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Background: It is often useful to ascertain whether adults have moderate to profound intellectual disability (approximate IQ less than 50; developmental age less than 108 months) when deciding whether to refer to specialist or mainstream services. The aim of the present study was to develop a simple measure to estimate moderate to profound intellectual disability in adults with a potential need for specialist care. Materials and Methods: Three hundred and twenty-two individuals with information on home interviews from the Leicestershire Learning Disability Register were also assessed using the Vineland Adaptive Behaviour Scales. A variety of variables concerning intelligence, adaptive functioning and dependency were used to predict developmental age (as estimated from the Vineland) using backward stepwise regression. The derived equation formed the Leicestershire Intellectual Disability (LID) tool. A cut-off point was chosen using a receiver operator characteristic (ROC) curve to achieve 95% sensitivity in identifying moderate to profound intellectual disability. Results: Seven variables from the home interviews were found to predict estimated developmental age at the 10% level (P less than or equal to 0.1). When the tool was used to detect adults with moderate to profound intellectual disability, the area under the ROC curve was 0.93. The chosen cut-off point was 95% sensitive and 65% specific. The positive predictive value was 95%, the negative predictive value was 65%, and the overall diagnostic accuracy was 91%. Conclusions: These preliminary findings suggest that the LID tool may help to identify adults with moderate to profound intellectual disability among those with potential need for specialist care. Further evaluation is recommended.

Background: Research into factors associated with survival in adults with intellectual disability is limited and no studies have controlled for changes in these factors over time. Material and Methods: All adults aged greater than or equal to 20 years with moderate to profound intellectual disability (approximate IQ less than 50) using specialist services in Leicestershire and Rutland, UK, were identified. The relationship between survival and physical, intellectual and social impairments was investigated, also adjusting for age, sex, ethnicity and exact year of birth. Results: Of 2453 adults studied, 402 (16%) died over a maximum follow-up period of 19 years. While physical, intellectual and social impairments were all associated with survival individually, physical impairment was the only impairment to significantly predict survival in the multi-variable analysis. Being non-mobile was associated with a sevenfold increased risk of death and being partially mobile with a twofold increased risk of death compared with being fully mobile [adjusted hazards ratios (HR) = 7.14; 95% confidence interval (CI) 4.99-10.21 and HR = 2.33; 95% CI 1.84-2.95]. Being male and earlier year of birth were also associated with shorter survival. Conclusions: The implications of these findings are discussed.

Abstract Background Given the extent and priority of urinary symptoms there is little evidence available to inform service provision in relation to the long term effects of interventions. This study aims to determine the long term (6 year) clinical effectiveness and costs of a new continence nurse led service compared to standard care for urinary symptoms. Methods A long term follow-up study of a 2-arm, non-blinded randomised controlled trial that recruited from a community based population between 1998-2000 in Leicestershire and Rutland UK was undertaken. 3746 men and women aged 40 years and over were followed up from the original trial. The continence nurse practitioner (CNP) intervention comprised a continence service provided by specially trained nurses delivering evidence-based interventions using pre-determined care pathways. The standard care (SC) arm comprised access to existing primary care including General Practitioner and continence advisory services in the area. Primary outcome: Improvement in one or more symptom. Secondary outcomes included: a) Leicester Impact scale; b) patient perception of problem; c) number of symptoms alleviated and cost-effectiveness; all were recorded at long term follow-up (average 6 years) post-randomisation. Results Overall at long-term follow-up (average 6 years) significantly more individuals in the CNP group (72%) had improved (i.e had fewer symptoms) compared to those in the SC group (67%) (difference of 5% 95% (CI = 0.6 to 9;p = 0.02)). Conclusion The differences in outcome between the two randomised groups shown immediately post treatment had decreased by half in terms of symptom improvement at long term follow-up. Although the difference was statistically significant, the clinical significance may not be, although the direction of the difference favoured the new CNP service.

A prevalence survey of disturbed micturition in the elderly identified 7% with important degrees of disorder, 1% with lesser disorder and 1% who were catheterized. Incontinence, urgency, frequency and nocturia were the symptoms most commonly reported. Fifty-three per cent of people describing incontinuce used preventive aids but one third of these continued to experience wetting of external clothing. Crude categorization of dysfunction on the basis of symptoms suggested that a component of unstable bladder was present in approximately 4% of the elderly population. [ABSTRACT FROM PUBLISHER]

Background: Continence services in the UK have developed at different rates within differing care models, resulting in scattered and inconsistent services. Consequently, questions remain about the most cost-effective method of delivering these services., Aim: To evaluate the impact of a new service led by a continence nurse practitioner compared with existing primary/secondary care provision for people with urinary incontinence and storage symptoms., Design of Study: Randomised controlled trial with a 3- and 6-month follow-up in men and women (n = 3746) aged 40 years and over living in private households (intervention [n = 2958]; control [n = 788])., Setting: Leicestershire and Rutland, UK., Method: The continence nurse practitioner intervention comprised a continence service provided by specially trained nurses delivering evidence-based interventions using predetermined care pathways. They delivered an 8-week primary intervention package that included advice on diet and fluids; bladder training; pelvic floor awareness and lifestyle advice. The standard care arm comprised access to existing primary care including GP and continence advisory services in the area. Outcome measures were recorded at 3 and 6 months post-randomisation., Results: The percentage of individuals who improved (with at least one symptom alleviated) at 3 months was 59% in the intervention group compared with 48% in the standard care group (difference of 11%, 95% CI = 7 to 16; P<0.001) The percentage of people reporting no symptoms or 'cured' was 25% in the intervention group and 15% in the standard care group (difference of 10%, 95% CI = 6 to 13, P = 0.001). At 6 months the difference was maintained. There was a significant difference in impact scores between the two groups at 3 and 6 months., Conclusions: The continence nurse practitioner-led intervention reduced the symptoms of incontinence, frequency, urgency and nocturia at 3 and 6 months; impact was reduced; and satisfaction with the new service was high.

Aims: Evidence for an association between diet and the symptom syndrome overactive bladder (OAB) would be valuable in understanding its aetiology. The present study investigates prospectively the association between the nutrient composition of the diet and the onset of OAB., Methods: A random sample of community dwelling women aged 40 years or over was studied. Baseline data on urinary symptoms and diet were collected from 6,371 women using a postal questionnaire and food frequency questionnaire. Follow-up data on urinary symptoms were collected from 5,816 of the women in a postal survey 1 year later. Logistic regression was used to investigate the association of diet (daily intakes of energy, macro and micronutrients) with 1 year incidence of OAB., Results: There was evidence that three nutrients may be associated with OAB onset. Higher intakes of vitamin D (P = 0.008), protein (P = 0.03), and potassium (P = 0.05) were significantly associated with decreased risks of onset. Although overall the associations with vitamin B6 and niacin were not significant (P = 0.08 and P = 0.13), there was some evidence of a decreased risk of onset with higher intakes., Conclusions: The results from this prospective study suggest possible aetiological associations between certain nutrients and OAB onset. The findings need confirmation and possible mechanisms to explain these associations need further investigation., (Copyright 2004 Wiley-Liss, Inc.)