Healthy living messages for people with learning disabilities

Background: Obesity, cardiovascular disease and osteoporosis are common nutritional disorders seen in people with learning disability (LD) and complexities of communication, visual, hearing and cognitive difficulties (NHS‐HS, 2004). The national Healthy Living Campaign (HLC) (Healthy Living, 2007) produces health promotion materials with consistent guidance on healthy eating for adults. However, the format could be regarded as inaccessible to the majority of those with LD (NHS‐HS, 2004). A pilot project, ‘Shop, Cook & Eat’, aimed to make the national HLC accessible to people with LD in a day centre/community setting and to empower people to make healthy choices has been initiated. Interactive learning methods including sensory activities, structured visits to supermarkets and allotments, and cooking skills development were used. Information and recipes with pictorial explanations were produced. This study aimed to evaluate this initiative. Methods: A participatory appraisal approach was used to pilot delivering of the HLC messages. A healthy eating group (eight participants >30 years) met weekly sessions from September 2006 to June 2008. The effectiveness of the materials was evaluated by a pictorial questionnaire that utilised an augmentative communication method, ‘Talking Mat’ (Murphy & Cameron, 2002). Questionnaires, which measured the impact on service users’ knowledge of healthy eating and living, were administered at the end of the programme to carers. An observation diary was used to record qualitative comments. Data analysis was carried out with Excel 2003. Results: Five subjects completed the questionnaire. At week 1, two participants had 90% correct answers on fruit and vegetables and showed no change after 5 weeks; two participants had 60% correct answers and increased their knowledge by 45% increase; one participant had 70% correct answers and showed 18% increase. Questions on fat showed all five participants increased their knowledge within 4 weeks of joining the scheme. Questionnaires completed by family and carers at the end of the learning programme showed that six participants increased consumption of new foods/fruit and vegetables, five demonstrated increased interest and involvement in cooking and shopping at home. Examples from the observation diary include a day centre worker noting improved lunch choices of one member of the group and a parent reporting that her son had advised her to cut the fat off the bacon. Discussion: This study shows that this educational programme, developed to suit adults with LD, has the potential to improve their dietary knowledge. However, the low response rate makes extrapolation of these results difficult. Additional factors such as levels of disability and the level of involvement of carers and family members must be considered as well as whether new knowledge is sustained. Conclusions: The results of this work suggest that it is possible to change the health knowledge of people with learning disabilities through use of interactive methods and materials in accessible format although larger studies are required. The results from this participatory appraisal approach could inform action planning for future groups on a wider scale. References Healthy Living [On line]. Available at http://www.healthyliving.gov.uk/ (accessed on 3 April 2007). Murphy, J. & Cameron, L. (2002) Let your Mats do the Talking. Speech and Language Therapy in Practice – Spring 2002 p18–20. NHS Health Scotland. (2004) People with Learning Disabilities in Scotland ‐ Health Needs Assessment Report. Edinburgh: NHS Health Scotland.     

Family influences, acculturation, and the prevalence of tobacco smoking among Asian youth in New Zealand: findings from a national survey

The associations among family factors, acculturation, and the risk of regular smoking among Asian youth were investigated in a nationally representative survey in New Zealand. The strong relationships between protective family factors and lower risks of smoking were not attenuated in the presence of indicators suggestive of acculturation.     

Neonatal Alloimmune Thromboeytopenia: A Case Report and a Review of the Literature

Summary: A 32-year-old woman in her third pregnancy underwent fetal blood sampling because of a previous child with neonatal thromboeytopenia. At 33 weeks' gestation, fetal thromboeytopenia was diagnosed. Treatment was instituted antenatally with serial fetal platelet transfusions and corticosteroid therapy. Delivery was by Caesarean section at 37 weeks' gestation. Neonatal treatment included further platelet transfusion and immunoglobulin infusion. Recovery of the neonate was complete on discharge from hospital 10 days after birth. The aetiology, diagnosis, clinical presentations and therapeutic options in cases of alloimmune thromboeytopenia are discussed.     

Physiological anticoagulants and activated protein C resistance in childhood stroke

Immunological and functional protein S, protein C and antithrombin III levels and anticoagulant responses to activated protein C were measured in 24 patients with stroke in childhood. No hereditary deficiencies were found. The protein S levels in healthy controls of younger age did not differ from the adult levels. For optimal screening of protein S deficiency, measurements using functional as well as immunological assays are recommended. Appropriate criteria for the diagnosis of the deficiencies must be carefully applied if unnecessary anxiety and inappropriate treatment of children are to be avoided.     

Difficulties in diagnosing intrinsic spinal cord tumours.

Thirteen children with intrinsic spinal cord tumours were seen between 1984 and 1995. In only one was this the presumptive diagnosis at referral, despite a high incidence of characteristic features. Eight had presented to their local paediatrician, four to local orthopaedic teams, and one to a general surgeon. Eleven had back pain. Eleven had either spinal curvature or change in gait. The interval between onset of symptoms and diagnosis ranged from one week to six years, with a mean of 17.5 months. In nine children symptoms had been present for four or more months. In nine, unrewarding investigations had been carried out. This paper highlights typical presenting features of these tumours and how earlier diagnosis can be achieved.     

Evaluation of attempted prevention of unexpected infant death in very high-risk infants by planned health care

Three hundred and ninety-six babies born in Sheffield between 1982 and 1990 identified as being at "very high risk" of unexpected infant death by means of a scoring system, received an intensive programme of health care including a case discussion between a paediatrician, the GP and the health visitor held in the family doctor's surgery, weekly visits from the health visitor and informal hospital admission. Significantly fewer sudden unexpected infant deaths occurred in this group than were expected by logistic regression anlysis or occurred in the best available control group with comparable scores ( p = 0.024). Problems in evaluation include identification of an adequate control population, ethical difficulties in introducing a controlled study when the programme is already perceived as effective, and the calculation of "expected death rates". The results of this study indicate that very energetic programmes of intervention may prevent some deaths in vulnerable infants.