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Biomedical subjects

E Emerson

Publications and source records attributed to E Emerson.

At least 37 records · Page 2Linked to original sources
PubMed2000

Reducing antipsychotic medication in people with a learning disability.

BACKGROUND: The use of antipsychotic drugs in people with learning disabilities is currently receiving intensified scrutiny and attempts are being made to reduce it. AIMS: A randomised controlled trial was designed to investigate factors influencing antipsychotic drug reduction among people with learning disabilities prescribed such medication for behavioural problems. METHOD: Thirty-six participants randomly allocated to the experimental group underwent four, monthly 25% drug reduction stages. There were no planned drug changes for the control group (n = 20). RESULTS: Twelve participants (33%) completed full withdrawal; a further seven (19%) achieved and maintained at least a 50% reduction. Drug reduction was associated with increased dyskinesia and higher activity engagement but not increased maladaptive behaviour. Some setting characteristics were associated with drug reinstatement. CONCLUSIONS: A substantial proportion of people with learning disability prescribed antipsychotic medications for behavioural purposes rather than for treating psychotic illness can have their drugs reduced or withdrawn.

Adult↗
PubMed2000

Psychiatric symptoms in adults with learning disability and challenging behaviour.

BACKGROUND: In people with learning disability one of the most frequent reasons for psychiatric referral is challenging behaviour. AIMS: To determine what proportion of people with challenging behaviour actually have psychiatric symptoms. METHOD: Using an instrument specifically designed for use by informants, a sample of 320 people with administratively defined learning disability, with and without challenging behaviour, was surveyed for the presence of psychiatric symptoms. RESULTS: Increasing severity of challenging behaviour was associated with increased prevalence of psychiatric symptoms, depression showing the most marked association. Anxiety symptoms were associated with the presence of self-injurious behaviour. CONCLUSIONS: There is clearly the potential for reducing challenging behaviour by improved identification and treatment of coexisting psychiatric disorders. The possibility of modifying diagnostic criteria for depression in people with learning disability, by including aspects of challenging behaviour, merits attention.

Adolescent↗
PubMed2000

Quality and costs of community-based residential supports, village communities, and residential campuses in the United Kingdom.

The costs, nature, and benefits of residential supports were examined for 86 adults with mental retardation living in village communities, 133 adults living in newly built residential campuses, and 281 adults living in dispersed housing schemes (small community-based group homes and supported living). Results indicated that (a) the adjusted comprehensive costs of provision in dispersed housing schemes were 15% higher than in residential campuses and 20% higher than in village communities; (b) dispersed housing schemes and village communities offered a significantly greater quality of care than did residential campuses; and (c) there appeared to be distinct patterns of quality of life benefits associated with dispersed housing schemes and village communities, with both approaches offering a greater quality of life than did residential campuses.

Adult↗
PubMed1999

Organizational culture and staff outcomes in services for people with intellectual disabilities.

Organizational culture has been shown by organizational psychology to influence important aspects of staff behaviour. In particular, mismatches between staff perceptions of real and ideal organizational cultures have been shown to be associated with a range of negative outcomes for staff, such as stress, sickness and staff turnover. The present study investigates organizational culture in services for people with intellectual disabilities. The aim was to discover the prevalent organizational cultures in these services, and associations between organizational culture and staff outcomes. As part of a large-scale survey of staff in services for people with intellectual disabilities, information concerning organizational culture and staff outcomes was collected from 450 staff. A self-report measure of real and ideal organizational culture produced nine dimensions of organizational culture: (I) tolerant/staff-oriented; (2) achievement-oriented; (3) innovative; (4) analytical; (5) social relationships; (6) rewarding staff; (7) stable work environment; (8) demanding; and (9) conflict management. These nine dimensions of organizational culture showed generally adequate psychometric properties. While there was some variation in organizational culture across services, there is little variation across staff with different job titles. Overall, the staff rated real organizational cultures to be relatively high in achievement orientation and fostering social relationships, and relatively low in managing conflict and providing rewards for staff. Staff rated ideal organizational cultures to be high in rewarding staff, being tolerant/staff-oriented and fostering social relationships, and low in demands on staff. Except for the dimension of making demands on staff, where staff rated organizations as considerably higher than ideal, staff generally rated organizations as being less than ideal on all dimensions of organizational culture. Organizational psychology theory predicts that poor 'person-organization fit' (i.e. a greater mismatch between real and ideal organizational culture) will be associated with a range of negative staff outcomes. This theory was largely supported by findings of the present study. The implications for practice and for future research are discussed.

Adaptation, Psychological↗
PubMed1999

Factors associated with staff stress and work satisfaction in services for people with intellectual disability.

Staff stress and morale have been identified as major issues affecting the quality of services for people with intellectual disability. The present study investigates factors directly and indirectly associated with staff general distress, job strain and work satisfaction amongst staff in services for people with intellectual disability. As part of a large-scale survey of staff in services for people with intellectual disability, information was collected from 450 staff concerning general distress, job strain and work satisfaction, and a wide range of factors potentially associated with these outcomes. Path analyses revealed that three factors accounted for 28% of the variance in general distress scores: (I) wishful thinking, (2) stress linked to work-home conflict and (3) role ambiguity. Six factors accounted for 50% of the variance in job strain scores: (I) wishful thinking, (2) stress linked to a lack of staff support, (3) alienative commitment, (4) role ambiguity, (5) stressors linked to a low status job and (6) working longer contracted hours. Six factors accounted for 66% of the variance in work satisfaction scores: (I) stress linked to a low status job, (2) support from supervisors, (3) influence over work decisions, (4) alienative commitment, (5) support from colleagues and (6) older staff age. A range of factors indirectly associated with the three outcome measures was also identified. The models of general distress, job strain and work satisfaction empirically derived in the present study confirm and extend previous research in this area. The implications for organizations and future research are discussed.

Adult↗
PubMed1999

A systematic analysis of the influence of prior social context on aggression and self-injury within analogue analysis assessments.

Experimental analogue analyses are sometimes used to identify the operant function of aberrant behavior for individuals with developmental disabilities. These methods are proposed to be superior to other assessment techniques because they systematically control for the presence and absence of hypothesized maintaining contingencies within the analogue analysis. Analogue analyses are usually performed over a brief period of time with little reference to the broader social context within which they are conducted. Social interactions that a person experiences prior to an analogue analysis assessment might influence performance within the assessment. The authors examined the influence of prior social conditions on levels of aberrant behavior under analogue assessments with two individuals with severe developmental disabilities. Results indicated that prior social conditions significantly influenced analogue analysis results in idiosyncratic ways for both. These findings are discussed in terms of the need to examine broad contextual influences when conducting functional analyses of aberrant behavior.

Adult↗
PubMed1998

The development of a self-report measure to assess the location and intensity of pain in people with intellectual disabilities.

The performance of a target group of 20 people with intellectual disability (ID) and a comparison group of 20 people who did not have ID was investigated on a series of tasks involving the judgement of the location of pain (on a bodymap) and the intensity of pain (on an analogue colour scale) in response to a series of photographs of simulated painful experiences. The results of the study indicated that: (1) there were no differences between the target and comparison groups in judging pain location for 93% of test items; (2) the performance of the target group in judging pain location was stable over time; (3) people with ID rated the pain images as more intense than the comparison group on all the 'mild' pain stimuli and 36% of the 'severe' pain stimuli; (4) the performance of the target group in judging pain intensity was logically consistent for 65% of comparisons (clear trends towards significance being apparent for a further 10% of items); (5) the performance of the target group in judging pain intensity was stable over time; and (6) the performance of the target group was unrelated to indicators of cognitive ability.

Adult↗
PubMed1998

Cell cycle-independent death of prostate adenocarcinoma is induced by the trk tyrosine kinase inhibitor CEP-751 (KT6587).

Advanced prostate cancer remains largely incurable, primarily because the very low growth fraction present in these tumors makes them generally resistant to treatment with standard chemotherapeutic agents that target cell division. Effective therapies should therefore induce death of prostate cancer cells, independent of their growth rate. trkA, the high-affinity tyrosine kinase-linked receptor for nerve growth factor, has been implicated in prostatic cancer growth and may represent a molecular target for therapeutic agents. At low mg/kg doses, the trk tyrosine kinase inhibitor CEP-751 (KT6587) inhibits prostatic cancer growth in nine different animal models independent of the tumor growth rate, androgen sensitivity, metastatic ability, or state of tumor differentiation. CEP-751 is selective for cancerous versus normal prostate cells and affects the growth of only a limited number of nonprostate tumors. Importantly, CEP-751 induces cell death of prostate cancer cells in a cell cycle-independent fashion and, therefore, represents a novel therapeutic approach to the management of both hormone-dependent and hormone-independent prostate cancer.

Adenocarcinoma↗
PubMed1997

Is there an increased prevalence of severe learning disabilities among British Asians?

Age-specific prevalence rates for learning disabilities among the Asian communities in three Metropolitan Boroughs in the North of England are presented. These data indicate that: (1) below school age there is little difference in the apparent prevalence of severe learning disabilities between the Asian and non-Asian communities; (2) between 5 and 34 years of age, however, the apparent prevalence of severe learning disabilities is approximately three times higher among the Asian community when compared with the non-Asian community.

Adolescent↗
PubMed1997

Mental disorders and problematic behaviours in people with intellectual disability: future directions for research.

In recent years there has been a major growth of interest in the field of mental health and intellectual disability. This article outlines some of the issues that will be important to address in the coming years. The issues discussed include: the interaction of biological and environmental factors in the aetiology of behavioural and psychiatric disorders; diagnosis and classification; epidemiology; dementia; recognition of mental illness in the community; treatment; service provision; and training.

Conduct Disorder↗
PubMed1996

Time-based lag sequential analysis and the functional assessment of challenging behaviour.

This paper describes the application of time-based lag sequential analysis to the functional assessment of challenging behaviours shown by people with severe learning disabilities. The potential uses of the approach are illustrated with regards to identifying: (1) aspects of the stimulus control of challenging behaviour; (2) antecedents to the occurrence of challenging behaviour; and (3) the environmental consequences of challenging behaviour. The uses and limitations of the approach are discussed.

Adolescent↗
PubMed1996

Factors associated with staff support and resident lifestyle in services for people with multiple disabilities: a path analytic approach.

The quality and costs of residential services for 40 adults with severe learning disabilities and sensory impairments across four different service models were evaluated. A path analytic approach was used to calculate factors associated with four indicators of service quality: (1) assistance received by residents from staff; (2) positive contact received by residents from staff; (3) resident engagement in constructive activity; and (4) the level of physical integration of residents. The path analyses accounted for between 50 and 77% of the variance in the indicators. Factors found to be commonly associated with all four indicators included a community location, a specialized service orientation, the cognitive abilities of residents and a high level of scheduled activity. Service resources in the form of costs or staff ratios were not associated with any indicator of service quality. The findings strongly suggest an inverse system of care in that residents with greater skills receive more staff support. The implications of these and other findings for further research and service practice are discussed.

Adult↗
PubMed1995

Beliefs and emotional reactions of care staff working with people with challenging behaviour.

Information collected in the context of a survey of all people with learning disabilities and challenging behaviour in a single metropolitan borough indicated: (1) care staff report that a significant proportion of their colleagues usually display such emotional reactions as sadness, despair, anger, annoyance, fear and disgust to episodes of challenging behaviour; (2) respondents reported that the most significant sources of stress associated with caring for someone with challenging behaviour centred upon the 'daily grind' of caring, their difficulty in understanding the person's behaviour, the unpredictability of the behaviour and the apparent absence of an effective way forward; (3) care staff attribute the causes of the person's challenging behaviour to a diversity of internal psychological, broad environmental, behavioural and medical factors. These results are discussed in relation to their implications for staff-seeking and implementing external advice regarding the management of challenging behaviour.

Activities of Daily Living↗
PubMed1995

The form and function of challenging behaviours.

Aspects of the topography and behavioural function underlying the challenging behaviours of all people with learning disabilities and challenging behaviour (n = 70) in a defined geographical area were investigated. Results indicated that: (1) more severe challenging behaviours were shown by people with more severe disabilities; (2) a significant minority (44%) of people showed more than one form of challenging behaviour, this rising to 79% among people with more severe challenging behaviours; and (3) cross-sectional analyses revealed specific clusters of problematic, aggressive and self-injurious behaviours. Analysis of information derived from the Motivation Assessment Scale (MAS) indicated that (5) the most common functions of challenging behaviours appeared to be 'self-stimulation' (for self-injury, destructiveness and 'other' challenging behaviours) and securing the attention of carers (for aggressive behaviours). However, (6) parametric analyses failed to identify any consistent relationships between the form and function of an individual's challenging behaviour for aggressive, destructiveness and 'other' challenging behaviours, but (7) clients with self-injurious behaviour were significantly more likely to score highly on the 'self-stimulation' sub-scale than other sub-scales of the MAS. Finally, (8) significant consistency of behavioural functions across different forms of challenging behaviours shown by the same individual were found for the two combinations of aggressive-destructive behaviours and self-injury-'other' behaviours.

Activities of Daily Living↗
PubMed1993

Organizational predictors of staff stress, satisfaction, and intended turnover in a service for people with multiple disabilities.

Questionnaire data were collected from 64 direct-care staff members in a residential facility for people with multiple disabilities. Path analyses identified a number of organizational factors that predicted levels of perceived stress, overall job satisfaction, overall life satisfaction, and perceived likelihood of leaving the organization. Factors found to be common influences on all outcome measures included support from other staff (largely supervisory), job variety, staff perceptions of organizational democracy, goodness-of-fit between the attitudes and aims of staff and those of the organization, staff development, and income. Implications of the findings for service managers were discussed.

Adult↗
PubMed1992

Schedule-induced stereotypy.

The phenomena of the induction and entrainment of adjunctive behaviours was investigated in eight people with severe or profound mental retardation who exhibited stereotypic behaviours. The occurrence of collateral behaviours was investigated under extinction and massed reinforcer baselines and a variety of periodic or intermittent schedules of reinforcement for the performance of a simple experimental task. Seven of the eight subjects demonstrated evidence of schedule-induced stereotypic behaviour in the experimental conditions: five of the eight subjects also showed evidence of the entrainment of these behaviours within the first third of the interreinforcement interval. The results are discussed in relation to the analysis and intervention of problem behaviours in people with severe or profound mental retardation.

Adolescent↗