Assessing the Barriers to Achieving Genuine Housing Choice for Adults with a Learning Disability: The Views of Family Carers and Professionals

It has been reported that the capability of adults with a learningdisability to choose their housing is too often impeded by theviews and actions of their family carers and involved professionals(McGlaughlin and Gorfin, with Saul, in press). This study furtherexplores these apparent barriers to providing genuine housingchoice for adults with learning disabilities. It discusses findingsfrom a series of focus groups which explored family and professionalviews about housing and choice. The views expressed indicatethat risk is a fundamental concern for both professionals andfamilies when considering more independent housing for thisgroup. Although opportunities for choice were generally supported,many argued for the need to assess the ability to make informeddecisions. There were also examples of problematic relationshipsbetween professionals and carers, creating a barrier to choice.Carers need involvement, information and support during thedevelopment of housing plans if the needs of the primary serviceusersare to be met. The barriers identified have to be removed ifservice-users are to truly become the focus of decisions andbe enabled to make genuine informed choices.     

Adjusting overall survival for treatment switches: commonly used methods and practical application

In parallel group trials, long‐term efficacy endpoints may be affected if some patients switch or cross over to the alternative treatment arm prior to the event. In oncology trials, switch to the experimental treatment can occur in the control arm following disease progression and potentially impact overall survival. It may be a clinically relevant question to estimate the efficacy that would have been observed if no patients had switched, for example, to estimate ‘real‐life’ clinical effectiveness for a health technology assessment. Several commonly used statistical methods are available that try to adjust time‐to‐event data to account for treatment switching, ranging from naive exclusion and censoring approaches to more complex inverse probability of censoring weighting and rank‐preserving structural failure time models. These are described, along with their key assumptions, strengths, and limitations. Best practice guidance is provided for both trial design and analysis when switching is anticipated. Available statistical software is summarized, and examples are provided of the application of these methods in health technology assessments of oncology trials. Key considerations include having a clearly articulated rationale and research question and a well‐designed trial with sufficient good quality data collection to enable robust statistical analysis. No analysis method is universally suitable in all situations, and each makes strong untestable assumptions. There is a need for further research into new or improved techniques. This information should aid statisticians and their colleagues to improve the design and analysis of clinical trials where treatment switch is anticipated. Copyright © 2013 John Wiley & Sons, Ltd.     

Leisure-time physical activity and health-care utilization in older adults

This study examined whether leisure-time physical activity (LTPA) was associated with health-care utilization in a racially diverse sample of rural and urban older adults. Community-dwelling adults (N = 1,000, 75.32 +/- 6.72 years old) self-reported participating in LTPA and their use of the health-care system (physician visits, number and length of hospitalizations, and emergency-room visits). After controlling for variables associated with health and health-care utilization, older adults who reported lower levels of LTPA also reported a greater number of nights in the hospital in the preceding year. There was no support, however, for a relationship between LTPA and the other indicators of health-care utilization. Our findings suggest that being physically active might translate to a quicker recovery for older adults who are hospitalized. Being physically active might not only have health benefits for older persons but also lead to lower health-care costs.     

Siblings in lockdown: International evidence for birth order effects on child adjustment in the Covid19 pandemic

Supportive family relationships may mitigate the impact of the Covid19 pandemic on young children's adjustment, but existing work is limited by its focus on within-country variation and parental influences. Addressing these gaps, and drawing on reported buffering effects of older siblings on child mental health (Lawson and Mace, 2010), the current international study examined whether child adjustment problems were, on average, elevated by the pandemic and whether this buffering effect of older siblings would be maintained. In the first wave of the Covid19 pandemic (April to July 2020), 2516 parents of 3- to 8-year-old children living in Australia, China, Italy, Sweden, United Kingdom, and United States of America—six countries with contrasting governmental responses to the pandemic—completed an online survey about family experiences and relationships and child adjustment, as indexed by ratings on the Strengths and Difficulties Questionnaire (SDQ: R. Goodman, 1997). As expected, child SDQ total difficulty scores were elevated in all sites except Sweden (which notably did not enforce mass school closures). Compared to children without siblings, children with one or more older siblings showed fewer adjustment problems. Children from lone-parent households displayed more adjustment problems, as did those whose parents reported increased sibling conflict. Finally, child adjustment problems were negatively associated with family socio-economic status, but positively related to the indices of Covid-19 family disruption and government stringency. We discuss these findings in relation to existing work on asymmetric effects of older versus younger siblings, and siblings as sources of support.     

Giving HOPE and minimising trauma: An intervention to support women who are separated from their babies at birth due to safeguarding concerns

Whatever the circumstances, the separation of infants from their mothers at birth is a traumatic experience for all concerned. The paper reports on a study designed to improve practice in this highly sensitive area. An analysis of data collected through semi-structured interviews with 38 mothers who had experienced removal at birth identified four common themes: isolation and unacknowledged support needs; shame, stigma and the failure of others to acknowledge their maternal identity; acute trauma, immediate downturn and disenfranchised grief following infant removal; and strategies to mitigate their pain and grief. These last themes included the use of artefacts both as transitional objects to help mothers come to terms with the permanent loss of a baby, and as a means of keeping maternal identity alive and connecting with an infant who might eventually return home. In response to these findings, and in collaboration with a group of women with lived experience, HOPE boxes were designed to ameliorate the trauma and psychological burden borne by women in this situation. The contents of the boxes have been chosen to reflect the changing experiences of the women's journeys but also the range of possible potential outcomes. The intervention has considerable potential to minimise the trauma of this painful experience.     

Bayesian modelling of effects of prenatal alcohol exposure on child cognition based on data from multiple cohorts

High levels of prenatal alcohol exposure (PAE) result in significant cognitive deficits in children, but the exact nature of the dose-response relationship is less well understood. To investigate this relationship, data were assembled from six longitudinal birth cohort studies examining the effects of PAE on cognitive outcomes from early school age through adolescence. Structural equation models (SEMs) are a natural approach to consider, because of the way they conceptualise multiple observed outcomes as relating to an underlying latent variable of interest, which can then be modelled as a function of exposure and other predictors of interest. However, conventional SEMs could not be fitted in this context because slightly different outcome measures were used in the six studies. In this paper we propose a multi-group Bayesian SEM that maps the unobserved cognition variable to a broad range of observed outcomes. The relation between these variables and PAE is then examined while controlling for potential confounders via propensity score adjustment. By examining different possible dose-response functions, the proposed framework is used to investigate whether there is a threshold PAE level that results in minimal cognitive deficit.