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

Sedentary time among spouses:A cross-sectional study exploring associations in 1 sedentary time and behaviour in parents of 5 and 6 year old children

BACKGROUND: Sedentary time is associated with obesity and is a risk factor for other adverse health outcomes. We examined how sedentary time and screen viewing (SV) behaviours in parents of young children are associated and whether associations differed for weekdays versus weekend days. METHODS: Data were from a cross sectional study (B-ProAct1v) based in Bristol, UK investigating associations between physical activity and SV in children and parents. Parents were eligible for analysis if they and their partner had both provided valid accelerometer data (290 dyads) or had both provided valid screen-viewing data (325 dyads). Multivariable regression models were used to examine associations of (a) sedentary behaviours and (b) self-reported time spent on weekdays and weekend days watching TV, using a PC, and using a phone in the dyads. Models were adjusted for the number of media items in the house, mothers’ age and body mass index, and household index of multiple deprivation. RESULTS: Sedentary behaviour was lower at weekends than on weekdays for fathers and mothers. In contrast, the proportion of parents watching at least 2 h TV was higher on weekend days than on weekdays. Adjusted multivariable linear regression models suggested that 3 min of sedentary time on weekend days in fathers were associated with an additional minute of mothers’ sedentary time (B 0.38; 95 % CI 0.26 to 0.49). Logistic regression indicated that mothers’ screen use was positively predicted by fathers’ use (e.g., the odds of a mother watching more than 2 h TV on a weekend day were increased fivefold if the father also watched this amount OR 5.09, 95 % CI 3.30 to 7.86), except for PC use at weekends where the association was reversed and the odds of mothers using a PC for more than 30 min per weekend day was halved if the father used a PC for this amount of time (OR 0.45, 95 % CI 0.22 to 0.94). CONCLUSIONS: Programmes that encourage at least one adult in the household to decrease sedentary behaviour and become more active, particularly at weekends, should be developed

Delivery and Receipt of a Self-determination Theory-based Extra-curricular Physical Activity Intervention:Exploring Theoretical Fidelity in Action 3:30

The implementation, fidelity, and receipt of a self-determination-theory-based after-school physical activity intervention (Action 3:30) delivered by teaching assistants (TAs) was examined using a mixed-methods process evaluation. Physical activity motivation and need satisfaction were reported by 539 participants at baseline, the end of intervention, and 4-month follow-up. Pupil- and TA-reported autonomy-support and teaching efficacy were collected alongside interviews with 18 TAs and focus groups with 60 participants. Among intervention boys there were small increases in identified, introjected, and external motivation and no differences in need satisfaction. Among girls, intrinsic and identified motivation and autonomy and relatedness were lower in the intervention group. Qualitative evidence for fidelity was moderate, and boys reported greater need satisfaction than girls. TAs provided greater structure than involvement or autonomy-support and felt least efficacious when facing school-based challenges. The findings highlight the refinements needed to enhance theoretical fidelity and intervention effectiveness for boys and girls.</jats:p

The Fourth SeaWiFS HPLC Analysis Round-Robin Experiment (SeaHARRE-4)

Ten international laboratories specializing in the determination of marine pigment concentrations using high performance liquid chromatography (HPLC) were intercompared using in situ samples and a mixed pigment sample. Although prior Sea-viewing Wide Field-of-view Sensor (SeaWiFS) High Performance Liquid Chromatography (HPLC) Round-Robin Experiment (SeaHARRE) activities conducted in open-ocean waters covered a wide dynamic range in productivity, and some of the samples were collected in the coastal zone, none of the activities involved exclusively coastal samples. Consequently, SeaHARRE-4 was organized and executed as a strictly coastal activity and the field samples were collected from primarily eutrophic waters within the coastal zone of Denmark. The more restrictive perspective limited the dynamic range in chlorophyll concentration to approximately one and a half orders of magnitude (previous activities covered more than two orders of magnitude). The method intercomparisons were used for the following objectives: a) estimate the uncertainties in quantitating individual pigments and higher-order variables formed from sums and ratios; b) confirm if the chlorophyll a accuracy requirements for ocean color validation activities (approximately 25%, although 15% would allow for algorithm refinement) can be met in coastal waters; c) establish the reduction in uncertainties as a result of applying QA procedures; d) show the importance of establishing a properly defined referencing system in the computation of uncertainties; e) quantify the analytical benefits of performance metrics, and f) demonstrate the utility of a laboratory mix in understanding method performance. In addition, the remote sensing requirements for the in situ determination of total chlorophyll a were investigated to determine whether or not the average uncertainty for this measurement is being satisfied

Application of computer-aided tomography techniques to visualize kelp holdfast structure reveals the importance of habitat complexity for supporting marine biodiversity

Ecosystem engineers that increase habitat complexity are keystone species in marine systems, increasing shelter and niche availability, and therefore biodiversity. For example, kelp holdfasts form intricate structures and host the largest number of organisms in kelp ecosystems. However, methods that quantify 3D habitat complexity have only seldom been used in marine habitats, and never in kelp holdfast communities. This study investigated the role of kelp holdfasts (Laminaria hyperborea) in supporting benthic faunal biodiversity. Computer-aided tomography (CT-) scanning was used to quantify the three-dimensional geometrical complexity of holdfasts, including volume, surface area and surface fractal dimension (FD). Additionally, the number of haptera, number of haptera per unit of volume, and age of kelps were estimated. These measurements were compared to faunal biodiversity and community structure, using partial least-squares regression and multivariate ordination. Holdfast volume explained most of the variance observed in biodiversity indices, however all other complexity measures also strongly contributed to the variance observed. Multivariate ordinations further revealed that surface area and haptera per unit of volume accounted for the patterns observed in faunal community structure. Using 3D image analysis, this study makes a strong contribution to elucidate quantitative mechanisms underlying the observed relationship between biodiversity and habitat complexity. Furthermore, the potential of CT-scanning as an ecological tool is demonstrated, and a methodology for its use in future similar studies is established. Such spatially resolved imager analysis could help identify structurally complex areas as biodiversity hotspots, and may support the prioritization of areas for conservation