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Asher RC, Shrewsbury VA, Innes B, Fitzpatrick A, Simmonds S, Collins CE. Designing the Food and Lifestyle Information Program (FLIP) culinary nutrition intervention for adults with mild-to-moderate intellectual disability. J Hum Nutr Diet 2024; 37:1109-1122. [PMID: 38923091 DOI: 10.1111/jhn.13329] [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: 11/30/2023] [Accepted: 05/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND People with intellectual disability have diverse needs and experience higher rates of diet-related chronic disease such as type 2 diabetes compared to people without disability. However, they are infrequently included in development and implementation of interventions to address diet-related chronic disease. The present study describes the process to plan, develop and refine the Food and Lifestyle Information Program (FLIP) culinary nutrition intervention for adults with mild-to-moderate intellectual disability. METHODS The project was initiated by a disability service provider and was guided by the Cook-Ed™ model and inclusive research principles. Initially the disability service provider and academic research team members co-designed pre-program consultation and pilot studies, and draft program resources. Pre-program consultation explored paid disability support worker (n = 10) perceptions of cooking and food skills, nutrition priorities and optimal program format, which guided further program drafting. Program resources and pilot study design were further developed and refined with co-researchers with lived experience of intellectual disability who attended a pre-pilot and then pilot study sessions as remunerated co-facilitators. RESULTS Key characteristics of the FLIP intervention arising from pre-program consultation included providing cooking task instruction in small steps, enabling participant choice in program activities, promoting an inclusive and social atmosphere, and providing paper-based resources. CONCLUSIONS FLIP intervention co-design was enabled through ongoing input from the disability service provider and people with lived experience of intellectual disability. Evaluation of FLIP feasibility, acceptability and preliminary effectiveness to improve diet-related health is underway.
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Affiliation(s)
- Roberta C Asher
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Vanessa A Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Beth Innes
- Sports 4 All, Fern Bay, Newcastle, NSW, Australia
| | - Arron Fitzpatrick
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Sarah Simmonds
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Rutherford G, Hussain R, Tait K. Pattern of multimorbidity in middle-aged and older-aged people with mild intellectual disability in Australia. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13215. [PMID: 38413378 DOI: 10.1111/jar.13215] [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: 05/24/2023] [Revised: 11/15/2023] [Accepted: 12/12/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Non-communicable diseases (NCDs), also known as chronic diseases, now constitute a major proportion of ill-health across most adult and older populations including in people with intellectual disability. The current paper is a comparative analysis of prevalence of NCDs across mid-aged and older-aged people with mild intellectual disability. METHOD Comparative data comes from two cross-sectional surveys using similar methodology and timeframes. The analysis sample comprises mid-aged group (30-50 years, N = 291) and older-aged group (≥60 years, N = 391). RESULTS People with mild intellectual disability start developing NCDs in early to mid-adulthood and increases with age. The mean number of NCDs in mid-aged group was 0.86 (SD, 0.84) compared to 3.82 in older group (SD, 2.67). CONCLUSION There needs to be early identification and management of NCDs using relevant health promotion and preventative measures at optimal intervention points. The training of healthcare professionals needs improvement.
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Affiliation(s)
- Grace Rutherford
- School of Medicine & Psychology, Australian National University, Canberra, Australia
| | - Rafat Hussain
- School of Medicine & Psychology, Australian National University, Canberra, Australia
| | - Kathleen Tait
- Macquarie School of Education, Macquarie University, Sydney, Australia
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Sappok T, Kowalski C, Zenker M, Weißinger F, Berger AW. [Cancer in people with an intellectual disability in Germany: prevalence, genetics, and care situation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:362-369. [PMID: 38334785 DOI: 10.1007/s00103-024-03837-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024]
Abstract
Intellectual disability has a prevalence rate of approximately 1% of the population; in Germany, this is around 0.5-1 million people. The life expectancy of this group of people is reduced, with cancer being one of the most common causes of death (approx. 20%). Overall, the risk of cancer and mortality is increased compared to the general population.Certain genetic syndromes predispose to cancer in this vulnerable group, but associated comorbidities or lifestyle could also be risk factors for cancer. People with cognitive impairments are less likely to attend preventive check-ups, and challenges arise in medical care due to physical, communicative, and interactional characteristics. Optimized cooperation between clinical centers for people with disabilities and the respective cancer centers is required in order to tailor the processes to the individual.In Germany, there is a lack of data on the prevalence of cancer entities and the use and need for healthcare services. There is an urgent need to focus attention on cancer prevention, treatment, and research in the vulnerable and heterogeneous group of people with intellectual disabilities suffering from cancer in order to effectively counteract the increase in cancer-related deaths in this population group.The article summarizes specialist knowledge on cancer in people with an intellectual disability, identifies special features of treatment, presents care structures, and derives specific requirements for clinics and research.
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Affiliation(s)
- Tanja Sappok
- Medizinische Fakultät und Universitätsklinik OWL, Krankenhaus Mara, Universitätsklinik für Inklusive Medizin, Universität Bielefeld, Maraweg 21, 33617, Bielefeld, Deutschland.
| | | | - Martin Zenker
- Medizinische Fakultät, Universitätsklinikum Magdeburg, Institut für Humangenetik, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Florian Weißinger
- Klinik für Innere Medizin, Hämatologie, Onkologie, Stammzelltransplantation, Palliativmedizin, Evangelisches Klinikum Bethel, Bielefeld, Deutschland
| | - Andreas W Berger
- Klinik für Innere Medizin II - Gastroenterologie und gastrointestinale Onkologie, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Deutschland
- Medizinisches Zentrum für Erwachsene mit Behinderungen, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Deutschland
- Universitätsklinikum Ulm, Department für Innere Medizin, Klinik für Innere Medizin I, Universität Ulm, Ulm, Deutschland
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Altuna M, Estanga A, Garrido A, Saldias J, Cañada M, Echeverria M, Larrea JÁ, Ayo P, Fiz A, Muñoz M, Santa-Inés J, García-Landarte V, García-Sebastián M. Down Syndrome-Basque Alzheimer Initiative (DS-BAI): Clinic-Biological Cohort. J Clin Med 2024; 13:1139. [PMID: 38398452 PMCID: PMC10889106 DOI: 10.3390/jcm13041139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Down syndrome (DS) is the most common genetically determined intellectual disability. In recent decades, it has experienced an exponential increase in life expectancy, leading to a rise in age-related diseases, including Alzheimer's disease (AD). Specific health plans for the comprehensive care of the DS community are an unmet need, which is crucial for the early and accurate diagnosis of main medical comorbidities. We present the protocol of a newly created clinical and research cohort and its feasibility in real life. METHODS The Down Syndrome-Basque Alzheimer Initiative (DS-BAI) is a population-based, inclusive, multidisciplinary initiative for the clinical-assistance and clinical-biological research approach to aging in DS led by the CITA-Alzheimer Foundation (Donostia, Basque Country). It aims to achieve the following: (1) provide comprehensive care for adults with DS, (2) optimize access to rigorous and quality training for socio-family and healthcare references, and (3) create a valuable multimodal clinical-biological research platform. RESULTS During the first year, 114 adults with DS joined the initiative, with 36% of them showing symptoms indicative of AD. Furthermore, adherence to training programs for healthcare professionals and families has been high, and the willingness to collaborate in basic and translational research has been encouraging. CONCLUSION Specific health plans for DS and conducting clinical and translational research on the challenges of aging, including AD, are necessary and feasible.
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Affiliation(s)
- Miren Altuna
- Fundación CITA-Alzheimer Fundazioa, 20009 Donostia, Spain
- Debabarrena Integrated Health Organization, Osakidetza Basque Health Service, 20690 Gipuzkoa, Spain
- Department of Medicine, Faculty of Health Sciences, University of Deusto, 48007 Bilbo, Spain
| | - Ainara Estanga
- Fundación CITA-Alzheimer Fundazioa, 20009 Donostia, Spain
| | - Adolfo Garrido
- Donostialdea Integrated Health Organisation, Clinical Biochemistry Department, Osakidetza Basque Health Service, 20014 Donostia, Spain
| | - Jon Saldias
- Fundación CITA-Alzheimer Fundazioa, 20009 Donostia, Spain
| | - Marta Cañada
- Fundación CITA-Alzheimer Fundazioa, 20009 Donostia, Spain
| | - Maitane Echeverria
- Donostialdea Integrated Health Organisation, Clinical Biochemistry Department, Osakidetza Basque Health Service, 20014 Donostia, Spain
| | - José Ángel Larrea
- Department of Medicine, Faculty of Health Sciences, University of Deusto, 48007 Bilbo, Spain
- Donostialdea Integrated Health Organisation, Radiology Department, Osakidetza Basque Health Service, 20014 Donostia, Spain
| | | | | | - María Muñoz
- Fundación Goyeneche de San Sebastián, 20018 Donostia, Spain
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Mann C, Jun GT. A scoping review of clusters of multiple long-term conditions in people with intellectual disabilities and factors impacting on outcomes for this patient group. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:1045-1061. [PMID: 35695384 PMCID: PMC10647926 DOI: 10.1177/17446295221107275] [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] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
People with intellectual disabilities (ID) are vulnerable to multiple long-term conditions (MLTC). However, in the UK, there are no individual strategies tailored for them. This study synthesised evidence on prevalence of MLTC in people with ID alongside risk factors, outcomes and preventative strategies. The scoping review used the tool Abstrackr to search retrieved articles from three bibliographic databases. Of 933 articles initially screened and further identified, 20 papers met our inclusion criteria. Our findings revealed significant data on prevalence of MLTC in people with ID across the studies, but very limited data on clusters or patterns of co-occurrence in this population. The majority of papers explored risk factors and strategies for prevention of MLTC, but far fewer compared outcomes by MLTC. The identified gaps in the literature indicate the need for further research to identify clusters of MLTC and tailored prevention strategies to reduce poor outcomes in this population.
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Affiliation(s)
- Claire Mann
- School of Design and Creative Arts, Loughborough University, Loughborough, UK
| | - Gyuchan T Jun
- School of Design and Creative Arts, Loughborough University, Loughborough, UK
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Haenen A, Frielink N, van Ool J, Tan FIY, Embregts PJCM. Exploring the experiences of self-determination of individuals with mild intellectual disabilities and epilepsy. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1326-1336. [PMID: 37620292 DOI: 10.1111/jar.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 07/15/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND While epilepsy can decrease quality of life and self-determination in individuals without intellectual disabilities, the impact of epilepsy on experienced self-determination in people with intellectual disabilities remains unclear. METHOD We conducted semi-structured interviews with six adults (four men, two women) aged 30-61 with mild intellectual disabilities and drug-resistant epilepsy to investigate their experiences of self-determination. The data were analysed using Interpretative Phenomenological Analysis. RESULTS Three main themes were identified: (A) I am a competent person with epilepsy; (B) My social needs: being accepted as I am and stability in relationships; and (C) Being in control. CONCLUSIONS In this study, the impact of epilepsy on experienced self-determination of people with mild intellectual disabilities outweighs the influence of intellectual disabilities. Identity formation, friendships with peers, and autonomy support in risk management are identified as important topics in supporting this group.
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Affiliation(s)
- Alexandra Haenen
- Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
- Centre for Residential Epilepsy Care, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands
| | - Noud Frielink
- Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
| | - Jans van Ool
- Centre for Residential Epilepsy Care, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands
| | - Francis I Y Tan
- Centre for Residential Epilepsy Care, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands
| | - Petri J C M Embregts
- Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
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Newman B, Fisher KR, Trollor J. How do Australian mental health services use easy read to make information accessible for people with intellectual disability? JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1354-1362. [PMID: 37688365 PMCID: PMC10946455 DOI: 10.1111/jar.13156] [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: 04/20/2022] [Revised: 07/10/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Access to health information is a right for all people. Easy read information is one strategy used to make information accessible for people with intellectual disability. This research explored how easy read is used and the ways accessible information can address access barriers, with a focus on Australian mental health services. METHODS Semi-structured interviews were conducted across four sites to explore how easy read was used. Participants (n = 49) were easy read users, health practitioners and staff from services providing mental health care in New South Wales, Australia. An integrated health literacy framework was used to analyse data. RESULTS Most mental health staff did not use easy read or other accessible information, and did not consistently offer people with intellectual disability opportunities to understand, appraise and apply health information. This investigation confirmed the limited availability of accessible information resources, including easy read, and the importance of relationships of support when accessing health information. CONCLUSION People with intellectual disability did not routinely have access to mental health information. Substantial change is required to address this disparity. IMPLICATIONS Agency policy and processes require change to support staff practices that uphold the right to information. Inclusive practices that incorporate using easy read in health contexts, including mental health, are needed to facilitate change.
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Affiliation(s)
- Bronwyn Newman
- Centre for Health Systems and Safety Research (CHSSR) Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Karen R. Fisher
- Social Policy Research CentreUniversity of New South WalesSydneyNew South WalesAustralia
| | - Julian Trollor
- Department of Disability and NeuropsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
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Barak S, Dunsky A. Long-term outdoor recreation program for adults with intellectual disabilities: Feasibility and effects. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1113-1123. [PMID: 37357316 DOI: 10.1111/jar.13130] [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: 05/16/2022] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND While people with intellectual disabilities tend to refrain from physical activity, outdoor physical activity programs increase motivation to engage in physical activity. METHOD Eighty adults with intellectual disabilities participated in a 12-month outdoor physical activity program. Attendance was used to assess feasibility. Aerobic capacity (6-min walk test), lower extremity endurance (30-s chair stand), and mobility (timed up and go) were assessed at three-time points: before, during, and after the program. Six interviews were also conducted with six staff members and participants. RESULTS The physical activity program was feasible, with all six groups completing the year-long activity. The six-minute walk and timed-up-and-go tests improved significantly. The qualitative analysis indicates the program's strengths (instructors' qualities and programs' social component) and weaknesses (dependency on weather and bureaucracy). CONCLUSION Among adults with intellectual disabilities, a long-term outdoor physical activity program is feasible as a means for increasing aerobic capacity and improving mobility ability.
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Affiliation(s)
- Sharon Barak
- Faculty of Health Science, Department of Nursing, Ariel University, Ariel, Israel
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Ayelet Dunsky
- School of Human Movement and Sport Sciences, The Levinsky-Wingate Academic College, Netanya, Israel
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Raburn IC, Bunnik EM, Cronin AJ. Vulnerable person investigation plan (VIP) to optimise inclusion in clinical trials. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109053. [PMID: 37185105 DOI: 10.1136/jme-2023-109053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Affiliation(s)
| | - Eline M Bunnik
- Medical Ethics, Philosophy and History of Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Antonia J Cronin
- MRC Centre for Transplantation, Kings College London, London, UK
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Smajdor A. Reification and assent in research involving those who lack capacity. JOURNAL OF MEDICAL ETHICS 2023:jme-2022-108710. [PMID: 36690468 DOI: 10.1136/jme-2022-108710] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
In applied ethics, and in medical treatment and research, the question of how we should treat others is a central problem. In this paper, I address the ethical role of assent in research involving human beings who lack capacity. I start by thinking about why consent is ethically important, and consider what happens when consent is not possible. Drawing on the work of the German philosopher Honneth, I discuss the concept of reification-a phenomenon that manifests itself when we fail to observe or respond to our fellow humans' need for recognition. I suggest that assent is a way of responding to this moral need for recognition, which exists independently of cognitive capacity. I will look at the circumstances in which consent cannot be obtained from human beings, and ask whether some of the same ethically important considerations that underpin the need for consent might be achieved through seeking assent. I discuss the ways in which this might be beneficial for researchers, for prospective research participants and for society at large.
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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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Bertapelli F, Pitetti K, Guerra-Junior G. Association of muscular strength with total and central adiposity in adolescents with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:89-99. [PMID: 36127302 DOI: 10.1111/jir.12981] [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: 04/19/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND It has been established that for youth without disabilities, muscular strength (MS) is negatively associated with total and central adiposity. However, this relationship has not been clearly established for youth with intellectual disability (ID). The purpose of this study was to examine the association of MS with total and central adiposity in adolescents with ID. METHOD Participants were 59 adolescents (40 males and 19 females: age 16.29 ± 1.66 years) with ID. Total and central adiposity were evaluated with dual-energy x-ray absorptiometry (DXA), body mass index (BMI), BMI z-score, waist circumference (WC), and conicity index (C-index). MS was evaluated with the score on the Bruininks-Oseretsky Test of Motor Proficiency (range, 0 to 42, with higher scores indicating better performance). Sex-specific maturity offset equations were used to evaluate somatic maturity. Spearman's correlation coefficients and sequential multiple regression were used to examine associations between MS and adiposity. RESULTS Muscular strength score was negatively associated with BMI (sr = -0.32; P < 0.05), percent body fat (%BF; total, trunk, android and gynoid regions) (sr = -0.51 to -0.58; P < 0.01), and android-to-gynoid fat ratio (sr = -0.29; P < 0.05). After control for somatic maturity and sex, regression analysis indicated that MS score explained 10%-17% of the variance in BMI, BMI z-score, %BF (total, trunk, android and gynoid regions), WC, C-index and android-to-gynoid fat ratio. CONCLUSIONS These findings suggest that MS is associated with DXA- and anthropometric-determined total and central adiposity among adolescents with ID.
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Affiliation(s)
- F Bertapelli
- School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - K Pitetti
- Department of Physical Therapy, Wichita State University, Wichita, Kansas, USA
| | - G Guerra-Junior
- School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
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Sappok T, Hassiotis A, Bertelli M, Dziobek I, Sterkenburg P. Developmental Delays in Socio-Emotional Brain Functions in Persons with an Intellectual Disability: Impact on Treatment and Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013109. [PMID: 36293690 PMCID: PMC9603789 DOI: 10.3390/ijerph192013109] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 05/06/2023]
Abstract
Intellectual disability is a neurodevelopmental disorder with a related co-occurrence of mental health issues and challenging behaviors. In addition to purely cognitive functions, socio-emotional competencies may also be affected. In this paper, the lens of developmental social neuroscience is used to better understand the origins of mental disorders and challenging behaviors in people with an intellectual disability. The current concept of intelligence is broadened by socio-emotional brain functions. The emergence of these socio-emotional brain functions is linked to the formation of the respective neuronal networks located within the different parts of the limbic system. Thus, high order networks build on circuits that process more basic information. The socio-emotional skills can be assessed and complement the results of a standardized IQ-test. Disturbances of the brain cytoarchitecture and function that occur at a certain developmental period may increase the susceptibility to certain mental disorders. Insights into the current mental and socio-emotional functioning of a person may support clinicians in the calibration of treatment and support. Acknowledging the trajectories of the socio-emotional brain development may result in a more comprehensive understanding of behaviors and mental health in people with developmental delays and thus underpin supports for promotion of good mental health in this highly vulnerable population.
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Affiliation(s)
- Tanja Sappok
- Berlin Center for Mental Health in Developmental Disabilities, Ev. Krankenhaus Königin Elisabeth Herzberge, 10365 Berlin, Germany
- Correspondence:
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, London NW1 0PE, UK
| | - Marco Bertelli
- CREA (Research and Clinical Centre), San Sebastiano Foundation, Misericordia di Firenze, 50142 Florence, Italy
| | - Isabel Dziobek
- Clinical Psychology of Social Interaction, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Paula Sterkenburg
- Bartiméus, 3941 XM Doorn, The Netherlands
- Department of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
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Liao P, Vajdic CM, Reppermund S, Cvejic RC, Srasuebkul P, Trollor JN. Mortality rate, risk factors, and causes of death in people with epilepsy and intellectual disability. Seizure 2022; 101:75-82. [DOI: 10.1016/j.seizure.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/18/2022] [Accepted: 07/23/2022] [Indexed: 10/16/2022] Open
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Sánchez-Luquez KY, Carpena MX, Karam SM, Tovo-Rodrigues L. The contribution of whole-exome sequencing to intellectual disability diagnosis and knowledge of underlying molecular mechanisms: A systematic review and meta-analysis. MUTATION RESEARCH. REVIEWS IN MUTATION RESEARCH 2022; 790:108428. [PMID: 35905832 DOI: 10.1016/j.mrrev.2022.108428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 01/01/2023]
Abstract
Whole-exome sequencing (WES) is useful for molecular diagnosis, family genetic counseling, and prognosis of intellectual disability (ID). However, ID molecular diagnosis ascertainment based on WES is highly dependent on de novo mutations (DNMs) and variants of uncertain significance (VUS). The quantification of DNM frequency in ID molecular diagnosis ascertainment and the biological mechanisms common to genes with VUS may provide objective information about WES use in ID diagnosis and etiology. We aimed to investigate and estimate the rate of ID molecular diagnostic assessment by WES, quantify the contribution of DNMs to this rate, and biologically and functionally characterize the genes whose mutations were identified through WES. A PubMed/Medline, Web of Science, Scopus, Science Direct, BIREME, and PsycINFO systematic review and meta-analysis was performed, including studies published between 2010 and 2022. Thirty-seven articles with data on ID molecular diagnostic yield using the WES approach were included in the review. WES testing accounted for an overall diagnostic rate of 42% (Confidence interval (CI): 35-50%), while the estimate restricted to DNMs was 11% (CI: 6-18%). Genetic information on mutations and genes was extracted and split into two groups: (1) genes whose mutation was used for positive molecular diagnosis, and (2) genes whose mutation led to uncertain molecular diagnosis. After functional enrichment analysis, in addition to their expected roles in neurodevelopment, genes from the first group were enriched in epigenetic regulatory mechanisms, immune system regulation, and circadian rhythm control. Genes from uncertain diagnosis cases were enriched in the renin angiotensin pathway. Taken together, our results support WES as an important approach to the molecular diagnosis of ID. The results also indicated relevant pathways that may underlie the pathogenesis of ID with the renin-angiotensin pathway being suggested to be a potential pathway underlying the pathogenesis of ID.
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Affiliation(s)
| | - Marina Xavier Carpena
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil.
| | - Simone M Karam
- Postgraduate Program in Public Health, Universidade Federal do Rio Grande, Rio Grande, Brazil.
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16
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Doody O, Hennessy T, Moloney M, Lyons R, Bright AM. The value and contribution of intellectual disability nurses/nurses caring for people with intellectual disability in intellectual disability settings: A scoping review. J Clin Nurs 2022; 32:1993-2040. [PMID: 35301775 DOI: 10.1111/jocn.16289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/22/2021] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND People with intellectual disability experience poorer health and healthcare access issues. As a leading role in healthcare provision for people with intellectual disability nurses are key to supporting person-centred care and health outcomes. However, little is known about specialist intellectual disability nursing and their contribution to care provision for people with intellectual disability. METHODS A systematic scoping review. Searches of seven academic databases including MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Academic Search Complete, PsycINFO, Embase, Scopus and Web of Science were conducted to identify relevant literature. Literature addressing intellectual disability nursing or nursing care for people with intellectual disability in intellectual disability centres/units/care homes were reviewed and reported as per PRISMA-ScR checklist and PRISMA flow diagram. RESULTS The published literature (n = 68) is extensive and describes the value and contribution of intellectual disability nursing across all domains of professional practice and supports a biopsychosocial-educational approach to addressing the physical, mental and social needs of clients with intellectual disability across the care continuum of health management, health promotion and health education. CONCLUSIONS Despite the importance of the review question and the large volume of publication evidence detailing wide-ranging professional nursing roles and responsibilities, there remains limited literature on the assessment and intervention strategies employed by intellectual disability nurses that highlight their specialist knowledge and skill. Future research should focus on making the role of the nurse more visible and presenting their unique contributions to client care, service delivery, policy and ultimately to the art and science of nursing.
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Affiliation(s)
- Owen Doody
- Department of Nursing and Midwifery, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Therese Hennessy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Mairead Moloney
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Rosemary Lyons
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Ann-Marie Bright
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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17
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Kim YS, Kim JH, Kwon S, Ho S. Mortality rate and cause among people with intellectual disabilities in South Korea: A nationwide representative cross-sectional study from 2015 to 2019. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000744. [PMID: 36962442 PMCID: PMC10021350 DOI: 10.1371/journal.pgph.0000744] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Abstract
People with intellectual disabilities (ID) age faster and have a higher prevalence of degenerative diseases. The aim of this study was to identify the patterns/ causes of death among people with ID. We conducted a nationwide, retrospective, cross-sectional study of people with ID in South Korea. The database was compiled by merging data of people registered with ID, based on the 2015-2019 Standards from the Ministry of Health and Welfare, with the cause of death data published by the Korea National Statistical Office. The International Classification of Diseases-10 (ICD-10) was used to categorize causes of death. The mortality and standardized mortality rates were calculated and major causes of death were analyzed. As of 2019, the mortality rate of people with ID in South Korea was 784.6. The rate showed an irregular pattern, increasing or decreasing year by year (increasing from 725 in 2015 to 834 in 2018). The mortality rate of people with ID was approximately 1.4 times higher than the general population; the standardized mortality rate was 3.2 times higher. The main causes of death (48%) in people with ID were, in order of prevalence, circulatory diseases (cerebrovascular disease), neoplasms (malignant neoplasms of the digestive system), and diseases of the respiratory system (pneumonia). The leading causes of death (>60%) in the general population were, in order of prevalence, neoplasms, diseases of the circulatory system, and respiratory system diseases. An accurate understanding of the causes of death of people with ID is important to promote the development and application of health promotion programs and management thereof.
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Affiliation(s)
- Ye-Soon Kim
- Department of Healthcare and Public Health Research, National Rehabilitation Center, Seoul, South Korea
| | - Joo-Hee Kim
- Department of Healthcare and Public Health Research, National Rehabilitation Center, Seoul, South Korea
| | - Sooyoung Kwon
- Department of Healthcare and Public Health Research, National Rehabilitation Center, Seoul, South Korea
| | - Seunghee Ho
- Department of Healthcare and Public Health Research, National Rehabilitation Center, Seoul, South Korea
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18
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Fortune N, Madden RH, Clifton S. Health and Access to Health Services for People with Disability in Australia: Data and Data Gaps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11705. [PMID: 34770219 PMCID: PMC8583158 DOI: 10.3390/ijerph182111705] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/17/2022]
Abstract
The right of people with disability to enjoyment of the highest attainable standard of health without discrimination on the basis of disability is enshrined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Among its obligations as a signatory to the CRPD, Australia is required to collect appropriate information, including statistical and research data, to inform development and implementation of policies to give effect to the Convention. In this commentary, we first describe how the International Classification of Functioning, Disability and Health (ICF) conceptual model of disability can be operationalised in statistical data collections, with a focus on how this is achieved in key Australian data sources such that people with disability can be identified as a population group. We then review existing statistical data on health and health service use for people with disability in Australia, highlighting data gaps and limitations. Finally, we outline priorities and considerations for improving data on health and access to health services for people with disability. As well as conceptual, practical, and ethical considerations, a key principle that must guide future disability data development is that people with disability and their representative organisations must be involved and participate fully in the development of disability data and statistics, and in their use.
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Affiliation(s)
- Nicola Fortune
- Centre for Disability Research and Policy, The University of Sydney, Susan Wakil Health Building, Western Ave., Camperdown, NSW 2050, Australia; (R.H.M.); (S.C.)
- Centre of Research Excellence in Disability and Health, University of Melbourne, 207 Bouverie Str., Carlton, VIC 3053, Australia
| | - Rosamond H. Madden
- Centre for Disability Research and Policy, The University of Sydney, Susan Wakil Health Building, Western Ave., Camperdown, NSW 2050, Australia; (R.H.M.); (S.C.)
| | - Shane Clifton
- Centre for Disability Research and Policy, The University of Sydney, Susan Wakil Health Building, Western Ave., Camperdown, NSW 2050, Australia; (R.H.M.); (S.C.)
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19
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Newman B, Fisher KR, Trollor J. Right to Information for People with Intellectual Disability in Australian Mental Health Policy. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2021. [DOI: 10.1111/jppi.12396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bronwyn Newman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation Macquarie University Sydney New South Wales Australia
| | - Karen R Fisher
- Social Policy Research Centre UNSW Sydney Sydney New South Wales Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry School of Psychiatry, UNSW Sydney, New South Wales Sydney Australia
- Centre for Healthy Brain Ageing (CHeBA) UNSW Sydney Sydney Australia
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20
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Meehan E, Gallagher AL, Ryan J, Kerr C, O' Sullivan R, Galvin R, Manikandan M, Wormald A, Robinson K. Unmet healthcare needs in adults with childhood-onset neurodisabilities: a protocol for a systematic review. HRB Open Res 2021; 4:107. [PMID: 36071876 PMCID: PMC9399657 DOI: 10.12688/hrbopenres.13309.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background
Many adults with childhood-onset neurodisabilities, such as those with intellectual disability or cerebral palsy, report difficulties accessing the healthcare that they require when they are no longer eligible for paediatric services. Compared to the general population, this population is at greater risk of developing many ageing-related diseases and has higher rates of preventable deaths and premature mortality. Addressing unmet healthcare needs is essential to ensuring equitable access in a quality healthcare system. The aim of this systematic review is to synthesise the current available evidence related to unmet healthcare needs in adults with a range of childhood-onset neurodisabilities.
Methods
A systematic review of quantitative research studies of adults with a range of diagnoses that fall under the neurodisability umbrella and outcomes related to unmet healthcare needs will be undertaken. The Conducting Systematic Reviews and Meta-Analyses of Observational Studies (COSMOS-E) guidelines will be adhered to. Searches of key databases will be undertaken, and a two-phase screening process carried out by pairs of independent reviewers to select studies that meet the inclusion criteria. Data will be extracted using a purposefully designed form. Risk of bias will be assessed using the Joanna Briggs Institute Critical Appraisal Tools. If it is possible to pool prevalence data, a meta-analysis will be undertaken. Where pooling of data is not possible, a structured synthesis approach will be used, and results will be presented in tables and summarised narratively.
Conclusions
In recent years, there has been increased emphasis placed on promoting positive ageing and improving the healthcare experiences throughout the lifespan for people with neurodisabilities. Findings of this systematic review can inform decision-making related to healthcare for this vulnerable population and has the potential to contribute to reducing preventable deaths and premature mortality and promoting positive and healthy ageing for this group.
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Affiliation(s)
- Elaine Meehan
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Aoife L. Gallagher
- School of Allied Health, University of Limerick, Limerick, Ireland
- Health Implementation Science and Technology Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Jennifer Ryan
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claire Kerr
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Rose Galvin
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Manjula Manikandan
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Andrew Wormald
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
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21
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Altuna M, Giménez S, Fortea J. Epilepsy in Down Syndrome: A Highly Prevalent Comorbidity. J Clin Med 2021; 10:2776. [PMID: 34202784 PMCID: PMC8268854 DOI: 10.3390/jcm10132776] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022] Open
Abstract
Individuals with Down syndrome (DS) have an increased risk for epilepsy during the whole lifespan, but especially after age 40 years. The increase in the number of individuals with DS living into late middle age due to improved health care is resulting in an increase in epilepsy prevalence in this population. However, these epileptic seizures are probably underdiagnosed and inadequately treated. This late onset epilepsy is linked to the development of symptomatic Alzheimer's disease (AD), which is the main comorbidity in adults with DS with a cumulative incidence of more than 90% of adults by the seventh decade. More than 50% of patients with DS and AD dementia will most likely develop epilepsy, which in this context has a specific clinical presentation in the form of generalized myoclonic epilepsy. This epilepsy, named late onset myoclonic epilepsy (LOMEDS) affects the quality of life, might be associated with worse cognitive and functional outcomes in patients with AD dementia and has an impact on mortality. This review aims to summarize the current knowledge about the clinical and electrophysiological characteristics, diagnosis and treatment of epileptic seizures in the DS population, with a special emphasis on LOMEDS. Raised awareness and a better understanding of epilepsy in DS from families, caregivers and clinicians could enable earlier diagnoses and better treatments for individuals with DS.
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Affiliation(s)
- Miren Altuna
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain
| | - Sandra Giménez
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, 08029 Barcelona, Spain
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22
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Bailie J, Laycock A, Matthews V, Bailie RS. Increasing health assessments for people living with an intellectual disability: lessons from experience of Indigenous-specific health assessments. Med J Aust 2021; 215:16-18.e1. [PMID: 34080698 DOI: 10.5694/mja2.51124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jodie Bailie
- University Centre for Rural Health, University of Sydney, Lismore, NSW
| | - Alison Laycock
- University Centre for Rural Health, University of Sydney, Lismore, NSW
| | - Veronica Matthews
- University Centre for Rural Health, University of Sydney, Lismore, NSW
| | - Ross S Bailie
- University Centre for Rural Health, University of Sydney, Lismore, NSW
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23
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Hirvikoski T, Boman M, Tideman M, Lichtenstein P, Butwicka A. Association of Intellectual Disability With All-Cause and Cause-Specific Mortality in Sweden. JAMA Netw Open 2021; 4:e2113014. [PMID: 34156453 PMCID: PMC8220491 DOI: 10.1001/jamanetworkopen.2021.13014] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
IMPORTANCE Knowledge of the health challenges and mortality in people with intellectual disability (ID) should guide health policies and practices in contemporary society. OBJECTIVE To examine premature mortality in individuals with ID. DESIGN, SETTING, AND PARTICIPANTS This population-based longitudinal cohort study obtained data from several national health care, education, and population registers in Sweden. Two registers were used to identify individuals with ID: the National Patient Register and the Halmstad University Register on Pupils With Intellectual Disability. Two cohorts were created: cohort 1 comprised young adults (born between 1980 and 1991) with mild ID, and cohort 2 comprised individuals (born between 1932 and 2013) with mild ID or moderate to profound ID; each cohort had matched reference cohorts. Data analyses were conducted between June 1, 2020, and March 31, 2021. EXPOSURES Mild or moderate to profound ID. MAIN OUTCOMES AND MEASURES The primary outcome was overall (all-cause) mortality, and the secondary outcomes were cause-specific mortality and potentially avoidable mortality. RESULTS Cohort 1 included 13 541 young adults with mild ID (mean [SD] age at death, 24.53 [3.66] years; 7826 men [57.8%]), and its matched reference cohort consisted of 135 410 individuals. Cohort 2 included 24 059 individuals with mild ID (mean [SD] age at death, 52.01 [16.88] years; 13 649 male individuals [56.7%]) and 26 602 individuals with moderate to profound ID (mean [SD] age at death, 42.16 [21.68] years; 15 338 male individuals [57.7%]); its matched reference cohorts consisted of 240 590 individuals with mild ID and 266 020 with moderate to profound ID. Young adults with mild ID had increased overall mortality risk compared with the matched reference cohort (odds ratio [OR], 2.86; 95% CI, 2.33-3.50), specifically excess mortality in neoplasms (OR, 3.58; 95% CI, 2.02-6.35), diseases of the nervous system (OR, 40.00; 95% CI, 18.43-86.80) and circulatory system (OR, 9.24; 95% CI, 4.76-17.95). Among deaths that were amenable to health care (OR, 7.75; 95% CI, 4.85-12.39), 55% were attributed to epilepsy. In cohort 2, increased risk of overall mortality was observed among both individuals with mild ID (OR, 6.21; 95% CI, 5.79-6.66) and moderate to profound ID (OR, 13.15; 95% CI, 12.52-13.81) compared with the matched reference cohorts. Those with moderate to profound ID had a higher risk in several cause-of-death categories compared with those with mild ID or the matched reference cohort. Adjustment for epilepsy and congenital malformations attenuated the associations. The relative risk of premature death was higher in women (OR, 6.23; 95% CI, 4.42-8.79) than in men (OR, 1.99; 95% CI, 1.53-2.60), but the absolute risk of mortality was similar (0.9% for women vs 0.9% for men). CONCLUSIONS AND RELEVANCE This study found excess premature mortality and high risk of deaths with causes that were potentially amenable to health care intervention among people with ID. This finding suggests that this patient population faces persistent health challenges and inequality in health care encounters.
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Affiliation(s)
- Tatja Hirvikoski
- Department of Women’s and Children’s Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet, Karolinska Institutet, Stockholm, Sweden
- Habilitation and Health, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
| | - Marcus Boman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Tideman
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
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24
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Sappok T, Steinhart I. [Leave No One Behind: Intellectual Disability and (Mental) Illness - A Challenge for Health Care]. PSYCHIATRISCHE PRAXIS 2021; 48:115-118. [PMID: 33860475 DOI: 10.1055/a-1400-1746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Tanja Sappok
- Behandlungszentrum für psychische Gesundheit bei Entwicklungsstörungen, Berlin
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Improving health care for disabled people in COVID-19 and beyond: Lessons from Australia and England. Disabil Health J 2020; 14:101050. [PMID: 33341397 PMCID: PMC7969381 DOI: 10.1016/j.dhjo.2020.101050] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/14/2020] [Accepted: 12/02/2020] [Indexed: 11/23/2022]
Abstract
COVID-19 has exacerbated pre-existing difficulties children and adults with disability face accessing quality health care. Some people with disability are at greater risk of contracting COVID-19 because they require support for personal care and are unable to physically distance, e.g. those living in congregate settings. Additionally, some people with disability have health conditions that put them at higher risk of poor outcomes if they become infected. Despite this, governments have been slow to recognise, and respond to, the unique and diverse health care needs of people with disability during COVID-19. While some countries, including Australia, have improved access to high-quality health care for people with disability others, like England, have failed to support their citizens with disability. In this Commentary we describe the health care responses of England and Australia and make recommendations for rapidly improving health care for people with disability in the pandemic and beyond.
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Experiences of LGBTIQA+ People with Disability in Healthcare and Community Services: Towards Embracing Multiple Identities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218080. [PMID: 33147846 PMCID: PMC7662209 DOI: 10.3390/ijerph17218080] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/18/2022]
Abstract
Healthcare and disability support services are increasing their efforts towards inclusion and recognising the needs of different groups. This research project was conducted by academic and peer researchers (LGBTIQA+ people with disability) in Victoria, Australia using four focus groups with LGBTIQA+ people with disability. We report on two overarching themes relating to participants’ experiences of accessing health services as LGBTIQA+ people with disability: difficulties in managing multiple identities and the impacts of community services and supports. Participants described having to repeatedly ‘come out’ in a range of ways and contexts as complex and layered processes in which it was difficult to present their full range of needs and experiences to services. We also found that the role of community in promoting a sense of belonging and resilience increased capacity to manage health service use and advocacy. Services and communities aiming to be inclusive to all have the opportunity to recognise and respond to the issues faced by LGBTIQA+ people with disability as a way to pay attention to how overt and subtle practices of discrimination continue to operate despite repeated attempts at or claims of being ‘inclusive.’ Our research suggests actual inclusive, accessible services can be achieved in part through policy and practice that actively responds to the specific needs of LGBTIQA+ people with disability, in addition to LGBTIQA+ education for disability services and disability and accessibility education for LGBTIQA+ focused services. As we do in this article, we argue that this work must be done by prioritising authentic participation of LGBTIQA+ people with disability in the services and research that is about them.
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