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Huang E, Albrecht L, O’Hearn K, Nicolas N, Armstrong J, Weinberg M, Menon K. Reporting of social determinants of health in randomized controlled trials conducted in the pediatric intensive care unit. Front Pediatr 2024; 12:1329648. [PMID: 38361997 PMCID: PMC10867174 DOI: 10.3389/fped.2024.1329648] [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: 10/29/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction The influence of social determinants of health (SDOH) on access to care and outcomes for critically ill children remains an understudied area with a paucity of high-quality data. Recent publications have highlighted the importance of incorporating SDOH considerations into research but the frequency with which this occurs in pediatric intensive care unit (PICU) research is unclear. Our objective was to determine the frequency and categories of SDOH variables reported and how these variables were defined in published PICU randomized controlled trials (RCTs). Methods We searched Medline, Embase, Lilacs, and Central from inception to Dec 2022. Inclusion criteria were randomized controlled trials of any intervention on children or their families in a PICU. Data related to study demographics and nine WHO SDOH categories were extracted, and descriptive statistics and qualitative data generated. Results 586 unique RCTs were included. Studies had a median sample size of 60 patients (IQR 40-106) with 73.0% of studies including ≤100 patients and 41.1% including ≤50 patients. A total of 181 (181/586, 30.9%) studies reported ≥1 SDOH variable of which 163 (163/586, 27.8%) reported them by randomization group. The most frequently reported categories were food insecurity (100/586, 17.1%) and social inclusion and non-discrimination (73/586, 12.5%). Twenty-five of 57 studies (43.9%) investigating feeding or nutrition and 11 of 82 (13.4%) assessing mechanical ventilation reported baseline nutritional assessments. Forty-one studies investigated interventions in children with asthma or bronchiolitis of which six reported on smoking in the home (6/41, 14.6%). Discussion Reporting of relevant SDOH variables occurs infrequently in PICU RCTs. In addition, when available, categorizations and definitions of SDOH vary considerably between studies. Standardization of SDOH variable collection along with consistent minimal reporting requirements for PICU RCT publications is needed.
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Affiliation(s)
- Emma Huang
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Albrecht
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Katie O’Hearn
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Naisha Nicolas
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Jennifer Armstrong
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Maya Weinberg
- Faculty of Science, University of Ottawa, Ottawa, ON, Canada
| | - Kusum Menon
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada
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O'Connor AM, Cassedy A, Wray J, Brown KL, Cohen M, Franklin RCG, Gaynor JW, MacGloin H, Mahony L, Mussatto K, Newburger JW, Rosenthal DN, Teitel D, Ernst MM, Wernovsky G, Marino BS. Differences in Quality of Life in Children Across the Spectrum of Congenital Heart Disease. J Pediatr 2023; 263:113701. [PMID: 37640230 DOI: 10.1016/j.jpeds.2023.113701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To create complexity groups based upon a patient's cardiac medical history and to test for group differences in health-related quality of life (HRQOL). METHODS Patients 8-18 years with congenital heart disease (CHD) and parent-proxies from the Pediatric Cardiac Quality of Life Inventory (PCQLI) Testing Study were included. Outcome variables included PCQLI Total, Disease Impact, and Psychosocial Impact scores. Using a patient's medical history (cardiac, neurologic, psychological, and cognitive diagnosis), latent class analysis (LCA) was used to create CHD complexity groups. Covariates included demographics and burden of illness (number of: school weeks missed, physician visits in the past year, and daily medications). Generalized estimation equations tested for differences in burden of illness and patient and parent-proxy PCQLI scores. RESULTS Using 1482 CHD patients (60% male; 84% white; age 12.3 ± 3.0 years), latent class analysis (LCA) estimates showed 4 distinct CHD complexity groups (Mild, Moderate 1, Moderate 2, and Severe). Increasing CHD complexity was associated with increased risk of learning disorders, seizures, mental health problems, and history of stroke. Greater CHD complexity was associated with greater burden of illness (P < .01) and lower patient- and parent-reported PCQLI scores (P < .001). CONCLUSIONS LCA identified 4 congenital heart disease (CHD) complexity groupings. Increasing CHD complexity was associated with higher burden of illness and worse patient- and parent-reported HRQOL.
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Affiliation(s)
- Amy M O'Connor
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Jo Wray
- Department of Pediatric Cardiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kate L Brown
- Department of Pediatric Cardiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Mitchell Cohen
- Division of Cardiology, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ; Division of Cardiology, Department of Pediatrics, Inova Children's Hospital, Falls Church, VA
| | - Rodney C G Franklin
- Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - J William Gaynor
- Division of Cardiothoracic Surgery, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Helen MacGloin
- Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Lynn Mahony
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Jane W Newburger
- Division of Cardiology, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - David N Rosenthal
- Division of Cardiology, Department of Pediatrics, Lucille Packard Children's Hospital Stanford, Palo Alto, CA
| | - David Teitel
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Michelle M Ernst
- Division of Behavior Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Gil Wernovsky
- Division of Cardiology, Departments of Pediatrics and Critical Care Medicine, Children's National Hospital, Washington, DC; Division of Cardiac Critical Care, Departments of Pediatrics and Critical Care Medicine, Children's National Hospital, Washington, DC
| | - Bradley S Marino
- Divisions of Pediatric Cardiology and Critical Care Medicine, Department of Heart, Vascular & Thoracic, Children's Institute, Cleveland Clinic Children's, Cleveland, OH
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Pfitzer C, Sievers LK, Hütter A, Khaliq HA, Poryo M, Berger F, Bauer UMM, Helm PC, Schmitt KRL. Microcephaly is associated with impaired educational development in children with congenital heart disease. Front Cardiovasc Med 2022; 9:917507. [PMID: 36277771 PMCID: PMC9584804 DOI: 10.3389/fcvm.2022.917507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives This study aims to evaluate the school careers of patients with congenital heart disease (CHD) and microcephaly. Methods An exploratory online survey was conducted on patients from a previous study on somatic development in children with CHD in 2018 (n = 2818). A total of 750 patients participated in the online survey (26.6%). This publication focuses on 91 patients (12.1%) diagnosed with CHD and microcephaly who participated in the new online survey. Results Microcephaly was significantly associated with CHD severity (p < 0.001). Microcephalic patients suffered from psychiatric comorbidity two times as often (67.0%) as non-microcephalic patients (29.8%). In particular, the percentage of patients with developmental delay, intellectual debility, social disability, learning disorder, or language disorder was significantly increased in microcephalic CHD patients (p < 0.001). A total of 85.7% of microcephalic patients and 47.6% of non-microcephalic patients received early interventions to foster their development. The school enrollment of both groups was similar at approximately six years of age. However, 89.9% of non-microcephalic but only 51.6% of microcephalic patients were enrolled in a regular elementary school. Regarding secondary school, only half as many microcephalic patients (14.3%) went to grammar school, while the proportion of pupils at special schools was eight times higher. Supportive interventions, e.g., for specific learning disabilities, were used by 52.7% of microcephalic patients and 21.6% of non-microcephalic patients. Conclusion Patients with CHD and microcephaly are at high risk for impaired educational development. Early identification should alert clinicians to provide targeted interventions to optimize the developmental potential.
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Affiliation(s)
- Constanze Pfitzer
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany,Berlin Institute of Health (BIH), Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Laura K. Sievers
- Department of Internal Medicine I., Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany,*Correspondence: Laura K. Sievers
| | - Alina Hütter
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Hashim-Abdul Khaliq
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | - Martin Poryo
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | - Felix Berger
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany,Department of Pediatric Cardiology, Charite – Universitaetsmedizin Berlin, Berlin, Germany
| | - Ulrike M. M. Bauer
- National Register for Congenital Heart Defects, Berlin, Germany,Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Paul C. Helm
- National Register for Congenital Heart Defects, Berlin, Germany,Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Katharina R. L. Schmitt
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Read J, Ridout D, Johnson S, Hoskote A, Sheehan K, Wellman P, Jones A, Wray J, Brown K. Postoperative morbidities with infant cardiac surgery and toddlers' neurodevelopment. Arch Dis Child 2022; 107:922-928. [PMID: 35793944 DOI: 10.1136/archdischild-2021-322756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 05/04/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the relationship between morbidities after infant cardiac surgery and neurodevelopment and behaviour at age 2-3 years. DESIGN/SETTING A prospective cohort follow-up study, in four paediatric cardiac centres. We excluded children with known syndromes. Home-based neurodevelopmental assessments using the Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III) were undertaken in 81 children and secondary outcome measures of development and behaviour were completed by parents. A further 41 families completed the secondary outcome measures remotely. RESULTS Children were grouped as multiple morbidities/extracorporeal life support (ECLS) (n=19), single morbidities (n=36) and no morbidities (n=59). Group comparisons found that children with multiple morbidities/ECLS, compared with no morbidities, had: (a) lower adjusted mean scores for core Bayley-III composites (none reached the level of statistical significance), with mean differences of cognitive -6.1 (95% CI -12.4 to 0.1) p=0.06, language -9.1 (95% CI -18.6 to 0.3) p=0.06 and motor -4.4 (95% CI -12.0 to 3.1) p=25; (b) greater adjusted odds of at least one low or borderline Bayley-III composite result 4.0 (95% CI 1.0 to 16.0) (p=0.05); (c) greater adjusted risk of an abnormal Ages and Stages Questionnaire (ASQ) result 5.3 (95% CI 1.3 to 21.1) (p=0.03) and a borderline ASQ result 4.9 (95% CI 1.0 to 25.0) (p=0.05); and no difference in the risk of an abnormal Strengths and Difficulties Questionnaire result 1.7 (95% CI 0.3 to 10.4) p=0.58. These outcomes were not statistically different between the single morbidity and no morbidity groups. CONCLUSIONS Children who experience multiple morbidities/ECLS after infant heart surgery are at a greater risk of neurodevelopmental difficulties than their peers who had no complications and should be prioritised for neurodevelopmental follow-up.
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Affiliation(s)
- Julie Read
- Centre for Outcomes and Experience Research in Child Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Deborah Ridout
- Paediatric Epidemiology Biostatistics, University College London Institute of Child Health, London, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Aparna Hoskote
- Heart and Lung Division, Great Ormond Street Hospital National Institute Health Research Biomedical Research Centre, London, UK
| | - Karen Sheehan
- Department of Paediatric Cardiology, Bristol Royal Children's Hospital, Bristol, UK
| | - Paul Wellman
- Department of Paediatric Intensive Care, Evelina London Children's Hospital, London, UK
| | - Alison Jones
- Department of Paediatric Intensive Care, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Child Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Katherine Brown
- Heart and Lung Division, Great Ormond Street Hospital National Institute Health Research Biomedical Research Centre, London, UK
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Majeed A, Rofeberg V, Bellinger DC, Wypij D, Newburger JW. Machine Learning to Predict Executive Function in Adolescents with Repaired d-Transposition of the Great Arteries, Tetralogy of Fallot, and Fontan Palliation. J Pediatr 2022; 246:145-153. [PMID: 35314155 DOI: 10.1016/j.jpeds.2022.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To identify predictors of impaired executive function in adolescents after surgical repair of critical congenital heart disease (CHD). STUDY DESIGN We analyzed patient factors, medical and surgical history, and family social class from 3 single-center studies of adolescents with d-transposition of the great arteries (d-TGA), tetralogy of Fallot (TOF), and Fontan repair. Machine learning models were developed using recursive partitioning to predict an executive function composite score based on five subtests (population mean 10, SD 3) of the Delis-Kaplan Executive Function System. RESULTS The sample included 386 patients (139 d-TGA, 91 TOF, 156 Fontan) of age 15.1 ± 2.1 (mean ± SD) years and an executive function composite score of 8.6 ± 2.4. Family social class emerged as the most important predictive factor. The lowest (worst) mean executive function score (5.3) occurred in patients with low to medium social class (Hollingshead index <56) with one or more neurologic events and a diagnosis of TOF. The highest (best) mean score (9.7) occurred in subjects with high social class (Hollingshead index ≥56) and shorter duration of deep hypothermic circulatory arrest. Other factors predicting lower executive function scores included low birth weight and a greater number of catheterizations. CONCLUSIONS In regression tree modeling, family social class was the strongest predictor of executive function in adolescents with critical CHD, even in the presence of medical risk factors. Additional predictors included CHD diagnosis, birth weight, neurologic events, and number of procedures. These data highlight the importance of social class in mitigating risks of executive dysfunction in CHD.
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Affiliation(s)
- Amara Majeed
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Valerie Rofeberg
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - David C Bellinger
- Department of Neurology, Boston Children's Hospital, Boston, MA; Department of Neurology, Harvard Medical School, Boston, MA
| | - David Wypij
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
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Association of Socioeconomic Status With Postdischarge Pediatric Resource Use and Quality of Life. Crit Care Med 2022; 50:e117-e128. [PMID: 34495879 PMCID: PMC8810731 DOI: 10.1097/ccm.0000000000005261] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Socioeconomic factors may impact healthcare resource use and health-related quality of life, but their association with postcritical illness outcomes is unknown. This study examines the associations between socioeconomic status, resource use, and health-related quality of life in a cohort of children recovering from acute respiratory failure. DESIGN Secondary analysis of data from the Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial. SETTING Thirty-one PICUs. PATIENTS Children with acute respiratory failure enrolled whose parent/guardians consented for follow-up. MEASUREMENTS AND MAIN RESULTS Resource use included in-home care, number of healthcare providers, prescribed medications, home medical equipment, emergency department visits, and hospital readmission. Socioeconomic status was estimated by matching residential address to census tract-based median income. Health-related quality of life was measured using age-based parent-report instruments. Resource use interviews with matched census tract data (n = 958) and health-related quality of life questionnaires (n = 750/958) were assessed. Compared with high-income children, low-income children received care from fewer types of healthcare providers (β = -0.4; p = 0.004), used less newly prescribed medical equipment (odds ratio = 0.4; p < 0.001), and had more emergency department visits (43% vs 33%; p = 0.04). In the youngest cohort (< 2 yr old), low-income children had lower quality of life scores from physical ability (-8.6 points; p = 0.01) and bodily pain/discomfort (+8.2 points; p < 0.05). In addition, health-related quality of life was lower in those who had more healthcare providers and prescribed medications. In older children, health-related quality of life was lower if they had prescribed medications, emergency department visits, or hospital readmission. CONCLUSIONS Children recovering from acute respiratory failure have ongoing healthcare resource use. Yet, lower income children use less in-home and outpatient services and use more hospital resources. Continued follow-up care, especially in lower income children, may help identify those in need of ongoing healthcare resources and those at-risk for decreased health-related quality of life.
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Tulegenova AM, Dauletova G, Nakipov Z, Sarsenbayeva G, Dossybayeva G, Sadibekova Z, Raissova K, Turgambayeva A. Assessment of the Quality of Life and Living Conditions of the Rural Population of the Kazakhstan during the COVID-19 Pandemic. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Low availability of medical care and low level of comfort living in rural areas, underdeveloped infrastructure, and difficult working conditions lead to the deterioration of health of rural residents. Rural areas are characterized by less comfortable living conditions than in the city, which can affect health-related quality of life.
AIM: The purpose of this study was to assess the satisfaction of the population with the quality of life in rural areas as well as to study the quality of life of the rural population of the Republic of Kazakhstan related to health.
METHODS: This study was a one-stage cross-sectional study. Online questionnaire was asked by 411 local residents, of which only 302 were suitable for processing.
RESULTS: The results showed that almost a third of the respondents are unemployed (27.2%). In the course of the survey, respondents could subjectively assess their own health, for example, almost a third of respondents (35.76%) assess their health as “poor” and “below average.” At the same time, 18.21% of respondents are not satisfied with the quality of medical services provided in rural areas. The coefficients of correlation between the desire to move to the city and age, income level, family composition, marital status, and type of housing were established. The universal social functioning-36 index was 0.6 (±0.02) for women and 0.55 (±0.033) for men
CONCLUSIONS: We can say that the quality of life of the rural population remains quite low. This is evidenced by low income, high unemployment, and the problem of drinking water. Quarantine measures related to COVID-19 also had an impact on the increase in unemployment, however, during the quarantine, there is a deterioration in mental health indicators among men compared to women. The results of the study confirmed that the issue of accessibility of medical services remains very urgent for rural residents.
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Machen L, Davenport CA, Oakes M, Bosworth HB, Patel UD, Diamantidis C. Race, Income, and Medical Care Spending Patterns in High-Risk Primary Care Patients: Results From the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) Study. Kidney Med 2022; 4:100382. [PMID: 35072046 PMCID: PMC8767089 DOI: 10.1016/j.xkme.2021.08.016] [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] [Indexed: 11/27/2022] Open
Abstract
Rationale & Objective Little is known about how socioeconomic status (SES) relates to the prioritization of medical care spending over personal expenditures in individuals with multiple comorbid conditions, and whether this relationship differs between Blacks and non-Blacks. We aimed to explore the relationship between SES, race, and medical spending among individuals with multiple comorbid conditions. Study Design Cross-sectional evaluation of baseline data from a randomized controlled trial. Setting & Participants The STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) study is a completed randomized controlled trial of Duke University primary care patients with diabetes, hypertension, and chronic kidney disease. Participants underwent survey assessments inclusive of measures of socio-demographics and medication adherence. Predictors Race (Black or non-Black) and socioeconomic status (income, education, and employment). Outcomes The primary outcomes were based on 4 questions related to spending, asking about reduced spending on basic/leisure needs or using savings to pay for medical care. Participants were also asked if they skipped medications to make them last longer. Analytical Approach Multivariable logistic regression stratified by race and adjusted for age, sex, and household chaos was used to determine the independent effects of SES components on spending. Results Of 263 STOP-DKD participants, 144 (55%) were Black. Compared with non-Blacks, Black participants had lower incomes with similar levels of education and employment but were more likely to reduce spending on basic needs (29.2% vs 13.5%), leisure activities (35.4% vs 20.2%), and to skip medications (31.3% vs 15.1%), all P < 0.05. After multivariable adjustment, Black race was associated with increased odds of reduced basic spending (OR, 2.29; 95% CI, 1.14-4.60), reduced leisure spending (OR, 1.94; 95% CI, 1.05-3.58), and skipping medications (OR, 2.12; 95% CI, 1.12-4.04). Limitations This study was conducted at a single site in Durham, North Carolina, and nearly exclusively included insured patients. Further, the impact of the number of comorbid conditions, medication costs, or copayments was not assessed. Conclusions In primary care patients with multiple chronic diseases, Black patients are more likely to reduce spending on basic needs and leisure activities to afford their medical care than non-Black patients of equivalent SES. ClinicalTrials.gov Identifier NCT01829256
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Primary Disease, Sex, and Racial Differences in Health-Related Quality of Life in Adolescents and Young Adults with Heart Failure. Pediatr Cardiol 2022; 43:1568-1577. [PMID: 35378609 PMCID: PMC8979480 DOI: 10.1007/s00246-022-02884-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/21/2022] [Indexed: 11/22/2022]
Abstract
Health-related quality of life (HRQOL) is an important clinical and research trial endpoint in adult heart failure and has been shown to predict mortality and hospitalizations in adult heart failure populations. HRQOL has not been adequately studied in the growing pediatric and young adult heart failure population. This study described HRQOL in adolescents and young adults (AYAs) with heart failure and examined primary disease, sex, race, and other correlates of HRQOL in this sample. Participants in this cross-sectional, single-center study included adolescent and young adults with heart failure and a parent/guardian. Patients and their parent/proxies completed the PedsQL, a well-established measure of HRQOL in pediatric chronic illness populations. HRQOL is impaired in AYAs with heart failure resulting from dilated, hypertrophic, or other cardiomyopathy, congenital heart disease, or post-transplant with rejection/complications. Patients identifying as white endorsed poorer total HRQOL than non-white patients (p = 0.002). Subscale analysis revealed significant correlations between female sex (p = 0.01) and white race (p = 0.01) with poorer self-reported physical functioning. Family income was unrelated to HRQOL. Functional status was strongly associated with total (p = 0.0003) and physical HRQOL (p < 0.0001). Sociodemographic and disease-specific risk and resilience factors specific to HRQOL in AYAs with heart failure include primary cardiac disease, race, sex, and functional status. Building upon extensive work in adult heart failure, utilization, and study of HRQOL as a clinical and research trial outcome is necessary in pediatric heart failure. Developing targeted interventions for those at greatest risk of impaired HRQOL is an important next step.
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Klein JH, Gourishankar A, Krishnan A. Development of a national dataset for geospatial analysis of congenital heart disease. Front Pediatr 2022; 10:952048. [PMID: 36034569 PMCID: PMC9399633 DOI: 10.3389/fped.2022.952048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jennifer H Klein
- Division of Cardiology, Children's National Hospital, Washington, DC, United States
| | - Anand Gourishankar
- Division of Hospital Medicine, Children's National Hospital, Washington, DC, United States
| | - Anita Krishnan
- Division of Cardiology, Children's National Hospital, Washington, DC, United States
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11
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Moscato EL, Fisher AP, Gies LM, Smith-Paine JM, Miley AE, Beebe DW, Quinton TL, Pai ALH, Salloum R, Wade SL. A Mixed-Methods Analysis of Family Perceptions of Neuropsychological Evaluation and Resources for Pediatric Brain Tumor Survivors. Arch Clin Neuropsychol 2021; 36:1485–1501. [PMID: 33758918 DOI: 10.1093/arclin/acab014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Neuropsychological testing is often recommended for pediatric brain tumor survivors, yet little is known about perceptions of testing and resources. The purpose of this study is to examine survivor and caregiver perceptions about neuropsychology and resources and identify factors associated with receipt of neuropsychological testing. METHOD Survivors and their families (N = 55) completed questionnaires on demographics and family functioning. The Neurological Predictive Scale was used to rate treatment intensity and expected impact on neuropsychological functioning. Chi squares and logistic regression were used to examine the associations between demographic, disease, and treatment factors and receipt of neuropsychological testing. Qualitative interviews (N = 25) were completed with a subset of families and coded with thematic content analysis and a multicoder consensus process with high inter-rater reliability (kappas .91-.93). RESULTS The majority of survivors received neuropsychological testing. Survivors were more likely to receive neuropsychological testing if they were younger and if their caregivers had less than a college education and lower income. Qualitatively, families identified neurocognitive concerns. Some families reported that neuropsychological testing was helpful in clarifying deficits or gaining accommodations, while other families had difficulty recalling results or identified barriers to services. To mitigate the impact of deficits, families implemented metacognitive strategies and advocated for their survivor at school. Families desired more resources around the transition to adulthood and more opportunities for connection with other survivors. CONCLUSIONS Many families valued insights from neuropsychological services yet identified room for further improvement to address barriers and ensure accessibility and comprehensibility of neuropsychological findings.
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Affiliation(s)
- Emily L Moscato
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Allison P Fisher
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lisa M Gies
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Julia M Smith-Paine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aimee E Miley
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Dean W Beebe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Departments of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Thea L Quinton
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ahna L H Pai
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ralph Salloum
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shari L Wade
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Departments of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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12
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Belay W, Kaba M, Labisso WL, Tigeneh W, Sahile Z, Zergaw A, Ejigu A, Baheretibeb Y, Gufue ZH, Haileselassie W. The effect of interpersonal psychotherapy on quality of life among breast cancer patients with common mental health disorder: a randomized control trial at Tikur Anbessa Specialized Hospital. Support Care Cancer 2021; 30:965-972. [PMID: 34432169 DOI: 10.1007/s00520-021-06508-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the effect of interpersonal psychotherapy on anxiety, depression, and quality of life among breast cancer patients with mental health disorders at Tikur Anbessa Specialized Hospital, Ethiopia. METHODS A two-arm parallel randomized controlled trial study was conducted among 114 (n = 57 intervention, and n = 57 control group) breast cancer patients with common mental health disorder at the oncology center of Tikur Anbessa Specialized Hospital. The hospital anxiety and depression measurement scale was used to assess depression and anxiety disorder and a 30-item quality of life questionnaire was used to assess the quality of life. General linear model analysis was done, confounding factors were controlled, and p < 0.05 was used to declare statistical significance. RESULTS Patients in the intervention group showed a significant improvement in the anxiety (coefficient - 3.68; 95% CI - 5.67, - 1.69; p < 0.001), depression (coefficient - 3.22; 95% CI - 4.7, - 1.69; p < 0.001), physical functioning (coefficient 10.55; 95% CI 3.13, 17.98; p = 0.006), health-related quality of life (coefficient 21.85; 95% CI 14.1, 29.59; p < 0.001), insomnia (coefficient - 19.56; 95% CI - 31.87, - 7.25; p = 0.002), and fatigue (coefficient - 11.37; 95% CI - 21.49, - 1.24; p = 0.028) respectively. CONCLUSIONS The adapted Ethiopian version of interpersonal psychotherapy had improved anxiety, depression, and some domains of health-related quality of life. Hence, health programmers should consider incorporating it as a treatment option in oncology centers. TRIAL REGISTRATION NUMBER PACTR202011629348967 granted on 20 November 2020 which was retrospectively registered.
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Affiliation(s)
- Winini Belay
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Mirgissa Kaba
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wajana Lako Labisso
- Department of Pathology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondemagegnehu Tigeneh
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zekariyas Sahile
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Ababi Zergaw
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Ejigu
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yonas Baheretibeb
- Department of Psychiatry, School of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zenawi Hagos Gufue
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Werissaw Haileselassie
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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13
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Dungog RJ, Tamanal JM, Kim CH. The Assessment of Lifestyle Status among High School and College Students in Luzon, Philippines. J Lifestyle Med 2021; 11:57-65. [PMID: 34549027 PMCID: PMC8430313 DOI: 10.15280/jlm.2021.11.2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/15/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Lifestyle has been one of the central subjects of increasing research interest worldwide and acknowledged as part of the relevant factors of an individual's health status. The World Health Organization defines health as a state of complete physical, mental, and social well-being, and not merely the absence of disease. The purpose of this study is to assess lifestyle status among high school and college students and to explore which sociodemographic variables have influenced such existing healthy lifestyle behaviors. METHODS This is a descriptive cross-sectional study that was conducted among 230 students from the high school and college. The questionnaire included descriptive information and the Healthy Lifestyle Screening Tool (HLST) to assess lifestyle scores among students from the high school and college. Socio-demographic characteristics of students included were perceived family income, domestic status or people living with, school life satisfaction, happiness rate, and self-rated health status. RESULTS The results of this study showed the significance of lifestyle status among high school and college students having total scores of 106.56 (SD = 28.11) and 100.9 (32.91) respectively. Sociodemographic and health-related characteristics had significance in perceived economic status, life satisfaction, health status, and happiness rate. Furthermore, healthy lifestyle subcomponents had significant differences in water, air, rest, exercise, nutrition, and trust. CONCLUSION Healthy lifestyle status among students both in high school and college is low specifically in components such as sunlight, water, air, rest, exercise, nutrition, temperance as well as the general physical condition. Adherence to healthy lifestyle behaviors among students are needing emphasis and guidance through promotion and education. Health education programs and promotions in institutions need to be carried out and be well-implemented for students to achieve and maintain healthy lifestyle behaviors.
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Affiliation(s)
- Rusally Joy Dungog
- Department of Addiction Science, College of Health Science and Social Welfare, Sahmyook University Graduate School, Seoul, Korea
| | - Jerre Mae Tamanal
- Department of Addiction Science, College of Health Science and Social Welfare, Sahmyook University Graduate School, Seoul, Korea
| | - Cheong Hoon Kim
- Department of Addiction Science, College of Health Science and Social Welfare, Sahmyook University Graduate School, Seoul, Korea
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14
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Sananes R, Goldberg CS, Newburger JW, Hu C, Trachtenberg F, Gaynor JW, Mahle WT, Miller T, Uzark K, Mussatto KA, Pizarro C, Jacobs JP, Cnota J, Atz AM, Lai WW, Burns KM, Milazzo A, Votava-Smith J, Brosig CL. Six-Year Neurodevelopmental Outcomes for Children With Single-Ventricle Physiology. Pediatrics 2021; 147:peds.2020-014589. [PMID: 33441486 PMCID: PMC7849196 DOI: 10.1542/peds.2020-014589] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if neurodevelopmental deficits in children with single-ventricle physiology change with age and early developmental scores predict 6-year outcomes. METHODS In the Single Ventricle Reconstruction Trial, Bayley Scales of Infant Development, Second Edition, were administered at 14 months of age, and parents completed the Behavior Assessment System for Children, Second Edition (BASC-2) annually from the ages of 2 to 6 years. Scores were classified as average, at risk, or impaired. We calculated sensitivities, specificities, and positive and negative predictive values of earlier tests on 6-year outcomes. RESULTS Of 291 eligible participants, 244 (84%) completed the BASC-2 at 6 years; more Single Ventricle Reconstruction participants than expected on the basis of normative data scored at risk or impaired on the BASC-2 Adaptive Skills Index at that evaluation (28.7% vs 15.9%; P < .001). Children with Adaptive Skills Composite scores <2 SD below the mean at the age of 6 were more likely to have had delayed development at 14 months, particularly on the Psychomotor Development Index (sensitivity of 79%). However, the positive predictive value of the 14-month Mental Development Index and Psychomotor Development Index for 6-year BASC-2 Adaptive Scores was low (44% and 36%, respectively). Adaptive Skills Composite score impairments at the age of 6 were poorly predicted by using earlier BASC-2 assessments, with low sensitivities at the ages of 3 (37%), 4 (48%), and 5 years (55%). CONCLUSIONS Many children with hypoplastic left heart syndrome who have low adaptive skills at the age of 6 years will not be identified by screening at earlier ages. With our findings, we highlight the importance of serial evaluations for children with critical congenital heart disease throughout development.
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Affiliation(s)
- Renee Sananes
- Department of Pediatrics and Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Canada;
| | - Caren S. Goldberg
- Department of Pediatrics, Michigan Medicine, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Chenwei Hu
- New England Research Institutes, Watertown, Massachusetts
| | | | - J. William Gaynor
- Division of Pediatric Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William T. Mahle
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Thomas Miller
- Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah;,Division of Pediatric Cardiology, Maine Medical Center, Portland, Maine
| | - Karen Uzark
- Department of Pediatrics, Michigan Medicine, Medical School, University of Michigan, Ann Arbor, Michigan
| | | | - Christian Pizarro
- Department of Surgery, Nemours Cardiac Center, Alfred I du Pont Hospital for Children, Wilmington, Delaware
| | | | - James Cnota
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Andrew M. Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Wyman W. Lai
- Children’s Heart Institute, Children’s Hospital of Orange County, Orange, California
| | | | - Angelo Milazzo
- Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina;,Department of Pediatrics, East Carolina University, Greenville, North Carolina;,Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina; and
| | - Jodie Votava-Smith
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - Cheryl L. Brosig
- Pediatrics, Herma Heart Institute, Children’s Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
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15
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Morbidities After Cardiac Surgery: Impact on Children's Quality of Life and Parents' Mental Health. Ann Thorac Surg 2020; 112:2055-2062. [PMID: 33253670 PMCID: PMC8647554 DOI: 10.1016/j.athoracsur.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022]
Abstract
Background Most children now survive cardiac surgery, and the focus of quality improvement initiatives has shifted toward more complex outcome measures. The aim of this investigation was to study the impact of early postoperative morbidities on parent-reported patient quality of life and parental anxiety or depression over 6 months. Methods This prospective case-matched cohort study was conducted in 5 UK children’s cardiac centers. Measures of impact for patient categories of “single morbidity,” “multiple morbidities,” and “extracorporeal life support (ECLS)” were compared with “no morbidity.” The measures used were the Pediatric Quality of Life Inventory (PedsQL) and the 4-item Patient Health Questionnaire (PHQ-4) at 6 weeks and 6 months postoperatively. The study modeled the outcomes using mixed effects regression, adjusting for case mix and clustering within centers. Results The study included 666 patients who underwent operation at a median age of 81 days (interquartile range, 10 to 325 days). At 6-week follow-up, significant adjusted differences to the reference group with no morbidity were found for total PedsQL scores, which were lower in patients with ECLS (P = .01), multiple morbidities (P < .001), and a single morbidity (P = .04), as well as the proportion of parents with anxiety and depression, which were higher in the group with multiple morbidities (P = .04 and P = .01, respectively). At 6 months, measures had improved in all morbidity groups. The only significant adjusted difference in the reference group was for physical PedsQL scores in ECLS (P = .04) and multiple morbidities (P < .01). Conclusions Patient and parent well-being are strongly influenced by postoperative morbidities early after surgery, with improvement by 6 months. Family psychological support and holistic rehabilitation are vital for children who experience postoperative morbidities.
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16
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Pfitzer C, Buchdunger LA, Helm PC, Blickle MJ, Rosenthal LM, Ferentzi H, Berger F, Bauer UMM, Schmitt KRL. Education of Children With Cyanotic Congenital Heart Disease After Neonatal Cardiac Surgery. Ann Thorac Surg 2020; 112:1546-1552. [PMID: 33075323 DOI: 10.1016/j.athoracsur.2020.07.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of the study was to evaluate the educational achievement of patients diagnosed with univentricular heart physiology (UVHP) or transposition of the great arteries (TGA) after neonatal cardiac surgery. METHODS An exploratory online survey was performed with patients registered with the National Register for Congenital Heart Defects in Germany. For this publication, a subgroup analysis was conducted among patients diagnosed with TGA (n = 173; 36.3%) and UVHP (n = 304; 63.7%). RESULTS Median age of the sample at school enrollment was 6 years (range, 5-8 years). The majority were enrolled at a standard elementary school (n = 368 of 477; 77.1%), although patients with UVHP were enrolled significantly more often at a special needs school (n = 52 of 304; 17.1%, TGA patients n = 11/ of 173; 6.4%, P < .001). A total of 45.8% (n = 66 of 144) of the patients graduated with a high school diploma. A substantial number of patients had been diagnosed with behavioral or learning disorders (TGA patients n = 63 of 173 [36.4%], UVHP patients n = 148 of 304 [48.7%]) and received early supportive therapy or remedial teaching before (TGA patients n = 89 of 173 [51.4%], UVHP patients n = 209 of 304 [68.8%]) and/or during their school careers (TGA patients n = 54 of 173 [31.2%], UVHP patients n = 120 of 304 [39.5%]). CONCLUSIONS A large proportion of patients who underwent neonatal cardiac surgery graduated with a high school diploma. These results are of great importance to congenital heart defect patients, affected families, and treating physicians. Nevertheless, study participants, especially patients with UVHP, face some academic challenges. We conclude that long-term follow-up examinations and regular developmental assessments may be beneficial.
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Affiliation(s)
- Constanze Pfitzer
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany; Berlin Institute of Health, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany.
| | | | - Paul C Helm
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Maximilian J Blickle
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - Lisa-Maria Rosenthal
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - Hannah Ferentzi
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany; Department of Pediatric Cardiology, Charité- Universitaetsmedizin Berlin, Germany
| | - Ulrike M M Bauer
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany; Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Katharina R L Schmitt
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
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17
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Bucholz EM, Sleeper LA, Goldberg CS, Pasquali SK, Anderson BR, Gaynor JW, Cnota JF, Newburger JW. Socioeconomic Status and Long-term Outcomes in Single Ventricle Heart Disease. Pediatrics 2020; 146:peds.2020-1240. [PMID: 32973120 PMCID: PMC7546087 DOI: 10.1542/peds.2020-1240] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Low socioeconomic status (SES) has emerged as an important risk factor for higher short-term mortality and neurodevelopmental outcomes in children with hypoplastic left heart syndrome and related anomalies; yet little is known about how SES affects these outcomes over the long-term. METHODS We linked data from the Single Ventricle Reconstruction trial to US Census Bureau data to analyze the relationship of neighborhood SES tertiles with mortality and transplantation, neurodevelopment, quality of life, and functional status at 5 and 6 years post-Norwood procedure (N = 525). Cox proportional hazards regression and linear regression were used to assess the association of SES with mortality and neurodevelopmental outcomes, respectively. RESULTS Patients in the lowest SES tertile were more likely to be racial minorities, older at stage 2 and Fontan procedures, and to have more complications and fewer cardiac catheterizations over follow-up (all P < .05) compared with patients in higher SES tertiles. Unadjusted mortality was highest for patients in the lowest SES tertile and lowest in the highest tertile (41% vs 29%, respectively; log-rank P = .027). Adjustment for patient birth and Norwood factors attenuated these differences slightly (P = .055). Patients in the lowest SES tertile reported lower functional status and lower fine motor, problem-solving, adaptive behavior, and communication skills at 6 years (all P < .05). These differences persisted after adjustment for baseline and post-Norwood factors. Quality of life did not differ by SES. CONCLUSIONS Among patients with hypoplastic left heart syndrome, those with low SES have worse neurodevelopmental and functional status outcomes at 6 years. These differences were not explained by other patient or clinical characteristics.
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Affiliation(s)
- Emily M. Bucholz
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Caren S. Goldberg
- Department of Pediatrics, University of Michigan and C.S. Mott Children’s Hospital, Ann Arbor, Michigan
| | - Sara K. Pasquali
- Department of Pediatrics, University of Michigan and C.S. Mott Children’s Hospital, Ann Arbor, Michigan
| | - Brett R. Anderson
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York City, New York
| | - J. William Gaynor
- Division of Pediatric Cardiac Surgery, Cardiac Center, Children’s Hospital of Pennsylvania, Philadelphia, Pennsylvania; and
| | - James F. Cnota
- Department of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
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18
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Yaya S, Yeboah H, Charles CH, Otu A, Labonte R. Ethnic and racial disparities in COVID-19-related deaths: counting the trees, hiding the forest. BMJ Glob Health 2020; 5:bmjgh-2020-002913. [PMID: 32513864 PMCID: PMC7298686 DOI: 10.1136/bmjgh-2020-002913] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 01/13/2023] Open
Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada .,The George Institute for Global Health, University of Oxford, Oxford, United States
| | - Helena Yeboah
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Carlo Handy Charles
- Department of Sociology, McMaster University, Hamilton, Ontario, Canada.,Geography at the Laboratoire Caribéen de Sciences Sociales du Centre National de la Recherche Scientifique, Université des Antilles, Schoelcher, Martinique
| | - Akaninyene Otu
- Department of Infection and Travel Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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19
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Xiang L, Su Z, Liu Y, Huang Y, Zhang X, Li S, Zhang H. Impact of Family Socioeconomic Status on Health-Related Quality of Life in Children With Critical Congenital Heart Disease. J Am Heart Assoc 2020; 8:e010616. [PMID: 30563422 PMCID: PMC6405710 DOI: 10.1161/jaha.118.010616] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Socioeconomic status (SES) is associated with health‐related quality of life (HRQOL) for children with critical congenital heart disease; however, literature from newly industrialized countries is scarce. Methods and Results This cross‐sectional study included 2037 surviving patients operated on for critical congenital heart disease at a tertiary hospital in China between May 2012 and December 2015. All eligible patients were aged 2 to 12 years. HRQOL was measured by the Pediatric Quality of Life Inventory 4.0 generic and 3.0 cardiac modules. Family SES was assessed by a composite of household income in the past year and occupation and education level of each parent in the family. Mean scores of major domains in HRQOL were significantly lower in the low‐SES group than in the medium‐ and high‐SES groups (total generic scores: 71.2±7.9 versus 75.0±8.0 and 76.0±7.9, respectively [P<0.001]; psychosocial functioning: 70.8±9.0 versus 74.4±8.4 and 75.3±8.4 [P<0.001]; physical functioning: 71.6±10.4 versus 76.0±9.7 and 77.1±9.4 [P<0.001]; heart symptoms: 71.9±11.6 versus 75.7±11.0 and 76.8±10.3 [P<0.001]; cognitive problems: 65.4±11.1 versus 69.4±12.1 and 74.6±13.6 [P<0.001]). After adjustment for other clinical and demographic variables in the multivariable linear regression model, family SES significantly affected all dimensions of HRQOL except for treatment barriers, treatment anxiety, physical appearance and communication. Conclusions Family SES is an important factor associated with HRQOL in patients with critical congenital heart disease. Further targeted interventions to improve HRQOL that consider the family and environmental issues confronted by those who are economically disadvantaged might help these patients have better outcomes.
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Affiliation(s)
- Li Xiang
- 1 State Key Laboratory of Cardiovascular Disease and Key Laboratory of Cardiac Regenerative Medicine Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,2 Center for Pediatric Cardiac Surgery Fuwai Hospital National Clinical Research Center for Cardiovascular Diseases Beijing China
| | - Zhanhao Su
- 1 State Key Laboratory of Cardiovascular Disease and Key Laboratory of Cardiac Regenerative Medicine Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,2 Center for Pediatric Cardiac Surgery Fuwai Hospital National Clinical Research Center for Cardiovascular Diseases Beijing China
| | - Yiwei Liu
- 1 State Key Laboratory of Cardiovascular Disease and Key Laboratory of Cardiac Regenerative Medicine Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,2 Center for Pediatric Cardiac Surgery Fuwai Hospital National Clinical Research Center for Cardiovascular Diseases Beijing China
| | - Yuan Huang
- 1 State Key Laboratory of Cardiovascular Disease and Key Laboratory of Cardiac Regenerative Medicine Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,2 Center for Pediatric Cardiac Surgery Fuwai Hospital National Clinical Research Center for Cardiovascular Diseases Beijing China
| | - Xiaoling Zhang
- 1 State Key Laboratory of Cardiovascular Disease and Key Laboratory of Cardiac Regenerative Medicine Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shoujun Li
- 2 Center for Pediatric Cardiac Surgery Fuwai Hospital National Clinical Research Center for Cardiovascular Diseases Beijing China
| | - Hao Zhang
- 1 State Key Laboratory of Cardiovascular Disease and Key Laboratory of Cardiac Regenerative Medicine Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,2 Center for Pediatric Cardiac Surgery Fuwai Hospital National Clinical Research Center for Cardiovascular Diseases Beijing China
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20
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Kachmar AG, Connolly CA, Wolf S, Curley MAQ. Socioeconomic Status in Pediatric Health Research: A Scoping Review. J Pediatr 2019; 213:163-170. [PMID: 31300308 DOI: 10.1016/j.jpeds.2019.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To conduct a scoping review of the literature to describe current conceptualization and measurement of socioeconomic status in pediatric health research. STUDY DESIGN Four databases were used to identify relevant studies, followed by selection and data extraction. Inclusion criteria for studies were the following: enrolled subjects <18 years old, included a health-related outcome, published from 1999 to 2018, and explicitly measured socioeconomic status (SES). RESULTS Our literature search identified 1768 publications and 1627 unique records. After screening for duplication and relevance, 228 studies satisfied the inclusion criteria, with 75% (n = 170) published since 2009. There were 52 unique singular measures and an additional 20 composite measures. Income-related measures were used in 65% of studies (n = 147) and measures of education in 42% (n = 95). The majority of studies using census-derived variables or insurance status were conducted within the previous 10 years. CONCLUSIONS Pediatric studies use a variety of SES measures, which limits comparisons between studies. Few studies provide an evidenced-based rationale that connects the SES indicator to the health outcome, but the majority of studies do find a significant impact of SES on outcomes. SES should be comprehensively studied so that meaningful measures can be used to identify specific SES mechanisms that impact child health.
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Affiliation(s)
- Alicia G Kachmar
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Cynthia A Connolly
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Sharon Wolf
- Department of Human Development and Quantitative Methods, Graduate School of Education, University of Pennsylvania, Philadelphia, PA
| | - Martha A Q Curley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA; Department of Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
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21
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Teimouri A, Noori NM. Quality of Life Among Children With Congenital Heart Defect Based on Parents' proxy-report. CASPIAN JOURNAL OF HEALTH RESEARCH 2019. [DOI: 10.29252/cjhr.4.3.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Denniss DL, Sholler GF, Costa DSJ, Winlaw DS, Kasparian NA. Need for Routine Screening of Health-Related Quality of Life in Families of Young Children with Complex Congenital Heart Disease. J Pediatr 2019; 205:21-28.e2. [PMID: 30366775 DOI: 10.1016/j.jpeds.2018.09.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To assess health-related quality of life (HRQOL) in families of young children with complex congenital heart disease (CHD), and identify the demographic, clinical, and psychosocial factors that place these children and their mothers at greater risk of vulnerability. STUDY DESIGN This cross-sectional study took place from June 2015 to October 2016 at The Sydney Children's Hospitals Network Cardiac Service, Australia. Mothers of a child aged 1-5 years with either single ventricle CHD or CHD requiring neonatal biventricular repair were invited to participate. Eighty-seven mothers completed a suite of validated measures, including the Pediatric Quality of Life Inventory, which assessed the outcomes of child and maternal HRQOL. RESULTS Sixty percent of children with single ventricle CHD and 25% of children with biventricular repair had total Pediatric Quality of Life Inventory scores within the at-risk range. Lower child HRQOL was strongly associated with single ventricle CHD (β = -0.38; P < .001), physical comorbidity (β = -0.32; P = .001), feeding difficulties (β = -0.26; P = .008), and greater maternal psychological stress (β = -0.18; P = .045), accounting for 52% of the variance in child HRQOL. Lower maternal HRQOL was strongly associated with poorer family functioning (β = 0.61; P < .001), greater maternal psychological stress (β = -0.23; P = .004), child physical comorbidity (β = -0.17; P = .01), and a 'difficult' child temperament (β = -0.14; P = .01), accounting for 73% of the variance in maternal HRQOL. CONCLUSIONS Lower HRQOL is common in young children with complex CHD, particularly single ventricle CHD. Several predictors of HRQOL are potentially modifiable, offering possible pathways for prevention and early intervention. Routine screening is a necessary first step toward developing models of care to improve HRQOL in this population.
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Affiliation(s)
- Dominique L Denniss
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia
| | - Gary F Sholler
- Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, Royal North Shore Hospital, North Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - David S Winlaw
- Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Nadine A Kasparian
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia.
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Petersen I, Noelle J, Buchholz A, Kroencke S, Daseking M, Grabhorn E. Fatigue in pediatric liver transplant recipients and its impact on their quality of life. Pediatr Transplant 2019; 23:e13331. [PMID: 30588722 DOI: 10.1111/petr.13331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 01/14/2023]
Abstract
The aim of the study was to investigate the occurrence of fatigue in 100 pediatric liver transplant recipients aged 2-18 years and its impact on their health-related quality of life (HRQL). HRQL and fatigue were measured using the PedsQL 4.0 Inventory and the PedsQL Multidimensional Fatigue Scale, which encompasses three subscales: general fatigue, sleep/rest fatigue, and cognitive fatigue. The impact of the different domains of fatigue and of clinical and sociodemographic factors on the HRQL was identified with stepwise multiple regression analyses. Parent proxy-reports were available for all 100 participants (2-18 years), and child self-reports were available for 71 patients (8-18 years). Across all domains, participants and their parents reported significantly more fatigue than healthy peers in a large PedsQL validation study. Thirty-seven percent of patients and 57% of parents scored clinically relevant levels of fatigue. In the multiple regression analyses, none of the clinical and sociodemographic factors contributed to the HRQL for child self-report. Only general and cognitive fatigue were significant predictors of patients' HRQL, explaining 66% of the variance in the PedsQL total score. For parent proxy-report, general and cognitive fatigue also significantly predicted child's HRQL. Further predictors were child's age and family income. The regression model explained 65% of the variance. These findings demonstrate the importance of assessing fatigue during regular follow-up examinations. Further research is urgently needed to better understand the underlying mechanisms of fatigue. Improvement of fatigue symptoms is essential for better HRQL, for cognitive functioning, and for school achievement.
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Affiliation(s)
- Irene Petersen
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janka Noelle
- University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Buchholz
- University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sylvia Kroencke
- University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Daseking
- Department of Educational Psychology, Helmut Schmidt University, Hamburg, Germany
| | - Enke Grabhorn
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
BACKGROUND Little is known about health-related quality of life in young children undergoing staged palliation for single-ventricle CHD. The aim of this study was to assess the impact of CHD on daily life in pre-schoolers with single-ventricle CHD and to identify determinants of health-related quality of life. METHOD Prospective two-centre cohort study assessing health-related quality of life using the Preschool Paediatric Cardiac Quality of Life Inventory in 46 children at a mean age of 38 months and 3 weeks. Children with genetic anomalies were excluded. Scores were compared with reference data of children with biventricular CHD. Multiple linear regression analysis was used to identify determinants of health-related quality of life. RESULTS Health-related quality of life in pre-schoolers with single-ventricle CHD was comparable to children with biventricular CHD. Preterm birth and perioperative variables were significant predictors of low health-related quality of life. Notably, pre-Fontan brain MRI findings and neurodevelopmental status were not associated with health-related quality of life. Overall, perioperative variables explained 24% of the variability of the total health-related quality of life score.InterpretationDespite substantial health-related burden, pre-schoolers with single-ventricle CHD showed good health-related quality of life. Less-modifiable treatment-related risk factors and preterm birth had the highest impact on health-related quality of life. Long-term follow-up assessment of self-reported health-related quality of life is needed to identify patients with poorer health-related quality of life and to initiate supportive care.
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Socioeconomic Deprivation Status and Air Pollution by PM 10 and NO 2: An Assessment at Municipal Level of 11 Years in Italy. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2019; 2019:2058467. [PMID: 30719049 PMCID: PMC6335678 DOI: 10.1155/2019/2058467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 12/04/2018] [Indexed: 01/24/2023]
Abstract
The aim of this observational study was to assess the relationship between environmental risk factors and some aspects of social economic status (SES) of the population in different Italian municipalities. Nitrogen dioxide (NO2) and particulate matter (PM10) annual means were extracted from ISPRA-BRACE (environmental information system of 483 Italian municipalities, 6% of the total amount of administrative units) from 2002 to 2012. As an indicator of sociodemographic and SES data, we collected the following: resident population, foreign nationality, low level of education, unemployment, nonhome ownership, single-parent family, and overcrowding. Low educational level, unemployment, and lack of home ownership were indirectly associated with the higher mean values of NO2 at the statistically significant level (p < 0.05). Major resident population and rental housing percentage determined higher levels of PM10. Northern regions showed similar results compared to the national level, with the exception of foreign residency that showed direct correlation with the increase of PM10. The central regions showed a direct relationship between NO2 and PM10 levels and higher educational levels and between NO2 levels and percentage of single-parent family. In the southern areas, higher NO2 levels were correlated with a higher rental housing percentage, as well as higher PM10 levels with a higher percentage of unemployment and lower housing density. The study shows high heterogeneity in the findings but confirms the relationship between high educational level and employment with the increased concentration of pollutants. The higher rental housing percentage may increase the pollutants' levels too. The housing density does not seem to be in relationship with NO2 and PM10 at the national level. The analysis stratified by geographical areas showed that the direction of the correlations was different over time as the analysis was at a national level. The study represents an example of how data from national information systems can provide a preliminary evaluation and be a comparative tool for policy-makers to assess environmental risk factors and social inequalities.
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Ilowite MF, Al-Sayegh H, Ma C, Dussel V, Rosenberg AR, Feudtner C, Kang TI, Wolfe J, Bona K. The relationship between household income and patient-reported symptom distress and quality of life in children with advanced cancer: A report from the PediQUEST study. Cancer 2018; 124:3934-3941. [PMID: 30216416 DOI: 10.1002/cncr.31668] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/15/2018] [Accepted: 06/11/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Children with advanced cancer experience high symptom distress, which negatively impacts their health-related quality of life (HRQOL). To the authors' knowledge, the relationship between income and symptom distress and HRQOL is not well described. METHODS The Pediatric Quality of Life and Symptoms Technology (PediQUEST) multisite clinical trial evaluated an electronic patient-reported outcome system to describe symptom distress and HRQOL in children with advanced cancer via repeated surveys. The authors performed a secondary analysis of PediQUEST data for those children with available parent-reported household income (dichotomized at 200% of the Federal Poverty Level and categorized as low income [<$50,000/year] or high income [≥$50,000/year]). The prevalence of the 5 most commonly reported physical and psychological symptoms was compared between groups. Multivariable generalized estimating equation models were used to test the association between household income and symptom distress and HRQOL. RESULTS A total of 78 children were included in the analyses: 56 (72%) in the high-income group and 22 (28%) in the low-income group. Low-income children were more likely to report pain than high-income children (64% vs 42%; P=.02). In multivariable models, children from low-income families demonstrated a uniform trend toward higher total (βlow-high =3.1; 95% confidence interval [95% CI], -0.08 to 6.2 [P=.06]), physical (β=3.8; 95% CI, -0.4 to 8.0 [P=.09]), and psychological (β=3.46; 95% CI, -1.91 to 8.84 [P=.21]) symptom distress compared with children from high-income families. Low income was associated with a uniform trend toward lower total (β=-7.9; 95% CI, -14.8, to -1.1 [P=.03]), physical (β=-11.2; 95% CI, -21.2 to -1.2 [P=.04]), emotional (β=-5.8; 95% CI, -13.6 to 2.0 [P=.15]), social (β=-2.52; 95% CI, -9.27 to 4.24 [P=.47]), and school (β=-9.8; 95% CI, -17.8 to -1.8 [P=.03]) HRQOL. CONCLUSIONS In this cohort of children with advanced cancer, children from low-income families were found to experience higher symptom burden and worse QOL.
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Affiliation(s)
- Maya F Ilowite
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Population Sciences' Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hasan Al-Sayegh
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Clement Ma
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Veronica Dussel
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Center for Research and Implementation in Palliative Care, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Abby R Rosenberg
- Seattle Children's Hospital Cancer and Blood Disorders Center, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - Chris Feudtner
- The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tammy I Kang
- Section of Palliative Care, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Joanne Wolfe
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Population Sciences' Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Population Sciences' Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts
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Prevalence of Participating in Physical Activity From 2 Korean Surveillance Systems: KNHANES and KCHS. J Phys Act Health 2018; 15:763-773. [PMID: 30124089 DOI: 10.1123/jpah.2017-0428] [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] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to estimate the prevalence and trends of participation in physical activity (PA) in Korean adults. METHODS The Korea National Health and Nutrition Examination Survey (KNHANES; 2009-2013) and the Korea Community Health Survey (KCHS; 2009-2013) were used to estimate the prevalence of PA. Age standardization was performed using population projections for Korea in 2005 as a standard population. Trends of the prevalence from 2009 to 2013 were assessed by joinpoint regression analysis. RESULTS The age-standardized prevalence for achieving the recommended level of PA was 63.0% in KNHANES and 64.5% in KCHS for men, and 53.7% in KNHANES and 56.3% in KCHS for women. Decreasing trends were observed for the prevalence of achieving the recommended level of PA in the KNHANES and KCHS; however, only the trend for women in KNHANES was statistically significant. CONCLUSIONS Approximately, 60% of adults participate in the recommended level of PA in Korea. The survey design and characteristics should be considered when interpreting the prevalence of PA from different databases.
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Slonim-Nevo V, Sarid O, Friger M, Schwartz D, Sergienko R, Pereg A, Vardi H, Singer T, Chernin E, Greenberg D, Odes S. Effect of Social Support on Psychological Distress and Disease Activity in Inflammatory Bowel Disease Patients. Inflamm Bowel Dis 2018; 24:1389-1400. [PMID: 29893949 DOI: 10.1093/ibd/izy041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Psychological distress increases morbidity in ulcerative colitis (UC) and Crohn's disease (CD). We examined whether social support is associated with distress and disease activity. METHODS There were 110 UC and 147 CD patients who completed sociodemography, economic status, disease activity (UC: Patient Simple Clinical Colitis Activity Index (P-SCCAI), CD: Patient Harvey-Bradshaw Index . (P-HBI), Multidimensional Scale of Perceived Social Support (MSPSS), Brief Symptom Inventory with Global Severity Index (GSI) of psychological distress, and 2 health-related quality-of-life scales (SF-36 Physical Health and Mental Health, and Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Analysis included multiple linear regressions and structural equation modeling. RESULTS Disease activity was mild: UC: P-SCCAI 2.9 ± 3.5, CD: P-HBI 4.7 ± 4.7. Physical Health was better in UC 46.6 ± 11.4 versus CD 43.7 ± 10.9 (P < .02). GSI was lower in UC 0.6 ± 0.7 than CD 0.8 ± 0.7 (P = .002). MSPSS total score was equal in UC (5.9 ± 1.2) and CD (5.9 ± 1.1). MSPSS total correlated with P-SCCAI (correlation coefficient ‒0.240), GSI in UC (‒0.470), and GSI in CD (‒0.333). Economic status correlated with GSI in UC (‒0.408) and CD (‒0.356). MSPSS predicted GSI, Mental Health, and SIBDQ in UC and CD, and predicted P-SCCAI but not P-HBI; economic status predicted all the foregoing. Path analysis depicted GSI as mediating the effects of MSPSS and economic status on disease activity in both UC and CD. MSPSS (UC: β ‒0.34, CD: β ‒0.37) and economic status (UC: β ‒0.38, CD: β ‒0.22) reduced GSI, which then increased the disease activity (UC: β 0.56, CD: β 0.42). CONCLUSIONS Social support and economic status are linked to UC and CD patients' well-being. Interventions addressing these issues should be part of management.
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Affiliation(s)
- Vered Slonim-Nevo
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Orly Sarid
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Friger
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center, Beer Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Avihu Pereg
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Hillel Vardi
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Terri Singer
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Elena Chernin
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Dan Greenberg
- Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shmuel Odes
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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de Melo ALS, de Lira YFB, Lima LAB, Vieira FC, Dias AS, de Andrade LB. EXERCISE TOLERANCE, PULMONARY FUNCTION, RESPIRATORY MUSCLE STRENGTH, AND QUALITY OF LIFE IN CHILDREN AND ADOLESCENTS WITH RHEUMATIC HEART DISEASE. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2018; 36:199-206. [PMID: 29617473 PMCID: PMC6038777 DOI: 10.1590/1984-0462/;2018;36;2;00012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/18/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite the high prevalence of rheumatic heart disease in Brazil, the occurrence of functional impairment in children and adolescents with rheumatic heart disease is not clear. The aim of this study was to evaluate exercise tolerance, respiratory muscle strength, lung function, and quality of life of children and adolescents with rheumatic heart disease. METHODS Cross-sectional study, conducted from August to December 2014 with children and adolescents with rheumatic heart disease aged 8 to 16 years. The participants, after completing the socioeconomic, clinical, and quality of life questionnaires were tested by spirometry, manovacuometry and in a 6-minute walk test. The variables and their reference values were compared using the paired Student's t-test. Comparisons between predicted and observed walking distance were done also by Student's t-test, consdiering the categorization of the participants. Correlations between these differences and quantitative variables were assessed by Pearson's coefficient, being significant p<0.05. RESULTS All 56 participants had a walked distance lower than predicted (p<0.001). The differences between predicted and observed distances were positively correlated with the baseline heart rate (r=0.3545; p=0.007). Expiratory muscle strength was also lower than the predicted values (p<0,001). Regarding quality of life assessment, the mean scores were 70, 77 and 67% for general, physical, and psychosocial aspects, respectively. CONCLUSIONS Children and adolescents with rheumatic heart disease have reduced exercise tolerance, which is related to their higher baseline heart rate; they also show impaired expiratory strength and quality of life.
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Bucholz EM, Sleeper LA, Newburger JW. Neighborhood Socioeconomic Status and Outcomes Following the Norwood Procedure: An Analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial Public Data Set. J Am Heart Assoc 2018; 7:e007065. [PMID: 29420218 PMCID: PMC5850235 DOI: 10.1161/jaha.117.007065] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/13/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children with single ventricle heart disease require frequent interventions and follow-up. Low socioeconomic status (SES) may limit access to high-quality care and place these children at risk for poor long-term outcomes. METHODS AND RESULTS Data from the SVR (Pediatric Heart Network Single Ventricle Reconstruction Trial Public Use) data set were used to examine the relationship of US neighborhood SES with 30-day and 1-year mortality or cardiac transplantation and length of stay among neonates undergoing the Norwood procedure (n=525). Crude rates of death or transplantation at 1 year after Norwood were highest for patients living in neighborhoods with low SES (lowest tertile 37.0% versus middle tertile 31.0% versus highest tertile 23.6%, P=0.024). After adjustment for patient demographics, birth characteristics, and anatomy, patients in the highest SES tertile had significantly lower risk of death or transplant than patients in the lowest SES tertile (hazard ratio 0.62, 95% confidence interval, 0.40, 0.96). When SES was examined continuously, the hazard of 1-year death or transplant decreased steadily with increasing neighborhood SES. Hazard ratios for 30-day transplant-free survival and 1-year transplant-free survival were similar in magnitude. There were no significant differences in length of stay following the Norwood procedure by SES. CONCLUSIONS Low neighborhood SES is associated with worse 1-year transplant-free survival after the Norwood procedure, suggesting that socioeconomic and environmental factors may be important determinants of outcome in critical congenital heart disease. Future studies should investigate aspects of SES and environment amenable to intervention. CLINICAL TRIAL REGISTRATION URL:http://www.clinicaltrials.gov> http://www.clinicaltrials.gov. Unique identifier: NCT00115934.
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Affiliation(s)
- Emily M Bucholz
- Department of Medicine, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Lynn A Sleeper
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Jane W Newburger
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
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Resolving the Fontan paradox: Addressing socioeconomic and racial disparities in patients with a single ventricle. J Thorac Cardiovasc Surg 2018; 155:1727-1731. [PMID: 29395194 DOI: 10.1016/j.jtcvs.2017.11.103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/13/2017] [Accepted: 11/09/2017] [Indexed: 11/21/2022]
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Ernst MM, Marino BS, Cassedy A, Piazza-Waggoner C, Franklin RC, Brown K, Wray J. Biopsychosocial Predictors of Quality of Life Outcomes in Pediatric Congenital Heart Disease. Pediatr Cardiol 2018; 39:79-88. [PMID: 28980091 DOI: 10.1007/s00246-017-1730-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
The purpose of this prospective multi-center cross-sectional study was to identify key biopsychosocial factors that impact quality of life (QOL) of youth with congenital heart disease (CHD). Patient-parent pairs were recruited at a regular hospital follow-up visit. Patient- and parent-proxy-reported QOL were assessed using the Pediatric Cardiac Quality of Life Inventory (PCQLI). Wallander's and Varni's disability-stress coping model guided factor selection, which included disease factors, educational impairment, psychosocial stress, child psychological and parent/family factors. Measures utilized for these factors included the Pediatric Inventory for Parents, Self-Perception Profile for Children/Adolescents, Child Behavior Checklist, Revised Children's Manifest Anxiety Scale, Child PTSD Symptom Scale, State-Trait Anxiety Inventory, and Posttraumatic Diagnostic Scale. Ordinary least squares regression was applied to test the theoretical model, with backwards stepwise elimination process. The models accounted for a substantial amount of variance in QOL (Patient-reported PCQLI R 2 = 0.58, p < 0.001; Parent-proxy-reported PCQLI R 2 = 0.60, p < 0.001). For patient-reported QOL, disease factors, educational impairment, poor self-esteem, anxiety, patient posttraumatic stress, and parent posttraumatic stress were associated with lower QOL. For parent-proxy-report QOL, disease factors, educational impairment, greater parental medical stress, poorer child self-esteem, more child internalizing problems, and parent posttraumatic stress were associated with lower QOL. The results highlight that biopsychosocial factors account for over half the variance in QOL in CHD survivors. Assessing and treating psychological issues in the child and the parent may have a significant positive impact on QOL.
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Affiliation(s)
- Michelle M Ernst
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Division of Behavioral Medicine, Cincinnati Children's Hospital Medical Center, ML3015, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Bradley S Marino
- Department of Pediatrics and Medical Social Sciences, Divisions of Pediatric Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Carrie Piazza-Waggoner
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rodney C Franklin
- Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Katherine Brown
- Cardiorespiratory Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Jo Wray
- Cardiorespiratory Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Shaw BE, Brazauskas R, Millard HR, Fonstad R, Flynn KE, Abernethy A, Vogel J, Petroske C, Mattila D, Drexler R, Lee SJ, Horowitz MM, Rizzo JD. Centralized patient-reported outcome data collection in transplantation is feasible and clinically meaningful. Cancer 2017; 123:4687-4700. [PMID: 28817182 DOI: 10.1002/cncr.30936] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/23/2017] [Accepted: 07/05/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Allogeneic hematopoietic cell transplantation (HCT) cures many patients, but often with the risk of late effects and impaired quality of life. The value of quantifying patient-reported outcomes (PROs) is increasingly being recognized, but the routine collection of PROs is uncommon. This study evaluated the feasibility of prospective PRO collection by an outcome registry at multiple time points from unselected HCT patients undergoing transplantation at centers contributing clinical data to the Center for International Blood and Marrow Transplant Research (CIBMTR), and then it correlated the PRO data with clinical and demographic data. METHODS The Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), 36-Item Short Form Health Survey (SF-36), and Pediatric Quality of Life Inventory measures were administered before HCT, on day 100, and at 6 and 12 months. Patients were recruited by the transplant center, but posttransplant PRO collection was managed centrally by the CIBMTR. RESULTS There were 580 eligible patients, and 390 (67%) enrolled. Feasibility was shown by high time-specific retention rates (176 of 238 at 1 year or 74%) and participant satisfaction. Factors associated with higher response rates were an age > 50 years (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.03-2.41; P = .0355), white race (OR, 4.61; 95% CI, 2.66-7.99; P < .0001), and being married (OR, 2.28; 95% CI, 1.42-3.65; P = .0006) for adults and a higher family income for children (OR, 4.99; 95% CI, 2.12-11.75; P = .0002). Importantly, pre-HCT PRO scores independently predicted survival after adjustments for patient-, disease-, and transplant-related factors. The adjusted probabilities of 1-year survival were 56%, 67%, 75%, and 76% by increasing quartiles of the pre-HCT FACT-BMT score and 58%, 72%, 62%, and 82% by increasing quartiles of the pre-HCT SF-36 physical component score. CONCLUSIONS A hybrid model of local consent for centralized PRO collection is feasible, and pretransplant PROs provide critical prognostic information for HCT outcomes. Cancer 2017;123:4687-4700. © 2017 American Cancer Society.
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Affiliation(s)
- Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ruta Brazauskas
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Heather R Millard
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rachel Fonstad
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Kathryn E Flynn
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Jenny Vogel
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Charney Petroske
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Deborah Mattila
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Rebecca Drexler
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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Preschool Neurodevelopmental Outcomes in Children with Congenital Heart Disease. J Pediatr 2017; 183:80-86.e1. [PMID: 28081891 PMCID: PMC5368010 DOI: 10.1016/j.jpeds.2016.12.044] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/01/2016] [Accepted: 12/14/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe preschool neurodevelopmental outcomes of children with complex congenital heart disease (CHD), who were evaluated as part of a longitudinal cardiac neurodevelopmental follow-up program, as recommended by the American Heart Association and the American Academy of Pediatrics, and identify predictors of neurodevelopmental outcomes in these children. STUDY DESIGN Children with CHD meeting the American Heart Association/American Academy of Pediatrics high-risk criteria for neurodevelopmental delay were evaluated at 4-5 years of age. Testing included standardized neuropsychological measures. Parents completed measures of child functioning. Scores were compared by group (single ventricle [1V]; 2 ventricles [2V]; CHD plus known genetic condition) to test norms and classified as: normal (within 1 SD of mean); at risk (1-2 SD from mean); and impaired (>2 SD from mean). RESULTS Data on 102 patients were analyzed. Neurodevelopmental scores did not differ based on cardiac anatomy (1V vs 2V); both groups scored lower than norms on fine motor and adaptive behavior skills, but were within 1 SD of norms. Patients with genetic conditions scored significantly worse than 1V and 2V groups and test norms on most measures. CONCLUSIONS Children with CHD and genetic conditions are at greatest neurodevelopmental risk. Deficits in children with CHD without genetic conditions were mild and may not be detected without formal longitudinal testing. Parents and providers need additional education regarding the importance of developmental follow-up for children with CHD.
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Lilly CL, Umer A, Cottrell L, Pyles L, Neal W. Examination of cardiovascular risk factors and rurality in Appalachian children. Rural Remote Health 2017; 17:4200. [PMID: 28320207 DOI: 10.22605/rrh4200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTOIN The prevalence of childhood cardiovascular disease (CVD) risk factors often increases in more rural geographic regions in the USA. However, research on the topic often has conflicting results. Researchers note differences in definitions of rurality and other factors that would lead to differences in inference, including appropriate use of statistical clustering analysis, representative data, and inclusion of individual-level covariates. The present study's objective was to examine CVD risk factors during childhood by geographic distribution in the US Appalachian region as a first step towards understanding the health disparities in this area. METHODS Rurality and CVD risk factors (including blood pressure, body-mass index (BMI), and cholesterol) were examined in a large, representative sample of fifth-grade students (<i>N=</i>73 014) from an Appalachian state in the USA. A six-category Rural-Urban Continuum Codes classification system was used to define rurality regions. Mixed modeling analysis was used to appropriately cluster individuals within 725 unique zip codes in each of these six regions, and allowed for including several individual-level socioeconomic factors as covariates. RESULTS Rural areas had better outcomes for certain CVD risk factors (lowest low-density lipoprotein cholesterol (LDL-C), and blood pressure (BP) and highest high-density lipoprotein cholesterol (HDL-C)) whereas mid-sized metro and town areas presented with the worst CVD risk factors (highest BMI% above ideal, mean diastolic BP, LDL-C, total cholesterol, triglyceride levels and lowest HDL-C) outcomes in children and adolescence in this Appalachian state. CONCLUSIONS Counter to the study hypothesis, mid-sized metro areas presented with the worst CVD risk factors outcomes in children and adolescence in the Appalachian state. This data contradicts previous literature suggesting a straightforward link between rurality and cardiovascular risk factors. Future research should include a longitudinal design and explore some of the mechanisms between cardiovascular risk factors and rurality.
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Affiliation(s)
| | - Amna Umer
- West Virginia University, Morgantown, West Virginia, USA.
| | | | - Lee Pyles
- West Virginia University, Morgantown, West Virginia, USA.
| | - William Neal
- West Virginia University, Morgantown, West Virginia, USA.
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Nawata K, Kimura M. An Analysis of the Medical Costs of and Factors Affecting Diabetes Using the Medical Checkup and Payment Dataset in Japan: Can We Reduce the Prevalence of Diabetes? Health (London) 2017. [DOI: 10.4236/health.2017.98081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Odunlami GA. PREDICTING ADOLESCENTS' QUALITY OF LIFE USING DISCRIMINAT ANALYSIS. WORLD SCIENTIFIC NEWS 2017; 87:85-117. [PMID: 29708236 PMCID: PMC5922449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Psychosocial functioning and depression is associated with a wide range of impacts on adolescents' quality of life. In Nigeria, studies assessing the importance of psychosocial functioning and depression in distinguishing between the categories of quality of life and classifying adolescents into these categories have been limited in literature. This study investigated the domains of psychosocial functioning and child depression that significantly distinguish between the categories of quality of life and also classify into these groups. Data for 2019 adolescents aged 10-19 were obtained in a Benue State cross-sectional study. Preliminary analyses on their socio-demographic information were performed using descriptive statistics. Differences between categories (groups) of Quality of Life (low, moderate and excellent) on the basis of the attributes of the adolescents in terms of their psychosocial functioning and depression status , indicating which attributes contribute most to group separation were investigated using discriminant analysis. Chi-square analysis was used to assess the association between socio-demographic characteristics of the adolescents and levels of Quality of Life. The inter-relationships between the domains of Quality of Life and the adolescents age, position in the family, domains of psychosocial functioning and child depression status was assessed using correlation analysis. Prosocial behaviour (F=82.41, p<0.001) and ineffectiveness (F=31.19, p<0.001) were strong significant discriminating variables that predict adolescents' levels of total quality of life. Adolescent's psychosocial functioning and depression status relates with their physical health, psychological health, social relationship, environmental health and total quality of life.
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Affiliation(s)
- Grace Alaba Odunlami
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria. , +2347065518960
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Westhoff-Bleck M, Briest J, Fraccarollo D, Hilfiker-Kleiner D, Winter L, Maske U, Busch MA, Bleich S, Bauersachs J, Kahl KG. Mental disorders in adults with congenital heart disease: Unmet needs and impact on quality of life. J Affect Disord 2016; 204:180-6. [PMID: 27367306 DOI: 10.1016/j.jad.2016.06.047] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In adult congenital heart disease (ACHD), mental health status and quality of life become important issues due to improved life expectancy. Current literature provides conflicting data regarding mental health status in ACHD. Furthermore, none of the studies so far compared prevalence rates with a matched control group. METHODS The prevalence of mental disorders was assessed in 150 ACHD using a structured interview, and compared to 12-months estimates of the general German population. Quality of life (QoL) was measured with World Health Organization Quality of Life instrument. Furthermore, we related the diagnostic results of widely used screening instruments for depression (Beck Depression Inventory-2; BDI-2; Hospital Anxiety and Depression Scale; HADS) with clinical diagnoses, to receive optimal sensitivity and specificity values. RESULTS The prevalence of psychiatric disorders was significantly higher in ACHD than in the general population (48.0%; CI: 44.7-60.0 vs. 35.7%; CI: 33.5-37.9). Mood (30.7%; CI: 24.0-38.0 vs. 10.7%;CI:9.4-12.0) and anxiety disorders (28.0%; CI:22.0-36.7 vs. 16.8%; CI: 15.0-18.6) were the leading causes of psychiatric illness. Sixteen of 150 ACHD patients (10.7%) received specific treatment for psychiatric disorders before entering the study. Overall quality of life was independently and negatively associated with a diagnosis of major depression (p<0.001), alcohol dependency (p=0.004), nicotine dependency (p=0.036), and NYHA class (p=0.007). Accuracy of the HADS-D and BDI-2 as screening instruments was moderate (AUC 0.60-0.81), depending on the cut-off score used. CONCLUSIONS Psychiatric disorders, particularly mood and anxiety disorders are significantly more frequent in ACHD compared to the general population. However, these disorders are rarely diagnosed resulting in under treatment and loss of quality of life. Quality of life is independently associated with the existence of mood, anxiety and substance use disorders. When self-rating instruments (BDI-2, HADS) are used as screening instruments in ACHD care, lower cut-off values are recommended.
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Affiliation(s)
| | - Juliane Briest
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany
| | | | | | - Lotta Winter
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany
| | - Ulrike Maske
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Markus A Busch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany.
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Systematic psychosocial screening in a paediatric cardiology clinic: clinical utility of the Pediatric Symptom Checklist 17. Cardiol Young 2016; 26:1130-6. [PMID: 26423220 PMCID: PMC5621735 DOI: 10.1017/s1047951115001900] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the clinical utility of the Pediatric Symptom Checklist 17 for identifying psychosocial concerns and improving access to psychology services within a paediatric cardiology clinic. METHOD Parents of 561 children (aged 4-17 years) presenting for follow-up of CHD, acquired heart disease, or arrhythmia completed the Pediatric Symptom Checklist 17 as part of routine care; three items assessing parental (1) concern for learning/development, (2) questions about adjustment to cardiac diagnosis, and (3) interest in discussing concerns with a behavioural healthcare specialist were added to the questionnaire. A psychologist contacted the parents by phone if they indicated interest in speaking with a behavioural healthcare specialist. RESULTS Percentages of children scoring above clinical cut-offs for externalising (10.5%), attention (8.7%), and total (9.3%) problems were similar to a "normative" primary-care sample, whereas fewer children in this study scored above the cut-off for internalising problems (7.8%; p<0.01). Sociodemographic, but not clinical, characteristics were associated with Pediatric Symptom Checklist 17 scores. 17% of the parents endorsed concerns about learning/development, and 20% endorsed questions about adjustment to diagnosis. History of cardiac surgery was associated with increased concern about learning/development (p<0.01). Only 37% of the parents expressing psychosocial concerns reported interest in speaking with a psychologist. CONCLUSIONS The Pediatric Symptom Checklist 17 may not be sensitive to specific difficulties experienced by this patient population. A questionnaire with greater focus on learning/development and adjustment to diagnosis may yield improved utility. Psychology integration in clinics serving high-risk cardiac patients may decrease barriers to behavioural healthcare services.
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Atif M, Bashir A, Saleem Q, Hussain R, Scahill S, Babar ZUD. Health-related quality of life and depression among medical sales representatives in Pakistan. SPRINGERPLUS 2016; 5:1048. [PMID: 27462496 PMCID: PMC4940353 DOI: 10.1186/s40064-016-2716-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/29/2016] [Indexed: 11/14/2022]
Abstract
Pharmaceutical companies have been known to pose stress and mental harassment on medical sales representatives (MSRs) in-order to increase pharmaceutical sales. This cross sectional descriptive study, conducted during November and December 2014 in the Lahore and Bahawalpur districts of Punjab, Pakistan, evaluates the Health-Related Quality of Life (HRQoL) and extent of depression among MSRs in Pakistan. The significant predictors of HRQoL and depression among the MSRs were also determined. Using a convenience sampling technique, all consenting MSRs (N = 318) of pharmaceutical companies were asked to self-complete the Short Form-36 (SF-36v2) Health Survey and Stanford Personal Health Questionnaire (PHQ-8). The standard scoring scheme for the SF36v2 and PHQ-8 questionnaires was used. The PHQ-8 scores showed that 16.4 % (n = 52) and 2.5 % of respondents were suffering from major depression and severe major depression, respectively. Being depressed and having difficulty in achieving sales targets were the factors independently associated with lower physical health. Similarly, depression, insufficient time for the family and monthly income less than 36,000 Pakistan Rupees were significant predictors of lower mental health. The factors associated with depression included insufficient time for the family and unsatisfactory behavior of the managers. Compromised mental health and the prevalence of depression among the MSRs suggest pharmaceutical companies need to devise health management strategies and interventions to ensure effective prevention and management of mental health problems among Pakistani MSRs.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Arslan Bashir
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Quratulain Saleem
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Rabia Hussain
- Lahore Pharmacy College, Lahore Medical and Dental College, Lahore, Pakistan
| | - Shane Scahill
- School of Management, Massey University, Auckland, New Zealand
| | - Zaheer-Ud-Din Babar
- Lahore Pharmacy College, Lahore Medical and Dental College, Lahore, Pakistan ; School of Pharmacy, University of Auckland, Auckland, New Zealand
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O'Connor AM, Wray J, Tomlinson RS, Cassedy A, Jacobs JP, Jenkins KJ, Brown KL, Franklin RCG, Mahony L, Mussatto K, Newburger JW, Wernovsky G, Ittenbach RF, Drotar D, Marino BS. Impact of Surgical Complexity on Health-Related Quality of Life in Congenital Heart Disease Surgical Survivors. J Am Heart Assoc 2016; 5:e001234. [PMID: 27451455 PMCID: PMC5015349 DOI: 10.1161/jaha.114.001234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 05/03/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical complexity and related morbidities may affect long-term patient quality of life (QOL). Aristotle Basic Complexity (ABC) score and Risk Adjustment in Congenital Heart Surgery (RACHS-1) category stratify the complexity of pediatric cardiac operations. The purpose of this study was to examine the relationship between surgical complexity and QOL and to investigate other demographic and clinical variables that might explain variation in QOL in pediatric cardiac surgical survivors. METHODS AND RESULTS Pediatric Cardiac Quality of Life (PCQLI) study participants who had undergone cardiac surgery were included. The PCQLI database provided sample characteristics and QOL scores. Surgical complexity was defined by the highest ABC raw score or RACHS-1 category. Relationships among surgical complexity and demographic, clinical, and QOL variables were assessed using ordinary least squares regression. A total of 1416 patient-parent pairs were included. Although higher ABC scores and RACHS-1 categories were associated with lower QOL scores (P<0.005), correlation with QOL scores was poor to fair (r=-0.10 to -0.29) for all groups. Ordinary least squares regression showed weak association with R(2)=0.06 to R(2)=0.28. After accounting for single-ventricle anatomy, number of doctor visits, and time since last hospitalization, surgical complexity scores added no additional explanation to the variance in QOL scores. CONCLUSIONS ABC scores and RACHS-1 categories are useful tools for morbidity and mortality predictions prior to cardiac surgery and quality of care initiatives but are minimally helpful in predicting a child's or adolescent's long-term QOL scores. Further studies are warranted to determine other predictors of QOL variation.
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Affiliation(s)
- Amy M O'Connor
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jo Wray
- Cardiorespiratory Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ryan S Tomlinson
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, The Congenital Heart Institute of Florida, All Children's Hospital and Children's Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates, St. Petersburg and Tampa, FL
| | - Kathy J Jenkins
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kate L Brown
- Cardiorespiratory Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rodney C G Franklin
- Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Lynn Mahony
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kathleen Mussatto
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Wisconsin, Milwaukee, WI
| | - Jane W Newburger
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Gil Wernovsky
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, PA Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, PA
| | - Richard F Ittenbach
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dennis Drotar
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Bradley S Marino
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Marino BS, Cassedy A, Drotar D, Wray J. The Impact of Neurodevelopmental and Psychosocial Outcomes on Health-Related Quality of Life in Survivors of Congenital Heart Disease. J Pediatr 2016; 174:11-22.e2. [PMID: 27189685 DOI: 10.1016/j.jpeds.2016.03.071] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 03/04/2016] [Accepted: 03/28/2016] [Indexed: 01/30/2023]
Affiliation(s)
- Bradley S Marino
- Divisions of Cardiology and Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dennis Drotar
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jo Wray
- Critical Care and Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Chen X, Velez JC, Barbosa C, Pepper M, Gelaye B, Redline S, Williams MA. Evaluation of actigraphy-measured sleep patterns among children with disabilities and associations with caregivers' educational attainment: results from a cross-sectional study. BMJ Open 2015; 5:e008589. [PMID: 26644120 PMCID: PMC4679893 DOI: 10.1136/bmjopen-2015-008589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To use wrist-actrigrphy to collect objective measures of sleep and to characterise actigraphy-measured sleep patterns among children with disabilities. We also assessed the extent to which, if at all, caregivers' education is associated with children's sleep disturbances. DESIGN Cross-sectional study. SETTING A rehabilitation centre in the Patagonia region, Chile. METHODS This study was conducted among 125 children aged 6-12 years with disabilities (boys: 55.2%) and their primary caregivers in Chile. Children wore ActiSleep monitors for 7 days. A general linear model was fitted to generate least-square means and SEs of sleep efficiency (proportion of the sleep period spent asleep) across caregivers' education levels adjusting for children's age, sex, disability type, caregiver-child relationship and caregivers' age. Multivariable logistic regression analyses were conducted to estimate ORs and 95% CIs of longer sleep latency (≥ 30 min) and longer wake after sleep onset (WASO) (≥ 90 min) (a measure of sleep fragmentation) in relation to caregivers' educational attainment. RESULTS Median sleep latency was 27.3 min, WASO 88.1 min and sleep duration 8.0 h. Mean sleep efficiency was 80.0%. Caregivers' education was positively and significantly associated with children's sleep efficiency (p trend<0.001). Adjusted mean sleep efficiency was 75.7% (SE=1.4) among children of caregivers <high school education, and 81.9% (SE=1.0) among children of caregivers >high school education. Compared to children whose caregivers had >high school, children of caregivers with <high school had higher odds of longer sleep latency (OR=3.27; 95% CI 1.12 to 9.61) and longer WASO (OR=5.95; 95% CI 1.91 to 18.53). Associations were consistent across disability types. CONCLUSIONS Children with disabilities experience difficulties initiating sleep (prolonged sleep latency) and maintaining sleep (long WASO, low sleep efficiency). Among children with disabilities, lower level of caregivers' education is associated with more sleep disturbances.
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Affiliation(s)
- Xiaoli Chen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Juan Carlos Velez
- Centro de Rehabilitación Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Clarita Barbosa
- Centro de Rehabilitación Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Micah Pepper
- Centro de Rehabilitación Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Susan Redline
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Mussatto KA, Hoffmann R, Hoffman G, Tweddell JS, Bear L, Cao Y, Tanem J, Brosig C. Risk Factors for Abnormal Developmental Trajectories in Young Children With Congenital Heart Disease. Circulation 2015; 132:755-61. [PMID: 26304667 DOI: 10.1161/circulationaha.114.014521] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Children with congenital heart disease are at risk for developmental delay. This study sought to identify early risk factors for abnormal developmental trajectories in children with congenital heart disease. METHODS AND RESULTS Children with congenital heart disease at high risk for developmental delay, without known genetic abnormality, and with ≥3 assessments by the use of the Bayley Scales of Infant and Toddler Development, Third Edition, were studied. Logistic regression was used to assess the impact of patient and clinical factors on cognitive, language, and motor score trajectories; classified as: average or improved if all scores were ≥85 (<1 standard deviation below the mean) or increased to ≥85 and never decreased; or abnormal if all scores were <85, fell to <85 and never improved, or fluctuated above and below 85. Data on 131 children with 527 Bayley Scales of Infant and Toddler Development, Third Edition assessments were analyzed. Subject age was 5.5 to 37.4 months. Overall, 56% had cognitive, language, and motor development in the average range. Delays occurred in single domains in 23%. Multiple domains were delayed in 21%. More cardiac surgeries, longer hospital stay, poorer linear growth, and tube feeding were associated with worse outcomes in all domains (P<0.05). In the multivariable model, the need for tube feeding was a risk factor for having an abnormal developmental trajectory (odds ratio, 5.1-7.9). Minority race and lack of private insurance had significant relationships with individual domains. CONCLUSIONS Longitudinal developmental surveillance identified early factors that can help quantify the risk of developmental delay over time. Strategies to improve modifiable factors and early therapeutic intervention can be targeted to children at highest risk.
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Affiliation(s)
- Kathleen A Mussatto
- From Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee (K.A.M., J.T.); and Departments of Pediatrics (R.H., L.B., Y.C., C.B.), Anesthesiology (G.H.), and Surgery (J.S.T.), Medical College of Wisconsin, Milwaukee.
| | - Raymond Hoffmann
- From Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee (K.A.M., J.T.); and Departments of Pediatrics (R.H., L.B., Y.C., C.B.), Anesthesiology (G.H.), and Surgery (J.S.T.), Medical College of Wisconsin, Milwaukee
| | - George Hoffman
- From Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee (K.A.M., J.T.); and Departments of Pediatrics (R.H., L.B., Y.C., C.B.), Anesthesiology (G.H.), and Surgery (J.S.T.), Medical College of Wisconsin, Milwaukee
| | - James S Tweddell
- From Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee (K.A.M., J.T.); and Departments of Pediatrics (R.H., L.B., Y.C., C.B.), Anesthesiology (G.H.), and Surgery (J.S.T.), Medical College of Wisconsin, Milwaukee
| | - Laurel Bear
- From Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee (K.A.M., J.T.); and Departments of Pediatrics (R.H., L.B., Y.C., C.B.), Anesthesiology (G.H.), and Surgery (J.S.T.), Medical College of Wisconsin, Milwaukee
| | - Yumei Cao
- From Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee (K.A.M., J.T.); and Departments of Pediatrics (R.H., L.B., Y.C., C.B.), Anesthesiology (G.H.), and Surgery (J.S.T.), Medical College of Wisconsin, Milwaukee
| | - Jena Tanem
- From Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee (K.A.M., J.T.); and Departments of Pediatrics (R.H., L.B., Y.C., C.B.), Anesthesiology (G.H.), and Surgery (J.S.T.), Medical College of Wisconsin, Milwaukee
| | - Cheryl Brosig
- From Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee (K.A.M., J.T.); and Departments of Pediatrics (R.H., L.B., Y.C., C.B.), Anesthesiology (G.H.), and Surgery (J.S.T.), Medical College of Wisconsin, Milwaukee
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Karsenty C, Maury P, Blot-Souletie N, Ladouceur M, Leobon B, Senac V, Mondoly P, Elbaz M, Galinier M, Dulac Y, Carrié D, Acar P, Hascoet S. The medical history of adults with complex congenital heart disease affects their social development and professional activity. Arch Cardiovasc Dis 2015; 108:589-97. [DOI: 10.1016/j.acvd.2015.06.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 05/05/2015] [Accepted: 06/09/2015] [Indexed: 11/29/2022]
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Kim JH, Park EC. Impact of socioeconomic status and subjective social class on overall and health-related quality of life. BMC Public Health 2015; 15:783. [PMID: 26275823 PMCID: PMC4536592 DOI: 10.1186/s12889-015-2014-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 07/02/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Our objective was to investigate the impact of socioeconomic status and subjective social class on health-related quality of life (HRQOL) vs. overall quality of life (QOL). METHODS We performed a longitudinal analysis using data regarding 8250 individuals drawn from the Korean Longitudinal Study of Aging (KLoSA). We analyzed differences between HRQOL and QOL in individuals of various socioeconomic strata (high, middle, or low household income and education levels) and subjective social classes (high, middle, or low) at baseline (2009). RESULTS Individuals with low household incomes and of low subjective social class had the highest probability of reporting discrepant HRQOL and QOL scores (B: 4.796; P < 0.0001), whereas individuals with high household incomes and high subjective social class had the lowest probability of discrepant HRQOL and QOL scores (B: -3.625; P = 0.000). Similar trends were seen when education was used as a proxy for socioeconomic status. CONCLUSION In conclusion, both household income/subjective social class and education/subjective social class were found to have an impact on the degree of divergence between QOL and HRQOL. Therefore, in designing interventions, socioeconomic inequalities should be taken into account through the use of multi-dimensional measurement tools.
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Affiliation(s)
- Jae-Hyun Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
- Department of Preventive Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea.
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Abstract
PURPOSE This review aims to outline a systematic approach for the assessment of quality of life in children and adolescents with CHD and to cite its main determinants. METHODS A systematic critical literature search in PubMed, Scopus, and Cinahl databases resulted in 954 papers published after 2000. After the quality assessment, 32 original articles met the inclusion criteria. RESULTS Methodological quality of the included studies varied greatly, showing a moderate quality. Impaired quality of life was associated with more severe cardiac lesions. Children with CHD, after cardiac surgery, reported diminished quality of life concerning physical, psycho-social, emotional, and school functioning. The majority of clinical studies showed significant differences among children and their parents' responses regarding their quality of life, with a tendency of children to report greater quality of life scores than their parents. According to our analysis, concerning children with CHD, the most cited determinants of their quality of life were as follows: (a) parental support; (b) lower socio-economic status; (c) limitations due to physical impairment; (d) sense of coherence; as well as (e) the level of child's everyday anxiety and depression. These findings suggest that differences in quality of life issues may exist across lesion severities. CONCLUSION Quality of life in children with CHD should be assessed according to age; severity; therapeutic approach; acceptance of the disease; and personality features. Effective management and early recognition of significant impairments in quality of life could impact clinical outcomes in children with CHD.
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Costello JM, Mussatto K, Cassedy A, Wray J, Mahony L, Teele SA, Brown KL, Franklin RC, Wernovsky G, Marino BS. Prediction by clinicians of quality of life for children and adolescents with cardiac disease. J Pediatr 2015; 166:679-83.e2. [PMID: 25722271 PMCID: PMC4347874 DOI: 10.1016/j.jpeds.2014.11.061] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 10/16/2014] [Accepted: 11/26/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether clinicians could reliably predict health-related quality of life (HRQOL) for children with cardiac disease, the level of agreement in predicted HRQOL scores between clinician sub-types, and agreement between clinician-predicted HRQOL scores and patient and parent-proxy reported HRQOL scores. STUDY DESIGN In this multicenter, cross-sectional study, a random sample of clinical summaries of children with cardiac disease and related patient and parent-proxy reported HRQOL scores were extracted from the Pediatric Cardiac Quality of Life Inventory data registry. We asked clinicians to review each clinical summary and predict HRQOL. RESULTS Experienced pediatric cardiac clinicians (n = 140), including intensive care physicians, outpatient cardiologists, and intensive care, outpatient, and advanced practice nurses, each predicted HRQOL for the same 21 pediatric cardiac patients. Reliability within clinician subspecialty groups for predicting HRQOL was poor (intraclass correlation coefficients, 0.34-0.38). Agreement between clinician groups was low (Pearson correlation coefficients, 0.10-0.29). When comparing the average clinician predicted HRQOL scores to those reported by patients and parent-proxies by Bland Altman plots, little systematic bias was present, but substantial variability existed. Proportional bias was found, in that clinicians tended to overestimate HRQOL for those patients and parent-proxies who reported lower HRQOL, and underestimate HRQOL for those reporting higher HRQOL. CONCLUSIONS Clinicians perform poorly when asked to predict HRQOL for children with cardiac disease. Clinicians should be cognizant of these data when providing counseling. Incorporating reported HRQOL into clinical assessment may help guide individualized treatment decision-making.
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Affiliation(s)
- John M. Costello
- Ann & Robert H. Lurie Children's Hospital of Chicago & Northwestern University Feinberg School of Medicine
| | | | - Amy Cassedy
- Cincinnati Children's Hospital Medical Center
| | - Jo Wray
- Great Ormond Street Hospital for Children NHS Trust
| | - Lynn Mahony
- University of Texas Southwestern Medical Center
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Czosek RJ, Cassedy AE, Wray J, Wernovsky G, Newburger JW, Mussatto KA, Mahony L, Tanel RE, Cohen MI, Franklin RC, Brown KL, Rosenthal D, Drotar D, Marino BS. Quality of life in pediatric patients affected by electrophysiologic disease. Heart Rhythm 2015; 12:899-908. [PMID: 25602174 DOI: 10.1016/j.hrthm.2015.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Treatment of electrophysiologic (EP) disease in pediatric patients has improved; however, the effects on quality of life (QOL) are unknown. OBJECTIVE The purpose of this study was to compare QOL within EP disease groups and to other congenital heart diseases, to evaluate the effects of cardiac rhythm devices on QOL, and to identify drivers of QOL in EP disease. METHODS Cross-sectional study of patient/parent proxy-reported Pediatric Cardiac Quality of Life Inventory scores (Total, Disease Impact, Psychosocial Impact) in subjects aged 8 to 18 years from 11 centers with congenital complete heart block (CCHB), ventricular tachycardia (VT), supraventricular tachycardia (SVT), and long QT syndrome (LQTS). QOL was compared between EP disease groups and congenital heart disease groups [bicuspid aortic valve (BAV), tetralogy of Fallot (TOF), and Fontan]. General linear modeling was used to perform group comparisons and to identify predictors of QOL variation. RESULTS Among 288 patient-parent pairs, mean age was 12.8 ± 3.0 years. CCHB (μ = 83) showed higher patient Total QOL than other EP disease cohorts (P ≤ .02; LQTS μ = 73; SVT μ = 74). SVT (μ = 75) and LQTS (μ = 75) had lower patient Total scores than BAV (μ = 81; P ≤ .008). Patient/parent-proxy QOL scores for all EP disease groups were not different than TOF and higher than Fontan. The presence of a cardiac rhythm device was associated with lower QOL scores in LQTS (μ = 66 vs μ = 76; P < .01). Predictors of lower patient/parent-proxy QOL included EP disease type (P ≤ .03), increased medical care utilization (P ≤ .04), and no parental college degree (P ≤ .001). CONCLUSION Given the significant variation in QOL in EP disease type, stratification by EP disease type and increased medical care utilization may allow for targeted interventions to improve QOL.
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Affiliation(s)
- Richard J Czosek
- The Heart Institute, Department of Pediatrics, Division of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Amy E Cassedy
- Department of Biostatistics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jo Wray
- Critical Care and Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | | | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Lynn Mahony
- Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, Texas
| | - Ronn E Tanel
- Division of Pediatric Cardiology, UCSF Benioff Children's Hospital, and Department of Pediatrics, UCSF School of Medicine, San Francisco, California
| | - Mitchell I Cohen
- Phoenix Children's Hospital and Arizona Pediatric Cardiology Consultants/Pediatrix, University of Arizona School of Medicine-Phoenix, Phoenix, Arizona
| | - Rodney C Franklin
- Department of Paediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Kate L Brown
- Critical Care and Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - David Rosenthal
- Department of Pediatrics, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California
| | - Dennis Drotar
- The Heart Institute, Department of Pediatrics, Division of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Bradley S Marino
- The Heart Institute, Department of Pediatrics, Division of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Gottlieb L, Hessler D, Long D, Amaya A, Adler N. A randomized trial on screening for social determinants of health: the iScreen study. Pediatrics 2014; 134:e1611-8. [PMID: 25367545 DOI: 10.1542/peds.2014-1439] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is growing interest in clinical screening for pediatric social determinants of health, but little evidence on formats that maximize disclosure rates on a wide range of potentially sensitive topics. We designed a study to examine disclosure rates and hypothesized that there would be no difference in disclosure rates on face-to-face versus electronic screening formats for items other than highly sensitive items. METHODS We conducted a randomized trial of electronic versus face-to-face social screening formats in a pediatric emergency department. Consenting English-speaking and Spanish-speaking adult caregivers familiar with the presenting child's household were randomized to social screening via tablet computer (with option for audio assist) versus a face-to-face interview conducted by a fully bilingual/bicultural researcher. RESULTS Almost all caregivers (96.8%) reported at least 1 social need, but rates of reporting on the more sensitive issues (household violence and substance abuse) were significantly higher in electronic format, and disclosure was marginally higher in electronic format for financial insecurity and neighborhood and school safety. There was a significant difference in the proportion of social needs items with higher endorsement in the computer-based group (70%) than the face-to-face group (30%). CONCLUSIONS Pediatric clinical sites interested in incorporating caregiver-reported socioeconomic, environmental, and behavioral needs screening should consider electronic screening when feasible, particularly when assessing sensitive topics such as child safety and household member substance use.
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Affiliation(s)
| | | | - Dayna Long
- Department of Psychiatry, University of California, San Francisco, San Francisco, California; and
| | - Anais Amaya
- Department of Psychiatry, University of California, San Francisco, San Francisco, California; and
| | - Nancy Adler
- Department of Family and Community Medicine, and
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