Improving healthcare for people with learning disabilities, autism or both: A co-produced research project

Study title: Improving healthcare for people with learning disabilities, autism or both: A co-produced research project. Research aims: To identify the barriers and facilitators that people with learning disabilities and/or autism experience in accessing and or using healthcare for their general health. Methods: Group discussions involving 23 people with learning disabilities and / or autism, supported by their carers, were held in January 2019

The tailoring and implementation of evidence-based multi-component weight management interventions for adults with intellectual disabilities who are obese: a whole systems approach

Adults with intellectual disabilities in the UK are more likely to be obese than their non-disabled peers and are at risk of experiencing serious medical conditions such as heart disease, stroke and Type 2 diabetes. UK weight management guidance recommends multi-component weight management interventions, tailored for different population groups. The aim of this thesis was to explore how evidence-based multi-component weight management interventions can be tailored for adults with intellectual disabilities who are obese. The thesis comprised three phases. Phase One included an integrative review of evidence-based multi-component weight management interventions for adults with intellectual disabilities; an exploration of theories used to underpin weight management interventions for this population; and a mapping exercise to investigate the extent of weight management service provision for adults with, and without, intellectual disabilities. The review found emerging evidence to suggest that multi-component weight management interventions can be tailored and are effective for adults with intellectual disabilities. However, the review identified few studies (n=5) and none of the identified studies explored this population’s views and experiences of such interventions. Phase One also found gaps in underpinning theories and insufficient service provision for this population. Phase Two comprised three studies to explore participants’ views and experiences of the barriers and facilitators to weight management for adults with intellectual disabilities. These studies included a qualitative study involving interviews with 14 health care practitioners; a co-produced focus group qualitative study involving 19 adults with intellectual disabilities and 8 of their carers; and a survey involving 19 carers and support workers. Thematic analysis of participants’ responses highlighted their frustrations with several barriers including a lack of accessible healthy lifestyle information, a lack of resources, a lack of reasonable adjustments, inconsistencies in caring support, unmet training needs for carers and support workers, and socio-economic and environmental barriers. Facilitators included the provision of clear and accessible healthy lifestyle information, provision of resources, consistent caring support, reasonable adjustments, and training for carers, support workers and health care practitioners. Phase Three involved a synthesis of findings from Phases One and Two. The overall findings imply that it is inequitable support and barriers associated with complex systems-related issues, rather than poor lifestyle choices or a lack of motivation, which inhibits this population from managing their weight if they want to. A whole systems approach is needed to address the systems-related issues and barriers experienced by this population, rather than a sole reliance on non-evidence-based weight management interventions (such as diet-only or exercise-only interventions) focused primarily on individual behaviour change to achieve short-term weight loss. The thesis has implications for research, policy and practice. It presents a whole systems approach and a logic model outlining the types of systems-related activities needed at several levels to overcome identified barriers and to contribute to reductions in the inequities and inequalities experienced by adults with intellectual disabilities who want to manage their weight

Barriers and facilitators to deprescribing in primary care: a systematic review

Background Managing polypharmacy is a challenge for healthcare systems globally. It is also a health inequality concern as it can expose some of the most vulnerable in society to unnecessary medications and adverse drug-related events. Care for most patients with multimorbidity and polypharmacy occurs in primary care. Safe deprescribing interventions can reduce exposure to inappropriate polypharmacy. However, these are not fully accepted or routinely implemented. Aim To identify barriers and facilitators to safe deprescribing interventions for adults with multimorbidity and polypharmacy in primary care. Design and setting Systematic review of studies published from 2000, examining safe deprescribing interventions for adults with multimorbidity and polypharmacy (PROSPERO: CRD42019121848). Method A search of electronic databases: Medline, Embase, CINHAL, Cochrane and HMIC (26.02.19) using an agreed search strategy; supplemented by handsearching of relevant journals, and screening of reference lists and citations of included studies. Results Forty studies from 14 countries were identified. Cultural and organisational barriers included a culture of diagnosis and prescribing; evidence-based guidance focused on single diseases; a lack of evidence-based guidance for the care of older people with multimorbidities; and a lack of shared communication, decision-making systems, tools and resources. Interpersonal and individual-level barriers included professional etiquette; fragmented care; prescribers’ and patients’ uncertainties; and gaps in tailored support. Facilitators included prudent prescribing; greater availability and acceptability of non-pharmacological alternatives; resources; improved communication, collaboration, knowledge and understanding; patient-centred care; and shared decision-making. Conclusion A whole systems patient-centred approach to safe deprescribing interventions is required, involving key decision-makers, healthcare professionals, patients and carers

Young People’s Attitudes, Perceptions and Experiences of Social Distancing and Self-Isolation During the Second Wave of the COVID-19 Pandemic

Objectives: Social distancing and self-isolation were key parts of the UK’s strategy for reducing the spread of COVID-19. This study explored young people’s attitudes, perceptions and experiences of social distancing and social isolation during the COVID-19 pandemic. Methods: Qualitative individual, family and paired-friendship interviews were conducted. All 26 participants lived or worked in East London and were aged between 20 and 39 years. Results: Qualitative analysis revealed three main themes: 1) trust and breaking of the social distancing and self-isolation rules—trust in their friends to be careful and say if they are unwell; 2) own rule making—making their own household rules which made them less guilty about breaking national rules as they were adhering to rules (albeit their own); and 3) lack of clarity around self isolation and the need for practical support—confusion around length of time needed to self isolate and what self-isolation really meant. Conclusion: Developing more effective and targeted communications and practical support mechanisms to encourage better adherence to social distancing and self-isolation rules among young people will be essential to prevent the spread of COVID-19

Parametric subharmonic instability of the internal tide at 29°N

Author Posting. © American Meteorological Society, 2013. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 43 (2013): 17–28, doi:10.1175/JPO-D-11-0108.1.Observational evidence is presented for transfer of energy from the internal tide to near-inertial motions near 29°N in the Pacific Ocean. The transfer is accomplished via parametric subharmonic instability (PSI), which involves interaction between a primary wave (the internal tide in this case) and two smaller-scale waves of nearly half the frequency. The internal tide at this location is a complex superposition of a low-mode waves propagating north from Hawaii and higher-mode waves generated at local seamounts, making application of PSI theory challenging. Nevertheless, a statistically significant phase locking is documented between the internal tide and upward- and downward-propagating near-inertial waves. The phase between those three waves is consistent with that expected from PSI theory. Calculated energy transfer rates from the tide to near-inertial motions are modest, consistent with local dissipation rate estimates. The conclusion is that while PSI does befall the tide near a critical latitude of 29°N, it does not do so catastrophically.This work was sponsored by NSF OCE 04-25283.2013-07-0

Colonic oncostatin M expression evaluated by immunohistochemistry and infliximab therapy outcome in corticosteroid-refractory acute severe ulcerative colitis

Ulcerative colitis (UC) is a chronic relapsing remitting inflammatory disease of the colon. The lifetime risk of presentation with acute severe ulcerative colitis (ASUC) is 15%.1 Patients with ASUC receive first line therapy with intravenous corticosteroids, however, approximately 30% have corticosteroid-refractory disease.2,3 In this situation, rescue medical therapy options include the anti-tumor necrosis factor (TNF) monoclonal antibody infliximab (IFX) or the calcineurin inhibitor ciclosporin.2 A significant proportion of patients fail to respond to IFX therapy with reported colectomy rates at 1 year of 35%.4 Biomarkers which identify patients with corticosteroid-refractory ASUC, with a reduced likelihood of IFX response, would significantly advance clinical care for these patients

Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review

Background Globally, people with intellectual disabilities, autism, or both, experience health inequalities. Death occurs at a younger age and the prevalence of long-term morbidities is higher than in the general population. Despite this, their primary healthcare access rates are lower, their health needs are often unmet, and their views and experiences are frequently overlooked in research, policy and practice. Aim To investigate the barriers and facilitators reported by individuals with intellectual disabilities, autism or both, and / or their carers, to accessing and utilising primary healthcare for their physical and mental health needs. Design and setting An integrative review utilising systematic review methodology. (PROSPERO: CRD42018103103). Method Electronic databases MEDLINE, Embase, CINAHL and Cochrane were searched for relevant studies (all languages) using a search strategy. Two researchers independently screened the results and assessed the quality of studies. Results Sixty-three international studies were identified. Six main themes relating to barriers and facilitators emerged from an analysis of these studies. The themes included training; knowledge and awareness; communication; fear and embarrassment; involvement in healthcare decision-making; and time. All the themes were underpinned by the need for greater care, dignity, respect, collaborative relationships and the need for reasonable adjustments. Opposing barriers and facilitators were identified within each of the main themes. Conclusions Adolescents and adults with intellectual disabilities, autism, or both, experience several barriers to accessing and utilising primary healthcare. The findings highlight the reasonable adjustments and facilitators that can be implemented to ensure that these individuals are not excluded from primary healthcare. How this fits in? This review synthesises evidence on the barriers and facilitators to accessing and utilising primary healthcare perceived by people with intellectual disabilities, autism or both. The findings highlight important considerations for primary healthcare policy, practice and further research