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Jones JT, Talib N, Cramer E, Gasparovich ME, Schroeder EN, McLaughlin M, Kitchen J. Normal joint range of motion in children with Down syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2023; 193:e32076. [PMID: 37916894 DOI: 10.1002/ajmg.c.32076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/10/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
Down syndrome (DS) is one of the most common chromosomal conditions that results in intellectual disability. Children with DS have many different inflammatory and noninflammatory conditions that can affect joint mobility leading to arthralgia and altered joint range of motion (ROM), and it is important to have normal reference values for comparison to determine the degree of impairment. The objective of this study was to establish normative joint ROM values, using a standardized measurement approach, for upper and lower joints of healthy children of both genders with DS. This study evaluated joint ROM in healthy males and females with DS who had no previous musculoskeletal pathology. Younger males have more ROM than females at the same age and both genders lose ROM with age but continue to have increased ROM in the ankles compared to children without DS. This study establishes optimal estimates of joint ROM in children with DS, and this information should be helpful to clinicians when assessment requires evaluation of joint ROM to know if evaluation falls within the normal ROM. This reference should be helpful to track joint disease progression over time or as part of a musculoskeletal screen for abnormal joint ROM in children with DS.
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Affiliation(s)
- Jordan T Jones
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Nasreen Talib
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Emily Cramer
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Meg E Gasparovich
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | | | - Matthew McLaughlin
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Jacqueline Kitchen
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
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Jones JT, Smith C, Talib N. Brief Musculoskeletal Screen and Patient Education for Down Syndrome-Associated Arthritis. Glob Pediatr Health 2021; 8:2333794X211045562. [PMID: 34527768 PMCID: PMC8436300 DOI: 10.1177/2333794x211045562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/20/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jordan T Jones
- Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri-Kansas City, Kansas City, MO, USA.,University of Kansas School of Medicine, Kansas City, KS, USA
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Harp JP, Koehl LM, Pelt KLV, Hom CL, Doran E, Head E, Lott IT, Schmitt FA. Cognitive and Behavioral Domains That Reliably Differentiate Normal Aging and Dementia in Down Syndrome. Brain Sci 2021; 11:brainsci11091128. [PMID: 34573150 PMCID: PMC8468129 DOI: 10.3390/brainsci11091128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/18/2021] [Accepted: 08/22/2021] [Indexed: 11/16/2022] Open
Abstract
Primary care integration of Down syndrome (DS)-specific dementia screening is strongly advised. The current study employed principal components analysis (PCA) and classification and regression tree (CART) analyses to identify an abbreviated battery for dementia classification. Scale- and subscale-level scores from 141 participants (no dementia n = 68; probable Alzheimer’s disease n = 73), for the Severe Impairment Battery (SIB), Dementia Scale for People with Learning Disabilities (DLD), and Vineland Adaptive Behavior Scales—Second Edition (Vineland-II) were analyzed. Two principle components (PC1, PC2) were identified with the odds of a probable dementia diagnosis increasing 2.54 times per PC1 unit increase and by 3.73 times per PC2 unit increase. CART analysis identified that the DLD sum of cognitive scores (SCS < 35 raw) and Vineland-II community subdomain (<36 raw) scores best classified dementia. No significant difference in the PCA versus CART area under the curve (AUC) was noted (D(65.196) = −0.57683; p = 0.57; PCA AUC = 0.87; CART AUC = 0.91). The PCA sensitivity was 80% and specificity was 70%; CART was 100% and specificity was 81%. These results support an abbreviated dementia screening battery to identify at-risk individuals with DS in primary care settings to guide specialized diagnostic referral.
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Affiliation(s)
- Jordan P. Harp
- Department of Neurology, University of Kentucky, Lexington, KY 40506, USA;
- Correspondence:
| | - Lisa M. Koehl
- Department of Neurology, University of Kentucky, Lexington, KY 40506, USA;
| | - Kathryn L. Van Pelt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40506, USA;
| | - Christy L. Hom
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA 92697, USA;
| | - Eric Doran
- Department of Pediatrics, School of Medicine, University of California, Irvine, CA 92697, USA;
| | - Elizabeth Head
- Department of Pathology & Laboratory Medicine, University of California, Irvine, CA 92697, USA;
| | - Ira T. Lott
- Departments of Neurology and Pediatrics, University of California, Irvine, CA 92697, USA;
| | - Frederick A. Schmitt
- Department of Neurology and Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40506, USA;
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Altered Folate Homeostasis in Children with Down Syndrome: A Potential Basis for Enhanced Methotrexate Toxicity. J Pediatr 2020; 221:235-239. [PMID: 32111377 PMCID: PMC7247922 DOI: 10.1016/j.jpeds.2020.01.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/17/2019] [Accepted: 01/13/2020] [Indexed: 11/21/2022]
Abstract
Methotrexate is used to treat autoimmune and oncologic diseases in children with Down syndrome. However, increased methotrexate-related toxicity is reported in this population. We evaluated differences in the concentrations and distribution of erythrocyte folates in children with Down syndrome as a potential basis for this enhanced toxicity.
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Baumgardner DJ, Chicoine B. Challenges of Pediatric Disease in Adulthood. J Patient Cent Res Rev 2020; 7:142-146. [PMID: 32377547 PMCID: PMC7197890 DOI: 10.17294/2330-0698.1756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Dennis J. Baumgardner
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Brian Chicoine
- Adult Down Syndrome Center, Advocate Medical Group, Park Ridge, IL
- Family Medicine, Advocate Lutheran General Hospital, Park Ridge, IL
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Ophthalmologic Manifestations and Retinal Findings in Children with Down Syndrome. J Ophthalmol 2020; 2020:9726261. [PMID: 32089873 PMCID: PMC7029299 DOI: 10.1155/2020/9726261] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/08/2020] [Accepted: 01/20/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate ocular findings in children with Down syndrome and to compare with the healthy children group. Methods The study patients were divided into two groups as the diagnosed Down syndrome group and the control group. The study was designed as a prospective and single-center study in Istanbul University Faculty of Medicine Department of Ophthalmology. The study included 93 patients in the age range from 7 to 18 years, who applied to the ophthalmology department of our clinic in the period from July 2017 to June 2018. The study included the patients allocated into the control group and the Down syndrome patients allocated into the patient group, containing 49 and 44 participants, respectively. All patients underwent complete ophthalmologic examination with biomicroscopy. Autorefractometer measurements were performed in all patients, and the best corrected visual acuity (BCVA) was determined with the use of the Snellen chart. All patients underwent spectral domain optical coherence tomography (SD-OCT) measurements for central foveal retinal (CRT), subfoveal choroidal (CCT), and peripapillary retinal nerve fiber layer (pRNFL) thicknesses. Results The average CRT was 241.2 ± 25.7 microns in Down syndrome group and 219.4 ± 21.1 microns in the control group. There was a statistically significant difference between the groups in regards to CRT (p < 0.001). The average pRNFL values were 123.1 ± 15.4 microns in the Down syndrome group and 102.2 ± 8.7 microns in the control group (p < 0.001). The average pRNFL values were 123.1 ± 15.4 microns in the Down syndrome group and 102.2 ± 8.7 microns in the control group (. Conclusions In the subjects with Down syndrome, the incidence of lens opacities, strabismus, and amblyopia was higher than the control group. CRT and pRNFL were thicker in the Down syndrome group than in control group. This may represent retinal developmental changes in the patients with Down syndrome.
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Clinical Features and Treatment of Down Syndrome Arthropathy: Experience from Two US Tertiary Hospitals. Paediatr Drugs 2019; 21:33-39. [PMID: 30547384 DOI: 10.1007/s40272-018-0322-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Arthropathy of Down syndrome (DA) is largely under-recognized, with an average 2-year delay in diagnosis. Most patients present with polyarthritis, and treatment has historically been challenging. OBJECTIVES Our objective was to investigate the clinical features and treatment of DA in the largest cohort reported to date. METHODS In a retrospective chart review at two tertiary care hospitals, International Classification of Diseases, ninth revision, clinical modification (ICD-9-CM) codes for Down syndrome (DS) and juvenile idiopathic arthritis (JIA), between 1 January 1995 and 31 December 2015, were identified and charts reviewed. RESULTS In total, 43 patients were identified, with an average (± standard deviation [SD]) follow-up period of 6 ± 4.4 years. The average age of symptom onset was 7.4 ± 3.9 years, with a mean delay of 19 ± 17 months from symptom onset to diagnosis. At diagnosis, 77% of patients had morning stiffness and 72% had abnormal laboratory values; there was an average of 15 ± 13 active joints (range 1-56). Treatment approaches varied, and there was a significant decrease in joints with active arthritis (p < 0.001), with 25% and 39% having at least one change in disease-modifying antirheumatic drug (DMARD) and biologic therapy, respectively. DMARD therapy was discontinued in 60% because of side effects, and 39% had inadequate response to first-line biologic therapy. CONCLUSIONS DA remains under-recognized, with delays in diagnosis and extensive musculoskeletal symptoms at presentation. While DA can improve with current therapy for JIA (corticosteroids, DMARDs, biologics), barriers include medication toxicity, intolerance, and ineffectiveness. Earlier diagnosis through improved screening and more targeted treatment may allow for earlier disease control and better outcomes.
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Mengoni SE, Redman S. Evaluating Health Visitors' Existing Knowledge of Down Syndrome and the Effect of a Training Workshop. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018. [DOI: 10.1111/jppi.12271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Silvana E. Mengoni
- Department of Psychology and Sports Sciences, Centre for Health Services and Clinical Research; University of Hertfordshire; UK
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van Dijk M, Lipke-Steenbeek W. Measuring feeding difficulties in toddlers with Down syndrome. Appetite 2018; 126:61-65. [PMID: 29601917 DOI: 10.1016/j.appet.2018.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Abstract
Early feeding problems occur frequently across the population, but have a higher incidence in children with Down syndrome (DS). Early identification can possibly be improved with the help of a valid screening instrument based on caregiver reports. In a previous study, we investigated the concurrent validity of the Dutch version of the Montreal Children's Hospital Feeding Scale (MCH-FS, SEP in Dutch) in a sample of typically developing toddlers, and we found a correlation between the score on the instrument and observed behavior during a regular meal. The current pilot study was a replication in a sample of children with DS (aged 1; 0-3; 0) and their primary caregivers (n = 32). The results showed that children in the sample did not score higher on the SEP than children in their respective norm groups. In addition, when caregivers reported more symptoms of feeding problems on the SEP, children showed more food refusal and negative affect during the observed meal. This suggests that the screening instrument is particularly associated with negative mealtime interactions. This is in contrast with earlier results, which mainly indicated a relation with eating skills.
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Affiliation(s)
- Marijn van Dijk
- Heymans Institute for Psychological Research, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
| | - Wilma Lipke-Steenbeek
- Department of Health and Social Work, Windesheim University of Applied Sciences, Campus 2, 8017 CA, Zwolle, The Netherlands.
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Zhong X, Singh N, Boyd L, Lawson C. Patient-Centered Strategies to Improve Radiographic Practice for Patients with Down Syndrome: A Systematic Review. J Med Imaging Radiat Sci 2016; 47:367-372. [PMID: 31047263 DOI: 10.1016/j.jmir.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/18/2016] [Accepted: 09/16/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Down syndrome is a common human genetic disorder caused by trisomy of chromosome 21. Individuals with Down syndrome can present with a range of health issues during their lives that may require imaging for diagnosis. Radiographers, therefore, play a significant role in the management and communication of Down syndrome patients' health. PURPOSE This review identified patient-centered strategies that radiographers should use to provide quality imaging services for Down syndrome patients, who may have limited verbal ability and behavioral issues. METHOD A systematic review using the established PRISMA guidelines was undertaken of current literature obtained through the Ovid and Scopus databases. A total of 189 articles were found, of which 41 were categorized and analyzed in detail. FINDINGS A high level of care for Down syndrome patients will require longer than usual procedures, and the patients will not respond well to being rushed or ignored. Down syndrome patients have difficulty verbalizing, yet they understand more than is often thought. Individuals may require increased imaging time to give them time to respond, especially to pain. Patients are at risk of injury with AAI or other pathologies, and caution should be taken with flexion and extension spine x-rays. Radiographs may reveal undisclosed physical abuse. CONCLUSION Specific strategies with verbal and nonverbal communication help to facilitate communication, reduce anxiety and fear, and improve compliance with Down syndrome patients. Patients may require an increased level of care; increased imaging time; and allowing support people to be present during the examination process.
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Affiliation(s)
- Xiao Zhong
- Medical Imaging, Latrobe Regional Hospital, Traralgon, Victoria, Australia
| | - Nabita Singh
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lori Boyd
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria, Australia
| | - Celeste Lawson
- Professional Communication Program, School of Education and the Arts, Central Queensland University, Rockhampton, Queensland, Australia.
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Abstract
Optometrists as primary eye care providers examine patients from diverse populations, including those with special needs such as Down syndrome. Down syndrome is a chromosomal abnormality associated with several health conditions including vision anomalies such as refractive, accommodative and vergence anomalies, as well as ocular pathology. In this article, a narrative review of Down syndrome including the background, historical perspective, aetiology and genetic mechanisms, types, epidemiology, as well as the physical and medical profile of Down syndrome is presented.Keywords: Down syndrome review; Trisomy 21; historical perspective; etiology; types and epidemiology; features; Optometrist
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Abstract
OBJECTIVE The main aim of this case series report is to alert physicians to the occurrence of catatonia in Down syndrome (DS). A second aim is to stimulate the study of regression in DS and of catatonia. A subset of individuals with DS is noted to experience unexplained regression in behavior, mood, activities of daily living, motor activities, and intellectual functioning during adolescence or young adulthood. Depression, early onset Alzheimer's, or just "the Down syndrome" are often blamed after general medical causes have been ruled out. Clinicians are generally unaware that catatonia, which can cause these symptoms, may occur in DS. STUDY DESIGN Four DS adolescents who experienced regression are reported. Laboratory tests intended to rule out causes of motor and cognitive regression were within normal limits. Based on the presence of multiple motor disturbances (slowing and/or increased motor activity, grimacing, posturing), the individuals were diagnosed with unspecified catatonia and treated with anti-catatonic treatments (benzodiazepines and electroconvulsive therapy [ECT]). RESULTS All four cases were treated with a benzodiazepine combined with ECT and recovered their baseline functioning. CONCLUSION We suspect catatonia is a common cause of unexplained deterioration in adolescents and young adults with DS. Moreover, pediatricians and others who care for individuals with DS are generally unfamiliar with the catatonia diagnosis outside schizophrenia, resulting in misdiagnosis and years of morbidity. Alerting physicians to catatonia in DS is essential to prompt diagnosis, appropriate treatment, and identification of the frequency and course of this disorder.
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Affiliation(s)
- Neera Ghaziuddin
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Armin Nassiri
- Community Psychiatry, San Jose, California, University of Missouri, Columbia, Missouri, USA
| | - Judith H Miles
- Thompson Center for Autism and Neurodevelopmental Disorders and Department of Child Health, University of Missouri, Columbia, Missouri, USA
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Fernandez F, Reeves RH. Assessing cognitive improvement in people with Down syndrome: important considerations for drug-efficacy trials. Handb Exp Pharmacol 2015; 228:335-80. [PMID: 25977089 DOI: 10.1007/978-3-319-16522-6_12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Experimental research over just the past decade has raised the possibility that learning deficits connected to Down syndrome (DS) might be effectively managed by medication. In the current chapter, we touch on some of the work that paved the way for these advances and discuss the challenges associated with translating them. In particular, we highlight sources of phenotypic variability in the DS population that are likely to impact performance assessments. Throughout, suggestions are made on how to detect meaningful changes in cognitive-adaptive function in people with DS during drug treatment. The importance of within-subjects evaluation is emphasized.
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Affiliation(s)
- Fabian Fernandez
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA,
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Chan KG, Lim KA, Ling HK. Care demands on mothers caring for a child with
D
own syndrome:
M
alaysian (
S
arawak) mothers' perspectives. Int J Nurs Pract 2014; 21:522-31. [DOI: 10.1111/ijn.12275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kim Geok Chan
- Faculty of Medicine and Health SciencesUniversiti Malaysia Sarawak Malaysia
| | - Khatijah Abdullah Lim
- Department of Nursing ScienceFaculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
| | - How Kee Ling
- Centre of Excellence for Disability StudiesUniversiti Malaysia Sarawak Kuching Sarawak Malaysia
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Jensen KM, Davis MM. Health care in adults with Down syndrome: a longitudinal cohort study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:947-958. [PMID: 22775057 DOI: 10.1111/j.1365-2788.2012.01589.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Individuals with Down syndrome increasingly survive into adulthood, yet little is known about their healthcare patterns as adults. Our study sought to characterise patterns of health care among adults with Down syndrome based on whether they had fully transitioned to adult-oriented providers by their inception in this cohort. METHODS In this retrospective observational cohort study, healthcare utilisation and annualised patient charges were evaluated in patients with Down syndrome aged 18-45 years who received care in a single academic health centre from 2000 to 2008. Comparisons were made based on patients' provider mix (only adult-focused or 'mixed' child- and adult-focused providers). RESULTS The cohort included 205 patients with median index age = 28 years; 52% of these adult patients had incompletely transitioned to adult providers and received components of their care from child-focused providers. A higher proportion of these 'mixed' patients were seen exclusively by subspecialty providers (mixed = 81%, adult = 46%, P < 0.001), suggesting a need for higher intensity specialised services. Patients in the mixed provider group incurred higher annualised charges in analyses adjusted for age, mortality, total annualised encounters, and number of subspecialty disciplines accessed. These differences were most pronounced when stratified by whether patients were hospitalised during the study period (e.g., difference in adjusted means between mixed versus adult provider groups: $571 without hospitalisation, $19,061 with hospitalisation). CONCLUSIONS In this unique longitudinal cohort of over 200 adults aged 18-45 years with Down syndrome, over half demonstrated incomplete transition to adult care. Persistent use of child-focused care, often with a subspecialty emphasis, has implications for healthcare charges. Future studies must identify reasons for distinct care patterns, examine their relationship with clinical outcomes, and evaluate which provider types deliver the highest quality care for adults with Down syndrome and a wide variety of comorbidities.
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Affiliation(s)
- K M Jensen
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan , USA.
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Jensen KM, Taylor LC, Davis MM. Primary care for adults with Down syndrome: adherence to preventive healthcare recommendations. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:409-421. [PMID: 22463763 DOI: 10.1111/j.1365-2788.2012.01545.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Due to significant medical improvements, persons with Down syndrome now live well into adulthood. Consequently, primary care for adults with Down syndrome needs to incorporate routine care with screening for condition-specific comorbidities. This study seeks to evaluate the adherence of primary care physicians to age- and condition-specific preventive care in a cohort of adults with Down syndrome. METHODS In this retrospective observational cohort study, preventive screening was evaluated in patients with Down syndrome aged 18-45 years who received primary care in an academic medical centre from 2000 to 2008. Comparisons were made based on the field of patients' primary care providers (Family or Internal Medicine). RESULTS This cohort included 62 patients, median index age = 33 years. Forty per cent of patients received primary care by Family Physicians, with 60% seen by Internal Medicine practices. Patient demographics, comorbidities and overall screening patterns were similar between provider groups. Despite near universal screening for obesity and hypothyroidism, adherence to preventive care recommendations was otherwise inconsistent. Screening was 'moderate' (50-80%) for cardiac anomalies, reproductive health, dentition, and the combined measure of behaviour, psychological, or memory abnormalities. Less than 50% of patients were evaluated for obstructive sleep apnea, atlanto-axial instability, hearing loss or vision loss. CONCLUSIONS We observed inconsistent preventive care in adults with Down syndrome over this 8.5-year study. This is concerning, given that the adverse effects of many of these conditions can be ameliorated if discovered in a timely fashion. Further studies must evaluate the implications of screening practices and more timely identification of comorbidities on clinical outcomes.
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Affiliation(s)
- K M Jensen
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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Gamis AS, Smith FO. Transient myeloproliferative disorder in children with Down syndrome: clarity to this enigmatic disorder. Br J Haematol 2012; 159:277-87. [DOI: 10.1111/bjh.12041] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alan S. Gamis
- Division of Hematology/Oncology; Children's Mercy Hospitals & Clinics; Kansas City MO USA
| | - Franklin O. Smith
- University of Cincinnati Cancer Institute; University of Cincinnati College of Medicine; Cincinnati OH USA
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Lewis MEN, Gauderer MWL, Blackhurst DW, Rogers RC, Cornett WR. Do patients with Down syndrome develop appendicitis? J Pediatr Surg 2011; 46:197-9. [PMID: 21238666 DOI: 10.1016/j.jpedsurg.2010.09.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 09/30/2010] [Indexed: 01/07/2023]
Abstract
BACKGROUND/PURPOSE Given the number of individuals with Down syndrome (DS) and the high incidence of acute appendicitis (AA) in the general population, one would expect a certain number of patients with DS to develop AA. However, clinical experience suggests that AA is uncommon in patients with DS. This study was undertaken to determine whether the incidence of AA is significantly decreased in patients with DS. METHODS A 13-year cross-sectional study of the state's hospital discharge database was performed to estimate the annual incidence of AA in patients with DS and in the general population. Estimates were generated for both pediatric (0-17 years) and adult (≥ 18 years) populations and were compared using 95% confidence intervals (CIs). In addition, the authors' hospital database was queried over a 10-year time frame. RESULTS Incidence estimates of AA in children with DS and in the general pediatric population were 2.5 and 8.9 per 1000, respectively. In adults, the incidence estimates were 2.7 and 5.7 per 1000. CONCLUSIONS The incidence of AA is markedly lower in patients with DS than in the general population. Although the biological basis for this remains unknown, this information is relevant in the evaluation of the acute abdomen in patients with DS.
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Affiliation(s)
- M Elizabeth N Lewis
- Division of Pediatric Surgery, Department of Pediatrics, Children's Hospital, Greenville Hospital System University Medical Center, Greenville, South Carolina 29605-4253, USA
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Abstract
Advances in understanding the human genome and clinical application have led to identification of genetically based disorders that have distinctive behavioral phenotypes and risk for serious psychiatric disorders. Some patients have unrecognized genetic disorders presenting as psychiatric symptoms. Practitioners must be knowledgeable about the association between symptoms and underlying genetic bases. Treatment of neurogenetic disorders includes providing information about causes and prognoses. Patients are served best if they remain long term with a multidisciplinary team of providers who recognize the realities of a lifetime course, the high risk for symptom recurrence, and the need for providing information and support to families and coordinating medical and psychiatric care.
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Affiliation(s)
- Carl Feinstein
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5719, USA.
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