The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study

SummaryBackgroundThe Confidential Inquiry into premature deaths of people with intellectual disabilities in England was commissioned to provide evidence about contributory factors to avoidable and premature deaths in this population.MethodsThe population-based Confidential Inquiry reviewed the deaths of people with intellectual disabilities aged 4 years and older who had been registered with a general practitioner in one of five Primary Care Trust areas of southwest England, who died between June 1, 2010, and May 31, 2012. A network of health, social-care, and voluntary-sector services; community contacts; and statutory agencies notified the Confidential Inquiry of all deaths of people with intellectual disabilities and provided core data. The Office for National Statistics provided data about the coding of individual cause of death certificates. Deaths were described as avoidable (preventable or amenable), according to Office for National Statistics definitions. Contributory factors to deaths were identified and quantified by the case investigator, verified by a local review panel meeting, and agreed by the Confidential Inquiry overview panel. Contributory factors were grouped into four domains: intrinsic to the individual, within the family and environment, care provision, and service provision. The deaths of a comparator group of people without intellectual disabilities but much the same in age, sex, and cause of death and registered at the same general practices as those with intellectual disabilities were also investigated.FindingsThe Confidential Inquiry reviewed the deaths of 247 people with intellectual disabilities. Nearly a quarter (22%, 54) of people with intellectual disabilities were younger than 50 years when they died, and the median age at death was 64 years (IQR 52–75). The median age at death of male individuals with intellectual disabilities was 65 years (IQR 54–76), 13 years younger than the median age at death of male individuals in the general population of England and Wales (78 years). The median age at death of female individuals with intellectual disabilities was 63 years (IQR 54–75), 20 years younger than the median age at death for female individuals in the general population (83 years). Avoidable deaths from causes amenable to change by good quality health care were more common in people with intellectual disabilities (37%, 90 of 244) than in the general population of England and Wales (13%). Contributory factors to premature deaths in a subset of people with intellectual disabilities compared with a comparator group of people without intellectual disabilities included problems in advanced care planning (p=0·0003), adherence to the Mental Capacity Act (p=0·0008), living in inappropriate accommodation (p<0·0001), adjusting care as needs changed (p=0·009), and carers not feeling listened to (p=0·006).InterpretationThe Confidential Inquiry provides evidence of the substantial contribution of factors relating to the provision of care and health services to the health disparities between people with and without intellectual disabilities. It is imperative to examine care and service provision for this population as potentially contributory factors to their deaths—factors that can largely be ameliorated.FundingDepartment of Health for England

Protective socks for people with diabetes: a systematic review and narrative analysis

Padded socks to protect the at-risk diabetic foot have been available for a number of years. However, the evidence base to support their use is not well known. We aimed to undertake a systematic review of padded socks for people with diabetes. Additionally, a narrative analysis of knitted stitch structures, yarn and fibres used together with the proposed benefits fibre properties may add to the sock. Assessment of the methodological quality was undertaken using a quality tool to assess non-randomised trials. From the 81 articles identified only seven met the inclusion criteria. The evidence to support to use of padded socks is limited. There is a suggestion these simple-to-use interventions could be of value, particularly in terms of plantar pressure reduction. However, the range of methods used and limited methodological quality limits direct comparison between studies. The socks were generally of a sophisticated design with complex use of knit patterns and yarn content. This systematic review provides limited support for the use of padded socks in the diabetic population to protect vulnerable feet. More high quality studies are needed; including qualitative components of sock wear and sock design, prospective randomized controlled trials and analysis of the cost-effectiveness of protective socks as a non-surgical intervention

Climbing to New Heights: Lessons From Mount Everest on PCI and TDI Convergence

This paper applies attitude theory to assess the influence of beliefs and evaluations of Nepal with desired linkages and travel intentions. The main contribution is to connect TDI and PCI research by testing a general country image model in a tourism context. Attitude theory acts as the connection between the two fields

Healthy living and cancer: evidence from UK Biobank.

CONTEXT: UK Biobank is a prospective study of half a million subjects, almost all aged 40-69 years, identified in 22 centres across the UK during 2006-2010. OBJECTIVE: A healthy lifestyle has been described as 'better than any pill, and no side effects [5]. We therefore examined the relationships between healthy behaviours: low alcohol intake, non-smoking, healthy BMI, physical activity and a healthy diet, and the risk of all cancers, colon, breast and prostate cancers in a large dataset. METHOD: Data on lifestyle behaviours were provided by 343,150 subjects, and height and weight were measured at recruitment. 14,285 subjects were diagnosed with cancer during a median of 5.1 years of follow-up. RESULTS: Compared with subjects who followed none or a single healthy behaviour, a healthy lifestyle based on all five behaviours was associated with a reduction of about one-third in incident cancer (hazard ratio [HR] 0.68; 95% confidence intervals [CI] 0.63-0.74). Colorectal cancer was reduced in subjects following the five behaviours by about one-quarter (HR 0.75; 95% CI 0.58-0.97), and breast cancer by about one-third (HR 0.65; 95% CI 0.52-0.83). The association between a healthy lifestyle and prostate cancer suggested a significant increase in risk, but this can be attributed to bias consequent on inequalities in the uptake of the prostate specific antigen screening test. CONCLUSIONS: Taken together with reported reductions in diabetes, vascular disease and dementia, it is clearly important that every effort is taken to promote healthy lifestyles throughout the population, and it is pointed out that cancer and other screening clinics afford 'teachable moments' for the promotion of a healthy lifestyle

THE EXPANDED CITY - STAGE TWO

For 10 years In Certain Places has focused on and shaped developments within the city centre of Preston. The Expanded City is a three-stage programme of artistic research, interventions and events, designed to inform a series of planned infrastructure projects on the outskirts of Preston. Part of Preston’s ‘City Deal’ – a central government initiative which aims to encourage economic growth by addressing strategic infrastructure challenges – the scheme includes the creation of over 17,000 houses as well as new roads and amenities. In the first stage of The Expanded City project (2015-2016) commissioned artists Olivia Keith, Gavin Renshaw, Emily Speed and duo Ian Nesbitt and Ruth Levene investigated the physical and cultural topography of the outskirts of Preston, ‘deep mapping’ the areas marked for growth. The artists share an interest in boundaries, routes, edges and the urban/rural binary, and work across a range of media, including film, photography and performance. This second phase running from 2017 until 2018 was a continuation of the artists' active research and saw the project expand with a series of Network events which brought external perspectives from experts and local communities directly into the development of the artists’ work. These included; Ruth Levene and Ian Nesbitt's 'Precarious Landscape Bus Tour' with archaeologist Bob Johnston; Gavin Renshaw's 'Routes in, Routes Out' in conversation event with cycling journalist Jack Thurston; Olivia Keith two week residency at the Final Whistle Cafe in Cottam culminating in a workshop 'Traces of Place'; Emily Speed's in conversation event with architect Lee Ivett on the topic of playspace 'What do we need in a Space for Play?'; and Lauren Velvick's 'Open House' event, an informal evening of music and discussion about the politics and practicalities of housing, leading to the creation of an 'Open House' publication. The second phase featured the 'Lie of the Land' symposium, a day of artworks, presentations and conversations, which drew on research undertaken by the artists to explore how our everyday lives are shaped by the ownership, management and development of land. The symposium featured talks by Peter Hetherington – journalist and author of the book 'Whose Land is Our Land: The use and abuse of Britain’s forgotten acres', and Julia Heslop – a Newcastle-based artist whose self-build housing project, 'Protohome' (2016), examined participatory alternatives to mainstream housing provision. The event also included a bus tour to sites in and around Preston, during which The Expanded City artists presented their research into issues of housing, cycling infrastructure and the changing landscape. The symposium was accompanied by 'The Expanded City Map' created by artist Claire Tindale. The map geographically locates and gives details of the main research insights generated through the projects by the commissioned artists This phase saw the finalisation by The Decorators of two pieces emerging from their research the 'Learning from Preston' report and the 'Garstang Road Stories' audio artwork. (https://podtail.com/en/podcast/the-decorators-on-air/garstang-road-stories/) Ruth Levene and Ian Nesbitt's research culminated in May 2018 with them curating 'Notes from a Precarious Landscape' – a community exhibition curated by in a vacant house in a new development in Cottam, North Preston, which included contributions from residents of Preston and its surrounding villages. The exhibition explored the ways in which the land around the city is changing or has changed in the past. Emily Speed’s research in phase two of The Expanded City culminated in the project ‘Model Village?’ in June 2018, during which she worked with members of the public, including local residents and school pupils of all ages to construct a temporary model village on the site of a housing development. Participants were asked ‘What would your dream place to live or play in look like?’ and had the opportunity to use coloured clay to build their ideal home, and make a mark on the village by creating, extending, squashing or customising its buildings, trees, parks and streets. Gavin Renshaw's research in this phase concluded with the production of a cycling map for Preston which collates routes, information relevant to cyclists, such as storage, topography and traffic black spots, and existing cycle infrastructure within a single, visual inventory. Olivia Keith's project 'Traces of Place' involved a two-week residency at the Final Whistle Café in Cottam during the summer of 2017, in which she collated memories and contributions from local people.. As a direct result of her work and the conversations hosted, Olivia was invited to contribute to the 'Streets of Change: Beattie’s Preston and Beyond' exhibition at the Harris Museum and Art Gallery, where she created 'Setting in Place: The Making of a Jellied Map of Nether Bartle' a performance installation in two separate venues, Bartle Hall and Harris Museum & Art Gallery, Preston. Another outcome from her research was the creation of a linocut 'Nether Bartle map' as a prompt for discussions around naming and place. The Expanded City has been developed in response to an invitation from Preston City Council, to inform a programme of infrastructure projects on the outskirts of the city proposed by a £430m City Deal scheme. The City Deal scheme aims to deliver new jobs and housing, by addressing strategic transport, environmental, community and cultural infrastructure challenges

PCR-based amplification of circulating RNAs as prognostic and predictive biomarkers – Focus on neuroblastoma

Metastatic disease is a major challenge for cancer cure, haematogenous spread and subsequent growth of tumour cells at distant sites being the cause of most cancer deaths. Molecular characterization and detection of the tumour cells responsible for haematogenous spread may increase understanding of the biology of metastasis, help improve patient management and allow evaluation of novel treatments to prevent and eradicate this disease. The bone marrow is a common site to which tumour cells metastasize, from which they may re-circulate to other organs with a favourable microenvironment for growth. The detection of tumour cells in blood suggests one route for metastasis, and provides an accessible, minimally invasive liquid sample through which it may be possible to monitor and detect minimal disease and early signs of metastasis. Significant improvements in the sensitivity and specificity of tumour cell detection have been made, such that it is now possible to unambiguously detect a single tumour cell in over 10 million normal cells. However, the clinical impact of such low level disease and how to interpret the natural variation that can arise from sequential sampling of bone marrow aspirates and blood is currently largely unknown. This commentary will focus on the technical advancements and application of reverse transcriptase polymerase chain reaction to detect cancer mRNAs in bone marrow and blood, and discuss the potential clinical impact of this test in neuroblastoma