Developmental Disabilities

发育障碍
  • DOI:
    文章类型: Journal Article
    背景:患有智力和发育障碍(IDD)的人面临无法满足的医疗保健需求的高风险,并面临公平护理的障碍,然而,很少有卫生专业学生接受足够的培训来满足这些需求。
    目标:计划并实施了与宾夕法尼亚州特殊奥林匹克运动会(SOPA)运动员和工作人员的互动小组讨论,以便卫生专业的学生/受训者获得IDD知识,健康障碍,SOPA资源,志愿者的机会。
    方法:小组成员包括两名SOPA运动员及其导师;有关个人医疗保健经验的问题征求了回应(2019年秋季)。与会者完成了一项混合方法的事件后调查,以获取事件满意度,反思,以及对了解更多有关IDD患者的兴趣。
    结果:有60人参加,43人(72%)完成了事件后评估。与会者报告满意度高(88%),对未来培训的渴望(100%),和学习交流的兴趣(88%),提供护理(88%),并解决IDD健康障碍(91%)。
    结论:协作社区小组可以有效地让医疗保健学生参与有关护理IDD患者的讨论。
    BACKGROUND: People with intellectual and developmental disabilities (IDD) are at high risk for unmet health care needs and face barriers to equitable care, yet few health professions students receive adequate training to meet these needs.
    OBJECTIVE: An interactive panel discussion with Special Olympics Pennsylvania (SOPA) athletes and staff was planned and implemented so that health professions students/trainees would gain knowledge of IDD, health barriers, SOPA resources, and volunteer opportunities.
    METHODS: Panelists included two SOPA athletes and their mentors; questions solicited responses about personal health care experiences (Fall 2019). Attendees completed a mixed-methods post-event survey capturing event satisfaction, reflections, and interest in learning more about patients with IDD.
    RESULTS: Sixty individuals attended, and 43 (72%) completed post-event evaluation. Attendees reported high satisfaction (88%), desire for future trainings (100%), and interest in learning about communicating (88%), providing care (88%), and addressing IDD health barriers (91%).
    CONCLUSIONS: Collaborative community panels could be effective in engaging health care students in discussion about caring for patients with IDD.
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  • 文章类型: Journal Article
    目的:探索以全球发育迟缓和癫痫为特征的儿童的遗传基础。
    方法:选择2023年2月19日在广州市妇女儿童医学中心柳州医院就诊的儿童作为研究对象。收集患儿的临床资料。这个孩子接受了整个外显子组测序,候选变异体通过Sanger测序和生物信息学分析进行验证。
    结果:孩子,一个8个月大的女孩,表现为全球发育迟缓,癫痫,和高乳酸血症.颅骨MRI显示不同的骨髓增生性脑白质营养不良。脑电图显示背景活动缓慢。基因检测显示,她携带了SLC25A12基因的纯合变体,即c.115T>G(p.Phe39Val),她的父母都是杂合携带者。根据美国医学遗传学和基因组学学院的指南,预测该变体具有不确定的意义(PM2_支持+PM3_支持+PP3_中度+PP4_中度)。I-Mutantv3.0软件预测该变体可能会影响蛋白质产物的稳定性。
    结论:纯合c.115T>G(p。Phe39Val)SLC25A12基因的变异可能是该儿童疾病的发病机理。
    OBJECTIVE: To explore the genetic basis for a child featuring global developmental delay and epilepsy.
    METHODS: A child who had presented at Guangzhou Women and Children\'s Medical Center Liuzhou Hospital on February 19, 2023 was selected as the study subject. Clinical data of the child was collected. The child was subjected to whole exome sequencing, and candidate variant was validated by Sanger sequencing and bioinformatic analysis.
    RESULTS: The child, an 8-month-old girl, had manifested with global developmental delay, epilepsy, and hyperlactacidemia. Cranial MRI revealed diverse hypomyelinating leukodystrophies. Electroencephalogram showed slow background activities. Genetic testing revealed that she has harbored a homozygous variant of the SLC25A12 gene, namely c.115T>G (p.Phe39Val), for which both of her parents were heterozygous carriers. Based on the guidelines from the American College of Medical Genetics and Genomics, the variant was predicted to be of uncertain significance (PM2_Supporting+PM3_Supporting+PP3_Moderate+PP4_Moderate). I-Mutant v3.0 software predicted that the variant may affect the stability of protein product.
    CONCLUSIONS: The homozygous c.115T>G (p.Phe39Val) variant of the SLC25A12 gene probably underlay the pathogenesis of the disease in this child.
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  • 文章类型: Journal Article
    目的:探讨1例智力发育障碍(IDD)合并癫痫患儿的临床特征和遗传基础。
    方法:选取广东医科大学附属医院儿童医学中心2021年2月收治的儿童作为研究对象。收集患儿的临床资料。收集儿童及其父母的外周血样本并进行全外显子组测序(WES)。通过Sanger测序验证候选变体。
    结果:患者,一个3个月27天的女婴,在新生儿期出现了症状,其中包括严重的发育迟缓,呼吸困难和停顿,增加了四肢的肌肉张力,喂养困难,和癫痫发作。脑MRI显示双侧小脑发育不全,视频脑电图显示,主要来自右顶叶的尖锐波略有增加,枕骨,和后颞区。WES透露,她有一个误解c.3196G>A(p。Glu1066Lys)CLTC基因的变体,通过Sanger测序证实是从头的。根据美国医学遗传学和基因组学学院(ACMG)的指南,该变异体被分类为可能致病(PS2+PM2_支持+PP3)。
    结论:c.3196G>A(p。Glu1066Lys)CLTC基因的错义变异可能是该儿童发病机理的基础。上述发现促进了她的诊断和治疗。
    OBJECTIVE: To explore the clinical features and genetic basis for a child with Intellectual developmental disorder (IDD) and epilepsy.
    METHODS: A child who was admitted to the Children\'s Medical Center of the Affiliated Hospital of Guangdong Medical University in February 2021 was selected as the study subject. Clinical data of the child was collected. Peripheral blood samples of the child and her parents were collected and subjected to whole exome sequencing (WES). Candidate variant was verified by Sanger sequencing.
    RESULTS: The patient, a 3-month-and-27-day female infant, had developed the symptoms in the neonatal period, which included severe developmental delay, respiratory difficulties and pauses, increased muscle tone of four limbs, feeding difficulty, and seizures. Cerebral MRI revealed bilateral cerebellar hypoplasia, and video EEG showed slightly increased sharp waves emanating predominantly from the right parietal, occipital, and posterior temporal regions. WES revealed that she has harbored a missense c.3196G>A (p.Glu1066Lys) variant of the CLTC gene, which was confirmed to be de novo by Sanger sequencing. Based on the guideline from the American College of Medical Genetics and Genomics (ACMG), the variant was classified as likely pathogenic (PS2+PM2_Supporting+PP3).
    CONCLUSIONS: The c.3196G>A (p.Glu1066Lys) missense variant of the CLTC gene probably underlay the pathogenesis in this child. Above finding has facilitated her diagnosis and treatment.
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  • 文章类型: Journal Article
    目的:回顾性评估两种轮椅座椅系统的比较效果,定制外形轮椅座椅(CCS)和模块化轮椅座椅(MWS),关于患有神经肌肉和神经系统疾病的儿童的脊柱侧凸进展,并确定脊柱侧凸进展的任何预测因素。
    方法:纵向,回顾性队列研究设置:国家卫生服务区域姿势和行动服务参与者:患有神经肌肉和神经系统疾病的非门诊儿科轮椅使用者(N=75;36男性,39名女性;座位干预时的平均年龄,10.50±3.97年)由南威尔士态势和机动性服务于2012年至2022年发布的CCS和MWS。
    方法:两种专门的轮椅座椅系统,CCS和MWS。
    方法:使用广义最小二乘(GLS)模型来估计座椅类型随时间对Cobb角的影响。
    结果:在75名参与者中,51%有脑瘫。50个发行了CCS,25个发行了MWS。MWS组的基线Cobb角为32.9±18.9°,CCS组为48.0±31.0°。GLS模型证明了自坐位干预以来的时间(χ2=122,p<0.0001),座椅类型(χ2=52.5,p<0.0001),和基线脊柱侧凸严重程度(χ2=41.6,p<0.0001)可预测脊柱侧凸进展。条件不是一个强有力的预测因子(χ2=9.96,p=.0069),性别(χ2=5.67,p=.13)和干预年龄(χ2=4.47,p=.35)均无预测作用。随着时间的推移,医疗状况与座椅类型的估计对比表明,随着时间的推移,MWS和CCS之间的差异较小。与MWS相比,预测的脊柱侧凸速度随着时间的推移随着CCS的使用而减弱。虽然,脊柱侧凸恶化,无论干预。
    结论:我们的研究结果表明,与MWS相比,患有神经和神经肌肉疾病的儿童轮椅使用者,CCS处方显示随着时间的推移脊柱侧凸进展有更大的缓解。
    OBJECTIVE: To retrospectively evaluate the comparative effect of two wheelchair seating systems, Custom-Contoured Wheelchair Seating (CCS) and Modular Wheelchair Seating (MWS), on scoliosis progression in children with neuromuscular and neurological disorders and to determine any predictors for scoliosis progression.
    METHODS: Longitudinal, retrospective cohort study SETTING: National Health Service regional posture and mobility service PARTICIPANTS: Non-ambulant paediatric wheelchair users with neuromuscular and neurological disorders (N = 75; 36 male, 39 female; mean age at seating intervention, 10.50 ± 3.97 years) issued CCS and MWS by the South Wales Posture and Mobility Service from 2012 to 2022.
    METHODS: Two specialized wheelchair seating systems, CCS and MWS.
    METHODS: A generalized least squares (GLS) model was used to estimate the effect of seat type on Cobb angle over time.
    RESULTS: Of the 75 participants enrolled, 51% had cerebral palsy. Fifty were issued CCS and 25 were issued MWS. Baseline Cobb angle was 32.9±18.9° for the MWS group and 48.0±31.0° for the CCS group. The GLS model demonstrated that time since seating intervention (χ2 = 122, p < .0001), seating type (χ2 = 52.5, p < .0001), and baseline scoliosis severity (χ2 = 41.6, p < .0001) were predictive of scoliosis progression. Condition was not a strong predictor (χ2 = 9.96, p = .0069), and sex (χ2 = 5.67, p = .13) and age at intervention (χ2 = 4.47, p = .35) were not predictive. Estimated contrasts of medical condition with seat type over time demonstrated smaller differences between MWS and CCS over time. Predicted scoliosis velocity was found to attenuate with use of CCS over time compared to MWS, although, scoliosis deteriorated regardless of intervention.
    CONCLUSIONS: Our findings showed paediatric wheelchair users with neurological and neuromuscular disorders prescribed CCS showed greater mitigation of scoliosis progression over time compared to those issued MWS.
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  • 文章类型: Journal Article
    背景:先前的研究将组织文化确定为与具有智力和发育障碍的团体家庭居民的生活质量结果相关的许多因素之一。本研究旨在阐述英格兰地区群体家庭文化的维度。
    方法:参与者的观察和对工作人员的半结构化访谈在两组家庭中进行。字段注释,采访笔记和成绩单进行了分析,使用归纳主题分析的研究人员天真的项目和以前的文献。在对先前文献中的理论模型敏感后,重新检查了初始编码,以确定最简约的拟合。对于每个维度,使用五点李克特量表对两种设置进行评级和比较。
    结果:这些发现描述了七个维度的群体家庭文化。不同方面的评级好坏参半,反映了员工实践中反映的文化不一致。在团体住宅中分配全球文化评级的挑战,其中包括随着时间的推移,多名员工和多名居民之间的互动,被突出显示。
    结论:文化观察措施的发展被强调为有智力和发育障碍的个人服务中的理解和应对文化可能有帮助。
    BACKGROUND: Previous research identifies organisational culture as one of a number of factors associated with the quality of life outcomes of group home residents\' with intellectual and developmental disabilities. This study aims to elaborate on the dimensions of group home culture in settings in England.
    METHODS: Participant observations and semi-structured interviews with staff were carried out in two group homes. Field-notes, interview notes and transcripts were analysed using inductive thematic analysis by a researcher naïve to the project and the previous literature. Initial coding was re-examined after sensitisation to theorised models in previous literature to identify the most parsimonious fit. The two settings were rated and compared using a five-point Likert scale for each of the dimensions.
    RESULTS: The findings describe group home culture across seven dimensions. There were mixed ratings across the different dimensions reflecting inconsistencies in culture that were reflected in staff practice. The challenge in assigning a global rating of culture in group homes, which includes interactions across multiple staff and multiple residents over time, was highlighted.
    CONCLUSIONS: The development of an observational measure of culture is highlighted as potentially helpful in understanding and responding to culture in services for individuals with intellectual and developmental disabilities.
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  • 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: Case Reports
    虽然平衡的相互易位相对常见,它们通常在临床上保持沉默,除非它们导致功能基因的破坏。在这项研究中,我们介绍了一个男孩表现出发育迟缓和轻度智力障碍的情况。初始核型分析显示染色体5和6之间的易位t(5;6)(q13;q23),分辨率有限。光学基因组作图(OGM)能够更精确地描绘相互易位中涉及的断点区域。虽然6号染色体上的断点区不包含任何已知的基因,OGM揭示了5号染色体上RASGRF2(Ras蛋白特异性鸟嘌呤核苷酸释放因子2)基因的破坏,暗示RASGRF2是导致患者观察到的发育延迟的潜在候选基因。到目前为止,尚未报道RASGRF2在发育迟缓方面的变化,但是对RASGRF2基因的研究强调了它在神经发育各个方面的重要性,包括突触可塑性,信号通路,和行为反应。这项研究强调了OGM在识别断点区域中的实用性,提供对神经发育障碍的理解的可能见解。它还有助于受影响的个人获得更多有关其状况的潜在原因的知识。
    While balanced reciprocal translocations are relatively common, they often remain clinically silent unless they lead to the disruption of functional genes. In this study, we present the case of a boy exhibiting developmental delay and mild intellectual disability. Initial karyotyping revealed a translocation t(5;6)(q13;q23) between chromosomes 5 and 6 with limited resolution. Optical genome mapping (OGM) enabled a more precise depiction of the breakpoint regions involved in the reciprocal translocation. While the breakpoint region on chromosome 6 did not encompass any known gene, OGM revealed the disruption of the RASGRF2 (Ras protein-specific guanine nucleotide releasing factor 2) gene on chromosome 5, implicating RASGRF2 as a potential candidate gene contributing to the observed developmental delay in the patient. Variations in RASGRF2 have so far not been reported in developmental delay, but research on the RASGRF2 gene underscores its significance in various aspects of neurodevelopment, including synaptic plasticity, signaling pathways, and behavioral responses. This study highlights the utility of OGM in identifying breakpoint regions, providing possible insights into the understanding of neurodevelopmental disorders. It also helps affected individuals in gaining more knowledge about potential causes of their conditions.
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  • 文章类型: Journal Article
    这项研究探讨了全外显子组测序(WES)在患有发育迟缓/智力障碍(DD/ID)的儿科患者中的诊断率。同时还探索了反向表型(RP)在精炼诊断中的实用性。一组100名儿科患者接受了WES,在66%的病例中得到诊断。值得注意的是,RP在先前基因检测阴性的病例中发挥了重要作用,强调其在复杂诊断场景中的重要性。该研究揭示了一系列导致DD/ID的遗传条件,说明病因的异质性。尽管面临挑战,WES证明了有效性,特别是在代谢异常的情况下。在一半的WES阳性患者中发现了反向表型。神经网络模型表现出中等到特殊的预测能力,可以帮助患者选择WES和RP。这些发现强调了采用全面的遗传方法和RP在揭示DD/ID的遗传基础中的重要性,从而促进受影响的个人和家庭的个性化管理和遗传咨询。这项研究有助于了解DD/ID的遗传景观,加强我们对临床遗传学这一特定领域的理解和指导临床实践。
    This study delves into the diagnostic yield of whole-exome sequencing (WES) in pediatric patients presenting with developmental delay/intellectual disability (DD/ID), while also exploring the utility of Reverse Phenotyping (RP) in refining diagnoses. A cohort of 100 pediatric patients underwent WES, yielding a diagnosis in 66% of cases. Notably, RP played a significant role in cases with negative prior genetic testing, underscoring its significance in complex diagnostic scenarios. The study revealed a spectrum of genetic conditions contributing to DD/ID, illustrating the heterogeneity of etiological factors. Despite challenges, WES demonstrated effectiveness, particularly in cases with metabolic abnormalities. Reverse phenotyping was indicated in half of the patients with positive WES findings. Neural network models exhibited moderate-to-exceptional predictive abilities for aiding in patient selection for WES and RP. These findings emphasize the importance of employing comprehensive genetic approaches and RP in unraveling the genetic underpinnings of DD/ID, thereby facilitating personalized management and genetic counseling for affected individuals and families. This research contributes insights into the genetic landscape of DD/ID, enhancing our understanding and guiding clinical practice in this particular field of clinical genetics.
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  • 文章类型: Editorial
    罕见发育障碍(DD)的遗传咨询和治疗选择因使用大规模并行测序用于诊断目的而带来的机会而发生了革命性的变化[。..].
    Genetic counseling and treatment options for rare developmental disabilities (DDs) have been revolutionized by the opportunities made possible by using massively parallel sequencing for diagnostic purposes [...].
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  • 文章类型: Case Reports
    迄今为止,只有13项研究描述了10p11.2-p12大量重叠缺失的患者.这些个体具有以智力残疾为特征的共同表型,发育迟缓,明显的面部畸形特征,异常行为,视力障碍,心脏畸形,和男性的隐睾。分子细胞遗传学分析显示,该染色体区域的缺失共享80kb的最小重叠区域(SRO)。其仅含有WAC基因(具有卷曲螺旋的含WW结构域的衔接子)。在这份临床病例报告中,我们报告了一个5岁的女孩,出生在非近亲的父母,带有10p11.22p11.21微删除。她提出了与文献中描述的其他患者重叠的临床特征,如变形性状,说话延迟,和行为异常(多动),即使WAC基因不参与微缺失。我们的结果是第一个强调此处描述的缺失代表了一种连续的基因综合征,足以解释不同的表型,但与文献中报道的先前病例部分重叠。即使不涉及相同的基因。特别是,在这项研究中,我们推测似乎与正常运动发育有关的WAC基因的作用。事实上,我们发现,我们的患者是文献中描述的唯一一个在10p11.22p11.21区域存在大缺失而不涉及WAC基因缺失的患者,and,有趣的是,患者没有运动延迟。
    To date, only 13 studies have described patients with large overlapping deletions of 10p11.2-p12. These individuals shared a common phenotype characterized by intellectual disability, developmental delay, distinct facial dysmorphic features, abnormal behaviour, visual impairment, cardiac malformation, and cryptorchidism in males. Molecular cytogenetic analysis revealed that the deletion in this chromosomal region shares a common smallest region of overlap (SRO) of 80 kb, which contains only the WAC gene (WW-domain-containing adaptor with coiled coil). In this clinical case report, we report a 5-year-old girl, born from non-consanguineous parents, with a 10p11.22p11.21 microdeletion. She presents clinical features that overlap with other patients described in the literature, such as dysmorphic traits, speech delay, and behavioural abnormalities (hyperactivity), even though the WAC gene is not involved in the microdeletion. Our results are the first to highlight that the deletion described here represents a contiguous gene syndrome that is enough to explain the distinct phenotype but partially overlaps with the previous cases reported in the literature, even though the same genes are not involved. In particular, in this study, we speculate about the role of the WAC gene that seems to be associated with normal motor development. In fact, we found that our patient is the only one described in the literature with a large deletion in the 10p11.22p11.21 region without the involvement of the WAC gene deletion, and, interestingly, the patient did not have motor delay.
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