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Bhatt N, Calhoun C, Longoria J, Nwosu C, Howell KE, Varughese T, Kang G, Jacola L, Hankins JS, King A. Health literacy correlates with abbreviated full-scale IQ in adolescent and young adults with sickle cell disease. Pediatr Blood Cancer 2023; 70:e30281. [PMID: 36861391 PMCID: PMC10425156 DOI: 10.1002/pbc.30281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Sickle cell disease (SCD) is a chronic condition with progressive neurocognitive deficits. Health literacy (HL) is essential during adolescence and young adulthood, as the transition to adult care requires healthcare decisions. HL is known to be low in SCD; however, relation between general cognitive ability and HL has not been investigated. METHODS This cross-sectional study included adolescent and yound adults (AYAs) with SCD from two institutions. Logistic regression measured the association between HL, measured by the Newest Vital Sign tool, and general cognitive ability, measured with abbreviated full-scale intelligence quotient (FSIQ) on the Wechsler Abbreviated Scale of Intelligence. RESULTS Our cohort contained 93 participants at two sites: 47 (51%) at Memphis, TN and 46 (49%) at St. Louis, MO, ranging from ages 15-45 years (mean = 21 years) and with a majority (70%) possessing a high school education or greater. Only 40/93 participants (43%) had adequate HL. Lower abbreviated FSIQ (p < .0001) and younger age at assessment (p = .0003) were associated with inadequate HL. For every standard score point increase in abbreviated FSIQ, the odds of having adequate HL compared to limited or possibly limited HL increase by 1.142 (95% confidence interval [CI]: 1.019-1.322) and 1.116 (95% CI: 1.045-1.209), respectively, after adjusting for age, institution, income, and educational attainment. CONCLUSIONS Understanding and addressing HL is imperative in improving self-management and health outcomes. Among AYA with SCD, low HL was prevalent and influenced by abbreviated FSIQ. Routine screening for neurocognitive deficits and HL should be performed to guide development of interventions to adapt to the HL of AYA with SCD.
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Affiliation(s)
- Nidhi Bhatt
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Cecelia Calhoun
- Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, CT
| | - Jennifer Longoria
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Chinonyelum Nwosu
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kristen E. Howell
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Taniya Varughese
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, MO
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Lisa Jacola
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane S. Hankins
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Allison King
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, MO
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Heitzer AM, Okhomina VI, Trpchevska A, MacArthur E, Longoria J, Potter B, Raches D, Johnson A, Porter JS, Kang G, Hankins JS. Social determinants of neurocognitive and academic performance in sickle cell disease. Pediatr Blood Cancer 2023; 70:e30259. [PMID: 36815529 PMCID: PMC10339212 DOI: 10.1002/pbc.30259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is associated with poor neurocognitive outcomes due to biomedical and psychosocial factors. The aims of this study were to investigate associations between household and neighborhood socioeconomic status (SES) with cognitive and academic outcomes in SCD and to determine if these relationships were modified by sickle genotype, fetal hemoglobin, or age. PROCEDURE We prospectively recruited patients to complete a battery of neurocognitive and academic measures. Household SES was measured using the Barratt Simplified Measure of Social Status, a composite index of parent education and occupation. The Social Vulnerability Index was used to classify individuals based on social vulnerabilities at the neighborhood level. RESULTS Overall, 299 patients between the ages of 4 and 18 (mean = 11.4, standard deviation = 4.3) years diagnosed with SCD (57% SS/SB0 -thalassemia) completed testing. Stepwise multivariate models demonstrated that patients with low social vulnerability (i.e., high SES) at the neighborhood level displayed intelligence and math scores that were 4.70 and 7.64 points higher than those living in areas with moderate social vulnerability, respectively (p < .05). Reading performance did not differ based on neighborhood SES; however, the effect of neighborhood SES was dependent on age, such that older participants living in neighborhoods with moderate or high levels of social vulnerability displayed poorer reading scores than those with low social vulnerability (p < .05). CONCLUSIONS This study identified patients with SCD at higher risk of poor academic performance based on SES. Interventions addressing academic difficulties should be offered to all children with SCD, but should be emergently offered to this subpopulation.
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Affiliation(s)
| | | | - Ana Trpchevska
- St. Jude Children’s Research Hospital, Department of Psychology
| | - Erin MacArthur
- St. Jude Children’s Research Hospital, Department of Psychology
| | | | - Brian Potter
- St. Jude Children’s Research Hospital, Department of Psychology
| | - Darcy Raches
- St. Jude Children’s Research Hospital, Department of Psychology
| | - Ayanna Johnson
- St. Jude Children’s Research Hospital, Department of Psychology
| | | | - Guolian Kang
- St. Jude Children’s Research Hospital, Department of Biostatistics
| | - Jane S. Hankins
- St. Jude Children’s Research Hospital, Department of Hematology
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Verlhac S, Ithier G, Bernaudin F, Oloukoi C, Cussenot I, Balandra S, Kheniche A, Ntorkou A, Ouaziz H, Tanase A, Sekkal A, Belarbi N, Elmaleh M, Alison M. Evolution of Extracranial Internal Carotid Artery Disease in Children With Sickle Cell Anemia. Stroke 2022; 53:2637-2646. [PMID: 35387492 DOI: 10.1161/strokeaha.121.037980] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cerebral arteriopathy in patients with sickle cell anemia mainly affects the intracranial anterior circulation. However, the extracranial internal carotid artery (eICA) can also be stenosed and responsible for ischemic lesions. In children with sickle cell anemia, we perform routine annual Doppler ultrasound assessment of the eICA and magnetic resonance imaging with 3-dimensional time-of-flight magnetic resonance angiography of the Willis circle and neck arteries in those with abnormal velocity. Our aim was to report the evolution of eICA stenoses from 2011 to the present as a function of therapy in a retrospective case-series study. We hypothesized that chronic transfusion (CTT) would be more effective than hydroxyurea and simple observation on the evolution of eICA stenosis. METHODS Eligibility criteria were a history of eICA velocity ≥160 cm/s with a minimum Doppler and magnetic resonance imaging follow-up of 1 year. eICAs were graded for stenosis according to NASCET (The North American Symptomatic Carotid Endarterectomy Trial). Magnetic resonance imaging was investigated for ischemic lesions. Treatment with hydroxyurea and CTT were obtained from the chart review. RESULTS Fifty-four patients were included. Eight patients had a stroke history. The median (range) follow-up was 4.7 years (1.1-9.2 years). On the first neck magnetic resonance angiography, stenosis was present in 48/54 (89%) patients. Kinking was found in 39/54 (72%) patients. On the last neck magnetic resonance angiography, the proportion of patients with eICA stenosis decreased to 39/54 (72%). ICA occlusion occurred in 5 patients despite CTT. Three patients had carotid webs without intracranial stenosis. The proportion of patients with improvement in stenosis score was 8% with no treatment intensification, 20% with hydroxyurea, and 48% with CTT (P=0.016). The mean (SD) change per year in stenosis score was 0.40 (0.60) without intensification, 0.20 (0.53) with hydroxyurea, and -0.18 (0.55) with CTT (P=0.006). Ischemic lesions were present initially in 46% of patients, and the incidence of progressive ischemic lesions was 2.5 events/100 patient-years. Cox regression analysis showed that the initial score for eICA stenosis was a significant predictive factor for the risk of new silent cerebral infarct events. CONCLUSIONS Our study reinforces the need to assess cervical arteries for better prevention of cerebral ischemia and encourage initiation of CTT in sickle cell anemia children with eICA stenosis.
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Affiliation(s)
- Suzanne Verlhac
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Ghislaine Ithier
- Department of Pediatrics, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (G.I.)
| | - Françoise Bernaudin
- Referral Center for Sickle Cell Disease, Department of Clinical Research, Intercommunal Creteil Hospital, France (F.B.)
| | - Carmelia Oloukoi
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Isabelle Cussenot
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Stephane Balandra
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Ahmed Kheniche
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Alexandra Ntorkou
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Hayat Ouaziz
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Anka Tanase
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Amina Sekkal
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Nadia Belarbi
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Monique Elmaleh
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
| | - Marianne Alison
- Referral Center for Sickle Cell Disease, Department of Pediatric Imaging, Robert-Debre Hospital, AP-HP, Nord, Paris University, France. (S.V., C.O., I.C., S.B., A.K., A.N., H.O., A.T., A.S., N.B., M.E., M.A.)
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