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1.
Lancet Psychiatry ; 7(2): 148-161, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31879245

RESUMO

BACKGROUND: Mental disorders are among the leading causes of non-fatal disease burden in India, but a systematic understanding of their prevalence, disease burden, and risk factors is not readily available for each state of India. In this report, we describe the prevalence and disease burden of each mental disorder for the states of India, from 1990 to 2017. METHODS: We used all accessible data from multiple sources to estimate the prevalence of mental disorders, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by these disorders for all the states of India from 1990 to 2017, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We assessed the heterogeneity and time trends of mental disorders across the states of India. We grouped states on the basis of their Socio-demographic Index (SDI), which is a composite measure of per-capita income, mean education, and fertility rate in women younger than 25 years. We also assessed the association of major mental disorders with suicide deaths. We calculated 95% uncertainty intervals (UIs) for the point estimates. FINDINGS: In 2017, 197·3 million (95% UI 178·4-216·4) people had mental disorders in India, including 45·7 million (42·4-49·8) with depressive disorders and 44·9 million (41·2-48·9) with anxiety disorders. We found a significant, but modest, correlation between the prevalence of depressive disorders and suicide death rate at the state level for females (r2=0·33, p=0·0009) and males (r2=0·19, p=0·015). The contribution of mental disorders to the total DALYs in India increased from 2·5% (2·0-3·1) in 1990 to 4·7% (3·7-5·6) in 2017. In 2017, depressive disorders contributed the most to the total mental disorders DALYs (33·8%, 29·5-38·5), followed by anxiety disorders (19·0%, 15·9-22·4), idiopathic developmental intellectual disability (IDID; 10·8%, 6·3-15·9), schizophrenia (9·8%, 7·7-12·4), bipolar disorder (6·9%, 4·9-9·6), conduct disorder (5·9%, 4·0-8·1), autism spectrum disorders (3·2%, 2·7-3·8), eating disorders (2·2%, 1·7-2·8), and attention-deficit hyperactivity disorder (ADHD; 0·3%, 0·2-0·5); other mental disorders comprised 8·0% (6·1-10·1) of DALYs. Almost all (>99·9%) of these DALYs were made up of YLDs. The DALY rate point estimates of mental disorders with onset predominantly in childhood and adolescence (IDID, conduct disorder, autism spectrum disorders, and ADHD) were higher in low SDI states than in middle SDI and high SDI states in 2017, whereas the trend was reversed for mental disorders that manifest predominantly during adulthood. Although the prevalence of mental disorders with onset in childhood and adolescence decreased in India from 1990 to 2017, with a stronger decrease in high SDI and middle SDI states than in low SDI states, the prevalence of mental disorders that manifest predominantly during adulthood increased during this period. INTERPRETATION: One in seven Indians were affected by mental disorders of varying severity in 2017. The proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990. Substantial variations exist between states in the burden from different mental disorders and in their trends over time. These state-specific trends of each mental disorder reported here could guide appropriate policies and health system response to more effectively address the burden of mental disorders in India. FUNDING: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.


Assuntos
Carga Global da Doença/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoas com Deficiência Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
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.
J Intellect Disabil ; 23(3): 432-445, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31496387

RESUMO

This article discusses potential opportunities for best practice in the United Kingdom that may be brought about by the Care Act (2014). Carers in the United Kingdom were given new rights within this legislation with a focus on needs led assessment. The underpinning philosophy of the Care Act is to streamline the previous legislation and offers a framework for carers and people in receipt of care, to enable a more personalized approach to care and support. Offering a discussion of likely opportunities brought about by provisions of the Care Act, this article draws on a small study involving older parent/carers of sons or daughters with intellectual disabilities. Exploring the extent to which such parents of adults with intellectual disabilities were aware of the details of this legislation and the potential impact it may have on their lives highlighted other significant areas, some of which are discussed below. Semi-structured interviews were conducted with five parents over the age of 60 of sons or daughters with intellectual disabilities in North West England. The study adds to the body of knowledge and understanding about parents of adults with intellectual disabilities and explores and provides a deeper understanding of parents' experiences of the implementation of this specific piece of legislation and their perception of the relevance of it to themselves. Findings include some awareness of the legislation and some feelings of optimism about its likely implications, although participants appeared less clear about the specificities and the impact of these upon them and/or their sons or daughters. Findings from the semi-structured interviews also showed parent's articulation of the extent of reciprocal care manifest between them and their son or daughter with an intellectual disability, as well as an awareness of the fragility of their own emotional well-being.


Assuntos
Crianças Adultas/legislação & jurisprudência , Cuidadores , Deficiência Intelectual/enfermagem , Legislação como Assunto , Pessoas com Deficiência Mental/legislação & jurisprudência , Pais , Adulto , Idoso , Cuidadores/legislação & jurisprudência , Cuidadores/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pais/psicologia , Pesquisa Qualitativa , Reino Unido
4.
J Intellect Disabil ; 23(3): 413-431, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31496388

RESUMO

Most people with intellectual disabilities (IDs) live at home with family, and most carers and care recipients wish to continue this arrangement. However, despite worry about what will happen when carers are unable to continue caring, most families do not plan for the future. The Future Care Road Map (FCRM) pilot study sought to enhance future care planning for families of adults with ID. Twelve families were facilitated through the FCRM process to establish future care plans, including future living and care arrangements. The pilot successfully improved future planning, but readiness of families and facilitation were important to outcomes. Continued care within the family was the most common future wish of care recipients. However, caring capacity emerged as a pervasive theme. Ultimately, it may be the capacity of the family, services or individual with ID themselves to provide future care which determines how feasibly future wishes translate into future plans.


Assuntos
Planejamento Antecipado de Cuidados , Envelhecimento , Cuidadores , Família , Deficiência Intelectual/enfermagem , Pessoas com Deficiência Mental , Adulto , Humanos , Projetos Piloto
6.
Trials ; 20(1): 500, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412913

RESUMO

BACKGROUND: Persons with mild to borderline intellectual disabilities generally show dysfunctions in mentalization and stress regulation, resulting in problematic social relationships and personal distress. Intervention programs may improve mentalizing abilities. The aim of this study is to examine the effectiveness of the serious game 'You & I' in changing mentalizing abilities and stress regulation in adults with mild to borderline intellectual disabilities. METHODS: A two-arm, parallel, superiority randomized controlled trial will be used with 172 adults with mild to borderline intellectual disabilities. Participants will be randomly assigned to either the experimental group to play the serious game 'You & I' or a waitlist control group. Participants will be assessed at baseline, post intervention (5 weeks after baseline), and follow-up (6-8 weeks after post intervention). They also will fill in questionnaires for personal factors, personal development, personal well-being, social validity, autism spectrum quotient (demographic variables), mentalizing abilities (primary outcome measure), and stress regulation (secondary outcome measure). DISCUSSION: The serious game 'You & I' aims to improve mentalizing abilities in adults with mild to borderline intellectual disabilities, which is expected to lead to improved regulation of stress in social relationships. The study's unique feature is the use of a serious game to improve mentalizing abilities. If the intervention is effective, the serious game can be implemented on a broad scale in Dutch care organizations for people with intellectual disabilities as an effective preventive tool to improve mentalizing abilities. TRIAL REGISTRATION: Netherlands Trial Register, NTR7418 . Registered on 2 August 2018.


Assuntos
Deficiência Intelectual/reabilitação , Mentalização , Pessoas com Deficiência Mental/reabilitação , Estresse Psicológico/prevenção & controle , Jogos de Vídeo , Adaptação Psicológica , Estudos de Equivalência como Asunto , Humanos , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/psicologia , Pessoas com Deficiência Mental/psicologia , Países Baixos , Comportamento Social , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Fatores de Tempo , Resultado do Tratamento
7.
Orv Hetil ; 160(35): 1380-1386, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31448643

RESUMO

Introduction: Dental care for mentally disabled people poses a growing challenge for healthcare. In Hungary, the number of mentally disabled people needing special dental care is ca. 100 000. Aim: The aim of our retrospective analysis is to provide a summary of the demographic data and the treatment outcomes of patients with mental disorders treated at the Department of the Oral and Maxillofacial Surgery of the Semmelweis University in the past five years. Method: Dental care for patients with a severe level of mental disability can be carried out in general anaesthesia only. At Semmelweis University, in the Oral and Maxillofacial Department, 1717 mentally disabled adults received dental care during the past five years. (Patients included people with a mild, medium or severe level of mental disability, patients with Down's syndrome, autism, epilepsy or panic disorder.) Results: The single biggest achievement seems to be the fact that the issue of acute dental care and oral surgery has basically been settled. A workable relationship has been forged with foundations and organizations dealing with the problems of these patients. It has been realized, however, that in the case of mentally disabled patients there is an enormous need for prevention and ongoing care. Conclusions: Up to now no survey has been carried out in Hungary with the aim of objectively revealing the dental care needs of these patients. Internationally, however, several surveys have been published. It can be stated on the basis of these that both caries frequency and the presence of parodontal diseases increase in correlation with age and the level of disability. Oral hygiene is insufficient, patients or their caretakers do not get proper information, only a few of them receive adequate training and they are not motivated to keep up oral health. Dental care, except for tending acute cases, is not satisfactory. For the sake of prevention, cooperation is needed with non-governmental organizations, foundations, special education teachers and psychiatrists specialized in this field. Orv Hetil. 2019; 160(35): 1380-1386.


Assuntos
Assistência Odontológica para Pessoas com Deficiências/estatística & dados numéricos , Cárie Dentária/cirurgia , Pessoas com Deficiência Mental/estatística & dados numéricos , Doenças Periodontais/cirurgia , Cirurgia Bucal/estatística & dados numéricos , Adulto , Assistência Odontológica para Pessoas com Deficiências/tendências , Cárie Dentária/epidemiologia , Humanos , Hungria/epidemiologia , Doenças Periodontais/epidemiologia , Estudos Retrospectivos , Cirurgia Bucal/tendências
8.
BMC Health Serv Res ; 19(1): 518, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340813

RESUMO

BACKGROUND: Validated instruments are needed to assess the delivery of patient-centred care (PCC) to people with intellectual disabilities (PWIDs) needing 24-h care in residential settings. Eight dimensions of PCC have been identified: taking patients' preferences into account; access to care; emotional support; physical comfort; information and education; involvement of family and friends; coordination of care; and continuity and secure transition. Objective of this study is to validate an instrument to assess these eight PCC dimensions among informal caregivers of PWIDs in residential settings (institutional settings as well as group homes in the community). The original 24-item instrument was developed and validated among professionals providing care to PWIDs. METHODS: This study was conducted in a disability care centre in the Netherlands. All informal caregivers of PWIDs living in institutional settings or group homes in the community in need of 24-h care were invited to participate (n = 941). The response rate was 31% (n = 289). We tested the instrument using structural equation modelling, and examined its validity and reliability. RESULTS: Confirmatory factor analyses revealed good indices of fit and overall internal consistency, as represented by Cronbach's alpha values. All eight dimensions of PCC were related positively to satisfaction with care (all p ≤ 0.001). As expected, informal caregivers were less critical of PCC and its underlying dimensions, except for information and education, than were professionals working in the same disability care centre. CONCLUSIONS: The psychometric properties of the 24-item PCC instrument for informal caregivers (PCC-IC) were satisfactory, indicating that the PCC-IC is valid and reliable for the assessment of the eight dimensions of PCC among informal caregivers of PWIDs in residential settings.


Assuntos
Atitude Frente a Saúde , Cuidadores , Pessoas com Deficiência Mental , Assistência Centrada no Paciente , Psicometria , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Estudos Transversais , Análise Fatorial , Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Reprodutibilidade dos Testes
9.
Bull Hist Med ; 93(2): 180-206, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303628

RESUMO

This article analyzes the gap between the defectological narrative of care and the reality of institutional life for children with learning disabilities in the Soviet Union of the 1930s. It shows that, under Stalin, the Soviet discipline of defectology entailed a promise of correction and social integration that aligned well with the official rhetoric of triumphant socialism and that incorporated new, specific ideological meanings into its long-standing narrative of care. I also show that the defectological narrative was rarely realized in practice due to not only scarce material resources but also a profound reversal of defectological and Marxist conceptions of labor. By analyzing the disconnect between rhetoric and reality in the treatment of "mentally retarded" children in prewar Stalinism, this article contributes to a deeper understanding of the Soviet system and ideology of care.


Assuntos
Pessoas com Deficiência Mental/história , Adolescente , Criança , Pré-Escolar , Comunismo , História do Século XX , Humanos , Pessoas com Deficiência Mental/reabilitação , Socialismo , U.R.S.S.
10.
BMC Infect Dis ; 19(1): 549, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226951

RESUMO

BACKGROUND: Intestinal parasitic infections are still common in low-income countries including Ethiopia, particularly in children due to low-quality drinking water, poor personal and environmental sanitation. Disabled individuals are excluded from most academic, economic, social and cultural opportunities, they are among the poorest and most marginalized of the whole world's people. The aim of this study was to assess the prevalence of intestinal parasitic infections and associated factors among mentally disabled and non-disabled students at primary schools in Bahir Dar city, Amhara regional state, Ethiopia, 2018. METHODS: A school-based Comparative cross-sectional study design was conducted from November 1-30, 2018. A total of 418 study participants, 104 mentally disabled and 314 non-disabled students were recruited through a simple random sampling technique. The collected data were coded, entered and cleaned with EpiData version 3.1 and analyzed using SPSS version 23. Multivariable logistic regression was conducted to identify factors associated with intestinal parasitic infections. The adjusted odds ratio with a 95% Confidence interval at a 5% level of significance was used to measure the strength of association. RESULTS: The mean age of study participants was 14.05 ± 3.66 and 11.96 ± 2.94 for mentally disabled students and non-disabled students. Prevalence of parasitic infection was 56.70% (n = 59) for mentally disabled students whereas 41.10%(n = 129) for non-disabled students. Unclean fingernails [AOR = 2.42; 1.40,4.17], health checkups [AOR = 1.87;1.16,3.02], hand washing with water only [AOR = 2.48; 1.49,4.12], cooking and sanitation source of water [AOR = 4.40;2.32,8.36], Grade [ (1-4)] [AOR = 2.27;1.41,3.67], sex [AOR = 1.64;1.03,2.63] and Family size> = 7 [AOR = 2.74;1.25,5.99] were variables which showed statistically significant association with intestinal parasitic infections. CONCLUSION: The prevalence of intestinal parasitic infection was higher among mentally disabled students than non-disabled students. Unclean fingernails, health checkups, hand washing habits, source of water, family size, sex and Grade of students have had a statistically significant association with intestinal parasitic infections. Periodic medicinal treatment was needed twice a year for mentally disabled and once a year for non-disabled students.


Assuntos
Crianças com Deficiência/estatística & dados numéricos , Enteropatias Parasitárias/epidemiologia , Pessoas com Deficiência Mental/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Criança , Estudos Transversais , Crianças com Deficiência/psicologia , Etiópia/epidemiologia , Feminino , Humanos , Higiene , Masculino , Áreas de Pobreza , Prevalência , Fatores de Risco , Estudantes/psicologia
11.
BMC Public Health ; 19(1): 706, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174506

RESUMO

BACKGROUND: Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England. METHODS: Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters. RESULTS: Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective. CONCLUSION: Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions.


Assuntos
Continuidade da Assistência ao Paciente/economia , Acesso aos Serviços de Saúde/economia , Deficiência Intelectual/economia , Pessoas com Deficiência Mental/estatística & dados numéricos , Adulto , Idoso , Análise Custo-Benefício , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida
12.
J Appl Res Intellect Disabil ; 32(5): 1203-1215, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31066173

RESUMO

BACKGROUND: This study explored understandings that service-users with intellectual disabilities and challenging behaviour held around their behaviour, what shaped these understandings, and the relationship between how behaviours are managed and well-being. METHODS: Eight participants (three female, five male) partook in individual semi-structured qualitative interviews. Interviews were transcribed and analysed using interpretative phenomenological analysis. RESULTS: Three master themes emerged from this analysis: (a) challenging behaviour can be explained via an internal or external frame of reference, with each framework having different implications for how participants attempted to manage behaviour. (b) Positive relationships provide a long-term buffer to challenging behaviour, with positive relationships with family, staff and peers operating through different mechanisms to achieve this. (c) A greater ability to exert power and control in day-to-day life was perceived to reduce challenging behaviour in the long term. CONCLUSIONS: Implications for practice are discussed.


Assuntos
Deficiência Intelectual/psicologia , Pessoas com Deficiência Mental/psicologia , Comportamento Problema/psicologia , Adulto , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Adulto Jovem
14.
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
15.
J Appl Res Intellect Disabil ; 32(5): 1007-1017, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31033103

RESUMO

BACKGROUND: This paper examines the appropriateness of using interpretative phenomenological analysis (IPA) in research with people who have intellectual disabilities, focussing on quality. METHODS: We conducted a systematic search to identify published studies. We assessed the quality of the studies using a bespoke framework, adapted from previous reviews, and articles on indicators of "good" IPA work. RESULTS: Twenty-eight papers were reviewed. The studies were of varying quality: 6 (22%) papers were rated as "good" quality; 16 (57%) were "acceptable", and 6 (21%) were "poor." This ratio was comparable to that found in assessments of IPA papers in other domains, suggesting that issues of quality reflect researcher competence, rather than challenges with the population. CONCLUSIONS: IPA can be an appropriate methodology to use with people with intellectual disabilities. We encourage researchers to develop more detailed analyses, to provide more transparency about their sampling strategies, and more detail of the characteristics of their samples.


Assuntos
Deficiência Intelectual , Pessoas com Deficiência Mental , Pesquisa Qualitativa , Humanos
16.
J Appl Res Intellect Disabil ; 32(4): 932-941, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30950144

RESUMO

BACKGROUND: The move to community support for all people with intellectual disabilities is an aspiration with international significance. In this article, we draw on rich accounts from women with intellectual disabilities detained under the Mental Health Act (E&W) 1983 and staff at an National Health Service secure setting in England to explore how "moving on" is defined and perceived. METHODS: The study reports on an ethnographic study using the field-notes and the 26 semi-structured interviews with detained women and staff on three wards. RESULTS: We first explore staff conceptions of moving on, which include behavioural change and utilizing coping strategies. Then, we discuss the areas of analysis that women discussed: taking back responsibility, success in arranged relationships, acceptance of regime and resistance to progression. CONCLUSION: The concepts of moving on were not determined by the women but by the service. We recommend further research which explores women's own rehabilitation requirements.


Assuntos
Institucionalização , Deficiência Intelectual/psicologia , Deficiência Intelectual/reabilitação , Tratamento Psiquiátrico Involuntário , Pessoas com Deficiência Mental/psicologia , Pessoas com Deficiência Mental/reabilitação , Adulto , Inglaterra , Feminino , Humanos , Legislação como Assunto , Programas Nacionais de Saúde , Autonomia Pessoal , Pesquisa Qualitativa
17.
J Appl Res Intellect Disabil ; 32(4): 901-912, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30950169

RESUMO

AIM: Very little attention has been paid to the views and experiences of young people with mild intellectual disabilities on the broad topics of adulthood and adult identity. The following study was undertaken to explore how young adults with mild intellectual disabilities conceptualize, relate to, and experience the process of transition. METHOD: Eight young adults with mild to borderline intellectual disabilities participated in semi-structured interviews. Results were analysed using interpretive thematic analysis. RESULTS: Two umbrella themes were identified: "On a developmental pathway" and "Negotiations in the environment". CONCLUSIONS: The participants concerns were surprisingly similar to those commonly expressed by young adults without disabilities. Self-perceived adult identity appeared to be affected by the participants' personal definitions of adulthood, as well as by social comparisons with both peers and adults. Finally, while concerns were expressed about their capacity to cope with responsibility, most felt optimistic about adopting full adult status in the future.


Assuntos
Adaptação Psicológica , Desenvolvimento do Adolescente , Deficiência Intelectual/psicologia , Pessoas com Deficiência Mental/psicologia , Autoimagem , Adolescente , Feminino , Humanos , Masculino , Autonomia Pessoal , Pesquisa Qualitativa
18.
J Appl Res Intellect Disabil ; 32(4): 913-931, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30950177

RESUMO

BACKGROUND: Due to complex processes of implementation of innovations aimed at persons with intellectual disabilities in healthcare organizations, lifestyle interventions are not used as intended or not used at all. In order to provide insight into determinants influencing this implementation, this study aims to ascertain if the Measurement Instrument for Determinants of Innovations (MIDI) is useful for objectively evaluating implementation. METHOD: With semi-structured interviews, data concerning determinants of implementation of lifestyle interventions were aggregated. These data were compared to the determinants questioned in the MIDI. Adaptations to the MIDI were made in consultation with the author of the MIDI. RESULTS: All determinants of the MIDI, except for that concerning legislation and regulations, were represented in the interview data. Determinants not represented in the MIDI were the level of intellectual disabilities, suitability of materials and physical environment, multi-levelness of interventions and several persons who could be involved in the intervention, such as direct support persons (DSPs), a therapist or family, and the communication between these involved persons. CONCLUSION: The present authors suggested making adjustments to existing questions of the MIDI in order to improve usability for deployment in organizations that provide care to persons with intellectual disabilities. The adjustments need to be tested with other interventions.


Assuntos
Assistência à Saúde , Implementação de Plano de Saúde , Serviços de Saúde para Pessoas com Deficiência , Deficiência Intelectual/reabilitação , Estilo de Vida , Pessoas com Deficiência Mental/reabilitação , Assistência à Saúde/legislação & jurisprudência , Assistência à Saúde/normas , Implementação de Plano de Saúde/legislação & jurisprudência , Implementação de Plano de Saúde/normas , Serviços de Saúde para Pessoas com Deficiência/legislação & jurisprudência , Serviços de Saúde para Pessoas com Deficiência/normas , Humanos , Inovação Organizacional , Pesquisa Qualitativa
19.
Australas Psychiatry ; 27(5): 522-524, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30931584

RESUMO

OBJECTIVES: This study aimed to highlight the interplay of intellectual disability and psychiatric presentation using a case series. METHODS: A brief review of the current literature and an illustrative case series of five intellectually disabled patients with psychiatric patients whose diagnosis were clarified over time who presented with a psychiatric illness are provided. RESULTS: The presence of intellectual disability often compounds the difficulty of establishment of mental-health diagnosis. CONCLUSIONS: More focus is required on training and skills development across mental-health services regarding the assessment of psychiatric disorders in people with an intellectual disability.


Assuntos
Competência Clínica , Deficiência Intelectual/diagnóstico , Transtornos Mentais/diagnóstico , Serviços de Saúde Mental , Psiquiatria/educação , Austrália , Competência Clínica/normas , Comorbidade , Humanos , Deficiência Intelectual/epidemiologia , Internato e Residência , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/normas , Pessoas com Deficiência Mental , Pessoas Mentalmente Doentes , Nova Zelândia , Sociedades Médicas
20.
J Appl Res Intellect Disabil ; 32(5): 1058-1066, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30980465

RESUMO

BACKGROUND: This article is about interactions that occur when someone with intellectual disabilities is engaged in everyday activities with a personal assistant (PA) or a support worker. METHOD: We examine the detail of nine hours of naturally occurring video-recorded interactions, to explore how "relational autonomy" is done in practice. Nine people with ID and seven staff took part in the research, which took place in England from 2016-17. RESULTS: We selected six extracts to illustrate different types of joint decision-making. Informed by inclusive research with a drama group of people with intellectual disabilities, we focus on the ways in which (a) future plans are discussed; (b) choices are offered during an activity; (c) people reflect on their decisions. CONCLUSION: The article concludes with discussion about the teaching and learning content of choice-making, on relational autonomy, and the practice learning for PAs, support workers and for people with intellectual disabilities.


Assuntos
Atividades Cotidianas , Tomada de Decisões , Deficiência Intelectual , Relações Interpessoais , Pessoas com Deficiência Mental , Autonomia Pessoal , Adolescente , Adulto , Feminino , Humanos , Deficiência Intelectual/enfermagem , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
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