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Henderson A, Fleming M, Cooper SA, Pell JP, Melville C, Mackay DF, Hatton C, Kinnear D. COVID-19 infection and outcomes in a population-based cohort of 17 203 adults with intellectual disabilities compared with the general population. J Epidemiol Community Health 2022; 76:550-555. [PMID: 35232778 PMCID: PMC8914402 DOI: 10.1136/jech-2021-218192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adults with intellectual disabilities (ID) may be at higher risk of COVID-19 death. We compared COVID-19 infection, severe infection, mortality, case fatality and excess deaths, among adults with, and without, ID. METHODS Adults with ID in Scotland's Census, 2011, and a 5% sample of other adults, were linked to COVID-19 test results, hospitalisation data and deaths (24 January 2020-15 August 2020). We report crude rates of COVID-19 infection, severe infection (hospitalisation/death), mortality, case fatality; age-standardised, sex-standardised and deprivation-standardised severe infection and mortality ratios; and annual all-cause mortality for 2020 and 2015-2019. FINDINGS Successful linkage of 94.9% provided data on 17 203 adults with, and 188 634 without, ID. Adults with ID had more infection (905/100 000 vs 521/100 000); severe infection (538/100 000 vs 242/100 000); mortality (258/100 000 vs 116/100 000) and case fatality (30% vs 24%). Poorer outcomes remained after standardisation: standardised severe infection ratio 2.61 (95% CI 1.81 to 3.40) and mortality ratio 3.26 (95% CI 2.19 to 4.32). These were higher at ages 55-64: 7.39 (95% CI 3.88 to 10.91) and 19.05 (95% CI 9.07 to 29.02), respectively, and in men, and less deprived neighbourhoods. All-cause mortality was slightly higher in 2020 than 2015-2019 for people with ID: standardised mortality ratio 2.50 (95% CI 2.18 to 2.82) and 2.39 (95% CI 2.28 to 2.51), respectively. CONCLUSION Adults with ID had more COVID-19 infections, and worse outcomes once infected, particularly adults under 65 years. Non-pharmaceutical interventions directed at formal and informal carers are essential to reduce transmission. All adults with ID should be prioritised for vaccination and boosters regardless of age.
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Affiliation(s)
- Angela Henderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Chris Hatton
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
| | - Deborah Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Cooper SA, Henderson A, Kinnear D, Mackay D, Fleming M, Smith GS, Hughes-McCormack LA, Rydzewska E, Dunn K, Pell JP, Melville C. Cohort profile: Scotland's record-linkage e-cohorts of people with intellectual disabilities, and autistic people (SCIDA). BMJ Open 2022; 12:e057230. [PMID: 35568493 PMCID: PMC9109103 DOI: 10.1136/bmjopen-2021-057230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To investigate health, mortality and healthcare inequalities experienced by people with intellectual disabilities, and autistic people, and their determinants; an important step towards identifying and implementing solutions to reduce inequalities. This paper describes the cohorts, record-linkages and variables that will be used. PARTICIPANTS Scotland's Census, 2011 was used to identify Scotland's citizens with intellectual disabilities, and autistic citizens, and representative general population samples with neither. Using Scotland's community health index, the Census data (demography, household, employment, long-term conditions) were linked with routinely collected health, death and healthcare data: Scotland's register of deaths, Scottish morbidity data 06 (SMR06: cancer incidence, mortality, treatments), Prescribing Information System (identifying asthma/chronic obstructive pulmonary disease; angina/congestive heart failure/hypertension; peptic ulcer/reflux; constipation; diabetes; thyroid disorder; depression; bipolar disorders; anxiety/sleep; psychosis; attention deficit hyperactivity disorder; epilepsy; glaucoma), SMR01 (general/acute hospital admissions and causes, ambulatory care sensitive admissions), SMR04 (mental health admissions and causes), Scottish Care Information-Diabetes Collaboration (diabetic care quality, diabetic outcomes), national bowel screening programme and cervical screening. FINDINGS TO DATE Of the whole population, 0.5% had intellectual disabilities, and 0.6% were autistic. Linkage was successful for >92%. The resultant e-cohorts include: (1) 22 538 people with intellectual disabilities (12 837 men and 9701 women), 4509 of whom are children <16 years, (2) 27 741 autistic people (21 390 men and 6351 women), 15 387 of whom are children <16 years and (3) representative general population samples with neither condition. Very good general health was reported for only 3389 (15.0%) people with intellectual disabilities, 10 510 (38.0%) autistic people, compared with 52.4% general population. Mental health conditions were reported for 4755 (21.1%) people with intellectual disabilities, 3998 (14.4%) autistic people, compared with 4.2% general population. FUTURE PLANS Analyses will determine the extent of premature mortality, causes of death, and avoidable deaths, profile of health conditions and cancers, healthcare quality and screening and determinants of mortality and healthcare.
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Affiliation(s)
- Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Angela Henderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Deborah Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Gillian S Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Ewelina Rydzewska
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kirsty Dunn
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Ward LM, Stanley B, Greenlaw N, Cooper SA, Pacitti C, Henderson A, Gibson J, Kinnear D. Risk of anticholinergic burden in adults with intellectual disabilities: a Scottish retrospective cohort study of n = 17 220. J Intellect Disabil Res 2021; 65:813-830. [PMID: 34169610 DOI: 10.1111/jir.12861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Several drugs have anticholinergic side effects that are associated with adverse health outcomes. Anticholinergic burden studies in adults with intellectual disabilities (ID) have focused exclusively on older adults. This study investigates anticholinergic burden and its associations in adults with ID of all ages (17-94 years). METHODS Adults with ID (n = 4 305), each with three general population age-sex-neighbourhood-matched controls (n = 12 915), were linked to their prescribed medications with anticholinergic effects between 2009 and 2017. Analyses were undertaken using logistic regression models. RESULTS Adults with ID were more likely to be prescribed any anticholinergic medicines, odds ratio (OR) = 1.49 (1.38-1.59), especially 'very strong' risk medicines, OR = 2.59 (2.39-2.81); 48.5% had very high total anticholinergic burden (3+) compared with 35.4% of the general population, OR = 1.77 (1.64-1.90). This group difference was greater for males, OR = 2.02 (1.84-2.22), than females, OR = 1.48 (1.33-1.65). Adults with ID had significantly higher odds of having very high total anticholinergic burden up to 75 years old, with the greatest group effect occurring in younger ages, 17-24-year-olds, OR = 3.05 (2.39-3.89), and the extent of the difference decreased as age increased. The main effect of neighbourhood deprivation showed greater group differences with increasing affluence of neighbourhood. Results examining only the ID group showed that very high total anticholinergic burden was greatest for females, OR = 1.21 (1.07-1.37), and those over age 55, and extent of neighbourhood deprivation was not significant. CONCLUSIONS Adults with ID are at higher risk of anticholinergic burden than the general population, especially young adults. Overall anticholinergic burden increased with age, but burden was high across all ages in the ID group. Very high total anticholinergic burden is prevalent across all types of neighbourhoods for the adults with ID, in contrast to the steeper gradient seen in the general population. Adults with ID have increased likelihood of unintended adverse effects, regardless of potential confounds, so clinicians undertaking medication reviews need to consider anticholinergic side effects and cumulative burden across concomitant medications, including in young adults with ID, not just older adults, and particularly women.
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Affiliation(s)
- L M Ward
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - B Stanley
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - N Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - S-A Cooper
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - C Pacitti
- NHS Greater Glasgow & Clyde, Leverndale Hospital, Glasgow, UK
| | - A Henderson
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - J Gibson
- School of Medicine, Dentistry and Nursing, Glasgow Dental Hospital and School, Glasgow, UK
| | - D Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
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Truesdale M, Melville C, Barlow F, Dunn K, Henderson A, Hughes-McCormack LA, McGarty A, Rydzewska E, Smith GS, Symonds J, Jani B, Kinnear D. Respiratory-associated deaths in people with intellectual disabilities: a systematic review and meta-analysis. BMJ Open 2021; 11:e043658. [PMID: 34261677 PMCID: PMC8280912 DOI: 10.1136/bmjopen-2020-043658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To review and synthesise evidence on rates of respiratory-associated deaths and associated risk factors in the intellectual disability population. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, CINAHL, ISI Web of Science (all databases including Medline) and PsychINFO were searched for studies published between 1st January 1985 and 27th April 2020 and examined study and outcome quality. Reference lists and Google Scholar were also hand searched. RESULTS We identified 2295 studies, 17 were included in the narrative synthesis and 10 studies (11 cohorts) in the meta-analysis. Data from 90 302 people with intellectual disabilities and 13 808 deaths from all causes in people with intellectual disabilities were extracted. Significantly higher rates of respiratory-associated deaths were found among people with intellectual disabilities (standardised mortality ratio(SMR): 10.86 (95% CI: 5.32 to 22.18, p<0.001) compared with those in the general population, lesser rates for adults with ID (SMR: 6.53 (95% CI: 4.29 to 9.96, p<0.001); and relatively high rates from pneumonia 26.65 (95% CI: 5.63 to 126.24, p<0.001). The overall statistical heterogeneity was I2=99.0%. CONCLUSION Premature deaths due to respiratory disorders are potentially avoidable with improved public health initiatives and equitable access to quality healthcare. Further research should focus on developing prognostic guidance and validated tools for clinical practice to mitigate risks of respiratory-associated deaths. PROSPERO REGISTRATION NUMBER CRD42020180479.
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Affiliation(s)
- Maria Truesdale
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Fiona Barlow
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kirsty Dunn
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Angela Henderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Arlene McGarty
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ewelina Rydzewska
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Gillian S Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Joseph Symonds
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Bhautesh Jani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Deborah Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Rydzewska E, Dunn K, Cooper SA, Kinnear D. Mental ill-health in mothers of people with intellectual disabilities compared with mothers of typically developing people: a systematic review and meta-analysis. J Intellect Disabil Res 2021; 65:501-534. [PMID: 33738865 DOI: 10.1111/jir.12827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/01/2020] [Accepted: 02/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Mothers of people with intellectual disabilities (IDs) face exceptional challenges and may be more prone to experiencing mental ill-health compared with mothers of typically developing people. These mental ill-health problems may differ at different stages of the caregiving trajectory. However, there is no evidence synthesis on this topic. We aimed to systematically review evidence in this area and identify gaps in the existing literature. METHOD Prospero registration: CRD42018088197. Medline, Embase, CINAHL and PsycINFO databases were searched. No time limits were applied. Studies were limited to English language. Inclusion criteria were studies of mothers of people with IDs that also included a comparison group of mothers of typically developing/developed children. Data were extracted from selected studies using a structured database. Study selection and quality appraisal were double rated. Where possible, meta-analyses were performed. RESULTS Of the retrieved articles, 32/3089 were included, of which 10 reported on anxiety, 21 on depression and 23 on other indicators of mental ill-health. Overall, previous studies reported that mothers of people with IDs experienced poorer mental health as compared with mothers of typically developing people. Meta-analyses revealed significant findings for anxiety, depression, parenting stress, emotional burden and common mental disorders, but not for somatic symptoms. However, there was a considerable heterogeneity; hence, interpretation of results should be cautious. Identified gaps included scarce research on mental ill-health of mothers of adults with IDs at different stages of the caregiving trajectory. CONCLUSIONS There is evidence of poorer mental ill-health in mothers of people with IDs compared with mothers of typically developing people, but lack of focus on different stages of the caregiving trajectory, methodological inconsistencies between studies and lack of robust studies pose limitations. This highlights the need both for improved support for mothers of people with IDs and for further methodologically robust research.
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Affiliation(s)
- E Rydzewska
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - K Dunn
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - S-A Cooper
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - D Kinnear
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Fulton L, Kinnear D, Jahoda A. Belonging and reciprocity amongst people with intellectual disabilities: A systematic methodological review. J Appl Res Intellect Disabil 2021; 34:1008-1025. [PMID: 33723903 DOI: 10.1111/jar.12881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 01/17/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Social inclusion has been explored using a wide range of theories and methods. Belonging and reciprocity have been identified as key components of social inclusion. This systematic methodological review identifies and evaluates the theoretical frameworks and qualitative approaches adopted to explore belonging and reciprocity in the lives of adults with intellectual disabilities. METHOD A systematic search was conducted across ten databases. Screening and quality appraisal were carried out independently by two researchers, and data were extracted to provide detailed accounts of the theories and methods employed. RESULTS Seventeen papers met inclusion criteria. Clear conceptualisations of belonging and reciprocity were lacking, and these concepts were rarely the focus of the research. Theoretical and methodological shortcomings across this literature were identified and discussed. CONCLUSIONS More nuanced conceptualisations of belonging and reciprocity may be helpful in future research, to better capture the context and meaning of individual lives and relationships.
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Affiliation(s)
- Lauren Fulton
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Deborah Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andrew Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Henderson A, Kinnear D, Fleming M, Stanley B, Greenlaw N, Young-Southward G, Pell JP, Cooper SA. Antipsychotic and antidepressant prescribing for 704 297 children and young people with and without intellectual disabilities: record linkage study. Br J Psychiatry 2021; 218:58-62. [PMID: 33541472 DOI: 10.1192/bjp.2020.232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Psychotropics are overprescribed for adults with intellectual disabilities; there are few studies in children and young people. AIMS To investigate antipsychotic and antidepressant prescribing in children and young people with and without intellectual disabilities, and prescribing trends. METHOD Scotland's annual Pupil Census, which identifies pupils with and without intellectual disabilities, was record-linked to the Prescribing Information System. Antidepressant and antipsychotic data were extracted. Logistic regression was used to analyse prescribing between 2010 and 2013. RESULTS Of the 704 297 pupils, 16 142 (2.29%) had a record of intellectual disabilities. Antipsychotic and antidepressant use increased over time, and was higher in older pupils; antipsychotic use was higher in boys, and antidepressant use was higher in girls. Overall, antipsychotics were prescribed to 281 (1.74%) pupils with intellectual disabilities and 802 (0.12%) without (adjusted odds ratio 16.85, 95% CI 15.29-18.56). The higher use among those with intellectual disabilities fell each year (adjusted odds ratio 20.19 in 2010 v. 14.24 in 2013). Overall, 191 (1.18%) pupils with intellectual disabilities and 4561 (0.66%) without were prescribed antidepressants (adjusted odds ratio 2.28, 95% CI 2.03-2.56). The difference decreased each year (adjusted odds ratio 3.10 in 2010 v. 2.02 in 2013). CONCLUSIONS Significantly more pupils with intellectual disabilities are prescribed antipsychotics and antidepressants than are other pupils. Prescribing overall increased over time, but less so for pupils with intellectual disabilities; either they are not receiving the same treatment advances as other pupils, or possible overprescribing in the past is changing. More longitudinal data are required.
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Affiliation(s)
| | - Deborah Kinnear
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Bethany Stanley
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Nicola Greenlaw
- Institute of Health and Wellbeing, University of Glasgow, UK
| | | | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, UK
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Ward LM, Cooper SA, McSkimming P, Greenlaw N, Pacitti C, Gibson J, Henderson A, Stanley B, Pell J, Kinnear D. Dental attendance, restoration and extractions in adults with intellectual disabilities compared with the general population: a record linkage study. J Intellect Disabil Res 2020; 64:980-986. [PMID: 32996662 DOI: 10.1111/jir.12786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Oral health may be poorer in adults with intellectual disabilities (IDs) who rely on carer support and medications with increased dental risks. METHODS Record linkage study of dental outcomes, and associations with anticholinergic (e.g. antipsychotics) and sugar-containing liquid medication, in adults with IDs compared with age-sex-neighbourhood deprivation-matched general population controls. RESULTS A total of 2933/4305 (68.1%) with IDs and 7761/12 915 (60.1%) without IDs attended dental care: odds ratio (OR) = 1.42 [1.32, 1.53]; 1359 (31.6%) with IDs versus 5233 (40.5%) without IDs had restorations: OR = 0.68 [0.63, 0.73]; and 567 (13.2%) with IDs versus 2048 (15.9%) without IDs had dental extractions: OR = 0.80 [0.73, 0.89]. Group differences for attendance were greatest in younger ages, and restoration/extractions differences were greatest in older ages. Adults with IDs were more likely prescribed with anticholinergics (2493 (57.9%) vs. 6235 (48.3%): OR = 1.49 [1.39, 1.59]) and sugar-containing liquids (1641 (38.1%) vs. 2315 (17.9%): OR = 2.89 [2.67, 3.12]). CONCLUSION Carers support dental appointments, but dentists may be less likely to restore teeth, possibly extracting multiple teeth at individual appointments instead.
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Affiliation(s)
- L M Ward
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - S-A Cooper
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - P McSkimming
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - N Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - C Pacitti
- Leverndale Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - J Gibson
- School of Medicine, Dentistry & Nursing, Glasgow Dental Hospital and School, Glasgow, UK
| | - A Henderson
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - B Stanley
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - J Pell
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - D Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
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Fleming M, Salim EE, Mackay DF, Henderson A, Kinnear D, Clark D, King A, McLay JS, Cooper SA, Pell JP. Neurodevelopmental multimorbidity and educational outcomes of Scottish schoolchildren: A population-based record linkage cohort study. PLoS Med 2020; 17:e1003290. [PMID: 33048945 PMCID: PMC7553326 DOI: 10.1371/journal.pmed.1003290] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/03/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Neurodevelopmental conditions commonly coexist in children, but compared to adults, childhood multimorbidity attracts less attention in research and clinical practice. We previously reported that children treated for attention deficit hyperactivity disorder (ADHD) and depression have more school absences and exclusions, additional support needs, poorer attainment, and increased unemployment. They are also more likely to have coexisting conditions, including autism and intellectual disability. We investigated prevalence of neurodevelopmental multimorbidity (≥2 conditions) among Scottish schoolchildren and their educational outcomes compared to peers. METHODS AND FINDINGS We retrospectively linked 6 Scotland-wide databases to analyse 766,244 children (390,290 [50.9%] boys; 375,954 [49.1%] girls) aged 4 to 19 years (mean = 10.9) attending Scottish schools between 2009 and 2013. Children were distributed across all deprivation quintiles (most to least deprived: 22.7%, 20.1%, 19.3%, 19.5%, 18.4%). The majority (96.2%) were white ethnicity. We ascertained autism spectrum disorder (ASD) and intellectual disabilities from records of additional support needs and ADHD and depression through relevant encashed prescriptions. We identified neurodevelopmental multimorbidity (≥2 of these conditions) in 4,789 (0.6%) children, with ASD and intellectual disability the most common combination. On adjusting for sociodemographic (sex, age, ethnicity, deprivation) and maternity (maternal age, maternal smoking, sex-gestation-specific birth weight centile, gestational age, 5-minute Apgar score, mode of delivery, parity) factors, multimorbidity was associated with increased school absenteeism and exclusion, unemployment, and poorer exam attainment. Significant dose relationships were evident between number of conditions (0, 1, ≥2) and the last 3 outcomes. Compared to children with no conditions, children with 1 condition, and children with 2 or more conditions, had more absenteeism (1 condition adjusted incidence rate ratio [IRR] 1.28, 95% CI 1.27-1.30, p < 0.001 and 2 or more conditions adjusted IRR 1.23, 95% CI 1.20-1.28, p < 0.001), greater exclusion (adjusted IRR 2.37, 95% CI 2.25-2.48, p < 0.001 and adjusted IRR 3.04, 95% CI 2.74-3.38, p < 0.001), poorer attainment (adjusted odds ratio [OR] 3.92, 95% CI 3.63-4.23, p < 0.001 and adjusted OR 12.07, 95% CI 9.15-15.94, p < 0.001), and increased unemployment (adjusted OR 1.57, 95% CI 1.49-1.66, p < 0.001 and adjusted OR 2.11, 95% CI 1.83-2.45, p < 0.001). Associations remained after further adjustment for comorbid physical conditions and additional support needs. Coexisting depression was the strongest driver of absenteeism and coexisting ADHD the strongest driver of exclusion. Absence of formal primary care diagnoses was a limitation since ascertaining depression and ADHD from prescriptions omitted affected children receiving alternative or no treatment and some antidepressants can be prescribed for other indications. CONCLUSIONS Structuring clinical practice and training around single conditions may disadvantage children with neurodevelopmental multimorbidity, who we observed had significantly poorer educational outcomes compared to children with 1 condition and no conditions.
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Affiliation(s)
- Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Ehsan E. Salim
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Daniel F. Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Angela Henderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Deborah Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - David Clark
- Information Services Division, Edinburgh, United Kingdom
| | - Albert King
- ScotXed, Scottish Government, Edinburgh, United Kingdom
| | - James S. McLay
- Department of Child Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Henderson A, Mcskimming P, Kinnear D, McCowan C, McIntosh A, Allan L, Cooper SA. Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study. BMJ Open 2020; 10:e036862. [PMID: 32912946 PMCID: PMC7488805 DOI: 10.1136/bmjopen-2020-036862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate psychotropic prescribing in the intellectual disabilities population over 10 years, and associated mental ill health diagnoses. DESIGN Comparison of cross-sectional data in 2002-2004 (T1) and 2014 (T2). Longitudinal cohort study with detailed health assessments at T1 and record linkage to T2 prescribing data. SETTING General community. PARTICIPANTS 1190 adults with intellectual disabilities in T1 compared with 3906 adults with intellectual disabilities in T2. 545/1190 adults with intellectual disabilities in T1 were alive and their records linked to T2 prescribing data. MAIN OUTCOME MEASURES Encashed regular and as-required psychotropic prescriptions. RESULTS 50.7% (603/1190) of adults in T1 and 48.2% (1881/3906) in T2 were prescribed at least one psychotropic; antipsychotics: 24.5% (292/1190) in T1 and 16.7% (653/3906) in T2; antidepressants: 11.2% (133/1190) in T1 and 19.1% (746/3906) in T2. 21.2% (62/292) prescribed antipsychotics in T1 had psychosis or bipolar disorder, 33.2% (97/292) had no mental ill health or problem behaviours, 20.6% (60/292) had problem behaviours but no psychosis or bipolar disorder. Psychotropics increased from 47.0% (256/545) in T1 to 57.8% (315/545) in T2 (p<0.001): antipsychotics did not change (OR 1.18; 95% CI 0.87 to 1.60; p=0.280), there was an increase for antidepressants (OR 2.80; 95% CI 1.96 to 4.00; p<0.001), hypnotics/anxiolytics (OR 2.19; 95% CI 1.34 to 3.61; p=0.002), and antiepileptics (OR 1.40; 95% CI 1.06 to 1.84; p=0.017). Antipsychotic prescribing increased for people with problem behaviours in T1 (OR 6.45; 95% CI 4.41 to 9.45; p<0.001), more so than for people with other mental ill health in T1 (OR 4.11; 95% CI 2.76 to 6.11; p<0.001). CONCLUSIONS Despite concerns about antipsychotic prescribing and guidelines recommending their withdrawal, it appears that while fewer antipsychotic prescriptions were initiated by T2 than in T1, people were not withdrawn from them once commenced. People with problem behaviours had increased prescribing. There was also a striking increase in antidepressant prescriptions. Adults with intellectual disabilities need frequent and careful medication reviews.
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Affiliation(s)
- Angela Henderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paula Mcskimming
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Deborah Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- School of Medicine, University of Saint Andrews, Saint Andrews, Fife, UK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Linda Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Abstract
Studies on children and adults combined suggest higher mortality rates for autistic than other people, but few report mortality rates for autistic children. In addition, past studies may not be representative of the current generation of children diagnosed with autism. We examined mortality in children using data from Scotland’s annual pupil census, linked to National Records of Scotland deaths register, between 2008 and 2015. In total, 9754 (1.2%) of 787,666 pupils had autism. They were more likely to live in neighbourhoods of greater deprivation and receive free school meals. Six autistic pupils died; crude mortality rate 15.8/100,000 person-years (95% CI = 7.1–35.1), compared with 458 other pupils; crude mortality rate 12.5/100,000 person-years (95% CI = 11.4–13.7). The indirectly standardised mortality ratio was 1.1 (95% CI = 0.5–2.5). In the autistic pupils, the most common causes of death were nervous system diseases, for example, epilepsy. Avoidable causes were common. In the comparison group, external causes and cancers were the most common causes of death. We cautiously conclude that mortality in the current generation of autistic children is no higher than for other children, perhaps due to recent widening of criteria for autism spectrum diagnosis, but some deaths could have been avoided by better care.
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Dunn K, Jahoda A, Kinnear D. The experience of being a father of a son or daughter with an intellectual disability: Older fathers' perspectives. J Appl Res Intellect Disabil 2020; 34:118-128. [PMID: 32794330 DOI: 10.1111/jar.12791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 06/25/2020] [Accepted: 07/16/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND As life expectancy for people with an intellectual disability increases, there is a growing cohort of older father carers. This study aimed to gain a more in-depth understanding of older father carers' experiences of parenting. METHODS Semi-structured interviews were conducted with 7 older fathers (M = 63.9 years) and analysed using constructivist grounded theory. RESULTS Three conceptual categories were identified. "Wearing different hats: how fathers' sense of identity had altered over the years. "Family comes first": importance placed on the family unit. "Getting on in years": the challenges faced by ageing fathers parenting their son/daughter. CONCLUSIONS Fathers re-evaluated their priorities and found a new identity in their parenting role, although they continued to see themselves as secondary carers. Fathers worried about the future as their health declined but drew strength from the benefits they had derived and the challenges that they had overcome to do their best for their son/daughter and their family.
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Affiliation(s)
- Kirsty Dunn
- Department of Mental Health and Wellbeing, Gartnavel Royal Hospital, Glasgow, UK
| | - Andrew Jahoda
- Department of Mental Health and Wellbeing, Gartnavel Royal Hospital, Glasgow, UK
| | - Deborah Kinnear
- Department of Mental Health and Wellbeing, Gartnavel Royal Hospital, Glasgow, UK
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Smith GS, Fleming M, Kinnear D, Henderson A, Pell JP, Melville C, Cooper SA. Rates and causes of mortality among children and young people with and without intellectual disabilities in Scotland: a record linkage cohort study of 796 190 school children. BMJ Open 2020; 10:e034077. [PMID: 32773385 PMCID: PMC7418667 DOI: 10.1136/bmjopen-2019-034077] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To investigate mortality rates and causes in children and young people with intellectual disabilities. DESIGN Retrospective cohort; individual record linkage between Scotland's annual pupil census and National Records of Scotland death register. SETTING General community. PARTICIPANTS Pupils receiving local authority-funded schooling in Scotland, 2008 to 2013, with an Additional Support Need due to intellectual disabilities, compared with other pupils. MAIN OUTCOME MEASURES Deaths up to 2015: age of death, age-standardised mortality ratios (age-SMRs); causes of death including cause-specific age-SMRs; avoidable deaths as defined by the UK Office of National Statistics. RESULTS 18 278/947 922 (1.9%) pupils had intellectual disabilities. 106 died over 67 342 person-years (crude mortality rate=157/100 000 person-years), compared with 458 controls over 3 672 224 person-years (crude mortality rate=12/100 000 person-years). Age-SMR was 11.6 (95% CI 9.6 to 14.0); 16.6 (95% CI 12.2 to 22.6) for female pupils and 9.8 (95% CI 7.7 to 12.5) for male pupils. Most common main underlying causes were diseases of the nervous system, followed by congenital anomalies; most common all-contributing causes were diseases of the nervous system, followed by respiratory system; most common specific contributing causes were cerebral palsy, pneumonia, respiratory failure and epilepsy. For all contributing causes, SMR was 98.8 (95% CI 69.9 to 139.7) for congenital anomalies, 76.5 (95% CI 58.9 to 99.4) for nervous system, 63.7 (95% CI 37.0 to 109.7) for digestive system, 55.3 (95% CI 42.5 to 72.1) for respiratory system, 32.1 (95% CI 17.8 to 57.9) for endocrine and 14.8 (95% CI 8.9 to 24.5) for circulatory system. External causes accounted for 46% of control deaths, but the SMR for external-related deaths was still higher (3.6 (95% CI 2.2 to 5.8)) for pupils with intellectual disabilities. Deaths amenable to good care were common. CONCLUSION Pupils with intellectual disabilities were much more likely to die than their peers, and had a different pattern of causes, including amenable deaths across a wide range of disease categories. Improvements are needed to reduce amenable deaths, for example, epilepsy-related and dysphagia, and to support families of children with life-limiting conditions.
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Affiliation(s)
- Gillian S Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Deborah Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Angela Henderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Al Slamah T, Nicholl BI, Alslail FY, Harris L, Melville CA, Kinnear D. Cultural adaptation of self-management of type 2 diabetes in Saudi Arabia (qualitative study). PLoS One 2020; 15:e0232904. [PMID: 32722666 PMCID: PMC7386581 DOI: 10.1371/journal.pone.0232904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 04/23/2020] [Indexed: 11/22/2022] Open
Abstract
Background Saudi Arabia is continuously working on developing its health care system, however with the high prevalence of type 2 diabetes and comorbidities, such as cardiovascular diseases, self-management education programmes are essential. As part of a planned series of studies to develop a culturally sensitive type 2 diabetes self-management programme, this study explores the need versus barriers and facilitators relevant to implementing a national programme for type 2 diabetes self-management education within the community and health care system in Saudi Arabia. Methods A qualitative methodology was used to explore the views of a multidisciplinary group of diabetes health professionals and adult patients with type 2 diabetes. The views of nine health professionals working at a specialised diabetes care centre were gathered at two focus groups (four and five) that included doctors, nutritionists, health educators and nurses. Individual interviews with 12 patients with type 2 diabetes (six females and six males) attending the centre were also carried out. Recurring themes through the translated transcripts were studied and treated by the research group under pre-set protocols. Results Focus groups with health professionals revealed three main themes. 1. Resources: availability of resources and how they impacted on performance and patients’ care; 2.Familiarity with self-management education programmes: educating patients and raising awareness among them; and 3. Lifestyle: patients’ lifestyle and how it could affect their compliance with self-management programmes. Interviews with patients also revealed three main themes. 1. Habits: post diagnosis changes in patients’ attitudes and behaviours towards diet and physical activity; 2. Health education: awareness of managing type 2 diabetes through health centre advice or self-education; and 3. Culture and society: a lack of cultural or social support created by some social practices or conventions. Conclusion The findings from this study highlight a gap in type 2 diabetes care system that can be breached through the development of a Saudi specific self-management programme for type 2 diabetes. The identified barriers and facilitators can be used for adapting a self-management programme to the Saudi context. However, initial training is needed for local health professionals to understand the mechanisms of self-management programmes. Such programmes will need to infiltrate to the society, and the patients’ families, in particular to tackle the rising prevalence of type 2 diabetes in Saudi Arabia and provide a friendlier, more supportive environment for the current patients to self-manage their diabetes.
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Affiliation(s)
- Thamer Al Slamah
- Human Health Department, College of Applied Medical Sciences, Qassim University, Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
- General Practice and Primary Care, Institute of Health and Wellbeing College of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, United Kingdom
| | - Barbara I. Nicholl
- General Practice and Primary Care, Institute of Health and Wellbeing College of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, United Kingdom
| | - Fatima Y. Alslail
- Director of the National Diabetes Control and Prevention Program, Ministry of Health, Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | - Leanne Harris
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Craig A. Melville
- Mental Health and Wellbeing, Institute of Health and Wellbeing College of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, United Kingdom
| | - Deborah Kinnear
- Mental Health and Wellbeing, Institute of Health and Wellbeing College of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
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Cooper SA, Allan L, Greenlaw N, McSkimming P, Jasilek A, Henderson A, McCowan C, Kinnear D, Melville C. Rates, causes, place and predictors of mortality in adults with intellectual disabilities with and without Down syndrome: cohort study with record linkage. BMJ Open 2020; 10:e036465. [PMID: 32423940 PMCID: PMC7239521 DOI: 10.1136/bmjopen-2019-036465] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate mortality in adults with intellectual disabilities: rates, causes, place, demographic and clinical predictors. DESIGN Cohort study with record linkage to death data. SETTING General community. PARTICIPANTS 961/1023 (94%) adults (16-83 years; mean=44.1 years; 54.6% male) with intellectual disabilities, clinically examined in 2001-2004; subsequently record-linked to their National Health Service number, allowing linkage to death certificate data, 2018. OUTCOME MEASURES Standardised mortality ratios (SMRs), underlying and all contributing causes of death, avoidable deaths, place, and demographic and clinical predictors of death. RESULTS 294/961 (30.6%) had died; 64/179 (35.8%) with Down syndrome, 230/783 (29.4%) without Down syndrome. SMR overall=2.24 (1.98, 2.49); Down syndrome adults=5.28 (3.98, 6.57), adults without Down syndrome=1.93 (1.68, 2.18); male=1.69 (1.42, 1.95), female=3.48 (2.90, 4.06). SMRs decreased as age increased. More severe intellectual disabilities increased SMR, but ability was not retained in the multivariable model. SMRs were higher for most International Statistical Classification of Diseases and Related Health Problems, 10th Revision chapters. For adults without Down syndrome, aspiration/reflux/choking and respiratory infection were the the most common underlying causes of mortality; for Down syndrome adults 'Down syndrome', and dementia were most common. Amenable deaths (29.8%) were double that in the general population (14%); 60.3% died in hospital. Mortality risk related to percutaneous endoscopic gastrostomy/tube fed, Down syndrome, diabetes, lower respiratory tract infection at cohort-entry, smoking, epilepsy, hearing impairment, increasing number of prescribed drugs, increasing age. Bowel incontinence reduced mortality risk. CONCLUSIONS Adults with intellectual disabilities with and without Down syndrome have different SMRs and causes of death which should be separately reported. Both die younger, from different causes than other people. Some mortality risks are similar to other people, with earlier mortality reflecting more multimorbidity; amenable deaths are also common. This should inform actions to reduce early mortality, for example, training to avoid aspiration/choking, pain identification to address problems before they are advanced, and reasonable adjustments to improve healthcare quality.
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Affiliation(s)
- Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Linda Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paula McSkimming
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Adam Jasilek
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Angela Henderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- School of Medicine, University of St. Andrews, Aberdeen, UK
| | - Deborah Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Al Slamah T, Nicholl BI, Alslail FY, Harris L, Kinnear D, Melville CA. Correlates of type 2 diabetes and glycaemic control in adults in Saudi Arabia a secondary data analysis of the Saudi health interview survey. BMC Public Health 2020; 20:515. [PMID: 32303201 PMCID: PMC7164173 DOI: 10.1186/s12889-020-08597-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 03/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is evidence that type 2 diabetes self-management programmes may have a positive impact on health outcomes of adults living in Gulf countries. However, none of the programmes evaluated were developed using evidence about the specific needs of adults with Type 2 diabetes living in the Gulf countries. This study is part of a wider programme of research, which uses a cultural adaptation framework to generate information on how to tailor type 2 diabetes self-management to the Saudi context. METHODS Secondary data analysis of the Saudi Health Interview Survey (SHIS) (N = 10,821) was conducted. Bivariate and multivariate logistic regression modelling assessed factors associated with type 2 diabetes and its control / self-management including sociodemographic factors (e.g. age, gender), lifestyle (e.g. diet, physical activity), and health seeking behaviours (e.g. chronic illnesses, health services). RESULTS 7% (N = 808) of all participants had type 2 diabetes (59% male), however it represents 35% at or above 55 years. In multivariate analysis at older age, being overweight or obese, male, having hypertension, and reporting a reduction in health status in the 12 months prior to questionnaire completion, were significantly associated with having type 2 diabetes. Participants who reported walking for more than 10 min per day were less likely to report type 2 diabetes. Unexpectedly there was a significant association between type 2 diabetes and lower frequency of fast food intake, while increased fruit and vegetable intake was associated with poor glycaemic control. CONCLUSIONS Being overweight and/or hypertensive are concomitant with type 2 diabetes in Saudi Arabia. Any self-management programmes for type 2 diabetes patients with either of these conditions should be tailored accordingly. Walking behaviours should be prioritised in Saudi self-management programmes. Prediabetes management programmes may be of special importance to the Saudi community.
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Affiliation(s)
- Thamer Al Slamah
- Human Health Department, College of Applied Medical Sciences, Qassim University, Buraydah, Kingdom of Saudi Arabia.
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road R202 House 2, Glasgow, G12 9LX, UK.
- College of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, UK.
| | - Barbara I Nicholl
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road R202 House 2, Glasgow, G12 9LX, UK
- College of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, UK
| | - Fatima Y Alslail
- Director of the National Diabetes Control and Prevention Program, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Leanne Harris
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Deborah Kinnear
- Mental Health and Wellbeing, Institute of Health and Wellbeing, Glasgow, UK
| | - Craig A Melville
- College of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, UK
- Mental Health and Wellbeing, Institute of Health and Wellbeing, Glasgow, UK
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Kinnear D, Rydzewska E, Dunn K, Hughes-McCormack L, Melville C, Henderson A, Cooper SA. The relative influence of intellectual disabilities and autism on sensory impairments and physical disability: A whole-country cohort of 5.3 million children and adults. J Appl Res Intellect Disabil 2020; 33:1059-1068. [PMID: 32187783 PMCID: PMC8641374 DOI: 10.1111/jar.12728] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/29/2020] [Accepted: 03/02/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Intellectual disabilities and autism are lifelong and often co-occur. Little is known on their extent of independent association with sensory impairments and physical disability. METHODS For Scotland's population, logistic regressions investigated age-gender-adjusted odds ratios (OR) of associations, independently, of intellectual disabilities and autism with sensory impairments and physical disability. RESULTS 1,548,819 children/youth, and 3,746,584 adults. In children/youth, the effect size of intellectual disabilities and autism, respectively, was as follows: blindness (OR = 30.12; OR = 2.63), deafness (OR = 13.98; OR = 2.31), and physical disability (OR = 43.72; OR = 5.62). For adults, the effect size of intellectual disabilities and autism, respectively, was as follows: blindness (OR = 16.89; OR = 3.29), deafness (OR = 7.47; OR = 2.36), and physical disability (OR = 6.04; OR = 3.16). CONCLUSIONS Intellectual disabilities have greater association with the population burden of sensory impairments/physical disability, but autism is also associated regardless of overlap with intellectual disabilities. These may impact further on communication limitations due to autism and intellectual disabilities, increasing complexity of assessments/management of other health conditions. Clinicians need to be aware of these important issues.
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Affiliation(s)
- Deborah Kinnear
- Mental Health and Wellbeing Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ewelina Rydzewska
- Mental Health and Wellbeing Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kirsty Dunn
- Mental Health and Wellbeing Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Laura Hughes-McCormack
- Mental Health and Wellbeing Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Mental Health and Wellbeing Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Angela Henderson
- Mental Health and Wellbeing Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sally-Ann Cooper
- Mental Health and Wellbeing Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Kinnear D, Allan L, Morrison J, Finlayson J, Sherriff A, Macpherson L, Henderson A, Ward L, Muir M, Cooper SA. Prevalence of factors associated with edentulousness (no natural teeth) in adults with intellectual disabilities. J Intellect Disabil Res 2019; 63:1475-1481. [PMID: 31062460 DOI: 10.1111/jir.12628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Poor oral health is largely preventable. Prevention includes toothbrushing and regular dental checks. Oral health has important consequences for general nutrition, chewing, communication, wider systemic disease, self-confidence and participation in society. This study investigated the prevalence of edentulousness (no natural teeth) in adults with intellectual disabilities (IDs) compared with the general population and associated factors. METHODS An adult cohort with IDs residing in Greater Glasgow and Clyde, Scotland, underwent detailed health assessments between 2002 and 2004. Between 2004 and 2006, a subsample had an oral check. Data on edentulousness in the cohort were compared with adult participants from Greater Glasgow and Clyde in the 2008 Scottish Health Survey. Within the IDs cohort, binary logistic regression analyses investigated potential relationships between edentulousness and demographic and clinical factors. RESULTS Five hundred sixty adults with IDs were examined [53.2% (298) male, mean age = 46.3 years, range 18-81 years] and compared with 2547 general population: edentulousness was 9% vs. 1% aged 25-34 years; 22% vs. 2% aged 35-44 years; 39% vs. 7% aged 45-54 years; 41% vs. 18% aged 55-64 years; and 76% vs. 34% aged 65-74 years. In both groups, edentulousness increased with age. After stratification for age, rates of edentulousness were consistently higher in the ID cohort. Odds ratios within age strata were not homogenous (Mantel-Haenszel test, P < 0.0001). Edentulousness was more likely in those with more severe IDs (adjusted odds ratio (AOR) = 2.36; 95% confidence interval (CI) [1.23 to 4.51]); those taking antipsychotics (AOR = 2.09; 95% CI [1.25 to 3.51]) and those living in the most deprived neighbourhoods (AOR = 2.69; 95% CI [1.11 to 6.50]). There was insufficient evidence for associations with sex, type of accommodation/support, antiepileptics, problem behaviours or autism. CONCLUSIONS Adults with IDs have a high prevalence of edentulousness and need supported daily oral care to reduce the need for extractions. Despite previous reports on poor oral care and the move towards person-centred care, carers and care-giving organisations need greater support to implement daily oral care. Prescribers need awareness of the potentially contributory role of antipsychotics, which may relate to xerostomia.
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Affiliation(s)
- D Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - L Allan
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - J Morrison
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - J Finlayson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - A Sherriff
- School of Medicine, Dentistry & Nursing, Glasgow Dental Hospital & School, Glasgow, UK
| | - L Macpherson
- School of Medicine, Dentistry & Nursing, Glasgow Dental Hospital & School, Glasgow, UK
| | - A Henderson
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - L Ward
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - M Muir
- Department of Public Health, NHS Ayrshire and Arran, Ayr, South Ayrshire, UK
| | - S A Cooper
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
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Abstract
BACKGROUND Caring for a child with intellectual disabilities can be a very rewarding but demanding experience. Research in this area has primarily focused on mothers, with relatively little attention given to the mental health of fathers. AIMS The purpose of this review was to summarise the evidence related to the mental health of fathers compared with mothers, and with fathers in the general population. METHOD A meta-analysis was undertaken of all studies published by 1 July 2018 in Medline, PsycINFO, CINAHL and EMBASE, using terms on intellectual disabilities, mental health and father carers. Papers were selected based on pre-defined inclusion and exclusion criteria. RESULTS Of 5544 results, 20 studies met the inclusion criteria and 12 had appropriate data for meta-analysis. For comparisons of fathers with mothers, mothers were significantly more likely to have poor general mental health and well-being (standardised mean difference (SMD) -0.38, 95% CI -0.56 to -0.20), as well as higher levels of depression (SMD, -0.46; 95% CI -0.68 to -0.24), stress (SMD, -0.32; 95% CI -0.46 to -0.19) and anxiety (SMD, -0.30; 95% CI -0.50 to -0.10). CONCLUSIONS There is a significant difference between the mental health of father and mother carers, with fathers less likely to exhibit poor mental health. However, this is based on a small number of studies. More data is needed to determine whether the general mental health and anxiety of father carers of a child with intellectual disabilities differs from fathers in the general population.
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Affiliation(s)
- Kirsty Dunn
- Research Assistant, Mental Health and Wellbeing Group, University of Glasgow, UK
| | - Deborah Kinnear
- Senior Lecturer, Mental Health and Wellbeing Group, University of Glasgow, UK
| | - Andrew Jahoda
- Professor, Mental Health and Wellbeing Group, University of Glasgow, UK
| | - Alex McConnachie
- Professor, Mental Health and Wellbeing Group, University of Glasgow, UK
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Ward LM, Cooper SA, Hughes-McCormack L, Macpherson L, Kinnear D. Oral health of adults with intellectual disabilities: a systematic review. J Intellect Disabil Res 2019; 63:1359-1378. [PMID: 31119825 DOI: 10.1111/jir.12632] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND There have been several past reports that adults with intellectual disabilities experience poor oral health (tooth loss, periodontal health and untreated dental caries). Loss of a functional dentition has serious consequences, including problems with chewing, swallowing, nutrition, speech, temporomandibular joint osteoarthritis and pain and systemic health conditions. Poor oral health is largely preventable through proactive oral care support. In recent years, social care provision for adults has changed, with deinstitutionalisation and home-based personalised care now being the typical provision in high income countries. Hence, oral health inequalities might be reducing. However, there is limited recent evidence-synthesis on the topic. We aimed to address this. METHOD PROSPERO registration number: CRD42018089880. We conducted a preferred reporting items for systematic reviews and meta-analyses systematic review of publications since 2008. Four databases were searched with a clear search strategy, strict inclusion criteria for selection of papers, double scoring (two raters), systematic data extraction and quality appraisal of included papers. RESULTS A total of 33/3958 retrieved articles were included, of which 14 were drawn from dental service users and 10 from Special Olympic athletes, therefore not necessarily being representative of the wider population with intellectual disabilities. Despite this limitation, adults with intellectual disabilities were still shown to experience poor oral health. High levels of poor oral hygiene and gingivitis were found, with many also affected by periodontitis and untreated dental decay. There is clear unmet need relating to both periodontal (gum) and tooth health, leading to tooth loss. CONCLUSIONS Despite reports in the past of poor oral health amongst adults with intellectual disabilities, and despite it being preventable, there remains a high burden of poor oral health. This highlights the need to raise awareness, and for polices on effective daily oral care, and appropriate service provision. The importance of oral health and its possible negative sequelae needs to be elevated amongst carers and professionals.
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Affiliation(s)
- L M Ward
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - S A Cooper
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - L Hughes-McCormack
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - L Macpherson
- School of Medicine, Dentistry & Nursing, Glasgow Dental Hospital and University of Glasgow Dental School, Glasgow, UK
| | - D Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
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Salim E, Fleming M, MacKay DF, Henderson A, Kinnear D, Clark D, King A, McLay JS, Cooper SA, Pell JP. Neurodevelopmental multimorbidity and educational outcomes of 766,244 Scottish schoolchildren. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Neurodevelopmental conditions commonly co-exist in children but, in comparison with adults, childhood multimorbidity has attracted less attention in research and clinical practice.
Methods
Record linkage of five Scotland-wide databases produced a cohort of 766,244 children attending Scottish schools between 2009 and 2013. Autistic spectrum disorder (ASD) and intellectual disabilities were ascertained from records of special educational need in the annual Pupil Census and attention deficit hyperactivity disorder (ADHD) and depression through relevant encashed prescriptions.
Results
Neurodevelopmental multimorbidity (≥2 conditions) was identified in 4,789 (0·6%) children; with ASD and ADHD the most common combination. Multimorbidity was associated with significantly increased risk of school absenteeism (adjusted IRR 1·23, 95% CI 1·20-1·28), school exclusion (adjusted IRR 3·04, 95% CI 2·74-3·38), low attainment (adjusted OR 12·07, 95% CI 9·15-15·94) and unemployment (adjusted OR 2·11, 95% CI 1·83-2·45) with clear dose relationships evident between number of conditions (0, 1, ≥2) and the last three outcomes. The associations with multimorbidity were stronger in girls than boys. Co-existence of depression was the strongest driver of absenteeism and co-existence of ADHD the strongest driver of exclusion. Low attainment and unemployment were, in part, mediated by absence and attainment respectively, and were not driven by specific conditions but rather multimorbidity from any cause.
Conclusions
Structuring clinical practice and training around single conditions may disadvantage children with multimorbidity who are at significantly increased risk of adverse outcomes if their complex needs are not recognised and managed.
Key messages
Neurodevelopmental multimorbidity can have significant impacts on children’s education. A holistic healthcare approach is needed to reduce the address their needs and reduce the risk of adverse outcomes.
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Affiliation(s)
- E Salim
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - M Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D F MacKay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - A Henderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D Clark
- ISD, Information Service Division, Edinburgh, UK
| | - A King
- ScotXed, Scottish Government, Edinburgh, UK
| | - J S McLay
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - S A Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Kinnear D, Rydzewska E, Dunn K, Hughes-McCormack LA, Melville C, Henderson A, Cooper SA. Relative influence of intellectual disabilities and autism on mental and general health in Scotland: a cross-sectional study of a whole country of 5.3 million children and adults. BMJ Open 2019; 9:e029040. [PMID: 31462474 PMCID: PMC6719834 DOI: 10.1136/bmjopen-2019-029040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To determine the relative extent that autism and intellectual disabilities are independently associated with poor mental and general health, in children and adults. DESIGN Cross-sectional study. For Scotland's population, logistic regressions investigated odds of intellectual disabilities and autism predicting mental health conditions, and poor general health, adjusted for age and gender. PARTICIPANTS 1 548 819 children/youth aged 0-24 years, and 3 746 584 adults aged more than 25 years, of whom 9396/1 548 819 children/youth had intellectual disabilities (0.6%), 25 063/1 548 819 children/youth had autism (1.6%); and 16 953/3 746 584 adults had intellectual disabilities (0.5%), 6649/3 746 584 adults had autism (0.2%). These figures are based on self-report. MAIN OUTCOME MEASURES Self-reported general health status and mental health. RESULTS In children/youth, intellectual disabilities (OR 7.04, 95% CI 6.30 to 7.87) and autism (OR 25.08, 95% CI 23.08 to 27.32) both independently predicted mental health conditions. In adults, intellectual disabilities (OR 3.50, 95% CI 3.20 to 3.84) and autism (OR 5.30, 95% CI 4.80 to 5.85) both independently predicted mental health conditions. In children/youth, intellectual disabilities (OR 18.34, 95% CI 17.17 to 19.58) and autism (OR 8.40, 95% CI 8.02 to 8.80) both independently predicted poor general health. In adults, intellectual disabilities (OR 7.54, 95% CI 7.02 to 8.10) and autism (OR 4.46, 95% CI 4.06 to 4.89) both independently predicted poor general health. CONCLUSIONS Both intellectual disabilities and autism independently predict poor health, intellectual disabilities more so for general health and autism more so for mental health. Intellectual disabilities and autism are not uncommon, and due to their associated poor health, sufficient services/supports are needed. This is not just due to coexistence of these conditions or just to having intellectual disabilities, as the population with autism is independently associated with substantial health inequalities compared with the general population, across the entire life course.
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Affiliation(s)
- Deborah Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ewelina Rydzewska
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kirsty Dunn
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Angela Henderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Victor C, Williams V, Kinnear D, Ryan S. AGEING WITH A LEARNING DISABILITY: A CRITICAL LITERATURE REVIEW. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Victor
- Brunel University London, Uxbridge, England, United Kingdom
| | | | | | - S Ryan
- University of Oxford, Oxford, UK
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Okon M, Henderson A, Kinnear D, Cooper SA. Trends and variations in per capita expenditure on adult intellectual disabilities health and social care across Scotland, and by urban/rural class. J Appl Res Intellect Disabil 2018; 32:121-130. [PMID: 29993166 DOI: 10.1111/jar.12514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 04/19/2018] [Accepted: 06/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Following the global financial crisis in 2007/08, the UK implemented an austerity programme which may impact on services. Scotland comprises both densely populated urban conurbations and highly dispersed remote rural and island communities. METHOD Expenditure data were extracted from Scottish Government statistics. Per capita expenditure was calculated using adjusted Scotland's 2011 census data. RESULTS There was a 3.41% decrease in real term expenditure on adult intellectual disabilities services between 2012/13 and 2014/15 (>£32 million). In 2014/15, per capita expenditure on adult intellectual disabilities health care ranged from £1,211 to £17,595; social care from £21,147 to £83,831; and combined health and social care expenditures from £37,703 to £85,929. Per capita expenditure on combined health and social care was greater in rural areas, with more on intellectual disabilities social care, though less on health care. CONCLUSIONS Scottish expenditure on adult intellectual disabilities services has not kept abreast of rising living costs. It varies considerably across the country: a postcode lottery.
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Affiliation(s)
- Marian Okon
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Angela Henderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Deborah Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bussières A, Vieira A, Kinnear D, Figueroa PU. P-253UNIPORTAL VIDEO-ASSISTED THORACIC SURGERY LOBECTOMY COMBINED WITH POSTERIOR MIDLINE APPROACH FOR SUPERIOR SULCUS TUMOURS INVADING THE SPINE. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Osugo M, Morrison J, Allan L, Kinnear D, Cooper SA. Prevalence, types and associations of medically unexplained symptoms and signs. A cross-sectional study of 1023 adults with intellectual disabilities. J Intellect Disabil Res 2017; 61:637-642. [PMID: 28295826 DOI: 10.1111/jir.12372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Medically unexplained symptoms and signs are common in the general population and can respond to appropriate managements. We aimed to quantify the types and prevalence of unexplained symptoms and signs experienced by adults with ID and to determine the associated factors. METHOD In a population-based study, 1023 adults with ID aged 16 and over had a detailed health assessment, which systematically considered symptoms and signs. Descriptive data were generated on their symptoms and signs. Backwards stepwise logistic modelling was undertaken to determine the factors independently associated with the unexplained symptoms. RESULTS Medically unexplained symptoms and signs were present in 664 (64.9%), 3.8 times higher than in the general population, and 470 (45.9%) had multiple unexplained symptoms or signs. Some were similar to those reported in the general population, such as dyspnoea, dyspepsia, headache, nausea and dizziness. However, others are not commonly reported in the general population, including dysphagia, ataxia, polyuria, oedema and skin rash. Having unexplained symptoms and signs was independently associated with older age, female gender, not having Down syndrome, extent of ID and more GP visits in the last 12 months. It was not associated with living in deprived areas, type of living/support arrangements, number of hospital visit in the last 12 months, smoking, autism, problem behaviours or mental disorders. CONCLUSIONS People with ID have substantial additional unexplained symptoms and signs, some of which are painful or disabling. These findings should inform the content of health checks undertaken for adults with intellectual disabilities, which should not just focus on management of their long-term conditions and health promotion.
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Affiliation(s)
- M Osugo
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - J Morrison
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - L Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - D Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - S-A Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Gilhooly M, Dalley G, Gilhooly K, Harries P, Kinnear D. FINANCIAL EXPLOITATION THROUGH THE LENS OF THE BYSTANDER INTERVENTION MODEL. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M.L. Gilhooly
- Brunel University London, Uxbridge, England, United Kingdom,
| | - G. Dalley
- Brunel University London, Uxbridge, England, United Kingdom,
| | - K.J. Gilhooly
- Brunel University London, Uxbridge, England, United Kingdom,
| | - P. Harries
- Brunel University London, Uxbridge, England, United Kingdom,
| | - D. Kinnear
- University of Glasgow, Glasgow, Scotland, United Kingdom
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Williams V, Kinnear D, Victor C. 'The little things count': delivering dignified care. Nurs Times 2016; 112:28-29. [PMID: 30549779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In the wake of recent care failings there has been increasing demand for health professionals to provide "good" or dignified care. But what does this mean? This article summarises a study that aimed to ascertain what health professionals think they need to do to provide such care to their patients.
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Williams V, Kinnear D, Victor C. ‘It's the little things that count’: healthcare professionals’ views on delivering dignified care: a qualitative study. J Adv Nurs 2016; 72:782-90. [DOI: 10.1111/jan.12878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Veronika Williams
- Nuffield Department of Primary Care Health Sciences; University of Oxford; UK
| | - Deborah Kinnear
- Institute of Health and Wellbeing; College of Medical; Veterinary and Life Sciences; University of Glasgow; UK
| | - Christina Victor
- Brunel University London; College of Health and Life Sciences; Uxbridge UK
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Kinnear D, Victor C, Williams V. What facilitates the delivery of dignified care to older people? A survey of health care professionals. BMC Res Notes 2015; 8:826. [PMID: 26710882 PMCID: PMC4693419 DOI: 10.1186/s13104-015-1801-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 12/14/2015] [Indexed: 12/05/2022] Open
Abstract
Background Whilst the past decade has seen a growing emphasis placed upon ensuring dignity in the care of older people this policy objective is not being consistently achieved and there appears a gap between policy and practice. We need to understand how dignified care for older people is understood and delivered by the health and social care workforce and how organisational structures and policies can promote and facilitate, or hinder, the delivery of such care. Methods To achieve our objective of understanding the facilitators and to the delivery of dignified care we undertook a survey with health and social care professionals across four NHS Trusts in England. Participants were asked provide free text answers identifying any facilitators/barriers to the provision of dignified care. Survey data was entered into SPSSv15 and analysed using descriptive statistics. These data provided the overall context describing staff attitudes and beliefs about dignity and the provision of dignified care. Qualitative data from the survey were transcribed verbatim and categorised into themes using thematic analysis. Results 192 respondents were included in the analysis. 79 % of respondents identified factors within their working environment that helped them provide dignified care and 68 % identified barriers to achieving this policy objective. Facilitators and barriers to delivering dignified care were categorised into three domains: ‘organisational level’; ‘ward level’ and ‘individual level’. Within the these levels, respondents reported factors that both supported and hindered dignity in care including ‘time’, ‘staffing levels’, training’,’ ‘ward environment’, ‘staff attitudes’, ‘support’, ‘involving family/carers’, and ‘reflection’. Conclusion Facilitators and barriers to the delivery of dignity as perceived by health and social care professionals are multi-faceted and range from practical issues to interpersonal and training needs. Thus interventions to support health and social care professionals in delivering dignified care, need to take a range of issues into account to ensure that older people receive a high standard of care in NHS Trusts.
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Affiliation(s)
- Deborah Kinnear
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK.
| | - Christina Victor
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK.
| | - Veronika Williams
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, University of Oxford, Oxford, UK.
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Kinnear D, Williams V, Victor C. The meaning of dignified care: an exploration of health and social care professionals' perspectives working with older people. BMC Res Notes 2014; 7:854. [PMID: 25428168 PMCID: PMC4289061 DOI: 10.1186/1756-0500-7-854] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 11/18/2014] [Indexed: 11/22/2022] Open
Abstract
Background Despite well established national and local policies championing the need to provide dignity in care for older people, there continues to be a wealth of empirical evidence documenting how we are failing to deliver this. While we have evidence as to what older people and their relatives understand by the term ‘dignified care’ we have less insight into the perspectives of staff regarding their understanding of this key policy objective. This paper aimed to explore the meaning of dignified care from the perspective of health and social care professionals’ working with older people. In-depth interviews and focus groups with health and social care professionals were carried out across four NHS Trusts in England, as part of a larger study, to investigate how dignified care for older people is understood and delivered. A total of 48 health professionals took part in in-depth interviews and 33 health and social care professionals participated in one of eight focus groups. Results Health and social care professionals defined the meaning of dignified care as: ‘dignity is the backbone of care’, ‘it’s the “little things”’, ‘feeling safe and secure’, ‘treat as you want to be treated’, ‘treat as an individual’ and ‘Dignity encompasses multiple factors’. ‘Hands on’ aspects of care were rarely mentioned when defining dignity. This suggests that policies around providing dignified care are being interpreted as an approach towards care and not with direct care provision. This limited interpretation of dignity may be one factor contributing to the continued neglect of older people in acute settings. Conclusions These findings highlight that proactive measures are required to ensure that both relational and ‘hands on’ aspects of care are met for all older people receiving care in NHS trusts.
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Affiliation(s)
- Deborah Kinnear
- Dundee Dental Hospital and School, University of Dundee, Dundee, UK.
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Sandino J, Crawford G, Fillmore L, Kinnear D. Energy Efficiency in Wastewater Treatment in North America: A Compendium of Best Practices and Case Studies of Novel Approaches. ACTA ACUST UNITED AC 2011. [DOI: 10.2175/193864711802836445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sandino J, Crawford G, Fillmore L, Kinnear D. Energy Efficiency in Wastewater Treatment in North America: A WERF Compendium of Best Practices and Case Studies of Novel Approaches. ACTA ACUST UNITED AC 2010. [DOI: 10.2175/193864710798181854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Copp JB, Johnson BR, Shaw A, Burbano MS, Narayanan B, Frank K, Kinnear D, Melcer H, Brischke K. A balancing act: the consulting engineers' pragmatic view of process modelling. Water Sci Technol 2009; 59:763-769. [PMID: 19237771 DOI: 10.2166/wst.2009.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Modelling: what do we know, what do we want to know and why? The practical application of models to real projects is often circular because these questions weren't asked prior to making the decision to model the plant under study. Modelling wastewater treatment plants can provide insight into the inner workings of the process that might not be attainable any other way, but is that added process knowledge always needed or necessary and what criteria does one use to determine the level of effort required? These complex modelling decisions require education, communication, and improved understanding amongst both modellers and clients. This submission explores the use of models by consultants for consulting purposes and the balancing acts (time versus knowledge and cost versus benefit) that the consulting engineer must manage when embarking on any modelling project.
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Affiliation(s)
- J B Copp
- Primodal, Inc., 122 Leland Street, Hamilton, L8S 3A4, Ontario, Canada.
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Feagan BG, McDonald JW, Rochon J, Laupacis A, Fedorak RN, Kinnear D, Saibil F, Groll A, Archambault A, Gillies R. Low-dose cyclosporine for the treatment of Crohn's disease. The Canadian Crohn's Relapse Prevention Trial Investigators. N Engl J Med 1994; 330:1846-51. [PMID: 8196727 DOI: 10.1056/nejm199406303302602] [Citation(s) in RCA: 170] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Long-term corticosteroid therapy for Crohn's disease is associated with important types of morbidity, such as osteoporosis. Safe and effective alternative treatments are required. Although a short-term benefit of cyclosporine in active Crohn's disease has been suggested, the long-term safety and efficacy of this treatment have not been established. METHODS We conducted a randomized, double-blind, placebo-controlled evaluation of the effect of 18 months of low-dose cyclosporine treatment on the course of Crohn's disease. Adult patients whose disease had been active within the previous two years were randomly assigned to receive cyclosporine (151 patients) or placebo (154 patients) in addition to their usual therapy. Randomization was stratified according to center and score on the Crohn's Disease Activity Index (193 patients had scores of 150 or less, and 112 had scores greater than 150). The primary outcome measure was clinically important worsening of Crohn's disease, defined as a 100-point increase in the Crohn's Disease Activity Index from the patient's base-line value. Secondary outcomes were the use of prednisone and 5-amino-salicylates, mean score on the Crohn's Disease Activity Index and mean quality-of-life score, and the need for surgery. RESULTS The condition of more patients worsened with cyclosporine than with placebo (91 of 151, or 60.3 percent, vs. 80 of 154, or 51.9 percent; P = 0.10). The median time to worsening of disease in patients receiving cyclosporine was 338 days, as compared with 492 days in patients receiving placebo (P = 0.25; relative risk, 1.22; 95 percent confidence interval, 0.86 to 1.72). Analyses of the mean Crohn's Disease Activity Index and quality-of-life scores and of the use of prednisone and 5-aminosalicylates also failed to demonstrate benefit. CONCLUSIONS In our patient population, the addition of low-dose cyclosporine to conventional treatment for Crohn's disease did not improve symptoms or reduce requirements for other forms of therapy.
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Affiliation(s)
- B G Feagan
- Department of Medicine, University of Alberta, Edmonton, Canada
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Irvine EJ, Feagan B, Rochon J, Archambault A, Fedorak RN, Groll A, Kinnear D, Saibil F, McDonald JW. Quality of life: a valid and reliable measure of therapeutic efficacy in the treatment of inflammatory bowel disease. Canadian Crohn's Relapse Prevention Trial Study Group. Gastroenterology 1994; 106:287-96. [PMID: 8299896 DOI: 10.1016/0016-5085(94)90585-1] [Citation(s) in RCA: 483] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND/AIMS Quality of life (QOL), a subjective index of health perception and function, embraces physical, social, and emotional performance but has not had a prominent role in clinical trials of inflammatory bowel disease (IBD). To test the robustness of the Inflammatory Bowel Disease Questionnaire (IBDQ), a disease-specific QOL index, this study assessed its validity, reliability, and responsiveness during a multicenter trial. METHODS Three hundred five patients with stable Crohn's disease received cyclosporin or placebo for 18 months. IBDQ and dimensional scores (bowel, social, systemic, and emotional) were correlated with disease activity (Crohn's disease activity index [CDAI] and Harvey-Bradshaw index). Concordance of IBDQ scores was tested in 280 stable subjects. Linear regression evaluated change in IBDQ scores over time. RESULTS IBDQ scores correlated highly with CDAI (r = -0.67; P < 0.0001). The reliability coefficient for IBDQ score was 0.70 vs. 0.66 for CDAI and 0.55 for Harvey-Bradshaw index. Regression line slopes of IBDQ scores were significantly different in patients who deteriorated from those who remained stable ([b] < 0.15; P < 0.0001). QOL scores were lower in patients who required surgery. CONCLUSIONS The IBDQ is a valid reliable assessment tool that reflects important changes in the health status of patients with IBD. The IBDQ is a robust measure of therapeutic efficacy and should be used in future clinical trials in IBD.
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Affiliation(s)
- E J Irvine
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Sontag S, Graham DY, Belsito A, Weiss J, Farley A, Grunt R, Cohen N, Kinnear D, Davis W, Archambault A. Cimetidine, cigarette smoking, and recurrence of duodenal ulcer. N Engl J Med 1984; 311:689-93. [PMID: 6382004 DOI: 10.1056/nejm198409133111101] [Citation(s) in RCA: 168] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Three hundred seventy patients with recently healed duodenal ulcer entered into a one-year, double-blind, randomized multicenter trial comparing placebo with three different dose schedules of cimetidine (200 mg twice a day, 300 mg twice a day, and 400 mg at bedtime) for the prevention of recurrent duodenal ulcer. By the end of one year, the cumulative symptomatic recurrence rate as demonstrated by endoscopy was similar for the patients receiving the three dosages of cimetidine (19 per cent, 15 per cent, and 13 per cent, respectively; not significant), whereas the placebo-treated group had a 34.7 per cent symptomatic recurrence rate (P less than 0.01 as compared with each cimetidine group). Cigarette smoking was found to be an important variable; among the placebo recipients ulcer recurrence was significantly more likely in smokers (72 per cent) than in nonsmokers (21 per cent, P less than 0.001). The frequency of ulcer recurrence in smokers was significantly reduced by treatment with cimetidine (from 72 per cent to 34 per cent, P less than 0.). Smokers who received cimetidine were at least as likely to have a recurrence as were nonsmokers who received placebo (34 per cent vs. 21 per cent, not significant). Thus, smoking appears to be a major factor in recurrence of duodenal ulcer, and in smokers, giving up smoking may be more important in the prevention of ulcer recurrences than administration of cimetidine.
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Graycar A, Kinnear D. Caring for elderly relatives. Effects on families. Aust Fam Physician 1983; 12:267-8, 270. [PMID: 6615351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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