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Chung J, Krell K, Pless A, Michael C, Torres A, Baker S, Blake JM, Caughman K, Cullen S, Gallagher M, Hoke-Chandler R, Maina J, McLuckie D, O'Neill K, Peña A, Royal D, Slape M, Spinazzi NA, Torres CG, Skotko BG. Healthcare experiences of patients with Down syndrome from primarily Spanish-speaking households. Am J Med Genet A 2023; 191:2132-2141. [PMID: 37338115 PMCID: PMC10524629 DOI: 10.1002/ajmg.a.63250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/28/2023] [Accepted: 05/06/2023] [Indexed: 06/21/2023]
Abstract
We report on the health care experiences of individuals with Down syndrome (DS) from families who are primarily Spanish-speaking. Data were collected through three methods: (1) a nationally distributed, 20-item survey, (2) two focus groups with seven family caregivers of individuals with DS who self-identified as living in primarily Spanish speaking households, and (3) 20 interviews with primary care providers (PCPs) who care for patients who are underrepresented minorities. Standard summary statistics were used to analyze the quantitative survey results. Focus group and interview transcripts, as well as an open-ended response question in the survey, were analyzed using qualitative coding methods to identify key themes. Both caregivers and PCPs described how language barriers make giving and receiving quality care difficult. Caregivers additionally described condescending, discriminatory treatment within the medical system and shared feelings of caregiver stress and social isolation. Challenges to care experienced by families of individuals with DS are compounded for Spanish-speaking families, where the ability to build trust with providers and in the health care system may be compromised by cultural and language differences, systemic issues (lack of time or inability to craft more nuanced schedules so that patients with higher needs are offered more time), mistrust, and sometimes, overt racism. Building this trust is critical to improve access to information, care options, and research opportunities, especially for this community that depends on their clinicians and nonprofit groups as trusted messengers. More study is needed to understand how to better reach out to these communities through primary care clinician networks and nonprofit organizations.
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Affiliation(s)
- Jeanhee Chung
- Laboratory of Computer Science, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kavita Krell
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Albert Pless
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carie Michael
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy Torres
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jasmine M Blake
- Departments of Internal Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Sarah Cullen
- Massachusetts Down Syndrome Congress, Burlington, Massachusetts, USA
| | - Maureen Gallagher
- Massachusetts Down Syndrome Congress, Burlington, Massachusetts, USA
| | | | | | | | - Kate O'Neill
- LuMind IDSC Down Syndrome Foundation, Burlington, Massachusetts, USA
| | - Angeles Peña
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | | | - Michelle Slape
- LuMind IDSC Down Syndrome Foundation, Burlington, Massachusetts, USA
| | - Noemi Alice Spinazzi
- Division of Primary Care, Department of Pediatrics, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Carlos G Torres
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Krell K, Pless A, Michael C, Torres A, Chung J, Baker S, Blake JM, Caughman K, Cullen S, Gallagher M, Hoke-Chandler R, Maina J, McLuckie D, O'Neill K, Peña A, Royal D, Slape M, Spinazzi NA, Torres CG, Skotko BG. Healthcare experiences of patients with Down syndrome who are Black, African American, of African descent, or of mixed race. Am J Med Genet A 2023; 191:742-752. [PMID: 36493376 PMCID: PMC9928895 DOI: 10.1002/ajmg.a.63069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
Scant research has explored the healthcare experiences of people with Down syndrome (DS) in the United States who are Black, African American, of African descent, or of mixed race. The purpose of this study was to identify and describe the barriers and facilitators that such patients and their caregivers face when accessing healthcare. We gathered data in three ways: focus groups with caregivers, a national survey completed by caregivers, and in-depth interviews with primary care providers. Many caregivers and primary care physicians felt that patients with DS who are Black, African American, of African descent, or of mixed race receive a lower quality of medical care than their white counterparts with DS. Caregivers mentioned feeling tired of being reminded by the medical community about their race and wanting acknowledgment that raising a child with DS can be hard at times. Many felt that the medical community's conscious and unconscious racial biases do negatively impact the care of their loved ones with DS. Caregivers desired more race concordant medical providers or, when not possible, medical providers who are willing to learn more about DS and build trusted, longitudinal relationships. Primary care providers discussed the need for funded resources and support services to effectively care for their patients with DS.
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Affiliation(s)
- Kavita Krell
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Albert Pless
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carie Michael
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy Torres
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeanhee Chung
- Laboratory of Computer Science, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jasmine M Blake
- Departments of Internal Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Sarah Cullen
- Massachusetts Down Syndrome Congress, Burlington, Massachusetts, USA
| | - Maureen Gallagher
- Massachusetts Down Syndrome Congress, Burlington, Massachusetts, USA
| | | | | | | | - Kate O'Neill
- LuMind IDSC Down Syndrome Foundation, Burlington, Massachusetts, USA
| | - Angeles Peña
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Michelle Slape
- LuMind IDSC Down Syndrome Foundation, Burlington, Massachusetts, USA
| | - Noemi Alice Spinazzi
- Division of Primary Care, Department of Pediatrics, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Carlos G Torres
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Ho PSY, Quigley MA, Tucker DF, Kurinczuk JJ. Risk factors for hospitalisation in Welsh infants with a congenital anomaly. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001238. [PMID: 36053619 PMCID: PMC8845320 DOI: 10.1136/bmjpo-2021-001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/12/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate risk factor associated with hospitalisation of infants with a congenital anomaly in Wales, UK. DESIGN A population-based cohort study. SETTING Data from the Welsh Congenital Anomaly Register and Information Service linked to the Patient Episode Database for Wales and livebirths and deaths from the Office for National Statistics. PATIENTS All livebirths between 1999 and 2015 with a diagnosis of a congenital anomaly, which was defined as a structural, metabolic, endocrine or genetic defect, as well as rare diseases of hereditary origin. MAIN OUTCOME MEASURES Adjusted OR (aOR) associated with 1 or 2+ hospital admissions in infancy versus no admissions were estimated for sociodemographic, maternal and infant factors using multinomial logistic regression for the subgroups of all, isolated, multiple and cardiovascular anomalies. RESULTS 25 523 infants affected by congenital anomalies experienced a total of 50 705 admissions in infancy. Risk factors for ≥2 admissions were younger maternal age ≤24 years (aOR: 1.17; 95% CI 1.06 to 1.30), maternal smoking (aOR: 1.20; 1.10 to 1.31), preterm birth (aOR: 2.52; 2.25 to 2.83) and moderately severe congenital heart defects (aOR: 6.25; 4.47 to 8.74). Girls had an overall decreased risk of 2+ admissions (aOR: 0.84; 0.78 to 0.91). Preterm birth was a significant risk factor for admissions in all anomaly subgroups but the effect of the other characteristics varied according to anomaly subgroup. CONCLUSIONS Over two-thirds of infants with an anomaly are admitted to hospital during infancy. Our findings identified sociodemographic and clinical characteristics contributing to an increased risk of hospitalisation of infants with congenital anomalies.
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Affiliation(s)
- Peter S Y Ho
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,National Institute for Health Research (NIHR) Policy Research Unit- Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David F Tucker
- Public Health Wales, Public Health Knowledge & Research, Congenital Anomaly Register & Information Service for Wales, Public Health Wales, Swansea, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,National Institute for Health Research (NIHR) Policy Research Unit- Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Impact of prenatal screening on congenital heart defects in neonates with Down syndrome in the US. Pediatr Res 2021; 90:1081-1085. [PMID: 33674738 DOI: 10.1038/s41390-021-01416-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 01/12/2021] [Accepted: 02/02/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Non-invasive prenatal screening (NIPS) has fundamentally changed the screening process for Down syndrome (DS). Rates of complex congenital heart defects (CHD) have decreased in international studies but whether these shifts exist in the US is unknown. METHODS Encounters for neonates with DS from 2007 to 2018 were obtained from the Pediatric Health Information System database. CHD were categorized as complex CHD, atrioventricular septal defects (AVSD), ventricular septal defects (VSD), and tetralogy of Fallot (TOF). Comparisons were made between pre-NIPS era (2007-2010) vs. post-NIPS era (2014-2018) and between states with low vs. high access to pregnancy termination as described by the Guttmacher Institute. RESULTS Among 9122 patients, 6% had complex CHD, 22% had an AVSD, 22% had a VSD, and 4% had TOF. No difference in proportions of CHD was seen between eras. A small difference was observed in the proportion of AVSD between states with low vs. high access to pregnancy termination (23 vs. 17%, p < 0.001). CONCLUSIONS The proportion of CHD in patients with DS appears to be stable despite widespread adoption of NIPS in the US. Variations were observed between states with low vs. high access to pregnancy termination. Population based studies are needed to fully evaluate the current epidemiology of CHD in DS. IMPACT Through investigation of the Pediatric Health Information System database, this study assesses contemporary epidemiology of congenital heart disease among patients with Down syndrome. It has been suggested that improved prenatal screening for Down syndrome has altered the cardiac phenotype in international populations. Whether a similar shift also exists in the United States is unknown. In a contemporary United States cohort, a shift in the proportion or type of heart defects over the past decade was not observed. Regional differences in the proportion of heart defects were seen and may be due to differential access to prenatal care.
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Morris JK, Garne E, Loane M, Barisic I, Densem J, Latos-Bieleńska A, Neville A, Pierini A, Rankin J, Rissmann A, de Walle H, Tan J, Given JE, Claridge H. EUROlinkCAT protocol for a European population-based data linkage study investigating the survival, morbidity and education of children with congenital anomalies. BMJ Open 2021; 11:e047859. [PMID: 34183346 PMCID: PMC8240574 DOI: 10.1136/bmjopen-2020-047859] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Congenital anomalies (CAs) are a major cause of infant mortality, childhood morbidity and long-term disability. Over 130 000 children born in Europe every year will have a CA. This paper describes the EUROlinkCAT study, which is investigating the health and educational outcomes of children with CAs for the first 10 years of their lives. METHODS AND ANALYSIS EUROCAT is a European network of population-based registries for the epidemiological surveillance of CAs. EUROlinkCAT is using the EUROCAT infrastructure to support 22 EUROCAT registries in 14 countries to link their data on births with CAs to mortality, hospital discharge, prescription and educational databases. Once linked, each registry transforms their case data into a common data model (CDM) format and they are then supplied with common STATA syntax scripts to analyse their data. The resulting aggregate tables and analysis results are submitted to a central results repository (CRR) and meta-analyses are performed to summarise the results across all registries. The CRR currently contains data on 155 594 children with a CA followed up to age 10 from a population of 6 million births from 1995 to 2014. ETHICS The CA registries have the required ethics permissions for routine surveillance and transmission of anonymised data to the EUROCAT central database. Each registry is responsible for applying for and obtaining additional ethics and other permissions required for their participation in EUROlinkCAT. DISSEMINATION The CDM and associated documentation, including linkage and standardisation procedures, will be available post-EUROlinkCAT thus facilitating future local, national and European-level analyses to improve healthcare. Recommendations to improve the accuracy of routinely collected data will be made.Findings will provide evidence to inform parents, health professionals, public health authorities and national treatment guidelines to optimise diagnosis, prevention and treatment for these children with a view to reducing health inequalities in Europe.
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Affiliation(s)
- Joan K Morris
- Population Health Research Institute, St George's University of London, London, UK
| | - Ester Garne
- Paediatric Department, Hospital Lillebaelt, Kolding, Denmark
| | - Maria Loane
- Faculty of Life and Health Sciences, Ulster University, Coleraine, UK
| | - Ingeborg Barisic
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | | | - Anna Latos-Bieleńska
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Amanda Neville
- IMER Registry (Emila Romagna Registry of Birth Defects), University Hospital of Ferrara, Emilia-Romagna, Italy
| | - Anna Pierini
- Instituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Hermien de Walle
- Department of Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Joachim Tan
- Population Health Research Institute, St George's University of London, London, UK
| | - Joanne Emma Given
- Faculty of Life and Health Sciences, Ulster University, Coleraine, UK
| | - Hugh Claridge
- Population Health Research Institute, St George's University of London, London, UK
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6
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The direct health care cost to Medicare of Down syndrome dementia as compared with Alzheimer's disease among 2015 Californian beneficiaries. Ann Phys Rehabil Med 2020; 64:101430. [PMID: 32853759 DOI: 10.1016/j.rehab.2020.07.011] [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] [Received: 08/06/2019] [Revised: 07/05/2020] [Accepted: 07/12/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Aging individuals with Down syndrome (DS) are at increased risk of dementia due to trisomy of chromosome 21 on which the amyloid precursor protein gene is located and with increased life expectancy. Yet, little is known about the costs associated with DS dementia and how this compares to Alzheimer's disease (AD). OBJECTIVE To better understand direct healthcare costs and care consumption in DS dementia, we compared the total cost of care to US Medicare and the drivers of these medical expenditures in individuals with DS with and without dementia, and in those with AD without DS. METHODS The effect of dementia in DS on costs and care utilization was estimated with 2015 California Medicare fee-for-service data (parts A and B). Among 3,001,977 Californian Medicare beneficiaries, 353 individuals had DS with dementia (age 45-89 years). We compared their number of chronic comorbidity conditions among 27 and their care and Medicare costs to those of age- and sex-matched individuals with DS without dementia and those with AD without DS. RESULTS Medicare annual cost per beneficiary was a mean of 43.5% and 82.2% higher with DS dementia (mean $35,011) than DS without dementia (mean $24,401) and AD without dementia (mean $19,212), related to greater utilization of inpatient services. DS dementia was associated with increased level of multimorbidity (mean of 3.4 conditions in addition to dementia vs. 2.7 and 2.2 conditions for DS without dementia and AD, respectively), with more emergency room visits (88% vs. 76.5% and 54.4%) and with more primary care physician visits (91.2% vs. 87.3% and 81.3%). CONCLUSION DS adults with dementia have higher health care costs than DS adults without dementia and adults with AD. Understanding costs and complex health care needs in DS dementia could facilitate management of adult and geriatric care resources for these high-need high-cost individuals.
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7
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Knollman PD, Heubi CH, Wiley S, Smith DF, Shott SR, Ishman SL, Meinzen-Derr J. Demographic and Clinical Characteristics Associated With Adherence to Guideline-Based Polysomnography in Children With Down Syndrome. Otolaryngol Head Neck Surg 2020; 164:877-883. [PMID: 32928046 DOI: 10.1177/0194599820954837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare the demographic and clinical characteristics of children with Down syndrome who did and did not receive polysomnography to evaluate for obstructive sleep apnea after publication of the American Academy of Pediatrics' guidelines recommending universal screening by age 4 years. STUDY DESIGN Retrospective cohort study. SETTING Single tertiary pediatric hospital. METHODS Review was conducted of children with Down syndrome born between 2007 and 2012. Children who obtained polysomnography were compared with children who did not, regarding demographic data, socioeconomic status, and comorbidities. RESULTS We included 460 children with Down syndrome; 273 (59.3%) received at least 1 polysomnogram, with a median age of 3.6 years (range, 0.1-8.9 years). There was no difference in the distribution of sex, insurance status, or socioeconomic status between children who received polysomnography and those who did not. There was a significant difference in race distribution (P = .0004) and distance from home to the medical center (P < .0001) between groups. Among multiple medical comorbidities, only children with a history of hypothyroidism (P = .003) or pulmonary aspiration (P = .01) were significantly more likely to have obtained polysomnography. CONCLUSIONS Overall, 60% of children with Down syndrome obtained a polysomnogram. There was no difference between groups by payer status or socioeconomic status. A significant difference in race distribution was noted. Proximity to the medical center and increased medical need appear to be associated with increased likelihood of obtaining a polysomnogram. This study illustrates the need for improvement initiatives to increase the proportion of patients receiving guideline-based screening.
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Affiliation(s)
- Philip D Knollman
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Christine H Heubi
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - David F Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sally R Shott
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stacey L Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jareen Meinzen-Derr
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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8
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Abstract
Introducción: El síndrome de Down presenta importantes diferencias en tasas de incidencia según territorios y países, siendo además una de los trastornos genéticos más complejos, aunque su detección sea la más precoz de los trastornos genéticos. En España se ha producido una drástica reducción de nacimientos, existiendo un aumento en otras zonas del mundo como Latinoamérica. Objetivo y método: Se pretende realizar una revisión sistemática sobre el conocimiento científico actual relacionado con intervenciones tempranas en SD desde los años 2000 al 2017, utilizando la metodología PRISMA. Resultados: Se observa intensas lagunas metodológicas, enfatizándose las investigaciones transversales por encima de los longitudinales y sobre todo en zonas concretas del mundo. De este síndrome siguen interesando los factores cognitivos en detrimento de variables familiares y otros aspectos claves para un desarrollo psicoevolutivo adecuado. No se observan trabajos de intervención temprana ni de evaluación de programas en países hispanohablantes, y la mayoría de publicaciones científicas mezclan edades y sexos en sus muestras. Discusión: Se discuten los resultados obtenidos de la revisión realizada. Conclusiones: A lo largo del tiempo se observa una importante reducción del interés científico por este síndrome. Se siguen realizando trabajos de manera redundante sobre los mismos aspectos, sin valorar subdimensiones imprescindibles para el desarrollo biopsicosocial de este colectivo.
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9
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Ridding A, Williams J. Being a dad to a child with Down's syndrome: Overcoming the challenges to adjustment. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:678-690. [PMID: 30632665 PMCID: PMC6850302 DOI: 10.1111/jar.12563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 11/22/2018] [Accepted: 12/01/2018] [Indexed: 11/28/2022]
Abstract
Background Historically, research exploring the impact of having a child with an Intellectual Disability (ID), has focussed exclusively on mothers. The present study aimed to investigate fathers’ experiences of parenting a child with Down's syndrome (DS), their contributions, influences on family functioning and inclusion in their child's support provision. Method Semi‐structured interviews were conducted with 15 fathers. Interviews were analysed using Grounded Theory (GT). Results Fathers’ adjustment appeared to be on a fluid trajectory with three key categories influencing this: “Accommodating the Child,” “Adapting the Parental/Spousal Role” and “Adapting Society.” Conclusions The accounts uncovered fathers’ adjustment trajectory to parenting a child with DS, concluding that despite practical and emotional challenges, fathers employed strategies to achieve positive adjustment. Fathers identified the need for services to recognize their role and involve them in their child's support provision. Implications for clinical practice and future research are discussed.
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10
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Dukhovny D, Hwang SS, Gopal D, Cabral H, Missmer S, Diop H, Declercq E, Stern JE. Length of stay and cost of birth hospitalization: effects of subfertility and ART. J Perinatol 2018; 38:1457-1465. [PMID: 30166621 PMCID: PMC6217794 DOI: 10.1038/s41372-018-0205-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to measure delivery length of stay (LOS) and cost as proxies for infant morbidity in assisted reproductive technology (ART) and subfertile deliveries. STUDY DESIGN Massachusetts singleton births, ≥ 23 weeks gestational age (GA) between 2004 and 2010, were linked with ART data, vital records, and hospital discharges. LOS and costs (2010 US dollars) of infants born to fertile (no ART or indicators of infertility), subfertile (indicators of infertility but no ART), and ART-treated (linked to ART data) deliveries were compared. Least-square means and SE were calculated. RESULTS Of 345,756 singletons (fertile n = 332,481, subfertile n = 4987, and ART-treated n = 8288), overall LOS was 3.79 ± 0.01, 4.32 ± 0.15, and 4.90 ± 0.04 days, and costs were $2980 ± 6, $3217 ± 58, and $4483 ± 62, respectively. GA and birthweight predicted much of the intergroup difference. CONCLUSION Maternal fertility group was not an independent predictor of infant LOS and costs. Prematurity and birthweight were driving factors in resource utilization.
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Affiliation(s)
- Dmitry Dukhovny
- Department of Pediatrics, Oregon Health and Science University, Portland, USA.
| | - Sunah S. Hwang
- Section of Neonatology, Department of Pediatrics,
University of Colorado School of Medicine
| | - Daksha Gopal
- Department of Biostatistics, Boston University School of
Public Health
| | - Howard Cabral
- Department of Biostatistics, Boston University School of
Public Health
| | - Stacey Missmer
- Department of Obstetrics, Gynecology, and Reproductive
Biology, Michigan State University
| | | | - Eugene Declercq
- Department of Community Health Sciences, Boston University
School of Public Health
| | - Judy E. Stern
- Department of Obstetrics and Gynecology and Pathology,
Dartmouth-Hitchcock
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11
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Dunn K, Hughes-McCormack L, Cooper SA. Hospital admissions for physical health conditions for people with intellectual disabilities: Systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31 Suppl 1:1-10. [PMID: 28467010 DOI: 10.1111/jar.12360] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND People with intellectual disabilities may have inequalities in hospital admissions compared with the general population. The present authors aimed to investigate admissions for physical health conditions in this population. METHODS The present authors conducted a systematic review, searching six databases using terms on intellectual disabilities and hospital admission. Papers were selected based on pre-defined inclusion/exclusion criteria, data extracted, tabulated and synthesized and quality assessed. PROSPERO registration number: CRD42015020575. RESULTS Seven of 29,613 papers were included. There were more admissions, and a different pattern of admissions (more medical and dental), for people with intellectual disabilities, but most studies did not take account of higher disease prevalence. Three papers considered admissions for ambulatory care-sensitive conditions, two of which accounted for disease prevalence (asthma, diabetes) and found higher admission rates for people with intellectual disabilities. CONCLUSION Admissions are common. Asthma and diabetes admission data suggest suboptimal primary health care for people with intellectual disabilities compared with the general population, but evidence is limited.
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Affiliation(s)
- Kirsty Dunn
- Institute of Health and Wellbeing, Gartnavel Royal Hospital, University of Glasgow, Glasgow, UK
| | - Laura Hughes-McCormack
- Institute of Health and Wellbeing, Gartnavel Royal Hospital, University of Glasgow, Glasgow, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, Gartnavel Royal Hospital, University of Glasgow, Glasgow, UK
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Courtney-Long EA, Romano SD, Carroll DD, Fox MH. Socioeconomic Factors at the Intersection of Race and Ethnicity Influencing Health Risks for People with Disabilities. J Racial Ethn Health Disparities 2017; 4:213-222. [PMID: 27059052 PMCID: PMC5055843 DOI: 10.1007/s40615-016-0220-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/19/2016] [Accepted: 03/09/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES People with disabilities are known to experience disparities in behavioral health risk factors including smoking and obesity. What is unknown is how disability, race/ethnicity, and socioeconomic status combine to affect prevalence of these health behaviors. We assessed the association between race/ethnicity, socioeconomic factors (income and education), and disability on two behavioral health risk factors. METHODS Data from the 2007-2010 Behavioral Risk Factor Surveillance System were used to determine prevalence of cigarette smoking and obesity by disability status, further stratified by race and ethnicity as well as income and education. Logistic regression was used to determine associations of income and education with the two behavioral health risk factors, stratified by race and ethnicity. RESULTS Prevalence of disability by race and ethnicity ranged from 10.1 % of Asian adults to 31.0 % of American Indian/Alaska Native (AIAN) adults. Smoking prevalence increased with decreasing levels of income and education for most racial and ethnic groups, with over half of white (52.4 %) and AIAN adults (59.3 %) with less than a high school education reporting current smoking. Education was inversely associated with obesity among white, black, and Hispanic adults with a disability. CONCLUSION Smoking and obesity varied by race and ethnicity and socioeconomic factors (income and education) among people with disabilities. Our findings suggest that disparities experienced by adults with disabilities may be compounded by disparities associated with race, ethnicity, and socioeconomic factors. This knowledge may help programs in formulating health promotion strategies targeting people at increased risk for smoking and obesity, inclusive of those with disabilities.
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Affiliation(s)
- Elizabeth A Courtney-Long
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mailstop E-88, Atlanta, GA, 30341-3717, USA.
| | - Sebastian D Romano
- Oak Ridge Institute for Science and Education Fellowship with the National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA
- Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE MS E-97, Atlanta, GA, 30333, USA
| | - Dianna D Carroll
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mailstop E-88, Atlanta, GA, 30341-3717, USA
- Commissioned Corps, U.S. Public Health Service, Atlanta, GA, USA
| | - Michael H Fox
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mailstop E-88, Atlanta, GA, 30341-3717, USA
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Contributions to Racial Disparity in Mortality among Children with Down Syndrome. J Pediatr 2016; 174:240-246.e1. [PMID: 27063805 DOI: 10.1016/j.jpeds.2016.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/19/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate whether racial differences across a variety of medical factors collected in a longitudinal clinical database at a specialty clinical for children with Down syndrome provide insight into contributors to racial disparity in mortality. STUDY DESIGN Comprehensive medical histories of 763 children receiving medical care at a Down syndrome specialty clinic were retrospectively reviewed regarding prenatal, postnatal, and medical issues, as well as subspecialty referrals. Frequency calculations and logistic regression were performed. The National Death Index was used to query death record databases to correlate medical histories with mortality data. RESULTS Prenatal drug use and intubation were significantly more frequent, but hyperbilirubinemia was significantly less frequent, in black children compared with white children with Down syndrome. Among children with Down syndrome aged <5 years, significant increases in referral to cardiology were seen for black children compared with white children. Trends were seen in an increased incidence of congenital heart disease for black children. Correlations with death records did not demonstrate differences in rates of cardiac-related deaths. Minimal racial disparity was seen for all other measures investigated. CONCLUSION Racial disparity in mortality exists, but the underlying cause remains unidentified despite use of a comprehensive, longitudinal database of individuals with Down syndrome and review of death records. Referrals to cardiology might be a clue to the underlying cause, perhaps as an indicator of access to care, but cardiac disease does not account for the disparity in mortality.
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Riehle-Colarusso T, Oster ME. Down Syndrome: Changing Cardiac Phenotype? Pediatrics 2016; 138:peds.2016-1223. [PMID: 27252034 PMCID: PMC5482505 DOI: 10.1542/peds.2016-1223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tiffany Riehle-Colarusso
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia; and
| | - Matthew E. Oster
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia,Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
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Cuskelly M. Contributors to Adult Sibling Relationships and Intention to Care of Siblings of Individuals With Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 121:204-218. [PMID: 27119212 DOI: 10.1352/1944-7558-121.3.204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The contribution of childhood sibling relationships to adult sibling relationships and intention to provide care was investigated in a sample in which one member of each dyad had Down syndrome. Thirty-nine adult siblings of an adult with Down syndrome who had participated in a study of sibling relationships in childhood/adolescence provided data about the quality of current relationships and of their intention to provide care for their brother/sister with Down syndrome in the future. Only behavior problems in the child with Down syndrome predicted warmth of the current adult relationship. Although adult sibling relationships were reported to be warm, the quality of neither the current nor the past relationship was associated with the reported intention to provide care.
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Affiliation(s)
- Monica Cuskelly
- Monica Cuskelly, The University of Queensland, School of Education, Brisbane, Queensland, Australia
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Cassell CH, Grosse SD, Kirby RS. Leveraging birth defects surveillance data for health services research. ACTA ACUST UNITED AC 2014; 100:815-21. [DOI: 10.1002/bdra.23330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Cynthia H. Cassell
- National Center on Birth Defects and Developmental Disabilities; Centers for Disease Control and Prevention; Atlanta Georgia
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities; Centers for Disease Control and Prevention; Atlanta Georgia
| | - Russell S. Kirby
- Birth Defects Surveillance Program; Department of Community and Family Health; College of Public Health, University of South Florida; Tampa Florida
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Dawson AL, Cassell CH, Oster ME, Olney RS, Tanner JP, Kirby RS, Correia J, Grosse SD. Hospitalizations and associated costs in a population-based study of children with Down syndrome born in Florida. ACTA ACUST UNITED AC 2014; 100:826-36. [PMID: 25124730 DOI: 10.1002/bdra.23295] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/11/2014] [Accepted: 07/22/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Our objective was to examine differences in hospital resource usage for children with Down syndrome by age and the presence of other birth defects, particularly severe and nonsevere congenital heart defects (CHDs). METHODS This was a retrospective, population-based, statewide study of children with Down syndrome born 1998 to 2007, identified by the Florida Birth Defects Registry (FBDR) and linked to hospital discharge records for 1 to 10 years after birth. To evaluate hospital resource usage, descriptive statistics on number of hospitalized days and hospital costs were calculated. Results were stratified by isolated Down syndrome (no other coded major birth defect); presence of severe and nonsevere CHDs; and presence of major FBDR-eligible birth defects without CHDs. RESULTS For 2552 children with Down syndrome, there were 6856 inpatient admissions, of which 68.9% occurred during the first year of life (infancy). Of the 2552 children, 31.7% (n = 808) had isolated Down syndrome, 24.0% (n = 612) had severe CHDs, 36.3% (n = 927) had nonsevere CHDs, and 8.0% (n = 205) had a major FBDR-eligible birth defect in the absence of CHD. Infants in all three nonisolated DS groups had significantly higher hospital costs compared with those with isolated Down syndrome. From infancy through age 4, children with severe CHDs had the highest inpatient costs compared with children in the other sub-groups. CONCLUSION Results support findings that for children with Down syndrome the presence of other anomalies influences hospital use and costs, and children with severe CHDs have greater hospital resource usage than children with other CHDs or major birth defects without CHDs.
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Affiliation(s)
- April L Dawson
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
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