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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wakamatsu K, Oshiro T, Kitahara N, Moriyama Y, Nabekura T, Hashi K, Hayashi K, Saiki A, Okazumi S. Feasibility of Laparoscopic Sleeve Gastrectomy for Patients with Obesity and Disorders of Intellectual Development: a Single Institutional Experience. Obes Surg 2023; 33:1327-1332. [PMID: 36943609 PMCID: PMC10156847 DOI: 10.1007/s11695-023-06543-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Owing to their difficulty following clinical advice for procedural safety and ideal surgical outcomes, bariatric and metabolic surgery (BMS) for patients with disorders of intellectual development (DID) is concerning. Studies reporting the feasibility of BMS for this population remain scarce. This study aims to clarify the feasibility of laparoscopic sleeve gastrectomy (LSG) for patients with clinically severe obesity and DID. METHODS A retrospective analysis of a single institutional prospective database collected from 2010 to 2022 was performed. The Wechsler Adult Intelligence Scale (WAIS) was used to measure intellectual ability before LSG. A multidisciplinary team approach was implemented to give special support and care to patients with DID. Patients were categorized into groups according to their WAIS scores. LSG outcomes were statistically compared between the DID and average intellectual ability groups. RESULTS Using the WAIS to measure intellectual ability among patients who underwent LSG, we identified 14 patients with DID (IQ score: < 69, mean IQ: 63.4) and 71 with average intellectual ability (IQ score: 90-109, mean IQ: 98.9). Operative outcomes were comparable between the groups as follows: operation time (DID: 163 ± 41 min, average intelligence: 162 ± 30 min), hospital stay (DID: 4 [4-5] days, average intelligence: 5 [4-6] days), and total comorbidities (DID: 7.1%, average intelligence: 8.4%). No reoperations were performed, and no mortalities were observed. CONCLUSIONS With medical and social support and care, performing LSG on patients with clinically severe obesity and DID is safe, with good short-term results.
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Affiliation(s)
- Kotaro Wakamatsu
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan.
| | - Natsumi Kitahara
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Yuuki Moriyama
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Taiki Nabekura
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Kozue Hashi
- Department of Neuropsychiatry, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Karin Hayashi
- Department of Psychiatry, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Atsuhito Saiki
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
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Lemay KR, Kogan CS, Rebello TJ, Keeley JW, Bhargava R, Sharan P, Sharma M, Kommu JVS, Kishore MT, de Jesus Mari J, Ginige P, Buono S, Recupero M, Zingale M, Zagaria T, Cooray S, Roy A, Reed GM. An international field study of the ICD-11 behavioural indicators for disorders of intellectual development. J Intellect Disabil Res 2022; 66:376-391. [PMID: 35170825 DOI: 10.1111/jir.12924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The World Health Organization (WHO) has approved the 11th Revision of the International Classification of Diseases (ICD-11). A version of the ICD-11 for Mental, Behavioural and Neurodevelopmental Disorders for use in clinical settings, called the Clinical Descriptions and Diagnostic Requirements (CDDR), has also been developed. The CDDR includes behavioural indicators (BIs) for assessing the severity of disorders of intellectual development (DID) as part of the section on neurodevelopmental disorders. Reliable and valid diagnostic assessment measures are needed to improve identification and treatment of individuals with DID. Although appropriately normed, standardised intellectual and adaptive behaviour assessments are considered the optimal assessment approach in this area, they are unavailable in many parts of the world. This field study tested the BIs internationally to assess the inter-rater reliability, concurrent validity, and clinical utility of the BIs for the assessment of DID. METHODS This international study recruited a total of 206 children and adolescents (5-18 years old) with a suspected or established diagnosis of DID from four sites across three countries [Sri-Lanka (n = 57), Italy (n = 60) and two sites in India (n = 89)]. Two clinicians assessed each participant using the BIs with one conducting the clinical interview and the other observing. Diagnostic formulations using the BIs and clinical utility ratings were collected and entered independently after each assessment. At a follow-up appointment, standardised measures (Leiter-3, Vineland Adaptive Behaviour Scales-II) were used to assess intellectual and adaptive abilities. RESULTS The BIs had excellent inter-rater reliability (intra-class correlations ranging from 0.91 to 0.97) and good to excellent concurrent validity (intra-class correlations ranging from 0.66 to 0.82) across sites. Compared to standardised measures, the BIs had more diagnostic overlap between intellectual and adaptive functioning. The BIs were rated as quick and easy to use and applicable across severities; clear and understandable with adequate to too much level of detail and specificity to describe DID; and useful for treatment selection, prognosis assessments, communication with other health care professionals, and education efforts. CONCLUSION The inclusion of newly developed BIs within the CDDR for ICD-11 Neurodevelopmental Disorders must be supported by information on their reliability, validity, and clinical utility prior to their widespread adoption for international use. BIs were found to have excellent inter-rater reliability, good to excellent concurrent validity, and good clinical utility. This supports use of the BIs within the ICD-11 CDDR to assist with the accurate identification of individuals with DID, particularly in settings where specialised services are unavailable.
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Affiliation(s)
- K R Lemay
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - C S Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - T J Rebello
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and Research Foundation for Mental Hygiene, New York, NY, USA
| | - J W Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - R Bhargava
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - P Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - M Sharma
- School of Social Sciences, Indira Gandhi National Open University, New Delhi, India
| | - J V S Kommu
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - M T Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - J de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - P Ginige
- Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - S Buono
- Department of Psychology, Oasi Research Institute-IRCCS, Troina, Italy
| | - M Recupero
- Department of Psychology, Oasi Research Institute-IRCCS, Troina, Italy
| | - M Zingale
- Department of Psychology, Oasi Research Institute-IRCCS, Troina, Italy
| | - T Zagaria
- Department of Psychology, Oasi Research Institute-IRCCS, Troina, Italy
| | - S Cooray
- Faculty of Psychiatry of Learning Disability, Royal College of Psychiatrists, London, UK
| | - A Roy
- Coventry and Warwickshire Partnership NHS Trust, Birmingham, UK
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - G M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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