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Dos Santos TR, Carlucci NSS, de Avó LRDS, Barbato IT, Pinto LLDC, Pilotto RF, Germano CMR, Melo DG. Quality of life of Brazilian families who have children with Fragile X syndrome: a descriptive study. J Community Genet 2023; 14:407-418. [PMID: 37594660 PMCID: PMC10444934 DOI: 10.1007/s12687-023-00660-0] [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: 02/20/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023] Open
Abstract
This study aimed to assess the Family Quality of Life (FQoL) of Brazilian families with male children with Fragile X syndrome (FXS). Data from 53 families were collected using forms that included sociodemographic and clinical information, as well as the Beach Center Family Quality of Life Scale, a 5-point Likert scale ranging from "very dissatisfied" (1) to "very satisfied" (5). The mean overall FQoL score was 3.56 ± 0.79; the emotional well-being domain had the lowest score (2.98 ± 1.11) and showed significant differences between the other domains: family interaction (3.81 ± 0.89; p < 0.001), parenting (3.66 ± 0.89; p < 0.001), physical and material well-being (3.48 ± 0.83; p < 0.001), and disability-related support (3.75 ± 0.98; p < 0.001). Physical and material well-being was the second-lowest domain and was statistically different from the family interaction domain (p = 0.013). Lower FQoL satisfaction ratings were found in families with children who had difficulty getting along with people of the same age (t(51) = -3.193, p = 0.002; d = 1.019) and difficulty in living together on a day-to-day basis (t(51) = -3.060, p = 0.004; d = 0.888). These results highlight the importance of proper emotional support for the family, emphasizing the need to provide assistance not only for individuals with FXS but also for other family members. Besides, we advocate for the adoption of public policies that provide financial assistance to families and the implementation of the Brazilian Policy of Comprehensive Care for People with Rare Diseases.
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Affiliation(s)
- Thamires Rosa Dos Santos
- Departamento de Medicina, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, Brasil
| | | | - Lucimar Retto da Silva de Avó
- Departamento de Medicina, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, Brasil
- Instituto Nacional de Genética Médica Populacional, INAGEMP, Porto Alegre, Rio Grande do Sul, Brasil
| | - Ingrid Tremel Barbato
- Laboratório Neurogene, Florianópolis, Santa Catarina, Brasil
- Associação Catarinense da Síndrome do X Frágil, Florianópolis, Santa Catarina, Brasil
| | - Louise Lapagesse de Camargo Pinto
- Serviço de Referência em Doenças Raras do Hospital Infantil Joana de Gusmão, Florianópolis, Santa Catarina, Brasil
- Curso de Medicina, Universidade do Sul de Santa Catarina (UNISUL), Campus Tubarão, Tubarão, Santa Catarina, Brasil
| | - Rui Fernando Pilotto
- Departamento de Genética, Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brasil
| | - Carla Maria Ramos Germano
- Departamento de Medicina, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, Brasil
- Instituto Nacional de Genética Médica Populacional, INAGEMP, Porto Alegre, Rio Grande do Sul, Brasil
| | - Débora Gusmão Melo
- Departamento de Medicina, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, Brasil.
- Instituto Nacional de Genética Médica Populacional, INAGEMP, Porto Alegre, Rio Grande do Sul, Brasil.
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Kelm K, Bolduc FV. How Knowledge Mapping Can Bridge the Communication Gap Between Caregivers and Health Professionals Supporting Individuals With Complex Medical Needs: A Study in Fragile X Syndrome. Front Psychiatry 2021; 12:731011. [PMID: 34899415 PMCID: PMC8651701 DOI: 10.3389/fpsyt.2021.731011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
The challenges of caring for children with complex health needs, such as intellectual disability (ID) and autism spectrum disorder (ASD), are multiple and experienced by both caregivers and health professionals. Fragile X syndrome (FXS) is the most common single gene cause of ID and ASD, and provides a pertinent model to understand these complexities of care, as well as the communication challenges experienced between caregivers and healthcare professionals. In recent years both caregivers and healthcare professionals have recognized the need for enhancing communication both in clinical and research settings. Knowledge mapping has emerged as a tool to support quality communication between team participants. Here we review how differences in mental models, as well as challenges related to health literacy and knowledge transfer can have an impact on communication. Next, we present different knowledge mapping approaches used in complex situations, with a focus on concept maps and care maps. Finally, we highlight the potential benefits and limitations of mapping to improve communication issues related to caring for individuals with FXS and potentially other neurodevelopmental disorders (NDDs).
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Affiliation(s)
- Karen Kelm
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Francois V. Bolduc
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Women and Children Health Research Institute, University of Alberta, Edmonton, AB, Canada
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Baker EK, Arora S, Amor DJ, Date P, Cross M, O'Brien J, Simons C, Rogers C, Goodall S, Slee J, Cahir C, Godler DE. The Cost of Raising Individuals with Fragile X or Chromosome 15 Imprinting Disorders in Australia. J Autism Dev Disord 2021; 53:1682-1692. [PMID: 34292487 DOI: 10.1007/s10803-021-05193-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
The study characterised differences in costs associated with raising a child between four rare disorders and examined the associations between these costs with clinical severity. Caregivers of 108 individuals with Prader-Willi, Angelman (AS), Chromosome 15q Duplication and fragile X (FXS) syndromes completed a modified Client Services Receipt Inventory and participants completed intellectual/developmental functioning and autism assessments. AS incurred the highest yearly costs per individual ($AUD96,994), while FXS had the lowest costs ($AUD33,221). Intellectual functioning negatively predicted total costs, after controlling for diagnosis. The effect of intellectual functioning on total costs for those with AS was significantly different to the other syndromes. The study highlights the significant costs associated with these syndromes, particularly AS, linked with severity of intellectual functioning.
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Affiliation(s)
- Emma K Baker
- Diagnosis and Development, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Sheena Arora
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, NSW, Australia
| | - David J Amor
- Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - Perrin Date
- Diagnosis and Development, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Meagan Cross
- Foundation for Angelman Syndrome Therapeutics (FAST), Salisbury, QLD, Australia
| | - James O'Brien
- Prader-Willi Syndrome Australia Ltd, Melbourne, VIC, Australia
| | - Chloe Simons
- Foundation for Angelman Syndrome Therapeutics (FAST), Salisbury, QLD, Australia
| | - Carolyn Rogers
- Genetics of Learning Disability Service, Hunter Genetics, Waratah, NSW, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, NSW, Australia
| | - Jennie Slee
- Department of Health, Government of Western Australia, Genetic Services of Western Australia, Perth, WA, Australia
| | - Chris Cahir
- Dup15q Australia Ltd, Melbourne, VIC, Australia
| | - David E Godler
- Diagnosis and Development, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia. .,Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
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Guo Q, Chang YY, Huang CH, Hsiao YS, Hsiao YC, Chiu IF, Zhou Y, Zhang H, Ko TM. Population-based carrier screening and prenatal diagnosis of fragile X syndrome in East Asian populations. J Genet Genomics 2021; 48:1104-1110. [PMID: 34412977 DOI: 10.1016/j.jgg.2021.04.012] [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: 01/21/2021] [Revised: 04/13/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
Identification of carriers of fragile X syndrome (FXS) with the subsequent prenatal diagnosis and knowledge of FXS-associated genetic profiles are essential for intervention in specific populations. We report the results of carrier screening of 39,458 East Asian adult women and prenatal diagnosis from 87 FXS carriers. The prevalence of FXS carriers and full mutation fetuses was estimated to be 1/581 and 1/3124 in East Asian populations, respectively. We confirmed the validity of the current threshold of CGG trinucleotide repeats for FMR1 categorization; the integral risks of full mutation expansion were approximately 6.0%, 43.8%, and 100% for premutation alleles with 55-74, 75-89, and ≥90 CGG repeats, respectively. The protective effect of AGG (adenine-guanine-guanine nucleotides) interruption in East Asian populations was validated, which is important in protecting premutation alleles with 75-89 CGG repeats from full mutation expansion. Finally, family history was shown not an effective indicator for FXS carrier screening in East Asian populations, and population-based screening was more cost-effective. This study provides an insight into the largest carrier screening and prenatal diagnosis for FXS in East Asian populations to date. The FXS-associated genetic profiles of East Asian populations are delineated, and population-based carrier screening is shown to be promising for FXS intervention.
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Affiliation(s)
- Qiwei Guo
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, Xiamen, Fujian 361102, China.
| | - Yih-Yuan Chang
- Genephile Bioscience Laboratory, Ko's Obstetrics and Gynecology, Taipei 100, Taiwan, China
| | - Chien-Hao Huang
- Genephile Bioscience Laboratory, Ko's Obstetrics and Gynecology, Taipei 100, Taiwan, China
| | - Yu-Shan Hsiao
- Genephile Bioscience Laboratory, Ko's Obstetrics and Gynecology, Taipei 100, Taiwan, China
| | - Yu-Chiao Hsiao
- Biofast Biotechnology Co., Ltd., Xiamen, Fujian 361102, China
| | - I-Fan Chiu
- Biofast Biotechnology Co., Ltd., Xiamen, Fujian 361102, China
| | - Yulin Zhou
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, Xiamen, Fujian 361102, China
| | - Haixia Zhang
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, Xiamen, Fujian 361102, China
| | - Tsang-Ming Ko
- Genephile Bioscience Laboratory, Ko's Obstetrics and Gynecology, Taipei 100, Taiwan, China.
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Do TQN, Riley C, Paramsothy P, Ouyang L, Bolen J, Grosse SD. Fragile X Syndrome-Associated Emergency Department Visits in the United States, 2006-2011. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:103-108. [PMID: 32058813 PMCID: PMC7305836 DOI: 10.1352/1944-7558-125.2.103] [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] [Indexed: 06/10/2023]
Abstract
Using national data, we examined emergency department (ED) encounters during 2006-2011 for which a diagnosis code for fragile X syndrome (FXS) was present (n = 7,217). Almost half of ED visits coded for FXS resulted in hospitalization, which is much higher than for ED visits not coded for FXS. ED visits among females coded for FXS were slightly more likely to result in hospitalization. These findings underscore the importance of surveillance systems that could accurately identify individuals with FXS, track healthcare utilization and co-occurring conditions, and monitor quality of care in order to improve care and reduce FXS-associated morbidity.
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Affiliation(s)
- Thuy Quynh N Do
- Thuy Quynh N. Do, Catharine Riley, Pangaja Paramsothy, Lijing Ouyang, Julie Bolen, and Scott D. Grosse, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
| | - Catharine Riley
- Thuy Quynh N. Do, Catharine Riley, Pangaja Paramsothy, Lijing Ouyang, Julie Bolen, and Scott D. Grosse, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
| | - Pangaja Paramsothy
- Thuy Quynh N. Do, Catharine Riley, Pangaja Paramsothy, Lijing Ouyang, Julie Bolen, and Scott D. Grosse, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
| | - Lijing Ouyang
- Thuy Quynh N. Do, Catharine Riley, Pangaja Paramsothy, Lijing Ouyang, Julie Bolen, and Scott D. Grosse, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
| | - Julie Bolen
- Thuy Quynh N. Do, Catharine Riley, Pangaja Paramsothy, Lijing Ouyang, Julie Bolen, and Scott D. Grosse, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
| | - Scott D Grosse
- Thuy Quynh N. Do, Catharine Riley, Pangaja Paramsothy, Lijing Ouyang, Julie Bolen, and Scott D. Grosse, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
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A genetic model for multimorbidity in young adults. Genet Med 2019; 22:132-141. [DOI: 10.1038/s41436-019-0603-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/21/2019] [Indexed: 01/29/2023] Open
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Mavoglurant in Fragile X Syndrome: Results of two open-label, extension trials in adults and adolescents. Sci Rep 2018; 8:16970. [PMID: 30451888 PMCID: PMC6242849 DOI: 10.1038/s41598-018-34978-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023] Open
Abstract
Fragile X syndrome (FXS) is the most common monogenic cause of inherited intellectual and developmental disabilities. Mavoglurant, a selective metabotropic glutamate receptor subtype-5 antagonist, has shown positive neuronal and behavioral effects in preclinical studies, but failed to demonstrate any behavioral benefits in two 12-week, randomized, placebo-controlled, double-blind, phase IIb studies in adults and adolescents with FXS. Here we report the long-term safety (primary endpoint) and efficacy (secondary endpoint) results of the open-label extensions. Adolescent (n = 119, aged 12–19 years) and adult (n = 148, aged 18–45 years) participants received up to 100 mg bid mavoglurant for up to 34 months. Both extension studies were terminated prematurely due to lack of proven efficacy in the core studies. Mavoglurant was well tolerated with no new safety signal. Five percent of adults and 16.9 percent of adolescents discontinued treatment due to adverse events. Gradual and consistent behavioral improvements as measured by the ABC-CFX scale were observed, which were numerically superior to those seen in the placebo arm of the core studies. These two extension studies confirm the long-term safety of mavoglurant in FXS, but further investigations are required to determine whether and under which conditions the significant preclinical results obtained with mGluR5 inhibition can translate to humans.
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Evans MI, Evans SM, Bennett TA, Wapner RJ. The price of abandoning diagnostic testing for cell-free fetal DNA screening. Prenat Diagn 2018; 38:243-245. [DOI: 10.1002/pd.5226] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 12/27/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Mark I. Evans
- Department of Obstetrics and Gynecology; Mt Sinai School of Medicine; New York NY USA
- Fetal Medicine Foundation of America; New York NY USA
- Comprehensive Genetics; New York NY USA
| | - Shara M. Evans
- Fetal Medicine Foundation of America; New York NY USA
- Comprehensive Genetics; New York NY USA
| | - Terry Ann Bennett
- Department of Obstetrics and Gynecology, Tisch Medical School; New York University; New York NY USA
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology; Columbia University College of Physicians and Surgeons; New York NY USA
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Lindley LC, Cozad MJ. Comparative Effectiveness of Usual Source of Care Approaches to Improve End-of-Life Outcomes for Children With Intellectual Disability. J Pain Symptom Manage 2017; 54:298-304. [PMID: 28797858 DOI: 10.1016/j.jpainsymman.2017.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/12/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Children with intellectual disability (ID) are at risk for adverse end-of-life outcomes including high emergency room utilization and hospital readmissions, along with low hospice enrollment. OBJECTIVES The objective of this study was to compare the effectiveness of usual source of care approaches to improve end-of-life outcomes for children with ID. METHODS We used longitudinal California Medicaid claims data. Children were included who were 21 years with fee-for-service Medicaid claims, died between January 1, 2007, and December 31, 2010, and had a moderate-to-profound ID diagnosis. End-of-life outcomes (i.e., hospice enrollment, emergency room utilization, hospital readmissions) were measured via claims data. Our treatments were usual source of care (USC) only vs. usual source of care plus targeted case management (USC plus TCM). Using instrumental variable analysis, we compared the effectiveness of treatments on end-of-life outcomes. RESULTS Ten percent of children with ID enrolled in hospice, 73% used the emergency room, and 20% had three or more hospital admissions in their last year of life. USC plus TCM relative to USC only had no effect on hospice enrollment; however, it significantly reduced the probability of emergency room utilization (B = -1.29, P < 0.05) and hospital readmissions (B = -1.71, P < 0.001). CONCLUSIONS Our findings demonstrated that USC plus TCM was more effective at improving end-of-life outcomes for children with ID. Further study of the extent of UCS and TCM involvement in reducing emergency room utilization and hospital readmissions at end of life is needed.
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Affiliation(s)
- Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, Tennessee.
| | - Melanie J Cozad
- Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia, South Carolina
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