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Baumer NT, Hojlo MA, Lombardo AM, Milliken AL, Pawlowski KG, Sargado S, Soccorso C, Davidson EJ, Barbaresi WJ. Development and implementation of a longitudinal clinical database for down syndrome in a large pediatric specialty clinic: Methodology and feasibility. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024; 28:196-215. [PMID: 36245216 DOI: 10.1177/17446295221133874] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Down syndrome (DS) is a complex condition associated with multiple medical, developmental, and behavioral concerns. A prospective, longitudinal clinical database was integrated into a specialty Down Syndrome Program, with the goals of better understanding the incidence, course, and impact of co-occurring medical, neurodevelopmental, and mental health conditions in DS. We describe the process of developing the database, including a systematic approach to data collection and database infrastructure, and report on feasibility, challenges, and solutions of initial implementation. Between March 2018 and November 2021, data from 842 patients (ages 4.8 months to 26 years) was collected. Challenges included caregiver form completion as well as time and personnel required for successful implementation. With full integration into clinical visit flow, the database proved to be feasible. The database enables identification of patterns of development and health throughout the lifespan and it facilitates future data sharing and collaborative research to advance care.
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Affiliation(s)
- Nicole T Baumer
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, MA, USA; Department of Neurology, Boston Children's Hospital, MA, USA; Harvard Medical School, Harvard University, MA, USA
| | - Margaret A Hojlo
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, MA, USA
| | - Angela M Lombardo
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, MA, USA
| | - Anna L Milliken
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, MA, USA
| | - Katherine G Pawlowski
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, MA, USA
| | - Sabrina Sargado
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, MA, USA; Harvard Medical School, Harvard University, MA, USA
| | - Cara Soccorso
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, MA, USA; Harvard Medical School, Harvard University, MA, USA
| | - Emily J Davidson
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, MA, USA; Harvard Medical School, Harvard University, MA, USA
| | - William J Barbaresi
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, MA, USA; Harvard Medical School, Harvard University, MA, USA
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Kyritsi EM, Kanaka-Gantenbein C. Autoimmune Thyroid Disease in Specific Genetic Syndromes in Childhood and Adolescence. Front Endocrinol (Lausanne) 2020; 11:543. [PMID: 32973676 PMCID: PMC7466763 DOI: 10.3389/fendo.2020.00543] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
Autoimmune thyroid disease (ATD) is the most frequent cause of acquired thyroid dysfunction, most commonly presenting either as Hashimoto's thyroiditis or Graves' Disease. Hashimoto's thyroiditis is characterized by the presence of thyroid-specific autoantibodies, more commonly anti-thyroperoxidase antibodies in the serum and the typical inhomogeneous echostructure of the thyroid on a thyroid ultrasound examination. Hashimoto's thyroiditis can for a long time be accompanied by normal thyroid function and hypothyroidism can only progressively be established. Graves' disease is much less frequent in childhood and adolescence and presents with overt hyperthyroidism. After the onset of puberty, ATD affects females with a higher incidence than males, while during the prepubertal period there is not such a clear preponderance of affected females. ATD can occur either isolated or in the context of other autoimmune disorders, such as type 1 Diabetes mellitus (T1D), celiac disease, alopecia areata, vitiligo, etc. Especially at the pediatric age, a higher incidence of ATD is also observed in the context of specific genetic syndromes, such as trisomy 21 (Down syndrome), Klinefelter syndrome, Turner syndrome, or 22q11.2 deletion syndrome. Nevertheless, although thyroid dysfunction may also be observed in other genetic syndromes, such as Prader-Willi or Williams syndrome, the thyroid dysfunction in these syndromes is not the result of thyroid autoimmunity. Interestingly, there is emerging evidence supporting a possible link between autoimmunity and RASopathies. In this review article the incidence, as well as the clinical manifestation and accompanied pathologies of ATD in specific genetic syndromes will be presented and regular follow-up for the early identification of the disorder will be proposed.
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Belton A, O'Dwyer M, Peklar J, McCallion P, McCarron M, Henman MC. Medication Use and Health Screening in an Ageing Adult Population With Down Syndrome in Ireland: A Descriptive Study. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018. [DOI: 10.1111/jppi.12241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- A. Belton
- School of Pharmacy and Pharmaceutical Sciences; Trinity College Dublin, Dublin, Ireland
- IDS-TILDA School of Nursing and Midwifery; Trinity College Dublin, Dublin, Ireland
| | - M. O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences; Trinity College Dublin, Dublin, Ireland
- IDS-TILDA School of Nursing and Midwifery; Trinity College Dublin, Dublin, Ireland
| | - J. Peklar
- Faculty for Pharmacy; University of Ljubljana; Ljubljana Slovenia
| | - P. McCallion
- IDS-TILDA School of Nursing and Midwifery; Trinity College Dublin, Dublin, Ireland
- Center for Excellence in Aging and Community Wellness; University at Albany; Albany NY 12222 USA
| | - M. McCarron
- IDS-TILDA School of Nursing and Midwifery; Trinity College Dublin, Dublin, Ireland
- Faculty of Health Sciences; Trinity College Dublin, Dublin, Ireland
| | - M. C. Henman
- School of Pharmacy and Pharmaceutical Sciences; Trinity College Dublin, Dublin, Ireland
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Lavigne J, Sharr C, Elsharkawi I, Ozonoff A, Baumer N, Brasington C, Cannon S, Crissman B, Davidson E, Florez JC, Kishnani P, Lombardo A, Lyerly J, McDonough ME, Schwartz A, Berrier K, Sparks S, Stock-Guild K, Toler TL, Vellody K, Voelz L, Skotko BG. Thyroid dysfunction in patients with Down syndrome: Results from a multi-institutional registry study. Am J Med Genet A 2017; 173:1539-1545. [PMID: 28332275 DOI: 10.1002/ajmg.a.38219] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/16/2017] [Indexed: 11/11/2022]
Abstract
The goals of this undertaking were to assess the outcomes of thyroid screening tests and adherence to thyroid screening guidelines across five Down syndrome (DS) specialty clinics in various states. Data related to thyroid screening were collected for 663 individuals across five clinics specializing in the comprehensive care of individuals with DS for a period of 1 year. Of the 663 participants, 47.7% of participants had a TSH and free T4 ordered at their DS specialty clinic visit. Approximately 19.0% (60/316) had a new thyroid disorder diagnosis made. We conclude that a sizable proportion of the patients with DS are not up-to-date on current guidelines when they present to a DS specialty clinic, while adherence to thyroid screening guidelines helps facilitate early diagnoses. Hypothyroidism is prevalent in the population, consistent with reported literature. DS specialty clinics can help patients stay current on screening guidelines.
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Affiliation(s)
- Jenifer Lavigne
- Department of Pediatrics, Clinical Genetics, Levine Children's Hospital at Carolinas Healthcare System, Charlotte, North Carolina
| | - Christianne Sharr
- Down Syndrome Program, Division of Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Ibrahim Elsharkawi
- Down Syndrome Program, Division of Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Al Ozonoff
- Harvard Medical School, Boston, Massachusetts.,Center for Patient Safety and Quality Research, Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Massachusetts
| | - Nicole Baumer
- Harvard Medical School, Boston, Massachusetts.,Down Syndrome Program, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Campbell Brasington
- Department of Pediatrics, Clinical Genetics, Levine Children's Hospital at Carolinas Healthcare System, Charlotte, North Carolina
| | - Sheila Cannon
- Down Syndrome Center of Western Pennsylvania, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Blythe Crissman
- Comprehensive Down Syndrome Program, Division of Medical Genetics, Duke University Medical Center, Durham, North Carolina
| | - Emily Davidson
- Harvard Medical School, Boston, Massachusetts.,Down Syndrome Program, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Jose C Florez
- Down Syndrome Program, Division of Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Priya Kishnani
- Comprehensive Down Syndrome Program, Division of Medical Genetics, Duke University Medical Center, Durham, North Carolina
| | - Angela Lombardo
- Down Syndrome Program, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Jordan Lyerly
- Department of Pediatrics, Clinical Genetics, Levine Children's Hospital at Carolinas Healthcare System, Charlotte, North Carolina
| | - Mary Ellen McDonough
- Down Syndrome Program, Division of Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Alison Schwartz
- Down Syndrome Program, Division of Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Kathryn Berrier
- Comprehensive Down Syndrome Program, Division of Medical Genetics, Duke University Medical Center, Durham, North Carolina
| | - Susan Sparks
- Department of Pediatrics, Clinical Genetics, Levine Children's Hospital at Carolinas Healthcare System, Charlotte, North Carolina
| | - Kara Stock-Guild
- Down Syndrome Program, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Tomi L Toler
- Down Syndrome Program, Division of Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Kishore Vellody
- Down Syndrome Center of Western Pennsylvania, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Lauren Voelz
- Down Syndrome Program, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Brian G Skotko
- Down Syndrome Program, Division of Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Zigman WB. Atypical aging in down syndrome. ACTA ACUST UNITED AC 2013; 18:51-67. [DOI: 10.1002/ddrr.1128] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 11/14/2012] [Accepted: 11/29/2012] [Indexed: 12/20/2022]
Affiliation(s)
- Warren B. Zigman
- Department of Psychology, Laboratory of Community Psychology, NYS Institute for Basic Research in Developmental Disabilities; Staten Island; New York
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Määttä T, Määttä J, Tervo-Määttä T, Taanila A, Kaski M, Iivanainen M. Healthcare and guidelines: a population-based survey of recorded medical problems and health surveillance for people with Down syndrome. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2011; 36:118-126. [PMID: 21501111 DOI: 10.1080/13668250.2011.570253] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Medical problems are described in a population of persons with Down syndrome. Health surveillance is compared to the recommendations of national guidelines. METHOD Case records from the specialised and primary healthcare and disability services were analysed. RESULTS A wide spectrum of age-specific medical and surgical problems was described. Congenital heart defects and middle ear infections were mostly experienced by younger people, while thyroid disease, epilepsy, and Alzheimer's disease were frequent among older people. Psychiatric disorders and behavioural problems were frequent in all age groups. CONCLUSIONS Health surveillance remained insufficient, despite the guidelines available. A joint effort by healthcare and disability service providers is required to ensure that the medical needs of people with Down syndrome are adequately met across their entire lifespan. An active provision of healthcare and monitoring for this vulnerable group is needed.
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Affiliation(s)
- Tuomo Määttä
- Service Centre of Kuusanmäki, 87250 Kajaani, Finland.
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Prasher V, Ninan S, Haque S. Fifteen-year follow-up of thyroid status in adults with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2011; 55:392-396. [PMID: 21272106 DOI: 10.1111/j.1365-2788.2011.01384.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The natural history of thyroid function in adults with Down syndrome is relatively unknown with limited long-term follow-up data. METHOD This study investigated annual thyroid function tests in 200 adults with Down syndrome over a 15-year period. RESULTS For healthy adults with Down syndrome there is a gradual increase in thyroxine and possible gradual decline in thyroid-stimulating hormone with age. The 15-year incidence for definite hypothyroidism remains low and subclinical hypothyroidism is not a precursor for the onset of definite hypothyroidism. CONCLUSIONS The incidence of thyroid dysfunction is markedly less than would be expected from prevalence studies. Subclinical hypothyroidism is not necessarily a precursor to definite hypothyroidism. Prevalence studies have overstated the association between thyroid dysfunction and Down syndrome. Routine screening for adults with Down syndrome who are euthyroid can be reduced to every 5 years rather than the 1-2 years, as is the present policy.
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Cognitive deficits and associated neurological complications in individuals with Down's syndrome. Lancet Neurol 2010; 9:623-33. [PMID: 20494326 DOI: 10.1016/s1474-4422(10)70112-5] [Citation(s) in RCA: 305] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Improvements in medical interventions for people with Down's syndrome have led to a substantial increase in their longevity. Diagnosis and treatment of neurological complications are important in maintaining optimal cognitive functioning. The cognitive phenotype in Down's syndrome is characterised by impairments in morphosyntax, verbal short-term memory, and explicit long-term memory. However, visuospatial short-term memory, associative learning, and implicit long-term memory functions are preserved. Seizures are associated with cognitive decline and seem to cause additional decline in cognitive functioning, particularly in people with Down's syndrome and comorbid disorders such as autism. Vision and hearing disorders as well as hypothyroidism can negatively impact cognitive functioning in people with Down's syndrome. Dementia that resembles Alzheimer's disease is common in adults with Down's syndrome. Early-onset dementia in adults with Down's syndrome does not seem to be associated with atherosclerotic complications.
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van Schrojenstein Lantman-de Valk HMJ. Healthy Persons With Intellectual Disabilities in an Inclusive Society. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2009. [DOI: 10.1111/j.1741-1130.2009.00213.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Carroll KN, Arbogast P, Dudley JA, Cooper WO. Increase in incidence of medically treated thyroid disease in children with Down Syndrome after rerelease of American Academy of Pediatrics Health Supervision guidelines. Pediatrics 2008; 122:e493-8. [PMID: 18606626 PMCID: PMC2666985 DOI: 10.1542/peds.2007-3252] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The purpose of this work was to estimate the incidence of medically treated thyroid disease in children with Down syndrome enrolled in Tennessee Medicaid (TennCare) during 1995-2005 and to determine whether rates increased after rerelease of American Academy of Pediatrics guidelines in 2001. PATIENTS AND METHODS We conducted a population-based retrospective cohort study in which we identified children with Down syndrome by using TennCare files and birth certificates. We included 1- to 18-year-olds who were continuously enrolled in TennCare and did not fill a prescription for thyroid medication during a 90-day prestudy period. The rate of medically treated thyroid disease (prescription filled for thyroid medication) was the main outcome. We used Poisson regression to estimate rates of medically treated thyroid disease according to study year, age, gender, race, region of residence, and payer type. RESULTS During the 11-year study period, 1257 children with Down syndrome (28% black, 72% white) met inclusion criteria. Overall, 10.8% filled a new prescription for thyroid medication. Rates of medically treated thyroid disease per 1000 child-years were 13.25 (1995-1997), 13.34 (1998-1999), 13.62 (2000-2001), 22.37 (2002-2003), and 22.51 (2004-2005). After adjusting for child age and race, there was an increased rate of medically treated thyroid disease in 2002-2003 and 2004-2005 compared with 1995-1997. In a comparison cohort of children without Down syndrome, there was a smaller increase in the rate of medically treated thyroid disease when comparing 2002-2003 and 2004-2005 with 1995-1997. CONCLUSIONS Over the 11-year period, 10.8% of children with Down syndrome filled a new prescription for a thyroid medication. A 73% increase in the incidence of medically treated thyroid disease occurred after rerelease of American Academy of Pediatrics guidelines, which may have influenced screening.
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Affiliation(s)
- Kecia N. Carroll
- Department of Pediatrics, Division of General Pediatrics, Child and Adolescent Health Research Unit
| | - Patrick Arbogast
- Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Judith A. Dudley
- Preventive Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - William O. Cooper
- Department of Pediatrics, Division of General Pediatrics, Child and Adolescent Health Research Unit
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Groen MA, Alku P, Bishop DVM. Lateralisation of auditory processing in Down syndrome: a study of T-complex peaks Ta and Tb. Biol Psychol 2008; 79:148-57. [PMID: 18479803 PMCID: PMC2580799 DOI: 10.1016/j.biopsycho.2008.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 03/17/2008] [Accepted: 04/05/2008] [Indexed: 11/24/2022]
Abstract
It has long been argued that abnormal cerebral lateralisation might underlie the language problems that characterise Down syndrome, but to date only behavioural evidence has been provided. We used the auditory event-related potentials Ta and Tb of the T-complex to investigate lateralised processing of speech (vowels) and non-speech (simple and complex tones) sounds in children with Down syndrome and age-matched typically developing children. We also explored associations with speech and language abilities. Although changes in the Ta and Tb in response to increases in stimulus complexity and ‘speechness’ were similar across group, the Tb peak was delayed in children with Down syndrome across conditions. In addition, marked differences in the patterns of lateralisation of Ta latency and Tb amplitude were observed in children with Down syndrome, in response to both speech and non-speech sounds. No associations were found between Ta and Tb characteristics and speech and language abilities in children with DS.
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Affiliation(s)
- Margriet Anna Groen
- University of Hamburg, Biological Psychology and Neuropsychology, Hamburg, Germany.
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