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<p>Every year 120 children with Downs Syndrome is born in Sweden. The aim of the study was to investigate if there were any differences between mothers and fathers of children with Downs Syndrome regarding: experience of support from health care personnel and physicians in the time of delivery and from who parents sought most emotional support.</p><p>Participants of the study was 80 mothers and 79 fathers that answered a questionnaire. There was a difference between parents if they thought they received support from health care personnel, mothers (59 %) and fathers (38 %) thought that they didn’t receive support. Emotional support sought mothers (52 %), in grater wideness then the fathers (23 %), with other families with handicapped children. Both mothers (79 %) and fathers (77 %) answered that they sought the mort emotional support with there spouse.</p> / <p>Varje år föds cirka 120 barn med Downs Syndrom i Sverige. Syftet med studien var att undersöka om det fanns skillnader mellan mödrar och fäder till barn med Downs Syndrom i form av: upplevelser av stöd från vårdpersonal i samband med förlossningen samt från vem eller vilka föräldrarna sökt mest emotionellt stöd. Medverkande i studien var 80 mödrar och 79 fäder som besvarat en enkät. Det fanns en skillnad mellan föräldrarna om de ansåg att de fått stöd från vårdpersonal, mödrarna (59 %) och fäderna (38 %) tyckte att de ej fått stöd. Emotionellt stöd sökte mödrarna (52 %) i större utsträckning än fäderna (23 %) hos andra föräldrar till handikappade barn. Både mödrar (79 %) och fäder (77 %) uppgav att de sökt mest emotionellt stöd hos sin partner.</p>

Every year 120 children with Downs Syndrome is born in Sweden. The aim of the study was to investigate if there were any differences between mothers and fathers of children with Downs Syndrome regarding: experience of support from health care personnel and physicians in the time of delivery and from who parents sought most emotional support. Participants of the study was 80 mothers and 79 fathers that answered a questionnaire. There was a difference between parents if they thought they received support from health care personnel, mothers (59 %) and fathers (38 %) thought that they didn’t receive support. Emotional support sought mothers (52 %), in grater wideness then the fathers (23 %), with other families with handicapped children. Both mothers (79 %) and fathers (77 %) answered that they sought the mort emotional support with there spouse. / Varje år föds cirka 120 barn med Downs Syndrom i Sverige. Syftet med studien var att undersöka om det fanns skillnader mellan mödrar och fäder till barn med Downs Syndrom i form av: upplevelser av stöd från vårdpersonal i samband med förlossningen samt från vem eller vilka föräldrarna sökt mest emotionellt stöd. Medverkande i studien var 80 mödrar och 79 fäder som besvarat en enkät. Det fanns en skillnad mellan föräldrarna om de ansåg att de fått stöd från vårdpersonal, mödrarna (59 %) och fäderna (38 %) tyckte att de ej fått stöd. Emotionellt stöd sökte mödrarna (52 %) i större utsträckning än fäderna (23 %) hos andra föräldrar till handikappade barn. Både mödrar (79 %) och fäder (77 %) uppgav att de sökt mest emotionellt stöd hos sin partner.

Syftet med studien var att, genom granskning av vetenskapliga artiklar, undersöka olika former av arbetsterapeutiska interventioner för barn med Downs syndrom. Insamlingen av data genomfördes genom en litteratursökning via databaser som fanns att tillgå via Luleå tekniska universitet. Artiklarna kvalitetsgranskades för att avgöra om de var lämpliga att inkludera i studien. Totalt identifierades 18 artiklar som legat till grund för studien. Resultatet visade att det finns arbetsterapeutiska interventioner för barn med Downs syndrom. De identifierade arbetsterapeutiska interventionerna kategoriserades utifrån Fishers (2009) sex interventionsformer: “preparation”, “rote practice/exercise”, “simulated occupation”, “restorative occupation”, “acquistional occupation” och “adaptive occupation”. Dock inkluderades artiklarnas interventioner endast av fyra av Fishers (2009) sex interventionsformer. Vidare undersöktes det om artiklarnas arbetsterapeutiska interventioner skedde på aktivitets-eller funktionsnivå. Resultatet av litteraturöversikten visade på att den större andelen av de arbetsterapeutiska interventionerna för barn med Downs syndrom sker på funktionsnivå, det vill säga utifrån de interventioner som Fisher (2009) beskriver som: “preparation”, “rote practice/exercise” och “simulate / The purpose of the study was to investigate available types of occupational therapeutic interventions for children with Down's syndrome by reviewing scientific articles. Data collection was carried out through a literature search through databases that were available through Luleå University of Technology. The articles were quality-reviewed to determine if they were suitable for inclusion in the study. In total, 18 articles were identified as the basis for the study. The results showed that there are occupational therapy interventions for children with Down's syndrome. The identified occupational therapeutic interventions were categorized based on Fisher's (2009) six forms of intervention: "preparation", "rote practice / exercise", "simulated occupation", "restorative occupation", "acquistional occupation" and "adaptive occupation". However, the interventions of the articles were included only by four of Fisher's (2009) six intervention forms. Furthermore, it was examined whether the articles' occupational therapeutic interventions took place at the level of activity or function. The result of the literature review showed that the larger proportion of the occupational therapeutic interventions for children with Down syndrome occurs at the functional level, that is, based on the interventions that Fisher (2009) describes as: "preparation", "rote practice / exercise" and "simulated occupation”.

Objectives: The following thesis is presented within two separate pieces of work. A systematic literature review (SLR) aimed to evaluate the individual characteristics and psychometric properties of four dementia screening tools. These were the Dementia Questionnaire for People with Learning Disabilities (DLD) (Evenhuis, 2007), the Dementia Scale for Down Syndrome (DSDS) (Gedye, 1995), the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) (Deb et al, 2007a) and the Adaptive Behaviour Dementia Questionnaire (ABDQ) (Prasher et al, 2004). The empirical research (ER) aimed to evaluate the clinical utility and longitudinal accuracy of two of these tools; the DLD and the ABDQ in a clinical population with intellectual disability (ID) and Down syndrome (DS). Methods: For the SLR a comprehensive list of electronic academic databases were searched to identify studies which included information relating to the psychometric properties of the DLD, DSDS, DSQIID and the ABDQ. Information within the studies was then extracted and rated using two quality assessment measures. These were the Characteristics of Assessment Instruments for Psychiatric Disorders in Persons with Intellectual Developmental Disabilities (CAPS-IDD) (Zeilinger et al, 2013b) and the Qualsyst (Kmet, 2004). For the ER, a repeated measures MANOVA was used to assess change over time between two groups of people with intellectual disabilities and Down syndrome; one with dementia and one without. Results: In the SLR, 16 studies were identified and rated using the CAPS-IDD and the Qualsyst. Detailed information related to the dementia screening tools and quality ratings of the papers are provided. In the ER both the ABDQ and the DLD demonstrated a clear difference between those who develop dementia and those who do not, with those in the ‘dementia’ group exhibiting increasing scores over time. Conclusions: The SLR concludes that the evidence base for these dementia screening tools remain limited. The largest evidence base was evidenced for the DLD. The ER concludes that the ABDQ and the DLD are useful tools to differentiate between those who develop dementia and those who do not. Further analysis incorporating the exploration of individual component items of tools is recommended.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

A terapia fotodinâmica antimicrobiana (aPDT) tem sido amplamente utilizada em Periodontia por permitir redução de periodontopatógenos, com ausência de efeitos sistêmicos colaterais e mínimas possibilidades de resistência bacteriana. Surge assim uma boa alternativa adjuvante para o tratamento da doença periodontal (DP), como para os pacientes com Síndrome de Down (SD) que possuem maior severidade e alta prevalência dessa doença. O objetivo desse estudo foi avaliar a efetividade da aPDT como adjuvante da raspagem e alisamento corono-radicular (RACR) em pacientes com SD. Foram realizadas avaliações dos parâmetros clínicos como: índice de placa (IP), índice gengival (IG), nível clínico de inserção (NCI), profundidade (PS) e sangramento à sondagem (SS) no período inicial e após 1 e 3 meses do tratamento. Para a aPDT, foi utilizado laser vermelho (658nm; 0,1W; 2229J/cm2; 10s por ponto), com o corante azul de metileno (AM) como agente fotossensibilizador na concentração de 100&#x3BC;g/ml, com tempo de pré-irradiação de 3 minutos, com repetidas sessões após 3,7 e 14 dias. As análises estatísticas foram realizadas com testes paramétricos e não paramétricos (p<0,05). Participaram desse estudo 33 pacientes com SD, randomizados aleatoriamente em dois grupos: C (RACR), composto por 6 mulheres e 11 homens (27±9,16 anos) e aPDT (realizadas associação da aPDT com a RACR), composta por 9 homens e 7 mulheres (27,12±9,74anos). Os pacientes são os principais responsáveis pela sua escovação (100%) com baixíssima ajuda pelos pais e/ou responsáveis na supervisão ou reforço da escovação (12,12%). Houve melhora de todos os índices periodontontais nos tempos inicias (baseline), como após 1 e 3 meses tanto para o grupo C (redução da PS de 0,97mm do baseline para 3 meses; redução do SS de 16,13% do baseline para 3 meses; redução do IP de 11,29% do baseline para 3 meses, redução do NCI de 0,09mm do baseline para 3 meses) e para o grupo aPDT (redução da PS de 1,56mm do baseline para 3 meses, redução do SS de 16,77% do baseline para 3 meses, redução do IP de 13,81% do baseline para 3 meses, redução do NCI de 0,13mm do baseline para 3 meses). Conclui-se que ambos os tratamentos resultaram em melhoras clínicas (PS, SS, IP, NCI) significantes no tratamento da doença periodontal em pacientes com SD. / Antimicrobial photodynamic therapy (aPDT) has been widely used in Periodontics to obtain reduction of periodontopathogenic bacteria with absence of systemic side effects and minimal bacterial resistance. Therefore, a good adjuvant alternative for periodontal disease (PD) treatment arises, especially for patients with Down syndrome (DS) who present greater severity and high prevalence of PD. The aim of this study was to evaluate the effectiveness of aPDT as an adjuvant of scaling and root planning (SRP) for treatment of PD in patients with DS. Periodontal clinical exam was evaluated by: plaque index (PI), gingival index (GI), clinical attachment loss (CAL), probing depth (PD) and bleeding on probing (BOP) in baseline, one and three-month treatment periods. The aPDT protocol was red laser (658nm; 0.1W; 2229J/cm2, 10s per point), methylene blue dye (MB), 100&#x3BC;g/ml, with a 3-minute preirradiation. aPDT sessions were repeated after 3, 7 and 14 days. Statistical analysis was performed using parametric and non-parametric tests (p<0.05). 33 patients with DS participated in this study, randomly assigned into two groups: C (SRP), composed of 6 women and 11 men (27 ± 9.16 years old) and aPDT (SRP + aPDT), composed of 9 men and 7 women (27.12 ± 9,74 years old). Patients were the main contributors to the brushing (100%) with very low support by parents and/or guardians in monitoring or enhancing brushing (12.12%). There was improvement of clinical parameters in baseline (B), and after 1 and 3 months for group C (reduction on PB of 0.97mm from baseline to 3 months; reduction on BOP of 16.13% from baseline to 3 months; reduction on PI of 11.29% from baseline to 3 months, reduction on CAL of 0.09mm from baseline to 3 months) and for the aPDT group (reduction on PB of 1.56mm from baseline to 3 months, reduction on BOP of 16.77% from baseline to 3 months, reduction on PI of 13.81% from baseline to 3 months, reduction on CAL of 0.13mm from baseline to 3 months). In conclusion, besides an improvement in periodontal condition, aPDT as an adjuvant of SRP did not enhance the clinical periodontal parameters in relation to SRP alone.

A síndrome de Down (SD) é a mais comum doença de origem genética, causada pela trissomia do cromossomo 21 e caracterizada por comprometimento intelectual, alterações físicas e várias comorbidades sistêmicas. O objetivo deste trabalho foi de avaliar as alterações sistêmicas e comportamentais de interesse odontológico nos pacientes com SD e discutir a adequação no manejo odontológico frente às comorbidades apresentadas. Foram analisados 52 pacientes com SD em atendimento no CAPE-FOUSP. Os responsáveis foram entrevistados com relação às alterações sistêmicas, com base em um questionário desenvolvido especificamente para esta pesquisa. Foram pesquisadas as seguintes alterações: cardíacas, respiratórias, neurológicas e comportamentais, imunológicas, hematológicas, endócrinas (disfunção da glândula tireóide e diabetes mellitus), doenças infecciosas e articulares. Os pacientes realizaram exames complementares, como a aferição da pressão arterial, do IMC e da glicemia capilar e os seguintes exames laboratoriais: hemograma, coagulagrama, hormônio tireotrófico (TSH), tri-iodotironina total (T3 total), tiroxina livre (T4 livre), tiroxina total (T4 total), colesterol total e frações, triglicerídeos, hemoglobina glicosilada, sorologia para hepatite B e C, aspartato aminotransferase (AST), alanina aminotransferase (ALT). Os resultados mostram que as alterações sistêmicas mais freqüentes foram as respiratórias, sendo a pneumonia a mais comum e sua incidência era inversamente proporcional à idade dos pacientes, seguida pelas alterações cardíacas, sendo que 13 pacientes apresentaram apenas uma, e 4 apresentaram múltiplas alterações; e o sopro foi a doença cardíaca mais relatada. Dentro das alterações neurológicas e comportamentais, 37 pacientes apresentavam pelo menos uma das características do início da doença de Alzheimer. Dez pacientes apresentaram hipotireodismo, 7 pacientes hipotireoidismo subclínico, 3 pacientes estado de pré-diabetes, dois pacientes estado de pré-hipertensão. Os níveis de colesterol total estavam dentro dos padrões desejáveis em 36 pacientes, assim como os triglicerídeos em 42 pacientes, com correlação inversa ao índice de massa corporal que apresentou 37 pacientes com sobrepeso ou algum grau de obesidade. Analisando o hemograma, foi observado 5 pacientes com anemia e 10 com leucopenia. Pesquisando a vacinação contra hepatite A e B, 24 pacientes foram vacinados para hepatite A, 26 para hepatite B onde 12 pacientes não apresentaram soroconversão frente a vacina. Um paciente foi diagnosticado com hepatite C. Quanto a presença de instabilidade atlato-axial, 8 pacientes relataram sua presença. Podemos concluir que muitas das alterações sistêmicas citadas na literatura estão presentes nos pacientes atendidos no CAPE, mostrando a necessidade de conhecermos a história médica dos pacientes com SD antes de atendê-los no consultório odontológico, e adequando o tratamento de acordo com cada alteração apresentada pelos pacientes tornando seu tratamento seguro e eficaz. / Downs syndrome (DS) is the most common genetic disorder and it is caused by the trissomy of 21 chromosome. It is characterized by mental retardation, physical alterations and several systemic co morbidities. The aim of this study was to evaluate behavior and systemic alterations with dental implications in DS patients and discuss the dental management of these patients. We evaluate 52 patients with DS under dental treatment at the Special Care Dentistry Center of the School of Dentistry, University of São Paulo. The guardians were interviewed about systemic co morbidities based on a special chart developed for this research. The following systemic alterations were analyzed: cardiac, respiratory, neurological and behavior, immunological, hematological, endocrine (thyroid disorders and diabetes), infeccious diseases and joint alterations. Patients were submitted to complementary exams such as : blood pressure and glucose levels, body mass index, CBC, coagulagrama hormone (TSH), total triiodothyronine (T3), free thyroxine (FT4), total thyroxine (T4), total cholesterol and fractions, triglycerides, glycated hemoglobin, serology for hepatitis B and C, aspartate aminotransferase (AST), alanine aminotransferase (ALT). The results show that the most frequent systemic alterations were respiratory alterations, pneumonia being the most common and its incidence was inversely proportional to the age of the patients, followed by cardiac abnormalities, while 13 patients had only one, and four had multiple abnormalities, and the heart murmur was the most frequent cardiac alterations. Within the neurological and behavioral disorders, 37 patients had at least one characteristic of early Alzheimer\'s disease. Ten patients had hypothyroidism, 7 patients had subclinical hypothyroidism, 3 patients state of pre-diabetes, two patients a state of pre-hypertension. The total cholesterol levels were desirable in 36 patients, and triglycerides in 42 patients, with inverse correlation to body mass index. 37 patients showed some degree of overweight or obesity. CBC showed 5 patients with anemia and 10 with leukopenia. 24 patients were vaccinated for hepatitis A, and 26 for hepatitis B, but 12 patients did not show seroconversion against the vaccine. One patient was diagnosed with hepatitis C. As the presence of atlanto-axial instability, eight patients reported their presence. We can conclude that many of the systemic alterations reported in the literature are present in patients with DS seen at CAPE. It is necessary for the dentist to know the medical history of patients with SD before the dental treatment, and it is necessary to adjust the treatment according to each systemic alterations presented by patients in order to provide a safe and effective treatment.

A síndrome de Down (SD) é a mais comum doença de origem genética, causada pela trissomia do cromossomo 21 e caracterizada por comprometimento intelectual, alterações físicas e várias comorbidades sistêmicas. O objetivo deste trabalho foi de avaliar as alterações sistêmicas e comportamentais de interesse odontológico nos pacientes com SD e discutir a adequação no manejo odontológico frente às comorbidades apresentadas. Foram analisados 52 pacientes com SD em atendimento no CAPE-FOUSP. Os responsáveis foram entrevistados com relação às alterações sistêmicas, com base em um questionário desenvolvido especificamente para esta pesquisa. Foram pesquisadas as seguintes alterações: cardíacas, respiratórias, neurológicas e comportamentais, imunológicas, hematológicas, endócrinas (disfunção da glândula tireóide e diabetes mellitus), doenças infecciosas e articulares. Os pacientes realizaram exames complementares, como a aferição da pressão arterial, do IMC e da glicemia capilar e os seguintes exames laboratoriais: hemograma, coagulagrama, hormônio tireotrófico (TSH), tri-iodotironina total (T3 total), tiroxina livre (T4 livre), tiroxina total (T4 total), colesterol total e frações, triglicerídeos, hemoglobina glicosilada, sorologia para hepatite B e C, aspartato aminotransferase (AST), alanina aminotransferase (ALT). Os resultados mostram que as alterações sistêmicas mais freqüentes foram as respiratórias, sendo a pneumonia a mais comum e sua incidência era inversamente proporcional à idade dos pacientes, seguida pelas alterações cardíacas, sendo que 13 pacientes apresentaram apenas uma, e 4 apresentaram múltiplas alterações; e o sopro foi a doença cardíaca mais relatada. Dentro das alterações neurológicas e comportamentais, 37 pacientes apresentavam pelo menos uma das características do início da doença de Alzheimer. Dez pacientes apresentaram hipotireodismo, 7 pacientes hipotireoidismo subclínico, 3 pacientes estado de pré-diabetes, dois pacientes estado de pré-hipertensão. Os níveis de colesterol total estavam dentro dos padrões desejáveis em 36 pacientes, assim como os triglicerídeos em 42 pacientes, com correlação inversa ao índice de massa corporal que apresentou 37 pacientes com sobrepeso ou algum grau de obesidade. Analisando o hemograma, foi observado 5 pacientes com anemia e 10 com leucopenia. Pesquisando a vacinação contra hepatite A e B, 24 pacientes foram vacinados para hepatite A, 26 para hepatite B onde 12 pacientes não apresentaram soroconversão frente a vacina. Um paciente foi diagnosticado com hepatite C. Quanto a presença de instabilidade atlato-axial, 8 pacientes relataram sua presença. Podemos concluir que muitas das alterações sistêmicas citadas na literatura estão presentes nos pacientes atendidos no CAPE, mostrando a necessidade de conhecermos a história médica dos pacientes com SD antes de atendê-los no consultório odontológico, e adequando o tratamento de acordo com cada alteração apresentada pelos pacientes tornando seu tratamento seguro e eficaz. / Downs syndrome (DS) is the most common genetic disorder and it is caused by the trissomy of 21 chromosome. It is characterized by mental retardation, physical alterations and several systemic co morbidities. The aim of this study was to evaluate behavior and systemic alterations with dental implications in DS patients and discuss the dental management of these patients. We evaluate 52 patients with DS under dental treatment at the Special Care Dentistry Center of the School of Dentistry, University of São Paulo. The guardians were interviewed about systemic co morbidities based on a special chart developed for this research. The following systemic alterations were analyzed: cardiac, respiratory, neurological and behavior, immunological, hematological, endocrine (thyroid disorders and diabetes), infeccious diseases and joint alterations. Patients were submitted to complementary exams such as : blood pressure and glucose levels, body mass index, CBC, coagulagrama hormone (TSH), total triiodothyronine (T3), free thyroxine (FT4), total thyroxine (T4), total cholesterol and fractions, triglycerides, glycated hemoglobin, serology for hepatitis B and C, aspartate aminotransferase (AST), alanine aminotransferase (ALT). The results show that the most frequent systemic alterations were respiratory alterations, pneumonia being the most common and its incidence was inversely proportional to the age of the patients, followed by cardiac abnormalities, while 13 patients had only one, and four had multiple abnormalities, and the heart murmur was the most frequent cardiac alterations. Within the neurological and behavioral disorders, 37 patients had at least one characteristic of early Alzheimer\'s disease. Ten patients had hypothyroidism, 7 patients had subclinical hypothyroidism, 3 patients state of pre-diabetes, two patients a state of pre-hypertension. The total cholesterol levels were desirable in 36 patients, and triglycerides in 42 patients, with inverse correlation to body mass index. 37 patients showed some degree of overweight or obesity. CBC showed 5 patients with anemia and 10 with leukopenia. 24 patients were vaccinated for hepatitis A, and 26 for hepatitis B, but 12 patients did not show seroconversion against the vaccine. One patient was diagnosed with hepatitis C. As the presence of atlanto-axial instability, eight patients reported their presence. We can conclude that many of the systemic alterations reported in the literature are present in patients with DS seen at CAPE. It is necessary for the dentist to know the medical history of patients with SD before the dental treatment, and it is necessary to adjust the treatment according to each systemic alterations presented by patients in order to provide a safe and effective treatment.

Syftet med denna studie är att undersöka hur Karlstadmodellen och TAKK (Tecken somAlternativ och Kompletterande Kommunikation) kan användas i förskoleverksamheten för attfrämja hela barngruppens språkutveckling.De metoder som har används för att undersöka och svara på frågeställningen är intervju ochenkätundersökning. Det gjordes tre olika intervjuer. En med en mamma till ett barn demDowns syndrom och som även är certifierad handledare i Karlstadmodellen. En med enbarnskötare som arbetat med ett barns språkutveckling med hjälp av Karlstadmodellen. Ochden tredje intervjun gjordes med tre sjuksköterskor på Barnavårdscentralen.Enkätundersökningen skickades ut till 16 förskolor och 14 svarade. Detta genererade i 56besvarade enkäter. På så vis blir det totala bortfallet 13 obesvarade enkäter.I resultatet framkom det att man i Karlstadmodellen och TAKK arbetar med ett nätverk kringdet barn som är i behov av stöd. Detta är troligen något som skulle vara svårt att applicera påen hel barngrupp. Däremot finns det modeller likande TAKK som är anpassade för barngrupp.Respondenterna från två av intervjuerna anser att man skulle kunna använda sig utav vissalekar från Karlstadmodellen till hela barngruppen. / The purpose with this study is to examine how The Karlstad model and Signs and AlternativeCommunication can be used in preschool to help the whole group of children with theirlanguage development.The methods that have been used to examine and answer all the questions is interviews andquestionnaire. There were three different interviews made. The first interview was with amother to a child with Down syndrome, who is also a certified mentor in the Karlstad model.The next person to be interviewed was a caretaker of children who works with children’slanguage development with help from the Karlstad model. And the third interviewed wasmade with three nurses at the children’s care center.The questionnaire was sent to 16 preschools and 14 of them replied. This generated in 56answered questionnaires.The result shows that those who use The Karlstad model and Signs and AlternativeCommunication work with a network around the child in need of support. This is probablysomething that would be hard to work with in a group of children in preschool. But there ismodels like Signs and Alternative Communication who is adjusted for child groups. Therespondents from two of the interviews consider that some games from the Karlstad modelcan be used for a whole group of children.