Book Summary: Nurses play a key role in high-quality health care for people with intellectual and developmental disabilities (IDD)--and now this up-to-date textbook fully prepares them to provide patients with the best possible services across the lifespan. The most comprehensive text available for nurses who specialize in IDD, this essential book clarifies evidence-based practices and gives readers an integrated, interdisciplinary approach to care that meets each person's individual needs. Cecily Betz and Wendy Nehring--authors of the respected text Promoting Health Care Transitions for Adolescents with Special Health Care Needs and Disabilities--gather the latest research and wisdom of 18 diverse authorities in the medical field. Together, they give pre- and in-service nurses the foundation of knowledge they need to help ensure equal access to health care for people with IDD choose from today's models and philosophies of carepromote their patients' psychosocial developmentprovide effective physical careconduct health assessments and develop individualized plans of caremaintain successful interdisciplinary collaboration with other professionals address the issues associated with specific disabilities, including autism, Down syndrome, cerebral palsy, fragile X, sensory impairment, and medical and behavioral health problems support developmental transitions across the lifespan expand their knowledge of genetics and apply it to nursing practice skillfully manage ethical and legal issuesunderstand the service agencies used by individuals with IDD Enhanced with clinical practice guidelines to support effective work with individuals who have IDD, this textbook lights every nurse's path to person-centered, evidence-based care that improves their patients' lives.

Written by nurse practitioners for nurse practitioners, this one-of-a-kind resource provides the expert guidance you need to provide comprehensive primary care to children with special needs and their families. It addresses specific conditions that require alterations in standard primary care and offers practical advice on managing the major issues common to children with chronic conditions. A consistent format makes it easy to locate essential information on each condition. Plus, valuable resources help you manage the issues and gaps in health care coverage that may hinder quality care.

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Made available in DSpace on 2014-06-11T19:27:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-04-23Bitstream added on 2014-06-13T20:17:10Z : No. of bitstreams: 1 messias_lpa_me_araca.pdf: 396179 bytes, checksum: 7ab8325928adf5a9ec2e467e4b72278a (MD5) / O objetivo do presente estudo foi avaliar a ocorrência dos principais microrganismos periodontopatogênicos e dois viruses herpéticos na saliva e no biofilme microbiano supra e subgengival de 50 crianças e adolescentes com Síndrome de Down, através de métodos moleculares, comparando com um grupo de indivíduos de um grupo controle que não apresentam a síndrome. Espécimes clínicos foram coletados desses pacientes após avaliação das condições sócio-econômicas e comportamentais. A microbiota bucal dos pacientes foi caracterizada através da obtenção de amostras do biofilme subgengival, supragengival e saliva, as quais foram transportadas para o laboratório de Microbiologia e Imunologia da FOA-UNESP para detecção dos principais patógenos por PCR. As características de saúde periodontal foram avaliadas segundo índices específicos. A possibilidade de inter-relações entre os diferentes microrganismos foi determinada através dos testes de Qui-quadrado, teste exato de Fisher e Mann-Whitney. Verificou-se que as condições de saúde periodontal das crianças e adolescentes portadores de Síndrome de Down não diferia significativamente do grupo controle. A ocorrência das espécies microbianas anaeróbias e microaerófilas mais associadas ao ambiente periodontal foi semelhante nos dois grupos de crianças e adolescentes, independentemente da condição gengival, com modesto aumento na ocorrência de Prevotella intermedia e Enterobacteriaceae na saliva dos pacientes sindrômicos, o mesmo ocorrendo com Enterobacteriaceae, Campylobacter rectus, Prevotella nigrescens e gênero Pseudomonas no biofilme supragengival e P. intermedia no biofilme subgengival de pacientes sindrômicos sadios e pseudomonados naqueles com gengivite. A microbiota associada às diferentes condições periodontais nos dois grupos também evidenciou pequenas diferenças, mas confirma o papel... / This study aimed to evaluate the occurrence of the major periodontal pathogens and two herpetic viruses in saliva and dental biofilm from 50 children and adolescents with Down’s syndrome through molecular tools, comparing with those of individuals of a control group who did not present this syndrome. Clinical samples were collected from patients soon after evaluation of socioeconomic and behavioral conditions. The oral microflora was characterized by mean of samples of supragingival and subgingival biofilm and saliva, which were transferred to Microbiology and Immunology Laboratory at FOA-UNESP for detection of the major pathogens by PCR. Periodontal conditions were evaluated through specific indexes. The possibility of relationship between different microorganisms and clinical conditions were determined through Chi-Square test, Fisher’s exact test and Mann-Whitney test. It was verified that periodontal conditions of children and adolescents with Down’s syndrome did not differ significantly from the control group conditions. The occurrence of anaerobes and microaerophiles associated with periodontal environment was similar in both groups of children and adolescents, regardless of the gingival condition, with modest increase in the occurrence of Prevotella intermedia and Enterobacteriaceae in the saliva of patients syndromic patients, the same occurred with Enterobacteriaceae, Campylobacter rectus, Prevotella nigrescens and genus Pseudomonas in the supragingival biofilm and P. intermedia in subgingival biofilm of periodontally healthy patients and pseudomonads in syndromic patients with gingivitis. The microbiota associated with different periodontal conditions in both groups showed minor differences, but confirms the role of strict anaerobes in this process as well as the role of and cytomegalovirus and Epstein-Barr virus, while in syndromic patients, besides these... (Complete abstract click electronic access below)

Poster exhibited at GPSC Student Showcase, November 7th, 2014, University of Arizona. / Given the early emergence of Alzheimer’s disease (AD) related pathology in Down syndrome (DS; Trisomy 21), it is possible that changes may be evident in childhood or adolescence in Apolipoprotein (APOE) e3/e4 or e4/e4 genotypes in relation to e3/e3 genotypes. Given findings of early involvement of striatum amyloid beta (Aβ) peptide deposition in DS, we propose that a profile of executive and inhibitory control dysfunction will be found in youth carrying the risk e4 allele. From a pool of 72 children and adolescents with DS we examined a sub-sample with the risk e4 allele (n = 8; e3/e4) and without the risk e4 allele (n = 8; e3/e3). Participants were matched for age and ethnicity (range 8 - 21 years; mean age 14 years). Karyotypes were gathered from medical records, confirming a diagnosis of Trisomy 21. We collected genetic information (Oragene saliva kit) in home; they were sent to the Emory Biomarker Service Center to determine genotypes. We administered the Kaufman Brief Intelligence Test (KBIT-2) and a set of cognitive outcomes measures validated for Down syndrome, the Arizona Cognitive Test Battery. Results from the KBIT-2 indicated no significant differences in verbal raw score (p = 0.65), non-verbal raw score (p = 0.69), or intelligence quotient (IQ) (p = 0.32). Neuropsychological test scores did differ; with poorer performance in the e4 sample on the CANTAB Paired Associates Learning task (p = 0.05) and parent/caregiver reports of working memory (p = 0.08). Therefore, as early as adolescence some changes may be seen in e4 carriers.

<p>This thesis presents a study of children’s speech. The children have Down syndrome (DS). Often the speech of children with DS is hard for other people to understand. The aim of the study is to try a new way of describing these children’s speech. My perspective reflects an ambition to conceive the children as active, speaking subjects.</p><p>In phenomenology human beings are regarded as always being intentional. The phenomenological perspective on intentionality views articulation as intentional, even though we normally experience it as “automatic”. This seemed to be a fertile perspective for this study, where the central focus is on the intentionality in the speech, i.e. the relation between the speaker and his or her speech while speaking. I have drawn mainly on Merleau-Ponty’s views on speech.</p><p>The speech of four children 6–7 years old was studied. The children were videotaped together with an adult in a specific situation (while naming pictures of familiar objects). The children’s speech was transcribed phonetically and some of the words were subjected to acoustic analysis. The main features of the situation were noted down. By means of the acoustic analysis, it was possible to study particular words in minute detail. These words were interpreted in relation to the context in which each utterance was made.</p><p>The four children all differ individually in their speaking strategies. The children’s speaking strategies may be described as flexible or rigid, diversified or undiversified. Within the child’s total expression there is a part which, in my opinion, the child could reach and develop. In my study, I introduce the terms the accessible speech or the accessible expression for that part of the child’s expression. By the terms the visible speech or the visible expression, I have tried to capture the part of the expression which I conceive that the child is capable of approaching as an object.</p><p>The terms accessibility and visibility involve the notion of intentionality; the speech is accessible or visible to someone. The children show us what is within reach for them. I believe that a good starting point for supporting the children’s speech development is the point where they reveal accessible and/or visible speech.</p>

<p>In every market, competition is a vital ingredient for any working market economy. Large stores like IKEA, OnOff and El-Giganten are often positioned in locations near each other. Shopping areas like Gekås have proven to have large attraction power towards the customers. In down-town shopping areas it is common that large stores take advantage of each other’s capabilities to invoke customers’ interest. By doing so, businesses work together to create a large customer base.</p><p>The purpose of this paper is to determine how owners and managers of medium sized retail stores should choose location for their shop.</p><p>Both a qualitative and quantitative approach were used in this thesis; the qualitative approach was used for conducting interviews with 6 people involved in running the stores and municipality. This was done to collect information from actors that had the experience and knowledge about the subject of the thesis. The quantitative approach involved a survey done upon shopping habits of consumers in the same area. The reason for conducting both these researches was to diminish the biased answers that we would have got from conducting the research from one group only. By asking the store managers/owner and customers, as well as a representative of the municipality, we were able to provide a complete perspective on the situation.</p><p>Our findings showed that there were some major differences between a down-town shopping area and a shopping mall. It also became clear that the preferences and capabilities of the stores were important for selecting locations. Consumer preference on where to go shop was showed to be almost the same for A6 and down-town with a slight advantage towards A6. Still, the requirements on opening a store in a shopping mall oppose down-town was different.</p>

The recent evidence concerning the nature of cognitive development in Down Syndrome (DS) suggests that it is different than normal development. The neuropathology seen in DS implicates a prenatal interruption of normal neural development as a possible basis for these differences. Since the hippocampal formation (HF) undergoes extensive postnatal maturation and is found to be abnormal in DS, it is proposed that cognitive deficits associated with DS would be most evident in tasks requiring hippocampal function. The performance of DS children at 16-18 months and 28-30 months of age was compared to that of age-matched control groups of normal children on two cognitive tasks requiring abilities that develop during the first postnatal year shown not to involve hippocampal function, and a task requiring abilities that develop during the second postnatal year shown to require hippocampal functioning. The results show that the DS performed comparably on the nonhippocampal tasks but differently on the hippocampal task. The normal children's performance supports the position that the ability to perform HF tasks develops during the second postnatal year while the performance of the older DS children suggested that this development does not occur in DS. The specificity of the deficits to the hippocampal task was interpreted as indicative of a lack of HF development in DS.

Children and adolescents with Down Syndrome (DS) have a high incidence of sleep problems, including Obstructive Sleep Apnea Syndrome (OSAS). They are also likely to have deficits in neuropsychological tasks tapping prefrontal function and hippocampal function. There has recent revival of literature suggesting an active role for sleep in memory consolidation and problem-solving in both children and adults. Furthermore, given the cognitive and behavioral sequellae of OSAS in typically developing children it is logical to test if the hypoxemia and increased sleep fragmentation, the two major pathophysiological mechanisms of OSAS, seen in children with DS and OSAS may exacerbate learning or behavior disorders.Forty children with DS aged 7-18 were administered the Arizona Cognitive Test Battery (ACTB) for DS (Edgin et al., 2010), and in-home ambulatory polysomnography. Their parents were asked to complete several questionnaires assessing their child's sleep and behavior. Seventy-seven percent (n = 40) of our sample met criteria for pediatric sleep apnea (AHI>1.5), and the mean apnea hypoppnea index (AHI) was 8.4 events per hour. Our sample had a mean arousal index of 10.3, a respiratory arousal index of 3.2, and a SaO2 nadir of 86.9%. Over 70% of our sample had a SaO2 nadir below 90%. We examined the relationship between OSAS severity and cognitive and behavioral outcomes. We found that children with DS with a lower apnea hypopnea index (AHI) attained a greater number of stages on the CANTAB PAL task compared to chronologically age-matched children with higher AHI, and the variance in performance was partially explained by sleep fragmentation (i.e., the arousal index) and experimenter-rated "attention" but not hypoxemia. In addition, we also found that the low apnea group showed a trend toward outperforming the high apnea group on the KBIT-II Verbal IQ scale and DAS-2 Pattern Construction subtest.These findings have important clinical implications. First, these results suggest that early screening for OSAS in DS is important, as OSAS severity seems to explain some of the variance in cognitive functioning. Second, these findings suggest that an early intervention for OSAS might be warranted.