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Fagundes NCF, Young R, Flores-Mir C, Heo G, Perez A. Parental experiences in navigating health services for paediatric residual obstructive sleep apnoea: An exploratory qualitative descriptive study. Orthod Craniofac Res 2024. [PMID: 38590218 DOI: 10.1111/ocr.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES To explore parents' experiences and perceptions regarding engagement in health services for managing residual paediatric obstructive sleep apnoea (OSA) across levels of care. METHODS Qualitative description guided study design. Data were collected through semi-structured interviews with parents of children diagnosed with residual OSA at a university-based sleep clinic. The relevant literature informed the interview guide and was piloted before data collection. Inductive, manifest content analysis was used to describe parents' perceptions and experiences using data-driven categories and sub-categories. Several strategies were employed to ensure rigour in this study. RESULTS Eight interviews were conducted. Parents' views were organized into five categories: awareness of the sleep issue, interaction with non-sleep specialists, interaction with sleep specialists, interaction with dental professionals, and further actions and support. Parents reported several engagement issues due to their interactions with different care providers. These issues included having to personally identify and raise the sleep problem, feeling that care providers did not take this problem seriously, waiting for an extended period to be referred for sleep services, and receiving conflicting or insufficient treatment recommendations. Overall, parents perceived that their actions and the services received across levels of care were not effective enough to address paediatric OSA. CONCLUSION Based on this exploratory qualitative descriptive research, along with developing evidence-based clinical guidelines for paediatric OSA screening and management tailored to different levels of care, strategies intended to improve the engagement of patients and care providers in addressing paediatric OSA should be developed and empirically tested.
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Affiliation(s)
- Nathalia Carolina Fernandes Fagundes
- School of Dentistry, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Orthodontics, Faculty of Dentistry, Federal University of Para, Belém, Brazil
| | - Rochelle Young
- Division of Pulmonary and Sleep Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Carlos Flores-Mir
- School of Dentistry, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Giseon Heo
- School of Dentistry, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Arnaldo Perez
- School of Dentistry, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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Cancian M, Triggianese P, Modica S, Arcoleo F, Bignardi D, Brussino L, Colangelo C, Di Agosta E, Firinu D, Guarino MD, Giardino F, Giliberti M, Montinaro V, Senter R. The impact of puberty on the onset, frequency, location, and severity of attacks in hereditary angioedema due to C1-inhibitor deficiency: A survey from the Italian Network for Hereditary and Acquired Angioedema (ITACA). Front Pediatr 2023; 11:1141073. [PMID: 37144145 PMCID: PMC10152551 DOI: 10.3389/fped.2023.1141073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/08/2023] [Indexed: 05/06/2023] Open
Abstract
Introduction Hereditary angioedema due to C1-inhibitor deficiency is influenced by hormonal factors, with a more severe course of disease in women. Our study aims to deepen the impact of puberty on onset, frequency, location and severity of attacks. Methods Retrospective data were collected through a semi-structured questionnaire and shared by 10 Italian reference centers of the Italian Network for Hereditary and Acquired Angioedema (ITACA). Results The proportion of symptomatic patients increased significantly after puberty (98.2% vs 83.9%, p=0.002 in males; 96.3% vs 68,4%, p<0.001 in females); the monthly mean of acute attacks was significantly higher after puberty, and this occurred both in females (median (IQR) = 0.41(2) in the three years before puberty vs 2(2.17) in the three years after, p<0.001) and in males (1(1.92) vs 1.25(1.56) respectively, p<0.001). The increase was greater in females. No significant differences were detected in attack location before and after puberty. Discussion Overall, our study confirms previous reports on a more severe phenotype in the female gender. Puberty predisposes to increased numbers of angioedema attacks, in particular in female patients.
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Affiliation(s)
- Mauro Cancian
- UOSD Allergologia, University Hospital of Padua, Padua, Italy
- Correspondence: Mauro Cancian
| | | | | | - Francesco Arcoleo
- UOC di Patologia Clinica e Immunologia, AOR Villa Sofia-Cervello, Palermo, Italy
| | | | - Luisa Brussino
- University Hospital Ordine Mauriziano di Torino, Turin, Italy
| | | | - Ester Di Agosta
- Immunoallergology unit, Careggi University Hospital, Florence, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Francesco Giardino
- Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Marica Giliberti
- Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | | | - Riccardo Senter
- UOSD Allergologia, University Hospital of Padua, Padua, Italy
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Triggianese P, Senter R, Petraroli A, Zoli A, Lo Pizzo M, Bignardi D, Di Agosta E, Agolini S, Arcoleo F, Rossi O, Modica S, Greco E, Chimenti MS, Spadaro G, De Carolis C, Cancian M. Pregnancy in women with Hereditary Angioedema due to C1-inhibitor deficiency: Results from the ITACA cohort study on outcome of mothers and children with in utero exposure to plasma-derived C1-inhibitor. Front Med (Lausanne) 2022; 9:930403. [PMID: 36186797 PMCID: PMC9515414 DOI: 10.3389/fmed.2022.930403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background In women with Hereditary Angioedema (HAE) due to C1-inhibitor (C1INH) deficiency (C1INH-HAE), pregnancy counseling and treatment can be challenging. Despite the evidence of the immediate favorable outcome and safety of plasma-derived (pd)C1INH concentrate, there are no data regarding any difference among women who underwent or not pdC1INH during pregnancy or on children with in utero exposure to pdC1INH. The present interview study aimed at analyzing outcome of C1INH-HAE mothers and children according to pdC1INH-exposure during pregnancies. Methods C1INH-HAE women who experienced at least 1 pregnancy were included from seven centers of the Italian Network for Hereditary and Acquired Angioedema (ITACA). The interview study retrospectively analyzed pregnancies who underwent (group 1) or not (group 2) pdC1INH. The overall goals of the study included immediate and long-term outcomes, in terms of outcomes in the time interval between pregnancy and survey. Results A total of 168 pregnancies from 87 included women were analyzed. At term delivery (>37 gestation-week, GW) has been registered in 73.8% of cases, while spontaneous abortion (SA) occurred in 14.2% of cases with a mean GW 7 ± 2. The group 1 including pdC1INH-treated pregnancies comprised a third of the cohort (51/168, time interval 1.5 ± 10.4 yrs), while the group 2 represented 69.6% (117/168, time interval 32.8 ± 14 yrs). The same prevalence of SA occurred when comparing group 1 (11.7%) with group 2 (15.4%) with a similar GW at SA. The group 1 was older at the pregnancy time and younger at the interview than the group 2 (P < 0.01 for both); moreover, the group 1 showed a higher prevalence of cesarean delivery (P < 0.0001). The overall prevalence of obstetrical syndromes was similar between two groups: however, gestational diabetes was described only in pdC1INH-untreated pregnancies. In utero pdC1INH-exposed children (n = 45) did not show differences compared with unexposed ones (n = 99) in neonatal short-term outcomes. Conclusion Through appropriate management and counseling, most of C1INH-HAE women undergo successful pregnancy and delivery. For pregnant C1INH-HAE women being treated with pdC1INH, our findings are reassuring and might lead to an improvement of both the knowledge about treatments and the experience of HAE itself.
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Affiliation(s)
- P. Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
- *Correspondence: P. Triggianese
| | - R. Senter
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
| | - A. Petraroli
- Centro Interdipartimentale di Ricerca in Scienze Immunologiche di Base e Cliniche (CISI) dell'Università degli Studi di Napoli Federico II, Naples, Italy
| | - A. Zoli
- Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Lo Pizzo
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - D. Bignardi
- Department of Medicine Integrated With the Territory, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - E. Di Agosta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - S. Agolini
- Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - F. Arcoleo
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - O. Rossi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - S. Modica
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - E. Greco
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - M. S. Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - G. Spadaro
- Centro Interdipartimentale di Ricerca in Scienze Immunologiche di Base e Cliniche (CISI) dell'Università degli Studi di Napoli Federico II, Naples, Italy
| | - C. De Carolis
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - M. Cancian
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
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Maiello A, Auriemma E, De Luca Picione R, Pacella D, Freda MF. Giving Meaning to Non-Communicable Illness: Mixed-Method Research on Sense of Grip on Disease (SoGoD). Healthcare (Basel) 2022; 10:healthcare10071309. [PMID: 35885835 PMCID: PMC9320476 DOI: 10.3390/healthcare10071309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
When people receive a diagnosis of chronic or non-communicable disease, they need to reorganize their lives to understand and accommodate the changes associated with the new health condition. This reorganization, which involves the activation of a process through which meaning is given to the illness, could be fostered by narrative methods also in the context of Primary Care. The Sense of Grip on Disease (SoGoD) model intends to focus on the role of sense-meaning-making processes in the psychological adjustment to non-communicable illness, emphasizing the patients’ role in managing their own health condition. In this study, the authors propose a mixed-method research method which implies the adaptation of the narrative interview on the Sense of Grip on Disease. The interview was administered to 31 adults suffering from non-communicable diseases and has been analyzed with a theory-driven approach, which aims to explore the modalities of five narrative functions: organization of temporality, integration of illness, expression of emotions, social sharing and orientation to action. Through a Multiple Correspondence Analysis and a Cluster Analysis, the authors have identified two different ‘Grip Profiles’, called “Dynamic Profile” and “Compliant Profile”, representative of different degrees of flexibility, integration and adjustment to disease.
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Affiliation(s)
- Assunta Maiello
- Department of Humanities, University of Naples Federico II, 80138 Naples, Italy; (A.M.); (M.F.F.)
| | - Ersilia Auriemma
- Department of Humanities, University of Naples Federico II, 80138 Naples, Italy; (A.M.); (M.F.F.)
- Correspondence:
| | | | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy;
| | - Maria Francesca Freda
- Department of Humanities, University of Naples Federico II, 80138 Naples, Italy; (A.M.); (M.F.F.)
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