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Aotearoa New Zealand is a country of just under 5 million people with a diverse population, the main ethnic groups being of European descent and Maori. There are well-developed public and private healthcare systems. As in other countries, Aotearoa New Zealand has closed the large institutions and developed community-based services for people with intellectual disability. Aotearoa New Zealand has specific legislation for people with intellectual disability presenting to the criminal justice system and has unusually and explicitly excluded people with intellectual disability from mental health legislation since 1992. Partly as a result, most health professional training schemes have little focus on issues for people with intellectual and developmental disabilities. Therefore, one of the main challenges over the coming decade will be to ensure there is a sufficient workforce of psychiatrists and other professionals who have the training and expertise to work with people with intellectual disability requiring mental health and forensic services.
There is little evidence to guide pharmacological treatment in adults with Down syndrome and Alzheimer's disease.
To investigate the effect of cholinesterase inhibitors or memantine on survival and function in adults with Down syndrome and Alzheimer's disease.
This was a naturalistic longitudinal follow-up of a clinical cohort of 310 people with Down syndrome diagnosed with Alzheimer's disease collected from specialist community services in England.
Median survival time (5.59 years, 95% CI 4.67–6.67) for those on medication (n = 145, mainly cholinesterase inhibitors) was significantly greater than for those not prescribed medication (n = 165) (3.45 years, 95% CI 2.91–4.13, log-rank test P<0.001). Sequential assessments demonstrated an early effect in maintaining cognitive function.
Cholinesterase inhibitors appear to offer benefit for people with Down syndrome and Alzheimer's disease that is comparable with sporadic Alzheimer's disease; a trial to test the effect of earlier treatment (prodromal Alzheimer's disease) in Down syndrome may be indicated.
Declaration of interest
A.S. has undertaken consulting for Ono Pharmaceuticals, outside the submitted work. Z.W. has received a consultancy fee and grant from GE Healthcare, outside the submitted work.
There is limited empirical information on service-level outcome domains and indicators for the large number of people with intellectual disabilities being treated in forensic psychiatric hospitals.
This study identified and developed the domains that should be used to measure treatment outcomes for this population.
A systematic review of the literature highlighted 60 studies which met eligibility criteria; they were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, patients and experts.
The final framework encompassed three a priori superordinate domains: (a) effectiveness, (b) patient safety and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviours, reactive and restrictive interventions, quality of life and patient satisfaction.
To index recovery, services need to measure treatment outcomes using this framework.
To assess the quality of nutrition content and the integration of user quality components and behaviour change theory relevant to food purchasing behaviour in a sample of existing mobile apps.
Descriptive comparative analysis of eleven mobile apps comprising an assessment of their alignment with existing evidence on nutrition, behaviour change and user quality, and their potential ability to support healthier food purchasing behaviour.
Mobile apps freely available for public use in GoogePlay were assessed and scored according to agreed criteria to assess nutrition content quality and integration of behaviour change theory and user quality components.
A sample of eleven mobile apps that met predefined inclusion criteria to ensure relevance and good quality.
The quality of the nutrition content varied. Improvements to the accuracy and appropriateness of nutrition content are needed to ensure mobile apps support a healthy behaviour change process and are accessible to a wider population. There appears to be a narrow focus towards behaviour change with an overemphasis on behavioural outcomes and a small number of behaviour change techniques, which may limit effectiveness. A significant effort from the user was required to use the mobile apps appropriately which may negatively influence user acceptability and subsequent utilisation.
Existing mobile apps may offer a potentially effective approach to supporting healthier food purchasing behaviour but improvements in mobile app design are required to maximise their potential effectiveness. Engagement of mobile app users and nutrition professionals is recommended to support effective design.
Eddie Chaplin, Research Lead, South London and Maudsley NHS Foundation Trust, and Visiting Researcher, Institute of Psychiatry, Psychology & Neuroscience, King's College London,
Jane McCarthy, Consultant Psychiatrist, East London NHS Foundation Trust, and Visiting Senior Lecturer, Institute of Psychiatry, Psychology & Neuroscience, King's College London
This chapter provides an introduction to and offers an overview of the current evidence base relating to offenders with intellectual disability. In particular, it discusses clinical presentation, risk assessment, clinical interventions and service provision for this group.
Definition and terminology
Although the term ‘mental retardation’ is still used as a diagnostic term in the International Classification of Diseases (ICD-10; World Health Organization, 1992), it is perceived to be offensive to people with intellectual disability and has been replaced in policy, administrative and legislative forums in many countries by ‘intellectual disability’ (Salvador-Carulla et al, 2011). The term mental retardation will be updated to intellectual developmental disorders in the ICD-11 manual currently being revised. Often terminology to describe this group changes according to the context. For example, intellectual disability is still often substituted for learning disabilities in the UK by both services and user groups and is the term used in the Mental Health Act. This chapter will use the term intellectual disability, which is defined as impairments in social and intellectual functioning that occur during the developmental period (Department of Health, 2001).
The Mental Health Act 1983 for England and Wales sets out the law for the assessment and treatment of people with mental disorder and the criteria for compulsory action to be taken where the person is a risk to themselves or others, while safeguarding the individual. This includes civil detention and disposal or transfer to healthcare via the courts as a sentence or pre-sentencing assessment. The Act also legislates on appropriate aftercare, treatment and consent, safeguards, advocacy and appeals. The definition of mental disorder under the Act has been updated and replaced by a wider definition in the 2007 amendments to ‘any disorder or disability of the mind’. This does not include intellectual disability per se. The Act is clear that people with intellectual disability shall not be considered ‘to be suffering from mental disorder’ and therefore cannot be considered for detention for assessment and/or treatment under the Act simply as a result of their intellectual disability, unless the disability is associated with abnormally aggressive or seriously irresponsible conduct.
Although epidemiological findings support a role for vitamin K status in the improvement of bone indices in adult patients with Crohn's disease (CD), this needs to be confirmed in double-blind, randomised controlled trials (RCT) with phylloquinone (vitamin K1). By conducting two RCT, the present study aimed to first establish whether supplementation with 1000 μg of phylloquinone daily near-maximally suppresses the percentage of undercarboxylated osteocalcin in serum (%ucOC; marker of vitamin K status) in adult patients with CD currently in remission as it does in healthy adults and second determine the effect of supplementation with phylloquinone at this dose for 12 months on the indices of bone turnover and bone mass. The initial dose-ranging RCT was conducted in adult patients with CD (n 10 per group) using 0 (placebo), 1000 or 2000 μg of phylloquinone daily for 2 weeks. In the main RCT, the effect of placebo v. 1000 μg vitamin K/d (both co-administered with Ca (500 mg/d) and vitamin D3 (10 μg/d)) for 12 months (n 43 per group) on the biochemical indices of bone turnover (determined by enzyme immunoassay) and bone mass (determined by dual-energy X-ray absorptiometry) were investigated. At baseline, the mean %ucOC was 47 %, and this was suppressed upon supplementation with 1000 μg of phylloquinone daily ( − 81 %; P< 0·01) and not suppressed further by 2000 μg of phylloquinone daily. Compared with the placebo, supplementation with 1000 μg of phylloquinone daily for 12 months had no significant effect (P>0·1) on bone turnover markers or on the bone mass of the lumbar spine or femur, but modestly increased (P< 0·05) the bone mass of the total radius. Despite near maximal suppression of serum %ucOC, supplementation with 1000 μg of phylloquinone daily (with Ca and vitamin D3) had no effect on the indices of bone health in adult CD patients with likely vitamin K insufficiency.
This paper presents the results of an analysis of the realization of word-final /k/ in a sample of read and casual speech by 28 female pupils from a single-sex Glaswegian high school. Girls differed in age, socioeconomic background, and ethnicity. Ejectives were the most usual variant for /k/ in both speech styles, occurring in the speech of every pupil in our sample. Our narrow auditory analysis revealed a continuum of ejective production, from weak to intense stops. Results from multinomial logistic regression show that ejective production is promoted by phonetic, linguistic and interactional factors: ejectives were used more in read speech, when /k/ occurred in the /-ŋk/ cluster (e.g. tank), and when the relevant word was either at the end of a clause or sentence, or in turn-final position. At the same time, significant interactions between style, and position in turn, and the social factors of age and ethnicity, show that the use of ejectives by these girls is subject to a fine degree of sociolinguistic control, alongside interactional factors. Finally, cautious comparison of these data with recordings made in 1997 suggests that these results may also reflect a sound change in progress, given the very substantial real-time increase in ejective realizations of /k/ in Glasgow over the past fourteen years.
People with intellectual disability often have health needs that go unrecognised and untreated; this may be because of difficulties in communication, diagnostic overshadowing, discrimination or indifference. There is concern that public health measures aimed at reducing the main health killers in the population will not address these issues for people with intellectual disability and may preferentially widen the inequality that already exists. This book is a comprehensive and systematic review of physical and mental health co-morbidities in people with intellectual disability. Such an evidence base is vital in shaping public health policy, healthcare commissioning and the development of more effective healthcare systems, as well as supporting better understanding and practice at an individual clinical level. This is essential reading for policy makers and commissioners of services, as well as individual practitioners across mainstream and specialist health and social care, in considering not only service developments but practice at the coalface.