The mathematical development of children with Apert syndrome

Apert syndrome is a rare condition (birth prevalence of 1 in 65000) with associated risks of other physical disabilities. Children with the condition experience major surgery involving the fingers. It has been suggested that these children have greater difficulty with mathematics than with other curriculum subjects. This study explored the mathematical learning of 10 primary school age children with Apert syndrome over two years. The children in the study had varied sensory disabilities, which included hearing and visual impairments, as well as limited finger mobility. The children were visited five or six times at school, in order to detect change over time. The children were observed when they were learning mathematics in school. To explore the children’s understanding and thinking in mathematics, clinical interviews using items from number skills tests were conducted. Standardized measures of working memory and mathematical achievement were administered. Interviews were carried out with the children’s parents and school staff supporting their education. A central finding of this study is that children with Apert syndrome are heterogeneous. The only factor that the children in the study shared was their initial lack of finger use when engaging with work involving number and arithmetic. In line with contemporary neuroscience, this study suggests that finger knowledge and awareness, or finger gnosis, and finger mobility are important in early number development. Exercises in developing of finger gnosis may enable flexibility in strategy use and development for solving problems in arithmetic. However, children with Apert syndrome will continue to be confronted with many other challenges that impact their learning of mathematics

Prevalence, incidence and concomitant co-morbidities of type 2 diabetes mellitus in South Western Germany - a retrospective cohort and case control study in claims data of a large statutory health insurance

Background: Type 2 diabetes mellitus (T2DM) has become a world-wide epidemic. This chronic metabolic disease has a major impact on life expectancy and on quality of life. The burden of this disease includes a number of co-morbidities. However, estimates of prevalence, incidence and associated diseases as well as the current temporal development and regional differences are largely missing for South Western Germany. Methods: Lifetime diagnosis-based prevalence, incidence and presence of concomitant co-morbidities were examined between the years 2007 and 2010 in the claims data set of all insured persons of the AOK Baden-Wuerttemberg, a large statutory health insurance. The analysis was based on the respective WHO-ICD-10 codes. Data were standardized for age and sex on the residential population of about 10 million inhabitants of South Western Germany. Results: The total study cohort involved approximately 3.5 million persons each year. The standardized diagnosis-based prevalence (SDP) of T2DM rose from 6.6 %, 7.4 %, 8.0 %, up to 8.6 % in the years 2007 to 2010. Yearly SDP was between 14.0 % and 18.9 % at an age range of 60 to 64 years and between 26.7 % and 31.8 % at an age of 75 years or older. In the year 2010 the regional distributions of standardized diagnosis-based prevalence were between 7.6 % and 11.6 %, respectively. Incidence rates were 8.3 in 2008, 7.8 in 2009, and 8.7 in 2010 (all rates per 1000). The excess disease risk (odds ratio) of T2DM was for adiposity 2.8 to 3.0, hypertension 2.4 to 3.7, coronary heart disease 1.8 to 1.9, stroke 1.7 to 1.8, renal insufficiency 2.8 to 3.4, and retinopathy 2.8 to 2.9 in the years 2007 to 2010. These co-morbidities appeared several years earlier compared to the non-diabetic population. Conclusions: T2DM is common and increasing in South Western Germany. In particular a quarter of the population in higher ages was afflicted by T2DM. Interestingly a region-specific pattern was observed as well as an increase in numbers during earlier years in life. Our data underline the need for diabetes awareness programmes including early diagnosis measures as well as structured and timely health surveys for major diseases such as T2DM and its concomitant co-morbidities.Published versio