Breast cancer is one of the commonest cancers to affect women. Present health service guidelines call for screening and mammography for all women aged between 50 and 65 years in an effort to increase early detection and improve survival rates. Nulliparity is one of the associated risk factors for breast cancer. Women with intellectual disability (ID) are increasing in longevity and are frequently nulliparous, and therefore, they are at increased risk of developing breast cancer. The aim of the present study was to review the uptake and knowledge of women with ID living in the community of breast screening programmes. A postal survey of women aged > or = 50 years with ID living in community group homes was used to gather data. Only one-third of the women carried out regular breast examination and a similar proportion had received invitations to mammography. General practitioners and practice nurses were currently playing very minor roles in breast screening these women. Primary health care professionals may be missing opportunistic health promotion opportunities and the support services for women with ID living in the community could be provided with better training and resources to improve breast cancer screening in this vulnerable group.

Advancing knowledge of the existence of Helicobacter pylori and its association with gastrointestinal tract malignancy, and previous research showing higher-than-expected gastrointestinal tract malignancy in institutionalized adults with intellectual disability (ID) prompted a review of all deaths as a result of cancer in the Stoke Park group of hospitals for people with ID between 1946 and 1996. A 50-year, retrospective case note analysis of all deaths from cancer in an institution for people with ID was undertaken. Death from stomach cancer accounted for up to 48% of all cancer deaths. A further 25 residents had died of perforated stomach ulcers. The higher proportion of deaths specifically caused by stomach cancer in a population with ID has not been noted previously. It is postulated that the high levels of H. pylori infection found in institutionalized populations may be instrumental in this higher mortality rate and that the closure of the institutions without evaluation of H. pylori status transfers the problem unresolved to the community. Existing guidelines for the screening and eradication of H. pylori developed for the general population are inadequate when applied to people with ID, and therefore, the value of population screening and mass eradication programmes is explored.

This paper reviews the epidemiology of Helicobacter pylori (H. Pylori) in adults with intellectual disability (ID) including clinical presentation, risk factors for infection and diseases, and assesses the best options for testing and treatment. It was observed that particular groups of adults with ID have significantly higher rates of H. pylori infection, and possibly disease consequences including peptic ulcer disease and gastric cancer, when compared to the general population, although the presentation with typical dyspepsia in people with ID is rare. Identified independent risk factors for infection include a history of institutionalization, lower ability, higher levels of behavior problems, and living with flatmates with oral hypersalivation or fecal incontinence. The presence of ID and the associated biopsychosocial factors necessitate development of adaptations to the usual testing and treatment methods as part of a preventive health strategy in order to relieve occult symptoms, and prevent disease development. Among the available tests, the fecal antigen or serology tests are equally acceptable to adults with ID regardless of their level of disability or behaviors, although only those who function more normally can perform the urea breath test. The H. pylori eradication rate is lower, with treatment side‐effect and recurrence rates higher, compared to the general population; but, given the evidence that patients with ID carry the infection and associated pathology for long periods, testing and treating those with at‐risk is recommended. While not recommending screening all adults with ID for H. pylori infection, the authors provide an overall evidence‐based position statement on whom to test and treat, and how to diagnose and manage this infection, an important cause of preventable disease.

Aotearoa New Zealand is a country of just under 5 million people with a diverse population, the main ethnic groups being of European descent and Maori. There are well-developed public and private healthcare systems. As in other countries, Aotearoa New Zealand has closed the large institutions and developed community-based services for people with intellectual disability. Aotearoa New Zealand has specific legislation for people with intellectual disability presenting to the criminal justice system and has unusually and explicitly excluded people with intellectual disability from mental health legislation since 1992. Partly as a result, most health professional training schemes have little focus on issues for people with intellectual and developmental disabilities. Therefore, one of the main challenges over the coming decade will be to ensure there is a sufficient workforce of psychiatrists and other professionals who have the training and expertise to work with people with intellectual disability requiring mental health and forensic services.

In 1953 while undergoing a 90-day streptomycin course for T.B. in the urinary tract, my husband Harold noticed an inability to write in a flowing legible manner, and that on picking up a pen or knife or spoon, his hand wavered for an instant before grasping the object. This was the first indication that something was amiss and we were advised to ignore it, since this was better so. However, Harold is a civil engineer, an occupation demanding the ability to pinpoint a particular feature on a drawing or demanding dexterity with a level or a theodolite, and it was not so easy to ignore this increasing clumsiness of his right hand. We were more than fortunate in our G.P., for one of his close relatives suffered from Parkinson's Disease for 20 years, and "lived a long and healthy life". His understanding of problems in the home, arising from the malady, and his advice in the early days were the utmost help to the whole family.We went through a period of two or three years when weekends and holiday times were punctuated by a more defined malaise, for want of a better description, when Harold would stay in bed for days, yet when at work he was organised and felt no great strain. We quickly came to the conclusion that the Parkinson patient, in order to keep well, must be fully occupied. There were times, of course, when he was not well and felt unable to go to work for perhaps a few days. On one of these occasions the G.P. had to visit in order to sign a certificate and told me bluntly to get tough and get Harold up and back to work. I must have put the message over, for it was the last occasion he stayed away from work and he confined his off days to Saturday or Sunday. Fortunately this phase passed after his operation.All this time we had been gradually going into a lower gear. We had worked actively in church and Sunday school until Harold dropped all his activities except choir, and eventually that finished when his walk deteriorated again and he felt too conspicuous entering the church with the choir.The two older children were always busy with school activities and studies and the house was alive with their friends or with a bunch of young musicians. It does not sound an ideal background for an invalid but it did work well and stimulated his interest. This attitude of "everybody's looking at me" to which I referred just now is constantly with these patients, and magnifies their inability out of all proportion, so that the whole situation can snowball and causes further distress. The prospect of having a meal out became a nightmare, and the result was repeatedly that if we were to go out or to visit, then some inner mechanism seized up and my husband would be sick and have to retire to bed. Restaurants or hotels were out then and picnics took their place. Very pleasant, even in winter. Visits diminished and friends came to us instead. To prevent embarrassment in public, for instance on a railway station or a hospital corridor, I would walk a little ahead to clear a way for Harold and he would follow; so long as he k...