Rebecca Stores

Sleep disorders and their clinical significance in children with Down syndrome

Aim  Our aim was to review basic aspects of sleep disorders in children with Down syndrome in the light of present‐day findings of such disorders in children in general, including other groups of children with developmental disabilities.

Audiovisual distraction as an adjunct to pain and anxiety relief during minor surgery

BACKGROUND Minor surgery for ingrown toenails can provoke anxiety and the anaesthetic injection can be acutely painful. Distraction techniques may reduce the associated pain and anxiety. OBJECTIVE To investigate an audiovisual distraction (Bedscapes) on pain and anxiety during minor surgery for the correction of ingrown toenail. METHOD In a randomised controlled trial, patients (N=152) with ingrown toenails requiring surgical correction under local anaesthesia were allocated to receive Bedscapes+standard care or standard care alone. Pain levels due to local anaesthetic injection were assessed post-procedure, and anxiety levels were assessed pre- and post-procedure in both groups. Follow-up focus groups were conducted with 14 patients allocated to the Bedscapes group, and one-to-one interviews were held with four podiatrists. RESULTS Participants with high pre-procedure anxiety scores experienced greater pain on injection, and older patients reported lower pain than younger patients, regardless of group allocation. Bedscapes did not reduce pain or anxiety, and was apparently no more effective than interpersonal interaction between podiatry staff and the patient. CONCLUSIONS Pain of injected anaesthesia correlates closely with pre-operative anxiety. Formal audiovisual distraction has no added benefit over interpersonal interaction in the alleviation of pain and anxiety in patients undergoing nail surgery.

The role of the home environment in dementia care and support: Systematic review of qualitative research:

Background The domestic home is the preferred site for care provision for people with dementia and their families, therefore creating a dementia and caring friendly home environment is crucial. This systematic review synthesised qualitative studies to explore the role of the home environment and identify potential barriers and facilitators in home dementia care and support to inform future practice and research. Methods A systematic search in 12 databases identified international qualitative literature on perceptions and experiences of community-dwelling people with dementia, family and formal carers regarding the role of the home environment and ways to tackle daily challenges. Results Forty qualitative studies were included and analysed using thematic synthesis. The main three themes were: ‘home as a paradox’, ‘there is no magic formula’ and ‘adapting the physical space, objects and behaviour’. Findings indicate that home is an important setting and is likely to change significantly responding to the changing nature of dementia. Themes were later validated by family carers of people with dementia. Conclusions The home environment is an important setting for care and needs to remain flexible to accommodate changes and challenges. Family carers and people with dementia implement and often improvise, various environmental strategies. Continuous and tailor-made support at home is required.

THE JOURNEY WITH DEMENTIA FROM THE PERSPECTIVE OF BANGLADESHI FAMILY CAREGIVERS IN ENGLAND

of insanity” and “Alzheimer’s disease results from a curse”. We compared responses between persons living in rural and urban settings in Mexico and the U.S. settings using chi-square tests. Results:Urban participants (n 1⁄4 31) had higher levels of education (14.7 vs. 10.6 years, p<0.05), and a higher mean age (41.5 vs. 35.6, p<0.05) relative to rural participants (n 1⁄4 79). Rural participants were significantly more likely to endorse that AD can result from a curse (23.5% vs. 0%, p<.0.01), is a form of insanity (45.6% vs 3.8%, p<0.01), can be caused by traumatic life experiences (19.2% vs. 0%, p<0.01), and that AD can arise as “God’s will” (21.4% vs. 4.2%, p<0.05). Conclusions: In order to ethically conduct ADAD prevention studies, it is critical that potential participants are educated regarding the biological nature of the disease and the potential options for medical interventions. However, our study shows that misconceptions and myths about AD are prevalent, particularly in rural Mexico. Families at-risk for AD need additional education regarding AD in order to understand the potential impact of AD on their lives and inform decisions regarding research participation.

Perception and attitude toward ageing and dementia among the Bangladeshi community in England

Background: Worldwide, an increasing ageing population mean more people may suffer from dementia. Despite a rapid growth of older Bangladeshi immigrants living in the UK, there is little evidence about how community members (who are not affected by dementia) understand and view the process of ageing and dementia. Yet, Bangladeshis have a higher risk of developing type 2 diabetes and heart disease; both important indicators of developing dementia in old age. In previous research, conducted with immigrant South Asians, the concept of stigma and its impact on the understanding of dementia has been commonly acknowledged as a big challenge to seeking service support. This study aimed to explore and analyse the perception, knowledge, and attitude of ageing and dementia among the Bangladeshi community.

Sleep disorders in children with Down syndrome: Stores and Stores reply.

SIR–We appreciate Dr Kawada’s comments on our review. We agree with his point that physiological monitoring in children with neurodevelopmental disabilities can be difficult and are grateful to him for drawing attention to the article by Paasch et al., which points out ways in which this might be minimized. This has been our group’s experience as well. Similarly, we agree that subjective and objective measures of sleep do not necessarily correspond (disparities may well be instructive about various factors determining parents’ judgments). That said, it is also our experience that parental reports can correspond with objective measures (including actigraphy) of some aspects of sleep in children with Down syndrome. We have taken note of the articles by Dr Kawarda and his colleagues concerning the general use of actigraphy in the assessment of children’s sleep.