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Nguyen TQ, Kerley CI, Key AP, Maxwell-Horn AC, Wells QS, Neul JL, Cutting LE, Landman BA. Phenotyping Down syndrome: discovery and predictive modelling with electronic medical records. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:491-511. [PMID: 38303157 PMCID: PMC11023778 DOI: 10.1111/jir.13124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/20/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Individuals with Down syndrome (DS) have a heightened risk for various co-occurring health conditions, including congenital heart disease (CHD). In this two-part study, electronic medical records (EMRs) were leveraged to examine co-occurring health conditions among individuals with DS (Study 1) and to investigate health conditions linked to surgical intervention among DS cases with CHD (Study 2). METHODS De-identified EMRs were acquired from Vanderbilt University Medical Center and facilitated creating a cohort of N = 2282 DS cases (55% females), along with comparison groups for each study. In Study 1, DS cases were one-by-two sex and age matched with samples of case-controls and of individuals with other intellectual and developmental difficulties (IDDs). The phenome-disease association study (PheDAS) strategy was employed to reveal co-occurring health conditions in DS versus comparison groups, which were then ranked for how often they are discussed in relation to DS using the PubMed database and Novelty Finding Index. In Study 2, a subset of DS individuals with CHD [N = 1098 (48%)] were identified to create longitudinal data for N = 204 cases with surgical intervention (19%) versus 204 case-controls. Data were included in predictive models and assessed which model-based health conditions, when more prevalent, would increase the likelihood of surgical intervention. RESULTS In Study 1, relative to case-controls and those with other IDDs, co-occurring health conditions among individuals with DS were confirmed to include heart failure, pulmonary heart disease, atrioventricular block, heart transplant/surgery and primary pulmonary hypertension (circulatory); hypothyroidism (endocrine/metabolic); and speech and language disorder and Alzheimer's disease (neurological/mental). Findings also revealed more versus less prevalent co-occurring health conditions in individuals with DS when comparing with those with other IDDs. Findings with high Novelty Finding Index were abnormal electrocardiogram, non-rheumatic aortic valve disorders and heart failure (circulatory); acid-base balance disorder (endocrine/metabolism); and abnormal blood chemistry (symptoms). In Study 2, the predictive models revealed that among individuals with DS and CHD, presence of health conditions such as congestive heart failure (circulatory), valvular heart disease and cardiac shunt (congenital), and pleural effusion and pulmonary collapse (respiratory) were associated with increased likelihood of surgical intervention. CONCLUSIONS Research efforts using EMRs and rigorous statistical methods could shed light on the complexity in health profile among individuals with DS and other IDDs and motivate precision-care development.
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Affiliation(s)
- T Q Nguyen
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, TN, USA
| | - C I Kerley
- School of Engineering, Vanderbilt University, Nashville, TN, USA
| | - A P Key
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Speech and Hearing Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A C Maxwell-Horn
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Q S Wells
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J L Neul
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L E Cutting
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - B A Landman
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- School of Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
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3
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Santoro SL, Baker S, Blake JM, Cabrera MJ, Caughman K, Chung J, Cullen S, Gallagher M, Haugen K, Hoke-Chandler R, Krell K, Maina J, McLuckie D, Merker VL, Michael C, O’Neill K, Peña A, Pless A, Royal D, Slape M, Spinazzi NA, Torres A, Torres CG, Skotko BG. Views on the impact of the COVID-19 pandemic on health in people with Down syndrome from diverse backgrounds. Am J Med Genet A 2023; 191:2045-2056. [PMID: 37264986 PMCID: PMC10524618 DOI: 10.1002/ajmg.a.63233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023]
Abstract
Down syndrome (DS) has a unique medical and psychological profile. To date, few studies have asked individuals with DS about their views of health, and fewer have explored the impact of COVID-19 on the health of individuals with DS and their families. We used a mixed methods approach including two studies on the health of individuals with DS and their parents conducted during the COVID-19 pandemic: (1) eight virtual focus groups, comprised of 20 parents and 8 individuals with DS to obtain participants' views of health, and (2) a 20-item questionnaire on health care experience of patients with DS who are African American or come from primarily Spanish-speaking homes. Focus group transcripts were coded using a hybrid inductive/deductive framework and thematically analyzed using the Framework Method. This questionnaire included questions regarding the impact of COVID-19 on caregivers and their loved ones with DS; responses to these questions were summarized using descriptive statistics. Individuals with DS discussed the impact of the COVID-19 pandemic on their physical and social health including masking, online learning, and online communication with friends and family. Parents of individuals with DS discussed how the COVID-19 pandemic negatively impacted their child's physical, social, and mental health, as a result of virtual schooling and decreased socialization. There were unexpected positives of the pandemic such as improved hygiene and eased scheduling with telehealth visits. Caregivers noted COVID-19 impacted their own anxiety, employment, and other domains that have potential ripple effects on the health of their children. The COVID-19 pandemic had a pervasive impact on the mental health and wellness of caregivers as well as the physical, social, and mental health of individuals with DS.
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Affiliation(s)
- Stephanie L. Santoro
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Jasmine M. Blake
- Departments of Internal Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maria J. Cabrera
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | - Jeanhee Chung
- Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA
| | - Sarah Cullen
- Massachusetts Down Syndrome Congress, Burlington, MA
| | | | - Kelsey Haugen
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | - Kavita Krell
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | | | - Vanessa L. Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Carie Michael
- Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - Kate O’Neill
- LuMind IDSC Down Syndrome Foundation, Burlington, MA
| | - Angeles Peña
- Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Albert Pless
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | | | - Noemi Alice Spinazzi
- Division of Primary Care, Department of Pediatrics, University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, CA
| | - Amy Torres
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | - Brian G. Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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4
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Sideropoulos V, Van Herwegen J, Meuleman B, Alessandri M, Alnemary FM, Rad JA, Lavenex PAB, Bolshakov N, Bölte S, Buffle P, Cai RY, Campos R, Chirita-Emandi A, Costa AP, Costanzo F, Des Portes V, Dukes D, Faivre L, Famelart N, Fisher MH, Gamaiunova L, Giannadou A, Gupta R, Hardan AY, Houdayer-Robert F, Hrncirova L, Iaochite RT, Jariabkova K, Klein-Tasman BP, Lavenex P, Malik S, Mari F, Martinez-Castilla P, Menghini D, Nuske HJ, Palikara O, Papon A, Pegg RS, Pouretemad H, Poustka L, Prosetzky I, Renieri A, Rhodes SM, Riby DM, Rossi M, Sadeghi S, Su X, Tai C, Tran M, Tynan F, Uljarević M, Van Hecke AV, Veiga G, Verloes A, Vicari S, Werneck-Rohrer SG, Zander E, Samson AC. Anxiety, concerns and COVID-19: Cross-country perspectives from families and individuals with neurodevelopmental conditions. J Glob Health 2023; 13:04081. [PMID: 37497751 PMCID: PMC10373111 DOI: 10.7189/jogh.13.04081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Background The COVID-19 pandemic had a major impact on the mental health and well-being of children with neurodevelopmental conditions (NDCs) and of their families worldwide. However, there is insufficient evidence to understand how different factors (e.g., individual, family, country, children) have impacted on anxiety levels of families and their children with NDCs developed over time. Methods We used data from a global survey assessing the experience of 8043 families and their children with NDCs (mean of age (m) = 13.18 years, 37% female) and their typically developing siblings (m = 12.9 years, 45% female) in combination with data from the European Centre for Disease Prevention and Control, the University of Oxford, and the Central Intelligence Agency (CIA) World Factbook, to create a multilevel data set. Using stepwise multilevel modelling, we generated child-, family- and country-related factors that may have contributed to the anxiety levels of children with NDCs, their siblings if they had any, and their parents. All data were reported by parents. Results Our results suggest that parental anxiety was best explained by family-related factors such as concerns about COVID-19 and illness. Children's anxiety was best explained by child-related factors such as children's concerns about loss of routine, family conflict, and safety in general, as well as concerns about COVID-19. In addition, anxiety levels were linked to the presence of pre-existing anxiety conditions for both children with NDCs and their parents. Conclusions The present study shows that across the globe there was a raise in anxiety levels for both parents and their children with NDCs because of COVID-19 and that country-level factors had little or no impact on explaining differences in this increase, once family and child factors were considered. Our findings also highlight that certain groups of children with NDCs were at higher risk for anxiety than others and had specific concerns. Together, these results show that anxiety of families and their children with NDCs during the COVID-19 pandemic were predicted by very specific concerns and worries which inform the development of future toolkits and policy. Future studies should investigate how country factors can play a protective role during future crises.
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Affiliation(s)
- Vassilis Sideropoulos
- Department of Psychology and Human Development, IOE, UCL's Faculty of Education and Society, London, UK
| | - Jo Van Herwegen
- Department of Psychology and Human Development, IOE, UCL's Faculty of Education and Society, London, UK
| | - Ben Meuleman
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Michael Alessandri
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | | | - Jamal Amani Rad
- Department of Cognitive Modeling, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | | | | | - Sven Bölte
- Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Center for Psychiatry Research, Department of Women's and Children's Health, Stockholm, Sweden
| | - Paulina Buffle
- Laboratory of Sensori-Motor Affective and Social Development, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Ru Y Cai
- Aspect Research Centre for Autism Practice, Autism Spectrum Australia, Frenchs Forest, New South Wales, Australia
| | - Ruth Campos
- Department of Basic Psychology, Faculty of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Adela Chirita-Emandi
- Department of Microscopic Morphology - Genetics, Center of Genomic Medicine, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
| | - Andreia P Costa
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Luxembourg
| | - Floriana Costanzo
- Child and Adolescents Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Vincent Des Portes
- National Reference Center for Intellectual Disabilities of Rare causes, Lyon University Hospital, France
| | - Daniel Dukes
- Institute of Special Education, University of Fribourg, Fribourg, Switzerland
| | - Laurence Faivre
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, INSERM UMR1231, Hôpital d'Enfants, CHU Dijon, Dijon Cedex, France
| | | | - Marisa H Fisher
- Department of Counselling, Educational Psychology, & Special Education, Michigan State University, East Lansing, Michigan, USA
| | - Liudmilla Gamaiunova
- Institute for Social Sciences of Religions, University of Lausanne, Lausanne, Switzerland
| | | | - Rashmi Gupta
- Cognitive and Behavioural Neuroscience Laboratory, Department of Humanities and Social Sciences, Indian Institute of Technology Bombay, Mumbai, Powai, Maharashtra, India
| | - Antonio Y Hardan
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, California, USA
| | | | - Lenka Hrncirova
- Department of Special and Inclusive Education, Faculty of Education, Masaryk University, Brno, Czech Republic
| | | | - Katarina Jariabkova
- Institute for Research in Social Communication, Slovak Academy of Sciences, Bratislava, Slovakia
| | | | - Pierre Lavenex
- Laboratory of Brain and Cognitive Development, Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | | | | | - Pastora Martinez-Castilla
- Department of Developmental and Educational Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Deny Menghini
- Child and Adolescents Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Heather J Nuske
- Penn Center for Mental Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Olympia Palikara
- Department of Education Studies, Faculty of Social Sciences, University of Warwick, Warwick, UK
| | - Anouk Papon
- Faculty of Psychology, UniDistance Suisse, Brig, Switzerland
| | - Robin S Pegg
- Williams Syndrome Association, Troy, Michigan, USA
| | - Hamidreza Pouretemad
- Department of Cognitive Psychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany
| | - Ingolf Prosetzky
- Faculty of Social Sciences, University of Applied Sciences Zittau / Görlitz, Görlitz, Germany
| | | | - Sinead M Rhodes
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Deborah M Riby
- Department of Psychology, Centre for Neurodiversity & Development, Durham University, Durham, UK
| | - Massimiliano Rossi
- Service de génétique HCL, INSERM U1028, CNRS UMR5292, CRNL, GENDEV Team, UCBL1, Bron, France
| | - Saeid Sadeghi
- Department of Cognitive Psychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Xueyen Su
- Department of Early Childhood Education, Faculty of Education, East China Normal University, Shanghai, China
| | - Claire Tai
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Michel Tran
- Faculty of Psychology, UniDistance Suisse, Brig, Switzerland
| | - Fionnuala Tynan
- Faculty of Education, Mary Immaculate College, Limerick, Ireland
| | - Mirko Uljarević
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, California, USA
| | - Amy V Van Hecke
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA
| | - Guida Veiga
- Comprehensive Health Research Centre (CHRC), Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Évora, Portugal
| | - Alain Verloes
- Department of Genetics, APHP.NUP Robert DEBRE University Hospital, Paris, France
| | - Stefano Vicari
- Department of Life Sciences and Public Health, Catholic University, Rome, Italy
| | - Sonja G Werneck-Rohrer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Eric Zander
- Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Center for Psychiatry Research, Department of Women's and Children's Health, Stockholm, Sweden
| | - Andrea C Samson
- Faculty of Psychology, UniDistance Suisse, Brig, Switzerland
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6
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Sideropoulos V, Sokhn N, Palikara O, Van Herwegen J, Samson AC. Anxiety, concerns and emotion regulation in individuals with Williams syndrome and Down syndrome during the COVID-19 outbreak: a global study. Sci Rep 2023; 13:8177. [PMID: 37210403 DOI: 10.1038/s41598-023-35176-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 05/14/2023] [Indexed: 05/22/2023] Open
Abstract
Individuals with neurodevelopmental conditions (NDCs) have been reported to experience increased levels of anxiety during the COVID-19 pandemic. In our study, we document how individuals with Down Syndrome (DS; N = 557; Mage = 16.52; 233 female) and Williams syndrome (WS, N = 247; Mage = 18.43; 113 female) experienced the first wave (April 2020-May 2020) of the COVID-19 pandemic across the world. Using multilevel linear mixed regressions, we studied (a) parental reported anxiety of individuals with DS and WS, (b) these individuals' specific concerns, and (c) their use and efficacy of emotion regulation (ER) strategies during the first wave of COVID-19. Predictors of anxiety, such as the age of the individual with NDC, type of condition, and time, were investigated. Individuals with WS experienced higher levels of anxiety compared to those with DS and the older the individuals with NDC were the more anxiety they experienced. In terms of concerns, group effects indicated that individuals with WS scored higher for most of the concerns. There were no gender differences in concerns, yet most of the concerns increased with age except for concerns about loss of routine, boredom, loss of institutional support and family conflict. Finally, significant group effects were found and indicated a more frequent use of a variety of adaptive and maladaptive ER strategies in individuals with WS. We did not identify group differences in the efficacy of ER strategies. Our results indicate that individuals with WS are likely to exhibit higher levels of anxiety, but also higher levels of concerns depending on their age. Similarly, individuals with WS use a variety of ER strategies more frequently but these strategies are not necessarily more efficient for them. We discuss the impact of these findings in relation to anxiety identification and support across individuals with NDCs.
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Affiliation(s)
- Vassilis Sideropoulos
- Department of Psychology and Human Development, IOE, UCL's Faculty of Education and Society, 25 Woburn Square, London, UK.
| | - Nayla Sokhn
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
- Eye and Brain Mapping Laboratory (iBMLab), Department of Psychology, University of Fribourg, Fribourg, Switzerland
- Faculty of Psychology, UniDistance Suisse, Brig, Switzerland
| | - Olympia Palikara
- Department of Education Studies, University of Warwick, Coventry, UK
| | - Jo Van Herwegen
- Department of Psychology and Human Development, IOE, UCL's Faculty of Education and Society, 25 Woburn Square, London, UK
| | - Andrea C Samson
- Institute of Special Education, University of Fribourg, Fribourg, Switzerland
- Faculty of Psychology, UniDistance Suisse, Brig, Switzerland
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