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Background: Dysphagia can have serious health implications including choking and respiratory infection leading to poorer quality of life. People with intellectual disabilities are at higher risk of dysphagia related health complications and early death. Robust dysphagia screening tools are vital for this population. Method: A scoping review and appraisal of the evidence for dysphagia and feeding screening tools for use with people with intellectual disabilities was undertaken. Results: Seven studies (using six screening tools) met the review inclusion criteria. Mostly studies were limited by no defined dysphagia criteria, no verification of tools with a gold reference standard (e.g., videofluoroscopic examination) and lack of participant diversity (small samples, narrow age range, severity of intellectual disability or limited settings). Conclusions: There is urgent need for development and rigorous appraisal of existing dysphagia screening tools to meet the needs of a wider range of people with intellectual disabilities (particularly mild-to-moderate severity) and in wider settings.

Background: It is thought that people with Down syndrome die younger than the general population, but that survival rates are improving. Methods: Five databases were searched for keywords related to intellectual disabilities, Down syndrome and mortality. Strict inclusion criteria were applied. Information from 34 selected studies was tabulated, extracted and synthesized. Results: People with Down syndrome died about 28 years younger than the general population. Congenital heart anomalies, comorbidities, low birthweight, and Black and minority ethnicity influenced earlier age of death, as did younger maternal age and poorer parental education. Congenital heart anomalies and respiratory conditions were the leading causes of death, and more common than in the general population. Survival rates have improved over time, particularly for those with congenital heart anomalies. Conclusions: People with Down syndrome are living longer but still die younger of different causes than the general population. More robust comparative data are needed, and ethnic differences require further study.

Background: Death of people with intellectual disabilities is considered to be earlier than for the general population. Methods: Databases were searched for key words on intellectual disabilities and death. Strict inclusion/exclusion criteria were used. Information was extracted from selected papers, tabulated and synthesized. Prospero registration number: CRD42015020161. Results: Of 19,111 retrieved articles, 27 met criteria. Death was earlier by 20 years. It has improved in recent decades; however, the same inequality gap with the general population remains. More severe intellectual disabilities, and/or additional comorbidities rendered it shortest. Standardized mortality rates showed a greater inequality for women than men. Respiratory disease and circulatory diseases (with greater congenital and lesser ischaemic disease compared with the general population) were the main causes of death. Cancer was less common, and cancer profile differed from the general population. Some deaths are potentially avoidable. All research is from high-income countries, and cause of death is surprisingly little investigated. Conclusions: Improved health care, including anticipatory care such as health checks, and initiatives addressing most relevant lifestyle behaviours and health risks are indicated.

Background: The health-related behaviours of people with intellectual disabilities may be determined by organisational influences. This innovative study aimed to explore managers' and staffs' perspectives on organisational influences on the promotion of healthy behaviours for this population. Method: A qualitative methodology was employed. Four focus groups with staff and eleven telephone interviews with managers were undertaken across three residential services in one region (Northern Ireland) of the UK. Transcripts were analysed thematically. Findings: The organisations involved in this study did not have the cultural ethos or capacity to sustain consistent support for staff involvement in health promotion. Organisational support and outcome-focused strategies are recommended for encouraging staff involvement in health promotion activities. Conclusion: These findings have implications for some organisations that support people with intellectual disabilities in improving the way they facilitate health promotion. They highlight the need for organisational cultures to facilitate knowledge translation and embrace evidence-based health promotion interventions.

This chapter describes how canonical correlation was used in conjunction with an item response theory model to address the relationship between college students' civic engagement involvement and attitudes as undergraduates. The constructs of interest were students' participation in civic, political, and expressive activities, as well as their community service, civic and political self-efficacy attitudes, commitment to civic accountability, and tolerance of diversity.

This article describes a hybrid standard setting method that combines characteristics of the Angoff (1971) and Bookmark (Mitzel, Lewis, Patz & Green, 2001) methods. The proposed approach utilizes strengths of each method while addressing weaknesses. An ordered item booklet, with items sorted based on item difficulty, is used in combination with individual item ratings rather than a bookmark placement. The ordered item booklet attempts to make individual item ratings more palatable by providing some amount of information about item difficulty to the Subject Matter Experts (SMEs) participating in the standard setting. Allowing for individual item ratings attempts to addresses the issue of SMEs disagreeing with the order of items in the booklet in a Bookmark standard setting. This article illustrates the method as it was applied to a healthcare examination used for state licensure, comparing it with a more traditional Angoff approach. Results suggest that the proposed method has promise for future use pending further exploration.

The study set out to explore whether local area coordinators (LACs) and their managers view the health role of LACs as an essential component of their work and identify the health-related activities undertaken by LACs in Scotland. A mixed methods cross-sectional phenomenological study involving local authority service managers (n = 25) and LACs (n = 40) was adopted. Quantitative data from LACs were obtained using online and postal questionnaires. Qualitative data from local authority service managers and LACs were collected using one-to-one interviews and focus groups. Thematic analysis was undertaken of the qualitative data. The results indicate that there is a need to develop further the wider public health role of LACs to incorporate health-related activities focused on broader community-based outcomes such as empowerment and community integration. By adopting a public health role, LACs will be able to contribute to the reduction of health inequalities in people with learning disabilities.

Recently, higher education has witnessed a renewed commitment to the mission of preparing students for lives of active citizenship. Under the leadership of President Lawrence S. Bacow, Tufts University (Medford, Massachusetts) has articulated an institutional mission that embraces three areas of focus: active citizenship, internationalism, and life sciences and the environment. The Jonathan M. Tisch College of Citizenship and Public Service (Tisch College) was established in 2000 to facilitate and support a wide range of programs that build faculty and student knowledge, skills, and values in civic engagement. To evaluate these efforts, the Office of Institutional Research and Evaluation conducts annual surveys that, among other things, assess student, faculty, and alumni participation in civic engagement. Questions on students' involvement in civic engagement activities and their attitudes toward such activities have been incorporated into standard outcomes assessment instruments, including the New Student Survey, the Sophomore Experience and First Year Engineering Advising Surveys, and the Tufts Senior Survey. In addition, items designed to capture the number of hours and in what ways alumni are contributing to their community have been added to the graduate and professional schools' alumni surveys. Students' attitudes toward the importance of civic engagement are measured on five factors: (1) value and commitment to the public good; (2) personal efficacy through community service; (3) personal efficacy through politics; (4) appreciation of dynamics of diversity; and (5) awareness of and interest in community and national issues. Students' behaviors that exhibit their dedication to civic engagement are scaled according to the number of hours they spend participating in community service activities, civic actions, and political actions. Preliminary survey results suggest that students' involvement in particular activities affects their attitudes toward their self-efficacy, the value of commitment to the public good, and levels of community and national knowledge. These initial results suggest that involvement in civic engagement activities can affect students' civic and political attitudes, a finding that could substantiate the need for institutions of higher education to promote these types of activities. These findings, which already allude to a link between students' engagement in activities and their adoption of positive civic engagement attitudes, will help Tufts and other universities shape and direct programs that enhance student commitment to civically engaged lives.

Abstract Using a mixed method longitudinal cohort design, the Tufts University study is examining student involvement in and attitudes towards civic engagement during the undergraduate years and beyond. It does [...]

Objectives: Examine the online interactions, social networks, and perspectives of nursing actors on COVID‐19 from conversations on Twitter to understand how the profession responded to this global pandemic. Design: Mixed methods. Sample: Ten‐thousand five‐hundred and seventy‐four tweets by 2790 individuals and organizations. Measurements: NodeXL software was used for social network analysis to produce a network visualization. The betweenness centrality algorithm identified key users who were influential in COVID‐19 related conversations on Twitter. Inductive content analysis enabled exploration of tweet content. A communicative figurations framework guided the study. Results: Nursing actors formed different social groupings, and communicated with one another across groups. Tweets covered four themes; (1) outbreak and clinical management of the infectious disease, (2) education and information sharing, (3) social, economic, and political context, and (4) working together and supporting each other. Conclusion: In addition to spreading knowledge, nurses tried to reach out through social media to political and healthcare leaders to advocate for improvements needed to address COVID‐19. However, they primarily conversed within their own professional community. Action is needed to better understand how social media is and can be used by nurses for health communication, and to improve their preparedness to be influential on social media beyond the nursing community. [ABSTRACT FROM AUTHOR]

On September 23, 2010, the American Board of Medical Specialties (ABMS) approved emergency medical services (EMS) as a subspecialty of emergency medicine. As a result, the American Board of Emergency Medicine (ABEM) is planning to award the first certificates in EMS medicine in the fall of 2013. The purpose of subspecialty certification in EMS, as defined by ABEM, is to standardize physician training and qualifications for EMS practice, to improve patient safety and enhance the quality of emergency medical care provided to patients in the prehospital environment, and to facilitate integration of prehospital patient treatment into the continuum of patient care. In February 2011, ABEM established the EMS Examination Task Force to develop the Core Content of EMS Medicine (Core Content) that would be used to define the subspecialty and from which questions would be written for the examinations, to develop a blueprint for the examinations, and to develop a bank of test questions for use on the examinations. The Core Content defines the training parameters, resources, and knowledge of the treatment of prehospital patients necessary to practice EMS medicine. Additionally, it is intended to inform fellowship directors and candidates for certification of the full range of content that might appear on the examinations. This article describes the development of the Core Content and presents the Core Content in its entirety. [ABSTRACT FROM AUTHOR]

Twenty-seven total laryngectomy patients (19 males and 8 females) and 18 normal control subjects (10 males and 8 females) were subjected to electroglottography-based single voice recordings using sustained vowels and connected speech. The results showed poorer values and larger variability for all the voice measures for the total laryngectomy patients (TO speech) as compared to that of normal subjects. There were statistically significant differences (p<0.05) for all study parameters between the TO and normal speech. This study shows that robust and reliable data can be obtained using electroglottography in laryngectomees with both a sustained vowel and connected speech. Using these parameters, TO speech is significantly different from normal speech and is highly variable. This methodology has enormous potential for further investigations in laryngectomees and other patients with head and neck cancer. [ABSTRACT FROM AUTHOR]

Objective: To investigate current Down syndrome live birth and death rates, and childhood hospitalisations, compared with peers., Setting: General community., Participants: All live births with Down syndrome, 1990-2015, identified via Scottish regional cytogenetic laboratories, each age-sex-neighbourhood deprivation matched with five non-Down syndrome controls. Record linkage to Scotland's hospital admissions and death data., Primary Outcome: HRs comparing risk of first hospitalisation (any and emergency), readmission for children with Down syndrome and matched controls were calculated using stratified Cox proportional hazards (PH) model, and length of hospital stay was calculated using a conditional log-linear regression model., Results: 689/1479 (46.6%) female and 769/1479 (51.9%) male children/young people with Down syndrome were identified (1.0/1000 births, with no reduction over time); 1235 were matched. 92/1235 (7.4%) died during the period, 18.5 times more than controls. More of the Down syndrome group had at least one admission (incidence rate ratio(IRR) 72.89 (68.72-77.32) vs 40.51 (39.15-41.92); adjusted HR=1.84 (1.68, 2.01)) and readmissions (IRR 54.85 (51.46-58.46) vs 15.06 (14.36-15.80); adjusted HR=2.56 (2.08, 3.14)). More of their admissions were emergencies (IRR 56.78 (53.13-60.72) vs 28.88 (27.73-30.07); first emergency admission adjusted HR=2.87 (2.61, 3.15)). Children with Down syndrome had 28% longer first admission after birth. Admission rate increased from 1990-2003 to 2004-2014 for the Down syndrome group (from 90.7% to 92.2%) and decreased for controls (from 63.3% to 44.8%)., Conclusions: We provide contemporaneous statistics on the live birth rate of babies with Down syndrome, and their childhood death rate. They require more hospital admissions, readmissions emergency admissions and longer lengths of stays than their peers, which has received scant research attention in the past. This demonstrates the importance of statutory planning as well as informal support to families to avoid added problems in child development and family bonding over and above that brought by the intellectual disabilities associated with Down syndrome., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

On September 23, 2010, the American Board of Medical Specialties (ABMS) approved emergency medical services (EMS) as a subspecialty of emergency medicine. As a result, the American Board of Emergency Medicine (ABEM) is planning to award the first certificates in EMS medicine in the fall of 2013. The purpose of subspecialty certification in EMS, as defined by ABEM, is to standardize physician training and qualifications for EMS practice, to improve patient safety and enhance the quality of emergency medical care provided to patients in the prehospital environment, and to facilitate integration of prehospital patient treatment into the continuum of patient care. In February 2011, ABEM established the EMS Examination Task Force to develop the Core Content of EMS Medicine (Core Content) that would be used to define the subspecialty and from which questions would be written for the examinations, to develop a blueprint for the examinations, and to develop a bank of test questions for use on the examinations. The Core Content defines the training parameters, resources, and knowledge of the treatment of prehospital patients necessary to practice EMS medicine. Additionally, it is intended to inform fellowship directors and candidates for certification of the full range of content that might appear on the examinations. This article describes the development of the Core Content and presents the Core Content in its entirety.