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Chieffe D, Hartnick C. Neurostimulation for Pediatric Obstructive Sleep Apnea. Otolaryngol Clin North Am 2024; 57:447-455. [PMID: 38508882 DOI: 10.1016/j.otc.2024.02.007] [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] [Indexed: 03/22/2024]
Abstract
Up to 80% of children with Down syndrome (DS) are affected by obstructive sleep apnea (OSA), and only 16% to 30% will have resolution of their OSA with adenotonsillectomy. Hypoglossal nerve stimulation is a well-established therapy for adults with OSA and was recently approved by the Food and Drug Administration for use in children with DS and residual OSA. There is robust experience with this therapy in adults that has led to well-established care pathways. However, given the challenges inherent to caring for a complex pediatric population, these pathways are not directly transferrable to children with DS.
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Affiliation(s)
- Doug Chieffe
- Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
| | - Christopher Hartnick
- Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA; Division of Pediatric Otolaryngology, Pediatric Airway, Voice, and Swallowing Center; Harvard Medical school, Boston, MA, USA.
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Chieffe D, Liu RH, Hartnick C. Challenges and adverse events in pediatric hypoglossal nerve stimulation. Int J Pediatr Otorhinolaryngol 2024; 176:111831. [PMID: 38113620 DOI: 10.1016/j.ijporl.2023.111831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Hypoglossal nerve stimulation was recently FDA approved for use in children with Down Syndrome and persistent obstructive sleep apnea. Although there is a robust experience in hypoglossal nerve stimulation in adults, we observed several challenges that are unique to providing this therapy to a complex pediatric population with a high rate of sensory processing disorders. We sought to review the adverse events and challenges to inform clinicians as hypoglossal nerve stimulation becomes a more accessible option for this complex population. METHODS Retrospective case series of children with Down Syndrome and persistent OSA who underwent hypoglossal nerve stimulation. Inclusion and exclusion criteria included Down Syndrome, age 10-22 years, persistent severe OSA after adenotonsillectomy (AHI>10 with <25 % central or mixed events), inability to tolerate positive airway pressure, and absence of concentric palatal collapse on sleep endoscopy. Patients were identified and their charts were reviewed. Adverse events and their subsequent management were recorded. The major outcome variable was the total number of adverse events. RESULTS A total of 53 patients underwent implantation of a hypoglossal nerve stimulator; 35 (66 %) patients were male and the average age at implantation was 15.1 years (standard deviation 3.0y). A total of 30 adverse events were noted, including 17 nonserious and 13 serious. The most common nonserious complications included temporary tongue discomfort, rash at the surgical site, and cellulitis. Serious complications included readmission (for cellulitis, pain, and device extrusion), reoperation (most commonly for battery depletion) and pressure ulcer formation. CONCLUSION Hypoglossal nerve stimulation provides a much-needed therapy for children with DS and persistent OSA after adenotonsillectomy. Although there is a robust experience in providing this treatment to adults, many considerations must be made when adapting this technology to a pediatric population with a high rate of sensory processing disorders.
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Shaikh A, Li YQ, Lu J. Perspectives on pain in Down syndrome. Med Res Rev 2023; 43:1411-1437. [PMID: 36924439 DOI: 10.1002/med.21954] [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: 05/07/2021] [Revised: 01/08/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
Down syndrome (DS) or trisomy 21 is a genetic condition often accompanied by chronic pain caused by congenital abnormalities and/or conditions, such as osteoarthritis, recurrent infections, and leukemia. Although DS patients are more susceptible to chronic pain as compared to the general population, the pain experience in these individuals may vary, attributed to the heterogenous structural and functional differences in the central nervous system, which might result in abnormal pain sensory information transduction, transmission, modulation, and perception. We tried to elaborate on some key questions and possible explanations in this review. Further clarification of the mechanisms underlying such abnormal conditions induced by the structural and functional differences is needed to help pain management in DS patients.
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Affiliation(s)
- Ammara Shaikh
- Department of Human Anatomy, College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning Province, China
| | - Yun-Qing Li
- Department of Anatomy, Histology, and Embryology & K. K. Leung Brain Research Centre, The Fourth Military Medical University, Xi'an, Shaanxi Province, China
- Department of Anatomy, Basic Medical College, Zhengzhou University, Zhengzhou, China
| | - Jie Lu
- Department of Human Anatomy, College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning Province, China
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El-Tallawy SN, Ahmed RS, Nagiub MS. Pain Management in the Most Vulnerable Intellectual Disability: A Review. Pain Ther 2023; 12:939-961. [PMID: 37284926 PMCID: PMC10290021 DOI: 10.1007/s40122-023-00526-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023] Open
Abstract
This review is made up of two parts; the first part discussing intellectual disability (ID) in general, while the second part covers the pain associated with intellectual disability and the challenges and practical tips for the management of pain associated with (ID). Intellectual disability is characterized by deficits in general mental abilities, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience. ID is a disorder with no definite cause but has multiple risk factors, including genetic, medical, and acquired. Vulnerable populations such as individuals with intellectual disability may experience more pain than the general population due to additional comorbidities and secondary conditions, or at least the same frequency of pain as in the general population. Pain in patients with ID remains largely unrecognized and untreated due to barriers to verbal and non-verbal communication. It is important to identify patients at risk to promptly prevent or minimize those risk factors. As pain is multifactorial, thus, a multimodal approach using both pharmacotherapy and non-pharmacological management is often the most beneficial. Parents and caregivers should be oriented to this disorder, given adequate training and education, and be actively involved with the treatment program. Significant work to create new pain assessment tools to improve pain practices for individuals with ID has taken place, including neuroimaging and electrophysiological studies. Recent advances in technology-based interventions such as virtual reality and artificial intelligence are rapidly growing to help give patients with ID promising results to develop pain coping skills with effective reduction of pain and anxiety. Therefore, this narrative review highlights the different aspects regarding the current status of the pain associated with intellectual disability, with more emphasis on the recent pieces of evidence for the assessment and management of pain among populations with intellectual disability.
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Affiliation(s)
- Salah N. El-Tallawy
- King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Anesthesia Department, Faculty of Medicine, Minia University and NCI, Cairo University, Giza, Egypt
| | - Rania S. Ahmed
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Kildal ESM, Quintana DS, Szabo A, Tronstad C, Andreassen O, Nærland T, Hassel B. Heart rate monitoring to detect acute pain in non-verbal patients: a study protocol for a randomized controlled clinical trial. BMC Psychiatry 2023; 23:252. [PMID: 37060049 PMCID: PMC10103503 DOI: 10.1186/s12888-023-04757-1] [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: 02/26/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Autism entails reduced communicative abilities. Approximately 30% of individuals with autism have intellectual disability (ID). Some people with autism and ID are virtually non-communicative and unable to notify their caregivers when they are in pain. In a pilot study, we showed that heart rate (HR) monitoring may identify painful situations in this patient group, as HR increases in acutely painful situations. OBJECTIVES This study aims to generate knowledge to reduce the number of painful episodes in non-communicative patients' everyday lives. We will 1) assess the effectiveness of HR as a tool for identifying potentially painful care procedures, 2) test the effect of HR-informed changes in potentially painful care procedures on biomarkers of pain, and 3) assess how six weeks of communication through HR affects the quality of communication between patient and caregiver. METHODS We will recruit 38 non-communicative patients with autism and ID residing in care homes. ASSESSMENTS HR is measured continuously to identify acutely painful situations. HR variability and pain-related cytokines (MCP-1, IL-1RA, IL-8, TGFβ1, and IL-17) are collected as measures of long-term pain. Caregivers will be asked to what degree they observe pain in their patients and how well they believe they understand their patient's expressions of emotion and pain. Pre-intervention: HR is measured 8 h/day over 2 weeks to identify potentially painful situations across four settings: physiotherapy, cast use, lifting, and personal hygiene. INTERVENTION Changes in procedures for identified painful situations are in the form of changes in 1) physiotherapy techniques, 2) preparations for putting on casts, 3) lifting techniques or 4) personal hygiene procedures. DESIGN Nineteen patients will start intervention in week 3 while 19 patients will continue data collection for another 2 weeks before procedure changes are introduced. This is done to distinguish between specific effects of changes in procedures and non-specific effects, such as caregivers increased attention. DISCUSSION This study will advance the field of wearable physiological sensor use in patient care. TRIAL REGISTRATION Registered prospectively at ClinicalTrials.gov (NCT05738278).
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Affiliation(s)
- Emilie S M Kildal
- K.G. Jebsen, Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway.
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
- Department of Psychiatry, Lovisenberg Diakonale Sykehus, Oslo, Norway.
| | - Daniel S Quintana
- K.G. Jebsen, Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, University of Oslo, Oslo, Norway
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - Attila Szabo
- K.G. Jebsen, Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, University of Oslo, Oslo, Norway
| | - Christian Tronstad
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
| | - Ole Andreassen
- K.G. Jebsen, Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, University of Oslo, Oslo, Norway
| | - Terje Nærland
- K.G. Jebsen, Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway.
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway.
| | - Bjørnar Hassel
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurohabilitation, Oslo University Hospital, Oslo, Norway
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McDonagh K, McGuire BE, Durand H. Being a parent of a child with Down's arthritis: an interpretative phenomenological analysis. Disabil Rehabil 2022; 44:7030-7038. [PMID: 34550867 DOI: 10.1080/09638288.2021.1979663] [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] [Indexed: 01/13/2023]
Abstract
PURPOSE To explore the parental impact and experiences of caring for a child with Down's arthritis (DA), an aggressive, erosive form of arthritis affecting children with Down syndrome. MATERIALS AND METHODS Ten mothers of children with DA were interviewed via telephone. Interviews were guided using a semi-structured non-directive topic guide and ranged from 17 to 242 minutes in duration. Interpretative phenomenological analysis was the method of analysis. RESULTS Three superordinate themes were identified: "Struggle for Help," "Mothers Know Best," and "Daily Impacts." Common challenges included issues around child pain, communication, and challenges in accessing diagnoses and relevant healthcare services. Parents portrayed a reality characterised by ongoing struggles, particularly parents of nonverbal children and those living further from paediatric rheumatology services. Connecting with other parents of children with DA provided a vital source of emotional and informational support. CONCLUSIONS Findings provide novel insight into the experience of being mother of a child with DA, highlighting regional healthcare disparities, the need for upskilling of healthcare professionals, and for increased public awareness. Further research is needed to better understand the impact of DA on fathers and siblings. Findings can contribute to development and provision of supports to children with DA and their families.Implications for RehabilitationHealthcare professionals need to be upskilled in the treatment of, and communication with, children with Down syndrome with chronic illnesses and their families.A specialised stream of care for children with Down's arthritis (DA) within paediatric rheumatology services may facilitate timely diagnosis and treatment and minimise risk of future complications.Formalised support services for children with DA and their families are needed to minimise emotional distress.
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Affiliation(s)
- Kelly McDonagh
- Centre for Pain Research, National University of Ireland, Galway, Ireland.,School of Psychology, National University of Ireland, Galway, Ireland
| | - Brian E McGuire
- Centre for Pain Research, National University of Ireland, Galway, Ireland.,School of Psychology, National University of Ireland, Galway, Ireland
| | - Hannah Durand
- Centre for Pain Research, National University of Ireland, Galway, Ireland.,School of Psychology, National University of Ireland, Galway, Ireland.,Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
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McCann B, Levman J, Baumer N, Lam MY, Shiohama T, Cogger L, MacDonald A, Ijner P, Takahashi E. Structural magnetic resonance imaging demonstrates volumetric brain abnormalities in down syndrome: Newborns to young adults. Neuroimage Clin 2021; 32:102815. [PMID: 34520978 PMCID: PMC8441087 DOI: 10.1016/j.nicl.2021.102815] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/29/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022]
Abstract
Down syndrome (DS) is a genetic disorder caused by the presence of an extra full or partial copy of chromosome 21 and characterized by intellectual disability. We hypothesize that performing a retrospective analysis of 73 magnetic resonance imaging (MRI) examinations of participants with DS (aged 0 to 22 years) and comparing them to a large cohort of 993 brain MRI examinations of neurotypical participants (aged 0 to 32 years), will assist in better understanding what brain differences may explain phenotypic developmental features in DS, as well as to provide valuable confirmation of prospective literature findings clinically. Measurements for both absolute volumes and volumes corrected as a percentage of estimated total intracranial volume (%ETIV) were extracted from each examination. Our results presented novel findings such as volume increases (%ETIV) in the perirhinal cortex, entorhinal cortex, choroid plexus, and Brodmann's areas (BA) 3a, 3b, and 44, as well as volume decreases (%ETIV) in the white matter of the cuneus, the paracentral lobule, the postcentral gyrus, and the supramarginal gyrus. We also confirmed volumetric brain abnormalities previously discussed in the literature. Findings suggest the presence of volumetric brain abnormalities in DS that can be detected clinically with MRI.
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Affiliation(s)
- Bernadette McCann
- Department of Human Kinetics, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada
| | - Jacob Levman
- Department of Computer Science, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada.
| | - Nicole Baumer
- Department of Neurology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Melanie Y Lam
- Department of Human Kinetics, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada
| | - Tadashi Shiohama
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Liam Cogger
- Department of Education, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada
| | - Allissa MacDonald
- Department of Biology, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada
| | - Prahar Ijner
- Department of Computer Science, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada
| | - Emi Takahashi
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, 401 Park Dr., Boston, MA 02215, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, 149 Thirteenth Street, Suite 2301, Charlestown, MA 02129, USA
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Vogel ER, Staffa SJ, DiNardo JA, Brown ML. Dosing of Opioid Medications During and After Pediatric Cardiac Surgery for Children With Down Syndrome. J Cardiothorac Vasc Anesth 2021; 36:195-199. [PMID: 34526241 DOI: 10.1053/j.jvca.2021.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/02/2021] [Accepted: 08/11/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine whether children with Down syndrome (DS) receive higher doses of opioid medications compared with children without DS for repair of complete atrioventricular canal (CAVC). DESIGN A retrospective chart review of children with and without DS who underwent primary repair of CAVC. The exclusion criteria included unbalanced CAVC and patients undergoing biventricular staging procedures. The primary outcome was oral morphine equivalents (OME) received in the first 24 hours after surgery. The secondary outcomes included intraoperative OME, OME at 48 and 72 hours, nonopioid analgesic and sedative medications received, pain scores, time to extubation, and length of stay. SETTING A pediatric academic medical center in the United States. PARTICIPANTS One hundred thirty-one patients with DS and 24 without, all <two years old, who underwent a CAVC repair. INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS Patients with DS were older than patients without DS (median 96.3 days [interquartile range {IQR} 70.7-128.2] v 75.9 days [IQR 49.8-107.3], p = 0.033) but otherwise not statistically different in the baseline characteristics. There was no difference in OME received in the first 24 hours postoperatively between groups (3.01 mg/kg [IQR 1.23-5.43] v 3.57 mg/kg [IQR 1.54-7.06], p = 0.202). OME at 48 and 72 hours was lower in the DS group compared with the control group. Similar amounts of opioid and non-opioid analgesics and sedatives were otherwise given to both groups of patients. Median pain scores did not differ between groups. CONCLUSIONS These results suggested that patients with DS undergoing CAVC repair do not have increased opioid requirements compared with a similar control group.
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Affiliation(s)
- Elizabeth R Vogel
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA
| | - James A DiNardo
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA
| | - Morgan L Brown
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA.
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Increased heart rate functions as a signal of acute distress in non-communicating persons with intellectual disability. Sci Rep 2021; 11:6479. [PMID: 33742078 PMCID: PMC7979830 DOI: 10.1038/s41598-021-86023-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/05/2021] [Indexed: 01/10/2023] Open
Abstract
Intellectual disability (ID) affects approximately 1% of the population. Some patients with severe or profound ID are essentially non-communicating and therefore risk experiencing pain and distress without being able to notify their caregivers, which is a major health issue. This real-world proof of concept study aimed to see if heart rate (HR) monitoring could reveal whether non-communicating persons with ID experience acute pain or distress in their daily lives. We monitored HR in 14 non-communicating participants with ID in their daily environment to see if specific situations were associated with increased HR. We defined increased HR as being > 1 standard deviation above the daily mean and lasting > 5 s. In 11 out of 14 participants, increased HR indicated pain or distress in situations that were not previously suspected to be stressful, e.g. passive stretching of spastic limbs or being transported in patient lifts. Increased HR suggesting joy was detected in three participants (during car rides, movies). In some situations that were previously suspected to be stressful, absence of HR increase suggested absence of pain or distress. We conclude that HR monitoring may identify acute pain and distress in non-communicating persons with ID, allowing for improved health care for this patient group.
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Hüls A, Costa AC, Dierssen M, Baksh RA, Bargagna S, Baumer NT, Brandão AC, Carfi A, Carmona-Iragui M, Chicoine BA, Ghosh S, Lakhanpaul M, Manso C, Mayer MA, Ortega MDC, de Asua DR, Rebillat AS, Russell LA, Sgandurra G, Valentini D, Sherman SL, Strydom A. Medical vulnerability of individuals with Down syndrome to severe COVID-19-data from the Trisomy 21 Research Society and the UK ISARIC4C survey. EClinicalMedicine 2021; 33:100769. [PMID: 33644721 PMCID: PMC7897934 DOI: 10.1016/j.eclinm.2021.100769] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Health conditions, immune dysfunction, and premature aging associated with trisomy 21 (Down syndrome, DS) may impact the clinical course of COVID-19. METHODS The T21RS COVID-19 Initiative launched an international survey for clinicians or caregivers on patients with COVID-19 and DS. Data collected between April and October 2020 (N=1046) were analysed and compared with the UK ISARIC4C survey of hospitalized COVID-19 patients with and without DS. FINDINGS The mean age of COVID-19 patients with DS in the T21RS survey was 29 years (SD = 18). Similar to the general population, the most frequent signs and symptoms of COVID-19 were fever, cough, and shortness of breath. Joint/muscle pain and vomiting or nausea were less frequent (p < 0.01), whereas altered consciousness/confusion were more frequent (p < 0.01). Risk factors for hospitalization and mortality were similar to the general population with the addition of congenital heart defects as a risk factor for hospitalization. Mortality rates showed a rapid increase from age 40 and were higher in patients with DS (T21RS DS versus non-DS patients: risk ratio (RR) = 3.5 (95%-CI=2.6;4.4), ISARIC4C DS versus non-DS patients: RR = 2.9 (95%-CI=2.1;3.8)) even after adjusting for known risk factors for COVID-19 mortality. INTERPRETATION Leading signs/symptoms of COVID-19 and risk factors for severe disease course are similar to the general population. However, individuals with DS present significantly higher rates of medical complications and mortality, especially from age 40. FUNDING Down Syndrome Affiliates in Action, DSMIG-USA, GiGi's Playhouse, Jerome Lejeune Foundation, LuMind IDSC Foundation, The Matthew Foundation, NDSS, National Task Group on Intellectual Disabilities and Dementia Practices.
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Affiliation(s)
- Anke Hüls
- Department of Epidemiology and Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Alberto C.S. Costa
- Departments of Pediatrics and of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mara Dierssen
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
| | - R. Asaad Baksh
- Institute of Psychiatry, Psychology, and Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King's College London, London, United Kingdom
- The London Down Syndrome (LonDownS) Consortium, London, United Kingdom
| | | | - Nicole T. Baumer
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Angelo Carfi
- Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Carmona-Iragui
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | | | - Sujay Ghosh
- Cytogenetics and Genomics Reserach Unit. Department of Zoology, University of Calcutta.Kolkata. West Bengal, India
| | - Monica Lakhanpaul
- UCL- Great Ormond Street Institute of Child Health, London, United Kingdom
- Whttington NHS Trust, London, United Kingdom; Down Syndrome Medical Interest Group, London, United Kingdom
| | | | - Miguel-Angel Mayer
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute and DCEXS Universitat Pompeu Fabra, Barcelona, Spain
| | - Maria del Carmen Ortega
- Department of Psychiatry, Research Institute i+12. Hospital Universitario 12 de Octubre. Madrid, Spain
| | - Diego Real de Asua
- Department of Internal Medicine and Instituto de Investigación Biomédica-La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Lauren Ashley Russell
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Diletta Valentini
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stephanie L. Sherman
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Andre Strydom
- Institute of Psychiatry, Psychology, and Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King's College London, London, United Kingdom
- The London Down Syndrome (LonDownS) Consortium, London, United Kingdom
- South London and the Maudsley NHS Foundation Trust
| | - T21RS COVID-19 Initiative
- Department of Epidemiology and Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Departments of Pediatrics and of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
- Institute of Psychiatry, Psychology, and Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King's College London, London, United Kingdom
- The London Down Syndrome (LonDownS) Consortium, London, United Kingdom
- Fondazione Stella Maris IRCCS, Pisa, Italy
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
- Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL, USA
- Cytogenetics and Genomics Reserach Unit. Department of Zoology, University of Calcutta.Kolkata. West Bengal, India
- UCL- Great Ormond Street Institute of Child Health, London, United Kingdom
- Whttington NHS Trust, London, United Kingdom; Down Syndrome Medical Interest Group, London, United Kingdom
- CM: DOWN ESPAÑA, Madrid, Spain
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute and DCEXS Universitat Pompeu Fabra, Barcelona, Spain
- Department of Psychiatry, Research Institute i+12. Hospital Universitario 12 de Octubre. Madrid, Spain
- Department of Internal Medicine and Instituto de Investigación Biomédica-La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
- Institut Jérôme Lejeune, Paris, France
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Institute of Psychiatry, Psychology, and Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King's College London, London, United Kingdom
- The London Down Syndrome (LonDownS) Consortium, London, United Kingdom
- South London and the Maudsley NHS Foundation Trust
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Hassan NM, Buldt AK, Shields N, Landorf KB, Menz HB, Munteanu SE. Reproducibility of foot dimensions measured from 3-dimensional foot scans in children and adolescents with Down syndrome. J Foot Ankle Res 2020; 13:31. [PMID: 32498702 PMCID: PMC7271427 DOI: 10.1186/s13047-020-00403-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/26/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Children and adolescents with Down syndrome have a distinctive foot shape (such as wide and flat feet) that often leads to difficulty with footwear fitting. 3-dimensional (3D) scanning can accurately measure the foot dimensions of individuals with Down syndrome, which may assist shoe fit. However, the reproducibility of measuring foot dimensions using 3D scans in children and adolescents with Down syndrome is unknown. The aim of this study was to determine the intra- and inter-rater reproducibility of measuring foot dimensions of children and adolescents with Down syndrome using 3D scanning. METHODS 3D foot scans of 30 participants with Down syndrome aged 5 to 17 years were obtained using the FotoScan 3D scanner. Foot dimensions assessed were foot length, ball of foot length, outside ball of foot length, diagonal foot width, horizontal foot width, heel width, ball girth, instep girth, first and fifth toe height, and instep height. Additionally, the Wesjflog Index and forefoot shape were determined. Measurements were completed by two raters independently on two separate occasions, 2 weeks apart. Intra- and inter-rater reliability were assessed using intra-class correlation coefficients (ICCs) and Gwet's AC1 statistics with 95% confidence intervals. Agreement was determined by calculating limits of agreement (LOA) and percentage agreement. RESULTS Eighteen participants were female and 12 were male (mean age 10.6 [3.9] years). Intra-rater reproducibility (ICCs ranged from 0.74 to 0.99, 95% LOA from - 13.7 mm to 16.3 mm) and inter-rater reproducibility (ICCs ranging from 0.73 to 0.99, 95% LOA from - 18.8 mm to 12.7 mm) was good to excellent, although some measurements (ball of foot length, outside ball of foot length, heel width and girth measurements) displayed wider LOAs indicating relatively poorer agreement. Forefoot shape displayed substantial to almost perfect reliability (Gwet's AC1 0.68 to 0.85) and percentage agreement ranged from 73 to 87%, indicating acceptable agreement. CONCLUSIONS The measurement of specific foot dimensions of children and adolescents with Down syndrome using 3D scans is reproducible. Findings of this study may be used to support future research measuring specific foot dimensions of children and adolescents with Down syndrome using 3D foot scans.
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Affiliation(s)
- Nirmeen M Hassan
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia. .,Living with Disability Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.
| | - Andrew K Buldt
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, Victoria, 3086, Australia
| | - Nora Shields
- Living with Disability Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, Victoria, 3086, Australia.,Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia
| | - Karl B Landorf
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.,Living with Disability Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, Victoria, 3086, Australia
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, Victoria, 3086, Australia
| | - Shannon E Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, Victoria, 3086, Australia
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Levman J, MacDonald A, Baumer N, MacDonald P, Stewart N, Lim A, Cogger L, Shiohama T, Takahashi E. Structural magnetic resonance imaging demonstrates abnormal cortical thickness in Down syndrome: Newborns to young adults. NEUROIMAGE-CLINICAL 2019; 23:101874. [PMID: 31176294 PMCID: PMC6551568 DOI: 10.1016/j.nicl.2019.101874] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 05/17/2019] [Accepted: 05/25/2019] [Indexed: 12/11/2022]
Abstract
Down syndrome (DS) is a genetic disorder caused by an extra copy of all or part of chromosome 21 and is characterized by intellectual disability. We performed a retrospective analysis of 47 magnetic resonance imaging (MRI) examinations of participants with DS (aged 5 to 22 years) and compared them with a large cohort of 854 brain MRIs obtained from neurotypical participants (aged 5 to 32 years) with the objective of assessing the clinical presentation of Down syndrome, towards better understanding the neurological development associated with the condition. An additional cohort of 26 MRI exams from patients with DS and 139 exams from neurotypical participants (aged 0–5 years) are included as part of a supplementary analysis. Regionally distributed cortical thickness measurements, including average measurements as well as standard deviations (intra-regional cortical thickness variability) were extracted from each examination. The largest effect sizes observed were associated with increased average cortical thickness in the postcentral gyrus with specific abnormalities observed in Brodmann's areas 1 and 3b in DS, which was observed across all age ranges. We also observed strong effect sizes associated with decreased cortical thickness variability in the lateral orbitofrontal gyrus, the postcentral gyrus and more in DS participants. Findings suggest regionally irregular gray matter development in DS that can be detected with MRI. Large scale study of the clinical presentation of Down Syndrome Abnormally increased mean cortical thicknesses identified in key regions. Abnormally decreased variability in cortical thicknesses identified within key regions Findings may be connected with abnormal pruning in Down Syndrome.
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Affiliation(s)
- Jacob Levman
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, 401 Park Dr., Boston, MA 02215, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Mathematics, Statistics and Computer Science, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada.
| | - Allissa MacDonald
- Department of Biology, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada
| | - Nicole Baumer
- Department of Neurology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Patrick MacDonald
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, 401 Park Dr., Boston, MA 02215, USA
| | - Natalie Stewart
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, 401 Park Dr., Boston, MA 02215, USA
| | - Ashley Lim
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, 401 Park Dr., Boston, MA 02215, USA
| | - Liam Cogger
- Department of Mathematics, Statistics and Computer Science, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada
| | - Tadashi Shiohama
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, 401 Park Dr., Boston, MA 02215, USA
| | - Emi Takahashi
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, 401 Park Dr., Boston, MA 02215, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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13
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Doody O, Bailey ME. Understanding pain physiology and its application to person with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2019; 23:5-18. [PMID: 28502222 DOI: 10.1177/1744629517708680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The issue of pain warrants attention as, by virtue of having an intellectual disability, a person may have associated medical or physical conditions and associated factors increasing their risk of pain disorders. People with intellectual disability experiencing pain need to be provided with the best possible care. The focus of this article is on the exploration of pain: physiology and types; manifestations and responses in the context of intellectual disability in order to promote effective, knowledgeable assessment and management of pain for this client group. Pain is a subjective, complex, physiological and psychological phenomenon that can be acute or chronic and may be classified according to its cause. Within the experience of pain, the concept of total pain describes the physical, psychological, social and spiritual factors that influence the experience of pain.
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14
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MOLDOVEANU GG. Anesthetic Management of a Down Syndrome Patient with Subocclusive Syndrome. MAEDICA 2018; 13:159-164. [PMID: 30069246 PMCID: PMC6060294 DOI: 10.26574/maedica.2018.13.2.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The present study aims to describe the anesthetic management of a patient with Down syndrome in connection to the degree of difficulty in orotracheal intubation and the associated risks of general anesthesia. The established diagnosis was subocclusive syndrome, requiring an emergent surgical intervention. Preoperatively, the patient was stabilized, and secondly, a series of clinical and paraclinical investigations were carried out in order to assess the best management of the anesthetic procedure. Risk factors were identified, including ischemic heart disease, grade II obesity, hyperglycemia, patient's old age and marked mental retardation. The results of examinations that were carried out showed that the degree of difficulty of orotracheal intubation was low. Finally, the preoperative assessment indicated that the most appropriate approach for this patient was to perform a general anesthesia with endotracheal intubation. However, special care was given to the anesthetic and postoperative condition of the patient in order to lower the possible complications of the surgical intervention.
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15
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de Knegt NC, Lobbezoo F, Schuengel C, Evenhuis HM, Scherder EJA. Self-Reported Presence and Experience of Pain in Adults with Down Syndrome. PAIN MEDICINE 2018; 18:1247-1263. [PMID: 27694149 DOI: 10.1093/pm/pnw226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective The aim was to examine whether the presence of pain (based on physical conditions and participants' report) and self-reported pain experience in adults with Down syndrome (DS) differ from general population controls. Design Cross-sectional study of 224 adults with DS (mean age = 38.1 years, mild-severe intellectual disabilities) and 142 age-matched controls (median age = 40.5 years, mean estimated IQ = 105.7) in the Netherlands. Methods File-based medical information was evaluated. Self-reported presence and experience of pain were assessed in rest and after movement during a test session (affect with facial affective scale (FAS: 0.04-0.97), intensity assessed with numeric rating scale (NRS: 0-10). Results Compared with controls, more DS participants had physical conditions that may cause pain and/or discomfort ( p = .004, 50% vs 35%), but fewer DS participants reported pain during the test session ( p = .003, 58% vs 73%). Of the participants who indicated pain and comprehended self-reporting scales ( n = 198 FAS, n = 161 NRS), the DS group reported a higher pain affect and intensity than the controls ( p < .001, FAS: 0.75-0.85 vs 0.50-0.59, NRS: 6.00-7.94 vs 2.00-3.73). Conclusions Not all adults with DS and painful/discomforting physical conditions reported pain. Those who did indicated a higher pain experience than adults from the general population. Research into spontaneous self-report of pain, repeated pain assessment, and acute pain is needed in people with DS for more insight into pain experience and mismatches between self-report and medical information.
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Affiliation(s)
- Nanda C de Knegt
- Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, the Netherlands
| | - Carlo Schuengel
- Department of Clinical Child and Family Studies and EMGO+ Institute for Health and Care Research
| | - Heleen M Evenhuis
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
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Abstract
OBJECTIVES To assess if morphine pharmacokinetics are different in children with Down syndrome when compared with children without Down syndrome. DESIGN Prospective single-center study including subjects with Down syndrome undergoing cardiac surgery (neonate to 18 yr old) matched by age and cardiac lesion with non-Down syndrome controls. Subjects were placed on a postoperative morphine infusion that was adjusted as clinically necessary, and blood was sampled to measure morphine and its metabolites concentrations. Morphine bolus dosing was used as needed, and total dose was tracked. Infusions were continued for 24 hours or until patients were extubated, whichever came first. Postinfusion, blood samples were continued for 24 hours for further evaluation of kinetics. If patients continued to require opioid, a nonmorphine alternative was used. Morphine concentrations were determined using a unique validated liquid chromatography tandem-mass spectrometry assay using dried blood spotting as opposed to large whole blood samples. Morphine concentration versus time data was modeled using population pharmacokinetics. SETTING A 16-bed cardiac ICU at an university-affiliated hospital. PATIENTS Forty-two patients (20 Down syndrome, 22 controls) were enrolled. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The pharmacokinetics of morphine in pediatric patients with and without Down syndrome following cardiac surgery were analyzed. No significant difference was found in the patient characteristics or variables assessed including morphine total dose or time on infusion. Time mechanically ventilated was longer in children with Down syndrome, and regarding morphine pharmacokinetics, the covariates analyzed were age, weight, presence of Down syndrome, and gender. Only age was found to be significant. CONCLUSIONS This study did not detect a significant difference in morphine pharmacokinetics between Down syndrome and non-Down syndrome children with congenital heart disease.
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Axmon A, Sandberg M, Ahlström G, Midlöv P. Prescription of potentially inappropriate medications among older people with intellectual disability: a register study. BMC Pharmacol Toxicol 2017; 18:68. [PMID: 29070067 PMCID: PMC5657112 DOI: 10.1186/s40360-017-0174-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older people have a greater disease burden and are more likely than younger to be prescribed medications. They are also more sensitive to adverse effects. With this in mind, a range of medications have been suggested inappropriate in this population. People with intellectual disability (ID) have a higher disease burden than the general population, putting them at even greater risk of prescription of such medications. The aim of this study was to describe prescription of potentially inappropriate medications among older people with ID in relation to prescriptions among their age peers in the general population. METHODS We established an administrative cohort of people with ID (ID cohort; n = 7936), using a Swedish national register. A referent cohort from the general population (gPop) was matched one-to-one by sex and year of birth. Data regarding prescription of potentially inappropriate medications were collected from the Swedish prescribed drug register for the years 2006-2012. RESULTS People with ID were more likely than the general population to be prescribed medications with anticholinergic effects, intermediate- or long-acting benzodiazepines, and antipsychotics at least once during the study period, and also had more number of years with prescription. Except for benzodiazepines, those in the ID cohort with at least one prescription had larger amounts prescribed than those in the gPop cohort. People in the ID cohort were less likely than the general population to be prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Among those with at least one prescription of NSAIDs, those in the ID cohort had prescriptions during fewer years and in lower amounts than those in the gPop cohort. CONCLUSIONS Although prescription of potentially inappropriate medications overall is more common among people with ID than in the general population, the opposite pattern is found for medications for pain management. This may be a result of pain being under-recognized and under-treated in this population. Thus, there is a need for training as well as increased knowledge and awareness among care and health care professionals regarding signs of adverse effects and the need of continuous evaluation of treatment in this vulnerable group.
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Affiliation(s)
- Anna Axmon
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, SE, Sweden. .,Department of Health Sciences, Lund University, 221 00, Lund, SE, Sweden.
| | - Magnus Sandberg
- Department of Health Sciences, Lund University, 221 00, Lund, SE, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Lund University, 221 00, Lund, SE, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, 221 00, Lund, SE, Sweden
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18
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Carmona-Iragui M, Santos T, Videla S, Fernández S, Benejam B, Videla L, Alcolea D, Blennow K, Blesa R, Lleó A, Fortea J. Feasibility of Lumbar Puncture in the Study of Cerebrospinal Fluid Biomarkers for Alzheimer’s Disease in Subjects with Down Syndrome. J Alzheimers Dis 2016; 55:1489-1496. [PMID: 27858714 DOI: 10.3233/jad-160827] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- María Carmona-Iragui
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Telma Santos
- Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Sebastián Videla
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Department of Experimental and Health Sciences, Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Susana Fernández
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Bessy Benejam
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Laura Videla
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Daniel Alcolea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, University of Göteborg, Göteborg, Sweden
| | - Rafael Blesa
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain
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19
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Special Olympics swimming: positive effects on young people with Down syndrome. SPORT SCIENCES FOR HEALTH 2016. [DOI: 10.1007/s11332-016-0293-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Salazar EG, Li Y, Fisher BT, Rheingold SR, Fitzgerald J, Seif AE, Huang YS, Bagatell R, Aplenc R. Supportive care utilization and treatment toxicity in children with Down syndrome and acute lymphoid leukaemia at free-standing paediatric hospitals in the United States. Br J Haematol 2016; 174:591-9. [PMID: 27161549 DOI: 10.1111/bjh.14085] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/26/2016] [Indexed: 12/22/2022]
Abstract
Although inferior outcomes of children with Down syndrome (DS) and acute lymphoid leukaemia (ALL) are established, national supportive care patterns for these patients are unknown. A validated retrospective cohort of paediatric patients diagnosed with ALL from 1999 to 2011 was assembled from the US Pediatric Health Information System (PHIS) database to examine organ toxicity, sepsis, and resource utilization in children with and without DS. Among 10699 ALL patients, 298 had DS-ALL (2·8%). In a multivariate model, DS was associated with increased risk of cardiovascular (odds ratio [OR] 2·0, 95% confidence interval [CI] 1·6-2·7), respiratory (OR 2·1, 95% CI: 1·6-2·9), neurologic (OR 3·4, 95% CI 1·9-6·2), and hepatic (OR 1·4, 95% CI 1·0-1·9) dysfunction and sepsis (OR 1·8, 95% CI: 1·4-2·4). Children with DS-ALL used significantly more respiratory support, insulin, and anti-infectives, including broad-spectrum Gram-positive agents, quinolones, and azoles. They used significantly fewer analgesics and antiemetics compared to non-DS-ALL children. Ultimately, this study confirms the increased risk of infectious and end-organ toxicity in children with DS-ALL and quantifies important differences in resource utilization between children with DS and non-DS ALL. These findings highlight the importance of investigating the impact of these care variations and developing specific supportive care guidelines for this population.
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Affiliation(s)
- Elizabeth G Salazar
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Yimei Li
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Brian T Fisher
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,The Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan R Rheingold
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julie Fitzgerald
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alix E Seif
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yuan-Shung Huang
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rochelle Bagatell
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard Aplenc
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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