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Verhagen MJA, van Balen EC, Blijlevens NMA, Coppens M, van Heerde WL, Leebeek FWG, Rijpma SR, van Vulpen LFD, Gouw SC, Schols SEM. Patients with moderate hemophilia A and B with a severe bleeding phenotype have an increased burden of disease. J Thromb Haemost 2024; 22:152-162. [PMID: 37813197 DOI: 10.1016/j.jtha.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Patients with moderate hemophilia express varying bleeding phenotypes. OBJECTIVES To assess the burden of disease in patients with moderate hemophilia and a mild or severe phenotype incorporating the thrombin generation profile. METHODS This sub-study of the 6th Hemophilia in the Netherlands study, analyzed data of adults with moderate hemophilia A or B. Patient characteristics and information on bleeding tendency, joint status, and quality of life were obtained from electronic patient files and self-reported questionnaires. A severe bleeding phenotype was defined as an annual bleeding rate ≥5, an annual joint bleeding rate ≥3, and/or the use of secondary/tertiary prophylaxis, and a mild phenotype vice versa. TG was measured with the Nijmegen Hemostasis Assay. RESULTS This study included 116 patients: 21% had a severe phenotype of whom 46% used prophylaxis. Patients with a severe phenotype treated on demand reported a higher median annual bleeding rate (7), annual joint bleeding rate (3), and more frequently an impaired joint (77%) than patients with a severe phenotype on prophylaxis (2; 0; 70%) or patients with a mild phenotype (0; 0; 47%). Furthermore, patients with a severe phenotype treated on demand experienced a more decreased quality of life. Despite similar factor activity levels, patients with a severe phenotype had a lower thrombin peak height and thrombin potential (0.7%; 0.06%) than patients with a mild phenotype (21.3%; 46.8%). CONCLUSION Patients with moderate hemophilia and a severe phenotype treated on demand displayed a high burden of disease as well as a low thrombin generation profile advocating them toward more intensive prophylactic treatment.
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Affiliation(s)
- Marieke J A Verhagen
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands; Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Nijmegen, the Netherlands; Department of Laboratory Medicine, Laboratory of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Erna C van Balen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michiel Coppens
- Department of Vascular Medicine and Haemophilia Treatment Center, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Waander L van Heerde
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands; Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Nijmegen, the Netherlands; Enzyre BV, Novio Tech Campus, Nijmegen, the Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sanna R Rijpma
- Department of Laboratory Medicine, Laboratory of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lize F D van Vulpen
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Samantha C Gouw
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Pediatric Hematology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Saskia E M Schols
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands; Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Nijmegen, the Netherlands.
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2
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van Balen EC, Hassan S, Smit C, Driessens MHE, Beckers EAM, Coppens M, Eikenboom JC, Hooimeijer HL, Leebeek FWG, Mauser-Bunschoten EP, van Vulpen LFD, Schols SEM, Rosendaal FR, van der Bom JG, Gouw SC. Socioeconomic participation of persons with hemophilia: Results from the sixth hemophilia in the Netherlands study. Res Pract Thromb Haemost 2022; 6:e12741. [PMID: 36051543 PMCID: PMC9414229 DOI: 10.1002/rth2.12741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 11/12/2022] Open
Abstract
Background and objectives Treatment availability and comprehensive care have resulted in improved clinical outcomes for persons with hemophilia. Recent data on socioeconomic participation in the Netherlands are lacking. This study assessed participation in education, in the labor market, and social participation for persons with hemophilia compared with the general male population. Methods Dutch adults and children (5–75 years) of all hemophilia severities (n = 1009) participated in a questionnaire study that included sociodemographic, occupational, and educational variables. Clinical characteristics were extracted from electronic medical records. General population data were extracted from Statistics Netherlands. Social participation was assessed with the PROMIS Ability to Participate in Social Roles and Activities short form, with a minimal important difference set at 1.0. Results Data from 906 adults and children were analyzed. Participation in education of 20 to 24 year olds was 68% (general male population: 53%). Educational attainment was higher compared with Dutch males, especially for severe hemophilia. Absenteeism from school was more common than in the general population. The employment‐to‐population ratio and occupational disability were worse for severe hemophilia than in the general population (64.3% vs. 73.2% and 14.7% vs. 4.8%, respectively), but similar for nonsevere hemophilia. Unemployment was 5.4% (general male population: 3.4%). Absenteeism from work was less common (38% vs. 45.2%). Mean PROMIS score was similar to or higher than in the general population (54.2; SD 8.9 vs. 50; SD 10). Conclusion Socioeconomic participation of persons with nonsevere hemophilia was similar to the general male population. Some participation outcomes for persons with severe hemophilia were reduced.
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Affiliation(s)
- Erna C van Balen
- Department of Clinical Epidemiology Leiden University Medical Center The Netherlands
| | - Shermarke Hassan
- Department of Clinical Epidemiology Leiden University Medical Center The Netherlands
| | - Cees Smit
- Department of Clinical Epidemiology Leiden University Medical Center The Netherlands
| | | | - Erik A M Beckers
- Department of Hematology Maastricht University Medical Centre Maastricht The Netherlands
| | - Michiel Coppens
- Department of Vascular Medicine Amsterdam Cardiovascular Sciences Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Jeroen C Eikenboom
- Department of Internal Medicine Division of Thrombosis and Hemostasis Leiden University Medical Center Leiden The Netherlands
| | - Hélène L Hooimeijer
- Department of Paediatrics University Medical Center Groningen Groningen The Netherlands
| | - Frank W G Leebeek
- Department of Hematology Erasmus University Medical Center Erasmus MC Rotterdam The Netherlands
| | - Evelien P Mauser-Bunschoten
- Center for Benign Haematology Thrombosis and Haemostasis Van Creveldkliniek University Medical Center Utrecht University Utrecht Utrecht The Netherlands
| | - Lize F D van Vulpen
- Center for Benign Haematology Thrombosis and Haemostasis Van Creveldkliniek University Medical Center Utrecht University Utrecht Utrecht The Netherlands
| | - Saskia E M Schols
- Department of Hematology Radboud university medical center Nijmegen The Netherlands.,Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht Nijmegen The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology Leiden University Medical Center The Netherlands
| | - Johanna G van der Bom
- Department of Clinical Epidemiology Leiden University Medical Center The Netherlands.,Center for Clinical Transfusion Research Sanquin Research/LUMC Leiden The Netherlands
| | - Samantha C Gouw
- Department of Clinical Epidemiology Leiden University Medical Center The Netherlands.,Pediatric Hematology Emma Children's Hospital Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
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3
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Isfordink CJ, Gouw SC, van Balen EC, Hassan S, Beckers EAM, van der Bom JG, Coppens M, Eikenboom J, Fischer K, Hooimeijer L, Leebeek FWG, Rosendaal FR, Schols SEM, Smit C, van Vulpen LFD, Mauser‐Bunschoten EP. Hepatitis C virus in hemophilia: Health-related quality of life after successful treatment in the sixth Hemophilia in the Netherlands study. Res Pract Thromb Haemost 2021; 5:e12616. [PMID: 34870068 PMCID: PMC8599142 DOI: 10.1002/rth2.12616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Persons with hemophilia and hepatitis C virus (HCV) infection have a lower health-related quality of life (HRQoL) than those never HCV infected. However, it is unknown whether HRQoL after HCV eradication is comparable to individuals never HCV infected. We aimed to compare HRQoL between HCV-cured and never chronically HCV-infected persons with hemophilia. METHODS All persons with hemophilia in the Netherlands were invited for a nationwide study conducted in 2018-2019. For the current analysis, participants born before 1992 with data on HRQoL and HCV status were included. HCV status was collected from medical records. HRQoL was measured by RAND-36 questionnaire, with a minimally important difference set at 4.0 points. Multivariable linear regression was used to adjust for age, hemophilia severity, HIV status, and self-reported joint impairment. RESULTS In total, 486 persons were eligible; 180 were HCV cured and 306 never chronically HCV infected. Compared with those never HCV infected, HCV-cured individuals were older (57 vs. 53 years), more often had severe hemophilia (67% vs. 21%), and reported more impaired joints (median 3 vs. 0). Compared with those never HCV infected, adjusted RAND-36 domain scores of HCV-cured individuals cured were lower on all RAND-36 domains except Pain, ranging from a difference of 4.5 (95% CI, -8.8 to -0.3) for Physical functioning to 11.3 (95% CI, -19.4 to -3.1) for Role limitations due to physical problems. CONCLUSION Despite effective HCV treatment, HRQoL of HCV-cured persons with hemophilia is still lower than HRQoL of those never chronically HCV-infected on all RAND-36 domains. This implies that careful psychosocial follow-up and support are indicated.
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Affiliation(s)
- Cas J. Isfordink
- Van CreveldkliniekCenter for Benign HaematologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Department of Gastroenterology and HepatologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Samantha C. Gouw
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Pediatric HematologyAmsterdam UMCEmma Children's HospitalUniversity of AmsterdamAmsterdamThe Netherlands
| | - Erna C. van Balen
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Shermarke Hassan
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Erik A. M. Beckers
- Department of HematologyMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Johanna G. van der Bom
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Center for Clinical Transfusion ResearchSanquin‐Leiden University Medical CenterLeidenThe Netherlands
| | - Michiel Coppens
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jeroen Eikenboom
- Division of Thrombosis and HemostasisDepartment of Internal MedicineLeiden University Medical CenterLeidenThe Netherlands
| | - Kathelijn Fischer
- Van CreveldkliniekCenter for Benign HaematologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Louise Hooimeijer
- Department of PaediatricsUniversity Medical Center GroningenGroningenThe Netherlands
| | - Frank W. G. Leebeek
- Department of HematologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Frits R. Rosendaal
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Saskia E. M. Schols
- Department of HematologyRadboud University Medical CenterNijmegenThe Netherlands
- Hemophilia Treatment Center Nijmegen‐Eindhoven‐MaastrichtNijmegenThe Netherlands
| | - Cees Smit
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Lize F. D. van Vulpen
- Van CreveldkliniekCenter for Benign HaematologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Eveline P. Mauser‐Bunschoten
- Van CreveldkliniekCenter for Benign HaematologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
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4
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van Balen EC, Haverman L, Hassan S, Taal EM, Smit C, Driessens MH, Beckers EAM, Coppens M, Eikenboom J, Hooimeijer HL, Leebeek FWG, van Vulpen LFD, Schols SEM, Terwee CB, Rosendaal FR, van der Bom JG, Gouw SC. Validation of PROMIS Profile-29 in adults with hemophilia in the Netherlands. J Thromb Haemost 2021; 19:2687-2701. [PMID: 34245088 PMCID: PMC8596807 DOI: 10.1111/jth.15454] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS) Profile-29 questionnaire is widely used worldwide, but it has not yet been validated in the Netherlands, nor in persons with hemophilia. OBJECTIVE To validate the Dutch-Flemish version of the PROMIS-29 Profile v2.01 in adults with hemophilia. METHODS Dutch males with hemophilia (all severities) completed questionnaires that contained sociodemographic and clinical characteristics, the PROMIS-29, RAND-36, and the Hemophilia Activities List (HAL). Structural validity of each subscale was assessed with confirmatory factor analysis (CFA). Internal consistency was calculated for each subscale with sufficient model fit in CFA. Construct validity was assessed by testing hypotheses about (1) correlations of each PROMIS-29 subscale with corresponding scales of RAND-36 and domains of HAL, and (2) mean differences in T-scores between subgroups with different hemophilia severities, self-reported joint impairment, and HIV infection status. We considered ≥75% of data in accordance with the hypotheses evidence for construct validity. RESULTS In total, 770 persons with hemophilia participated in this cross-sectional study. CFA revealed sufficient structural validity for five subscales: Physical Function, Depression, Sleep Disturbance, Ability to Participate in Social Roles and Activities, and Pain Interference. Internal consistency was high and Cronbach's alpha ranged from 0.79 for Sleep Disturbance to 0.96 for Pain Interference. Differences between clinical subgroups were in the expected direction. Construct validity was confirmed for Physical Function, Anxiety, Depression, Fatigue, Sleep Disturbance, and Pain Intensity. CONCLUSION This study revealed sufficient evidence for structural validity, internal consistency, and construct validity for most PROMIS Profile-29 subscales among people with hemophilia in the Netherlands.
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Affiliation(s)
- Erna C. van Balen
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Lotte Haverman
- Child and Adolescent Psychiatry & Psychosocial CareAmsterdam Reproduction and DevelopmentAmsterdam Public HealthEmma Children’s HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Shermarke Hassan
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Elisabeth M. Taal
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Cees Smit
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Erik A. M. Beckers
- Department of HematologyMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Michiel Coppens
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jeroen Eikenboom
- Department of Internal MedicineDivision of Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - Hélène L. Hooimeijer
- Department of PaediatricsUniversity Medical Center GroningenGroningenThe Netherlands
| | | | - Lize F. D. van Vulpen
- Department of Benign HematologyVan CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Saskia E. M. Schols
- Department of HematologyRadboud University Medical CenterNijmegenthe Netherlands
- Hemophilia Treatment Center Nijmegen‐Eindhoven‐MaastrichtNijmegenThe Netherlands
| | - Caroline B. Terwee
- Department of Epidemiology and Data ScienceAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamThe Netherlands
| | - Frits R. Rosendaal
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Johanna G. van der Bom
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Center for Clinical Transfusion ResearchSanquin Research/LUMCLeidenThe Netherlands
| | - Samantha C. Gouw
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Pediatric HematologyEmma Children’s HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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5
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Hassan S, van Balen EC, Smit C, Mauser‐Bunschoten EP, van Vulpen LFD, Eikenboom J, Beckers EAM, Hooimeijer L, Ypma PF, Nieuwenhuizen L, Coppens M, Schols SEM, Leebeek FWG, Driessens MH, Rosendaal FR, van der Bom JG, Gouw SC. Health and treatment outcomes of patients with hemophilia in the Netherlands, 1972-2019. J Thromb Haemost 2021; 19:2394-2406. [PMID: 34117710 PMCID: PMC8518083 DOI: 10.1111/jth.15424] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/07/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION We conducted six cross-sectional nationwide questionnaire studies among all patients with hemophilia in the Netherlands from 1972 until 2019 to assess how health outcomes have changed, with a special focus on patients >50 years of age. METHODS Data were collected on patient characteristics, treatment, (joint) bleeding, joint impairment, hospitalizations, human immunodeficiency virus and hepatitis C infections, and general health status (RAND-36). RESULTS In 2019, 1009 patients participated, of whom 48% had mild, 15% moderate, and 37% severe hemophilia. From 1972 to 2019, the use of prophylaxis among patients with severe hemophilia increased from 30% to 89%. Their median annual bleeding rate decreased from 25 to 2 bleeds. Patients with severe hemophilia aged <16 years reported joint impairment less often over time, but in those aged >40 years joint status did not improve. In 2019, 5% of all 1009 patients were positive for the human immunodeficiency virus. The proportion of patients with an active hepatitis C infection drastically decreased from 45% in 2001 to 2% in 2019 due to new anti-hepatitis C treatment options. Twenty-five percent had significant liver fibrosis even after successful therapy. Compared to the general male population, patients aged >50 years reported much lower scores on the RAND-36, especially on physical functioning. DISCUSSION/CONCLUSION Our study shows that increased use of prophylactic treatment and effective hepatitis C treatment have improved joint health and nearly eradicated hepatitis C infection in patients with hemophilia in the Netherlands. However, patients still suffer from hemophilia-related complications, especially patients aged >50 years.
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Affiliation(s)
- Shermarke Hassan
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Erna C. van Balen
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Cees Smit
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | | | - Lize F. D. van Vulpen
- Van CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Jeroen Eikenboom
- Department of Internal MedicineDivision of Thrombosis and HemostasisLeiden University Medical CenterLeidenthe Netherlands
| | - Erik A. M. Beckers
- Department of HematologyMaastricht University Medical CentreMaastrichtthe Netherlands
| | - Louise Hooimeijer
- Department of PaediatricsUniversity Medical Center GroningenGroningenthe Netherlands
| | - Paula F. Ypma
- Department of HematologyHagaZiekenhuisThe Haguethe Netherlands
| | | | - Michiel Coppens
- Department of Vascular MedicineAmsterdam University Medical CentresAmsterdamthe Netherlands
| | - Saskia E. M. Schols
- Department of HematologyRadboud University Medical CenterNijmegenthe Netherlands
- Hemophilia Treatment Center Nijmegen‐Eindhoven‐MaastrichtNijmegenthe Netherlands
| | | | | | - Frits R. Rosendaal
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Johanna G. van der Bom
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
- Center for Clinical Transfusion ResearchSanquin‐Leiden University Medical CenterLeidenthe Netherlands
| | - Samantha C. Gouw
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
- Pediatric HematologyEmma Children’s HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
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6
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Versloot O, van Balen EC, Hassan S, Schols SEM, Leebeek FWG, Eikenboom J, Coppens M, van Vulpen LFD, Smit C, Driessens MHE, van der Net J, Gouw SC, Fischer K. Similar sports participation as the general population in Dutch persons with haemophilia; results from a nationwide study. Haemophilia 2021; 27:876-885. [PMID: 34146370 PMCID: PMC8518501 DOI: 10.1111/hae.14366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/27/2021] [Accepted: 06/09/2021] [Indexed: 01/20/2023]
Abstract
Introduction Although sports participation is advocated in people with haemophilia (PWH), detailed data concerning sports participation in Dutch PWH is lacking. Aim to assess sports participation in Dutch PWH (6‐65 years) compared to the Dutch general population (GP). Methods Data from a nationwide, cross‐sectional study in PWH were analysed. Sports participation (type, duration, frequency) was assessed by the Modifiable Activities Questionnaire (MAQ), limitations in activities using the (Paediatric) Haemophilia Activities List ((Ped)HAL). Sports in the two highest categories according to the National Hemophilia Foundation classification were considered high‐risk sports. Groups were compared using Chi‐square testing. Results A total of 524 Adult PWH (median age: 45 (IQR: 30–55); 37% severe) and 126 paediatric PWH (median age: 11 (IQR: 8–14); 52% severe) were included. Sports participation was higher in adults (70%) than the GP (58%) and similar to the GP in children (PWH: 68%, GP: 72%). High‐risk sports participation decreased with age in PWH: from 65% (6‐12 years) to 17% (50‐65 years), which was also observed in the GP. Sports participation in children was independent of severity (non‐severe: 67% vs. severe: 65%; P = 0.97), but not in adults (non‐severe: 75%, severe: 62%; P < 0.01). Non‐severe PWH played more high‐risk sports than severe PWH: children at 65% vs. 48% (P = 0.05), adults at 25% vs. 15% (P = 0.07). Discussion These results suggest that sports participation in PWH was comparable to the GP. Sports participation was dependent of haemophilia severity in adults. Children were more involved in high‐risk sports than adults. More studies on sports‐related injury‐risk are needed for adequate counselling.
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Affiliation(s)
- Olav Versloot
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erna C van Balen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Shermarke Hassan
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Saskia E M Schols
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.,Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Nijmegen, The Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeroen Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Lize F D van Vulpen
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cees Smit
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Janjaap van der Net
- Center for Child Development, Exercise and Physical Literacy, University Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Samantha C Gouw
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kathelijn Fischer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
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- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
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7
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van Balen EC, O'Mahony B, Cnossen MH, Dolan G, Blanchette VS, Fischer K, Gue D, O'Hara J, Iorio A, Jackson S, Konkle BA, Nugent DJ, Coffin D, Skinner MW, Smit C, Srivastava A, van Eenennaam F, van der Bom JG, Gouw SC. Patient-relevant health outcomes for hemophilia care: Development of an international standard outcomes set. Res Pract Thromb Haemost 2021; 5:e12488. [PMID: 34027286 PMCID: PMC8117824 DOI: 10.1002/rth2.12488] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/05/2020] [Accepted: 12/29/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Patient-relevant health outcomes for persons with hemophilia should be identified and prioritized to optimize and individualize care for persons with hemophilia. Therefore, an international group of persons with hemophilia and multidisciplinary health care providers set out to identify a globally applicable standard set of health outcomes relevant to all individuals with hemophilia. METHODS A systematic literature search was performed to identify possible health outcomes and risk adjustment variables. Persons with hemophilia and multidisciplinary health care providers were involved in an iterative nominal consensus process to select the most important health outcomes and risk adjustment variables for persons with hemophilia. Recommendations were made for outcome measurement instruments. RESULTS Persons with hemophilia were defined as all men and women with an X-linked inherited bleeding disorder caused by a deficiency of coagulation factor VIII or IX with plasma activity levels <40 IU/dL. We recommend collecting the following 10 health outcomes at least annually, if applicable: (i) cure, (ii) impact of disease on life expectancy, (iii) ability to engage in normal daily activities, (iv) severe bleeding episodes, (v) number of days lost from school or work, (vi) chronic pain, (vii) disease and treatment complications, (viii) sustainability of physical functioning, (ix) social functioning, and (x) mental health. Validated clinical as well as patient-reported outcome measurement instruments were endorsed. Demographic factors, baseline clinical factors, and treatment factors were identified as risk-adjustment variables. CONCLUSION A consensus-based international set of health outcomes relevant to all persons with hemophilia, and corresponding measurement instruments, was identified for use in clinical care to facilitate harmonized longitudinal monitoring and comparison of outcomes.
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Affiliation(s)
- Erna C. van Balen
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Marjon H. Cnossen
- Department of Pediatric HematologyErasmus University Medical Center – Sophia Children's HospitalRotterdamThe Netherlands
| | - Gerard Dolan
- Centre for Haemostasis and ThrombosisSt Thomas' HospitalLondonUK
| | - Victor S. Blanchette
- Division of Hematology/OncologyDepartment of PediatricsHospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - Kathelijn Fischer
- Van CreveldkliniekDepartment of HematologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Deborah Gue
- British Columbia Provincial Bleeding Disorders Program – Adult DivisionSt. Paul's HospitalVancouverBCCanada
| | - Jamie O'Hara
- Faculty of Health and Social CareUniversity of ChesterChesterUK
| | - Alfonso Iorio
- Department of MedicineMcMaster‐Bayer Endowed Research Chair in Clinical Epidemiology of Congenital Bleeding DisordersMcMaster UniversityHamiltonONCanada
- Department of Health Research Methods, Evidence and ImpactMcMaster‐Bayer Endowed Research Chair in Clinical Epidemiology of Congenital Bleeding DisordersMcMaster UniversityHamiltonONCanada
| | - Shannon Jackson
- British Columbia Provincial Bleeding Disorders Program – Adult DivisionSt. Paul's HospitalVancouverBCCanada
| | - Barbara A. Konkle
- Bloodworks NorthwestSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
| | - Diane J. Nugent
- Children's HospitalUniversity of CaliforniaIrvine
- Center for Inherited Blood DisordersOrangeCAUSA
| | | | - Mark W. Skinner
- National Hemophilia FoundationNew YorkNYUSA
- Institute for Policy Advancement LtdWashingtonDCUSA
| | - Cees Smit
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Alok Srivastava
- Department of HaematologyChristian Medical CollegeVelloreIndia
| | - Fred van Eenennaam
- The Decision GroupAmsterdamThe Netherlands
- Erasmus School of Accounting & AssuranceErasmus UniversityRotterdamThe Netherlands
| | - Johanna G. van der Bom
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Center for Clinical Transfusion ResearchSanquin/LUMCLeidenThe Netherlands
| | - Samantha C. Gouw
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Pediatric HematologyAmsterdam University Medical CenterEmma Children's HospitalUniversity of AmsterdamAmsterdamThe Netherlands
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8
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Hassan S, Monahan RC, Mauser-Bunschoten EP, van Vulpen LFD, Eikenboom J, Beckers EAM, Hooimeijer L, Ypma PF, Nieuwenhuizen L, Coppens M, Schols SEM, Leebeek FWG, Smit C, Driessens MH, le Cessie S, van Balen EC, Rosendaal FR, van der Bom JG, Gouw SC. Mortality, life expectancy, and causes of death of persons with hemophilia in the Netherlands 2001-2018. J Thromb Haemost 2021; 19:645-653. [PMID: 33217158 PMCID: PMC7986360 DOI: 10.1111/jth.15182] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 10/20/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment of patients with hemophilia has advanced over the past decades, but it is unknown whether this has resulted in a normal life expectancy in the Netherlands. OBJECTIVE This observational cohort study aimed to assess all-cause and cause-specific mortality in patients with hemophilia in the Netherlands between 2001 and 2018 and to compare mortality and life expectancy with previous survival assessments from 1973 onward. PATIENTS/METHODS All 1066 patients with hemophilia who participated in a nationwide survey in 2001 were followed until July 2018. RESULTS Information on 1031 individuals (97%) was available, of whom 142 (14%) deceased during follow-up. Compared with the general Dutch male population, mortality of patients with hemophilia was still increased (standardized mortality ratio: 1.4, 95% confidence interval: 1.2-1.7). Intracranial bleeding and malignancies were the most common causes of death. Estimated median life expectancy of patients with hemophilia was 77 years, 6 years lower than the median life expectancy of the general Dutch male population (83 years). Over the past 45 years, death rates of patients with hemophilia have consistently decreased, approaching the survival experience of the general population. Over the past decades, mortality due to human immunodeficiency virus and hepatitis C virus infections has decreased, death due to intracranial hemorrhages has increased, and death due to ischemic heart disease has remained consistently low over time. CONCLUSIONS Survival in patients with hemophilia in the Netherlands has improved over time but is still lower than that of the general population.
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Affiliation(s)
- Shermarke Hassan
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rory C Monahan
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Lize F D van Vulpen
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jeroen Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik A M Beckers
- Department of Hematology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Louise Hooimeijer
- Department of Paediatrics, University Medical Center Groningen, Groningen, the Netherlands
| | - Paula F Ypma
- Department of Hematology, HagaZiekenhuis, The Hague, the Netherlands
| | | | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Saskia E M Schols
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Cees Smit
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Erna C van Balen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Samantha C Gouw
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
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9
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van Balen EC, Wolansky MJ, Kosatsky T. Increasing use of pyrethroids in Canadian households: should we be concerned? Can J Public Health 2012; 103:e404-7. [PMID: 23618016 PMCID: PMC6975195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 09/07/2012] [Accepted: 09/20/2012] [Indexed: 03/29/2024]
Abstract
Pyrethroids are a class of plant-derived insecticides and their man-made analogues that are increasingly applied in Canada as first choice for pest control in many agricultural and residential settings. Their popularity is partly due to their alleged safety compared to the older organochlorine and organophosphate insecticides. Application of pyrethroids is expanding because of recent increases in the level of pest infestations--such as bed bugs--and the decreased susceptibility of target species to many pest control products. Pyrethroid residues have been documented in homes, child care centres and food. While pyrethroids are considered of low health risk for humans, their increased use is of concern. Our current understanding of the adverse effects of pyrethroids derives mainly from studies of short-term effects in laboratory animals, case reports of self- and accidental poisonings, and high-dose occupational exposures, for which the levels and formulations of pyrethroid products differ from those relevant for long-term exposure in the general population. The available data suggest that the reproductive and nervous systems, endocrine signalling pathways, and early childhood development may be targets for adverse effects in the case of repeated exposure to pyrethroid formulations. Given uncertainty about the existence of long-term health effects of exposure to pyrethroids, particularly under realistic scenarios, we should be cautious when promoting pyrethroid products as safe methods for pest control.
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Affiliation(s)
- Erna C. van Balen
- National Collaborating Centre for Environmental Health, Vancouver, BC Canada
| | | | - Tom Kosatsky
- National Collaborating Centre for Environmental Health, Vancouver, BC Canada
- British Columbia Centre for Disease Control, Vancouver, BC Canada
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10
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Abstract
Pyrethroids are a class of plant-derived insecticides and their man-made analogues that are increasingly applied in Canada as first choice for pest control in many agricultural and residential settings. Their popularity is partly due to their alleged safety compared to the older organochlorine and organophosphate insecticides. Application of pyrethroids is expanding because of recent increases in the level of pest infestations--such as bed bugs--and the decreased susceptibility of target species to many pest control products. Pyrethroid residues have been documented in homes, child care centres and food. While pyrethroids are considered of low health risk for humans, their increased use is of concern. Our current understanding of the adverse effects of pyrethroids derives mainly from studies of short-term effects in laboratory animals, case reports of self- and accidental poisonings, and high-dose occupational exposures, for which the levels and formulations of pyrethroid products differ from those relevant for long-term exposure in the general population. The available data suggest that the reproductive and nervous systems, endocrine signalling pathways, and early childhood development may be targets for adverse effects in the case of repeated exposure to pyrethroid formulations. Given uncertainty about the existence of long-term health effects of exposure to pyrethroids, particularly under realistic scenarios, we should be cautious when promoting pyrethroid products as safe methods for pest control.
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Affiliation(s)
- Erna C van Balen
- National Collaborating Centre for Environmental Health, Vancouver, BC
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