Service-user groups whose goals include the promotion of self-advocacy for people with an intellectual disability aim, among other things, to encourage service users to identify problems and find solutions. However, service users' contributions to group sessions may not always be full and spontaneous. This presents a dilemma to the facilitator. In two case studies, we identify two ways in which the dilemma is managed. In one case, the facilitator takes an initiating role in each stage of a decision-making cycle. In the other, the facilitator short-circuits the decision-making cycle. The former seems to be closer to the philosophy of self-advocacy, but both nevertheless result in clients not taking the initiative and arguably disempowers them.

Arterial stiffness is a risk factor for cardiovascular disease that is affected by diet. However, research understanding how these dietary risk factors are related to arterial stiffness during childhood is limited. The purpose of this review was to determine whether various dietary factors were associated with arterial stiffness in the pediatric population. Five databases were systematically searched. Intervention studies, cross-sectional and cohort studies were included that investigated nutrient or food intake and outcomes of arterial stiffness, primarily measured by pulse wave velocity (PWV) and augmentation index (AIx), in the pediatric population (aged 0–18 years). A final 19 studies (six intervention and 13 observational) were included. Only two intervention studies, including a vitamin D and omega-3 supplementation trial, found protective effects on PWV and AIx in adolescents. Findings from observational studies were overall inconsistent and varied. There was limited evidence to indicate a protective effect of a healthy dietary pattern on arterial stiffness and an adverse effect of total fat intake, sodium intake and fast-food consumption. Overall, results indicated that some dietary factors may be associated with arterial stiffness in pediatric populations; however, inconsistencies were observed across all study designs. Further longitudinal and intervention studies are warranted to confirm the potential associations found in this review.