The association between loneliness and common mental disorders in adults with borderline intellectual impairment

Background: Loneliness is linked to a number of adverse health outcomes in the general population. There is a lack of evidence on the prevalence and impact of loneliness in people with borderline intellectual impairment. / Methods: Data from the 2014 Adult Psychiatric Morbidity Survey, a national survey of England, was analysed using Weights-adjusted regression analyses to compare the prevalence of loneliness and the association between loneliness and socio-demographic and clinical variables in people with borderline intellectual impairment and the general population. / Results: Data from 6877 participants were included. Ten percent (n=671) of the sample had borderline intellectual impairment and their prevalence of loneliness was 24.5% compared to 18.4% in the general population. This difference was explained by exposure to social disadvantages. Associations were found in both groups between loneliness and being single, unemployed, low income, lower social support, feeling unsafe and discrimination in the past year. Loneliness was associated with lower wellbeing and higher rates of common mental disorders, suicidal thoughts and chronic physical disorders in both groups. Intellectual functioning moderated the relationship between loneliness and income (OR 1.82; 95%CI 1.06 to 3.11) and suicidal thoughts in the last week (OR 0.13; 95% CI 0.02 to 0.93). / Limitations: IQ was measured using the National Adult Reading Test (NART), which is only valid for English speakers and loneliness was measured using a single item. / Conclusion: Loneliness is more prevalent in people with borderline intellectual impairment. Interventions ttargeting social disadvantages (e.g. low income) may lead reduce loneliness and vulnerability to mental health problems

The role of planets in shaping planetary nebulae

In 1997 Soker laid out a framework for understanding the formation and shaping of planetary nebulae (PN). Starting from the assumption that non-spherical PN cannot be formed by single stars, he linked PN morphologies to the binary mechanisms that may have formed them, basing these connections almost entirely on observational arguments. In light of the last decade of discovery in the field of PN, we revise this framework, which, although simplistic, can still serve as a benchmark against which to test theories of PN origin and shaping. Within the framework, we revisit the role of planets in shaping PN. Soker invoked a planetary role in shaping PN because there are not enough close binaries to shape the large fraction of non-spherical PN. In this paper we adopt a model whereby only ~20% of all 1-8 solar mass stars make a PN. This reduces the need for planetary shaping. Through a propagation of percentages argument, and starting from the assumption that planets can only shape mildly elliptical PN, we conclude, like in Soker, that ~20% of all PN were shaped via planetary and other substellar interactions but we add that this corresponds to only ~5% of all 1-8 solar mass stars. This may be in line with findings of planets around main sequence stars. PN shaping by planets is made plausible by the recent discovery of planets that have survived interactions with red giant branch (RGB) stars. Finally, we conclude that of the ~80% of 1-8 solar mass stars that do not make a PN, about one quarter do not even ascend the AGB due to interactions with stellar and substellar companions, while three quarters ascend the AGB but do not make a PN. Once these stars leave the AGB they evolve normally and can be confused with post-RGB, extreme horizontal branch stars. We propose tests to identify them.Comment: 23 pages, accepted by PAS

Findings from an online survey of family carer experience of the management of challenging behaviour in people with intellectual disabilities, with a focus on the use of psychotropic medication

Background: There is relatively little published data that report the experiences and views of family carers of people with intellectual disabilities who display challenging behaviour who are prescribed psychotropic medication. / Materials and methods: An online structured questionnaire was created by the Challenging Behaviour Foundation, a UK charity, and family carers of people with intellectual disability. Questions concerned the management of challenging behaviour and asked family carers about their experiences and views on the use of psychotropic medication. Responses were gathered between August and October 2016. Results are summarised using descriptive and inferential statistics and descriptive analysis of free‐text comments. / Findings: Ninety‐nine family carers completed the survey. Family carers reported gaps in the holistic and proactive management of challenging behaviour. Whilst some felt involved in decisions around psychotropic medication prescribing, others described feeling marginalised and lacking information and influence. The decision to prescribe psychotropic medication evoked complex emotions in family carers and medication use was associated with mixed outcomes in those prescribed. Family carers identified areas of good practice and those areas where they believe improvements are needed. / Conclusions: Psychotropic medication should be only one option in a multimodal approach to challenging behaviour, but this may not always be reflected in current practice. Greater effort needs to be made to ensure that services are equipped to provide optimum care and to embed shared decision‐making into routine practice

Movement side effects of antipsychotic drugs in adults with and without intellectual disability: UK population-based cohort study

OBJECTIVES: To measure the incidence of movement side effects of antipsychotic drugs in adults with intellectual disability and compare rates with adults without intellectual disability. DESIGN: Cohort study using data from The Health Improvement Network. SETTING: UK primary care. PARTICIPANTS: Adults with intellectual disability prescribed antipsychotic drugs matched to a control group of adults without intellectual disability prescribed antipsychotic drugs. OUTCOME MEASURES: New records of movement side effect including acute dystonias, akathisia, parkinsonism, tardive dyskinaesia and neuroleptic malignant syndrome. RESULTS: 9013 adults with intellectual disability and a control cohort of 34 242 adults without intellectual disability together contributed 148 709 person-years data. The overall incidence of recorded movement side effects was 275 per 10 000 person-years (95% CI 256 to 296) in the intellectual disability group and 248 per 10 000 person-years (95% CI 237 to 260) in the control group. The incidence of any recorded movement side effect was significantly greater in people with intellectual disability compared with those without (incidence rate ratio 1.30, 95% CI 1.18 to 1.42, p<0.001, after adjustment for potential confounders), with parkinsonism and akathisia showing the greatest difference between the groups. Neuroleptic malignant syndrome, although occurring infrequently, was three times more common in people with intellectual disability-prescribed antipsychotic drugs (incidence rate ratio 3.03, 95% CI 1.26 to 7.30, p=0.013). Differences in rates of movement side effects between the groups were not due to differences in the proportions prescribed first and second-generation antipsychotic drugs. CONCLUSIONS: This study provides evidence to substantiate the long-held assumption that people with intellectual disability are more susceptible to movement side effects of antipsychotic drugs. Assessment for movement side effects should be integral to antipsychotic drug monitoring in people with intellectual disability. Regular medication review is essential to ensure optimal prescribing in this group

Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study

To describe the incidence of recorded mental illness and challenging behaviour in people with intellectual disability in UK primary care and to explore the prescription of psychotropic drugs in this group

Dune formation on the present Mars

We apply a model for sand dunes to calculate formation of dunes on Mars under the present Martian atmospheric conditions. We find that different dune shapes as those imaged by Mars Global Surveyor could have been formed by the action of sand-moving winds occuring on today's Mars. Our calculations show, however, that Martian dunes could be only formed due to the higher efficiency of Martian winds in carrying grains into saltation. The model equations are solved to study saltation transport under different atmospheric conditions valid for Mars. We obtain an estimate for the wind speed and migration velocity of barchan dunes at different places on Mars. From comparison with the shape of bimodal sand dunes, we find an estimate for the timescale of the changes in Martian wind regimes.Comment: 16 pages, 12 figure

Prognostic factors of depression and depressive symptoms after hip fracture surgery: systematic review.

BACKGROUND: Patients with hip fracture and depression are less likely to recover functional ability. This review sought to identify prognostic factors of depression or depressive symptoms up to 1 year after hip fracture surgery in adults. This review also sought to describe proposed underlying mechanisms for their association with depression or depressive symptoms. METHODS: We searched for published (MEDLINE, Embase, PsychInfo, CINAHL and Web of Science Core Collection) and unpublished (OpenGrey, Greynet, BASE, conference proceedings) studies. We did not impose any date, geographical, or language limitations. Screening (Covidence), extraction (Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, adapted for use with prognostic factors studies Checklist), and quality appraisal (Quality in Prognosis Studies tool) were completed in duplicate. Results were summarised narratively. RESULTS: In total, 37 prognostic factors were identified from 12 studies included in this review. The quality of the underlying evidence was poor, with all studies at high risk of bias in at least one domain. Most factors did not have a proposed mechanism for the association. Where factors were investigated by more than one study, the evidence was often conflicting. CONCLUSION: Due to conflicting and low quality of available evidence it is not possible to make clinical recommendations based on factors prognostic of depression or depressive symptoms after hip fracture. Further high-quality research investigating prognostic factors is warranted to inform future intervention and/or stratified approaches to care after hip fracture. TRIAL REGISTRATION: Prospero registration: CRD42019138690

Millimetre observations of Pleiades stars: a lack of solar-analogue planetesimal discs at 100 Myr?

Solar analogues approximately 100 Myr old may have dusty debris from collisions within evolving cometary belts, and such remnant discs might also be associated with earlier stellar-spin braking. We observed at 1.2 mm wavelength a sample of 17 fast and slow rotators, mostly single K dwarfs, in the 100 Myr Pleiades cluster. No dust was detected for individual stars or the ensemble, so there are no cold massive debris discs nor any discernible relation of such distant material to stellar spin. The net limits from these data and our earlier far-infrared results imply that the typical Pleiades G/K dwarf has a relative disc-to-star luminosity ≲ 2 × 10^(−4). Collisional evolution models have predicted greater luminosities at the 10^8 yr epoch, for debris discs evolving out of a proto-solar nebula. This suggests that substantial primordial discs such as that of the Sun are not the norm amongst young solar analogues, or that dynamical interactions with giant planets can remove much of the comet belt by as early as 100 Myr

An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial

Objective To evaluate the clinical efficacy of an established programme of occupational therapy in maintaining functional activity and reducing further health risks from inactivity in care home residents living with stroke sequelae. Design Pragmatic, parallel group, cluster randomised controlled trial. Setting 228 care homes (>10 beds each), both with and without the provision of nursing care, local to 11 trial administrative centres across the United Kingdom. Participants 1042 care home residents with a history of stroke or transient ischaemic attack, including those with language and cognitive impairments, not receiving end of life care. 114 homes (n=568 residents, 64% from homes providing nursing care) were allocated to the intervention arm and 114 homes (n=474 residents, 65% from homes providing nursing care) to standard care (control arm). Participating care homes were randomised between May 2010 and March 2012. Intervention Targeted three month programme of occupational therapy, delivered by qualified occupational therapists and assistants, involving patient centred goal setting, education of care home staff, and adaptations to the environment. Main outcome measures Primary outcome at the participant level: scores on the Barthel index of activities of daily living at three months post-randomisation. Secondary outcome measures at the participant level: Barthel index scores at six and 12 months post-randomisation, and scores on the Rivermead mobility index, geriatric depression scale-15, and EuroQol EQ-5D-3L questionnaire, at all time points. Results 64% of the participants were women and 93% were white, with a mean age of 82.9 years. Baseline characteristics were similar between groups for all measures, personal characteristics, and diagnostic tests. Overall, 2538 occupational therapy visits were made to 498 participants in the intervention arm (mean 5.1 visits per participant). No adverse events attributable to the intervention were recorded. 162 (11%) died before the primary outcome time point, and 313 (30%) died over the 12 months of the trial. The primary outcome measure did not differ significantly between the treatment arms. The adjusted mean difference in Barthel index score at three months was 0.19 points higher in the intervention arm (95% confidence interval −0.33 to 0.70, P=0.48). Secondary outcome measures also showed no significant differences at all time points. Conclusions This large phase III study provided no evidence of benefit for the provision of a routine occupational therapy service, including staff training, for care home residents living with stroke related disabilities. The established three month individualised course of occupational therapy targeting stroke related disabilities did not have an impact on measures of functional activity, mobility, mood, or health related quality of life, at all observational time points. Providing and targeting ameliorative care in this clinically complex population requires alternative strategies