Helen Beange

People With Mental Retardation Have an Increased Prevalence of Osteoporosis: A Population Study

Prevalence of and risk factors for osteoporosis in a community population of 94 young adults with mental retardation was examined. Results show lower bone mineral density in this group than in an age-matched reference population. Factors associated with low bone mineral density included small body size, hypogonadism, and Down syndrome in both genders and a high phosphate level in females. Low vitamin D levels were common in both genders, despite high levels of exposure to sunshine. A history of fracture was also common. Low bone mineral density and fracture were associated in females but not males. Because morbidity following fracture is likely to be more serious in this population, further investigation of osteoporosis and prevention strategies for both osteoporosis and fractures are important.

Health targets for people with an intellectual disability

This article describes the development and identification of a set of health targets for adults with an intellectual disability. The authors developed the targets through a process of collaboration, consultation and literature review. The targets were included if reliable studies had shown the conditions to be highly prevalent, easily detected, and amenable to treatments that are readily available. It is envisaged that these targets will be further refined and eventually endorsed by IASSID for presentation to the World Health Organisation in the year 2000.

Mortality of people with intellectual disability in northern Sydney

A population-derived cohort of 693 people with intellectual disability in the Lower North Shore (LNS) area of Sydney, New South Wales, Australia was followed from 1989 to 1999 to determine mortality rates, the demographics of the deceased, and causes of death. The deceased were identified through the New South Wales Registrar of Births, Deaths and Marriages. The general population of LNS was used for comparison. Age- and sex-adjusted mortality rates were higher than those in the LNS population. The overall standardised mortality ratio (SMR) was 4.9, while the SMRs for men and women were 4.1 and 6.2, respectively. The death rates were highest at both ends of the age spectrum. The main cause of death was respiratory disease, followed by external causes and cancer. Of those who had died, the greatest proportion were functioning in the severe to profound range of intellectual disability, and half were living in institutional care. Public health resources and services need to be directed to this vulnerable population in order to address the excess mortality.

On the need for a specialist service within the generic hospital setting for the adult patient with intellectual disability and physical health problems

Although the presence of intellectual disability (ID) per se is not usually regarded as a health problem, the biopsychosocial implications of cognitive impairment contribute to the vulnerability of adult patients with ID in any healthcare system. The adult patient with ID differs from a patient in the general population in terms of health determinants, morbidity and mortality profiles, and in the ability to access quality healthcare. These differences represent a risk for adverse health and well-being outcomes in this population, and for increased costs of health services, particularly in the hospital setting. This paper focuses on addressing the issues facing the adult patient with ID, their caregivers, and health professionals, specifically in the setting of secondary and tertiary level healthcare systems.

Project renourish: A dietary intervention to improve nutritional status in people with multiple disabilities

An intervention was designed to improve the nutrition of underweight persons with multiple disabilities who lived in a large institution. They were given an enriched diet, with increased energy density, for a year. Measurements of anthropometric status, biochemical status and clinical measures such as antibiotic and suppository usage, were taken before the intervention, at 6 months, and at 12 months. Baseline measures of the 69 subjects showed that they were severely underweight, and had levels of vitamin D, folate, haemoglobin, and ferritin which were all either low or borderline. Thirty-two individuals had vitamin D levels below the normal range. After 12 months on the diet there were significant improvements in weight, in serum calcium and serum vitamin D levels, and in haematological status. Rates of intercurrent infections were significantly less than in the same season of the previous year. Constipation had significantly diminished. It was concluded that dietary treatment is worth trying for similar...

Men’s health and well-being: testosterone deficiency

Those involved in the clinical care of men with developmental disabilities will be aware that sexual immaturity is common. We have formally confirmed this in an Australian population (Beange, McElduff, & Baker, 1995; McElduff, Center, & Beange, 2003). Hypogonadism is more common in men with developmental disabilities than in the general population (Conway, Handelsman, Lording, Stuckey, & Zajac, 2000). We discuss whether or not this impacts on their health. Let us explore precisely what hypogonadism in males means. The testis has two related but separate functions. These are: to produce sperm and to produce the male sex hormone testosterone. Normal sperm production requires appropriate concentrations of testosterone. Sperm production is formally measured by counting sperm in an ejaculated semen specimen. Testicular volume* is a reasonably good clinical marker of sperm production. A testis which is smaller than normal is very likely to have impaired sperm production. However, a normal-sized testis may not produce a normal amount of sperm. ; The hypothalamic pituitary axis, which controls testicular function, secretes two gonadotropic hormones (pituitary hormones which control the gonads), follicle stimulating hormone (FSH) and luteinising hormone (LH). FSH is predominantly concerned with sperm production. In primary (testicular) problems with sperm production, FSH will be elevated and the degree of elevation broadly indicates the

Hypogonadism in men with intellectual disabilities: a population study

We examined the gonadal status of a subset of men from a previously reported population sample. We found that hypogonadism, defined in a variety of ways, was common in the population. We found hypofunction in both testosterone production and inferentially, in sperm production, the two interdependent functions of the testes. Various measures of health such as total cholesterol and haemoglobin were correlated with testosterone concentration in this cross-sectional sample. The data raise the possibility that low testosterone concentrations are associated with adverse health outcomes. This hypothesis will need to be studied more carefully and tested in controlled trials of androgen replacement therapy.

Physical aspects of health in the learning disabled

The papers discussed in this review have identified a high prevalence of gastro-oesophageal disease, Helicobacter pylori infection and sensory impairments in people with an intellectual disability, and have advanced the understanding of dementia and osteoporosis in this population, A greater understanding of intellectual disability in the primary care setting has also emerged. Curr Opin Psychiatry 11:531-534

Osteoporosis in groups with intellectual disability

We have measured the lumbar bone mineral density in a selected group of 53 people with intellectual impairment and found them to be significantly osteoporotic. In this study, small height and, for women only, hypogonadism were associated with lower bone mineral density measurements.

Iodine deficiency in Australia: be alarmed

Iodine deficiency, the leading preventable cause of intellectual impairment in the world (World Health Organization, 1999), has reappeared in Australia. Recently, we identified the re-emergence of iodine deficiency in Sydney (Gunton, Hams, Fiegert & McElduff, 1999). This has been confirmed locally (Li, Ma, Boyages & Eastman, 2001) and interstate (Guttikonda et al., 2002), most recently in a study of Melbourne schoolchildren (McDonnell, Harris & Zacharin, 2003). We also provided evidence that iodine deficiency influences neonatal thyroid function (McElduff, McElduff, Gunton, Hams & Wiley, 2002). Evidence has been presented from other developed countries that iodine deficiency is re-emerging as a major potential health problem (Hollowell et al., 1998). The reasons for this are not clear, but a loss of awareness of the potential of iodine deficiency in the developed world and a decreased use of iodised salt appear to be major contributors (Gunton et al., 1999). Iodine deficiency impairs brain development through foetal hypothyroidism and in particular hypothyroidism in the early stages of pregnancy (Glinoer et al., 1992; Hetzel, 2000). Endemic cretinism, which is characterised by intellectual impairment, spastic diplegia and deafness, is due to severe iodine deficiency during pregnancy (Hetzel, Chavadej & Potter, 1988). It has been suggested that severe brain impairment easily identified as cretinism is merely one end of a continuous spectrum of neuro-psychological impairment induced by iodine deficiency (Boyages, 1994). Maternal iodine supplementation in populations with high levels of endemic cretinism results in a reduced incidence of cretinism without significant adverse effects (Mahomed & Gulmezoglu, 2000). In populations with less severe iodine deficiency and without cretinism the benefit of iodine