Psychiatric disturbances in children with intellectual disability : Prevalence, risk factors and assessment

Children with intellectual disability are at increased risk for emotional and behavioural problems, but many of these disturbances fail to be diagnosed. Structured checklists have been used to supplement the psychiatric assessment of children without intellectual disability, but for children with intellectual disability, only a few checklists are available. The aim of the study was to investigate psychiatric disturbances among children with intellectual disability: the prevalence, types and risk factors of psychiatric disturbances as well as the applicability of the Finnish translations of the Developmental Behaviour Checklist (DBC-P) and the Child Behavior Checklist (CBCL) in the assessment of psychopathology. The subjects comprised 155 children with intellectual disability, and data were obtained from case records and five questionnaires completed by the parents or other carers of the child. According to case records, a psychiatric disorder had previously been diagnosed in 11% of the children. Upon careful re-examination of case records, the total proportion of children with a psychiatric disorder increased to 33%. According to checklists, the frequency of probable psychiatric disorder was 34% by the DBC-P, and 43% by the CBCL. The most common diagnoses were pervasive developmental disorders and hyperkinetic disorders. The results support previous findings that compared with children without intellectual disability, the risk of psychiatric disturbances is 2-3-fold in children with intellectual disability. The risk of psychopathology was most significantly increased by moderate intellectual disability and low socio-economic status, and decreased by adaptive behaviour, language development, and socialisation as well as living with both biological parents. The results of the study suggest that both the DBC-P and the CBCL can be used to discriminate between children with intellectual disability with and without emotional or psychiatric disturbance. The DBC-P is suitable for children with any degree of intellectual disability, and the CBCL is suitable at least for children with mild intellectual disability. Because the problems of children with intellectual disability differ somewhat from those of children without intellectual disability, checklists designed specifically for children with intellectual disability are needed.

Monimuotoisuus ja esteettömyys : Näkövammaisten asiantuntijoiden työelämäkokemuksia

The purpose of this study is to analyse education, employment, and work-life experiences of visually impaired persons in expert jobs. The empirical data consists of 30 thematic interviews (24 visually impaired persons, 1 family-member of a visually impaired person, 5 persons working with diversity issues), of supplementary articles, and of statistics on the socio-economic status of the visually impaired. The interviewees experiences of education and employment have been analysed by a qualitative method. The analysis has been deepened by reflecting it against the recent discussion on the concept of diversity. The author s methodological choice as a disability researcher has been to treat the interviewees as co-researchers rather than objects of research. Accessibility in its different forms is a prerequisite of diversity in the workplace, and this study examines what kind of accessibility is required by visually impaired professionals. Access to working life depends on the attitudes prejudices and expectations that society has towards a minority group. Social accessibility is connected with internal relationships in the workplace, and achieving social accessibility is a bilateral process. Information technology has revolutionised the visually impaired people s possibilities of accessing information and performing expert tasks. Accessible environment, good mobility skills, and transportation services enable visually impaired employees to get to their workplaces and to navigate there with ease. Integration has raised the level of education and widened the selection of career options for the visually impaired. However, even visually impaired people with academic degrees often need employment support services. Visually impaired professionals are mainly employed in the public and third sector. Achieving diversity in the labour market is a multiactor process. Social support services are needed, as well as courage and readiness from employers to hire people with disabilities. The organisations of the visually impaired play an important role in affecting the attitudes and providing peer support. Visually impaired employees need good professional skills, blindness skills, and social courage, and they need to be comfortable with their disability. In the workplace, diversity may actualise as diverse ways of working: the work is done by using technical aids or other means of compensating for the lack of eyesight. When an employee must find compensatory solutions for disability-related limitations at work, this will also develop his/her problem-solving abilities. Key words: visually impaired, diversity, accessibility, working life

Doing marriage and parenthood: The division of household labour across two life course events

The current study is a longitudinal investigation into changes in the division of household labour across transitions to marriage and parenthood in the UK. Previous research has noted a more traditional division of household labour, with women performing the majority of housework, amongst spouses and couples with children. However, the bulk of this work has been cross-sectional in nature. The few longitudinal studies that have been carried out have been rather ambiguous about the effect of marriage and parenthood on the division of housework. Theoretically, this study draws on gender construction theory. The key premise of this theory is that gender is something that is performed and created in interaction, and, as a result, something fluid and flexible rather than fixed and stable. The idea that couples ‘do gender’ through housework has been a major theoretical breakthrough. Gender-neutral explanations of the division of household labour, positing rational acting individuals, have failed to explicate why women continue to perform an unequal share of housework, regardless of socio-economic status. Contrastingly, gender construction theory situates gender as the key process in dividing household labour. By performing and avoiding certain housework chores, couples fulfill social norms of what it means to be a man and a woman although, given the emphasis on human agency in producing and contesting gender, couples are able to negotiate alternative gender roles which, in turn, feed back into the structure of social norms in an ever-changing societal landscape. This study adds extra depth to the doing gender approach by testing whether or not couples negotiate specific conjugal and parent roles in terms of the division of household labour. Both transitions hypothesise a more traditional division of household labour. Data comes from the British Household Panel Survey, a large, nationally representative quantitative survey that has been carried out annually since 1991. Here, data tracks the same 776 couples at two separate time points – 1996 and 2005. OLS regression is used to test whether or not transitions to marriage and parenthood have a significant impact on the division of household labour whilst controlling for host of relevant socio-economic factors. Results indicate that marriage has no significant effect on how couples partition housework. Those couples making the transition from cohabitation to marriage do not show significant changes in housework arrangements from those couples who remain cohabiting in both waves. On the other hand, becoming parents does lead to a more traditional division of household labour whilst controlling for socio-economic factors which accompany the move to parenthood. There is then some evidence that couples use the site of household labour to ‘do parenthood’ and generate identities which both use and inform socially prescribed notions of what it means to be a mother and a father. Support for socio-economic explanations of the division of household labour was mixed although it remains clear that they, alone, cannot explain how households divide housework.

Myotonic dystrophy type 2 (DM2) : Diagnostic methods and molecular pathology

Myotonic dystrophies type 1 (DM1) and type 2 (DM2) are the most common forms of muscular dystrophy affecting adults. They are autosomal dominant diseases caused by microsatellite tri- or tetranucleotide repeat expansion mutations in transcribed but not translated gene regions. The mutant RNA accumulates in nuclei disturbing the expression of several genes. The more recently identified DM2 disease is less well known, yet more than 300 patients have been confirmed in Finland thus far, and the true number is believed to be much higher. DM1 and DM2 share some features in general clinical presentation and molecular pathology, yet they show distinctive differences, including disease severity and differential muscle and fiber type involvement. However, the molecular differences underlying DM1 and DM2 muscle pathology are not well understood. Although the primary tissue affected is muscle, both DMs show a multisystemic phenotype due to wide expression of the mutation-carrying genes. DM2 is particularly intriguing, as it shows an incredibly wide spectrum of clinical manifestations. For this reason, it constitutes a real diagnostic challenge. The core symptoms in DM2 include proximal muscle weakness, muscle pain, myotonia, cataracts, cardiac conduction defects and endocrinological disturbations; however, none of these is mandatory for the disease. Myalgic pains may be the most disabling symptom for decades, sometimes leading to incapacity for work. In addition, DM2 may cause major socio-economical consequences for the patient, if not diagnosed, due to misunderstanding and false stigmatization. In this thesis work, we have (I) improved DM2 differential diagnostics based on muscle biopsy, and (II) described abnormalities in mRNA and protein expression in DM1 and DM2 patient skeletal muscles, showing partial differences between the two diseases, which may contribute to muscle pathology in these diseases. This is the first description of histopathological differences between DM1 and DM2, which can be used in differential diagnostics. Two novel high-resolution applications of in situ -hybridization have been described, which can be used for direct visualization of the DM2 mutation in muscle biopsy sections, or mutation size determination on extended DNA-fibers. By measuring protein and mRNA expression in the samples, differential changes in expression patterns affecting contractile proteins, other structural proteins and calcium handling proteins in DM2 compared to DM1 were found. The dysregulation at mRNA level was caused by altered transciption and abnormal splicing. The findings reported here indicate that the extent of aberrant splicing is higher in DM2 compared to DM1. In addition, the described abnormalities to some extent correlate to the differences in fiber type involvement in the two disorders.

Periodontal and dental health and oral self-care among adults with diabetes mellitus.

ABSTRACT Bakhshandeh, Soheila. Periodontal and dental health and oral self-care among adults with diabetes mellitus. Department of Oral Public Health, Institute of Dentistry, Faculty of Medicine, University of Helsinki, Helsinki, Finland. 2011. 49 pp. ISBN 978-952-10-7193-5(paperback). The aim of the present study was to assess oral health and treatment needs among Iranian adults with diabetes according to socio-demographic status, oral hygiene, diabetes related factors, and to investigate the relation between these determinants and oral health. Moreover, the effect of an educational oral health promotion intervention on their oral health and periodontal treatment needs was studied. The target population comprised adults with diabetes in Tehran, Iran. 299 dentate patients with diabetes, who were regular attendants to a diabetic clinic, were selected as the study subjects. Data collection was performed through a clinical dental examination and self-administered structured questionnaire. The questionnaire covered information of the subject s social background, medical history, oral health behaviour and smoking. The clinical dental examinations covered the registration of caries experience (DMFT), community periodontal index (CPI) and plaque index (PI). The intervention provided the adults with diabetes dental health education through a booklet. Reduction in periodontal treatment needs one year after the baseline examination was used as the main outcome. A high prevalence of periodontal pockets among the study population was found; 52% of the participants had periodontal pockets with a pocket depth of 4 to 5 mm and 35% had periodontal pockets with pocket depth of 6 mm or more. The mean of the DMFT index was 12.9 (SD=6.1), being dominated by filled teeth (mean 6.5) and missing teeth (mean 5.0). Oral self-care among adults with diabetes was inadequate and poor oral hygiene was observed in more than 80% of the subjects. The educational oral health promotion decreased periodontal treatment needs more in the study groups than in the control group. The poor periodontal health, poor oral hygiene and insufficient oral self-care observed in this study call for oral health promotion among adult with diabetes. An educational intervention showed that it is possible to promote oral health behaviour and to reduce periodontal treatment needs among adults with diabetes. The simplicity of the model used in this study allows it to be integrated to diabetes programmes in particular in countries with a developing health care system.

Neighborhoods attributes as determinants of children's academic achievement

Resumen: Los estudios sobre los efectos del vecindario sobre los logros educativos han confirmado la existencia de estos efectos particularmente en la adolescencia. Una deficiencia común de la investigación empírica hasta la fecha, la falta de información en múltiples contextos, se aborda en este trabajo mediante el uso de encuestas escolares de datos para obtener una mayor comprensión sobre el efecto de la pobreza en los niños que cursan el nivel primario de enseñanza en los EE.UU. Este trabajo propone la utilización de un modelo jerárquico lineal de clasificación cruzada para tomar en cuenta en forma apropiada la estructura anidada de la información ya que los niños pertenecen simultáneamente a los dos grupos, el barrio y la escuela. Los resultados que se presentan, basados en la encuesta ECLS-K, una muestra de más de 20000 niños en aproximadamente 1.000 vecindarios y 1200 escuelas 1200, pone de manifiesto la asociación entre la composición socioeconómica del vecindario y los resultados académicos de los estudiantes. Este estudio proporciona evidencia a favor de las teorías de la socialización y epidémica. La presencia de adultos con buen nivel educativo en el vecindario así como la mediana de ingresos tienen impacto positivo en el logro del estudiante. De la misma forma, elevados niveles de pobreza tienen una influencia significativa, pero negativa en los resultados académicos. Sin embargo, el impacto se produce cuando se supera el umbral de 30% de hogares pobres en el vecindario. Los resultados agregados son invariantes a distintas especificaciones en términos de variables, esto no sucede cuando se analizan subgrupos clasificados según su origen étnico, género y estatus socio-económico.

Las situaciones de alfabetización temprana en hogares de dos grupos sociales de Argentina

Resumen: En el marco de las perspectivas socioculturales actuales (Nelson, 2010) y en las líneas de investigación de alfabetización temprana y familiar (Hannon & Bird, 2004), se analizan 296 situaciones de alfabetización registradas en hogares de 20 niños de 4 años de poblaciones urbano marginadas y 20 niños de sectores medios. Empleando un procedimiento cualitativo (Strauss & Corbin, 1991) se analizaron comparativamente las situaciones registradas en ambos grupos atendiendo al tipo y a la estructura de la situación y a la interacción entre los participantes. Se identificaron diferencias en el tipo y la cantidad de situaciones en las que participaron los niños de ambos grupos. No se observaron diferencias en el interés de los niños por la lectura y la escritura.

Estado e imaginario tecnológico : un análisis de las reconfiguraciones en las políticas educativas nacionales de incorporación de TIC

Este artículo presenta los primeros resultados de una investigación mayor que se ubica en la articulación entre las políticas educativas de incorporación de TIC y el discurso docente de nivel medio, considerando dicha articulación en el marco del imaginario tecno-comunicacional contemporáneo. Ante los procesos de internacionalización de la toma de decisiones, la hegemonía neoliberal como paradigma socio-económico y los discursos de la Sociedad de la Información, Argentina, y en general los Estados nacionales, han sido permeables a los discursos sociales que promueven la incorporación de TIC. Este trabajo, desde una perspectiva socio-discursiva, se focaliza en el nivel de las políticas educativas definidas por el Estado argentino en la última década. A partir del rastreo de líneas de sentido que atraviesan los discursos analizados, se observa una búsqueda de distanciamiento del abordaje instrumental y el desplazamiento hacia otros núcleos significantes como formación ciudadana e inclusión social.

Assessing the sustainability of brackish water aquaculture systems in the Philippines. Working Paper 4: Aquaculture and poverty - a case study of five coastal communities in the Philippines

After reviewing the rather thin literature on the subject, we investigate the relationship between aquaculture and poverty based on a case study of five coastal communities in the Philippines. The analysis relies on a data set collated through a questionnaire survey of 148 households randomly selected in these five communities. The methodological approach combines the qualitative analysis of how this relationship is perceived by the surveyed households and a quantitative analysis of the levels and determinants of poverty and inequality in these communities. There is overwhelming evidence that aquaculture benefits the poor in important ways and that it is perceived very positively by the poor and non-poor alike. In particular, the poor derive a relatively larger share of their income from aquaculture than the rich, and a lowering of the poverty line only reinforces this result. Further, a Gini decomposition exercise shows unambiguously that aquaculture represents an inequality-reducing source of income. We believe that the pro-poor character of brackish water aquaculture in the study areas is explained by the fact that the sector provides employment to a large number of unskilled workers in communities characterized by large surpluses of labour. Our results also suggest that the analysis of the relationship between aquaculture and poverty should not focus exclusively on the socio-economic status of the farm operator/owner, as has often been the case in the past. [PDF contains 51 pages]

Characterization of rural livelihood of Lake Chad basin fishermen

The study examined the characterization of rural livelihood of the fishermen in the Nigeria portion of Lake Chad Basin are as part of European Commission (EC) founded project entitled "Sustainable development of continental fisheries; a regional study of policy options and policy formation mechanisms for the Lake Chad Basin" Wealth ranking exercise which was not based on real income but on production capacity of the fishermen was carried out in twenty (20) villages survey on the western part of the region using Rapid Rural Appraisal Technique with semi- structured interviews. The different activities carried out by the villagers for living were identified according to their socio-economic status. This was followed by an assessment of the socio-economic characterization within each wealth group. Series of comparative analysis of the ethnic composition, accessibility of fishing gear ownership by the population were done. The results show that the 3 wealth groups in the region include the rich (Group 1) the middle class (Group 2) and the poor (Group 3). It was identified that fishing is just one component of the socio-economic production system along side farming, livestock rearing and trading which are closely integrated. The diversified livelihood system being practiced in the Chad Basin region are not only less vulnerable but also more sustainable

Estudio comparativo del estado nutricional de dos muestras de jóvenes adultos

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Los "medici" en la epigrafía de la Hispania romana

[ES] La epigrafía latina nos permite conocer la existencia de veintiséis médicos en Hispania, los cuales llevaron a cabo su trabajo en diferentes ámbitos y especialidades. Gracias a la información de los textos de las inscripciones podemos estudiar cuestiones como el estatus socio-jurídico propio de los individuos dedicados a esta actividad, las posibles mejoras en el nivel económico de que pudieron ser objeto o los desplazamientos inherentes al ejercicio de la profesión. La mayor concentración de epígrafes en las antiguas Emerita Augusta y Gades nos hace pensar en estas ciudades como importantes centros médicos durante la época altoimperial en Hispania.

Fragilidade em idosos brasileiros: avaliação de sua prevalência pelos critérios propostos pela Escala de Fragilidade do Cardiovascular Health Study em uma população da cidade do Rio de Janeiro

A síndrome de fragilidade pode ser definida como um estado de vulnerabilidade a agentes estressores, um resultado de declínios orgânicos observados em múltiplos sistemas, comprometendo a habilidade do indivíduo em manter a homeostase. O objetivo deste estudo transversal foi avaliar a prevalência desta condição através da Escala de Fragilidade proposta pelo Cardiovascular Health Study em uma população de idosos, clientes de uma operadora de saúde, que vivem na zona norte da cidade do Rio de Janeiro, além de observar o comportamento deste instrumento em uma amostra brasileira. 754 indivíduos foram avaliados quanto aos cinco critérios da escala além de variáveis sociodemográficas, capacidade funcional, quedas, perfil cognitivo e comorbidades relatadas. Foram considerados Frágeis aqueles que apresentaram três ou mais dos seguintes critérios: a) lentificação da velocidade da marcha; b) reduzida força de preensão palmar; c) sensação de exaustão; d) baixa atividade física; e) perda de peso. Os resultados apontam que, dentre os avaliados, 9,2% eram Frágeis. Estes eram mais idosos, com pior status socioeconômico, com pior desempenho cognitivo e maior comprometimento funcional (p< 0,05). Entre os 9,2% de Frágeis, 87% apresentaram alteração da velocidade da marcha, 79,7% da força de preensão palmar, 66,8% baixa atividade física, 52,2% relato de sensação de exaustão e 36,2% relato de perda de peso. A distribuição de suas frequências quando comparado ao estudo original foi bastante semelhante. Vários estudos partem do postulado que a fragilidade pode ser identificada através de medidas clínicas. Através de sua identificação precoce, é possível reconhecer uma entidade potencialmente reversível, reduzindo morbidade e mortalidade na população idosa, no entanto é fundamental um estudo acurado sobre como esta entidade será mensurada e quais serão os critérios adotados para defini-la. Maiores estudos são necessários para realizar, no Brasil, uma análise mais aprofundada desta pertinente questão.

Estimativa do custo da asma em tratamento ambulatorial especializado em unidade universitária no Sistema Único de Saúde

A asma é considerada um problema de saúde pública mundial. É necessário expandir o conhecimento sobre seus custos associados em diferentes regiões. O principal objetivo foi estimar os custos do tratamento da asma em uma população de asmáticos com diferentes níveis de gravidade, sob tratamento ambulatorial especializado. Os objetivos secundários foram analisar as características clínicas e sócio-econômicas da população e o custo incremental da associação com a rinite e infecções respiratórias (IR). Asmáticos ≥ 6 anos de idade com asma persistente foram incluídos consecutivamente de março de 2011 a setembro de 2012. Todos realizaram visitas clínicas de rotina com intervalos de 3-4 meses e 2 entrevistas com intervalos de 6 meses para coleta dados. Variáveis clínicas e dados primários sobre os custos da asma, rinite e infecções respiratórias (IR) foram coletados diretamente dos pacientes ou responsáveis (< 18 anos), sob uma perspectiva da sociedade. Os custos em reais foram convertidos em dólares usando a paridade do poder de compra em 2012 (US$ 1,00 = R$ 1,71). Cento e oito pacientes completaram o estudo, sendo 73,8% mulheres. A maioria (75,0%) reside no município do RJ, sendo que 60,1% destes moram longe da unidade de saúde. Rinite crônica estava presente em 83,3%, e mais da metade tinha sobrepeso ou obesidade, nos quais a prevalência de asma grave foi maior (p = 0,001). Metade ou mais dos trabalhadores e estudantes faltaram as suas atividades em decorrência da asma. A renda familiar mensal (RFM) média foi de US$ 915,90 (DP=879,12). O custo médio estimado da asma/rinite/IR foi de US$ 1.276,72 por paciente-ano (DP=764,14) e o custo médio específico da asma foi de US$ 1.140,94 (DP=760,87). Asmáticos obesos, graves ou não controlados tiveram maiores custos em comparação aos não obesos, moderados/leves e controlados (p <0,05 em todas as comparações). A população estudada tem nível sócio-econômico médio/baixo, alta prevalência de rinite crônica e de sobrepeso/obesidade. Maior peso e menor RFM foram mais frequentes entre os graves e não controlados, respectivamente. Asmáticos obesos, graves ou não controlados tiveram maiores custos. O custo incremental da rinite e IR foi de 12%. O custo médio da asma foi equivalente à metade do relatado na União Européia e nos Estados Unidos da América, e foi maior do que a média na região Ásia-Pacífico. Num cenário ideal, onde todos os asmáticos brasileiros recebessem tratamento no Sistema Único de Saúde de acordo com a Iniciativa Global para Asma, o custo total da asma seria equivalente a 3,4-4,5% e 0,4-0,6% do Produto Interno Bruto (PIB) da saúde e do PIB brasileiro, respectivamente. Estratégias de saúde pública com programas estruturados que facilitem o melhor controle da asma e estimulem a redução de peso poderão contribuir para reduzir os custos da doença, o que poderia tornar a oferta de tratamento medicamentoso gratuito para todos os asmáticos persistentes no SUS uma meta alcançável. Recomendamos estender este estudo de custo da asma para diferentes regiões do país.

Nazwiska mieszkańców Poznania od XVI do XVIII wieku w świetle ksiąg metrykalnych Kolegiaty św. Marii Magdaleny. Studium onomastyczno-socjolingwistyczne

Wydział Filologii Polskiej i Klasycznej