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PubMed1984

Professional collaboration in services for mentally handicapped people.

There has been growing academic and practitioner interest in the problems of and opportunities for joint working in the care of mentally handicapped people. The paper outlines alternative methods of such joint working and tests these against survey and case study evidence. Attention is drawn to the danger that joint working may have little impact at patient level and the paper recommends an emphasis on the appointment of frontline key workers.

Humans↗
PubMed1994

Seroprevalence of hepatitis B and C in a Merseyside hospital for the mentally handicapped.

This study reports the prevalence of antibodies to hepatitis B virus (HBV) and C virus (HCV), and the frequency of potential exposure to these viruses among patients and staff in six long-stay wards of a hospital caring for mentally handicapped adults from the Mersey region. A retrospective survey of risk behaviour among 134 patients and questionnaire survey of 75 nursing staff was performed. Serum samples from both groups were tested for HBV markers and patient sera for antibodies to HCV by enzyme-linked immunosorbent assay (ELISA). None of the 102 patients tested had antibodies against HCV, although 17 had detectable antibody to HBV core (anti-HBc). Seven out of the 17 were positive for HBV surface antigen. None was positive for IgM antibody to HBV core. Only 1 out of 61 staff had anti-HBc and none was positive for surface antigen. Twenty-nine of 75 (39%) staff reported bites sufficient to break the skin and 52 (69%) significant other injuries from patients; 25 (31%) of staff had not received HBV vaccination. None of the patients had received HBV vaccine. We conclude that HCV does not appear to be a major hazard in this closed community but the prevalence of HBV markers indicating past exposure among patients is high, vaccine uptake is incomplete and incidents which may allow viral transmission are frequent.

Adult↗
PubMed2001

Cultural diversity and patients with reduced capacity: the use of ethics consultation to advocate for mentally handicapped persons in living organ donation.

Living organ donation will soon become the source of the majority of organs donations for transplant. Should mentally handicapped people be allowed to donate, or should they be considered a vulnerable group in need of protection? I discuss three cases of possible living organ donors who are developmentally disabled, from three different cultures, the United States, Germany, and India. I offer a brief discussion of three issues raised by the cases: (1) cultural diversity and cultural relativism; (2) autonomy, rationality, and self-interest; and (3) the proper use and role for clinical ethics consults.

Cultural Diversity↗
PubMed1999

The identification of early risk factors for severe emotional disturbances and emotional handicaps: an epidemiological approach.

Epidemiological methodology is used to examine the relationship between early childhood risk factors and future identification as having a Severe Emotional Disturbance or as having an Emotional Handicap (SED/EH) at age 13. Data were obtained from 1979/1980 Florida birth records that were electronically linked with 1992/1993 Florida school records. An epidemiological perspective was chosen due to its ability to model both individual and community-level risk. In regards to increasing an individual's risk of SED/EH, two factors, gender (being male) and low maternal education (mother not completing high school at the time of the child's birth), were found to have particularly strong effects. When examining effects of these risk factors upon overall rates of SED/EH in the community, maternal education and marital status (being unmarried at the time of the child's birth) were associated with a large proportion of the cases. Health/biological markers were moderately associated with SED/EH on the individual level, but were related to a relatively small percentage of cases in the population. In addition, effects varied based upon ethnic/cultural heritage. Researchers are encouraged to consider using an epidemiological perspective and its potential utility in the field of community psychology and public policy is discussed.

Adolescent↗
PubMed1998

Validity of the Autism/Pervasive Developmental Disorder subscale of the Diagnostic Assessment for the Severely Handicapped-II.

This study was designed to establish the empirical validity of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II) to screen for the presence of autism in severely and profoundly mentally retarded adults. Participants included 51 individuals residing in a large developmental center in Central Louisiana. The Autism/Pervasive Developmental Disorder subscale of the DASH-II was internally consistent. Additionally, the DASH-II was just as likely as the Childhood Autism Rating Scale (CARS) to classify autistic and control individuals. Specific items on the subscale were examined to identify those items most associated with a diagnosis of autism.

Adolescent↗
PubMed2000

[Project for supporting visually handicapped aged persons: developing a guide for the community of Münster].

In this paper we wish to outline both the function and the role of projects as part of a course in "Nursing Education" (Pflegepädagogik) at the Fachhochschule Münster, as well as to present a specific project which has enabled the students to gain experience in project management and qualitative research. The project target group were visually handicapped old people for whom a guide was produced as a health promotion strategy within the framework of governmental health objectives in the state of Northrhine-Westfalia.

Aged↗
PubMed1999

Bacteremia after dental treatment in mentally handicapped people.

Bacteremia may occur after disruption of the oral mucous membrane, particularly after dental treatment. 18 mentally handicapped patients who underwent dental treatment with general anesthesia were included in our study. None of the patients had general illnesses or received antibiotic protection. From each patient several blood samples were drawn aseptically during dental treatment and cultured. The majority of aerobic bacteria recovered belonged to Streptococcus sp and Gemella sp., anaerobic bacteria mainly belonged to Porphyromonas gingivalis and Peptostreptococcus sp. Resistance of the isolated bacteria to penicillin as well as to oxacillin, erythromycin and Co-trimoxazole was substantial. The highest resistance rate could be shown against fucidic acid.

Adolescent↗
PubMed2003

Efficacy of a 0.5% chlorhexidine gel on the control of gingivitis in Brazilian mentally handicapped patients.

OBJECTIVE: To evaluate the effectiveness of a 0.5% chlorhexidine gel on the reduction of interdental gingival bleeding. MATERIAL AND METHODS: Forty-three mentally handicapped subjects, living in an institution (Casas André Luiz, Brazil), were enrolled in a double-blind randomised clinical trial. The subjects were randomly divided into two groups: test (chlorhexidine gel) and control (placebo gel). The gel was applied with trays, twice a day, over a period of 8 weeks. The interdental bleeding index (IBI) was recorded before and after the period in which the gel was used. RESULTS: Statistical analysis showed that baseline IBI scores were similar (p=0.82) for test and control groups (55.6% and 54.5%, respectively). After 8 weeks, a statistically significant (p<0.001) decrease in IBI means took place in the test group (33.2%). The control group presented a small increase (60.6%) in IBI scores. The difference between groups was significant at the end of the study (p<0.001). CONCLUSION: The results indicated that the use of a 0.5% chlorhexidine gel was effective in reducing interdental gingival bleeding in special patients.

Adolescent↗
PubMed2001

Extraction as a treatment alternative follows repeated trauma in a severely handicapped patient.

Handicapped patients with protruding maxillary incisors are prone to repeated dental trauma. A 13-year-old girl with cerebral palsy, severe mental retardation and seizure disorder was referred to our department for restoring the traumatized anterior teeth. Despite drug combination, the frequency of seizure attack was around 10 times a month. The oral examination showed multiple caries, gingival hyperplasia, class II malocclusion with 14 mm overjet and deep overbite. During the first 3 years of a 7-year follow-up period, six episodes of anterior tooth trauma due to seizure attack occurred. The trauma-related treatment performed included endodontic therapy, multiple composite restorations, apical repositional flap, and finally extraction of all four upper incisors with fabrication of a semi-fixed band-retained denture. The denture restored normal overbite and overjet with improved esthetics. For 4 years following the fabrication of denture, no trauma occurred to the anterior teeth in later seizure attacks. Considering inadequate control of seizure disorder, little ability of the patient to receive comprehensive orthodontic treatment, poor prognosis of restorations, and possible future injuries, the removal of non-functional, nonesthetic, trauma-susceptible incisor teeth can be justified as an alternative to tooth preservation.

Adolescent↗
PubMed1990

Child functional independence and maternal psychosocial stress as risk factors threatening adaptation in mothers of physically or sensorially handicapped children.

This study investigated the contribution of child functional independence and maternal psychosocial stress to the adaptation of 119 mothers. Each mother had a child, aged 2-18 years, with a physical or sensory disability. Multiple dimensions of each construct were measured through self-report. Child functional independence did not uniquely explain variation in mothers' adaptation. However, maternal stress was uniquely associated with maternal mental health, but not physical health or social functioning, even when controlling for demographic status, disability type, and functional independence. Daily hassles and handicap-related psychosocial stress in particular put mothers at risk for reporting mental health problems.

Activities of Daily Living↗
PubMed1983

The self-serving function of hypochondriacal complaints: physical symptoms as self-handicapping strategies.

The present experiment tested the hypothesis that hypochondriacal individuals commonly use reports of physical illness and symptoms as a strategy to control attributions made about their performances in evaluative settings (i.e., self-handicapping strategies). Specifically, it was predicted that hypochondriacal individuals would report more recent physical illness and complaints and more current physical symptoms in an evaluative setting in which poor health could serve as an alternative explanation for poor performance than would either individuals in an evaluative setting in which poor health was precluded as an excuse or individuals in a nonevaluative setting. As predicted, results supported this self-protective pattern of complaints in a hypochondriacal sample but not in a nonhypochondriacal group. The self-protective role of hypochondriacal behavior is discussed in relation to other theory and research on the nature and treatment of hypochondriasis.

Anxiety↗
PubMed1990

Depressive self-presentation: beyond self-handicapping.

An experiment was conducted to examine the notion that depressives' responses would reflect a protective self-presentation style (Hill, Weary, & Williams, 1986), the underlying goal of which would be the avoidance of future performance demands and potential losses in self-esteem. In this study, depressed and nondepressed Ss were asked to perform a relatively simple visual-motor task. Half of the depressed and half of the nondepressed Ss were told that if they were successful at the task, they would be asked to perform a 2nd, similar task. The remaining Ss were given no such expectation of future performance. We predicted and found that depressed compared with nondepressed Ss strategically failed at the task when presented with the possibility of future performance and further losses in esteem. Moreover, this strategic failure was associated with some costs; depressed-future performance expectancy Ss experienced more discomfort or negative affect as a result of their performance. The relationship between this depressive self-presentation and self-handicapping strategies is discussed.

Achievement↗
PubMed1990

The benefit of dental care to an elderly population assessed using a sociodental measure of oral handicap.

The provision of dental care is based on the assumption that it contributes to quality of life. One hundred elderly people requesting dental care were interviewed and treated. Assessment was made using a sociodental index as well as clinical criteria. The index measured four categories of oral handicap (impairment of function, comfort, self-image and social interaction) prior to treatment and any benefit conferred by the treatment. Seventy-four per cent benefited from treatment. The greatest improvements were in self-image and social interaction. Function was the most difficult category to satisfy. One third of subjects whose oral function was compromised before treatment were still in this state after treatment.

Aged↗
PubMed1993

Intravenous sedation for handicapped dental patients: a clinical trial of midazolam and propofol.

A double blind, cross-over study to compare intravenous sedation using continuous infusions of midazolam and propofol was carried out in 18 handicapped patients, aged between 5 and 26 years. Using a syringe pump (Ohmeda 9000) midazolam was delivered at 0.4 mg/kg/h with a bolus dose of 0.02 mg/kg and propofol was infused at 4.0 mg/kg/h with a bolus dose of 0.2 mg/kg. Sequential analysis showed that induction and recovery times were shorter with propofol (P < 0.05 and P < 0.01 respectively) and more work was performed over unit time (P < 0.05), with 15.7 units of work being completed per hour on patients under propofol sedation compared to 11.0 units under midazolam. The quality of sedation was assessed as better in patients receiving propofol; eight cases were abandoned under midazolam infusion due to failure of induction, uncontrolled movement and/or emotional outbursts compared with none under propofol. All parents/patients preferred propofol sedation, because recovery was faster and smoother.

Adolescent↗
PubMed2002

Polymorphisms in the C-terminal domain of MECP2 in mentally handicapped boys: implications for genetic counselling.

Numerous recent reports have proposed that mutations in the C-terminal domain of the MECP2 gene could be a frequent cause of mental retardation in males. We have identified two mutations in this particular domain (S359P and E397K) in two boys who were screened for MECP2 mutations in a series of 23 mentally handicapped boys fitting the clinical description of the previously reported cases. A detailed familial study based on three generations shows that the first mutation (S359P) was also inherited by a healthy cousin thus ruling out its involvement in the etiology of the phenotype of this patient. The second mutation (E397K) was also found in normal individuals. These findings clearly call for a careful consideration of the pathogenicity of the MECP2 mutations identified in sporadic male cases before genetic counselling or prenatal diagnosis is proposed to the corresponding families.

Amino Acid Substitution↗
PubMed1982

Establishing generalized, productive verb-noun phrase usage in a manual language system with moderately handicapped children.

Strategies for producing generalized language skills continue to be of considerable interest to those working with severely language-delayed children. Research on generalized instruction-following suggested that strategies employing linguistic elements (verbs, nouns, adjectives, etc.) arranged in systematic combination matrices were successful in producing generalized and novel responses among handicapped children. The efficacy of a training matrix in the development of expressive verb-noun phrase usage was demonstrated. Two of the three students showed considerable gains in trained responses as well as predicted, novel responses, while a third who had much less training, showed some gains. Increases were also found in the overall development of expressive language tests. This approach is discussed in relation to other experimental approaches to language development.

Child↗
PubMed1989

A classical conditioning procedure for the hearing assessment of multiply handicapped persons.

The present study evaluated the viability of a classical conditioning procedure with an air puff as unconditioned stimulus for the hearing assessment of multiply handicapped children and adolescents. All subjects were also exposed to operant conditioning, which consisted of a modified visual reinforcement audiometry (VRA) procedure or involved edible reinforcement contingent on a reaching response (for blind subjects). The findings indicate that the classical conditioning procedure was successful with 21 of the 23 subjects, whereas operant conditioning succeeded with 15 of the subjects. Thresholds obtained with classical conditioning were mostly equal to or within 10 dB of those obtained with operant conditioning and also matched previously available hearing estimates. These findings seem to suggest that the classical procedure can be a useful behavioral alternative for audiological assessment.

Adolescent↗
PubMed1989

Transparency and recall of symbols among intellectually handicapped adults.

The purpose of this investigation was to examine the transparency and recall of symbols representing three parts of speech (nouns, verbs, descriptors) from three different graphic symbol systems (Blissymbols, Picture Communication System, and Picsyms) among adults with intellectual handicaps. Results suggested that the Picture Communication System (PCS) and Picsyms were more transparent and easier to learn than Blissymbols. Subjects correctly identified significantly fewer Blissymbols representing nouns than either PCS or Picsyms representing nouns. In early stages of recall for nouns, PCS and Picsyms were significantly easier to recall than Blissymbols. Implications of the data for symbol system selection use for persons with severe speech impairments are discussed.

Adult↗