Abstract:

Introduction: Dermatoglyphics is the study of finger prints from toes, fingers palms, and soles of animals and humans. Dermatoglyphic examination is opening up as an exceptionally tool for initial investigations into circumstances with an alleged genetic basis. The current study was conducted to determine worthiness of dermatoglyphics in prophesying genetic vulnerability of children to dental caries via cost-effective means.

Materials and Methods: Cross-sectional study was undertaken on 100 children of age group between 4–14 years divided equally into two groups namely: Caries-free group (def/DMF score “0”) and Caries group (def/DMF score more than or equal to “5”). Both were subdivided into 25 males and 25 females. Each child’s handprints were taken and observed for dermatoglyphic pattern; total finger ridge count TFRc and atd angle.

Results: Whorls were found more in caries group whereas ulnar loops were more common in caries free group. Total finger ridge count was significantly higher in caries group. The atd angles did not show any significant differences among caries and caries free group.

Conclusion: Dermatoglyphic pattern variation may be an impor-tant tool in identification of people at risk of developing dental caries, which will enable an early detection and prevention of the disease.

Detta kapitel handlar om arbetet med att utforma riktlinjer för hur  man möter och ger stöd till föräldrar som fått ett barn med funktionsnedsätt- ning (Downs syndrom). Tidsmässigt rör det om den första tiden för föräldrarna, om vad som sägs till dem och vad som görs inom förloss- nings- och barnsjukvården. Hur reagerar föräldrarna i den för dem nya, oväntade, okända och sannolikt skrämmande situationen? Vad vill för- äldrarna ha och vad behöver de ha och inte minst vad ges de för initialt omhändertagande? De nya nationella medicinska riktlinjerna har för första gången fått ett eget avsnitt som handlar om just detta första om- händertagande. Avsnittet har sin utgångspunkt i både beprövad erfaren- het och empirisk forskning. Vårdprogrammet presenterades 21 mars 2013.

Detta arbete kan också ses som ett exempel på hur man kan ”fånga upp” ett vårdproblem från empirin, processa det genom  forskningsprocessen och hur man sedan implementera resultatet åter till empirin.

In this study 165 Swedish parents of young children with Downs’s syndrome (DS) were investigated regarding their perception of the quality of the first information and support received after the birth of the child. The parents’ opinions were compared with clinical routines at the paediatric clinics regarding these issues. Strong clinical ambitions fell short, however, since 70 % of the parents felt insufficiently informed; 56 % felt unsupported, and the timing of the disclosure varied between 0 hour to >5 days. On the basis of a grounded theory analysis the parents’ written narratives regarding the quality of the first information and support were analysed to better understand the reasons underlying the parental dissatisfaction. Criticisms were raised by the parents concerning: the low communication skills by professionals; the lack of privacy; too much negative information; and an unmet desire to early meet other DS parents.

The implications of being DS parents regarding their daily life were examined by measuring parental health, stress, sense of coherence, employment and sick leave rates. Results were compared with those in a randomly selected group of parents of healthy age-matched children. The similarities between the DS and control parents were more pronounced than the differences regarding divorce rates, siblings in the family, time spent on child care, employment and sick leave rates, and their self-perceived health, stress, and sense of coherence. However, self-perceived health of the DS mothers was impaired and stress was increased. A small group of DS parents (5 mothers and 1 father) had an extremely high rate of sick leave and no such group was seen in the control parents. In addition, the DS mothers stayed at home because of the child’s sickness most frequently and the DS fathers stayed at home for this reason more than control mothers.

Conclusions: Existing guidelines for optimal first information and support of new parents of children with DS are not always followed in Sweden. Qualitative clinical improvements from the parents’ perspective are proposed. Most DS parents live an ordinary family life in respect to the measured parameters, but the risk for health deterioration, particularly in DS mothers, might need attention.

Denna artikel har som syfte att uppgradera riktlinjerna för den första informationen och stödet till föräldrar som fått barn med medfödda funktionshinder, tillstånd som är uppenbara omedelbart efter födseln. Slutsatserna är hämtade från en svensk studie om nyblivna föräldrar till ett barn med Downs syndrom – den senaste empiriska nationella genomgången av föräldrars syn på hur informationen och stödet fungerar, publicerad redan 2002.

In this comparative study, self-perceived health was investigated in 165 parents of 86 children with Down's syndrome (DS), using the Swedish version of the SF-36 questionnaire. Questionnaires were mailed to parents of children with DS in a defined Swedish population. The results were compared with those in a randomised control group of parents from the Swedish SF-36 norm population. Mothers and fathers replied separately. Student's t-test with the Bonferroni correction was used for multiple statistical comparisons. The mothers of children with DS ('DS mothers') had significantly lower, less favourable scores than did the fathers of DS children ('DS fathers') in the Vitality (p < 0.0005) domain. Further, DS mothers spent significantly more time in caring for their child with DS than did the DS fathers (p < 0.0001). DS mothers also had lower scores than the mothers of the control group in the Vitality (p < 0.001) and Mental Health (p < 0.001) domains. DS fathers and control fathers differed significantly in the Mental Health domain (p < 0.002), but not otherwise. In conclusion, DS mothers showed poorer health than their spouses and the control mothers. No differences similar to those found between the DS mothers and DS fathers were observed between control mothers and control fathers.

Becoming parents of a child with Down's syndrome (DS) challenges the adjustment ability in parenthood. Individuals with higher sense of coherence (SOC) are supposed to manage stressors better than those with lower SOC. The aims of this study were to investigate parental self-perceived stress, SOC, frequency of gainful employment and amount of time spent on child care in Swedish DS parents (165 parents; 86 mothers, 79 fathers) and to compare those with control parents of healthy children (169 parents; 87 mothers, 82 fathers). The mean age of the children was 4.7 years. Parents responded to questionnaires separately including Hymovich's Parent Perception Inventory as stress measurement and Antonovsky's short version of the Orientation to Life. No differences concerning total employment rate were observed, but the DS mothers were more often employed part-time than control mothers. The DS parents did not spend more time on child care than the control parents and they did not differ in mean SOC score, but the DS parents perceived greater stress. The differences in stress, particularly between the DS and control mothers, were related to time-demanding areas. Parents with high SOC scores experienced significantly less self-perceived stress.

When parents are informed that their newborn child has Down syndrome (DS), they often respond with a traumatic crisis reaction. The aims of this study were to assess the clinical goals regarding the first information and support provided to parents of newborn children with DS at the Swedish paediatric departments, and to analyse the parents' experiences of how they were first informed and treated. Data were collected during 1992-1993 from all of the 51 departments of paediatrics in Sweden. Information on the parents' experiences, collected retrospectively in 1996, was based on recollection by 165 parents of 86 children with DS born between 1989 and 1993 at 10 of the paediatric departments considered representative for Sweden. Seventy-five percent of the families were informed about the diagnosis within 24 h post partum. Some parents felt they were informed too late, and a few parents that they were told too soon. Half of the parents were satisfied with the timing. About 70% of the parents considered the information insufficient and 60% felt that they had been unsupported. Seventy percent would have liked more frequent information. Parental criticisms concerning the way in which the information was provided were that they received too much negative information about DS and that both the communication skills and the basic knowledge of DS on the part of the professionals could have been better. CONCLUSION: The Swedish paediatric departments fall short of their reported strong clinical goals regarding the initial information in Sweden, and improvements in this area are desirable.

BACKGROUND: The aims of present study were to study sickness absence among Swedish parents of children with Down's syndrome (DS) and to compare their rates of absence with those of control parents. Sickness absence data for 165 DS parents were compared with those for 174 control parents; all data were for the period 1997-2000. Sickness absence rates were also related to parental self-perceived health, stress and sense of coherence. METHODS: The self-administrated measures of parental self-perceived health, stress and sense of coherence were compared with the number of days of sickness absence. RESULTS: In about two-thirds of the parents in both the study and the control group, no days of sickness absence were registered. Six of the DS parents had remarkably large numbers of days of sickness absence (more than 100 per year). None of the control parents had such high sickness absence rates. It is speculated that there is a small group (less than 5%) of parents who are more vulnerable to the birth of a child with DS. Apart from these six DS parents, sickness absence was not more frequent among the DS parents than among the control parents. DS parents stayed at home to care for their sick DS child three times more often than control parents did for their non-disabled child. DS fathers took greater responsibility in the care of their temporarily sick child and stayed at home to care for the child even more often than control mothers did. DS parents with sickness periods experienced small deterioration in self-perceived health, significantly higher stress and decreased sense of coherence in comparison with parents without sickness periods. CONCLUSIONS: There was a great similarity in sick leave rates due to one's own sickness between DS and control parents, but a small group of DS parents (<5%) may be more vulnerable. DS fathers stayed at home to care for their sick DS child remarkably often.

BACKGROUND: The prevalence of thyroid disease is increased in Down's syndrome. Most available data come from cross sectional studies. AIMS: To study longitudinally thyroid function in patients with Down's syndrome in Uppsala county (85 patients) up to the age of 25 years. METHODS: Observational study based on yearly follow up in a children's clinic. Thyroid function tests were performed at each visit to the clinic. RESULTS: Hypothyroidism was found in 30 and hyperthyroidism was found in two of the 85 patients. No sex difference was seen. Half of the patients with hypothyroidism acquired the condition before the age of 8 years, but only one of them displayed thyroid autoantibodies at diagnosis. Most patients who developed hypothyroidism after this age had thyroid autoantibodies. In the prepubertal patients with hypothyroidism, growth velocity was lower during the year before the start of thyroxine treatment than during the year after treatment began; it was also lower than that of sex and age matched euthyroidic children with Down's syndrome. CONCLUSION: Thyroid dysfunction in patients with Down's syndrome is common in childhood. Consequently, annual screening is important. Autoimmune thyroid disease is uncommon in young children with Down's syndrome but is common after 8 years of age.

From a public health perspective, it is important that children with Down syndrome (DS) lay the foundations of physical activity (PA) early in life to keep active in school, as teenagers and as adults. The aims were to investigate PA patterns in children and adolescents with DS, as well as their parents' and siblings' PA patterns.

METHODS: A survey was performed among 310 families with children with DS (54% boys and 46% girls) aged 8-18 years (mean 14.04, SD 3.18) in Sweden. Chi-squared tests and multiple logistic regression were carried out.

RESULTS: Nineteen percent of children and adolescents with DS and 34% of the parents were active three or more times per week. The child's PA level was significantly associated with parents' PA (OR = 5.5), siblings' PA (OR = 5.1) and the child's locomotion ability (OR = 3.5). Physically active parents had active children to a greater extent than inactive parents (59% vs. 29%; p < 0.001).

CONCLUSIONS: Physically active parents have active children. To promote PA among children and adolescents with DS, it is important to promote and pay attention to the parents' and siblings' PA behavior, as children with DS are dependent on support from the family.

Kapitlet handlar om barn och ungdomar med Downs syndrom och deras möjligheter till fysisk aktivitet. Texten startar med att förklara vad Downs syndrom är och vilka svårigheter som kan uppstå vid fysisk aktivitet. Därefter beskrivs WHO:s rekommendationer för fysisk aktivitet för barn och ungdomar och sist kommer en beskrivning av en studie vi har genomfört med barn och ungdomar i åldrarna 8–18 år. Alla barn behöver röra på sig för att utvecklas optimalt. Det gäller även barn med Downs syndrom.

Introduction, aim and theoretical framework

About 150 children with Down Syndrome (DS) are born in Sweden every year. According to the Swedish National Sports Confederation, these children have the right to play sports and to be physically active like other children. Sports for children should be based on children’s own needs and circumstances and take into account of the variations in development. Children with DS have been shown to have low fitness, poor motor skills, very lo participation in sports activities and a high prevalence of overweight (Whitt-Glover et al, 2006). The aim of the study was to investigate sports habits and physical activity (PA) among children and adolescents with DS in the age 8-18 years in Sweden.

Method

Information was obtained by a questionnaire performed among families with children with DS, all information was given by the parents. Furthermore, new additional questions focusing on PA and sports participation, attitudes and living habits among both children and adults were included. The sample consisted of 310 children with DS and their families in Sweden. The statistics were carried out by using SPSS. Additional information on children’s PA was given in written narratives. The written information was analyzed with qualitative text analyses.

Results

Overall activity patterns among children with DS seemed to be quite similar to the patterns among other childre without disabilities. A polarized picture emerged in which some were very active and some were completely inactive. Relationships between parents’ own level of PA and children’s activity could be shown, as well as associations between parental involvement in the activities and children’s activity levels. The parents expressed the difficulties children with DS have to participate in sports together with other children. Three main areas could be identified as barriers. 1. Time consuming. The parents stated that it was much time consuming to organize opportunities fo children with DS to engage in sports activities in the family situation. 2. Characteristics of the children. The children are slow and sometimes difficult to motivate which take a lot of effort. They also have physical problems, for example poor motor skills, perceptual difficulties, poor movement planning which exclude participation in many activities. Some parents also indicated a lack of endurance capacity and rapid mood swings as additional factors that contributed to the difficulties. 3. Society and sports clubs. Parents stated that there were few possibilities for PA which are manageable for children with DS offered by the society and sport clubs. Parents didn’t experience any negative reactions from other children without disabilities or their parents when children with DS participated in sports activities with other children. However, they had a feeling that the children with DS slowed down th tempo for the whole group.

Discussion and conclusions

The results highlight the barriers that parents of children with DS experience as detrimental for how much PA children with DS can undertake and the effect that common characteristics associated with DS can have on main taining an active lifestyle. Society and sport clubs seem to have a small range of activities for children with DS.