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Long KL, Karimi A, Mini A, Stephens DP, Nelson EL. The meaning of adulthood for emerging adults with Down syndrome: Parent perspectives on relevant skills. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13286. [PMID: 39075798 DOI: 10.1111/jar.13286] [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: 09/22/2023] [Revised: 06/19/2024] [Accepted: 07/09/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Parents' conceptualizations of adulthood for their emerging adults with Down syndrome have the potential to impact the transition planning process as families prepare for life after graduation. AIMS This study aimed to explore parent perceptions of the meaning of adulthood for their emerging adults with Down syndrome. METHODS In this qualitative study, we interviewed 11 parents of emerging adults with Down syndrome using phenomenological methodology and analysed these data using thematic analysis. RESULTS Three topics emerged: (1) Parents' constructions of the meaning of adulthood; (2) Parents' perceptions about the transition to adulthood; and (3) Parents' perceptions of current adult life skills. Ten themes arose out of these topics. CONCLUSIONS Parents expressed ambivalence about the meaning of adulthood for their emerging adults with Down syndrome, sharing that in some ways they were adults and in others they were not. The meaning of adulthood was closely tied to obtained skills, particularly those related to personal safety.
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Affiliation(s)
- Katherine L Long
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Atefeh Karimi
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Antonella Mini
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Dionne P Stephens
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Eliza L Nelson
- Department of Psychology, Florida International University, Miami, Florida, USA
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Ong MBH, Davey MJ, Nixon GM, Walter LM, Horne RS. Effect of sleep disordered breathing severity in children with Down syndrome on parental wellbeing and social support. Sleep Med 2024; 116:71-80. [PMID: 38432030 DOI: 10.1016/j.sleep.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Sleep disorders, particularly sleep disordered breathing (SDB), are common in children with Down syndrome (DS). We investigated the relationship between SDB severity and parental psychological wellbeing and their perception of social support. METHODS 44 children with DS (3-19 years) underwent overnight polysomnography and were categorised into three groups: primary snoring, Mild and Moderate/Severe obstructive sleep apnoea (OSA). Parents completed questionnaires about their child's behaviour (Child Behavior Checklist), sleep symptoms (Pediatric Sleep Survey Instrument) and SDB-related quality of life (OSA-18), together with the DUKE-UNC Functional Social Support (DUKE) and Psychological General Well-Being Index (PGWBI) questionnaires for themselves. 34 children completed a follow-up study after 2 years. RESULTS There were no significant differences between SDB severity groups for parental perceived social support or psychological wellbeing. Total scores on the DUKE were below average and PGWBI scores were indicative of moderate psychological distress in all three groups. Reduced perceived levels of social support were significantly correlated with externalising child behaviour and sleep disturbance. Diminished parental psychological wellbeing was also significantly correlated with increased sleep disturbances and reduced quality of life in children. At follow-up there were no significant changes in any questionnaire outcome, however parents of children with improved SDB severity had improved PGWBI vitality scores. CONCLUSION The degree of parent-reported sleep disturbance in children with DS was linked to suboptimal perceived parental social support and poor psychological wellbeing. Our results emphasise the need for enhanced awareness of the detrimental effects of sleep problems in children with DS on parental wellbeing.
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Affiliation(s)
- Miles Beng Hee Ong
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Margot J Davey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Gillian M Nixon
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Lisa M Walter
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Rosemary Sc Horne
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
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Van Riper M, Knafl GJ, Knafl KA, do Céu Barbieri-Figueiredo M, Barnoy S, Caples M, Choi H, Cosgrove B, Duarte ED, Honda J, Marta E, Phetrasuwan S, Alfieri S, Angelo M, Deoisres W, Fleming L, Dos Santos AS, da Silva MJR. Family adaptation in families of individuals with Down syndrome from 12 countries. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024; 196:e32075. [PMID: 37929633 DOI: 10.1002/ajmg.c.32075] [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: 08/09/2023] [Revised: 10/11/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
Our current understanding of adaptation in families of individuals with Down syndrome (DS) is based primarily on findings from studies focused on participants from a single country. Guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation, the purpose of this cross-country investigation, which is part of a larger, mixed methods study, was twofold: (1) to compare family adaptation in 12 countries, and (2) to examine the relationships between family variables and family adaptation. The focus of this study is data collected in the 12 countries where at least 30 parents completed the survey. Descriptive statistics were generated, and mean family adaptation was modeled in terms of each predictor independently, controlling for an effect on covariates. A parsimonious composite model for mean family adaptation was adaptively generated. While there were cross-country differences, standardized family adaptation mean scores fell within the average range for all 12 countries. Key components of the guiding framework (i.e., family demands, family appraisal, family resources, and family problem-solving communication) were important predictors of family adaptation. More cross-country studies, as well as longitudinal studies, are needed to fully understand how culture and social determinants of health influence family adaptation in families of individuals with DS.
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Affiliation(s)
- Marcia Van Riper
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - George J Knafl
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathleen A Knafl
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Maria Caples
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Beth Cosgrove
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Elena Marta
- Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Sara Alfieri
- Università Cattolica del Sacro Cuore, Milan, Italy
| | | | | | - Louise Fleming
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Berger H, Wittman J, Smith K, Horick N, Norris K, Young A, Magana Gomez J, Ocampo KKE, Skotko BG. Health care satisfaction and medical literacy habits among caregivers of individuals with Down syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024; 196:e32074. [PMID: 37946659 DOI: 10.1002/ajmg.c.32074] [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: 08/05/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023]
Abstract
Patients with Down syndrome have significant specialized health care needs. Our objective was to understand the needs, satisfaction, and online habits of caregivers as they care for persons with Down syndrome. A mixed-method survey was distributed through REDCap from April 2022 to June 2022 in the United States; a Spanish-translated version was distributed through SurveyMonkey from August 2022 to March 2023 in Mexico. We received 290 completed responses from the United States and 58 from caregivers in Mexico. We found that current health care options are not meeting the needs of many individuals with DS in both the United States (39.7%) and Mexico (46.6%). Caregivers expressed frustrations with the inaccessibility and inapplicability of health care information. In particular, they often found the volume of information overwhelming, given their limited medical background. Additionally, health care recommendations were not customized and lacked practical recommendations. Most caregivers in both the United States (72.1%) and Mexico (82.8%) believe it is not easy to find answers to medical questions about their loved ones with DS. Online platforms with customized, specific health information related to DS could offer innovative solutions to these unmet needs for families and primary care providers.
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Affiliation(s)
- Heidi Berger
- Simpson College, Department of Mathematics, Indianola, Iowa, USA
| | | | - Katelyn Smith
- Simpson College, Department of Mathematics, Indianola, Iowa, USA
| | - Nora Horick
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenneth Norris
- Simpson College, Department of Mathematics, Indianola, Iowa, USA
| | - Allison Young
- Simpson College, Department of Mathematics, Indianola, Iowa, USA
| | - Javier Magana Gomez
- Nutrition Faculty, Autonomous University of Sinaloa, Culiacan, Sinaloa, Mexico
| | | | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Wang Y, Qiu Y, Ren L, Jiang H, Chen M, Dong C. Social support, family resilience and psychological resilience among maintenance hemodialysis patients: a longitudinal study. BMC Psychiatry 2024; 24:76. [PMID: 38279114 PMCID: PMC10811847 DOI: 10.1186/s12888-024-05526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 01/16/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Psychological distress is common in maintenance hemodialysis patients, and high psychological resilience can promote psychological well-being. The current research focuses on psychological resilience protective factors such as family resilience and social support. However, the trajectories of psychological resilience, family resilience, and social support over time and their longitudinal relationships in maintenance hemodialysis patients have not been fully explored yet. Therefore, this study aims to explore the longitudinal relationship between these factors. METHODS Patients who received regular hemodialysis treatment for more than three months at dialysis centers of three tertiary hospitals in Zhejiang, China, were recruited from September to December 2020. A total of 252 patients who met the inclusion and exclusion criteria completed three follow-up surveys, including social support, family resilience, and psychological resilience assessments. A repeated measures ANOVA was used to explore differences in their respective scores at different time points. The cross-lagged analysis was performed in AMOS using the maximum likelihood method to examine the the reciprocal predictive relationships between these factors. RESULTS Social support and psychological resilience remained relatively stable over time, whereas family resilience indicated a little increasing trend. According to the cross-lagged analysis, higher T1 social support predicted higher family resilience at T2 [β = 0.123, 95% CI (0.026-0.244)]. Further, the effects of T2 social support to T3 family resilience [β = 0.194, 95%CI (0.039-0.335)] and psychological resilience [β = 0.205, 95%CI (0.049-0.354)] were significant. Finally, the effects of T2 family resilience to T3 social support [β = 0.122, 95%CI (0.010-0.225)] and psychological resilience [β = 0.244, 95%CI (0.119-0.359)] were also significant. CONCLUSIONS The study showed that the directionality of the relationship appears to be from social support or family resilience to patients' psychological resilience but not vice versa. This finding reminds healthcare professionals to emphasize the vital role of social and family resources in providing appropriate support and interventions for maintenance hemodialysis patients to promote psychological resilience and mental health development.
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Affiliation(s)
- Yuxin Wang
- School of Nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, 325035, China
| | - Yuan Qiu
- Zhejiang Tourism and Health College, Zhoushan, China
| | - Liya Ren
- School of Nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, 325035, China
| | - Hao Jiang
- School of Nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, 325035, China
| | - Meijia Chen
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Chaoqun Dong
- School of Nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, 325035, China.
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Zhang X, Xie J, Wu W, Cao L, Jiang Z, Li Z, Li Y. The mediation effect of mental resilience between stress and coping style among parents of children with cochlear implants: Cross-sectional study. J Pediatr Nurs 2024; 74:1-9. [PMID: 37979333 DOI: 10.1016/j.pedn.2023.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE This study aimed to examine the relationship of stress, mental resilience, and coping style, and the mediation effect of mental resilience between stress and coping style among parents of children with cochlear implants. DESIGN AND METHODS A cross-sectional design was used. A total of 231 parents of children with cochlear implants were recruited from May 1, 2022, to February 28, 2023 at a comprehensive tertiary hospital and a cochlear implant rehabilitation center in China. Parenting Stress Index-Short Form (PSI-SF), the Connor-Davidson Resilience Scale (CD-RISC) and the Simplified Coping Style Questionnaire(SCSQ) were used to measure stress, mental resilience, and coping style respectively. RESULTS The mean score observed for PSI-SF, CD-RISC, active coping, and passive coping was 87.85 ± 24.59, 55.63 ± 16.11, 21.36 ± 6.73, and 9.05 ± 4.52, respectively. Mental resilience was a significant mediator explaining the effect of stress on active coping (β = -0.294; 95% bias-corrected bootstrap CI: -0.358 to -0.164). CONCLUSIONS Attention should be paid to the status of stress, mental resilience and coping style in parents of children with cochlear implants. Mental resilience mediated stress and coping style. PRACTICE IMPLICATIONS This study provides a theoretical basis for establishing an active coping care program for parents of children with cochlear implants. There is a need to identify strategies that can help increase the level of mental resilience of parents of children with cochlear implants and more subjective and objective social support should be provided to reduce their stress and to encourage active coping style.
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Affiliation(s)
- Xiaodan Zhang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiao Xie
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Otolaryngology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weijing Wu
- Department of Otolaryngology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lifang Cao
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zheyi Jiang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhu Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Van Riper M, Cosgrove B, Fleming L. Adaptation at the Family Level in Families of Individuals With Down Syndrome: A Scoping Review. JOURNAL OF FAMILY NURSING 2023; 29:324-347. [PMID: 37066798 PMCID: PMC10629249 DOI: 10.1177/10748407231163236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Down syndrome (DS) is a chromosomal disorder associated with intellectual and physical disabilities and has historically been viewed by health care providers through a negative lens when considering the effect the condition has on the individual, family, and community. The purpose of this scoping review was to provide an overview of recent research concerning adaptation in families of individuals with DS with a focus on family adaptation rather than individual or dyadic adaptation. Three literature indexes were searched from 2017 to 2022, with 41 articles included. Foci of the studies included strength/resilience, stress/coping, and negative/challenge. Thirteen studies reported using a family framework. Multiple methodological approaches and family measures were used in the studies and are outlined. Findings from this review show there has been a shift in focus when researching families of individuals with DS from a negative and challenging experience to one of strength and resilience.
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Shetty J, Shetty A, Mundkur SC, Dinesh TK, Pundir P. Economic burden on caregivers or parents with Down syndrome children-a systematic review protocol. Syst Rev 2023; 12:3. [PMID: 36609318 PMCID: PMC9817293 DOI: 10.1186/s13643-022-02165-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Financial burden is a common phenomenon, often noticed in the caregivers of children with Down syndrome. It echoes adverse effects on the caregiver's mental and physical health. The economic burden covers direct healthcare costs, direct non-health-care costs, and indirect costs and is substantial for the family of a person with Down syndrome, as well as for society. Evidence, in this area, is necessary to reduce mental stress and promote financial well-being among caregivers. METHODS In this review, quantitative studies that assess the economic burden on caregivers of children with Down syndrome will be considered. We will perform a systematic literature search conducted from the year 2000 to 2022 on electronic databases CINAHL, EBSCO, EMBASE, PubMed, Scopus, Web of Science, and EconLit. An additional gray literature search will be carried out. Two researchers will independently conduct the screening and data extraction and assess the risk of bias. DISCUSSIONS The review attempts to methodically analyze the economic burden among caregivers of children with Down syndrome from the societal perspective and individual perspectives. The current study will provide an evidence base to researchers, academicians, and society in identifying need-based learning to caregivers, and the selection of appropriate therapies for children suffering from Down syndrome. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021265312.
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Affiliation(s)
- Jyothi Shetty
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ankitha Shetty
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Suneel C Mundkur
- Department of Paediatrics, Kasturba Medical College, Manipal, Karnataka, India
| | - Tantri Keerthi Dinesh
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prachi Pundir
- The George Institute for Global Health, New Delhi, India
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Impact of Assistive Technologies to Inclusive Education and Independent Life of Down Syndrome Persons: A Systematic Literature Review and Research Agenda. SUSTAINABILITY 2022. [DOI: 10.3390/su14084630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since the beginning of the 21st century, the lifespan of people born with Down syndrome (DS) has increased. They now outlive their parents and rely on their relatives who usually sacrifice their own families to care for their disabled siblings. To reduce the pressure on families and the wider community, it is crucial to prepare DS people for independent life from early childhood. Emerging technologies can significantly support the process of acquiring the skills that are necessary for solving real-life problems at home and work. To assess their impact and estimate how much they are implemented in inclusive education, a review of 564 papers published after 2015 was done using the PRISMA review model. After gradual exclusion, 24 papers were used for the final review. Thematic analysis resulted in four themes with one common concept: variety. The results of examining the four research questions defined in the paper’s background confirm that the synergy of emerging assistive technologies and inclusive education has the potential of becoming a very effective strategy for creating an independent life for DS individuals. Many questions remain open, mainly related to a DS persons’ specific needs and capabilities. The acceptance of the proposed synergy will depend on them.
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Fucà E, Costanzo F, Ursumando L, Vicari S. Parenting Stress in Mothers of Children and Adolescents with Down Syndrome. J Clin Med 2022; 11:jcm11051188. [PMID: 35268278 PMCID: PMC8911183 DOI: 10.3390/jcm11051188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/04/2022] Open
Abstract
Parenting stress has deleterious effects on parents, children, and overall family functioning. Parents of children with intellectual disability, including Down Syndrome (DS), show higher levels of parenting stress than parents of typically developing children. This research aimed to (i) evaluate parenting stress levels in a group of mothers of youths with DS using a parent-report questionnaire, (ii) identify children’s individual and clinical features associated with maternal stress, and (iii) identify specific situational life/demographics factors related to maternal stress. Seventy-eight youths with DS underwent a neuropsychological evaluation, whereas mothers completed questionnaires for the assessment of parenting stress and of the child’s emotional and behavioral problems. We found that Parent–Child Difficult Interaction was the domain with the highest percentage of clinical scores (39.7%). Both internalizing and externalizing problems correlated with maternal stress, as well as autistic symptoms. The levels of maternal stress were not associated with any socio-demographic variable. After controlling for child-related correlates of maternal stress and for mothers’ age and education level, unemployed mothers exhibited higher levels of parental distress than employed mothers. The present study highlights that unemployment is related with parenting stress and potentially amenable to policy interventions supporting parents in combining work and family care.
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Affiliation(s)
- Elisa Fucà
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (E.F.); (L.U.); (S.V.)
| | - Floriana Costanzo
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (E.F.); (L.U.); (S.V.)
- Correspondence: ; Tel.: +39-06-6859-7091
| | - Luciana Ursumando
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (E.F.); (L.U.); (S.V.)
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (E.F.); (L.U.); (S.V.)
- Department of Life Sciences and Public Health, Catholic University, 00168 Rome, Italy
- Casa San Giuseppe, Centro di Riabilitazione Opera Don Guanella, 00165 Rome, Italy
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