Voices from the past: early institutional experience of children with disabilities - the case of Scotland

In Scotland, public interest in children with disabilities followed an uneven path. The proponents for such interest included workers in medicine, education and training, public administration, law and order, religion and moral rectitude, philanthropy and charity. Their foci of attention were similarly divers. Initial attention towards children with ‘disabilities’ was directed towards those with sensory impairments. This was followed by provision for children with mental disabilities. Until the introduction of compulsory education in 1872, philanthropists and charities were largely unaware of children with physical impairments. The Scottish experience was distinctive from the rest of the United Kingdom because of its own legal system, and was set against a background of heavy industrialization accompanied by poverty and bad housing. Legislation in such areas as poor law reform and education was not introduced simultaneously to that for England and Wales. The Church of Scotland maintained a strong influence in local government, through the network of clearly defined parishes, despite the secularization that was intent in such legislation as the Poor Law (Scotland) Act of 1843. The influence of Presbyterian clergymen and church elders committed to strongly held ideals of religious belief, respectability and self-help is often apparent in the institutions established for children with disabilities. The following research makes use of archival sources on institutions receiving, accommodating and caring for children with disabilities, supplemented by some contemporary narrative and oral testimony. While the archival sources show that the attention paid to children with disabilities did not develop simultaneously for categories of impairment broadly grouped as sensory, mental and physical, they also indicate that the responses to different forms of disablement followed diverse approaches and objectives

Investigation of SARS-CoV-2 faecal shedding in the community: a prospective household cohort study (COVID-LIV) in the UK

Background SARS-CoV-2 is frequently shed in the stool of patients hospitalised with COVID-19. The extent of faecal shedding of SARS-CoV-2 among individuals in the community, and its potential to contribute to spread of disease, is unknown. Methods In this prospective, observational cohort study among households in Liverpool, UK, participants underwent weekly nasal/throat swabbing to detect SARS-CoV-2 virus, over a 12-week period from enrolment starting July 2020. Participants that tested positive for SARS-CoV-2 were asked to provide a stool sample three and 14 days later. In addition, in October and November 2020, during a period of high community transmission, stool sampling was undertaken to determine the prevalence of SARS-CoV-2 faecal shedding among all study participants. SARS-CoV-2 RNA was detected using Real-Time PCR. Results A total of 434 participants from 176 households were enrolled. Eighteen participants (4.2%: 95% confidence interval [CI] 2.5–6.5%) tested positive for SARS-CoV-2 virus on nasal/throat swabs and of these, 3/17 (18%: 95% CI 4–43%) had SARS-CoV-2 detected in stool. Two of three participants demonstrated ongoing faecal shedding of SARS-CoV-2, without gastrointestinal symptoms, after testing negative for SARS-CoV-2 in respiratory samples. Among 165/434 participants without SARS-CoV-2 infection and who took part in the prevalence study, none had SARS-CoV-2 in stool. There was no demonstrable household transmission of SARS-CoV-2 among households containing a participant with faecal shedding. Conclusions Faecal shedding of SARS-CoV-2 occurred among community participants with confirmed SARS-CoV-2 infection. However, during a period of high community transmission, faecal shedding of SARS-CoV-2 was not detected among participants without SARS-CoV-2 infection. It is unlikely that the faecal-oral route plays a significant role in household and community transmission of SARS-CoV-2

Psychiatric disorders in pregnancy and the postpartum : principles and treatment/ Edit.: Victoria Hendrick

xii, p. 241: ill.; 25 c

Relapse of Major Depression During Pregnancy in Women Who Maintain or Discontinue Antidepressant Treatment

Nongravid individuals are known to be at high risk of having a relapse of depression if antidepressant therapy is discontinued. Pregnant women presumably are also at risk, despite the long held view of pregnancy as somehow protecting against psychiatric illness. This prospective study compared the risk of relapse in pregnant women who maintained or discontinued antidepressive drug treatment. The participants were 201 pregnant women cared for at centers expert in managing psychiatric disorders during pregnancy. All of them had a history of major depression before pregnancy, were at less than 16 weeks gestation, and had been euthymic for at least 3 months before the last menses. The women were currently receiving antidepressant therapy or had received it within 12 weeks before the last menstrual period.Participants were assessed using the Hamilton Rating Scale for Depression (HAM-D), the Structured Clinical Interview mood module for depression, and the Clinical Global Impressions Scale. The mean age at the first episode of depression was 19 years and the mean duration of depression exceeded 15 years. Just over half the participants had a current or past history of comorbid psychiatric illness—most often anxiety and eating disorders—and 44% reported 5 or more prior recurrent depressive episodes. More than 90% of women were receiving antidepressant therapy at baseline, most often with a selective serotonin reuptake inhibitor or a dual-action antidepressant.Relapse occurred in 68% of women who discontinued their antidepressant medication and in 26% who remained on treatment. Half of all relapses occurred in the first trimester and 90% by the end of the second trimester. The risk of relapse was 45% for women who increased their medication (most likely in response to increasing symptoms indicating impending relapse) and 35% for those who decreased it. Mean HAM-D scores were 23.7 and 20.8, respectively, for those who discontinued or maintained their medication. There were no suicide attempts during the study. The time to relapse was shorter in women who increased or stopped medication than in those who maintained or decreased treatment; 60% of women who discontinued their medication at the beginning of pregnancy restarted it.After adjusting for several possibly confounding factors, women who stopped treatment had a 5-fold increase in the risk of relapsing during pregnancy compared with those who maintained their medication. Women who reintroduced their medication after stopping it had a lesser risk of relapse, although they remained more vulnerable than those who did not alter their medication. The risk of relapse during pregnancy was increased in women who had been ill for longer than 5 years and in those having more than 4 episodes of recurrent depression.These findings suggest that pregnancy does not protect against a relapse of major depression. Affected women should be made aware of the risk of discontinuing their antidepressant medication during pregnancy