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Relationship between daily swallowing frequency and pneumonia in patients with severe cerebral palsy. BMC Pediatr 2022; 22:485. [PMID: 35964106 PMCID: PMC9375420 DOI: 10.1186/s12887-022-03547-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Aspiration pneumonia is a major complication that occurs in patients with severe cerebral palsy and is associated with their survival prognosis, necessitating appropriate assessment and response. We focused on swallowing frequency as an index of daily swallowing function due to the difficulty in evaluating the risk of pneumonia. The swallowing motion protects the airway by safely directing the food, saliva, and secretions accumulated in the pharynx into the esophagus to prevent aspiration and entry into the trachea. Thus, swallowing frequency may be correlated with the incidence of pneumonia. In this study, we aimed to investigate the relationship between swallowing frequency and history of pneumonia in patients with severe cerebral palsy. Methods Fifty-seven patients with cerebral palsy were included in this study. Swallowing frequency was measured three times for each patient on separate days, and the reproducibility was examined by calculating the intraclass correlation coefficient. Further, the relationship between swallowing frequency and history of pneumonia was investigated using multivariate logistic regression analysis. Results While swallowing frequency differed between participants, it was constant within individuals (intraclass correlation coefficient: 0.941). Furthermore, the swallowing frequencies per hour were 12.2 ± 12.2 and 27.0 ± 20.4 in the patient groups with and without a history of pneumonia, respectively (P < 0.001). Swallowing frequency (odds ratio: 10.489, 95% confidence interval: 2.706–40.663, P = 0.001) was significantly associated with the incidence of pneumonia in the previous year. Conclusions Swallowing frequency could be used as an index for assessing the risk of dysphagia and pneumonia in patients with severe cerebral palsy.
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Hemsley B, Steel J, Sheppard JJ, Malandraki GA, Bryant L, Balandin S. Dying for a Meal: An Integrative Review of Characteristics of Choking Incidents and Recommendations to Prevent Fatal and Nonfatal Choking Across Populations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1283-1297. [PMID: 31095917 DOI: 10.1044/2018_ajslp-18-0150] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The purpose of this study was to conduct an integrative review of original research, across adult populations relating to fatal or nonfatal choking on food, to understand ways to respond to and prevent choking incidents. Method Four scientific databases (CINAHL, Medline, Web of Science, and EMBASE) were searched for original peer-reviewed research relating to fatal or nonfatal choking on foods. Data were extracted on study characteristics; factors leading up to, events at the time of, and actions taken after the choking incident; and impacts of choking incidents. An integrative review of the findings across studies identified several risk factors and recommendations to reduce the risk of choking. Results In total, 52 studies met the criteria for inclusion in this review, of which 31 were quantitative, 17 were qualitative, and 4 were of a mixed methods design. Studies reported the observations and narratives of bystanders or researchers, or else were large-scale autopsy studies, and included both the general public and people at risk of dysphagia. A range of food types were involved, and several actions were reported in response to food choking. Strategies to reduce the risk of choking were identified in the studies and are presented in 5 main categories. Conclusions Factors leading up to choking incidents extend well beyond the individual to the environment for mealtimes; the provision of appropriate mealtime assistance and oral care; and regular monitoring of general health, oral health, and medications. Bystanders' increased awareness and knowledge of how to respond to choking are vital. The results of this review could be used to inform service policy and training, for individuals at risk of choking, the people who support them, and the general public. Further research is needed to explore choking prevention and airway protection in individuals with dysphagia. Supplemental Material https://doi.org/10.23641/asha.8121131.
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Affiliation(s)
- Bronwyn Hemsley
- Graduate School of Health, The University of Technology, NSW, Sydney, Australia
| | - Joanne Steel
- Graduate School of Health, The University of Technology, NSW, Sydney, Australia
- The University of Newcastle, NSW, Australia
| | - Justine Joan Sheppard
- Department of Biobehavioral Sciences, Teacher's College, Columbia University, New York, NY
| | - Georgia A Malandraki
- Department of Speech, Language and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Lucy Bryant
- Graduate School of Health, The University of Technology, NSW, Sydney, Australia
| | - Susan Balandin
- School of Health & Social Development, Deakin University, Melbourne, Victoria, Australia
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Manduchi B, Fainman GM, Walshe M. Interventions for Feeding and Swallowing Disorders in Adults with Intellectual Disability: A Systematic Review of the Evidence. Dysphagia 2019; 35:207-219. [PMID: 31372756 DOI: 10.1007/s00455-019-10038-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/14/2019] [Accepted: 07/20/2019] [Indexed: 12/11/2022]
Abstract
Feeding and swallowing disorders are prevalent in adults with Intellectual Disability (ID) and can potentially lead to discomfort, malnutrition, dehydration, aspiration, and choking. Most common interventions include: diet modification, compensatory strategies, swallowing therapy, and non-oral feeding. Despite their common use, the research evidence for these interventions is lacking. The current study aimed to systematically review the evidence for the safety and the effectiveness of interventions for feeding and swallowing disorders in adults with ID. Seven electronic databases, conference proceedings, and reference lists of relevant studies were reviewed from online availability to March 2019, with no language restrictions. Eligibility criteria encompassed experimental or non-experimental study design, adults (> 18 years) with ID and feeding and/or swallowing disorders (any etiology and severity) and any intervention for feeding and/or swallowing disorders. Methodological quality was assessed by two independent reviewers using the Downs and Black checklist. Four articles met the inclusion criteria. All included studies considered enteral feeding as an intervention strategy and had a retrospective observational design. Overall, included studies reported positive change in nutritional status and a high incidence of adverse events following enteral feeding initiation. Risk of bias was high with variability in methodological quality. The safety and effectiveness of interventions for feeding and swallowing in adults with ID is unclear. This review highlights the lack of evidence-based practice in this area. Directions for further research are provided. Before enteral feeding initiation, risks and benefits should be appropriately balanced on an individual basis, and caregivers should be involved in the decision-making process.
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Affiliation(s)
- Beatrice Manduchi
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, D02KF66, Ireland.
| | - Gina Marni Fainman
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, D02KF66, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, D02KF66, Ireland
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Mac Giolla Phadraig C, Nunn J, McCallion P, Donnelly-Swift E, van Harten M, McCarron M. Total tooth loss without denture wear is a risk indicator for difficulty eating among older adults with intellectual disabilities. J Oral Rehabil 2018; 46:170-178. [DOI: 10.1111/joor.12738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/18/2018] [Accepted: 10/19/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Caoimhin Mac Giolla Phadraig
- Department of Child and Public Dental Health; Dublin Dental University Hospital; Dublin Ireland
- School of Dental Science; Trinity College Dublin; Dublin Ireland
| | - June Nunn
- Department of Child and Public Dental Health; Dublin Dental University Hospital; Dublin Ireland
- School of Dental Science; Trinity College Dublin; Dublin Ireland
| | - Philip McCallion
- School of Nursing and Midwifery; Trinity College Dublin; Dublin Ireland
- School of Social Work; Temple University; Philadelphia Pennsylvania
| | - Erica Donnelly-Swift
- Department of Child and Public Dental Health; Dublin Dental University Hospital; Dublin Ireland
- School of Dental Science; Trinity College Dublin; Dublin Ireland
| | - Maria van Harten
- Department of Child and Public Dental Health; Dublin Dental University Hospital; Dublin Ireland
- School of Dental Science; Trinity College Dublin; Dublin Ireland
| | - Mary McCarron
- School of Nursing and Midwifery; Trinity College Dublin; Dublin Ireland
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Robertson J, Chadwick D, Baines S, Emerson E, Hatton C. Prevalence of Dysphagia in People With Intellectual Disability: A Systematic Review. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 55:377-391. [PMID: 29194030 DOI: 10.1352/1934-9556-55.6.377] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Dysphagia (feeding and swallowing disorder) is associated with serious health complications and psychosocial sequelae. This review summarizes international research relating to the prevalence of dysphagia in people with intellectual disability. Studies published from 1990 to July 2016 were identified using Medline, Cinahl, PsycINFO, Web of Science, email requests, and cross-citations. Twenty studies were identified. Dysphagia in people with intellectual disability appears to be associated with more severe levels of intellectual disability, comorbid cerebral palsy, and motor impairments. However, further research with representative samples of people with intellectual disability using adequate methods of assessment are required in order to provide more precise prevalence estimates and clarify factors that may be associated with dysphagia in this population.
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Affiliation(s)
- Janet Robertson
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
| | - Darren Chadwick
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
| | - Susannah Baines
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
| | - Eric Emerson
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
| | - Chris Hatton
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
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6
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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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Perez CM, Wagner AP, Ball SL, White SR, Clare ICH, Holland AJ, Redley M. Prognostic models for identifying adults with intellectual disabilities and mealtime support needs who are at greatest risk of respiratory infection and emergency hospitalisation. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:737-754. [PMID: 28497469 PMCID: PMC5518212 DOI: 10.1111/jir.12376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 11/15/2016] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Among adults with intellectual disabilities (ID), problems with eating, drinking and swallowing (EDS), and an associated need for mealtime support, are common, with an estimated 15% of adults known to specialist ID services requiring mealtime support. We set out to identify which adults with ID who receive mealtime support are at an increased risk of respiratory infections and emergency hospitalisation related to EDS problems. METHOD An exploratory, prospective cohort study was undertaken in the East of England. At baseline, structured interviews with the caregivers of 142 adults with ID and any type of mealtime support needs were used to gather information on health and support needs over the previous 12 months. These interviews were repeated at follow-up, 12 months later. The resulting dataset, covering a 24-month period, was analysed with logistic regression, using model averaging to perform sensitivity analysis, and backwards step-wise variable selection to identify the most important predictors. RESULTS Individuals with a history of respiratory infections (in the first year of study), those who had epilepsy and those with caregiver-reported difficulty swallowing were most likely to have respiratory infections in the second year. Adults with increasing mealtime support needs, epilepsy and/or full mealtime support needs (fed mainly or entirely by a caregiver or enterally) were at increased risk of emergency hospitalisation for EDS-related problems. CONCLUSIONS Our findings highlight the importance of carefully monitoring health issues experienced by adults with ID and EDS problems, as well as their eating, drinking and swallowing skills. However, the models developed in this exploratory research require validation through future studies addressing the EDS problems commonly experienced by adults with ID and their implications for health outcomes and quality of life. Further research into the relationship between epilepsy and EDS problems would provide much-needed insight into the complex relationship between the two areas.
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Affiliation(s)
- C. M. Perez
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - A. P. Wagner
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- Health Economics Group, Norwich Medical SchoolUniversity of East AngliaNorwichUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
| | - S. L. Ball
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - S. R. White
- MRC Biostatistics UnitUniversity of CambridgeCambridgeUK
| | - I. C. H. Clare
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
| | - A. J. Holland
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
| | - M. Redley
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
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Wagner AP, Croudace TJ, Bateman N, Pennington MW, Prince E, Redley M, White SR, Ring H. Clinical services for adults with an intellectual disability and epilepsy: A comparison of management alternatives. PLoS One 2017; 12:e0180266. [PMID: 28671982 PMCID: PMC5495336 DOI: 10.1371/journal.pone.0180266] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/13/2017] [Indexed: 12/21/2022] Open
Abstract
Background Intellectual disability (ID) is relatively common in people with epilepsy, with prevalence estimated to be around 25%. Surprisingly, given this relatively high frequency, along with higher rates of refractory epilepsy than in those without ID, little is known about outcomes of different management approaches/clinical services treating epilepsy in adults with ID—we investigate this area. Materials & methods We undertook a naturalistic observational cohort study measuring outcomes in n = 91 adults with ID over a 7-month period (recruited within the period March 2008 to April 2010). Participants were receiving treatment for refractory epilepsy (primarily) in one of two clinical service settings: community ID teams (CIDTs) or hospital Neurology services. Results The pattern of comorbidities appeared important in predicting clinical service, with Neurologists managing the epilepsy of relatively more of those with neurological comorbidities whilst CIDTs managed the epilepsy of relatively more of those with psychiatric comorbidities. Epilepsy-related outcomes, as measured by the Glasgow Epilepsy Outcome Scale 35 (GEOS-35) and the Epilepsy and Learning Disabilities Quality of Life Scale (ELDQoL) did not differ significantly between Neurology services and CIDTs. Discussion In the context of this study, the absence of evidence for differences in epilepsy-related outcomes amongst adults with ID and refractory epilepsy between mainstream neurology and specialist ID clinical services is considered. Determining the selection of the service managing the epilepsy of adults with an ID on the basis of the skill sets also required to treat associated comorbidities may hence be a reasonable heuristic.
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Affiliation(s)
- Adam P. Wagner
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England, Cambridge, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Tim J. Croudace
- School of Nursing and Midwifery and Social Dimensions of Health Institute, University of Dundee, Dundee, United Kingdom
| | - Naomi Bateman
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | | | - Elizabeth Prince
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Marcus Redley
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Simon R. White
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Howard Ring
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
- * E-mail:
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10
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Chang CK, Chen CY, Broadbent M, Stewart R, O'Hara J. Hospital admissions for respiratory system diseases in adults with intellectual disabilities in Southeast London: a register-based cohort study. BMJ Open 2017; 7:e014846. [PMID: 28360254 PMCID: PMC5372120 DOI: 10.1136/bmjopen-2016-014846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/17/2017] [Accepted: 03/01/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intellectual disability (ID) carries a high impact on need for care, health status and premature mortality. Respiratory system diseases contribute a major part of mortality among people with ID, but remain underinvestigated as consequent morbidities. METHODS Anonymised electronic mental health records from the South London and Maudsley Trust (SLaM) were linked to national acute medical care data. Using retrospective cohort and matched case-control study designs, adults with ID receiving SLaM care between 1 January 2008 and 31 March 2013 were identified and compared with local catchment residents for respiratory system disease admissions. Standardised admission ratios (SARs) were first calculated, followed by a comparison of duration of hospitalisation with respiratory system disease between people with ID and age-matched and gender-matched random counterparts modelled using linear regression. Finally, the risk of readmission for respiratory system disease was analysed using the Cox models. RESULTS For the 3138 adults with ID identified in SLaM, the SAR for respiratory system disease admissions was 4.02 (95% CI 3.79 to 4.26). Compared with adults without ID, duration of hospitalisation was significantly longer by 2.34 days (95% CI 0.03 to 4.64) and respiratory system disease readmission was significantly elevated (HR=1.35; 95% CI 1.17 to 1.56) after confounding adjustment. CONCLUSIONS Respiratory system disease admissions in adults with ID are more frequent, of longer duration and have a higher likelihood of recurring. Development and evaluation of potential interventions to the preventable causes of respiratory diseases should be prioritised.
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Affiliation(s)
- Chin-Kuo Chang
- Department of Psychological Medicine, King's College London (Institute of Psychiatry, Psychology, and Neuroscience), London, UK
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Chih-Yin Chen
- Nursing Department, Chang Jung Christian University, Tainan City, Taiwan
| | - Mathew Broadbent
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London (Institute of Psychiatry, Psychology, and Neuroscience), London, UK
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Jean O'Hara
- King's Health Partners, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology, and Neuroscience, London, UK
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11
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Robertson J, Chadwick D, Baines S, Emerson E, Hatton C. People with intellectual disabilities and dysphagia. Disabil Rehabil 2017; 40:1345-1360. [DOI: 10.1080/09638288.2017.1297497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Janet Robertson
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Darren Chadwick
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Susannah Baines
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Eric Emerson
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
- Centre for Disability Research and Policy, University of Sydney, Sydney, Australia
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
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12
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Petrovic BB, Peric TO, Markovic DLJ, Bajkin BB, Petrovic D, Blagojevic DB, Vujkov S. Unmet oral health needs among persons with intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 59:370-377. [PMID: 27697655 DOI: 10.1016/j.ridd.2016.09.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 09/04/2016] [Accepted: 09/26/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to examine the factors affecting oral health status among intellectually disabled individuals in Serbia. The sample population was categorized according to age, sex, living arrangements, general health and the level of intellectual disability (ID). The diagnosis of dental caries was performed using the DMFT/dmft criteria. The oral hygiene and gingival health were assessed with the plaque index (Silness&Löe) and gingival index (Löe&Silness), respectively. Descriptive analysis, step-wise and logistic regression were performed to analyze related influential factors for caries presence, number of extracted teeth, teeth restored, the oral hygiene level and the extent of gingival inflammation. Odds ratios for caries were significantly higher among adult persons with ID, in persons with co-occurring developmental disorders (DDS) and increased with the level of ID. Group with DDS was associated with a 1.6 times greater odds of untreated decay, while the institutionalization was associated with 2.4 times greater odds of untreated decay. Institutionalization and co-occurring disabilities have been found to be significantly associated with a higher probability of developing gingivitis. Targeting oral health services to individuals with ID are encouraged and may help to reduce overall negative effect on oral and general health associated with delayed treatments, chronic dental pain, emergency dental care, tooth loss and advanced periodontal disease.
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Affiliation(s)
- Bojan B Petrovic
- Dentistry Clinic of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
| | - Tamara O Peric
- Department of Pediatric and Preventive Dentistry, Faculty of Dentistry, University of Belgrade, Belgrade, Serbia
| | - Dejan L J Markovic
- Department of Pediatric and Preventive Dentistry, Faculty of Dentistry, University of Belgrade, Belgrade, Serbia
| | - Branislav B Bajkin
- Dentistry Clinic of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Djorde Petrovic
- Dentistry Clinic of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Duska B Blagojevic
- Dentistry Clinic of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Sanja Vujkov
- Dentistry Clinic of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Wooderson JR, Cuskelly M, Meyer KA. Evaluating the Performance Improvement Preferences of Disability Service Managers: An Exploratory Study Using Gilbert's Behavior Engineering Model. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:661-671. [PMID: 27279462 DOI: 10.1111/jar.12260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Front-line managers play an important role in managing the performance of staff working in services for people with intellectual disability, but little is known about the practices they prefer to use to improve staff performance and whether these align with what research has shown to be effective. METHOD This study comprised two phases. First, the present authors tested the validity and reliability of a short questionnaire designed to evaluate managers' preferences for performance improvement practices. Then, the present authors collected and analysed responses from 175 managers working in disability services in Queensland, Australia. RESULTS The questionnaire demonstrated good content validity, concurrent validity and test-retest reliability. The participants believed strategies related to changing employee individual characteristics to be more effective than strategies aimed at improving environmental factors. CONCLUSIONS This study provides important considerations regarding the professional development needs of front-line managers working in organizations that provide services to people with intellectual disability.
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Affiliation(s)
- John R Wooderson
- School of Education, University of Queensland, St Lucia, QLD, Australia
| | - Monica Cuskelly
- School of Education, University of Queensland, St Lucia, QLD, Australia
| | - Kim A Meyer
- School of Education, University of Queensland, St Lucia, QLD, Australia
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