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Autistic individuals are at increased risk of trauma exposure and post-traumatic stress disorder (PTSD). Diagnostic overshadowing, however, often results in PTSD symptoms being mislabelled as autistic traits. This study aims to develop professional consensus on the identification and assessment of co-occurring PTSD in autistic adults.

An online modified Delphi design was used to gather professionals’ perspectives on key aspects of the identification and assessment of PTSD in autistic adults. Data were gathered qualitatively in Round 1 and then synthesised using content analysis into a list of statements that were rated in Round 2. Statements reaching 60–79% consensus and additional suggestions were sent out for rating in Round 3. Consensus for the final statement list was set at 80% agreement.

Overall, 108 statements reached consensus. These form the basis of professional-informed recommendations to facilitate the identification and assessment of PTSD symptoms in autistic adults.

The final Delphi statements provide a framework to assist with the assessment and recognition of traumatic stress reactions in autistic adults presenting to mental health, diagnostic or social services.

To the best of the authors’ knowledge, this is the first study to explore the presentation and identification of PTSD in autistic adults (with and without intellectual disability), using a bottom-up approach informed by professional consensus.

This study aims to evaluate the quality of a speech and language therapy (SLT) swallow service provided to adults with intellectual disability (ID) by exploring the process and outcome factors; to explore the process of what is done to and for the patient including identifying dysphagia, choking and pneumonia risk, typical interventions and management; examine clinical outcomes; and explore the relationship of outcomes with risk factors, satisfaction with the service and the impact of the service on the number of choking incidents and admissions to acute hospital with swallow concerns.

There were three specific work packages: (1) collecting and scrutinising patient data from the clinical record for adults with ID referred to the SLT swallow service over a six-month period. The researcher created aims, defined the limits to achieve the aims, designed a standardised data collection form, set out where data was in the clinical record, piloted, set limits for collection and trained reviewers; (2) gathering experience and satisfaction surveys from patients, caregivers and referrers over the six-month study period; and (3) monitoring choking adverse incident reports and hospital admission with swallow concerns for the whole ID population.

Choking and hospital admission were the main reasons for referral, and pneumonia risk significantly predicted dysphagia impairment. The research highlighted common dysphagia risk factors, interventions and recommendations for this population. The SLT swallow service is a quality service that is highly valued by patients, their caregivers and referrers. The service achieves significant clinical improvements, helps identify dysphagia and provides management to reduce associated risks.

This study found common dysphagia risk factors, interventions and recommendations; it also found that the therapy outcome measures/Royal College of Speech and Language Therapy online outcome tool was a meaningful outcome measure, and that pneumonia risk significantly predicted dysphagia impairment, all of which could inform the identified dysphagia research priorities for this population.

Naming usual care in treatment and recommendations could help ensure a fair service and could help form quality indicators. People with ID, their caregivers and staff generated valuable ideas for improvement, and further involvement work could create a logic model for the service. Other future work could explore the use of screening tools, increase multidisciplinary team working, improve access to instrumental assessments, raise awareness of swallowing and promote important oral health and medication reviews. By using this information to shape quality improvement work and policies, one can work toward addressing high health-related inequalities and preventable deaths associated with dysphagia in this vulnerable population.

It may be useful to raise awareness that adults with ID age earlier and that one should not exclude them from older people’s services because of an age threshold, often set higher than their life expectancy. This study highlighted a possible inequality of access issue for adults with ID who do not have direct care or day care staff. There is a need to increase access to awareness training so caregivers and general practitioners can recognise swallow difficulties and know how to make a referral for a swallow assessment.

Overall, the evaluation of the swallow service to adults with ID suggests that SLT have a quality service for adults with ID that is highly valued and provides significant clinical improvements. By building on these strengths, SLT could extend the reach, influence and impact of their services to help those adults with ID who have emerging swallow difficulties or who do not access the service.

The majority of emerging adults in the United States spend time in cohabiting unions. Prior research has suggested that higher levels of sexual non-exclusivity may exist among those in cohabiting relationships compared to marital unions. Although these basic patterns have been explored in prior work, research examining the potential reasons why levels of sexual non-exclusivity differ by union status has been limited. Drawing on a relational perspective and using the fifth wave of data from the Toledo Adolescent Relationships Study (TARS), the present study found that higher levels of sexual non-exclusivity in cohabiting relationships were explained by intimate relationship characteristics and sexual histories rather than sociodemographic factors, partner heterogamy, or partner- and couple-level drug use. These findings highlighted that understanding the higher rates of sexually non-exclusive experiences in cohabiting relationships, compared to marital relationships, requires attention to specific dynamics of the intimate partnership and prior relational experiences of both partners. The study concluded that cohabitation has a unique place in emerging adults’ relationship landscape and may set the groundwork for future relationship functioning.

A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a significant emotional and/or behavioural need in the absence of a mental health diagnosis. The region’s intensive support teams (ISTs) for adults with ID therefore piloted a short-term “behavioural support service” for this population. The purpose of this paper is to evaluate this pilot.

This study represents a mixed-methods service evaluation over a four year pilot period. The quantitative component examined referral rates and demographic data of accepted and declined referrals; and length of referral episodes and Health of The Nation Outcomes Scores (HoNOS) for accepted referrals. The qualitative component used thematic analysis to identify key themes relating to reasons for referral, clinical/therapeutic needs, and the models of support that most informed assessments and interventions at individual and systems levels.

The ISTs accepted 30 referrals and declined 53. Most accepted referrals were male (83%), and under 24 years old (57%). Average HoNOS scores were above the thresholds generally associated with hospital admission. Key qualitative themes were: transitional support; sexual risks/vulnerabilities; physical aggression; domestic violence; and attachment, trauma and personality difficulties. Support mostly followed psychotherapeutic modalities couched in trauma, attachment and second- and third-wave cognitive behavioural therapies. Positive Behaviour Support (PBS) did not emerge as a model of preference for service users or professionals.

This project represents one of the first of this type for autistic adults without an ID in the UK. It provides recommendations for future service development and research, with implications for Transforming Care policy and guidance.

The main purpose of this study is to test for the interaction effect of digital literacy in the relationship between financial technologies (FinTechs) of biometrics and mobile money and digital financial inclusion among the unbanked poor women, youth and persons with disabilities (PWDs) in rural Uganda.

Covariance-based structural equation modeling was used to construct the interaction effect using data collected from the unbanked poor women, youth and PWDs located in the four regions in Uganda as prescribed by Hair et al. (2022).

The findings from this study are threefold: first; the results revealed a positive interaction effect of digital literacy between FinTechs of biometrics and mobile money and digital financial inclusion. Second; the results also confirmed that biometrics identification positively promotes digital financial inclusion. Lastly; the results showed that mobile money positively promotes digital financial inclusion. A combination of FinTechs of biometrics and mobile money together with digital literacy explain 29% variation in digital financial inclusion among the unbanked poor women, youth and PWDs in rural Uganda.

The data for this study were collected mainly from the unbanked poor women, youth and PWDs. Further studies may look at data from other sections of the vulnerable population in under developed financial markets. Additionally, the data for this study were collected only from Uganda as a developing country. Thus, more data may be obtained from other developing countries to draw conclusive and generalized empirical evidence. Besides, the current study used cross sectional design to collect the data. Therefore, future studies may adopt longitudinal research design to investigate the impact of FinTechs on digital financial inclusion in the presence of digital literacy across different time range.

The governments in developing countries like Uganda should support women, youth, PWDs and other equally vulnerable groups, especially in the rural communities to understand and use FinTechs. This can be achieved through digital literacy that can help them to embrace digital financial services and competently navigate and perform digital transactions over digital platforms like mobile money without making errors. Besides, governments in developing countries like Uganda can use this finding to advocate for the design of appropriate digital infrastructures to reach remote areas and ensure “last mile connectivity for digital financial services' users.” The use of off-line solutions can complement the absence or loss of on-line network connectivity for biometrics and mobile money to close the huge digital divide gap in rural areas. This can scale-up access to and use of financial services by the unbanked rural population.

This paper sheds more light on the importance of digital literacy in the ever complex and dynamic global FinTech ecosystem in the presence of rampant cyber risks. To the best of the authors' knowledge, limited studies currently exist that integrate digital literacy as a moderator in the relationship between FinTechs and digital financial inclusion, especially among vulnerable groups in under-developed digital financial markets in developing countries. This is the novelty of the paper with data obtained from the unbanked poor women, youth and PWDs in rural Uganda.

Factors that may influence risk and/or vulnerability to young people’s involvement in terrorism are currently unclear. Understanding the factors that contribute to a young person’s risk profile is a high priority for Youth Justice Services to enable the development of targeted interventions and subsequent risk reduction. The purpose of this study is to systematically identify and critically review studies relating to young peoples’ involvement in terrorism to understand potential risk and/or vulnerability factors and the implications for intervention.

Literature was evaluated using the systematic review method. Twelve papers were selected for the systematic review according to the inclusion criteria.

Twelve factors emerged that indicated relevance to terrorism by young people and were combined into five overarching themes: contextual, social, psychological factors, trauma and use of time.

This systematic review is one of the first of its kind relating to terrorism by young people. The reported findings will be valuable to practitioners seeking to understand the risk and vulnerability factors related to terrorism by young people and the implications for intervention. Directions for future research are explored.

This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.

The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.

DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.

The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.

Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.

DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

This paper aims to report the findings of a survey study exploring perceptions about cognitive impairment. These findings are relevant to public health campaigns and education programmes.

A survey exploring respondents’ views and knowledge about mild cognitive impairment (MCI) was circulated via UK networks. A total of 417 respondents completed the survey, including people living with cognitive impairment (n = 10), care partners (n = 23), older adults (n = 83), younger adults (n = 83), general health-care professionals (n = 96), dementia specialist health-care professionals (n = 48) and dementia specialists (n = 40).

Respondents were more confident in their knowledge about dementia than cognitive impairment but wanted more information about both conditions. Younger adults were uncertain about many aspects of MCI, and were the most likely to view MCI as a normal part of ageing. Diet (45.1%, n = 188) and personal behaviour (63.8%, n = 266) were the least endorsed possible causes of MCI, suggesting a lack of awareness of lifestyle choices as risk factors for MCI.

The results highlight the need to provide education and awareness raising about MCI to enable people to seek help in a timely manner and be able to make informed lifestyle choices that may reduce their risk of MCI and dementia. Implementing education about MCI and dementia in schools is a key target, as younger people were the most uncertain or misinformed about these topics. It is clear that further public health initiatives around MCI are both warranted and welcomed by the general public.

This study aims to critically evaluate the trajectory of the “Child First” guiding principle for youth justice in England and Wales, which challenges adult-centric constructions of children (when they offend) as “threatening” and asserts a range of theoretical and principled assumptions about the nature of childhood and children’s evolving capacity.

Focussing on how Child First seeks to transcend the socio-historically bifurcated (polarised/dichotomised) thinking and models/strategies/frameworks of youth justice, this study examines the extent and nature of this binary thinking and its historical and contemporary influence on responses to children’s offending, latterly manifested as more hybridised (yet still discernibly bifurcated) approaches.

Analyses identified an historical and contemporary influence on bifurcated responses to offending by children in the United Kingdom/England and Wales, subsequently manifested as more hybridised (yet still discernibly bifurcated) approaches. Analyses also identified a contemporary, progressive challenge to bifurcated youth justice thinking, policy and practice through the “Child First” guiding principle.

By tracing the trajectory of Child First as an explicit, progressive challenge to previous youth justice thinking and formal “approaches”, to the best of the authors’ knowledge, they are the first to question whether, in taking this approach, Child First represents a clean break with the past, or is just the latest in a series of strategic realignments in youth justice seeking to resolve inherent tensions between competing constructions of children and their behaviour.

The current research aimed to investigate the external enablement role of Digital Infrastructures (DI) in the interplay of entrepreneurial cognitions and innovation.

Data from the Global Entrepreneurship Monitor (GEM) and Digital Economy and Society Index (DESI) were used for analyses. This yielded a sample of 8,601 Generation Z entrepreneurs operating in 25 European countries.

Applying hierarchical moderated regressions showed that socio-cognitive components of an entrepreneurial mindset (self-efficacy, risk propensity, opportunity identification) affect innovation among Generation Z entrepreneurs. More importantly, DI plays an external enablement role in the interplay of cognitions and innovation among Generation Z entrepreneurs.

This study contributes to the socio-cognitive theory of entrepreneurship by integrating an external enablement perspective into the study of cognitions and entrepreneurial outcomes (here, innovation). It contributes to the digital technology perspective of entrepreneurship by connecting the conversation about the socio-cognitive perspective of entrepreneurship regarding the role of cognitions in innovation to the conversation in information systems (IS) regarding technology affordances and constraints. This study extends the application of the external enabler framework to the post-entry stage of entrepreneurial activity and integrates a generational perspective into it.