Suchergebnisse

This study describes the process of identification and subsequent examination of the delivery of health care to people with an intellectual disability in a single general practice.The study was undertaken in group practice with a list size of 11,425. Identification through practice and community intellectual disability teams was followed by a note‐based assessment of health promotion and consultation rates. Comparison was made with age‐sex matched non‐disabled controls. A total of 26 individuals with an intellectual disability was identified, 14 male and 12 female, with an age range of 3 to 75 years. Of these 7 (26.9%) were on the local Social Services register. A diverse range of causes of disability was seen. People with an intellectual disability did not differ significantly from controls in terms of consultation rates. They were significantly less likely to have received regular immunisations (chi square = 4.92, df=1, p = 0.027), urine analysis (Fisher's exact test, two tail, p = 0.014)) and cervical cytology (Fisher's exact test, two tail, p = 0.01). They were more likely to have epilepsy (chi square = 8, df = 2, p = 0.02), have had a greater number of outpatient appointments (t = 3.4, df= 50, p = 0.001) and have seen a greater number of specialists (t = 3.65, df = 50, p = 0.001). Only one health gain target baseline could be measured, the name of the key‐worker in notes, this was present in 3 (11.5%) of cases.

This paper responds to the Alpine Rendez-Vous (ARV) 'crisis' in technology enhanced learning (TEL). It takes a contested area of policy, rapid change in the National Health Service (NHS), and documents the responses to 'information overload' by group of General Practitioners Practices in the North of England. Located between the spaces identified by Traxler and Lally as 'competitive industrialisation' and Web 1.0, and the consumer/ customer focus and ubiquitous ownership enabled by portable and devices and web 2.0, in this work we see the parallels of the responses of publicly funded bodies moving towards privatisation as part of a neo-liberal agenda. Interviews with health professionals revealed marginalized spaces for informal learning in their workplaces; and a desire to build a community that would enable them to overcome the time/space barriers to networking. The EU Learning Layers Integrating Project develops mobile and social technologies that unlock and enable peer production within and across traditional workplace boundaries. Through the health professional narratives, we capture insights into their daily life, enable the articulation of their needs for an online 'Help-Seeking' networking service, underpinned by their desire to consult what Vygotsky calls 'the more capable peer'.

OBJECTIVES:The aim of this study was to compare effectiveness and safety of low-strength and high-strength direct oral anticoagulants (DOACs) with warfarin in the Australian Veteran population. DESIGN:Sequential cohort study using inverse probability of treatment weighting (IPTW) and propensity score matching. Initiators of high-strength (apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg) and low-strength DOACS (apixaban 2.5 mg, dabigatran 110 mg, rivaroxaban 15 mg) were compared with warfarin initiators. SETTING:Australian Government Department of Veterans' Affairs claims database. PARTICIPANTS:4836 patients who initiated oral anticoagulants (45.8%, 26.0% and 28.2% on low-strength, high-strength DOACs and warfarin, respectively) between August 2013 and March 2015. Mean age was 85, 75 and 83 years for low-strength, high-strength DOACs and warfarin initiators, respectively. MAIN OUTCOME MEASURES:One-year risk of hospitalisation for ischaemic stroke, any bleeding event or haemorrhagic stroke. Secondary outcomes were 1-year risk of hospitalisation for myocardial infarction and death. RESULTS:Using the IPTW method, no difference in risk of ischaemic stroke or bleeding was found with low-strength DOACs compared with warfarin. As a class, no increased risk of myocardial infarction was found for low-strength DOACs, however, risk was elevated for apixaban (HR 2.25, 95% CI 1.23 to 4.13). For high-strength DOACs, no difference was found for ischaemic stroke compared with warfarin, however, there was a significant reduction in risk of bleeding events (HR 0.63, 95% CI 0.44 to 0.89) and death (HR 0.40, 95% CI 0.28 to 0.58). Propensity score matching showed no difference in risk of ischaemic stroke or bleeding. CONCLUSION:We found that in the practice setting both DOAC formulations were similar to warfarin with regard to effectiveness and had no increased risk of bleeding. ; Nicole L Pratt, Emmae Ramsay, Lisa M Kalisch Ellett, Katherine Duszynski, Sepehr Shakib, Mhairi Kerr, Gillian Caughey, Elizabeth Ellen Roughead

Background  Evidence suggests that people with intellectual disabilities experience secondary health conditions and report inequities in health status and access to health systems. Reliable information is essential to identify health disparities. A review of health interview and health examination surveys conducted in 17 European countries was undertaken to determine whether people with intellectual disabilities were represented.Method  Using the online HIS HES database, 123 health surveys were scrutinized to determine whether they contained questions relevant to the Pomona 18 indicator set, and whether data could be extracted specifically on behalf of respondents with intellectual disabilities.Results  Findings reveal that while items relating to 16 of the Pomona 18 health indicators were found in 123 of the surveys scrutinized, only nine surveys were identified as having potential to extract data on respondents with intellectual disabilities.Conclusion  These findings have implications for those charged with the collection of comparable information about population health.

Abstract  Disparities in the health status and care experienced by people with intellectual disabilities are increasingly being recognized. This special report presents the results of an international expert consensus workshop held under the auspices of the Health Issues Special Interest Research Group of the International Association for the Scientific Study of Intellectual Disabilities. The workshop's presentations were designed to identify domains of health disparity and identify examples of evidence‐based or good practice and from them define statements and recommendations that would form the basis of an agenda for change. The report recognizes the breadth of domains that impact on disparity in health among people with intellectual disabilities by highlighting the importance of classification and the direct recognition of the increased morbidity and reduced life expectancy that these people experience. The report also considers population‐based causes of disparity relating to social circumstances and inequalities in the provision of health and social services. Individual predispositions attributable to sex or genetic factors and potential solutions actualized through self‐determination are discussed.

Abstract  The European Commission's Health Monitoring Programme culminated in the development of a set of European Community Health Indicators (ECHI) for the general population. Despite evidence of marked disparities between the health of people with intellectual disabilities (ID) and their peers in the general population, the ECHI contain no significant reference to people with ID. To address this deficit, a two‐year grant from the Health Monitoring Programme was awarded to the Pomona project (a collection of researchers from 13 European countries). The project comprised exchanges of expertise; a critical review of published evidence about health and ID; and consultative processes in member states. The project's finding was that there was no systematic monitoring of the health of people with ID in EU member states and, as a consequence, a set of health indicators specific to people with ID was proposed that could lead to such systemic monitoring.