Health screening for people with learning disabilities by a community learning disability nursing service in Northern Ireland

Over the last 30 years there has been a considerable increase in the life expectancy of people with learning disabilities. This has resulted in changing patterns of morbidity and mortality and an increasing recognition of the health needs of people with learning disabilities. Major strides forward have been made in the reduction of preventable illnesses among the general population. However, among people with learning disabilities such illnesses have received only limited health promotion attention until recently. In the last decade major gaps have been identified in the ability of current primary health services to respond to the needs of people with learning disabilities. The need to respond effectively to this situation has been identified as a priority by the current United Kingdom Government. Following an overview of the literature in relation to the changing health profile of people with learning disabilities and the need for health screening, consideration is given to some of the key difficulties which may be encountered when attempting to utilize current primary health services. The analysis of data derived from the health screening of 373 people with learning disabilities by a community nursing service in Down and Lisburn Health and Social Services Trust reveals the need for further action in relation to cardiovascular status, sensory deficits, mobility and aspects of sexual health.     

Poverty and health promotion in primary health care: professionals' perspectives

This paper examines the effectiveness of current strategies for health promotion in the UK in the light of knowledge about the links between health, illness and poverty. The implications of recent policies which target health promotion within primary health care (PHC) settings are examined. The results of an exploratory study undertaken during 1993/94 in a city in South West England are discussed. This qualitative study used semi-structured interviews to investigate the perceptions of a range of PHC professionals. Fifty-four interviews were carried out amongst staff in 16 PHC practices. This paper reports on professionals' views and practice in relation to promoting health in areas of poverty and with low-income clients. These findings are discussed in relation to the literature and the constraints on effective health promotion in PHC are explored particularly in relation to issues of poverty and deprivation.     

Antimicrobial treatment reduces intestinal microflora and improves protein digestive capacity without changes in villous structure in weanling pigs

The immediate post-weaning period is often associated with gut malfunction and diarrhoea for young pigs. Administration of antimicrobials remains an effective way to control weaning diarrhoea but it remains unclear how they affect gut physiology and microbiology although this is a prerequisite for being able to devise better alternatives. Hence, for 7 d we treated pigs, weaned at 24 d of age, with a combination of amoxicillin (25 mg/kg feed and injection of 8.75 mg/kg body weight per 12 h) and ZnO (2.5 g/kg feed). The pigs treated with antimicrobials (n 11) showed no signs of gut malfunction at any time, whereas untreated weaned controls (n 11) developed clinical diarrhoea. The antimicrobial treatment resulted in a higher daily weight gain compared with weaned controls (101 v. -44 g/d, P < 0.0001), whereas both groups had a similar degree of villous atrophy compared with unweaned 24-d-old controls (n 8; P < 0.05). The antimicrobial treatment gave a dramatic reduction in small intestinal microbial diversity, and specifically prevented tissue colonization with Escherichia coli compared with weaned controls. Further, the antimicrobial treatment improved amylase, trypsin and small intestinal aminopeptidase A and N activities (all P < 0.05). Specifically for the colon, the antimicrobial treatment was associated with reduced tissue weight ( -23 %, P < 0.05), reduced concentration of SCFA (P < 0.05), and increased mucosal goblet cell area (P < 0.0001) compared with weaned controls. We conclude that the beneficial effects of antimicrobials are mediated not only through reduction in intestinal bacterial load, but also through a stimulation of protein digestive function and goblet cell density.