People with intellectual disability and their risk of exposure to violence: Identification and prevention - a literature review

The aim of the literature review was to identify knowledge and knowledge gaps concerning risks of violence toward children, youth, adults and elderly with intellectual disabilities, and how risks can be identified and prevented. The research revealed that children, youths and adults labelled with intellectual disabilities are more exposed to violence than others and that the target group lack knowledge about risks of violence and what it means to be exposed to violence. It was also found that professionals who work with people with intellectual disabilities may lack knowledge about violence, and those who work with violence lack knowledge about intellectual disabilities. There is thus a need to further elaborate routines to identify exposure to violence, and to identify the target group and a need to create collaborative teams with professionals who have in-depth knowledge of violence, and those who have in-depth knowledge about the target group.

Factors associated with positive work experience among professionals supporting people with intellectual disabilities: a comparative analysis of three welfare organisations in Sweden

Given the crucial role professionals play in maintaining the well-being of people with intellectual disabilities, their views on work satisfaction are relevant to analyse. A comparative analysis that takes into account the support provided in different welfare organisations can be of certain importance. The aim is to analyse the most common aspects of professional work satisfaction in work with people with intellectual disabilities in schools, healthcare, and social services, and to apply a comparative analysis of such experience taking into account respondents' organisational affiliations. Data were collected using a digital questionnaire. Given the aim of the study, we drew on one open-ended question: 'describe aspects of your work that are most satisfactory for you'. The analysis shows that respondents associated positive work experience with seven aspects: autonomy, competence, nature of the work, collaboration, trust and recognition, work environment, and service users. Findings indicate that discretion is an important facet of work satisfaction among respondents in all three organisations. Flexibility, autonomy in decision-making, the ability to plan and act within certain institutional and legal frameworks, and the ability to prioritise among daily work assignments are empirical examples of this.

Opportunity to participate in planning and evaluation of support for children with disabilities: Parents' and professionals' perspectives

A random sample of parents of children with disabilities (n = 144) from three Swedish municipalities participated in a structured telephone interview including seven questions on child participation and 156 professionals from the same municipalities completed a web-based survey including six questions on child participation. The aim of the study was to explore parents' and professionals' (1) ratings of the opportunities available to children with disabilities to participate in planning, decision-making and evaluation of support and (2) satisfaction with the children's current level of such participation. The results indicated that opportunities for children with disability to participate directly in decision-making processes were limited. Parents and professionals rated older children's opportunities to participate as better compared to younger. Most professionals relied more on parents' descriptions of the child's needs and opinions of support services than on direct communication with the child.

Investigating feasibility and fidelity of the Parenting Young Children program in Sweden

SPECIFIC AIMS

This study explored feasibility and fidelity of an education program for parents with intellectual disability. The Australian Parenting Young Children intervention was translated and adapted for support workers in the Swedish social services.

METHOD

Fidelity was examined using implementation diaries tracking frequency of implementation of program activities and teaching approaches ((over 14 months, completed by 27 support workers from 15 municipalities). Eighteen of these support workers and their managers (n = 12) completed questionnaires examining feasibility using Roger's concepts of program compatibility and complexity.

FINDINGS

Results showed that implementation of Parenting Young Children was feasible, with overall positive attitudes to Evidence Based Practice, good program compatibility, low perceived program complexity, and high satisfaction with implementation support. The fidelity measures suggest problems in how the program is used by some support workers: parents received less than the recommended number of sessions and activities such as observation of parents and follow up, were infrequently used by support workers.

DISCUSSION

The findings raise questions about how program support and education should be provided. Difficulties in defining fidelity within the flexibility of the Parenting Young Children program are also discussed.

Value of antigranulocyte scintigraphy with Tc-99m-sulesomab in diagnosing combat-related infections of the musculoskeletal system

AIM

Combat-related extremity injuries are regularly associated with long-term complications such as chronic infection, especially osteomyelitis. Clinical examination and laboratory parameters do not usually allow reliable diagnosis. In contrast, imaging techniques enable constructive assertions to be made about the location and extent of an infection of the peripheral musculoskeletal system. The aim of this study was therefore to determine the diagnostic reliability of three-phase bone scanning and antigranulocyte scintigraphy using Tc-99m-sulesomab (Leukoscan) in the diagnostic clarification of infections associated with combat-related extremity injuries.

METHODS

Twenty-seven male patients (mean age 33.9 years) with suspected combat-associated infections of the extremities were included in this retrospective analysis. All patients underwent three-phase bone scanning using Tc-99m-HDP followed by antigranulocyte scintigraphy with Tc-99m-sulesomab. In 26 of the 27 patients, a CT scan of affected limb was obtained, where the secondary fusion with single photon emission CT data set was possible. The diagnostic reliability of imaging techniques was validated against microbiological samples obtained during surgery and used as gold standard.

RESULTS

Three-phase bone scanning yielded a positive result in all patients, with 18 scans classified as true positive (TP) and nine scans as false positive (FP). This produced a sensitivity of 100%, a specificity of 0% and a positive predictive value (PPV) of 67%. Antigranulocyte scintigraphy recognised 13 patients as TP, 1 patient as FP, 8 patients as true negative (TN) and 5 patients as false negative (FN), which gave a sensitivity of 72%, a specificity of 88%, a PPV of 93%, a negative predictive value (NPV) of 62% and an accuracy of 78%. CT recognised in 7 cases a TP result, in 3 cases an FP, in 5 cases a TN and in 11 cases an FN result. This produced a sensitivity of 39%, a specificity of 63%, a PPV of 70%, an NPV of 31% and an accuracy of 46%.

CONCLUSIONS

Three-phase bone scanning did not deliver any diagnostic benefit, since no result was able to differentiate unequivocally between infection-related and reactive changes. Antigranulocyte scintigraphy using Tc-99m-sulesomab represented a highly suitable technique for diagnostically clarifying combat-related infections of the extremities. It is superior to CT in sensitivity, specificity, PPV, NPV and accuracy.

Groups for Parents with Intellectual Disabilities: A Qualitative Analysis of Experiences

BACKGROUND

Parents with intellectual disabilities (IDs) are often socially isolated and need support.

MATERIALS AND METHODS

This qualitative study is based on participant observations of a group for parents with with intellectual disabilities. Data were categorized and interpreted in the framework of social capital and symbolic interactionism.

RESULTS

Being a part of the parent group provided parents with a social network, which had the potential to be supportive in everyday life. The social workers in the group were seen as allies, and parents appeared to trust them and felt they could seek advice and tell them about their personal problems. The parents sometimes asked for advice about how to handle contacts with other professionals in their everyday life. The parents valued the social contact with the other parents.

CONCLUSIONS

The group provided the parents with the opportunity to meet both other parents and two social workers. The group gave a greater number of social relations, adding to the parents' social capital and helping to reduce social isolation.

Understanding support workers' competence development in working with parents with intellectual disability

Training for support workers who work with parents with intellectual disability can be aided by understanding how they perceive the training process and their competence development. This study explored the perceptions of competence development and the training process in Swedish support workers trained in the evidence-informed programme 'Parenting Young Children' (PYC). Training included a workshop, monthly peer support groups and access to a programme manual. Five focus groups discussed experiences of the PYC programme and the training they received. Twelve support workers completed a competency questionnaire. The findings of the current study suggest that perceived skill improved over time. Specifically, the findings suggest that peer support is a beneficial training follow-up mechanism for knowledge exchange and performance reflection. The main issues faced in skill development were transfer of learning and accessing parents to work with. These findings also highlight the importance of facilitative administration and technical support for managers and agencies.

Everyday life of young adults with intellectual disabilities: inclusionary and exclusionary processes among young adults of parents with intellectual disability

Ten young adults with an intellectual disability whose parents, too, have an intellectual disability were interviewed and completed questionnaires for this exploratory study aimed at charting their experiences of everyday life. Most of the participants reported high life satisfaction, especially with the domains of friends, leisure time, and family, and considered their families as a resource for their empowerment and development of resilience. The study participants' informal networks were composed of only a few individuals who, moreover, were mostly of dissimilar age and also included support professionals. The participants typically described themselves as excluded from others, an experience that was articulated most conspicuously in their narratives about the special schools they were attending.

Parents' experience of support in Sweden: its availability, accessibility, and quality

Semi-structured interviews were conducted with six parents of children with intellectual disabilities, in the Western region of Sweden. The aim of the study was to explore and to gain a deeper understanding of parents' experiences of received support for them and their children with intellectual disabilities. We focused particularly on their experiences of the availability, accessibility, and the quality of services. Parents in this study were unsure about what the diagnosis meant specifically for their child as well as for their whole family. Moreover, the parents experienced great difficulty in obtaining information about available services, which resulted in feelings of helplessness to some. Parents also reported that although services are available, they were not easily accessible. Lastly, parents felt that the quality of care and support were to some extent inadequate, as no attention was paid by professionals to their actual needs or wishes.

Parenting with disabilities: experiences from implementing a parenting support programme in Sweden

This article reports on the initial stages of implementing an Australian-based education programme for parents with intellectual disabilities (IDs) in Sweden. The clinical utility of the programme, Parenting Young Children (PYC), in the new country context is explored through Swedish professionals' experiences in learning and using it. Study participants found PYC well suited for use in their working environment. Most of them reported the programme to have strengthened their work with parents. The programme was seen as benefiting both the study participants in their work with parents with IDs and these parents themselves, and its structure and content were found to be helpful in several ways. The checklists forming part of PYC were considered useful, but their purpose was sometimes misunderstood. The reported study helps to identify what is needed to improve the translation of the programme into the new country context, to promote appropriate and more effective use of programme materials.

Women and men with intellectual disabilities who sell or trade sex: voices from the professionals

The phenomenon of women and men with intellectual disabilities (ID) selling or exchanging sexual services is poorly understood. In this study, the authors explored the knowledge and perceptions of this phenomenon shared by professionals working in the field. Focus group discussions demonstrated broad familiarity with the phenomenon. Different motives and contributing factors were identified for the behavior, blurring the boundary line between free choice and exploitation. Two distinct discourses emerged from the interviews based on the assumed "rationality" of the sex transaction and its rewards: Those with ID who traded sexual favors were presented as either conscious and autonomous agents or unaware and exploited victims.

Young adults with intellectual disability recall their childhood

Eleven young adults with an intellectual disability were interviewed for this exploratory study aimed at charting their experiences of growing up in homes where at least one parent had the same or a similar disability. Two main themes emerged from the interviews. Firstly, a clear majority of the young adults had positive experiences of family life during their upbringing, as expressed especially through their memories of their grandparents. Secondly, the study participants all described experiences of being bullied and harassed outside the family context. The results obtained in this study highlight the importance of the parents, the family, and informal networks in the upbringing of these children. The study also considers the consequences that the study participants' negative experiences of peer contacts and their sense of exclusion might have for their prospects in later life.

Encounters with professionals: views and experiences of mothers with intellectual disability

Seven Swedish mothers with an intellectual disability were interviewed for this exploratory study, aimed at charting such mothers' views and experiences of their encounters with different health and social service professionals. Three distinct themes emerged from the interviews. First, the mothers experienced the interaction to be marred by lack of comprehensibility, resulting from inadequate information and their perception of not being treated properly. Second, despite their reservations about the nature of the interaction, several of the mothers also reported having received support that had strengthened their parental ability and had been experienced as empowering. Third, several of the mothers also clearly perceived themselves as subjects needing support. The results, overall, indicated that the interaction between the mother and the professionals suffered from a certain paternalism in the attitude of the latter.

Altered NMDA receptor expression and behavior following postnatal hypoxia: potential relevance to schizophrenia

The present study investigated the effects of chronic, repeated hypoxia during a postnatal vulnerable period. Acoustic startle response in adult rats was measured along with NMDA receptor binding and mRNA expression of subunits at postnatal days (PND) 11 and 120. Rats at PND 120 exhibited a deficit in prepulse inhibition of acoustic startle response. In PND 11 rats, chronic hypoxia decreased NMDA receptor binding and increased transcript expression of NR1 subunit in frontal and temporal regions, nucleus accumbens and hippocampus, while NR2A subunit expression was downregulated in hippocampal subregions. At PND 120, gene expression of NR1 was still increased in hippocampal, frontal and temporal subregions as well as nucleus accumbens. A prepulse inhibition deficit points to schizophrenia-like behavior in adult (PND 120) rats. Compensatory upregulation of NR1 expression may occur due to NMDA receptor hypofunction. We discuss this animal model to further analyze effects of hypoxia as a factor of obstetric complications in the pathophysiology of schizophrenia.

Parents' descriptions of development and problems associated with infants with Turner syndrome: a retrospective study

OBJECTIVE

To describe parents' experiences of having an infant diagnosed with Turner syndrome and to determine whether receiving the diagnosis influenced the parents' perceptions of their child's development and/or problems during infancy. In addition, we set out to determine whether the late development of the infant and the perceived problems were related to genotype.

METHODS

In this retrospective study, 54 parents (39 mothers and 15 fathers) from different families, each containing a girl with Turner syndrome, were interviewed in order to describe the development, feeding and overall well-being of their daughter during infancy (defined as being before the age of 2 years).

RESULTS

Late development was reported to occur in the areas of motor activity (39%), fine motor control (59%), speech (37%) and language (37%). Feeding problems were frequent (74%) and screaming periods occurred in 41%. No differences were found between the responses of the parents whose children were diagnosed before 2 years of age and the responses of those whose children were diagnosed after 2 years of age. No differences were found concerning development and/or problems between the genotypes.

CONCLUSIONS

Parents reported delayed development and problems to do with feeding and crying during infancy. These problems had an effect on their everyday life and that of their families, especially the problems relating to feeding. Parents reported that support and advice would have been of significant benefit in coping with the feeding difficulties. Parents were particularly concerned that the personnel at well-baby clinics should be more knowledgeable about the difficulties that can occur in families with an infant with Turner syndrome.

Parents' needs for knowledge concerning the medical diagnosis of their children

It is reported that parents can handle their reactions of having a child with a chronic illness by seeking information and gaining knowledge about the diagnosis. It has been suggested that this is a way for parents to restore order in a chaotic existence. A complement to this perspective is to focus on what it means to be a parent and what is included in parenthood. The purpose of the present study was to increase our understanding of parents' need for knowledge. Interviews were conducted with parents (n = 44) who have experienced receiving a diagnosis of Turner Syndrome (TS) for their daughter, in order to explore the parents' motives and strategies for seeking information about the condition. Out of the 44 parents interviewed, 26 (21 mothers and 5 fathers) had sought information. It was found that the motives for seeking information were, to some extent, related to the parents' experiences of the consultation at the time of diagnosis. Twenty-three parents (21 mothers and 2 fathers) were dissatisfied with the information provided by the physician, while 21 (12 mothers and 9 fathers) were satisfied. Among the dissatisfied parents 16 (15 mothers and 1 father) sought information, and among the satisfied 10 parents (6 mothers and 4 fathers) sought information when they received the diagnosis for their daughter. The mothers described different strategies to gain information. They attended the library to borrow medical literature, looked up the syndrome in reference books, read articles in newspapers and asked questions of other mothers who had daughters with TS. However, it was found that the dissatisfied mothers used more and different strategies to find information compared with the fathers and the mothers who were satisfied. The motives of all the parents were to learn more about the condition. However, the dissatisfied mothers reported that they sought information because they found it important to control the actions of the professionals. The mothers that were satisfied with the information argued that they sought information in order to be able to explain the condition to others.

Parents' experiences of receiving the diagnosis of Turner syndrome: an explorative and retrospective study

Turner syndrome (TS) is a sex-chromosome disorder occurring in approximately 1:2500 female births. In this explorative and retrospective study, 44 parents (33 mothers and 11 fathers) from different families, each containing a girl with TS, were interviewed to explore their perceptions and experiences of the diagnostic process, including the period of investigation and the time when the diagnosis was given. There was wide variation in degree of retrospection in this study; one parent who was interviewed had a daughter of 17 years of age who was diagnosed before 1 month of age. On the other hand, two girls had been diagnosed only 6 months before their parents were interviewed. Most parents (n=27) reported that it was professionals who observed that their daughter should be referred for investigation, and the remainder (n=17) reported that they themselves perceived the need for investigation. Their experiences were found to affect the parents' descriptions of the diagnostic process. The parents who initiated the investigation themselves described the diagnosis in terms of confirmation of their own suspicions. When professionals initiated the investigation the parents reported that they felt unprepared when they received the diagnosis. The results of this study indicate that the parents' experiences of receiving the diagnosis of TS appear to depend on the ability of the doctor to provide relevant information and to manage the psychosocial aspects correctly. A better understanding of parents' experiences should enable health professionals to counsel parents more effectively concerning the diagnosis of TS.

Construction of a global assessment scale of family function, using a questionnaire

Self-report questionnaires are commonly used in family research, but very little attention is paid to the specific measurement properties of the ordered categorical data recorded. The item responses of self-report questionnaires consist of ordered categories. The main property of this type of data is that the labels do not represent a mathematical value but only an order, i.e., one set of labels can be replaced by another set of increasing numbers of symbols. The non-additivity of categorical data means that sum scores cannot be used as a global assessment of the variable. The aims of this study were to further develop the third version of the self-report questionnaire Family Adaptability and Cohesion, Evaluation Scales (FACES), for use in Sweden and to construct a global scale of family function for the variables cohesion and adaptability. The statistical methods used take account of the rank-invariant properties of ordered categorical data.

Family function in families with children of normal height and in families with short children

The purpose of this study was to examine any differences regarding cohesion and adaptability between Swedish families with children of normal stature (group A) and those with children of short stature (group B). Cohesion and adaptability were measured using a Swedish translation of the third version of the self-report questionnaire FACES (Family Adaptability and Cohesion, Evaluation Scales). Most of the 55 families in group A and most of the 49 families in group B appeared to be well balanced with regard to cohesion and adaptability. There was no statistically significant difference between the two groups concerning the variable cohesion. Significant differences were found in adaptability: fathers in group A had higher values than mothers in group A and than mothers and fathers in group B.

CONCLUSION

There are no major differences between families with children of normal stature and those with short children. However, it was found that fathers with children of normal stature perceived a greater adaptation within their families compared with mothers with children of normal stature and mothers and fathers with children of short stature.

Development of obliterative bronchiolitis after allogeneic rat lung transplantation: implication of acute rejection and the time point of treatment

BACKGROUND

Chronic allograft failure represents the major cause of late morbidity and mortality after solid organ transplantation. Despite the pathological and clinical changes of this disease being well-described, the etiology and the causative factors are still under discussion. Several clinical, as well experimental studies, emphasize the significance of acute rejection. In rat model of left lung allo-transplantation (F344-to-WKY) the influence of acute rejection (AR) on the development of chronic rejection (CR) was studied.

METHODS

In Group I (n = 25) no immunosuppression was used, while methylprednisolone (MP) (10 mg/kg) was applied in Group II (n = 20) in the early phase of AR on postoperative Days 9, 10, 11 and in Group III (n = 20) during AR on Day 14, Day 15, Day 16. The rats were sacrificed on Day 5, Day 15/20, Day 30, Day 60, Day 100 and following HE-staining the extend of AR as well CR was graded according to the working formulation of The International Society of Heart and Lung Transplantation.

RESULTS

In Group I, AR was found at Day 15 and Day 30 which resolved spontaneously and resulted in CR on Day 60 and Day 100. In Group II, signs of AR were less evident on Day 20, while mild AR persisted on Day 30 and Day 60. On Day 100, normal lung structure was found in all rats. The recipients of Group III showed decreased signs of AR in the early course, however, severe CR was found on Day 60 and Day 100. Extensive airway inflammation with destruction of the subepithelial layer of the smaller airways resulted in severe early obliterative bronchiolitis.

CONCLUSIONS

Untreated severe AR in the early course after lung transplantation results in CR in the F344-to-WKY model. Preventive treatment with MP during the early phase of AR clearly diminishes the degree of AR and the graft recovers completely without any evidence of CR. Late application of steroids during the zenith of AR is successful to control the extent of AR, however, it fails to prevent CR.