Developmental Disabilities

发育障碍
  • 文章类型: Journal Article
    在大多数低收入国家,可以说在较富裕国家的资源匮乏的地区,残疾学龄前儿童及其照顾者在提供保健和社会服务方面被忽视。然而,正如这份对已发表文献的快速回顾所确定的那样,有低成本的,以证据为基础的战略,以满足他们的需求,可以在当地人民的社区实施。检查了必要支架的五个关键特征。首先,创建和实施支持服务所需的领导职能。第二,以家庭为中心,向护理人员和承担这种形式支持的人员提供家庭支持。第三,为同伴支持提供蓬勃发展的机会,并鼓励跨家庭成立倡导团体。第四,动员社区内重要群体的支持:特别是,传统的治疗师和领导者,卫生服务和扶贫倡议。第五,设计如何向儿童提供学前教育机会,作为他们融入小学的前奏。审查还有进一步的目的。它提供了一个例子,说明公共卫生研究人员和学者如何通过向社区从业人员传播,将循证知识更快速地应用到现有和新的支持服务中。
    Preschoolers with disabilities and their caregivers have been neglected in health and social service provision in most low-income countries and arguably also in low-resourced areas of more affluent nations. Yet as this rapid review of the published literature identifies, there are low-cost, evidence-based strategies to address their needs that can be implemented in communities by local people. Five key features of the necessary supports are examined. First, the leadership functions required to create and implement the support services. Second, the family-centred, home-based support provided to caregivers and the personnel undertaking this form of support. Third, providing opportunities for peer support to flourish and encouraging the formation of advocacy groups across families. Fourth, mobilizing the support of significant groups within the community: notably, traditional healers and leaders, health services and poverty alleviation initiatives. Fifth, devising ways in which preschool educational opportunities can be offered to children as a prelude to their inclusion in primary schools. The review serves a further purpose. It provides an example of how public health researchers and academics could achieve more rapid implementation of evidence-based knowledge into existing and new support services through dissemination to community practitioners.
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  • 文章类型: Journal Article
    这项审查的目的是探索父母在急诊科(ED)管理患有智力和/或发育障碍(IDD)的孩子方面的经验和信息需求。我们搜索了六个电子数据库和灰色文献,以确定自2000年以来发表的英文主要研究。我们使用融合集成方法同时合成了定量和定性结果数据,并使用了混合方法评估工具(MMAT)来评估纳入研究的方法学质量。纳入了来自7项研究的9篇文章(3篇定性,3定量,1混合方法)。确定了与父母自我报告经验相关的四个主要主题:1)ED管理和抚养子女的适当性;2)承认/认可子女的IDD并将这些考虑因素纳入整体护理和管理;3)管理和导航ED环境;4)决定在访问ED时披露子女的状况。两篇文章提供了与信息需求相关的数据,强调父母希望拥有支持ED方向的资源,并在ED设置内外访问服务。从数量有限的研究来看,很明显,父母希望与医疗保健提供者进行更好的沟通,并希望ED工作人员对抚养孩子所需的物理空间设置有更多的了解.支持ED员工和父母进行有效沟通和共同努力的资源可以确保满足患有IDD的儿童的护理需求。需要进一步研究了解父母在ED中管理患有IDD的孩子的经验和信息需求,以指导有效资源的开发。
    The objective of this review was to explore parents\' experiences and information needs regarding management of their child with an intellectual and/or developmental disability (IDD) in the emergency department (ED). We searched six electronic databases and grey literature to identify primary studies in English published since 2000. We synthesized quantitative and qualitative outcome data simultaneously using a convergent integrated approach and used a Mixed Methods Appraisal Tool (MMAT) to assess methodological quality of the included studies. Nine articles derived from seven studies were included (3 qualitative, 3 quantitative, 1 mixed method). Four main themes related to parents\' self-reported experiences were identified: 1) appropriateness of the ED to manage and support their child; 2) acknowledgement/recognition of their child\'s IDD and incorporation of those considerations into overall care and management; 3) managing and navigating the ED environment; and 4) decision to disclose their child\'s condition when visiting the ED. Two articles provided data relevant to information needs, highlighting parents\' desire to have resources supporting ED orientation and access to services within and outside of the ED setting. From the limited number of studies, it was evident that parents wanted better communication with healthcare providers and a greater understanding by ED staff around physical space settings needed to support their child. Resources supporting ED staff and parents to communicate effectively and work together can ensure that children with IDDs care needs are met. Further research into understanding parents\' experiences and information needs related to managing a child with an IDD in the ED is needed to guide the development of effective resources.
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  • 文章类型: Journal Article
    背景:建议为患有智力障碍的女孩和年轻女性提供月经教育和月经管理指导,以确保青春期的平稳过渡并支持月经自我调节。
    方法:本系统综述的目的是探索对智障女孩和年轻女性的月经教育干预措施。
    结果:纳入9项研究。在小组(n=4)和单独(n=5)中提供干预。大多数研究使用玩偶(n=7)和任务分析(n=7)来教授垫更换技能。所有参与者都报告了干预后参与者技能和/或知识的显着改善。只有一项研究将自我代理和自尊作为干预的结果。对智障女孩和年轻妇女的月经教育主要侧重于垫替代技能。
    结论:需要进一步的研究来了解月经健康和卫生教育对变量的影响,除了技能提高,如自我调节和与月经健康相关的长期健康结果。
    BACKGROUND: Providing menstrual education and guidance for menstrual management for girls and young women with intellectual disabilities is recommended to ensure smooth pubertal transitions and to support menstrual self-agency.
    METHODS: The purpose of this systematic review is to explore menstrual education interventions for girls and young women with intellectual disabilities.
    RESULTS: Nine studies were included. Interventions were provided in small groups (n = 4) and individually (n = 5). Most studies used dolls (n = 7) and task analysis (n = 7) to teach pad-replacement skills. All reported significant improvements in participant skills and/or knowledge following the intervention. Only one study addressed self-agency and self-esteem as an outcome of the intervention. Menstrual education for girls and young women with intellectual disabilities is largely focused on pad-replacement skills.
    CONCLUSIONS: Further research is needed to understand the impact of menstrual health and hygiene education on variables apart from skill improvement such as self-agency and long-term health outcomes related to menstrual health.
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  • 文章类型: Journal Article
    NR4A2基因编码类固醇-甲状腺激素-类视黄醇受体超家族的孤儿转录因子。这篇综述侧重于迄今为止报道的与致病变异相关的临床发现,包括三个未报告的病例。此外,它在神经退行性疾病中的作用,如帕金森病或阿尔茨海默病,被检查,以及对基于可调节NR4A2转录活性的小分子开发针对这些神经系统疾病的新疗法的最新建议的简要探索。所有患者共有的主要特征是轻度至重度发育迟缓/智力障碍。表达性和接受性语言的中度至重度障碍至少有42%,而53%的患者报告了神经精神问题。运动障碍,包括肌张力障碍,舞蹈病或共济失调,在37%的患者中描述,尽管可能被低估了,因为它经常在青春期晚期-年轻成年期发作。最后,42%的患者出现了令人惊讶的癫痫,其中三个耐药。发病年龄差异很大,从五个月到二十六年,癫痫的分类也是如此,范围从局灶性癫痫到婴儿痉挛或Lennox-Gastaut综合征。因此,我们建议NR4A2应被视为发育性脑病和癫痫性脑病基因诊断的一级靶基因.
    The NR4A2 gene encodes an orphan transcription factor of the steroid-thyroid hormone-retinoid receptor superfamily. This review focuses on the clinical findings associated with the pathogenic variants so far reported, including three unreported cases. Also, its role in neurodegenerative diseases, such as Parkinson\'s or Alzheimer\'s disease, is examined, as well as a brief exploration on recent proposals to develop novel therapies for these neurological diseases based on small molecules that could modulate NR4A2 transcriptional activity. The main characteristic shared by all patients is mild to severe developmental delay/intellectual disability. Moderate to severe disorder of the expressive and receptive language is present in at least 42%, while neuro-psychiatric issues were reported in 53% of patients. Movement disorders, including dystonia, chorea or ataxia, are described in 37% patients, although probably underestimated because of its frequent onset in late adolescence-young adulthood. Finally, epilepsy was surprisingly present in 42% of patients, being drug-resistant in three of them. The age at onset varied widely, from five months to twenty-six years, as did the classification of epilepsy, which ranged from focal epilepsy to infantile spasms or Lennox-Gastaut syndrome. Accordingly, we propose that NR4A2 should be considered as a first-tier target gene for the genetic diagnosis of developmental and epileptic encephalopathy.
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  • 文章类型: Journal Article
    目的:在个人月经周期中教授所需技能的研究支持程序很少。这项研究的目的是双重的。首先,进行了文献综述,以寻找有关月经护理主题的出版物。第二,根据WhatWorksClearinghouse™(WWC)标准对这些研究进行了评估,并进行了分析,以确定是否存在与教授这些技能相关的临床组件.
    方法:根据PRISMA指南进行文献综述。该评论确定了向被诊断患有自闭症谱系障碍(ASD)或其他残疾的人传授月经护理技能的出版物。该综述专门针对采用单主题研究方法的研究。根据WWC的标准对发现的研究进行了分析,以评估每个研究方法的严密性。最后,对与月经护理技能教学相关的临床指标进行分类.
    结果:结果强调缺乏对月经护理技能教学的经验支持。在过去40年的研究中,确定了7项单受试者设计研究。一项研究符合获得WWC最高评级所需的所有标准。
    结论:月经护理技能的复杂性和私密性会使干预发展望而生畏。本文旨在为月经护理研究人员提供实施高质量研究的指导。此外,科学家-从业者可以找到有关重要考虑因素的指导,以支持既有效又尊重的编程。
    OBJECTIVE: There is a paucity in research supporting procedures to teach skills needed during an individual\'s menstrual cycle. The purpose of this study was two-fold. First, a literature review was conducted to find publications on the topic of menstrual care. Second, the studies found were evaluated against What Works Clearinghouse™ (WWC) standards and analyzed to determine the presence of clinical components relevant to teaching these skills.
    METHODS: A literature review was conducted according to PRISMA guidelines. The review identified publications that taught menstrual care skills to individuals diagnosed with autism spectrum disorder (ASD) or other disabilities. The review focused specifically on studies that employed single-subject research methodology. Studies found were analyzed against the WWC\'s criteria to assess the rigor of each studies\' methodology. Finally, studies were categorized across indicators that are clinically relevant to teaching menstrual care skills.
    RESULTS: The results highlighted a lack of empirical support for teaching menstrual care skills. 7 single-subject design studies were identified in the previous 40 years of research. One study met all criteria required to receive the WWC\'s highest rating.
    CONCLUSIONS: The complexity and private nature of menstrual care skills can make intervention development daunting. This paper was intended to provide menstrual care researchers with guidance in implementing high-quality studies. Additionally, scientist-practitioners can find guidance regarding important considerations to support programming that is both effective and respectful.
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  • 文章类型: Journal Article
    背景:成人日服务(ADS)是治疗性的,社会,以及让人们留在家中的健康相关活动,而不是机构设置。虽然有越来越多的关于老年人广告的文献,对于患有智力和/或发育障碍(IDD)的年轻成年人,有关ADS的信息要少得多。
    方法:研究人员对6个数据库(共892篇)进行了范围审查。
    结果:应用纳入和排除标准后,回顾了74篇文章,10篇符合学习要求。研究小组发现,文献仅限于使用ADS作为平台的简单描述性报告或干预措施。
    结论:简单地说,我们对ADS中为患有IDD的年轻人提供的服务知之甚少。讨论了对未来研究的影响,包括需要对ADS中针对IDD年轻人提供的服务进行分类,并评估其对参与者福祉的影响。
    BACKGROUND: Adult day services (ADS) are therapeutic, social, and health-related activities that keep people in their homes, rather than institutional settings. While there is a growing body of literature on ADS for older adults, there is far less information available about ADS for younger adults with intellectual and/or developmental disabilities (IDDs).
    METHODS: Researchers conducted a scoping review of 6 databases (892 total articles).
    RESULTS: After applying inclusion and exclusion criteria, 74 full articles were reviewed, with 10 articles meeting study requirements. The research team found the literature is limited to simple descriptive reports or interventions that use ADS as a platform.
    CONCLUSIONS: Simply put, we know very little about the services provided to younger adults with IDD in ADS. Implications for future research are discussed, including the need to catalog the services offered in ADS for younger adults with IDD and to evaluate their impact on participant well-being.
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  • 文章类型: Journal Article
    背景:大多数患有神经发育障碍(NDD)的儿童居住在低收入和中等收入国家(LMIC)。NDD是撒哈拉以南非洲(SSA)国家的公共卫生问题。已建议将养育护理作为解决儿童发展需求和释放其全部潜力的途径。包括那些有NDD的。然而,在SSA的许多国家,关于使用“培育护理框架”支持NDD儿童的策略的信息很少。这篇综述旨在综合有关SSA中NDD儿童的养育护理实践的信息。审查还将确定在为NDD儿童提供养育护理方面的差距。Further,审查将重点介绍护理的驱动因素以及护理人员的经历。
    方法:审查将分为六个步骤:研究问题的说明,识别相关研究,选择要包括的研究,提取,映射,绘制数据,整理,总结,并报告结果,和利益相关者协商。我们建议进行数据库搜索,然后手动搜索文献综合。我们将搜索以下电子数据库:PubMed,ScienceDirect,Scopus,打开灰色和非洲在线期刊(AJOL)。所有在2018年5月至2023年5月之后发表的包含相关术语的研究都将被识别和纳入。研究小组将开发一个数据提取表格,用于从每个纳入的研究中获取相关信息。将创建一个模式图,该模式图将总结和分析每篇文章的关键发现。
    结论:我们预计这项研究将为现有的养育护理实践提供证据,并揭示在为NDD儿童提供养育护理方面的差距。还将确定照料的关键决定因素以及儿童父母/照料者的经历。该研究将提供有关干预措施的关键建议,以提高NDD儿童的护理质量。通过这项研究,对这些儿童未满足的养育护理需求的认识将会提高。所产生的证据可能有助于决策者和利益相关者解决患有NDD的儿童的需求。
    BACKGROUND: The majority of children with neurodevelopmental disorders (NDDs) reside in low- and middle-income countries (LMICs). NDDs are a public health concern in countries in sub-Saharan Africa (SSA). Nurturing care has been recommended as a pathway for addressing the developmental needs and unlocking the full potential of children, including those with NDDs. However, little information exists on the strategies to support children with NDDs using the Nurturing Care Framework in many countries in SSA. This review aims to synthesize information on nurturing care practices for children with NDDs in SSA. The review will also determine gaps in the provision of nurturing care for children with NDDs. Further, the review will highlight the drivers of care as well as the experiences of the caregivers.
    METHODS: The review will be implemented in six steps: specification of the research question, identification of relevant studies, selection of studies to be included, extracting, mapping, and charting the data, collating, summarizing, and reporting the results, and stakeholder consultation. We propose a database search followed by a manual search for the literature synthesis. We will search the following electronic databases: PubMed, ScienceDirect, Scopus, Open Grey and African Journals Online (AJOL). All studies published after May 2018 to May 2023 that include relevant terms will be identified and included. The research team will develop a data extraction form for use in capturing relevant information from each of the included studies. A patterning chart that will summarize and analyze the key findings of each article will be created.
    CONCLUSIONS: We anticipate that the study will provide evidence on the existing nurturing care practices and unearth gaps in the provision of nurturing care for children with NDDs. Key determinants of care and the experiences of the parents/caregivers of children will also be identified. The study will provide key recommendations on interventions to improve the quality of care for children with NDDs. Through this study, awareness of the unmet nurturing care needs of these children will be increased. The evidence generated may assist policymakers and stakeholders in addressing the needs of children with NDDs.
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  • 文章类型: Journal Article
    ALG13-先天性糖基化障碍(CDG),是由ALG13(OMIM300776)中的致病变体引起的罕见X连接CDG,其影响N连接的糖基化途径。受影响的个体在婴儿期表现为主要的神经系统表现。癫痫痉挛是ALG13-CDG的常见表现症状。其他常见的表型包括发育迟缓,癫痫发作,智力残疾,小头畸形,和低张力。ALG13-CDG的当前管理旨在解决患者的症状。迄今为止,据报道,ALG13-CDG患者不到100人。在这篇文章中,一个国际CDG专家组审查了所有报告的ALG13-CDG患者,并提出了ALG13-CDG的诊断和治疗指南.该指南基于最佳可用数据和专家意见。神经症状在ALG13-CDG的表型中占主导地位,其中癫痫性痉挛被证实是ALG13-CDG最常见的表现症状,与张力减退和发育迟缓有关。我们建议ACTH/泼尼松龙治疗应首先进行试验,其次是vigabatrin,然而,生酮饮食已被证明在ALG13-CDG中具有有希望的结果。为了优化医疗管理,我们还建议早期心脏,胃肠,骨骼,以及受影响患者的行为评估。
    ALG13-Congenital Disorder of Glycosylation (CDG), is a rare X-linked CDG caused by pathogenic variants in ALG13 (OMIM 300776) that affects the N-linked glycosylation pathway. Affected individuals present with a predominantly neurological manifestation during infancy. Epileptic spasms are a common presenting symptom of ALG13-CDG. Other common phenotypes include developmental delay, seizures, intellectual disability, microcephaly, and hypotonia. Current management of ALG13-CDG is targeted to address patients\' symptoms. To date, less than 100 individuals have been reported with ALG13-CDG. In this article, an international group of experts in CDG reviewed all reported individuals affected with ALG13-CDG and suggested diagnostic and management guidelines for ALG13-CDG. The guidelines are based on the best available data and expert opinion. Neurological symptoms dominate the phenotype of ALG13-CDG where epileptic spasm is confirmed to be the most common presenting symptom of ALG13-CDG in association with hypotonia and developmental delay. We propose that ACTH/prednisolone treatment should be trialed first, followed by vigabatrin, however ketogenic diet has been shown to have promising results in ALG13-CDG. In order to optimize medical management, we also suggest early cardiac, gastrointestinal, skeletal, and behavioral assessments in affected patients.
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  • 文章类型: Journal Article
    背景:获得适当的医疗保健对于儿童的健康发展至关重要。这是农村和边远地区所缺乏的,影响健康结果。尽管努力改善这些社区的获取,到目前为止,没有一篇综述系统地绘制了有关有发育需求儿童护理的专职健康模式的文献。这项范围界定审查旨在解决这一知识差距。
    方法:遵守PRISMA-ScR和JoannaBriggs研究所的指导方针,进行了系统的搜索。共检索了8个数据库(从开始到2023年5月)和106个灰色文献来源。两名审稿人独立进行了两阶段的筛选过程。使用定制工具提取数据,并利用医学研究所的质量领域进行叙述合成。这篇评论是通过开放科学框架先验注册的。
    结果:在文献中确定了25篇引文。据报道,来自五个主要是西方国家的各种护理模式。在这些地区确定的护理模式被归类为筛查服务,角色替代,咨询服务,或基于在线的服务。在所有质量领域(除安全性外)报告了对医疗保健质量的积极影响,其中有效性领域是最常见的报告。
    结论:目前针对农村和偏远地区有发育需要的儿童实施了多种护理模式,这些模式似乎提高了护理质量。由于内部的复杂性,和限制,证据基础,尚不清楚一种护理模式是否优于另一种护理模式。这篇综述为进一步研究提供了基础,以探索为什么某些模型可能比其他模型更有效。
    BACKGROUND: Access to appropriate healthcare is essential for children\'s healthy development. This is lacking in rural and remote areas, impacting health outcomes. Despite efforts to improve access for these communities, to date, no review has systematically mapped the literature on allied health models of care for children with developmental needs. This scoping review seeks to address this knowledge gap.
    METHODS: Adhering to the PRISMA-ScR and Joanna Briggs Institute guidelines, a systematic search was conducted. A total of 8 databases (from inception to May 2023) and 106 grey literature sources were searched. Two reviewers independently undertook a two-stage screening process. Data were extracted using customised tools and narratively synthesised utilising the Institute of Medicine\'s quality domains. This review is registered a priori via Open Science Framework.
    RESULTS: Twenty-five citations were identified within the literature. Varied models of care were reported from five mostly Western countries. Models of care identified in these areas were classified as screening services, role substitution, consultative services, or online-based services. Positive impacts on quality of healthcare were reported across all quality domains (apart from safety) with the domain of effectiveness being the most commonly reported.
    CONCLUSIONS: Multiple models of care are currently in operation for children with developmental needs in rural and remote areas and appear to improve the quality of care. Due to complexities within, and limitations of, the evidence base, it is unclear if one model of care is superior to another. This review provides a basis for further research to explore why some models may be more effective than others.
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  • 文章类型: Meta-Analysis
    发展延迟是低收入和中等收入国家的公共卫生问题。然而,在低收入和中等收入国家没有关于发展延迟的总结证据,关于这个问题的初步研究表明,结果各不相同,没有定论。本系统评价和荟萃分析旨在评估低收入和中等收入国家儿童中确认的发育迟缓及其决定因素的汇总程度。
    我们遵循系统评价和荟萃分析(PRISMA)指南的首选报告项目撰写本系统评价和荟萃分析。主要研究从PubMed搜索,PsycINFO,Hinari,科学直接,非洲在线杂志,WebofScience,和谷歌学者数据库。纽卡斯尔-渥太华量表,适应横断面研究,用于评估纳入研究的质量。通过I2和Eggers检验评估异质性和发表偏倚,分别。由于高度的异质性,采用随机效应模型进行分析。具有95%置信区间(CI)的赔率(OR)用于显示发育延迟与其决定因素之间的关联。
    确认发育迟缓的合并患病率为18.83,95%CI(15.53-22.12)。在亚组分析中,在非洲进行的研究中观察到发育迟缓的高患病率[26.69%(95%CI,15.78-37.60)].母亲教育[3.04;95%CI(2.05,4.52)]和低出生体重[3.61;95%CI(1.72,7.57)]是发育迟缓的重要决定因素。
    与高收入国家相比,低收入和中等收入国家的发展延迟合并流行率高。母亲的教育水平和出生时的体重与发育迟缓显着相关。因此,低出生体重率和生活在低收入和中等收入国家的文盲母亲人数。
    PROSPERO,CRD42024513060。
    Developmental delay is a public health problem in low- and middle-income countries. However, there is no summarized evidence in low- and middle-income countries on developmental delay, and primary studies on this issue show varied and inconclusive results. This systematic review and meta-analysis aimed to assess the pooled magnitude of confirmed developmental delay and its determinants among children in low- and middle-income countries.
    We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to write this systematic review and meta-analysis. Primary studies were searched from PubMed, PsycINFO, Hinari, Science Direct, African Journal of Online, Web of Science, and Google Scholar databases. The Newcastle-Ottawa Scale, adapted for the cross-sectional studies, was used to assess the quality of the included studies. Heterogeneity and publication bias were assessed by the I2 and Eggers tests, respectively. Due to the high heterogeneity, the random effects model was used for analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to show the association between developmental delay and its determinants.
    The pooled prevalence of confirmed developmental delay was 18.83, 95% CI (15.53-22.12). In the subgroup analysis, a high prevalence of developmental delay [26.69% (95% CI, 15.78-37.60)] was observed in studies performed in Africa. Maternal education [3.04; 95% CI (2.05, 4.52)] and low birth weight [3.61; 95% CI (1.72, 7.57)] were significant determinants of developmental delay.
    The pooled prevalence of developmental delay in low- and middle-income countries was high as compared to that in high-income countries. Maternal education level and weight at birth were significantly associated with developmental delays. Therefore, strategies should be designed to decrease the rate of low birth weight and the number of illiterate mothers living in low- and middle-income countries.
    PROSPERO, CRD42024513060.
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