St.Amant

Symptom assessment is key to managing symptom burden following a cancer diagnosis. Adults with intellectual or developmental disabilities (IDD) experience worse outcomes from cancer; disparities may also exist in routine cancer symptom screening. This study investigated whether differences exist in routine cancer symptom assessment between people with and without IDD in a public healthcare system. We conducted a matched retrospective cohort study of adults in Ontario, Canada, with and without IDD who received a cancer diagnosis between 2010 and 2019 using administrative health data. Among people with cancer, those with IDD were hard-matched 1:5 to those without IDD on age at diagnosis, sex, diagnosis year, cancer type and regional cancer centre registration. Cumulative incidence of first symptom assessment accounting for death as a competing risk was estimated. Sub-distribution and cause-specific hazards models were used. Effect modification by age, sex and cancer stage was investigated. A total of 1545 people with IDD were matched to 7725 people without IDD. Individuals with IDD experienced a lower incidence of cancer symptom assessment (1-year probability: 0.62 vs. 0.77) and lower rates of symptom assessment (sub-distribution HR: 0.63, 95% CI: 0.59, 0.67; cause-specific HR: 0.69, 95% CI: 0.65, 0.73) relative to those without IDD. Results were most pronounced for those in advanced cancer stages. Among persons with cancer, the incidence of symptom assessment is lower for individuals with IDD compared to those without; the magnitude of these findings varied across cancer stages. These findings may indicate systemic barriers to equitable healthcare access for people with cancer and IDD.

Worldwide, the community transition process away from institutions has increased in the past 30–50 years among persons with severe intellectual and developmental disabilities. This process, also known as “deinstitutionalization”, could potentially impact problem behaviors and communication. This study examined the impacts of community transitions on behavioural and communication outcomes in Canadians with intellectual and developmental disabilities. Data were collected using the Comprehensive Health Assessment Program and medical chart reviews. Descriptive, aggregate-level, and individual-level analyses were conducted for 32 adults who transitioned to community living. Descriptive analyses and the McNemar Chi-Square Test were conducted. Following community transitions, the study group experienced a significant decrease in problem behaviours and changes in communication. The study findings suggest that deinstitutionalization could provide effective strategies for addressing problem behaviors and fostering improvements in communication, promoting the well-being and quality of life of persons with intellectual and developmental disabilities.

This study examined opportunities and barriers for implementing evidence-based Social and Emotional Learning (SEL) programs in Prairie Canadian Schools. Educators from Manitoba, Saskatchewan and Alberta completed an online survey on SEL feasibility and reported on five feasibility domains: (1) attitudes about SEL, (2) knowledge about SEL, (3) job stress, (4) resources for implementing SEL, and (5) SEL practices. Results indicated that positive attitudes toward SEL significantly predicted increased perceived feasibility for evidence-based SEL implementation. Additionally, both knowledge and access to resources predicted increased SEL practice by Prairie Canadian educators. Analyses for open-ended responses paralleled quantitative results. Specifically, Canadian educators had positive views about SEL programing, but like previous research conducted in other countries, indicated that they require better access to SEL training, and resources (e.g., more time to plan and teach SEL, funding and program materials). A unique Canadian context-related finding from this study was that some Prairie Canadian educators indicated a paucity of French materials for SEL programs, which impeded implementation. In order to effectively implement evidence-based SEL in Prairie Canadian schools, policy makers must address the indicated barriers for Canadian educators, such as increased SEL training and resources, and easy access to appropriate French materials.

<em>Over the last three decades, the construct of Quality of Life (QoL) has been advocated as an important indicator of the quality and effectiveness of social care practice and policy for persons with intellectual and developmental disabilities. As part of a larger multi-year evaluation study, this cross-sectional investigation describes the QoL of 59 persons with severe or profound intellectual and developmental disabilities who were living in the complex care residence, Health and Transition Services of St.Amant, in the City of Winnipeg, Canada, and were in transition to community homes. QoL data on the 59 individuals prior to their transition were collected mostly retrospectively by proxy administering the standardized tool San Martin Scale to St.Amant staff who were most knowledgeable of the life of the persons being assessed while residing in the complex care residence. Results are presented in a descriptive fashion by reporting on the QoL of our study population in the eight QoL dimensions assessed in the San Martin Scale. Importantly, an accurate assessment of the QoL of the 59 participants before their transition to community living serves as the baseline for their evaluation post-transition. Overall, our study population scored at the same level as, or above scores for the San Martin reference sample with intellectual and developmental disabilities in the QoL dimensions of Self-determination, Emotional Well-being, Physical Well-being, and Social Inclusion. Conversely, overall, our study population scored lower than the reference sample in the dimensions of Rights, Personal Development, Inter-personal Relations, and Material Well-being. We provide some recommendations for social care practice for persons with intellectual and developmental disabilities grounded in our findings.</em>

BackgroundLife course gender-role traits and social stereotypes could affect the pattern of medication adherence in old age.ObjectivesThe main purpose of this study was to investigate gender based cognitive determinants of medication adherence in a sample of older adults who suffer from at least a chronic condition.MethodsIn this cross-sectional design, 455 older adults participated from five health centers in Tabriz city, Iran from June to August 2017 using a random sampling method. Next, required data about medication adherence, knowledge and beliefs about prescribed medications, perceived self-efficacy in medication adherence, illness perception, and reasons for medication non-adherence were gathered using a structured written questionnaire through face-to-face interviews with the attendees.ResultsLow medication adherence was reported by 54.5% of the study participants. Perceived self-efficacy for medication adherence (OR = 1.04; 95% CI: 1.00, 1.08) and medication adherence reason (OR = 0.96; 95% CI: 0.92, 0.99) were two identified strong predictors of medication adherence among the studied older men. Illness perception (OR = 1.02; 95% CI: 1.00, 1.02) and beliefs toward prescribed medication (OR = 0.95; 95% CI: 0.93, 0.98) were both recognized as the significant predictors of medication adherence in the older women subgroup.ConclusionGender based variations were noted regarding the medication adherence in the studied sample and attributes of cognitive function were the main pinpointed elucidating parameters for the non-conformity. The explicit cognitive processes must be considered in care provision or interventional programs that target medication adherence in older adults.

The Assessment of Basic Learning Abilities (ABLA) is an empirically validated clinical tool for assessing the learning ability of persons with intellectual disabilities and children with autism. An ABLA tester uses standardized prompting and reinforcement procedures to attempt to teach, individually, each of six tasks, called levels, to a testee, until a pass or a fail criterion is met on each level. The six levels are ordered in difficulty from Level 1 to Level 6. We examined the predictive validity of the ABLA performance of nine children with autism who passed ABLA Levels 2 or 3, and failed higher levels. We attempted to teach 20 criterion tasks to each child, using standardized prompting and reinforcement procedures, until each child met either the pass or the fail criterion of the ABLA on each task. We predicted that each child would pass the criterion tasks that corresponded to his/her previously passed ABLA levels, and would fail the criterion tasks that corresponded to his/her previously failed ABLA levels. A parent of each child was also asked to predict the child's pass-fail learning performance on the 20 criterion tasks. Ninety-two percent of the predictions based on the children's ABLA performance were confirmed, and the ABLA was significantly more accurate than the parents for predicting the children's performance on the criterion tasks.

Many individuals with intellectual disability engage in challenging behaviour. This can significantly limit quality of life and also negatively impact caregivers (e.g., direct care staff, family caregivers and teachers). Fortunately, efficacious staff training may alleviate some negative side effects of client challenging behaviour. Currently, a systematic review of studies evaluating whether staff training influences client challenging behaviour has not been conducted. The purpose of this article was to identify emerging patterns, knowledge gaps and make recommendations for future research on this topic. The literature search resulted in a total of 19 studies that met our inclusion criteria. Articles were separated into four staff training categories. Studies varied across sample size, support staff involved in training, study design, training duration and data collection strategy. A small sample size (n = 19) and few replication studies, alongside several other procedural limitations prohibited the identification of a best practice training approach.

Seventy children aged 2 to 7 years were exposed to the MRI environment through a series of steps typical of a research study. Their willingness to proceed through the process was used to estimate the prevalence of fear. Thirty-seven children (53%; 95% confidence interval [41%, 65%]) completed the approach sequence. Although the correlation of child age in months (Mean (M) = 60.1, standard deviation = 16.5, N = 70) and highest successful step (M = 5.8, standard deviation = 2.6, 95% confidence interval [5.2, 6.4]) completed was not statistically significant at the 0.05 level, r (68) = 0.21, P = 0.08, 95% confidence interval [-0.03, 0.42], the proportion of children aged 6-7 years who successfully completed all steps (14 of 21, 67%, 95% confidence interval [50%, 84%]) was significantly different from the proportion of children aged 2-3 years who completed all steps (six of 23, 26%, 95% confidence interval [11%, 41%]) (Fisher's exact test, two-tailed P = 0.0148). A failure rate of at least 50% should be included into group size calculations when performing studies with young children (2-7 years), in addition to motion and other experimental factors.