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PubMed1994

A framework for commissioning services for people with learning disabilities.

The needs of people who have global developmental learning disabilities (mental handicap) are complex and lifelong. Unless social and health service commissioners agree a framework for conceptualizing their need, there is a danger that services could become fragmented. This paper uses the World Health Organization's model of disabilities to put in context these needs. Using this model it is logical for health services to focus on (1) ensuring access to the full range of primary and secondary health services, (2) reducing the occurrence and severity of intellectual and associated impairments and (3) ensuring the provision of assessment and treatment of behaviour disorders and associated mental health problems. Some of these inputs are required before birth and in early childhood, but a number of people will require health services throughout life because of the presence of other disabilities or continuing behaviour and/or mental health problems. At school age, the education authority should provide the lead in ensuring the best physical and social learning environment. All children with learning disabilities will be socially disadvantaged in adulthood unless they are provided with opportunities for social integration, continuing education, skills training, employment and normal living facilities which meet their needs. Although there appears a logical shift in agencies' responsibilities as children with intellectual impairment progress through life, there is considerable diversity within this group and care can only be effectively provided on the basis of a sophisticated assessment of individual need and provision of integrated care.

Activities of Daily Living↗

PubMed2005

Travelling to Africa: health risks reviewed.

Africa's varied ecology presents a wide range of travel health threats: infections; accidents; envenomations; an uncertain drug supply; problematic access to competent medical care outside South Africa. Important vaccine preventable diseases include yellow fever, meningococcal disease, typhoid, polio, rabies, and hepatitis A and B; routine vaccinations should be up to date. Much, but not all, of sub-Saharan Africa is malarious with chloroquine resistant falciparum dominating; chemoprophylaxis and personal protection measures will often be indicated. Other threats are less obvious, e.g. helminth and protozoal infections. The immunocompromised and other high-risk groups may require special attention. Risk mitigation strategies may include education, vaccination, chemoprophylaxis, personal protection measures, provision of treatment and equipment packs, behaviour modification, and evacuation insurance.

Accident Prevention↗

PubMed2000

Deprivation of straw bedding alters PGF(2alpha)-induced nesting behaviour in female pigs.

Sows are highly motivated to build a maternal nest on the day preceding parturition. A model for nest building has been established in pigs, in which exogenously administered prostaglandin F(2alpha) (PGF(2alpha)) may be used to elicit nesting behaviour in cyclic, pseudopregnant and pregnant pigs. The aim of this experiment was to examine the effects of deprivation of straw bedding on PGF(2alpha)-induced nest building in pseudopregnant Large White gilts. Oestradiol valerate injections (5 mg/day) were given on days 11-15 of the oestrous cycle to induce pseudopregnancy. The pigs were housed individually in a pen (2.8x1.7 m) and provided with 2-kg fresh straw each day. On the test day, on day 46 or 47 of pseudopregnancy, half of the pigs were deprived of straw (substrate effect) and they were injected intramuscularly with saline or 15 mg of PGF(2alpha) (Lutalyse, Upjohn) (treatment effect) allocated in a Latin-square design. Behaviour was recorded onto video tapes for 1 h either side of treatment for analysis using a computerised event recorder. PGF(2alpha)-treated pigs housed in bare or strawed pens showed significantly higher frequencies of pawing and rooting, and stood for longer than saline-treated controls. This treatment effect has been previously shown to be comparable to pre-partum nest building. The removal of straw significantly reduced the frequency of pawing and the duration of rooting by PGF(2alpha)-treated pigs. The results demonstrate that nesting behaviour can be initiated by exogenously administered PGF(2alpha) and is further modified by the provision of straw. This suggests that PGF(2alpha)-induced nesting behaviour is subject to environmental feedback.

Journal Article↗

PubMed2002

Caries experience in existing and new nursing home residents in Adelaide, Australia.

OBJECTIVES: The Adelaide Dental Study of Nursing Homes was instigated to provide comprehensive information concerning oral disease experience, incidence and increments in a random sample of those older South Australians residing in Adelaide nursing homes. METHODS: This paper presents caries experience results for existing and new nursing home residents, and caries incidence and increments for existing residents, from dental inspections conducted at the baseline and one-year data collections. RESULTS: The residents in this study were very functionally dependent, medically compromised, cognitively impaired and behaviourally difficult older adults, the great majority of whom had moderate to severe cognitive impairment. Residents gave their carers many complex and challenging behavioural problems during oral hygiene care provision. Existing and new residents had similar dental history, oral hygiene, and sociodemographic characteristics, and similar cognitive, medical, functional, and nutritional status. Oral disease experience was high in both existing and new residents. There were no significant differences between existing and new residents for their dentate status, tooth status, coronal caries experience, or root caries experience, with the exceptions that new residents had significantly greater mean number of teeth, more filled coronal and root surfaces, and also new residents had significantly fewer decayed retained roots. Large numbers of tooth surfaces were covered in plaque and debris that negated more precise assessment of caries. The existing residents had caries increments on both coronal (2.5 surfaces) and root surfaces (1.0 surfaces) over the one-year period. Coronal caries incidence was 64% and root caries incidence was 49% of existing residents. CONCLUSIONS: Oral disease experience was high in both existing and new residents. There were few significant differences between existing and new residents' oral health status. New residents were being admitted to nursing homes with a compromised oral health status. Coronal and root caries increments and incidence were high for existing residents over the one-year period.

Activities of Daily Living↗

PubMed1997

Psychodynamic perspectives on psychosis and psychotherapy. II: Practice.

Psychodynamic theory has a contribution to make to the overall care and management of people suffering from psychosis. The research literature in support of these contributions is reviewed and key psychodynamic concepts of value in understanding psychosis are illustrated by the case example of a two-year supportive psychodynamic psychotherapy with a man experiencing paranoid and grandiose delusions. The contribution psychodynamic approaches may make to currently evolving cognitive--behavioural therapies, and to the overall provision of care are discussed.

Adult↗

PubMed1977

The other handicap: brightness.

Because of changing attitudes to the measurement of mental abilities, only the slow child is assessed and receives special educational help. By contrast, the bright child may remain undetected because unassessed. For these children there are few special provisions, and they may present as behaviourally disturbed or educationally retarded. We describe four such children, and we feel that more facilities should be devoted to helping bright children, both at home and in school.

Child↗

PubMedDate not supplied

Making clinical governance work.

This paper summarises a conference that took place at the Royal College of Physicians about the work of the Clinical Effectiveness and Evaluation Unit (CEEu) and the National Collaborating Centre for Chronic Conditions (NCC-CC). The importance of the clinical standards, audit, and evidence-based guidelines and their contribution to the clinical governance arena was acknowledged. In addition, consideration was given to the fact that information provision alone does not change clinician behaviour. Multifaceted strategies are discussed and lessons learnt examined. The CEEu and NCC-CC have made significant contributions at a national level in the development of clinical governance.

Academic Medical Centers↗

PubMed2002

Decreasing STD incidence and increasing condom use among Chinese sex workers following a short term intervention: a prospective cohort study.

OBJECTIVE: To describe the impact of a repeating behavioural intervention focused on preventive education and provision of STD testing and treatment services to female sex workers. METHODS: A prospective cohort study of 966 sex workers (first of its kind in China) was conducted in Guangzhou from March 1998 to October 1999. At each visit information was collected on sexual behaviour, condom use and knowledge about HIV transmission and condom use, education was given, STD were diagnosed, and treatment was provided free of charge. We evaluated trends in condom use, knowledge about HIV transmission and condom use, and STD incidences. Generalised estimating equations were applied to control for repeated measurements. RESULTS: The proportion of consistent condom use increased from the intake through the third follow up visit (from 30% to 81%), as well as the proportion of having good knowledge on HIV transmission (4.3% to 98.6%) and condom use (23.6% to 79.3%). The incidence of gonorrhoea, trichomoniasis, and chlamydia decreased over each follow up visit; from 17.5/100 person years (PY), 22.4/100PY, 65.9/100PY at the first follow up visit to 5.1/100PY, 3.0/100PY, 16.1/100PY at the third follow up visit, for each STD respectively. CONCLUSIONS: STD care and prevention programmes targeting sex workers are feasible in China and, more importantly, intervention consisting of prevention education and STD care is likely to reduce unprotected sexual behaviour and STD incidence in this group at high risk for HIV and other STD infection.

Adult↗

PubMed2000

An action research inquiry into a health visitor parenting programme for parents of pre-school children with behaviour problems.

An action research inquiry into a health visitor parenting programme for parents of pre-school children with behaviour problems Parent education programmes have recently been given a high profile in this country, such provision deemed necessary because of the commonality of children's behaviour problems and because of their potentially far-reaching effects on the child, the family and society. This action research study, undertaken in Scotland, aims to explore a health visitor parenting programme for parents of pre-school children with behaviour problems. Within this study, children with behaviour problems were identified as those whose parents perceived them to have such problems, the children eliciting a wide range of behaviours and to varying degrees. Critical social science is the chosen methodology, since it allows exploration of how people comprehend their social reality. Group interactions were recorded on audio-tape and themes associated with the methodology of enlightenment, empowerment and emancipation were identified. The results of the study demonstrate how a liberating, collaborative approach to parental education can empower mothers, by increasing understanding and raising self-esteem.

Adaptation, Psychological↗

PubMed2001

An evaluation of community learning disability services for children with a learning disability.

This study outlines the results of a survey carried out with parents of children with a learning disability, general practitioners and community learning disability teams as to the health service needs for this client group. Overall, 40% of parents were very dissatisfied or dissatisfied with the services they received. A number of gaps in service provision were identified. In particular, psychological and behavioural difficulties of children were of major concern to all those involved, but needs in relation to these areas were often unmet or inadequately dealt with. Of greater concern was that some families in the area studied were paying privately for child learning disability clinical psychology services because they had such difficulty in accessing NHS services. Implications for service provision are discussed.

Adolescent↗

PubMed2004

Do family-planning workers in China support provision of sexual and reproductive health services to unmarried young people?

OBJECTIVE: To ascertain the perspectives of family-planning service providers in eight sites in China on the provision of sexual and reproductive health services to unmarried young people. METHODS: Data were drawn from a survey of 1927 family-planning workers and 16 focus group discussions conducted in eight sites in China in 1998-99. FINDINGS: Family-planning workers recognized the need to protect the sexual health of unmarried young people and were unambiguous about the need for government agencies to provide information and education on sexual and reproductive health to unmarried young people; however, perceptions about the appropriate age for and content of such education remained conservative. While about 70% of family-planning workers were willing to provide contraceptives to unmarried young people, and about 60% approved government provision of contraceptive services to unmarried young people, only one quarter agreed that the services could be extended to senior high schools. CONCLUSION: Family-planning workers in China are ambivalent about the provision of sexual and reproductive health services to unmarried young people, which potentially poses a significant obstacle to the adoption of safe sex behaviours by young people, as well as to the provision of sexual and reproductive health information and services to young unmarried people in China. Training programmes for family-planning workers are urgently needed to address this issue.

Adolescent↗

PubMed2006

Syndrome specificity and behavioural disorders in young adults with intellectual disability: cultural differences in family impact.

BACKGROUND: This study examined whether behaviour problems and adaptive behaviour of low functioning young adults, and well-being of their families, varied by diagnostic syndrome [intellectual disability (ID) only, cerebral palsy, Down syndrome, autism], as well as by cultural group. METHODS: Behaviour disorders in young adults with moderate to severe ID were assessed from information provided by 282 caregivers during in-home interviews. The sample consisted of 150 Anglo participants, and 132 Latino, primarily Spanish-speaking, participants drawn from Southern California. RESULTS: Behaviour disorders and maternal well-being showed the same pattern across disability syndromes. Autism was associated with the highest scores in multiple behaviour problem areas as well as maternal reports of lower well-being. Down syndrome was associated with the lowest behaviour problem scores and the highest maternal well-being. When behaviour problems were controlled for, diagnostic groups accounted for no additional variance in maternal stress or depression. The pattern of behaviour problems and well-being did not differ by sample (Anglo vs. Latino), although level on well-being measures did. Latina mothers reported significantly higher depression symptoms and lower morale, but also higher positive impact from their child than did Anglo mothers. CONCLUSIONS: Caregivers of young adults with autism report more maladaptive behaviour problems and lower personal well-being, or stress, relative to other diagnostic groups, regardless of cultural group. However, cultural differences exist in caregiver reports of depression, morale, and positive perceptions. Implications for service provision aimed at families of children with challenging behaviour problems are discussed in the context of culture.

Activities of Daily Living↗

PubMed2000

STI prevention and the male sex industry in London: evaluating a pilot peer education programme.

OBJECTIVE: To evaluate the effectiveness of a pilot peer education STI prevention programme with male sex workers. DESIGN: A process and outcome evaluation of the pilot programme undertaken in three London male escort agencies, using a quasi-experimental design. SUBJECTS: Workers in three London escort agencies, including 88 who completed a questionnaire, five peer educators, and a further 16 men (including management) working in two of these agencies. METHODS: A peer education STI prevention programme run by the Working Men Project (WMP), a specialist sexual health service for male sex workers, was piloted in two London escort agencies. Five male sex workers participated in a 2 day peer education training programme. They then returned to their respective agencies to disseminate information and condoms, in an attempt to influence norms of behaviour. An outcome evaluation aimed to assess changes in STI related knowledge, high risk sexual behaviour, and attendance at a sexual health service. A pre-intervention questionnaire assessing variables such as STI related knowledge, sexual behaviour, and demographic information was administered in both agency A and agency B and a third agency, C, which acted as a control. Ten weeks after the peer educators returned to their agencies, the same questionnaire was administered in the same agencies. Peer educator referrals to the WMP were also recorded over this time period. The process evaluation involved interviews and focus groups with peer educators, and the completion of diaries about their experiences in the role. A further 16 men working in the agencies (including managers and an owner) were interviewed about their experience of the programme. Participant observation was also undertaken through regular outreach work to the agencies. RESULTS: 57 men completed the questionnaire at time 1 and 44 at time 2. Unfortunately, only 13 of these were matched, precluding any meaningful analysis of change in STI related knowledge and sexual behaviour. The questionnaire provided a profile of the men working in the agencies. Of the 88 men who completed the questionnaire at least once, the majority were homosexual, and in their late teens/early 20s. Most were of a "white" ethnic group, though there was some range within these categories. Most preferred to speak English and education levels were high. Relative STI knowledge revealed a high understanding of HIV and hepatitis B, moderate understanding of gonorrhoea, syphilis, genital warts and herpes, and little knowledge of non-specific urethritis (NSU) or chlamydia. Sexual behaviour suggested a highly sexually active population with both male and female paying and non-paying partners. Condom use was highest for paying partners, particularly for anal sex. Condom use for oral sex with all partners was less consistent, and condom use for all types of sex with regular partners was lower than with other partners. The small number of men engaging in vaginal sex with paying and regular partners were less likely to use condoms. 26 new patients registered at the WMP as a result of peer educator referrals, representing 65% of all new contacts over the study period. The process evaluation revealed that while the training programme was considered adequate and while peer educators felt the programme and their roles to be a success, their experience of the role was difficult. The role of management support was crucial in supporting the programme. The assumption that "peers" are particularly effective educators was not borne out by the results. While peers were considered suitable to discuss some aspects of the industry, many preferred to consult "professionals" about health related matters. The concept of "peers" was problematic with most of the men drawing "peers" from subgroups within the agencies. Other constraints on behaviour such as a lack of power, particularly with regard to a lack of management support, or poverty, had a substantial impact on behaviour which were not influenced by the peer educators. CONCLUSIONS: The study illustrated the difficulties of utilising quasi-experimental evaluation methodology with this client group. It also demonstrated the limitations of peer education based on information provision health education models which focus on individual behaviour change. Suggestions are given for future interventions.

Adolescent↗

PubMed2006

Nurses' perceptions of quality end-of-life care on an acute medical ward.

AIM: This paper reports the findings of a study that generated a conceptual model of the nursing behaviours and social processes inherent in the provision of quality end-of-life care from the perspective of nurses working in an acute care setting. BACKGROUND: The majority of research examining the issue of quality end-of-life care has focused on the perspectives of patients, family members and physicians. The perspective of nurses has generally received minimal research attention, with the exception of those working within palliative or critical care. The vast majority of hospitalized patients, however, continue to be cared for and die on medical units. To date, little research has been conducted examining definitions and determinants of quality end-of-life care from the perspective of nurses working in acute adult medical settings. METHOD: Grounded theory method was used in this study of 10 nurses working on acute medical units at two tertiary university-affiliated hospitals in central Canada. Data were collected during 2002 by interview and participant observation. FINDINGS: The basic social problem uncovered in the data was that of nurses striving to provide high quality end-of-life care on an acute medical unit while being pulled in all directions. The unifying theme of 'Creating a haven for safe passage' integrated the major sub-processes into the key analytic model in this study. 'Creating a haven for safe passage' represents a continuum of behaviours and strategies, and includes the sub-processes of 'facilitating and maintain a lane change'; 'getting what's needed'; 'being there'; and 'manipulating the care environment'. CONCLUSION: The ability of nurses to provide quality end-of-life care on an acute medical unit is a complex process involving many factors related to the patient, family, healthcare providers and the context in which the provision of end-of-life care takes place.

Adult↗

PubMed1997

Trials of providing costing information to general practitioners: a systematic review.

OBJECTIVE: To determine if providing general practitioners (GPs) with costing information can change their clinical behaviour and reduce medical costs. DATA SOURCES: MEDLINE, CINAHL, Health Plan and EMBASE and citations in review articles were searched for studies published between 1980 and 1996. STUDY SELECTION: Studies were included if they provided costing information to GPs with the aim of decreasing costs by changing behaviour, included an objective measure of GP performance or clinical care, and used a randomised or quasi-randomised controlled design, crossover design or a controlled time series. DATA EXTRACTION: Data extracted included study design, intervention used and measure of GP performance/clinical care (including test ordering, drug prescribing, hospital and primary care visits and costs). DATA SYNTHESIS: Six studies met the inclusion criteria. Computerised feedback on drug costs increased generic prescribing, and "academic detailing" decreased inappropriate prescribing of target drugs. Providing costing information also decreased ordering of diagnostic tests. "Gatekeeper" physicians reduced use of hospital and specialist services. Only two studies found the changes were sustained for nine months or longer and only one evaluated health outcomes. CONCLUSION: The provision of costing information can change GP behaviour in all service areas. Sustainability of these changes and linking of cost savings to health outcomes have not been well studied.

Family Practice↗

PubMed1982

Patterns of gender-role behaviour in children attending traditional and non-traditional day-care centres.

Using a sex-typed free-play task and the Draw-a-Person test, the gender-role behaviour of children attending a day-care centre whose staff adhered to a "non-sexist" child-rearing philosophy was compared to the gender-role behaviour of children attending a more traditional day-care center. Parental provision of sex-typed and neutral toys and approval of cross-sex role behaviour was also assessed. On both measures, the two groups of children showed culturally typical patterns of gender-role behaviour. The parents of the two groups of children were generally similar in terms of the kinds of toys they provided and in their attitudes toward the expression of cross-sex role behaviour. Potential explanations for the inability to demonstrate effects of the "non-sexist" child-rearing philosophy were discussed.

Attitude↗

PubMed1998

The effect of quality and availability of foraging materials on feather pecking in laying hen chicks.

Feather pecking resulting in feather damage, injuries and mortality causes severe welfare problems in laying hens. In the present study, we tested whether there is an inverse relationship between feather pecking and foraging behaviour (exploratory and manipulative behaviour away from the feeder). Forty-eight groups of 30 or 31 chicks, Gallus gallus domesticus, were reared in pens and provided with different types of foraging material. Feather pecking and foraging behaviour were quantified when the chicks were 4 and 5 weeks of age. In experiment 1, chicks with access to long-cut straw showed more foraging behaviour and less feather pecking than chicks that were provided with the same straw but in shredded form. On the other hand, there was no difference in foraging behaviour and feather pecking between chicks reared with access to long-cut straw and polystyrene blocks. In experiment 2, the importance of the form of the foraging material was confirmed. Chicks provided with polystyrene blocks performed more foraging behaviour and less feather pecking than chicks with access to polystyrene beads. The provision of an area with a layer of wood-shavings to promote scratching behaviour had no significant effect, however, on the incidence of feather pecking. In experiment 3, polystyrene blocks and beads were offered during the whole day or only in the morning. Both the quality and the availability of the foraging materials had a significant effect on foraging behaviour and a significant but opposite effect on feather pecking. Focal animal observations showed that the chicks performed different types of foraging behaviour at polystyrene blocks and beads. This suggests that not only the quantity but also the quality of foraging behaviour elicited by a given material may be important to prevent the development of feather pecking. Feather pecking should thus be considered as redirected foraging behaviour. Copyright 1998 The Association for the Study of Animal Behaviour. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗

PubMed1989

The role of the clinical health psychologist in the management of chronic paediatric illness. A report of 2 cases.

Behavioural problems in chronically ill children are common and adequate provision for holistic management is necessary. It appears preferable for psychological intervention to start not when the child is referred with behavioural problems but as soon as the medical condition is diagnosed. These children, and their families, are usually in need of psychological care from the earliest stages of the disease process. Two case reports are cited in this context. The role of the clinical health psychologist is emphasised.

Child↗