1
|
Zhang W, Zhu T, Wang S, Zhang Y, Chen W, Li K. Chain-mediating effects of kinesiophobia and self-efficacy on pain catastrophizing and physical activity in haemophilia patients. Haemophilia 2024; 30:809-816. [PMID: 38616526 DOI: 10.1111/hae.15008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/06/2024] [Accepted: 03/20/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND There is a lack of research on the relationship between pain catastrophizing, kinesiophobia, and physical activity (PA) in people with haemophilia (PWH), and the underlying mechanisms connecting these variables remain unclear. AIM The study's aim was to clarify the roles of kinesiophobia and self-efficacy in the relationship between pain catastrophizing and PA in PWH. METHODS This cross-sectional study included adult PWH at the Haemophilia Centre of a Tertiary hospital in Beijing, China. The following questionnaires were used to collect data: the general information, the International Physical Activity Short Questionnaire, the Pain Catastrophizing Scale, the Tampa Scale of Kinesiophobia Scale, and the Exercise Self-Efficacy Scale. RESULTS The study included a total of 187 PWH, including 154 having haemophilia A and 33 having haemophilia B. The median interquartile range of PA was 594 (198, 1554) MET-min/wk. There were significant differences in PA of patients based on age stage, treatment modality, highest pain score within the last seven days, and presence of haemophilic arthropathy (p < .05). It was showed that pain catastrophizing could directly predict PA (p < .001), accounting for 38.13% of the total effect. Pain catastrophizing also had indirect effects on PA through the mediating factors of kinesiophobia or self-efficacy, and through the chain-mediating effect of kinesiophobia and self-efficacy, accounting for 38.40%, 17.07%, and 6.40%, respectively. CONCLUSION The study discovered that PWH have limited PA due to pain catastrophizing. This not only directly affects their activity but also indirectly influences it through kinesiophobia and self-efficacy.
Collapse
Affiliation(s)
- Wenjing Zhang
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tienan Zhu
- Department of Haematology, Peking Union Medical College Hospital, Beijing, China
| | - Shujie Wang
- Department of Haematology, Peking Union Medical College Hospital, Beijing, China
| | - Yanbin Zhang
- Department of Haematology, Peking Union Medical College Hospital, Beijing, China
| | - Wenkun Chen
- Department of Haematology, Peking Union Medical College Hospital, Beijing, China
| | - Kuixing Li
- Department of Haematology, Peking Union Medical College Hospital, Beijing, China
| |
Collapse
|
2
|
Hay CRM, Makris M, Shima M, Nagao A, Jiménez-Yuste V, Skinner M, Kessler CM, von Mackensen S. Association of patient, treatment and disease characteristics with patient-reported outcomes: Results of the ECHO Registry. Haemophilia 2024; 30:106-115. [PMID: 38030962 DOI: 10.1111/hae.14895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Patient-reported outcomes (PROs) in people living with haemophilia A (PLWHA) are often under-reported. Investigating PROs from a single study with a diverse population of PLWHA is valuable, irrespective of FVIII product or regimen. AIM To report available data from the Expanding Communications on Haemophilia A Outcomes (ECHO) registry investigating the associations of patient, treatment and disease characteristics with PROs and clinical outcomes in PLWHA. METHODS ECHO (NCT02396862), a prospective, multinational, observational registry, enrolled participants aged ≥16 years with moderate or severe haemophilia A using any product or treatment regimen. Data collection, including a variety of PRO questionnaires, was planned at baseline and annually for ≥2 years. Associations between PRO scores and patient, treatment and disease characteristics were determined by statistical analyses. RESULTS ECHO was terminated early owing to logistical constraints. Baseline data were available from 269 PLWHA from Europe, the United States and Japan. Most participants received prophylactic treatment (76.2%), with those using extended-half-life products (10.0%) reporting higher treatment satisfaction. Older age and body weight >30 kg/m2 (>BMI) were associated with poorer joint health. Older age was associated with poorer physical functioning and work productivity. Health-related quality of life and pain interference also deteriorated with age and >BMI; >BMI also increased pain severity scores. CONCLUSION ECHO captured a variety of disease characteristics, treatment patterns, PROs and clinical outcomes obtained in real-world practice with ≤1 year's follow-up. Older age, poorer joint health and >BMI adversely affected multiple aspects of participant well-being.
Collapse
Affiliation(s)
- Charles R M Hay
- Manchester University Department of Haematology, Manchester, UK
| | - Michael Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Azusa Nagao
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan
| | | | - Mark Skinner
- Institute for Policy Advancement Ltd., Washington, DC, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
3
|
Ai D, Cui C, Tang Y, Wang Y, Zhang N, Zhang C, Zhen Y, Li G, Huang K, Liu G, Chen Z, Zhang W, Wu R. Machine learning model for predicting physical activity related bleeding risk in Chinese boys with haemophilia A. Thromb Res 2023; 232:43-53. [PMID: 37931538 DOI: 10.1016/j.thromres.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Physical activity is a crucial part of an active lifestyle for haemophiliac children. However, the fear of bleeds has been identified as barriers to participating physical activity for haemophiliac children even with prophylaxis. Lack of evidence and metrics driven by data is key problem. OBJECTIVES We aim to develop machine learning models based on clinical data with multiple potential factors considered to predict risk of physical activity bleeding for haemophilia children with prophylaxis. METHODS From this cohort study, we collected information on 98 haemophiliac children with adequate prophylaxis (trough FVIII:C level > 1 %). The involved potential predictor variables include demographic information, treatment information, physical activity, joint evaluation, and pharmacokinetic parameters, etc. We applied CoxPH, Random Survival Forests (RSF) and DeepSurv to construct prediction models for the risk of bleeding during physical activities. All three survival analysis models were internally and externally validated. RESULTS A total of 98 patients were enrolled in this study. Their median age was 7.9 (5.5, 10.2) years. The CoxPH, RSF and DeepSurv models' discriminative and calibration abilities were all high, and the RSF model had the best performance (Internal validation: C-index, 0.7648 ± 0.0139; Brier Score, 0.1098 ± 0.0015; External validation: C-index, 0.7260 ± 0.0154; Brier Score, 0.0930 ± 0.0018). The prediction curves demonstrated that the developed RSF model can distinguish the risks well between bleeding and non-bleeding patients, as well as patients with different levels of physical activity. Meanwhile, the feature importance analysis confirmed that physical activity bleeding was deduced by comprehensive effects of various factors, and the importance of different factors on bleeding outcome is discrepant. CONCLUSIONS This study revealed from the mechanism that it is necessary to incorporate multiple factors to accurately predict physical activity related bleeding risk. In clinical practice, the designed machine learning models can provide guidance for children with haemophilia A to positively participate in physical activity.
Collapse
Affiliation(s)
- Di Ai
- Haemophilia Comprehensive Care Center, Hematology Center, Beijing Key Laboratory of Pediatric Hematology-Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Chang Cui
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yongqiang Tang
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China.
| | - Yan Wang
- Department of Rehabilitation, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ningning Zhang
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chenyang Zhang
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Yingzi Zhen
- Haemophilia Comprehensive Care Center, Hematology Center, Beijing Key Laboratory of Pediatric Hematology-Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Gang Li
- Hematologic Disease Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Kun Huang
- Haemophilia Comprehensive Care Center, Hematology Center, Beijing Key Laboratory of Pediatric Hematology-Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Guoqing Liu
- Haemophilia Comprehensive Care Center, Hematology Center, Beijing Key Laboratory of Pediatric Hematology-Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Zhenping Chen
- Hematologic Disease Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Wensheng Zhang
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China.
| | - Runhui Wu
- Haemophilia Comprehensive Care Center, Hematology Center, Beijing Key Laboratory of Pediatric Hematology-Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China.
| |
Collapse
|
4
|
Chantrain VA, Lambert C, De Smet P, Lobet S, Foubert A, Meeus M, Hermans C, Roussel NA. Pain interferes with daily activities, emotions and sleep in adults with severe, moderate and mild haemophilia: A national cross-sectional survey. Haemophilia 2023; 29:521-529. [PMID: 36657103 DOI: 10.1111/hae.14747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/17/2022] [Accepted: 12/18/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Pain is a major issue in people with haemophilia (PwH). Few studies comprehensively assessed pain in PwH using a biopsychosocial framework and studies in mild PwH are lacking. AIM To assess pain prevalence, pain interference and their relationship with health-related quality of life (HR-QoL) in male adults with haemophilia. METHODS A survey was initiated by the Belgian national member organisation. Pain in the last 24 h, pain severity (BPI-PS) and pain interference (BPI-PI) scores were obtained with the Brief Pain Inventory short-form (BPI). HR-QoL was evaluated with the EQ-5D-3L, giving the health utility index (EQ-HUI). Associations between EQ-HUI, BPI-PS and BPI-PI were analysed using Pearson's correlation test. A multiple regression analysed the relationship between HR-QoL and BPI-PS, with age and haemophilia severity as confounding factors. RESULTS Within 185 respondents (97, 31 and 57 respectively severe, moderate and mild PwH), 67% (118/177) reported pain. In severe, moderate and mild PwH, respectively 86% (79/92), 71% (22/31) and 32% (17/54) reported pain. Median [IQR] BPI-PS, BPI-PI and EQ-HUI scores were respectively 1.5 [.0; 4.0], 1.6 [.0; 3.6] and .81 [.69; 1.00]. PwH reported pain interference with general activity (56% (99/176)), psychosocial factors such as mood (53% (93/175)), and sleep (51% (90/177)). Moderate correlations were found between EQ-HUI, BPI-PS and BPI-PI. After adjusting for age and haemophilia severity, BPI-PS explained 14% of HR-QoL variance. CONCLUSIONS Pain is a major issue amongst PwH, including people with mild haemophilia. Pain interferes with activities, emotions, sleep and HR-QoL, arguing for a comprehensive biopsychosocial approach of pain.
Collapse
Affiliation(s)
- Valérie-Anne Chantrain
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium.,Pain in Motion, International Research Group, www.paininmotion.be.,Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Catherine Lambert
- Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Patrick De Smet
- AHVH (Association de l'hémophilie/Hemofilievereniging), Belgian national member organization for haemophilia, Brussels, Belgium
| | - Sébastien Lobet
- Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium.,Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCLouvain), Brussels, Belgium.,Secteur de kinésithérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Anthe Foubert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium.,Pain in Motion, International Research Group, www.paininmotion.be.,Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group, www.paininmotion.be.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Cedric Hermans
- Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Nathalie Anne Roussel
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| |
Collapse
|
5
|
Ransmann P, Krüger S, Hilberg T, Hagedorn T, Roussel N. Prevalence of pain in adult patients with moderate to severe haemophilia: a systematic review. Scand J Pain 2022; 22:436-444. [PMID: 35297228 DOI: 10.1515/sjpain-2021-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Patients with haemophilia (PwH) often suffer from joint pain due to repetitive haemarthroses and resulting arthropathy. Literature focuses so far on pain causes, diagnosis or treatment. A summary of prevalence rates, providing facts on the absolute occurrence of pain, is not sufficiently described so far. This review aimed to explore and systematically review different pain conditions, focussing on prevalence rates of pain in adult PwH. METHODS A review of English articles using PubMed and Web of Science was conducted in February 2020. The search strategy included patients with haemophilia A or B suffering from pain. The articles were selected based on defined PICOS-selection criteria. RESULTS Out of 606 identified articles, 13 studies matched the given eligibility criteria and indicated pain prevalence rates. The weighted mean (WM) for the prevalence rate (varying timeframes) for chronic pain was 40% whereas for point prevalence the rate was WM=75%. Regarding pain intensity, findings of the EQ-5D-3L revealed moderate pain to be more present (61.0%) compared to extreme (11.6%). The main problem was the inconsistency of the definition of both acute and chronic pain as well as for prevalence types. CONCLUSIONS Pain is a major problem in patients with haemophilia. Pain therapy should be carried out taking into account the difference between bleeding-related or arthropathy-related causes of pain. In addition, the intensity and duration of pain should be recorded consistently to better monitor therapy and allow comparison with existing data.
Collapse
Affiliation(s)
- Pia Ransmann
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Steffen Krüger
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thorsten Hagedorn
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Nathalie Roussel
- Department of Rehabilitation Science and Physiotherapy (MOVANT), University of Antwerp, Wilrijk, Belgium
| |
Collapse
|
6
|
McLaughlin P, Holland M, Dodgson S, Khair K. Project GYM: A randomized feasibility study investigating effect on motivation of personal trainer-led exercise in young men with hemophilia. Res Pract Thromb Haemost 2021; 5:e12613. [PMID: 34870067 PMCID: PMC8626598 DOI: 10.1002/rth2.12613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/08/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Many young men with hemophilia engage in physical activity and sport but face challenges to participation because of their hemophilia. Project GYM aimed to investigate the feasibility of a hemophilia-specific fitness program led by a personal trainer (PT) and its impact on gym activity, motivation, and adherence to exercise. METHODS This was a nonblinded, randomized feasibility study, recruiting participants aged 18 to 25 years with hemophilia A or B (all severities, ± inhibitor) from three London hemophilia centers. All participants were given an activity tracker and free gym membership. Participants were randomized to a "gym only" or "gym and PT" arm. Participants completed questionnaires evaluating motivation to exercise, quality of life, physical activity levels, self-efficacy, and self-esteem at study start and study end. RESULTS Of 142 eligible individuals, 19 agreed to participate. Participants were healthy, with mean body mass index and adiposity slightly lower than the UK average. They reported low bleed numbers and had good joint health (median Hemophilia Joint Health Score [HJHS], 0; range, 0-13). The gym and PT group had more gym attendance than the gym-only group. Seven participants increased their activity levels and nine stayed the same, with no statistical difference between groups. HJHS scores improved in 3 participants and were unchanged in 12. There was no bleeding associated with gym activity. CONCLUSION Project GYM has demonstrated the safety and feasibility of a tailored physical training program in young men with hemophilia. Increased gym attendance, with and without support from a PT, is associated with increased physical activity.
Collapse
Affiliation(s)
- Paul McLaughlin
- Katharine Dormandy Haemophilia Centre and Thrombosis UnitRoyal Free London NHS Foundation TrustLondonUK
| | | | | | | |
Collapse
|
7
|
Khair K, Holland M, Dodgson S, McLaughlin P, Fletcher S, Christie D. Fitness enhances psychosocial well-being and self-confidence in young men with hemophilia: Results from Project GYM. Res Pract Thromb Haemost 2021; 5:e12622. [PMID: 34870069 PMCID: PMC8626601 DOI: 10.1002/rth2.12622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/08/2021] [Accepted: 09/29/2021] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Contemporary hemophilia care supports physical activity, its benefits being well recognized. Despite recognition of the psychological challenges encountered by people with hemophilia, little is known about the psychological impact of physical fitness in this population. AIM To identify changes in psychological well-being in young men with hemophilia through participation in a gym program. METHODS This observational feasibility study of a 6-month gym participation program used validated questionnaires pre- and poststudy to evaluate motivation to exercise, physical activity levels, self-efficacy, self-esteem, and quality of life. Individual audio-recorded interviews about study participation and impact were transcribed verbatim and analyzed for recurring themes using thematic analysis. RESULTS Nineteen participants aged 18-25 years with hemophilia A or B (all severities ± inhibitor) consented to the study; two were lost to follow-up. There was a shift in motivation to exercise as shown by the Stages of Change grouping moving from contemplation to action and maintenance phases (p = 0.03). Self-efficacy overall scores showed a trend (p < 0.06) towards improvement. Median self-esteem scores improved from 22 (range 12-30, n = 19) to 25 (range 13-30, n = 17), a statistically significant change (p = 0.02). Three participants recorded scores below the accepted normal range before study, of whom two improved at study end. The key themes identified from the interviews were: fear, self-confidence, "being normal," pain, weight loss, ability, getting fitter. CONCLUSIONS The psychological wellbeing of young men with hemophilia improved during this study. This may have been related to participating in a gym-based, physical exercise program.
Collapse
Affiliation(s)
| | | | | | - Paul McLaughlin
- Katharine Dormandy Haemophilia Centre and Thrombosis UnitRoyal Free NHS Foundation TrustLondonUK
| | - Simon Fletcher
- Haemophilia CentreOxford Haemophilia and Thrombosis CentreThe Churchill HospitalOxfordUK
| | | |
Collapse
|
8
|
Moretti L, Bizzoca D, Buono C, Ladogana T, Albano F, Moretti B. Sports and Children with Hemophilia: Current Trends. CHILDREN 2021; 8:children8111064. [PMID: 34828778 PMCID: PMC8625282 DOI: 10.3390/children8111064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 12/18/2022]
Abstract
Hemophilia is a sex-linked recessive disorder characterized by a lack of blood factors necessary for clotting. This review aims to investigate the benefits of sports activities in children with hemophilia in terms of both physical and psychological wellness. Sports activity is necessary for children with hemophilia to preserve joints’ range of motion, reduce joint bleeding, improve muscle mass and strength, enhance proprioception and prevent secondary chronic diseases. In the past, high-impact sports were usually forbidden in children with hemophilia because of their high bleeding risk. Recent studies, however, have shown that prophylaxis therapy can allow a hemophilic child to take part in vigorous activities or high-impact sports. The benefits of sports activity in children with hemophilia are expressed by a better muscular trophism and an improved bone mineral density. Moreover, physical activity has a positive impact on children’s psychosocial well-being. Due to prophylaxis therapy, the quality of life of children with hemophilia is similar to their peers, and this has allowed an improvement in sports participation, including team sports.
Collapse
Affiliation(s)
- Lorenzo Moretti
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy; (L.M.); (C.B.); (T.L.); (F.A.); (B.M.)
| | - Davide Bizzoca
- PhD Course in Public Health, Clinical Medicine and Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence: or
| | - Claudio Buono
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy; (L.M.); (C.B.); (T.L.); (F.A.); (B.M.)
| | - Teresa Ladogana
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy; (L.M.); (C.B.); (T.L.); (F.A.); (B.M.)
| | - Federica Albano
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy; (L.M.); (C.B.); (T.L.); (F.A.); (B.M.)
| | - Biagio Moretti
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy; (L.M.); (C.B.); (T.L.); (F.A.); (B.M.)
| |
Collapse
|
9
|
Promoting Sports Practice in Persons with Hemophilia: A Survey of Clinicians' Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211841. [PMID: 34831596 PMCID: PMC8625842 DOI: 10.3390/ijerph182211841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 11/16/2022]
Abstract
Historically, people with hemophilia have been warned to avoid physical activities as a possible cause of bleeding; however, currently, sport is considered necessary, especially in the developmental age, for providing a good quality of life. A survey was proposed to a group of hematologists and sports physicians working in Puglia, Italy, to explore their approach to physical activities for their patients with hemophilia and to obtain suggestions about possible interventions to promote the access of patients to sports. The survey was answered by 6 hematologists and 15 sports physicians. In total, 71% (about six patients/year/physician) of patients with hemophilia seen by sports physicians asked for counseling about sports, and 67% (about five patients/year/physician) actually practiced sports. On the other hand, only 31% (about 16 patients/year/hematologist) of patients asked hematologists questions on sports, and only 16% (about seven patients/year/hematologist) of patients with hemophilia and that were followed-up by hematologists practiced sports. The sports most often recommended to patients with hemophilia by physicians included swimming, athletics, tennis, running and gymnastics. According to hematologists, physical activity was very efficient in improving the quality of life of patients; stability of joints; their psychological, social and musculoskeletal wellbeing; and in reducing the risk of bleedings. On the other hand, physical activity was considered less important in all these areas by sport physicians. In conclusion, answers to this survey suggested that sports could be promoted among hemophilic patients by increasing the sports physicians' knowledge about hemophilia and their special role in this area. In addition, interviewed clinicians were of the opinion that increased awareness of specific guidelines and clinical practice protocols among both hematologists and sports physicians could be beneficial. Finally, answers suggested that access to fitness certification should be facilitated.
Collapse
|
10
|
Pillard F, Pécourneau V, Pereira O, Gérard S, Voisin S, Clayessens-Donadel S. Home-based and personalized endurance training program for patients with mild to moderate hemophilia A: What can be expected? Sci Sports 2021. [DOI: 10.1016/j.scispo.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Versloot O, van Balen EC, Hassan S, Schols SEM, Leebeek FWG, Eikenboom J, Coppens M, van Vulpen LFD, Smit C, Driessens MHE, van der Net J, Gouw SC, Fischer K. Similar sports participation as the general population in Dutch persons with haemophilia; results from a nationwide study. Haemophilia 2021; 27:876-885. [PMID: 34146370 PMCID: PMC8518501 DOI: 10.1111/hae.14366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/27/2021] [Accepted: 06/09/2021] [Indexed: 01/20/2023]
Abstract
Introduction Although sports participation is advocated in people with haemophilia (PWH), detailed data concerning sports participation in Dutch PWH is lacking. Aim to assess sports participation in Dutch PWH (6‐65 years) compared to the Dutch general population (GP). Methods Data from a nationwide, cross‐sectional study in PWH were analysed. Sports participation (type, duration, frequency) was assessed by the Modifiable Activities Questionnaire (MAQ), limitations in activities using the (Paediatric) Haemophilia Activities List ((Ped)HAL). Sports in the two highest categories according to the National Hemophilia Foundation classification were considered high‐risk sports. Groups were compared using Chi‐square testing. Results A total of 524 Adult PWH (median age: 45 (IQR: 30–55); 37% severe) and 126 paediatric PWH (median age: 11 (IQR: 8–14); 52% severe) were included. Sports participation was higher in adults (70%) than the GP (58%) and similar to the GP in children (PWH: 68%, GP: 72%). High‐risk sports participation decreased with age in PWH: from 65% (6‐12 years) to 17% (50‐65 years), which was also observed in the GP. Sports participation in children was independent of severity (non‐severe: 67% vs. severe: 65%; P = 0.97), but not in adults (non‐severe: 75%, severe: 62%; P < 0.01). Non‐severe PWH played more high‐risk sports than severe PWH: children at 65% vs. 48% (P = 0.05), adults at 25% vs. 15% (P = 0.07). Discussion These results suggest that sports participation in PWH was comparable to the GP. Sports participation was dependent of haemophilia severity in adults. Children were more involved in high‐risk sports than adults. More studies on sports‐related injury‐risk are needed for adequate counselling.
Collapse
Affiliation(s)
- Olav Versloot
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erna C van Balen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Shermarke Hassan
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Saskia E M Schols
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.,Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Nijmegen, The Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeroen Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Lize F D van Vulpen
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cees Smit
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Janjaap van der Net
- Center for Child Development, Exercise and Physical Literacy, University Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Samantha C Gouw
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kathelijn Fischer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | -
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
12
|
Berntorp E, Hermans C, Solms A, Poulsen L, Mancuso ME. Optimising prophylaxis in haemophilia A: The ups and downs of treatment. Blood Rev 2021; 50:100852. [PMID: 34243987 DOI: 10.1016/j.blre.2021.100852] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 01/19/2023]
Abstract
The classical goals of haemophilia A treatment are to prevent bleeds, minimise the risk of long-term complications associated with joint damage, and improve quality of life by maintaining appropriate factor VIII [FVIII] levels. The dose and frequency of FVIII replacement therapies required to reduce bleeds is now known to vary amongst individuals, and may change for the same individual over time, meaning that a standardised dose and regimen may not provide optimal protection to all patients. Here we review the evolving treatment landscape for haemophilia A, and discuss how an increased understanding of the pharmacology and pharmacokinetics underlying FVIII replacement and non-factor replacement therapies could improve patient outcomes. We also review the strengths and weaknesses of current treatments and explore the benefits of personalised therapy and review how this may best be achieved with current treatment options. The key points of our review are summarised in this accompanying short video.
Collapse
Affiliation(s)
- Erik Berntorp
- Malmö Center for Thrombosis and Haemostasis, Lund University, Sweden.
| | - Cédric Hermans
- Division of Adult Haematology, Haemostasis and Thrombosis Unit, Université Catholique de Louvain (UCLouvai), Brussels, Belgium
| | | | - Lone Poulsen
- Haemophilia Center, Aarhus University Hospital, Denmark
| | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| |
Collapse
|
13
|
High prevalence of overweight/obesity in adult persons with hemophilia in Utah and a review of the literature. Blood Coagul Fibrinolysis 2021; 31:522-529. [PMID: 32941196 DOI: 10.1097/mbc.0000000000000957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: The objectives of this study were firstly to determine the prevalence of overweight/obesity in adult persons with hemophilia in Utah, and to explore the association between age, disease severity and race with body mass index (BMI), and secondly to provide recent data on the prevalence of overweight/obesity in the hemophilia population via a review of the literature. We conducted a retrospective cross section study of adult persons with hemophilia who were seen at a Utah hemophilia treatment center from 1 January 2017 to 31 December 2019. The electronic database PubMed was searched for studies with observation periods from 1 January 2012 to 31 December 2019. The age-adjusted prevalence for overweight/obesity in the adult Utah hemophilia population was higher than the overall Utah population and the general US population. After adjusting for race and age, mild hemophilia was associated with a 7.7% higher BMI (95% confidence interval, 0.023-15.98%, P < 0.05). Review of the literature demonstrated high levels of overweight/obesity in hemophilia communities globally with considerable heterogeneity between studies. Despite increasing awareness, prevalence of overweight/obesity in the hemophilia population remains high in comparison with the general population. There is a critical need to address this issue acutely at hemophilia treatment centers due to the considerable burden of obesity.
Collapse
|
14
|
Kennedy M, O'Gorman P, Monaghan A, Lavin M, O'Mahony B, O'Connell NM, O' Donnell JS, Turecek PL, Gormley J. A systematic review of physical activity in people with haemophilia and its relationship with bleeding phenotype and treatment regimen. Haemophilia 2021; 27:544-562. [PMID: 33751742 PMCID: PMC8359343 DOI: 10.1111/hae.14282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Although the measurement of physical activity (PA) amongst people with haemophilia (PWH) has become increasingly widespread in recent years, the relationship between PA and bleeding phenotype remains poorly understood. In addition, the influence of various treatment regimens on this relationship has not been defined. AIM This review aimed to systematically assess the data that are available regarding PA levels amongst PWH, as well as the relationship between PA and bleeding. METHODS A systematic search of the online databases EMBASE, Cochrane, MEDLINE Ovid, CINAHL and Web of Science was conducted by two independent reviewers. Quality assessment was undertaken using the AXIS Critical Appraisal Tool for Cross-sectional Studies and the STROBE checklist. RESULTS Of 1902 sources identified overall, 36 articles were included. Low-to-moderate transparency of reporting and various sources of bias were identified. PA levels varied amongst heterogeneous samples of PWH. The relationship between PA and bleeds was inconclusive, although there was evidence that improvements in treatment over recent decades have appeared to enable PWH to become more physically active. CONCLUSION Based upon the limited available evidence, the relationship between PA and bleeding phenotype in PWH remains unclear. However, with the development of improved prophylaxis treatment regimens in recent years, there is evidence that PA levels have increased, especially amongst people with severe haemophilia. The use of validated outcome measures of PA and more robust reporting of bleeds and treatment regimen are warranted in future research, especially in a rapidly evolving era of new treatments for PWH.
Collapse
Affiliation(s)
- Megan Kennedy
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | - Philip O'Gorman
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | - Ann Monaghan
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | - Michelle Lavin
- National Coagulation Centre, St. James's Hospital, Dublin 8, Ireland.,Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Niamh M O'Connell
- National Coagulation Centre, St. James's Hospital, Dublin 8, Ireland
| | - James S O' Donnell
- National Coagulation Centre, St. James's Hospital, Dublin 8, Ireland.,Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter L Turecek
- Baxalta Innovations GmbH, A Member of the Takeda Group of Companies, Vienna, Austria
| | - John Gormley
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | | |
Collapse
|
15
|
Cikili-Uytun M, Çetin FH, Yılmaz R, Uytun S, Babadağı Z, Karadogan M, Mutlu FT, Altuner-Torun Y. Psychiatric problems and its contributing factors in children and adolescents with hemophilia: a single centre study in a Turkish sample. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2020. [DOI: 10.1186/s43054-020-00032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We aimed to evaluate the psychiatric symptoms in addition quality of life in children and adolescents with hemophilia and to determine which factors contributed to psychiatric problems of them.
A total of 20 children and adolescents with hemophilia A or B and 20 healthy controls, aged 6–16 years old, were included. Kiddie-Schedule for Affective Disorders and Schizophrenia, present and life time version (K-SADS-PL) was applied to parents. Sociodemographic questionnaire, Child Depression Inventory (CDI), The Spielberger State-Trait Anxiety Inventory (STAI), and KINDLR Questionnaire was used for children and adolescents in both groups. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and KINDL parent form were used for mothers in both groups.
Results
The study results demonstrated higher anxiety scores and increased anxiety disorder diagnosis among children and adolescents with hemophilia. However, mother’s anxiety and depression scores are higher than control group, and QoL of their children also shows lower scores in parents’ KINDL forms. Mothers’ depression and anxiety scores are associated with childrens’ depression, anxiety, and QoL scores.
Conclusion
Psychiatric factors should not be ignored in the treatment and follow-up of children and adolescents with hemophilia and their parents.
Collapse
|
16
|
Pieniążek M, Mańko G, Sosulska A, Jaszczur-Nowicki J, Lozinska I, Jarząbek B. Assessing the level of well-being in individuals practicing sport. REHABILITACJA MEDYCZNA 2020. [DOI: 10.5604/01.3001.0014.2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and aim: There is an increasing body of evidence that physical exercise may have a positive effect on people’s mental condition and well-being. Numerous study results indicate that physical activity helps in the treatment of depression and anxiety. This allows for a conclusion that sport – to a great extent – influences not only people’s physical aspects, but also their psyche. Sedentary lifestyle, time pressure and stress that accompanies people at an increasingly younger age contribute both to higher incidence of numerous civilisation diseases and to problems with mental health. The purpose of the study was to verify whether individuals practicing sports manifest better well-being than non-training individuals.
Methods: A general interview was conducted with 80 students (40 individuals practicing sports and 40 individuals not practicing sports at all), whereupon they were requested to complete the Warwick-Edinburgh Mental Well-being Scale questionnaire.
Results: The individuals practicing sport exhibit greater well-being than the subjects from the control group. It was also demonstrated that the males in the study group exhibit greater wellbeing than the females from the same group However, no findings were made that longer duration of a single training session, its frequency or the time when a given person started practicing sport had any influence on his/her well-being.
Conclusions: Practicing sports has a positive influence on people’s well-being. Physical activity should be promoted from as early an age as possible to minimise the risk of numerous diseases in the future, including those affecting mental health.
Collapse
Affiliation(s)
- Magdalena Pieniążek
- Department of Rehabilitation in Internal Diseases, Faculty of Rehabilitation, Bronisław Czech University School of Physical Education in Kraków, Poland / Zakład Rehabilitacji w Chorobach Wewnętrznych, Wydział Rehabilitacji Ruchowej, AWF Kraków
| | - Grzegorz Mańko
- Faculty of Health Sciences, Department of Biomechanics and Kinesiology, Medical College (Collegium Medicum) of the Jagiellonian University in Kraków, Poland / Wydział Nauk o Zdrowiu, Zakład Biomechaniki i Kinezjologii, UJCM w Krakowie
| | - Angelika Sosulska
- Faculty of Health Sciences, Department of Biomechanics and Kinesiology, Medical College (Collegium Medicum) of the Jagiellonian University in Kraków, Poland / Wydział Nauk o Zdrowiu, Zakład Biomechaniki i Kinezjologii, UJCM w Krakowie
| | - Jarosław Jaszczur-Nowicki
- Department of Tourism, Recreation and Ecology, University of Warmia and Mazury in Olsztyn, Poland / Katedra Turystyki, Rekreacji i Ekologii, Uniwersytet Warmińsko-Mazurski w Olsztynie
| | - Irina Lozinska
- Doctoral Studies, Faculty of Physical Education and Sport, Bronisław Czech University School of Physical Education in Kraków, Poland / Studia Doktoranckie, Wydział Wychowania Fizycznego i Sportu, AWF Kraków
| | - Beata Jarząbek
- SPZOZ Myślenice, Neurology Department, Poland / SPZOZ Myślenice, Oddział Neurologii
| |
Collapse
|
17
|
Versloot O, Timmer MA, de Kleijn P, Schuuring M, van Koppenhagen CF, van der Net J, Fischer K. Sports participation and sports injuries in Dutch boys with haemophilia. Scand J Med Sci Sports 2020; 30:1256-1264. [PMID: 32246553 PMCID: PMC7317861 DOI: 10.1111/sms.13666] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/26/2020] [Accepted: 03/24/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Sports participation in children with hemophilia is generally considered to be associated with increased injury risk, which is generally considered highest in severe hemophilia. AIM To assess sports participation according to age and severity in children with hemophilia and its association with sports injuries. METHODS In a retrospective single-center study, sports participation, injuries, and bleeding data from three consecutive annual clinic visits were collected for young patients with hemophilia (PWH, aged 6-18). Sports in categories 2.5 and 3 of 3 according to the National Hemophilia Foundation classification were considered high-risk. Groups were compared using chi-square testing. RESULTS 105 PWH (median age: 13(IQR 10-14); 53% severe; bleeding rate: 1/y) were identified; three were unable to perform sports and were excluded. The majority of PWH (77%) played sports weekly, of which 80% high-risk sports. Sports participation (median 3.0x/wk), and the proportion of injured PWH was similar in severe (42%) and non-severe (33%) PWH. Sports injuries were rare (65% no injuries in 3 years, median 0/y (IQR 0-1)). Annually, PWH did not report more injuries (15%) than age-matched boys (28%). Sports injuries were not associated with frequency and type of sports. DISCUSSION This retrospective study showed high sports participation (including high-risk sports) and low injury rates. Sports participation was similar across severities and injury rates were not higher than among the general population. Injuries were not associated with frequency or type of sports. A prospective study with objective assessment of sports participation and injuries is warranted to confirm these findings and avoid recall bias.
Collapse
Affiliation(s)
- Olav Versloot
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Merel A Timmer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Piet de Kleijn
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marleen Schuuring
- Center for Child Development, Exercise and Physical Literacy, University Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | | | - Janjaap van der Net
- Center for Child Development, Exercise and Physical Literacy, University Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Kathelijn Fischer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
18
|
Martin AP, Burke T, Asghar S, Noone D, Pedra G, O'Hara J. Understanding minimum and ideal factor levels for participation in physical activities by people with haemophilia: An expert elicitation exercise. Haemophilia 2020; 26:711-717. [PMID: 32268007 DOI: 10.1111/hae.13985] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The benefits of physical activity (PA) for people with haemophilia (PWH) may include improvements in joint, bone and muscle health. However, the factor VIII activity level required to avoid a bleeding episode associated with PA is unknown. AIM To elicit the opinion of clinical experts on the minimum level and ideal factor VIII activity ('level') required to avoid a bleeding episode during participation in different types of PA for PWH. METHODS Based on the 2017 National Hemophilia Foundation PA descriptions, clinical experts estimated a minimally acceptable and an ideal factor level at which a bleed could be avoided. The uncertainty around estimates was quantified using an approach to construct a probability distribution to represent expert opinion. RESULTS Minimum and ideal factor level increased with higher risk PA, whether or not joint morbidity was present, as did the experts' uncertainty in their estimates (ie the range between lowest and highest estimates for minimum and ideal levels). Mean minimum levels ranged from 4% to 48% for low to high risk for people without joint morbidity, and from 7% to 47% for those with joint morbidity. For ideal factor levels, corresponding figures were 9%-52% and 12%-64%, respectively. CONCLUSION To support a patient-centric outcome, expert opinion indicates that the clinical norm of 0.01 IU/mL (1%) trough level is insufficient. It is anticipated that introducing a more targeted approach to meet the needs of patients who are increasingly physically active will benefit patients further in addition to recent treatment advances.
Collapse
Affiliation(s)
| | | | | | | | | | - Jamie O'Hara
- HCD Economics, Daresbury, UK.,Faculty of Health and Social Care, University of Chester, Chester, UK
| |
Collapse
|
19
|
Negri L, Buzzi A, Aru AB, Cannavò A, Castegnaro C, Fasulo MR, Lassandro G, Rocino A, Santoro C, Sottilotta G, Giordano P, Mazzucconi MG, Mura R, Peyvandi F, Delle Fave A. Perceived well-being and mental health in haemophilia. PSYCHOL HEALTH MED 2020; 25:1062-1072. [PMID: 31984755 DOI: 10.1080/13548506.2020.1717556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The investigation of mental health among persons with haemophilia is mostly focused on negative and disease-related indicators. Literature however shows that psychosocial resources and optimal daily functioning can co-exist with chronic disease. The Dual Continua Model operationalizes positive mental health as 'flourishing', a condition comprising emotional, psychological, and social well-being dimensions. In the present study physical and mental health were comparatively assessed through positive and negative indicators in adults with haemophilia and a control group. Participants included 84 Italian persons with severe haemophilia (Mage = 43.44; SDage = 13.04) and 164 adults without history of chronic illness (Mage = 40.98; SDage = 12.26), who completed the Short Form Health Survey, the Positive and Negative Affect Schedule, and the Mental Health Continuum Short Form. MANOVA and post-hoc t-tests provided evidence of worse general health, lower negative affect and higher psychological well-being among participants with haemophilia compared with the control group. Moreover, the percentage of flourishing individuals was higher among participants with haemophilia. Results support previous evidence suggesting that a chronic disease does not prevent mental well-being attainment. The identification of assets and strengths allowing people with haemophilia to flourish can be fruitfully used to design resource-centered interventions.
Collapse
Affiliation(s)
- Luca Negri
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano , Milano, Italy
| | | | - Anna Brigida Aru
- SC Oncoematologia Pediatrica e Patologia della Coagulazione, Ospedale Pediatrico Microcitemico "Antonio Cao" , Cagliari, Italy
| | - Antonino Cannavò
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milano, Italy
| | | | - Maria Rosaria Fasulo
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milano, Italy
| | - Giuseppe Lassandro
- Dipartimento di Scienze Biomediche ed Oncologia Umana - Sezione di Pediatria, Università degli Studi di Bari "Aldo Moro" , Bari, Italy
| | - Angiola Rocino
- UOC di Ematologia - Centro Emofilia e Trombosi, Ospedale Ascalesi - ASL NA1 , Napoli, Italy
| | - Cristina Santoro
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università degli Studi di Roma La Sapienza , Roma, Italy
| | - Gianluca Sottilotta
- UOSD Microcitemie - Centro Emofilia - Servizio Emostasi e Trombosi, Grande Ospedale Metropolitano "Bianchi-Melacrino Morelli" , Reggio Calabria, Italy
| | - Paola Giordano
- Dipartimento di Scienze Biomediche ed Oncologia Umana - Sezione di Pediatria, Università degli Studi di Bari "Aldo Moro" , Bari, Italy
| | - Maria Gabriella Mazzucconi
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università degli Studi di Roma La Sapienza , Roma, Italy
| | - Rosamaria Mura
- SC Oncoematologia Pediatrica e Patologia della Coagulazione, Ospedale Pediatrico Microcitemico "Antonio Cao" , Cagliari, Italy
| | - Flora Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milano, Italy
| | - Antonella Delle Fave
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano , Milano, Italy
| |
Collapse
|
20
|
Nagao A, Suzuki N, Takedani H, Yamasaki N, Chikasawa Y, Sawada A, Kanematsu T, Nojima M, Higasa S, Amano K, Fukutake K, Fujii T, Matsushita T, Suzuki T. Ischaemic events are rare, and the prevalence of hypertension is not high in Japanese adults with haemophilia: First multicentre study in Asia. Haemophilia 2019; 25:e223-e230. [DOI: 10.1111/hae.13749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/25/2019] [Accepted: 03/13/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Azusa Nagao
- Department of Blood Coagulation Ogikubo Hospital Tokyo Japan
| | - Nobuaki Suzuki
- Department of Transfusion Medicine Nagoya University Hospital Aichi Japan
| | - Hideyuki Takedani
- Department of Joint Surgery IMSUT Hospital, The Institute of Medical Science, The University of Tokyo Tokyo Japan
| | - Naoya Yamasaki
- Division of Blood Transfusion Hiroshima University hospital Hiroshima Japan
| | - Yushi Chikasawa
- Department of Laboratory Medicine Tokyo Medical University Tokyo Japan
| | - Akihiro Sawada
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Hyogo Japan
| | - Takeshi Kanematsu
- Department of Clinical Laboratory Nagoya University Hospital Aichi Japan
| | - Masanori Nojima
- Center for Translational Research The Institute of Medical Science Hospital, The University of Tokyo Tokyo Japan
| | - Satoshi Higasa
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Hyogo Japan
| | - Kagehiro Amano
- Department of Laboratory Medicine Tokyo Medical University Tokyo Japan
- Department of Molecular Genetics of Coagulation Disorders Tokyo Medical University Tokyo Japan
| | - Katsuyuki Fukutake
- Department of Laboratory Medicine Tokyo Medical University Tokyo Japan
- Department of Molecular Genetics of Coagulation Disorders Tokyo Medical University Tokyo Japan
| | - Teruhisa Fujii
- Division of Blood Transfusion Hiroshima University hospital Hiroshima Japan
| | - Tadashi Matsushita
- Department of Transfusion Medicine Nagoya University Hospital Aichi Japan
| | - Takashi Suzuki
- Department of Blood Coagulation Ogikubo Hospital Tokyo Japan
| |
Collapse
|
21
|
Chang CY, Li TY, Cheng SN, Pan RY, Cheng CN, Wang HJ, Hu SH, Chen YC. Obesity and overweight in patients with hemophilia: Prevalence by age, clinical correlates, and impact on joint bleeding. J Chin Med Assoc 2019; 82:289-294. [PMID: 30946208 DOI: 10.1097/jcma.0000000000000047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The prevalence of obesity in patients with hemophilia (PWH) varies among different ethnicities, and its influence on joint bleeding and hemophilic arthropathy has not been studied in Taiwan population. We explored the prevalence and clinical correlates of obesity and the impact of body mass index (BMI) on annual joint bleeding rate (AJBR) and hemophilic arthropathy in PWH in Taiwan. METHODS We retrospectively collected clinical information on 140 severe/40 moderate PWH from 2006 to 2014. The patients' median age was 31.5 years, ranged from 6 to 73 years. Their BMI, 6 index joints score by Pettersson scoring, AJBR, and other clinical data were analyzed. RESULTS The prevalence of overweight and obesity by age group was 7.1% in PWH aged ≤10 years, and rapidly increased to 34.5% in PWH aged 11 to 18 years, 46.7% in PWH aged 18 to 29 years, 61.8% in PWH aged 30 to 39 years, 60.6% in PWH aged 40 to 49 years, and 48% in PWH aged ≥50 years, respectively. Two peak rates were 72.7% in PWH aged 35 to 44 years and 66.7% in PWH aged >65 years. Age, HCV infection, knee score, elbow score, and total 6 index joints scores were found to correlate positively with BMI. However, subtype and severity of hemophilia, ankle scores, HBV and HIV infection did not correlate with BMI. Finally, BMI was found to correlate positively with AJBR in both adult and pediatric PWH. CONCLUSION The prevalence of overweight and obesity in adolescent and adult PWH was higher than those in the general male population in Taiwan, which rapidly increased with age to peak in PWH aged 35 to 44 years and >65 years. High index joint score, with the exception of ankle scores, positively correlated with high BMI. Further, BMI and obesity also had positive correlation with AJBR in PWH. To our knowledge, this is the first study examining these associations in PWH in Taiwan.
Collapse
Affiliation(s)
- Chia-Yau Chang
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Division of Pediatric Hematology/Oncology, Hemophilia Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Tsung-Ying Li
- Department of Rehabilitation, Tri-Service General Hospital, Taipei, Taiwan, ROC
- Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Shin-Nan Cheng
- Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC
- Department of Pediatrics, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ru-Yu Pan
- Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan, ROC
- Department of Orthopedics, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Chao-Neng Cheng
- Department of Pediatrics, National Cheng Kung University Hospital, Taichung, Taiwan, ROC
| | - Hung-Jung Wang
- Division of Pediatric Hematology/Oncology, Hemophilia Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Shu-Hsia Hu
- Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Yeu-Chin Chen
- Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan, ROC
- Division of Hematology/Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| |
Collapse
|
22
|
Wilding J, Zourikian N, Di Minno M, Khair K, Marquardt N, Benson G, Ozelo M, Hermans C. Obesity in the global haemophilia population: prevalence, implications and expert opinions for weight management. Obes Rev 2018; 19:1569-1584. [PMID: 30188610 DOI: 10.1111/obr.12746] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/24/2018] [Indexed: 12/18/2022]
Abstract
Overweight and obesity may carry a significant disease burden for patients with haemophilia (PWH), who experience reduced mobility due to joint inflammation, muscle dysfunction and haemophilic arthropathy. This review aimed to define the prevalence and clinical impact of overweight/obesity in the global population of PWH. A detailed literature search pertaining to overweight/obesity in haemophilia in the last 15 years (2003-2018) was conducted, followed by a meta-analysis of epidemiological data. The estimated pooled prevalence of overweight/obesity in European and North American PWH was 31%. Excess weight in PWH is associated with a decreased range in motion of joints, accelerated loss of joint mobility and increase in chronic pain. Additionally, the cumulative disease burden of obesity and haemophilia may impact the requirement for joint surgery, occurrence of perioperative complications and the prevalence of anxiety and depression that associates with chronic illness. Best practice guidelines for obesity prevention and weight management, based on multidisciplinary expert perspectives, are considered for adult and paediatric PWH. Recommendations in the haemophilia context emphasize the importance of patient education and tailoring engagement in physical activity to avoid the risk of traumatic bleeding.
Collapse
Affiliation(s)
- J Wilding
- Obesity and Endocrinology Research Group, Institute of Ageing and Chronic Disease, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK
| | - N Zourikian
- Pediatric/Adult Comprehensive Hemostasis Center, CHU Sainte-Justine/Sainte-Justine University Hospital Center, Montréal, Québec, Canada
| | - M Di Minno
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - K Khair
- Haemophilia Comprehensive Care Centre, Great Ormond Street Hospital for Children, London, UK
| | - N Marquardt
- Institut für Experimentelle Hämatologie und Transfusionsmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - G Benson
- Northern Ireland Haemophilia Comprehensive Care Centre and Thrombosis Unit, Belfast City Hospital, Belfast, UK
| | - M Ozelo
- International Haemophilia Training Centre (IHTC) 'Claudio L.P. Correa', INCT do Sangue Hemocentro UNICAMP, University of Campinas, Campinas, Brazil
| | - C Hermans
- Division of Haematology, Haemostasis and Thrombosis Unit, Haemophilia Clinic, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
23
|
Gupta S, Shapiro AD. Optimizing bleed prevention throughout the lifespan: Womb to Tomb. Haemophilia 2018; 24 Suppl 6:76-86. [PMID: 29878655 DOI: 10.1111/hae.13471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2018] [Indexed: 01/07/2023]
Abstract
The focus of care providers, patients and families is the ability to tailor care for persons with haemophilia (PWH) across the lifespan. Care requires knowledge of the bleeding disorder and age-related complications, risk of therapeutic interventions, and evaluation of individual characteristics that contribute to outcomes. The ultimate goal is to live a normal life without the burden of bleeding, for PWH and carriers. A wide range of therapeutic options is required to achieve personalized care. Over the last decade, substantial therapeutic advantages have been achieved in the treatment of haemophilia that include the development of a robust array of factor concentrates, novel haemostatic agents, and increased knowledge and awareness of disease associated outcomes and risk factors. Significant strides on the road to accessible gene therapy have been realized. This increased range of therapeutic modalities provides options for development and implementation of care plans for each patient at each stage of life that are more flexible compared to prior care regimens. Paradigms for management of haemophilia are changing. As a community, we must work together to use these resources wisely, to learn from outcomes with new therapies and diagnostic tools, to assure all patients can achieve improved care and outcomes regardless of disease state or country of origin.
Collapse
Affiliation(s)
- S Gupta
- Indiana Hemophilia and Thrombosis Center, Inc., Indianapolis, IN, USA
| | - A D Shapiro
- Indiana Hemophilia and Thrombosis Center, Inc., Indianapolis, IN, USA
| |
Collapse
|
24
|
von Mackensen S, Hilberg T, Valentino LA, Kurnik K, Khair K. Validation of the Haemophilia & Exercise Project-Test-Questionnaire (HEP-Test-Q)-An instrument for the assessment of subjective physical functioning in children with haemophilia. Haemophilia 2018; 24:888-895. [PMID: 30004619 DOI: 10.1111/hae.13533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Contemporary haemophilia management recommends sport and physical activity in children with haemophilia. Assessment of subjective physical functioning requires standardized and validated instruments. AIMS To adapt and psychometrically test the adult Haemophilia & Exercise Project-Test-Questionnaire (HEP-Test-Q) for children (aged 6-17 years). METHODS In discussion rounds with children, single items of the adult HEP-Test-Q were reformulated to make them understandable without changing the item concept. The validation of the child-adapted version in children with haemophilia (n = 228) included pre-testing with feasibility testing, cognitive interviewing (n = 34), pilot-testing of the revised version in the EIS Study (n = 67) and field-testing in the SO-FIT Study (n = 127). RESULTS Pre-testing revealed a completion time of 8.2 ± 4.1 minutes and children liked the instrument. Cognitive interviews demonstrated that most items were easy to understand; 9 items were reformulated. Pilot-testing demonstrated good psychometric characteristics in terms of reliability (α = .94 Total Score) and validity. Convergent validity testing showed moderate correlations with the Haemo-QoL (r = -.491), but low correlations with the Petrini Score (r = -.293). Known groups' validity revealed significant differences in clinical subgroups; chronic pain (P < .002) and target joints (P < .021). Field-testing confirmed psychometric characteristics; Cronbach's alpha ranged from α = .80 ("endurance") to α = .94 (Total Score). The child-adapted HEP-Test-Q showed moderate correlations with the PedHAL (r = .634, P < .0001) and the Haemo-QoL SF (r = -.575, P < .0001). Known groups' validity testing proved that the HEP-Test-Q could discriminate between clinical subgroups. CONCLUSION The child-adapted HEP-Test-Q is a short, practical and acceptable instrument for the assessment of subjective physical functioning. Outcomes can be compared to adults because item concepts are identical to the adult version.
Collapse
Affiliation(s)
- S von Mackensen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | | | - K Kurnik
- Department of Paediatric Haemostasis, University Children's Hospital, Munich, Germany
| | - K Khair
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| |
Collapse
|
25
|
Pinto PR, Paredes AC, Pedras S, Costa P, Crato M, Fernandes S, Lopes M, Carvalho M, Almeida A. Sociodemographic, Clinical, and Psychosocial Characteristics of People with Hemophilia in Portugal: Findings from the First National Survey. TH OPEN 2018; 2:e54-e67. [PMID: 31249930 PMCID: PMC6524863 DOI: 10.1055/s-0038-1624568] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/04/2017] [Indexed: 12/18/2022] Open
Abstract
Hemophilia is a rare genetic bleeding disorder associated with pain, impaired functionality, and decreased quality of life (QoL). Several studies have focused on patient-reported outcomes of people with hemophilia (PWH) worldwide, but no such data are available for Portugal. This survey aimed to describe sociodemographic, clinical, and psychosocial characteristics of PWH of all ages in Portugal. Questionnaires were answered by self-report or by parents of children with hemophilia (proxy version). Variables assessed were sociodemographic and clinical, physical activity patterns, pain, functionality (HAL/PedHAL), QoL (A36 Hemofilia-QoL/CHO-KLAT), anxiety and depression (PROMIS), and illness perceptions (IPQ-R). One-hundred and forty-six PWH answered the survey: 106 adults, 21 children/teenagers between 10 and 17 years, 11 children between 6 and 9 years, and 8 children between 1 and 5 years. Most participants had severe hemophilia (60.3%) and type A was most commonly reported (86.3%). Bleeding episodes, joint deterioration, and pain were very prevalent, with the ankles and knees being the most affected joints, as illustrated by HAL/PedHAL scores. The A36 Hemofilia-QoL assessment showed moderate QoL (96.45; 0–144 scale) and significant anxiety and depression symptoms were found in 36.7 and 27.2% of adults, respectively. CHO-KLAT global score (0–100 scale) was 75.63/76.32 (self-report/proxy). Concerning hemophilia-related illness beliefs, a perception of chronicity and symptoms unpredictability was particularly prominent among adults and children/teenagers. This survey provided a comprehensive characterization of Portuguese PWH, including the first report of psychosocial characteristics. The findings allow for a deeper understanding of life with hemophilia in Portugal and the identification of relevant health care and research needs.
Collapse
Affiliation(s)
- Patrícia Ribeiro Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ana Cristina Paredes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Susana Pedras
- School of Psychology, University of Minho, Braga, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Miguel Crato
- Portuguese Haemophilia Association, Lisbon, Portugal.,European Haemophilia Consortium, Brussels, Belgium
| | - Susana Fernandes
- Department of Transfusion Medicine and Blood Bank, Centre of Hemophilia, Centro Hospitalar São João, Porto, Portugal
| | - Manuela Lopes
- Department of Transfusion Medicine and Blood Bank, Centre of Hemophilia, Centro Hospitalar São João, Porto, Portugal
| | - Manuela Carvalho
- Department of Transfusion Medicine and Blood Bank, Centre of Hemophilia, Centro Hospitalar São João, Porto, Portugal
| | - Armando Almeida
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| |
Collapse
|
26
|
Djalalinia S, Qorbani M, Rezaei N, Sheidaei A, Mahdavi-Gorabi A, Kasaeian A, Motlagh ME, Asayesh H, Safiri S, Kelishadi R. Joint association of screen time and physical activity with anthropometric measures in Iranian children and adolescents: the weight disorders survey of the CASPIAN-IV study. J Pediatr Endocrinol Metab 2017; 30:731-738. [PMID: 28672741 DOI: 10.1515/jpem-2016-0486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/06/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aims to assess the joint association of screen time (ST) and physical activity (PA) with anthropometric indices among Iranian children and adolescents. METHODS In this national study, 23,183 school students, aged 6-18 years, were studied. By using a multi-stage cluster sampling method, they were selected from rural and urban areas of 30 provinces of Iran. ST and PA were assessed by self-administered validated questionnaires. Height, weight, hip and waist circumferences (WC) were measured according to standard protocols, and body mass index (BMI) was calculated. ST of <2 h per day was categorized as "low" and ≥2 h per day as "high". PA levels were obtained by a 7-day recall of sports or activities that made participants sweat or make their legs feel tired, or games that made them breathe heavily. Using this questionnaire, the score of 1-1.9 was categorized as "low" and scores between 2 and 5 as "high" PA. Logistic regression analyses were used to evaluate the joint association of PA and ST categories with odds of anthropometric measures. RESULTS In both genders, those students categorized as "Low PA & High ST" had the highest levels of BMI z-scores (boys: 0.15±1.12, girls: 0.17±1.08), WC (boys: 69.93±13.89 cm, girls: 67.30±11.26 cm), and hip circumference (boys: 82.41±13.90 cm, girls: 84.05±13.7 cm), as well as the highest prevalence of overweight (boys: 15.32%, girls: 14.04%) (p<0.001 in all comparisons). In linear multivariate model, students with "High PA & High ST" had significant increased levels of z-scores for BMI, WC and hip circumference (p<0.05). CONCLUSIONS The current findings underscore the importance of reducing ST along with increasing PA for prevention and control of excess weight in children and adolescents.
Collapse
|
27
|
Bertamino M, Riccardi F, Banov L, Svahn J, Molinari AC. Hemophilia Care in the Pediatric Age. J Clin Med 2017; 6:E54. [PMID: 28534860 PMCID: PMC5447945 DOI: 10.3390/jcm6050054] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 01/19/2023] Open
Abstract
Hemophilia is the most common of the severe bleeding disorders and if not properly managed since early infancy can lead to chronic disease and lifelong disabilities. However, it enjoys the most efficacious and safe treatment among the most prevalent monogenic disorders. Hemophilia should be considered in the neonatal period in the case of unusual bleeding or in the case of positive family history. Later, hemophilia should be suspected mainly in males because of abnormal bruising/bleeding or unusual bleeding following invasive procedures-for example, tonsillectomy or circumcision. Prophylactic treatment that is started early with clotting-factor concentrates has been shown to prevent hemophilic arthropathy and is, therefore, the gold standard of care for hemophilia A and B in most countries with adequate resources. Central venous access catheters and arterovenous fistulas play an important role in the management of hemophilia children requiring repeated and/or urgent administration of coagulation factor concentrates. During childhood and adolescence, personalized treatment strategies that suit the patient and his lifestyle are essential to ensure optimal outcomes. Physical activity is important and can contribute to better coordination, endurance, flexibility and strength. The present article focuses also on questions frequently posed to pediatric hematologists like vaccinations, day-care/school access and dental care.
Collapse
Affiliation(s)
- Marta Bertamino
- Thrombosis and Hemostasis Unit, Regional Reference Center for Hemorrhagic Diseases, Giannina Gaslini Children's Hospital, 16147 Genova, Italy.
| | - Francesca Riccardi
- Hematology Unit, Giannina Gaslini Children's Hospital, 16147 Genova, Italy.
| | - Laura Banov
- Thrombosis and Hemostasis Unit, Regional Reference Center for Hemorrhagic Diseases, Giannina Gaslini Children's Hospital, 16147 Genova, Italy.
| | - Johanna Svahn
- Thrombosis and Hemostasis Unit, Regional Reference Center for Hemorrhagic Diseases, Giannina Gaslini Children's Hospital, 16147 Genova, Italy.
| | - Angelo Claudio Molinari
- Thrombosis and Hemostasis Unit, Regional Reference Center for Hemorrhagic Diseases, Giannina Gaslini Children's Hospital, 16147 Genova, Italy.
| |
Collapse
|
28
|
Baumann K, Hernandez G, Witkop M, Peltier S, Dunn S, Cutter S, Frick N, Haugstad K, Guelcher C, Frey MJ, Rotellini D, Clark DB, Iyer NN, Cooper DL. Impact of mild to severe hemophilia on engagement in recreational activities by US men, women, and children with hemophilia B: The Bridging Hemophilia B Experiences, Results and Opportunities into Solutions (B-HERO-S) study. Eur J Haematol 2017; 98 Suppl 86:25-34. [PMID: 28319336 DOI: 10.1111/ejh.12852] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 11/30/2022]
Abstract
The psychosocial impact of hemophilia on activities was recently investigated in the Hemophilia Experiences, Results and Opportunities (HERO) study (675 people with hemophilia and 561 caregivers of children with hemophilia in 10 countries). The impact of hemophilia B may not be accurately reflected in the HERO results, as ~75% of respondents described issues affecting males with hemophilia A. To address the needs of this population, the Bridging Hemophilia B Experiences, Results and Opportunities Into Solutions (B-HERO-S) was developed as a pilot study in the United States in collaboration with the hemophilia community. The analysis reported here assessed engagement in recreational activities and changes to treatment regimens around activities as reported by 299 adults with hemophilia B and 150 caregivers of children with hemophilia B. Nearly all adults with hemophilia B (98%) experienced a negative impact on their participation in recreational activities due to hemophilia-related issues, and most caregivers (90%) reported that hemophilia B had a negative impact on their child's engagement in recreational activities. One of the main reasons identified for discontinuing past activities was the risk of bruising or bleeding (adults/children with hemophilia B, 49%/41%). In particular, adults with hemophilia B reported a history of activity-related bleeding, and most adults decreased their participation in high-risk activities as they aged. Substantial percentages of adults and children with hemophilia B (including mild/moderate severity) altered their treatment regimens to accommodate planned activities. These findings may help inform guidelines for individualizing treatment regimens around participation in recreational activities based on hemophilia severity, baseline factor level, and activity risk and intensity.
Collapse
Affiliation(s)
- Kimberly Baumann
- Center for Bleeding and Clotting Disorders, University of Minnesota Health, Minneapolis, MN, USA
| | - Grace Hernandez
- Center for Comprehensive Care and Diagnosis of Inherited Bleeding Disorders, Orange, CA, USA
| | | | - Skye Peltier
- Center for Bleeding and Clotting Disorders, University of Minnesota Health, Minneapolis, MN, USA
| | - Spencer Dunn
- Center for Comprehensive Care and Diagnosis of Inherited Bleeding Disorders, Orange, CA, USA
| | - Susan Cutter
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Neil Frick
- National Hemophilia Foundation, New York, NY, USA
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Ikarugi H, Yamamoto J. The exercise paradox may be solved by measuring the overall thrombotic state using native blood. Drug Discov Ther 2017; 11:15-19. [PMID: 28202881 DOI: 10.5582/ddt.2016.01077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
While exercise is widely believed to prevent atherothrombotic diseases, it occasionally causes sudden death. This exercise paradox may be due to the inadequate testing of the thrombotic and thrombolytic status. A recently developed shear-induced thrombosis/endogenous fibrinolysis test performed with non-anticoagulated blood samples allows the assessment of the thrombotic state of an individual both at rest and after exercise. This sensitive and physiologically relevant test may help to solve the aforementioned exercise paradox.
Collapse
|