Parallel stigma? Nurses and people with learning disabilities

The present paper discusses the history of learning disability nursing in the context of its development within the nursing profession and its relationship with people with learning disabilities. The study provides a brief sketch of the development of learning disability nursing as a discrete branch of the nursing profession before exploring its history in the light of theories of marginalization and stigma. Although the present author recognizes the profound differences between the history of people with learning disabilities and those paid to care for them, he seeks to establish some common ground on the basis of parallel stigma.     

Care home design for people with dementia: What do people with dementia and their family carers value?

Objectives: To report on the views of people with dementia who live in care homes and their family carers on aspects of design that are important to them, and discuss these in relation to developing physical care environments that respond to the wishes of people with dementia and their family carers.

Method: Six focus groups were held: two in Northern Ireland and four in Scotland. A total of 40 people participated in the focus groups. Twenty nine people were with dementia (24 female and five male), and 11 were family carers (10 female and one male).

Results: Carers discussed the features of a building they took into account when selecting a care home, and discussed this in relation to ‘bricks and mortar versus people’. Key themes reported by people with dementia and their family carers included how the space in the environment is used, for example, what happens in the building and the presence or absence of certain design features. Outside space and wayfinding aids were identified as positive features of the home, along with a general lack of concern about ensuite provision.

Conclusion: The results demonstrate the complexity of building design as it must provide living space acceptable to people with dementia living there and family members who visit, as well as provide a workable environment for staff. The findings highlight areas that should be considered by care home teams involved in the build of a new home or the redevelopment of an existing care home.     

Patients as parents and young people approaching adulthood: how should we manage the interface between mental health services for young people and adults?

PURPOSE OF REVIEW: The present review discusses critically recent research findings (published during the period 2003-2004) on the mental health needs of young people in transition (old adolescents and young adults), including those of young parents. Also, the evidence on effective interventions and service models is considered. RECENT FINDINGS: Emerging evidence indicates that young people have high rates of mental health needs (in addition to high prevalence of psychiatric disorders) that may be related to life transitions. These needs often fall between the remit of adolescent/adult and mental health/social care services, and therefore are not adequately met. With the exception of mental health interventions for early psychosis and psychosocial programmes for teenage parents, there is very limited knowledge on how best to meet the mental health needs of young people in transition. SUMMARY: It is widely recognized that young people in transition require services and interventions tailored to their characteristics, rather than a mere extension to either child/adolescent or adult services. Recent policies and research findings have led to the development of early psychosis interventions, with initial encouraging messages. Similar initiatives are required for young people with nonpsychotic disorders.     

Do American Indian mascots = American Indian people? Examining implicit bias towards American Indian people and American Indian mascots

Empirical examinations of American Indian (AI) mascots have only recently entered into the discourse of mainstream psychology. The present studies examined implicit attitudes of non-AI people towards AI mascots and the extent to which they are related to attitudes towards AI people. Significant concordance was observed between negative bias toward AI mascots and AI people. Negative AI mascot bias also predicted stereotype-consistent expectations of an AI person. The implications of these findings are discussed.     

Typical or pathological? Routinized and compulsive-like behaviors in children and young people with Down syndrome

Routinized and compulsive-like behaviors (RCB) are common in typically developing children and in children and adults with Down syndrome, but what functions do they serve? Parents completed questionnaires for RCB, behavior problems, and adaptive behaviors. Children who had Down syndrome had significantly higher levels of RCB than did the typically developing children at all MAs; RCBs were positively associated with adaptive behaviors for younger MA and CA groups, but not older MA children and all adults with Down syndrome. For children with Down syndrome and MAs over 5 years and all adults, RCBs were associated with behavior problems. We concluded that RCBs support developmental progress for all children with MAs less than 5 years, but may have different functions for older individuals.     

What do children and young people want from mental health services?

PURPOSE OF REVIEW: The purpose of this paper is to review the literature reporting on children and young people's views on child and adolescent mental health services. RECENT FINDINGS: The review demonstrates that there is limited research exploring the views of children and young people regarding mental health services. Despite its limitations, the research available shows that young people, their parents and healthcare providers often have different expectations of services. Young people want accessible services staffed by those they are able to trust and who demonstrate an ability to listen; above all, young people want to be involved in the decisions made about them. SUMMARY: To date, children and young people have not been actively engaged or involved in service development. This is an evolving field and we need to ensure that existing evidence is taken into account as well as investigating further the views of young people. Child and adolescent mental health services need to consider how we serve young people, particularly children, whose perspectives may differ from those of their parents.     

Co‐constructed talk in the conversations of people with dysarthria and aphasia

This paper uses the methodology of conversation analysis (CA) to examine the practice of co‐constructed turn and utterance production in impaired communication. An investigation of the conversations between two family dyads, featuring one person with dysarthric speech and one with aphasic language, reveals one way in which single turns and utterances are produced through the collaborative activities of two people in interaction. Such a practice is shown to operate without problems for the participants or the need for explicit acceptance by the speakers. It is proposed that co‐construction in disordered speech and language is one way in which communicative competence is accomplished. By drawing attention to similarities in the consequences of dysarthria and aphasia in everyday interaction, it is suggested that researchers and clinicians might profitably look across disorder‐specific boundaries.     

Do people with dementia find lies and deception in dementia care acceptable?

Objectives: Research suggests that the use of lies and deception are prevalent in dementia care settings. This issue has been explored from the view point of carers and professionals, and the acceptability and ethicality of deception in dementia care remains an area of heated debate. This article explored the issue of lies and deception in dementia care from the unique perspective of the people being lied to: People with Dementia.

Method: This study used a qualitative methodology, specifically, Grounded Theory (GT). The study used a two-phased design. Phase one involved a series of one-to-one interviews with People with Dementia. During phase two, the participants were re-interviewed in order to develop the emerging theory.

Results: Lies were considered to be acceptable if told in People with Dementia's best interest. This best interest decision was complex, and influenced by factors such as the person with dementia's awareness of the lie, and the carer's motivation for lying. A model depicting these factors is discussed.

Conclusion: This study enables the perspective of People with Dementia to be considered, therefore providing a more complete understanding of the use of deceptive practices in dementia care settings. This study suggests that the use of lies and deception in dementia care warrants further investigation.     

Domiciliary and day care services: Why do people with dementia refuse?

Objective: To explore the reasons given for refusal of day services, and to examine the relationship between willingness to accept day services and clinical variables.

Method: Fifty people with dementia who lived alone and had refused day services were interviewed.

Results: The most common reasons for reluctance to attend day services were the belief that they did not need day services, that they liked being on their own, and the belief that they would not enjoy it. People who persistently refused day services tended to have additional worries about meeting new people, losing their independence and being institutionalised. Fifty-four per cent of people with dementia who lived alone and had refused day services scored six or more on the Cornell Scale for Depression in Dementia, suggesting possible presence of major depression.

Conclusion: In patients with dementia who live alone and refuse day services, their misconceptions about day services and possibility of undiagnosed depression need further exploration.     

Vagus nerve stimulation in people with epilepsy and intellectual disability—English version

Clinical Epileptology - In view of the still high rate of pharmaco-resistance in epilepsy, it is crucial to shed light on the non-pharmacological forms of therapy. Consideration of the patient...     

Factors influencing the person–carer relationship in people with anxiety and dementia

Objective: The relationship between people with dementia and their carers is complex and has a significant impact on the dementia experience. The aim of this current study was to determine (1) which factors are associated with the quality of the patient–carer relationship and (2) whether these differ between the two perspectives.

Method: Participants (people with dementia and their carers) were taken from a randomised controlled trial of cognitive behaviour therapy for anxiety in dementia. The quality of the relationship from both perspectives, anxiety and depression in both parties; and the quality of life, neuropsychiatric symptoms and cognitive functioning in people with dementia was examined at three time points (baseline, 15 weeks and 6 months).

Results: There were 127 observations from 50 dyads (100 individuals) across the three time points. Factors significantly related to quality of relationship from the person with dementia's perspective were their own aggression, agitation, irritability, depression, anxiety and quality of life. Factors significantly associated with quality of relationship from the carer's perspective were their own anxiety and depression, and the depression, irritability, behavioural disturbances and quality of life of the person with dementia. People with dementia generally rated the quality of relationship higher, irrespective of level of dementia, depression or anxiety.

Conclusion: This study is novel in that it provides a valuable insight into the impact of mental health on relationship quality for both members of the dyad. The findings emphasise the importance of providing interventions which target mood for both parties, and behavioural problems for people with dementia.     

Ethnicity a risk factor? The relation between ethnicity and large‐ and small‐vessel disease in White people,Black people,and Asians within a hospital‐based population

Background: Previous studies suggest that in patients with ischaemic stroke, White people often present with large‐vessel and Black people with small‐vessel strokes. This study investigates the relation between large‐ and small‐vessel disease, and ethnicity in White, Black, and Asian patients in Amsterdam, the Netherlands. Methods: In a hospital‐based population of 668 patients ethnicity was determined by self‐identification. The relation between ethnicity and carotid stenosis, as an indicator of large‐vessel disease, was determined using univariate analysis, and adjusted for age, gender, hypertension and smoking. Subsequently the relation between ethnicity and lacunar infarcts, as a manifestation of small‐vessel disease, was investigated. Results: The odds ratio for having carotid stenosis, compared to White patients, was 0.55 (0.23–1.33) for Blacks, 0.53 (0.18–1.52) for Asians, and 0.64 (0.14–2.85) for other ethnicities. The adjusted odds ratio for a non‐White patient compared to a White patient was 0.44 (0.19–1.02) (P = 0.05). The non‐White patients more often presented with lacunar infarcts compared to Whites. Conclusion: We found an association between White patients and the presence of carotid artery stenosis. Not only in Black but also in Asian patients the association with carotid artery stenosis was substantially lower. In the non‐White population there was an association with lacunar infarcts compared to Whites.     

Community pharmacists’ experiences and people at risk of suicide in Canada and Australia: a thematic analysis

Purpose

To explore Canadian and Australian community pharmacists’ practice experiences in caring for people at risk of suicide.

Methods

We conducted a thematic analysis of 176 responses to an open-ended extension question in an online survey.

Results

Four themes were identified and include referrals and triage, accessibility for confiding, emotional toll, and stigma. Subthemes included gatekeeping the medication supply, sole disclosure, planning for end of life, concerns of support people, assessing the validity of suicidality, gaps in the system, not directly asking, ill-equipped, resources in the pharmacy, relying on others to continue care, and attention seeking.

Conclusions

Community pharmacists are caring for patients at risk of suicide frequently, and often with patients seeking the help of pharmacists directly. Pharmacists engage in activities and actions that would be considered outside of the traditional dispensing roles and provide support and intervention to people at risk of suicide through collaboration and other mechanisms. Further research to determine appropriate education and training and postvention supports is required.

     

Is there a symbiotic relationship between staff and people who are mentally handicapped?

SUMMARY. The article, prompted by a quotation from Wolfensberger, stimulates all who work with people who are mentally handicapped to examine their motives for doing so. It may be that some staff need the people with whom they work just as much as those people need them. This symbiosis could have significant repercussions in the planning of individual programmes and future services.     

Contaminated and unusual food combinations: what do people with Prader-Willi syndrome choose?

Although hyperphagia is a salient feature of Prader-Willi syndrome, researchers have yet to move beyond food preference and taste studies to examine more troublesome food-seeking behaviors in this population (e.g., eating food from the trash, eating inappropriate or unpalatable food combinations). Visually based tasks were used to examine willingness to eat contaminated food and various odd food combinations in 50 adolescents and adults with Prader-Willi syndrome, 42 IQ-matched participants with mental retardation, and 50 control participants without mental retardation. Although participants with Prader-Willi syndrome showed understandings similar to those of control participants about the purpose and fate of food, they endorsed eating contaminated food as well as highly unusual edible and inedible food combinations. Findings suggest novel adjuncts to traditional dietary approaches in the Prader-Willi syndrome population. Implications are also discussed for future research on food ideation in this population.