Down Syndrome: Current Status, Challenges and Future Perspectives

Global, regional, and national impact of Down syndrome on child and adolescent mortality from 1980 to 2021, with projections to 2050: a cross-sectional study

Introduction

Down syndrome, resulting from trisomy 21, is a prevalent genetic disorder. Despite improvements in life expectancy and quality of life due to medical progress, children and adolescents (under the age of 20 years) with Down syndrome still face higher mortality rates. Future research is essential to elucidate the epidemiological patterns and trends in Down syndrome among children and adolescents, enabling the development of effective prevention and intervention strategies to improve survival and health outcomes.

Methods

This study draws on Global Burden of Disease (GBD) 2021 mortality data for children and adolescents with Down syndrome. Pearson's correlation coefficient was leveraged to assess the relationship between Down syndrome mortality and the Socio-demographic Index (SDI). The estimated annual percentage change (EAPC) in mortality was calculated to track temporal trends, and the Bayesian age-period-cohort (BAPC) model was employed to forecast future mortality.

Results

Over the past 42 years, there have been fluctuations in mortality among children and adolescents with Down syndrome. Globally, deaths have decreased by 22.8% from 26.95 thousand (95% uncertainty interval [UI], 10.10-74.66 thousand) in 1980 to 20.81 thousand (95% UI, 14.18-36.49 thousand) in 2021. Furthermore, BAPC model projections indicate a sustained reduction in mortality for children and adolescents with Down syndrome. Predominantly, deaths occur in 0-4 age group, with higher death rates in Low SDI regions, and notably, the number and rate of female patients exceed those of male patients. Intriguingly, a negative correlation was observed between death rates and higher SDI.

Conclusion

Most countries have seen a decline in Down syndrome deaths among children and adolescents over the last 42 years, but a few high SDI countries are witnessing an increase. Future health interventions should prioritize these countries, focusing on resource allocation, infrastructure, and health education. Continued efforts on care for the 0-4 age group with Down syndrome are crucial to further reducing deaths in this age group.

The good, the bad, and the utilitarian: attitudes towards genetic testing and implications for disability

The present study focused on the link between the attitudes towards genetic testing and views on selective reproduction choices following genetic testing. First, we explored the potential demographical (age, gender, number of children, relationship status) and personal factors (perceived morality, religiosity, parenting intentions, instrumental harm) underlying these attitudes using a specific moral psychology approach, i.e., the two-dimension model of utilitarianism (i.e., instrumental harm and impartial beneficence). Next, we investigated participants' hypothetical reproduction choices depending on the future child's potential future condition, assessed through genetic screening. Our sample consisted of 1627 Romanian adults aged 17 to 70 (M = 24.46). Results indicated that one's perceived morality was the strongest predictor of positive attitudes towards genetic testing, and instrumental harm was the strongest predictor of negative attitudes. Also, more religious individuals with more children had more moral concerns related to genetic testing. Participants considered Down syndrome as the condition that parents (others than themselves) should most take into account when deciding to have children (35%), followed by progressive muscular dystrophy (29.1%) and major depressive disorder (29%). When expressing their choices for their future children (i.e., pregnancy termination decisions), participants' knowledge about potential deafness in their children generated the most frequent (37.7%) definitive termination decisions (i.e., "definitely yes" answers), followed by schizophrenia (35.8%), and major depressive disorder (35.2%). Finally, we discuss our results concerning their practical implications for disability and prenatal screening ethical controversies.

Hashimoto's Thyroiditis and Graves' Disease in Genetic Syndromes in Pediatric Age

Autoimmune thyroid diseases (AITDs), including Hashimoto’s thyroiditis (HT) and Graves’ disease (GD), are the most common cause of acquired thyroid disorder during childhood and adolescence. Our purpose was to assess the main features of AITDs when they occur in association with genetic syndromes. We conducted a systematic review of the literature, covering the last 20 years, through MEDLINE via PubMed and EMBASE databases, in order to identify studies focused on the relation between AITDs and genetic syndromes in children and adolescents. From the 1654 references initially identified, 90 articles were selected for our final evaluation. Turner syndrome, Down syndrome, Klinefelter syndrome, neurofibromatosis type 1, Noonan syndrome, 22q11.2 deletion syndrome, Prader–Willi syndrome, Williams syndrome and 18q deletion syndrome were evaluated. Our analysis confirmed that AITDs show peculiar phenotypic patterns when they occur in association with some genetic disorders, especially chromosomopathies. To improve clinical practice and healthcare in children and adolescents with genetic syndromes, an accurate screening and monitoring of thyroid function and autoimmunity should be performed. Furthermore, maintaining adequate thyroid hormone levels is important to avoid aggravating growth and cognitive deficits that are not infrequently present in the syndromes analyzed.

Measurement of Family Management in Families of Individuals With Down Syndrome: A Cross-Cultural Investigation

Down syndrome (DS) is the most common genetic cause of intellectual disability worldwide. The purpose of this analysis was to determine the internal consistency reliability of eight language versions of the Family Management Measure (FaMM) and compare family management of DS across cultures. A total of 2,740 parents of individuals with DS from 11 countries completed the FaMM. The analysis provided evidence of internal consistency reliability exceeding .70 for four of six FaMM scales for the entire sample. Across countries, there was a pattern of positive family management. Cross-cultural comparisons revealed parents from Brazil, Spain, and the United States had the most positive family management and respondents from Ireland, Italy, Japan, and Korea had the least positive. The rankings were mixed for the four remaining countries. These findings provide evidence of overall strong internal consistency reliability of the FaMM. More cross-cultural research is needed to understand how social determinants of health influence family management in families of individuals with DS.