Trauma?informed care: A qualitative study exploring the views and experiences of professionals in specialist health services for adults with intellectual disabilities

Background: Although, trauma and its sequelae is increasingly recognised as a major morbidity factor in people with intellectual disabilities, there has been a lack of inquiry into how health care professionals address trauma in adults with ID.Aims: This study aimed to explore the perspectives of practitioners in specialist intellectual disability health services involved in the assessment and treatment of adults with intellectual disability regarding the current provision and the necessary developments to address trauma in adults with intellectual disabilities. Methods: Twenty-five face-to-face and telephone qualitative interviews involving practitioners from specialist intellectual disability health services were conducted across 6 different geographical health service areas in the United Kingdom. Data were analysed using thematic content analysis. Findings: Analysis of the data revealed seven central themes: (i) unmasked trauma; (ii) trauma informed care; (iii) person-centred care and support; (iv) multi-disciplinary working; (v) reasonable adjustments; (vi) barriers to treatment and (vii) awareness, training and education.Conclusion and Implications: The study highlighted the need for trauma-informed care and multi-disciplinary working as key features for future service development. It also recognised the urgent need to develop an evidence-base for effective psychological interventions for PTSD in adults with ID in addition to the need for awareness, training and education of health care staff, in order to improve service provision amongst this population group

Towards onset prevention of cognition decline in adults with Down syndrome (The TOP-COG study): A pilot randomised controlled trial.

BACKGROUND: Dementia is very common in Down syndrome (trisomy 21) adults. Statins may slow brain amyloid β (Aβ, coded on chromosome 21) deposition and, therefore, delay Alzheimer disease onset. One prospective cohort study with Down syndrome adults found participants on statins had reduced risk of incident dementia, but there are no randomised controlled trials (RCTs) on this issue. Evidence is sparse on the best instruments to detect longitudinal cognitive decline in older Down syndrome adults. METHODS: TOP-COG was a feasibility/pilot, double-blind RCT of 12 months simvastatin 40 mg versus placebo for the primary prevention of dementia in Alzheimer disease in Down syndrome adults aged 50 years or older. Group allocation was stratified by age, apolipoprotein E (APOE) ε4 allele status, and cholesterol level. Recruitment was from multiple general community sources over 12 months. Adults with dementia, or simvastatin contraindications, were excluded. Main outcomes were recruitment and retention rates. Cognitive decline was measured with a battery of tests; secondary measures were adaptive behaviour skills, general health, and quality of life. Assessments were conducted pre randomisation and at 12 months post randomisation. Blood Aβ40/Aβ42 levels were investigated as a putative biomarker. Results were analysed on an intention-to-treat basis. A qualitative sub-study was conducted and analysed using the Framework Approach to determine recruitment motivators/barriers, and participation experience. RESULTS: We identified 181 (78 %) of the likely eligible Down syndrome population, and recruited 21 (11.6 %), from an area with a general population size of 3,135,974. Recruitment was highly labour-intensive. Thirteen (62 %) participants completed the full year. Results favoured the simvastatin group. The most appropriate cognitive instrument (regarding ease of completion and detecting change over time) was the Memory for Objects test from the Neuropsychological Assessment of Dementia in Individuals with Intellectual Disabilities battery. Cognitive testing appeared more sensitive than proxy-rated adaptive behaviour, quality of life, or general health scores. Aβ40 levels changed less for the simvastatin group (not statistically significant). People mostly declined to participate because of not wanting to take medication, and not knowing if they would receive simvastatin or placebo. Participants reported enjoying taking part. CONCLUSION: A full-scale RCT is feasible. It will need 37 % UK population coverage to recruit the required 160 participants. Information/education about the importance of RCT participation is needed for this population. TRIAL REGISTRATION: ISRCTN67338640 .This study was funded by the Chief Scientist Office, Scottish Government Health Department (reference: CZH/4/626). JS is funded by the NHS Lothian R&D Directorate. The study was supported by Down Syndrome Scotland, and we thank them, and all members of the Trial Steering Committee and Data Management and Ethics Committee.This is the final version of the article. It first appeared from BioMed Central via https://doi.org/10.1186/s13063-016-1370-

A mixed methods, randomised controlled feasibility trial of Eye Movement Desensitisation and Reprocessing (EMDR) plus Standard Care (SC) vs. SC alone for DSM-5 Posttraumatic Stress Disorder (PTSD) in adults with intellectual disabilities (IDs

Objective: To report the results of the first randomised feasibility trial of Eye Movement Desensitisation and Reprocessing (EMDR) plus Standard Care (SC) vs. SC alone for DSM-5 Posttraumatic Stress Disorder (PTSD) in adults with intellectual disabilities (IDs). Method: A total of 29 participants were randomised to either to EMDR + SC (n= 15) or SC (n= 14). Participants completed measures on traumatic stress (PCL-C) and comorbid distress at baseline, 1-week post-treatment and 3-month follow-up. Results: In the EMDR + SC group, 9 (60%) participants at post-treatment and 7 (47%) participants at 3-month follow-up were diagnosis free. In SC, 4 (27%) at post-treatment and follow-up were diagnosis free. At post-treatment 3 participants (20%) dropped out from the EMDR + SC group, and 1 (7%) dropped out from the SC group. Conclusions: It is feasible, acceptable and potentially effective to deliver EMDR in this population group

Towards onset prevention of cognition decline in adults with Down syndrome (The TOP-COG study). Pilot randomised controlled trial.

Background Dementia is very common in Down syndrome (trisomy 21) adults. Statins may slow brain amyloid ß (Aß, coded on chromosome 21) deposition and therefore delay Alzheimer disease onset. One prospective cohort study with Down syndrome adults found participants on statins had reduced risk of incident dementia, but there are no randomised controlled trials (RCTs). Evidence is sparse on the best instruments to detect longitudinal cognitive decline in older Down syndrome adults. Methods TOP-Cog was a feasibility/pilot double-blind RCT of 12 months simvastatin 40mg versus placebo for the primary prevention of dementia in Alzheimer disease in Down syndrome adults aged 50 years or older. Group allocation was stratified by age, apolipoprotein E ε4, and cholesterol level. Recruitment was from multiple general community sources over 12 months. Adults with dementia, or simvastatin contraindications, were excluded. Main outcomes were recruitment and retention rates. Cognitive decline was measured with a battery of tests; secondary measures were adaptive behaviour skills, general health, and quality of life. Assessments were conducted pre-randomisation and 12 months post-randomisation. Blood Aβ40/Aβ42 levels were investigated as a putative biomarker. Results were analysed on an intention-to-treat basis. A qualitative sub-study was conducted and analysed using the Framework approach to determine recruitment motivators/barriers, and participation experience. Results We identified 181 (78%) of the likely eligible Down syndrome population, and recruited 21 (11.6%), from an area with a general population size of 3,135,974. Recruitment was highly labour intensive. Thirteen (62%) completed the full year. Results favoured the simvastatin group. The most appropriate cognitive instrument (regarding ease of completion and detecting change over time) was the Memory for Objects test from the Neuropsychological Assessment of Dementia in Intellectual Disabilities battery. Cognitive testing appeared more sensitive than proxy-rated adaptive behaviour, quality of life, or general health scores. Aβ40 changed less for the simvastatin group (not statistically significant). People mostly declined to participate because of not wanting to take medication, and not knowing if they would receive simvastatin or placebo. Participants reported enjoying taking part. Conclusion A full-scale RCT is feasible. It will need 37% UK population coverage to recruit the required 160 participants. Information/education about the importance of RCT participation is needed for this population.This study was funded by the Chief Scientist Office, Scottish Government Health Department (reference: CZH/4/626). JS is funded by the NHS Lothian R&D Directorate. The study was supported by Down Syndrome Scotland, and we thank them, and all members of the Trial Steering Committee and Data Management and Ethics Committee.This is the final version of the article. It first appeared from BioMed Central via https://doi.org/10.1186/s13063-016-1370-

Bignonia capreolata L.

原著和名: ツリガネカヅラ科名: ノウゼンカズラ科 = Bignoniaceae採集地: 千葉県 船橋市三山2-2-1 東邦大学 (下総 東邦大学)採集日: 1975/5/14採集者: 萩庭丈壽整理番号: JH026893国立科学博物館整理番号: TNS-VS-97689