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Background  Dental disease is more common among people with intellectual disabilities than in the general population. Improvements in oral health require individuals to engage in daily oral hygiene and regular visits to a dental practitioner; both may be challenging for the individual with intellectual impairment.Materials and Methods  A review of policies relating to behaviour management and physical restraint for individuals with intellectual disabilities and challenging behaviours was undertaken. Published studies of behaviour management in individuals with intellectual disabilities attending for dental treatment were reviewed. Reference to studies of children with average IQ and other populations were made where appropriate.Results  There is little published evidence regarding behaviour management for people with intellectual disabilities who require dental treatment. Current policies place great emphasis on pharmacological management and restrictive behaviour management techniques. There is a paucity of studies which have employed a functional analysis framework. There are few incentives for dentists to implement positive approaches to behaviour management as current systems of payment reward the completion of numbers of treatments and thus there is an incentive to complete treatments quickly rather than to spend time with patients.Conclusions  There is a need for research addressing the behaviour management of individuals with intellectual disabilities who require dental treatment, particularly the efficacy of non‐restrictive techniques and the provision of incentives that reward the use of positive behaviour management among dentists. The use of restrictive techniques should be carefully monitored for compliance with best practice guidelines.

SummaryThe high variability between centres in the incidence of side effects related to intrauterine devices (IUDs) is taken to indicate the need to direct research attention towards the context in which IUDs are inserted, as opposed to exclusive concern with the nature of the device. This paper considers the significance of psychological factors at the time of insertion in the light of recent studies indicating the benefits of adequate patient preparation.

A definition recently proposed by the Institute of Logistics states that: "Logistics is the time‐related positioning of resources". Experience indicates that major benefits can be derived by focusing on the effective management of the key resources of the business. The key to success involves understanding what constitutes best practice in management of these resources with respect to time and how this can be applied, given the unique characteristics of a particular business. By viewing logistics as a time‐based strategy many benefits can be obtained. Presents an overview of the strategic issues based on experience with partner companies at the Warwick Manufacturing Group, University of Warwick. Discusses the tools and measures used for re‐engineering the supply chain through the use of time, and gives a brief example demonstrating the success of this approach.

BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters of practice managers reported having received ...

Staff members of community-based residential programs serving individuals with intellectual disabilities often have difficulty helping participants develop social relationships with community members. A "social guide model" taught staff of an apartment-based residential program to use a set of "community network strategies" to improve the social relationships of three women with disabilities. Results demonstrated a functional relationship between staff members' use of the strategies under the supervision of the social guide model and increases in the size of participants' social networks and the frequency with which they experienced social integration. The intervention also was associated with a higher weekly rate of introduction of new network members and a higher rate of socially integrated activities per network member per week. Gains generally were maintained during a follow-up period, with a regular staff member assuming the role of social guide.

Pregnancy occurring in girls under the age of 17 is of particular interest to those providing obstetric care and family planning services, as well as to the social welfare services in the community. Childbirth in girls of this age carries greater risk to mother and child than in the immediately older age groups and a young mother having a baby, whether married or not, may face social and economic difficulties. This study is designed to find out basic facts about girls having terminations of pregnancy or continuing to have a baby in this young age group, relating to: parents and family of origin, housing, education, religion, knowledge of sex and fertility, use of contraception and nature of the relationship with the father of the child.The findings suggest that there is an urgent need for improving the provision and effectiveness of sex education, that the provision of contraceptive advice to the very young should be reviewed and improved, and that the type of relationships between boys and girls leading to the pregnancies described in this study are neither casual nor 'promiscuous'. The findings that those conceiving under the age of 15, and keeping the baby, made their first attendance at the antenatal clinic very late in the pregnancy suggests that these girls take an undue risk with their health, possibly due to the present state of the law regarding sexual intercourse in young people. The ideas of 'wantedness' and 'planning' in relation to conception are discussed.

Social life can be diminished by barriers inadvertently associated with "support." Social barriers were identified for three adults with severe intellectual disabilities. A multiple baseline design across subjects was used to examine the effects of removing these barriers on the social life of each participant. The dependent variables in the study were (a) the number of social activities done per week, (b) the number of different people with whom social activities were done each week, and (c) the stability of social relationships across time as indexed by the number of different weeks in which activities occurred with a companion across the 27 weeks of the study. The independent variable was a seven-component "barrier reduction" package. Support staff were taught to use each component of the package, and pre-post measurement of package use was obtained. Results indicate that the staff successfully implemented the barrier reduction package, and that implementation was associated with change in the social life of each participant. The study raises implications for (a) assessing structural barriers, (b) modifying structural barriers, and (c) measurement of "social stability" as an important index of social life for future research.

The activity preferences of 15 adults with intellectual disabilities from eight community-based residential programs were assessed by the participants themselves, residential program staff, and advocates. The study provides descriptive information concerning the degree to which participants' perceived activity preferences were subsequently included in their Individualized Habilitation Plans (IHPs). Results indicate that 78% of participants' IHP objectives were preferred activities. Further analyses revealed that preferred activities requiring a greater degree of staff support were included on the IHP as training objectives, and preferred activities that participants performed infrequently were included as participation objectives. The study indicates a need for more information about how to assess and honor the preferences of people with severe disabilities.

SummaryIn this survey of attitudes towards permanent contraceptive methods, four groups were studied: (A) men having undergone a vasectomy 12 months previously (n = 61); (B) men currently attending for vasectomy (n = 58); (C) female partners of men currently undergoing vasectomy (n = 60); and (D) women undergoing sterilization by tubal ligation (n = 52). All patients completed a questionnaire which included questions on the reasons for selecting their chosen method, and attitudes towards permanent methods and hypothetical pills and injectable contraceptives for men. Results showed that contraception was generally regarded as a mutual responsibility. This attitude was more pronounced in the vasectomy groups than among the sterilization women. Generally favourable reactions were elicited with respect to vasectomy, although substantial proportions expressed a preference for alternative methods (40%). Women undergoing sterilization exhibited predominantly negative attitudes towards this procedure. The implications of these findings, in terms of enhancing the acceptability of new male methods and improving subsequent adjustment to currently available permanent methods, are discussed.

ABSTRACTThis study investigated U.K. dentists' knowledge and practice of behavioral management principles (BMPs) as applied to adults with learning disabilities (AWLD).A postal questionnaire enquired into the dentists' experience in managing AWLD, utilization of behavioral management techniques, and knowledge of BMPs. The response rate was 41% (N = 53). Two groups were investigated: specialists (dentists registered on the Special Care Dentistry specialists' list, n = 37) and nonspecialists (dentists not on the list, n = 16).Although specialists treated more AWLD than nonspecialists, both groups of dentists reported they felt highly confident in managing AWLD. However, all dentists' knowledge of the principles of nonpharmacological BMPs was low. Specialists had a tendency to use a greater range of nonpharmacological behavioral management techniques compared to non‐specialists.These results suggest that dental team members need more training in the theory and practice of BMPs, which might lead to less reliance on costly pharmacological interventions and a clinical experience that is more respectful of the dignity and independence of AWLD.