Abilities, disabilities and possibilities: a qualitative study exploring the academic and social experiences of gifted and talented students who have co-occurring learning disabilities

It is estimated that 1-2.5% of the UK school population are gifted and talented students who have co-occurring learning disabilities (National Association for Gifted Children, 2001). Many authors have published recommendations for helping to support this unique group. However, far fewer have supported these with empirical research. The current study used 1:1 interviews with secondary school and university students (N=18) to explore their academic and social experiences. As well as being identified as gifted and talented, the students also had a diagnosis of dyslexia, dyspraxia or Autism Spectrum Disorder (ASD). A semi-structured interview schedule was used to ask students about their extra-curricular activities, friendships, bullying, support and future ambitions. Interpretative Phenomenological Analysis of interview transcripts revealed eight themes: everyday life, extra activities, social development, support, identification, underachievement, mental health issues and suggestions. Students were capable of making friends and mixing with peers but experienced problems with bullying and social isolation. Teachers, mentors, family and technology were found to be helpful, however, support could be inconsistent and parents themselves may benefit from support groups. Finally, some commonly used strategies to help these students were collated and could be useful to help others who share the same or similar experiences

La enfermedad mental en el anciano: representaciones sociales de los estudiantes de medicina em el Reino Unido

Objectivo O estudo propõe investigar as representações sociais de estudantes de medicina sobre a doença mental entre idosos. Método a pesquisa qualitativa e exploratória foi baseada na teoria das representações sociais. Os principais métodos utilizados foram dois grupos focais com estudantes pré-clínicos (grupo 1, N=4; grupo 2, N=4) e dez entrevistas individuais com estudantes em prática clínica. A análise temática explorou os significados e diferenças entre os grupos. Resultados Três principais temas refletem as representações dos participantes sobre a doença mental na velhice: doença mental na velhice, polarização do cuidado, desafios ao cuidado. A atenção primária à saúde constitui uma estratégia importante para ultrapassar barreiras ao cuidado em saúde mental na comunidade. Contudo, crenças depreciativas, estigma e organização de serviços se apresentam como os principais desafios. Conclusão Esse estudo aponta para a necessidade de profissionais de saúde responderem aos desafios culturais e organizacionais ao cuidado em saúde mental do idoso.Este estudio tiene como propósito explorar la representaciones sociales de los estudiantes de medicina acerca de las enfermedades mentales en adultos en edad madura. Objective Present and analyze the case of an adolescent who is addicted to drugs, pregnant and the victim of lifelong domestic violence. Method Abarca una investigación exploratoria y cualitativa basada en la teoría de representaciones sociales. Se realizan entrevistas a dos grupos de interés, médicos pre-clínica (grupo 1, N=4, grupo 2, N=4) así como 10 entrevistas individuales a estudiantes de medicina clínica. Results Tres temas generales reflejan las representaciones de los participantes sobre los problemas mentales en el futuro - enfermedades mentales a edades avanzadas, polarización de la atención, y desafíos de la atención. La atención primaria en salud aparece como una estrategia importante para hacer frente a los obstáculos a la atención de la salud mental en la comunidad. No obstante, representacionces descalificadoras, estigmas y la organización de servicios constitutyen los retos principales al cuidado de la salud mental en la madurez. Conclusion Este artículo destaca la necesidad de hacer frente a los obstáculos culturales y organizativos para promover la calidad en la atención.Objective This study aims to explore medical students’ social representations of mental ill health in older adults. Method It comprises an exploratory and qualitative investigation based on the theory of social representations. Two focus groups with pre-clinical medics (group 1, N=4; group 2, N=4) and 10 individual interviews with clinical medical students were conducted. Thematic analysis at a latent level explored meanings and differences between groups. Results Three overarching themes reflect participants’ representations of mental health problems in later life – mental ill health in old age, polarisation of care, and challenges to care. Primary health care appears as an important strategy to overcome barriers to mental health care in the community. Nevertheless, disqualifying representations, stigma and organization of services constitute the main challenges to quality mental health care in later life. Conclusion This paper highlights the need to address cultural and organizational barriers to promote quality care

"A woman's life is tension": A gendered analysis of women's distress in poor urban India.

The mental health of women living in poverty is a growing public health concern, particularly in India where the burden of illness is compounded by critical shortages in mental health providers and fragmented services. This was an exploratory study which sought to examine low-income women's perceptions of mental illness and its management in the context of urban poverty in India. This research was prompted by the lack of empirical studies documenting how women in marginalized sections of society understand mental illness. Data were collected through a combination of 10 focus group discussions and two individual interviews with a total of 63 women residing in low-income areas of Mumbai. Social representations theory was used to explore shared meanings of mental illness among women in this setting. Thematic analysis of the data showed that women use the expression "tension" to talk about mental illness. Tension was described both as an ordinary part of life and a condition having its origins in more profound gender-related stressors, particularly pressures surrounding motherhood, chronic poverty and domestic conflict. Approaches to managing tension were pluralistic and focused on the resumption of social roles. Findings are consistent with other studies in similar cultural contexts, suggesting a shared, transnational character to women's distress and the need for scholarship on women's mental health in low-income settings to be more attuned to gendered forms of marginalization

What We Mean When We Talk About Adherence In Respiratory Medicine

The Respiratory Effectiveness Group (REG; www.effectivenessevaluation.org) supported the Expert Adherence Panel Meeting at which many of the concepts presented in this paper were first discussed. REG also supported the manuscript submission costs. ALD, EvG, and MdB have received funding from the European Community's 7th Framework (FP7/2007-2013) under grant agreement no. 282593. Teva supported the meeting costs at which the concepts in this paper were discussed by the co-authors and the open access publication fee for this article. The authors had full editorial control over the ideas presented.Peer reviewedPublisher PD

“…I’ve said I wish I was dead, you’d be better off without me”: a systematic review of people’s experiences of living with severe asthma

Objective: Our aim was to conduct a systematic review and synthesis of qualitative evidence exploring the lived experience of adults with severe asthma. Data sources: We searched MEDLINE via OvidSP, PsycINFO via OvidSP, PubMed, CINAHL, EMBASE, Sociological Abstracts, Google Scholar, the journals Qualitative Health Research and Qualitative Research, and a study of experiences of living with asthma by the Health Experiences Research group. Study selections: Studies were included if they used qualitative methods and explored the subjective experiences of adults (≥18 years) with a clear diagnosis of severe asthma. Results: From 575 identified studies, five met the inclusion criteria. Synthesis revealed an overarching theme of efforts that people living with severe asthma engage in to achieve personal control over their condition. Individuals ‘strive for autonomy’ through dealing with symptoms and treatment, acquiring knowledge, making decisions and reclaiming identity. Conclusion: This systematic review found a paucity of qualitative studies reporting on people's perspectives of living with severe asthma, and a focus on clinical rather than personal issues. Our synthesis reveals that severe asthma was disempowering, and a threat to identity and life roles. What was important to people living with severe asthma was striving to achieve a greater level of personal control over their condition, but these efforts received little support from their healthcare providers. Thus, more attention should be paid to understanding the self-management strategies and personal goals of people living with severe asthma. This may assist in designing interventions to better support patient self-management and improve health outcomes

Barriers and Facilitators of Conducting Medication Reviews in Nursing Home Residents:A Qualitative Study

Objectives: Inappropriate medication prescribing is a recognized clinical problem in nursing home residents of whom many have polypharmacy. However, results about the effectiveness of medication reviews targeted at improving prescribing and deprescribing have been equivocal. We therefore examined barriers and facilitators of conducting medication reviews. Method: We purposively sampled medication reviews to capture salient barriers and facilitators of conducting medication reviews both in nursing home care units for dementia and disabling conditions. We held semi-structured interviews about consecutive steps of medication reviews. Interviews were transcribed verbatim and analyzed with the "method of constant comparison." Results: Six nursing home residents/relatives of nursing home residents, 8 elder care physicians, 5 pharmacists, and 10 nurses took part in the semi-structured interviews. We observed four overarching themes of barriers and facilitators: "realizing fidelity of the patient perspective (theme 1)," "level of comprehensiveness of medication reviews (theme 2)," "inclinations of healthcare providers (theme 3)," and "inter-professional collaboration and alliances (theme 4)." Theme 1 "realizing fidelity of the patient perspective" referred to the observation that assessing the patient perspective was a delicate balance between the value and the impediments of a proper assessment of the patient perspective. Theme 2 "level of comprehensiveness of medication reviews" reflected the struggle of practitioners to find an optimum between medication reviews being both comprehensive and feasible. Theme 3 "inclinations of healthcare providers" concerned setting intervention targets that were complementary to the practices of physicians and keeping the pharmacist blind to the patient perspective as a countermeasure to physicians' inclinations. Finally, theme 4 "inter-professional collaboration and alliances" highlighted mutual support and inter-professional collaboration to strengthen healthcare practitioners' contributions. Discussion: These themes of barriers and facilitators emphasize the need to improve meta-communication during the medication review process. This pertains to the need for healthcare providers to appraise the fidelity of the patient perspective in a dialogue with residents/relatives. Furthermore, discourse between healthcare practitioners is needed beforehand about the level of comprehensiveness intervention targets, and inter-professional collaboration

Factors associated with medication adherence in school-aged children with asthma

Adherence to preventive asthma treatment is poor, particularly in children, yet the factors associated with adherence in this age group are not well understood. Adherence was monitored electronically over 6 months in school-aged children who attended a regional emergency department in New Zealand for an asthma exacerbation and were prescribed twice-daily inhaled corticosteroids. Participants completed questionnaires including assessment of family demographics, asthma responsibility and learning style. Multivariable analysis of factors associated with adherence was conducted. 101 children (mean (range) age 8.9 (6–15) years, 51% male) participated. Median (interquartile range) preventer adherence was 30% (17–48%) of prescribed. Four explanatory factors were identified: female sex (+12% adherence), Asian ethnicity (+19% adherence), living in a smaller household (−3.0% adherence per person in the household), and younger age at diagnosis (+2.7% for every younger year of diagnosis) (all p<0.02). In school-aged children attending the emergency department for asthma, males and non-Asian ethnic groups were at high risk for poor inhaled corticosteroid adherence and may benefit most from intervention. Four factors explained a small proportion of adherence behaviour indicating the difficulty in identifying adherence barriers. Further research is recommended in other similar populations

Point OutWords: protocol for a feasibility randomised controlled trial of a motor skills intervention to promote communicative development in non-verbal children with autism

Abstract: Background: Point OutWords is a caregiver-delivered, iPad-assisted intervention for non-verbal or minimally verbal children with autism. It aims to develop prerequisite skills for communication such as manual and oral motor skills, sequencing, and symbolic representation. This feasibility trial aims to determine the viability of evaluating the clinical efficacy of Point OutWords. Methodology: We aim to recruit 46 non-verbal or minimally verbal children with autism and their families, approximately 23 per arm. Children in the intervention group will use Point OutWords for half an hour, five times a week, for 8 weeks. Children in the control group will have equal caregiver-led contact time with the iPad using a selection of control apps (e.g. sensory apps, drawing apps). Communication, motor, and daily living skills are assessed at baseline and post-intervention. Parents will keep diaries during the intervention period and will take part in focus groups when the intervention is completed. Discussion: Point OutWords was developed in collaboration with children with autism and their caregivers, to provide an intervention for a subgroup of autism that has been historically underserved. As autism is a heterogeneous condition, it is unlikely that one style of intervention will address all aspects of its symptomatology; the motor skills approach of Point OutWords can complement other therapies that address core autistic symptoms of social cognition and communication more directly. The current feasibility trial can inform the selection of outcome measures and design for future full-scale randomised controlled trials of Point OutWords and of other early interventions in autism. Trial registration: ISRCTN, ISRCTN12808402. Prospectively registered on 12 March 2019