Assessment of objectively measured physical activity levels in individuals with intellectual disabilities with and without Down's syndrome

Objective

To investigate, using accelerometers, the levels of physical activity being undertaken by individuals with intellectual disabilities with and without Down''s syndrome.

Methods

One hundred and fifty two individuals with intellectual disabilities aged 12–70 years from East and South-East England. Physical activity levels in counts per minute (counts/min), steps per day (steps/day), and minutes of sedentary, light, moderate, vigorous, and moderate to vigorous physical activity (MVPA) measured with a uni-axial accelerometer (Actigraph GT1M) for seven days.

Results

No individuals with intellectual disabilities met current physical activity recommendations. Males were more active than females. There was a trend for physical activity to decline and sedentary behaviour to increase with age, and for those with more severe levels of intellectual disability to be more sedentary and less physically active, however any relationship was not significant when adjusted for confounding variables. Participants with Down''s syndrome engaged in significantly less physical activity than those with intellectual disabilities without Down''s syndrome and levels of activity declined significantly with age.

Conclusions

Individuals with intellectual disabilities, especially those with Down''s syndrome may be at risk of developing diseases associated with physical inactivity. There is a need for well-designed, accessible, preventive health promotion strategies and interventions designed to raise the levels of physical activity for individuals with intellectual disabilities. We propose that there are physiological reasons why individuals with Down''s syndrome have particularly low levels of physical activity that also decline markedly with age.     

The charismatic gift

Drawing on ethnographic analysis of a Swedish-based body of conservative Protestants known as the 'Word of Life', this article argues that certain forms of charismatic giving are orientated towards extending aspects of the 'inner' self beyond cultural and physical boundaries. The notion of a 'charismatic gift' in the Christian (and Weberian) sense of a quality of authoritative inspiration is linked to a Maussian concept of the gift as breaking down distinctions between persons as well as between persons and objects.     

A family-based intervention for prevention and self-management of disabilities due to leprosy,podoconiosis and lymphatic filariasis in Ethiopia: A proof of concept study

A key issue for persons with leprosy-, lymphatic filariasis- and podoconiosis-related disabilities is the life-long need to practice self-management routines. This is difficult to sustain without regular encouragement and support of others. Family-based support may be a sustainable and feasible strategy to practice self-management routines. This proof of concept study aimed to develop and pilot a family-based intervention to support prevention and self-management of leprosy, lymphatic filariasis and podoconiosis-related disabilities in Ethiopia.We used a quasi-experimental pre/post intervention study design with a mixed methods approach. The study population included persons affected by leprosy, lymphatic filariasis and podoconiosis and their family members. All persons affected had visible impairments due to their condition. We collected physical impairment outcomes, data on activity limitations, stigma and family quality of life using the SALSA scale (range 0–80), the SARI stigma scale (range 0–63) and the Beach Centre Family Quality of Life scale (range 0–125) and conducted in-depth interviews and focus group discussions. Quantitative data were analysed using paired t-tests, unequal variances t-tests, linear regression and binary logistic regression. Qualitative data were coded using open, inductive coding and content analysis.The family-based intervention consisted of self-management of disabilities, awareness raising and socio-economic empowerment. The intervention was delivered over several monthly group meetings over the course of several months. A total of 275 (100%) persons affected attended at least one session with a family member, and 215 (78%) attended at least three sessions. There was no significant improvement in eye and hand problems after the intervention. However, foot and leg impairments, number of acute attacks, lymphedema and shoe wearing all significantly improved at follow-up. In addition, family quality of life significantly improved from 67.4 at baseline to 89.9 at follow-up for family members and from 76.9 to 84.1 for persons affected (p<0.001). Stigma levels significantly decreased from 24.0 at baseline to 16.7 at follow-up (p<0.001). Activity levels improved, but not significantly.This proof of concept study showed that the family-based intervention had a positive effect on impairments and self-management of disabilities, family quality of life and stigma. We recommend a large-scale efficacy trial, using a randomised controlled trial and validated measurement tools, to determine its effectiveness and long-term sustainability.     

Effects of aquatic exercise and CES treatment on the changes of cognitive function,BDNF, IGF-1, and VEGF of persons with intellectual disabilities

[Purpose]

The purpose of this study was to investigate the effects of aquatic exercise and CES treatment on the cognitive function by using K-WAB and BDNF, IGF-1, and VEGF of persons with intellectual disabilities.

[Methods]

All subjects were 15 male with intellectual disabilities who were participating in the aquatic training program and CES treatment during 12 weeks at rehabilitation center. The subjects were divided into control group, exercise group, and exercise+CES group. Blood samples for BDNF, IGF-1, and VEGF were taken from brachial vein at rest between before and after treatment.

[Results]

The results are summarized as follows: Cognitive function level increased significantly in the exercise+CES group compared to those in the exercise and control group. The changes of blood IGF-1 concentration were no significant difference among groups. The changes of blood BDNF and VEGF concentration were significantly increased in exercise group and exercise+CES group than control group. However, blood BDNF and VEGF concentration were significantly difference between exercise group and exercise+CES group.

[Conclusion]

In conclusion, it can be concluded that CES treatment with exercise can amend cognitive function of persons with intellectual disabilities more effectively and increase of BDNF and VEGF by exercise can explain the cognitive function improvement of persons with intellectual disabilities.     

The savant syndrome: an extraordinary condition. A synopsis: past,present, future

Savant syndrome is a rare, but extraordinary, condition in which persons with serious mental disabilities, including autistic disorder, have some ‘island of genius’ which stands in marked, incongruous contrast to overall handicap. As many as one in 10 persons with autistic disorder have such remarkable abilities in varying degrees, although savant syndrome occurs in other developmental disabilities or in other types of central nervous system injury or disease as well. Whatever the particular savant skill, it is always linked to massive memory. This paper presents a brief review of the phenomenology of savant skills, the history of the concept and implications for education and future research.     

Ethnic Elders and American Health Care—A Physician's Perspective

The aging process is a fugue composed of innumerable themes; the theme of “ethnicity” is by far one of its more dominant. Due to the increasing incidence of chronic, progressive infirmity and acute, catastrophic illness, the elderly are thrust into direct contact with the health care systems of their society. The experiences of ethnic elders in American health care situations are fraught with conflict and mutual dissatisfaction with the physician-patient relationship. Both providers and consumers of health care services harbor differing culture-bound perceptions of health, illness and the healing process; these cultural beliefs define personal and professional needs and expectations and notions of how those needs are to be met by others. Both physicians and patients can enhance their communication and their compassion for one another by acknowledgment of cultural differences and by increased willingness to interpret motives and behavior within native context.It behooves us in medicine to examine the cultural traditions underlying our own attitudes, beliefs and values about the aged in a universal sense, as well as in a culturally specific sense, that we may gain insight that will be helpful in serving elderly persons more effectively, and in solving some of the problems inherent in the aging process.     

Causes,Coping, and Culture: A Comparative Survey Study on Representation of Back Pain in Three Swiss Language Regions

Introduction

This study intends to contribute to a research tradition that asks how causal attributions of illnesses affect coping behavior. Causal attributions are understood as the most important element of illness representations and coping as a means to preserve quality of life. The issue is applied to a condition so far often neglected in research on illness representations–back pain–and a third concept is added to the picture: culture.

Aim

The aim of this study is (a) to explore the causal factors to which persons with back pain attribute the further course of their illness, (b) to find out whether the attributed causes are predictors of coping maxims, and (c) to find out whether cultural factors affect attributions and coping and moderate the relationship between the two.

Methods

A total of 1259 gainfully employed or self-employed persons with recent episodes of back pain were recruited in the three language regions of Switzerland. They were asked to complete a structured online interview, measuring among many other variables attributed causes, coping maxims, and affiliation to one of the Swiss micro-cultures (German-, French- or Italian-speaking).

Results

Attributed causes of the illness that can be influenced by a patient go along with more active coping styles. Cultural affiliation impacts on coping maxims independently, but culture moderates the relationship of attributed causes and coping maxims only in two of twenty possible cases.

Implications

The results show that cultural differences can be analytically incorporated in the models of illness representations. Results may help to improve healthcare providers’ communication with patients and plan public health campaigns. The approach to micro-cultural differences and the substantive relationships between alterability of causes and activity in coping may help the further development of models of illness representations.     

Quality of life in people with physical disabilities

The aim of this study was to examine the possible differences in self-reported quality of life of people with physical disabilities with regard to both socio-demographic and disability-related characteristics. Testing was conducted on 153 respondents with physical disabilities, residents of the City of Zagreb. Positive correlations were found between the quality of life and income satisfaction, residence size (per capita floor area) and level of residence equipment. Multivariate analysis of variance showed statistically significant differences in quality of life among respondents with regard to the marital status, work status and home ownership. Statistically significant differences in the quality of life were found among the participants depending on their level of physical mobility and type of physical disability. The level of physical mobility is associated with general satisfaction with the accomplishment of goals, aspirations and hopes. The type of physical disability is related to the satisfaction with leisure activities, with the material status, expectations to achieve in the future what has not formerly been achieved. There was also a significant relation between the type of physical disability and general satisfaction with life in the past year. Positive correlations between duration of disability and quality of life were found. Membership in associations of persons with physical disability and related benefits were shown to contribute to the quality of life.     

The story catches you and you fall down: tragedy,ethnography, and "cultural competence"

Anne Fadiman's The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (Noonday Press, 1997) is widely used in "cultural competence" efforts within U.S. medical school curricula. This article addresses the relationship between theory, narrative form, and teaching through a close critical reading of that book that is informed by theories of tragedy and ethnographies of medicine. I argue that The Spirit Catches You is so influential as ethnography because it is so moving as a story; it is so moving as a story because it works so well as tragedy; and it works so well as tragedy precisely because of the static, reified, essentialist understanding of "culture" from which it proceeds. If professional anthropologists wish our own best work to speak to "apparitions of culture" within medicine and other "cultures of no culture," I suggest that we must find compelling new narrative forms in which to convey more complex understandings of "culture."     

Principal/agent theory and decision making in health care

Principal/agent theory, an economics concept that defines an agency relationship as "a contract under which one or more persons engage another person (the agent) to perform some service on their behalf which involves delegating some decision-making authority to the agent," is held to be applicable to the patient/physician relationship, in contrast to the view that this is a fiduciary relationship, not a contractual one. The distinction between fiduciary and contractual relationships is illuminated in the process of evaluating objections to the application of the principal/agent theory to the patient/physician relationship. The ability of the principal/agent theory to reveal important features of advance directives, understood as public documents rather than as confidential instructions from patient to physician, is also examined.     

Physical, occupational, respiratory, speech, equine and pet therapies for mitochondrial disease

Treatments for mitochondrial disease, while developing, remain limited. Therapies complementary to traditional medical and surgical approaches may benefit the patient with mitochondrial disease. The goals of the 'allied health professions' of physical, occupational, speech and respiratory therapies are to maintain and if possible, improve patients' existing strength, functioning and mobility. These therapists also play an important role in helping patients to compensate for disabilities and adapt to progressive symptoms. Novel forms of physical and occupational therapies, equine or "hippotherapy" and pet therapy, use the human to animal relationship to improve physical and emotional health. To enhance quality of life, an integrated team of experts, under the guidance and supervision of the physician, should be available to the patient with mitochondrial disease.     

The indigenization of neurasthenia in Hong Kong

Despite its origin in Western psychiatry, neurasthenia has become a popular concept in Chinese folk medicine, referring to a variety of somatic and psychological symptoms. Review of Chinese medicinal materials and patent medicines shows that neurasthenia is associated more often with somatic symptoms in tonic type medicine and with psychological and psychosomatic symptoms in sedative and tranquilizer type medicine. Popular Chinese books on neurasthenia suggest that causes might be attributed to lifestyle, psychological factors, and health problems. Recommendations on treatment emphasize self-help approaches through changing lifestyle, examining attitudes, tonic care, and relaxation. As a broad term used loosely by professionals and the lay public in Hong Kong, neurasthenia serves the important function of destigmatizing psychiatric disorders. Psychosexual problems may also be conveyed discreetly through somatic presentation. The indigenization of neurasthenia exemplifies how an originally Western concept acquires cultural meaning. Implications of illness conceptualization and the medical paradigm are discussed.     

Culture and Disability Behavior

A substantial amount of literature suggests that illness behavior in the United States is a product of a patient''s core culture; equally credible findings do not support this contention. Most students and graduates in the health care professions believe that illness and disability behavior are affected by a patient''s culture, but they are hard put to find convincing examples of that relationship. In experience with medical students studying the social and cultural bases of illness behavior, with patients who are disabled and with persons who claim disability in the absence of physical disease or disabling psychopathology, I observed no deviant disability behavior that was typical for the members of any cultural group, and no behavior was displayed by the members of one cultural group that was not seen in members of other cultural groups. No cultural stereotypes were upheld. I did find evidence that disability behavior is influenced by personality factors, social situations and the gains derived from the disability status. Evolving concepts of “entitlement,” which are closely related to socioeconomic status, also have a significant influence. The impact of feedback from others in a person''s many social and medical subcultures is a more crucial determinant of illness and disability behavior, except in those for whom illness and disability behavior is determined by the limitations imposed by the disease or by a personality structure resistant to cultural expectations and social feedback.     

Self-reported physical activity correlates in Swedish adults with multiple sclerosis: a cross-sectional study

Background

The benefits of physical activity in persons with Multiple Sclerosis (MS) are considerable. Knowledge about factors that correlate to physical activity is helpful in order to develop successful strategies to increase physical activity in persons with MS. Previous studies have focused on correlates to physical activity in MS, however falls self-efficacy, social support and enjoyment of physical activity are not much studied, as well as if the correlates differ with regard to disease severity. The aim of the study was to examine associations between physical activity and age, gender, employment, having children living at home, education, disease type, disease severity, fatigue, self-efficacy for physical activity, falls self-efficacy, social support and enjoyment of physical activity in a sample of persons with MS and in subgroups with regard to disease severity.

Methods

This is a cross-sectional survey study including Swedish community living adults with MS, 287 persons, response rate 58.2%. The survey included standardized self-reported scales measuring physical activity, disease severity, fatigue, self-efficacy for physical activity, falls self-efficacy, and social support. Physical activity was measured by the Physical Activity Disability Survey – Revised.

Results

Multiple regression analyzes showed that 59% (F(6,3)?=?64.9, p?=?0.000) of the variation in physical activity was explained by having less severe disease (β?=??0.30), being employed (β?=?0.26), having high falls self-efficacy (β?=?0.20), having high self-efficacy for physical activity (β?=?0.17), and enjoying physical activity (β?=?0.11). In persons with moderate/severe MS, self-efficacy for physical activity explained physical activity.

Conclusions

Consistent with previous research in persons with MS in other countries this study shows that disease severity, employment and self-efficacy for physical activity are important for physical activity. Additional important factors were falls self-efficacy and enjoyment. More research is needed to confirm this and the subgroup differences.

     

微生态学与中医“心与小肠相表里”新论

本文阐述了中医“心与小肠相表里”的理论内涵。中医“心与小肠相表里”与现代医学提出的“脑—肠轴”理论是相通的,具体可理解为中枢神经系统与肠道菌群的密切关系。脑与肠道菌群是相关的,二者在生理上相互配合、在病理上互相影响。同时探讨了微生态学与中医“心与小肠相表里”的相关性,阐述了脑对肠道菌群的调控和肠道菌群对中枢神经系统疾病的发生、发展的影响。依据中医“心与小肠相表里”理论和微生态学的临床应用,提出了用改善肠道菌群的微生态方法治疗和预防一些神经系统疾病的新理念。     

Pharmacology and Diagnosis of Pesticide-Induced Illnesses

Although emphasis upon the concept of environmental health is a recent development in the medical community at large, the environment in which man worked has been of considerable concern to physicians in occupational medicine for a quarter of a century or more.Among the environmental factors which may adversely affect the health of exposed persons are the pesticides. The pharmacologic properties of these chemicals as well as the diagnostic signs and symptoms are presented herein.     

Not a slippery slope or sudden subversion: German medicine and national socialism in 1933.

The history of medicine this century is darkened by the downfall of the German medical profession, exposed during the doctors'' trial at Nuremberg in 1946. Relying largely on documents published during 1933 in German medical journals, this paper examines two widely accepted notions of those events, metaphorically termed "slippery slope" and "sudden subversion." The first connotes a gradual slide over infinitesimal steps until, suddenly, all footing is lost; the second conveys forced take over of the profession''s leadership and values. Both concepts imply that the medical profession itself became the victim of circumstances. The slippery slope concept is a prominent figure of argument in the current debate on bioethics. The evidence presented here, however, strongly suggests that the German medical community set its own course in 1933. In some respects this course even outpaced the new government, which had to rein in the profession''s eager pursuit of enforced eugenic sterilizations. In 1933 the convergence of political, scientific, and economic forces dramatically changed the relationship between the medical community and the government. That same convergence is occurring again and must be approached with great caution if medicine is to remain focused on the preservation of physical and medical integrity.     

多维视角下医患关系内涵与对策分析

医患关系是一个复杂的医学和社会学交叉的概念,和谐的医患关系对于促进医疗体系健康发展具有重要的实践意义。近年来国内外学者对医患关系的关注程度日渐增加,通过多维视角下中国医患关系的内涵、现状分析,探究构建和谐医患关系的对策。     

‘You are inferior!’ Revisiting the expressivist argument

According to the expressivist argument the choice to use biotechnologies to prevent the birth of individuals with specific disabilities is an expression of disvalue for existing people with this disability. The argument has stirred a lively debate and has recently received renewed attention. This article starts with presenting the expressivist argument and its core elements. It then goes on to present and examine the counter‐arguments before it addresses some aspects that have gained surprisingly little attention. The analysis demonstrates that the expressivist argument has a wide range of underpinnings and that counter‐arguments tend to focus on only a few of these. It also reveals an important aspect that appears to have been ignored, i.e., that people do not select foetuses based on chromosomes or other biological traits, but based on characteristics of living persons with specific disabilities. This makes it more difficult to undermine the claim that negative selection of foetuses expresses a disvaluing of persons with such disabilities. It leaves the expressivist argument with a strong bite still.     

The Zone of Social Abandonment in Cultural Geography: On the Street in the United States, Inside the Family in India

This essay examines the spaces across societies in which persons with severe mental illness lose meaningful social roles and are reduced to "bare life." Comparing ethnographic and interview data from the United States and India, we suggest that these processes of exclusion take place differently: on the street in the United States, and in the family household in India. We argue that cultural, historical, and economic factors determine which spaces become zones of social abandonment across societies. We compare strategies for managing and treating persons with psychosis across the United States and India, and demonstrate that the relative efficiency of state surveillance of populations and availability of public social and psychiatric services, the relative importance of family honor, the extent to which a culture of psychopharmaceutical use has penetrated social life, and other historical features, contribute to circumstances in which disordered Indian persons are more likely to be forcefully "hidden" in domestic space, whereas mentally ill persons in the United States are more likely to be expelled to the street. However, in all locations, social marginalization takes place by stripping away the subject's efficacy in social communication. That is, the socially "dead" lose communicative efficacy, a predicament, following Agamben, we describe as "bare voice."