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Background: Given the much greater COVID-19 mortality risk experienced by people with intellectual disabilities (ID), understanding the willingness of people with ID to take a COVID-19 vaccine is a major public health issue., Method: In December 2020 to February 2021, across the United Kingdom, 621 adults with ID were interviewed remotely and 348 family carers or support workers of adults with ID with greater needs completed an online survey, including a question on willingness to take a COVID-19 vaccine if offered., Results: Eighty-seven per cent of interviewees with ID were willing to take a COVID-19 vaccine, with willingness associated with white ethnicity, having already had a flu vaccine, gaining information about COVID-19 from television but not from social media, and knowing COVID-19 social restrictions rules. A percentage of 81.7% of surveyed carers of adults with ID with greater needs reported that the person would be willing to take a COVID-19 vaccine, with willingness associated with white ethnicity, having a health condition of concern in the context of COVID-19, having had a flu vaccine, being close to someone who had died due to COVID-19, and having shielded at some point during the pandemic., Conclusions: Reported willingness to take the COVID-19 vaccine is high among adults with ID in the United Kingdom, with factors associated with willingness having clear implications for public health policy and practice., (© 2021 The Authors. Journal of Intellectual Disability Research published by MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disibilities and John Wiley & Sons Ltd.)

Objective: To determine rates of potentially preventable hospitalisation of people with intellectual disability in New South Wales, and compare them with those for the NSW population., Design: Retrospective cohort study., Setting: Potentially preventable hospitalisations in NSW, as defined by the National Healthcare Agreement progress indicator 18, 1 July 2001 - 30 June 2015., Participants: Data collected in a retrospective data linkage study of 92 542 people with intellectual disability in NSW; potentially preventable hospitalisations data for NSW published by HealthStats NSW., Main Outcome Measures: Age-adjusted rates of potentially preventable hospitalisation by group (people with intellectual disability, NSW population), medical condition type (acute, chronic, vaccine-preventable), and medical condition., Results: The annual age-standardised rate for people with intellectual disability ranged between 5286 and 6301 per 100 000 persons, and for the NSW population between 1278 and 1511 per 100 000 persons; the rate ratio (RR) ranged between 3.5 (95% CI, 3.3-3.7) in 2014-15 and 4.5 (95% CI, 4.2-4.9) in 2002-03. The difference was greatest for admissions with acute (RR range: 5.3 [95% CI, 4.9-5.7] in 2014-15 to 8.1 [95% CI, 7.4-8.8] in 2002-03) and vaccine-preventable conditions (RR range: 2.1 [95% CI, 1.6-3.0] in 2007-08 to 3.4 [95% CI, 2.2-5.2] in 2004-05). By specific condition, the highest age-standardised rate was for admissions with convulsions and epilepsy (all years, 2567 per 100 000 population; v NSW population: RR, 22.2; 95% CI, 21.3-23.1)., Conclusion: Age-standardised rates of potentially preventable hospitalisation are higher for people with intellectual disability than for the general population. The reasons for these differences should be investigated, and strategies for averting potentially preventable hospitalisation developed., (© 2021 AMPCo Pty Ltd.)

Disability due to mental health disorders has been increasing in many countries over the past years. The COVID-19 pandemic may worsen this trend because of 3 different, and at times overlapping, pathways. This article describes each pathway, and by drawing on the experience of previous coronavirus epidemics and recent recessions, attempts to estimate the likelihood that claims due to mental health disorders will increase., (Copyright © 2021 Journal of Insurance Medicine.)

The Research in the field of mental health and educational needs of children with intellectual disabilities has increased over the years. However, the focus on milder disabilities such as mild intellectual disability and borderline intellectual functioning (MBID; intelligence quotient: 50-85) is still limited. The current study aimed at understanding peer victimization and its relationship to the self-esteem of children with MBID in regular and special schools. The study utilized a cross-sectional research design with a sample of 40 children who met the inclusion criteria. On analysis, the results showed that peer victimization was more common in regular schools ( U = 51, p ≤ 0.001), wherein the peer victimization had a significant negative correlation with their self-esteem ( r = -0.536, p ≤ 0.001). Overall, the findings implied the need for promotion of inclusive education in regular schools by sensitization against peer victimization of children with disabilities.

Background: Much remains unknown about the longitudinal health and well-being of individuals with intellectual disability (ID); thus, new methods to identify those with ID within nationally representative population studies are critical for harnessing these data sets to generate new knowledge., Objective: Our objective was to describe the development of a new method for identifying individuals with ID within large, population-level studies not targeted on ID., Methods: We used a secondary analysis of the de-identified, restricted-use National Longitudinal Study of Adolescent to Adult Health (Add Health) database representing 20,745 adolescents to develop a method for identifying individuals who meet the criteria of ID. The three criteria of ID (intellectual functioning, adaptive functioning, and disability originating during the developmental period) were derived from the definitions of ID used by the American Psychiatric Association and the American Association on Intellectual and Developmental Disabilities. The ID Indicator was developed from the variables indicative of intellectual and adaptive functioning limitations included in the Add Health database from Waves I to III., Results: This method identified 441 adolescents who met criteria of ID and had sampling weights. At Wave I, the mean age of this subsample of adolescents with ID was 16.1 years. About half of the adolescents were male and from minority racial groups. Their parents were predominately female, were married, had less than a high school education, and had a median age of 41.62 years. The adolescents' mean maximum abridged Peabody Picture Vocabulary Test standardized score was 69.6, and all demonstrated at least one adaptive functioning limitation., Discussion: This study demonstrates the development of a data-driven method to identify individuals with ID using commonly available data elements in nationally representative population data sets. By utilizing this method, researchers can leverage existing rich data sets holding potential for answering research questions, guiding policy, and informing interventions to improve the health of the ID population.

Objectives: To investigate the prevalence and background of children with medical complexity (CMC) and its secular trend in Japan., Methods: CMC were defined as patients under the age of 20 years requiring medical care and devices. The patients were enrolled using the national health insurance claims data of three hospitals and two rehabilitation centers in Tottori Prefecture. The study period was divided into three periods: Period 1, 2007-2010; Period 2, 2011-2014; and Period 3, 2015-2018., Results: A total of 378 CMC were enrolled. The prevalence of CMC was 1.88 per 1000 population among subjects aged <20 years in 2018, and it increased by approximately 1.9 times during the study period. The number of CMC who presented with severe motor and intellectual disabilities did not change from Period 1 to Period 3. Meanwhile, the number of CMC who had relatively preserved motor and intellectual abilities increased from 58 to 98. The proportion of CMC who required respiratory management and oxygen therapy increased by 1.3 and 1.8 times, respectively. By contrast, the proportion of CMC who need tube feeding decreased significantly between periods 1 and 3 (P < 0.05)., Conclusions: The prevalence of CMC increased almost twice during the 12-year study period; however, the increase in the number of patients with relatively preserved motor and intellectual abilities was pronounced. This study showed that the need for medical care and devices differed based on the underlying disorders and severity of CMC; therefore, individualized medical, welfare, and administrative services and education about the various types of CMC must be provided., (Copyright © 2020 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)

Background: Neurosensory deprivation associated with vision is a well-known fact in people with intellectual disability (ID). This work aims to report the visual status of a population with ID in Portugal., Methods: A vision screening protocol was conducted during two Special Olympics events. The vision protocol included personal medical history, ocular health evaluation, and clinical measures, such as visual acuity (VA), binocular vision, colour vision, refractive error, and intraocular pressure. This protocol was administered to 134 subjects., Results: Half of the subjects reported that they had never attended or they did not remember having attended a previous eye exam. Additionally, 10% of them had not attended an eye exam in the immediate past three years. Half the subjects failed the VA test and 13% presented moderate Visual Impairment (VI) (VA worse than 0.5 logMAR in the best eye). Manifest ocular deviation was found in 25% of the subjects and the most common ocular health dysfunction conditions were conjunctiva hyperaemia, meibomian gland dysfunction, and lens anomalies. Refractive error correction allowed a reduction in the level of moderate VI to 3.7%., Conclusions: The population analysed showed a poor eye care attendance rate and vision-related conditions are in agreement with previous reports. The development of national strategies to promote the awareness for routine eye care in people with ID and improving accessibility to eye care services may mitigate many of the most prevalent conditions encountered.

Background: Despite the recognised benefits of sport, participation is often reported to be low for youth with intellectual disability (ID). The current study was the first to longitudinally examine sport retention in this population, a critical aspect of ensuring participation., Methods: Study participants were parents/caregivers of athletes with ID involved in community Special Olympics (SO), 11-22 years of age (N = 345). Participants completed an online survey in 2012 that included caregiver demographic and athlete intrapersonal, interpersonal and broader contextual variables. Retention rates for 2019 were determined using the SO provincial registration lists., Results: Of the 345 survey participants, 81.7% remained active athletes in 2019. Caregiver demographic and athlete intrapersonal factors were largely unrelated to retention. In contrast, retention was associated with the frequency and number of sports athletes participated in, the perceived psychosocial gains of SO involvement and the environmental supports that were available to facilitate participation; frequency of sport participation was the strongest predictor of remaining a registered athlete., Conclusions: This study has implications for future initiatives aimed at increasing sport retention in a population that struggles to be engaged in sport. Efforts should focus on the athlete experience and sport-specific factors. Coaches and caregivers can foster positive experiences and play an important role in continued sport participation., (© 2020 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Objective: To examine the effects of transition challenges on the success and timeliness of transitions from institutions to community living for long-stay participants in the Money Follows the Person (MFP) Rebalancing Demonstration and determine whether outcomes vary by age and disability., Data Source: Secondary data on transition challenges for individuals enrolled in Connecticut's MFP program between December 2008 and December 2017., Study Design: Challenges were analyzed for older adults, people with mental health disability, and people with physical disability. Bivariate and multivariate analyses investigated which transition challenges and selected demographic variables predict transition versus closure and length of transition period for each group., Data Extraction Methods: The sample includes 3506 persons who attempted transition from institutions to community living and whose case concluded with transition or closure from 2015 to 2017., Principal Findings: The association between most transition challenges and the ability of long-stay institutional residents to return to the community, and to do so in a timely manner, varies significantly among older adults and younger persons with physical or mental health disabilities. For all groups, however, consumer engagement challenges predicted closure without transition (OR: 1.3-3.9) and housing challenges predicted longer transition periods (84-132 days). Length of institutional stay was associated with both outcomes for older adults and persons with physical disability. Other challenges, such as issues with services and supports, differed among the three groups on both outcomes., Conclusions: Knowledge of the effects of transition challenges on success and timeliness of transition for each group allows program managers and health and service providers to focus resources on addressing the most serious challenges. Particular emphasis should be placed on consumer engagement and housing challenges, and on targeting persons for transition early in their institutional stay. Federal and state transition programs can benefit by individualizing supports for residents to yield successful outcomes., (© Health Research and Educational Trust.)

Purpose: In Kenya, the employment rate for persons with disabilities is about 1% compared to 73.8% for the general population, and the situation is even worse for persons with mental disabilities. Persons with mental disabilities are often regarded as "mad", and stand little or no chance of employment. We undertook an exploratory study with employers and potential employers to understand factors that hinder or facilitate their employment and to gain insight into employers' perceptions of mental disability. Materials and methods: We adopted a mixed method study design, including in-depth interviews ( n  = 10) and questionnaires ( n  = 158) with (potential) employers in Kenya to explore the barriers and facilitators of employment for persons with mental disabilities. Results: Out of the 158 employers who completed the questionnaire, only 15.4% had ever employed persons with mental disabilities. The perceptions that these persons are not productive and may be violent was associated with an unwillingness to employ them (OR: 10.11, 95%CI: 2.87-35.59 and OR: 3.6, 95%CI: 1.34-9.64, respectively). The possession of skills was the highest reported facilitator of employing persons with mental disabilities. Employers suggested that information about mental illness and the disclosure by prospective employees with mental disabilities are relevant for the provision of reasonable accommodation in the workplace. Conclusion: Possession of skills and disclosure by persons with mental disabilities could improve their employability. Information targeted at all actors including employers, employees, government, and policymakers is necessary for balancing employers and employees expectations.Implications for rehabilitationDisabled persons' organisations or mental disability programs that seek to improve the employment of persons with mental disabilities should incorporate methods that address employer expectations through dialogue to find mutual benefits.Employers require essential information about mental illness, and guidance and support in order to provide reasonable accommodation in the workplace for persons with mental disabilities.Disabled persons' organisations and inclusive employment programs should share the positive experiences of employers of persons with mental disabilities with employers who are unaware of the work abilities of persons with mental disabilities to stimulate adoption of inclusive practices.

Background: People with intellectual disability (ID) experience higher mortality than the general population. This study examines factors contributing to deaths in people with intellectual disability., Method: Linked administrative data spanning ten years for 49,947 people with intellectual disability receiving disability services were analysed to assess the impact of demographic variables, comorbidities and health service utilization on the risk of death using Cox proportional hazard models., Results: People admitted for cancer were 8 times more likely to die within the study period compared to people not admitted for cancer. Down syndrome, cerebral palsy and heart disease also increased the risk of death. Emergency department presentations and/or mental health admissions increased the risk of death 4 times., Conclusions: Our findings provide a basis for policy changes and public health interventions. Cancer screening, mental health interventions, inclusion of people with intellectual disability in health policy and improved health care are needed to meet the needs of this population., (© 2019 John Wiley & Sons Ltd.)

Background: Transport is an important basis for social participation. Challenges to accessing and using transport for people with intellectual disabilities increase their risk of exclusion and loneliness., Method: Data from a nationally representative study of older people with intellectual disabilities (n = 708) were used to examine longitudinal changes in transport usage and factors associated with using public transport and other travel options., Results: Findings confirmed that this population depends on others for transportation. The most frequently used mode, staff-supported transport, showed no significant longitudinal change. Public transport was secondary, with only moderate continued use between data collection points. Level of intellectual disability most strongly predicted public transport use, while community residence most strongly predicted using public transport to attend work or day programmes., Conclusions: Transport usage is associated with demand and supply factors linked to the person's environment, including having somewhere to go that requires transport and availability of transport options., (© 2019 John Wiley & Sons Ltd.)

Background: Studies have reported unmet health needs in individuals with intellectual disability (ID). This study illustrated and analysed patterns of healthcare services utilization among people with intellectual disability and compared their use to that of the general population., Method: Participants (N = 791, aged 15-82) were mainly recruited through government-financed agencies specializing in services for people with intellectual disabilities in Québec, Canada. Comparisons were possible by using health administrative data., Results: Some services were more used by people with intellectual disability than the general population (general medicine, psychiatry, PSA blood tests), and others were accessed at significantly lower frequencies (optometry, physiotherapy, Pap tests). Similar rates were found for mammography, dentistry and psychology. Inequities were more salient for individuals who had more severe levels of intellectual disability., Conclusions: Our findings support that the population with intellectual disability would benefit from policies and practices aimed at enhancing the access to healthcare services., (© 2020 John Wiley & Sons Ltd.)

Background: Adults with an intellectual disability (ID) have much lower rates of employment than their counterparts without intellectual disability, which increases their risk of poverty and social exclusion. Differential treatment of people with intellectual disability in welfare and training policies suggests an expectation they will be passive welfare recipients rather than productive employees., Methods: This paper aims to examine occupational activities by older people with intellectual disability in Ireland, exploring factors influencing outcomes using data from the IDS-TILDA study (n = 708)., Results: Most people were unemployed but engaged in regular occupational activity. Occupational activity was associated with better emotional/mental health. Activities of Daily Living (ADL) functioning was associated with an active occupational status, while social supports most strongly predicted high occupational engagement across a range of activities., Conclusions: A focus on the individual meaning derived from a broad range of engagement may better support people with intellectual disabilities to benefit from regular occupational activity., (© 2019 John Wiley & Sons Ltd.)

Background: Previous research has shown poor hospital experiences and dire outcomes for people with intellectual disability. The main objective of this study was to prospectively track episodes for adults with intellectual disability (ID) in Australian hospitals, with a focus on indications of the quality of care provided., Methods: A prospective audit of hospital records over 35 months yielded quantitative data about patient characteristics, frequency and length of hospital episodes, diagnostic assessments and outcomes, post-emergency department (ED) destinations and post-discharge recommendations. Fifty participants were recruited largely by identification on hospital ED entry. An audit of patients' hospital records was conducted towards the end of hospital episodes, using a tool developed for the study., Results: Participants were mostly men (70%), aged 42.9 years on average, living mostly with family (46%) or in supported accommodation (44%). Of 157 recorded episodes, 96% started in ED,  85% required urgent or semi-urgent care and 62% were in the first 3 months of study participation. Average time in ED exceeded the 4-h national benchmark, met in 40% of episodes. One or more diagnostic assessments were conducted in 91% episodes and others in short stay units. Almost half (49%) resulted in a ward stay. With an extreme data point removed, <1-35 days were spent in wards. The most frequent diagnosis in 75% of episodes was for digestive problems, followed by nervous system problems then injuries. Median length of bed stays reflected data available for Australian refined diagnosis-related groups. High hospital re-presentations were found: for 67% of episodes in total, 26% (n = 12) of which were within 72 h and 59% (n = 23) within 30 days., Conclusions: Adults with ID presented frequently to ED and often had lengthy stays. We found no indication of poor care practices in terms of hospital staff willingness to keep patients in ED and conduct of diagnostic assessments. Frequent re-presentations, however, indicated failed hospital care at some level., (© 2020 The Authors. Journal of Intellectual Disability Research published by MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disibilities and John Wiley & Sons Ltd.)

Rehabilitation services for people with mental illnesses have been extensively researched. However, services with similar aims and specifications for patients with intellectual disabilities (IDs) have had little focus. This study describes the characteristics and outcomes of 21 patients admitted to a specialist ID rehabilitation service over an 8-year time frame. Rather that solely accepting 'step-down' referrals, some patients were referred from community settings. During the study, 20 patients were discharged, 80% to lower levels of service restriction, while 14.3% to higher levels. The study suggested that rehabilitation services have an important role within the wider service model for people with ID. Within the service studied, patients were referred from both higher and lower levels of restriction, suggesting the rehabilitation service 'bridged the gap' between inpatient and community settings, supporting the aim of caring for patients in the least restrictive setting for their needs.

Background: Workforce inclusion is an important political goal in many countries. However, nearly 70% of Norwegians registered with mild intellectual disabilities (IDs) are not registered employed or attending in day care centres. This study investigates the association between age, gender, functional level and hospital admissions with employment or attendance in public financed, community-based day care centres for adults with mild IDs in Norway., Method: This study is based on data from a linkage of the national population-based registries from 2013 to 2015: Statistics Norway (SSB), the Norwegian Information System for the Nursing and Care Sector (IPLOS) and the Norwegian Patient Registry (NPR). The sample consisted of 2370 adults registered with a mild ID, receiving disability pension in Norway, aged 18-67 years. Binary and multinomial logistic analyses, adjusted for age, gender, functional level and hospital admissions, were performed., Results: In 2015, 45.7% and 19.6% of the samples aged 20-31 and 52-63 years, respectively, were registered as employed or in day care centres. Participation in day care is a public service registered in IPLOS, which requires registration of functional level, while attendance in employment support is registered in SSB, where functional level is not registered. Compared with people registered with a high functional level, the probability of being employed or in day care centres was lower for people without registration of functional level. People with hospital admissions were less likely to be employed, especially if they had both psychiatric and somatic hospital admissions. People were less likely to attend day care and open employment only if they had a combination of both types of hospital admissions. Attendance in day care centres was less likely for men than women., Conclusions: Older people with mild ID, without registered functional level (meaning not receiving public community-based services) and with a history of hospital admissions were significantly less likely to be employed or participate in day care centres. The clear association between not being employed or attending day care centres and not having one's functional level registered implies there is a need for increased focus on how to enhance work participation among people with mild IDs who are not within the system of receiving public services., (© 2019 The Authors. Journal of Intellectual Disability Research published by MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Purpose: The purpose of this study is to examine diabetes standard of care among individuals who have diabetes with and without cognitive limitation disabilities (CLDs). Individuals with CLDs are more likely to develop diabetes and less likely to participate in diabetes standard of care services compared to those without CLDs., Methods: We used pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey (HC-MEPS). Dependent variables were utilization of dilated eye exams, foot checks, A1C blood tests, and engagement in moderate or vigorous physical exercise 5 times per week. Our independent variable was diabetes with CLDs vs diabetes without CLDs. We controlled for predisposing, enabling, and need factors., Results: Findings suggest that individuals with diabetes and CLDs were less likely to engage in moderate or vigorous physical exercise 5 times per week compared to individuals without CLDs. For other diabetes care services, individuals with CLDs are as likely to participate in health services utilization as those without CLDs., Conclusions: Our study supports research that indicates individuals with diabetes and CLDs were less likely to participate in physical exercise compared to individuals without CLDs. Conversely, individuals with diabetes and CLDs were just as likely to receive a dilated eye exam, have their feet checked, and have their A1C checked as individuals without CLDs, which is a very encouraging finding.

Background: Mental disorders are among the leading causes of non-fatal disease burden in India, but a systematic understanding of their prevalence, disease burden, and risk factors is not readily available for each state of India. In this report, we describe the prevalence and disease burden of each mental disorder for the states of India, from 1990 to 2017., Methods: We used all accessible data from multiple sources to estimate the prevalence of mental disorders, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by these disorders for all the states of India from 1990 to 2017, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We assessed the heterogeneity and time trends of mental disorders across the states of India. We grouped states on the basis of their Socio-demographic Index (SDI), which is a composite measure of per-capita income, mean education, and fertility rate in women younger than 25 years. We also assessed the association of major mental disorders with suicide deaths. We calculated 95% uncertainty intervals (UIs) for the point estimates., Findings: In 2017, 197·3 million (95% UI 178·4-216·4) people had mental disorders in India, including 45·7 million (42·4-49·8) with depressive disorders and 44·9 million (41·2-48·9) with anxiety disorders. We found a significant, but modest, correlation between the prevalence of depressive disorders and suicide death rate at the state level for females (r 2 =0·33, p=0·0009) and males (r 2 =0·19, p=0·015). The contribution of mental disorders to the total DALYs in India increased from 2·5% (2·0-3·1) in 1990 to 4·7% (3·7-5·6) in 2017. In 2017, depressive disorders contributed the most to the total mental disorders DALYs (33·8%, 29·5-38·5), followed by anxiety disorders (19·0%, 15·9-22·4), idiopathic developmental intellectual disability (IDID; 10·8%, 6·3-15·9), schizophrenia (9·8%, 7·7-12·4), bipolar disorder (6·9%, 4·9-9·6), conduct disorder (5·9%, 4·0-8·1), autism spectrum disorders (3·2%, 2·7-3·8), eating disorders (2·2%, 1·7-2·8), and attention-deficit hyperactivity disorder (ADHD; 0·3%, 0·2-0·5); other mental disorders comprised 8·0% (6·1-10·1) of DALYs. Almost all (>99·9%) of these DALYs were made up of YLDs. The DALY rate point estimates of mental disorders with onset predominantly in childhood and adolescence (IDID, conduct disorder, autism spectrum disorders, and ADHD) were higher in low SDI states than in middle SDI and high SDI states in 2017, whereas the trend was reversed for mental disorders that manifest predominantly during adulthood. Although the prevalence of mental disorders with onset in childhood and adolescence decreased in India from 1990 to 2017, with a stronger decrease in high SDI and middle SDI states than in low SDI states, the prevalence of mental disorders that manifest predominantly during adulthood increased during this period., Interpretation: One in seven Indians were affected by mental disorders of varying severity in 2017. The proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990. Substantial variations exist between states in the burden from different mental disorders and in their trends over time. These state-specific trends of each mental disorder reported here could guide appropriate policies and health system response to more effectively address the burden of mental disorders in India., Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India., (Copyright © 2020 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.)

Background: Adults with intellectual disabilities (IDs) have higher rates of morbidity and mortality compared with the general population, necessitating a need to identify modifiable targets for intervention to mitigate risk. While the benefits of leisure-time physical activity (PA) are well established in the general population; there is a dearth of evidence confirming its health benefits among adults with IDs. The purpose of this study was to examine the association between leisure-time PA and all-cause mortality among a population-based sample of adults with IDs., Methods: A total of 413 adults with IDs from 17 waves (1997-2014) of the National Health Interview Survey, a U.S. nationally representative survey, were studied. Minutes per week of leisure-time PA was ascertained by self-report and classified as poor, intermediate or ideal levels of PA., Results: Over a median follow-up of 7.2 years, 60 participants died. In a multivariable-adjusted model, higher levels of leisure-time PA were dose-dependently associated with a lower risk of all-cause mortality (P-trend = 0.008). The multivariable-adjusted hazard ratios (95% confidence interval) for all-cause mortality comparing participants with intermediate and ideal versus poor levels of PA were 0.43 (0.18, 1.04) and 0.30 (0.10, 0.87), respectively., Conclusion: These findings show that leisure-time PA confers mortality benefit in adults with IDs and should be considered as a priority target for promoting health and longevity in this population., (© 2019 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Patients with chronic mental illness are highly vulnerable to chronic respiratory problems. We examined the influence of mental disability on respiratory infection-related utilization risk in individuals with and without mental disabilities. A population-based, retrospective cohort design and two-part model were used to analyze respiratory infection-related utilization in individuals with MDs (MD group) and a matched reference group. The respiratory infection-related utilization rate in one year was lower in the MD group (53.8%) than in the reference group (56.6%). The odds ratios (ORs) were significantly higher among individuals with profound MDs (aOR = 1.10; 95% CI 1.07-1.14) and those with a history of dental cavities (aOR = 1.16; 95% CI: 1.13-1.19) or periodontal disease (aOR = 1.22; 95% CI: 1.19-1.26) after controlling for covariables. The average number of visits was higher in the MD group (5.3) than in the reference group (4.0). The respiratory infection-related utilization rate and average number of visits were significantly higher in the mild, moderate and severe disabled groups with a history of periodontal disease, respectively, than that of the reference group. In conclusion, healthcare authorities must develop an incentive program to prevent respiratory infections among individuals with MDs., Competing Interests: The authors declare no conflicts of interest.

Introduction: Dental care for mentally disabled people poses a growing challenge for healthcare. In Hungary, the number of mentally disabled people needing special dental care is ca. 100 000. Aim: The aim of our retrospective analysis is to provide a summary of the demographic data and the treatment outcomes of patients with mental disorders treated at the Department of the Oral and Maxillofacial Surgery of the Semmelweis University in the past five years. Method: Dental care for patients with a severe level of mental disability can be carried out in general anaesthesia only. At Semmelweis University, in the Oral and Maxillofacial Department, 1717 mentally disabled adults received dental care during the past five years. (Patients included people with a mild, medium or severe level of mental disability, patients with Down's syndrome, autism, epilepsy or panic disorder.) Results: The single biggest achievement seems to be the fact that the issue of acute dental care and oral surgery has basically been settled. A workable relationship has been forged with foundations and organizations dealing with the problems of these patients. It has been realized, however, that in the case of mentally disabled patients there is an enormous need for prevention and ongoing care. Conclusions: Up to now no survey has been carried out in Hungary with the aim of objectively revealing the dental care needs of these patients. Internationally, however, several surveys have been published. It can be stated on the basis of these that both caries frequency and the presence of parodontal diseases increase in correlation with age and the level of disability. Oral hygiene is insufficient, patients or their caretakers do not get proper information, only a few of them receive adequate training and they are not motivated to keep up oral health. Dental care, except for tending acute cases, is not satisfactory. For the sake of prevention, cooperation is needed with non-governmental organizations, foundations, special education teachers and psychiatrists specialized in this field. Orv Hetil. 2019; 160(35): 1380-1386.

Background: Intestinal parasitic infections are still common in low-income countries including Ethiopia, particularly in children due to low-quality drinking water, poor personal and environmental sanitation. Disabled individuals are excluded from most academic, economic, social and cultural opportunities, they are among the poorest and most marginalized of the whole world's people. The aim of this study was to assess the prevalence of intestinal parasitic infections and associated factors among mentally disabled and non-disabled students at primary schools in Bahir Dar city, Amhara regional state, Ethiopia, 2018., Methods: A school-based Comparative cross-sectional study design was conducted from November 1-30, 2018. A total of 418 study participants, 104 mentally disabled and 314 non-disabled students were recruited through a simple random sampling technique. The collected data were coded, entered and cleaned with EpiData version 3.1 and analyzed using SPSS version 23. Multivariable logistic regression was conducted to identify factors associated with intestinal parasitic infections. The adjusted odds ratio with a 95% Confidence interval at a 5% level of significance was used to measure the strength of association., Results: The mean age of study participants was 14.05 ± 3.66 and 11.96 ± 2.94 for mentally disabled students and non-disabled students. Prevalence of parasitic infection was 56.70% (n = 59) for mentally disabled students whereas 41.10%(n = 129) for non-disabled students. Unclean fingernails [AOR = 2.42; 1.40,4.17], health checkups [AOR = 1.87;1.16,3.02], hand washing with water only [AOR = 2.48; 1.49,4.12], cooking and sanitation source of water [AOR = 4.40;2.32,8.36], Grade [ (1-4)] [AOR = 2.27;1.41,3.67], sex [AOR = 1.64;1.03,2.63] and Family size> = 7 [AOR = 2.74;1.25,5.99] were variables which showed statistically significant association with intestinal parasitic infections., Conclusion: The prevalence of intestinal parasitic infection was higher among mentally disabled students than non-disabled students. Unclean fingernails, health checkups, hand washing habits, source of water, family size, sex and Grade of students have had a statistically significant association with intestinal parasitic infections. Periodic medicinal treatment was needed twice a year for mentally disabled and once a year for non-disabled students.

Background: Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England., Methods: Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters., Results: Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective., Conclusion: Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions.

Objective: An enterohaemorrhagic Escherichia coli (EHEC) outbreak at an institute with multiple facilities for children and adults with intellectual disabilities was investigated to characterize the cases and identify risk factors for infection., Methods: A case was defined as a resident, a staff member or a visitor at the institute from 16 May through 30 June 2005 testing positive for type 2 Vero toxin-producing EHEC O157:H7 (confirmed case) or exhibiting bloody diarrhoea for two or more days (probable case). We collected and analysed demographic, clinical, laboratory and individual behaviour data to identify possible risk factors for infection and infection routes., Results: We recorded 58 confirmed cases, of which 13 were symptomatic. One probable case was also found. The median age of the patients was 37 years (range: 6-59 years). Thirty-six patients (61%) were male. Thirteen patients (93%) had diarrhoea and six (43%) had abdominal pain. Two developed haemolytic-uraemic syndrome but recovered. All the patients were treated with antibiotics and tested negative after treatment. Some residents had problems with personal hygiene. The residents of one of the facilities who cleaned a particular restroom had 18.0 times higher odds of being infected with EHEC (95% confidence interval: 4.0-102.4) than those who did not., Discussion: The source of the outbreak could not be identified; however, the infection may have spread through environmental sources contaminated with EHEC. We recommend that institutional settings, particularly those that accommodate people with intellectual disabilities, clean restrooms as often as possible to reduce possible infection from contact with infected surfaces., ((c) 2019 The authors; licensee World Health Organization.)

Background: Little is known about the health needs of people with intellectual disabilities who access out-of-hours primary care services, raising concerns about accessibility and quality of care for this group. This study aims to identify commonly presented health problems of people with intellectual disabilities in this specific setting compared with the general population., Method: Cross-sectional study with routine data at two out-of-hours cooperatives with a total of 41,166 persons aged 20-65 requesting outof-hours primary care in 2014, of which 315 persons were identified as having an intellectual disability., Results: Having an intellectual disability was associated with a higher probability of presenting with epilepsy (OR 45.65) and concerns about, and adverse effects of, medical treatment (OR 23.37, and 8.41, respectively)., Conclusions: Given the high rates of epilepsy and medication-related concerns of people with intellectual disabilities, this study suggests that these issues require special attention to improve the accessibility and quality of out-of-hours primary care., (© 2018 John Wiley & Sons Ltd.)

Background: Schools are expected to be an environment where children can reach their fullest potential and develop their talents, personality, as well as their mental and physical abilities. Children with disabilities often have restricted participation and lower achievement in school. The aim is to investigate if there are any differences in participation and achievement in school between adolescents, with and without self-reported neuropsychiatric disabilities, and to explore the relations between achievement and participation., Methods: A cross-sectional study was carried out based on data collected from 1520 adolescents in the sixth and seventh grade, from the south of Sweden. Multiple logistic regression was conducted to explore the relationship between having a neuropsychiatric disability, with participation and achievement, and how different factors affected this relationship., Results: Having a self-reported neuropsychiatric disability increases the likelihood of having restricted participation (adjusted odds ratio (AOR): 2.89; 95% confidence interval (CI): 1.99-4.23) and lower achievement in school (AOR: 2.94; 95% CI: 2.06-4.24). These adolescents were also more likely to have negative relationships to their teachers, be bullied, have poorer connectedness to their parents, come from families with less money, be trying drugs and be male, in comparison to the adolescents without a neuropsychiatric disability. The odds of having lower achievement increased with lower engagement and absenteeism from class., Conclusions: Adolescents with self-reported neuropsychiatric disabilities have a disadvantaged situation in school, and are exposed to factors that could have long-term negative effects. More longitudinal research is required to conclude what factors are causing restricted participation and low achievement.

Introduction: Prior studies have found that women with disabilities are less likely to receive adequate prenatal care than women without disabilities. However, little is known about differences in patterns of prenatal care by type of disability. Therefore, this study examined timing and frequency of prenatal care among women with physical, sensory, or intellectual/developmental disabilities compared with women without disabilities., Methods: This was a retrospective cohort study using linked maternal and infant hospital discharge and birth certificate data for all births in California in 2000-2012 (N=6,745,201). Analyses were conducted in 2017-2018. Modified Poisson regression analyses compared women with each type of disability with women without disabilities on trimester of prenatal care initiation and number of prenatal care visits., Results: Women with intellectual/developmental disabilities or with limited hearing had significantly higher RR of delaying prenatal care initiation until the second or third trimester (intellectual/developmental disabilities: adjusted RR=1.21, 95% CI=1.09, 1.33; hearing: adjusted RR=1.11, 95% CI=1.02, 1.21), whereas women with physical disabilities and limited vision had lower risk of delaying care (physical: adjusted RR=0.91, 95% CI=0.88, 0.94; vision: adjusted RR=0.85, 95% CI=0.73, 0.99). Women with limited hearing or vision or intellectual/developmental disabilities had higher risk of receiving fewer prenatal visits than recommended, compared with women without disabilities. Women with physical disabilities or intellectual/developmental disabilities had higher RR of receiving more than the typical number of visits., Conclusions: There were key differences in prenatal care utilization by disability type, reflective of particularly pronounced disparities for women with intellectual/developmental disabilities and women with limited hearing. Delays in receipt of prenatal care and low numbers of prenatal care visits may contribute to the poorer birth outcomes that have been observed previously in these groups. Targeted interventions are needed to improve uptake of prenatal care in these vulnerable populations., (Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Aim: This study explored patterns of service use and associated socioeconomic factors among Chinese elders with mental disabilities., Methods: Data from the second China National Sample Survey on Disability (CNSSD) were used in this study. Univariate and multivariate logistic regression models were used to calculate the odds ratios and 95% confidence intervals for factors associated with utilization of mental health services among Chinese elderly people with a mental disability., Results: Among elderly people with a mental disability in the CNSSD, 46.35% had used mental health services. Urban residence, higher education level, being married, medical insurance coverage, and higher annual family income per capita were associated with more utilization of mental health services., Conclusions: This study revealed a low level of mental health service utilization among the Chinese population with mental disorders or a mental disability. Strategies to improve the insurance coverage of mental healthcare, to increase public awareness of mental disorders, and to reduce regional inequality of mental health resources are warranted.

Objectives: To evaluate the association between mass casualty shooting venues, types of firearms, and the age of perpetrators in the United States., Methods: We analyzed data on mass casualty (≥ 3 fatalities) shootings for August 1982 through February 14, 2018. We describe data overall, specifically by school venues and the weapons used. We categorized perpetrators by ages of younger than 18 years, 18 to 20 years, and 21 years and older. We described the number of victims (fatalities plus injuries) by medians and average per event., Results: Of 97 events, the median perpetrator age was 35 years and 21 years for school shootings. Four of 16 school events were committed by those aged 18 to 20 years, and all of those events included long guns. Victims of perpetrators aged 18 to 20 years made up 9.0% of all victims and 31.1% of victims of school shootings., Conclusions: Persons aged 18 to 20 years perpetrated about 1 in 8 shootings, accounting for about 1 in 3 victims of school shootings. Public Health Implications. Legislation to prevent mass casualty events must be multifaceted, including age restrictions, restrictions on certain types of firearms, and improved resources for mental health, with particular emphasis on mental health and firearm restrictions for young adults.

The low employment rates of individuals with intellectual disability (ID) are a major concern. This study examined the effect of postsecondary education on employment atrnd earnings for individuals with ID and the effect of state variation on those outcomes. Rehabilitation Services Administration 911 (RSA-911) files for 2008-2013 were analyzed (n = 11,280 individuals with ID). Multilevel modeling techniques were used to understand state variation, such as various economic and programmatic features that influence outcomes. Postsecondary education was associated with increased employment, increased weekly earnings, decreased reliance on Supplemental Security Income (SSI) benefits. Policy implications are discussed.

The impact of sexual abuse among those with an intellectual disability is an area in need of further research. The current article provides an in-depth narrative review of the sexual abuse literature relevant to individuals with an intellectual disability. The 29 articles included in this study focused on (a) the prevalence of sexual abuse, (b) the risk factors associated with this population, and (c) the psychological impact of abuse. The findings confirmed that children and adults with an intellectual disability are at a higher risk of sexual abuse than nondisabled peers. Research regarding risk factors is equivocal, with a range of possible factors indicated. Similarly, evidence suggests that there is no single diagnostic trajectory when dealing with the sequelae of sexual abuse among those with an intellectual disability. The article concludes by discussing recommendations for future research and development of policy around this area.

The present study sought to identify predictors associated with paid employment outcomes for community and technical college students with intellectual disability (ID). Data used were collected from the Transition and Postsecondary Programs for Students With Intellectual Disabilities (TPSID) implemented in two community and technical colleges in the upper Midwest. The participants included 228 students with ID attending college who received supports based on the Check & Connect model. Results using logistic regression showed that students who only took inclusive classes, participated in campus events, had prior paid work experience, and participated in volunteering and/or community service were more likely to earn at or above minimum wage during their most recent year in the TPSID program. Implications for policy and practice are discussed.

This study compares characteristics and outcomes of 70 defendants with and 1,122 without intellectual and developmental disabilities (IDD) participating in a mental health court. Demographic and clinical characteristics differed, but criminal justice or program characteristics did not. Age, race, marital status, living situation, court location, health insurance status, and likelihood of mental illness or substance abuse diagnosis differed between the two groups. When controlling for other factors, a diagnosis of IDD did not affect the odds of negative termination from the court but did reduce the odds of rearrest within 1 year of leaving the court. Some mental health courts exclude people with IDD; the study concludes inclusion is appropriate.

In 1975, federal law mandated that children with disabilities be educated in their least restrictive environment, or alongside peers without disabilities in general education classrooms to the maximum extent appropriate. More than 40 years later, I investigated how national trends in educational placement have changed over time for students with intellectual disability. Specifically, I examined the degree placements have trended toward less restrictive environments. I found historical trends of incremental progress toward less restrictive settings, but no evidence of such progress in recent years. Furthermore, most students were educated predominantly in segregated settings every year. I discuss how these findings relate to previous studies, as well as implications for individualized education program teams and advocates for educational inclusion.

Millions of Americans rely on Internet access to fulfill everyday needs, yet psychiatric units frequently restrict patients from going online. This article reviews the evolution of legal rights for hospitalized psychiatric patients in the United States over the past 50 years and argues that legal oversight of psychiatric hospitalization has not kept pace with the rise of digital technology. As a result of this discrepancy, Internet access on inpatient psychiatry remains controversial and often varies by institution. This article examines literature on Internet use by psychiatric patients, as well as recent court cases relevant to this topic. Finally, this article addresses clinical considerations surrounding Internet access for psychiatric inpatients and provides recommendations for the development of Internet policies in inpatient psychiatric settings., (© 2018 American Academy of Psychiatry and the Law.)

Objective: The objective was to determine population-based estimates of use of contraception among women 15-44 years of age in the United States by disability status., Study Design: We examined the relationship between disability status and use of contraception among 7505 women at risk of unintended pregnancy using data from the 2011-2015 National Survey of Family Growth., Results: After examining the full distribution of contraceptive method use by disability status, we found that disability status was significantly associated with differences in three categories of use: female sterilization, the oral contraceptive pill and nonuse of contraception. Multivariate analysis shows that use of female sterilization was higher among women with cognitive disabilities (aOR=1.54, 95% CI=1.12-2.12) and physical disabilities (aOR=1.59, CI=1.08-2.35) than for those without disabilities after controlling for age, parity, race, insurance coverage and experience of unintended births. Use of the pill was less common among women with physical disabilities than for those without disabilities (aOR=0.57, CI=0.40-0.82). Finally, not using a method was more common among women with cognitive disabilities (aOR=1.90, CI=1.36-2.66)., Conclusions: Self-reported cognitive disabilities ("serious difficulty concentrating, remembering or making decisions"), as well as physical disabilities, are significant predictors of contraceptive choices after controlling for several known predictors of use., Implications: The patterns found here suggest that screening for self-reported cognitive and physical disabilities may allow health care providers to tailor counseling and sex education to help women with disabilities prevent unintended pregnancy and reach their family size goals., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Adults with autism spectrum disorders (ASD) experience challenges in participating in the labour market and struggle to achieve and maintain appropriate professional positions, possibly due to impairments of communication and social interaction. Studies have shown high rates of unemployment as well as evidence of inadequate employment. As knowledge on the participation in the German labour market is scarce, the aim of our study was to examine employment status, type of occupation and inadequate employment in a sample of clinically mostly late-diagnosed and most likely not intellectually disabled adults with ASD in Germany., Methods: We conducted a cross-sectional-survey in clinically mostly late-diagnosed adults with ASD. Employment status, type of occupation, and the level of formal education and training were examined through a postal questionnaire. Inadequate employment regarding participants' current and longest practised occupation was assessed by transforming participants' information into skill levels of the "Classification of Occupations 2010" of the German Federal Employment Agency, and comparing these with participants' level of formal education and training., Results: The response rate was 43.2% (N = 185 of N = 428 potential participants). 94.6% were first-time diagnosed when being 18 years of age or older. 56.8% held a general university entrance-level qualification and 24.9% had obtained a Masters' or diploma degree as their highest vocational qualification. 94.1% had been employed at some time. Of these, 68.4% reported being currently employed, 13.5% being currently unemployed and 17.0% being retired for health reasons. Regarding the longest-practised and the current occupation, the highest proportion of participants was found in the occupational area "health and social sector, teaching and education" (22.4% and 23.3%, respectively). With respect to inadequate employment, 22.1% were found to be overeducated in relation to their longest-practised occupation and 31.3% in relation to their current occupation. This is significantly higher than the percentage of overeducation in the general population., Conclusions: Despite largely high formal qualifications, the clinically mostly late-diagnosed adults with ASD represented in our sample are disadvantaged regarding their participation in the German labour market, especially with respect to rates of unemployment, early retirement and overeducation. Employment support programs should be developed to improve employment outcomes.

This study aims to compare, among a representative sample of substantiated child maltreatment cases, the characteristics of those with intellectual disability (ID) from those without ID. Using the 2008 Canadian Incidence Study of Reported Child Abuse and Neglect, 5,797 cases of substantiated maltreatment that involved children aged between 0 and 14 years were analyzed. One in 10 children (11.3%) was identified with ID. Results revealed functional problems to be higher among children with ID and their parents. Moreover, children with ID experienced more severe maltreatment, and were more often referred to ongoing child protection services. These findings suggest that maltreated children with ID are facing additional challenges that must be accounted for in service planning and delivery.

Objectives: Homeless Mentally Ill (HMI) patients represent a unique global problem and pose a challenge in treatment, management and rehabilitation services. There is sparse data on HMI patients in India. The objective of this paper is to study the clinical outcome and rehabilitation of HMI patients., Methods: We performed a retrospective chart review of 'HMI' patients from 1st January 2002 to 31st December 2015, who were admitted under Department of Psychiatry at National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Clinical outcomes were analysed by descriptive statistics and predictors of family reintegration were analysed by logistic regression model., Results: Seventy-eight HMI (unknown) patients were admitted in fourteen years period. 64(82%) were improved at discharge, 40(51.3%) were reintegrated to the family; 15(19.2%) were sent to state home for women, and 17(21.8%) were sent to Non-Governmental Organization (NGO)/Rehabilitation Centre and 6 (7.8%) required multispecialty care in general hospital or absconded from the hospital during inpatient care. The logistic regression model showed that mental retardation (B=-2.204, P=0.002) was negatively correlated with family reintegration and clinical improvement at discharge (B=2.373, P=<0.001) was positively correlated with family reintegration., Conclusions: In our study majority of HMI patients improved at the time of discharge. Family reintegration was possible in about half of HMI patients after treatment. Mental retardation and clinical improvement are important predictors of family reintegration of HMI patients., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Purpose: To estimate the prevalence of, and association between, co-morbid visual and psychiatric disabilities among elderly (>65 years-of-age) persons in China., Methods: Random representative samples were obtained using multistage, stratified, cluster sampling, with probabilities proportional to size. Standard weighting procedures were used to construct sample weights that reflected this multistage, stratified cluster sampling survey scheme. Logistic regression models were used to elucidate associations between visual and psychiatric disabilities., Results: Among the Chinese elderly, >160,000 persons have co-morbid visual and psychiatric disabilities. The weighted prevalence among this cohort is 123.7 per 100,000 persons. A higher prevalence of co-morbid visual and psychiatric disabilities was found in the oldest-old (p<0.001); women (65-79 years-of-age, p=0.001; ≥80 years-of-age, p=0.004); illiterate (65-79 years-of-age, p<0.001; ≥80 years-of-age, p=0.02); and single elders (65-79 years-of-age, p=0.01; ≥80 years-of-age, p=0.001). Presence of a visual disability was significantly associated with a higher risk of having a psychiatric disability among persons aged ≥80 years-of-age [adjusted odds ratio, 1.24; 95% confidence interval (CI), 1.03-1.54]., Conclusion: A significant number of Chinese elderly persons were living with co-morbid visual and psychiatric disabilities. To address the challenge of these co-morbid disorders among Chinese elders, it is incumbent upon the government to implement additional and more comprehensive prevention and rehabilitation strategies for health-care systems, reinforce health promotion among the elderly, and improve accessibility to health-care services.

Background: Little research exists on suspension of students with autism or intellectual disabilities. We examined suspension rates of students with autism or intellectual disability in Maryland from 2004 to 2015 to understand whether race and disability status predicted the odds of being suspended., Method: We used school enrollment data and school suspension data in Maryland for analysis. Descriptive statistics by race and disability category were calculated. Logistic regression was used to examine differences in odds of suspension by race and by disability (ID and autism) each year., Results: Suspension rates in Maryland decreased overall from 2004 to 2015, but African American students with intellectual disability or no disability were significantly more likely to be suspended. White students with autism and White students with intellectual disability had significantly higher odds of suspension than White students without a disability., Conclusions: Overall risk for suspension in Maryland decreased over time. African American students with autism or intellectual disability, as well as white students with autism or intellectual disability, experienced significantly higher odds of suspension when compared to their White students without a disability. This relatively unexplored issue commands attention from researchers and policymakers alike., (© 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Background: To date, little is known about the predictors of healthcare service utilisation in children with intellectual disability (ID). The aim of this study was to identify the factors associated with service complexity in children with ID in Ontario, Canada., Methods: The population of this cross-sectional study consisted of 330 children with ID ages 4 to 18 years who accessed mental health services from November of 2012 to June of 2016 in four agencies. All participants completed the interRAI Child and Youth Mental Health and Developmental Disability Assessment Instrument, which is a semi-structured clinician-rated assessment that covers a range of common issues in children with ID. The outcome of this study was a service complexity variable based on (1) mental health service utilisation including any services provided to the child and (2) the management involved in providing that care. Eight individual items were summed, resulting in a scale that ranged from 0 to 8. Scores were then dichotomised into two groups: a score of 0-2 identified children with a low service complexity and a score of 3 or higher identified children with a high service complexity., Results: After adjustment for other covariates, gender was not associated with service complexity. Children aged 11-14 years and children with autism spectrum disorder used over twofold higher levels of service complexity than children aged equal to or less than 10 years or children with other causes of ID. Moreover, victims of bullying, high scores on the family functioning scale or learning or communication disorder were associated with greater service complexity., Conclusions: The findings of this study indicate that a variety of factors are related to service complexity ranged from children's nonclinical (age and experiences of bullying) to clinical (e.g. aggression, learning/communication problems and autism spectrum disorder) characteristics., (© 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Purpose: Adults with intellectual disabilities experience poorer physical health and health care quality, but there is limited information on the potential for reducing emergency hospital admissions in this population. We describe overall and preventable emergency admissions for adults with vs without intellectual disabilities in England and assess differences in primary care management before admission for 2 common ambulatory care-sensitive conditions (ACSCs)., Methods: We used electronic records to study a cohort of 16,666 adults with intellectual disabilities and 113,562 age-, sex-, and practice-matched adults without intellectual disabilities from 343 English family practices. Incident rate ratios (IRRs) from conditional Poisson regression were analyzed for all emergency and preventable emergency admissions. Primary care management of lower respiratory tract infections and urinary tract infections, as exemplar ACSCs, before admission were compared in unmatched analysis between adults with and without intellectual disabilities., Results: The overall rate for emergency admissions for adults with vs without intellectual disabilities was 182 vs 68 per 1,000 per year (IRR = 2.82; 95% CI, 2.66-2.98). ACSCs accounted for 33.7% of emergency admissions among the former compared with 17.3% among the latter (IRR = 5.62; 95% CI, 5.14-6.13); adjusting for comorbidity, smoking, and deprivation did not fully explain the difference (IRR = 3.60; 95% CI, 3.25-3.99). Although adults with intellectual disability were at nearly 5 times higher risk for admission for lower respiratory tract infections and urinary tract infections, they had similar primary care use, investigation, and management before admission as the general population., Conclusions: Adults with intellectual disabilities are at high risk for preventable emergency admissions. Identifying strategies for better detecting and managing ACSCs, including lower respiratory and urinary tract infections, in primary care could reduce hospitalizations., Competing Interests: Conflicts of interest: authors report none., (© 2017 Annals of Family Medicine, Inc.)

Background/objectives: Largely unresearched are the similarities and differences compared to the general population in the aging of people with an intellectual disability (ID). Data reported here compare the health and health-care utilization of the general aging population in Ireland with those who are aging with ID., Design: Data for comparisons were drawn from the 2010 The Irish Longitudinal Study on Ageing (TILDA) and the Intellectual Disability Supplement (IDS)-TILDA Wave 1 data sets., Setting: TILDA participants were community dwelling only while IDS-TILDA participants were drawn from community and institutional settings., Participants: TILDA consists of a sample of 8,178 individuals aged 50 years and older who were representative of the Irish population. The IDS-TILDA consists of a random sample of 753 persons aged 40 and older. Using age 50 as the initial criterion, 478 persons with ID were matched with TILDA participants on age, sex, and geographic location to create the sample for this comparison., Measurements: Both studies gathered self-reported data on physical and mental health, behavioral health, functional limitations, and health-care utilization., Results: Rates of chronic disease appeared higher overall for people with ID as compared to the general population. There were also age-related differences in the prevalence of diabetes and cancer and different rates of engagement between the two groups in relevant behavioral health activities such as smoking. There were higher utilization levels among IDS-TILDA participants for allied health and general practitioner visits., Conclusion: Different disease trajectories found among IDS-TILDA participants raise concerns. The longitudinal comparison of data for people with ID and for the general population offered a better opportunity for the unique experiences of people with ID to be included in data that inform health planning.

Objective: People with intellectual developmental disorders (IDD) have worse health statuses in comparison with general population. The objective of this paper is to compare access and hospital morbimortality in people with IDD and general population., Material and Methods: We conducted a retrospective cross-sectional analytical study and analyzed data on admissions and discharges between IDD patients and the rest of them, in Ciudad Real, España., Results: Out of 51 325 hospital admissions, 441 (0.9%) belonged to the group of persons with IDD. The IDD group had fewer programmed hospitalization than the general population and fewer surgical interventions. They presented more admissions for mental disorders and respiratory system diseases., Conclusions: The data presented confirm TDI population have different patterns of disease. Furthermore, this study reveal potential difficulties in access to health care in this population.

Recent literature indicates that people with Disorders of Intellectual Development (DID) experience health disparities in the pathologies that they present, and a worst access to health care. However, current evidence-based knowledge is still sparse outside the Anglo-Saxon countries. The POMONA-I and POMONA-II European projects aimed to collect information on the health status of people with DID in Europe. The POMONA-ESP project in Spain is meant to collect health information in a wide and representative sample of persons with DID. Also, there are studies that claim for the need of specialized services for people with DID at the public health system. There are also studies about the current state of the education and training about DID for students within the health sector. In this paper we review the latest evidences about the health of the persons with DID and we present the main research activities and care initiatives about this issue.

Objective: To better understand the health profiles of people with intellectual disability (ID), focusing on the variables that are associated with a poorer health status., Materials and Methods: Data were collected from the Survey on Disability, Personal Autonomy and Dependency (EDAD 2008) of the Spanish National Statistics Institute (INE). The health data of 2840 subjects with IDD were analyzed in order to verify the impact of different variables on their health profiles., Results: People with severe and profound levels of IDD presented a higher number of medical diagnoses. At residence centers there was a larger proportion of individuals with a higher prevalence of chronic diseases and more severe conditions; age also was an important factor., Conclusion: The health profiles of individuals with IDD differ depending on the severity level of their IDD and their degree of institutionalization. Further research is needed to provide better health care for people with IDD.

Objective: We use nationally representative data on working-age recipients of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) to profile beneficiaries with psychiatric disabilities and compare them with beneficiaries eligible for SSDI and SSI on the basis of other health conditions., Method: Using data from 4 National Beneficiary Survey rounds, we conducted descriptive analyses of the personal and health characteristics and employment experiences of beneficiaries with and without psychiatric disabilities. Our sample includes 16,190 SSDI and SSI beneficiaries, of whom 6,447 have psychiatric disabilities. We conducted statistical tests of significance (χ2 and t statistics) to assess the difference between beneficiaries with and without psychiatric disabilities., Results: Beneficiaries with psychiatric disabilities differ in many ways from other beneficiaries. They are significantly more likely to be younger than 55 years of age, female, have children, be unmarried, live alone, and be in poverty. Although a greater share report a desire to work, they are also more likely than their counterparts with other disabilities to report various employment barriers, including being discouraged by previous work attempts, the perception that others do not think they can work, a lack of transportation, and not wanting to lose cash or health insurance benefits., Conclusions and Implications for Practice: The findings suggest that beneficiaries with psychiatric disabilities face numerous significant employment obstacles that would need to be addressed for supported employment or similar approaches to be successful. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)