Who is at risk? Adults with intellectual disability at risk of admission to mental health inpatient care.

BACKGROUND: NHS England's Transforming Care agenda aims to reduce the number of adults with intellectual disabilities and autistic adults in mental health hospitals. The aim was to understand the demographic and clinical characteristics of those most at risk of admission. METHOD: A cohort, retrospective study of adults using community intellectual disability services in the North West of England from 2018 to 2022 was undertaken. RESULTS: We compared 211 adults at imminent risk of admission to a mental health hospital and 249 at significant (but not imminent) risk on a validated risk stratification tool. Individuals at significant risk were more likely to have moderate intellectual disability. Individuals at imminent risk were more likely to have diagnoses of mild intellectual disability, autism, personality disorder, or psychosis. CONCLUSION: By furthering our understanding of the clinical characteristics of those most at risk of admission, the findings inform more appropriate targeting of resources.

Monocytes from patients with osteoarthritis display increased osteoclastogenesis and bone resorption: the In Vitro Osteoclast Differentiation in Arthritis study.

OBJECTIVE: To compare the osteoclastogenic capacity of peripheral blood mononuclear cells (PBMCs) from patients with osteoarthritis (OA) to that of PBMCs from self-reported normal individuals. METHODS: PBMCs from 140 patients with OA and 45 healthy donors were assayed for CD14+ expression and induced to differentiate into osteoclasts over 3 weeks in vitro. We assessed the number of osteoclasts, their resorptive activity, osteoclast apoptosis, and expression of the following cytokine receptors: RANK, interleukin-1 receptor type I (IL-1RI), and IL-1RII. A ridge logistic regression classifier was developed to discriminate OA patients from controls. RESULTS: PBMCs from OA patients gave rise to more osteoclasts that resorbed more bone surface than did PBMCs from controls. The number of CD14+ precursors was comparable in both groups, but there was less apoptosis in osteoclasts obtained from OA patients. Although no correlation was found between osteoclastogenic capacity and clinical or radiographic scores, levels of IL-1RI were significantly lower in cultures from patients with OA than in cultures from controls. Osteoclast apoptosis and expression levels of IL-1RI and IL-1RII were used to build a multivariate predictive model for OA. CONCLUSION: During 3 weeks of culture under identical conditions, monocytes from patients with OA display enhanced capacity to generate osteoclasts compared to cells from controls. Enhanced osteoclastogenesis is accompanied by increased resorptive activity, reduced osteoclast apoptosis, and diminished IL-1RI expression. These findings support the possibility that generalized changes in bone metabolism affecting osteoclasts participate in the pathophysiology of OA.

Thinking about challenging behavior: a repertory grid study of inpatient staff beliefs.

Studies examining staff attitudes toward people with intellectual disability have traditionally used pre-determined categories and models or been open to researcher bias. The use of methods derived from personal construct psychology permits an objective investigation of staff views and attitudes without such limitations. Fourteen staff from an inpatient intellectual disability service were interviewed about their perceptions of clients with challenging behavior primarily using the repertory grid technique as developed from personal construct theory. Staff was found to construe their clients and their behaviors in a heterogeneous manner that was not readily reducible to a group average, and they did not make or use attributions about them in a consistent manner. Future research should incorporate work culture and the staff-client relationship. The results have implications for clinical decision making, team working, and clinical supervision.

Prostaglandin D2 induces apoptosis of human osteoclasts by activating the CRTH2 receptor and the intrinsic apoptosis pathway.

Prostaglandin D(2) (PGD(2)) is a lipid mediator synthesized from arachidonic acid that directly activates two specific receptors, the D-type prostanoid (DP) receptor and chemoattractant receptor homologous molecule expressed on T-helper type 2 cells (CRTH2). PGD(2) can affect bone metabolism by influencing both osteoblast and osteoclast (OC) functions, both cells involved in bone remodeling and in in vivo fracture repair as well. The objective of the present study was to determine the effects of PGD(2), acting through its two specific receptors, on human OC apoptosis. Human OCs were differentiated in vitro from peripheral blood mononuclear cells in the presence of receptor activator for nuclear factor κB ligand (RANKL) and macrophage-colony stimulating factor (M-CSF), and treated with PGD(2), its specific agonists and antagonists. Treatment with PGD(2) for 24hours in the presence of naproxen (10µM) to inhibit endogenous prostaglandin production increased the percentage of apoptotic OCs in a dose-dependent manner, as did the specific CRTH2 agonist compound DK-PGD(2) but not the DP agonist compound BW 245C. In the absence of naproxen, the CRTH2 antagonist compound CAY 10471 reduced OC apoptosis rate but the DP antagonist BW A868C had no effect. The induction of PGD(2)-CRTH2 dependent apoptosis was associated with the activation of caspase-9, but not caspase-8, leading to caspase-3 cleavage. These data show that PGD(2) induces human OC apoptosis through activation of CRTH2 and the apoptosis intrinsic pathway.

Domiciliary and day care services: Why do people with dementia refuse?

OBJECTIVE: To explore the reasons given for refusal of day services, and to examine the relationship between willingness to accept day services and clinical variables. METHOD: Fifty people with dementia who lived alone and had refused day services were interviewed. RESULTS: The most common reasons for reluctance to attend day services were the belief that they did not need day services, that they liked being on their own, and the belief that they would not enjoy it. People who persistently refused day services tended to have additional worries about meeting new people, losing their independence and being institutionalised. Fifty-four per cent of people with dementia who lived alone and had refused day services scored six or more on the Cornell Scale for Depression in Dementia, suggesting possible presence of major depression. CONCLUSION: In patients with dementia who live alone and refuse day services, their misconceptions about day services and possibility of undiagnosed depression need further exploration.

Does self-directed and web-based support for parents enhance the effects of viewing a reality television series based on the Triple P-Positive Parenting Programme?

BACKGROUND: This study investigated whether providing self-directed and web-based support for parents enhanced the effects of viewing a reality television series based on the Triple P - Positive Parenting Programme. METHOD: Parents with a child aged 2 to 9 (N = 454) were randomly assigned to either a standard or enhanced intervention condition. In the standard television alone viewing condition, parents watched the six-episode weekly television series, 'Driving Mum and Dad Mad'. Parents in the enhanced television viewing condition received a self-help workbook, extra web support involving downloadable parenting tip sheets, audio and video streaming of positive parenting messages and email support, in addition to viewing the television series. RESULTS: Parents in both conditions reported significant improvements in their child's disruptive behaviour and improvements in dysfunctional parenting practices. Effects were greater for the enhanced condition as seen on the ECBI, two of the three parenting indicators and overall programme satisfaction. However, no significant differences were seen on other measures, including parent affect indicators. The level of improvement was related to number of episodes watched, with greatest changes occurring in families who watched each episode. Improvements achieved at post-intervention by parents in both groups were maintained at six-month follow-up. Online tip sheets were frequently accessed; uptake of web-based resources was highest early in the series. CONCLUSIONS: The value of combining self-help approaches, technology and media as part of a comprehensive public health approach to providing parenting support is discussed.

Prostaglandin D2 receptors control osteoclastogenesis and the activity of human osteoclasts.

We recently showed that human osteoblasts synthesize prostaglandin D(2) (PGD(2)) and express both DP and CRTH2 receptors. Activation of the DP receptor decreased osteoprotegerin production, whereas activation of the CRTH2 receptor induced osteoblast chemotaxis and decreased RANKL expression. Our objectives in this study were to determine the presence, distribution, and action of these receptors in the functions of human osteoclasts and in osteoclastogenesis. Immunohistochemistry was used to detect the presence of DP and CRTH2 in in vitro-differentiated human osteoclasts in culture and in osteoclasts in situ. The effects of the activation of PGD(2) receptors on the cytoskeleton were determined by fluorescence microscopy. Specific agonists and antagonists allowed the study of the roles of these receptors on bone resorption and osteoclast differentiation. Our results show that in vitro-differentiated human osteoclasts and authentic fetal osteoclasts express both DP and CRTH2 receptors, as shown by immunocytochemistry. Similar results were obtained in osteoclasts from normal, osteoporotic, pagetic, and osteoarthritic adult bone tissues. Stimulation of osteoclasts with PGD(2) induced a robust reorganization of the cytoskeleton with a decrease in the number of cells presenting actin rings and an increase of lamellipodia, effects mediated by the DP and CRTH2 receptors, respectively. PGD(2) showed an inhibitory effect on bone resorption activity acting through the DP receptor. In vitro osteoclastogenesis from peripheral blood mononuclear cells cultured in the presence of RANKL and macrophage-colony stimulating factor was decreased by activation of either DP or CRTH2 receptors. These results suggest that PGD(2) receptors could be useful targets in certain bone diseases because their specific activation/inhibition leads to a decrease in osteoclastogenesis and to inhibition of bone resorption by osteoclasts.

The cognitive foundations of reading and arithmetic skills in 7- to 10-year-olds.

A range of possible predictors of arithmetic and reading were assessed in a large sample (N=162) of children between ages 7 years 5 months and 10 years 4 months. A confirmatory factor analysis of the predictors revealed a good fit to a model consisting of four latent variables (verbal ability, nonverbal ability, search speed, and phonological memory) and two manifest variables (digit comparison and phoneme deletion). A path analysis showed that digit comparison and verbal ability were unique predictors of variations in arithmetic skills, whereas phoneme deletion and verbal ability were unique predictors of variations in reading skills. These results confirm earlier findings that phoneme deletion ability appears to be a critical foundation for learning to read (decode). In addition, variations in the speed of accessing numerical quantity information appear to be a critical foundation for the development of arithmetic skills.

Hidden language impairments in children: parallels between poor reading comprehension and specific language impairment?

This study investigates the oral language skills of 8-year-old children with impaired reading comprehension. Despite fluent and accurate reading and normal nonverbal ability, these children are poor at understanding what they have read. Tasks tapping 3 domains of oral language, namely phonology, semantics, and morphosyntax, were administered, along with measures that reflect an interaction of language domains that we refer to as broader language skills. Relative to control children matched for age and decoding ability, poor comprehenders were impaired across all measures except those tapping phonological skills. In addition to low oral language ability characterizing the group as a whole, some individuals had marked language impairments; it is argued that a substantial minority can be classified as having specific language impairment. However, none of the children had been previously recognized as having a language or reading impairment. These findings demonstrate that serious reading and language impairments are not always obvious in children who have good phonological ability and appear, superficially at least, to read well.