Accessibility of generic services to children with intellectual disability: An evaluation of shared family care

This paper summarises one aspect of an evaluation of the Shared Family Care Service operating in the state of Victoria. The focus of this study is on accessibility of Shared Family Care to children with intellectual disabilities or developmental delay. The study found that children with a range of intellectual and multiple disabilities were being referred to the program and the eligibility and acceptance criteria used within the foster care agencies did not restrict access. Potential restrictions in accessibility of the service were noted in relation to regional/agency differences in sources of referral, and in the perceptions of regional Disability Service staff regarding the circumstances in which this service would be considered by them as an option when out-of-home care was required. However, the major factor found to be restricting access to the service was lack of caregivers for the children being referred. © 1991, Taylor & Francis Group, LLC. All rights reserved

Community integration and parental coping

Habilitation policies based on the principles of integration and normalization have encouraged increasing numbers of people with disabilities to be supported within their own families rather than in segregated accommodation. However, stigmatizing social attitudes and reactions continue to form barriers to the achievement of social integration. This paper describes the results of a two-stage panel design study, in which the stigma of disability was operationalized and explored within the conceptual framework of the stress process, involving ‘stressors’, ‘mediators’ and ‘manifestations’ of stress. Three age cohorts, comprising children, teenagers and adults with intellectual and multiple disabilities were included. Distressing reactions of others were found to persist as stressors over the seven-year duration of the study. Parental stress was associated with ‘controlled affect’, in which parents remain silent in the face of stigmatizing social reactions but feel uncomfortable or angry, and ‘disassociatin’ in which parents move away from the situation as quickly as possible or avoid taking the disabled member to places away from home. Verbal interaction, in which parents explain to people about the disability, was found to be potentially modulating of parental stress. No significant change occurred over the duration of the study either in the stress which parents attributed to social attitudes or in the reactions of others they perceived to be distressing. Implications of these data for community living support service providers are discussed. © 1992 Chapman & Hall

Parental stress attributed to family members with and without disability: A longitudinal study

In this longitudinal study, stress attributed by parents to their family member with intellectual disability was investigated over a period of seven years in relation to specific foci of parental worry, and also in relation to stress attributed to the youngest sibling without a disability. The stress parents attributed to their family member with a disability was about double that attributed to the youngest sibling without a disability. However multiple regression analysis revealed that the stress attributed to the sibling without a disability actually accounted for most of the variance in explaining the stress attributed to the family member with a disability. It is concluded that the stress attributed to any specific child may be an indicator of more general family stress. It was also found that, while the strength of parental worry decreased from time 1 to 2, the pattern of worries did not change over time, and nor did the specific foci of worry differentiate low-stressed from high-stressed parents. It is suggested that the latter result may be due to the inadequacy of the specific foci to cover all sources of parental stress over the duration of the study

A model system for the construction and evaluation of general service plans

The appropriate delivery of service to people with an intellectual disability can be facilitated with the use of General Service Plans (GSPs). However, the guidelines for their construction are inadequate. This paper provides a suggested content for such plans, a protocol for their evaluation, and an assessment of GSPs in Victoria constructed between 1987 and 1990. It is concluded that the suggested evaluation procedures have face validity and are simple to implement. A large number of GSPs were found to have been inadequately prepared. © 1994, Taylor & Francis Group, LLC. All rights reserved

Assessment of mobile health apps using built-in smartphone sensors for diagnosis and treatment: Systematic survey of apps listed in international curated health app libraries

Background: More than a million health and well-being apps are available from the Apple and Google app stores. Some apps use built-in mobile phone sensors to generate health data. Clinicians and patients can find information regarding safe and effective mobile health (mHealth) apps in third party-curated mHealth app libraries. Objective: These independent Web-based repositories guide app selection from trusted lists, but do they offer apps using ubiquitous, low-cost smartphone sensors to improve health? This study aimed to identify the types of built-in mobile phone sensors used in apps listed on curated health app libraries, the range of health conditions these apps address, and the cross-platform availability of the apps. Methods: This systematic survey reviewed three such repositories (National Health Service Apps Library, AppScript, and MyHealthApps), assessing the availability of apps using built-in mobile phone sensors for the diagnosis or treatment of health conditions. Results: A total of 18 such apps were identified and included in this survey, representing 1.1% (8/699) to 3% (2/76) of all apps offered by the respective libraries examined. About one-third (7/18, 39%) of the identified apps offered cross-platform Apple and Android versions, with a further 50% (9/18) only dedicated to Apple and 11% (2/18) to Android. About one-fourth (4/18, 22%) of the identified apps offered dedicated diagnostic functions, with a majority featuring therapeutic (9/18, 50%) or combined functionality (5/18, 28%). Cameras, touch screens, and microphones were the most frequently used built-in sensors. Health concerns addressed by these apps included respiratory, dermatological, neurological, and anxiety conditions. Conclusions: Diligent mHealth app library curation, medical device regulation constraints, and cross-platform differences in mobile phone sensor architectures may all contribute to the observed limited availability of mHealth apps using built-in phone sensors in curated mHealth app libraries. However, more efforts are needed to increase the number of such apps on curated lists, as they offer easily accessible low-cost options to assist people in managing clinical conditions

Assessment of mobile health apps using built-in smartphone sensors for diagnosis and treatment: Systematic survey of apps listed in international curated health app libraries

Background: More than a million health and well-being apps are available from the Apple and Google app stores. Some apps use built-in mobile phone sensors to generate health data. Clinicians and patients can find information regarding safe and effective mobile health (mHealth) apps in third party-curated mHealth app libraries. Objective: These independent Web-based repositories guide app selection from trusted lists, but do they offer apps using ubiquitous, low-cost smartphone sensors to improve health? This study aimed to identify the types of built-in mobile phone sensors used in apps listed on curated health app libraries, the range of health conditions these apps address, and the cross-platform availability of the apps. Methods: This systematic survey reviewed three such repositories (National Health Service Apps Library, AppScript, and MyHealthApps), assessing the availability of apps using built-in mobile phone sensors for the diagnosis or treatment of health conditions. Results: A total of 18 such apps were identified and included in this survey, representing 1.1% (8/699) to 3% (2/76) of all apps offered by the respective libraries examined. About one-third (7/18, 39%) of the identified apps offered cross-platform Apple and Android versions, with a further 50% (9/18) only dedicated to Apple and 11% (2/18) to Android. About one-fourth (4/18, 22%) of the identified apps offered dedicated diagnostic functions, with a majority featuring therapeutic (9/18, 50%) or combined functionality (5/18, 28%). Cameras, touch screens, and microphones were the most frequently used built-in sensors. Health concerns addressed by these apps included respiratory, dermatological, neurological, and anxiety conditions. Conclusions: Diligent mHealth app library curation, medical device regulation constraints, and cross-platform differences in mobile phone sensor architectures may all contribute to the observed limited availability of mHealth apps using built-in phone sensors in curated mHealth app libraries. However, more efforts are needed to increase the number of such apps on curated lists, as they offer easily accessible low-cost options to assist people in managing clinical conditions

A model system for the evaluation of individual program plans

Individual Program Plans are an essential component of quality assurance in service delivery to people with an intellectual disability. This paper describes a system for the evaluation of such plans. One hundred and sixty- three plans were analysed from clients being serviced by 11 Community Living Support Services. While the plans prepared by non-government agencies were generally superior, the average level of plan presentation was poor. Only 14% offered any criterion for evaluating performance objectives, the average number of skill building objectives was less then three per plan, and only 39% of plans were current. It is concluded that if Individual Program Plans are to realize their quality assurance potential, the issues of staff resources, staff training in plan preparation and overall professional accountability will need to be addressed

Effect of vitamin D supplementation on depression in older Australian adults

Objectives: To investigate whether vitamin D supplementation reduces depressive symptoms and incidence of antidepressant use. Methods: We used data from the D-Health Trial (N = 21,315), a randomized double-blind placebo-controlled trial of monthly vitamin D3 for the prevention of all-cause mortality. Participants were Australians aged 60–84 years. Participants completed the Patient Health Questionnaire (PHQ–9) at 1, 2 and 5 years after randomization to measure depressive symptoms; national prescribing records were used to capture antidepressant use. We used mixed models and survival models. Results: Analyses of PHQ-9 scores included 20,487 participants (mean age 69·3 years, 46% women); the mean difference (MD) in PHQ-9 score (vitamin D vs. placebo) was 0·02 (95% CI −0·06, 0·11). There was negligible difference in the prevalence of clinically relevant depression (PHQ-9 score ≥10) (odds ratio 0·99; 95% CI 0·90, 1·08). We included 16,670 participants in the analyses of incident antidepressant use (mean age 69·4 years, 43% women). Incidence of antidepressant use was similar between the groups (hazard ratio [HR] 1·04; 95% CI 0·96, 1·12). In subgroup analyses, vitamin D improved PHQ-9 scores in those taking antidepressants at baseline (MD −0·25; 95% CI −0·49, −0·01; p-interaction = 0·02). It decreased risk of antidepressant use in participants with predicted 25(OH)D concentration <50 nmol/L (HR 0·88; 95% CI 0·75, 1·02; p-interaction = 0·01) and increased risk in those with predicted 25(OH)D ≥ 50 nmol/L (HR 1·10; 95% CI 1·01, 1·20). Conclusion: Monthly supplementation with high-dose vitamin D3 was not of benefit for measures of depression overall, but there was some evidence of benefit in subgroup analyses. Clinical Trial Registration: The trial is registered on the Australian New Zealand Clinical Trials Registry: ACTRN12613000743763. https://www.anzctr.org.au/

The impact of viral mutations on recognition by SARS-CoV-2 specific T cells

We identify amino acid variants within dominant SARS-CoV-2 T cell epitopes by interrogating global sequence data. Several variants within nucleocapsid and ORF3a epitopes have arisen independently in multiple lineages and result in loss of recognition by epitope-specific T cells assessed by IFN-γ and cytotoxic killing assays. Complete loss of T cell responsiveness was seen due to Q213K in the A∗01:01-restricted CD8+ ORF3a epitope FTSDYYQLY207-215; due to P13L, P13S, and P13T in the B∗27:05-restricted CD8+ nucleocapsid epitope QRNAPRITF9-17; and due to T362I and P365S in the A∗03:01/A∗11:01-restricted CD8+ nucleocapsid epitope KTFPPTEPK361-369. CD8+ T cell lines unable to recognize variant epitopes have diverse T cell receptor repertoires. These data demonstrate the potential for T cell evasion and highlight the need for ongoing surveillance for variants capable of escaping T cell as well as humoral immunity

The impact of viral mutations on recognition by SARS-CoV-2 specific T cells

We identify amino acid variants within dominant SARS-CoV-2 T cell epitopes by interrogating global sequence data. Several variants within nucleocapsid and ORF3a epitopes have arisen independently in multiple lineages and result in loss of recognition by epitope-specific T cells assessed by IFN-γ and cytotoxic killing assays. Complete loss of T cell responsiveness was seen due to Q213K in the A∗01:01-restricted CD8+ ORF3a epitope FTSDYYQLY207-215; due to P13L, P13S, and P13T in the B∗27:05-restricted CD8+ nucleocapsid epitope QRNAPRITF9-17; and due to T362I and P365S in the A∗03:01/A∗11:01-restricted CD8+ nucleocapsid epitope KTFPPTEPK361-369. CD8+ T cell lines unable to recognize variant epitopes have diverse T cell receptor repertoires. These data demonstrate the potential for T cell evasion and highlight the need for ongoing surveillance for variants capable of escaping T cell as well as humoral immunity