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.     

Oral verapamil with chemotherapy for advanced non-small cell lung cancer: a randomised study.

To determine if the chemotherapy resistance of non-small cell lung cancer could be modified by oral verapamil, 72 patients were entered into a randomised trial of verapamil plus chemotherapy vs the same chemotherapy alone. Verapamil 480 mg day-1 was given for 3 days starting 24 h prior to chemotherapy which consisted of bolus vindesine 7 mg followed by ifosfamide/mesna 5 g m-2 over 24 h, followed by mesna alone for a further 8 h. Cycles were repeated every 3 weeks for up to six courses. Sixty-six patients were eligible for tumour response analysis and responses occurred in 41% of those randomised to chemotherapy plus verapamil and in 18% of those randomised to chemotherapy alone (P = 0.057). Median survival from start of treatment was significantly better in the verapamil arm (P = 0.02). Toxicity of the combination of chemotherapy plus verapamil was principally neurological and was manageable. Thus the addition of oral verapamil to vindesine/ifosfamide chemotherapy is feasible and in this study was associated with improved outcome. Further confirmation of these observations is required in non-small cell lung cancer, a tumour characterised by resistance to conventional chemotherapy.     

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.     

Double blind, placebo controlled study of nedocromil sodium in asthma

After a two week baseline, 209 asthmatic children (mean age 10 years, range 6-17) were randomly allocated to receive 4 mg nedocromil sodium (n = 110) or placebo (n = 99) four times daily for 12 weeks in addition to their current treatment. The children completed daily diary cards and visited the clinic at four week intervals. Statistically significant differences in favour of nedocromil sodium were seen for clinician assessment of asthma severity and diary card symptom scores, pulmonary function and inhaled beta 2 bronchodilator use. Total symptom score decreased by 50% from baseline in the nedocromil sodium group and by 9% in the placebo group during the final four weeks. Nedocromil sodium was considered very or moderately effective by 78% of children/parents (placebo 59%) and 73% of clinicians (placebo 50%). Nausea, headache and sleepiness, and dyspnoea led to withdrawal of one child from nedocromil sodium and placebo treatments, respectively. Reports of sore throat and headache were marginally greater with the nedocromil sodium treatment. It is concluded that nedocromil sodium was both effective and safe in the treatment of asthma in children.     

Epidemiology in the pharmaceutical industry: a perspective for infectious diseases

As access to observational data and databases expands so does the need for epidemiologists in industry. As an example, in the U.K. arm of the Department of Epidemiology at GlaxoWellcome Research and Development, the number of PhD-trained epidemiologists increased from zero in 1996 to eight in 1999. Their remit is often broad, including designing and co-ordinating, pharmacoepidemiologic research, studies of risk factors for disease and disease progression and pregnancy registries. Where appropriate, existing data sources, such as research databases, are employed for studies. Otherwise, primary data collection is pursued using standard methodology, for example, cross-sectional, case-control and cohort studies. This paper describes a structure for epidemiologic research in the pharmaceutical industry, the role of the industry epidemiologist and the scope of epidemiological studies. Two examples of observational studies of HSV-2/HIV interactions are given, and implications for research agendas discussed. The pharmaceutical industry is becoming increasingly committed to epidemiological research, and research agendas often involve extensive collaboration with leading external academic and public health groups.