dentists, who must obtain continuing education and training in this area.

[Acute disautonomia associated to Hodgkin lymphoma]. / Disautonomia aguda associada a linfoma de Hodgkin.

The case of a 31 man with acute disautonomia envolving the parasympathetic and sympathetic systems but sparing sympathetic cholinergic division is presented. A Hodgkin lymphoma was diagnosed allowing the diagnosis of a paraneoplastic syndrome.