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Carvalho LML, Jorge AADL, Bertola DR, Krepischi ACV, Rosenberg C. A Comprehensive Review of Syndromic Forms of Obesity: Genetic Etiology, Clinical Features and Molecular Diagnosis. Curr Obes Rep 2024; 13:313-337. [PMID: 38277088 DOI: 10.1007/s13679-023-00543-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 01/27/2024]
Abstract
Syndromic obesity refers to obesity occurring with additional clinical findings, such as intellectual disability/developmental delay, dysmorphic features, and congenital malformations. PURPOSE OF REVIEW: To present a narrative review regarding the genetic etiology, clinical description, and molecular diagnosis of syndromic obesity, which is a rare condition with high phenotypic variability and genetic heterogeneity. The following syndromes are presented in this review: Prader-Willi, Bardet-Biedl, Pseudohypoparathyroidism, Alström, Smith-Magenis, Cohen, Temple, 1p36 deletion, 16p11.2 microdeletion, Kleefstra, SIM1-related, Börjeson-Forssman-Lehmann, WAGRO, Carpenter, MORM, and MYT1L-related syndromes. RECENT FINDINGS: There are three main groups of mechanisms for syndromic obesity: imprinting, transcriptional activity regulation, and cellular cilia function. For molecular diagnostic, methods of genome-wide investigation should be prioritized over sequencing of panels of syndromic obesity genes. In addition, we present novel syndromic conditions that need further delineation, but evidences suggest they have a higher frequency of obesity. The etiology of syndromic obesity tends to be linked to disrupted neurodevelopment (central) and is associated with a diversity of genes and biological pathways. In the genetic investigation of individuals with syndromic obesity, the possibility that the etiology of the syndromic condition is independent of obesity should be considered. The accurate genetic diagnosis impacts medical management, treatment, and prognosis, and allows proper genetic counseling.
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Affiliation(s)
- Laura Machado Lara Carvalho
- Human Genome and Stem Cell Research Center, Department of Genetics and Evolutionary Biology, Laboratory of Human Genetics - LGH, Institute of Biosciences, University of São Paulo (USP), Matão Street 277 - Room 350, São Paulo, SP, Brazil
| | - Alexander Augusto de Lima Jorge
- Genetic Endocrinology Unit, Cellular and Molecular Endocrinology Laboratory (LIM/25), Faculty of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Débora Romeo Bertola
- Human Genome and Stem Cell Research Center, Department of Genetics and Evolutionary Biology, Laboratory of Human Genetics - LGH, Institute of Biosciences, University of São Paulo (USP), Matão Street 277 - Room 350, São Paulo, SP, Brazil
- Genetics Unit of Instituto da Criança, Faculty of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Ana Cristina Victorino Krepischi
- Human Genome and Stem Cell Research Center, Department of Genetics and Evolutionary Biology, Laboratory of Human Genetics - LGH, Institute of Biosciences, University of São Paulo (USP), Matão Street 277 - Room 350, São Paulo, SP, Brazil
| | - Carla Rosenberg
- Human Genome and Stem Cell Research Center, Department of Genetics and Evolutionary Biology, Laboratory of Human Genetics - LGH, Institute of Biosciences, University of São Paulo (USP), Matão Street 277 - Room 350, São Paulo, SP, Brazil.
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Rana D, Westrop S, Jaiswal N, Germeni E, McGarty A, Ells L, Lally P, McEwan M, Melville C, Harris L, Wu O. Lifestyle modification interventions for adults with intellectual disabilities: systematic review and meta-analysis at intervention and component levels. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:387-445. [PMID: 38414293 DOI: 10.1111/jir.13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Adults with intellectual disabilities (IDs) are susceptible to multiple health risk behaviours such as alcohol consumption, smoking, low physical activity, sedentary behaviour and poor diet. Lifestyle modification interventions can prevent or reduce negative health consequences caused by these behaviours. We aim to determine the effectiveness of lifestyle modification interventions and their components in targeting health risk behaviours in adults with IDs. METHODS A systematic review and meta-analysis were conducted. Electronic databases, clinical trial registries, grey literature and citations of systematic reviews and included studies were searched in January 2021 (updated February 2022). Randomised controlled trials and non-randomised controlled trials targeting alcohol consumption, smoking, low physical activity, sedentary behaviours and poor diet in adults (aged ≥ 18 years) with ID were included. Meta-analysis was conducted at the intervention level (pairwise and network meta-analysis) and the component-level (component network meta-analysis). Studies were coded using Michie's 19-item theory coding scheme and 94-item behaviour change taxonomies. Risk of bias was assessed using the Cochrane Risk of Bias (ROB) Version 2 and Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I). The study involved a patient and public involvement (PPI) group, including people with lived experience, who contributed extensively by shaping the methodology, providing valuable insights in interpreting results and organising of dissemination events. RESULTS Our literature search identified 12 180 articles, of which 80 studies with 4805 participants were included in the review. The complexity of lifestyle modification intervention was dismantled by identifying six core components that influenced outcomes. Interventions targeting single or multiple health risk behaviours could have a single or combination of multiple core-components. Interventions (2 RCTS; 4 non-RCTs; 228 participants) targeting alcohol consumption and smoking behaviour were effective but based on limited evidence. Similarly, interventions targeting low physical activity only (16 RCTs; 17 non-RCTs; 1413 participants) or multiple behaviours (low physical activity only, sedentary behaviours and poor diet) (17 RCTs; 24 non-RCTs; 3164 participants) yielded mixed effectiveness in outcomes. Most interventions targeting low physical activity only or multiple behaviours generated positive effects on various outcomes while some interventions led to no change or worsened outcomes, which could be attributed to the presence of a single core-component or a combination of similar core components in interventions. The intervention-level meta-analysis for weight management outcomes showed that none of the interventions were associated with a statistically significant change in outcomes when compared with treatment-as-usual and each other. Interventions with core-components combination of energy deficit diet, aerobic exercise and behaviour change techniques showed the highest weight loss [mean difference (MD) = -3.61, 95% credible interval (CrI) -9.68 to 1.95] and those with core-components combination dietary advice and aerobic exercise showed a weight gain (MD 0.94, 95% CrI -3.93 to 4.91). Similar findings were found with the component network meta-analysis for which additional components were identified. Most studies had a high and moderate risk of bias. Various theories and behaviour change techniques were used in intervention development and adaptation. CONCLUSION Our systematic review is the first to comprehensively explore lifestyle modification interventions targeting a range of single and multiple health risk behaviours in adults with ID, co-produced with people with lived experience. It has practical implications for future research as it highlights the importance of mixed-methods research in understanding lifestyle modification interventions and the need for population-specific improvements in the field (e.g., tailored interventions, development of evaluation instruments or tools, use of rigorous research methodologies and comprehensive reporting frameworks). Wide dissemination of related knowledge and the involvement of PPI groups, including people with lived experience, will help future researchers design interventions that consider the unique needs, desires and abilities of people with ID.
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Affiliation(s)
- D Rana
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - S Westrop
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Mental Health and Wellbeing, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N Jaiswal
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - E Germeni
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - A McGarty
- Mental Health and Wellbeing, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - L Ells
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
| | - P Lally
- UCL Institute of Epidemiology and Health Care, University College London, London, UK
- Department of Psychology, University of Surrey, Guildford, UK
| | - M McEwan
- People First (Scotland), Edinburgh, UK
| | - C Melville
- Mental Health and Wellbeing, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - L Harris
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - O Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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McDermott S, McCarron M, Burke E, McCallion P, O'Donovan MA. Enabling older adults with intellectual disability to become physical activity leaders in their community: Pilot study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231177190. [PMID: 37406191 DOI: 10.1177/17446295231177190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
People with intellectual disabilities (ID) have high levels of sedentary behaviour and co-morbid health conditions. There is also increased longevity for this group which is an incredible success story but one which also poses challenges to the health system. For the first time, the mainstream health system needs to plan for and address age related health needs of people with ID. It also demands consideration of age-appropriate health-promotion efforts to support this ageing population with life-long disability. A physical activity programme, People with Intellectual Disability as Physical Activity Leaders (PPALs), was co-designed and co-developed with older adults (40+ years) with intellectual disability (ID). The process, content and outcomes of the pilot are presented in this paper. Expertise from three sectors: non-statutory academic and people with intellectual disabilities and their supporters worked collaboratively for successful completion of the project.
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Affiliation(s)
- Sonia McDermott
- Trinity Centre for Ageing and Intellectual Disability, Trinity College Dublin, Dublin, Ireland
| | - Mary McCarron
- Trinity Centre for Ageing and Intellectual Disability, Trinity College Dublin, Dublin, Ireland
| | - Eilish Burke
- Trinity Centre for Ageing and Intellectual Disability, Trinity College Dublin, Dublin, Ireland
| | - Philip McCallion
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - Mary-Ann O'Donovan
- Centre for Disability Studies, Affiliate of the University of Sydney, Sydney, NSW, Australia
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Gutiérrez-Cruz C, Del-Cuerpo I, García-Ramos A, Muñoz-López S, Rubio-Cabeza J, Roman-Espinaco A. Effect of the environmental factor of coexistence on the physical condition of people with mild and moderate intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:585-593. [PMID: 36814055 DOI: 10.1111/jar.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/21/2022] [Accepted: 01/25/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The main objective of this study was to compare the physical condition of people with intellectual disabilities living in residential homes (RH; restricted residential environment) versus independent homes (IH; family houses while performing paid work). The effect of gender on physical condition was also evaluated separately for each group. METHOD Sixty individuals with mild to moderate intellectual disability, 30 living in RH and 30 living in IH, participated in this study. The RH and IH groups were homogeneous in terms of gender distribution (17 males and 13 females) and intellectual disability level. Body composition, postural balance, and static and dynamic force were considered as dependent variables. RESULTS The IH group performed better in the postural balance and dynamic force tests compared to the RH group, but no significant differences between the groups were observed for any body composition or static force variable. Women in both groups tended to have better postural balance than men, while men presented higher dynamic force. CONCLUSIONS The IH group presented a higher physical fitness compared to RH group. This result emphasises the need to increase the frequency and intensity of the physical activity sessions commonly programed for individuals living in RH.
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Affiliation(s)
- Carmen Gutiérrez-Cruz
- Department of Didactics of Musical and Corporal Expression, University of Granada, Granada, Spain.,Hermanas Hospitalarias, Fundación Purísima Concepción de Granada, Granada, Spain
| | - Indya Del-Cuerpo
- Department of Physical Education and Sport, University of Granada, Granada, Spain
| | - Amador García-Ramos
- Hermanas Hospitalarias, Fundación Purísima Concepción de Granada, Granada, Spain.,Department of Sports Sciences and Physical Conditioning, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Saray Muñoz-López
- Hermanas Hospitalarias, Fundación Purísima Concepción de Granada, Granada, Spain
| | - José Rubio-Cabeza
- Hermanas Hospitalarias, Fundación Purísima Concepción de Granada, Granada, Spain
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Carvalho LML, Pinto CF, de Oliveira Scliar M, Otto PA, Krepischi ACV, Rosenberg C. SCAF4-related syndromic intellectual disability. Am J Med Genet A 2023; 191:570-574. [PMID: 36333968 DOI: 10.1002/ajmg.a.63032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/13/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
The causal link between variants in the SCAF4 gene and a syndromic form of intellectual disability (ID) was established in 2020 by Fliedner et al. Since then, no additional cases have been reported. We performed exome sequencing in a 16-year-old Brazilian male presenting with ID, epilepsy, behavioral problems, speech impairment, facial dysmorphisms, heart malformations, and obesity. A de novo pathogenic variant [SCAF4(NM_020706.2):c.374_375dup(p.Glu126LeufsTer20)] was identified. This is the second study reporting the involvement of SCAF4 in syndromic ID, and the description of the patient's clinical features contributes to defining the phenotypic spectrum of this recently described Mendelian disorder.
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Affiliation(s)
- Laura Machado Lara Carvalho
- Human Genome and Stem Cell Research Center, Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Carla Franchi Pinto
- Department of Pathological Sciences, Faculty of Medical Sciences of Santa Casa de São Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Marília de Oliveira Scliar
- Human Genome and Stem Cell Research Center, Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Paulo A Otto
- Human Genome and Stem Cell Research Center, Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Ana Cristina Victorino Krepischi
- Human Genome and Stem Cell Research Center, Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Carla Rosenberg
- Human Genome and Stem Cell Research Center, Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
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Song M, Rubin BS, Ha JW, Ware RS, Doan TN, Harley D. Use of psychotropic medications in adults with intellectual disability: A systematic review and meta-analysis. Aust N Z J Psychiatry 2023; 57:661-674. [PMID: 36700564 DOI: 10.1177/00048674221149864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study presents the proportion of adults with intellectual disability using psychotropic medications including antipsychotics, antidepressants, anxiolytics, hypnotics and sedatives, and psychostimulants. METHODS A search was performed in PubMed, Embase, PsycINFO, Web of Science, and Scopus up to 31 December 2021. Articles were included if they reported the proportion of adults with intellectual disability using psychotropic medications. Frequency of use was estimated using a random effects meta-analysis. Meta-regression analysis was used to assess the association between study-level characteristics and variability in estimates, when heterogeneity was considerable. RESULTS Twenty-four articles were included in pooled analysis. The pooled prevalence of psychotropic medications was 41% (95% confidence interval: 35-46%). Pooled prevalences of subclasses were as follows: antipsychotics 31% (27-35%), antidepressants 14% (9-19%), anxiolytics 9% (4-15%), hypnotics/sedatives 5% (2-8%), and psychostimulants 1% (1-2%). Heterogeneity was considerable between studies, except for psychostimulants. There was no significant association between assessed characteristics and variability in prevalence estimates. CONCLUSION Two-fifths of adults with intellectual disability were prescribed psychotropic medications. Antipsychotics and antidepressants were used by one-third and one-seventh of adults, respectively. There was considerable variability between studies, and further investigation is required to determine the source of variability. More studies are needed to better characterise prescribed psychotropic medications, including effectiveness and adverse effects, to ensure appropriate use of these drugs.
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Affiliation(s)
- Menghuan Song
- Queensland Centre for Intellectual and Developmental Disability (QCIDD), Mater Research Institute-University of Queensland (MRI-UQ), Mater Misericordiae Hospital, Brisbane, QLD, Australia
| | - Bryn S Rubin
- Ochsner Clinical School, University of Queensland, Brisbane, QLD, Australia
| | - Justin Wt Ha
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Robert S Ware
- Queensland Centre for Intellectual and Developmental Disability (QCIDD), Mater Research Institute-University of Queensland (MRI-UQ), Mater Misericordiae Hospital, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Tan N Doan
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - David Harley
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
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Dean S, Marshall J, Whelan E, Watson J, Zorbas C, Cameron AJ. A Systematic Review of Health Promotion Programs to Improve Nutrition for People with Intellectual Disability. Curr Nutr Rep 2021; 10:255-266. [PMID: 34893970 DOI: 10.1007/s13668-021-00382-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW To investigate the type and effectiveness of health promotion programs designed to improve nutrition for people with intellectual disability. This review also sought to highlight gaps in the evidence by mapping interventions to the socio-ecological model. RECENT FINDINGS To date, reviews on health promotion programs for people with intellectual disability have focused on individualised weight management interventions and behaviour change techniques. No reviews have focused solely on nutrition or considered a broader range of interventions and policies targeted beyond the individual. This review found that health promotion interventions to date were predominantly at the individual level of the socio-ecological model and of varying effectiveness. Of the non-individually focused interventions, those targeting the physical environment or considering multiple socio-ecological levels achieved the greatest improvements in nutrition outcomes. Nutrition and obesity prevention research and policy need to include intellectual disability as part of equity considerations, while intellectual disability policy needs to consider the broader food environment.
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Affiliation(s)
- Sarah Dean
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Josephine Marshall
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Erin Whelan
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Jo Watson
- Faculty of Health, School of Health and Social Development, Deakin University, Geelong, 3220, Australia
| | - Christina Zorbas
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Adrian J Cameron
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia.
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Liao P, Vajdic C, Trollor J, Reppermund S. Prevalence and incidence of physical health conditions in people with intellectual disability - a systematic review. PLoS One 2021; 16:e0256294. [PMID: 34428249 PMCID: PMC8384165 DOI: 10.1371/journal.pone.0256294] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/03/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To synthesize evidence on the prevalence and incidence of physical health conditions in people with intellectual disability (ID). METHODS We searched Medline, PsycInfo, and Embase for eligible studies and extracted the prevalence, incidence, and risk of physical health conditions in people with ID. RESULTS Of 131 eligible studies, we synthesized results from 77 moderate- to high-quality studies, which was mainly limited to high-income countries. The highest prevalence estimates were observed for epilepsy, ear and eye disorders, cerebral palsy, obesity, osteoporosis, congenital heart defects, and thyroid disorders. Some conditions were more common in people with a genetic syndrome. Compared with the general population, many health conditions occur more frequently among people with ID, including asthma and diabetes, while some conditions such as non-congenital circulatory diseases and solid cancers occur at the same or lower rate. The latter associations may reflect under-detection. CONCLUSIONS People with ID have a health profile more complex than previously known. There is a pressing need for targeted, evidence-informed population health initiatives including preventative programs for this population.
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Affiliation(s)
- Peiwen Liao
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, Australia
| | - Claire Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, Australia
| | - Simone Reppermund
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, Australia
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Lally P, Beeken RJ, Wilson R, Omar R, Hunter R, Fovargue S, Anderson D, King M, Hassiotis A, Croker H. A manualised weight management programme for adults with mild-moderate intellectual disabilities affected by excess weight: A randomised controlled feasibility trial (Shape Up-LD). JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:112-122. [PMID: 34297441 DOI: 10.1111/jar.12922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim was to pilot an adapted manualised weight management programme for persons with mild-moderate intellectual disabilities affected by overweight or obesity ('Shape Up-LD'). METHOD Adults with intellectual disabilities were enrolled in a 6-month trial (3-month active intervention and 3-month follow-up) and were individually randomised to Shape Up-LD or a usual care control. Feasibility outcomes included recruitment, retention, initial effectiveness and cost. RESULTS Fifty people were enrolled. Follow-up rates were 78% at 3 months and 74% at 6 months. At 3 and 6 months, controlling for baseline weight, no difference was observed between groups (3 months: β: -0.34, 95% confidence interval [CI]: -2.38, 1.69, 6 months: β: -0.55, 95%CI -4.34, 3.24). CONCLUSION It may be possible to carry out a trial of Shape Up-LD, although barriers to recruitment, carer engagement and questionnaire completion need to be addressed, alongside refinements to the intervention.
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Affiliation(s)
- Phillippa Lally
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, UK.,Leeds Institute of Health Sciences, London, UK
| | - Rose Wilson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care & Population Health, University College London, London, UK.,Priment Clinical Trials Unit, London, UK
| | | | | | - Michael King
- Division of Psychiatry, University College London, London, UK
| | | | - Helen Croker
- Department of Behavioural Science and Health, University College London, London, UK
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Yuan YQ, Liu Y, Wang MJ, Hou X, Zhang SH, Wang XL, Han YN, Sang P, Bian Y, Roswal G. Prevalence of overweight and obesity in children and adolescents with intellectual disabilities in China. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:655-665. [PMID: 33851750 DOI: 10.1111/jir.12840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/04/2021] [Accepted: 03/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Overweight and obesity in children and adolescents has become a worldwide epidemic. There are several studies that have concentrated on the prevalence rate of children and adolescents with intellectual disabilities (ID), whereas data on such a population on the mainland of China remain unclear. The purpose of this study was to investigate the prevalence rate of overweight and obesity among school-aged children and adolescents with ID on China's mainland. METHODS This study employed a cross-sectional design to examine the body weight status of 1873 children and adolescents (ages 6-18 years old) with ID in 35 special education schools. Body mass index was calculated, and the concepts of overweight and obesity were defined according to the standard of the Working Group for Obesity in China. RESULTS Data indicated that 18.2% (95% CI: 16.5%-20.0%) of children and adolescents with ID were overweight and 14.4% (95% CI: 12.8%-16.0%) were obese. Boys with ID were more likely to be overweight than girls with ID (OR = 1.48[95% CI: 1.13-1.94], P < 0.05). Children and adolescents with Down syndrome or autism spectrum disorder had a trend to be classified as overweight (OR = 1.76[95% CI: 1.22-2.54], P < 0.05; OR = 1.57[95% CI: 1.17-2.09], P < 0.05, respectively) or obesity (OR = 1.82[95% CI: 1.23-2.69], P < 0.05; OR = 1.40 [95% CI: 1.02-1.93], P < 0.05, respectively) compared with those with ID without these conditions. Moreover, children and teenagers with ID living in urban areas had a predisposition to be overweight (OR = 2.16[95% CI: 1.14-4.09], P < 0.05) or obese (OR = 3.25[95% CI: 1.41-7.50], P < 0.05) relative to those who lived in rural areas. CONCLUSION Results indicated that in China, the prevalence rate of overweight and obesity among school-aged children and adolescents with ID was remarkably high. Therefore, future research should make every effort to focus on reducing and preventing overweight and obesity of this population in China.
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Affiliation(s)
- Y Q Yuan
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Y Liu
- Department of Physical Education, Shandong Jianzhu University, Jinan, China
| | - M J Wang
- School of Chinese WuShu, Shandong Sport University, Rizhao, China
| | - X Hou
- Department of Sports Science and Physical Education, Tsinghua University, Beijing, China
| | - S H Zhang
- Department of Physical Education, China Disabled Persons' Federation, Beijing, China
| | - X L Wang
- Graduate School, Harbin Sport University, Harbin, China
| | - Y N Han
- Beijing Xuanwu District Special Education School, Beijing, China
| | - P Sang
- Shaanxi Xi'an Special Education School, Xi'an, China
| | - Y Bian
- Tianjin Hebei District Special Education School, Tianjin, China
| | - G Roswal
- School of Health Professions and Wellness, Jacksonville State University, Jacksonville, AL, USA
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Improving Beverage Choice in Adults with Developmental Disabilities: Implementation of a Token Reinforcement System in a Community Residential Setting. J Autism Dev Disord 2021; 52:1523-1535. [PMID: 33961181 DOI: 10.1007/s10803-021-05051-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
Individuals with developmental disabilities (DD) are twice as likely to have obesity than non-disabled individuals. Replacing the consumption of sugar sweetened beverages (SSBs) with water has many health benefits, including weight reduction. In this study, a token reinforcement system was implemented to increase water consumption and decrease the consumption of SSBs with 14 adult participants with DD living in a community-based independent supported living (ISL) center. Token reinforcement reduced the consumption of SSBs, with associated reductions in calorie consumption and body weight. Findings are especially important for treatment settings where resources for individualized meal planning and staffing to support comprehensive behavioral interventions may be limited.
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Taggart L, Doherty AJ, Chauhan U, Hassiotis A. An exploration of lifestyle/obesity programmes for adults with intellectual disabilities through a realist lens: Impact of a 'context, mechanism and outcome' evaluation. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:578-593. [PMID: 33342030 DOI: 10.1111/jar.12826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/16/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity is higher in people with intellectual disabilities. AIMS There are two aims of this explorative paper. Firstly, using a realist lens, to go beyond 'what works' and examine the 'context, mechanisms and outcomes' (CMO) of lifestyle/obesity programmes for this population. Second, using a logic model framework to inform how these programmes could be implemented within practice. METHOD We explored six-review papers and the individual lifestyle/obesity programmes that these papers reviewed using the CMO framework. RESULTS There were few theoretically underpinned, multi-component programmes that were effective in the short to long-term and many failed to explore the 'context and mechanisms'. We developed a logic model and engaged in two co-production workshops to refine this model. DISCUSSION Using a realist approach, programmes need to be underpinned by both individual and systems change theories, be multi-component, have a closer understanding of the interplay of the 'context and mechanisms', and co-designed using a logic model framework.
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Affiliation(s)
- Laurence Taggart
- Institute of Nursing & Health Research, Ulster University, Co Antrim, UK
| | - Alison Jayne Doherty
- Faculty of Health & Wellbeing, University of Central Lancashire (UCLan), Preston, UK
| | - Umesh Chauhan
- Faculty of Health & Wellbeing, University of Central Lancashire (UCLan), Preston, UK
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Development and Cross-Validation of a Prediction Equation for Estimating Percentage Body Fat From Body Mass Index in Young People With Intellectual Disability. Adapt Phys Activ Q 2020; 37:481-497. [PMID: 32998109 DOI: 10.1123/apaq.2019-0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/11/2020] [Accepted: 03/15/2020] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to develop and cross-validate an equation for estimating percentage body fat (%BF) from body mass index and other potential independent variables among young persons with intellectual disability. Participants were 128 persons with intellectual disability (62 women; age 16-24 years) split between development (n = 98) and cross-validation (n = 30) samples. Dual-energy X-ray absorptiometry served as the reference method for %BF. An equation including 1/body mass index and sex (0 = male; 1 = female) was highly accurate in estimating %BF (p < .001; R2 = .82; standard error of estimate = 5.22%). Mean absolute and root mean square errors were small (3.1% and 3.9%, respectively). A Bland-Altman plot indicated nearly zero mean difference between actual and predicted %BF with modest 95% confidence intervals. The prediction equation was %BF = 56.708 - (729.200 × [1/body mass index]) + (12.134 × sex). Health care professionals may use the prediction equation for monitoring %BF among young people with intellectual disability.
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Boer PH. The effect of 8 weeks of freestyle swim training on the functional fitness of adults with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:770-781. [PMID: 32808345 DOI: 10.1111/jir.12768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/27/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Studies conducted on adults with Down syndrome have demonstrated the improvement of functional fitness (aerobic capacity, muscular strength, balance, flexibility, functional ability, body mass or body mass index) with varying exercise modalities but often with one or two components in isolation. Such modalities included walking, running, cycling, rowing or resistance training. Freestyle swim training has shown significant improvements of all parameters associated with functional fitness in the general population. Swimming is an aerobic activity where many of the large muscle groups are involved and may provide more functional fitness benefits. As a consequence, the purpose of our study was to investigate the effect of freestyle swim training on the functional fitness of adults with Down syndrome. METHODS Twenty-six adults with Down syndrome (33 ± 6 years; 34 ± 9 kg/m2 ) were randomly allocated to an exercise (n = 13; 81.3 kg) or control group (n = 13; 81.5 kg). The exercise group performed 8 weeks of freestyle swim training, three times a week, 30 min per session (increased to 40 min after 4 weeks). To evaluate differences between groups, a one-way analysis of variance was used, controlling for differences at baseline. RESULTS After 8 weeks of training, the results showed significant differences between the exercise and control group for body mass, body mass index, aerobic capacity, dynamic balance, muscular strength, 12-m swim time and functional ability (P < 0.05). Effect sizes ranged from small to large. CONCLUSIONS Various components of functional fitness improved significantly after an intervention period of freestyle swim training. The collective improvement of many functional fitness parameters shown by this study may hold benefits for these often-neglected and in many cases functionally impaired individuals.
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Affiliation(s)
- P H Boer
- Department of Human Movement Science, Faculty of Education, Cape Peninsula University of Technology, Wellington, South Africa
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Increasing Exercise Intensity: Teaching High-Intensity Interval Training to Individuals with Developmental Disabilities Using a Lottery Reinforcement System. Behav Anal Pract 2020; 13:826-837. [PMID: 33269193 DOI: 10.1007/s40617-020-00428-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Rates of overweight and obesity are above 70% in typically developing adults in the United States, with higher rates observed in individuals diagnosed with developmental disability (DD). Lottery reinforcement systems have been validated as effective exercise interventions for individuals with DD. Although high-intensity interval training (HIIT) has demonstrated health benefits, it has not been studied using individuals within this population. The purpose of this study was to implement a lottery reinforcement system to systematically increase heart rate (HR) during 30-min HIIT sessions with 3 adults with DD. Results demonstrated increases in HR from below to within the prescribed range in all 3 participants. For 1 participant, weight decreased by 10.8 pounds during the 9-week program. Implications include that lottery systems increase exercise intensity with adults with DD, that HR during exercise can be reliably controlled using a lottery system, and that similar programs may result in health benefits.
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Doherty AJ, Jones SP, Chauhan U, Gibson J. Eating well, living well and weight management: A co-produced semi-qualitative study of barriers and facilitators experienced by adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2020; 24:158-176. [PMID: 29764278 DOI: 10.1177/1744629518773938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Adults with intellectual disabilities in England experience health inequalities. They are more likely than their non-disabled peers to be obese and at risk of serious medical conditions such as heart disease, stroke and type 2 diabetes. This semi-qualitative study engaged adults with intellectual disabilities in a co-production process to explore their perceived barriers and facilitators to eating well, living well and weight management. Nineteen participants with intellectual disabilities took part in four focus groups and one wider group discussion. They were supported by eight of their carers or support workers. Several barriers were identified including personal income restrictions, carers' and support workers' unmet training needs, a lack of accessible information, inaccessible services and societal barriers such as the widespread advertising of less healthy foodstuffs. A key theme of frustration with barriers emerged from analysis of participants' responses. Practical solutions suggested by participants included provision of clear and accessible healthy lifestyle information, reasonable adjustments to services, training, 'buddying' support systems or schemes and collaborative working to improve policy and practice.
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Affiliation(s)
- A J Doherty
- School of Nursing, Faculty of Health & Wellbeing, University of Central Lancashire, UK
| | - S P Jones
- School of Nursing, Faculty of Health & Wellbeing, University of Central Lancashire, UK
| | - U Chauhan
- MacKenzie Chair in Primary Care Medicine, Faculty of Clinical and Biomedical Sciences, University of Central Lancashire
| | - Jme Gibson
- School of Nursing, Faculty of Health & Wellbeing, University of Central Lancashire, UK
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Cavedon V, Zancanaro C, Milanese C. Body composition assessment in athletes with physical impairment who have been practicing a wheelchair sport regularly and for a prolonged period. Disabil Health J 2020; 13:100933. [PMID: 32402793 DOI: 10.1016/j.dhjo.2020.100933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 03/28/2020] [Accepted: 04/10/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Today several important aspects related to the impact of long-term wheelchair sports on whole-body and regional body composition in athletes with a physical impairment are poorly understood. OBJECTIVE This cross-sectional study aimed at investigating the impact of the long-term regular practice of wheelchair sports on body composition in male wheelchair athletes (WA) as compared with both non-athletic participants with a physical impairment and non-athletic able-bodied participants. METHODS Nine WA were each matched pairwise by age, duration of injury and body mass index (BMI) with a participant with a physical impairment not engaged in any wheelchair sport (N-WA) and by age and BMI with an able-bodied (AB) participant. Whole-body and regional bone mineral content (BMC), fat-free soft tissue mass (FFSTM), fat mass (FM) and percentage FM (%FM) were assessed by means of Dual-Energy X-ray Absorptiometry. RESULTS WA had significantly lower FM and %FM vs. N-WA at the whole-body level (P = 0.01 for both) and in the trunk region (P = 0.001 and P = <0.001, respectively). The only difference in body composition variables between WA and AB was found in the legs where WA had significantly higher FM (P = 0.014) along with lower BMC (P = 0.009) and FFSTM (P = 0.005) vs. AB in the legs. CONCLUSIONS The results of the present study showed that the regular, long-term practice of wheelchair sport may be associated with beneficial body composition adaptations in athletes with a physical impairment at the whole-body and trunk level.
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Affiliation(s)
- Valentina Cavedon
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy.
| | - Carlo Zancanaro
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy.
| | - Chiara Milanese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy.
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Boer PH, de Beer Z. The effect of aquatic exercises on the physical and functional fitness of adults with Down syndrome: A non-randomised controlled trial. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:1453-1463. [PMID: 31468607 DOI: 10.1111/jir.12687] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/06/2019] [Accepted: 08/11/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The importance of exercise for individuals with Down syndrome (DS) has been well documented. The use of aquatic exercises may be an attractive alternative to land-based exercises for individuals with musculoskeletal conditions such as low muscle tone and excess adiposity as found in adults with DS. As a result, the purpose of the current study was to study the effect of an aquatic training intervention on the functional fitness for adults with DS. METHODS Participants were recruited from two intellectually disabled care centres in the Western Cape of South Africa. Twenty-three adults with DS (13 men and 10 women) (31.4 ± 7.4 years) were allocated to an aquatic training group or a control group. The exercise group performed 35 min of aquatic training, three times a week for 6 weeks, with an increase duration of 45 min after 3 weeks. Outcome measures assessed were aerobic capacity, muscular strength, functional ability and balance. RESULTS The aerobic capacity and functional ability of the participants in the aquatic group improved significantly than in the control group with strong to medium effect sizes. Two out of the three strength parameters also improved significantly than in the control group. CONCLUSIONS The functional fitness of adults with DS improved with an aquatic intervention but was insufficient to improve balance and upper body strength. The improvement of various parameters associated with functional fitness is important in this population who age prematurely, suffer from the early onset of age-related conditions, are vulnerable to falls and susceptible to chronic conditions.
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Affiliation(s)
- Pieter-Henk Boer
- Department of Human Movement Science, Faculty of Education, Cape Peninsula University of Technology, Wellington, South Africa
| | - Zelda de Beer
- Department of Human Movement Science, Faculty of Education, Cape Peninsula University of Technology, Wellington, South Africa
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Sadowsky M, McConkey R, Shellard A. Obesity in youth and adults with intellectual disability in Europe and Eurasia. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:321-326. [PMID: 31482623 DOI: 10.1111/jar.12667] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 05/13/2019] [Accepted: 08/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Information about obesity among people with intellectual disability comes mostly from small-scale, national samples in high-income countries. There are limited data from transnational studies. METHOD BMI scores had been obtained for over 25,000 youth and adults with intellectual disabilities drawn from 60 European and Eurasian countries. Their height and weight had been measured using standardized procedures when they attended Special Olympics Healthy Athletes events. RESULTS Binary logistic regression identified higher levels of obesity for athletes living in high-income countries, and for adult females, for those aged 30 years and over, and also for youth aged 8-13 years. CONCLUSIONS Participation in sports does not appear to have protected these athletes from obesity. Arguably, this remains the most pressing health issue for people with intellectual disability, particularly in Western Europe.
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Affiliation(s)
| | | | - Amy Shellard
- Special Olympics International, Washington, DC, USA
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20
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Westrop SC, Melville CA, Muirhead F, McGarty AM. Gender differences in physical activity and sedentary behaviour in adults with intellectual disabilities: A systematic review and meta-analysis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1359-1374. [PMID: 31373127 DOI: 10.1111/jar.12648] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/09/2019] [Accepted: 06/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Adults with intellectual disabilities are reported to be highly inactive, with research required to understand contributory factors. This systematic review aimed to investigate gender differences in physical activity (PA) and sedentary behaviour (SB) in adults with intellectual disabilities. METHODS This systematic review was reported in accordance with PRISMA guidelines. Seven databases were searched up to, and including, January 2018. Screening identified papers that assessed gender-specific PA and/or SB outcomes in adults with intellectual disabilities. Data were synthesized using a narrative synthesis and random effects model meta-analyses. RESULTS Twenty-six papers were included; 25 measured PA, and eight assessed SB. Women with intellectual disabilities were least active with a significant overall effect of gender identified. For SB, no consistent gender differences were found. CONCLUSIONS Reflecting the general population, men with intellectual disabilities were most active. Intellectual disability research should consider the role of gender to inform future interventions targeting inactivity.
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Affiliation(s)
- Sophie C Westrop
- College of Medical Veterinary and Life Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig A Melville
- College of Medical Veterinary and Life Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Fiona Muirhead
- Physical Activity and Health Research Group, University of Strathclyde, Glasgow, UK
| | - Arlene M McGarty
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Lunsky Y, De Oliveira C, Wilton A, Wodchis W. High health care costs among adults with intellectual and developmental disabilities: a population-based study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:124-137. [PMID: 30381849 DOI: 10.1111/jir.12554] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 08/27/2018] [Accepted: 09/12/2018] [Indexed: 05/08/2023]
Abstract
OBJECTIVE While it is generally accepted that adults with intellectual and developmental disabilities (IDDs) use health services to a greater extent than the general population, there is remarkably little research that focuses on the costs associated with their health care. Using population-based data from adults with IDD in Ontario, this study aimed to estimate overall health care costs, classify individuals into high and non-high cost categories and describe differences in the demographics, clinical profiles and health care use patterns between these groups. DESIGN A retrospective cohort study based in Ontario, Canada, was conducted with the use of linked administrative health data. METHODS A costing algorithm developed for the general population in Ontario was applied to estimate health care costs of adults with IDD under age 65 for 2009 and 2010. Individuals were categorised into two groups according to whether their total annual health care costs were among the highest decile in the general population. These groups were compared on demographic and clinical variables, and relative mean costs for six types of health care services in the two groups were computed. In addition, we computed the proportion of individuals who remained in the high cost group over 2 years. RESULTS Among adults with IDD, 36% had annual health care expenditures greater than $2610 CAD (top decile of all Ontario adults under 65). These individuals were more likely to be female, to be in the oldest age groups, to live in group homes and to be receiving disability income support than individuals whose expenditures were below the high cost threshold. In addition, they had higher rates of all the physical and mental health conditions studied. Greatest health care expenses were due to hospitalisations, especially psychiatric hospitalisations, continuing care/rehabilitation costs and medication costs. The majority of individuals whose health care costs placed them in the high cost category in 2009 remained in that category a year later. DISCUSSION Adults with IDD are nearly 4 times as likely to incur high annual health care costs than those without IDD. Individuals with IDD and high health care costs have unique health and demographic profiles compared with adults with IDD whose annual health care costs are below the high cost threshold. Attending to their health care needs earlier in their health care trajectory may be an opportunity to improve health and reduce overall health care costs. It is important that we explore how to best meet their needs. Models proposed to meet the needs of adults with high health care costs in the general population may not apply to this unique group.
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Affiliation(s)
- Y Lunsky
- Azrieli Centre for Adult Neurodevelopmental Disabilities and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - C De Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - W Wodchis
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Croot L, Rimmer M, Salway S, Hatton C, Dowse E, Lavin J, Bennett SE, Harris J, O'Cathain A. Adjusting a mainstream weight management intervention for people with intellectual disabilities: a user centred approach. Int J Equity Health 2018; 17:159. [PMID: 30348176 PMCID: PMC6198382 DOI: 10.1186/s12939-018-0871-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background People with intellectual disabilities (ID) may not be able to access and respond to uniformly delivered health interventions. Public bodies have a legal duty to make ‘reasonable adjustments’ to policies and practices to provide fair access and treatment for people with ID. This study aimed to identify adjustments to the Slimming World weight management programme to improve accessibility and assess acceptability and feasibility for this population. Methods This user-centred qualitative study was carried out with a steering group of people with ID (n = 4). Barriers and facilitators to using Slimming World were identified through interviews and focus groups with people with ID (n = 54), carers (n = 12) current members with ID (n = 8) and Slimming World group leaders (n = 11). Adjustments were made and their feasibility and acceptability were explored in a before-and-after mixed methods study where people with ID attended Slimming World for eight weeks. Participants (n = 9), carers (n = 7) and Slimming World group leaders (n = 4) were interviewed to explore their experiences of the adjustments. Participants were weighed at baseline then each week. Results Four key adjustments were identified and addressed by Slimming World who developed prototype Easy Read materials and a letter for carers. Six of the nine participants attended Slimming World for eight weeks and lost weight (1.4 kg to 6.6 kg, reduction in BMI between 0.5 and 1.7 kg/m2), indicating that the adjustments were feasible and acceptable. Two participants dropped out because they felt uncomfortable in a mainstream group and another left because they lacked control over food choice in their residential setting. Conclusions This user-centred approach identified reasonable adjustments that were feasible to implement. In a small uncontrolled feasibility study, people with ID were positive about the adjustments and lost weight. However, issues in the wider context of people’s lives, such as obesogenic environments and concerns about joining mainstream groups, limited the acceptability of Slimming World even with these adjustments. These findings have important implications for policy and suggest that environmental and organisational level interventions are needed alongside those targeting individual behaviour to tackle the obesogenic environment in which many people with ID spend their time, in order to reduce inequalities associated with the consequences of obesity.
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Affiliation(s)
- Liz Croot
- School of Health and Related Research, Sheffield University, Sheffield, UK.
| | - Melanie Rimmer
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Sarah Salway
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Chris Hatton
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Emma Dowse
- Slimming World Health and Research Team, Slimming World, Alfreton, UK
| | - Jacquie Lavin
- Slimming World Health and Research Team, Slimming World, Alfreton, UK
| | - Sarah E Bennett
- Slimming World Health and Research Team, Slimming World, Alfreton, UK
| | - Janet Harris
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Alicia O'Cathain
- School of Health and Related Research, Sheffield University, Sheffield, UK
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Foley JT, Lloyd M, Turner L, Temple VA. Body mass index and waist circumference of Latin American adult athletes with intellectual disability. SALUD PUBLICA DE MEXICO 2018; 59:416-422. [PMID: 29211262 DOI: 10.21149/8204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 05/15/2017] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To examine both body mass index (BMI) status and waist circunference (WC) in a large international sample of adult Special Olympics participants from Latin America. It also explored the association of age and sex with obesity in this population. MATERIALS AND METHODS BMI and WC records from a total of 4174 (2683 male and 1491 female) participant records from the Special Olympics International Health Promotion database were examined. RESULTS The prevalence of overweight and obesity was quite high (i.e. > 40%), but generally lower than studies involving adults with intellectual disabilities from Europe and the USA. Chi-square analyses revealed that both increasing age and being female significantly predicted levels of overweight, obesity, and WC. CONCLUSIONS These results suggest that efforts need to be made to prevent and reduce rates of overweight and obesity among Latin American Special Olympics participants, particularly women.
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Affiliation(s)
- John T Foley
- Physical Education Department, State University of New York College at Cortland. USA
| | - Meghann Lloyd
- Faculty of Health Sciences, University of Ontario Institute of Technology. Canada
| | - Lesley Turner
- Physical Education Department, State University of New York College at Cortland. USA
| | - Viviene A Temple
- School of Exercise Science, Physical and Health Education, University of Victoria. Canada
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Mitchell F, Stevens G, Jahoda A, Matthews L, Hankey C, Murray H, Melville C. The lifestyle behaviours of young adults with intellectual disabilities as they transition from school to adulthood: A pilot and feasibility study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31:1154-1163. [PMID: 29953690 DOI: 10.1111/jar.12489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/09/2018] [Accepted: 05/23/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the general population, the transition from adolescence to adulthood has been identified as a "high-risk" period for weight gain. There has been no research examining health behaviours over this transition in adults with intellectual disabilities. METHODS/DESIGN The feasibility of recruitment, retention and relevant health behaviours were measured in 31 adolescents with mild-moderate intellectual disabilities. Anthropometric, objective physical activity, dietary and self-determination measures were collected over a 12-month transitional period from school to adulthood. RESULTS Key results suggest weight and BMI increased significantly from month 6 to month 12 (p = 0.044 and p = 0.043). Waist circumference increased significantly from baseline to month 12 (p = 0.049), and from month 6 to month 12 (p = 0.03). DISCUSSION Recruiting and retaining young adults with intellectual disabilities over a 12-month health behaviour study is feasible. The data indicate the transition from school to adulthood may be the start of a high-risk period for weight gain.
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Affiliation(s)
- Fiona Mitchell
- Physical Activity and Health Research Group, University of Strathclyde, Glasgow, UK
| | - Gemma Stevens
- School of Applied Social Studies, Robert Gordon University, Aberdeen, UK
| | - Andrew Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Heather Murray
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Pan CC, Maïano C, Morin AJS. Physical self-concept and body dissatisfaction among Special Olympics athletes: A comparison between sex, weight status, and culture. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 76:1-11. [PMID: 29544161 DOI: 10.1016/j.ridd.2018.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 12/14/2017] [Accepted: 02/13/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Little research has looked at the associations between sex, weight status and culture, and the physical self-perceptions and body dissatisfaction of individuals with intellectual disabilities (ID) involved in Special Olympics (SO) sports. AIMS To examine sex- (male vs female), weight status- (non-overweight/obese vs. overweight/obese), and culture-based (North American vs. Asian) differences in physical self-concept and body dissatisfaction among SO athletes. METHODS AND PROCEDURES A total of 139 SO athletes (aged 12-30 years) with ID participated in this study and completed measures of physical self-perceptions and body dissatisfaction. Differences according to sex, weight status, culture, and their interactions were examined. OUTCOMES AND RESULTS Males SO athletes presented higher levels of self-perceived physical strength and ideal body shape than females. Additionally, non-overweight/obese SO athletes presented higher levels of self-perceived physical appearance and physical condition than their overweight/obese counterparts, as well as lower actual body shape perceptions and body dissatisfaction. Moreover, North-American SO athletes presented higher levels of self-perceived physical appearance and sport competence than their Asians counterparts, as well as lower actual body shapes perceptions and body dissatisfaction. CONCLUSION AND IMPLICATIONS This study reveals substantial sex-, weight status-, and culture-based differences in the physical self-concept and body dissatisfaction of SO athletes.
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Affiliation(s)
- Cheng-Chen Pan
- Special Education Center, National Taiwan Normal University, 162 Sec. 1, Heping E. Rd., Taipei City 10610, Taiwan, ROC.
| | - Christophe Maïano
- Cyberpsychology Laboratory, Department of Psychoeducation and Psychology, Université du Québec en Outaouais (UQO), 5, rue Saint-Joseph, Saint-Jérôme, J7Z 0B7, Canada
| | - Alexandre J S Morin
- Substantive Methodological Synergy Research Laboratory, Department of Psychology, Concordia University, 7141 Sherbrooke West, PY-146, Montreal, Quebec, H4B 1R6, Canada
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Li H, Fujiura G, Magaña S, Parish S. Health care expenditures of overweight and obese U.S. adults with intellectual and developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 75:1-10. [PMID: 29427860 PMCID: PMC9494707 DOI: 10.1016/j.ridd.2018.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 12/30/2017] [Accepted: 01/25/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND U.S. adults with intellectual and developmental disabilities (IDD) have poorer health status and greater risks for being overweight and obese, which are major drivers of health care expenditures in the general population. Health care expenditures and IDD have not been studied using nationally representative samples, and the impact of overweight and obesity have not been examined. AIM Using nationally representative data, we aimed to compare the health care expenditures of not-overweight, overweight and obese U.S. adults with IDD, and calculate model-adjusted expenditures. METHODS AND PROCEDURES Pooled data from the 2002-2011 Medical Expenditure Panel Survey linked to National Health Interview Survey (n = 1224) were analyzed. Two-part model regressions were conducted, with covariates being year of survey, age, sex, race/ethnicity, household income status, geographical region, urban/rural, marital status, insurance coverage, perceived health status, and perceived mental health status. OUTCOMES AND RESULTS Overall, obese adults with intellectual and developmental disabilities had higher expenditures than their non-obese peers. Being obese was associated with an estimated additional $2516 in mean expenditures and $1200 in median expenditures compared with the reference group, who were neither overweight nor obese. CONCLUSIONS AND IMPLICATIONS Obesity is an important predictor of higher health care costs among community-living adults with IDD Finding effective strategies and interventions to address obesity in this population has great financial and policy significance.
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Affiliation(s)
- Henan Li
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, USA.
| | - Glenn Fujiura
- Department of Disability and Human Development, The University of Illinois at Chicago, USA
| | - Sandra Magaña
- Steve Hicks School of Social Work, University of Texas at Austin, USA
| | - Susan Parish
- Bouvé College of Health Sciences, Northeastern University, USA
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Castro O, Ng K, Novoradovskaya E, Bosselut G, Hassandra M. A scoping review on interventions to promote physical activity among adults with disabilities. Disabil Health J 2018; 11:174-183. [DOI: 10.1016/j.dhjo.2017.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 09/21/2017] [Accepted: 10/07/2017] [Indexed: 11/29/2022]
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Harris L, McGarty AM, Hilgenkamp T, Mitchell F, Melville CA. Correlates of objectively measured sedentary time in adults with intellectual disabilities. Prev Med Rep 2018; 9:12-17. [PMID: 29255667 PMCID: PMC5725213 DOI: 10.1016/j.pmedr.2017.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/09/2017] [Accepted: 11/27/2017] [Indexed: 12/03/2022] Open
Abstract
Sedentary behaviour is an independent risk factor for adverse health conditions. Adults with intellectual disabilities spend a high proportion of their day engaged in sedentary behaviour, however, there is limited evidence on potential correlates of objectively measured sedentary behaviour in this population group. In Glasgow, UK from July to September 2017, a secondary analysis of pooled baseline accelerometer data from two randomised controlled trials of lifestyle behaviour change programmes was conducted. Backwards linear regression was used to investigate the associations between demographic, biological, and environmental correlates and objective measure of sedentary behaviour (percentage of time spent sedentary). One-hundred and forty-three participants provided valid accelerometer data. Mean percentage time spent sedentary (adjusted for wear time) was 72.9% [Standard Deviation (SD) = 8.7] per day. In the final model, physical and mental health problems were significantly (p < 0.05) associated with increased percentage time spent sedentary. This is the first study to provide evidence on multi-level, demographic, biological, and environmental correlates of objectively measured sedentary behaviour in adults with intellectual disabilities. To inform the development of interventions to modify sedentary behaviours in adults with intellectual disabilities, further research is required including a wide range of socio-ecological correlates.
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Affiliation(s)
- Leanne Harris
- Institute of Health and Wellbeing, College of Medicine, Veterinary and Life Sciences, University of Glasgow, G12 0XH, United Kingdom
| | - Arlene M. McGarty
- Institute of Health and Wellbeing, College of Medicine, Veterinary and Life Sciences, University of Glasgow, G12 0XH, United Kingdom
| | - Thessa Hilgenkamp
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Netherlands
| | - Fiona Mitchell
- Physical Activity for Health, School of Psychological Sciences and Health, University of Strathclyde, G1 1QE, United Kingdom
| | - Craig A. Melville
- Institute of Health and Wellbeing, College of Medicine, Veterinary and Life Sciences, University of Glasgow, G12 0XH, United Kingdom
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Kinnear D, Morrison J, Allan L, Henderson A, Smiley E, Cooper SA. Prevalence of physical conditions and multimorbidity in a cohort of adults with intellectual disabilities with and without Down syndrome: cross-sectional study. BMJ Open 2018; 8:e018292. [PMID: 29431619 PMCID: PMC5829598 DOI: 10.1136/bmjopen-2017-018292] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate the prevalence of multimorbidity in adults with intellectual disabilities with and without Down syndrome. DESIGN Large, population-based cross-sectional study. SETTING The geographical area of one Health Board, Scotland. PARTICIPANTS All adults (aged 16+ years) known to general practitioners to have intellectual disabilities and adults receiving services provided or paid by intellectual disabilities health or social work services. 1023/1562 potential participants took part (65.5%); 562 (54.9%) men and 461 (45.1%) women, aged 43.9 years (16-83 years). 186 had Down syndrome and 837 did not. MAIN OUTCOME MEASURES The prevalence of International Statistical Classification of Diseases, 10th revision, physical health conditions and multimorbidity detected at a comprehensive health assessment. RESULTS The mean number of physical health conditions/participant was 11.04, and 98.7% had multimorbidity. The most prevalent conditions are painful and/or disabling and, in some cases, life threatening. The five most prevalent were visual impairment, obesity, epilepsy, constipation and ataxic/gait disorders. The pattern of multimorbidity differs from that seen in the general population and is spread across the entire adult life course. The extent of multimorbidity in the adults with Down syndrome was similar to that of the adults without Down syndrome, while the prevalence of individual conditions differed. CONCLUSIONS This robustly designed study with a large population found an extremely high prevalence of multimorbidity in adults with intellectual disabilities across the entire adult life course. This increases complexity of medical management that secondary healthcare services and medical education are not yet geared towards, as these tend to focus on single conditions. This is in addition to complexity due to limitations in communication and understanding. As the physical conditions within their multimorbidity also differ from that seen in the older general population, urgent attention is needed to develop the care pathways and guidelines that are required to inform and so improve their healthcare.
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Affiliation(s)
- Deborah Kinnear
- Mental Health and Wellbeing Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill Morrison
- General Practice and Primary Care Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Linda Allan
- Mental Health and Wellbeing Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Angela Henderson
- Mental Health and Wellbeing Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Elita Smiley
- East Renfrewshire Integrated Learning Disability Team, Barrhead Health & Care Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sally-Ann Cooper
- Mental Health and Wellbeing Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Fortune N, Madden R, Almborg AH. Use of a New International Classification of Health Interventions for Capturing Information on Health Interventions Relevant to People with Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010145. [PMID: 29342077 PMCID: PMC5800244 DOI: 10.3390/ijerph15010145] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 12/03/2022]
Abstract
Development of the World Health Organization’s International Classification of Health Interventions (ICHI) is currently underway. Once finalised, ICHI will provide a standard basis for collecting, aggregating, analysing, and comparing data on health interventions across all sectors of the health system. In this paper, we introduce the classification, describing its underlying tri-axial structure, organisation and content. We then discuss the potential value of ICHI for capturing information on met and unmet need for health interventions relevant to people with a disability, with a particular focus on interventions to support functioning and health promotion interventions. Early experiences of use of the Swedish National Classification of Social Care Interventions and Activities, which is based closely on ICHI, illustrate the value of a standard classification to support practice and collect statistical data. Testing of the ICHI beta version in a wide range of countries and contexts is now needed so that improvements can be made before it is finalised. Input from those with an interest in the health of people with disabilities and health promotion more broadly is welcomed.
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Affiliation(s)
- Nicola Fortune
- National Centre for Classification in Health, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Richard Madden
- National Centre for Classification in Health, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Ann-Helene Almborg
- National Board of Health and Welfare, SE-10630 Stockholm, Sweden.
- Nordic WHO Family of International Classifications Collaborating Centre, Directorate for E-Health, NO-0130 Oslo, Norway.
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Harris L, Melville C, Murray H, Hankey C. The effects of multi-component weight management interventions on weight loss in adults with intellectual disabilities and obesity: A systematic review and meta-analysis of randomised controlled trials. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 72:42-55. [PMID: 29107176 DOI: 10.1016/j.ridd.2017.10.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adults with intellectual disabilities have been shown to experience higher rates of obesity in comparison to the general population. AIM To examine the effectiveness of randomised controlled trials of multi-component weight management interventions for adults with intellectual disabilities and overweight/obesity. METHODS AND PROCEDURES A systematic search of six electronic databases was conducted from database inception to January 2016. Risk of bias was assessed by the Cochrane Collaboration tool. Behavioural change techniques were defined by coding against the Coventry Aberdeen LOndon REfined (CALO-RE) taxonomy. Meta-analyses were conducted as Weighted Mean Difference (WMD) between intervention and control/comparator intervention. OUTCOMES AND RESULTS Six randomised controlled trials were included. The interventions did not adhere to clinical recommendations [the inclusion of an energy deficit diet (EDD), physical activity, and behaviour change techniques]. Meta-analysis revealed that current multi-component weight management interventions are not more effective than no treatment (WMD: -0.38kg; 95% CI -1.34kg to 0.58kg; p=0.44). CONCLUSION AND IMPLICATIONS There is a paucity of randomised controlled trials of multi-component weight management interventions for adults with intellectual disabilities and overweight/obesity. Current interventions, based on a health education approach are ineffective. Future long-term interventions that include an EDD and adhere to clinical recommendations on the management of obesity are warranted.
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Affiliation(s)
- Leanne Harris
- College of Medical Veterinary and Life Sciences, Institute of Mental Health & Wellbeing, University of Glasgow, Glasgow G12 0XH, UK.
| | - Craig Melville
- College of Medical Veterinary and Life Sciences, Institute of Mental Health & Wellbeing, University of Glasgow, Glasgow G12 0XH, UK.
| | - Heather Murray
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Catherine Hankey
- College of Medical Veterinary and Life Sciences, Institute of Health & Wellbeing, University of Glasgow, Glasgow G31 2ER, UK.
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O'Leary L, Cooper S, Hughes‐McCormack L. Early death and causes of death of people with intellectual disabilities: A systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31:325-342. [DOI: 10.1111/jar.12417] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lisa O'Leary
- Institute of Health and Wellbeing College of Medical Veterinary and Life Sciences Mental Health and Wellbeing University of Glasgow Glasgow UK
| | - Sally‐Ann Cooper
- Institute of Health and Wellbeing College of Medical Veterinary and Life Sciences Mental Health and Wellbeing University of Glasgow Glasgow UK
| | - Laura Hughes‐McCormack
- Institute of Health and Wellbeing College of Medical Veterinary and Life Sciences Mental Health and Wellbeing University of Glasgow Glasgow UK
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Carey IM, Hosking FJ, Harris T, DeWilde S, Beighton C, Cook DG. An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
People with intellectual disability (ID) have poorer health than the general population; however, there is a lack of comprehensive national data describing their health-care needs and utilisation. Annual health checks for adults with ID have been incentivised through primary care since 2009, but only half of those eligible for such a health check receive one. It is unclear what impact health checks have had on important health outcomes, such as emergency hospitalisation.
Objectives
To evaluate whether or not annual health checks for adults with ID have reduced emergency hospitalisation, and to describe health, health care and mortality for adults with ID.
Design
A retrospective matched cohort study using primary care data linked to national hospital admissions and mortality data sets.
Setting
A total of 451 English general practices contributing data to Clinical Practice Research Datalink (CPRD).
Participants
A total of 21,859 adults with ID compared with 152,846 age-, gender- and practice-matched controls without ID registered during 2009–13.
Interventions
None.
Main outcome measures
Emergency hospital admissions. Other outcomes – preventable admissions for ambulatory care sensitive conditions, and mortality.
Data sources
CPRD, Hospital Episodes Statistics and Office for National Statistics.
Results
Compared with the general population, adults with ID had higher levels of recorded comorbidity and were more likely to consult in primary care. However, they were less likely to have long doctor consultations, and had lower continuity of care. They had higher mortality rates [hazard ratio (HR) 3.6, 95% confidence interval (CI) 3.3 to 3.9], with 37.0% of deaths classified as being amenable to health-care intervention (HR 5.9, 95% CI 5.1 to 6.8). They were more likely to have emergency hospital admissions [incidence rate ratio (IRR) 2.82, 95% CI 2.66 to 2.98], with 33.7% deemed preventable compared with 17.3% in controls (IRR 5.62, 95% CI 5.14 to 6.13). Health checks for adults with ID had no effect on overall emergency admissions compared with controls (IRR 0.96, 95% CI 0.87 to 1.07), although there was a relative reduction in emergency admissions for ambulatory care-sensitive conditions (IRR 0.82, 95% CI 0.69 to 0.99). Practices with high health check participation also showed a relative fall in preventable emergency admissions for their patients with ID, compared with practices with minimal participation (IRR 0.73, 95% CI 0.57 to 0.95). There were large variations in the health check-related content that was recorded on electronic records.
Limitations
Patients with milder ID not known to health services were not identified. We could not comment on the quality of health checks.
Conclusions
Compared with the general population, adults with ID have more chronic diseases and greater primary and secondary care utilisation. With more than one-third of deaths potentially amenable to health-care interventions, improvements in access to, and quality of, health care are required. In primary care, better continuity of care and longer appointment times are important examples that we identified. Although annual health checks can also improve access, not every eligible adult with ID receives one, and health check content varies by practice. Health checks had no impact on overall emergency admissions, but they appeared influential in reducing preventable emergency admissions.
Future work
No formal cost-effectiveness analysis of annual health checks was performed, but this could be attempted in relation to our estimates of a reduction in preventable emergency admissions.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Iain M Carey
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Fay J Hosking
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Tess Harris
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Stephen DeWilde
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Carole Beighton
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Derek G Cook
- Population Health Research Institute, St George’s, University of London, London, UK
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A cluster randomised control trial of a multi-component weight management programme for adults with intellectual disabilities and obesity. Br J Nutr 2017; 118:229-240. [DOI: 10.1017/s0007114517001933] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AbstractThere have been few published controlled studies of multi-component weight management programmes that include an energy deficit diet (EDD), for adults with intellectual disabilities and obesity. The objective of this study was to conduct a single-blind, cluster randomised controlled trial comparing a multi-component weight management programme to a health education programme. Participants were randomised to either TAKE 5, which included an EDD or Waist Winners Too (WWToo), based on health education principles. Outcomes measured at baseline, 6 months (after a weight loss phase) and 12 months (after a 6-month weight maintenance phase), by a researcher blinded to treatment allocation, included: weight; BMI; waist circumference; physical activity; sedentary behaviour and health-related quality of life. The recruitment strategy was effective with fifty participants successfully recruited. Both programmes were acceptable to adults with intellectual disabilities, evidenced by high retention rates (90 %). Exploratory efficacy analysis revealed that at 12 months there was a trend for more participants in TAKE 5 (50·0 %) to achieve a clinically important weight loss of 5–10 %, in comparison to WWToo (20·8 %) (OR 3·76; 95 % CI 0·92, 15·30; 0·064). This study found that a multi-component weight management programme that included an EDD, is feasible and an acceptable approach to weight loss when tailored to meet the needs of adults with intellectual disabilities and obesity.
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Rintala P, Temple VA, Lloyd M, Faro C, Foley JT. Association of poverty and social exclusion with body mass index among Special Olympics athletes in Europe. Int J Public Health 2017; 62:921-928. [DOI: 10.1007/s00038-017-0982-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022] Open
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Ranjan S, Nasser JA, Fisher K. Prevalence and potential factors associated with overweight and obesity status in adults with intellectual developmental disorders. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31 Suppl 1:29-38. [DOI: 10.1111/jar.12370] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Sobhana Ranjan
- Department of Nutrition Sciences; College of Nursing and Health Professions; Drexel University; Philadelphia PA USA
| | - Jennifer A. Nasser
- Department of Nutrition Sciences; College of Nursing and Health Professions; Drexel University; Philadelphia PA USA
| | - Kathleen Fisher
- Doctoral Nursing Programs; College of Nursing and Health Professions; Drexel University; Philadelphia PA USA
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Dunkley AJ, Tyrer F, Spong R, Gray LJ, Gillett M, Doherty Y, Martin-Stacey L, Patel N, Yates T, Bhaumik S, Chalk T, Chudasama Y, Thomas C, Sadler S, Cooper SA, Gangadharan SK, Davies MJ, Khunti K. Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Alison J Dunkley
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Freya Tyrer
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Rebecca Spong
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mike Gillett
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Yvonne Doherty
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | | | - Naina Patel
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Sabyasachi Bhaumik
- Learning Disabilities Service, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Thomas Chalk
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Yogini Chudasama
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Chloe Thomas
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Susannah Sadler
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Stevens G, Jahoda A, Matthews L, Hankey C, Melville C, Murray H, Mitchell F. A theory-informed qualitative exploration of social and environmental determinants of physical activity and dietary choices in adolescents with intellectual disabilities in their final year of school. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31 Suppl 1:52-67. [DOI: 10.1111/jar.12340] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Gemma Stevens
- Department of Physical Activity for Health; University of Strathclyde; Glasgow UK
| | - Andrew Jahoda
- Institute of Health and Wellbeing; University of Glasgow; Glasgow UK
| | - Lynsay Matthews
- Institute of Health and Wellbeing; University of Glasgow; Glasgow UK
| | - Catherine Hankey
- Human Nutrition; School of Medicine, Nursing and Dentistry; University of Glasgow; Glasgow UK
| | - Craig Melville
- Institute of Health and Wellbeing; University of Glasgow; Glasgow UK
| | - Heather Murray
- Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
| | - Fiona Mitchell
- Department of Physical Activity for Health; University of Strathclyde; Glasgow UK
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Emerson E, Robertson J, Baines S, Hatton C. Obesity in British children with and without intellectual disability: cohort study. BMC Public Health 2016; 16:644. [PMID: 27460572 PMCID: PMC4962444 DOI: 10.1186/s12889-016-3309-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 07/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background Reducing the prevalence of and inequities in the distribution of child obesity will require developing interventions that are sensitive to the situation of ‘high risk’ groups of children. Children with intellectual disability appear to be one such group. We aimed to estimate the prevalence of obesity in children with and without intellectual disability in a longitudinal representative sample of British children and identify risk factors associated with obesity at age 11. Methods Information was collected on a nationally representative sample of over 18,000 at ages 9 months, 3, 5, 7 and 11 years. We used UK 1990 gender-specific growth reference charts and the LMS Growth programme to identify age and gender-specific overweight and obesity BMI thresholds for each child at ages 5, 7 and 11 years. Results Children with intellectual disabilities were significantly more likely than other children to be obese at ages five (OR = 1.32[1.03–1.68]), seven (OR = 1.39[1.05–1.83]) and eleven (OR = 1.68[1.39–2.03]). At ages five and seven increased risk of obesity among children with intellectual disabilities was only apparent among boys. Among children with intellectual disability risk of obesity at age eleven was associated with persistent maternal obesity, maternal education, child ethnicity and being bullied at age five. Conclusions Children with intellectual disability are a high-risk group for the development of obesity, accounting for 5–6 % of all obese children. Interventions to reduce the prevalence and inequities in the distribution of child obesity will need to take account of the specific situation of this group of children.
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Affiliation(s)
- Eric Emerson
- Centre for Disability Research, Lancaster University, Lancaster, UK. .,Centre for Disability Research and Policy, University of Sydney, Sydney, New South Wales, Australia.
| | - Janet Robertson
- Centre for Disability Research, Lancaster University, Lancaster, UK
| | - Susannah Baines
- Centre for Disability Research, Lancaster University, Lancaster, UK
| | - Chris Hatton
- Centre for Disability Research, Lancaster University, Lancaster, UK
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Matthews L, Mitchell F, Stalker K, McConnachie A, Murray H, Melling C, Mutrie N, Melville C. Process evaluation of the Walk Well study: a cluster-randomised controlled trial of a community based walking programme for adults with intellectual disabilities. BMC Public Health 2016; 16:527. [PMID: 27387203 PMCID: PMC4936049 DOI: 10.1186/s12889-016-3179-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 06/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Walking interventions can be effective in encouraging sedentary populations to become more active; however, limited research has explored the effectiveness of walking interventions for adults with intellectual disabilities. This process evaluation explored the delivery of a community based walking intervention for adults with intellectual disabilities. METHODS Walk Well was a single-blind cluster randomised controlled trial of a 12-week physical activity consultation-led walking intervention. 102 participants were randomised to the Walk Well intervention or a waiting list control group. Participants in the intervention group received three physical activity consultations with a walking advisor at baseline, 6 & 12-weeks. They were encouraged to use a pedometer to set goals and monitor their daily step count. Primary outcome was change in daily step count at 12-weeks. Process evaluation measures included qualitative interviews with key stakeholders (n = 6) and quantifiable data collected as part of the intervention. Additional process data were extracted from a sub-set of qualitative interviews with participants and carers (n = 20). Data were analysed for process information related to context, recruitment and retention, reach, implementation, and fidelity. RESULTS Walk Well was not effective in significantly increasing levels of physical activity. The process evaluation did, however, highlight several important areas for consideration in future studies, including: a successful recruitment and retention strategy reaching a representative sample of adults with intellectual disabilities in the community; feasible and (for most) enjoyable methods of engaging adults with intellectual disabilities in activities to support behaviour change; potential need for greater intervention duration and frequency of contact; advantages and disadvantages of using pedometers as a behaviour change tool; the need for strategies which engage carers in supporting participants; and the complex issue of 'freedom of choice' in relation to lifestyle behaviours and study participation. CONCLUSIONS Walking interventions for adults with intellectual disabilities can be feasibly delivered in the community in relation to reach, recruitment, retention and intervention fidelity. More intensive intervention methods need to be explored as well as strategies to engage and motivate carers in their support of participants. TRIAL REGISTRATION Current Controlled Trials ISRCTN50494254 (3(rd) April 2012).
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Affiliation(s)
- Lynsay Matthews
- Institute of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland.
| | - Fiona Mitchell
- Department of Physical Activity for Health, University of Strathclyde, Glasgow, Scotland
| | - Kirsten Stalker
- Glasgow School of Social Work, University of Strathclyde, Glasgow, Scotland
| | - Alex McConnachie
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
| | - Heather Murray
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
| | - Chris Melling
- Social Work Services, Glasgow City Council, Glasgow, Scotland
| | - Nanette Mutrie
- Institute for Sport, Physical Education and Health Sciences, Moray House School of Education, University of Edinburgh, Edinburgh, Scotland
| | - Craig Melville
- Institute of Health and Wellbeing, Academic Unit for Mental Health & Wellbeing, University of Glasgow, Glasgow, Scotland
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Pan CC, Davis R, Nichols D, Hwang SH, Hsieh K. Prevalence of overweight and obesity among students with intellectual disabilities in Taiwan: A secondary analysis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 53-54:305-313. [PMID: 26986697 DOI: 10.1016/j.ridd.2016.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 01/23/2016] [Accepted: 02/29/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE The study aims to investigate the prevalence and likelihood of overweight and obesity in a large sample of students with intellectual disabilities (ID) from Taiwan. METHOD A secondary analysis of a cross sectional study was employed to examine the body weight status among 7 to 18 year-old students with ID enrolled in public special education schools in 2013. The students were divided into three age groups (7-12 yrs, 13-15 yrs, and 16-18 yrs), four ID levels (mild, moderate, severe, and profound) and six comorbidities of ID (ID only, ID caused by genetic disorders, ID with physical disability, ID with multiple disabilities without physical disabilities, ID with autism spectrum disorders, and others with rare diseases). RESULTS The sample represented 34.8% of students with ID attending public special education schools in Taiwan. Within this sample, 35.2% were identified as being overweight or obese. The 16 to 18 year-old age group were approximately two times (AOR=2.02, more likely to be obese than the 7-12 year-old group. Students with ID caused by genetic disorders such as Down syndrome (AOR=2.00) appeared to be more overweight or obese in comparison to those with ID only. Students with moderate (AOR=1.64) and severe ID (AOR=1.49) were more overweight/obese compared to those with profound ID. CONCLUSION The findings not only highlight the high prevalence of overweight/obesity but also stress the need for health promotion initiatives to address issues of overweight/obesity within this population.
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Affiliation(s)
- Cheng-Chen Pan
- Department of Kinesiology, Texas Woman's University, P. O. Box 425647, Denton, TX 76204, United States.
| | - Ronald Davis
- Department of Kinesiology, Texas Woman's University, P. O. Box 425647, Denton, TX 76204, United States
| | - David Nichols
- Department of Kinesiology, Texas Woman's University, P. O. Box 425647, Denton, TX 76204, United States
| | - Shann Hwa Hwang
- Department of Family Sciences, Texas Woman's University, P. O. Box 425769, Denton, TX 76204, United States
| | - Kelly Hsieh
- Department of Disability and Human Development, University of Illinois at Chicago, 1640 W. Roosevelt Rd Suite 708, Chicago, IL 60608, United States
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Sheehan R, Gandesha A, Hassiotis A, Gallagher P, Burnell M, Jones G, Kerr M, Hall I, Chaplin R, Crawford MJ. An audit of the quality of inpatient care for adults with learning disability in the UK. BMJ Open 2016; 6:e010480. [PMID: 27091821 PMCID: PMC4838729 DOI: 10.1136/bmjopen-2015-010480] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To audit patient hospital records to evaluate the performance of acute general and mental health services in delivering inpatient care to people with learning disability and explore the influence of organisational factors on the quality of care they deliver. SETTING Nine acute general hospital Trusts and six mental health services. PARTICIPANTS Adults with learning disability who received inpatient hospital care between May 2013 and April 2014. PRIMARY AND SECONDARY OUTCOME MEASURES Data on seven key indicators of high-quality care were collected from 176 patients. These covered physical health/monitoring, communication and meeting needs, capacity and decision-making, discharge planning and carer involvement. The impact of services having an electronic system for flagging patients with learning disability and employing a learning disability liaison nurse was assessed. RESULTS Indicators of physical healthcare (body mass index, swallowing assessment, epilepsy risk assessment) were poorly recorded in acute general and mental health inpatient settings. Overall, only 34 (19.3%) patients received any assessment of swallowing and 12 of the 57 with epilepsy (21.1%) had an epilepsy risk assessment. For most quality indicators, there was a non-statistically significant trend for improved performance in services with a learning disability liaison nurse. The presence of an electronic flagging system showed less evidence of benefit. CONCLUSIONS Inpatient care for people with learning disability needs to be improved. The work gives tentative support to the role of a learning disability liaison nurse in acute general and mental health services, but further work is needed to confirm these benefits and to trial other interventions that might improve the quality and safety of care for this high-need group.
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Affiliation(s)
- Rory Sheehan
- Division of Psychiatry, University College London, London, UK
| | - Aarti Gandesha
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | | | - Pamela Gallagher
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Matthew Burnell
- Faculty of Population Health Sciences, University College London, London, UK
| | - Glyn Jones
- Abertawe Bro Morgannwg University Health Board, Cardiff, UK
| | - Michael Kerr
- Welsh Centre for Learning Disabilities, Cardiff University, Cardiff, UK
| | - Ian Hall
- Tower Hamlets Community Learning Disability Service, London, UK
| | - Robert Chaplin
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Michael J Crawford
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
- Centre for Mental Health, Imperial College London, London, UK
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Boer PH, Moss SJ. Effect of continuous aerobic vs. interval training on selected anthropometrical, physiological and functional parameters of adults with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:322-334. [PMID: 26805768 DOI: 10.1111/jir.12251] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 11/02/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND A large percentage of adults with Down syndrome (DS) are overweight and have extremely low aerobic capacities compared with the general population and persons with intellectual disability without DS. Previous aerobic training intervention studies showed limited potential to significantly ameliorate anthropometrical and cardiovascular variables. The primary purpose of this study was to determine the effect of continuous aerobic training (CAT) vs. interval training (IT) on selected anthropometrical, health, physical and functional parameters of adults with DS. METHODS Forty-two adults with DS (25 men and 17 women) and a mean age of 33.8 (±8.6) years were randomly allocated to one of three groups (IT, CAT and control). Training was performed for 12 weeks. The IT group performed 10-30 s all out sprints with 90 s (1:3 work-rest ratio) of low cadence, low intensity cycling or walking. The CAT group performed continuous cycling and walking at an intensity of 70-80% of VO2 peak. Heart rate monitors were used for monitoring training intensities. After 6 weeks of training, the intensity of the CAT was increased to 85% of VO2 peak, whilst the intensity of the IT group remained 'all out'. An increase of 5 min in duration was implemented after 6 weeks for both training groups. To evaluate pre-post differences between groups, a repeated analysis of covariance with post hoc Bonferroni test was performed RESULTS: After 12 weeks of training, body weight and body mass index decreased significantly more in the IT group compared with control and CAT (P < 0.05). Participants in the IT group decreased their body weight from 71.4 ± 8 to 69.4 ± 8 kg and their body mass index from 29.3 ± 4 to 28.5 ± 4 kg/m2 . Significant ameliorations for functional parameters and leg strength were shown for CAT compared with control (P < 0.05). Participants in the CAT group improved their performance in the 6 minute walk distance (499 ± 78 to 563 ± 75 m), 8-ft up-and-go (5.9 ± 1.2 to 4.8 ± 0.9) and leg strength (13.1 ± 2 to 15.2 ± 2). VO2 peak and time to exhaustion significantly improved in both the IT and CAT group compared with control (P < 0.01). Moreover, a significant improvement for relative VO2 peak was also determined for IT compared with CAT (P < 0.05). Participants in the IT group increased their VO2 peak from 32 ± 8 to 37 ± 8 mL/min/kg. Submaximal heart rate and VO2 values improved significantly within both exercise groups (P < 0.05). CONCLUSION Interval training and CAT can both be pursued by adults with DS to positively impact on various parameters of anthropometry, fitness and functional ability, with IT more appropriate for improving body weight and aerobic capacity.
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Affiliation(s)
- P H Boer
- Physical Activity, Sport and Recreation (PhASRec) Research Focus Area, Faculty of Health Sciences, North West University, Potchefstroom, South Africa
| | - S J Moss
- Physical Activity, Sport and Recreation (PhASRec) Research Focus Area, Faculty of Health Sciences, North West University, Potchefstroom, South Africa
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Chitty KM, Evans E, Torr JJ, Iacono T, Brodaty H, Sachdev P, Trollor JN. Central nervous system medication use in older adults with intellectual disability: Results from the successful ageing in intellectual disability study. Aust N Z J Psychiatry 2016; 50:352-62. [PMID: 26019276 DOI: 10.1177/0004867415587951] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Information on the rates and predictors of polypharmacy of central nervous system medication in older people with intellectual disability is limited, despite the increased life expectancy of this group. This study examined central nervous system medication use in an older sample of people with intellectual disability. METHODS Data regarding demographics, psychiatric diagnoses and current medications were collected as part of a larger survey completed by carers of people with intellectual disability over the age of 40 years. Recruitment occurred predominantly via disability services across different urban and rural locations in New South Wales and Victoria. Medications were coded according to the Monthly Index of Medical Specialties central nervous system medication categories, including sedatives/hypnotics, anti-anxiety agents, antipsychotics, antidepressants, central nervous system stimulants, movement disorder medications and anticonvulsants. The Developmental Behaviour Checklist for Adults was used to assess behaviour. RESULTS Data were available for 114 people with intellectual disability. In all, 62.3% of the sample was prescribed a central nervous system medication, with 47.4% taking more than one. Of those who were medicated, 46.5% had a neurological diagnosis (a seizure disorder or Parkinson's disease) and 45.1% had a psychiatric diagnosis (an affective or psychotic disorder). Linear regression revealed that polypharmacy was predicted by the presence of neurological and psychiatric diagnosis, higher Developmental Behaviour Checklist for Adults scores and male gender. CONCLUSION This study is the first to focus on central nervous system medication in an older sample with intellectual disability. The findings are in line with the wider literature in younger people, showing a high degree of prescription and polypharmacy. Within the sample, there seems to be adequate rationale for central nervous system medication prescription. Although these data do not indicate non-adherence to guidelines for prescribing in intellectual disability, the high rate of polypharmacy and its relationship to Developmental Behaviour Checklist for Adults scores reiterate the importance of continued medication review in older people with intellectual disability.
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Affiliation(s)
- Kate M Chitty
- Department of Developmental Disability Neuropsychiatry, UNSW Australia, Sydney, NSW, Australia
| | - Elizabeth Evans
- Department of Developmental Disability Neuropsychiatry, UNSW Australia, Sydney, NSW, Australia
| | - Jennifer J Torr
- Centre for Developmental Disability Health, Monash University, Notting Hill, VIC, Australia
| | - Teresa Iacono
- La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, UNSW Australia, Sydney, NSW, Australia Dementia Collaborative Research Centre, UNSW Australia, Sydney, NSW, Australia Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, UNSW Australia, Sydney, NSW, Australia Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry, UNSW Australia, Sydney, NSW, Australia Centre for Healthy Brain Ageing, UNSW Australia, Sydney, NSW, Australia
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Koritsas S, Iacono T. Weight, nutrition, food choice, and physical activity in adults with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:355-364. [PMID: 26712472 DOI: 10.1111/jir.12254] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 11/12/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND The aim of this study was to describe the nutrition, food choice, physical activity and weight status in a group of adults with intellectual disability (ID) in Victoria, Australia. METHOD Disability workers and adults with ID were recruited through disability services. In total, 51 disability workers (11 men, 40 women) and 68 (47 men, 21 women) adults with ID participated in the research. Disability workers provided information about the nutrition, food choice and physical activity levels of adults with ID through a questionnaire administered by a general practitioner or research nurse. The questionnaire also included The Australian Nutrition Screening Initiative checklist. RESULTS Body Mass Index was in the healthy range for only 37.5% of participants and in the obese range for almost half (41%). Similarly, the majority of participants had an abdominal circumference in a range that put them at increased or substantially increased risk of metabolic complications. The mean score obtained on the Australian Nutrition Screening Initiative checklist indicated a moderate risk of malnutrition (M = 4.2); however, 17.6% of participants achieved scores that put them in the high-risk category. More than half of the participants were reported to have a little choice in the type of food they ate and when they ate. Physical activity data indicated that the majority of participants (60.3%) did not meet national physical activity guidelines. CONCLUSIONS These findings suggest that people with ID are at risk of developing diseases associated with obesity, inactivity, and poor nutrition. Strategies to encourage people with ID to engage in physical activity and healthy eating are, therefore, a matter of priority and should involve their disability workers.
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Affiliation(s)
| | - T Iacono
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
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Boer PH, Moss SJ. Validity of the 16-metre PACER and six-minute walk test in adults with Down syndrome. Disabil Rehabil 2016; 38:2575-83. [DOI: 10.3109/09638288.2015.1137982] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Pieter-Henk Boer
- Physical Activity, Sport and Recreation (PhaSRec) Research Focus Area, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Sarah Johanna Moss
- Physical Activity, Sport and Recreation (PhaSRec) Research Focus Area, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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Mitchell F, Jahoda A, Hankey C, Matthews L, Murray H, Melville C. 'Moving on and feeling good': a feasibility study to explore the lifestyle behaviours of young adults with intellectual disabilities as they transition from school to adulthood-a study protocol. Pilot Feasibility Stud 2016; 2:8. [PMID: 27965828 PMCID: PMC5154056 DOI: 10.1186/s40814-015-0044-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/31/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The transition from adolescence to adulthood is a 'high-risk' period for weight gain in the general population. There is speculation that this may also be a risk period for adults with intellectual disabilities; however, there has been no research which has monitored change in health indicators. Since adults with intellectual disabilities have higher rates of obesity and engage in more sedentary behaviour and less physical activity than the general population, there is a need to understand more about the lifestyle behaviours of this population during the transition to adulthood. This protocol paper will provide details of the moving on and feeling good feasibility study, designed for young people with intellectual disabilities. METHODS/DESIGN A multi-point recruitment strategy will be used to recruit 30 participants with a mild-moderate level of intellectual disability. The aim of the feasibility study is to examine the feasibility of recruitment, participant retention and the measurement of relevant health behaviour outcomes. The study will assess the feasibility of monitoring weight, diet and physical activity levels in adolescents over a 12-month transitional period from school to adult life. This mixed method study will provide insight into the lives of young people with intellectual disabilities and will examine the use of Walker et al.'s social-ecological approach to promote self-determination specific to lifestyle behaviours, during this transition period. Baseline data will be collected during the final year of school, with follow-up data collection at 6 and 12 months. Anthropometric (weight, height, waist and hip circumference), objective physical activity measures (7-day accelerometer wear) and dietary and choice measures will be collected at each time point to assess the feasibility of measuring diet patterns, food frequency, physical activity and BMI. Furthermore, ten participants will be selected for short semi-structured scoping interviews at baseline and 12-month follow-up, to gain information on psychological, social and environmental factors which might affect behaviour change. DISCUSSION The outcomes from the feasibility study will aid the development and piloting of a sufficiently powered randomised controlled trial. This would allow us to evaluate the effectiveness and sustainability of a lifestyle behaviour intervention, over a 5-year transition period.
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Affiliation(s)
- Fiona Mitchell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland UK
| | - Andrew Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland UK
| | - Catherine Hankey
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland UK
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland UK
| | - Heather Murray
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland UK
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Jones N, Melville CA, Harris L, Bleazard L, Hankey CR. A qualitative study exploring why adults with intellectual disabilities and obesity want to lose weight and views of their carers. BMC OBESITY 2015; 2:49. [PMID: 26693285 PMCID: PMC4683767 DOI: 10.1186/s40608-015-0080-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/09/2015] [Indexed: 11/19/2022]
Abstract
Background Obesity is more prevalent in adults with intellectual disabilities (ID) compared to the general population. Motivations for weight loss may influence engagement with weight management programmes and have only been studied in adults without ID. Aims: To determine reasons given by adults with ID and obesity for seeking weight loss and whether these reasons differ from those of their carers. Methods Prior to a multi-component weight management intervention, participants were asked “why do you want to lose weight?” Carers were asked their views and these were compared to the answers given by the adult with ID. Responses were themed. The Fisher’s Exact analysis was used to test for any relationship between reasons for seeking weight loss and participants’ level of ID, age, gender and BMI. Results Eighteen men and 32 women; age 41.6 SD 14.6 years; BMI 40.8 SD 7.5 kg/m2; Level ID Mild (28 %), Moderate (42 %), Severe (22 %), Profound (8 %). Eleven were unable to respond. Six themes emerged; Health; Fitness / Activity / Mobility; Appearance / Clothes; Emotional / Happiness; For Others; Miscellaneous. The most frequent reason given overall and by women was “appearance.” Carers cited “health” most frequently and “appearance” least, rarely agreeing with participants. “Health” was given as a reason more from older adults and those with milder ID. No statistically significant associations were found between reasons for seeking weight loss and BMI age, gender or level of ID but the differing views of adults with ID and their carers were clear. Conclusions Views of adults with obesity and mild or moderate ID can be collected. The opposing views of adults and their carers may affect motivation for weight loss.
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Affiliation(s)
- N Jones
- Mental Health and Wellbeing, University of Glasgow, 1st Floor Admin Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - C A Melville
- Mental Health and Wellbeing, University of Glasgow, 1st Floor Admin Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - L Harris
- Mental Health and Wellbeing, University of Glasgow, 1st Floor Admin Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - L Bleazard
- Mental Health and Wellbeing, University of Glasgow, 1st Floor Admin Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - C R Hankey
- Human Nutrition Section, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER UK
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Temple VA, Foley JT, Lloyd M. Body Mass Index of Adult Special Olympians by Country Economic Status. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2015. [DOI: 10.1111/jppi.12123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | - John T. Foley
- State University of New York College at Cortland; Cortland NY USA
| | - Meghann Lloyd
- University of Ontario Institute of Technology; Oshawa ON Canada
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Multiple physical and mental health comorbidity in adults with intellectual disabilities: population-based cross-sectional analysis. BMC FAMILY PRACTICE 2015; 16:110. [PMID: 26310664 PMCID: PMC4551707 DOI: 10.1186/s12875-015-0329-3] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 08/21/2015] [Indexed: 11/29/2022]
Abstract
Background Adults with intellectual disabilities have increased early mortality compared with the general population. However, their extent of multimorbidity (two or more additional conditions) compared with the general population is unknown, particularly with regards to physical ill-health, as are associations between comorbidities, neighbourhood deprivation, and age. Methods We analysed primary health-care data on 1,424,378 adults registered with 314 representative Scottish practices. Data on intellectual disabilities, 32 physical, and six mental health conditions were extracted. We generated standardised prevalence rates by age-groups, gender, and neighbourhood deprivation, then calculated odds ratio (OR) and 95 % confidence intervals (95 % CI) for adults with intellectual disabilities compared to those without, for the prevalence, and number of condition. Results Eight thousand fourteen (0.56 %) had intellectual disabilities, of whom only 31.8 % had no other conditions compared to 51.6 % without intellectual disabilities (OR 0.26, 95 % 0.25–0.27). The intellectual disabilities group were significantly more likely to have more conditions, with the biggest difference found for three conditions (10.9 % versus 6.8 %; OR 2.28, 95 % CI 2.10–2.46). Fourteen physical conditions were significantly more prevalent, and four cardiovascular conditions occurred less frequently, as did any cancers, and chronic obstructive pulmonary diseases. Five of the six mental health conditions were significantly more prevalent. For the adults with intellectual disabilities, no gradient was seen in extent of multimorbidity with increasing neighbourhood deprivation; indeed findings were similar in the most affluent and most deprived areas. Co-morbidity increased with age but is highly prevalent at all ages, being similar at age 20–25 to 50–54 year olds in the general population. Conclusions Multi-morbidity burden is greater, occurs at much earlier age, and the profile of health conditions differs, for adults with intellectual disabilities compared with the general population. There is no association with neighbourhood deprivation; people with intellectual disabilities need focussed services irrespective of where they live, and at a much earlier age than the general population. They require specific initiatives to reduce inequalities. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0329-3) contains supplementary material, which is available to authorized users.
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