ORCID Profile
0000-0002-4863-7639
Current Organisation
UNSW Sydney
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Publisher: Informa UK Limited
Date: 2009
Publisher: Wiley
Date: 04-02-2013
DOI: 10.1111/JIR.12015
Abstract: Falls are a significant and recurrent problem for in iduals with intellectual disability (ID). There has been little exploration of the fall event from the perspective of the in idual who falls or their carers. Research has focused predominantly on personal risk factors, leaving the behavioural and contextual analysis of falls much less understood. This study aimed to identify these additional factors as well as briefly explore the fall experience for in iduals and their carers. A qualitative design was used incorporating fall reconstructions and ethnographic-style interviews conducted in the home setting. Nine people with ID and their carers/family member participated: five pairs were living at home and four were in out-of-family-home settings. Interviews were recorded, transcribed verbatim and major themes identified via thematic analysis. We identified 17 themes that contributed to falls and fell under the three headings of in idual, behavioural or contextual factors. Themes include decreased physical capacity, unsafe behaviours, limited hazard awareness and the impact of others in the home on an in idual's fall behaviours. Additionally, families and in iduals identified a number of consequences and adaptations which they implemented to alleviate possible fall impact. Qualitative interviews, observational methods and carer assistance are valuable in offering insight into understanding the in idual, behavioural and contextual factors associated with falls in people with ID. The fall reconstruction technique may be a useful supplement when evaluating intrinsic risk in programmes designed to reduce falls.
Publisher: Springer Science and Business Media LLC
Date: 21-09-2020
DOI: 10.1186/S12909-020-02235-W
Abstract: People with intellectual disability (ID) have multiple and complex health needs, more frequent healthcare episodes, and experience poorer health outcomes. Research conducted two decades ago showed that medical professionals were lacking in the knowledge and skills required to address the complex needs of this patient group. The aim of the current study was to determine whether Australian undergraduate medical schools that offer ID health education content had changed the amount and nature of such teaching over this period. Identical or equivalent questionnaire items were compared across eight Australian medical schools that participated in curricula audits conducted in 1995 (referred to as T1) and 2013/14 (T2). The audits were of the nature of the ID content, methods used to teach it, and who taught it. There was no significant difference in the number of hours of compulsory ID content offered to medical students at T2 (total = 158.3 h median = 2.8 h per ID unit) compared with T1 (total = 171 h median = 2.5 h). At T2 compared with T1, units with ID content taught in the area of general practice had increased (2 units 3.6% to 7 units 16.3%), while decreases were seen in paediatrics (22 units 40.0% to 10 units 23.3%) and psychiatry (10 units 18.2% to 4 units 9.3%). The number of schools using problem- and/or enquiry-based learning rose to six at T2 from one at T1. Inclusive teaching practices (people with ID develop or deliver content) in compulsory/elective units had increased at T2 (10 units 23.3%) compared with T1 (6 units 10.9%), but direct clinical contact with people with ID had decreased (29 units 52.7% to 11 units 25.6%). Overall, little progress has been made to address the gaps in ID education for medical students identified from an audit conducted in 1995. Renewal of ID content in medical curricula is indicated as a key element in efforts to improve workforce capacity in this area and reduce barriers to care, with the aim of reversing the poor health outcomes currently seen for this group.
Publisher: Wiley
Date: 31-01-2020
Publisher: Wiley
Date: 15-01-1999
DOI: 10.1002/(SICI)1096-8628(19990115)82:2<123::AID-AJMG4>3.0.CO;2-C
Abstract: To determine if persons with the Prader-Willi syndrome (PWS) have increased psychopathology when compared with matched controls, and whether there is a specific behavior phenotype in PWS, the behavior of 46 persons with PWS was compared with that of control in iduals derived from a community s le (N = 454) of persons with mental retardation (MR). Behaviors were studied using the Developmental Behaviour Checklist, an instrument of established validity in the evaluation of behavioral disturbance in in iduals with MR. PWS subjects were found to be more behaviorally disturbed than controls overall, and especially in antisocial behavior. In addition, some in idual behaviors were more common in PWS subjects than controls. When these behaviors are considered together with findings from other studies using acceptably rigorous methods, a consensus behavior phenotype for PWS can be formulated. This will provide a valid foundation for studies of the mechanism of genetic pathogenesis of behavior in PWS.
Publisher: SAGE Publications
Date: 16-05-2023
DOI: 10.1177/17446295231175541
Abstract: This study reports on a five-year data set about the deaths of 599 in iduals in New South Wales Australia, who at the time of their death were living in out-of-home care. Analysis aimed to: i) gain a clearer understanding of place of death for people with intellectual disability and ii) identify and analyse associated variables to investigate how well they predict place of death for this population. Hospital admissions, polypharmacy and living situation were the strongest standalone predictors of place of death. A hospital death was more likely if the target population were subject to polypharmacy, lived in a group home, had a moderate intellectual disability or had GORD. Death, and place of death, is an issue requiring in idual consideration. This study has identified some of the variables that need attention when supporting people with intellectual disability to have a good death.
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/PY12153
Abstract: Australian data suggest up to 15% of people with intellectual disability (ID) have asthma. The inhaled route of administration is optimal for the management of obstructive airways diseases however, correct inhaler use requires dexterity and particular breathing patterns and potentially represents a problem in this population due to physical and cognitive deficits. Understanding the nature and extent of inhaler use in persons with ID is important, as correct inhaler technique is imperative for optimal clinical outcomes however, currently no evidence base exists to inform health professionals. This study describes respiratory medication use, reported prevalence of asthma, and asthma management practices undertaken in a clinic s le of Australian adults with ID. Results showed a prevalence of retrospectively reported asthma of 6%, with 86% of asthma patients prescribed inhaled medication. A review of patient records also indicated omission of some recommended asthma management strategies.
Publisher: Informa UK Limited
Date: 12-09-2016
DOI: 10.3109/02770903.2015.1065423
Abstract: This aim of this study was to assess inhaler technique of people with intellectual disability (ID), and evaluate the effectiveness of teaching with respect to their in idual ability to adopt correct technique. Seventeen people with ID were recruited through existing networks of general practitioners and disability support organisations. Inhaler technique was assessed using validated checklists and placebo devices, followed by provision of in idualised training. The educational interaction between participant and researcher was captured via video recording and analysed qualitatively. Seventeen people with ID participated females comprised 65%. At baseline, no participants correctly used any device. Pressurised metered dose inhalers, with or without accessory devices, were the most poorly used devices. Inhalation steps were poorly performed across all devices. Following training, the proportions of assessed participants that were able to master inhaler technique were 100% of Accuhaler users, 40% of Turbuhaler users, 25% of pressurised metered dose inhaler users and 0% of Handihaler users. Barriers identified included poor comprehension of breathing processes, the lack of attentiveness and poor dexterity. Facilitators for educator delivery of inhaler technique education included the use of analogies and being patient. This is the first study to examine inhaler technique mastery in people with ID. Results show that with education that addresses the unique patient barriers inherent in this group, some in iduals can be trained to mastery. Structured modules of inhaler technique training tailored for people with ID, but which can be in idualised, are recommended.
Publisher: Informa UK Limited
Date: 06-2008
Publisher: Informa UK Limited
Date: 05-03-2020
Publisher: Springer Science and Business Media LLC
Date: 02-08-2018
Publisher: Springer Science and Business Media LLC
Date: 14-10-2014
DOI: 10.1007/S11657-014-0197-9
Abstract: The aim of this study was to determine the vitamin D response to sunlight ultraviolet radiation in older people. Increases in vitamin D depended on the season of exposure, but the changes were small. Natural sun exposure is not a practical intervention for vitamin D deficiency in this population. The purpose of this study is to measure the ultraviolet radiation (UVR) exposure of those in residential aged care in an earlier trial of sunlight exposure and to determine its effect on their vitamin D response. Attendance data, demographic, clinical and biochemical variables for 248 participants were used for a secondary analysis of a previous cluster randomized trial of sunlight exposure and falls. The ambient solar UV Index data were used to calculate the participants' UVR dose. Multiple linear regression was used to test if UVR exposure over 6 months, as measured by the standard erythemal dose (SED), was a predictor of vitamin D response, controlling for age, gender, BMI, calcium intake, baseline vitamin D and season of exposure. The median 25-hydroxyvitamin D (25OHD) was 32.4 nmol/L at baseline and 34.6 nmol/L at 6 months (p = 0.35). The significant predictors of 25OHD at 6 months were UVR exposures in spring-summer (coefficient = 0.105, 95 % confidence interval (CI) 0.001-0.209, p = 0.05) and autumn-winter (coefficient = 0.056, 95 % CI 0.005-0.107, p = 0.03) and baseline vitamin D (adjusted coefficient = 0.594, 95 % CI 0.465-0.724, p = 0.00). In those starting sunlight sessions in spring, an increase of 1 unit in log SED was associated with 11 % increase in 25OHD. Natural UVR exposure can increase 25OHD levels in older people in residential care, but depends on the season of exposure. However, due to inadequate sun exposure, 25OHD did not reach optimal levels. Nevertheless, where sun exposure is encouraged in this group, the focus for the start of exposure should be in the months of spring or autumn, as this timing was associated with a vitamin D response.
Publisher: Wiley
Date: 24-11-2010
DOI: 10.1111/J.1365-2788.2010.01333.X
Abstract: Falls among people with intellectual disability (ID) occur at a younger age than the general population and are a significant cause of injury and hospitalisation. There is very limited research investigating risk factors for falls among people with ID and none with people living outside of formal care arrangements, either independently or with their family.We used a medical chart audit to identify the incidence and risk factors for falls among people with ID living in a variety of settings. We retrospectively identified 114 consecutive patients, aged 18 years and over who attended a clinic for people with developmental disabilities within a 15-month period. Fall information was measured by carer recall of falls in the past 12 months. Potential risk factors were extracted from medical reports and a patient information questionnaire. Potential predictors were identified using univariate analysis and entered into a multiple logistic regression. Of 114 participants, 39 (34%) reported a fall in the previous 12 months.The number of reported falls was similar for formal care and non-formal care arrangements.The vast majority of fallers (84%) reported sustaining an injury from a fall and many potential risk factors were identified. Multivariate analysis revealed having seizures in the past 5 years, a history of fracture and increasing age were risk factors for falls. Falls are a significant health concern for adults with ID of all ages as a result of their incidence and the resulting injuries. Falls appear to be equally an issue for people residing in formal and non-formal care accommodation. Further research is needed to develop screening tools and interventions for this population.
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1016/J.ARCHGER.2011.08.009
Abstract: The purpose of this study was to investigate the factors influencing low adherence with therapeutic sunlight exposure in a randomized controlled trial conducted with older people living in intermediate care facilities. The study involved participants in the FREEDOM (Falls Risk Epidemiology: Effect of vitamin D on skeletal Outcomes and other Measures) study, a randomized controlled trial of therapeutic sun exposure to reduce falls in older people in intermediate care facilities. Semi-structured interviews were conducted with thirty participants in the FREEDOM trial, and with ten sunlight officers who were employed to facilitate the sun exposure. Two focus groups involving 10 participants in the FREEDOM trial were also held at the end of the intervention period. Common themes were derived from the interview and focus group transcripts. The study showed that the perceived health benefits did not influence adherence with the sun exposure. Factors such as socializing with others and being outdoors were more important in encouraging attendance. The main barriers to adherence included the perceived inflexibility and regimentation of daily attendance, clash with other activities, unsuitable timing and heat discomfort. This study showed that providing greater flexibility and autonomy to older people in how and when they receive sun exposure is likely to improve adherence.
Publisher: Springer Science and Business Media LLC
Date: 11-11-2016
DOI: 10.1007/S11096-015-0217-X
Abstract: Fifteen percent of Australians with intellectual disability (ID) are reported to have asthma. People with ID are at risk of poor health knowledge due to deficits in intellectual and adaptive functioning, but their medication knowledge has largely been ignored in research to date. To explore the level of understanding of asthma medication use of people with ID who self-administer their inhaled medications, in order to inform future educational support. Setting The research was conducted in NSW, Australia, at the participants' homes, the point of health care access, or the offices of relevant support organisations. In this qualitative study face-to-face interviews were conducted with people with ID using a semi-structured interview guide. The interviews were recorded, transcribed and thematically analysed. Main outcome Identification of barriers to asthma medication self-management by people with ID. Seventeen people with ID who self-administer their asthma medications were interviewed. Factors influencing their asthma medication knowledge and use included understanding of their illness and the need for medication aspects of self-management and autonomy versus dependence. This s le of people with ID had a good understanding of the importance of using their inhaled asthma medications, as well as asthma triggers, and the difference between use of preventer and reliever medications. Both enablers and barriers to asthma medication self-management were identified in the domains of managing attacks, adherence, knowledge of side effects and sources of information on correct use of inhalers. The level of autonomy for medication use varied, with motivation to self-manage asthma influenced by the level of support that was practically available to in idual participants. This research investigated aspects of asthma medication self-management of people with ID. Based on the barriers identified, pharmacists should promote use of spacers and written asthma action plans as well as counsel people with ID about how to recognise and minimise side effects of asthma medications. Specific strategies for pharmacists when educating people with ID and their caregivers include active listening to determine understanding of concepts, exercising care with language, and working with the person's known routines to maximise adherence with preventer medications.
Publisher: Hindawi Limited
Date: 26-02-2011
DOI: 10.1155/2011/134571
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.ARCHGER.2010.01.008
Abstract: Older people have a high prevalence of falls and fractures, partly due to vitamin D deficiency. Sunlight is a major source of vitamin D, but many older people living in intermediate care facilities have inadequate sunlight exposure. The aim of this study was to determine the sun exposure practices and attitudes to sunlight in this population. Fifty-seven older residents of intermediate care facilities in Sydney, Australia were interviewed to determine their sun exposure practices, their views on sunlight and health and whether these have changed over their lives, factors affecting sunlight exposure and their knowledge of vitamin D. Sixty percent of the participants preferred to be outdoors, despite more than 92% believing that sunlight was healthy. In their youth however, almost 90% had preferred to be outdoors. Poor health, physical constraints and a sense of lack of ownership of outdoor spaces were barriers to sunlight exposure. Improved physical access, more outdoor leisure activities and promotion of greater autonomy may improve safe and appropriate sunlight exposure in this population.
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/AH14035
Abstract: Objective The aim of the present study was to assess whether the outdoor areas of residential aged care facilities used for a sunlight intervention trial had the design features that encouraged participants’ use of these spaces. Methods The design principles recommended in the ‘Vitamin D and the Built Environment in Victoria’ guidelines were used to assess the outdoor spaces of residential aged care facilities that were used in a randomised controlled trial (RCT) of sunlight exposure. Attendance rates in the sunlight RCT were analysed in relation to global impression scores of the facilities using one-way analysis of variance. Results Thirty-six outdoor areas of 31 facilities were assessed. The facilities met the guidelines for sun exposure, and were generally safe and accessible. However, many lacked privacy, security and aesthetic appeal. Most of the outdoor spaces were not used for regularly scheduled activities. Attendance rates were higher in those facilities with the highest global impression scores compared with those with the lowest scores (F(2,367) = 3.262, P = 0.039). Conclusions The physical environment of the outdoor areas of residential aged care facilities was associated with their use for sunlight exposure. Suitably designed or modified spaces have the potential to encourage their greater use, and residential aged care facilities should also plan regular activities in those areas. These measures can facilitate safe sun exposure, as well as physical activity and social interaction in older people. What is known about the topic? Older people living in aged care facilities have inadequate outdoor sun exposure and vitamin D deficiency. The outdoor spaces of aged care facilities are not well used by residents. Design features that encourage greater use of outdoor spaces have been identified. What does this paper add? Participation rates in a trial of outdoor sun exposure in residents of aged care facilities were found to be higher in those facilities with better design features in their outdoor spaces. Most facilities do not schedule their regular activities outdoors. What are the implications for practitioners? Suitable design or modification of outdoor spaces of residential aged care facilities can encourage their greater use. Regular scheduling of leisure and social activities can further promote their utilisation.
Publisher: Springer Science and Business Media LLC
Date: 12-05-2018
Publisher: Informa UK Limited
Date: 12-05-2015
Publisher: Springer Science and Business Media LLC
Date: 03-03-2011
DOI: 10.1007/S00198-011-1590-5
Abstract: Sunlight exposure by improving vitamin D status could be a simple public health strategy in reducing falls among frail elder people. In a randomised controlled trial, adherence to sunlight exposure was low (median adherence, 26%) and no effect of increased UV exposure on falls risk was observed (incidence rate ratio (IRR) 1.06, P = 0.73). This study aimed to determine whether increased sunlight exposure was effective to improve vitamin D status and reduce falls in the elderly. In a cluster randomised controlled trial (NCT00322166 at ClinicalTrials.gov), 602 residents aged 70 or more (mean age, 86.4 years 71% female) were recruited from 51 aged care facilities in Northern Sydney, Australia. Participants were randomised by facility to receive either increased sunlight exposure (additional 30-40 min/day in the early morning) with (UV+) or without (UV) calcium supplementation (600 mg/day) or neither (control) for a year. The co-primary endpoints were change in serum 25 hydroxy vitamin D (25OHD) and falls incidence after 12 months. Adherence to sunlight exposure was low (median adherence, 26% IQR, 7%-45%). Serum 25OHD levels were low at baseline (median, 32.9 nmol/L) and increased only slightly depending on the number of sunlight sessions attended over 12 months (P = 0.04). During the study, 327 falls occurred in 111 (54%) subjects in the control group, 326 falls in 111 (58%) subjects in the UV only group and 335 falls in 108 (52%) subjects in the UV+ group. By intention-to-treat analysis, there was no significant effect of increased UV exposure on falls risk (IRR, 1.06 95% CI, 0.76-1.48 P = 0.73). However, in 66 participants who attended ≥130 sessions per year (adherence, ≥50% of 260 sessions-five per week), falls were significantly reduced (IRR, 0.52 95% CI, 0.31-0.88 P = 0.01) compared with the control group. Increased sunlight exposure did not reduce vitamin D deficiency or falls risk in frail older people. This public health strategy was not effective most likely due to poor adherence to the intervention.
No related grants have been discovered for Seeta Durvasula.