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1.
Metas enferm ; 22(10): 28-32, dic. 2019.
Artigo em Espanhol | IBECS | ID: ibc-185329

RESUMO

La población española con discapacidad asciende a 3,8 millones de personas (aproximadamente el 8% del total de la población) de las cuales un 9% tiene discapacidad intelectual (DI) reconocida. Más de la mitad de las personas con DI no han sido evaluadas de forma integral: screening genético, despistaje orgánico, evaluación psicopatológica y evaluación de grado de discapacidad. El Servicio Especializado en Salud Mental para Personas con Discapacidad Intelectual es un dispositivo único en la Comunidad de Madrid que forma parte del Servicio de Psiquiatría del Hospital Universitario de La Princesa. Cabe resaltar que los problemas de conducta son el principal motivo de consulta en este dispositivo y la principal causa de tratamiento psicofarmacológico incorrecto. El propósito de este trabajo es presentar el protocolo de trabajo de Enfermería dentro del equipo interdisciplinar del mencionado dispositivo, y que tiene como objetivo contribuir a garantizar un abordaje holístico de la población atendida en el Servicio Especializado en Salud Mental para Personas con DI y sus cuidadores principales. Se abordan aspectos de la atención a esta población, especificando las intervenciones y actividades del profesional de Enfermería especialista en salud mental dentro del equipo. La presencia del profesional de Enfermería especialista en salud mental garantiza la adecuada atención y el cribado de la patología orgánica más prevalente en esta población. El futuro inmediato pasa por ahondar en la necesidad de coordinación con los diferentes actores que intervienen en la atención a esta población


The Spanish population with disability amounts to 3.8 million persons (approximately 8% of the total); 9% of them presents recognized intellectual disability (ID). Over half of those persons with ID have not been evaluated comprehensively: genetic and organic screening, psychopathological evaluation, and assessment of their level of disability. The Unit Specialized in Mental Health for Patients with Intellectual Disability is a unique device in the Community of Madrid, part of the Psychiatry Unit of the Hospital Universitario de La Princesa. It is worth highlighting that behaviour problems are the main reason for consultation in this unit, and the main cause of incorrect psychopharmacological treatment. The objective of this article is to present the Working Protocol for Nurses within the interdisciplinary team of said Unit, with the objective to help to ensure a holistic approach for the population managed at the Unit Specialized in Mental Health for Patients with ID and their main caregivers. Aspects of care for this population are addressed, stating the specific interventions and activities within the team by the Nursing Professional specialized in Mental Health. The presence of the Nursing Professional Specialized in Mental Health guarantees an adequate care and screening for the most prevalent organic conditions in this population. In the immediate future, it will be necessary to go even deeper into the need for coordination with the different professionals involved in care for this population


Assuntos
Humanos , Papel do Profissional de Enfermagem , Deficiência Intelectual , Saúde Mental , Educação de Pessoa com Deficiência Intelectual , Enfermagem Psiquiátrica , Deficiência Intelectual/epidemiologia , Cuidadores
2.
Artigo em Inglês | MEDLINE | ID: mdl-31614615

RESUMO

Patients with chronic mental illness are highly vulnerable to chronic respiratory problems. We examined the influence of mental disability on respiratory infection-related utilization risk in individuals with and without mental disabilities. A population-based, retrospective cohort design and two-part model were used to analyze respiratory infection-related utilization in individuals with MDs (MD group) and a matched reference group. The respiratory infection-related utilization rate in one year was lower in the MD group (53.8%) than in the reference group (56.6%). The odds ratios (ORs) were significantly higher among individuals with profound MDs (aOR = 1.10; 95% CI 1.07-1.14) and those with a history of dental cavities (aOR = 1.16; 95% CI: 1.13-1.19) or periodontal disease (aOR = 1.22; 95% CI: 1.19-1.26) after controlling for covariables. The average number of visits was higher in the MD group (5.3) than in the reference group (4.0). The respiratory infection-related utilization rate and average number of visits were significantly higher in the mild, moderate and severe disabled groups with a history of periodontal disease, respectively, than that of the reference group. In conclusion, healthcare authorities must develop an incentive program to prevent respiratory infections among individuals with MDs.


Assuntos
Deficiência Intelectual/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Doenças Periodontais/epidemiologia , Infecções Respiratórias/epidemiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoas com Deficiência Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
3.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31558576

RESUMO

OBJECTIVES: To study the national prevalence of 10 developmental disabilities in US children aged 3 to 17 years and explore changes over time by associated demographic and socioeconomic characteristics, using the National Health Interview Survey. METHODS: Data come from the 2009 to 2017 National Health Interview Survey, a nationally representative survey of the civilian noninstitutionalized population. Parents reported physician or other health care professional diagnoses of attention-deficit/hyperactivity disorder; autism spectrum disorder; blindness; cerebral palsy; moderate to profound hearing loss; learning disability; intellectual disability; seizures; stuttering or stammering; and other developmental delays. Weighted percentages for each of the selected developmental disabilities and any developmental disability were calculated and stratified by demographic and socioeconomic characteristics. RESULTS: From 2009 to 2011 and 2015 to 2017, there were overall significant increases in the prevalence of any developmental disability (16.2%-17.8%, P < .001), attention-deficit/hyperactivity disorder (8.5%-9.5%, P < .01), autism spectrum disorder (1.1%-2.5%, P < .001), and intellectual disability (0.9%-1.2%, P < .05), but a significant decrease for any other developmental delay (4.7%-4.1%, P < .05). The prevalence of any developmental disability increased among boys, older children, non-Hispanic white and Hispanic children, children with private insurance only, children with birth weight ≥2500 g, and children living in urban areas and with less-educated mothers. CONCLUSIONS: The prevalence of developmental disability among US children aged 3 to 17 years increased between 2009 and 2017. Changes by demographic and socioeconomic subgroups may be related to improvements in awareness and access to health care.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Adolescente , Fatores Etários , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Espectro Autista/epidemiologia , Cegueira/epidemiologia , Paralisia Cerebral/epidemiologia , Criança , Pré-Escolar , Escolaridade , Feminino , Perda Auditiva/epidemiologia , Humanos , Cobertura do Seguro/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Masculino , Dinâmica Populacional , Prevalência , Convulsões/epidemiologia , Fatores Sexuais , Fatores Socioeconômicos , Gagueira/epidemiologia , Estados Unidos/epidemiologia
4.
World Neurosurg ; 132: e314-e323, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479789

RESUMO

OBJECTIVE: Very long-term outcomes are rarely reported for patients with shunted pediatric hydrocephalus. This study aimed to determine the functional, social, and neurocognitive outcomes of such patients after transition to adulthood. METHODS: Adult patients with pediatric hydrocephalus who underwent their first shunt operation between 1982 and 1992 were included. Functional, social, educational, working aspects, and verbal intelligence were evaluated. In patients with average or above average verbal intelligence, detailed neuropsychological testing was performed and memory, executive functioning, selective attention, and concentration were assessed. RESULTS: Overall, 137 patients underwent primary surgery because of pediatric hydrocephalus, 53 (38.7%) of whom died during the follow-up period. Of the 84 long-term survivors, 65 (77.4%) agreed to participate and were included for further analysis. Forty-five patients (69.2%) had completed secondary school, but only 34 (52.3%) were integrated in the open labor market. Although the verbal intelligence of 31 patients (47.7%) was within the normal range, 19 (29.2%) had a severe mental handicap. Shunt infections (P = 0.0025), epilepsy (P < 0.0001), and the number of shunt operations (P = 0.0082) were associated with reduced verbal intelligence. Most patients with average or above average verbal intelligence had deficits in detailed neuropsychological testing. In 23 patients, detailed neuropsychological testing was performed. CONCLUSIONS: The overall long-term outcome of patients with shunted pediatric hydrocephalus is poor. These results highlight the importance of lifelong routine controls to avoid later complications. Further, repeated neuropsychological examinations might be important to understand the patient's special needs to optimize professional support.


Assuntos
Derivações do Líquido Cefalorraquidiano , Hidrocefalia/complicações , Hidrocefalia/cirurgia , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/etiologia , Adulto , Criança , Feminino , Humanos , Masculino , Recuperação de Função Fisiológica , Estudos Retrospectivos , Sobreviventes , Tempo
5.
Psychiatr Danub ; 31(Suppl 3): 534-542, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488787

RESUMO

BACKGROUND: Poland is a democratic, sovereign state in Central Europe, member of the European Union. The healthcare in Poland is delivered to patients mainly through a public contributor called the National Health Fund, supervised by the Ministry of Health. The care for people with disabilities, including intellectual disabilities in Poland is coordinated by the Governmental Program on Activities for People with Disabilities and their Integration with the Society. The system of care for people with intellectual disability in Poland is constitutionally guaranteed. The aim of this review was to analyze the different forms of care for persons suffering from intellectual disability and mental health problems in our country. METHODS: Analysis of available documents on the policy and organizations of systems of services for this group of patients was performed. RESULTS: Non-governmental organizations play an important role in taking care of people with disabilities. In Poland there are no special psychiatric services dedicated for patients with intellectual disabilities. The comorbid psychiatric disorders are treated in general psychiatric wards or hospitals or in outpatient settings. Offenders with intellectual disabilities in the penitentiary system are referred to therapeutic settings in wards for convicts with non-psychotic mental disorders and intellectual disabilities. Training of medical students and young doctors offers only very limited basic knowledge on intellectual disability within psychiatry curriculum. The is no separate specialty in mental health in intellectual disability within psychiatry. CONCLUSIONS: The main conclusion of this review is that the specialist working with persons suffering from intellectual disabilities in Poland face many challenges regarding the need to introduces positive changes in this field.


Assuntos
Deficiência Intelectual , Serviços de Saúde Mental , Saúde Mental , Humanos , Deficiência Intelectual/epidemiologia , Saúde Mental/estatística & dados numéricos , Serviços de Saúde Mental/provisão & distribução , Polônia/epidemiologia
6.
Neurología (Barc., Ed. impr.) ; 34(6): 353-359, jul.-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185452

RESUMO

Introducción: La neurofibromatosis tipo 1 (NF1) es un síndrome neurocutáneo frecuente que en muchos casos se asocia a dificultades cognitivas específicas que habitualmente no son tenidas en cuenta en el seguimiento médico de estos pacientes. Objetivo: Trazar el perfil cognitivo de pacientes con NF1 detectando trastornos en funciones superiores asociados al mismo. Identificar motivos de consulta de pacientes pediátricos con NF1 en relación con su desempeño escolar. Métodos: Trabajo descriptivo transversal. Se evaluó neuropsicológicamente a 24 pacientes con NF1 con edades comprendidas entre los 5 y los 16 años de edad. Resultados: Los motivos de consulta más frecuentes fueron: problemas atencionales (58,33%), aprendizaje (25%), coordinación motora (25%) y lenguaje (0,8%). Si bien el estudio reveló que el 96% de los pacientes tenía compromiso en al menos una de las áreas evaluadas, solo el 83,34% de los padres las refirieron. El 58,33% presentó trastorno por déficit de atención con hiperactividad (TDAH), el 33,33% trastorno de aprendizaje no verbal (TANV), el 20,83% dificultades en aspectos expresivos del lenguaje, el 8,33% coeficiente intelectual (CI) limítrofe, el 4,16% retraso mental y el 4,16% no mostró dificultades. Conclusiones: Existe alta frecuencia de trastornos en funciones superiores en niños con NF1. Aunque muchos padres detectan dichos trastornos, se ha observado que otros son subestimados. Consideramos conveniente que todos los niños con NF1 cuenten con una evaluación neuropsicológica a fin de poder detectar dificultades existentes en cada caso y así poder elaborar una estrategia de rehabilitación cognitiva precoz y efectiva


Introduction: Neurofibromatosis type 1 (NF1) is a common neurocutaneous syndrome often associated with specific cognitive deficits that are rarely monitored during follow-up of these patients. Objective: The purpose of our study is two-fold. First, we aimed to describe the cognitive profile of patients with NF1 and detect disorders in higher brain functions associated with the disease. Second, we identified the reasons for consultation associated with school performance in these patients. Methods: We conducted a descriptive cross-sectional study of 24 paediatric patients (ages 5 to 16) with NF1 who underwent neuropsychological assessment. Results: The most frequent reasons for consultation were attention deficits (58.33%), learning disorders (25%), poor motor coordination (25%), and language impairment (0.8%). Although 96% of the patients displayed impairments in at least one of the assessed areas, only 83.34% of the parents had reported such impairments. Attention-deficit/hyperactivity disorder was present in 58.33% of the patients, whereas 33.33% had nonverbal learning disabilities, 20.83% had expressive language disorder, 8.33% had borderline intellectual functioning, 4.16% had mental retardation, and only 4.16% showed no cognitive impairment. Conclusion: Higher brain functions are frequently impaired in paediatric patients with NF1. Although many parents report such disorders, they can go undetected in some cases. Neuropsychological assessment is recommended for all paediatric patients with NF1 to detect cognitive impairment and provide early, effective rehabilitation treatment


Assuntos
Humanos , Masculino , Feminino , Criança , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos da Linguagem/diagnóstico , Transtornos de Aprendizagem/diagnóstico , Neurofibromatose 1/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Estudos Transversais , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/epidemiologia , Transtornos da Linguagem/epidemiologia , Transtornos de Aprendizagem/epidemiologia , Testes Neuropsicológicos/estatística & dados numéricos
7.
Psicothema ; 31(3): 271-276, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31292041

RESUMO

BACKGROUND: Child sexual abuse continues to be a problem aggravated by difficulty of detection. The aim of this study was to compare intra-familial (IF) and extra-familial (EF) child sexual abuse cases in search of differential variables that may allow for better intervention and prevention. METHOD: A sample of 221 forensic/legal cases (44.8% IF and 55.2% EF) dealing with children between 3 and 18 years of age (75% female) was analysed. RESULTS: IF sexual abuse was significantly more likely to occur more than once (p = .000; OR = 6.353), with greater delay in its revelation (>1 year OR = 8.132), and with younger victims (9.05 vs. 11.45; p = .000). Intellectual disability was more prevalent among EF victims (p = .017; OR = 3.053). There was a higher proportion of reconstructed families, more legal records, and more histories of domestic violence among IF sexual abuse families. Even among EF cases, 78% of abusers were known to the victims, and in around 80% of all cases the abuse was reported by a family member. CONCLUSION: Results point to the need for further development of detection programs in schools, police or health contexts since reporting by professionals is scarce.


Assuntos
Abuso Sexual na Infância/legislação & jurisprudência , Abuso Sexual na Infância/estatística & dados numéricos , Criminosos/estatística & dados numéricos , Família , Amigos , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Abuso Sexual na Infância/diagnóstico , Abuso Sexual na Infância/prevenção & controle , Pré-Escolar , Diagnóstico Tardio , Literatura Erótica , Características da Família , Feminino , Psiquiatria Legal , Humanos , Deficiência Intelectual/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Estudos Retrospectivos , Distribuição por Sexo , Espanha/epidemiologia , Adulto Jovem
8.
Nat Commun ; 10(1): 3043, 2019 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-31292440

RESUMO

There are established associations between advanced paternal age and offspring risk for psychiatric and developmental disorders. These are commonly attributed to genetic mutations, especially de novo single nucleotide variants (dnSNVs), that accumulate with increasing paternal age. However, the actual magnitude of risk from such mutations in the male germline is unknown. Quantifying this risk would clarify the clinical significance of delayed paternity. Using parent-child trio whole-exome-sequencing data, we estimate the relationship between paternal-age-related dnSNVs and risk for five disorders: autism spectrum disorder (ASD), congenital heart disease, neurodevelopmental disorders with epilepsy, intellectual disability and schizophrenia (SCZ). Using Danish registry data, we investigate whether epidemiologic associations between each disorder and older fatherhood are consistent with the estimated role of dnSNVs. We find that paternal-age-related dnSNVs confer a small amount of risk for these disorders. For ASD and SCZ, epidemiologic associations with delayed paternity reflect factors that may not increase with age.


Assuntos
Testes Genéticos , Modelos Genéticos , Idade Paterna , Adulto , Fatores Etários , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/genética , Criança , Dinamarca/epidemiologia , Epilepsia/epidemiologia , Epilepsia/genética , Feminino , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/genética , Humanos , Incidência , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/genética , Masculino , Pessoa de Meia-Idade , Mutação , Polimorfismo de Nucleotídeo Único , Prevalência , Sistema de Registros/estatística & dados numéricos , Medição de Risco/métodos , Esquizofrenia/epidemiologia , Esquizofrenia/genética , Sequenciamento Completo do Exoma
9.
PLoS One ; 14(7): e0219049, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31276474

RESUMO

BACKGROUND: There are few reports that objectively show actual health conditions among the homeless or diagnoses of non-communicable diseases based on blood tests. This report discloses the actual data from blood tests and non-communicable diseases among the participants. Furthermore, associations between the test values for lifestyle-related disease and mental disorder/intellectual disability, as well as personal backgrounds of homeless people, were analyzed from the data gathered in the survey. METHODS: This study was performed in a rented meeting room close to Nagoya Station on November 2, 2014. Blood samples, physical measurements, blood pressure measurements intellectual faculties were measured. Physical/mental diseases were diagnosed by doctors. Fisher's exact test was performed to compare between subgroups (by participants' socio-demographic data or the presence of mental illness/cognitive disability) according to non-communicable disease test values, and to calculate the odds ratio. RESULTS: Abnormalities among participants in test values for non-communicable disease were as follows: hypoalbuminemia in one participant (0.9%), abnormalities in liver function in 22 participants (19.3%), decreased renal function in two participants (1.8%), dyslipidemia in 67 participants (58.8%), "a person whose impaired glucose tolerance cannot be ruled out" in 20 participants (17.5%), obesity in 33 participants (28.9%), thinness in five participants (4.3%), and hypertension in 60 participants (52.6%). Compared to the National health and nutrition survey 2015, non-communicable diseases of the homeless people were similar or slightly better than in the general population in Japan. Participants aged 20-39 years had a significant positive tendency of having liver function abnormality compared to ≥60 years old participants. There was no significant tendency with socio-demographic characteristics in dyslipidemia and "impaired glucose tolerance". CONCLUSION: It was found that the percentage of homeless people in Nagoya who showed abnormalities of lifestyle-related disease was similar or better than that of general population in Japan.


Assuntos
Pessoas em Situação de Rua/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Transtornos Mentais/epidemiologia , Doenças não Transmissíveis/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Japão/epidemiologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/classificação , Inquéritos Nutricionais , Prevalência , Adulto Jovem
10.
PLoS One ; 14(6): e0215804, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220086

RESUMO

BACKGROUND: Attention to research and planning are increasingly being devoted to newcomer health, but the needs of newcomers with disabilities remain largely unknown. This information is difficult to determine since population-level data are rarely available on newcomers or on people with intellectual and developmental disabilities (IDD), although in Ontario, Canada these databases are accessible. This study compared the prevalence of IDD among first generation adult newcomers to adult non-newcomers in Ontario, and assessed how having IDD affected the health profile and health service use of newcomers. METHODS: This population-based retrospective cohort study of adults aged 19-65 in 2010 used linked health and social services administrative data. Prevalence of IDD among newcomers (n = 1,649,633) and non-newcomers (n = 6,880,196) was compared. Among newcomers, those with IDD (n = 2,830) and without IDD (n = 1,646,803) were compared in terms of health conditions, and community and hospital service use. RESULTS: Prevalence of IDD was lower in newcomers than non-newcomers (171.6 versus 898.3 per 100,000 adults, p<0.0001). Among newcomers, those with IDD were more likely than those without IDD to have comorbid physical health disorders, non-psychotic, psychotic and substance use disorders. Newcomers with IDD were also more likely to have psychiatry visits, and frequent emergency department visits and hospitalizations. CONCLUSION: First generation adult newcomers have lower rates of IDD than non-newcomers. How much of this difference is attributable to admission policies that exclude people expected to be high health service users versus how much is attributable to our methodological approach is unknown. Finding more medical and psychiatric comorbidity, and more health service use among newcomers with IDD compared to newcomers without IDD is consistent with patterns observed in adults with IDD more generally. To inform polices that support newcomers with IDD future research should investigate reasons for the prevalence finding, barriers and facilitators to timely health care access, and pathways to care.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Adulto , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Prevalência , Estudos Retrospectivos , Adulto Jovem
11.
Tijdschr Psychiatr ; 61(6): 375-383, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31243747

RESUMO

BACKGROUND: In ambulant psychiatric care, intellectual disability (id) is often not recognised. Therefore, a Screener for Intelligence and Learning disabilities (scil) was recently introduced to assist recognition. However, because, current therapy is not adjusted for id-related problems, its effectiveness remains unknown.
AIM: To gain insight into adequate adaptation of interventions by professionals for patients with severe mental illness (smi) and id, to improve the quality of care without the need to develop a completely new program of therapy.
METHOD: A qualitative design (n=15) including 8 interviews and one focus group, among psychiatric practitioners and id experts.
RESULTS: Five main themes were identified to adjust therapy: treatment, communication, inclusion of the network, estimation of support needs and self-management. CONCLUSIONS To align therapy with the requirements of patients with smi and id, a patient-oriented approach to care is necessary. Simple but effective modifications, summarised in a toolkit, appear to contribute to this. To offer appropriate care to patients with smi and id, attention is needed for both a support-oriented and a recovery-oriented approach.


Assuntos
Atitude do Pessoal de Saúde , Deficiência Intelectual/terapia , Transtornos Mentais/terapia , Assistência Centrada no Paciente , Comunicação , Grupos Focais , Humanos , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/psicologia , Programas de Rastreamento , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Assistência Centrada no Paciente/organização & administração , Pesquisa Qualitativa , Índice de Gravidade de Doença
12.
Australas Psychiatry ; 27(5): 519-521, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31179721

RESUMO

OBJECTIVE: The Royal Australian and New Zealand College of Psychiatrists' (RANZCP) treatment guidelines set the zeitgeist for psychiatric practice in Australasia. This review conceptualises the current approach to treatment of individuals with an intellectual disability and co-occurring mental illness in RANZCP guidelines, and its potential impact. CONCLUSIONS: The enduring omission of people with an intellectual disability and co-occurring mental illness from RANZCP clinical guidelines is a missed opportunity in normalising care and optimising outcomes for people with an intellectual disability. There are substantial cultural, political and historical overlays contributing to the ongoing divide between health and disability. In developing psychiatric guidelines, authors should consider including people with co-occurring intellectual disability as a specific population, that requires distinctive consideration.


Assuntos
Deficiência Intelectual/terapia , Transtornos Mentais/terapia , Guias de Prática Clínica como Assunto/normas , Psiquiatria/normas , Sociedades Médicas/normas , Austrália , Comorbidade , Humanos , Deficiência Intelectual/epidemiologia , Transtornos Mentais/epidemiologia , Nova Zelândia
13.
BMC Public Health ; 19(1): 748, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196050

RESUMO

BACKGROUND: Universal childhood vaccination programmes form a core component of child health policies in most countries, including the UK. Achieving high coverage rates of vaccines is critical for establishing 'herd immunity' and preventing disease outbreaks. Evidence from the UK has identified several groups of children who are at risk of not being fully immunised. Our aim was to determine whether children with intellectual disabilities constitute one such group. METHODS: Secondary analysis of parental report data on child vaccination collected in the UK's Millennium Cohort Study when the children were 9 months, 3 years, 5 years and 14 years old. RESULTS: With one exception (MMR coverage at age 5) vaccination coverage rates were lower for children with intellectual disabilities (when compared to children without intellectual disability) for all vaccinations at all ages. Complete coverage rates were significantly lower for children with intellectual disabilities at ages 9 months (unadjusted PRR non-vaccination = 2.03 (1.14-3.60), p < 0.05) and 3 years (unadjusted PRR = 2.16 (1.06-4.43), p < 0.05), but not at age 5 years (unadjusted PRR = 1.91 (0.67-5.49)). HPV vaccination was lower (but not significantly so) at age 14 (PRR = 1.83 (0.99-3.37), p = 0.054). Adjusting PRRs for between group differences in family socio-economic position and other factors associated with coverage reduced the strength of association between intellectual disability and coverage at all ages. However, incomplete vaccination remained significantly elevated for children with intellectual disabilities at ages 9 months and 3 years. There were no statistically significant differences between parents of children with/without intellectual disability regarding the reasons given for non-vaccination. CONCLUSIONS: Children with intellectual disabilities in the UK are at increased risk of vaccine preventable diseases. This may jeopardise their own health, the health of younger siblings and may also compromise herd immunity.


Assuntos
Crianças com Deficiência/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Reino Unido/epidemiologia
14.
J Pediatr Endocrinol Metab ; 32(7): 667-674, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31150357

RESUMO

Background Obesity with developmental disability/intellectual disability (DD/ID) is the most common association in syndromic obesity. Genomic analysis studies have allowed the decipherment of disease aetiology, both in cases of syndromic obesity as well as in cases of isolated or syndromic DD/ID. However, more data are needed to further elucidate the link between the two. The aim of this pangenomic study was to use single nucleotide polymorphism (SNP) array technology to determine the copy number variant (CNV) type and frequency associated with both obesity and DD/ID. Methods Thirty-six patients were recruited from the Clinical Emergency Hospital for Children, in Cluj-Napoca, Romania during the period 2015-2017. The main inclusion criterion was a diagnosis that included both obesity and DD/ID. Genomic analysis via SNP array technology was performed. Results Out of the 36 patients, 12 (33%) presented CNVs with a higher degree of pathogenicity (A group) and 24 (66%) presented benign CNVs (B group). The SNP array results for the A group were as follows: pathogenic CNVs in 8/12 patients (67%); variants of unknown significance (VOUS) in 2/12 patients (16%); and uniparental disomy (UPD) in 2/12 patients (16%). Conclusions Some of these CNVs have already been observed in patients with both obesity and DD/ID, but the others were noticed only in DD/ID patients and have not been described until now in association with obesity.


Assuntos
Biomarcadores/análise , Aberrações Cromossômicas , Deficiências do Desenvolvimento/genética , Genômica/métodos , Deficiência Intelectual/genética , Obesidade Pediátrica/genética , Polimorfismo de Nucleotídeo Único , Adolescente , Criança , Pré-Escolar , Variações do Número de Cópias de DNA , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/patologia , Feminino , Seguimentos , Testes Genéticos , Humanos , Lactente , Deficiência Intelectual/complicações , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/patologia , Masculino , Análise em Microsséries , Obesidade Pediátrica/complicações , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/patologia , Prognóstico , Romênia/epidemiologia
15.
J Pak Med Assoc ; 69(5): 684-689, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31105288

RESUMO

OBJECTIVE: To study the association of maternal, paternal and social factors with intellectual disability in special children.. METHODS: The case-control study was conducted in four schools of Lahore, Pakistan, from September 2014 to September 2015, and comprised intellectually disabled children aged 6-15 years, and an equal number of matching healthy subjects. group. Interviews were conducted with the help of a pre-tested structured questionnaire. SPSS -17 was utilised to analyse the data. RESULTS: Of the 298 participants, 149(50%) each were cases and controls. Overall, there were 83(56%) boys and 66(44%) girls. Significant association of intellectual disability was found with consanguinity (p=0.001), father's educational status (p=0.03), paternal history of mental retardation (p=0.01) and history of delayed cry (p=0.001). Breastfeeding (depicted a protective relationship (p=0.03). CONCLUSIONS: Parental, social, environmental and familial causes contributed to intellectual disability among the subjects.


Assuntos
Asfixia Neonatal/epidemiologia , Traumatismos do Nascimento/epidemiologia , Aleitamento Materno/estatística & dados numéricos , Anormalidades Congênitas/epidemiologia , Consanguinidade , Deficiência Intelectual/epidemiologia , Adolescente , Adulto , Ordem de Nascimento , Estudos de Casos e Controles , Criança , Síndrome de Down/epidemiologia , Status Econômico , Escolaridade , Pai , Feminino , Humanos , Masculino , Idade Materna , Mães , Oxigenoterapia , Paquistão/epidemiologia , Idade Paterna , Fatores de Risco , Escalas de Wechsler , Adulto Jovem
16.
J Appl Res Intellect Disabil ; 32(4): 981-993, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31038275

RESUMO

BACKGROUND: There are concerns that antipsychotics may be used inappropriately in adults with intellectual disability for problem behaviours in the absence of a diagnosed mental health condition. The aim was to examine the prevalence and patterns of antipsychotic use and their association with problem behaviours and mental health conditions in older adults with intellectual disability. METHODS: Cross-sectional data were drawn from Wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Medication data were available for 95.6% (n = 677). Those who reported antipsychotic use and reported psychotic or other mental health conditions and those who reported problem behaviours were compared. RESULTS: In total, 45.1% (n = 305) had antipsychotics, and of those with antipsychotic use and diagnosis information (n = 282), 25.9% (73) had a psychotic disorder. 58% of those exposed to antipsychotics reported problem behaviours. CONCLUSION: Reported use of antipsychotics significantly exceeded reported doctor's diagnosis of psychotic conditions in this study.


Assuntos
Antipsicóticos/uso terapêutico , Deficiência Intelectual , Transtornos Mentais , Comportamento Problema , Adulto , Idoso , Comorbidade , Estudos Transversais , Feminino , Humanos , Deficiência Intelectual/tratamento farmacológico , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/fisiopatologia , Irlanda/epidemiologia , Estudos Longitudinais , Masculino , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Mentais/fisiopatologia , Pessoa de Meia-Idade , Prevalência
17.
Eur J Pediatr ; 178(7): 1005-1011, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31053953

RESUMO

Untreated phenylketonuria (PKU) in pregnancy causes a severe embryopathy called maternal PKU syndrome. Here, we aimed to assess management issues and pregnancy outcomes in the first published series of PKU pregnancies from the developing world. Data were collected retrospectively in a single center from 71 pregnancies and 45 live births of 32 women with PKU, 11 of whom were diagnosed in adulthood after having an affected child. Microcephaly, intellectual disability, and dysmorphic facies were more prevalent in offspring of untreated than treated pregnancies with classical PKU (100% vs. 0%, 91% vs. 0%, and 73% vs. 23% with p < 0.001, p < 0.001, and p = 0.037, respectively). In treated pregnancies, phenylalanine levels were higher during weeks 6-14 than other periods of gestation (4.38 vs. 3.93, 2.00 and 2.28 mg/dl; p < 0.05). Poor compliance correlated with higher phenylalanine levels (ρ = - 0.64, p = 0.019) and fluctuations (ρ = - 0.66, p = 0.014).Conclusion: More frequent phenylalanine measurements during late first trimester are crucial to improve outcomes in treated pregnancies. In order to prevent untreated pregnancies via detecting undiagnosed adults, countries where significantly many women of childbearing age were not screened as newborns may consider pre-pregnancy PKU screening. Microcephaly in the newborn should prompt screening for PKU in the mother. What Is Known •Untreated phenylketonuria during pregnancy causes maternal phenylketonuria syndrome in the newborn. •Effective treatment throughout pregnancy can prevent adverse fetal outcomes. What Is New: •Metabolic control is related to frequency of follow-up and worsens during late first trimester. Closer follow-up during this period may improve metabolic control. •In order to prevent untreated pregnancies, pre-pregnancy phenylketonuria screening may be considered if many women of childbearing age were not screened as newborns.


Assuntos
Fenilcetonúria Materna/epidemiologia , Resultado da Gravidez/epidemiologia , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Feminino , Humanos , Recém-Nascido de Baixo Peso , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/etiologia , Microcefalia/epidemiologia , Microcefalia/etiologia , Fenilcetonúria Materna/diagnóstico , Gravidez , Estudos Retrospectivos , Turquia/epidemiologia
18.
J Autism Dev Disord ; 49(7): 2980-2989, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31053991

RESUMO

The aim of this study was to delve into the role of gender differences in social inclusion of children and youth with autism spectrum disorder (ASD) and intellectual disability (ID). A sample of 420 participants with ASD and ID aged between 4 and 21 years was evaluated using the ASD-KidsLife Scale. Females obtained lower scores in most of the items of social inclusion. These differences remained when the covariables of level of ID, support needs, and age were controlled. None of the items presented differential item functioning as a function of gender. Gender differences, as were found in social inclusion, are discussed and recommendations are given in order to provide equal opportunities to girls and boys with ASD.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Participação da Comunidade/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Adolescente , Transtorno Autístico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Espanha/epidemiologia , Adulto Jovem
19.
J Appl Res Intellect Disabil ; 32(5): 1228-1240, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31087472

RESUMO

BACKGROUND: The ageing of people with intellectual disabilities, involving consequences like dementia, creates a need for methods to support care staff. One promising method is Dementia Care Mapping (DCM). This study examined the effect of DCM on job satisfaction and care skills of ID-care staff. METHODS: We performed a quasi-experimental study in 23 group homes for older people with intellectual disabilities in the Netherlands. Among staff, we assessed job satisfaction and care skills as primary outcomes and work experience measures as secondary outcomes (N = 227). RESULTS: Dementia Care Mapping achieved no significantly better effect than care as usual (CAU) for primary outcomes on job satisfaction (MWSS-HC) and working skills (P-CAT). Effect sizes varied from -0.18 to -0.66. We also found no differences for any of the secondary outcomes. CONCLUSION: Dementia Care Mapping does not increase job satisfaction and care skills of staff caring for older people with intellectual disabilities. This result differs from previous findings and deserves further study.


Assuntos
Cuidadores , Demência/enfermagem , Instituição de Longa Permanência para Idosos , Deficiência Intelectual/enfermagem , Satisfação no Emprego , Casas de Saúde , Assistência Centrada no Paciente , Competência Profissional , Adulto , Comorbidade , Demência/epidemiologia , Feminino , Humanos , Deficiência Intelectual/epidemiologia , Masculino , Pessoa de Meia-Idade , Países Baixos
20.
J Appl Res Intellect Disabil ; 32(5): 1067-1077, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30983088

RESUMO

BACKGROUND: Obesity is common in adults with intellectual disabilities, yet little is known about how weight management interventions are provided for this population. METHODS: Semi-structured interviews were held with 14 healthcare practitioners involved in weight management interventions in an English county. A study topic guide was developed to elicit practitioners' views and experiences of barriers and facilitators to weight management for adults with intellectual disabilities. Responses were analysed using thematic analysis. RESULTS: Several barriers are involved in weight management for people with intellectual disabilities including communication challenges, general practitioners' lack of knowledge and awareness of weight management services, inconsistencies in caring support, resource constraints, wider external circumstances surrounding the individuals and motivational issues. Facilitators include reasonable adjustments to existing weight management services. However, there is a need for specialist weight management provision for people with intellectual disabilities. CONCLUSIONS: This study provides suggestions for future research, policy and practice consideration.


Assuntos
Atitude do Pessoal de Saúde , Acesso aos Serviços de Saúde , Deficiência Intelectual , Pessoas com Deficiência Mental , Obesidade/terapia , Programas de Redução de Peso , Adulto , Comorbidade , Humanos , Deficiência Intelectual/epidemiologia , Obesidade/epidemiologia , Pesquisa Qualitativa
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