1
|
Hirsch J, Halstead NV, Meyer T, Rague JT, Kim S, Rosoklija I, Kielb S, Larson JE, Swaroop VT, Bowman RM, Cheng EY, Bowen DK, Yerkes EB, Chu DI. Quality of Life and Bladder Symptoms in Adolescents and Young Adults With Spina Bifida Who Catheterize via Urethra vs Catheterizable Channel. J Urol 2024; 212:362-371. [PMID: 38701236 PMCID: PMC11233230 DOI: 10.1097/ju.0000000000004013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/24/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE We sought to assess associations between health-related quality of life (QOL), bladder-related QOL, bladder symptoms, and bladder catheterization route among adolescents and young adults with spina bifida. MATERIALS AND METHODS Clinical questionnaires administered to individuals ≥ 12 years old requiring catheterization between June 2019 to March 2020 in a spina bifida center were retrospectively analyzed. Questionnaires were completed in English or Spanish independently or with caregiver assistance. Medical records were reviewed for demographic and clinical characteristics. Primary exposure was catheterization route (urethra or channel). Primary outcome was health-related QOL, measured by Patient-Reported Outcomes Measurement Information System Pediatric Global Health 7 (PGH-7). Secondary outcomes were bladder-related QOL and bladder symptoms, measured by Neurogenic Bladder Symptom Score (NBSS). Nested, multivariable linear regression models assessed associations between catheterization route and questionnaire scores. RESULTS Of 162 patients requiring catheterization, 146 completed both the PGH-7 and NBSS and were included. Seventy-three percent were catheterized via urethra and 27% via channel. Median age was 17.5 years (range 12-31), 58% of patients were female, and 80% had myelomeningocele. Urinary incontinence was more common among those who catheterized via urethra (60%) compared to channel (33%). On adjusted analyses, catheterization route was not significantly associated with PGH-7 or NBSS bladder-related QOL scores. More bladder symptoms were associated with worse bladder-related QOL. Patients who catheterized via channel had fewer bladder symptoms than those who catheterized via urethra. CONCLUSIONS Catheterization route was not significantly associated with QOL. Though catheterization via channel was associated with fewer bladder symptoms, only degree of current bladder symptoms was significantly associated with bladder-related QOL.
Collapse
Affiliation(s)
- Josephine Hirsch
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - N Valeska Halstead
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - James T Rague
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Soojin Kim
- Division of Urology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Stephanie Kielb
- Division of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jill E Larson
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Vineeta T Swaroop
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Robin M Bowman
- Division of Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Diana K Bowen
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - David I Chu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| |
Collapse
|
2
|
Van Citters AD, Aliaj E, Alvarez JA, Brown CD, Cary J, Cravens R, Frederick CA, Georgiopoulos AM, Goss CH, Kazmerski TM, King JR, Lawrence M, Lovell C, Roman C, Tillman L, Yu E. Wellness in the modulator era: An observational study of the impact of CFTR modulator therapy on the well-being of people with cystic fibrosis. J Cyst Fibros 2024:S1569-1993(24)00779-3. [PMID: 39060182 DOI: 10.1016/j.jcf.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/03/2024] [Accepted: 06/15/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND People with cystic fibrosis (PwCF) have experienced substantial improvements in health following use of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies. However, less is known about how modulator therapies impact well-being. METHODS We used a cross-sectional observational study to identify relationships between CFTR modulator therapies, health-related quality of life (HRQoL), and well-being. Adult PwCF and caregivers of children with CF completed the Wellness in the Modulator Era (Well-ME) survey between June 22 and July 31, 2022. HRQoL was measured with PROMIS Global 10/Global 7 + 2 Parent Proxy. We used a mixed methods analysis to compare experiences and concerns of PwCF who currently (n = 665), no longer (n = 51), or never (n = 184) took modulator therapy. RESULTS Adult PwCF taking a modulator (n = 416) reported better PROMIS global physical health than those who no longer (n = 37) or never took a modulator (n = 94) and better PROMIS global mental health than those who never took a modulator. Caregiver-reported HRQoL was similar across children with CF who currently, no longer, or never took a modulator. PwCF taking a modulator reported larger improvements in physical health, quality of life, social well-being, and treatment burden than those who no longer or never took a modulator. Nearly one-quarter (23 %) of PwCF taking modulator therapy reported worsening of mental well-being. CONCLUSIONS This study expands our knowledge of well-being among PwCF in the CFTR modulator era as reported by patients and parents. Findings lay the groundwork for establishing future research priorities, policy efforts, and communications in areas that improve well-being for PwCF.
Collapse
Affiliation(s)
- Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Level 5 WTRB, One Medical Center Drive, Lebanon, NH, USA.
| | - Enid Aliaj
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD, USA
| | - Jessica A Alvarez
- Division of Endocrinology, Lipids, and Metabolism, Department of Medicine, Emory University, 101 Woodruff Cr NE, Atlanta, GA 30322, USA
| | - Cynthia D Brown
- Indiana University School of Medicine, Division of Pulmonary, Critical Care, Occupational and Sleep Medicine, 1120W. Michigan St, Indianapolis, IN 46202, USA
| | - Jamie Cary
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD, USA
| | - Rachel Cravens
- Community Advisor to the Cystic Fibrosis Foundation, Bethesda, MD, USA
| | - Carla A Frederick
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences of the University of Buffalo, 1001 Main Street, Conventus Building, 4th floor, Buffalo, NY 14023, USA
| | - Anna M Georgiopoulos
- Department of Child and Adolescent Psychiatry, Massachusetts General Hospital, Yawkey 6900, 55 Fruit St., Boston, MA 02114, USA
| | - Christopher H Goss
- Division of Pulmonary, Critical Care, and Sleep Medicine Department of Medicine and Pediatrics, University of Washington Medical Center, Seattle, Washington, United States; Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, University Center, 120 Lytton Avenue, Suite M060, Pittsburgh, PA, USA
| | - Joel R King
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Level 5 WTRB, One Medical Center Drive, Lebanon, NH, USA
| | - Melanie Lawrence
- Community Advisor to the Cystic Fibrosis Foundation, Bethesda, MD, USA
| | - Caitlyn Lovell
- Community Advisor to the Cystic Fibrosis Foundation, Bethesda, MD, USA
| | - Christina Roman
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD, USA
| | - Laura Tillman
- Community Advisor to the Cystic Fibrosis Foundation, Bethesda, MD, USA
| | - Elizabeth Yu
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD, USA
| |
Collapse
|
3
|
Ostojic K, Karem I, Paget S, Berg A, Burnett H, Scott T, Martin T, Dee-Price BJ, McIntyre S, Smithers-Sheedy H, Mimmo L, Masi A, Scarcella M, Azmatullah S, Calderan J, Mohamed M, Olaso A, van Hoek M, van Hoek D, Woodbury M, Wilkinson A, Chambers G, Zwi K, Dale R, Eapen V, Lingam R, Strnadová I, Woolfenden S, Azmatullah S, Berg A, Burnett H, Cadiri M, Calderan J, Chambers G, Dale R, Dee-Price BJ, Rojas DD, Eapen V, Henry G, Karem I, Lingam R, Martin T, Masi A, McIntyre S, Mimmo L, Mohamed M, Olaso A, Ostojic K, Paget S, Scarcella M, Scott T, Shiva S, Smithers-Sheedy H, Stojanovic V, Strnadová I, van Hoek D, van Hoek M, Vasquez J, Wilkinson A, Woodbury M, Woolfenden S, Zacharko J, Zwi K, Wallace S. EPIC-CP pilot trial study protocol: a multicentre, randomised controlled trial investigating the feasibility and acceptability of social prescribing for Australian children with cerebral palsy. BMJ Open 2024; 14:e076304. [PMID: 39002958 PMCID: PMC11255413 DOI: 10.1136/bmjopen-2023-076304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 05/29/2024] [Indexed: 07/15/2024] Open
Abstract
INTRODUCTION The social determinants of health contribute to poorer health outcomes for children with cerebral palsy (CP) and are barriers to families accessing health services. At an individual level, social determinants of health are experienced as unmet social needs, for example, unsafe housing conditions. There is emerging evidence that clinical pathways for the systematic identification and referral to services for unmet social needs can support families to address these needs. These clinical pathways have not been implemented for children with CP. The objectives are to investigate the feasibility and acceptability of two co-designed social needs clinical pathways for parents/caregivers of children with CP-social prescribing (ie, Community Linker plus resource pack) compared with resource pack only. METHODS AND ANALYSIS This pilot randomised controlled trial will run at the three tertiary paediatric rehabilitation services in New South Wales, Australia. A total of 120 participants will be recruited, with randomisation stratified by study site. A survey tool will be used to identify families experiencing unmet social needs. Parents/caregivers who report one or more unmet social need/s and consent will be eligible. The active control group will receive a resource pack containing information on community services to support unmet social needs. The social prescribing intervention group will receive one-on-one Community Linker support, in addition to the resource pack. The survey tool, intervention, logic model, and resource pack were co-designed with patient families and their healthcare workers. Feasibility of the research design and the clinical pathways will be evaluated using the number/proportion of parents/caregivers who complete the survey tool, consent, engage with the intervention, and complete research measures. Acceptability will be evaluated using questionnaires and qualitative interviews. ETHICS AND DISSEMINATION Human research ethics approval was granted by the Sydney Children's Hospitals Network Human Research Ethics Committee (2022/ETH01688). Participants and stakeholders will receive updates and findings via regular communication channels including meetings, presentations, and publications. TRIAL REGISTRATION NUMBER Australia New Zealand Clinical Trials Registry: 12622001459718.
Collapse
Affiliation(s)
- Katarina Ostojic
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
| | - Isra Karem
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
| | - Simon Paget
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Alison Berg
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Heather Burnett
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Timothy Scott
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Tanya Martin
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
| | - Betty-Jean Dee-Price
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Hayley Smithers-Sheedy
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Laurel Mimmo
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Anne Masi
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
| | - Michele Scarcella
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Sheikh Azmatullah
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Jack Calderan
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Masyitah Mohamed
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne Olaso
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew van Hoek
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Debbie van Hoek
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Mackenzie Woodbury
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Alunya Wilkinson
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Georgina Chambers
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
| | - Karen Zwi
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Russell Dale
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
| | - Iva Strnadová
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - EPIC-CP Group
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Sheikh Azmatullah
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Alison Berg
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Heather Burnett
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Mariyam Cadiri
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Jack Calderan
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Georgina Chambers
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Russell Dale
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Betty-Jean Dee-Price
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Delfina Diaz Rojas
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Valsamma Eapen
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Georgina Henry
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Isra Karem
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Raghu Lingam
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Tanya Martin
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Anne Masi
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Sarah McIntyre
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Laurel Mimmo
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Masyitah Mohamed
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Anne Olaso
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Katarina Ostojic
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Simon Paget
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Mick Scarcella
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Timothy Scott
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Shaini Shiva
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Hayley Smithers-Sheedy
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Vesna Stojanovic
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Iva Strnadová
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Debbie van Hoek
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Matthew van Hoek
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Joyce Vasquez
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Alunya Wilkinson
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Mackenzie Woodbury
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Sue Woolfenden
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Janet Zacharko
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Karen Zwi
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Seaneen Wallace
- Community Paediatrics Research Group, Central Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- The Children’s Hospital at Westmead Clinical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- HNEkidsRehab, John Hunter Children's Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Sydney Children's Hospital Randwick, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- EPIC-CP Research Group, The University of Sydney, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| |
Collapse
|
4
|
Zhang X, Blackwell CK, Moore J, Liu SH, Liu C, Forrest CB, Ganiban J, Stroustrup A, Aschner JL, Trasande L, Deoni SCL, Elliott AJ, Angal J, Karr CJ, Lester BM, McEvoy CT, O'Shea TM, Fry RC, Shipp GM, Gern JE, Herbstman J, Carroll KN, Teitelbaum SL, Wright RO, Wright RJ. Associations between neighborhood characteristics and child well-being before and during the COVID-19 pandemic: A repeated cross-sectional study in the Environmental influences on Child Health Outcomes (ECHO) program. ENVIRONMENTAL RESEARCH 2024; 252:118765. [PMID: 38548252 DOI: 10.1016/j.envres.2024.118765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 02/29/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
The corona virus disease (COVID-19) pandemic disrupted daily life worldwide, and its impact on child well-being remains a major concern. Neighborhood characteristics affect child well-being, but how these associations were affected by the pandemic is not well understood. We analyzed data from 1039 children enrolled in the Environmental influences on Child Health Outcomes Program whose well-being was assessed using the Patient-Reported Outcomes Measurement Information System Global Health questionnaire and linked these data to American Community Survey (ACS) data to evaluate the impacts of neighborhood characteristics on child well-being before and during the pandemic. We estimated the associations between more than 400 ACS variables and child well-being t-scores stratified by race/ethnicity (non-Hispanic white vs. all other races and ethnicities) and the timing of outcome data assessment (pre-vs. during the pandemic). Network graphs were used to visualize the associations between ACS variables and child well-being t-scores. The number of ACS variables associated with well-being t-scores decreased during the pandemic period. Comparing non-Hispanic white with other racial/ethnic groups during the pandemic, different ACS variables were associated with child well-being. Multiple ACS variables representing census tract-level housing conditions and neighborhood racial composition were associated with lower well-being t-scores among non-Hispanic white children during the pandemic, while higher percentage of Hispanic residents and higher percentage of adults working as essential workers in census tracts were associated with lower well-being t-scores among non-white children during the same study period. Our study provides insights into the associations between neighborhood characteristics and child well-being, and how the COVID-19 pandemic affected this relationship.
Collapse
Affiliation(s)
- Xueying Zhang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Climate Change, Environmental Health and Exposomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | | | - Shelley H Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chang Liu
- Department of Psychology, Washington State University, WA, USA
| | | | - Jody Ganiban
- Department of Psychological and Brain Sciences, George Washington University, Washington D.C, USA
| | - Annemarie Stroustrup
- Departments of Pediatrics and Occupational Medicine, Epidemiology & Prevention, Zucker School of Medicine at Hofstra / Northwell and Cohen Children's Hospital, New Hyde Park, NY, USA
| | - Judy L Aschner
- Departments of Pediatrics, Hackensack Meridian School of Medicine, Nutley NJ and Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Sean C L Deoni
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Amy J Elliott
- Avera Research Institute and University of South Dakota School of Medicine, Sioux Falls, SD, USA
| | - Jyoti Angal
- Avera Research Institute and University of South Dakota School of Medicine, Sioux Falls, SD, USA
| | - Catherine J Karr
- Department of Environmental and Occupational Health Sciences, University of Washington, WA, USA
| | - Barry M Lester
- Department of Psychiatry and Human Behavior/ Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Cindy T McEvoy
- Department of Pediatrics and Papé Pediatric Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - T Michael O'Shea
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Rebecca C Fry
- Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Gayle M Shipp
- Chareles Stewart Mott Department of Public Health, Michigan State University, MI, USA
| | - James E Gern
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| | - Julie Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, NY, USA
| | - Kecia N Carroll
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Climate Change, Environmental Health and Exposomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susan L Teitelbaum
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Climate Change, Environmental Health and Exposomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Climate Change, Environmental Health and Exposomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rosalind J Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Climate Change, Environmental Health and Exposomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
5
|
Martinelli M, Strisciuglio C, Lu P, Lev MRB, Beinvogl B, Di Lorenzo C, Cenni S, Nurko S, Pearlstein H, Rosen R, Shamir R, Staiano A. Impact of Coronavirus disease 2019 pandemic in children with functional abdominal pain disorders: Data from long-term follow-up. J Pediatr Gastroenterol Nutr 2024; 79:26-34. [PMID: 38698661 DOI: 10.1002/jpn3.12225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/20/2024] [Accepted: 03/22/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE We aimed to compare symptom frequency and severity in children with functional abdominal pain disorders (FAPDs) and to evaluate anxiety, quality of life (QoL) and global health during Coronavirus disease 2019 (COVID-19) related quarantine and after 17 months. METHODS Children diagnosed with FAPDs between October 2019 and February 2020 at 5 different centers were enrolled and prospectively interviewed during the COVID-19 quarantine and 17 months later when schools, hospital services, and routine activities had re-opened to the public. The patients were asked to complete the Rome IV questionnaire, the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) Generic Core Scale, the Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and global health questionnaires. Data about COVID-19 infection and its clinical outcome were also collected. RESULTS Ninety-nine out of 180 (55%) children completed the follow-up. The number of patients reporting a worsening of their symptoms was significantly higher at follow-up when compared to the quarantine period (24/99 [24.2%] vs. 12/99 [12.1%]; p = 0.04). The PedsQL 4.0 subtotal score at follow-up significantly decreased at 17 months of follow-up (65.57 [0-100]) when compared to the quarantine (71 [0-100], p = 0.03). Emotional functioning was the most significantly reduced (Follow-up: 64.7 [0-100] vs. Quarantine: 75 [0-100]; p = 0.006). We did not identify significant differences in symptoms and QoL between COVID-19 infected children and the remaining cohort at the two time points. CONCLUSIONS An improvement of symptoms and QoL was observed during the quarantine, followed by a worsening at-follow-up. These findings reinforce the hypothesis that the nest effect overweighted COVID-19 fears during the quarantine and highlight the importance of psychological factors in symptom exacerbation.
Collapse
Affiliation(s)
- Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Peter Lu
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Michal Rozenfeld Bar Lev
- Institute of Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Petach Tikvah, Israel
| | - Beate Beinvogl
- Boston Children's Hospital, Harvard medical School, Boston, Massachusetts, USA
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sabrina Cenni
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Samuel Nurko
- Boston Children's Hospital, Harvard medical School, Boston, Massachusetts, USA
| | - Haley Pearlstein
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Rachel Rosen
- Boston Children's Hospital, Harvard medical School, Boston, Massachusetts, USA
| | - Raanan Shamir
- Institute of Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Petach Tikvah, Israel
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| |
Collapse
|
6
|
Gross RS, Thaweethai T, Rosenzweig EB, Chan J, Chibnik LB, Cicek MS, Elliott AJ, Flaherman VJ, Foulkes AS, Gage Witvliet M, Gallagher R, Gennaro ML, Jernigan TL, Karlson EW, Katz SD, Kinser PA, Kleinman LC, Lamendola-Essel MF, Milner JD, Mohandas S, Mudumbi PC, Newburger JW, Rhee KE, Salisbury AL, Snowden JN, Stein CR, Stockwell MS, Tantisira KG, Thomason ME, Truong DT, Warburton D, Wood JC, Ahmed S, Akerlundh A, Alshawabkeh AN, Anderson BR, Aschner JL, Atz AM, Aupperle RL, Baker FC, Balaraman V, Banerjee D, Barch DM, Baskin-Sommers A, Bhuiyan S, Bind MAC, Bogie AL, Bradford T, Buchbinder NC, Bueler E, Bükülmez H, Casey BJ, Chang L, Chrisant M, Clark DB, Clifton RG, Clouser KN, Cottrell L, Cowan K, D’Sa V, Dapretto M, Dasgupta S, Dehority W, Dionne A, Dummer KB, Elias MD, Esquenazi-Karonika S, Evans DN, Faustino EVS, Fiks AG, Forsha D, Foxe JJ, Friedman NP, Fry G, Gaur S, Gee DG, Gray KM, Handler S, Harahsheh AS, Hasbani K, Heath AC, Hebson C, Heitzeg MM, Hester CM, Hill S, Hobart-Porter L, Hong TKF, Horowitz CR, Hsia DS, Huentelman M, Hummel KD, Irby K, Jacobus J, Jacoby VL, Jone PN, Kaelber DC, Kasmarcak TJ, Kluko MJ, Kosut JS, Laird AR, Landeo-Gutierrez J, Lang SM, Larson CL, Lim PPC, Lisdahl KM, McCrindle BW, McCulloh RJ, McHugh K, Mendelsohn AL, Metz TD, Miller J, Mitchell EC, Morgan LM, Müller-Oehring EM, Nahin ER, Neale MC, Ness-Cochinwala M, Nolan SM, Oliveira CR, Osakwe O, Oster ME, Payne RM, Portman MA, Raissy H, Randall IG, Rao S, Reeder HT, Rosas JM, Russell MW, Sabati AA, Sanil Y, Sato AI, Schechter MS, Selvarangan R, Sexson Tejtel SK, Shakti D, Sharma K, Squeglia LM, Srivastava S, Stevenson MD, Szmuszkovicz J, Talavera-Barber MM, Teufel RJ, Thacker D, Trachtenberg F, Udosen MM, Warner MR, Watson SE, Werzberger A, Weyer JC, Wood MJ, Yin HS, Zempsky WT, Zimmerman E, Dreyer BP. Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design. PLoS One 2024; 19:e0285635. [PMID: 38713673 PMCID: PMC11075869 DOI: 10.1371/journal.pone.0285635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/14/2023] [Indexed: 05/09/2024] Open
Abstract
IMPORTANCE The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. OBSERVATIONS We describe the protocol for the Pediatric Observational Cohort Study of the NIH's REsearching COVID to Enhance Recovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of four cohorts that comprise RECOVER-Pediatrics: 1) a de novo RECOVER prospective cohort of children and young adults with and without previous or current infection; and 2) an extant cohort derived from the Adolescent Brain Cognitive Development (ABCD) study (n = 10,000). The de novo cohort incorporates three tiers of data collection: 1) remote baseline assessments (Tier 1, n = 6000); 2) longitudinal follow-up for up to 4 years (Tier 2, n = 6000); and 3) a subset of participants, primarily the most severely affected by PASC, who will undergo deep phenotyping to explore PASC pathophysiology (Tier 3, n = 600). Youth enrolled in the ABCD study participate in Tier 1. The pediatric protocol was developed as a collaborative partnership of investigators, patients, researchers, clinicians, community partners, and federal partners, intentionally promoting inclusivity and diversity. The protocol is adaptive to facilitate responses to emerging science. CONCLUSIONS AND RELEVANCE RECOVER-Pediatrics seeks to characterize the clinical course, underlying mechanisms, and long-term effects of PASC from birth through 25 years old. RECOVER-Pediatrics is designed to elucidate the epidemiology, four-year clinical course, and sociodemographic correlates of pediatric PASC. The data and biosamples will allow examination of mechanistic hypotheses and biomarkers, thus providing insights into potential therapeutic interventions. CLINICAL TRIALS.GOV IDENTIFIER Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT05172011.
Collapse
Affiliation(s)
- Rachel S. Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Erika B. Rosenzweig
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York, United States of America
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Lori B. Chibnik
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Mine S. Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Rochester, Minnesota, United States of America
| | - Amy J. Elliott
- Avera Research Institute, Avera Health, Sioux Falls, South Dakota, United States of America
| | - Valerie J. Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, California, United States of America
| | - Andrea S. Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Margot Gage Witvliet
- Department of Sociology, Lamar University, Beaumont, Texas, United States of America
| | - Richard Gallagher
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Maria Laura Gennaro
- Public Health Research Institute and Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Terry L. Jernigan
- Center for Human Development, Department of Cognitive Science, University of California San Diego, San Diego, California, United States of America
- Departments of Psychiatry and Radiology, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Elizabeth W. Karlson
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stuart D. Katz
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Patricia A. Kinser
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Lawrence C. Kleinman
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Michelle F. Lamendola-Essel
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Joshua D. Milner
- Division of Pediatric Allergy, Department of Pediatrics, Immunology and Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York, United States of America
| | - Sindhu Mohandas
- Department of Infectious Diseases, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Praveen C. Mudumbi
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Kyung E. Rhee
- Division of Child and Community Health, Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Amy L. Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Jessica N. Snowden
- Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Cheryl R. Stein
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York, United States of America
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Kelan G. Tantisira
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Moriah E. Thomason
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Dongngan T. Truong
- Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, Utah, United States of America
| | - David Warburton
- Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Shifa Ahmed
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Almary Akerlundh
- Department of Pulmonary Research, Rady Children’s Hospital-San Diego, San Diego, California, United States of America
| | - Akram N. Alshawabkeh
- College of Engineering, Northeastern University, Boston, Massachusetts, United States of America
| | - Brett R. Anderson
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York, United States of America
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Andrew M. Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Robin L. Aupperle
- Oxley College of Health Sciences, Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
| | - Fiona C. Baker
- Department of Biosciences, SRI International, Menlo Park, California, United States of America
| | - Venkataraman Balaraman
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, United States of America
| | - Dithi Banerjee
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, Missouri, United States of America
| | - Deanna M. Barch
- Department of Psychiatry, Washington University in St. Louis, Saint Louis, Missouri, United States of America
| | - Arielle Baskin-Sommers
- Department of Psychology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Sultana Bhuiyan
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Marie-Abele C. Bind
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Amanda L. Bogie
- Department of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, United States of America
| | - Tamara Bradford
- Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of New Orleans and LSU Health Sciences Center, New Orleans, United States of America
| | - Natalie C. Buchbinder
- Center for Human Development, University of California San Diego, San Diego, California, United States of America
| | - Elliott Bueler
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Hülya Bükülmez
- Division of Rheumatology, Department of Pediatrics, The MetroHealth System, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - B. J. Casey
- Department of Neuroscience and Behavior, Barnard College—Columbia University, New York, New York, United States of America
| | - Linda Chang
- Departments of Diagnostic Radiology & Nuclear Medicine and Neurology, University of Maryland Baltimore, Baltimore, Maryland, United States of America
| | - Maryanne Chrisant
- Department of Women’s and Children’s Health, Charles E. Schmidt College of Medicine at Florida Atlantic University, Hollywood, Florida, United States of America
| | - Duncan B. Clark
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Rebecca G. Clifton
- Biostatistics Center, George Washington University, Washington, DC, United States of America
| | - Katharine N. Clouser
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University, Morgantown, West Virginia, United States of America
| | - Kelly Cowan
- Department of Pediatrics, Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, Vermont, United States of America
| | - Viren D’Sa
- Department of Pediatrics, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, United States of America
| | - Soham Dasgupta
- Department of Pediatrics, Norton Children’s Hospital, University of Louisville, Louisville, Kentucky, United States of America
| | - Walter Dehority
- Division of Infectious Diseases, Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Audrey Dionne
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Kirsten B. Dummer
- Department of Pediatrics, University of California San Diego, San Diego, California, United States of America
| | - Matthew D. Elias
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Shari Esquenazi-Karonika
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Danielle N. Evans
- Arkansas Children’s Research Institute, Arkansas Children’s Hospital, Little Rock, Arkansas, United States of America
| | - E. Vincent S. Faustino
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Alexander G. Fiks
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Daniel Forsha
- Department of Cardiology, Children’s Mercy Kansas City, Ward Family Heart Center, Kansas City, Missouri, United States of America
| | - John J. Foxe
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Naomi P. Friedman
- Institute for Behavioral Genetics and Department of Psychology and Neuroscience, University of Colorado Boulder, Bolder, Colorado, United States of America
| | - Greta Fry
- Pennington Biomedical Research Center Clinic, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Sunanda Gaur
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Dylan G. Gee
- Department of Psychology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Stephanie Handler
- Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Ashraf S. Harahsheh
- Division of Cardiology, Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, United States of America
| | - Keren Hasbani
- Division of Pediatric Cardiology, Department of Pediatrics, Dell Children’s Medical Center, Dell Medical School, Austin, Texas, United States of America
| | - Andrew C. Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, United States of America
| | - Camden Hebson
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Mary M. Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Christina M. Hester
- Division of Practice-Based Research, Innovation, & Evaluation, American Academy of Family Physicians, Leawood, Kansas, United States of America
| | - Sophia Hill
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Laura Hobart-Porter
- Departments of Pediatrics and Physical Medicine & Rehabilitation, Section of Pediatric Rehabilitation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Travis K. F. Hong
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, United States of America
| | - Carol R. Horowitz
- Center for Health Equity and Community Engaged Research and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Daniel S. Hsia
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Matthew Huentelman
- Division of Neurogenomics, Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Kathy D. Hummel
- Department of Pediatrics, Arkansas Children’s Hospital, University of Arkansas Medical School, Little Rock, Arkansas, United States of America
| | - Katherine Irby
- Department of Pediatrics, Arkansas Children’s Hospital, University of Arkansas Medical School, Little Rock, Arkansas, United States of America
| | - Joanna Jacobus
- Department of Psychiatry, University of California San Diego, San Diego, California, United States of America
| | - Vanessa L. Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Pei-Ni Jone
- Department of Pediatrics, Pediatric Cardiology, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - David C. Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System and the Departments of Pediatrics, Internal Medicine, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
- Departments of Pediatrics, Internal Medicine, and Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Tyler J. Kasmarcak
- Department of Pediatric Clinical Research, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Matthew J. Kluko
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Jessica S. Kosut
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, United States of America
| | - Angela R. Laird
- Department of Physics, Florida International University, Miami, Florida, United States of America
| | - Jeremy Landeo-Gutierrez
- Respiratory Medicine Division, Department of Pediatrics, University of California San Diego, San Diego, California, United States of America
| | - Sean M. Lang
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Christine L. Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States of America
| | - Peter Paul C. Lim
- Department of Pediatric Infectious Disease, Avera McKennan University Health Center, University of South Dakota, Sioux Falls, South Dakota, United States of America
| | - Krista M. Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States of America
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Russell J. McCulloh
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Kimberly McHugh
- Department of Pediatric Clinical Research, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Alan L. Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Torri D. Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Julie Miller
- Carelon Research, Newton, Massachusetts, United States of America
| | - Elizabeth C. Mitchell
- Division of Pediatric Cardiology, Department of Pediatrics, Cohen Children’s Medical Center (Northwell Health), New Hyde Park, New York, United States of America
| | - Lerraughn M. Morgan
- Department of Pediatrics, Valley Children’s Healthcare, Madera, California, United States of America
| | - Eva M. Müller-Oehring
- Department of Biosciences, SRI International, Menlo Park, California, United States of America
| | - Erica R. Nahin
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Michael C. Neale
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Manette Ness-Cochinwala
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Sheila M. Nolan
- Department of Pediatrics, New York Medical College, Valhalla, New York, United States of America
| | - Carlos R. Oliveira
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Onyekachukwu Osakwe
- Division of Pediatric Cardiology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Matthew E. Oster
- Department of Pediatric Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
| | - R. Mark Payne
- Division of Pediatric Cardiology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Michael A. Portman
- Division of Cardiology, Department of Pediatrics, Seattle Children’s and University of Washington, Seattle, Washington, United States of America
| | - Hengameh Raissy
- Department of Pediatrics, University of New Mexico, Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Isabelle G. Randall
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Suchitra Rao
- Division of Infectious Diseases, Department of Pediatrics, Epidemiology and Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Harrison T. Reeder
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Johana M. Rosas
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Mark W. Russell
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, United States of America
| | - Arash A. Sabati
- Department of Pediatric Cardiology, Phoenix Children’s Hospital, Phoenix, Arizona, United States of America
| | - Yamuna Sanil
- Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, Michigan, United States of America
| | - Alice I. Sato
- Department of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Michael S. Schechter
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, Missouri, United States of America
| | - S. Kristen Sexson Tejtel
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
| | - Divya Shakti
- Division of Pediatric Cardiology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Kavita Sharma
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Shubika Srivastava
- Division of Cardiovascular Medicine, Department of Pediatric Cardiology, Nemours Children’s Health, Wilmington, Delaware, United States of America
| | - Michelle D. Stevenson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, United States of America
| | - Jacqueline Szmuszkovicz
- Division of Cardiology, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Maria M. Talavera-Barber
- Department of Pediatrics, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, United States of America
| | - Ronald J. Teufel
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Deepika Thacker
- Division of Cardiovascular Medicine, Department of Pediatric Cardiology, Nemours Children’s Health, Wilmington, Delaware, United States of America
| | | | - Mmekom M. Udosen
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Megan R. Warner
- Department of Pulmonary Research, Rady Children’s Hospital-San Diego, San Diego, California, United States of America
| | - Sara E. Watson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, United States of America
| | - Alan Werzberger
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America
| | - Jordan C. Weyer
- Center for Individualized Medicine, Mayo Clinic Hospital, Rochester, Minnesota, United States of America
| | - Marion J. Wood
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - H. Shonna Yin
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - William T. Zempsky
- Department of Pediatrics, Connecticut Children’s Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut, United States of America
| | - Emily Zimmerman
- Department of Communication Sciences & Disorders, Northeastern University, Boston, Massachusetts, United States of America
| | - Benard P. Dreyer
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, United States of America
| | | |
Collapse
|
7
|
Palermo TM, Li R, Birnie KA, Crombez G, Eccleston C, Kashikar-Zuck S, Stone AL, Walco GA. Updated recommendations on measures for clinical trials in pediatric chronic pain: a multiphase approach from the Core Outcomes in Pediatric Persistent Pain (Core-OPPP) Workgroup. Pain 2024; 165:1086-1100. [PMID: 38112633 PMCID: PMC11017748 DOI: 10.1097/j.pain.0000000000003105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/09/2023] [Accepted: 08/31/2023] [Indexed: 12/21/2023]
Abstract
ABSTRACT Many gaps remain in finding effective, safe, and equitable treatments for children and adolescents with chronic pain and in accessing treatments in different settings. A major goal of the field is to improve assessment of pain and related experience. Valid and reliable patient-reported outcome measures are critical for advancing knowledge of clinical interventions for pediatric chronic pain. Building on the work of the Ped-IMMPACT group, we previously updated a core outcome set (COS) for pediatric chronic pain clinical trials using stakeholder feedback from providers, youth, and parents. The new COS includes 3 mandatory domains: pain severity, pain-related interference with daily living, and adverse events and 4 optional domains: overall well-being, emotional functioning, physical functioning, and sleep quality. The aim of this study was to use a multiphased approach to recommend specific measures for each of the 7 domains identified in our new COS for pediatric chronic pain. We synthesized evidence through conducting the following: (1) a Delphi study of experts to identify candidate measures for the new COS domains, (2) a review phase to gather evidence for measurement properties for candidate measures, and (3) an expert consensus conference to reach agreement on measurement recommendations. Final recommendations included 9 patient-reported measures. Important contextual considerations are discussed, and guidance is provided regarding strengths and limitations of the recommendations. Implementation of these recommendations may be enhanced by widespread dissemination and ease of access to measurement tools.
Collapse
Affiliation(s)
- Tonya M. Palermo
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine Seattle, WA, United States
| | - Rui Li
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Kathryn A. Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary Calgary, AB, Canada
| | - Geert Crombez
- Department of Experimental Clinical Psychology and Health Psychology, Ghent University, Ghent, Belgium
| | | | - Susmita Kashikar-Zuck
- University of Cincinnati, Department of Pediatrics, Cincinnati, OH, United States
- Cincinnati Children's Hospital Medical Center Cincinnati, OH, United States
| | - Amanda L. Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Gary A. Walco
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine Seattle, WA, United States
| |
Collapse
|
8
|
Edward J, Northrip KD, Rayens MK, Welker A, O’Farrell R, Knuf J, Fariduddin H, Costich J, D’Orazio J. Financial-legal navigation reduces financial toxicity of pediatric, adolescent, and young adult cancers. JNCI Cancer Spectr 2024; 8:pkae025. [PMID: 38552323 PMCID: PMC11087728 DOI: 10.1093/jncics/pkae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/12/2024] [Accepted: 03/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Pediatric, adolescent, and young adult patients with cancer and their caregivers are at high risk of financial toxicity, and few evidence-based oncology financial and legal navigation programs exist to address it. We tested the feasibility, acceptability, and preliminary effectiveness of Financial and Insurance Navigation Assistance, a novel interdisciplinary financial and legal navigation intervention for pediatric, adolescent and young adult patients and their caregivers. METHODS We used a single-arm feasibility and acceptability trial design in a pediatric hematology and oncology clinic and collected preintervention and postintervention surveys to assess changes in financial toxicity (3 domains: psychological response/Comprehensive Score for Financial Toxicity [COST], material conditions, and coping behaviors); health-related quality of life (Patient-Reported Outcomes Measurement Information System Physical and Mental Health, Anxiety, Depression, and Parent Proxy scales); and perceived feasibility, acceptability, and appropriateness. RESULTS In total, 45 participants received financial navigation, 6 received legal navigation, and 10 received both. Among 15 adult patients, significant improvements in FACIT-COST (P = .041) and physical health (P = .036) were noted. Among 46 caregivers, significant improvements were noted for FACIT-COST (P < .001), the total financial toxicity score (P = .001), and the parent proxy global health score (P = .0037). We were able to secure roughly $335 323 in financial benefits for 48 participants. The intervention was rated highly for feasibility, acceptability, and appropriateness. CONCLUSIONS Integrating financial and legal navigation through Financial and Insurance Navigation Assistance was feasible and acceptable and underscores the benefit of a multidisciplinary approach to addressing financial toxicity. CLINICALTRIALS.GOV REGISTRATION NCT05876325.
Collapse
Affiliation(s)
- Jean Edward
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Kimberly D Northrip
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Andrea Welker
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Rachel O’Farrell
- Danceblue Pediatric Hematology Oncology Clinic, Kentucky Children’s Hospital, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Jennifer Knuf
- Danceblue Pediatric Hematology Oncology Clinic, Kentucky Children’s Hospital, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Haafsah Fariduddin
- Markey STRONG, Markey Cancer Center, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Julia Costich
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - John D’Orazio
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Danceblue Pediatric Hematology Oncology Clinic, Kentucky Children’s Hospital, University of Kentucky HealthCare, Lexington, Kentucky, USA
| |
Collapse
|
9
|
Mansolf M, Blackwell CK, Cella D, Lai JS. Assessing the interchangeability of linked scores in multivariable statistical analyses. Qual Life Res 2024; 33:1121-1131. [PMID: 38294666 PMCID: PMC10978247 DOI: 10.1007/s11136-023-03592-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE Using the lens of classical test theory, we examine a linkage's generalizability with respect to use in multivariable analyses, including multiple regression and structural equation modeling, rather than comparison of established subpopulations as is most common in the literature. METHODS To aid in this evaluation, we present a structural-equation-modeling based statistical method to examine the suitability of a given linkage for use cases involving continuous and categorical variables external to the linkage itself. RESULTS Using the PROMIS® Parent Proxy and Early Childhood Global Health measures, we show that, although a high correlation between the scores (here, r = .829) may imply a general suitability for linking, a more detailed investigation of content, measurement structure, and results of the proposed methodology reveal important differences between the measures which can compromise interchangeability in certain use cases. CONCLUSION In addition to the statistical quality of a linkage, users of linking methodology should also assess the question of whether the linkage is appropriate to apply to particular use cases of interest.
Collapse
Affiliation(s)
- Maxwell Mansolf
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave Fl 27, Chicago, IL, 60611, USA.
| | - Courtney K Blackwell
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave Fl 27, Chicago, IL, 60611, USA
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave Fl 27, Chicago, IL, 60611, USA
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave Fl 27, Chicago, IL, 60611, USA
| |
Collapse
|
10
|
Horn TC, Lundine JP, Busch TA, Benkart RA, Taylor HG, Koterba CH. Long-Term Outcomes of Pediatric Traumatic Brain Injury Following Inpatient Rehabilitation. J Head Trauma Rehabil 2024; 39:E95-E104. [PMID: 38529909 DOI: 10.1097/htr.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVE Assess residual disability in youth with traumatic brain injury (TBI) treated in a pediatric inpatient rehabilitation unit and examine associations of disability with inpatient status and measures of concurrent functioning. SETTING Large, urban, quaternary care children's hospital in the Midwestern United States. PARTICIPANTS Forty-five youth aged 6 to 18 years treated in an inpatient rehabilitation unit for mild-complicated to severe TBI at a minimum of 12 months postdischarge (mean = 3.5 years). DESIGN Retrospective chart review of clinical data collected from standard clinical care at admission and discharge combined with follow-up data examining current functioning at the time of study enrollment. MAIN OUTCOME MEASURES Glasgow Outcome Scale-Extended, Pediatric Revision (GOS-E Peds), Neurology Quality of Life Measurement System Short Form (NeuroQOL) Social Interaction with Peers and Cognitive Short Forms, Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale, Strengths and Difficulties Questionnaire, and the Behavior Rating Inventory of Executive Function, 2nd Edition (BRIEF-2). RESULTS Based on parent report at follow-up, 62% of the children had residual TBI-related disabilities on the GOS-E Peds, while 38% reported "good recovery." Children with residual disability also reported more long-term problems in overall health, social relationships, emotional regulation, behaviors, and executive functioning than those with no residual disability. Measures of functional independence and cognitive recovery at discharge were associated with these impairments. CONCLUSIONS More than half of the children with TBI in this study had residual disability more than 1 year after inpatient rehabilitation. Findings highlight the associations between measures of functional independence and cognitive recovery during inpatient rehabilitation with later outcomes and underscore the need for continued services to support the needs of children with TBI following their inpatient rehabilitation stay.
Collapse
Affiliation(s)
- Timothy C Horn
- Author Affiliations: Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio (Messrs Horn and Busch, Ms Benkart, and Drs Taylor and Koterba); Departments of Speech & Hearing Science (Dr Lundine) and Pediatrics (Drs Taylor and Koterba), The Ohio State University, Columbus; and Division of Clinical Therapies & Inpatient Rehabilitation, Nationwide Children's Hospital, Columbus, Ohio (Drs Lundine and Koterba)
| | | | | | | | | | | |
Collapse
|
11
|
Valeska Halstead N, Hirsch J, Rosoklija I, Rague JT, Kim S, Meyer T, Larson JE, Swaroop VT, Bowman RM, Bowen DK, Kielb S, Cheng EY, Yerkes EB, Chu DI. Association Between Quality of Life and Neurogenic Bowel Symptoms by Bowel Management Program in Spina Bifida. Urology 2024; 184:228-234. [PMID: 38159612 PMCID: PMC10922677 DOI: 10.1016/j.urology.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To compare differences in bowel-specific quality of life (QOL), overall qQOL, and neurogenic bowel dysfunction (NBD) severity by bowel management program in patients with spina bifida (SB). METHODS We performed a retrospective cross-sectional study of patients ≥12 years old at our multidisciplinary SB center who completed both a modified Peristeen NBD questionnaire (assessing bowel symptom severity and bowel-specific QOL) and the Patient-Reported Outcomes Measurement Information System Pediatric Global Health questionnaire (assessing overall QOL). Nested, multivariable models were fit for associations between outcomes and bowel management program (enemas, conservative management, and none). RESULTS A total of 173 patients, 56.1% female and 64.6% with myelomeningocele, were included in our analysis. Median age was 18.2 years old. Patients reported using enemas (n = 42), conservative management (n = 63), and no bowel program (n = 68). When adjusting for covariates, there was no significant association between bowel-specific QOL nor overall QOL across bowel management programs. However, the use of conservative management compared to enemas was associated with worse bowel symptoms severity (adjusted beta=2.58, 95%CI=[0.09,5.06]). Additionally, greater bowel symptom severity was significantly associated with lower overall QOL (adjusted beta=-0.33, 95%CI=[-0.57,-0.10]). CONCLUSION NBD symptom severity in SB is more strongly associated with QOL than the individual bowel program being utilized. Our findings suggest that different degrees of NBD require different invasiveness of bowel programs, but it is the outcome of the bowel management program and not the specific program itself that is most associated with QOL.
Collapse
Affiliation(s)
| | - Josephine Hirsch
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - James T Rague
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Soojin Kim
- Department of Urological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Jill E Larson
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Vineeta T Swaroop
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Robin M Bowman
- Division of Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Diana K Bowen
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Stephanie Kielb
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - David I Chu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| |
Collapse
|
12
|
Li R, Gibler RC, Rheel E, Slack K, Palermo TM. Recommendations for Patient-Reported Outcomes Measurement Information System pediatric measures in youth with chronic pain: a COnsensus-based Standards for the selection of health Measurement INstruments systematic review of measurement properties. Pain 2024; 165:258-295. [PMID: 37530676 DOI: 10.1097/j.pain.0000000000002998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/14/2023] [Indexed: 08/03/2023]
Abstract
ABSTRACT The Patient-Reported Outcome Measurement Information System (PROMIS) pediatric measures assess physical, emotional, and social health among children and adolescents. However, their measurement properties have not been systematically examined in youth with chronic pain. A systematic review applying the COnsensus based Standards for the selection of health Measurement INstruments (COSMIN) methodology was conducted to evaluate self-reported PROMIS pediatric measures in youth with chronic pain, assessing 8 measurement properties across all versions (item bank, short form, and computer adaptive testing) from 63 studies covering 25 measures. Moderate or high-quality evidence was most available for content validity, structural validity, internal consistency (measurement precision), and construct validity. Four short-form PROMIS pediatric measures-mobility, anxiety, depressive symptoms, and physical stress experiences-achieved recommendation for the use in chronic pain clinical trials; 7 approached recommendation and 14, including the commonly used PROMIS Pediatric Pain Interference Scale, would be recommended with further evidence. Recommendations were also provided for the use of each measure in observational studies. Overall, based on the existing evidence, a total of 11 self-reported PROMIS pediatric short-form measures, including pain intensity, pain behavior, mobility, sleep disturbance, sleep-related impairment, anxiety, depressive symptoms, psychological stress experiences, physical stress experiences, family relationships, and positive effect, are recommended or approaching recommendation for use in youth ages 8 to 19 years with chronic pain. Research is needed to further establish test-retest reliability, measurement errors, cross-cultural validity, and responsiveness. Future work should expand the evaluation of PROMIS pediatric measures in subpopulations of youth with chronic pain, particularly young children and those with neurodevelopmental disabilities.
Collapse
Affiliation(s)
- Rui Li
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Robert C Gibler
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Emma Rheel
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Katherine Slack
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Tonya M Palermo
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| |
Collapse
|
13
|
Rhodes ET, Phan TLT, Earley ER, Eneli I, Haemer MA, Highfield NC, Khan S, Kim G, Kirk S, Sullivan EM, Stoll JM, Werk LN, Zeribi KA, Forrest CB, Lannon C. Patient-Reported Outcomes to Describe Global Health and Family Relationships in Pediatric Weight Management. Child Obes 2024; 20:1-10. [PMID: 36827448 PMCID: PMC10790547 DOI: 10.1089/chi.2022.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Background: Patient-reported outcomes (PROs) can assess chronic health. The study aims were to pilot a survey through the PEDSnet Healthy Weight Network (HWN), collecting PROs in tertiary care pediatric weight management programs (PWMP) in the United States, and demonstrate that a 50% enrollment rate was feasible; describe PROs in this population; and explore the relationship between child/family characteristics and PROs. Methods: Participants included 12- to 18-year-old patients and parents of 5- to 18-year-olds receiving care at PWMP in eight HWN sites. Patient-Reported Outcomes Measurement Information System (PROMIS®) measures assessed global health (GH), fatigue, stress, and family relationships (FR). T-score cut points defined poor GH or FR or severe fatigue or stress. Generalized estimating equations explored relationships between patient/family characteristics and PROMIS measures. Results: Overall, 63% of eligible parents and 52% of eligible children enrolled. Seven sites achieved the goal enrollment for parents and four for children. Participants included 1447 children. By self-report, 44.6% reported poor GH, 8.6% poor FR, 9.3% severe fatigue, and 7.6% severe stress. Multiple-parent household was associated with lower odds of poor GH by parent proxy report [adjusted odds ratio (aOR) 0.69, 95% confidence interval (CI) 0.55-0.88] and poor FR by self-report (aOR 0.36, 95% CI 0.17-0.74). Parents were significantly more likely to report that the child had poor GH and poor FR when a child had multiple households. Conclusions: PROs were feasibly assessed across the HWN, although implementation varied by site. Nearly half of the children seeking care in PWMP reported poor GH, and family context may play a role. Future work may build on this pilot to show how PROs can inform clinical care in PWMP.
Collapse
Affiliation(s)
- Erinn T. Rhodes
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - Thao-Ly T. Phan
- Department of General Pediatrics, Nemours Children's Health System/Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Elizabeth R. Earley
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ihuoma Eneli
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Matthew A. Haemer
- Section of Nutrition, Department of Pediatrics, University of Colorado, Denver, CO, USA
| | | | - Saba Khan
- The Healthy Weight Program and Policy Lab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Grace Kim
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- The Heart Institute and Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Janis M. Stoll
- Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Lloyd N. Werk
- Department of Pediatrics, Nemours Children's Hospital, Orlando, FL, USA
| | - Karen Askov Zeribi
- Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher B. Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Carole Lannon
- Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
14
|
Keenan HT, Wade SL, Miron D, Presson AP, Clark AE, Ewing-Cobbs L. Reducing Stress after Trauma (ReSeT): study protocol for a randomized, controlled trial of an online psychoeducational program and video therapy sessions for children hospitalized after trauma. Trials 2023; 24:766. [PMID: 38017574 PMCID: PMC10683223 DOI: 10.1186/s13063-023-07806-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Post-traumatic stress symptoms develop in a quarter to half of injured children affecting their longer-term psychologic and physical health. Evidence-based care exists for post-traumatic stress; however, it is not readily available in some communities. We have developed an eHealth program consisting of online, interactive educational modules and telehealth therapist support based in trauma-focused cognitive behavioral therapy, the Reducing Stress after Trauma (ReSeT) program. We hypothesize that children with post-traumatic stress who participate in ReSeT will have fewer symptoms compared to the usual care control group. METHODS This is a randomized controlled trial to test the effectiveness of the ReSeT intervention in reducing symptoms of post-traumatic stress compared to a usual care control group. One hundred and six children ages 8-17 years, who were admitted to hospital following an injury, with post-traumatic stress symptoms at 4 weeks post-injury, will be recruited and randomized from the four participating trauma centers. The outcomes compared across groups will be post-traumatic stress symptoms at 10 weeks (primary outcome) controlling for baseline symptoms and at 6 months post-randomization (secondary outcome). DISCUSSION ReSeT is an evidence-based program designed to reduce post-traumatic stress symptoms among injured children using an eHealth platform. Currently, the American College of Surgeons standards suggest that trauma programs identify and treat patients at high risk for mental health needs in the trauma system. If effectiveness is demonstrated, ReSeT could help increase access to evidence-based care for children with post-traumatic stress within the trauma system. TRIAL REGISTRATION ClinicalTrials.gov NCT04838977. 8 April 2021.
Collapse
Affiliation(s)
- Heather T Keenan
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA.
| | - Shari L Wade
- Cincinnati Children's Hospital Medical Center Division of Pediatric Rehabilitation, Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Devi Miron
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave. #8055, New Orleans, LA, 70112, USA
| | - Angela P Presson
- Department of Internal Medicine, University of Utah School of Medicine, 30 N Mario Capecchi Dr. , Salt Lake City, UT, 84112, USA
| | - Amy E Clark
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Linda Ewing-Cobbs
- Children's Learning Institute, McGovern Medical School at UTHealth, 7000 Fannin, Suite 2401, Houston, TX, 77030, USA
| |
Collapse
|
15
|
Pignolo RJ, Al Mukaddam M, Baujat G, Brown MA, De Cunto C, Hsiao EC, Keen R, Le Quan Sang KH, Grogan DR, Marino R, Strahs AR, Kaplan FS. Study methodology and insights from the palovarotene clinical development program in fibrodysplasia ossificans progressiva. BMC Med Res Methodol 2023; 23:269. [PMID: 37957586 PMCID: PMC10642058 DOI: 10.1186/s12874-023-02080-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The design of clinical trials in rare diseases is often complicated by a lack of real-world translational knowledge. Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare genetic disorder characterized by skeletal malformations and progressive heterotopic ossification (HO). Palovarotene is a selective retinoic acid receptor gamma agonist. Here, we describe the methodology of three studies in the palovarotene clinical development program in FOP and discuss insights that could inform future research, including endpoint suitability and the impact of trial design. METHODS PVO-1A-001 (NCT02322255) was a prospective, protocol-specified, longitudinal FOP natural history study (NHS). PVO-1A-201 (NCT02190747) was a randomized, double-blind, placebo-controlled phase II trial; PVO-1A-202 (NCT02279095) was its open-label extension. Trial designs, including treatment regimens and imaging assessments, were refined between PVO-1A-201 and PVO-1A-202, and within PVO-1A-202, based on emerging data as the studies progressed. Palovarotene doses were administered using a flare-up treatment regimen (higher dose for 2/4 weeks, followed by lower dose for 4/≥8 weeks; from flare-up onset), with or without accompanying chronic (daily) treatment. Flare-up and disease progression outcomes were assessed, including incidence and volume of new HO during flare-ups and/or annually, as well as other clinical, patient-reported, and exploratory outcomes. Safety was monitored throughout all studies. RESULTS Overall, 114 and 58 individuals with FOP were enrolled in the NHS and phase II trials, respectively. Results of the NHS and PVO-1A-201 were published in 2022; complete results of PVO-1A-202 will be publicly available in due course. Together the studies yielded important information on endpoint suitability, including that low-dose whole-body computed tomography was the optimum imaging modality for assessing HO progression annually and that long study durations are needed to detect substantial changes in functional and patient-reported outcomes. CONCLUSIONS A flexible clinical development program is necessary for underexplored rare diseases to overcome the many challenges faced. Here, the NHS provided a longitudinal evaluation of FOP progression and interventional trials were based on emerging data. The studies described informed the design and endpoints implemented in the phase III MOVE trial (NCT03312634) and provide a foundation for future clinical trial development. TRIAL REGISTRATION NCT02322255 (registered 23/12/2014); NCT02190747 (registered 15/07/2014); NCT02279095 (registered 30/10/2014).
Collapse
Affiliation(s)
| | - Mona Al Mukaddam
- Departments of Orthopedic Surgery & Medicine, The Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - Geneviève Baujat
- Département de Génétique, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, Université Paris Cité, Paris, France
| | - Matthew A Brown
- Faculty of Life Sciences and Medicine, King's College London, and Genomics England Ltd, London, UK
| | - Carmen De Cunto
- Pediatric Rheumatology Section, Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Edward C Hsiao
- Division of Endocrinology and Metabolism, the UCSF Metabolic Bone Clinic, the Eli and Edythe Broad Institute for Regeneration Medicine, and the Institute of Human Genetics, Department of Medicine, and the UCSF Program in Craniofacial Biology, University of California-San Francisco, San Francisco, CA, US
| | - Richard Keen
- Centre for Metabolic Bone Disease, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Kim-Hanh Le Quan Sang
- Département de Génétique, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, Université Paris Cité, Paris, France
| | | | | | | | - Frederick S Kaplan
- Departments of Orthopedic Surgery & Medicine, The Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| |
Collapse
|
16
|
Miller VA, Miller C, Davis SM, Nokoff NJ, Buchanan C, Friedrich EA, Carl A, Strine S, Vogiatzi MG. Information needs and health status in adolescents and young adults with differences of sex development or sex chromosome aneuploidies. J Pediatr Urol 2023; 19:586-595. [PMID: 37308330 DOI: 10.1016/j.jpurol.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION When and how to provide condition-related information to adolescents and young adults (AYAs) with differences of sex development or sex chromosome aneuploidies (DSDs or SCAs) is largely based on anecdotal experience and lacks informed guidance. For AYAs with a DSD or SCA, having accurate information is critical for attaining optimal adjustment and well-being, participating in decision making related to treatment options, and transitioning successfully to adult health care, yet prior studies have focused exclusively on parental perspectives and not on the views of adolescents themselves. OBJECTIVE The objective of this study was to describe unmet information needs in AYAs with a DSD or SCA and examine associations with perceived global health. METHODS Participants were recruited from specialty clinics at Children's Hospital of Philadelphia (n = 20) and Children's Hospital Colorado (n = 60). AYAs ages 12-21 years with a DSD or SCA and a parent completed a survey assessing perceived information needs across 20 topics, importance of those topics, and global health using the PROMIS Pediatric Global Health questionnaire (PGH-7). RESULTS AYAs had diagnoses of Klinefelter syndrome (41%), Turner syndrome (25%), and DSD (26%) and were 16.7 years (SD = 2.56) and 44% female. Parent participants were primarily mothers (81%). AYAs perceived that 48.09% of their information needs were unmet (SD = 25.18, range: 0-100). Parents perceived that 55.31% of AYAs' information needs were unmet (SD = 27.46 range: 5-100). AYAs and parents across conditions reported unmet needs related to information about transition to adult health care, financial support for medical care, and how the condition might affect the AYA's health in the future. While AYA-reported PGH-7 scores were not associated with percentage of AYA unmet information needs, parent-reported PGH-7 scores were (r = -.46, p < .001), such that lower parent-reported global health was associated with higher percentage of AYA unmet information needs. DISCUSSION/CONCLUSION On average, parents and AYAs perceived that half of AYAs' information needs were unmet, and a higher percentage of AYA unmet information needs was associated with lower perceived global health. The frequency of unmet needs in this sample of AYAs reflects an opportunity for improvement in clinical care. Future research is needed to understand how education to children and AYAs unfolds as they mature and to develop strategies to address the information needs of AYAs with a DSD or SCA, promote well-being, and facilitate AYA engagement in their own health care.
Collapse
Affiliation(s)
- Victoria A Miller
- Division of Adolescent Medicine, HUB, 3500 Civic Center Blvd., Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Christina Miller
- Graduate Program in Genetic Counseling, University of Colorado Anschutz Medical Campus, 13001 East 17th Place, W5107, Aurora, CO, 80045, USA
| | - Shanlee M Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO, 80045, USA
| | - Natalie J Nokoff
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO, 80045, USA
| | - Cindy Buchanan
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO, 80045, USA
| | - Elizabeth A Friedrich
- Division of Adolescent Medicine, HUB, 3500 Civic Center Blvd., Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Alexandra Carl
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO, 80045, USA
| | - Sophia Strine
- Division of Endocrinology and Diabetes, HUB, 3500 Civic Center Blvd., Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Maria G Vogiatzi
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Endocrinology and Diabetes, HUB, 3500 Civic Center Blvd., Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| |
Collapse
|
17
|
Engels G, Oechsle AL, Schlegtendal A, Maier C, Holzwarth S, Streng A, Lange B, Karch A, Petersmann A, Streeck H, Blaschke-Steinbrecher S, Härtel C, Schroten H, von Kries R, Berner R, Liese J, Brinkmann F, Toepfner N. SARS-CoV-2 sero-immunity and quality of life in children and adolescents in relation to infections and vaccinations: the IMMUNEBRIDGE KIDS cross-sectional study, 2022. Infection 2023; 51:1531-1539. [PMID: 37280412 PMCID: PMC10243264 DOI: 10.1007/s15010-023-02052-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/13/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The study evaluates the effects on sero-immunity, health status and quality of life of children and adolescents after the upsurge of the Omicron variant in Germany. METHODS This multicenter cross-sectional study (IMMUNEBRIDGE Kids) was conducted within the German Network University Medicine (NUM) from July to October 2022. SARS-CoV-2- antibodies were measured and data on SARS-CoV-2 infections, vaccinations, health and socioeconomic factors as well as caregiver-reported evaluation on their children's health and psychological status were assessed. RESULTS 497 children aged 2-17 years were included. Three groups were analyzed: 183 pre-schoolchildren aged 2-4 years, 176 schoolchildren aged 5-11 years and 138 adolescents aged 12-18 years. Positive antibodies against the S- or N-antigen of SARS-CoV-2 were detected in 86.5% of all participants (70.0% [128/183] of pre-schoolchildren, 94.3% of schoolchildren [166/176] and 98.6% of adolescents [136/138]). Among all children, 40.4% (201/497) were vaccinated against COVID-19 (pre-schoolchildren 4.4% [8/183], schoolchildren 44.3% [78/176] and adolescents 83.3% [115/138]). SARS-CoV-2 seroprevalence was lowest in pre-school. Health status and quality of life reported by the parents were very positive at the time of the survey (Summer 2022). CONCLUSION Age-related differences on SARS-CoV-2 sero-immunity could mainly be explained by differences in vaccination rates based on the official German vaccination recommendations as well as differences in SARS-CoV-2 infection rates in the different age groups. Health status and quality of life of almost all children were very good independent of SARS-CoV-2 infection and/or vaccination. TRIAL REGISTRATION German Registry for Clinical Trials Identifier Würzburg: DRKS00025546 (registration: 11.09.2021), Bochum: DRKS00022434 (registration:07.08.2020), Dresden: DRKS 00022455 (registration: 23.07.2020).
Collapse
Affiliation(s)
- Geraldine Engels
- Department of Pediatrics, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Anna-Lisa Oechsle
- Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, LMU Munich, Haydnstraße 5, 80336, Munich, Germany
| | - Anne Schlegtendal
- Children's Hospital, Ruhr University of Bochum, Alexandrinenstrasse 5, 44791, Bochum, Germany
| | - Christoph Maier
- Children's Hospital, Ruhr University of Bochum, Alexandrinenstrasse 5, 44791, Bochum, Germany
| | - Sarah Holzwarth
- Department of Pediatrics, Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Fetscherstr. 74, 01307, Dresden, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Berit Lange
- Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124, Brunswick, Germany
- German Centre for Infection Research (DZIF), TI BBD, Brunswick, Germany
| | - Andre Karch
- Institute for Epidemiology and Social Medicine, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Astrid Petersmann
- Institute for Clinical Chemistry and Laboratory Medicine, University Oldenburg, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany
- Institute for Clinical Chemistry and Laboratory Medicine, University of Greifswald, Ferdinand-Sauerbruchstrasse, 17475, Greifwald, Germany
| | - Hendrik Streeck
- Institute of Virology, University Hospital, University of Bonn, Venusberg-Campus 1, Gebäude 63, 53127, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Brunswick, Germany
| | | | - Christoph Härtel
- Department of Pediatrics, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Horst Schroten
- Pediatric Infectious Diseases, Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Rüdiger von Kries
- Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, LMU Munich, Haydnstraße 5, 80336, Munich, Germany
| | - Reinhard Berner
- Department of Pediatrics, Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Fetscherstr. 74, 01307, Dresden, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Folke Brinkmann
- Children's Hospital, Ruhr University of Bochum, Alexandrinenstrasse 5, 44791, Bochum, Germany
- Department of Pediatrics, University of Lübeck, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Nicole Toepfner
- Department of Pediatrics, Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Fetscherstr. 74, 01307, Dresden, Germany.
| |
Collapse
|
18
|
Bouffet E, Hansford JR, Garrè ML, Hara J, Plant-Fox A, Aerts I, Locatelli F, van der Lugt J, Papusha L, Sahm F, Tabori U, Cohen KJ, Packer RJ, Witt O, Sandalic L, Bento Pereira da Silva A, Russo M, Hargrave DR. Dabrafenib plus Trametinib in Pediatric Glioma with BRAF V600 Mutations. N Engl J Med 2023; 389:1108-1120. [PMID: 37733309 DOI: 10.1056/nejmoa2303815] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND Detection of the BRAF V600E mutation in pediatric low-grade glioma has been associated with a lower response to standard chemotherapy. In previous trials, dabrafenib (both as monotherapy and in combination with trametinib) has shown efficacy in recurrent pediatric low-grade glioma with BRAF V600 mutations, findings that warrant further evaluation of this combination as first-line therapy. METHODS In this phase 2 trial, patients with pediatric low-grade glioma with BRAF V600 mutations who were scheduled to receive first-line therapy were randomly assigned in a 2:1 ratio to receive dabrafenib plus trametinib or standard chemotherapy (carboplatin plus vincristine). The primary outcome was the independently assessed overall response (complete or partial response) according to the Response Assessment in Neuro-Oncology criteria. Also assessed were the clinical benefit (complete or partial response or stable disease for ≥24 weeks) and progression-free survival. RESULTS A total of 110 patients underwent randomization (73 to receive dabrafenib plus trametinib and 37 to receive standard chemotherapy). At a median follow-up of 18.9 months, an overall response occurred in 47% of the patients treated with dabrafenib plus trametinib and in 11% of those treated with chemotherapy (risk ratio, 4.31; 95% confidence interval [CI], 1.7 to 11.2; P<0.001). Clinical benefit was observed in 86% of the patients receiving dabrafenib plus trametinib and in 46% receiving chemotherapy (risk ratio, 1.88; 95% CI, 1.3 to 2.7). The median progression-free survival was significantly longer with dabrafenib plus trametinib than with chemotherapy (20.1 months vs. 7.4 months; hazard ratio, 0.31; 95% CI, 0.17 to 0.55; P<0.001). Grade 3 or higher adverse events occurred in 47% of the patients receiving dabrafenib plus trametinib and in 94% of those receiving chemotherapy. CONCLUSIONS Among pediatric patients with low-grade glioma with BRAF V600 mutations, dabrafenib plus trametinib resulted in significantly more responses, longer progression-free survival, and a better safety profile than standard chemotherapy as first-line therapy. (Funded by Novartis; ClinicalTrials.gov number, NCT02684058.).
Collapse
Affiliation(s)
- Eric Bouffet
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Jordan R Hansford
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Maria Luisa Garrè
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Junichi Hara
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Ashley Plant-Fox
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Isabelle Aerts
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Franco Locatelli
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Jasper van der Lugt
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Ludmila Papusha
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Felix Sahm
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Uri Tabori
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Kenneth J Cohen
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Roger J Packer
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Olaf Witt
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Larissa Sandalic
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Ana Bento Pereira da Silva
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Mark Russo
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Darren R Hargrave
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| |
Collapse
|
19
|
Ming DY, Wong W, Jones KA, Antonelli RC, Gujral N, Gonzales S, Rogers U, Ratliff W, Shah N, King HA. Feasibility of Implementation of a Mobile Digital Personal Health Record to Coordinate Care for Children and Youth With Special Health Care Needs in Primary Care: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46847. [PMID: 37728977 PMCID: PMC10551780 DOI: 10.2196/46847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Electronic health record (EHR)-integrated digital personal health records (PHRs) via Fast Healthcare Interoperability Resources (FHIR) are promising digital health tools to support care coordination (CC) for children and youth with special health care needs but remain widely unadopted; as their adoption grows, mixed methods and implementation research could guide real-world implementation and evaluation. OBJECTIVE This study (1) evaluates the feasibility of an FHIR-enabled digital PHR app for CC for children and youth with special health care needs, (2) characterizes determinants of implementation, and (3) explores associations between adoption and patient- or family-reported outcomes. METHODS This nonrandomized, single-arm, prospective feasibility trial will test an FHIR-enabled digital PHR app's use among families of children and youth with special health care needs in primary care settings. Key app features are FHIR-enabled access to structured data from the child's medical record, families' abilities to longitudinally track patient- or family-centered care goals, and sharing progress toward care goals with the child's primary care provider via a clinician dashboard. We shall enroll 40 parents or caregivers of children and youth with special health care needs to use the app for 6 months. Inclusion criteria for children and youth with special health care needs are age 0-16 years; primary care at a participating site; complex needs benefiting from CC; high hospitalization risk in the next 6 months; English speaking; having requisite technology at home (internet access, Apple iOS mobile device); and an active web-based EHR patient portal account to which a parent or caregiver has full proxy access. Digital prescriptions will be used to disseminate study recruitment materials directly to eligible participants via their existing EHR patient portal accounts. We will apply an intervention mixed methods design to link quantitative and qualitative (semistructured interviews and family engagement panels with parents of children and youth with special health care needs) data and characterize implementation determinants. Two CC frameworks (Pediatric Care Coordination Framework; Patient-Centered Medical Home) and 2 evaluation frameworks (Consolidated Framework for Implementation Research; Technology Acceptance Model) provide theoretical foundations for this study. RESULTS Participant recruitment began in fall 2022, before which we identified >300 potentially eligible patients in EHR data. A family engagement panel in fall 2021 generated formative feedback from family partners. Integrated analysis of pretrial quantitative and qualitative data informed family-centered enhancements to study procedures. CONCLUSIONS Our findings will inform how to integrate an FHIR-enabled digital PHR app for children and youth with special health care needs into clinical care. Mixed methods and implementation research will help strengthen implementation in diverse clinical settings. The study is positioned to advance knowledge of how to use digital health innovations for improving care and outcomes for children and youth with special health care needs and their families. TRIAL REGISTRATION ClinicalTrials.gov NCT05513235; https://clinicaltrials.gov/study/NCT05513235. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46847.
Collapse
Affiliation(s)
- David Y Ming
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Willis Wong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Richard C Antonelli
- Department of Pediatrics, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, United States
| | - Nitin Gujral
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Sarah Gonzales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Ursula Rogers
- AI Health, Duke University School of Medicine, Durham, NC, United States
| | - William Ratliff
- Duke Institute for Health Innovation, Duke University School of Medicine, Durham, NC, United States
| | - Nirmish Shah
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Heather A King
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veteran Affairs Health Care System, Durham, NC, United States
| |
Collapse
|
20
|
Lorthe E, Richard V, Dumont R, Loizeau A, Perez-Saez J, Baysson H, Zaballa ME, Lamour J, Pullen N, Schrempft S, Barbe RP, Posfay-Barbe KM, Guessous I, Stringhini S. Socioeconomic conditions and children's mental health and quality of life during the COVID-19 pandemic: An intersectional analysis. SSM Popul Health 2023; 23:101472. [PMID: 37560087 PMCID: PMC10407575 DOI: 10.1016/j.ssmph.2023.101472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Children and adolescents are highly vulnerable to the impact of sustained stressors during developmentally sensitive times. We investigated how demographic characteristics intersect with socioeconomic dimensions to shape the social patterning of quality of life and mental health in children and adolescents, two years into the COVID-19 pandemic. METHODS We used data from the prospective SEROCoV-KIDS cohort study of children and adolescents living in Geneva (Switzerland, 2022). We conducted an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy by nesting participants within 48 social strata defined by intersecting sex, age, immigrant background, parental education and financial hardship in Bayesian multilevel logistic models for poor health-related quality of life (HRQoL, measured with PedsQL) and mental health difficulties (measured with the Strengths and Difficulties Questionnaire). RESULTS Among participants aged 2-17 years, 240/2096 (11.5%, 95%CI 10.1-12.9) had poor HRQoL and 105/2135 (4.9%, 95%CI 4.0-5.9) had mental health difficulties. The predicted proportion of poor HRQoL ranged from 3.4% for 6-11 years old Swiss girls with highly educated parents and no financial hardship to 34.6% for 12-17 years old non-Swiss girls with highly educated parents and financial hardship. Intersectional strata involving adolescents and financial hardship showed substantially worse HRQoL than their counterparts. Between-stratum variations in the predicted frequency of mental health difficulties were limited (range 4.4%-6.5%). CONCLUSIONS We found considerable differences in adverse outcomes across social strata. Our results suggest that, post-pandemic, interventions to address social inequities in HRQoL should focus on specific intersectional strata involving adolescents and families experiencing financial hardship, while those aiming to improve mental health should target all children and adolescents.
Collapse
Affiliation(s)
- Elsa Lorthe
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics Paris (CRESS), Paris, France
| | - Viviane Richard
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Roxane Dumont
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Andrea Loizeau
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Javier Perez-Saez
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Hélène Baysson
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Maria-Eugenia Zaballa
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Julien Lamour
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nick Pullen
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stephanie Schrempft
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Rémy P. Barbe
- Division of Child and Adolescent Psychiatry, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Klara M. Posfay-Barbe
- Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Pediatrics, Gynecology & Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Idris Guessous
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
21
|
Santoro SL, Haugen K, Donelan K, Skotko BG. Global health measures from a National Down Syndrome Registry. Am J Med Genet A 2023; 191:2092-2099. [PMID: 37183579 PMCID: PMC10526626 DOI: 10.1002/ajmg.a.63243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
People with Down syndrome (DS) have a unique medical profile which may impact views of health. We aimed to study the use of global health measures for DS in a national cohort. We prospectively surveyed parents of individuals with DS from the DS-Connect® registry with validated Patient Reported Outcomes Measurement Information System (PROMIS)® instruments of global health. Analyses included use of scoring manuals and the PROMIS® scoring service, descriptive statistics, and t-tests. We received completed surveys from 223 parents of individuals with DS; previously published limitations of the instrument in this population were shown again. T-scores differed from the available comparative standardized scores to these measures from PROMIS® reference population on Fatigue (p < 0.001) and Global Health (p < 0.001), but not on Pain Interference (p = 0.41).
Collapse
Affiliation(s)
- Stephanie L. Santoro
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelsey Haugen
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen Donelan
- Health Policy Research Center, The Mongan Institute, Survey Research Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Institute of Healthcare Systems, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Brian G. Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
22
|
Teela L, Luijten MA, Kuijlaars IA, van Gastel TC, van Hoorn ES, Gouw SC, Fijnvandraat KC, Fischer K, Cnossen MH, Andeweg S, van der Velden – van ‘t Hoff C, Liem C, Jansen-Zijlstra ME, Peters M, Haverman L. Psychometrics of the patient-reported outcomes measurement information system measures in hemophilia: the applicability of the pediatric item banks. Res Pract Thromb Haemost 2023; 7:102159. [PMID: 37753226 PMCID: PMC10518485 DOI: 10.1016/j.rpth.2023.102159] [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: 05/02/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 09/28/2023] Open
Abstract
Background The use of patient-reported outcomes measures (PROMs) is important in hemophilia care, as it facilitates communication between patients and clinicians and promotes patient-centered care. Currently, a variety of PROMs with insufficient psychometric properties are used. Patient-reported outcomes measurement information system (PROMIS) measures, including Computer Adaptive Tests, were designed to measure generically and more efficiently and, therefore, are an alternative for the existing PROMs. Objectives To assess the feasibility, measurement properties, and outcomes of 8 PROMIS pediatric measures for boys with hemophilia. Methods In this multicenter study, boys with hemophilia completed 8 PROMIS measures and 2 legacy instruments. Feasibility was determined by the number of completed items and floor or ceiling effects (percentage of participants that achieved the lowest or highest possible score). Reliability was assessed as the percentage of scores with a SE ≤ 4.5. Construct validity was evaluated by comparing the PROMIS measures with the legacy instruments. Mean PROMIS T-scores were calculated and compared with the Dutch general population. Results In total, 77 boys with hemophilia participated. Reliability was good for almost all PROMIS measures and legacy instruments. The total number of completed items varied from 49 to 90 for the PROMIS pediatric measures, while the legacy instruments contained 117 to 130 items. Floor and ceiling effects were observed in both the PROMIS measures (0-39.5%) and legacy instruments (0-66.7%), but were higher for the legacy instruments. Conclusions The PROMIS pediatric measures are feasible to use for boys with hemophilia. With the use of the PROMIS measures in clinical care and research, a step toward worldwide standardization of PROM administration can be taken.
Collapse
Affiliation(s)
- Lorynn Teela
- Amsterdam UMC location University of Amsterdam, Emma Children’s Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental health and Digital health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child development, Amsterdam, The Netherlands
| | - Michiel A.J. Luijten
- Amsterdam UMC location University of Amsterdam, Emma Children’s Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child development, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental health and Methodology, Amsterdam, The Netherlands
- Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Isolde A.R. Kuijlaars
- Centre for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tessa C.M. van Gastel
- Amsterdam UMC location University of Amsterdam, Emma Children’s Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child development, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental health and Health Behaviours & Chronic Diseases, Amsterdam, The Netherlands
| | - Evelien S. van Hoorn
- Department of Public Health, Erasmus MC, Erasmus University Medical Centre Rotterdam, The Netherlands
| | - Samantha C. Gouw
- Amsterdam UMC location University of Amsterdam, Emma Children’s Hospital, Paediatric Haematology, Amsterdam, The Netherlands
| | - Karin C.J. Fijnvandraat
- Amsterdam UMC location University of Amsterdam, Emma Children’s Hospital, Paediatric Haematology, Amsterdam, The Netherlands
| | - Kathelijn Fischer
- Centre for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marjon H. Cnossen
- Department of Paediatric Haematology, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Centre Rotterdam, The Netherlands
| | - Sasja Andeweg
- Department of Paediatric Haematology, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Centre Rotterdam, The Netherlands
| | | | - Corinne Liem
- Department of Pediatric Haemato-Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Marjolein Peters
- Amsterdam UMC location University of Amsterdam, Emma Children’s Hospital, Paediatric Haematology, Amsterdam, The Netherlands
| | - Lotte Haverman
- Amsterdam UMC location University of Amsterdam, Emma Children’s Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental health and Digital health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child development, Amsterdam, The Netherlands
| |
Collapse
|
23
|
Amaral S, Schuchard J, Claes D, Dart A, Greenbaum LA, Massengill SF, Atkinson MA, Flynn JT, Dharnidharka VR, Fathallah-Shaykh S, Yadin O, Modi ZJ, Al-Uzri A, Wilson AC, Dell KM, Patel HP, Bruno C, Warady B, Furth S, Forrest CB. Patient-Reported Outcomes Over 24 Months in Pediatric CKD: Findings From the MyKidneyHealth Cohort Study. Am J Kidney Dis 2023; 82:213-224.e1. [PMID: 36889426 PMCID: PMC10440290 DOI: 10.1053/j.ajkd.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/24/2022] [Indexed: 03/08/2023]
Abstract
RATIONALE & OBJECTIVE The lived experience of children with chronic kidney disease (CKD) is poorly characterized. We examined the associations between patient-reported outcome (PRO) scores measuring their fatigue, sleep health, psychological distress, family relationships, and global health with clinical outcomes over time in children, adolescents, and younger adults with CKD and investigated how the PRO scores of this group compare with those of other children, adolescents, and younger adults. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 212 children, adolescentss, and adults aged 8 to 21 years with CKD and their parents recruited from 16 nephrology programs across North America. PREDICTORS CKD stage, disease etiology, and sociodemographic and clinical variables. OUTCOME PRO scores over 2 years. ANALYTICAL APPROACH We compared PRO scores in the CKD sample with a nationally representative general pediatric population (ages 8 to 17 years). Change of PROs over time and association of sociodemographic and clinical variables with PROs were assessed using multivariable regression models. RESULTS For all time points, 84% of the parents and 77% of the children, adolescents, and younger adults completed PRO surveys . The baseline PRO scores for the participants with CKD revealed a higher burden of fatigue, sleep-related impairment, psychological distress, impaired global health, and poorer family relationships compared with the general pediatric population, with median score differences≥1 SD for fatigue and global health. The baseline PRO scores did not differ by CKD stage or glomerular versus nonglomerular etiology. Over 2 years, PROs were stable with a<1-point annual change on average on each measure and intraclass correlation coefficients ranging from 0.53 to 0.79, indicating high stability. Hospitalization and parent-reported sleep problems were associated with worse fatigue, psychological health, and global health scores (all P<0.04). LIMITATIONS We were unable to assess responsiveness to change with dialysis or transplant. CONCLUSIONS Children with CKD experience a high yet stable burden of impairment across numerous PRO measures, especially fatigue and global health, independent of disease severity. These findings underscore the importance of assessing PROs, including fatigue and sleep measures, in this vulnerable population. PLAIN-LANGUAGE SUMMARY Children with chronic kidney disease (CKD) have many treatment demands and experience many systemic effects. How CKD impacts the daily life of a child is poorly understood. We surveyed 212 children, adolescents, and younger adults with CKD and their parents over 24 months to assess the participants' well-being over time. Among children, adolescents, and younger adults with CKD we found a very high and persistent burden of psychological distress that did not differ by degree of CKD or type of kidney disease. The participants with CKD endorsed greater impairment in fatigue and global health compared with healthy children, adolescents, and younger adults, and parent-reported sleep problems were associated with poorer patient-reported outcome (PRO) scores across all domains. These findings emphasize the importance of including PRO measures, including fatigue and sleep measures, into routine clinical care to optimize the lived experience of children with CKD.
Collapse
Affiliation(s)
- Sandra Amaral
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Julia Schuchard
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Donna Claes
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Larry A Greenbaum
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Susan F Massengill
- Department of Pediatrics, Levine Children's Hospital at Atrium, Charlotte, North Carolina
| | - Meredith A Atkinson
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Joseph T Flynn
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; Division of Nephrology, Seattle Children's Hospital, Seattle, Washington
| | - Vikas R Dharnidharka
- Department of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri; St. Louis Children's Hospital, St. Louis, Missouri
| | | | - Ora Yadin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, California
| | - Zubin J Modi
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Amira Al-Uzri
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Amy C Wilson
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Katherine M Dell
- Department of Pediatrics, Cleveland Clinic Children's and Case Western Reserve University, Cleveland, Ohio
| | - Hiren P Patel
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Cortney Bruno
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bradley Warady
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Susan Furth
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
24
|
Forsythe E, Mallya UG, Yang M, Huber C, Cala ML, Greatsinger A, Hagopian E, Pomeroy J, Haqq AM. Burden of hyperphagia and obesity in Bardet-Biedl syndrome: a multicountry survey. Orphanet J Rare Dis 2023; 18:182. [PMID: 37415189 DOI: 10.1186/s13023-023-02723-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/11/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Signs and symptoms of Bardet-Biedl syndrome (BBS) occur during early childhood, progress over time, and place substantial, multifaceted burden on patients and their caregivers. Hyperphagia may be a contributing factor to early-onset obesity in BBS; however, there are limited insights into its impacts on patients and caregivers. We quantified disease burden as it relates to the physical and emotional impacts of hyperphagia in BBS. METHODS The CAREgiver Burden in BBS (CARE-BBS) study was a multicountry, cross-sectional survey of adult caregivers of patients with BBS who have had hyperphagia and obesity. The survey consisted of questionnaires including Symptoms of Hyperphagia, Impacts of Hyperphagia, Impact of Weight on Quality of Life (IWQOL)-Kids Parent Proxy, and Patient-Reported Outcome Measurement Information System (PROMIS) v1.0-Global Health 7. In addition, clinical characteristics, medical history, and weight management questions were included. Outcomes were scored and summarized descriptively in aggregate and by country, age, and obesity severity according to weight class. RESULTS There were 242 caregivers of patients with BBS who completed the survey. Caregivers observed hyperphagic behaviors throughout the day, with negotiating for food (90%) and waking up and asking or looking for food during the night (88%) being the most frequent. Hyperphagia had at least a moderate negative impact on most patients' mood/emotions (56%), sleep (54%), school (57%), leisure (62%), and familial relationships (51%). Hyperphagia affected concentration at school (78%), and symptoms of BBS contributed to patients missing ≥ 1 day of school a week (82%). Responses from the IWQOL-Kids Parent Proxy suggested obesity most greatly negatively affected physical comfort (mean [standard deviation (SD)], 41.7 [17.2]), body esteem (41.0 [17.8]), and social life (41.7 [18.0]). On the PROMIS questionnaire, mean (SD) global health score for pediatric patients with BBS and overweight or obesity (36.8 [10.6]) was lower than the general population (mean, 50). CONCLUSIONS Evidence from this study suggests that hyperphagia and obesity may have broad negative impacts on the lives of patients with BBS, including physical health, emotional well-being, school performance, and personal relationships. Therapies that target hyperphagia may alleviate the extensive clinical and nonclinical impacts experienced by patients with BBS and their caregivers.
Collapse
Affiliation(s)
- Elizabeth Forsythe
- Clinical Genetics Department, Guy's Hospital, and National Bardet-Biedl Syndrome Clinics, Great Ormond Street and St Thomas' Hospitals, London, UK
| | | | | | | | | | | | | | - Jeremy Pomeroy
- Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Andrea M Haqq
- Department of Pediatrics, University of Alberta, 8440 - 112 St NW, Edmonton, AB, T6G 2B7, Canada.
| |
Collapse
|
25
|
Welsh JA, Pyo E, Huneault H, Gonzalez Ramirez L, Alazraki A, Alli R, Dunbar SB, Khanna G, Knight-Scott J, Pimentel A, Reed B, Rodney-Somersall C, Santoro N, Umpierrez G, Vos MB. Study protocol for a randomized, controlled trial using a novel, family-centered diet treatment to prevent nonalcoholic fatty liver disease in Hispanic children. Contemp Clin Trials 2023; 129:107170. [PMID: 37019180 PMCID: PMC10734403 DOI: 10.1016/j.cct.2023.107170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the leading liver disorder among U.S. children and is most prevalent among Hispanic children with obesity. Previous research has shown that reducing the consumption of free sugars (added sugars + naturally occurring sugars in fruit juice) can reverse liver steatosis in adolescents with NAFLD. This study aims to determine if a low-free sugar diet (LFSD) can prevent liver fat accumulation and NAFLD in high-risk children. METHODS In this randomized controlled trial, we will enroll 140 Hispanic children aged 6 to 9 years who are ≥50th percentile BMI and without a previous diagnosis of NAFLD. Participants will be randomly assigned to either an experimental (LFSD) or a control (usual diet + educational materials) group. The one-year intervention includes removal of foods high in free sugars from the home at baseline, provision of LFSD household groceries for the entire family (weeks 1-4, 12, 24, and 36), dietitian-guided family grocery shopping sessions (weeks 12, 24, and 36), and ongoing education and motivational interviewing to promote LFSD. Both groups complete assessment measures at baseline, 6, 12, 18, and 24 months. Primary study outcomes are percent hepatic fat at 12 months and incidence of clinically significant hepatic steatosis (>5%) + elevated liver enzymes at 24 months. Secondary outcomes include metabolic markers potentially mediating or moderating NAFLD pathogenesis. DISCUSSION This protocol describes the rationale, eligibility criteria, recruitment strategies, analysis plan as well as a novel dietary intervention design. Study results will inform future dietary guidelines for pediatric NAFLD prevention. TRIAL REGISTRATION ClinicalTrials.gov, NCT05292352.
Collapse
Affiliation(s)
- J A Welsh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - E Pyo
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - H Huneault
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - L Gonzalez Ramirez
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - A Alazraki
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - R Alli
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - S B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - G Khanna
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Jack Knight-Scott
- Department of Radiology, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - A Pimentel
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Grady Memorial Hospital, Atlanta, GA, United States
| | - B Reed
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - C Rodney-Somersall
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Grady Memorial Hospital, Atlanta, GA, United States
| | - N Santoro
- Department of Pediatrics, Kansas Medical Center, Kansas City, KS, United States; Department of Medicine and Health Sciences, "V.Tiberio" University of Molise, Campobasso, Italy; Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - G Umpierrez
- Grady Memorial Hospital, Atlanta, GA, United States; Division of Endocrinology, Metabolism, Emory University School of Medicine, Atlanta, GA, United States
| | - M B Vos
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States.
| |
Collapse
|
26
|
Sullivan GA, Huang LW, Schäfer WLA, Tian Y, Reiter AJ, Essner B, Hu A, Ingram MC, Balbale S, Johnson JK, Holl JL, Raval MV. Association of Multimodal Pain Control with Patient-Reported Outcomes in Children Undergoing Surgery. J Pediatr Surg 2023; 58:1206-1212. [PMID: 36948934 PMCID: PMC10198874 DOI: 10.1016/j.jpedsurg.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Our aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs). METHODS Data were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models. RESULTS Among 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11-0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10-0.70), and both in combination (RRR:0.08, 95% CI:0.02-0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL. CONCLUSION Use of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Gwyneth A Sullivan
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Lynn Wei Huang
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Willemijn L A Schäfer
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yao Tian
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Audra J Reiter
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bonnie Essner
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Andrew Hu
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Martha C Ingram
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Salva Balbale
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Julie K Johnson
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane L Holl
- Biological Sciences Division, Department of Neurology, Center for Healthcare Delivery Science and Innovation, University of Chicago, IL, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
27
|
Addala A, Wong JJ, Penaranda RM, Hanes SJ, Abujaradeh H, Adams RN, Barley RC, Iturralde E, Lanning MS, Tanenbaum ML, Naranjo D, Hood KK. Expanding the use of patient-reported outcomes (PROs): Screening youth with type 1 diabetes from underrepresented populations. J Diabetes Complications 2023; 37:108514. [PMID: 37263033 DOI: 10.1016/j.jdiacomp.2023.108514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/31/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
AIM Youth from lower socioeconomic status (SES) have suboptimal type 1 diabetes (T1D) outcomes. Patient reported outcomes (PROs) measure psychosocial states and are associated with T1D outcomes, however are understudied in low SES youth. We aimed to evaluate associations between PROs and public insurance status, a proxy for low SES. METHODS We analyzed survey data from 129 youth with T1D (age 15.7 ± 2.3 years, 33 % publicly insured) screened with PROMIS Global Health (PGH, measuring global health) and Patient Health Questionnaire (PHQ-9, measuring depressive symptoms) during diabetes appointments. Correlation and regression analyses evaluated differences in PGH and PHQ-9 by insurance status. RESULTS For youth with public insurance, lower global health correlated with lower self-monitoring blood glucose (SMBG; r = 0.38,p = 0.033) and older age (r = -0.45,p = 0.005). In youth with private insurance, lower global health correlated with lower SMBG (r = 0.27,p = 0.018) and female sex (rho = 0.26,p = 0.015). For youth with private insurance, higher depressive symptoms correlated with higher body mass index (r = 0.22,p = 0.03) and fewer SMBG (r = -0.35,p = 0.04). In multivariate regression analyses, public insurance was inversely associated with global health (p = 0.027). CONCLUSION PGH is a particularly salient PRO in youth with public insurance. Global health may be an important psychosocial factor to assess in youth with T1D from low SES backgrounds.
Collapse
Affiliation(s)
- Ananta Addala
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States; Stanford Diabetes Research Center, United States.
| | - Jessie J Wong
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | | | - Sarah J Hanes
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | | | - Rebecca N Adams
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | - Regan C Barley
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, United States
| | - Monica S Lanning
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | - Molly L Tanenbaum
- Stanford Diabetes Research Center, United States; Stanford University School of Medicine, Department of Medicine, Division of Endocrinology, Gerontology, and Metabolism, United States
| | - Diana Naranjo
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | - Korey K Hood
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| |
Collapse
|
28
|
Kulikov VN, Crosthwaite PC, Hall SA, Flannery JE, Strauss GS, Vierra EM, Koepsell XL, Lake JI, Padmanabhan A. A CBT-based mobile intervention as an adjunct treatment for adolescents with symptoms of depression: a virtual randomized controlled feasibility trial. Front Digit Health 2023; 5:1062471. [PMID: 37323125 PMCID: PMC10262850 DOI: 10.3389/fdgth.2023.1062471] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/27/2023] [Indexed: 06/17/2023] Open
Abstract
Background High rates of adolescent depression demand for more effective, accessible treatment options. A virtual randomized controlled trial was used to assess the feasibility and acceptability of a 5-week, self-guided, cognitive behavioral therapy (CBT)-based mobile application, Spark, compared to a psychoeducational mobile application (Active Control) as an adjunct treatment for adolescents with depression during the COVID-19 pandemic. Methods A community sample aged 13-21, with self-reported symptoms of depression, was recruited nationwide. Participants were randomly assigned to use either Spark or Active Control (NSpark = 35; NActive Control = 25). Questionnaires, including the PHQ-8 measuring depression symptoms, completed before, during, and immediately following completion of the intervention, evaluated depressive symptoms, usability, engagement, and participant safety. App engagement data were also analyzed. Results 60 eligible adolescents (female = 47) were enrolled in 2 months. 35.6% of those expressing interest were consented and all enrolled. Study retention was high (85%). Spark users rated the app as usable (System Usability Scalemean = 80.67) and engaging (User Engagement Scale-Short Formmean = 3.62). Median daily use was 29%, and 23% completed all levels. There was a significant negative relationship between behavioral activations completed and change in PHQ-8. Efficacy analyses revealed a significant main effect of time, F = 40.60, p < .001, associated with decreased PHQ-8 scores over time. There was no significant Group × Time interaction (F = 0.13, p = .72) though the numeric decrease in PHQ-8 was greater for Spark (4.69 vs. 3.56). No serious adverse events or adverse device effects were reported for Spark users. Two serious adverse events reported in the Active Control group were addressed per our safety protocol. Conclusion Recruitment, enrollment, and retention rates demonstrated study feasibility by being comparable or better than other mental health apps. Spark was highly acceptable relative to published norms. The study's novel safety protocol efficiently detected and managed adverse events. The lack of significant difference in depression symptom reduction between Spark and Active Control may be explained by study design and study design factors. Procedures established during this feasibility study will be leveraged for subsequent powered clinical trials evaluating app efficacy and safety. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT04524598.
Collapse
Affiliation(s)
- Vera N. Kulikov
- Research Department, Limbix Health, San Francisco, CA, United States
| | | | - Shana A. Hall
- Research Department, Limbix Health, San Francisco, CA, United States
| | | | | | - Elise M. Vierra
- Content Department, Limbix Health, San Francisco, CA, United States
| | - Xin L. Koepsell
- Content Department, Limbix Health, San Francisco, CA, United States
| | - Jessica I. Lake
- Science Department, Limbix Health, San Francisco, CA, United States
| | | |
Collapse
|
29
|
Gross R, Thaweethai T, Rosenzweig EB, Chan J, Chibnik LB, Cicek MS, Elliott AJ, Flaherman VJ, Foulkes AS, Witvliet MG, Gallagher R, Gennaro ML, Jernigan TL, Karlson EW, Katz SD, Kinser PA, Kleinman LC, Lamendola-Essel MF, Milner JD, Mohandas S, Mudumbi PC, Newburger JW, Rhee KE, Salisbury AL, Snowden JN, Stein CR, Stockwell MS, Tantisira KG, Thomason ME, Truong DT, Warburton D, Wood JC, Ahmed S, Akerlundh A, Alshawabkeh AN, Anderson BR, Aschner JL, Atz AM, Aupperle RL, Baker FC, Balaraman V, Banerjee D, Barch DM, Baskin-Sommers A, Bhuiyan S, Bind MAC, Bogie AL, Buchbinder NC, Bueler E, Bükülmez H, Casey B, Chang L, Clark DB, Clifton RG, Clouser KN, Cottrell L, Cowan K, D’Sa V, Dapretto M, Dasgupta S, Dehority W, Dummer KB, Elias MD, Esquenazi-Karonika S, Evans DN, Faustino EVS, Fiks AG, Forsha D, Foxe JJ, Friedman NP, Fry G, Gaur S, Gee DG, Gray KM, Harahsheh AS, Heath AC, Heitzeg MM, Hester CM, Hill S, Hobart-Porter L, Hong TK, Horowitz CR, Hsia DS, Huentelman M, Hummel KD, Iacono WG, Irby K, Jacobus J, Jacoby VL, Jone PN, Kaelber DC, Kasmarcak TJ, Kluko MJ, Kosut JS, Laird AR, Landeo-Gutierrez J, Lang SM, Larson CL, Lim PPC, Lisdahl KM, McCrindle BW, McCulloh RJ, Mendelsohn AL, Metz TD, Morgan LM, Müller-Oehring EM, Nahin ER, Neale MC, Ness-Cochinwala M, Nolan SM, Oliveira CR, Oster ME, Payne RM, Raissy H, Randall IG, Rao S, Reeder HT, Rosas JM, Russell MW, Sabati AA, Sanil Y, Sato AI, Schechter MS, Selvarangan R, Shakti D, Sharma K, Squeglia LM, Stevenson MD, Szmuszkovicz J, Talavera-Barber MM, Teufel RJ, Thacker D, Udosen MM, Warner MR, Watson SE, Werzberger A, Weyer JC, Wood MJ, Yin HS, Zempsky WT, Zimmerman E, Dreyer BP. Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.27.23289228. [PMID: 37214806 PMCID: PMC10197716 DOI: 10.1101/2023.04.27.23289228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Importance The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. Observations We describe the protocol for the Pediatric Observational Cohort Study of the NIH's RE searching COV ID to E nhance R ecovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of five cohorts that comprise RECOVER-Pediatrics: 1) a de novo RECOVER prospective cohort of children and young adults with and without previous or current infection; and 2) an extant cohort derived from the Adolescent Brain Cognitive Development (ABCD) study ( n =10,000). The de novo cohort incorporates three tiers of data collection: 1) remote baseline assessments (Tier 1, n=6000); 2) longitudinal follow-up for up to 4 years (Tier 2, n=6000); and 3) a subset of participants, primarily the most severely affected by PASC, who will undergo deep phenotyping to explore PASC pathophysiology (Tier 3, n=600). Youth enrolled in the ABCD study participate in Tier 1. The pediatric protocol was developed as a collaborative partnership of investigators, patients, researchers, clinicians, community partners, and federal partners, intentionally promoting inclusivity and diversity. The protocol is adaptive to facilitate responses to emerging science. Conclusions and Relevance RECOVER-Pediatrics seeks to characterize the clinical course, underlying mechanisms, and long-term effects of PASC from birth through 25 years old. RECOVER-Pediatrics is designed to elucidate the epidemiology, four-year clinical course, and sociodemographic correlates of pediatric PASC. The data and biosamples will allow examination of mechanistic hypotheses and biomarkers, thus providing insights into potential therapeutic interventions. Clinical Trialsgov Identifier Clinical Trial Registration: http://www.clinicaltrials.gov . Unique identifier: NCT05172011.
Collapse
Affiliation(s)
- Rachel Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Erika B. Rosenzweig
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Lori B. Chibnik
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Mine S. Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Rochester, MN, USA
| | - Amy J. Elliott
- Avera Research Institute, Avera Health, Sioux Falls, SD, USA
| | - Valerie J. Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Andrea S. Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | | | - Richard Gallagher
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Maria Laura Gennaro
- Public Health Research Institute and Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Terry L. Jernigan
- Center for Human Development, Cognitive Science, Psychiatry, Radiology, University of California San Diego, La Jolla, CA, USA
| | | | - Stuart D. Katz
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Patricia A. Kinser
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Lawrence C. Kleinman
- Department of Pediatrics, Division of Population Health, Quality, and Implementation Sciences (POPQuIS), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Joshua D. Milner
- Department of Pediatrics, Columbia University Medical Center: Columbia University Irving Medical Center, New York, NY, USA
| | - Sindhu Mohandas
- Department of Infectious Diseases, Children’s Hospital Los Angeles and the Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Praveen C. Mudumbi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - Kyung E. Rhee
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Amy L. Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Jessica N. Snowden
- Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Cheryl R. Stein
- Department of Child and Adolescent Psychiatry, Hassenfeld Children’s Hospital at NYU Langone, New York, NY, USA
| | - Melissa S. Stockwell
- Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY, USA
| | - Kelan G. Tantisira
- Division of Pediatric Respiratory Medicine, University of California San Diego, San Diego, CA, USA
| | - Moriah E. Thomason
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Dongngan T. Truong
- Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
| | - David Warburton
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Shifa Ahmed
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Almary Akerlundh
- Department of Pulmonary Research, Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | | | - Brett R. Anderson
- Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Andrew M. Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Robin L. Aupperle
- Oxley College of Health Sciences, Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Venkataraman Balaraman
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Dithi Banerjee
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, Saint Louis, MO, USA
| | | | - Sultana Bhuiyan
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Marie-Abele C. Bind
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Amanda L. Bogie
- Department of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Natalie C. Buchbinder
- Center for Human Development, University of California San Diego, San Diego, CA, USA
| | - Elliott Bueler
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Hülya Bükülmez
- Department of Pediatrics, Division of Rheumatology, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
| | - B.J. Casey
- Department of Neuroscience and Behavior, Barnard College - Columbia University, New York, NY, USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Duncan B. Clark
- Departments of Psychiatry and Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Katharine N. Clouser
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University, Morgantown, WV, USA
| | - Kelly Cowan
- Department of Pediatrics, Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Viren D’Sa
- Department of Pediatrics, Rhode Island Hospital, Providence, RI, USA
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Soham Dasgupta
- Department of Pediatrics, Norton Children’s Hospital, University of Louisville, Louisville, KY, USA
| | - Walter Dehority
- Department of Pediatrics, Division of Infectious Diseases, University of New Mexico, Albuquerque, NM, USA
| | - Kirsten B. Dummer
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Matthew D. Elias
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shari Esquenazi-Karonika
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Danielle N. Evans
- Arkansas Children’s Research Institute, Arkansas Children’s Hospital, Little Rock, AR, USA
| | | | - Alexander G. Fiks
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel Forsha
- Department of Cardiology, Children’s Mercy Kansas City, Ward Family Heart Center, Kansas City, MO, USA, Kansas City, MO, USA
| | - John J. Foxe
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Naomi P. Friedman
- Institute for Behavioral Genetics and Department of Psychology and Neuroscience, University of Colorado Boulder, Bolder, CO, USA
| | - Greta Fry
- Pennington Biomedical Research Center Clinic, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Sunanda Gaur
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dylan G. Gee
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ashraf S. Harahsheh
- Department of Pediatrics, Division of Cardiology, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Andrew C. Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Mary M. Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Christina M. Hester
- Division of Practice-Based Research, Innovation, & Evaluation, American Academy of Family Physicians, Leawood, KS, USA
| | - Sophia Hill
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Laura Hobart-Porter
- Departments of Pediatrics and Physical Medicine & Rehabilitation, Section of Pediatric Rehabilitation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Travis K.F. Hong
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Carol R. Horowitz
- Center for Health Equity and Community Engaged Research and Department of Population Health Science and Policy, New York, NY, USA
| | - Daniel S. Hsia
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Matthew Huentelman
- Division of Neurogenomics, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Kathy D. Hummel
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - William G. Iacono
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Katherine Irby
- Department of Pediatrics, Arkansas Children’s Hospital, University of Arkansas Medical School, Little Rock, AR, USA
| | - Joanna Jacobus
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Vanessa L. Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Pei-Ni Jone
- Department of Pediatrics, Pediatric Cardiology, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David C. Kaelber
- Departments of Pediatrics, Internal Medicine, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Tyler J. Kasmarcak
- Department of Pediatric Clinical Research, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J. Kluko
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Jessica S. Kosut
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Angela R. Laird
- Department of Physics, Florida International University, Miami, FL, USA
| | - Jeremy Landeo-Gutierrez
- Department of Pediatrics, Respiratory Medicine Division, University of California San Diego, San Diego, CA, USA
| | - Sean M. Lang
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Christine L. Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Peter Paul C. Lim
- Department of Pediatric Infectious Disease, Avera McKennan University Health Center, University of South Dakota, Sioux Falls, SD, USA
| | - Krista M. Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, ON, Canada
| | - Russell J. McCulloh
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alan L. Mendelsohn
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Torri D. Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - Lerraughn M. Morgan
- Department of Pediatrics, Valley Children’s Healthcare, Department of Pediatrics, Madera, CA, Madera, CA, USA
| | | | - Erica R. Nahin
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Michael C. Neale
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Manette Ness-Cochinwala
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sheila M. Nolan
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Carlos R. Oliveira
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew E. Oster
- Department of Pediatric Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - R. Mark Payne
- Department of Pediatrics, Division of Pediatric Cardiology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hengameh Raissy
- Department of Pediatrics, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA
| | - Isabelle G. Randall
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Suchitra Rao
- Department of Pediatrics, Division of Infectious Diseases, Epidemiology and Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Harrison T. Reeder
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Johana M. Rosas
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Mark W. Russell
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA
| | - Arash A. Sabati
- Department of Pediatric Cardiology, Phoenix Children’s Hospital, Phoenix, AZ, USA
| | - Yamuna Sanil
- Division of Pediatric Cardiology, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Alice I. Sato
- Department of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael S. Schechter
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Divya Shakti
- Department of Pediatrics, Pediatric Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kavita Sharma
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Michelle D. Stevenson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Maria M. Talavera-Barber
- Department of Pediatrics, Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USA
| | - Ronald J. Teufel
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Deepika Thacker
- Nemours Cardiac Center, Nemours Childrens Health, Delaware, Wilmington, DE, USA
| | - Mmekom M. Udosen
- RECOVER Neurocognitive and Wellbeing/Mental Health Team, NYU Grossman School of Medicine, New York, NY, USA
| | - Megan R. Warner
- Department of Pulmonary Research, Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | - Sara E. Watson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | - Alan Werzberger
- Department of Pediatrics, Columbia University Medical Center: Columbia University Irving Medical Center, New York, NY, USA
| | - Jordan C. Weyer
- Center for Individualized Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Marion J. Wood
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - H. Shonna Yin
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - William T. Zempsky
- Department of Pediatrics, Connecticut Children’s Medical Center, Hartford, CT, USA
| | - Emily Zimmerman
- Department of Communication Sciences & Disorders, Northeastern University, Boston, MA, USA
| | - Benard P. Dreyer
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
30
|
Reeve BB, Greenzang KA, Sung L. Patient-Reported Outcomes in Pediatric Patients With Cancer. Am Soc Clin Oncol Educ Book 2023; 43:e390272. [PMID: 37172266 PMCID: PMC11299117 DOI: 10.1200/edbk_390272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Patient-reported outcomes (PROs) are reported directly by the patients about their own health. The objective of this article was to provide an overview of PROs in pediatric cancer, to describe how PROs can be incorporated into pediatric cancer clinical trials, and to discuss how PROs can guide symptom management treatment choices in pediatric oncology. Pediatric patient self-report provides a distinct voice in describing their experience compared with family caregiver or clinician report. Thus, every effort should be made to allow children to self-report symptoms, functioning, and other quality-of-life impacts and to use that data to inform treatment decision making. In addition to its incorporation into routine clinical care, it is also important to incorporate PROs into clinical trials to understand the patient experience of treatment toxicities and their impact on quality of life. Key considerations include clearly articulated PRO aims, selection of outcomes, choice of PRO measures, and frequency of PRO assessments. Once PROs are integrated into routine clinical care, it will be important to enable evidence-based symptom management. Strategies should be based on clinical practice guidelines (CPGs). Development and adaptation of care pathways on the basis of CPGs is one approach to standardize evidence-based symptom management at individual institutions. PROs are important to pediatric patients with cancer and their families. Self-report should be emphasized wherever possible. Approaches to enable PRO reporting into routine clinical care and enable preventative and therapeutic actions for symptom management are important. These efforts will optimize quality of life for pediatric patients with cancer.
Collapse
Affiliation(s)
- Bryce B. Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Katie A. Greenzang
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
31
|
Abramsohn EM, Pinkerton EA, Wroblewski K, Anitescu M, Flynn KE, Hazen A, Schumm P, Lindau ST. Breast sensorisexual function: a novel patient-reported outcome measure of sexual sensory functions of the breast. J Sex Med 2023; 20:671-683. [PMID: 36897194 PMCID: PMC10149380 DOI: 10.1093/jsxmed/qdad024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND A validated measure assessing sexual sensory functions of the breast is needed to optimize sexual and other health outcomes after breast procedures. AIM To describe the development of a patient-reported outcome measure (PROM) to assess breast sensorisexual function (BSF). METHODS We applied the PROMIS standards (Patient Reported Outcomes Measurement Information System) for measure development and evaluation of validity. An initial conceptual model of BSF was developed with patients and experts. A literature review yielded a pool of 117 candidate items that underwent cognitive testing and iteration. Forty-eight items were administered to an ethnically diverse, national panel-based sample of sexually active women with breast cancer (n = 350) or without (n = 300). Psychometric analyses were performed. OUTCOMES The main outcome was BSF, a measure that assesses affective (satisfaction, pleasure, importance, pain, discomfort) and functional (touch, pressure, thermoreception, nipple erection) sensorisexual domains. RESULTS A bifactor model fit to 6 domains-excluding 2 domains with only 2 items each and 2 pain-related domains-revealed a single general factor representing BSF that may be adequately measured by the average of the items. This factor, with higher values denoting better function and with the standard deviation set to 1, was highest among women without breast cancer (mean, 0.24), intermediate among women with breast cancer but not bilateral mastectomy and reconstruction (-0.01), and lowest among those with bilateral mastectomy and reconstruction (-0.56). Between women with and without breast cancer, the BSF general factor accounted for 40%, 49%, and 100% of the difference in arousal, ability to orgasm, and sexual satisfaction, respectively. Items in each of 8 domains demonstrated unidimensionality (ie, they measured 1 underlying BSF trait) and high Cronbach's alphas for the entire sample (0.77-0.93) and the cancer group (0.71-0.95). Correlations with sexual function, health, and quality of life were positive for the BSF general factor and mostly negative for the pain domains. CLINICAL IMPLICATIONS The BSF PROM can be used to assess the impact of breast surgery or other procedures on the sexual sensory functions of the breast in women with and without breast cancer. STRENGTHS AND LIMITATIONS The BSF PROM was developed by using evidence-based standards, and it applies to sexually active women with and without breast cancer. Generalizability to sexually inactive women and other women warrants further study. CONCLUSION The BSF PROM is a measure of women's breast sensorisexual function with evidence of validity among women affected and unaffected by breast cancer.
Collapse
Affiliation(s)
- Emily M Abramsohn
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL 60637, United States
| | - El A Pinkerton
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL 60637, United States
| | - Kristen Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, IL 60637, United States
| | - Magdalena Anitescu
- Department of Anesthesiology, University of Chicago Medicine, Chicago, IL 60637, United States
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Alexes Hazen
- Hansjorg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY 10017, United States
| | - Phil Schumm
- Department of Public Health Sciences, The University of Chicago, Chicago, IL 60637, United States
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL 60637, United States
- Department of Medicine-Geriatrics, The University of Chicago, Chicago, IL 60637, United States
- The University of Chicago Comprehensive Cancer Center, Chicago, IL 60637, United States
| |
Collapse
|
32
|
Ciccia A, Nagele D, Chen Z, Albert J, Eagan-Johnson B, Vaccaro M, Dart L, Riccardi J, Lundine J. Cognitive, social, and health functioning of children with TBI engaged in a formal support program. NeuroRehabilitation 2023:NRE220208. [PMID: 37125569 DOI: 10.3233/nre-220208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Students with traumatic brain injury (TBI) often demonstrate difficulties that impact their successful return to school (RTS). OBJECTIVE To explore injury severity, age at injury, and time since injury as predictors for performance on measures of cognitive, social and health functioning for students' participating in a formal RTS cohort at the time of their enrollment in the School Transition After Traumatic Brain Injury (STATBI) research project. METHODS Outcome measures across cognitive, social, and health domains were analyzed for association with the explanatory variables of interest using quantile regressions and ordinary least squares regression, as appropriate. RESULTS Students (N = 91) injured after age 13 showed significantly lower cognitive outcomes than students whose injury occurred earlier. Additionally, students more than one-year post-injury demonstrated poorer social outcome on one measure compared to students whose injury occurred more recently. Health outcomes showed no significant association to any predictors. CONCLUSION The results of this analysis provide a baseline for a group of students with TBI as they enter a RTS research study. This data can now be paired with longitudinal measures and qualitative data collected simultaneously to gain a deeper understanding of how students with TBI present for RTS.
Collapse
Affiliation(s)
- Angela Ciccia
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Drew Nagele
- Brain Injury Association of Pennsylvania, Chambersburg, PA, USA
| | - Zhengyi Chen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jeffrey Albert
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | - Monica Vaccaro
- Brain Injury Association of Pennsylvania, Chambersburg, PA, USA
| | - Libby Dart
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jessica Riccardi
- Department of Communication Sciences and Disorders, University of Maine, Orono, ME, USA
| | - Jennifer Lundine
- Department of Speech and Hearing Sciences, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
33
|
Bigelow AM, Riggs KW, Morales DLS, Opotowsky AR, Lubert AM, Dillman JR, Veldtman GR, Heydarian HC, Trout AT, Cooper DS, Goldstein SL, Chin C, Palermo JJ, Ollberding NJ, Mays WA, Alsaied T. Isosorbide DiNitrate Effect on Hemodynamic Profile, Liver Stiffness, and Exercise Tolerance in Fontan Circulation (The NEET Clinical Trial). Pediatr Cardiol 2023:10.1007/s00246-023-03156-3. [PMID: 37084132 PMCID: PMC10119822 DOI: 10.1007/s00246-023-03156-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023]
Abstract
After Fontan operation, decreased venous capacitance and venoconstriction are adaptive mechanisms to maintain venous return and cardiac output. The consequent higher venous pressure may adversely impact end-organ function, exercise capacity and result in worse clinical outcomes. This pilot study evaluated the safety and effect of isosorbide dinitrate (ISDN), a venodilator, on exercise capacity, peripheral venous pressure (PVP), and liver stiffness in patients with Fontan circulation. In this prospective single-arm trial, 15 individuals with Fontan circulation were evaluated at baseline and after 4 weeks of therapeutic treatment with ISDN. Primary aims were to assess the safety of ISDN and the effect on maximal exercise. We also aimed to evaluate the effect of ISDN on ultrasound-assessed liver stiffness, markers of submaximal exercise, and PVP at rest and peak exercise. Repeated measures t-tests were used to assess change in variables of interest in response to ISDN. Mean age was 23.5 ± 9.2 years (range 11.2-39.0 years), and 10/15 (67%) were male. There was no statistically significant change in peak VO2 (1401 ± 428 to 1428 ± 436 mL/min, p = 0.128), but VO2 at the anaerobic threshold increased (1087 ± 313 to 1115 ± 302 mL/min, p = 0.03). ISDN was also associated with a lower peak exercise PVP (22.5 ± 4.5 to 20.6 ± 3.0 mmHg, p = 0.015). Liver stiffness was lower with ISDN, though the difference was not statistically significant (2.3 ± 0.4 to 2.1 ± 0.5 m/s, p = 0.079). Of the patients completing the trial, mild headache was common (67%), but there were no major adverse events. Treatment with ISDN for 4 weeks is well-tolerated in patients with a Fontan circulation. ISDN is associated with an increase in VO2 at anaerobic threshold, lower peak PVP, and a trend toward lower liver stiffness. Larger, longer duration studies will be necessary to define the impact of ISDN on clinical outcomes in the Fontan circulation.Clinical Trial Registration: URL: https://clinicaltrials.gov . Unique identifier: NCT04297241.
Collapse
Affiliation(s)
- Amee M Bigelow
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Kyle W Riggs
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, Manhasset, NY, USA
| | - David L S Morales
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
| | - Alexander R Opotowsky
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA.
| | - Adam M Lubert
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Gruschen R Veldtman
- Scottish Adult Congenital Cardiac Service and University of Glasgow, Institute of Cardiovascular Medicine and Sciences, Golden Jubilee Hospital, Glasgow, UK
| | - Haleh C Heydarian
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David S Cooper
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
| | - Stuart L Goldstein
- Faculty of Medicine, Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Clifford Chin
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
| | - Joseph J Palermo
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Nicholas J Ollberding
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Wayne A Mays
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
| | - Tarek Alsaied
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
- Pittsburgh Children's Hospital Medical Center, The Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
34
|
Santoro SL, Cabrera M, Haugen K, Krell K, Merker VL. Indicators of health in Down syndrome: A virtual focus group study with patients and their parents. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:354-365. [PMID: 36624557 PMCID: PMC9911361 DOI: 10.1111/jar.13065] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Down syndrome has a unique medical and psychological profile. To date, few studies have asked individuals with Down syndrome about their views of health. METHODS Eight focus groups of 20 parents and 8 individuals with Down syndrome, were conducted virtually via videoconferencing to obtain participants' views of health indicators. Focus group moderators employed some modifications for individuals with Down syndrome, including simplified language and use of graphics. Transcripts were coded using a hybrid inductive/deductive framework and thematically analysed using the Framework Method. RESULTS We describe lessons learned in conducting virtual focus groups of individuals with Down syndrome and their parents. Individuals with Down syndrome could describe their views of health indicators and identified many of the same topics as their parents. Both groups discussed physical, mental, and social health components. However, people with Down syndrome gave a more restricted range of examples, but with different nuances than parents. CONCLUSION Partcipants discussed physical, social, and mental well-being components of health in Down syndrome. Interviewing individuals with Down syndrome in virtual focus groups with appropriate modifications added important self-report health information.
Collapse
Affiliation(s)
- Stephanie L. Santoro
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Maria Cabrera
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Kelsey Haugen
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Kavita Krell
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Vanessa L. Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
35
|
Pignolo RJ, Kimel M, Whalen J, Kawata AK, Artyomenko A, Kaplan FS. The Fibrodysplasia Ossificans Progressiva Physical Function Questionnaire (FOP-PFQ): A patient-reported, disease-specific measure. Bone 2023; 168:116642. [PMID: 36526263 DOI: 10.1016/j.bone.2022.116642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess the reliability and validity of age-specific versions of the Fibrodysplasia Ossificans Progressiva Physical Function Questionnaire (FOP-PFQ), developed to measure the impact of FOP on physical function and activities of daily living. METHODS FOP-PFQ development included a literature review, two iterative phases of qualitative work involving individuals with FOP, and clinical expert review. The analysis used pooled FOP-PFQ data from an FOP natural history study (NCT02322255), a patient registry (NCT02745158), and phase II trials (NCT02190747; NCT02279095; NCT02979769). Item-level and factor analysis informed item retention and determined factor structure. Reliability was evaluated using Cronbach's alpha and intraclass correlation coefficients. Convergent validity was assessed by comparing scores with age, the Cumulative Analogue Joint Involvement Scale (CAJIS), the Patient-Reported Outcomes Measurement Information System Global Health Scale (PROMIS), and heterotopic ossification (HO) volume. Known-groups validity assessment used age, CAJIS, and HO volume. RESULTS Factor analysis confirmed a two-factor solution: Mobility and Upper Extremity. Results reflected high internal consistency and were supportive of test-retest reliability; correlation coefficients >0.90 demonstrated FOP-PFQ scores were stable over a one- to three-week period. The majority of scores were moderately (r = 0.30-0.50) to highly (r ≥ 0.50) correlated with CAJIS and HO volume, supporting convergent validity. With the exception of some age-based and functional groups, FOP-PFQ scores were significantly worse in groups with more severe disease, demonstrating known-groups validity. CONCLUSION The FOP-PFQ was demonstrated to be a reliable, valid measure that may be responsive to change in individuals with FOP, although some results were inconclusive for pediatric versions.
Collapse
Affiliation(s)
| | | | | | | | | | - Frederick S Kaplan
- Departments of Orthopaedic Surgery and Medicine, The Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
36
|
Pignolo RJ, Hsiao EC, Al Mukaddam M, Baujat G, Berglund SK, Brown MA, Cheung AM, De Cunto C, Delai P, Haga N, Kannu P, Keen R, Le Quan Sang KH, Mancilla EE, Marino R, Strahs A, Kaplan FS. Reduction of New Heterotopic Ossification (HO) in the Open-Label, Phase 3 MOVE Trial of Palovarotene for Fibrodysplasia Ossificans Progressiva (FOP). J Bone Miner Res 2023; 38:381-394. [PMID: 36583535 DOI: 10.1002/jbmr.4762] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare, severely disabling genetic disorder of progressive heterotopic ossification (HO). The single-arm, open-label, phase 3 MOVE trial (NCT03312634) assessed efficacy and safety of palovarotene, a selective retinoic acid receptor gamma agonist, in patients with FOP. Findings were compared with FOP natural history study (NHS; NCT02322255) participants untreated beyond standard of care. Patients aged ≥4 years received palovarotene once daily (chronic: 5 mg; flare-up: 20 mg for 4 weeks, then 10 mg for ≥8 weeks; weight-adjusted if skeletally immature). The primary endpoint was annualized change in new HO volume versus NHS participants (by low-dose whole-body computed tomography [WBCT]), analyzed using a Bayesian compound Poisson model (BcPM) with square-root transformation. Twelve-month interim analyses met futility criteria; dosing was paused. An independent Data Monitoring Committee recommended trial continuation. Post hoc 18-month interim analyses utilized BcPM with square-root transformation and HO data collapsed to equalize MOVE and NHS visit schedules, BcPM without transformation, and weighted linear mixed-effects (wLME) models, alongside prespecified analysis. Safety was assessed throughout. Eighteen-month interim analyses included 97 MOVE and 101 NHS individuals with post-baseline WBCT. BcPM analyses without transformation showed 99.4% probability of any reduction in new HO with palovarotene versus NHS participants (with transformation: 65.4%). Mean annualized new HO volume was 60% lower in MOVE versus the NHS. wLME results were similar (54% reduction fitted; nominal p = 0.039). All palovarotene-treated patients reported ≥1 adverse event (AE); 97.0% reported ≥1 retinoid-associated AE; 29.3% reported ≥1 serious AE, including premature physeal closure (PPC)/epiphyseal disorder in 21/57 (36.8%) patients aged <14 years. Post hoc computational analyses using WBCT showed decreased vertebral bone mineral density, content, and strength, and increased vertebral fracture risk in palovarotene-treated patients. Thus, post hoc analyses showed evidence for efficacy of palovarotene in reducing new HO in FOP, but high risk of PPC in skeletally immature patients. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
| | - Edward C Hsiao
- Division of Endocrinology and Metabolism, the UCSF Metabolic Bone Clinic, the Eli and Edythe Broad Institute for Regeneration Medicine, and the Institute of Human Genetics, Department of Medicine, and the UCSF Program in Craniofacial Biology, University of California-San Francisco, San Francisco, CA, USA
| | - Mona Al Mukaddam
- Departments of Orthopaedic Surgery & Medicine, The Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Geneviève Baujat
- Département de Génétique, Institut IMAGINE and Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Staffan K Berglund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Matthew A Brown
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Genomics England Ltd, London, UK
| | - Angela M Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Carmen De Cunto
- Pediatric Rheumatology Section, Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Patricia Delai
- Centro de Pesquisa Clinica, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Peter Kannu
- Hospital for Sick Children, Toronto, ON, Canada
| | - Richard Keen
- Centre for Metabolic Bone Disease, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Kim-Hanh Le Quan Sang
- Département de Génétique, Institut IMAGINE and Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Edna E Mancilla
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Frederick S Kaplan
- Departments of Orthopaedic Surgery & Medicine, The Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
37
|
de la Rosa R, Zablotny D, Ye M, Bush NR, Hessler D, Koita K, Bucci M, Long D, Thakur N. Biological Burden of Adverse Childhood Experiences in Children. Psychosom Med 2023; 85:108-117. [PMID: 36728584 PMCID: PMC9930178 DOI: 10.1097/psy.0000000000001167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to examine relationships between adverse childhood experiences (ACEs) and related life events and allostatic load (AL)-"wear and tear" from chronic stress-in a pediatric population. METHODS Children were screened with the PEdiatric ACEs and Related Life Event Screener (PEARLS) tool, a 17-item questionnaire capturing experiences of abuse, neglect, household challenges, and related life events. Biological data were available for 207 participants, and AL was operationalized using clinical or empirical cutoff points across 4 physiological systems (i.e., cardiac, metabolic, inflammatory, neurologic). Covariate-adjusted multivariable regression models were used to examine associations between AL with adversity and health. RESULTS Children (mean age = 6.5 years, range = 1-11 years) had an average AL score of 1.9 (standard deviation = 1.7), and a U-shaped relationship was observed with child's age. Continuous PEARLS and original ACE scores were not associated with AL. However, children with a reported PEARLS score of 1 to 2 or original ACEs score of 1 to 3 had 1.5 (incidence rate ratio [IRR] = 1.50, 95% confidence interval [CI] = 1.09-2.08) and 1.4 (IRR = 1.41, 95% CI = 1.08-1.84) times greater AL, respectively, compared with participants with none reported. In secondary analyses, caregiver mental illness was associated with higher child AL (adjusted IRR = 1.27, 95% CI = 1.01-1.58). AL was also associated with poorer perceived child general health (adjusted β = -0.87, 95% CI = -1.58 to -0.15) and greater odds of child obesity (adjusted odds ratio = 1.51, 95% CI = 1.23-1.89). CONCLUSIONS Measuring AL in a pediatric population requires careful consideration of age. Higher AL was associated with a greater number of reported adversities and worse child health.
Collapse
Affiliation(s)
- Rosemarie de la Rosa
- From the Department of Medicine (de la Rosa, Zablotny, Ye, Thakur), University of California San Francisco, San Francisco; School of Public Health (de la Rosa), University of California Berkeley, Berkeley; Departments of Psychiatry and Behavioral Science (Bush) and Pediatrics (Bush and Long) and Family and Community Medicine (Hessler), University of California San Francisco, San Francisco; UCSF Benioff Children's Hospital Oakland (Long), Oakland; Center for Youth Wellness (Koita, Bucci), San Francisco, California
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Koblick SB, Yu M, DeMoss M, Liu Q, Nessle CN, Rozwadowski M, Troost JP, Miner JA, Hassett A, Carlozzi NE, Barton DL, Tewari M, Hanauer DA, Choi SW. A pilot intervention of using a mobile health app (ONC Roadmap) to enhance health-related quality of life in family caregivers of pediatric patients with cancer. Mhealth 2023; 9:5. [PMID: 36760786 PMCID: PMC9902233 DOI: 10.21037/mhealth-22-24] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/25/2022] [Indexed: 01/28/2023] Open
Abstract
Background The Roadmap mobile health (mHealth) app was developed to provide health-related quality of life (HRQOL) support for family caregivers of patients with cancer. Methods Eligibility included: family caregivers (age ≥18 years) who self-reported as the primary caregiver of their pediatric patient with cancer; patients (age ≥5 years) who were receiving cancer care at the University of Michigan. Feasibility was calculated as the percentage of caregivers who logged into ONC Roadmap and engaged with it at least twice weekly for at least 50% of the 120-day study duration. Feasibility and acceptability was also assessed through a Feasibility and Acceptability questionnaire and the Mobile App Rating Scale to specifically assess app-quality. Exploratory analyses were also conducted to assess HRQOL self- or parent proxy assessments and physiological data capture. Results Between September 2020-September 2021, 100 participants (or 50 caregiver-patient dyads) consented and enrolled in the ONC Roadmap study for 120-days. Feasibility of the study was met, wherein the majority of caregivers (N=32; 65%) logged into ONC Roadmap and engaged with it at least twice weekly for at least 50% of the study duration (defined a priori in the Protocol). The Feasibility and Acceptability questionnaire responses indicated that the study was feasible and acceptable with the majority (>50%) reporting Agree or Strongly Agree with positive Net Favorability [(Agree + Strongly Agree) - (Disagree + Totally Disagree)] in each of the domains (e.g., Fitbit use, ONC Roadmap use, completing longitudinal assessments, engaging in similar future study, study expectations). Improvements were seen across the majority of the mental HRQOL domains across all groups; even though underpowered, there were significant improvements in caregiver-specific aspects of HRQOL and anxiety and in depression and fatigue for children (ages 8-17 years), and a trend toward improvement in depression for children ages 8-17 years and in fatigue for adult patients. Conclusions This study supports that mHealth technology may be a promising platform to provide HRQOL support for caregivers of pediatric patients with cancer. Importantly, the findings suggest that the study protocol was feasible, and participants were favorable to participate in future studies of this intervention alongside routine cancer care delivery.
Collapse
Affiliation(s)
- Sarah B. Koblick
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Miao Yu
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Matthew DeMoss
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Qiaoxue Liu
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Charles N. Nessle
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | | | - Jonathan P. Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer A. Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Afton Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Debra L. Barton
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Muneesh Tewari
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - David A. Hanauer
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
39
|
Child and family factors associated with positive outcomes among youth born extremely preterm. Pediatr Res 2023:10.1038/s41390-022-02424-x. [PMID: 36639518 DOI: 10.1038/s41390-022-02424-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/22/2022] [Accepted: 11/19/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND To analyze the relationship of child behavioral and communication disorders, and adverse family events, to later-in-life child health and cognitive function among youth born extremely preterm. METHODS The study participants were 694 children enrolled in the Extremely Low Gestational Age Newborn Study. At ages 2 and 10, we assessed internalizing and externalizing behaviors, and at age 10, we assessed adverse life events within the family. Associations were evaluated between these child and family factors and positive child health at age 10 years, and global health and cognitive function at age 15 years. RESULTS Lower T-scores for internalizing or externalizing behaviors at age 2 were associated with more positive health at age 10. The absence of internalizing behaviors at age 10 was associated with better global child health and better cognitive function at age 15. The absence of communication deficits at age 10 was associated with better cognitive function at age 15. The absence of parent job loss was associated with better global child health at age 15. CONCLUSION Among individuals born extremely preterm, child health and cognitive outcomes might be improved by timely interventions to address child behavioral symptoms and the impact of adverse life events in the family. IMPACT The absence of child behavioral and communication disorders, and adverse family events, were associated with more positive health, higher global health, and better cognitive function among youth born extremely preterm. Interventions to address behavioral disorders in early childhood, and to reduce the impact of adverse life events on the family, might promote improved health and developmental outcomes for adolescents born extremely preterm.
Collapse
|
40
|
Amtmann D, Gammaitoni AR, Galer BS, Salem R, Jensen MP. The impact of TK2 deficiency syndrome and its treatment by nucleoside therapy on quality of life. Mitochondrion 2023; 68:1-9. [PMID: 36374792 DOI: 10.1016/j.mito.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/11/2022] [Accepted: 10/23/2022] [Indexed: 11/13/2022]
Abstract
TK2d is an ultrarare autosomal recessive mitochondrial DNA depletion syndrome. Nucleoside therapy improves or stabilizes disease across key outcomes including survival, ambulation, and requirement for mechanical ventilation. However, little is known about the effects of nucleoside therapy treatment of TK2d from the patient's perspective. This study sought to address this knowledge gap. Participants with TK2d and/or their parents/caregivers completed online surveys with standardized health measures and interviews. During interviews, participants rated and described TK2d's impact on 13 quality of life domains, changes since starting nucleoside therapy, and if they would recommend nucleoside therapy. Twenty-five individuals participated (17 adults with TK2d, 4 parent-participant pairs, 4 parents of children with TK2d). Adult participants with TK2d had clinically meaningfully worse scores than the general population on global physical and mental health, physical function, pain interference, fatigue, anxiety, and social function. Children's mobility and pain interference were significantly worse than the general pediatric population. Physical domains most affected by TK2d were: mobility (84%), fatigue (60%), respiratory function (56%), and hospitalizations (55%). Psychosocial domains most affected were: impact on family members (39%), mood (36%), and social life (28%). Most (77%) treated patients reported improvement; whereas, 67% in the untreated group reported worsening. All participants would recommend nucleoside therapy. In summary, TK2d has significant negative impacts on most areas of life and function. Measures of fatigue, sleep, swallowing/eating, speaking, and mood, should be considered as outcomes in clinical trials and research studies. Nucleoside therapy appears to provide meaningful improvements across many health domains affected by TK2d. SYNOPSIS: The consequences of having TK2d are devastating for both those with the disorder and their families; however, nucleoside therapy appears to provide meaningful improvements across many health domains affected by TK2d.
Collapse
Affiliation(s)
- Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
| | - Arnold R Gammaitoni
- Zogenix, Inc., now a part of UCB, Medical Affairs, Emeryville, CA 94608, USA
| | - Bradley S Galer
- Zogenix, Inc., now a part of UCB, Medical Affairs, Emeryville, CA 94608, USA
| | - Rana Salem
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
41
|
Carpenter CM, Cooper SB, Wilson PL, Miller SM, Wyatt CW, Johnson BL, Shea KG, Ellis HB. An Activity Scale for All Youth Athletes? Clinical Considerations for the HSS Pedi-FABS. Orthop J Sports Med 2022; 10:23259671221143534. [PMID: 36582933 PMCID: PMC9793053 DOI: 10.1177/23259671221143534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) has demonstrated normally distributed scores in children aged 10 to 18 years. It has been used to evaluate knee injuries; however, there is limited information regarding its use in evaluating other injury types. Purpose To (1) assess the validity and utility of HSS Pedi-FABS in youth athletes with injuries to different parts of the body and (2) evaluate the association between the HSS Pedi-FABS and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health 7 (PGH), as well as PROMIS-Pain Interference (PGH-PI) and PROMIS-Fatigue (PGH-F) components. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods The authors performed a retrospective review of youth athletes aged 10 to 18 years who completed the HSS Pedi-FABS as part of their previsit intake questionnaire between April 2016 and July 2020. HSS Pedi-FABS score distributions were compared and evaluated for ceiling effects in cohorts determined by demographic, injury characteristic, and sports participation variables; a ceiling effect was determined to be present if >15% of respondents received the highest possible score. HSS Pedi-FABS scores were analyzed for a correlation with PGH, PGH-PI, and PGH-F components. Results Included were 2274 patients (mean age, 14.6 ± 2.1 years; 53.0% female) participating in 21 distinct primary sports for 9.6 ± 7.9 hours per week. The mean HSS Pedi-FABS scores by injury group were as follows: elbow (22.7 ± 6.7), shoulder (21.0 ± 8.7), ankle (20.2 ± 8.8), knee (19.5 ± 9.1), and hip (15.4 ± 10.4) (P < .001). Broad distribution was seen in each cohort, with no floor or ceiling effects. The HSS Pedi-FABS score correlated with patient-reported hours per week (r = 0.33), days per week (r = 0.33), and years of participation (r = 0.21) (P < .001 for all). All 3 PROMIS components correlated with HSS Pedi-FABS: PGH (r = 0.28), PGH-PI (r = -0.11), and PGH-F (r = -0.15) (P < .001). Conclusion Study findings indicated that the HSS Pedi-FABS is a valid tool for measuring physical activity level in most injured youth athletes, not just those with knee injuries. The correlation of HSS Pedi-FABS with the PGH suggests a positive relationship of childhood physical activity with general health.
Collapse
Affiliation(s)
- Connor M. Carpenter
- Center for Excellence in Sports Medicine, Scottish Rite for
Children, Frisco, Texas, USA.,Texas A&M University School of Medicine, Bryan, Texas,
USA.,Connor M. Carpenter, BBA, Center for Excellence in Sports
Medicine, Scottish Rite for Children, 5700 Dallas Pkwy, Frisco, TX 75034, USA
() (Twitter: @CMCarpenter25)
| | - Savannah B. Cooper
- Center for Excellence in Sports Medicine, Scottish Rite for
Children, Frisco, Texas, USA
| | - Philip L. Wilson
- Center for Excellence in Sports Medicine, Scottish Rite for
Children, Frisco, Texas, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern
Medical Center, Dallas, Texas, USA
| | - Shane M. Miller
- Center for Excellence in Sports Medicine, Scottish Rite for
Children, Frisco, Texas, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern
Medical Center, Dallas, Texas, USA
| | - Charles W. Wyatt
- Center for Excellence in Sports Medicine, Scottish Rite for
Children, Frisco, Texas, USA
| | - Benjamin L. Johnson
- Center for Excellence in Sports Medicine, Scottish Rite for
Children, Frisco, Texas, USA
| | - Kevin G. Shea
- Department of Orthopaedic Surgery, Stanford University School of
Medicine, Stanford, California, USA
| | - Henry B. Ellis
- Center for Excellence in Sports Medicine, Scottish Rite for
Children, Frisco, Texas, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern
Medical Center, Dallas, Texas, USA
| |
Collapse
|
42
|
Rague JT, Kim S, Hirsch J, Meyer T, Rosoklija I, Larson JE, Swaroop VT, Bowman R, Bowen DK, Cheng EY, Gordon EJ, Holmbeck G, Chu DI, Isakova T, Yerkes EB, Chu DI. The Association of Health Literacy with Health-Related Quality of Life in Youth and Young Adults with Spina Bifida: A Cross-Sectional Study. J Pediatr 2022; 251:156-163.e2. [PMID: 35970239 PMCID: PMC9843738 DOI: 10.1016/j.jpeds.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/08/2022] [Accepted: 08/09/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective of the study was to determine if health literacy is associated with health-related quality of life (HRQOL) in adolescents and young adults (AYAs) with spina bifida. STUDY DESIGN Between June 2019 and March 2020, the Patient-Reported Outcome Measurement Information System Pediatric Global Health-7 (PGH-7), a measure of HRQOL, and the Brief Health Literacy Screening Tool (BRIEF) were administered to patients ≥12 years old with a diagnosis of spina bifida seen in our multidisciplinary spina bifida center. Questionnaires were completed at scheduled clinic visits. The primary outcome was the PGH-7 normalized T-score. The primary exposure was the BRIEF score. Demographic and clinical characteristics were obtained from the medical record. Nested, multivariable linear regression models assessed the association between health literacy and the PGH-7 score. RESULTS Of 232 eligible patients who presented to clinic, 226 (97.4%) met inclusion criteria for this study. The median age was 17.0 years (range: 12-31). Most individuals were female (54.0%) and had myelomeningocele (61.5%). Inadequate, marginal, and adequate health literacy levels were reported by 35.0%, 28.3%, and 36.7% of individuals. In univariable analysis, higher health literacy levels were associated with higher PGH-7 scores. In nested, sequentially adjusted multivariable linear regression models, a higher health literacy level was associated with a stepwise increase in the PGH-7 score. In the fully adjusted model, adequate health literacy and marginal health literacy, compared with inadequate health literacy, were associated with increases in a PGH-7 score of 3.3 (95% CI: 0.2-6.3) and 1.1 (95% CI: -2.0 to 4.2), respectively. CONCLUSIONS Health literacy was associated with HRQOL after adjusting for demographic and clinical factors. Strategies incorporating health literacy are needed to improve HRQOL in AYAs with spina bifida.
Collapse
Affiliation(s)
- James T Rague
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Soojin Kim
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Josephine Hirsch
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Jill E Larson
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Vineeta T Swaroop
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Robin Bowman
- Division of Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Diana K Bowen
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Elisa J Gordon
- Department of Surgery-Division of Transplantation, Center of Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Grayson Holmbeck
- Department of Psychology, Loyola University of Chicago, Chicago, IL
| | - Daniel I Chu
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Tamara Isakova
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, and Division of Nephrology and Hypertension, Feinberg School of Medicine at Northwestern University, Chicago, IL
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - David I Chu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
| |
Collapse
|
43
|
Pignolo RJ, Baujat G, Brown MA, De Cunto C, Hsiao EC, Keen R, Al Mukaddam M, Le Quan Sang KH, Wilson A, Marino R, Strahs A, Kaplan FS. The natural history of fibrodysplasia ossificans progressiva: A prospective, global 36-month study. Genet Med 2022; 24:2422-2433. [PMID: 36152026 DOI: 10.1016/j.gim.2022.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE We report the first prospective, international, natural history study of the ultra-rare genetic disorder fibrodysplasia ossificans progressiva (FOP). FOP is characterized by painful, recurrent flare-ups, and disabling, cumulative heterotopic ossification (HO) in soft tissues. METHODS Individuals aged ≤65 years with classical FOP (ACVR1R206H variant) were assessed at baseline and over 36 months. RESULTS In total, 114 individuals participated; 33 completed the study (mean follow up: 26.8 months). Median age was 15.0 (range: 4-56) years; 54.4% were male. During the study, 82 (71.9%) individuals reported 229 flare-ups (upper back: 17.9%, hip: 14.8%, shoulder: 10.9%). After 84 days, 14 of 52 (26.9%) imaged flare-ups had new HO at the flare-up site (mean new HO volume: 28.8 × 103 mm3). Mean baseline low-dose whole-body computed tomography (excluding head) HO volume was 314.4 × 103 mm3; lowest at 2 to <8 years (68.8 × 103 mm3) and increasing by age (25-65 years: 575.2 × 103 mm3). The mean annualized volume of new HO was 23.6 × 103 mm3/year; highest at 8 to <15 and 15 to <25 years (21.9 × 103 and 41.5 × 103 mm3/year, respectively) and lowest at 25 to 65 years (4.6 × 103 mm3/year). CONCLUSION Results from individuals receiving standard care for up to 3 years in this natural history study show the debilitating effect and progressive nature of FOP cross-sectionally and longitudinally, with greatest progression during childhood and early adulthood.
Collapse
Affiliation(s)
| | - Geneviève Baujat
- Département de Génétique, Hôpital Universitaire Necker-Enfants Malades, Institut Imagine, Université Paris Cité, Paris, France
| | - Matthew A Brown
- Department of Medicine and Molecular Genetics, Faculty of Life Sciences and Medicine, School of Basic and Medical Biosciences, King's College London, London, United Kingdom; Genomics England, London, United Kingdom
| | - Carmen De Cunto
- Pediatric Rheumatology Section, Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Edward C Hsiao
- Division of Endocrinology and Metabolism, the UCSF Metabolic Bone Clinic, the Eli and Edyth Broad Institute for Regeneration Medicine, and the Institute of Human Genetics, Department of Medicine, and the UCSF Program in Craniofacial Biology, University of California San Francisco, San Francisco, CA
| | - Richard Keen
- Centre for Metabolic Bone Disease, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Mona Al Mukaddam
- Departments of Orthopaedic Surgery and Medicine, Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kim-Hanh Le Quan Sang
- Département de Génétique, Hôpital Universitaire Necker-Enfants Malades, Institut Imagine, Université Paris Cité, Paris, France
| | | | | | | | - Frederick S Kaplan
- Departments of Orthopaedic Surgery and Medicine, Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
44
|
Looman WS, Eull DJ, Bell AN, Gallagher TT, Nersesian PV. Participant-generated timelines as a novel strategy for assessing youth resilience factors: A mixed-methods, community-based study. J Pediatr Nurs 2022; 67:64-74. [PMID: 35964482 DOI: 10.1016/j.pedn.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/01/2022] [Accepted: 07/30/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to explore youth perceptions of resilience through participant-generated timelines as a potential new strategy for nursing research and practice. DESIGN AND METHODS We used a concurrent triangulation design to collect and analyze qualitative and quantitative data from a statewide, community-based sample of 448 youth ages 8 to 17 years. We collected three sources of data during two waves of data collection in 2019 and 2021: a participant-generated timeline, a brief structured interview, and a PROMIS pediatric global health measure. RESULTS The timeline activity was easy to administer and well accepted by youth in a community setting. Youth reporting an adverse experience or mental health challenge in the previous year had unique patterns of variability in the timelines, and more frequently reported certain resilience factors, including family support and regulatory, interpersonal, and meaning-making assets. Pandemic-related differences were noted between the two cohorts. CONCLUSIONS The timeline drawing activity reflects and extends findings from a standard measure of global health. This activity benefits both the participant and the clinician or researcher by helping youth to communicate how they make sense of the world, honoring different ways of knowing and prompting recollection of coping appraisals and resilience factors. PRACTICE IMPLICATIONS Participant-generated timelines are a developmentally appropriate and interactive strategy for assessing youth perceptions of their internal strengths. In conjunction with traditional assessments, this strategy may support the identification of malleable targets for intervention in practice with youth who have experienced adversity or mental health challenges.
Collapse
Affiliation(s)
- Wendy S Looman
- University of Minnesota School of Nursing, 5-140 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
| | - Donna J Eull
- University of Minnesota School of Nursing, 5-140 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Adrianna N Bell
- University of Minnesota School of Nursing, 5-140 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Tiffany T Gallagher
- University of Minnesota School of Nursing, 5-140 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Paula V Nersesian
- University of Southern Maine, Masterson Hall, 71 Bedford Street, Portland, ME 04104, USA
| |
Collapse
|
45
|
Schuchard J, Carle AC, Kappelman MD, Tucker CA, Forrest CB. Interpreting Patient-Reported Outcome Scores: Pediatric Inflammatory Bowel Disease as a Use Case. Acad Pediatr 2022; 22:1520-1528. [PMID: 34995822 PMCID: PMC9253201 DOI: 10.1016/j.acap.2021.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/22/2021] [Accepted: 12/26/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To demonstrate how to interpret Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric patient-reported outcome measure (PROM) scores for patients with pediatric inflammatory bowel disease (IBD). METHODS Using data from a prospective cohort study of patients ages 8 to 23 years with IBD (n = 1049), we established disease-specific percentiles and computed the minimal clinically important difference (MCID) change score for 6 pediatric PROMs. We applied these results, general population percentiles, and the reliable change index to interpret PROM scores in a clinical trial sample of patients ages 8 to 20 years with IBD (n = 294) in which PROMIS PROMs were obtained at baseline and 3 months later. RESULTS Application of general population percentiles showed that the clinical trial sample at baseline had moderately worse self-reported health than the general population (22% of patients at or above the 95th percentile on Fatigue; 21% on Pain Interference). IBD-specific percentiles showed that the sample was somewhat worse than the reference IBD sample (8% of patients at or above the 95th percentile on Fatigue; 11% on Pain Interference). Application of the MCID threshold indicated that among the subgroup of patients that improved by 15 or more on the short Pediatric Crohn's Disease Activity Index (n = 38), 45% also improved on IBD Symptoms, 47% for Fatigue, and 65% for Pain Interference. CONCLUSION This study established IBD-specific percentiles for 6 pediatric PROMIS measures and demonstrated the application of percentiles and other methods for interpreting PROM scores.
Collapse
Affiliation(s)
- Julia Schuchard
- Department of Pediatrics, Children's Hospital of Philadelphia (J Schuchard and CB Forrest), Philadelphia, Pa.
| | - Adam C Carle
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine (AC Carle), Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Arts and Sciences (AC Carle), Cincinnati, Ohio; Department of Psychology, University of Cincinnati College of Arts and Sciences (AC Carle), Cincinnati, Ohio
| | - Michael D Kappelman
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine (MD Kappelman), Chapel Hill, NC
| | - Carole A Tucker
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health (CA Tucker), Philadelphia, Pa
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia (J Schuchard and CB Forrest), Philadelphia, Pa
| |
Collapse
|
46
|
Ettinger AK, Risser L, Rahman S, Rigas D, Abromitis R, Stokes LR, Chavis V, Miller E. Defining and Measuring Child and Youth Thriving: A Scoping Review. Pediatrics 2022; 150:189736. [PMID: 36239092 DOI: 10.1542/peds.2022-056902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Promoting positive child and youth health and development requires clear definitions and comprehensive measures of child and youth thriving. The study's objectives were to identify the scope, range, and gaps in definitions and measures of thriving for children or youth (birth through young adult). METHODS Systematic searches of Pubmed, PsycInfo, Health and Psychosocial Instruments, Education Resources Information Center, and Scopus were conducted for articles that included definitions, conceptual frameworks, or measures of child and youth thriving. Inclusion criteria were that the articles: (1) provided a new definition or measure of child thriving, flourishing, or well-being; (2) focused on normally developing children 0 to 24 years old; and (3) were published between 2009 and 2022 in an English language peer-reviewed journal. Studies were categorized by child age, study type, population, and community-identified domains of thriving. RESULTS Of the 14 920 articles identified, 113 met inclusion criteria: 34 unique definitions or frameworks, 66 validated measures, and 12 articles presenting both a framework and measure. One-third of the articles focused on early childhood (0-5 years old); 47% on middle childhood (6-11 years old); 72% on adolescence (12-17 years old), and 22% on young adults (18-24 years old). CONCLUSIONS Current child thriving definitions, frameworks, and measures could be expanded in their coverage of age and key domains, such as racial equity and safety. Additional frameworks and measures focused on early childhood (0-5 years) and assessing thriving over time are needed.
Collapse
Affiliation(s)
- Anna K Ettinger
- Department of Psychology.,Division of Adolescent and Young Adult Health, Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lauren Risser
- Division of Adolescent and Young Adult Health, Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shiva Rahman
- Division of Adolescent and Young Adult Health, Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David Rigas
- Division of Adolescent and Young Adult Health, Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebecca Abromitis
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lynissa R Stokes
- Division of Adolescent and Young Adult Health, Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Elizabeth Miller
- Division of Adolescent and Young Adult Health, Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
47
|
Randomized Controlled Trial of Health Coaching for Parents of Children With Medical Complexity. Acad Pediatr 2022; 22:1482-1488. [PMID: 35644368 DOI: 10.1016/j.acap.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Parents of children with medical complexity (CMCs) struggle with managing their children's care needs. Health coaching provides patients with tools to take ownership of their care. We sought to assess the impact of health coaching for parents of CMCs on activation, child's health related quality of life (HRQL), and utilization. METHODS Parents of CMCs receiving primary care at two academic primary care practices were randomized to receive 3-6 months of coaching from a trained health coach (n = 54) or usual care (n = 71). Parents were surveyed on activation, HRQL, and experience of care at baseline and the end of the study period. Markers of utilization (missed visit rates, ED, and admissions) were measured for 12 months prior to and after enrollment. Parametric, nonparametric, and Poisson regression were used to assess baseline differences in characteristics and average pre-post differences between the groups. RESULTS At baseline, activation and rating of patient experience were high in both groups, while HRQL was one standard deviation below the population-based mean. Both groups had slight increases in HRQL and P-PAM without significant differences between groups. ED visits declined significantly more in the intervention group than the usual care group (0.68 visits, (-0.03, -1.32) P = .04); there were nonsignificant differences in changes in other utilization metrics. CONCLUSION Health coaching was associated with a decrease in ED use but not in changes in activation, patient experience, or HRQL. More inquiry is needed to understand whether health coaching is an effective modality for improving care for children with medical complexity.
Collapse
|
48
|
Pediatric Medical Traumatic Stress in Inflammatory Bowel Disease, Pancreatitis, and Cystic Fibrosis. J Pediatr Gastroenterol Nutr 2022; 75:455-461. [PMID: 35881966 DOI: 10.1097/mpg.0000000000003569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Known as pediatric medical traumatic stress (PMTS), posttraumatic stress symptoms from medical experiences have not been explored in children with chronic gastrointestinal diseases. This cross-sectional study of children and adolescents with inflammatory bowel disease, chronic pancreatitis and cystic fibrosis, aimed to (1) estimate the prevalence of medical potentially traumatic events (PTEs) and PMTS, (2) explore potential risk factors for PMTS, and (3) explore potential consequences of PMTS. METHODS This cross-sectional study used validated, self-report measures to evaluate PTEs and PMTS. Descriptive statistics and regression analyses were used to achieve study objectives. RESULTS Over two-thirds of children reported a medical potentially traumatic event (91 of 132, 69%). Forty-eight had PMTS symptoms (36%). PMTS was associated with medication burden, emergency and intensive care visits, and parent posttraumatic stress disorder in multivariate analysis. Potential consequences associated with PMTS included school absenteeism, home opioid use, poor quality of life, and parent missed work. CONCLUSIONS A substantial portion of our cohort reported medical PTEs and PMTS. The exploratory analysis identified potential associations between PMTS and illness factors, parent posttraumatic stress disorder, and functional impairments. Further studies of PMTS detection, prevention and treatment are integral to optimizing these children's health and quality of life.
Collapse
|
49
|
Pignolo RJ, Baujat G, Hsiao EC, Keen R, Wilson A, Packman J, Strahs AL, Grogan DR, Kaplan FS. Palovarotene for Fibrodysplasia Ossificans Progressiva (FOP): Results of a Randomized, Placebo-Controlled, Double-Blind Phase 2 Trial. J Bone Miner Res 2022; 37:1891-1902. [PMID: 35854638 PMCID: PMC9804935 DOI: 10.1002/jbmr.4655] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 06/15/2022] [Accepted: 07/16/2022] [Indexed: 01/07/2023]
Abstract
Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare genetic disorder characterized by progressive heterotopic ossification (HO), often heralded by flare-ups, leading to reduced movement and life expectancy. This placebo-controlled, double-blind trial (NCT02190747) evaluated palovarotene, an orally bioavailable selective retinoic acid receptor gamma agonist, for prevention of HO in patients with FOP. Patients experiencing a flare-up were enrolled in two cohorts: (1) patients ≥15 years were randomized 3:1 to palovarotene 10/5 mg (weeks 1-2/3-6) or placebo; (2) patients ≥6 years were randomized 3:3:2 to palovarotene 10/5 mg, palovarotene 5/2.5 mg (weeks 1-2/3-6), or placebo. Cohort data were pooled. The primary endpoint was the proportion of responders (no/minimal new HO at flare-up body region by plain radiograph) at week 6. Change from baseline in HO volume and new HO incidence were assessed by computed tomography (CT) at week 12. Tissue edema was assessed by magnetic resonance imaging (MRI) or ultrasound. Forty patients (aged 7-53 years) were enrolled (placebo: n = 10; palovarotene 5/2.5 mg: n = 9; palovarotene 10/5 mg: n = 21). Disease history was similar between groups. In the per-protocol population, the proportion of responders at week 6 by plain radiograph was 100% with palovarotene 10/5 mg; 88.9% with palovarotene 5/2.5 mg; 88.9% with placebo (Cochran-Armitage trend test: p = 0.17). At week 12, the proportions were 95.0% with palovarotene 10/5 mg; 88.9% with palovarotene 5/2.5 mg; 77.8% with placebo (Cochran-Armitage trend test: p = 0.15). Week 12 least-squares mean (LSmean) new HO volume, assessed by CT, was 3.8 × 103 mm3 with palovarotene 10/5 mg; 1.3 × 103 mm3 with palovarotene 5/2.5 mg; 18.0 × 103 mm3 with placebo (pairwise tests versus placebo: p ≤ 0.12). Palovarotene was well-tolerated. No patients discontinued treatment or required dose reduction; one patient had dose interruption due to elevated lipase. Although these findings were not statistically significant, they support further evaluation of palovarotene for prevention of HO in FOP in larger studies. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Robert J Pignolo
- Department of Medicine, Divisions of Geriatric Medicine and Gerontology, Hospital Internal Medicine, and Endocrinology, Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
| | - Geneviève Baujat
- Departement de Genetique, Institut IMAGINE and Hôpital Necker-Enfants Malades, Paris, France
| | - Edward C Hsiao
- Division of Endocrinology and Metabolism, UCSF Metabolic Bone Clinic, Institute for Human Genetics, Institute for Regeneration Medicine, and the Program for Craniofacial Biology, University of California-San Francisco, San Francisco, CA, USA
| | - Richard Keen
- Consultant Rheumatologist & Honorary Senior Lecturer in Metabolic Bone Disease, The Royal National Orthopaedic Hospital, Stanmore, UK
| | | | | | | | | | - Frederick S Kaplan
- Departments of Orthopaedic Surgery and Medicine, and The Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
50
|
Gmuca S, Weiss PF, McGill M, Xiao R, Ward M, Nelson M, Sherry DD, Cronholm PF, Gerber JS, Palermo TM, Young JF, Rosenberg AR. The Feasibility and Acceptability of Resilience Coaching for Adolescent Chronic Musculoskeletal Pain: A Single-Arm Pilot Trial. CHILDREN 2022; 9:children9101432. [PMID: 36291374 PMCID: PMC9600525 DOI: 10.3390/children9101432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022]
Abstract
Promoting Resilience in Stress Management (PRISM) is a well-established resilience coaching program for youth with chronic illness. It is a one-on-one intervention targeting skills in stress management, goal-setting, cognitive reframing, and meaning-making. We aimed to (i) assess the feasibility and acceptability of PRISM and (ii) explore PRISM’s impact on clinical outcomes among youth with chronic musculoskeletal pain (CMP). This was a single-arm pilot trial of PRISM for youth with CMP aged 12–17 years. Patients completed patient-reported outcome measures (PROs) pre- and post- intervention; patients and caregivers provided qualitative feedback. Twenty-seven patients were enrolled (63% enrollment rate); 82% percent were female. The patients’ median age was 16 years (IQR: 13–16). The intervention completion rate was 81% (n = 22). The mean satisfaction for PRISM overall was 4.3 (SD 0.9), while the mean acceptability of the intervention measure (AIM) was 4.4 (SD 0.89). Participants reported improved resilience (2.2 [SD 5.1]), functional disability (−3.5 [IQR: −6.0, 1.0]), and psychological distress (−1.0 [−5.0, 2.0]) from baseline to immediately post-treatment; pain intensity, pain catastrophizing, and global health were similar at both time points. Feedback was positive and suggested that a group component may be helpful. PRISM is feasible and acceptable among youth with CMP. Exploratory analyses suggest improvements in clinically relevant outcomes, warranting further investigation.
Collapse
Affiliation(s)
- Sabrina Gmuca
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Palliative Care and Resilience Program, Seattle Children’s Research Institute, Seattle, WA 98145, USA
- Correspondence: ; Tel.: +1-(718)-614-5251 or +1-(215)-590-2547; Fax: +1-(215)-590-4750
| | - Pamela F. Weiss
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mackenzie McGill
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Rui Xiao
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michaela Ward
- Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Maria Nelson
- Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David D. Sherry
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Peter F. Cronholm
- Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeffrey S. Gerber
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Jami F. Young
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA 98145, USA
- Department of Child and Adolescent Psychiatry and Behavioral Services, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Abby R. Rosenberg
- Palliative Care and Resilience Program, Seattle Children’s Research Institute, Seattle, WA 98145, USA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA 98104, USA
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA 98195, USA
| |
Collapse
|