Desinstitucionalización y vida en la comunidad. Declaración del Grupo de Investigación sobre Política y Práctica Comparativas, de la Asociación Internacional para el Estudio Científico de las Discapacidades Intelectuales (IASSID)

Los servicios sociales comunitarios para personas con discapacidad garantizan una mayor calidad de vida que los centros residenciales, y no son más costosos. Éstas son las principales conclusiones de un análisis que ha recibido el respaldo de la Asociación Internacional para el Estudio Científico de las Discapacidades Intelectuales (IASSID), que examina –a partir de artículos de síntesis– la literatura científica que compara la eficacia de los servicios comunitarios frente a los grandes centros residenciales en lo que al bienestar de las personas con discapacidad se refiere. Y el resultado no deja lugar a dudas: “una y otra vez, los estudios han mostrado que los servicios comunitarios son superiores a las instituciones”. Cuando lo que se compara son distintas modalidades de servicios comunitarios (hogares de grupo de gran tamaño, hogares de grupo de pequeño tamaño, fórmulas de vida independiente o semiindependiente), se encuentran pocas diferencias entre la vida independiente y los hogares de grupo más pequeños. Dada la relativa amplitud del corpus de investigaciones manejado, es lógico que se observen ciertas variaciones en las conclusiones de los estudios. Los autores del documento consideran que tres factores podrían explicar tales disparidades: las propias características de los residentes, el diseño de los servicios y la competencia del personal que los atiende

Adverse Fetal and Neonatal Outcomes Associated with a Life-Long High Fat Diet: Role of Altered Development of the Placental Vasculature

Maternal obesity results in a number of obstetrical and fetal complications with both immediate and long-term consequences. The increased prevalence of obesity has resulted in increasing numbers of women of reproductive age in this high-risk group. Since many of these obese women have been subjected to hypercaloric diets from early childhood we have developed a rodent model of life-long maternal obesity to more clearly understand the mechanisms that contribute to adverse pregnancy outcomes in obese women. Female Sprague Dawley rats were fed a control diet (CON - 16% of calories from fat) or high fat diet (HF - 45% of calories from fat) from 3 to 19 weeks of age. Prior to pregnancy HF-fed dams exhibited significant increases in body fat, serum leptin and triglycerides. A subset of dams was sacrificed at gestational day 15 to evaluate fetal and placental development. The remaining animals were allowed to deliver normally. HF-fed dams exhibited a more than 3-fold increase in fetal death and decreased neonatal survival. These outcomes were associated with altered vascular development in the placenta, as well as increased hypoxia in the labyrinth. We propose that the altered placental vasculature may result in reduced oxygenation of the fetal tissues contributing to premature demise and poor neonatal survival

The evaluation of a continuing professional development package for primary care dentists designed to reduce stress, build resilience and improve clinical decision-making

Introduction: Stress and burnout are widely accepted as a problem for primary care dental practitioners. Previous programmes to address this issue have met with some success. Burnout is associated with poor coping skills and emotion regulation, and increased rates of clinical errors. Anxiety is associated with poor decision-making and is thought to be associated with poor clinical decision-making. Attempts to improve decision-making use increasing meta-awareness and review of thinking processes. Bibliotherapy is an effective method of delivering cognitive behavioural therapy as self-help or guided self-help (with some therapist input) formats. Objective: To evaluate the efficacy of a specially designed CPD package which was designed to improve coping skills, build resilience and reduce the impact of anxiety on dentists’ clinical decision-making. Design: A multi-centred quasi-experiment Setting: Lincolnshire and Nottinghamshire (England) 2014 Materials and methods: Thirty-five volunteer primary care dentists used two versions (self-help [SH] and guided self-help [GSH], which included a 3 hour workshop) of a specially written cognitive-behavioural-therapy bibliotherapy programme designed to improve well-being and decision-making. Main Outcome Measures: The main outcome measures were dentists’ burnout, depression, anxiety, stress and decision-making style. Data were also collected on use and evaluation of the programme. Results: At 6 weeks there was a clinically and statistically significant reduction in depression, anxiety and stress levels, a statistically significant reduction in burnout (emotional exhaustion) and hypervigilant decision-making and an increase in personal achievement (burnout). The improvements in depression, stress, emotional exhaustion and hypervigilant decision-making were maintained at 6 months. Dentists were overwhelmingly positive in their evaluation of the project and used most of its contents. Conclusion: With the caveat of small numbers and the lack of a no-treatment control, this project demonstrated that a self-help package can be highly acceptable to dentists and, in the short-to-medium term, improve dentists’ well-being and decision-making with implications for patient safety

The US Program in Ground-Based Gravitational Wave Science: Contribution from the LIGO Laboratory

Recent gravitational-wave observations from the LIGO and Virgo observatories have brought a sense of great excitement to scientists and citizens the world over. Since September 2015,10 binary black hole coalescences and one binary neutron star coalescence have been observed. They have provided remarkable, revolutionary insight into the "gravitational Universe" and have greatly extended the field of multi-messenger astronomy. At present, Advanced LIGO can see binary black hole coalescences out to redshift 0.6 and binary neutron star coalescences to redshift 0.05. This probes only a very small fraction of the volume of the observable Universe. However, current technologies can be extended to construct "3rd Generation" (3G) gravitational-wave observatories that would extend our reach to the very edge of the observable Universe. The event rates over such a large volume would be in the hundreds of thousands per year (i.e. tens per hour). Such 3G detectors would have a 10-fold improvement in strain sensitivity over the current generation of instruments, yielding signal-to-noise ratios of 1000 for events like those already seen. Several concepts are being studied for which engineering studies and reliable cost estimates will be developed in the next 5 years

Structured observational research in services for people with learning disabilities

This review focuses on structured observational research, primarily in services for people with learning disabilities. Observational research is particularly useful where people using services are unable to answer interviews or questionnaires about their experiences, and where proxy respondents may not be sufficiently accurate sources of data. The review illustrates the use of observational data in assessing and improving the quality of services. Using examples from the research literature, the review deals with the question of what to observe and how to define it so that the information gathered is valid and reliable. It deals with sampling (how often to observe and for how long) in order to obtain representative information, considers the practical steps that have to be taken in order to make observations in services, and shows how to analyse and present observational data

Dispersed or clustered housing for adults with intellectual disabilities: a systematic review

Purpose of the reviewThe purpose of this review was (i) to find and summarise all the available research evidence on the quality and costs of dispersed community-based housing when compared with clustered housing, (ii) to assess the strength of the research and identify gaps in the evidence and (iii) to interpret the research to outline the benefits and drawbacks of each model.Studies reviewedThis review found 19 papers based on 10 studies presenting data comparing dispersed housing with some kind of clustered housing (village communities, residential campuses or clusters of houses). This is a sizeable body of research reporting the experience of nearly 2,500 people from four different countries. The studies covered all eight domains of quality of life, providing information on about 80 different aspects of these domains. Five studies included data on different aspects of service design and operation and three presented comparative costs. Almost all of the studies used quantitative methods with robust approaches to measurement. All studies focused on people with intellectual disabilities.ResultsDispersed housing has been found to be superior to clustered settings in at least some aspects of every outcomes than dispersed housing for people with intellectual disabilities. In terms of the quality of life domains of social inclusion, material well-being, self-determination, personal development and rights there are no studies reporting benefits of clustered settings. In the physical well-being domain, clustered settings have been found to be superior in hours of recreational activity, contact with dentists, psychiatrists and psychologists, some health screening, some aspects of safety, contact with family and friends, visitors to the home and satisfaction with relationships.However, in many of these cases the better results refer only to village communities and not to campus housing or clustered housing. These serve a minority of the less disabled population and they depend on a supply of people willing to live communally with disabled residents. They are therefore an important part of the spectrum of service provision but they are only ever likely to occupy a niche in the market for care. They are unlikely to be a feasible option across the board for disabled people.In terms of costs, the commonest finding is that clustered housing is less expensive than dispersed housing. However, this cost difference appears to be due to differences in staffing levels – i.e. fewer staff are provided to support people in clustered housing than in dispersed housing. In two of the three studies which examined costs controlling for this variable there was no statistically significant difference – in one case between specialised campus and specialised dispersed housing and in the other between samples matched for client characteristics.ConclusionThere is much less evidence comparing clustered settings with dispersed housing than comparing other congregate care settings (such as institutions) with dispersed housing. The results should therefore be treated with caution. They do, however, present a broadly consistent picture