Thesis (D.Ed.Psych.) - University of Queensland, 2005. / Includes bibliography.

While obstructive sleep apnea among children with Down syndrome is very common, the pre-existing risk factors and its impact to neurodevelopment are not well known. The aims and objectives of this systematic review are to determine the prevalence of OSA among DS children and to identify the associated risk factors. 6 articles that met the inclusion criteria were retrieved after using PubMed and Google Scholar in literature searching. The prevalence of OSA has great variation among different countries but are relatively high, ranging from 57% to 79%. OSA was significant associated with obesity, age and tonsil size. It is also known to associate with behavioral problem in DS children and delay their neurodevelopment. Therefore, early treatment followed by appropriate modification in lifestyle and diet is crucial in managing OSA. / published_or_final_version / Public Health / Master / Master of Public Health

Down’s syndrome is a common chromosomal disorder associated with intellectual disability, congenital anomalies and increased risk of a number of acquired diseases. Despite improvements in life expectancy due to improved medical care, clear health disparities still exist. Down’s syndrome remains an important cause of infant mortality and intellectual disability in Hong Kong and globally. Gaps in existing knowledge include an unknown prevalence of Down’s syndrome, especially amongst adults; unknown patterns of A&E and outpatient utilisation by people with Down’s syndrome; the applicability of international data on hospitalisations of people with Down’s syndrome to Hong Kong; and the current demand on Hong Kong’s public healthcare services by people with Down’s syndrome. This study uses Hospital Authority patient and healthcare episode data to identify people with Down’s syndrome alive in 2010. Data from the Hong Kong Census 2011 is then used to create an estimate of the age- specific point prevalence of Down’s syndrome in Hong Kong on 31/12/2010. The relative risk associated with Down’s syndrome of at least one admission is calculated. Age and gender stratified rates of A&E attendance, outpatient attendance and inpatient admissions for both the Down’s syndrome population and the general population are estimated and compared. Average length of stay is also calculated for both populations and compared. A negative binomial with log link regression model is used to examine the association between patient characteristics, including age, gender, ethnicity and known comorbidities, and admission factors, including admission type, admitting speciality, surgery and intensive care admission, on length of stay. Lastly, the proportion of Hospital Authority A&E attendances, outpatient attendances and inpatient admissions that are by people with Down’s syndrome is calculated. 2,144 people with Down’s syndrome were identified. The overall prevalence of Down’s syndrome on 31/12/2010 in Hong Kong was 3.00 per 10,000. It was highest in those aged under 5 years at 9.95 per 10,000 and decreased with age. Rates of A&E, outpatient attendance and inpatient admission were 2.0, 2.4 and 3.3 times higher respectively in the Down’s syndrome population compared to the general population. The Risk Ratio of at least one admission associated with Down’s syndrome was 2.59 (p<0.001). Factors significantly associated with increased length of stay included infant age group, known thyroid disease, known other circulatory malformation, non-emergency admission, surgery, admission to ICU and 3 or more known comorbidities. Known congenital heart disease and known epilepsy were significantly associated with a shorter length of stay. The overall proportion of A&E attendances, outpatient attendances and inpatient admissions that were by people with Down’s syndrome were 0.06%, 0.07% and 0.10% respectively. This study provides new knowledge on Down’s syndrome in Hong Kong which will be of use to those delivering and planning healthcare services for this population, and also to those providing genetic counselling on Down’s syndrome. At the same time, new questions are raised on morbidity, mortality and equity of healthcare access amongst people with Down’s syndrome. Further research is required to answer these questions and thus allow effective interventions for reducing morbidity and mortality in this population to be designed. / published_or_final_version / Public Health / Master / Master of Public Health

Thesis (MEd(Psych))--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: The literacy development of learners with special educational needs has traditionally been approached from a behaviouristic framework, which led to the reductionistic teaching of language, focussing on smaller units and sub-skills in order to facilitate a simplification of the learning process. During the 80's changes in the area of literacy development occurred, placing the focus on the whole language approach. This approach (embedded in a constructivistic framework) emphasises the holistic and integrated nature of the language and literacy system, which seems to hold advantages for learners with special educational needs. This also includes learners with Down Syndrome since literature shows that a phonetic approach (which is reductionistic in nature) does not seem to benefit these learners in terms of literacy development and support. The purpose of this study therefore was to ascertain the usefulness of the whole language approach in the development of literacy skills of a , learner with Down Syndrome. This was accomplished by means of a literature review and learner support twice a week. The research methology took the form of a single case study consisting of a learner with Down Syndrome within an inclusive classroom. The qualitative nature of the research, which were descriptive and explanatory, made it possible to provide a rich holistic description of the findings. Data derived from various sources were analyzed according to the constant comparative method in order to identify the main and sub-categories. The findings of the study showed real development in the literacy skills of the learner with Down Syndrome. Noticeable, was the fact that the learner's reading skills developed faster in relation to the other skills. This is supported by the literature review. A fifth dimension, namely personal development was identified which promoted development on the cognitive as well as affective area. Although the scope of the study was limited, it seemed that the whole language a / AFRIKAANSE OPSOMMING: Geletterdheidsontwikkeling van leerders met spesiale onderwysbehoeftes is tradisioneel vanuit 'n behavioristiese raamwerk benader, wat daartoe aanleiding gegee het dat taal gereduseer is tot kleiner eenhede en subvaardighede ten einde die leerproses te vergemaklik. Gedurende die tagtigerjare het veranderinge op die gebied van geletterdheidsontwikkeling plaasgevind, wat die fokus op die geheeltaalbenadering geplaas het. Hierdie benadering (gesetel in die konstruktivistiese verwysingsraamwerk) lê klem op die holistiese en geïntegreerde aard van die taal- en geletterdheidsisteem, wat blyk om voordeel vir leerders met spesiale onderwysbehoefte in te hou. Dit sluit ook die leerder met Downsindroom in, aangesien literatuur daarop wys dat die fonetiese benadering (reduksionisties van aard) nie blyk om tot voordeel van hierdie leerders se geletterdheidsontwikkeling en -ondersteuning te strek nie. Die doel van die studie was gevolglik om die bruikbaarheid van die geheeltaalbenadering in die ondersteuning van 'n leerder met Downsindroom se geletterdheidsvaardighede te ondersoek. Dit is by wyse van In literatuuroorsig en leerondersteuningsessies op 'n tweeweeklikse basis gedoen. Die navorsingsmetodiek het die vorm van 'n enkel gevallestudie aangeneem, bestaande uit 'n leerder met Downsindroom in 'n inklusiewe klaskamer. Die kwalitatiewe aard van die navorsing, wat beskrywend, verkennend en verklarend is, het dit moontlik gemaak om 'n ryk holistiese beskrywing van die bevindinge te gee. Data afkomstig van verskeie bronne is volgens die konstante vergelykende metode geanaliseer ten einde die hoofkategorieë en subkategorieë te identifiseer. Die bevindinge van die studie het gedui op 'n beduidende ontwikkeling van die die leerder met Downsindroom se geletterdheidsvaardighede. Opmerklik was die feit dat die leerder se leesvaardighede, in vergelyking met die ander geletterdheidsvaardighede, vinniger ontwikkel het. Dit word deur die literatuuroorsig ondersteun. 'n Vyfde dimensie, naamlik persoonsontwikkeling, is geïdentifiseer wat ontwikkeling op kognitiewe sowel as affektiewe gebied bevorder het. Alhoewel die omvang van die studie beperk was, blyk dit dat die geheeltaalbenadering tot voordeel van die leerder met Downsindroom se geletterdheidsontwikkeling strek.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / abstract / toc / Educational Psychology / Master / Master of Social Sciences

published_or_final_version / abstract / Speech and Hearing Sciences / Master / Master of Science in Audiology

The purpose of this study was to compare the accuracy of eight anthropometric regression equations with hydrostatic weighing for predicting the percent body fat of adult males with Down Syndrome (DS). Body fat percentages were predicted for 18 adult males with DS. Skinfold, circumference, and bioelectric impedance analysis data were collected to determine how accurately the regression equations could predict the percent fat of these individuals when compared to hydrostatic weighing. Since hydrostatic weighing involves a number of complex procedures two pilot studies were conducted. Four subjects participated in the pilot studies. The first pilot was conducted to determine if a constant value of residual volume could be utilized during hydrostatic weighing, or if a measured value, determined by oxygen dilution, needed to be used. The second pilot was performed to determine if hydrostatic weighing at total lung capacity without head submersion could be substituted for the conventional method of hydrostatic weighing. Paired t-tests revealed no significant differences in either pilot study, t (3) = .274, p. < .05 and t (3) = .314, 11 < .05, respectively. Pearson product-moment correlations revealed r values of .99 for both pilot studies. Based on these results a constant residual volume value of 1.50 L and hydrostatic weighing at total lung capacity without head submersion were the procedures utilized in the main research study. A one-way repeated measures analysis of variance revealed a significant difference between the body fat data obtained from hydrostatic weighing and the regression equations, F (8, 136) = 16.05, < .05. Dunnett's post-hoc procedure revealed significant differences in five of the eight equations. Of the three equations that did not yield significantly different results, only the Kelly and Rimmer (1987), r = .89, SEE = 2.51, 12 <.05, can be recommended for use. Based on these results, it appears that a constant value of 1.50 L for residual volume and hydrostatic weighing at total lung capacity without head submersion can be utilized when predicting the percent body fat of adult males with DS. This will allow increased numbers of individuals with DS to be hydrostatically weighed. Also, the use of the Kelly and Rimmer (1987) equation will allow researchers and practitioners to utilize an easy, fast, accurate, and inexpensive method of predicting the percent body fat of adult males with DS. / Graduation date: 1992

published_or_final_version / Public Health / Master / Master of Public Health

Down syndrome (DS) is the most common chromosomal disorder in humans. It is associated with various medical, social and developmental issues affecting all stages of life. Most people with DS now live to adulthood. However, limited data is available on the medical and social concerns and the impacts on their quality of life. In this study, my primary aim was to study the health-related quality of life (HRQoL) of Chinese with DS in Hong Kong. Secondarily, 2 other important aspects of medical care and counseling for people with DS were explored: the level of satisfaction in the transition from paediatric to adult medical care, and how language choice in medical settings can be of great significance to caretakers and families. In collaboration with Hong Kong Down Syndrome Association, a proxy-assessment survey was designed and administered to parents or caregivers of people with DS. I used the Health Utilities Index (HUI) to measure the HRQoL of people with DS. Logistic Regression Model was employed to estimate the associations between HRQoL scores and various physical and developmental-behavioural morbidities. The findings on the survey of service satisfaction and sensitive language are summarized quantitatively. I recruited 116 Chinese people with DS (n = 63 male; age ranged from 5 to 53). More than 50% of the subjects scored in the severe range on the HUI disability scale. Behavioural problems (HUI2) and hearing problems (HUI2 and HUI3) were statistically significant predictors (p-value<0.05) for a less favorable HRQoL score. A statistically significant inverse dose response relationship was observed between the HRQoL scores and the number of developmental-behaviour problems, as well as the number of chronic health problems. Satisfaction of service rated by caretakers reveals that >80% felt accessibility and coordination of both medical and social service were better when the subjects were in their childhood. Sixty percent felt that transition care is lacking and nearly 90% felt that caring for a person with DS is more difficult as they age. For the exploratory survey on language choice in medical setting, most participants rated ‘成為負擔 become a burden’ (82%), ‘冇用 useless’ (77%), ‘冇希望 hopeless’ (77%) and ‘唔正常 abnormal’ (76%) as offensive. Alternative words suggested include ‘可能需要特別指導及訓練 may need special guidance and training’ and ‘特殊 special’ instead of ‘成為負擔 become a burden’ and ‘唔正常 abnormal’ respectively. On the other hand, the least rated offensive words were ‘染色體異常 chromosome deviant’ (35%), “發育遲緩 growth delay” (35%) and ‘傷殘人士 handicapped person’ (34%). Medical and social issues addressed will be useful for health care providers, genetic counselors, and parents or caregivers to gain a broader perspective of the realistic outcome of individuals with DS under the healthcare infrastructure available in Hong Kong. This knowledge is important to inform expectations of families, improve communication between families and health care professionals, and to facilitate the design of targeted interventions to improve quality of life for people with this common genetic disorder. / published_or_final_version / Obstetrics and Gynaecology / Master / Master of Medical Sciences