To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Approximately 18% of adults with intellectual disabilities living in the community display behaviours that challenge. Intensive support teams (ISTs) have been recommended to provide high-quality responsive care aimed at avoiding unnecessary admissions and reducing lengthy in-patient stays.
To identify and describe the geographical distribution and characteristics of ISTs, and to develop a typology of IST service models in England.
We undertook a national cross-sectional survey of 73 ISTs. A hierarchical cluster analysis was performed based on six prespecified grouping factors (mode of referrals, size of case-load, use of outcome measures, staff composition, hours of operation and setting of service). A simplified form of thematic analysis was used to explore free-text responses.
Cluster analysis identified two models of IST provision: (a) independent and (b) enhanced provision based around a community intellectual disability service. ISTs aspire to adopt person-centred care, mostly use the framework of positive behaviour support for behaviour that challenges, and report concerns about organisational and wider context issues.
This is the first study to examine the delivery of intensive support to people with intellectual disability and behaviour that challenges. A two-cluster model of ISTs was found to have statistical validity and clinical utility. The clinical heterogeneity indicates that further evaluation of these service models is needed to establish their clinical and cost-effectiveness.
Contemporary Nigeria is not typically thought of as a mainstream tourist destination. Even Nigerian travel writer Pèḷú Awófèṣ ò,̣ who avidly promotes the country's potential for travellers, conceded in an interview with me in 2010 that he feared that ‘nobody will go anywhere in Nigeria specifically on vacation’. Nonetheless, as we saw in Chapter 1, the idea of travel for its own sake has had a limited but not insignificant resonance in southwest Nigeria throughout the twentieth century: in the notion of personal development and òḷ àjú associated with travel in many travel narratives, or in the newspapers’ promotion of travel as an improving, ‘civilised’ and relaxing leisure activity. In the postindependence era, there has been a growing interest in domestic tourism as both an aspirational leisure activity and a source of economic growth for the state, reflected in the publication of official tourist guides to Nigeria and the foundation of state tourism institutions such as the Nigeria Tourism Association (now the Nigeria Tourism Development Corporation) in 1962, the National Institute for Hospitality and Tourism in 1988, and the Federal Ministry of Culture and Tourism in 1999.
The press, too, has continued to promote tourism both within and beyond Nigeria. Today, many of Nigeria's newspapers host dedicated travel sections; these typically focus on domestic and international tourism news, information and PR pieces, although they occasionally publish short, first-person narratives describing journalists’ or readers’ own travels. Tourism journalism has undergone a professionalisation, including the foundation of the Association of Nigerian Journalists on Entertainment and Tourism and the Guild of Tourism Journalists, the latter of which is headed by Wálé Ojó-Lánre, a veteran of Nigerian tourism journalism. Some journalists have become known particularly for their extensive reporting on travel and tourism and for their occasional publication of narrative accounts of their own travels, such as Maurice Archibong, who wrote the ‘Travels’ column in the Daily Sun newspaper from 2003. Travel photojournalist and tourism professional John Olú Fáòṣèké has also published several works on tourism prospects in Nigeria and Africa, as well as a guidebook, Travellers’ Guide to Nigeria (1997).
Perceiving a gap in the state provision of travel infrastructure and marketing, private travel and tourism advocates have also sprung up to encourage Nigerians to travel within Nigeria.
Smoking prevalence is higher amongst individuals with schizophrenia and depression compared with the general population. Mendelian randomisation (MR) can examine whether this association is causal using genetic variants identified in genome-wide association studies (GWAS).
We conducted two-sample MR to explore the bi-directional effects of smoking on schizophrenia and depression. For smoking behaviour, we used (1) smoking initiation GWAS from the GSCAN consortium and (2) we conducted our own GWAS of lifetime smoking behaviour (which captures smoking duration, heaviness and cessation) in a sample of 462690 individuals from the UK Biobank. We validated this instrument using positive control outcomes (e.g. lung cancer). For schizophrenia and depression we used GWAS from the PGC consortium.
There was strong evidence to suggest smoking is a risk factor for both schizophrenia (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.67–3.08, p < 0.001) and depression (OR 1.99, 95% CI 1.71–2.32, p < 0.001). Results were consistent across both lifetime smoking and smoking initiation. We found some evidence that genetic liability to depression increases smoking (β = 0.091, 95% CI 0.027–0.155, p = 0.005) but evidence was mixed for schizophrenia (β = 0.022, 95% CI 0.005–0.038, p = 0.009) with very weak evidence for an effect on smoking initiation.
These findings suggest that the association between smoking, schizophrenia and depression is due, at least in part, to a causal effect of smoking, providing further evidence for the detrimental consequences of smoking on mental health.