Embedding routine health checks for adults with intellectual disabilities in primary care: practice nurse perceptions.

BACKGROUND: Adults with intellectual disabilities (IDs) have consistently poorer health outcomes than the general population. There is evidence that routine health checks in primary care may improve outcomes. We conducted a randomised controlled trial of practice nurse led health checks. Here, we report findings from the nested qualitative study. AIM: To explore practice nurse perceptions and experience of delivering an anticipatory health check for adults with IDs. DESIGN AND SETTING: Qualitative study in General Practices located in NHS Greater Glasgow and Clyde, Scotland, UK. METHOD: Eleven practice nurses from 11 intervention practices participated in a semi-structured interview. Analysis was guided by a framework approach. RESULTS: Practice nurses reported initially feeling 'swamped' and 'baffled' by the prospect of the intervention, but early misgivings were not realised. Health checks were incorporated into daily routines with relative ease, but this was largely contingent on existing patient engagement. The intervention was thought most successful with patients already well known to the practice. Chronic disease management models are commonly used by practice nurses and participants tailored health checks to existing practice. It emerged that few of the nurses utilised the breadth of the check instead modifying the check to respond to individual patients' needs. As such, already recognised 'problems' or issues dominated the health check process. Engaging with the health checks in this way appeared to increase the acceptability and feasibility of the check for nurses. There was universal support for the health check ethos, although some questioned whether all adults with IDs would access the health checks, and as a consequence, the long-term benefits of checks. CONCLUSION: While the trial found the intervention to be dominant over standard health care, the adjustments nurses made may not have maximised potential benefits to patients. Increasing training could further improve the benefits that health checks provide for people with IDs.

A population-based, cross-sectional study of the prevalence and correlates of sedentary behaviour of adults with intellectual disabilities.

BACKGROUND: High levels of sedentary behaviour have a negative impact on health and well-being. There is limited evidence on the prevalence and correlates of sedentary behaviour of adults with intellectual disabilities (ID). METHODS: A population-based sample of adults with ID were invited to take part in a comprehensive health check programme. Demographic and health data were collected during a structured interview and physical examination. Screen time was used as a proxy measure of sedentary behaviour. Bivariate and multivariate statistical modelling examined correlates of screen time. RESULTS: Fifty per cent of the 725 participants reported four or more hours of screen time per day. Male gender, higher levels of intellectual ability, mobility problems, obesity, not having hearing impairment and not having epilepsy were all significantly associated with higher screen time in the final multivariate model (R2  = 0.16; Hosmer-Lemeshow goodness of fit statistic P = 0.36). CONCLUSIONS: This is the first study to publish population-based data on the prevalence and correlates of sedentary behaviour in adults with ID. Compared with adults who do not have ID, adults with ID have higher levels, and different correlates, of sedentary behaviour. A better understanding of the social context of sedentary behaviour will inform the design of effective behaviour change programmes for adults with ID.

Absolute wavelength calibration of a Doppler spectrometer with a custom Fabry-Perot optical system.

An Ion Doppler Spectrometer (IDS) is used for fast measurements of C VI line emission (343.4 nm) in the Madison Symmetric Torus. Absolutely calibrated flow measurements are difficult because the IDS records data within 0.25 nm of the line. Commercial calibration lamps do not produce lines in this narrow range. A light source using an ultraviolet LED and etalon was designed to provide a fiducial marker 0.08 nm wide. The light is coupled into the IDS at f/4, and a holographic diffuser increases homogeneity of the final image. Random and systematic errors in data analysis were assessed. The calibration is accurate to 0.003 nm, allowing for flow measurements accurate to 3 km/s. This calibration is superior to the previous method which used a time-averaged measurement along a chord believed to have zero net Doppler shift.

The forensic value of the immunohistochemical detection of oestrogen receptors in vaginal epithelium.

This study investigated whether oestrogen receptors can be immunohistochemically detected in paraffin-embedded vaginal mucosa samples using monoclonal antibodies and whether the method would be suitable for the identification of vaginal cells in cytological smears. Samples of vaginal mucosa were obtained from living females and female corpses, as vaginal smears. For comparison purposes, resected prepuce samples and samples of postmortem male urethral mucosa were also investigated. Nuclear oestrogen receptors could be regularly detected in the basal, parabasal and deeper intermediate epithelium layers of freshly fixed vaginal mucosa but proved to be highly sensitive to autolytic changes. In the cytological smears obtained from living subjects, no oestrogen receptors were detectable. Oestrogen receptors were also detected in the basal epidermal cells of the male prepuce.

Nonisothermal kinetics with programmed temperature steps.

Data required for predicting the stability of an active principle in solution can be obtained by two kinetic methods. With the isothermal method, the degradation rate constants are determined at different temperatures, which are kept constant throughout the experiment. With the nonisothermal method, the temperature is increased with time. This paper describes a nonisothermal kinetic method in which the temperature is increased in consecutive equal steps. The results are compared with those obtained by the conventional isothermal method. The values for the activation energy are approximately the same by both methods. Although the technique of nonisothermal kinetics demands sophisticated equipment and high experimental accuracy, it provides a continuous picture over a wide temperature range.