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PubMed2006

Intellectual disability and mental illness in the NSW criminal justice system.

There has been increasing international, national and local recognition of the need for more appropriate responses and services for individuals who come in contact with the criminal justice system and who have an intellectual disability and mental health issues. This article provides an overview of prevalence data that indicates a significant over representation of people with intellectual disabilities in correctional facilities and reviews the problems facing this population. Findings from two specific evaluation studies undertaken by the Centre for Developmental Disability Studies are presented, along with recommendations for future provision based on these results. One of these projects trialled a case management approach to supporting offenders with an intellectual disability upon their release from prison. The 20-month follow-up found that a number of serious barriers were encountered within the overall system of provision for this population; the most serious of which related to lack of adequate accommodation upon release. The second project involved a two-stage evaluation of one model of provision for individuals with intellectual disabilities who are sex offenders, only some of whom were on parole. This service provided both residential and therapy services in a small group home located in the community. Residents were found to have high levels of emotional and behavioural difficulties, in addition to offending behaviour, that continue to require support and supervision. Critical issues, including guardianship involvement, restrictive practices and retrieval, therapy provision, and risk management issues are discussed in relation to overall clinical and lifestyle outcomes.

Adult↗

PubMed1996

The use of general anaesthesia for tooth extraction in young handicapped adults in France.

The anaesthetic management of handicapped young adults is often difficult. However, few examples were found in the literature that attempted to specifically measure the frequency of general anaesthesia in the dental treatment of this group of patients. This paper focuses on the management of mentally or physically handicapped young patients undergoing extractions at a specialist dental service in Southern France. A survey of 184 young patients treated during a 39-month period, either under general (34 cases) or local (150 cases) anaesthesia was carried out. A minimum one-year follow-up period was used for each patient. The main characteristics of the patients who received general or local anaesthesia were compared and the factors which indicated the choice of general rather than local anaesthesia were assessed. This study attempts to define precise selection criteria, including dental and non-dental factors. Limited past treatment history was found to be a strong indicator of the need for general anaesthesia. The results of this study suggest that non-dental background factors were also important. The need for general anaesthesia was markedly increased in the groups with severe behavioural disturbances or low levels of contact with the general dental practitioner. If provision of regular dental services for disabled young patients can significantly reduce the need for general anaesthesia, care will have to be taken in developing the relationships between the hospital and general dental practitioner.

Adult↗

PubMed1997

Schistosomiasis in two Nile delta villages: an anthropological perspective.

In the rapidly changing Nile delta villages, applied research for schistosomiasis control requires a holistic view of the social and environmental setting of the disease. An interdisciplinary, participatory study of two delta villages studied human behaviour in relation to disease transmission, knowledge and treatment using the insights and methods of social science, especially anthropology. Through primarily qualitative techniques such as focus group discussions and participant observation, we found that most people who used the canals for domestic, recreational or agricultural activities thought that they had little alternative but to do so, even though they knew of the risk of exposure to schistosomiasis. The knowledge and behaviour of villagers with regard to schistosomiasis affected their utilization of the local provisions for schistosomiasis diagnosis and treatment. Our monitoring of diagnosis and testing for schistosomiasis at a local health centre identified areas which could be upgraded, and we trained health staff to improve their knowledge of schistosomiasis. Our findings reinforce the need for integrated research and implementation strategies, taking into account the knowledge and capabilities of all those involved in schistosomiasis control at the village level, and the fostering of effective communication between villagers, both women and men, and the local staff in rural health centres.

Adolescent↗

PubMed1978

The effect of location on the elderly mentally infirm: relationship to mortality and behavioural deterioration.

An investigation was carried out into the effects of location on the elderly mentally infirm. While location had no bearing on subsequent mortality there was some evidence to suggest that some aspects of behavioural deterioration were influenced by the type of location and in those cases residential home placement seemed to produce the least deterioration over and 18-month period when the effects of mental and behavioural competent were taken into account. The implications of these findings for the provision of long-term care for the elderly are discussed.

Aged↗

PubMed2006

Home environment risk factors for falls in older people and the efficacy of home modifications.

Most homes contain potential hazards, and many older people attribute their falls to trips or slips inside the home or immediate home surroundings. However, the existence of home hazards alone is insufficient to cause falls, and the interaction between an older person's physical abilities and their exposure to environmental stressors appears to be more important. Taking risks or impulsivity may further elevate falls risk. Some studies have found that environmental hazards contribute to falls to a greater extent in older vigorous people than in older frail people. This appears to be due to increased exposure to falls hazards with an increase in the proportion of such falls occurring outside the home. There may also be a non-linear pattern between mobility and falls associated with hazards. Household environmental hazards may pose the greatest risk for older people with fair balance, whereas those with poor balance are less exposed to hazards and those with good mobility are more able to withstand them. Reducing hazards in the home appears not to be an effective falls-prevention strategy in the general older population and those at low risk of falls. Home hazard reduction is effective if targeted at older people with a history of falls and mobility limitations. The effectiveness may depend on the provision of concomitant training for improving transfer abilities and other strategies for effecting behaviour change.

Accidental Falls↗

PubMed2005

Informal learning in postgraduate medical education: from cognitivism to 'culturism'.

BACKGROUND: Work-based learning occupies a central role in the training and ongoing development of the medical workforce. With this arises the need to understand the processes involved, particularly those relating to informal learning. Approaches to informal learning in postgraduate medical education have tended to consider the mind as an independent processor of information. METHOD: In this paper, such cognitive approaches are critiqued and an alternative socio-cultural view on informal learning described. Recent and imminent changes in postgraduate medical education are identified, namely the reduction in patient experience, the fragmentation of teaching, and the development of competency frameworks and structured curricula. It is argued that although the latter may be useful in the construction of formal learning programmes, they will do little to enhance the progression of the individual from newcomer to old-timer or the cultural assimilation of the learner into a profession. DISCUSSION: Strategies for enhancing informal learning in the workplace are recommended in which increased attention is paid to the development of the medical apprentice within a community of social practice. These include the establishment of strong goals, the use of improvised learning practices, attention to levels of individual engagement and workplace affordances, immersion in professional discourse and behaviours, support in relation to the development of a professional identity and the provision of opportunities to transform social practice.

Cognition↗

PubMed2004

Neurobiology and genetics of behavioural syndromes of Alzheimer's disease.

The number of people with cognitive impairment is rising in parallel with changing demographics. As health care budgets are coming under increasing strain with regard to the provision of nursing care, there is a substantial need for effective therapies which encompass greater understanding of the components of dementia that finally necessitate admission to residential or nursing home care. Behavioural and psychological symptoms of dementia (BPSD) are major independent risk factors for admission to institutional care and research into the origin of BPSD is gathering pace. In this review, we evaluate the neurobiological and genetic changes described in individuals with BPSD in Alzheimer's disease. Particular emphasis is placed on genetic theories of causation, namely that BPSD results directly or indirectly from known genetic risk factors for AD, or distinct genetic risk factors for psychiatric illness assume clinical significance within the degenerated Alzheimer's brain.

Alzheimer Disease↗

PubMed1998

Flexible foraging strategy of Cory's shearwater, Calonectris diomedea, during the chick-rearing period.

Procellariiformes are well known for their low rates of food provisioning to their slow-growing chicks. In some species, the patterns of food delivery to chicks have been deduced from changes in their weight, obtained from periodic weighings. However, the behaviour of individual parents cannot be resolved using this method. In this study, we used a periodic weighing protocol with Cory's shearwater chicks on Selvagem Grande island, in the northeast Atlantic. In addition, we used an automatic logging system to examine the attendance of individual parents. In 1997, the chicks were fed infrequently, and were in significantly poorer condition, than in other years and at other colonies. This suggests that the adults were experiencing some difficulties in finding an adequate food supply close to the colony. Under these conditions, individual parents adopted a dual provisioning strategy, making both short and long foraging trips, a previously undescribed behaviour in any northern hemisphere petrel species. Although meals delivered to chicks were larger after long trips than after short trips, the average amount of food provisioned per day spent at sea decreased with increasing trip length, and so chicks did not benefit from longer trips. This finding suggests that long trips can be used to restore the adult's body condition, presumably depleted during short trips as shown previously for some petrels and albatrosses. The adoption of this flexible foraging strategy, which differs from the uniform intervals observed in Cory's shearwaters experiencing situations of 'normal' food abundance, may represent a mechanism through which breeding birds compromise between the needs of their chicks and the maintenance of their own body condition. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗

PubMed1993

Health transition: the cultural, social and behavioural determinants of health in the Third World.

The paper defines 'health transition' and outlines the development of recent research programmes. Evidence is reviewed as to the cultural, social and behavioural determinants of health in the Third World, and the extent to which they interact with the provision of health services in reducing mortality. Specific attention is given to the impact on mortality of education, and the historic experience of the now developed countries is compared with contemporary developing countries. Consideration is also given to the role of cultural factors and to radicalism, egalitarianism and the role of women in traditional society as well as fertility control and various forms of deleterious behaviour in contemporary society. The extent to which all these changes are facets of a single social transformation is discussed. Finally, the future of health transition research and its value for planned health interventions are summarized.

Cross-Cultural Comparison↗

PubMedDate not supplied

Different school placements following language unit attendance: which factors affect language outcome?

The study compared the outcomes of two groups of children who were attending language unit provision at 7 years of age. Of 242 children in the original study, 62 (28%) transferred to mainstream school placements at age 8 years. These children were then closely matched to children still attending language unit provision at this age using measures of non-verbal IQ, expression and comprehension. These two groups of children were compared on outcome at 11 years in the areas of language skill, non-verbal IQ and social behaviour. Teacher/speech-language therapist opinions of placement were also examined as factors affecting outcome. Results show that children who moved to mainstream provision at 8 years were more likely to be attending mainstream at 11 years, although the majority received extra support. No further differences were evident in outcome according to placement type. However, there was a main effect of teacher/therapist opinion on outcome--children whose teachers were not entirely happy with the 8-year placement performed more poorly at 11 years on language measures. There were no differences on any other measures. The findings suggest that follow-on placements for children attending language units need to be more closely in line with teacher's opinions and that more flexibility needs to be evident in school placement policy in order that appropriate educational settings can be arranged.

Child↗

PubMed2001

Measuring the well-being of people with dementia living in formal care settings: the use of Dementia Care Mapping.

Over the years there have been advances in the quality of care provision for people with dementia. How to measure the impact of care on the person with dementia has challenged researchers as, until recently, no evaluation tool offered a comprehensive overview of the behaviour patterns and well-being of persons with dementia. Dementia Care Mapping (DCM) is a tool used by care practitioners and researchers to capture both the process (behaviours) and outcome (well-being) of care and is therefore of use as a tool to evaluate quality of care. This study aims to assess, through DCM, the experience of dementia care provision in residential and nursing homes in two voluntary organizations in England. The data illustrates similarities in the well-being and behaviour patterns of 76 persons with dementia living in six care settings throughout England. Examples of instances when people with dementia were "put down" and when well-being was enhanced, are outlined. The homes in the study were meeting the physical care but not the broader psychosocial care needs of the observed residents. The action taken by the organizations as a result of the DCM evaluations is summarized.

Aged↗

PubMed2001

Views of Chinese parents on the provision of contraception to unmarried youth.

This study sought the views of Chinese parents on sex education and contraception for unmarried youth. Data were drawn from 16 focus group discussions conducted in eight sites in China in 1998-1999 with parents of unmarried children aged 18-24. While parents tended to recognise the reality of changing sexual norms, they were ambivalent with regard to sexual activity among young people and the provision of services to them. To prevent this ambivalence from posing a significant obstacle to the adoption of safe sex behaviours by young people, the dilemmas faced by parents need to be addressed through programmes for parents. Parents were clearly concerned for the well-being of their unmarried children, and keen to see their children protected from unwanted pregnancy and disease; they supported the provision of life skills education and the development of negotiation skills, self-esteem and the ability to exercise informed choice. Parents appeared willing for government to establish educational and service delivery programmes for the unmarried; it is important that government acts upon this.

Abortion, Induced↗

PubMed1998

Plumage brightness as an indicator of parental care in northern cardinals

Good parent and differential allocation models predict relationships between degree of sexual ornamentation and parental care, but relatively few studies have tested these models. The northern cardinal, Cardinalis cardinalis, is a sexually dichromatic species in which both sexes are ornamented. Males have red plumage, and females have tan plumage with limited areas of red feathering. Cardinals were used to address the two models and determine whether plumage brightness signals level of parental care by both sexes. Absolute effort in feeding nestlings by males was not correlated with male breast plumage colour, but effort by females was positively correlated with female underwing plumage colour. Absolute feeding effort by females was also inversely related to brightness of the mate's breast colour. As a consequence, the proportion of a pair's total feedings provided by the male was positively correlated with male breast colour. Proportion of total feedings provided by the female was positively correlated with female wing colour. Feeding efforts (both per nest and per nestling) were correlated between mates, but birds did not mate assortatively in relation to colour. These results support the good parent hypothesis, suggesting colour brightness is a signal of parental care. The results also indicate that ornamentation of both members of the pair may be important determinants of relative efforts in provisioning nestlings by parent birds. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗

PubMed2002

Alcoholism and somatic comorbidity among homeless people in Mannheim, Germany.

AIMS: To assess the prevalence of alcoholism and somatic codisorders of homeless people. DESIGN: Epidemiological cross-sectional field study in a sample of the homeless in the area. SETTING: The study was conducted from 1997 to 1999 in the inner-city area of Mannheim, Germany (approximately 320 000 inhabitants). PARTICIPANTS: One hundred and two single homeless people (15-16% of the estimated total population of single homeless people in the city). MEASUREMENT: Alcoholism, substance abuse and mental disorders were diagnosed with the SCID. Medical examinations were performed by an experienced physician. Blood samples were taken and urine samples collected. Further assessments were conducted for factors potentially correlating with mental or physical state. FINDINGS: Of the study probands, 63.7% presented with the alcohol dependence syndrome or harmful use, 61.7% had current somatic problems or disorders. Probands with alcohol dependence had significantly more frequent somatic disorders in total, more cerebral degeneration, liver disease or alcoholic polyneuropathies. Multiple stepwise regression identified alcoholism, life-satisfaction, duration of homelessness and lacking social support as significant explanatory factors for having a somatic disorder. Alcoholism increased the risk of physical ill-health more than fourfold. CONCLUSION: Alcoholism is a major contributor to the physical ill-health of homeless people. Treatment or rehabilitation of addictive behaviour among the homeless should be of major concern for adequate service planning or provision.

Alcoholism↗

PubMed2004

Factors associated with sex trade involvement among male participants in a prospective study of injection drug users.

OBJECTIVES: While much research to date has examined female sex trade work, little has been done to evaluate factors associated with male sex trade involvement or to assess their health service needs. This is particularly true for male sex trade workers who are also injection drug users (IDUs). Therefore, the present analyses were undertaken to evaluate factors associated with sex trade work in a prospective cohort study of male IDUs. METHODS: We identified factors associated with sex trade involvement among male participants enrolled in the Vancouver Injection Drug Users Study (VIDUS). Since serial measures for each individual were available at semiannual intervals, variables potentially associated with sex trade involvement were evaluated with adjusted odds ratios (AOR) and 95% confidence intervals (CI) computed using generalised estimating equations (GEE). RESULTS: Between 1996 and 2003, 995 male IDUs were enrolled into the VIDUS cohort among whom 108 (11%) reported being involved in the sex trade at enrolment and 102 (10%) individuals initiated sex trade involvement during the follow up period. In multivariate analyses, factors independently associated with sex trade involvement included HIV positive serostatus (AOR: 1.77 (95% CI: 1.44 to 2.17)), daily cocaine injection (AOR: 1.37 (95% CI: 1.11 to 1.70)), daily crack smoking (AOR: 1.36 (95% CI: 1.07 to 1.72)), borrowing syringes (AOR: 1.73 (95% CI: 1.32 to 2.25)), and inconsistent use of condoms with casual sexual partners (AOR 0.66, CI 0.53 to 0.82). We also found that male sex trade workers were more likely to report having sought but been unable to access substance abuse treatment (AOR: 1.28 (95% CI: 0.98 to 1.67); p=0.076). CONCLUSIONS: Males involved in the sex trade in this setting have higher levels of HIV infection and engage in risky injection behaviours at an elevated rate. Since these behaviours have major implications for HIV acquisition and public health, prevention efforts and targeted provision of addiction treatment to this population should be expanded.

Adult↗

PubMed2006

Seasonality of service provision in hip and knee surgery: a possible contributor to waiting times? A time series analysis.

BACKGROUND: The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. METHODS: We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100,000 population for all hip and knee replacements. RESULTS: There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p < 0.01; Bartlett-Kolmogorov-Smirnov Test = 0.31, p < 0.01) and strong (R2Autoreg = 0.85) seasonality was identified in the data. CONCLUSION: Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery.

Aged↗

PubMed2001

A conceptual framework for the economic analysis of factors influencing decision-making of small-scale farmers in animal health management.

The delivery of veterinary services in most of sub-Saharan Africa has undergone substantial changes, with the private sector gaining increasing recognition as an alternative to state provision. Given this policy shift, the authors argue that a better understanding of the behaviour and decision-making processes of small-scale farmers in animal health management is urgently required, to guide policy decisions regarding the delivery of animal health services. Whether the involvement of the private sector will improve overall efficiency in the delivery of veterinary services will depend greatly on the demand response of livestock producers who must make decisions about the health of livestock. The authors briefly review the decision-making process in small-scale farming systems, the economic nature of animal diseases and disease control and the models that have been used to guide resource allocation for disease control. To gain an improved understanding of the behaviour and decision-making processes of small-scale farmers, the authors propose a conceptual model including variables that relate to characteristics specific to small-scale farmers and farms, economic factors, institutional setting and biophysical factors. Two possible approaches are proposed for the economic analysis. Agricultural household modelling allows the derivation and testing of hypotheses regarding the demand elasticities for veterinary services, while qualitative choice models are better suited to the analysis of determinants behind the choices of farmers. The authors conclude that an urgent need exists for empirical research in this area.

Africa South of the Sahara↗

PubMed2005

CSOs: tools for assessing their operation in our systems.

In recent years, regulations have been introduced under European legislation to govern wastewater discharge into natural environments, with particular provisions for combined sewer overflows. It has therefore become indispensable to control the hydraulic behaviour of these constructions. This article addresses the issue of 1D and 3D hydraulic modelling of CSOs. In the case of 1D modelling, a computational tool that is adapted to the hydraulic complexity of side weirs has been designed. For 3D modelling, the Fluent calculation code has been tested. The two modelling approaches have been validated by the data collected from the small-scale model in Obernai (French).

Evaluation Studies as Topic↗