Prevalence of childhood disability and the characteristics and circumstances of disabled children in the UK : secondary analysis of the Family Resources Survey

Background: Robust data on the prevalence of childhood disability and the circumstances and characteristics of disabled children is crucial to understanding the relationship between impairment and social disadvantage. It is also crucial for public policy development aimed at reducing the prevalence of childhood disability and providing appropriate and timely service provision. This paper reports prevalence rates for childhood disability in the United Kingdom (UK) and describes the social and household circumstances of disabled children, comparing these where appropriate to those of non-disabled children. Methods: Data were generated from secondary analysis of the Family Resources Survey, a national UK cross-sectional survey, (2004/5) which had data on 16,012 children aged 0-18 years. Children were defined as disabled if they met the Disability Discrimination Act (DDA) definition (1995 and 2005). Frequency distributions and cross-tabulations were run to establish prevalence estimates, and describe the circumstances of disabled children. To establish the association between individual social and material factors and childhood disability when other factors were controlled for, logistic regression models were fitted on the dependent variable 'DDA defined disability'. Results: 7.3% (CI 6.9, 7.7) of UK children were reported by as disabled according to the DDA definition. Patterns of disability differed between sexes with boys having a higher rate overall and more likely than girls to experience difficulties with physical coordination; memory, concentration and learning; communication. Disabled children lived in different personal situations from their non-disabled counterparts, and were more likely to live with low-income, deprivation, debt and poor housing. This was particularly the case for disabled children from black/minority ethnic/ mixed parentage groups and lone-parent households. Childhood disability was associated with lone parenthood and parental disability and these associations persisted when social disadvantage was controlled for. Conclusion: These analyses suggest that UK disabled children experience higher levels of poverty and personal and social disadvantage than other children. Further research is required to establish accurate prevalence estimates of childhood disability among different black and minority ethnic groups and to understand the associations between childhood disability and lone parenthood and the higher rates of sibling and parental disability in households with disabled children

The need for harmonization and innovation of neuropsychological assessment in neurodegenerative dementias in Europe: consensus document of the Joint Program for Neurodegenerative Diseases Working Group

Cognitive, behavioural, and functional assessment is crucial in longitudinal studies of neurodegenerative dementias (NDD). Central issues, such as the definition of the study population (asymptomatic, at risk, or individuals with dementia), the detection of change/decline, and the assessment of relevant outcomes depend on quantitative measures of cognitive, behavioural, and functional status. Currently, we are far from having available reliable protocols and tools for the assessment of dementias in Europe. The main problems are the heterogeneity of the tools used across different European countries, the lack of standardisation of administration and scoring methods across centres, and the limited information available about the psychometric properties of many tests currently in widespread use. This situation makes it hard to compare results across studies carried out in different centres, thus hampering research progress, in particular towards the contribution to a “big data” common data set. We present here the results of a project funded by the Joint Program for Neurodegenerative Diseases (JPND) and by the Italian Ministry of Health. The project aimed at providing a consensus framework for the harmonisation of assessment tools to be applied to research in neurodegenerative disorders affecting cognition across Europe. A panel of European experts reviewed the current methods of neuropsychological assessment, identified pending issues, and made recommendations for the harmonisation of neuropsychological assessment of neurodegenerative dementias in Europe. A consensus was achieved on the general recommendations to be followed in developing procedures and tools for neuropsychological assessment, with the aim of harmonising tools and procedures to achieve more reliable data on the cognitive-behavioural examination. The results of this study should be considered as a first step to enhancing a common view and practise on NDD assessment across European countries

A core outcome set for pre‐eclampsia research: an international consensus development study

Objective To develop a core outcome set for pre‐eclampsia. Design Consensus development study. Setting International. Population Two hundred and eight‐one healthcare professionals, 41 researchers and 110 patients, representing 56 countries, participated. Methods Modified Delphi method and Modified Nominal Group Technique. Results A long‐list of 116 potential core outcomes was developed by combining the outcomes reported in 79 pre‐eclampsia trials with those derived from thematic analysis of 30 in‐depth interviews of women with lived experience of pre‐eclampsia. Forty‐seven consensus outcomes were identified from the Delphi process following which 14 maternal and eight offspring core outcomes were agreed at the consensus development meeting. Maternal core outcomes: death, eclampsia, stroke, cortical blindness, retinal detachment, pulmonary oedema, acute kidney injury, liver haematoma or rupture, abruption, postpartum haemorrhage, raised liver enzymes, low platelets, admission to intensive care required, and intubation and ventilation. Offspring core outcomes: stillbirth, gestational age at delivery, birthweight, small‐for‐gestational‐age, neonatal mortality, seizures, admission to neonatal unit required and respiratory support. Conclusions The core outcome set for pre‐eclampsia should underpin future randomised trials and systematic reviews. Such implementation should ensure that future research holds the necessary reach and relevance to inform clinical practice, enhance women's care and improve the outcomes of pregnant women and their babies

"In vitro" evaluation of the apical sealing of root canals obturated with different techniques Avaliação "in vitro" do selamento apical dos canais radiculares em função de diferentes técnicas de obturação

The purpose of this study was to compare the apical sealing of root canals obturated with different techniques. One hundred-six human mandibular incisors were submitted to instrumentation by means of the step-back technique. After instrumentation, one hundred teeth received an impermeable coating on the external surfaces of the crown and root (except for the area nearby the apical foramen). Afterwards, they were divided in five groups containing twenty elements each, according to the obturation technique employed: 1. lateral condensation with Kerr file; 2. continuous wave of condensation technique with System B; 3. thermoplasticized injectable gutta-percha technique with the Ultrafil system; 4. mechanically thermoplasticized gutta-percha with the JS Quick-Fill system and 5. thermoplasticized gutta-percha associated to a master cone with the Microseal system. The six remaining teeth were employed as negative and positive controls. After obturation, the access cavities were sealed and the teeth were immersed in aqueous 2% methylene blue dye for 72 hours at 37ºC. After that, the teeth were longitudinally sectioned and the apical microleakage was evaluated in a stereomicroscope. The Microseal system presented the best apical sealing ability, followed by System B, JS Quick-Fill, Ultrafil and the lateral condensation technique. The statistical analysis of the results demonstrated that: 1. the Microseal system presented an apical sealing similar to System B and better than the other groups; 2. System B presented better apical sealing than the lateral condensation technique, being similar to the other groups; and 3. the lateral condensation, Ultrafil and JS Quick-Fill groups demonstrated similar sealing ability.<br>Este estudo teve como objetivo avaliar o selamento apical de canais radiculares obturados por diferentes técnicas. Cento e seis incisivos inferiores humanos tiveram seus canais instrumentados através da técnica escalonada regressiva. Após a instrumentação, cem dentes foram impermeabilizados, exceto nas proximidades do forame apical, e divididos em cinco grupos de vinte elementos cada, de acordo com a técnica de obturação utilizada: 1. condensação lateral ativa realizada com lima tipo Kerr; 2. Onda Contínua de Condensação realizada com o System B; 3. guta-percha termoplastificada injetável realizada com o sistema Ultrafil; 4. guta-percha termoplastificada mecanicamente realizada com o sistema JS Quick-Fill; 5. guta-percha termoplastificada associada a um cone principal realizada com o sistema Microseal. Os seis dentes restantes foram utilizados como controles positivo e negativo. Após a obturação, os dentes foram imersos em solução aquosa de azul de metileno a 2%, durante setenta e duas horas, a 37ºC. A seguir, os dentes foram seccionados longitudinalmente e a infiltração apical avaliada em um estereomicroscópio. O sistema Microseal apresentou a melhor capacidade de selamento apical, seguido pelo System B, JS Quick-Fill, Ultrafil e pela técnica da condensação lateral. A análise estatística dos resultados demonstrou que: 1. o sistema Microseal apresentou selamento apical semelhante ao do System B e melhor que dos demais grupos; 2. o System B apresentou selamento apical melhor que o da técnica da Condensação Lateral e semelhante ao dos demais grupos; 3. os grupos da Condensação Lateral, Ultrafil e JS Quick-Fill, apresentaram capacidade de selamento semelhante

The personalisation of dementia services and existential realities: understanding Sikh carers caring for an older person with dementia in Wolverhampton

While personalisation and service choice remains a central plank of the Labour Government’s policies in health and social care, there is a growing evidence base confirming that ethnic minority groups, are disadvantaged as service users in the UK. Building on some baseline data collected in 2000 and 2003/04, our recent research (Jutlla and Moreland 2007) has reaffirmed the difficulties that Asian carers have in accessing services when caring for a relative with dementia. While such access data is important, we wish to move beyond the demographic aspects to consider the existential realities (the ontology) of the lives and cultures of those in minority ethnic groups. This paper consequently discusses the diversity and complexity of migration patterns among the Sikh community living in Wolverhampton. The paper conceptualises some of the ways in which different migration experiences and the realities of daily life influence the perceptions, experiences and patterns of care among migrant Sikh carers in Wolverhampton caring for an older person with dementia. The paper thus explores the thesis that the Sikh community is not a homogenous group; and that diversity and differences within the Sikh community can have important implications for care. Taking a biographical narrative approach to fieldwork, the relevant factors to be considered include: the carer’s country of origin; their migration route and reasons for migration; their age at migration and the cultural experiences of the carers and their communities both in the UK and India