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Vater M, Davis A, Jaser S. Evaluation of health literacy and its association with medication adherence and quality of life in childhood-onset systemic lupus erythematosus. Lupus 2024; 33:9612033241258189. [PMID: 38830236 PMCID: PMC11295410 DOI: 10.1177/09612033241258189] [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: 01/26/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Little is known about health literacy in childhood-onset systemic lupus erythematosus (cSLE) and how health literacy relates to medication adherence and psychosocial outcomes in this high-risk population. The objective of this study was to evaluate health literacy in adolescents and young adults with cSLE and its association with medication adherence and quality of life. METHODS Youth 10-24 years with cSLE (n = 48) completed the Brief Healthy Literacy Screen (BHLS) and the Newest Vital Sign (NVS) to assess health literacy. Participants also completed validated measures of medication adherence and quality of life. Descriptive analyses were used to determine levels of health literacy. Bivariate correlations were used to evaluate associations between measures of health literacy with adherence and quality of life. A multivariable regression analyses was used to determine if health literacy was a significant predictor of adherence or quality of life, after adjusting for age, sex, race, and household income. RESULTS Inadequate health literacy was common in this population, with 67% of youth categorized as having inadequate health literacy by the BHLS and 42% by the NVS. Higher medication adherence was associated with a higher BHLS score (r=.36, p = .017). BHLS was also significantly associated with better quality of life (r = 0.31, p = .034). CONCLUSION Inadequate health literacy is prevalent among youth with cSLE. Higher health literacy is associated with higher medication adherence and better quality of life, suggesting that attention to health literacy could improve outcomes for this vulnerable population.
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Affiliation(s)
- McKenzie Vater
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Rheumatology, Nashville, TN, USA
| | - Alaina Davis
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Rheumatology, Nashville, TN, USA
| | - Sarah Jaser
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Psychology, Nashville, TN, USA
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DeCoste C, Moaf P, Mohamed I, Ng L, Ostojic-Aitkens D, Levy DM, Hiraki LT, Toulany A, Knight A. Adolescent Health Care Needs and Relationship to Disease in Patients With Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2024; 76:841-849. [PMID: 38221711 DOI: 10.1002/acr.25297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/30/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Our objective was to characterize adolescent health and psychosocial issues in patients with childhood-onset systemic lupus erythematosus (cSLE) and evaluate demographic and disease characteristics associated with adolescent health. METHODS We retrospectively examined adolescents aged 12 to 18 years with cSLE seen at the Hospital for Sick Children meeting the American College of Rheumatology/Systemic Lupus International Collaborating Clinics classification criteria, assessed by adolescent medicine in the cSLE clinic between 2018 and 2020. Adolescent health issues were characterized using the Home, Education/Employment, Activities, Diet/Drugs, Sexuality, Suicide/mood (HEADDSS) framework. Issues were classified as presenting and/or identified; adolescent health burden was tabulated as the number of distinct adolescent issues per patient. Multiple Poisson regression models examined associations between patient and disease characteristics (age, sex, material deprivation, disease activity, disease damage, and high-dose glucocorticoid exposure) and adolescent health issues. RESULTS A total of 108 (60%) of 181 adolescents with cSLE were seen by adolescent medicine, with a median of 2 (interquartile range [IQR] 1-3) visits and a median of 2 (IQR 1-5) adolescent health issues during the study period. Common issues were mood (presenting in 21% vs identified in 50%), sleep (27% vs 2%), school and education (26% vs 1%), and nonadherence (23% vs 8%). Psychoeducation was provided by adolescent medicine to 54% of patients. High-dose glucocorticoids (risk ratio [RR] 1.82, 95% confidence interval [CI] 1.41-2.35, P < 0.001), material deprivation (RR 1.17, 95% CI 1.04-1.30, P = 0.007), and lower SLE Disease Activity Index scores (RR 0.95, 95% CI 0.92-0.98, P = 0.004) were associated with higher adolescent health burden. CONCLUSION Adolescents with cSLE experience many adolescent issues, especially low mood. High-dose glucocorticoids and social marginalization are associated with greater adolescent health burden. This study highlights the importance of addressing adolescent health needs as part of routine care.
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Affiliation(s)
| | - Paris Moaf
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Lawrence Ng
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Deborah M Levy
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linda T Hiraki
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alene Toulany
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea Knight
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Cardwell FS, Elliott SJ, Barber MRW, Cheema K, George S, Boucher A, Clarke AE. Canadian patient experiences of lupus nephritis: a qualitative analysis. Lupus Sci Med 2023; 10:e000982. [PMID: 38087643 PMCID: PMC10729228 DOI: 10.1136/lupus-2023-000982] [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: 06/21/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Lupus nephritis (LN) is one of the most severe manifestations of SLE; however, we know little about the lived experience of LN. This research investigates patient experiences and perspectives of (1) LN diagnosis; (2) living with LN; and (3) LN healthcare and treatment. METHODS Patients aged ≥18 years with biopsy-proven pure or mixed International Society of Nephrology/Renal Pathology Society class III, IV or V LN were purposefully recruited from a Canadian lupus cohort to participate in semistructured in-depth interviews. RESULTS Thirty patients with LN completed the interviews. The mean (SD) age was 42.1 (16.4) years, and 86.7% were female. Participants described challenges seeking, receiving and adjusting to a LN diagnosis, and some reported that their diagnosis process took weeks to years. While 16 participants were provided resources by healthcare providers to help them through the process of diagnosis, the need for accessible LN-specific information at diagnosis was highlighted (n=18). Participants also described the unpredictability of living with LN, particularly related to impacts on physical and mental health, relationships, leisure activities, employment and education, and family planning. While most (n=26) participants reported a positive impression of their care, the side effects of LN medications and the need to increase patient and societal awareness/understanding of LN were highlighted in the context of healthcare and treatment. CONCLUSIONS The unpredictability of living with LN, the heavy treatment burden and a lack of patient/societal awareness substantially affect the lived experience of LN. These findings will inform the development of LN-specific patient resources to increase understanding of LN and improve well-being for patients.
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Affiliation(s)
- Francesca S Cardwell
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan J Elliott
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
| | - Megan R W Barber
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kim Cheema
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sydney George
- Health Outcomes and Economics, GSK, Mississauga, Ontario, Canada
| | - Adrian Boucher
- Health Outcomes and Economics, GSK, Mississauga, Ontario, Canada
| | - Ann Elaine Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Mazhariazad F, Dianati M, Taghadosi M, Zamani B. Uncertainty and its related coping strategies in systemic lupus erythematosus. Life in the fog. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:233. [PMID: 37727415 PMCID: PMC10506748 DOI: 10.4103/jehp.jehp_1080_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/09/2022] [Indexed: 09/21/2023]
Abstract
BACKGROUND One of the most prevalent problems of patients with systemic lupus erythematosus (SLE) is the uncertainty over an indefinite future. Uncertainty has significant effects on quality of life. The aim of this study was to explore uncertainty and personal strategies to cope with it among patients with SLE. MATERIALS AND METHODS This qualitative study was conducted in 2020-2021 using conventional content analysis. Participants were 21 patients with SLE who were purposefully selected from rheumatology clinics in Kashan, Kerman, and Bandar Abbass in Iran. Data collection was performed using face-to-face, in-depth, semi-structured interviews and was continued up to data saturation. Data were analyzed concurrently with data collection through conventional content analysis approach proposed by Graneheim and Lundman. RESULTS Two main themes, namely, "life in the fog" and "attempt to find peace" emerged from patients' experiences of illness uncertainty of SLE. Life in the fog included three main categories of "perception of threat to health", "challenge of doubt and certainty," and "indefinite future." Attempt to find peace included three main categories of "spirituality," "reflection," and "attempt to acquire SLE-related knowledge. CONCLUSIONS Uncertainty is a major psychological stress for patients with SLE. Healthcare providers should therefore consider the challenges and concerns faced by patients and, through utilizing appropriate training and communicational practices, plan interventions and strategies to empower patients for coping with uncertainty.
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Affiliation(s)
- Fereshteh Mazhariazad
- Department of Medical-Surgical Nursing, Kashan University of Medical Sciences, Kashan, Iran
| | - Mansour Dianati
- Department of Medical-Surgical Nursing, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohsen Taghadosi
- Department of Medical-Surgical Nursing, Kashan University of Medical Sciences, Kashan, Iran
| | - Batool Zamani
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
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5
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Blamires J, Foster M, Napier S, Dickinson A. Experiences and Perspectives of Children and Young People Living with Childhood-Onset Systemic Lupus Erythematosus-An Integrative Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1006. [PMID: 37371240 DOI: 10.3390/children10061006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) impacts the daily life of children and young people. This study aimed to describe the experiences and perspectives of children and young people living with cSLE. An integrative review guided by Whittemore and Knafl was conducted. Extant empirical research published in peer-reviewed journals from 2000 to 2021 on children's self-reported experiences living with cSLE was identified from Scopus, CINAHL, Medline via PubMed, and PsycINFO via Ovid databases. Nineteen studies involving over 1400 participants were included. Four themes and fourteen sub-themes were identified: (1) challenging symptoms (disruptions to life and altered self, severity, fatigue, depression, and anxiety), (2) medicines and side effects (dreaded steroids, conflicting feelings, and medication adherence), (3) complicated life (school sports and social, giving things up, lack of understanding, and quality of life) and (4) ways of coping (family and friends, relationships with health providers, and maintaining positivity). While cSLE shares many similarities with adult-onset SLE, awareness of differences in experiences and perceptions of children and young people is crucial. The significant psychological and social impact of the disease and its treatments necessitates a comprehensive, holistic approach to managing cSLE that considers the unique needs of youth.
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Affiliation(s)
- Julie Blamires
- School of Clinical Sciences, Auckland University of Technology, Auckland 0627, New Zealand
| | - Mandie Foster
- School of Clinical Sciences, Auckland University of Technology, Auckland 0627, New Zealand
- School of Nursing and Midwifery, Edith Cowan University, Perth 6027, Australia
| | - Sara Napier
- School of Clinical Sciences, Auckland University of Technology, Auckland 0627, New Zealand
| | - Annette Dickinson
- School of Clinical Sciences, Auckland University of Technology, Auckland 0627, New Zealand
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Teixeira Santos FPS, Ferreira GA, de Paula JJ, de Souza KCP, Cançado Silva SL, Correa H. Cognitive dysfunction in patients with childhood-onset systemic lupus erythematosus may impact treatment. Adv Rheumatol 2023; 63:18. [PMID: 37095585 DOI: 10.1186/s42358-023-00300-8] [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: 08/07/2022] [Accepted: 04/12/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Cognitive dysfunction (CD) is a widespread manifestation in adult systemic lupus erythematosus (SLE) patients, but this subject is rarely examined in patients with childhood-onset SLE (cSLE). This study aimed to assess the frequency of CD, its associations with lupus clinical manifestations and its impact on the health-related quality of life (HRQL) in young adult cSLE patients. METHODS We evaluated 39 cSLE patients older than 18 years. They underwent a rheumatologic evaluation and extensive neuropsychological assessment, encompassing all cognitive domains described by the American College of Rheumatology. HRQL was assessed with the WHOOQOL-BREEF, General Activities of Daily Living Scale (GADL) and Systemic Lupus Erythematosus-specific quality-of-life instrument (SLEQOL). The activity of SLE was evaluated with the modified sle disease activity index (sledai-2k). RESULTS Impairment in at least one cognitive domain was found in 35 (87.2%) patients. The most compromised domains were attention (64.1%), memory (46.2%), and executive functions (38.5%). Patients with cognitive impairment were older, had more accumulated damage and had worse socioeconomic status. Regarding the association between cognitive dysfunction and HRQL, memory impairment was correlated with worse environmental perception and a worse relationship with the treatment. CONCLUSION In this study, the frequency of CD in cSLE patients was as high as that in the adult SLE population. CD can significantly impact the response of cSLE patients to treatment, justifying preventive measures in the care of this population.
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Affiliation(s)
- Flávia Patrícia Sena Teixeira Santos
- Post graduation Program in Molecular Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
- Division of Rheumatology, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Gilda Aparecida Ferreira
- Department of the Locomotor Apparatus, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Jonas Jadim de Paula
- Post graduation Program in Molecular Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Department of Psychology, Faculdade de Ciências Médicas de Minas Gerais, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Kalline Cristina Prata de Souza
- Post graduation Program in Molecular Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Sandro Luiz Cançado Silva
- Post graduation Program in Molecular Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Humberto Correa
- Post graduation Program in Molecular Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Department of Mental Health, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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7
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García-Rodríguez F, Arana-Guajardo AC, Villarreal-Treviño AV, Negrete-López R, López-Rangel JA, Fortuna-Reyna BJ, Corral-Trujillo ME, Jiménez-Hernández S, Áncer-Rodríguez PR, Herrera-López MG, Salas-Fraire Ó, Salas-Longoria K, de la O-Cavazos ME, Galarza-Delgado DÁ, Rubio-Pérez N. Design of a Rheumatology Transition Clinic for a Resource-Constrained Setting. Indian J Pediatr 2023; 90:29-37. [PMID: 35476251 DOI: 10.1007/s12098-022-04102-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/27/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To describe the design process of a medical care program for adolescents with pediatric onset rheumatic diseases (PRD) during the transition from pediatric to adult care in a resource-constrained hospital. METHODS The model of attention was developed in three steps: 1) the selection of a multidisciplinary team, 2) the evaluation of the state of readiness of patients and caregivers for the transition, and 3) the design of a strategy of attention according to local needs. The results of the first two steps were used in order to develop the strategy of attention. RESULTS The transition process was structured in three stages: pretransition (at pediatric rheumatology clinic), Transition Clinic for Adolescents with Rheumatic Diseases (TCARD, the main intervention), and post-transition (at adult rheumatology clinic). Each stage was divided, in turn, into a variable number of phases (8 in total), which included activities and goals that patients and caregivers were to accomplish during the process. A multidisciplinary approach was planned by pediatric and adult rheumatologists, nutritionists, physiatrists, psychiatrist, psychologist, nurse, and social worker. During TCARD, counseling, education, nutritional, physical, and mental health interventions were considered. CONCLUSIONS The proposed transition model for patients with rheumatic diseases can be a useful tool in developing countries.
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Affiliation(s)
- Fernando García-Rodríguez
- Department of Pediatrics, Universidad Autónoma de Nuevo León. Madero Y Gonzalitos S/N, Col. Mitras Centro 64460, Monterrey, Nuevo León, Mexico
| | - Ana C Arana-Guajardo
- Servicio de Reumatología, Instituto de Medicina Interna. Escuela Nacional de Medicina Sistema Tec Salud, Monterrey, Mexico
| | - Ana V Villarreal-Treviño
- Department of Pediatrics, Universidad Autónoma de Nuevo León. Madero Y Gonzalitos S/N, Col. Mitras Centro 64460, Monterrey, Nuevo León, Mexico
| | - Roberto Negrete-López
- Rheumatology Service, Universidad Autónoma de Nuevo León. Madero Y Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo León, Mexico
| | - José A López-Rangel
- Department of Psychiatry, Universidad Autónoma de Nuevo León. Madero Y Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo León, Mexico
| | - Brenda J Fortuna-Reyna
- Department of Pediatrics, Universidad Autónoma de Nuevo León. Madero Y Gonzalitos S/N, Col. Mitras Centro 64460, Monterrey, Nuevo León, Mexico
| | - María E Corral-Trujillo
- Rheumatology Service, Universidad Autónoma de Nuevo León. Madero Y Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo León, Mexico
| | - Sol Jiménez-Hernández
- Department of Pediatrics, Universidad Autónoma de Nuevo León. Madero Y Gonzalitos S/N, Col. Mitras Centro 64460, Monterrey, Nuevo León, Mexico
| | - Patricia R Áncer-Rodríguez
- Department of Nutrition at Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León.Madero Y Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo León, Mexico
| | - Mayra G Herrera-López
- Department of Nutrition at Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León.Madero Y Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo León, Mexico
| | - Óscar Salas-Fraire
- Department of Rehabilitation and Sports Medicine, Universidad Autónoma de Nuevo León.Madero Y Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo León, Mexico
| | - Karina Salas-Longoria
- Department of Rehabilitation and Sports Medicine, Universidad Autónoma de Nuevo León.Madero Y Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo León, Mexico
| | - Manuel E de la O-Cavazos
- Department of Pediatrics, Universidad Autónoma de Nuevo León. Madero Y Gonzalitos S/N, Col. Mitras Centro 64460, Monterrey, Nuevo León, Mexico
| | - Dionicio Á Galarza-Delgado
- Rheumatology Service, Universidad Autónoma de Nuevo León. Madero Y Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo León, Mexico
| | - Nadina Rubio-Pérez
- Department of Pediatrics, Universidad Autónoma de Nuevo León. Madero Y Gonzalitos S/N, Col. Mitras Centro 64460, Monterrey, Nuevo León, Mexico.
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Hussain A, Maheshwari MV, Khalid N, Patel PD, Alghareeb R. Diagnostic Delays and Psychosocial Outcomes of Childhood-Onset Systemic Lupus Erythematosus. Cureus 2022; 14:e26244. [PMID: 35911281 PMCID: PMC9313193 DOI: 10.7759/cureus.26244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/15/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that manifests in affected individuals with a variety of clinical features and involves multiple organs. Despite recent advances over the past decades, higher morbidity and mortality have been reported by studies in patients with childhood-onset systemic lupus erythematosus (cSLE) compared to patients with adult-onset. The interplay of several factors can cause diagnostic delays resulting in worse disease activity, multiple organ damage, increased risk of hospitalization, and management with aggressive treatment. Significant factors include demographic, clinical, and socioeconomic characteristics of patients with cSLE. Moreover, despite recent advances in lupus treatment, prolonged disease duration in these young patients can result in debilitating psychosocial outcomes and can significantly impact their health-related and general quality of life (QOL). Important domains affected include patient self-esteem, education, employment, healthcare utilization, and mental health. In this review, we examined the barriers that lead to a delay in diagnosing lupus in the pediatric population and addressed cSLE morbimortality and its long-term impact on patient health-related and general QOL.
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Wilson C, Spencer G. The mental health support needs of university students with long-term physical health conditions. HEALTH EDUCATION 2022. [DOI: 10.1108/he-01-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeSupporting the mental health of university students is a key priority for higher education. Students living with long-term health conditions are at increased risk of poor mental health; yet little work has focused on their particular mental health needs or indeed, the implications for health education in the university setting. This study sought to identify the mental health support needs of students with long-term conditions, including best ways for universities to support these students.Design/methodology/approachA UK national online survey of 200 university students living with long-term physical health conditions (e.g. asthma, endometriosis, epilepsy) was conducted in 2019.Findings95% of respondents reported that their long-term condition/s had at least a moderate impact on their mental wellbeing, with 81% reporting that they felt depressed and anxious at least once a month because of their health. The most common suggestion for how universities can better support their mental wellbeing was to raise awareness about long-term conditions on campuses, with many reporting a lack of understanding about long-term conditions from academic and support services staff members – with negative impacts on their mental health. Because of this, some respondents reported a reluctance to come forward and seek help from university services, with 25% not formally disclosing their conditions.Originality/valueThese reported concerns underscore the need to develop health education amongst university staff about long-term conditions and to ensure these students are supported with their health at university.
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Bhattad S, Mohite R, Singh N. Growth and development in children with rheumatic diseases: Maintaining a balance between drugs and disease activity. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_54_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Smith EMD, Gorst SL, Al-Abadi E, Hawley DP, Leone V, Pilkington C, Ramanan AV, Rangaraj S, Sridhar A, Beresford MW, Young B. 'It is good to have a target in mind': qualitative views of patients and parents informing a treat to target clinical trial in juvenile-onset systemic lupus erythematosus. Rheumatology (Oxford) 2021; 60:5630-5641. [PMID: 33629109 PMCID: PMC8645274 DOI: 10.1093/rheumatology/keab173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/05/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE We sought to explore patient and parental views on treatment targets, outcome measures and study designs being considered for a future JSLE treat-to-target (T2T) study. METHODS We conducted topic-guided, semistructured interviews with JSLE patients and parents and analysed the audio recorded interviews using thematic approaches. RESULTS Patients and parents differed regarding symptoms they felt would be tolerable, representing 'low disease activity'. Patients often classed symptoms that they had previously experienced, were 'invisible' or had minimal disruption on their life as signs of low disease activity. Parents were more accepting of visible signs but were concerned about potential organ involvement and symptom severity. Overall, patients and parents preferred that children were entirely asymptomatic, with no ongoing treatment side effects. They regarded fatigue as particularly challenging, requiring proper monitoring using a fatigue patient-reported outcome measure. Most families felt that reducing corticosteroids would also be a good treatment target. Overall, families liked the concept of T2T, commenting that it could help to improve disease control, help structure treatment and improve communication with clinicians and treatment compliance. They were concerned that T2T might increase the frequency of hospital visits, thus impacting upon schooling, parental employment and finances. Families made suggestions on how to modify the future trial design to mitigate such effects. CONCLUSION This study provides guidance from patients and parents on T2T targets and study designs. Complementary quantitative studies assessing the achievability and impact of different targets (e.g. lupus low disease activity state or remission) are now warranted to inform an international consensus process to develop treatment targets.
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Affiliation(s)
- Eve M D Smith
- Institute of Life Course and Medical Science, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust
| | - Sarah L Gorst
- Department of Health Data Science, University of Liverpool, Liverpool
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children’s Hospital, Birmingham
| | - Daniel P Hawley
- Department of Paediatric Rheumatology, Sheffield Children’s NHS Foundation Trust, Sheffield
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds General Infirmary, Leeds
| | | | - Athimalaipet V Ramanan
- Bristol Royal Hospital for Children & Translational Health Sciences, University of Bristol, Bristol
| | - Satyapal Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham
| | - Arani Sridhar
- Leicester Children’s Hospital, University Hospitals of Leicester NHS Trust, Leicester
| | - Michael W Beresford
- Institute of Life Course and Medical Science, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust
| | - Bridget Young
- Institute of Population Health, University of Liverpool, Liverpool, UK
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Case S, Sinnette C, Phillip C, Grosgogeat C, Costenbader KH, Leatherwood C, Feldman CH, Son MB. Patient experiences and strategies for coping with SLE: A qualitative study. Lupus 2021; 30:1405-1414. [PMID: 34013818 DOI: 10.1177/09612033211016097] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study explored challenges that patients with systemic lupus erythematosus (SLE) and childhood-onset SLE (cSLE) face to identify modifiable influences and coping strategies in patient experiences. METHODS Participants were recruited from two academic medical centers through a Lupus Registry of individuals ≥18 years old and ≥4 1997 ACR classification criteria for SLE and a centralized data repository of cSLE patients, and participated in three focus groups. Transcripts were coded thematically and adjudicated by two independent reviewers. RESULTS Thirteen adults, 7 (54%) with cSLE, participated in focus groups. Themes were categorized into two domains: (1) challenges with SLE diagnosis and management; and (2) patient coping strategies and modifiable factors of the SLE experience. Participants identified five primary challenges: diagnostic odyssey, public versus private face of SLE, SLE-related stresses, medication adherence, and transitioning from pediatric to adult care. Coping strategies and modifiable factors included social support, open communication about SLE, and strong patient-provider relationships. Several participants highlighted positive lessons learned through their experiences with SLE, including empathy, resilience, and self-care skills. CONCLUSIONS Patients with cSLE and SLE identified common challenges, modifying influences and coping strategies based on personal experiences. A strong patient-provider relationship and trust in the medical team emerged as key modifiable factors. Deriving optimism from experiences with SLE was unique to several patients diagnosed as children or young adults. Leveraging factors that improved the participants' experiences living with SLE may be used in future studies to address vulnerabilities in care.
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Affiliation(s)
- Siobhan Case
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
- Division of Allergy, Immunology, and Rheumatology, Boston Children's Hospital, Boston, MA, USA
| | - Corine Sinnette
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Courtnie Phillip
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Claire Grosgogeat
- Division of Allergy, Immunology, and Rheumatology, Boston Children's Hospital, Boston, MA, USA
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Cianna Leatherwood
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Candace H Feldman
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary Beth Son
- Division of Allergy, Immunology, and Rheumatology, Boston Children's Hospital, Boston, MA, USA
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13
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Trindade VC, Carneiro-Sampaio M, Bonfa E, Silva CA. An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus. Paediatr Drugs 2021; 23:331-347. [PMID: 34244988 PMCID: PMC8270778 DOI: 10.1007/s40272-021-00457-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 02/06/2023]
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) is a prototype of a multisystemic, inflammatory, heterogeneous autoimmune condition. This disease is characterized by simultaneous or sequential organ and system involvement, with unpredictable flare and high levels of morbidity and mortality. Racial/ethnic background, socioeconomic status, cost of medications, difficulty accessing health care, and poor adherence seem to impact lupus outcomes and treatment response. In this article, the management of cSLE patients is updated. Regarding pathogenesis, a number of potential targets for drugs have been studied. However, most treatments in pediatric patients are off-label drugs with recommendations based on inadequately powered studies, therapeutic consensus guidelines, or case series. Management practices for cSLE patients include evaluations of disease activity and cumulative damage scores, routine non-live vaccinations, physical activity, and addressing mental health issues. Antimalarials and glucocorticoids are still the most common drugs used to treat cSLE, and hydroxychloroquine is recommended for nearly all cSLE patients. Disease-modifying antirheumatic drugs (DMARDs) should be standardized for each patient, based on disease flare and cSLE severity. Mycophenolate mofetil or intravenous cyclophosphamide is suggested as induction therapy for lupus nephritis classes III and IV. Calcineurin inhibitors (cyclosporine, tacrolimus, voclosporin) appear to be another good option for cSLE patients with lupus nephritis. Regarding B-cell-targeting biologic agents, rituximab may be used for refractory lupus nephritis patients in combination with another DMARD, and belimumab was recently approved by the US Food and Drug Administration for cSLE treatment in children aged > 5 years. New therapies targeting CD20, such as atacicept and telitacicept, seem to be promising drugs for SLE patients. Anti-interferon therapies (sifalimumab and anifrolumab) have shown beneficial results in phase II randomized control trials in adult SLE patients, as have some Janus kinase inhibitors, and these could be alternative treatments for pediatric patients with severe interferon-mediated inflammatory disease in the future. In addition, strict control of proteinuria and blood pressure is required in cSLE, especially with angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use.
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Affiliation(s)
- Vitor Cavalcanti Trindade
- Children and Adolescent Institute, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Magda Carneiro-Sampaio
- Children and Adolescent Institute, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Clovis Artur Silva
- Children and Adolescent Institute, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
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14
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Resilience in women with primary Sjögren's syndrome. Rheumatol Int 2021; 41:1987-1994. [PMID: 34091740 DOI: 10.1007/s00296-021-04899-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
To assess the relationship between resilience and several diseases and individual features in primary Sjӧgren's Syndrome (SS) patients. Resilience was assessed using the Resilience Scale (RS-14). Disease activity, damage, and reported symptoms were assessed by means of ESSDAI (EULAR Sjögren's syndrome disease activity index), SSDDI (Sjӧgren's Syndrome Disease Damage Index) and ESSPRI (EULAR Sjӧgren's Syndrome Patient Reported Index). EuroQol, HADS (Hospital Anxiety and Depression Scale), SF-12 (Short-form 12 health survey), FAS (Fatigue Assessment Scale), FACIT-F (Functional Assessment of Chronic Illness Therapy - Fatigue), and IPAQ (International Physical Activity Questionnaire) questionnaires were submitted to evaluate physical and mental well-being of the recruited patients. Data about the autoimmune profile, systemic manifestations, and current therapy were collected. Educational qualifications and work activities were also considered. Descriptive, correlational, and linear regression analysis were performed. 74 consecutive women with primary SS and 74 sex and age-matched healthy subjects as a control group were recruited. SS patients displayed a moderate value of resilience (median 78.5) with no significant difference compared to controls (p = 0.38). An inverse relationship was found between resilience and mood disorders such as anxiety (p = 0.038) and depression (p < 0.001). Greater resilience was associated with a better perception of the quality of life (p = 0.02) and general health (p < 0.001), as well as with less fatigue (p = 0.008) and a more physically active lifestyle (p = 0.001). No significant relationship was found neither between resilience and age, socio-demographic and disease characteristics, nor with ESSDAI (p = 0.26), ESSPRI (p = 0.83) and SSDDI (p = 0.67). This is the first study assessing resilience in a large group of unselected primary SS patients. Most resilient primary SS patients are less depressed and show a better perception of their health. Greater resilience tends to correlate with less anxiety, physical and mental fatigue, and a more active lifestyle, while no association with disease activity and duration, damage, and socio-demographic features was detected. Considering the well-known role of resilience in helping to better cope with chronic illnesses, its assessment in SS patients should not be overlooked and the possible strategies for its improvement should be better explored and further implemented.
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15
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Wilson C, Stock J. 'Social media comes with good and bad sides, doesn't it?' A balancing act of the benefits and risks of social media use by young adults with long-term conditions. Health (London) 2021; 25:515-534. [PMID: 34080463 PMCID: PMC8424608 DOI: 10.1177/13634593211023130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Young adults are frequent users of social media, but the help and hindrance of social media for living well with long-term conditions (LTCs) in young adulthood is little-researched. The aim of this paper was to explore the experiences of social media use amongst young adults with LTCs. Interviews with 15 young adults with LTCs explored their experiences of using social media more broadly and in relation to online health communities. Social media came with both 'good and bad sides' which required a balancing act to manage (overarching theme), as reflected in the following subthemes: (1) Relationships: reducing social isolation versus need for face-to-face contact; (2) Comparisons: normalising versus negative (upward) comparisons; (3) Community: fitting in versus feeling left out; (4) Emotions: inspiring versus distress contagion; and (5) Knowledge: exchanging useful information versus fear of decline. The findings highlight the importance of young adults' self-reflection/awareness of social media's impact on their wellbeing, identifying when limited or increased use may be preferable. Whilst there is a 'good' to social media such as increased feelings of belonging and connection, this should not be the sole focus of future self-management interventions; as its use also contributes to feelings of distress, fear and not fitting in, and participants desire face-to-face contact.
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16
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Mendoza-Pinto C, García-Carrasco M, Campos-Rivera S, Munguía-Realpozo P, Etchegaray-Morales I, Ayón-Aguilar J, Alonso-García NE, Méndez-Martínez S. Medication adherence is influenced by resilience in patients with systemic lupus erythematosus. Lupus 2021; 30:1051-1057. [PMID: 33794703 DOI: 10.1177/09612033211004722] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Evidence on the relationship between resilience and medication adherence in systemic lupus erythematosus (SLE) patients is lacking. We aimed to examine the impact of resilience on medication adherence in SLE patients. METHOD In a cross-sectional analysis SLE outpatients were assessed for resilience (Connor-Davison Resilience Scale, CD-RISC), depressive symptoms (CES-D) and medication adherence (Compliance Questionnaire for Rheumatology [CQR]). The disease activity index (mexSLEDAI) and damage (SLICC Damage Index) were administered. Factors independently associated with adherence were identified using multivariate logistic regression. RESULTS Of the 157 patients, 152 (96.8%) were female with a median age of 45.9 (IQR: 39.0-55.5) years and disease duration of 14 (IQR: 10.0-19.0) years. Medication adherence (CQR ≥80%) and depressive symptoms were found in 74.5% and 43.9% of patients, respectively. Adherent patients had a lower CES-D score and a higher CD-RISC score. In the multivariate analysis adjusting for demographic and clinical confounders, resilience and older age protected against non-adherence (OR 0.96, [95% CI 0.94-0.99] and OR 0.96 [95% CI 0.93-0.98], respectively). CONCLUSION In SLE patients, resilience and older age, which possibly associated with better medication adherence, may protect against non-adherence.
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Affiliation(s)
- Claudia Mendoza-Pinto
- Systemic Autoimmune Diseases Research Unit, High-Specialty Medical Unit-CIBIOR, Mexican Social Security Institute, Puebla, México.,Department of Rheumatology and Immunology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Mario García-Carrasco
- Systemic Autoimmune Diseases Research Unit, High-Specialty Medical Unit-CIBIOR, Mexican Social Security Institute, Puebla, México.,Department of Rheumatology and Immunology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Sandra Campos-Rivera
- Department of Rheumatology and Immunology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Pamela Munguía-Realpozo
- Systemic Autoimmune Diseases Research Unit, High-Specialty Medical Unit-CIBIOR, Mexican Social Security Institute, Puebla, México.,Department of Rheumatology and Immunology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Ivet Etchegaray-Morales
- Department of Rheumatology and Immunology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Jorge Ayón-Aguilar
- Research Coordination, Puebla Delegation, Mexican Social Security Institute, Puebla, México
| | - Norma Edith Alonso-García
- Department of Psychology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
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17
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Tan QEC, Gao X, Ang WHD, Lau Y. Medication adherence: a qualitative exploration of the experiences of adolescents with systemic lupus erythematosus. Clin Rheumatol 2021; 40:2717-2725. [PMID: 33566194 DOI: 10.1007/s10067-021-05583-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/13/2020] [Accepted: 01/10/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION/OBJECTIVE There are increasing numbers of children diagnosed with systemic lupus erythematosus (SLE). Given the chronicity of the disease, individuals are confronted with cocktails of medications for an extended period. The present study explores experiences in medication adherence among adolescents with SLE in an acute care hospital. METHOD A descriptive qualitative design was employed. Fourteen adolescents with SLE were purposively selected. Face-to-face audio-recorded semi-structured interviews were conducted. Field notes and reflexive journals were maintained, and frequent debriefing sessions were performed to ensure the study's methodological rigour. Interviews were transcribed verbatim and thematic analyses were used. Constant comparative analysis was used to identify similarities and differences among the participants. RESULTS Four themes emerged from interviews: (1) making sense of the treatment; (2) contending with side effects of medications; (3) maintaining networks of support; and (4) creating a new normal. The participants were motivated to adhere to medications when they developed awareness, received social support from family and friends and created routines for new normal when confronted with their diseases. However, some attributed a lack of parental support, poor doctor-patient relationships and the large numbers of medications as deterrence to medication adherence. CONCLUSIONS This study highlights various medication-taking motivators and deterrents. Interdependent relationships between motivators and deterrents determine medication-taking behaviours. Findings from this multi-ethnic group of individuals of various ages and religious faith across the disease trajectory provide a deep insight into adolescents' experiences of medication adherence. This can contribute to the development of unique interventions for such individuals. Key points • Adolescents with systemic lupus erythematosus struggle with conforming to cocktails of medications. • A variety of factors either facilitate or impede their decisions to adhere to medication regimes. • Results suggest that tackling medication adherence among adolescents requires a multi-pronged approach from individual, familial and medical perspectives.
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Affiliation(s)
- Qiu Er Clarice Tan
- Department of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Xiaocong Gao
- Department of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
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18
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Kelly A, Niddrie F, Tunnicliffe DJ, Matus Gonzalez A, Hanson C, Jiang I, Major G, Singh-Grewal D, Tymms K, Tong A. Patients' attitudes and experiences of transition from paediatric to adult healthcare in rheumatology: a qualitative systematic review. Rheumatology (Oxford) 2021; 59:3737-3750. [PMID: 32413124 DOI: 10.1093/rheumatology/keaa168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/19/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES We aimed to describe patients' attitudes and experiences of transition from paediatric to adult healthcare in rheumatology to inform patient-centred transitional care programmes. METHODS We searched MEDLINE, EMBASE, PsycINFO and CINAHL to August 2019 and used thematic synthesis to analyse the findings. RESULTS From 26 studies involving 451 people with juvenile-onset rheumatic conditions we identified six themes: a sense of belonging (comfort in familiarity, connectedness in shared experiences, reassurance in being with others of a similar age, desire for normality and acceptance); preparedness for sudden changes (confidence through guided introductions to the adult environment, rapport from continuity of care, security in a reliable point of contact, minimizing lifestyle disruptions); abandonment and fear of the unknown (abrupt and forced independence, ill-equipped to hand over medical information, shocked by meeting adults with visible damage and disability, vulnerability in the loss of privacy); anonymous and dismissed in adult care (deprived of human focus, sterile and uninviting environment, disregard of debilitating pain and fatigue); quest for autonomy (controlled and patronized in the paediatric environment, liberated from the authority of others, freedom to communicate openly); and tensions in parental involvement (overshadowed by parental presence, guilt of excluding parents, reluctant withdrawal of parental support). CONCLUSION Young people feel dismissed, abandoned, ill-prepared and out of control during transition. However, successful transition can be supported by preparing for changes, creating a sense of belonging and negotiating parental involvement and autonomy. Incorporating patient-identified priorities into transitional services may improve satisfaction and outcomes in young people with juvenile-onset rheumatic conditions.
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Affiliation(s)
- Ayano Kelly
- College of Health and Medicine, Australian National University.,Department of Rheumatology, The Canberra Hospital, Canberra, ACT.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead
| | - Fiona Niddrie
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre/John Hunter Hospital, Newcastle
| | - David J Tunnicliffe
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,Sydney School of Public Health, The University of Sydney, Sydney
| | | | - Camilla Hanson
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,Sydney School of Public Health, The University of Sydney, Sydney
| | - Ivy Jiang
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,School of Medicine, University of New South Wales, Randwick
| | - Gabor Major
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre/John Hunter Hospital, Newcastle.,School of Medicine and Public Health, University of Newcastle, Newcastle
| | - Davinder Singh-Grewal
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre/John Hunter Hospital, Newcastle.,Department of Rheumatology, The Children's Hospital at Westmead, Westmead.,Discipline of Paediatrics and Child Health, The University of Sydney, Sydney.,School of Maternal and Child Health, University of New South Wales, Randwick.,Department of Rheumatology, Liverpool Hospital, Liverpool, NSW
| | - Kathleen Tymms
- College of Health and Medicine, Australian National University.,Department of Rheumatology, The Canberra Hospital, Canberra, ACT.,Canberra Rheumatology, Canberra, ACT, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,Sydney School of Public Health, The University of Sydney, Sydney
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19
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Jiang I, Major G, Singh-Grewal D, Teng C, Kelly A, Niddrie F, Chaitow J, O'Neill S, Hassett G, Damodaran A, Bernays S, Manera K, Tong A, Tunnicliffe DJ. Patient and parent perspectives on transition from paediatric to adult healthcare in rheumatic diseases: an interview study. BMJ Open 2021; 11:e039670. [PMID: 33397662 PMCID: PMC7783517 DOI: 10.1136/bmjopen-2020-039670] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To describe the experiences, priorities, and needs of patients with rheumatic disease and their parents during transition from paediatric to adult healthcare. SETTING Face-to-face and telephone semistructured interviews were conducted from December 2018 to September 2019 recruited from five hospital centres in Australia. PARTICIPANTS Fourteen young people and 16 parents were interviewed. Young people were included if they were English speaking, aged 14-25 years, diagnosed with an inflammatory rheumatic disease (eg, juvenile idiopathic arthritis, juvenile dermatomyositis, systemic lupus erythematosus, panniculitis, familial Mediterranean fever) before 18 years of age. Young people were not included if they were diagnosed in the adult setting. RESULTS We identified four themes with respective subthemes: avoid repeat of past disruption (maintain disease stability, preserve adjusted personal goals, protect social inclusion); encounter a daunting adult environment (serious and sombre mood, discredited and isolated identity, fear of a rigid system); establish therapeutic alliances with adult rheumatology providers (relinquish a trusting relationship, seek person-focused care, redefine personal-professional boundaries, reassurance of alternative medical supports, transferred trust to adult doctor) and negotiate patient autonomy (confidence in formerly gained independence, alleviate burden on patients, mediate parental anxiety). CONCLUSIONS During transition, patients want to maintain disease stability, develop a relationship with their adult provider centralised on personal goals and access support networks. Strategies to comprehensively communicate information between providers, support self-management, and negotiate individualised goals for independence during transition planning may improve satisfaction, and health and treatment outcomes.
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Affiliation(s)
- Ivy Jiang
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gabor Major
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle Faculty of Health and Medicine, Callaghan, New South Wales, Australia
| | - Davinder Singh-Grewal
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Claris Teng
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ayano Kelly
- Rheumatology, Canberra Rheumatology, Canberra City, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Fiona Niddrie
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jeffrey Chaitow
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Sean O'Neill
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Geraldine Hassett
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Arvin Damodaran
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Rheumatology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Sarah Bernays
- School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Karine Manera
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David J Tunnicliffe
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of Sydney, Sydney School of Public Health, New South Wales Ministry of Health, Sydney, New South Wales, Australia
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20
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Souza RRD, Barreto MDS, Teston EF, Reis PD, Cecilio HPM, Marcon SS. DUALITY OF LIVING WITH SYSTEMIC LUPUS ERYTHEMATOSUS: FLUCTUATING BETWEEN “GOOD DAYS” AND “BAD DAYS”. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to learn the perception of individuals with Systemic Lupus Erythematosus about living with the disease. Method: an exploratory and descriptive research study, of a qualitative nature, carried out with 26 individuals undergoing treatment at the rheumatology outpatient clinic of a university hospital in southern Brazil. The data were collected in the period from February to July 2019, by means of semi-structured interviews that were audio-recorded and subjected to the thematic modality of content analysis. Results: a category entitled: “Fluctuating between good and bad days in living with Systemic Lupus Erythematosus”, composed of two subcategories that portray that living with Lupus is something unstable/fickle, emerged from the results. This is because, as a result of the periods of remission and exacerbation of the signs and symptoms of the disease, the patients experience a paradox of constant oscillation between ups and downs. Conclusion: it was learned that individuals with Lupus perceive that living with the disease is marked by an oscillation between good days and bad days, which are related to periods of remission and exacerbation of the manifestations of the disease, respectively.
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Affiliation(s)
- Rebeca Rosa de Souza
- Universidade Estadual de Maringá, Brasil; Universidade Estadual do Paraná, Brasil
| | | | | | - Pamela dos Reis
- Universidade Estadual de Maringá, Brasil; Instituto Adventista do Paraná, Brasil
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21
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Kelly A, Tymms K, Fallon K, Sumpton D, Tugwell P, Tunnicliffe D, Tong A. Qualitative Research in Rheumatology: An Overview of Methods and Contributions to Practice and Policy. J Rheumatol 2021; 48:6-15. [PMID: 32669447 DOI: 10.3899/jrheum.191368] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2020] [Indexed: 12/12/2022]
Abstract
Patient-centered care is widely advocated in rheumatology. This involves collaboration among patients, caregivers, and health professionals and is particularly important in chronic rheumatic conditions because the disease and treatment can impair patients' health and well-being. Qualitative research can systematically generate insights about people's experiences, beliefs, and attitudes, which patients may not always express in clinical settings. These insights can address complex and challenging areas in rheumatology, such as treatment adherence and transition to adult healthcare services. Despite this, qualitative research comprises 1% of studies published in top-tier rheumatology journals. A better understanding about the effect and role, methods, and rigor of qualitative research is needed. This overview highlights the recent contributions of qualitative research in rheumatology, summarizes the common approaches and methods used, and outlines the key principles to guide appraisal of qualitative studies.
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Affiliation(s)
- Ayano Kelly
- A. Kelly, MBBS, FRACP, College of Health and Medicine, Australian National University, Canberra, and Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Canberra Rheumatology, Canberra, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia;
| | - Kathleen Tymms
- K. Tymms, MBBS, FRACP, College of Health and Medicine, Australian National University, and Canberra Rheumatology, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia
| | - Kieran Fallon
- K. Fallon, FACSEP, College of Health and Medicine, Australian National University, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia
| | - Daniel Sumpton
- D. Sumpton, MBBS, FRACP, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, and Department of Rheumatology, Concord Hospital, Sydney, Australia
| | - Peter Tugwell
- P. Tugwell, MD, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Tunnicliffe
- D. Tunnicliffe, PhD, A. Tong, PhD, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Allison Tong
- D. Tunnicliffe, PhD, A. Tong, PhD, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Ardalan K, Adeyemi O, Wahezi DM, Caliendo AE, Curran ML, Neely J, Kim S, Correll CK, Brunner EJ, Knight AM. Parent Perspectives on Addressing Emotional Health for Children and Young Adults With Juvenile Myositis. Arthritis Care Res (Hoboken) 2020; 73:18-29. [PMID: 32986925 DOI: 10.1002/acr.24466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/22/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess parent perspectives regarding the emotional health impact of juvenile myositis (JM) on patients and families, and to assess preferences for emotional health screening and interventions. METHODS Parents of children and young adults with JM were purposively sampled for participation in focus groups at the Cure JM Foundation National Family Conference in 2018. Groups were stratified by patient age group (6-12, 13-17, and 18-21 years), and conversations were audiorecorded, transcribed verbatim, and co-coded via content analysis, with subanalysis by age group. A brief survey assessed preferences for specific emotional health interventions. RESULTS Forty-five parents participated in 6 focus groups. Themes emerged within 2 domains: emotional challenges, and screening and interventions. Themes for emotional challenges comprised the impact of JM on: 1) patient emotional health, particularly depression and anxiety; 2) parent emotional health characterized by sadness, grief, anger, guilt, and anxiety; and 3) family dynamics, including significant sibling distress. Subanalysis revealed similar themes across age groups, but the theme of resiliency emerged specifically for young adults. Themes for emotional health screening and interventions indicated potential issues with patient transparency, several barriers to resources, the facilitator role of rheumatology providers, and preferred intervention modalities of online and in-person resources, with survey responses most strongly supporting child/parent counseling and peer support groups. CONCLUSION JM is associated with intense patient and family distress, although resiliency may emerge by young adulthood. Despite existing barriers, increasing access to counseling, peer support groups, and online resources with rheumatology facilitation may be effective intervention strategies.
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Affiliation(s)
- Kaveh Ardalan
- Duke University Medical Center, Durham, North Carolina, and Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Anne E Caliendo
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jessica Neely
- University of California San Francisco Medical Center, San Francisco
| | - Susan Kim
- University of California San Francisco Medical Center, San Francisco
| | | | | | - Andrea M Knight
- Hospital for Sick Children and University of Toronto Faculty of Medicine, Toronto, Ontario, Canada, and University of Pennsylvania Perelman School of Medicine, Philadelphia
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Bitencourt N, Kramer J, Bermas BL, Solow EB, Wright T, Makris UE. Clinical Team Perspectives on the Psychosocial Aspects of Transition to Adult Care for Patients With Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 73:39-47. [PMID: 32976698 DOI: 10.1002/acr.24463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/17/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The transition from pediatric to adult care for youth with childhood-onset systemic lupus erythematosus (SLE) is a vulnerable period. Adverse outcomes during this transition include gaps in care, unscheduled health care utilization, loss of insurance, and high disease activity. The objective of this study was to examine the clinical care teams' perspective on the psychosocial factors associated with transition outcomes, which are poorly understood in this population. METHODS We conducted in-depth interviews with clinical care team members who interact with childhood-onset SLE patients during transfer from pediatric to adult rheumatology. A semistructured interview guide was used to prompt participants' perspectives about the psychosocial factors associated with the transition process for patients with childhood-onset SLE. Audio recordings were transcribed and analyzed using the constant comparative method. We stopped conducting interviews once thematic saturation was achieved. RESULTS Thirteen in-depth interviews were conducted. Participants included pediatric rheumatologists (n = 4), adult rheumatologists from both academic and private practice settings (n = 4), nurses (n = 2), a nurse practitioner, a social worker, and a psychologist. We identified several themes deemed by clinical care teams as important during the transition, including the impact of the family, patient resilience and coping mechanisms, the role of mental health and emotional support, and the need for education, peer support, and social connectedness. CONCLUSION We identified several psychosocial themes that clinical team members believe impact the transition of patients with childhood-onset SLE into adult care. The role of parental modeling, youth resilience, mental health and emotional care, improved childhood-onset SLE education, and structured peer support and social connectedness are highlighted, which may be amenable to interventions.
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Affiliation(s)
| | - Justin Kramer
- University of Texas Southwestern Medical Center, Dallas
| | | | - E Blair Solow
- University of Texas Southwestern Medical Center, Dallas
| | - Tracey Wright
- University of Texas Southwestern Medical Center and Texas Scottish Rite Hospital for Children, Dallas
| | - Una E Makris
- University of Texas Southwestern Medical Center and Veterans Administration North Texas Health Care System, Dallas
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Sustaining, Forming, and Letting Go of Friendships for Young People with Inflammatory Bowel Disease (IBD): A Qualitative Interview-Based Study. Int J Chronic Dis 2020; 2020:7254972. [PMID: 32953877 PMCID: PMC7487095 DOI: 10.1155/2020/7254972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 01/09/2023] Open
Abstract
Inflammatory bowel disease (IBD) is an incurable, chronic, gastrointestinal condition that can constrain young people's social relationships. Few studies have specifically explored friendships of people with IBD. This qualitative, participatory study used interviews, photographs, and friendship maps to explore friendships and friendship networks of young people with IBD. An online Young Person's Advisory Group was actively engaged throughout the study. Thirty-one young people participated (n = 16 males, n = 15 female; n = 24 Crohn's disease, n = 6 ulcerative colitis, n = 1 IBD-unclassified; the mean age at study was 18.7 years; range 14-25 years). Findings present a metatheme “The importance and meaning of friendships” and three interwoven subthemes of “Sustaining friendships,” “Forming new friendships,” and “Letting go of friendships.” Friendship was important to the young people with IBD, providing support, but associated with challenges such as disclosure. Such challenges could be mitigated by clearer conversations with clinicians about friendships and more extensive conversations about friendships and long-term conditions in education settings.
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Trachana M, Pratsidou-Gertsi P, Kanakoudi-Tsakalidou F, Tzimouli V, Printza N, Papachristou F. Impact of the longitudinal quantitative assessment of juvenile systemic lupus erythematosus severity on the disease outcome. Clin Rheumatol 2020; 40:675-682. [PMID: 32638251 DOI: 10.1007/s10067-020-05252-8] [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: 03/28/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study on juvenile SLE patients aimed to evaluate retrospectively the impact of a tertiary center's management policy of the disease severity on its long-term progression and cumulative damage development as well as provision of quality-driven medical care (QmC). METHODS Disease activity was assessed by the Physician Global Assessment and SLEDAI-2K, flares by SELENA/SLEDAI, and damage by the pediatric SLICC/DI at diagnosis, 6 months post-diagnosis, and annually thereafter. At the same time, QmC was evaluated by relevant indices and quality of life was captured by the Greek version of the General Health Questionnaire only at the last visit. RESULTS A total of 35 patients (25/35 females) aged at diagnosis 5.5-15.16 years (median 11.83) with a median lag time to diagnosis 1.8 months had a follow-up of 5 (35/35) and 10 years (13/35), respectively. The predominant baseline manifestations were consistent with those previously reported. Out of 35 patients, 24 (68.5%) were clinically inactive at year 5, and 5/13 (38%) at year 10. All patients received immunosuppressives and 7/35 biologics in addition. At the end of their follow-up, damage was found in 9/35 patients, but none of them had a neuropsychiatric disorder. Over the study, 28/35 patients were compliant with the QmC recommendations. CONCLUSIONS An early diagnosis combined with a longitudinal quantitative assessment of the disease activity and severity contributes to the continuous evaluation of the disease state. They are the key determinants for the selection of an early, targeted, and personalized management; they restrict the cumulative damage development and contribute to an optimal outcome. Key Points • Juvenile SLE has a heavier introductory profile than in adults and an unpredictable trajectory. • The application of contemporary metric tools for assessing the disease state leads to an objective assessment and regimen selection. • An early diagnosis combined with longitudinal quantitative assessment is a key determinant for an optimal management and a minimal damage development.
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Affiliation(s)
- Maria Trachana
- Pediatric Immunology and Rheumatology Referral Center, 1st Dept. of Pediatrics, Hippokration General Hospital Aristotle University, 10, 49, Konstantinoupoleos Street, GR54642, Thessaloniki, Greece.
| | - Polyxeni Pratsidou-Gertsi
- Pediatric Immunology and Rheumatology Referral Center, 1st Dept. of Pediatrics, Hippokration General Hospital Aristotle University, 10, 49, Konstantinoupoleos Street, GR54642, Thessaloniki, Greece
| | - Florence Kanakoudi-Tsakalidou
- Pediatric Immunology and Rheumatology Referral Center, 1st Dept. of Pediatrics, Hippokration General Hospital Aristotle University, 10, 49, Konstantinoupoleos Street, GR54642, Thessaloniki, Greece
| | - Vasiliki Tzimouli
- Pediatric Immunology and Rheumatology Referral Center, 1st Dept. of Pediatrics, Hippokration General Hospital Aristotle University, 10, 49, Konstantinoupoleos Street, GR54642, Thessaloniki, Greece
| | - Nikoleta Printza
- Pediatric Nephrology Unit, 1st Dept. of Pediatrics, Hippokration General Hospital, Aristotle University, Thessaloniki, Greece
| | - Fotis Papachristou
- Pediatric Nephrology Unit, 1st Dept. of Pediatrics, Hippokration General Hospital, Aristotle University, Thessaloniki, Greece
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Putera AM, Irwanto I, Maramis MM, Prasetyo RV, Soemyarso NA, Noer MS. Effect of Mental Health Problems on the Quality of Life in Children with Lupus Nephritis. Neuropsychiatr Dis Treat 2020; 16:1583-1593. [PMID: 32617005 PMCID: PMC7326200 DOI: 10.2147/ndt.s250373] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Mental health problems, such as anxiety, depression, and ineffective family coping, in children with lupus nephritis (LN) can increase the severity and affect the management of the disease, thus affecting the quality of life (QoL) of patients. OBJECTIVE Analyzing the association between levels of depression, anxiety, coping, disease activity on the QoL of pediatric patients with LN. PATIENTS AND METHODS There were 62 pediatric LN participants (16 participants in the induction phase and 46 participants in the maintenance phase). Participants were measured for anxiety, depression, coping, disease activity (systemic lupus erythematosus disease activity index/SLEDAI), and QoL. The measurement results were compared between induction and maintenance groups. Analysis of the association between anxiety, depression, coping, and disease activity with the QoL of children with LN used a multiple logistic regression test with p <0.05. RESULTS The measurement results obtained anxiety (induction = 69.06±3.92 and maintenance = 45.24±10.33; p <0.001), depression (induction = 69.88±3.34 and maintenance = 42.20±9.12; p <0.001), coping (induction = 99.88±12.93 and maintenance = 115.67±7.34; p <0.001), SLEDAI (induction = 15.81±12.58 and maintenance = 0.43±1.26; p <0.001), and QoL (induction = 49.92±12.44 and maintenance = 88.15±8.06; p <0.001).. Anxiety level in the induction group (p = 0.043) and maintenance group (p <0.001; p = 0.032; p = 0.008; p = 0.009). Depression level in the induction group (p = 0.031) and maintenance group (p = 0.024; p = 0.042; p = 0.003). SLEDAI score in the maintenance group (p = 0.003; p = 0.003). Coping in induction group (p = 0.016; p = 0.016) and maintenance group (p = 0.005). CONCLUSION Mental health disorders reduce the QoL of LN children, and the level of QoL in induction phase is lower than maintenance phase.
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Affiliation(s)
- Azwin Mengindra Putera
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Irwanto Irwanto
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Margarita Maria Maramis
- Department of Psychiatry, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Risky Vitria Prasetyo
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ninik Asmaningsih Soemyarso
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Mohammad Sjaifullah Noer
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Wilson C, Stock J. The impact of living with long-term conditions in young adulthood on mental health and identity: What can help? Health Expect 2019; 22:1111-1121. [PMID: 31343110 PMCID: PMC6803559 DOI: 10.1111/hex.12944] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND It has been suggested that the mental health impacts of living with long-term conditions are greater in young adulthood compared to older adulthood, due to greater disruption to identity and routine life events. OBJECTIVES To explore the impact of living with long-term conditions in young adulthood on mental health and identity, and what helps living well with these conditions. METHODS Fifteen in-depth interviews with young adults with various conditions were conducted and analysed thematically. RESULTS Themes related to the impacts on mental health and identity include the following: negative mood and depression; anxiety and fear for the future; and identity as 'ill'/abnormal compared to former self and 'normal' others. Themes related to suggestions for addressing negative impacts include the following: promotion of positive thinking; support reaching acceptance with altered identity and limitations (through stages of denial, anger, depression, then acceptance); and more professional mental health support. DISCUSSION In order to promote mental health and a positive sense of self/identity, young adults with long-term conditions should be offered advice and support on positive thinking; the long and difficult process of reconstructing identity; and reaching acceptance. This is particularly important for young adults for whom the identity reconstruction process is more complex and psychologically damaging than for older adults, as this life stage is associated with health/vitality and illness represents a shift from a perceived normal trajectory to one that appears and feels abnormal.
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Affiliation(s)
- Ceri Wilson
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
| | - Jennifer Stock
- Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK.,Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
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Petrongolo JL, Zelikovsky N, Keegan RM, Furth SL, Knight A. Examining Uncertainty in Illness in Parents and Children With Chronic Kidney Disease and Systemic Lupus Erythematosus: A Mediational Model of Internalizing Symptoms and Health-Related Quality of Life. J Clin Psychol Med Settings 2019; 27:31-40. [PMID: 30989366 DOI: 10.1007/s10880-019-09617-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To examine if parent illness uncertainty is indirectly associated with child depression, anxiety, and HRQOL in the CKD/SLE population. Parent-child dyads (N = 31) from outpatient rheumatology and nephrology clinics included children (ages 9-18) diagnosed with CKD (Stage 1, 2, or nephrotic syndrome) or SLE. Parents completed demographic and uncertainty measures and children completed uncertainty, depression, anxiety, and HRQOL measures. This cross-sectional study examined mediational models using the percentile bootstrapping method. Parent uncertainty had an indirect effect on child depression, anxiety, and HRQOL through the mediator, child uncertainty. In other words, parents' illness uncertainty regarding their child's condition correlates to the child's illness uncertainty, which then is associated with the child's mental health and wellbeing. Reverse mediations illustrated that parent uncertainty did not mediate child uncertainty and outcome variables. Results extend previous research by examining parent and child illness uncertainty in understudied conditions (CKD/SLE) and the relationship to outcome variables commonly related to depression (e.g., anxiety and HRQOL). Findings allow health psychologists and medical personnel to understand the impact of uncertainty on the child's wellbeing and HRQOL. Clinical implications, including using specialized interventions to address illness uncertainty, are discussed.
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Affiliation(s)
- Jennifer L Petrongolo
- Department of Psychology, La Salle University, 1900 West Olney Avenue, Philadelphia, PA, 19141, USA.
| | - Nataliya Zelikovsky
- Department of Psychology, La Salle University, 1900 West Olney Avenue, Philadelphia, PA, 19141, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Rachel M Keegan
- Department of Psychology, La Salle University, 1900 West Olney Avenue, Philadelphia, PA, 19141, USA
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Andrea Knight
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
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Harry O, Crosby LE, Smith AW, Favier L, Aljaberi N, Ting TV, Huggins J, Modi AC. Self-management and adherence in childhood-onset systemic lupus erythematosus: what are we missing? Lupus 2019; 28:642-650. [PMID: 30907294 PMCID: PMC6506349 DOI: 10.1177/0961203319839478] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The aims of this study are (1) to characterize factors influencing self-management behaviors and quality of life in adolescent and young adult (AYA) patients with childhood-onset systemic lupus erythematosus (cSLE) and (2) to identify barriers and facilitators of treatment adherence via focus groups. METHODS AYAs with cSLE ages 12-24 years and primary caregivers of the adolescents participated in this study. Recruitment occurred during pediatric rheumatology clinic visits at a Midwestern children's hospital or the hospital's cSLE active clinic registry. Information about disease severity was obtained from patient health records. Pain and fatigue questionnaires were administered. Descriptive statistics were used to analyze data. RESULTS Thirty-one AYA patients and caregivers participated in six focus groups. Ten major themes emerged from sessions; four were expressed both by the AYA and caregiver groups: knowledge deficits about cSLE, symptoms limiting daily function, specifically mood and cognition/learning, barriers and facilitators of adherence, and worry about the future. Themes unique to AYA participants included symptoms limiting daily functioning-pain/fatigue, self-care and management, impact on personal relationships, and health care provider communication/relationship. For caregiver groups unique themes included need for school advocacy, disruption of family schedule, and sense of normalcy for their adolescent. CONCLUSION AYAs with cSLE face a lifelong disease characterized by pervasive pain, fatigue, organ damage, isolation-social and/or physical-and psycho-socioeducational challenges. This study confirmed that continued psychosocial support, health information education, adherence interventions, and personalized treatment plans are necessary to increase self-management and autonomy in AYAs with cSLE.
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Affiliation(s)
- Onengiya Harry
- Division of Rheumatology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH
| | - Lori E Crosby
- Division of Behavior Medicine and Clinical Psychology,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- College of Medicine, University of Cincinnati, Cincinnati,
OH
| | - Amiee W Smith
- Division of Behavior Medicine and Clinical Psychology,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Leslie Favier
- Division of Rheumatology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH
| | - Najla Aljaberi
- Division of Rheumatology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH
| | - Tracy V Ting
- Division of Rheumatology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH
- College of Medicine, University of Cincinnati, Cincinnati,
OH
| | - Jennifer Huggins
- Division of Rheumatology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH
- College of Medicine, University of Cincinnati, Cincinnati,
OH
| | - Avani C Modi
- Division of Behavior Medicine and Clinical Psychology,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- College of Medicine, University of Cincinnati, Cincinnati,
OH
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Illness uncertainty, social support, and coping mode in hospitalized patients with systemic lupus erythematosus in a hospital in Shaanxi, China. PLoS One 2019; 14:e0211313. [PMID: 30789919 PMCID: PMC6383916 DOI: 10.1371/journal.pone.0211313] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 01/11/2019] [Indexed: 12/17/2022] Open
Abstract
Objective To analyze the relationships between illness uncertainty, social support, and coping mode in hospitalized patients with systematic lupus erythematosus (SLE). Methods The General Health Questionnaire, Mishel Uncertainty in Illness Scale, Social Support Rating Scale, and Medical Coping Modes Questionnaire were to the hospitalized patients with SLE (N = 200) in a tertiary hospital in Shaanxi. Results The hospitalized patients with SLE showed a moderate level of illness uncertainty. Furthermore, illness uncertainty was negatively correlated with support availability (r = -0.161, P = 0.023) and facing coping mode (r = -0.231, P = 0.001), and was positively correlated with the yielding coping mode (r = 0.249, P < 0.001). Conclusion These findings suggest that support availability and coping modes were associated with moderate level of illness uncertainty, indicating that support availability support should be strengthened in hospitalized patients to actively face their disease. This subsequently improves their treatment compliance and quality of life.
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Rojas M, Rodriguez Y, Pacheco Y, Zapata E, Monsalve DM, Mantilla RD, Rodríguez-Jimenez M, Ramírez-Santana C, Molano-González N, Anaya JM. Resilience in women with autoimmune rheumatic diseases. Joint Bone Spine 2018; 85:715-720. [PMID: 29289647 DOI: 10.1016/j.jbspin.2017.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/13/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the relationship between resilience and clinical outcomes in patients with autoimmune rheumatic diseases. METHODS Focus groups, individual interviews, and chart reviews were done to collect data on 188 women with autoimmune rheumatic diseases, namely rheumatoid arthritis (n=51), systemic lupus erythematosus (n=70), systemic sclerosis (n=35), and Sjögren's syndrome (n=32). Demographic, clinical, and laboratory variables were assessed including disease activity by patient reported outcomes. Resilience was evaluated by using the Brief Resilience Scale. Bivariate, multiple linear regression, and classification and regression trees were used to analyse data. RESULTS Resilience was influenced by age, duration of disease, and socioeconomic status. Lower resilience scores were observed in younger patients (<48years) with systemic lupus erythematosus, rheumatoid arthritis, and systemic sclerosis who had low socioeconomic status, whereas older patients (>50years) had higher resilience scores regardless of socioeconomic status. There was no influence of disease activity on resilience. A particular behaviour was observed in systemic sclerosis in which patients with high socioeconomic status and regular physical activity had higher resilience scores. CONCLUSION Resilience in patients with autoimmune rheumatic diseases is a continuum process influenced by age and socioeconomic status. The ways in which these variables along with exercise influence resilience deserve further investigation.
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Affiliation(s)
- Manuel Rojas
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, 24 No. 63C-69 Carrera, Bogotá, Colombia
| | - Yhojan Rodriguez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, 24 No. 63C-69 Carrera, Bogotá, Colombia
| | - Yovana Pacheco
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, 24 No. 63C-69 Carrera, Bogotá, Colombia
| | - Elizabeth Zapata
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, 24 No. 63C-69 Carrera, Bogotá, Colombia
| | - Diana M Monsalve
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, 24 No. 63C-69 Carrera, Bogotá, Colombia
| | - Rubén D Mantilla
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, 24 No. 63C-69 Carrera, Bogotá, Colombia
| | - Monica Rodríguez-Jimenez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, 24 No. 63C-69 Carrera, Bogotá, Colombia
| | - Carolina Ramírez-Santana
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, 24 No. 63C-69 Carrera, Bogotá, Colombia
| | - Nicolás Molano-González
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, 24 No. 63C-69 Carrera, Bogotá, Colombia
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, 24 No. 63C-69 Carrera, Bogotá, Colombia.
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Haag H, Liang T, Avina-Zubieta JA, De Vera MA. How do patients with systemic autoimmune rheumatic disease perceive the use of their medications: a systematic review and thematic synthesis of qualitative research. BMC Rheumatol 2018; 2:9. [PMID: 30886960 PMCID: PMC6390776 DOI: 10.1186/s41927-018-0017-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/15/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Hans Haag
- University of British Columbia, Faculty of Pharmaceutical Sciences, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
- Arthritis Research Canada, Richmond, BC Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC Canada
| | - Tim Liang
- University of British Columbia, Faculty of Pharmaceutical Sciences, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
- Arthritis Research Canada, Richmond, BC Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC Canada
| | - J. Antonio Avina-Zubieta
- Arthritis Research Canada, Richmond, BC Canada
- Department of Medicine, Division of Rheumatology, University of British Columbia, Faculty of Medicine, Vancouver, BC Canada
| | - Mary A. De Vera
- University of British Columbia, Faculty of Pharmaceutical Sciences, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
- Arthritis Research Canada, Richmond, BC Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC Canada
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Adolescents’ experiences of living with sickle cell disease: An integrative narrative review of the literature. Int J Nurs Stud 2018; 80:20-28. [DOI: 10.1016/j.ijnurstu.2017.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 12/19/2022]
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Flournoy-Floyd M, Ortiz K, Egede L, Oates JC, Faith TD, Williams EM. "We Would Still Find Things to Talk About": Assessment of Mentor Perspectives in a Systemic Lupus Erythematosus Intervention to Improve Disease Self-Management, Empowering SLE Patients. J Natl Med Assoc 2018; 110:182-189. [PMID: 29580453 PMCID: PMC6931279 DOI: 10.1016/j.jnma.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/17/2017] [Accepted: 05/03/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder with significant disparate impact on African American women. The current study sought to highlight how the Peer Approaches to Lupus Self-management (PALS) intervention worked bi-directionally wherein both women with SLE leading the disease self-management program (mentors), and those participants who served as mentees, were empowered toward greater disease self-efficacy. METHODS Data was captured for this study in two formats from the seven mentors participating in the pilot study: 1) mentor logs and 2) mentor interviews with the principle investigator. This information was then analyzed for themes relating to their experience within the study. RESULTS We found that empowerment was facilitated by mentors taking their mentorship responsibilities seriously and seeking several avenues for collaboratively developing success with their mentees. Mentors reported that although challenges arose, their desire for success resulted in multiple approaches to be flexible and responsive to the needs of their mentees. Additionally, reciprocity was found to be a vital element of the program. CONCLUSIONS Key thematic areas supported our ability to demonstrate the usefulness of a peer mentoring program for SLE disease self-management on evoking empowerment through reciprocal relationships among mentors and mentees within our study population. Furthermore the feedback from PALS participants yielded very rich and contextual information that can be used as a thematic guide for developing and refining evidence-based interventions that seek to incorporate empowerment into disease self-management efforts for women suffering from SLE.
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Affiliation(s)
- Minnjuan Flournoy-Floyd
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857, USA
| | - Kasim Ortiz
- University of New Mexico, Department of Sociology, MSC05 3080 1915 Roma NE Ste. 1103, Albuquerque NM 87131-0001, USA
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Clinical Cancer Center Building, 5th Floor, Suite C5400, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA
| | - Jim C Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425, USA; Rheumatology Section, Ralph H. Johnson VA Medical Center 109 Bee Street, Charleston, SC 29401, USA
| | - Trevor D Faith
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA
| | - Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
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Donnelly C, Cunningham N, Jones JT, Ji L, Brunner HI, Kashikar-Zuck S. Fatigue and depression predict reduced health-related quality of life in childhood-onset lupus. Lupus 2018; 27:124-133. [PMID: 28662595 PMCID: PMC5537044 DOI: 10.1177/0961203317716317] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to identify risk factors for persistently reduced health-related quality of life in childhood-onset lupus and describe a risk profile for persistently reduced health-related quality of life. At a tertiary rheumatology clinic, 50 childhood onset lupus patients were assessed twice, approximately six months apart. Measures of disease activity and patient-reported measures of health-related quality of life, pain, depressive symptoms, anxiety and disability were collected at each visit. At visits 1 and 2, respectively, clinically relevant fatigue was present in 66% and 56% of patients; clinically significant depressive symptoms in 26% and 24%; and clinically significant anxiety in 34% and 28%. Poorer health-related quality of life at follow-up was significantly predicted by higher fatigue and depressive symptoms at the initial visit. Using clinically relevant cut-offs for fatigue and depressive symptoms, patients were assigned to Low ( n = 27) or High Risk ( n = 23) groups. A profile of significantly greater pain, anxiety and coping difficulties was seen in the High Risk group. Routine assessment of fatigue and mood symptoms in youth with childhood-onset lupus could be helpful in identifying those at risk for persistently poor health-related quality of life. Integration of behavioral interventions to address fatigue and mood symptoms into medical care for such patients may be beneficial, but more research in this area is needed.
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Affiliation(s)
- Catherine Donnelly
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati Medical Center, Cincinnati, OH
| | - Natoshia Cunningham
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jordan T Jones
- Department of Pediatrics, University of Missouri-Kansas City, Children’s Mercy Kansas City, Kansas City, MO
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Li Ji
- Peking Union Medical College Hospital, Beijing, China
| | - Hermine I Brunner
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Pediatrics, University of Missouri-Kansas City, Children’s Mercy Kansas City, Kansas City, MO
| | - Susmita Kashikar-Zuck
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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Knight A, Kogon AJ, Matheson MB, Warady BA, Furth SL, Hooper SR. Cognitive Function in Children with Lupus Nephritis: A Cross-Sectional Comparison with Children with Other Glomerular Chronic Kidney Diseases. J Pediatr 2017; 189:181-188.e1. [PMID: 28734655 PMCID: PMC5614831 DOI: 10.1016/j.jpeds.2017.06.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 05/10/2017] [Accepted: 06/19/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To identify factors contributing to cognitive impairment in children with lupus nephritis. STUDY DESIGN A cross-sectional analysis of a large multicenter national cohort of children with chronic kidney disease (CKD) using standardized measures to determine baseline neuropsychiatric function and health-related quality of life (HRQoL) in children with lupus nephritis (n = 34), and to compare baseline function with that in children with other forms of glomerular CKD (gCKD; n = 171). We used inverse probability weighting via a logistic model for propensity score analysis to achieve balance between children with lupus nephritis and those with other glomerular causes of CKD, adjusting for known confounders. We used linear regression models to compare neurocognitive outcomes between exposure groups, adjusting for current prednisone use and testing for an interaction between current prednisone use and lupus nephritis, and to test for an association between cognitive function and HRQoL. RESULTS Current prednisone use was independently associated with worse attention (P < .01) and better adaptive skills (P = .04), and there was a significant interaction between current prednisone use and lupus nephritis for internalizing problems, with worse parent-reported internalizing problems in children with lupus nephritis on prednisone (P = .047). Better parent-reported HRQoL was associated with better visual memory (P = .01), and better child-reported HRQoL was associated with better attention (P < .01) and inhibitory control (P < .01). Both parent and child HRQoL were associated with better measures of executive function (P = .02 and < .001, respectively). CONCLUSION Children with lupus nephritis have comparable or better cognitive function than their peers with other gCKDs, which is reassuring given the multiorgan and lifelong complications associated with lupus.
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Affiliation(s)
- Andrea Knight
- Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Amy J. Kogon
- Division of Nephrology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Matthew B. Matheson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Susan L. Furth
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA and
| | - Stephen R. Hooper
- Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC
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Sav A, Salehi A, Mair FS, McMillan SS. Measuring the burden of treatment for chronic disease: implications of a scoping review of the literature. BMC Med Res Methodol 2017; 17:140. [PMID: 28899342 PMCID: PMC5596495 DOI: 10.1186/s12874-017-0411-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/31/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although there has been growing research on the burden of treatment, the current state of evidence on measuring this concept is unknown. This scoping review aimed to provide an overview of the current state of knowledge as well as clear recommendations for future research, within the context of chronic disease. METHODS Four health-based databases, Scopus, CINAHL, Medline, and PsychInfo, were comprehensively searched for peer-reviewed articles published between the periods of 2000-2016. Titles and abstracts were independently read by two authors. All discrepancies between the authors were resolved by a third author. Data was extracted using a standardized proforma and a comparison analysis was used in order to explore the key treatment burden measures and categorize them into three groups. RESULTS Database searching identified 1458 potential papers. After removal of duplications, and irrelevant articles by title, 1102 abstracts remained. An additional 22 papers were added via snowball searching. In the end, 101 full papers were included in the review. A large number of the studies involved quantitative measures and conceptualizations of treatment burden (n = 64; 63.4%), and were conducted in North America (n = 49; 48.5%). There was significant variation in how the treatment burden experienced by those with chronic disease was operationalized and measured. CONCLUSION Despite significant work, there is still much ground to cover to comprehensively measure treatment burden for chronic disease. Greater qualitative focus, more research with cultural and minority populations, a larger emphasis on longitudinal studies and the consideration of the potential effects of "identity" on treatment burden, should be considered.
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Affiliation(s)
- Adem Sav
- School of Allied Health, Australian Catholic University, Banyo, Queensland, Australia. .,, PO Box 456, Virginia, 4014, Australia.
| | - Asiyeh Salehi
- Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD, Australia
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Sara S McMillan
- Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD, Australia
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Tunnicliffe DJ, Singh-Grewal D, Craig JC, Howell M, Tugwell P, Mackie F, Lin MW, O'Neill SG, Ralph AF, Tong A. Healthcare and Research Priorities of Adolescents and Young Adults with Systemic Lupus Erythematosus: A Mixed-methods Study. J Rheumatol 2017; 44:444-451. [PMID: 28250139 DOI: 10.3899/jrheum.160720] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Managing juvenile-onset systemic lupus erythematosus (SLE) is particularly challenging. The disease may be severe, adolescent patients have complex medical and psychosocial needs, and patients must navigate the transition to adult services. To inform patient-centered care, we aimed to identify the healthcare and research priorities of young patients with SLE and describe the reasons underpinning their priorities. METHODS Face-to-face, semistructured interviews and focus groups were conducted with patients with SLE, aged from 14 to 26 years, from 5 centers in Australia. For each of the 5 allocation exercises, participants allocated 10 votes to (1) research topics; research questions on (2) medical management, (3) prevention and diagnosis, (4) lifestyle and psychosocial; and (5) healthcare specialties, and discussed the reasons for their choices. Descriptive statistics were calculated for votes and qualitative data were analyzed thematically. RESULTS The 26 participants prioritized research that alleviated the psychological burden of SLE. They allocated their votes toward medical and mental health specialties in the management of SLE, while fewer votes were given to physiotherapy/occupational therapy and dietetics. The following 7 themes underpinned the participants' priorities: improving service shortfalls, strengthening well-being, ensuring cost efficiency, minimizing family/community burden, severity of comorbidity or complications, reducing lifestyle disruption, and fulfilling future goals. CONCLUSION Young patients with SLE value comprehensive care with greater coordination among specialties. They prioritized research focused on alleviating poor psychological outcomes. The healthcare and research agenda for patients with SLE should include everyone involved, to ensure that the agenda aligns with patient priorities, needs, and values.
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Affiliation(s)
- David J Tunnicliffe
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada. .,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead.
| | - Davinder Singh-Grewal
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Jonathan C Craig
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Martin Howell
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Peter Tugwell
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Fiona Mackie
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Ming-Wei Lin
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Sean G O'Neill
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Angelique F Ralph
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Allison Tong
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
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Advances in the care of children with lupus nephritis. Pediatr Res 2017; 81:406-414. [PMID: 27855151 DOI: 10.1038/pr.2016.247] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/07/2016] [Indexed: 12/27/2022]
Abstract
The care of children with lupus nephritis (LN) has changed dramatically over the past 50 y. The majority of patients with childhood-onset systemic lupus erythematosus (cSLE) develop LN. In the 1960's, prognosis in children was worse than in adults; therapies were limited and toxic. Nearly half of cases resulted in death within 2 y. Since this time, several diagnostic recommendations and disease-specific indices have been developed to assist physicians caring for patients with LN. Pediatric researchers are validating and adapting these indices and guidelines for the treatment of LN in cSLE. Classification systems, activity, and chronicity indices for kidney biopsy have been validated in pediatric cohorts in several countries. Implementation of contemporary immunosuppressive agents has reduced treatment toxicity and improved outcomes. Biomarkers sensitive to LN in children have been identified in the kidney, urine, and blood. Multi-institutional collaborative networks have formed to address the challenges of pediatric LN research. Considerable variation in evaluation and treatment has been addressed for proliferative forms of LN by development of consensus treatment practices. Patient survival at 5 y is now 95-97% and renal survival exceeds 90%. Moreover, international consensus exists for quality indicators for cSLE that consider the unique aspects of chronic disease in childhood.
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Thakral A, Klein-Gitelman MS. An Update on Treatment and Management of Pediatric Systemic Lupus Erythematosus. Rheumatol Ther 2016; 3:209-219. [PMID: 27747587 PMCID: PMC5127968 DOI: 10.1007/s40744-016-0044-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Indexed: 12/17/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder in which 20 % of patients are diagnosed in childhood. Childhood-onset SLE is associated with higher morbidity and mortality than adult-onset SLE. The aims of disease management with early immunosuppression are to decrease disease activity and improve quality of life. A multidisciplinary approach is necessary due to the complexity of lupus in pediatric patients. It is important to provide patients with high quality of care and to instill ownership of their disease process from a young age to prepare them to manage this life-long illness. This article reviews current management of SLE in children.
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Affiliation(s)
- Amit Thakral
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA.
| | - Marisa S Klein-Gitelman
- Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
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Tong A, Samuel S, Zappitelli M, Dart A, Furth S, Eddy A, Groothoff J, Webb NJA, Yap HK, Bockenhauer D, Sinha A, Alexander SI, Goldstein SL, Gipson DS, Hanson CS, Evangelidis N, Crowe S, Harris T, Hemmelgarn BR, Manns B, Gill J, Tugwell P, Van Biesen W, Wheeler DC, Winkelmayer WC, Craig JC. Standardised Outcomes in Nephrology-Children and Adolescents (SONG-Kids): a protocol for establishing a core outcome set for children with chronic kidney disease. Trials 2016; 17:401. [PMID: 27519274 PMCID: PMC4982996 DOI: 10.1186/s13063-016-1528-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/26/2016] [Indexed: 01/03/2023] Open
Abstract
Background Children with chronic kidney disease (CKD), requiring dialysis or kidney transplantation, have a mortality rate of up to 30-fold higher than the general aged-matched population, and severely impaired quality of life. Symptoms such as fatigue and pain are prevalent and debilitating. Children with CKD are at risk of cognitive impairment, and poorer educational, vocational, and psychosocial outcomes compared with their well peers, which have consequences through to adulthood. Treatment regimens for children with CKD are long-term, complex, and highly intrusive. While many trials have been conducted to improve outcomes in children with CKD, the outcomes measured and reported are often not relevant to patients and clinicians, and are highly variable. These problems can diminish the value of trials as a means to improve the lives of children with CKD. The Standardised Outcomes in Nephrology—Children and Adolescents (SONG-Kids) study aims to develop a core outcome set for trials in children and adolescents with any stage of CKD that is based on the shared priorities of all stakeholders. Methods/Design SONG-Kids involves five phases: a systematic review to identify outcomes (both domains and measures) that have been reported in randomised controlled trials involving children aged up to 21 years with CKD; focus groups (using nominal group technique) with adolescent patients and caregivers of paediatric patients (all ages) to identify outcomes that are relevant and important to patients and their family and the reasons for their choices; semistructured key informant interviews with health professionals involved in the care of children with CKD to ascertain their views on establishing core outcomes in paediatric nephrology; an international three-round online Delphi survey with patients, caregivers, clinicians, researchers, policy-makers, and members from industry to develop consensus on important outcome domains; and a stakeholder workshop to review and finalise the set of core outcome domains for trials in children with CKD (including nondialysis-dependent, dialysis, and kidney transplantation). Discussion Establishing a core outcome set to be reported in all trials conducted in children with any stage of CKD will enhance the relevance, transparency, and impact of research to improve the lives of children and adolescents with CKD.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia.
| | - Susan Samuel
- Department of Pediatrics, Section of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Michael Zappitelli
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Susan Furth
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine and Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allison Eddy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital AMC Academic Medical Center, Amsterdam, The Netherlands
| | - Nicholas J A Webb
- Department of Paediatric Nephrology and NIHR/Wellcome Trust Clinical Research Facility, University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester, UK
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Detlef Bockenhauer
- UCL Centre for Nephrology and Great Ormond Street Hospital for Children NHS Foundation Trus, London, UK
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Debbie S Gipson
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
| | | | | | - Brenda R Hemmelgarn
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Braden Manns
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - John Gill
- Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Wim Van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - David C Wheeler
- Centre for Nephrology, University College London, London, UK
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
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Abstract
PURPOSE OF REVIEW This article highlights efforts in pediatric rheumatology related to optimizing the care provided to patients with pediatric rheumatic diseases and describes various approaches to improve health outcomes. RECENT FINDINGS Recent studies report low rates of remission, frequent occurrence of comorbidities, disease damage, and decreased health-related quality of life in pediatric rheumatic diseases. The Pediatric Rheumatology Care and Outcomes Improvement Network is a quality improvement learning network that has demonstrated improvement in the process of care measures through use of a centralized patient registry, and interventions, including previsit planning, population management, shared decision making, and patient/parent engagement. A pediatric rheumatology patient-powered research network was established to enable patient and caregiver participation in setting research priorities and to facilitate data sharing to answer research questions. Quality measure development and benchmarking are proceeding in multiple pediatric rheumatic diseases. SUMMARY The review summarizes the current efforts to improve care delivery and outcomes in pediatric rheumatic diseases through a learning health system approach that harnesses knowledge from the clinical encounter to serve quality improvement, research, and discovery. Incorporating standard approaches to medication treatment plans may reduce variation in care, including using the patient voice to design research studies to bring focus on more patient relevant outcomes. VIDEO ABSTRACT http://links.lww.com/COR/A28.
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Affiliation(s)
| | | | - Esi M. Morgan
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- University of Cincinnati College of Medicine, Cincinnati, OH
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