Vision and oral health needs of individuals with intellectual disability

Assessment of Oral Health Conditions Among Physically Disabled Patients in Saudi Arabia

OBJECTIVES

This study was undertaken to assess the oral health status among physically disabled Saudi patients.

METHODS

Recruitment took place in the Armed Forces Centre for Health Rehabilitation in Taif, Saudi Arabia. 124 patients living with a physical disability were enrolled and divided into three groups: hemiplegia, paraplegia and quadriplegia. Data was collected on demographics and different oral indices, including the Decayed Missing Filled Teeth (DMFT) index, the Mean Decayed Teeth score, the Community Periodontal Index (CPI), the Community Periodontal Index of Treatment Needs (CPITN), and the Simplified Oral Hygiene Index (OHI-S).

RESULTS

High DMFT was observed among the hemiplegia group (mean = 22.61; P-value = .008) with no difference in the Mean Decayed Teeth. All groups showed signs of gingivitis in the form of gingival bleeding. The most compromised periodontal health in the form of pockets 6 mm or deeper was found in the hemiplegia group (53.7%; P-value = .001). This was also reflected in the CPITN (39.0%; P-value = .001), indicating the need for complex treatments in the same group. Regarding oral hygiene, all groups showed a "fair" oral hygiene condition (OHI-S < 3.0), with significantly poorer hygiene (mean = 2.49; P-value = .042) and greater debris accumulation (mean = 1.52; P-value = .024) among the quadriplegia group. In the regression analysis, both age and gender had significant effects on some indices, while disability type showed borderline effects.

CONCLUSION

The findings indicate poor oral health in these individuals, mainly due to physical limitations, hindering effective self-care practices.

CLINICAL SIGNIFICANCE

Oral health is a critical aspect in people with physical disabilities, as it is intrinsically linked to overall health and well-being. Recognizing the clinical importance of oral health among physically disabled patients is essential to improve access and affordability of dental care for this vulnerable group of the population.

Ocular Motility Patterns in Intellectual Disability: Insights from the Developmental Eye Movement Test

PURPOSE

To measure the ocular motility parameters of the Developmental Eye Movement (DEM) test objectively, with an eye tracker in subjects with intellectual disability (ID).

METHODS

The DEM test was performed on 45 subjects with ID, while their eye movements were recorded with an eye tracker. Some objective parameters of ocular motility were obtained through each subtest (A, B, and C) of the full DEM test.

RESULTS

There was a significant positive correlation between the saccadic speed (cc: 0.537; p = 0.001) and length (cc: 0.368; p = 0.030) of both eyes for the same subject. People with a higher percentage of ID exhibited a greater number of fixations, saccades, and errors, and took longer to perform the DEM test than those with a lower ID percentage, who had greater numbers of these parameters than subjects without ID. Subjects without ID exhibited faster saccades, with a higher amplitude, than subjects with ID.

CONCLUSIONS

The eye tracker quantifies ocular motility parameters involved in the DEM test in subjects with ID. Both eyes' movements in subjects with ID were conjugated, exhibiting saccades of the same length and speed. All parameters were different in subjects with ID compared to those in subjects without ID, so normative tables specifically for subjects with ID are necessary.

The association between the Patient Protection and Affordable Care Act and healthcare affordability among US adults with intellectual disability

BACKGROUND

Historically, US adults with intellectual disability (ID) experience worse healthcare access than the general population. However, the implementation of the Patient Protection and Affordable Care Act (ACA) may have reduced disparities in healthcare access.

METHODS

Using a pre-ACA 2011-2013 sample and a post-ACA implementation 2014-2016 sample from the National Health Interview Survey data, we examined the association between the ACA's introduction and healthcare access among adults with ID (N = 623). Negative binomial regression models were used to test the association between the ACA and the total number of foregone healthcare services. Binary logistic regression was used to explore whether the ACA's implementation was associated with the increased likelihood of possessing health insurance as well as the decreased likelihood of any and particular measures of foregone healthcare services due to cost.

RESULTS

The study provides evidence that the ACA's implementation was associated with the decreased likelihood of the total number and any foregone care services owing to cost. Findings also revealed that the ACA's implementation was associated with expansion of health insurance coverage and decreasing instances of foregone care services for medical care, dental care, specialist visit and mental care among adults with ID. However, persons with ID were still at a higher risk of foregone prescription medicines, follow-up medical care and eyeglasses due to cost in the post-ACA years.

CONCLUSIONS

The study provides evidence that healthcare access among Americans with ID improved after the ACA's implementation. However, challenges in access to follow-up care, eyeglasses and prescription medicines persist and require policy solutions, which extend beyond the ACA's provisions.

Maternal disability and prenatal oral health experiences: Findings from Pregnancy Risk Assessment Monitoring System

BACKGROUND

Although disability has associations with poor health and reduced access to health care services, limited research exists on the connection between disability, oral health, and oral health care use. Moreover, to the authors' knowledge, no study has examined the association between disability and oral health around the time of pregnancy. This is an important gap in research, considering that both disability and oral health play a critical role in maternal and infant well-being.

METHODS

The authors obtained cross-sectional data from 15 states from 2019 and 2020 from the Pregnancy Risk Assessment Monitoring System (N = 20,189). The authors used multivariable logistic regression analyses to assess the relationship between cumulative disabilities and specific forms of disability (seeing, hearing, walking, remembering, self-care, and communicating) for 6 indicators of oral health experiences during pregnancy.

RESULTS

Women reporting multiple forms of disabilities around the time of pregnancy (especially ≥ 3 disabilities) reported lower levels of knowledge of appropriate oral health care during pregnancy, were less likely to undergo dental prophylaxis during pregnancy, were more likely to report needing care for dental health problems, and had more unmet oral health care needs than those without disabilities.

CONCLUSIONS

Maternal disability is a risk factor for poorer oral health outcomes and oral health care use during pregnancy.

PRACTICAL IMPLICATIONS

Given the potential harms of poor oral health to maternal and infant well-being, the findings of this study suggest the need for increased health promotion efforts to foster improved oral health for pregnant women living with disabilities.

Quality of Clinical Guidelines on Oral Care for Children with Special Healthcare Needs: A Systematic Review

Robust evidence-based guidelines are important in everyday clinical practice, especially when delivering and managing oral care needs to a vulnerable group such as children with special healthcare needs (SHCNs).

METHODS

To assess the quality of guidelines on the management of oral care for children with special healthcare needs (SHCNs) and to find appropriate guidelines, an electronic search of MEDLINE Ovid was carried out alongside an additional search of common guideline websites. The AGREE II tool was used to assess the quality of the guidelines. Assessment was undertaken independently by three assessors. Furthermore, the underlying evidence used to formulate recommendations in the identified guidelines was qualitatively assessed.

RESULTS

There were nine guidelines, with 41 recommendations, that met the eligibility criteria. The quality of the guidelines was generally found to be poor. Only one guideline was assessed as "recommended" by the assessors, based on the quality of the methods, the reporting, or both. Only 2 of the 41 sets of recommendations, made across the nine guidelines, were judged to be valid and based on a rigorous systematic review of the evidence.

CONCLUSIONS

The current state of guidelines on oral care management for children with special healthcare needs (SHCNs) is, on the whole, of very low quality. The scientific community should work together to enhance the quality and strength of the current clinical guidelines and to ensure that they are trustworthy prior to implementation.

Qualitative inquiry from multiple perspectives of barriers and facilitators of oral health care for adults with disabilities

AIMS

Adults with special health care needs (ASHCN) face significant disparities in access to oral health care and subsequent health outcomes, resulting from several etiologies. This study investigated perspectives of patients, caregivers, and providers to better understand care barriers and facilitators for ASHCN.

METHODS

We conducted 26 semi-structured interviews with a purposive sample from an academic clinic specializing in oral health care for ASHCN with disabilities [patients (N = 4), caregivers (N = 8), and providers (N = 14)], and thematically analyzed transcripts for care barriers and facilitators.

RESULTS

Three overarching themes that encompassed overlapping barriers and facilitators of oral health care for ASHCN emerged: relational aspects, provider training/experience, and infrastructure aspects. Themes include intersecting perceptions of factors that hinder or help oral health care and management of ASHCN.

CONCLUSIONS

Building relationships with patients, inherent empathetic provider characteristics, and accommodating clinical infrastructure are imperative to facilitate oral health care for ASHCN. The primary themes revealed in this study are facilitators to care when they are present, and barriers to care when they are absent. No individual theme stands alone as a single contributor to quality care, and the provision of care for ASHCN relies on coordination of providers, patients, caregivers, and the overarching infrastructure.

Is health a priority? Examining health-related support needs in adults with intellectual disability through a self-determination framework

BACKGROUND

People with intellectual disabilities experience inequities in healthcare. Those are maintained by individual limitations as well as environmental factors. In this context, health needs are less likely to be expressed, identified and met.

METHOD

We led a survey in 832 adults with intellectual disabilities to identify if health was set as a priority and if so, what were their major health-related support needs (in terms of physical, social and psychological health).

RESULTS

67.1% of participants reported at least one need. Most frequently, two or more types of needs were reported with gender and living facility having an effect on whether participants would report these needs, but these did not affect which type of needs were reported.

CONCLUSIONS

Health-related support needs are highly prevalent and diversified in people with intellectual disabilities. This study emphasizes the importance to consider health as a global concept as well as the relationships between health and self-determination.

Assessment of oral health status among intellectually and physically disabled population in Chennai

Background:

Oral health is an integral part of general health. In certain populations, especially among intellectually and physically disabled individuals, oral health is neglected. People with disabilities deserve the same opportunities for oral health and hygiene as those who are abled, but sadly dental care is the most common unmet health care need of the disabled people.

Aim:

The purpose of the study is to assess the oral health status and dental care utilization of people above 15 years with intellectual and physical disability in Chennai.

Methodology:

A descriptive cross-sectional study was carried out to assess the dental caries experience, gingival status, prevalence of fluorosis and lesion, and dental service utilization among 132 intellectually and physically disabled people in Chennai. After obtaining the caregivers consent of the participants, oral health was assessed using the World Health Organization (WHO) proforma, 2013. Statistical analysis was done using Statistical Package for the Social Sciences Version 23.

Results:

When DMFT indexes were examined with regard to sex, the mean DMFT was found to be higher for males with 1.453 ± 1.847 whereas females have 1.403 ± 1.73, and mean DMFT was found to be more for the 26–35 years age group with 2.3 ± 2.01. 81.8% of the population had no gingival bleeding whereas only 18.18% had gingival bleeding.

Conclusion:

With the obtained results, people with physical disability have a high mean DMFT compared with intellectual disability. The present study showed dental negligence among mentally disabled population where the parents, caretakers, and dentists are responsible.

Awareness and Attitude of General and Specialist Dentists in Providing Oral Health-related Quality of Life for Children with Special Healthcare Needs

Special healthcare needs children (SHCNC) requires specialized knowledge acquired by additional training, as well as increased awareness and accommodative measures on part of general practitioners and specialist dentists beyond what is considered routine. Most dentists face challenges in treating these children, due to lack of awareness and insufficient training regarding the management of such children in a dental operatory.

Ed Zigler's developmental approach to intellectual disabilities: Past, present, and future contributions

Comprising two parts, Ed Zigler's developmental approach has greatly influenced how one conceptualizes children with intellectual disabilities (ID). In part one, Zigler championed a "two-group approach" concerning the cause of children's ID. He distinguished persons with a clear, organic cause of their ID from those displaying no clear cause. Members of this "organic" group often displayed IQs below 50 and co-occurring physical-medical conditions. The second, "cultural-familial" group, mostly showed IQs of 50-70, did not possess co-occurring physical or health problems, and often came from families of lower IQs and lower socioeconomic status. While the presence of these two groups has been supported, recent advances have also further differentiated the organic group, mostly in relation to behavioral phenotypes of persons with several genetic etiologies. In part two, Zigler championed the child with ID as a "whole person." Originally focused on the child's reactions to social deprivation and failure, recent studies directly examine parent-child, within-family, and wider system interactions throughout the life span. For decades a force within the ID field, Zigler's developmental approach to children with ID continues to influence researchers, interventionists, and policymakers.

Oral health knowledge and dental behavior among individuals with autism in Jordan: a case-control study

Background

Oral care is acknowledged as an integral component of general health and plays an essential role in establishing the desired level of quality of life for individuals with autism spectrum disorder (ASD).

Purpose

To investigate oral health knowledge and dental behaviors in individuals with ASD in comparison with individuals without ASD in Jordan.

Methods

A case–control study was carried out among 296 caregivers of individuals with ASD (n = 147) and control (n = 149) groups. A closed ended, validated self-designed questionnaire was distributed. The questionnaire included questions addressing participant’s oral health knowledge and behaviour. Data were analyzed using SPSS® software Version 22 with a 0.05 level of significance. A Chi-square test and contingency-table analysis were performed.

Results

Individuals with ASD in Jordan were significantly less knowledgeable about different oral health aspects than individuals without ASD (p < 0.05). Fewer individuals in the ASD group brushed their teeth once or twice daily (89%), compared to the control group (93%). Only 15% of the ASD participants could brush their teeth without help. The use of fluoridated toothpaste and the frequency of using mouth rinse demonstrated a significant difference between groups (p < 0.05).

Conclusion

ASD individuals in Jordan suffer from a significant lack of oral knowledge comparing to their controls, leading to a misunderstanding of the basic and highly important dental health aspects. Indicating that the knowledge was not enough to influence their dental behaviors. Children with ASD and their families should receive appropriate education in special need oral health care given by oral health professionals to reduce the risk of having dental problems and oral disease and enhance their quality of life.

Oral health needs of athletes with intellectual disability in Southern Europe: Greece, Italy and Spain

AIMS

The population with intellectual disabilities (ID) has been reported to be a vulnerable population in terms of oral health. The aims of this study were to evaluate the oral condition and treatment needs of Special Olympics (SO) athletes from Greece, Italy and Spain.

METHODS AND RESULTS

A cross-sectional study was performed with data collected in annual SO events held in Greece, Italy and Spain, between 2010 and 2012. The recorded parameters were the presence/absence of edentulism, untreated decay, filled or missing teeth, sealants, tooth injury and signs of gingival disease. Among the main findings, the prevalence of untreated decay was 57.0% in Greece, 48.8% in Italy and 41.7% of the Spanish athletes. The prevalence of signs of gingival disease was 61.1% in Greece, 60.6% in Italy and 66.1% in Spain. While the majority of the athletes were in need of dental treatment.

CONCLUSIONS

Oral disease is an unresolved problem among athletes with ID in these Mediterranean countries. Therefore efforts should be directed to meet their treatment needs and to prevent oral disease.

The oral health status and treatment needs of children with fetal alcohol spectrum disorder

OBJECTIVE

To investigate the oral health status and treatment needs of children with fetal alcohol spectrum disorder (FASD).

METHODS

In this retrospective study, the records of children between the ages of 6 and 14 who attended the College of Dentistry, University of Saskatchewan between 2016 and 2019 were reviewed. Demographic and clinical data was collected and compared for children who were identified as having FASD and a healthy control group.

RESULTS

From our total sample of 252 dental records, 68 children were identified with FASD. When compared to controls, children with FASD were significantly older at their first dental visit, and more dependent on public dental insurance. Children with FASD also had a significantly higher caries experience (97% vs 64.7%) and severity (DMFT/dmft score = 7.18 ± 1.79 vs 2.93 ± 0.98). Additionally, the results of our logistic regression model indicate that children with FASD were 4.71 times more likely (OR 4.71, 95% CI 1.58 -14.03) to be referred for treatment under general anesthesia (GA) when all other factors were controlled.

CONCLUSIONS

Children with FASD may be at a higher risk for poor oral health outcomes and have more extensive treatment needs. Our results indicate that they may also be at a higher risk for treatment under GA.

CLINICAL RELEVANCE

Oral healthcare providers need to be award of the unique needs of children with FASD to better prevent and manage their oral disease.

Visual Status in a Portuguese Population with Intellectual Disability

BACKGROUND

Neurosensory deprivation associated with vision is a well-known fact in people with intellectual disability (ID). This work aims to report the visual status of a population with ID in Portugal.

METHODS

A vision screening protocol was conducted during two Special Olympics events. The vision protocol included personal medical history, ocular health evaluation, and clinical measures, such as visual acuity (VA), binocular vision, colour vision, refractive error, and intraocular pressure. This protocol was administered to 134 subjects.

RESULTS

Half of the subjects reported that they had never attended or they did not remember having attended a previous eye exam. Additionally, 10% of them had not attended an eye exam in the immediate past three years. Half the subjects failed the VA test and 13% presented moderate Visual Impairment (VI) (VA worse than 0.5 logMAR in the best eye). Manifest ocular deviation was found in 25% of the subjects and the most common ocular health dysfunction conditions were conjunctiva hyperaemia, meibomian gland dysfunction, and lens anomalies. Refractive error correction allowed a reduction in the level of moderate VI to 3.7%.

CONCLUSIONS

The population analysed showed a poor eye care attendance rate and vision-related conditions are in agreement with previous reports. The development of national strategies to promote the awareness for routine eye care in people with ID and improving accessibility to eye care services may mitigate many of the most prevalent conditions encountered.

Parents' burdens of service for children with ASD – implications for service providers

Purpose

The purpose of this investigation is to gain insight into parents' perceptions of benefits vs burdens (value) of educational and healthcare service received for their child with ASD. Parents are the main integrators of long-term educational and healthcare service for their child with ASD.

Design/methodology/approach

Design/methodology/approach included (1) a sentiment analysis of discussion forum posts from an autism message board using a rule-based sentiment analysis tool that is specifically attuned to sentiments expressed in social media and (2) a qualitative content analysis of one-on-one interviews with parents of children diagnosed with ASD, complemented with interviews with experienced educators and clinicians.

Findings

Findings reveal the link between customized service integration and long-term benefits. Both parents and service providers emphasize the need to integrate healthcare and educational service to create holistic long-term care for a child with ASD. Parents highlight the benefits of varied services, but availability or cost are burdens if the service is not publicly provided, or covered by insurance. Service providers' lack of experience with ASD and people's ignorance of the challenges of ASD are burdens.

Practical implications

Ensuring health outcomes for a child with ASD requires an integrated service system and long-term, customer-centric service process because the scope of service covers the child's entire childhood. Customized educational and healthcare service must be allocated and budgeted early in order to reach the goal of a satisfactory service output for each child.

Originality/value

This is the first service research to focus on parents' challenges with obtaining services for their child with ASD. This paper provides service researchers and managers insight into parents' perceptions of educational and healthcare service value (i.e. benefits vs. burdens) received for their child with ASD. These insights into customer-centric perceptions of value may be useful to research and may help service providers to innovate and provide integrated service directly to parents, or indirectly to service providers, who serve children with ASD.

Memorization of daily routines by children with Down syndrome assisted by a playful virtual environment

A child with Down syndrome, like any other child, may benefit from interacting with memory stimuli, but needs additional support and help. The use of special teaching methods, which add playfulness and use of the computer, can enhance the memory processes of these children. In this work, we present the virtual environment "Nossa Vida (Our Life)", which was developed to assist children with Down syndrome to memorize action sequences of their daily routine. A daily routine memorization test (DRMT), consisting of a weekly reminder of typical daily routines completed by the children and parents, was performed before (pre-test) and after (post-test) the intervention. The work involved a multidisciplinary team and assessed the effectiveness of the test performed by 30 children with Down syndrome from APAE, a special education school for children with intellectual disabilities in São Paulo, Brazil. The children were separated into two groups (Experimental - GE and Control - GC) with homogeneity and normality of the data. Two hypotheses were tested in this study: H0 and H1, where: H0 = There is no statistical difference between memorizing daily tasks between individuals with Down syndrome who used our ludic virtual environment and those who used the conventional memory method.H1 = There is a difference between the group of subjects with Down Syndrome who used our virtual game environment and the group that did not use it in relation to memorizing the daily task. This produces t = -14.98 and p <0.0001, with H1 being accepted. The results showed that the EG presented significance in relation to the CG and the evolution mean of the children in the EG was 81.82% higher. According to experts (psychologist and pedagogue) from APAE and parents, the playful activities implemented in this virtual environment have been of great interest to children, who had fun, tested hypotheses and questioned them about the sequences of actions performed in their routine daily.

Using Vocal Production to Improve Long-Term Verbal Memory in Adults with Intellectual Disability

Individuals with intellectual disability (ID) typically show weak long-term memory (LTM) skills. Understanding verbal LTM processes and searching for effective mnemonics in this population is important, to improve intervention programs. The current study aimed to assess verbal LTM abilities of adults with mild ID of mixed etiologies, and to offer a simple memorization technique based on vocal production. Participants (n = 55) learned lists of different study materials (images of familiar and unfamiliar objects, written words, and sentences) by vocal production (saying or reading aloud) or by no-production (looking, listening, or reading silently). Memory tests followed. Better memory was found for vocally produced images of familiar objects, written words, and sentences. The results show that adults with mild ID can benefit from the relative distinctiveness of items at study. Hence, vocalization may be used in educational and therapeutic contexts for this population, improving memory performance.

Introducing the Beatalk technique: using beatbox sounds and rhythms to improve speech characteristics of adults with intellectual disability

BACKGROUND

Individuals with intellectual disability (ID) often demonstrate speech impairments and reduced intelligibility. However, traditional treatment methods, which involve using repetitive verbal and non-verbal exercises, may not be fully suitable for this population. As adults with ID tend to lose interest and motivation facing the demands of a typical speech therapy session, other intervention methods are needed. The current study tested a novel intervention technique, Beatalk, based on practising vocally produced sounds and rhythms, imitating the sounds produced by rhythm machines in an a cappella musical context (i.e., human beatboxing). Human beatboxing may be a particularly effective tool since it involves intense production of speech sounds (phonemes) that can be misarticulated in the presence of speech disorders; it is relatively easy to learn and practice, and is also considered 'fun'.

AIMS

As many of the features of beatboxing make it a promising method for speech therapy, this pioneering study aimed to examine its effectiveness in comparison with a traditional speech therapy.

METHODS & PROCEDURES

Twelve adults with moderate ID and low speech intelligibility (age 24-48 years) participated in a speech therapy group for 6 weeks. Six participants were assigned to the Beatalk (study) group and six to a traditional (control) therapy group. Pre- to post-treatment changes in speech intelligibility and voice measures were assessed.

OUTCOMES & RESULTS

The preliminary data demonstrate that both types of therapy groups resulted in improved performance in articulation accuracy and voice measures, yet the Beatalk technique yielded larger gains.

CONCLUSIONS & IMPLICATIONS

The results present initial evidence for the beneficial effect of the Beatalk technique as an intervention tool for adults with ID. It is an easy-to-use technique in the context of speech therapy, and may enhance verbal communication skills in this population.

Impact of sensory adapted dental environment on children with developmental disabilities

AIMS

This was a pilot study assessing the impact of a sensory adapted dental environment (SADE) on children with developmental disabilities (DD) receiving routine dental care.

METHODS

A crossover study of 22 children with DD, aged 6 through 21, was conducted at a University Pediatric Dental clinic. Each participant was randomized to a sequence of two dental cleanings on a 3- to 4-month recall schedule, one with a regular dental environment (RDE) and one with SADE. Outcomes included physiological measures (heart rate and oxygen saturation) and cooperation (Frankl scores).

RESULTS

Study subjects completed 36 visits. None of the physiological measures differed at either time point between the two treatment settings. The Frankl scores were significantly higher with SADE setting than RDE (P = 0.0368). Forty-six percent of parents strongly agreed that they would prefer the SADE for their child's next visit.

CONCLUSION

SADE may be associated with improved behavior in children with DD.

What should we expect from Switzerland's compulsory dental insurance reform?

BACKGROUND

A vast and heated debate is arising in Switzerland as a result of some recent citizens' initiatives aimed at introducing compulsory dental health care insurance. The Grand Conseils of the Vaud, Geneva, and Neuchâtel cantons recently approved three public initiatives and their citizens are expected to vote on the proposal in 2018. The process of collecting signatures has begun in several other cantons and the discussion has now moved to a national level.

DISCUSSION

At present, there is no scientific research that can help policy-makers and citizens to understand the main economic implications of such reform. We attempt to fill this gap by analysing three critical issues: the level and determinants of unmet needs for dental care in Switzerland; the protection of vulnerable individuals; and the economic sustainability of reform.

RESULTS AND SHORT CONCLUSIONS

The results show that income is not a unique determinant of barriers to access to dental care but rather, cultural and socio-demographic factors impact the perceived level of unmet dental care needs. The reform might only partially, if at all, improve the equity of the current system. In addition, the results show that the 1% wage-based contribution that the reform promoters suggest should finance the insurance is inadequate to provide full and free dental care to Swiss residents, but is merely sufficient to guarantee basic preventive care, whereas this could be provided by dental hygienists for less.

At the intersection of chronic disease, disability and health services research: A scoping literature review

BACKGROUND

There is a concerted effort underway to evaluate and reform our nation's approach to the health of people with ongoing or elevated needs for care, particularly persons with chronic conditions and/or disabilities.

OBJECTIVE

This literature review characterizes the current state of knowledge on the measurement of chronic disease and disability in population-based health services research on working age adults (age 18-64).

METHODS

Scoping review methods were used to scan the health services research literature published since the year 2000, including medline, psycINFO and manual searches. The guiding question was: "How are chronic conditions and disability defined and measured in studies of healthcare access, quality, utilization or cost?"

RESULTS

Fifty-five studies met the stated inclusion criteria. Chronic conditions were variously defined by brief lists of conditions, broader criteria-based lists, two or more (multiple) chronic conditions, or other constructs. Disability was generally assessed through ADLs/IADLs, functional limitations, activity limitations or program eligibility. A smaller subset of studies used information from both domains to identify a study population or to stratify it by subgroup.

CONCLUSIONS

There remains a divide in this literature between studies that rely upon diagnostically-oriented measures and studies that instead rely on functional, activity or other constructs of disability to identify the population of interest. This leads to wide ranging differences in population prevalence and outcome estimates. However, there is also a growing effort to develop methods that account for the overlap between chronic disease and disability and to "segment" this heterogeneous population into policy or practice relevant subgroups.

Global oral health status of athletes with intellectual disabilities

Background

The aim of this study is to identify the oral health status and treatment needs of Special Olympics athletes with intellectual disabilities from 181 countries by the assessment of oral health parameters and differences between world regions.

Material and methods

Data were collected through interview and oral examinations within the Healthy Athletes Screening. These data were analysed with descriptive statistics of oral health parameters of athletes from Africa, Asia Pacific, East Asia, Europe/Eurasia, Latin America, Middle East North Africa (MENA) and North America. Mean differences of untreated visible dental caries, gingival signs and missing teeth were tested between regions by one-way ANOVA test and between age groups (8–11, 12–18, 19–39 and 40+) by chi-square tests for multiple comparisons with Hochberg-adjusted p value. The level of significance for all tests was set at a p value < 0.05.

Results

A total of 149,272 athletes with intellectual disabilities were screened. More than 80% of the athletes reported that they cleaned their mouths at least once a day. Athletes in Europe/Eurasia, Latin America, and MENA presented higher rates of signs of gingival disease than other regions. The prevalence of untreated dental caries was significantly higher in Latin America and the group of 8–11-year-olds from Latin America, Europe/Eurasia and Asia Pacific.

Conclusions

The data provided by this study demonstrate that continuous efforts for preventive and restorative oral health care are needed for the oral health of these athletes with ID especially in Latin America, MENA and Europe/Eurasia regions.

Unmet oral health needs among persons with intellectual disability

The aim of this study was to examine the factors affecting oral health status among intellectually disabled individuals in Serbia. The sample population was categorized according to age, sex, living arrangements, general health and the level of intellectual disability (ID). The diagnosis of dental caries was performed using the DMFT/dmft criteria. The oral hygiene and gingival health were assessed with the plaque index (Silness&Löe) and gingival index (Löe&Silness), respectively. Descriptive analysis, step-wise and logistic regression were performed to analyze related influential factors for caries presence, number of extracted teeth, teeth restored, the oral hygiene level and the extent of gingival inflammation. Odds ratios for caries were significantly higher among adult persons with ID, in persons with co-occurring developmental disorders (DDS) and increased with the level of ID. Group with DDS was associated with a 1.6 times greater odds of untreated decay, while the institutionalization was associated with 2.4 times greater odds of untreated decay. Institutionalization and co-occurring disabilities have been found to be significantly associated with a higher probability of developing gingivitis. Targeting oral health services to individuals with ID are encouraged and may help to reduce overall negative effect on oral and general health associated with delayed treatments, chronic dental pain, emergency dental care, tooth loss and advanced periodontal disease.

An estimation of the prevalence of intellectual disabilities and its association with age in rural and urban populations in India

Background:

Intellectual disability (ID) is a global public health concern. Prevalence of ID and its association with age and other demographic factors is required for planning purposes in India.

Objective:

This study analyzed the age-adjusted prevalence of ID in rural and urban populations and its correlation with age in children and adults.

Materials and Methods:

Disability data published in the report (2002) of National Sample Survey Organization were analyzed, using Z-test to measure differences in age-adjusted prevalence. Spearman rho was calculated to determine strength and direction of the association, and regression analysis was used to predict prevalence rate, based on age in rural and urban population settings.

Results:

Overall, India has a prevalence of 10.5/1000 in ID. Urban population has slightly higher rate (11/1000) than rural (10.08/1000; P = 0.044). Age was found to be highly correlated with prevalence of ID in rural children (ϱ =0.981, P = 0.019) as well as in children (ϱ = −0.954, P = 0.000) and adults (ϱ = −0.957, P = 0.000) in urban population. The possibility of confounding or the existence of covariates for children in urban settings was noted.

Conclusion:

Results of this study match findings in other epidemiological studies. However, multistage, large-scale studies are recommended for investigating prevalence rates with different severity levels of ID.

Treatment needs and impact of oral health screening of athletes with intellectual disability in Belgium

BACKGROUND

Special Olympics Special Smiles (SOSS) is an initiative created for oral health data collection and education in oral hygiene for athletes with an intellectual disability. The aims of this study were to evaluate treatment needs of participants of Special Olympics in Belgium 2013 in comparison with those from 2008 and to assess the impact of screening and referral within the SOSS in a group of athletes who participated in two consecutive events, 2012 and 2013.

METHODS

Data were collected following a standardized protocol developed by the U.S. Centres for Disease Control and Prevention, Division of Oral Health. Oral hygiene habits, treatment urgency and reports of oral pain, gingival signs, sealants, untreated caries, missing and filled teeth were recorded. Data analysis of data from 2013 consisted in descriptive statistics followed by the analysis of the data by univariable and multivariable logistic regression. This data was compared with data from 2008 published by Leroy et al., 2012 using Chi square tests. Data from athletes who participated in both Special Olympics events (2012 and 2013) were compared using Exact McNemar's test and Chi-square test for homogeneity of proportions. The level of significance for all tests was set at a p-value < 0.05.

RESULTS

A total of 627 athletes with intellectual disability participated to the SOSS program in 2013, while 132 athletes met the inclusion criteria of being a participant at both SO Belgium 2012 and 2013. The prevalence of gingival signs was 44.3 % in 2013, slightly higher than in 2008 (42.4 %). The burden of untreated decay affected 27.1 % of the population showing a net increase in comparison to 2008 (20.9 %). McNemar's test and Chi-square test revealed that there were no statistically significant differences in the proportions of all compared parameters between 2012 and 2013.

CONCLUSION

Special Olympics results from 2013 indicate a considerable unmet treatment need among Belgian Special Olympics Athletes, persistent from 2008 to 2013. Moreover, SO intervention had no impact in the oral health of athletes who participated in 2012 and 2013 events. Continuous efforts for preventive and restorative oral health care are needed for this population.

Feasibility of a sensory-adapted dental environment for children with autism

OBJECTIVE

To provide an example of an occupational therapy feasibility study and evaluate the implementation of a randomized controlled pilot and feasibility trial examining the impact of a sensory-adapted dental environment (SADE) to enhance oral care for children with autism spectrum disorder (ASD).

METHOD

Twenty-two children with ASD and 22 typically developing children, ages 6-12 yr, attended a dental clinic in an urban hospital. Participants completed two dental cleanings, 3-4 mo apart, one in a regular environment and one in a SADE. Feasibility outcome measures were recruitment, retention, accrual, dropout, and protocol adherence. Intervention outcome measures were physiological stress, behavioral distress, pain, and cost.

RESULTS

We successfully recruited and retained participants. Parents expressed satisfaction with research study participation. Dentists stated that the intervention could be incorporated in normal practice. Intervention outcome measures favored the SADE condition.

CONCLUSION

Preliminary positive benefit of SADE in children with ASD warrants moving forward with a large-scale clinical trial.

Oral health needs of athletes with intellectual disability in Eastern Europe: Poland, Romania and Slovenia

OBJECTIVES

The aims of this study were to evaluate the oral condition and treatment needs of Special Olympics (SO) athletes from Poland, Romania and Slovenia.

METHODS

A cross-sectional study was performed with data collected through standardised oral screening of athletes who participated in the annual SO events held in Poland, Romania and Slovenia, between 2011 and 2012. The data were compiled and transferred to an SPSS data file for analysis using descriptive statistics.

RESULTS

A total of 3,545 athletes participated in the study. Among the main findings, the prevalence of untreated decay was 41% in Poland and 61% in Slovenia, whilst 70% of the Romanian athletes had signs of gingival disease and only 3.8% presented molar fissure sealants. In addition, 47% of Polish athletes were in need of urgent treatment.

CONCLUSIONS

Analysis of the results obtained following screening showed comparable oral health needs of athletes with intellectual disability among countries. Exploration of the oral health systems of the countries revealed similar significant co-payments and lack of incentive for dentists to treat patients with special needs. The results from Romania, Poland and Slovenia demonstrated the need for a structured system in which a special population is a target for oral-health-related education programmes and system-included preventive, restorative and maintenance interventions.

Relationship between periodontal status and degree of visual impairment in institutionalized individuals

Objective:

Periodontal disease is a set of inflammatory infections that affect the supporting structures of the dentition. Patients with visual impairment (VI) may have more difficulty in cleaning and maintaining oral health. The purpose of this study was to investigate the possible relationship between periodontal status and degree of VI in institutionalized individuals.

Materials and Methods:

Fifty-two visually impaired individuals were included in this cross-sectional study. The periodontal parameters assessed were clinical attachment level (CAL), probing depth (PD), and visible plaque index. The degree of VI was established as: Group 1 (mild or moderate VI), Group 2 (severe or profound VI), and Group 3 (completely blind); and the types of VI were considered as congenital and acquired. Fisher's exact, Kruskal–Wallis, Mann–Whitney, and Spearman correlation coefficient test were used. The level of significance was set at 5%.

Result:

Only plaque index was higher on proximal surfaces of subjects with mild/moderate VI when compared to the other degrees of VI (P = 0.01). Furthermore, we observed higher values for interproximal CAL (P = 0.01), total PD (P = 0.04), and interproximal PD in subjects with acquired VI when compared to subjects with congenital VI (P = 0.01).

Conclusions:

These findings suggest that periodontal status may be more related to the type of disability than with the degree of VI. Acquired VI people presented a worse periodontal health than the group with congenital VI.

Oral cleanliness and gingival health among Special Olympics athletes in Europe and Eurasia

Background

Special Olympics athletes, as well as the general population of people with intellectual disabilities, are expected to have poorer gingival health. The aim of the study is to explore the prevalence of gingival signs of inflammation and its relationship to oral cleanliness and age among Special Olympics athletes from Europe and Eurasia.

Material and Methods

A retrospective longitudinal study was performed with data collected through standardized oral from 15.941 athletes from annual Special Olympics events held in 49 countries, from Europe and Eurasia between 2007 and 2012. The data was analysed descriptively, with One-Way ANOVA test and Chi-Square test.

Results

The level of significance was predetermined at a p value < 0.05. A total of 7,754 athletes presented with gingival signs (48.64%). There were no significant differences (p= 0,095) in mean gingival signs between age groups, however the association between mouth cleaning and age, was statistically significant.

Conclusions

The data suggests that there is a high prevalence of gingival signs among individuals with special needs; over 50% in more than 20 countries. Therefore, there is a serious need for education and preventive programs for the patients, their parents and caregivers.

Key words:Gingivitis, prevalence, hygiene, disability, Special Olympics.

Evaluating representativeness and cancer screening outcomes in a state department of developmental services database

Though it is widely recognized that people with intellectual and developmental disabilities (IDD) face significant health disparities, the comprehensive data sets needed for population-level health surveillance of people with IDD are lacking. This paucity of data makes it difficult to track and accurately describe health differences, improvements, and changes in access. Many states maintain administrative health databases that, to date, have not been widely used for research purposes. In order to evaluate the feasibility of using administrative databases for research purposes, the authors attempted to validate Massachusetts' administrative health database by comparing it to a large safety net hospital system's patient data regarding cancer screening, and to the state's service enrollment tables. The authors found variable representativeness overall; the sub-population of adults who live in 24-hr supported residences were better represented than adults who live independently or with family members. They also found a fairly low false negative rate for cancer screening data as compared with the "gold standard" of hospital records. Despite some limitations, these results suggest that state-level administrative databases may represent an exciting new avenue for health research. These results should lend context to efforts to study cancer and health screening variables using administrative databases. The present study methods may also have utility to researchers in other states for critically evaluating other state IDD service databases. This type of evaluation can assist researchers in contextualizing their data, and in tailoring their research questions to the abilities and limitations of this kind of database.

Assessing Understanding and Obtaining Consent from Adults with Intellectual Disabilities for a Health Promotion Study

People with intellectual disabilities are often excluded from research, in part because they may be perceived as lacking capacity to provide informed consent. A requirement of informed decision making about research participation is ability to understand the study description and disclosures presented during the consent process. The authors' aims were to determine the extent to which study participants with intellectual disabilities were able to answer questions about key aspects of study disclosures, identify ways in which people who provided appropriate answers for all of the questions differed from those who had difficulty with one or more of the questions, and examine patterns of responses to see if certain issues were more difficult to understand than others. The authors piloted a short set of questions to assess the extent to which adults with intellectual disabilities were able to answer questions about key aspects of a health promotion study. More than half of study participants correctly answered all of the questions. For those not able to answer all questions, identifying potential risks of being in the study proved the most challenging. The findings indicate that many people with intellectual disabilities likely can provide their own consent to participate in low risk studies.

Gesundheitsförderung von Menschen mit intellektueller Behinderung

Zahlreiche Publikationen belegen, dass die Gesundheit von Menschen mit intellektueller Behinderung (IB) für Krankheiten und Störungen anfälliger ist als die der Allgemeinbevölkerung. Zudem sind bestimmte Risikoverhaltensweisen (z. B. schlechte Ernährung und wenig Bewegung) häufiger bei dieser Personengruppe zu finden. Trotz der sensibleren Gesundheitssituation steht die gesundheitspsychologische Forschung für Menschen mit IB noch am Anfang. Für diesen Überblicksartikel wurde Fachliteratur über Menschen mit IB nach gesundheitspsychologischen Konzeptionen durchsucht und bestehende Forschungsarbeiten analysiert. Des Weiteren wurden rezente Gesundheitsmodelle sowie Kontinuitäts- und Stadienmodelle für die Allgemeinbevölkerung und ihre einzelnen Bestandteile hinsichtlich ihrer Übertragbarkeit auf diese spezielle Population untersucht. Eine Generalisierung von Gesundheitsmodellen der Allgemeinbevölkerung auf die Gruppe von Menschen mit IB erscheint aus verschiedenen Gründen problematisch. So erweist sich z. B. die Erfassung einzelner Bestandteile durch ihre Abstraktheit als zu komplex für Menschen mit IB. Dieses und ähnliche Forschungshindernisse werden in diesem Artikel besprochen. Diese genaue Analyse hilft jedoch notwendige Kriterien für die Entwicklung eines theoretischen Gesundheitsmodells speziell für Menschen mit IB zu erstellen. Schlussendlich werden relevante Modellbausteine für Menschen mit IB, die auf den präsentierten Forschungsergebnissen aufbauen, vorgestellt und diskutiert. Schließlich werden zukünftige Forschungsfragen erörtert.

Oral hygiene and periodontal status of teenagers with special needs in the district of Nalgonda, India

OBJECTIVES

To assess oral hygiene status, oral hygiene practices and periodontal status among 14-17-year-old visually impaired, deaf and dumb, intellectually disabled and physically challenged and normal teenagers in the district of Nalgonda, South India.

MATERIALS AND METHODS

Seven hundred and fifty teenagers in the age group of 14-17 years, constituting visually impaired, deaf and dumb, intellectually disabled, physically challenged and normal teenagers, were studied. Oral hygiene status and periodontal status were assessed using clinical indices and compared.

RESULTS

Among the five groups chosen for the study, the intellectually disabled group had the highest plaque scores and poor oral hygiene. The visually impaired and deaf and dumb had better oral hygiene compared with other disability groups. Physically handicapped showed higher loss of attachment scores and deleterious and parafunctional habits. Normal teenagers had good oral hygiene and lower plaque scores. Oral health status relied basically on proper use of oral hygiene aids and training of the groups by their care takers.

CONCLUSION

Disabled groups showed poor oral hygiene and higher incidence of periodontal disease, which may be attributed to the lack of coordination, understanding, physical disability or muscular limitations. Hence, more attention needs to be given to the dental needs of these individuals through ultimate, accurate and appropriate prevention, detection and treatment.

Does intellectual disability affect the development of dental caries in patients with cerebral palsy?

The aim of this study was to evaluate if the severity of intellectual disability is a factor that affects the development of dental cavities in patients with cerebral palsy. This cross-sectional study was conducted on 165 individuals who were selected from a physical rehabilitation center, a special public school and a regular public school. Of these, 76 individuals had been diagnosed with spastic cerebral palsy and 89 had no neurological impairment. The subjects were matched based on age and gender and selected randomly by lottery. All patients were examined to determine the number of dental cavities, and tested for their intellectual functioning (Raven Test) and motor abilities. The study showed that children with CP who presented with intellectual disabilities had a larger number of dental cavities than children with CP without intellectual disabilities. Considering intellectual functioning and motor impairment in the multivariate logistic regression, only intellectual functioning was found to have a significant effect on the development of dental cavities. These results suggest that intellectual disability can be considered a contributing factor for the development of dental caries in patients with cerebral palsy.

Dental pain in children with intellectual disabilities: caregivers' perspective

Purpose. Description of pain is generally difficult in children, and more so in those with intellectual disabilities (ID). Aim. This study is aimed at evaluating dental pain from caregivers' perspective in children with ID. Methods. The study sampled 86 children (33 with ID, 53 normally developing) ages ranges from birth to 16 years old among those visiting the School of Dentistry, King Abdulaziz University, Saudi Arabia. Caregivers were asked about their awareness of dental pain in their wards using the Dental Discomfort Questionnaire (DDQ+). The children were examined for dental caries and periodontal status. Results. The mean DDQ+ in children with ID (4.55 ± 3.46) was not significantly different from that in healthy children (4.19 ± 3.26, P = 0.7). Children with ID had more salivation (P = 0.01) and were putting their hands inside their mouths more often (P = 0.003). Conclusions. Caregivers can recognize dental pain-related behaviors in children with ID such as excessive salivation and putting hands inside the mouth more often.

Ophthalmic disorders in adults with down syndrome

A myriad of ophthalmic disorders is associated with the phenotype of Down syndrome including strabismus, cataracts, and refractive errors potentially resulting in significant visual impairment. Ophthalmic sequelae have been extensively studied in children and adolescents with Down syndrome but less often in older adults. In-depth review of medical records of older adults with Down syndrome indicated that ophthalmic disorders were common. Cataracts were the most frequent ophthalmic disorder reported, followed by refractive errors, strabismus, and presbyopia. Severity of intellectual disability was unrelated to the presence of ophthalmic disorders. Also, ophthalmic disorders were associated with lower vision-dependent functional and cognitive abilities, although not to the extent that was expected. The high prevalence of ophthalmic disorders highlights the need for periodic evaluations and individualized treatment plans for adults with Down syndrome, in general, but especially when concerns are identified.