Needs and challenges of daily life for people with Down syndrome residing in the city of Rome, Italy.

BACKGROUND: Population-based surveys on the quality of life of people with Down syndrome (DS) are difficult to perform because of ethical and legal policies regarding privacy and confidential information, but they are essential for service planning. Little is known about the sample size and variability of quality of life of people with DS living in the city of Rome, which has a population of 2.7 million inhabitants. The aim of the present study is to explore the needs and challenges in health, social integration and daily life, of people with DS living in Rome. METHODOLOGY: A cross-sectional, census-based survey was conducted in 2006. All family doctors (3016 in total) of the National Health Service were involved by the Statistical Bureau of the Municipality of Rome. As per the census, every resident citizen is registered with a family doctor and every person with disabilities is coded. Associations for Down Syndrome encouraged their members to participate in the research. Questionnaires were completed by families of people with DS, in accordance with privacy laws. FINDINGS: An initial survey, conducted via a letter and a telephone contact with family doctors, identified 884 people with DS residing in the city of Rome. Data on the medical and social conditions of 518 people with DS, ranging in age from 0 to 64 years, were collected. Some 88% of these were living with their original family; 82.1% had one or more siblings, and 19.5% had lost one or both parents. A full 100% of children with DS were enrolled in the public school system. This ensures that they are fully occupied and entirely integrated in society. After secondary school there is a lack of opportunities. Thus, only 10% of adults were working with a regular contract. A mere 42.2% of people with DS aged 25-30 were involved in some form of regular activity (although not always on a daily basis). After the age of 30, the percentage of people demonstrating decline in function increased sharply, while disability-related support decreased. In other words, as people with DS age, daily life evolves increasingly around the home, with only occasional outdoor activities. CONCLUSION: The health, employment and social needs of the majority of people with DS in the city of Rome are not being met. The findings of this study underscore the urgent need for more comprehensive inclusion in society of adults with DS and for the provision of support services to create an enabling environment for inclusion. Because of the variability of performance among individuals with DS, there is a need to create more case-specific options in terms of work, living arrangements, social networking and medical services. Schooling and social inclusion in childhood alone do not guarantee a satisfactory quality of life in adulthood. It is argued herewith that policy of inclusion and support should extend over the entire lifetime of people with DS.

[Death caused by acute cardiac insufficiency due to rupture of the metal cage of a Braunwald-Cutter prosthesis. Description of a case]. / Morte da insufficienza cardiaca acuta dovuta a rottura del cestello metallico di una protesi di Braunwald-Cutter. Descrizione di un caso.

A case of a man aged 39 who died one year after aortic valve replacement by a Braunwald-Cutter prosthesis is reported. A massive aortic incompetence due to falling out of the plastic ball owing to the rupture of an arm of the cage, induced an intractable cardiac future. On necroscopy the ball was found in the aorta at the level of the renal arteries.

[Vertebral fracture caused by electric cardioversion]. / Frattura vertebrale da cardioversione elettrica.

A case of vertebral fracture following DC shock for ventricular fibrillation is reported. After a short review of the complications of this procedure the case is described and compared with two other cases known in literature. We conclude that, although this complication is uncommon, it must be kept in mind owing to its potential severity.