Medical Care of Adults With Down Syndrome: A Clinical Guideline.

Importance: Down syndrome is the most common chromosomal condition, and average life expectancy has increased substantially, from 25 years in 1983 to 60 years in 2020. Despite the unique clinical comorbidities among adults with Down syndrome, there are no clinical guidelines for the care of these patients. Objective: To develop an evidence-based clinical practice guideline for adults with Down syndrome. Evidence Review: The Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup (n = 13) developed 10 Population/Intervention/ Comparison/Outcome (PICO) questions for adults with Down syndrome addressing multiple clinical areas including mental health (2 questions), dementia, screening or treatment of diabetes, cardiovascular disease, obesity, osteoporosis, atlantoaxial instability, thyroid disease, and celiac disease. These questions guided the literature search in MEDLINE, EMBASE, PubMed, PsychINFO, Cochrane Library, and the TRIP Database, searched from January 1, 2000, to February 26, 2018, with an updated search through August 6, 2020. Using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework, in January 2019, the 13-member Workgroup and 16 additional clinical and scientific experts, nurses, patient representatives, and a methodologist developed clinical recommendations. A statement of good practice was made when there was a high level of certainty that the recommendation would do more good than harm, but there was little direct evidence. Findings: From 11 295 literature citations associated with 10 PICO questions, 20 relevant studies were identified. An updated search identified 2 additional studies, for a total of 22 included studies (3 systematic reviews, 19 primary studies), which were reviewed and synthesized. Based on this analysis, 14 recommendations and 4 statements of good practice were developed. Overall, the evidence base was limited. Only 1 strong recommendation was formulated: screening for Alzheimer-type dementia starting at age 40 years. Four recommendations (managing risk factors for cardiovascular disease and stroke prevention, screening for obesity, and evaluation for secondary causes of osteoporosis) agreed with existing guidance for individuals without Down syndrome. Two recommendations for diabetes screening recommend earlier initiation of screening and at shorter intervals given the high prevalence and earlier onset in adults with Down syndrome. Conclusions and Relevance: These evidence-based clinical guidelines provide recommendations to support primary care of adults with Down syndrome. The lack of high-quality evidence limits the strength of the recommendations and highlights the need for additional research.

Prophylactic Valacyclovir to Prevent Outbreaks of Primary Herpes Gladiatorum at a 28-Day Wrestling Camp: A 10-Year Review.

OBJECTIVE: To determine efficacy of using oral antiviral medication to reduce herpes gladiatorum (HG) at summer high-school wrestling camps. DESIGN: Usage of antiviral medication hypothetically reduces the likelihood of HG outbreaks. This is an observational study examining the effectiveness of oral antiviral medications in reducing outbreaks of HG because of Herpes Simplex type-1 virus (HSV). SETTING: A 28-day high-school summer wrestling camp at the University of Minnesota from 2003 to 2012. PARTICIPANTS: Each summer approximately 300 high-school wrestlers, age 13 to 18 years of age, participated in this camp. INTERVENTIONS: All athletes were recommended to take valacyclovir 1 g once a day for the duration of the camp. Athletes who did not use any antiviral medication comprised the comparison group for this study. Individuals were screened daily and those with outbreaks of HG were withheld from practice for 120 hours in accordance with National Collegiate Athletic Association/National Federation of State High School Associations guidelines. MAIN OUTCOME MEASURES: To measure viral outbreaks of HG due to HSV-1, determine level of compliance, and determine efficacy of antiviral medication in reducing the occurrence of HG at this 28-day wrestling camp. RESULTS: Of the 2793 athletes who completed camp, 1995 (71%) used antiviral medication, and 36 outbreaks occurred. Eighty-four athletes had a known history of HG/recurrent herpes labialis. Overall, prophylactic antiviral medication resulted in an 84.7% decrease in the probability of an outbreak. Prophylactic valacyclovir (1 g daily) lowered the incidence of individual outbreaks by 89.5%. CONCLUSIONS: Prophylactic use of valacyclovir 1 g once a day is efficacious in lowering the incidence of HSV outbreaks among adolescents at a 28-day wrestling camp.

El soliloquio, los amigos imaginarios y la vida de fantasía / No disponible

El soliloquio y los amigos imaginarios suelen ser bastante “normales” en los adolescentes y en los adultos con síndrome de Down. Para la mayoría de estas personas, hablar solas en voz alta, o con sus amigos imaginarios, puede tener muchas utilidades posibles. En general, la intervención sólo es necesaria cuando existen otros síntomas concordantes con una enfermedad mental, o cuando la conducta estuviera interfiriendo considerablemente la participación en otras actividades, o si se dieran ambas circunstancias a la vez(AU)

Addressing quality of life issues in adolescents: social skills interventions.

OBJECTIVE: The purpose of this study was to determine whether social skills training can improve the social interaction skills of adolescents with craniofacial conditions (CFCs) in a natural environment (school lunchroom). DESIGN: This study used a pre-post between-group comparison design. Differences between treatment and control subjects were analyzed via a repeated measures analysis of variance. SETTING: The observations were conducted in the respective school lunch-rooms of the adolescents. Social skills groups were conducted in an outpatient clinic setting. MAIN OUTCOME MEASURES: Structured data based on 45 minutes of observation was coded for type, frequency, and duration of social contact. Specific measures included subject initiations and responses, peer initiations and responses, conversation events, total positive communication, and frequency of nondirected comments. RESULTS: Both target and peer-controlled total communication improved across time with adolescents receiving social skills intervention showing significantly more improvement than those adolescents not receiving direct social skills interventions. Adolescents receiving treatment participated in significantly more target initiated conversations lasting at least three interchanges and showed a trend toward a greater frequency of target initiations and positive responses to peer initiations. Peers were more likely to respond to treatment subject initiations after intervention. Fewer treatment subjects used nondirected communication, whereas control subjects continued to use nondirected communication at a slightly increased frequency. CONCLUSIONS: This study provides preliminary evidence that social skills training can increase the frequency of positive social interactions with peers for adolescents with CFCs.

Algunas cuestiones sobre la vida de los adolescentes y adultos con síndrome de Down / No disponible

El notable incremento de la longevidad de las personas con síndrome de Down debe animar a los profesionales y cuidadores a dar lo mejor de sí mismos para asegurar que esta vida más larga sea también una vida más plena y más sana, tanto en términos de su salud en general como de bienestar emocional y de su funcionamiento social. Basados en su experiencia clínica con más de 1.200 jóvenes y adultos, los autores analizan los principales problemas de carácter psicosocial, laboral y médico que han encontrado, y ofrecen soluciones y recomendaciones para prevenirlos o para mejorarlos

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