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Hsiao YH, Chung HT, Wang JK, Mu PF, Chen SW, Shu YM, Chen CW. Subjective experience of parent-child relationship in adolescents with congenital heart disease: A qualitative study. J Pediatr Nurs 2024; 77:204-211. [PMID: 38593571 DOI: 10.1016/j.pedn.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 03/16/2024] [Accepted: 03/17/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE To explore the parent-child relationship through the subjective experience of adolescents with congenital heart disease (CHD). DESIGN AND METHODS A descriptive phenomenology approach was adopted. Twelve adolescents aged from 12 to 18 years with CHD were recruited from the pediatric cardiology clinics at two medical centers in Taiwan. Data were collected through in-depth interviews. Data were analyzed using Colaizzi's phenomenological analysis method, and results were reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS The experiences of the adolescents with CHD revealed five themes: 1. the enhancement of self-worth through parents' love; 2. the importance of parental support in desperate situations; 3. the development of a sense of security through mutual understanding; 4. growth under parental expectations; and 5. parental overcontrol disguised as love. CONCLUSIONS The parent-child relationship encompasses both positive and negative experiences. Adolescents prioritize their relationship with parents over that with peers. PRACTICE IMPLICATIONS Nurses caring for adolescents with CHD can improve care by recognizing the influence of parental love, support in challenges, mutual understanding, parental expectations, and potential negative consequences of overcontrol. This insight guides effective guidance for adolescents, enhancing parent-child interactions and overall well-being.
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Affiliation(s)
- Yu-Hsuan Hsiao
- Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan
| | - Hung-Tao Chung
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
| | - Jou-Kou Wang
- Department of Pediatric Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan.
| | - Pei-Fan Mu
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Shu-Wen Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Ying-Mei Shu
- Department of Nursing, Chang Gung University of Science and Technology, Taiwan.
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Zhang Y, Zhou H, Bai Y, Chen Z, Wang Y, Hu Q, Yang M, Wei W, Ding L, Ma F. Development and validation of a questionnaire to measure the congenital heart disease of children's family stressor. Front Public Health 2024; 12:1365089. [PMID: 38751578 PMCID: PMC11094312 DOI: 10.3389/fpubh.2024.1365089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Background Families of children with congenital heart disease (CHD) face tremendous stressors in the process of coping with the disease, which threatens the health of families of children with CHD. Studies have shown that nursing interventions focusing on family stress management can improve parents' ability to cope with illness and promote family health. At present, there is no measuring tool for family stressors of CHD. Methods The items of the scale were generated through qualitative interviews and a literature review. Initial items were evaluated by seven experts to determine content validity. Factor analysis and reliability testing were conducted with a convenience sample of 670 family members. The criterion-related validity of the scale was calculated using scores on the Self-Rating Anxiety Scale (SAS). Results The CHD Children's Family Stressor Scale consisted of six dimensions and 41 items. In the exploratory factor analysis, the cumulative explained variance of the six factors was 61.085%. In the confirmatory factor analysis, the six factors in the EFA were well validated, indicating that the model fits well. The correlation coefficient between CHD Children's Family Stressor Scale and SAS was r = 0.504 (p < 0.001), which indicated that the criterion-related validity of the scale was good. In the reliability test, Cronbach's α coefficients of six sub-scales were 0.774-0.940, and the scale-level Cronbach's α coefficient value was 0.945. Conclusion The study indicates that the CHD Children's Family Stressor Scale is valid and reliable, and it is recommended for use in clinical practice to assess CHD children's family stressors.
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Affiliation(s)
- Yi Zhang
- Department of Nursing, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, China
| | - Hang Zhou
- Department of Clinical Psychology, Yunnan Provincial Hospital of Infectious Disease, Kunming, China
| | - Yangjuan Bai
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhisong Chen
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanjiao Wang
- Psychiatric Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qiulan Hu
- ICU in Geriatric Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Mingfang Yang
- Urology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wei Wei
- Neurosurgery Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lan Ding
- General Surgery Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fang Ma
- Department of Nursing, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, China
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Marshall KH, Pincus HA, Tesson S, Lingam R, Woolfenden SR, Kasparian NA. Integrated psychological care in pediatric hospital settings for children with complex chronic illness and their families: a systematic review. Psychol Health 2024; 39:452-478. [PMID: 35635028 DOI: 10.1080/08870446.2022.2072843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/07/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To synthesize and critically evaluate evidence on the effectiveness of integrated psychological care models for children with complex chronic illness within pediatric hospital settings and provide recommendations for successful implementation. DESIGN Six electronic databases (Medline, Cochrane, Embase, PsycINFO, Scopus, CINAHL) were systematically searched for English language studies including families of children aged 0-17 years with complex chronic illness. Eligible studies reported on psychology or neuropsychology screening, assessment, intervention, or services provided within a pediatric hospital setting. RESULTS Fifteen studies were identified for review; nine assessed a psychological service, five examined psychosocial screening, and one examined a neuropsychology service. Three studies demonstrated the effectiveness of integrated psychological services in improving child or parent physical, psychological, or behavioral health outcomes. Uptake of psychosocial screening was high (84-96%), but only 25-37% of children or families identified as 'at-risk' engaged with on-site psychology services. Integrated psychological services offering consultations at the same time and location as the child's medical visit reported the highest rates of uptake (77-100%). CONCLUSIONS The available evidence supports co-location of child medical and psychological services. A more consistent and comprehensive approach to the assessment of patient- and caregiver-reported outcomes and implementation effectiveness is recommended.
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Affiliation(s)
- Kate H Marshall
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Harold A Pincus
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
- Irving Institute for Clinical and Translational Research, Columbia University and New York‑Presbyterian Hospital, New York, NY, USA
| | - Stephanie Tesson
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Susan R Woolfenden
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
- Sydney Institute for Women, Children and their Families, Sydney local health District, Sydney, NSW, Australia
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Wadey CA, Leggat FJ, Potter J, Amir NH, Forsythe L, Stuart AG, Barker AR, Williams CA. Parental recommendations and exercise attitudes in congenital hearts. Cardiol Young 2024; 34:667-675. [PMID: 37727882 DOI: 10.1017/s104795112300327x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Children and young people with CHD benefit from regular physical activity. Parents are reported as facilitators and barriers to their children's physical activity. The aim of this study was to explore parental factors, child factors, and their clinical experience on physical activity participation in young people with CHD. METHODS An online questionnaire was co-developed with parents (n = 3) who have children with CHD. The survey was then distributed in the United Kingdom by social media and CHD networks, between October 2021 and February 2022. Data were analysed using mixed methods. RESULTS Eighty-three parents/guardians responded (94% mothers). Young people with CHD were 7.3 ± 5.0 years old (range 0-20 years; 53% female) and 84% performed activity. Parental participation in activity (X2(1) = 6.9, P < 0.05) and perceiving activity as important for their child were positively associated with activity (Fisher's Exact, P < 0.05). Some parents (∼15%) were unsure of the safety of activity, and most (∼70%) were unsure where to access further information about activity. Fifty-two parents (72%) had never received activity advice in clinic, and of the 20 who received advice, 10 said it was inconsistent. Qualitative analysis produced the theme "Knowledge is power and comfort." Parents described not knowing what activity was appropriate or the impact of it on their child. CONCLUSION Parental participation and attitudes towards activity potentially influence their child's activity. A large proportion of young people performed activity despite a lack and inconsistency of activity advice offered by CHD clinics. Young people with CHD would benefit from activity advice with their families in clinics.
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Affiliation(s)
- Curtis A Wadey
- Faculty of Health and Life Sciences, Children's Health & Exercise Research Centre (CHERC), Public Health and Sports Sciences, University of Exeter, Exeter, UK
| | - Fiona J Leggat
- Population Health Research Institute, St George's, University of London, London, UK
| | - Julia Potter
- Department of Physical Education, University of Chichester, Chichester, UK
| | - Nurul H Amir
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Alan R Barker
- Faculty of Health and Life Sciences, Children's Health & Exercise Research Centre (CHERC), Public Health and Sports Sciences, University of Exeter, Exeter, UK
| | - Craig A Williams
- Faculty of Health and Life Sciences, Children's Health & Exercise Research Centre (CHERC), Public Health and Sports Sciences, University of Exeter, Exeter, UK
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Zaidi AH, Saleeb SF, Gurvitz M, Bucholz E, Gauvreau K, Jenkins KJ, de Ferranti SD. Social Determinants of Health Including Child Opportunity Index Leading to Gaps in Care for Patients With Significant Congenital Heart Disease. J Am Heart Assoc 2024; 13:e028883. [PMID: 38353239 PMCID: PMC11010070 DOI: 10.1161/jaha.122.028883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 10/11/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Gaps in care (GIC) are common for patients with congenital heart disease (CHD) and can lead to worsening clinical status, unplanned hospitalization, and mortality. Understanding of how social determinants of health (SDOH) contribute to GIC in CHD is incomplete. We hypothesize that SDOH, including Child Opportunity Index (COI), are associated with GIC in patients with significant CHD. METHODS AND RESULTS A total of 8554 patients followed at a regional specialty pediatric hospital with moderate to severe CHD seen in cardiology clinic between January 2013 and December 2015 were retrospectively reviewed. SDOH factors including race, ethnicity, language, and COI calculated based on home address and zip code were analyzed. GIC of >3.25 years were identified in 32% (2709) of patients. GIC were associated with ages 14 to 29 years (P<0.001), Black race or Hispanic ethnicity (P<0.001), living ≥150 miles from the hospital (P=0.017), public health insurance (P<0.001), a maternal education level of high school or less (P<0.001), and a low COI (P<0.001). Multivariable analysis showed that GIC were associated with age ≥14 years, Black race or Hispanic ethnicity, documenting <3 caregivers as contacts, mother's education level being high school or less, a very low/low COI, and insurance status (C statistic 0.66). CONCLUSIONS One-third of patients followed in a regional referral center with significant CHD experienced a substantial GIC (>3.25 years). Several SDOH, including a low COI, were associated with GIC. Hospitals should adopt formal GIC improvement programs focusing on SDOH to improve continuity of care and ultimately overall outcomes for patients with CHD.
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Affiliation(s)
- Abbas H. Zaidi
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
- Present address:
Nemours Children's Hospital‐DelawareWilmingtonDE
| | - Susan F. Saleeb
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Michelle Gurvitz
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Emily Bucholz
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
- Present address:
University of Colorado DenverDenverCO
- Present address:
Children’s Hospital ColoradoAuroraCO
| | - Kimberlee Gauvreau
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Kathy J. Jenkins
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Sarah D. de Ferranti
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
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Sholler GF, Selbie LA, Tallon M, Keating J, Ayer J, Burchill L, Cheung MMH, Cordina R, Culnane E, Donovan S, Eastaugh L, Elliott C, Fletcher J, Justo RN, Kasparian NA, Kelly A, Morsman D, Nicolae M, Orr Y, Pendrick E, Ramsay JM, Reményi B, Shipton S, Weintraub RG, Van Wijk E, Wheaton G, Venugopal P. Australian National Standards of Care for Childhood-onset Heart Disease (CoHD Standards). 1st Edition. Heart Lung Circ 2024; 33:153-196. [PMID: 38453293 DOI: 10.1016/j.hlc.2023.03.017] [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: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 03/09/2024]
Abstract
These first Australian National Standards of Care for Childhood-onset Heart Disease (CoHD Standards) have been developed to inform the healthcare requirements for CoHD services and enable all Australian patients, families and carers impacted by CoHD (paediatric CoHD and adult congenital heart disease [ACHD]) to live their best and healthiest lives. The CoHD Standards are designed to provide the clarity and certainty required for healthcare services to deliver excellent, comprehensive, inclusive, and equitable CoHD care across Australia for patients, families and carers, and offer an iterative roadmap to the future of these services. The CoHD Standards provide a framework for excellent CoHD care, encompassing key requirements and expectations for whole-of-life, holistic and connected healthcare service delivery. The CoHD Standards should be implemented in health services in conjunction with the National Safety and Quality Health Service Standards developed by the Australian Commission on Safety and Quality in Health Care. All healthcare services should comply with the CoHD Standards, as well as working to their organisation's or jurisdiction's agreed clinical governance framework, to guide the implementation of structures and processes that support safe care.
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Affiliation(s)
- Gary F Sholler
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
| | - Lisa A Selbie
- HeartKids Ltd, Parramatta, NSW, Australia; School of Biotechnology & Biomolecular Sciences University of NSW, Sydney, NSW, Australia and Johns Hopkins University, Baltimore, MD, USA
| | - Mary Tallon
- HeartKids Ltd, Parramatta, NSW, Australia; Perth Children's Hospital, Perth, WA, Australia; School of Nursing, Curtin University, Perth, WA, Australia
| | | | - Julian Ayer
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Luke Burchill
- The Royal Melbourne Hospital, Melbourne, Vic, Australia and Mayo Clinic, Rochester, New York, NY, USA
| | - Michael M H Cheung
- The University of Melbourne, Melbourne, Vic, Australia; The Royal Children's Hospital, Melbourne, Vic, Australia
| | - Rachael Cordina
- The University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Evelyn Culnane
- The Royal Children's Hospital, Melbourne, Vic, Australia
| | | | - Lucas Eastaugh
- The Royal Children's Hospital, Melbourne, Vic, Australia
| | | | - Jeffery Fletcher
- Queensland Paediatric Specialists, Southport, Qld, Australia; Department of Paediatrics, The Tweed Hospital, Tweed Heads, NSW, Australia and Griffith University, Brisbane, Qld, Australia
| | - Robert N Justo
- Queensland Children's Hospital, South Brisbane, Qld, Australia; The University of Queensland, Herston, Qld, Australia; Queensland Paediatric Cardiac Research, Children's Health Queensland, South Brisbane, Qld, Australia
| | - Nadine A Kasparian
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Ohio, OH, USA
| | - Andrew Kelly
- Women's and Children's Hospital, North Adelaide, SA, Australia
| | | | - Mugur Nicolae
- The University of Queensland, Herston, Qld, Australia; Mater Hospital Services, Brisbane, Qld, Australia
| | - Yishay Orr
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | | | | | - Bo Reményi
- Menzies School of Health Research, Charles Darwin University, Darwin, NT and Royal Darwin Hospital, Darwin, NT, Australia
| | | | - Robert G Weintraub
- The University of Melbourne, Melbourne, Vic, Australia; The Royal Children's Hospital, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Elsa Van Wijk
- HeartKids Ltd, Parramatta, NSW, Australia; Australian Institute of Company Directors, NSW, Australia
| | - Gavin Wheaton
- Women's and Children's Hospital, North Adelaide, SA, Australia; University of Adelaide, Adelaide, SA, Australia
| | - Prem Venugopal
- Queensland Children's Hospital, South Brisbane, Qld, Australia; The University of Queensland, Herston, Qld, Australia
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Mackie AS, Bravo-Jaimes K, Keir M, Sillman C, Kovacs AH. Access to Specialized Care Across the Lifespan in Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:267-282. [PMID: 38161668 PMCID: PMC10755796 DOI: 10.1016/j.cjcpc.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 01/03/2024]
Abstract
Individuals living with tetralogy of Fallot require lifelong specialized congenital heart disease care to monitor for and manage potential late complications. However, access to cardiology care remains a challenge for many patients, as does access to mental health services, dental care, obstetrical care, and other specialties required by this population. Inequities in health care access were highlighted by the COVID-19 pandemic and continue to exist. Paradoxically, many social factors influence an individual's need for care, yet inadvertently restrict access to it. These include sex and gender, being a member of a racial or ethnic historically excluded group, lower educational attainment, lower socioeconomic status, living remotely from tertiary care centres, transportation difficulties, inadequate health insurance, occupational instability, and prior experiences with discrimination in the health care setting. These factors may coexist and have compounding effects. In addition, many patients believe that they are cured and unaware of the need for specialized follow-up. For these reasons, lapses in care are common, particularly around the time of transfer from paediatric to adult care. The lack of trained health care professionals for adults with congenital heart disease presents an additional barrier, even in higher income countries. This review summarizes challenges regarding access to multiple domains of specialized care for individuals with tetralogy of Fallot, with a focus on the impact of social determinants of health. Specific recommendations to improve access to care within Canadian and American systems are offered.
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Affiliation(s)
- Andrew S. Mackie
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christina Sillman
- Adult Congenital Heart Disease Program, Sutter Heart and Vascular Institute, Sacramento, California, USA
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Hummel K, Ludomirsky A, Burgunder L, Lu M, Goldberg S, Sleeper L, Reichman J, Blume ED. The family burden of paediatric heart disease during the chronic phase of illness. Cardiol Young 2023:1-7. [PMID: 38014533 DOI: 10.1017/s1047951123003906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND CHD is a lifelong condition with a significant burden of disease to patients and families. With increased survival, attention has shifted to longer-term outcomes, with a focus on social determinants of health. Among children with CHD, socioeconomic status is associated with disparities in outcomes. Household material hardship is a concrete measure of poverty and may serve as an intervenable measure of socioeconomic status. METHODS A longitudinal survey study was conducted at multiple time points (at acute hospitalisation, then 12-24 months later in the chronic phase) to determine the prevalence of household material hardship among parents of children with advanced heart disease and quality of life during long-term follow-up. RESULTS The analytic cohort was 160 children with a median patient age of 1 year (IQR 1,4) with 54% of patients <2 years. During acute hospitalisation, over one-third of families reported household material hardship (37%), with significantly lower household material hardship in the chronic phase at 16% (N = 9 of 52). For parents reporting household material hardship during acute hospitalisation, 50% had resolution of household material hardship by the chronic phase. Household material hardship-exposed children were significantly more likely to be publicly insured (56% versus 20%, p = 0.03) with lower quality of life than those without household material hardship (64% versus 82%, p = 0.013). CONCLUSION The burden of heart disease during the chronic phase of illness is high. Household material hardship may serve as a target to ensure equity in the care and outcomes of CHD patients and their families.
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Affiliation(s)
- Kevin Hummel
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Intermountain Health Primary Children's Hospital, Salt Lake City, UT, USA
| | - Avital Ludomirsky
- Department of Cardiology, Childrens Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lauren Burgunder
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Intermountain Health Primary Children's Hospital, Salt Lake City, UT, USA
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Sarah Goldberg
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Lynn Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Jeffrey Reichman
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
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9
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Hofmann M, Schulz-Weidner N, Krämer N, Hain T. The Bacterial Oral Microbiome in Children with Congenital Heart Disease: An Extensive Review. Pathogens 2023; 12:1269. [PMID: 37887785 PMCID: PMC10610089 DOI: 10.3390/pathogens12101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Children with congenital heart disease have poorer oral health compared with healthy children. Oral diseases, such as dental caries and gingivitis, are associated with the oral microbiome. The objective of this review was to find evidence of differences in the bacterial colonization of the oral cavity of children with congenital heart disease (CHD) versus healthy children. A literature review was conducted according to predetermined criteria, including the need for controlled clinical trials. Half of the 14 studies that met the inclusion criteria reported significant differences in bacterial colonization in children with congenital heart disease. A variety of influencing factors were discussed. There is some evidence for alterations in the oral microflora as a result of physiopathological and treatment-related factors in children with CHD, but additional research is required to validate these findings.
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Affiliation(s)
- Maria Hofmann
- Dental Clinic—Department of Paediatric Dentistry, Justus Liebig University, Schlangenzahl 14, 35392 Giessen, Germany; (N.S.-W.); (N.K.)
| | - Nelly Schulz-Weidner
- Dental Clinic—Department of Paediatric Dentistry, Justus Liebig University, Schlangenzahl 14, 35392 Giessen, Germany; (N.S.-W.); (N.K.)
| | - Norbert Krämer
- Dental Clinic—Department of Paediatric Dentistry, Justus Liebig University, Schlangenzahl 14, 35392 Giessen, Germany; (N.S.-W.); (N.K.)
| | - Torsten Hain
- Institute of Medical Microbiology, Justus Liebig University, Schubertstrasse 81, 35392 Giessen, Germany;
- German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, Schubertstrasse 81, 35392 Giessen, Germany
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10
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Dorfman TL, Archibald M, Haykowsky M, Scott SD. An examination of the psychosocial consequences experienced by children and adolescents living with congenital heart disease and their primary caregivers: a scoping review protocol. Syst Rev 2023; 12:90. [PMID: 37268979 DOI: 10.1186/s13643-023-02249-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 04/28/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The chronicity of congenital heart disease (CHD) comes with significant psychosocial consequences for both children and adolescents living with CHD and their primary caregivers. Children and adolescents living with CHD undergo multiple traumatizing invasive surgical and medical procedures, struggle with disabilities resulting from their CHD, face unfair scrutiny and marginalization, and are at risk for mental health issues. Primary caregivers of children and adolescents living with CHD deal with increased stress, fear, anxiety, depression, and financial burden. The overarching objectives of this scoping review are to (1) determine the current state of knowledge on negative psychosocial consequences experienced by children and adolescents living with CHD and their primary caregivers in high-income countries and (2) inform research aimed at developing interventions in high-income countries to decrease the negative psychosocial consequences experienced by children and adolescents living with CHD and their primary caregivers. METHODS Databases and grey literature searched will include MEDLINE, CINAHL, EMBASE, PsycINFO, CENTRAL, Scopus, ProQuest Theses and Dissertations, and Google advanced search. Citation mining of included studies and relevant review articles will be completed. Studies will be screened by title and abstract and then full text by two independent reviewers, using pre-defined inclusion and exclusion criteria. Quality analysis will be conducted on all included studies by two reviewers using MMAT Version 2018. Studies will not be excluded due to quality assessment. Data from all eligible studies will be independently extracted by the two reviewers and verified by consensus. Data will be presented and synthesized in evidence tables to examine potential patterns. DISCUSSION The results of this review will provide recognition of the psychosocial impact of CHD and its treatments on children and adolescents living with CHD and their primary caregivers. It will also highlight interventions that have been developed to decrease these psychosocial consequences. The results from this review will inform a future integrated knowledge translation study by the first author aimed at decreasing one or more of the negative psychosocial consequences experienced by children or adolescents living with CHD and their primary caregivers. SYSTEMATIC REVIEW REGISTRATION Open Science Framework (OSF) Registration, https://doi.org/10.17605/OSF.IO/ZXYGW.
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Affiliation(s)
- Tamara L Dorfman
- Pediatric Cardiology, Stollery Children's Hospital, Walter C. Mackenzie Health Sciences Centre, Unit 4C3/4C4, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Mandy Archibald
- College of Nursing, University of Manitoba, Helen Glass Centre for Nursing, University of Manitoba (Fort Garry Campus), 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - Mark Haykowsky
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, University of Alberta, 3-141, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Shannon D Scott
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, University of Alberta, 3-141, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
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11
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Huang YC, Chen YC, Gau BS, Wang JK, Chang SH, Yang HL. Psychometric evaluation of the traditional chinese version of PedsQL ™ 3.0 cardiac module scale in adolescents with congenital heart disease: reliability, validity, measurement invariance, and adolescent-parent agreement. Health Qual Life Outcomes 2023; 21:39. [PMID: 37147623 PMCID: PMC10163758 DOI: 10.1186/s12955-023-02121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/25/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND In recent decades, 95% of children with congenital heart disease (CHD) can survive to adolescence and adulthood. However, adolescents with CHD are prone to poorer health-related quality of life (HRQoL). It is imperative to develop a reliable and valid instrument for health professionals to monitor the HRQoL. This study aims to: (1) evaluate the psychometric properties of the traditional Chinese version of Pediatric Quality of Life™ 3.0 Cardiac Module (PedsQL-CM) and measurement invariance across adolescents with CHD and their parents; and (2) investigate the adolescent-parent agreement in HRQoL. METHODS A total of 162 adolescents and 162 parents were recruited. Internal consistency was examined using Cronbach's alpha and McDonald's Omega. The criterion-related validity was evaluated with intercorrelations between the PedsQL-CM and PedsQL™ 4.0 Generic Core (PedsQL-GC) Scale. The construct validity was examined by second-order confirmatory factor analysis (CFA). Measurement invariance was evaluated using the multi-group CFA. The adolescent-parent agreement was analyzed with the intraclass correlation (ICC), paired t-tests, and Bland-Altman plots. RESULTS PedsQL-CM showed acceptable internal consistency (self-reports 0.88, proxy-reports 0.91). The intercorrelations were medium to large effect size (self-reports 0.34-0.77, proxy-reports 0.46-0.68). The CFA supported the construct validity (CFI = 0.967, TLI = 0.963, RMSEA = 0.036, 90% CI = 0.026-0.046, SRMR = 0.065). The multi-group CFA proved scalar invariance between self and parent proxy-reports. Parents significantly underestimated their adolescents' HRQoL in cognitive problems (Cohen's d = 0.21) and communication (Cohen's d = 0.23) subscales, while there was a negligible difference in total HRQoL (Cohen's d = 0.16). ICCs were poor to moderate effect size with the highest and lowest agreement in heart problems and treatment subscale (ICC = 0.70) and communication subscale (ICC = 0.27), respectively. The Bland-Altman plots showed lesser variability in the heart problem and treatment subscale and the total scale. CONCLUSION The traditional Chinese version of PedsQL-CM has acceptable psychometric properties to measure disease-specific HRQoL in adolescents with CHD. Parents may be proxies for adolescents with CHD to rate total HRQoL. When the patient-reported score is the primary outcome, the proxy-reported score could serve as a secondary outcome for research and clinical evaluation.
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Affiliation(s)
- Yong-Chen Huang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, No. 17, Xu-Zhou Road, Taipei City, 100, Taiwan
| | - Yueh-Chih Chen
- School of Nursing, College of Medicine, National Taiwan University, No. 1 Jen-Ai Road, Section 1, Taipei City, 100, Taiwan
| | - Bih-Shya Gau
- School of Nursing, College of Medicine, National Taiwan University, No. 1 Jen-Ai Road, Section 1, Taipei City, 100, Taiwan
- Department of Nursing, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan
| | - Shu-Hui Chang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, No. 17, Xu-Zhou Road, Taipei City, 100, Taiwan
| | - Hsiao-Ling Yang
- School of Nursing, College of Medicine, National Taiwan University, No. 1 Jen-Ai Road, Section 1, Taipei City, 100, Taiwan.
- Department of Nursing, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan.
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12
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Bolduc ME, Rennick JE, Gagnon I, Sokol E, Brossard-Racine M, Majnemer A. Identifying developmental challenges of youth with congenital heart defects: A patient-oriented perspective. Child Care Health Dev 2023; 49:258-267. [PMID: 35945137 DOI: 10.1111/cch.13037] [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: 02/08/2022] [Revised: 07/08/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Youth with congenital heart disease (CHD) are at high risk for a range of developmental impairments that become evident at different times across childhood and adolescence. This study aimed to explore perspectives of youth with CHD with respect to their developmental follow-up across childhood. METHODS Interpretive description was used as a methodological approach for this qualitative study. Youth aged 12-22 years with CHD requiring open-heart surgery before 2 years of age and who had received health services in Canada since birth were enrolled. RESULTS Ten youth with CHD, two males and eight females, aged 13-22 years (mean 19.8) participated in this study. With higher social and academic demands as well as increased level of autonomy associated with older age, some youth faced new challenges that they had not encountered as children. Youth with CHD identified four aspects of the continuum of care as needing to be changed to better respond to their needs. First, the format of developmental follow-up needs to be adapted to their unique challenges. Second, resources must be more easily accessible throughout childhood and adolescence. Third, planning for transition to adult care is essential to ensure continuity of services. Finally, they identified that the school system is an essential component of the continuum of care. CONCLUSIONS Adolescents and young adults with CHD are at high risk of developing physical, academic and psychosocial challenges; however, timely identification of challenges does not appear to be optimal across domains and transition points, from the perspective of the youth themselves. Youth with CHD reported not having the resources and supports they required to optimize their functioning. Our findings suggest that several approaches could be adopted to enhance identification and outcomes to address the limitations of current Canadian practices.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Janet E Rennick
- Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada.,Ingram School of Nursing, McGill University, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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13
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Stokes N, Stransky OM, West SC, Hoskoppal A, Talabi MB, Kazmerski TM. Sexual and Reproductive Health Care Experiences and Perceptions of Women with Congenital Heart Disease. Pediatr Cardiol 2023; 44:564-571. [PMID: 35732955 DOI: 10.1007/s00246-022-02951-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/02/2022] [Indexed: 11/29/2022]
Abstract
Due to medical advances, women with congenital heart disease (CHD) are living longer, healthier lives and many are considering pregnancy. The hemodynamic changes of pregnancy present high risks of morbidity and mortality for many women with CHD. As little is known about these women's reproductive health experiences, this study explores their perceptions of pregnancy and family planning care as related to CHD. Women ages 18-45 years with a diagnosis of CHD associated with a World Health Organization (WHO) classification II-IV for pregnancy morbidity and mortality participated in individual, semi-structured interviews exploring their experiences, attitudes, and preferences toward parenthood, pregnancy, contraception and family planning care provision. Interviews were audio-recorded, transcribed verbatim. Two independent coders performed analysis using deductive and inductive coding approaches. Twenty women with CHD participated in interviews (average age 30.1 years, SD 5.85). Nine women had a prior pregnancy and 14 considered becoming a parent in the future. We identified 5 key themes among the women: (1) CHD impacted their reproductive health goals and decisions; (2) Women with CHD perceived a lack of safe contraceptive methods for their condition; (3) Women desired tailored, disease-specific sexual and reproductive health (SRH) information; (4) Women viewed their cardiologist as the primary source for SRH information and prefer provider-initiated discussions starting in adolescence; and (5) Women desire coordinated pre-pregnancy and intrapartum care between their cardiologists and women's health providers. These results provide a foundation for interventions to improve patient-centered interdisciplinary reproductive healthcare for this population.
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Affiliation(s)
- Natalie Stokes
- Division of Cardiology, Department of Internal Medicine, School of Medicine and Heart & Vascular Institute, University of Pittsburgh, UPMC, 201 Lothrup St., Pittsburgh, PA, 15211, USA.
| | - Olivia M Stransky
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn C West
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Arvind Hoskoppal
- Division of Cardiology, Department of Internal Medicine, School of Medicine and Heart & Vascular Institute, University of Pittsburgh, UPMC, 201 Lothrup St., Pittsburgh, PA, 15211, USA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mehret Birru Talabi
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, USA.,UPMC, Pittsburgh, PA, USA
| | - Traci M Kazmerski
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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14
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"The only thing I wonder is when I will have surgery again": everyday life for children with right ventricle outflow tract anomalies during assessment for heart surgery. Cardiol Young 2023; 33:396-401. [PMID: 35351230 DOI: 10.1017/s1047951122000907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Children with right ventricle outflow tract anomalies require repeated heart surgeries, thereby needing regular preoperative assessments throughout their lifetime. This situation puts a heavy burden on these children. Thus, the aim of this study was to explore how children diagnosed with right ventricle outflow tract anomalies experience their heart disease and their everyday life during the preoperative assessment and after the decision on whether to perform a new cardiac surgery. METHODS Individual interviews were conducted with nine children between 9 to 17 years of age on three occasions from 2014 to 2016. In total there were 27 interviews which all were analyzed with thematic analysis. RESULTS The analysis yielded three themes and eight subthemes. The theme Me and my heart disease concerns children's experiences of the heart disease. Almost all described symptoms and how they adapt in their everyday life. The theme Being me concerns the children's sense of self, where their heart disease was not prominent. The theme Being placed in someone else's hands describes how the assessment was more of a safety net at least until the decision of heart surgery. CONCLUSION The children's symptoms, their experiences during the assessment, their future surgeries and how the heart disease affects their everyday life could be better understood as elements of their adaptation to the heart disease. In order to achieve individualized support based on the child's experiences and to ensure that these children are involved in their own care a child-centered approach is recommended.
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15
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Lavenant P, Cacioppo M, Ansquer H, Guillaumont S, Houx L, Brochard S, Amedro P, Pons C. Participation in physical activity of adolescents with congenital heart disease. Child Care Health Dev 2023; 49:311-320. [PMID: 35996333 DOI: 10.1111/cch.13045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/12/2022] [Accepted: 08/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Participation in physical activity improves health in individuals with congenital heart disease. However, most do not sufficiently engage in physical activity. The aim of this study was to collect information regarding the experiences of adolescents with congenital heart disease who practiced physical activities. METHODS French adolescents aged 13-18 years, diagnosed with congenital heart disease, class I or II dyspnoea on the NYHA scale and authorized physical activity were interviewed individually about their physical activity experiences using a semi-structured format. The qualitative interview transcript data were analysed using a phenomenological approach; data analysis was performed independently by three researchers and merged at each step until saturation. RESULTS Eleven adolescents with congenital heart disease participated. Three main themes emerged: 'own representation', 'physical activity (PA) set-up' and 'environment'. Adolescents had a generally positive view of physical activity, which was associated with positive experiences. However, they reported that their physical condition limited PA, and they wished for adapted activities. The results revealed the importance of environmental factors, for example, within the social and school environments. The participants indicated that they appreciated the social interactions that PA afforded, but that integration into a group could be difficult, especially in school, with some participants describing feelings such as anxiety, frustration or guilt when they could not participate fully. PA facilitators included familial support. However, participants noted a lack of clear medical guidance to help them choose suitable activities based on their circumstances and personal preferences. They wished for the public to be better informed about congenital heart disease to reduce stigmatism. CONCLUSIONS This study provides valuable information for clinicians, physical educators and policy makers to help them promote physical activity and support adolescents and their families in understanding their own condition, maximizing their potential and in their choice of activities.
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Affiliation(s)
| | - Marine Cacioppo
- Department of Physical and Medical Rehabilitation, CHRU de Brest, Brest, France.,Department of Paediatric Physical and Medical Rehabilitation, FONDATION ILDYS, Brest, France.,Laboratory of Medical Information Processing, INSERM U1101, Brest, France
| | | | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Laetitia Houx
- Department of Physical and Medical Rehabilitation, CHRU de Brest, Brest, France.,Department of Paediatric Physical and Medical Rehabilitation, FONDATION ILDYS, Brest, France.,Laboratory of Medical Information Processing, INSERM U1101, Brest, France
| | - Sylvain Brochard
- Department of Physical and Medical Rehabilitation, CHRU de Brest, Brest, France.,Department of Paediatric Physical and Medical Rehabilitation, FONDATION ILDYS, Brest, France.,Laboratory of Medical Information Processing, INSERM U1101, Brest, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Christelle Pons
- Department of Physical and Medical Rehabilitation, CHRU de Brest, Brest, France.,Department of Paediatric Physical and Medical Rehabilitation, FONDATION ILDYS, Brest, France.,Laboratory of Medical Information Processing, INSERM U1101, Brest, France
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16
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Psychosocial, neurodevelopmental, and transition of care practices provided to children with CHD across North American cardiac clinics. Cardiol Young 2023; 33:235-241. [PMID: 35184773 DOI: 10.1017/s1047951122000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Children with CHD are at risk for psychosocial and neurodevelopmental difficulties, as well as lapses in care during their transition from paediatric to adult CHD providers. The American Heart Association and American Academy of Pediatrics released guidelines for best practices in the neurodevelopmental and transitional care for children with CHD in 2012 and 2011, respectively. CHD providers from 48 (42.1% response rate) geographically diverse cardiac clinics completed a 31-item electronic survey designed to assess the cardiac teams' consistency with neurodevelopmental evaluation and management recommendations, consultation/liaison patterns for psychosocial services, and procedures regarding transitional services for emerging adults. Responses suggest most cardiac teams refer patients to psychosocial services as needed, and 39.6% of teams screen for psychosocial distress. CHD providers at 66.7% of cardiac clinics reported a formal neurodevelopmental programme/clinic. Nearly half of cardiac teams conduct routine neurodevelopmental evaluations, most frequently occurring at 9 months of age. Less than 10% of cardiac clinics have resources to meet the American Heart Association and American Academy of Pediatrics 2012 neurodevelopmental evaluation and management guidelines. Formal paediatric to adult CHD transition programmes were reported at 70.8% of cardiac clinics and were associated with younger ages of transition to adult CHD care. Care practices varied across the 48 represented cardiac clinics, indicating inconsistent practices for patients with CHD. Barriers and facilitators to the provision of care for children in these areas were reported and are presented. More support is needed for cardiac clinics to continue improvements in psychosocial, neurodevelopmental, and transitional care services.
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17
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Changing epidemiology of congenital heart disease: effect on outcomes and quality of care in adults. Nat Rev Cardiol 2023; 20:126-137. [PMID: 36045220 DOI: 10.1038/s41569-022-00749-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 01/21/2023]
Abstract
The epidemiology of congenital heart disease (CHD) has changed in the past 50 years as a result of an increase in the prevalence and survival rate of CHD. In particular, mortality in patients with CHD has changed dramatically since the latter half of the twentieth century as a result of more timely diagnosis and the development of interventions for CHD that have prolonged life. As patients with CHD age, the disease burden shifts away from the heart and towards acquired cardiovascular and systemic complications. The societal costs of CHD are high, not just in terms of health-care utilization but also with regards to quality of life. Lifespan disease trajectories for populations with a high disease burden that is measured over prolonged time periods are becoming increasingly important to define long-term outcomes that can be improved. Quality improvement initiatives, including advanced physician training for adult CHD in the past 10 years, have begun to improve disease outcomes. As we seek to transform lifespan into healthspan, research efforts need to incorporate big data to allow high-value, patient-centred and artificial intelligence-enabled delivery of care. Such efforts will facilitate improved access to health care in remote areas and inform the horizontal integration of services needed to manage CHD for the prolonged duration of survival among adult patients.
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18
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The role of the virtues in CHD. Cardiol Young 2022; 32:1193-1195. [PMID: 35620926 DOI: 10.1017/s1047951122000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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19
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Endo S, Higuchi M, Hotta N. The association between the social adaptive skills of school-aged children with congenital heart disease and mothers' decision factors for providing disease explanations in Japan: a cross-sectional study. CHILD HEALTH NURSING RESEARCH 2022; 28:187-196. [PMID: 35953068 PMCID: PMC9371799 DOI: 10.4094/chnr.2022.28.3.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose This study aimed to clarify the factors related to mothers' decisions to provide disease explanations to their children, investigate the associations between those factors and social adaptive skills, and examine support relative to children's growth and development. Methods Data were collected from anonymous, self-administered questionnaires answered by 71 mothers of outpatient school-aged children with congenital heart disease. The questionnaire items included characteristics of mothers and children, decision factors for providing disease explanations, and children's social adaptive skills (Asahide-Shiki social adaptive skills test). Factor analysis was performed on the decision factors, and multiple regression analysis was performed to examine the association between the identified factors and each social adaptive skill. Results The decision factors for providing disease explanations were the mother's explanation ability, the receptive capability of the child, and the child's interest and literacy regarding the explanation. Multiple regression analysis showed that language and social life skills were significantly associated with the child's receptive capability, and language and daily life skills were significantly associated with the child's interest and literacy regarding the explanation. Conclusion Improving children's language, social life, and daily life skills may enhance their receptive capability and literacy regarding explanations of their disease.
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Affiliation(s)
- Shinsaku Endo
- Associate Professor, Graduate School of Nursing, Nagoya City University, Nagoya, Aichi, Japan
- Corresponding author Shinsaku Endo Graduate School of Nursing, Nagoya City University, 1 Kawasumi Mizuho-cho Mizuhorr-ku, Nagoya 467-8601, Japan TEL: +82-52-853-8049 FAX: +82-52-853-8049 E-MAIL:
| | - Michiyo Higuchi
- Professor, Graduate School of Nursing, Nagoya City University, Nagoya, Aichi, Japan
| | - Noriko Hotta
- Professor Emeritus, Nagoya City University, Nagoya, Aichi, Japan
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20
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Kovacs AH, Brouillette J, Ibeziako P, Jackson JL, Kasparian NA, Kim YY, Livecchi T, Sillman C, Kochilas LK. Psychological Outcomes and Interventions for Individuals With Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2022; 15:e000110. [DOI: 10.1161/hcq.0000000000000110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although resilience and high quality of life are demonstrated by many individuals with congenital heart disease, a range of significant psychological challenges exists across the life span for this growing patient population. Psychiatric disorders represent the most common comorbidity among people with congenital heart disease. Clinicians are becoming increasingly aware of the magnitude of this problem and its interplay with patients’ physical health, and many seek guidance and resources to improve emotional, behavioral‚ and social outcomes. This American Heart Association scientific statement summarizes the psychological outcomes of patients with congenital heart disease across the life span and reviews age-appropriate mental health interventions, including psychotherapy and pharmacotherapy. Data from studies on psychotherapeutic, educational‚ and pharmacological interventions for this population are scarce but promising. Models for the integration of mental health professionals within both pediatric and adult congenital heart disease care teams exist and have shown benefit. Despite strong advocacy by patients, families‚ and health care professionals, however, initiatives have been slow to move forward in the clinical setting. It is the goal of this scientific statement to serve as a catalyst to spur efforts for large-scale research studies examining psychological experiences, outcomes, and interventions tailored to this population and for integrating mental health professionals within congenital heart disease interdisciplinary teams to implement a care model that offers patients the best possible quality of life.
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21
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Kasparian NA, Kovacs AH. Quality of life and other patient-reported outcomes across the lifespan among people with Fontan palliation. Can J Cardiol 2022; 38:963-976. [PMID: 35525399 DOI: 10.1016/j.cjca.2022.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 12/31/2022] Open
Abstract
Traditional congenital heart disease (CHD) outcomes include mortality (survival to adulthood and life expectancy) as well as cardiac and non-cardiac morbidity. Strategies to identify and manage sequelae have primarily focused on objective data obtained though invasive and non-invasive diagnostic approaches. In contrast, patient-reported outcomes (PROs) provide subjective information, using standardized measures, about patients' health and wellbeing as reported directly by patients, without interpretation, interference, or assumptions made by clinicians or others. Selection of PRO measures entails thoughtful consideration of who the individuals being surveyed are, why assessment is occurring (e.g., what are the domains of interest; clinical vs. research), and what processes are in place for acquisition, administration, interpretation, and response. In this review, we focus on three domains of PROs for pediatric and adult patients with Fontan physiology: physical health status, psychological functioning, and quality of life (QOL). Infants, children, adolescents, and adults with CHD face a spectrum of challenges that may influence PROs across the lifespan. In general, patients with Fontan palliation tend to have lower physical health status, experience more psychological distress, and have equivalent or reduced QOL compared to healthy peers. Herein, we provide an overview of PROs among people with Fontan circulation as a group, yet simultaneously emphasize that the optimal way to understand the experiences of any individual patient is to ask and listen. We also offer clinical and research initiatives to improve the adoption and utility of PROs in CHD settings, which demonstrate commitment to capturing, understanding, and responding to the patient voice.
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Affiliation(s)
- Nadine A Kasparian
- Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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22
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Liu HC, Chaou CH, Lo CW, Chung HT, Hwang MS. Factors Affecting Psychological and Health-Related Quality-of-Life Status in Children and Adolescents with Congenital Heart Diseases. CHILDREN 2022; 9:children9040578. [PMID: 35455622 PMCID: PMC9032000 DOI: 10.3390/children9040578] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022]
Abstract
Congenital heart disease (CHD), a severe cardiac defect in children, has unclear influences on young patients. We aimed to find the impacts of differently structure heart defects and various treatments on psychology and health-related quality of life (HRQoL) in CHD children and adolescents. CHD patients aged between 6 and 18 years old visited our hospital from 1 May 2018 to 31 September 2018, and their principal caregivers were asked to participate. We used two validated questionnaires, Children Depression Inventory-TW (CDI-TW) and Child Health Questionnaire—Parent Form 50 (CHQ-PF 50), to evaluate CHD patients’ psychological and HRQoL conditions. Participants were grouped based on their cardiac defects and previous treatments. We analyzed the results via summary independent-samples t-test with post hoc Bonferroni correction and multivariant analysis. Two hundred and seventy-seven children and their principal caregivers were involved. There was no apparent depressive condition in any group. Single cardiac defect patients exhibited similar HRQoL to controls; simultaneously, those with cyanotic heart disease (CyHD), most multiple/complex CHDs children and adolescents, and those who received invasive treatments had poorer HRQoL. CyHD impacted the most on patients’ psychological and HRQoL status. Patients with sole cardiac defect could live near-normal lifes; on the other hand, CyHD had the worst effects on patients’ psychology and HRQoL.
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Affiliation(s)
- Hao-Chuan Liu
- Division of Cardiology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan; (H.-T.C.); (M.-S.H.)
- Correspondence:
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City 333, Taiwan;
| | - Chiao-Wei Lo
- Department of Pediatrics, Cathay General Hospital, Taipei Branch, Taipei City 106, Taiwan;
| | - Hung-Tao Chung
- Division of Cardiology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan; (H.-T.C.); (M.-S.H.)
| | - Mao-Sheng Hwang
- Division of Cardiology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan; (H.-T.C.); (M.-S.H.)
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23
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Wiljén A, Chaplin JE, Crine V, Jobe W, Johnson E, Karlsson K, Lindroth T, Schwarz A, Stenmarker M, Thunberg G, Öhlén J, Nilsson S. The Development of an mHealth Tool for Children With Long-term Illness to Enable Person-Centered Communication: User-Centered Design Approach. JMIR Pediatr Parent 2022; 5:e30364. [PMID: 35258466 PMCID: PMC8941441 DOI: 10.2196/30364] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/19/2021] [Accepted: 11/07/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Children with long-term illnesses frequently experience symptoms that could negatively affect their daily lives. These symptoms are often underreported in health care. Despite a large number of mobile health (mHealth) tools, few are based on a theoretical framework or supported by scientific knowledge. Incorporating universal design when developing a product can promote accessibility and facilitate person-centered communication. OBJECTIVE The aim of this study is to identify the symptom-reporting needs of children with cancer and congenital heart defects that could be satisfied by using a mobile app. Another aim is to evaluate how the child might interact with the app by considering universal design principles and to identify parents' views and health care professionals' expectations and requirements for an mHealth tool. METHODS User-centered design is an iterative process that focuses on an understanding of the users. The adapted user-centered design process includes 2 phases with 4 stages. Phase 1 involved interviews with 7 children with long-term illnesses, 8 parents, and 19 health care professionals to determine their needs and wishes for support; a workshop with 19 researchers to deepen our understanding of the needs; and a workshop with developers to establish a preliminary tool to further investigate needs and behaviors. Phase 2 involved interviews with 10 children with long-term illnesses, 9 parents, and 21 health care professionals to evaluate the mock-up (prototype) of the mHealth tool. Data were synthesized using the interpretive description technique. RESULTS A total of 4 aspects of needs emerged from the synthesis of the data, as follows: different perspectives on provided and perceived support; the need for an easy-to-use, non-clinic-based tool to self-report symptoms and to facilitate communication; the need for safety by being in control and reaching the child's voice; and a way of mapping the illness journey to facilitate recall and improve diagnostics. The children with long-term illnesses expressed a need to not only communicate about pain but also communicate about anxiety, fatigue, fear, and nausea. CONCLUSIONS The findings of this study indicated that the PicPecc (Pictorial Support in Person-Centered Care for Children) app is a potential solution for providing communicative support to children with long-term illnesses dealing with multiple symptoms and conditions. The interview data also highlighted symptoms that are at risk of being overlooked if they are not included in the mobile app. Further studies are needed to include usability testing and evaluation in hospitals and home care settings.
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Affiliation(s)
- Angelica Wiljén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics, Region Västra Götaland, Södra Älvsborg Hospital, Borås, Sweden
| | - John Eric Chaplin
- Department of Paediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Vanessa Crine
- University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - William Jobe
- Department of Informatics, School of Business, Economics and IT, University West, Trollhättan, Sweden
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa.,Department of Inclusive Education, University of South Africa, Pretoria, South Africa
| | - Katarina Karlsson
- Department of Health Sciences, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Tomas Lindroth
- Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
| | - Anneli Schwarz
- Department of Research, Education and Innovation, Region Västra Götaland, Södra Älvsborg Hospital, Borås, Sweden
| | - Margaretha Stenmarker
- Department of Paediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics, Region Jönköping County, Jönköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gunilla Thunberg
- University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Dart Centre for Augmentative and Alternative Communication and Assistive Technology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital Region Västra Götaland, Gothenburg, Sweden
| | - Stefan Nilsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Harvey EG. Kinesio taping to address post-sternotomy scars in pediatric patients: A case report. Scars Burn Heal 2022; 8:20595131221095355. [PMID: 35572360 PMCID: PMC9102140 DOI: 10.1177/20595131221095355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The role of postoperative scar tissue adhesion and its impact on motor control in infants with congenital heart disease has not been explored in the literature. Elastic therapeutic tapes, such as Kinesio tape, are designed to affect the integumentary system. This case report aims to demonstrate the safety and present the observations following use of Kinesio tape to treat scar tissue in a pediatric patient after open-heart surgery in conjunction with standard rehabilitation. Method This retrospective case report presents observations of an infant's sternotomy scar adhesion and gross motor development after six applications of Kinesio tape. The sternotomy and drain tube scars were treated with Kinesio tape fascia applications in addition to standard physical therapy (PT). Discussion Several domains showed positive changes. The scar mobility and appearance improved. The patient's motor skills improved, possibly due to skin stretch's role in motor learning. The taping application did not cause discomfort, and there were no adverse reactions. Conclusion In this infant, the three-month-old sternotomy scar improved in adherence and appearance after six applications of Kinesio Fingerprint tape; motor skills also increased in the presence of standard PT. There were no adverse reactions noted with the protocol. Kinesio tape may provide a safe adjunct to treat scar tissue adhesion in infants with median sternotomy scars. Lay Summary Issue being explored Sternotomy scars can cause physical and psychological harm. Sensors (receptors) in the skin help with movement and balance responses. The impact of scar stiffness (adhesion) on developing motor control has not been reported in infants. Treating the scar in the remodelling phase with elastic tape may improve the scar's appearance and ability to move, thereby improving development.
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Affiliation(s)
- Elizabeth G Harvey
- Department of Interprofessional Health and Aging Studies, University of Indianapolis, Indianapolis, IN, USA
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25
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Petersson-Bloom L, Holmqvist M. Strategies in supporting inclusive education for autistic students-A systematic review of qualitative research results. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2022; 7:23969415221123429. [PMID: 36382073 PMCID: PMC9620685 DOI: 10.1177/23969415221123429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIM Strategies to modify and adjust the educational setting in mainstream education for autistic students are under-researched. Hence, this review aims to identify qualitative research results of adaptation and modification strategies to support inclusive education for autistic students at school and classroom levels. METHOD In this systematic review, four databases were searched. Following the preferred PRISMA approach, 108 studies met the inclusion criteria, and study characteristics were reported. Synthesis of key findings from included studies was conducted to provide a more comprehensive and holistic understanding. MAIN CONTRIBUTION This article provides insights into a complex area via aggregating findings from qualitative research a comprehensive understanding of the phenomena is presented. The results of the qualitative analysis indicate a focus on teachers' attitudes and students' social skills in research. Only 16 studies were at the classroom level, 89 were at the school level, and three studies were not categorized at either classroom or school level. A research gap was identified regarding studies focusing on the perspectives of autistic students, environmental adaptations to meet the students' sensitivity difficulties, and how to enhance the students' inclusion regarding content taught and knowledge development from a didactic perspective. CONCLUSIONS AND IMPLICATIONS Professional development that includes autism-specific understanding and strategies for adjusting and modifying to accommodate autistic students is essential. This conclusion may direct school leaders when implementing professional development programs. A special didactical perspective is needed to support teachers' understanding of challenges in instruction that autistic students may encounter.
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Affiliation(s)
- Linda Petersson-Bloom
- Linda Peterson-Bloom, Faculty of Learning
and Society, Malmö University, Malmö SE-205 06, Sweden.
| | - Mona Holmqvist
- Faculty of Learning and Society,
Malmö University, Malmö, Sweden
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Charles S, Mackie AS, Rogers LG, McCrindle BW, Kovacs AH, Yaskina M, Williams E, Dragieva D, Mustafa S, Schuh M, Anthony SJ, Rempel GR. A Typology of Transition Readiness for Adolescents with Congenital Heart Disease in Preparation for Transfer from Pediatric to Adult Care. J Pediatr Nurs 2021; 60:267-274. [PMID: 34352719 DOI: 10.1016/j.pedn.2021.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To understand the effectiveness of a nurse-led transition intervention by analyzing qualitative data generated in the context of a clinical trial. DESIGN & METHODS Qualitative study of a two-session transition intervention conducted by registered nurses at two sites. Adolescents aged 16-17 years with moderate or complex congenital heart disease (CHD) had been randomized to a two-session transition intervention or usual care. Session 1 emphasized patient education including creation of a health passport and goal setting. Session 2, two months later, emphasized self-management. Qualitative data extracted from intervention logs, field notes and audio recordings of the sessions were analyzed for content and themes. RESULTS Data from 111 transition intervention sessions with 57 adolescents were analyzed. Creating a health passport, goal setting, and role-plays were the elements of the intervention most valued by participants. A typology of transition readiness was identified: 1) the independent adolescent (5%), already managing their own care; 2) the ready adolescent who was prepared for transition after completing the intervention (46%); 3) the follow-up needed adolescent who was still in need of extra coaching (26%), and 4) the at-risk adolescent who warranted immediate follow-up (14%). Baseline knowledge and transition surveys scores validated the typology. CONCLUSIONS A two-session nursing intervention met the transition needs of approximately half of adolescents with CHD. However, additional transition-focused care was needed by 40% of participants (groups 3 and 4). PRACTICE IMPLICATIONS These findings will guide pediatric nurses and other healthcare professionals to optimize an individualized approach for ensuring transition readiness for adolescents with CHD.
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Affiliation(s)
| | - Andrew S Mackie
- Department of Pediatrics, University of Alberta, AB, Canada; Stollery Children's Hospital, AB, Canada.
| | - Laura G Rogers
- Faculty of Nursing, University of Alberta, AB, Canada; Faculty of Health Disciplines, Athabasca University, AB, Canada.
| | - Brian W McCrindle
- Paediatrics, University of Toronto, ON, Canada; The Hospital for Sick Children (SickKids), ON, Canada.
| | | | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Canada.
| | - Elina Williams
- Stollery Children's Hospital, AB, Canada; Western Canadian Children's Heart Network, Canada.
| | - Dimi Dragieva
- The Hospital for Sick Children (SickKids), ON, Canada.
| | | | | | - Samantha J Anthony
- The Hospital for Sick Children (SickKids), ON, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada.
| | - Gwen R Rempel
- Faculty of Nursing, University of Alberta, AB, Canada; Faculty of Health Disciplines, Athabasca University, AB, Canada.
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Abstract
Millions of children and adolescents are living with a chronic condition. It is common for mental and behavioral health challenges to arise during their courses of illness. With the complexity of care needed, pediatric subspecialty providers have recognized the need to integrate behavioral health interventions into practice. Continued research in this area has allowed for focused behavioral interventions, particularly in diabetes and asthma. Adult congenital heart programs have adapted a similar model of care and have shown promising success in promotion of health. More established programs have been in existence for childhood cancer and cystic fibrosis.
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Affiliation(s)
- Ethel Clemente
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA.
| | - Gordon Liu
- Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
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Saxena S, Vo J, Millage J, Wong D, Bélanger P, Fournier A, Bodiam L, Allison A, Longmuir PE. Developing patient resources to enable the exchange of healthy lifestyle information between clinicians and families of children with complex heart problems. Child Care Health Dev 2021; 47:357-366. [PMID: 33432602 DOI: 10.1111/cch.12848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/13/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Healthy active lifestyles are critically important for children with complex heart problems (CHP) that affect heart structure, rhythm or function. They are at increased risk for morbidities such as atherosclerosis, obesity, anxiety and depression. Educating children with CHP and their families about the relevance of healthy lifestyles is an important part of clinical care. DESIGN This study used a collaborative approach among six patients/family members and 22 health professionals to develop a series of knowledge-to-action tools suitable for counselling children with CHP and their families about their healthy lifestyle needs. METHODS After development of the knowledge-to-action tools had been completed, one cardiologist and one research assistant implemented one or more of these new resources during each clinic visit as appropriate for each patient. Thirty-nine parents and eight children completed post-clinic interviews to explore their perceptions of the new resources. The nine resources developed included brochures and websites addressing physical activity with a heart condition, body contact restrictions, exercise test results, emotional health, finding community resources, encouragement for asking healthy lifestyle questions and a brief, in-clinic healthy lifestyle assessment. RESULTS Families found the resources useful and helpful for clarifying their specific concerns. They also provided suggestions to improve the content and delivery of the resources so that they would be suitable for a variety of settings-schools, community and sports. CONCLUSION Future research is required to evaluate the effectiveness of these resources for raising awareness and knowledge about healthy active lifestyles among children with CHP and the impact of these resources for changing healthy lifestyle behaviours.
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Affiliation(s)
- Shikha Saxena
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer Vo
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Millage
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Derek Wong
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Priscilla Bélanger
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Amelie Fournier
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Lorene Bodiam
- Parks, Forestry and Recreation, City of Toronto, Toronto, Ontario, Canada
| | | | - Patricia E Longmuir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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29
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Vivian LMH, Hunter C, Tan L, Comitis G, Neveling G, Lawrenson J. Found in translation: navigating uncertainty to save a child's heart. Paediatric cardiac surgery in Cape Town, South Africa. MEDICAL HUMANITIES 2021; 47:112-122. [PMID: 32467300 DOI: 10.1136/medhum-2019-011650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
This medical humanities paper describes our qualitative research into pathways to care and informed consent for 10 children who had cardiac surgery in the Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Our multidisciplinary team consists of cardiologists, anthropologists, a social scientist and a general practitioner in two sites, South Africa and Australia. This paper builds on our first publication in a specialist cardiology journal on a 'qualitative snapshot' of these children's life stories from 2011 to 2016 but turns to the medical humanities to explore a concept of 'uncertainty'. Data analysis revealed that for the children's parents and doctors, 'uncertainty' underscored procedures. Indeed, the literature review showed that 'uncertainty' is intrinsic to heart surgery and was integral to Barnard's first heart transplant in Cape Town in 1967. We demonstrate that in meeting the challenges inherent in the 'uncertainty dimension', doctors established greater 'medical certainty'about each operation. This happened as they encountered the difficult clinical and biopsychosocial factors that were fundamental to the diagnosis of children's cardiac defects. It was doctors' translation of these decision-making processes that informed parental decisions and described why, despite feelings of uncertainty, parents signed consent. To visually describe heart surgery in this locality we asked the South African photographer, Guy Neveling to record some children undergoing echocardiograms and surgery. These photographs qualitatively demonstrate what medical certainty entails, and parents' trust in doctors and surgeons, whom they knew had 'reasonable certainty' that their child's 'heart is worth saving'.
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Affiliation(s)
- Lauraine Margaret Helen Vivian
- School of Child and Adolescent Health, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
- Global Health Section, Department of Public Health, University of Copenhagen Faculty of Health Sciences, Kobenhavn, Denmark
| | - Cynthia Hunter
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lawrence Tan
- Department of General Practice, Western Sydney University School of Science and Health, Sydney, New South Wales, Australia
| | - George Comitis
- School of Child and Adolescent Health, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Guy Neveling
- School of Child and Adolescent Health, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - John Lawrenson
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, Western Cape, South Africa
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Perceptions of Healthy Lifestyles Among Children With Complex Heart Disease and Their Caregivers. CJC Open 2021; 3:854-863. [PMID: 34401692 PMCID: PMC8347848 DOI: 10.1016/j.cjco.2021.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 01/24/2021] [Indexed: 01/22/2023] Open
Abstract
Background Children with complex heart problems may be at higher risk for sedentary lifestyle morbidities than their healthy peers. This project examined perceptions, barriers, and supports that influence healthy active lifestyles among children with complex heart problems and their caregivers, to enable effective health and quality-of-life interventions. Methods Inductive thematic analysis was conducted of semi-structured guided discussions from 6 focus groups (young child [n = 2]; older child [n = 4]; parents of young child [n = 4]; parents of older child [n = 4]; pediatric cardiologist [n = 5]; pediatric cardiac nurse [n = 5]) and individual interviews with 7 parents, 5 parent/child dyads, 2 adults with complex heart problems, 6 pediatric cardiologists, 3 pediatric cardiac nurses, 4 pediatric cardiology mental health professionals, and 14 recreation professionals. Results Four interrelated themes were identified: (i) "It takes a village"—coordinated and collaborative interdisciplinary support; (ii) clear healthy lifestyle communication among children, families, and professionals is critically important; (iii) Ccreating supportive environments by building professional expertise; (iv) inspiring healthy lifestyles in the children’s own environments. All groups identified a need to improve knowledge about childhood heart conditions among education and recreation professionals and to encourage effective communication between healthcare professionals and families. Participants indicated that these changes would support families, educators, and recreation professionals in engaging children with heart problems in healthy lifestyles in home, school, and community settings. Conclusions Important healthy lifestyle barriers were identified within individuals and in their interactions. There is a profound need to enhance knowledge of childhood heart conditions and improve interactions among key stakeholders—children and families, educators, and recreation and healthcare professionals.
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31
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Freisinger E, Gerß J, Makowski L, Marschall U, Reinecke H, Baumgartner H, Koeppe J, Diller GP. Current use and safety of novel oral anticoagulants in adults with congenital heart disease: results of a nationwide analysis including more than 44 000 patients. Eur Heart J 2020; 41:4168-4177. [DOI: 10.1093/eurheartj/ehaa844] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/19/2020] [Accepted: 09/25/2020] [Indexed: 12/22/2022] Open
Abstract
Abstract
Aims
To evaluate the use of novel oral anticoagulants (NOACs) compared with vitamin K antagonists (VKAs) in adult congenital heart disease (ACHD) and assess outcome in a nationwide analysis.
Methods and results
Using data from one of Germany’s largest Health Insurers, all ACHD patients treated with VKAs or NOACs were identified and changes in prescription patterns were assessed. Furthermore, the association between anticoagulation regimen and complications including mortality was studied. Between 2005 and 2018, the use of oral anticoagulants in ACHD increased from 6.3% to 12.4%. Since NOACs became available their utilization increased constantly, accounting for 45% of prescribed anticoagulants in ACHD in 2018. Adult congenital heart disease patients on NOACs had higher thromboembolic (3.8% vs. 2.8%), MACE (7.8% vs. 6.0%), bleeding rates (11.7% vs. 9.0%), and all-cause mortality (4.0% vs. 2.8%; all P < 0.05) after 1 year of therapy compared with VKAs. After comprehensive adjustment for patient characteristics, NOACs were still associated with increased risk of MACE (hazard rate—HR 1.22; 95% CI 1.09–1.36) and increased all-cause mortality (HR 1.43; 95% CI 1.24–1.65; both P < 0.001), but also bleeding (HR 1.16; 95% CI 1.04–1.29; P = 0.007) during long-term follow-up.
Conclusion
Despite the lack of prospective studies in ACHD, NOACs are increasingly replacing VKAs and now account for almost half of all oral anticoagulant prescriptions. Particularly, NOACs were associated with excess long-term risk of MACE, and mortality in this nationwide analysis, emphasizing the need for prospective studies before solid recommendations for their use in ACHD can be provided.
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Affiliation(s)
- Eva Freisinger
- Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149 Muenster, Germany
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstrasse 56, 48149 Muenster, Germany
| | - Lena Makowski
- Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149 Muenster, Germany
| | - Ursula Marschall
- Department of Medicine and Health Services Research, BARMER Health Insurance, Lichtscheider Strasse 89, 42285 Wuppertal, Germany
| | - Holger Reinecke
- Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149 Muenster, Germany
| | - Helmut Baumgartner
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149 Muenster, Germany
| | - Jeanette Koeppe
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstrasse 56, 48149 Muenster, Germany
| | - Gerhard-Paul Diller
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149 Muenster, Germany
- Competence Network for Congenital Heart Defects, Augustenburger Pl. 1, 13353 Berlin, Germany
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Lee S, Ahn JA. Experiences of Mothers Facing the Prognosis of Their Children with Complex Congenital Heart Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197134. [PMID: 33003537 PMCID: PMC7579087 DOI: 10.3390/ijerph17197134] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022]
Abstract
Mothers of children with complex congenital heart disease face unique challenges and emotional burdens, while their children go through physical and psychological difficulties during disease progression. In this study, we aimed to explore the in-depth experiences and feelings of mothers facing the prognosis of their children with complex congenital heart disease that was surgically corrected. This is a descriptive qualitative study. We conducted semi-structured, face-to-face interviews with 12 mothers of children with complex congenital heart disease at a tertiary hospital in Seoul, Korea. The interview data were analyzed by content analysis. Participants were mothers aged between 40–58 years whose children were diagnosed with complex congenital heart disease which was surgically corrected. Based on the content analysis, the mothers’ experiences and feelings were categorized as immense suffering and adapting to a new life. Under the main categories, the concepts included feeling of abandonment, anxiety with potentially losing their children, having hope, seeking reassurance, being encouraged, and trying to embrace the situation. Mothers who cared for their children with complex congenital heart disease expressed emotions that changed sequentially alongside physical and psychosocial changes in the children. The results of this study are valuable for understanding the experiences and emotions of mothers facing the prognosis of their children with complex congenital heart disease in order to aid in the development of programs that support these mothers.
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Affiliation(s)
- Sunhee Lee
- College of Nursing, The Catholic University of Korea, Seoul 06591, Korea;
| | - Jeong-Ah Ahn
- College of Nursing, Research Institute of Nursing Science, Ajou University, Suwon 16499, Korea
- Correspondence: ; Tel.: +82-31-219-7031
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Saarijärvi M, Wallin L, Moons P, Gyllensten H, Bratt EL. Factors affecting adolescents' participation in randomized controlled trials evaluating the effectiveness of healthcare interventions: the case of the STEPSTONES project. BMC Med Res Methodol 2020; 20:205. [PMID: 32746862 PMCID: PMC7398069 DOI: 10.1186/s12874-020-01088-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/27/2020] [Indexed: 01/10/2023] Open
Abstract
Background Recruitment of adolescents to intervention studies is a known challenge. For randomized controlled trials (RCT) to be generalizable, reach must be assessed, which means ascertaining how many of the intended population actually participated in the trial. The aim of this study was to evaluate the reach and representativeness of an RCT evaluating the effectiveness of a complex intervention for adolescents with chronic conditions. Methods A mixed methods sequential explanatory design was employed. Firstly, quantitative cross-sectional data from the RCT, patient registries and medical records were collected and analysed regarding baseline differences between participants and non-participants in the trial. Secondly, qualitative data on their reasons for participating or not were collected and analysed with content analysis to explain the quantitative findings. Results Participants showed larger differences in effect sizes and a significantly more complex chronic condition than non-participants. No other statistically significant differences were reported, and effect sizes were negligible. Reasons for declining or accepting participation were categorized into three main categories: altruistic reasons, personal reasons and external reasons and factors. Conclusions Integration of quantitative and qualitative findings showed that participation in the RCT was affected by disease complexity, the perceived need to give back to healthcare and research and the adolescents’ willingness to engage in their illness. To empower adolescents with chronic conditions and motivate them to participate in research, future intervention studies should consider developing tailored recruitment strategies and communications with sub-groups that are harder to reach.
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Affiliation(s)
- Markus Saarijärvi
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Lars Wallin
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatric Cardiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
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Journiac J, Vioulac C, Jacob A, Escarnot C, Untas A. What Do We Know About Young Adult Cardiac Patients' Experience? A Systematic Review. Front Psychol 2020; 11:1119. [PMID: 32733301 PMCID: PMC7358619 DOI: 10.3389/fpsyg.2020.01119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/30/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Studies interested in patients coping with a cardiac illness usually focus on children, teenagers, and adults above the age of 55. Apart from the field of congenital heart diseases, there is a general lack of literature regarding young adult cardiac patients (18-55 years old) who seem to cope with psychosocial issues. Therefore, the objective of this paper was to gather all the research carried out concerning the psychological experiences of young adult cardiac patients. Methods and Results: A comprehensive, systematic review was conducted on quantitative, qualitative, and mixed-method studies in PsycINFO, PubMed, ScienceDirect, and Cochrane Library databases. Out of the 10,747 articles found, 32 were included. While we aimed to include many cardiac diseases, coronary patients dominated the data. Five main themes emerged: emotional states (depression, anxiety, emotional distress, and stress), quality of life (health-related quality of life, physical functioning, and sexuality), adjusting to the medical environment (coping with the disease, health behavior change, financial barriers, and interactions with medical professionals), social life (social support and work), and identity (parenthood, new challenges, and new meanings). The results highlighted that their levels of depression, anxiety, stress, and quality of life were sometimes worse than in the general population and than in older and younger patients coping with a cardiac illness. Social isolation, identity changes, work, and parenthood were the specific challenges that this population had to face. Furthermore, young adult cardiac patients showed worse health behavior profiles than the general population and felt that they lacked information from professionals, especially regarding sexuality. Compared to men, women had worse psychosocial outcomes, especially regarding depression, stress, emotional distress, and quality of life. Conclusions: Young adult cardiac patients are to be considered with their own identity and challenges. They may be in need of specific interventions, some dedicated to women, and better communication is necessary with their families and professional caregivers so as to improve the patient's mental health, quality of life, coping skills, and adherence.
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Affiliation(s)
| | | | - Anne Jacob
- Université de Paris, LPPS, Boulogne-Billancourt, France
| | | | - Aurélie Untas
- Université de Paris, LPPS, Boulogne-Billancourt, France
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Moola FJ. Passive on the periphery: Exploring the experience of physical activity among children and youth with congenital heart disease using the draw-and-write technique. ARTS IN PSYCHOTHERAPY 2020. [DOI: 10.1016/j.aip.2020.101662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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36
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Girouard HS, Kovacs AH. Congenital heart disease: Education and employment considerations and outcomes. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2020. [DOI: 10.1016/j.ijcchd.2020.100005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Turriff A, Nolen R, D'Amanda C, Biesecker B, Cukras C, Sieving PA. "There Are Hills and Valleys": Experiences of Parenting a Son With X-Linked Retinoschisis. Am J Ophthalmol 2020; 212:98-104. [PMID: 31765628 DOI: 10.1016/j.ajo.2019.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the experiences of parents of sons with X-linked retinoschisis (XLRS). DESIGN Mixed methods-qualitative interviews with quantitative survey. METHODS Parents of sons with XLRS who were evaluated at the National Eye Institute between December 2017 and January 2019 were eligible for this study. Participation involved engaging in a semistructured interview and completing a survey assessing optimism, anxiety, personality traits, and sociodemographics using valid and reliable scales. Interview transcripts were coded and analyzed thematically, and scales were scored and used descriptively. RESULTS Eleven mothers and 8 fathers from 13 families participated. Optimism, anxiety, and personality traits fell into the normative ranges for the scales. Parents described a process of continuous adaptation to their son's condition. The initial diagnosis was characterized by shock, grief, and "devastation" for most parents. Maternal guilt was common, but usually lessened over time. As parents adjusted to life postdiagnosis, they attempted to achieve a state of normalcy while balancing a desire to protect their sons. Significant sources of stress included decisions around sports participation and driving. Among all parents, the fear of retinal detachment was an ongoing concern. Most parents did identify perceived benefits from their experiences, such as feelings of gratitude or family cohesion. CONCLUSIONS Most parents viewed XLRS as a significant challenge in their sons' lives, but one that could be overcome. Clinical encounters may be enhanced for families with XLRS by providing accurate information, preparing families for potential challenges, anticipating stressful decisions, and meeting other families with XLRS.
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O'Donovan C, Ingles J, Broadbent E, Skinner JR, Kasparian NA. How Patient Perceptions Shape Responses and Outcomes in Inherited Cardiac Conditions. Heart Lung Circ 2020; 29:641-652. [PMID: 31974024 DOI: 10.1016/j.hlc.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023]
Abstract
At least one-third of adults living with an inherited cardiac condition report clinically-significant levels of psychological distress. Poorer health-related quality of life compared with population norms is also consistently reported. These outcomes are associated with younger patient age, having an implantable cardioverter defibrillator, and receipt of uncertain clinical test results, and can influence self-management behaviours, such as adherence to potentially critical life-preserving medications. According to the Common Sense Model of Illness, people use information from multiple sources to 'make sense' of their health condition, and how they conceptualise the condition can strongly influence adaptation and coping responses. Previous studies with people with inherited cardiac conditions show that illness perceptions, such as greater perceived consequences and a poorer understanding of the condition, are associated with greater psychological distress and poorer adherence to medication. The Common Sense Model provides one potential framework for identifying patients who may be more vulnerable to adverse health outcomes, and for developing early interventions to reduce the physical and psychosocial burden of these conditions. Interventions based on the Common Sense Model have successfully improved physical and psychosocial outcomes associated with other cardiac conditions, and could be tailored for use with patients with an inherited cardiac condition (ICC).
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Affiliation(s)
- Claire O'Donovan
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Elizabeth Broadbent
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Jonathan R Skinner
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand; Department of Paediatrics Child and Youth Health, The University of Auckland, Auckland, New Zealand.
| | - Nadine A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Shorey S, Ng ED. The Lived Experiences of Children and Adolescents with Non-Communicable Disease: A Systematic Review of Qualitative Studies. J Pediatr Nurs 2020; 51:75-84. [PMID: 31926405 DOI: 10.1016/j.pedn.2019.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/13/2019] [Accepted: 12/20/2019] [Indexed: 12/15/2022]
Abstract
PROBLEM Children and adolescents with non-communicable disease face more difficulties in achieving developmental milestones than their healthy peers, which affect their life and overall wellbeing. A non-disease-specific approach is important in identifying common challenges faced by children and adolescents across multiple non-communicable diseases. ELIGIBILITY CRITERIA Qualitative studies reporting first-hand accounts of children and adolescents aged 4 to19 years with non-communicable disease. SAMPLE A library search was conducted in five electronic databases (CINAHL, Embase, PsycINFO, PubMed, Scopus, and ProQuest Dissertations and Theses) for original qualitative English language papers. Fifty-five articles met the inclusion criteria and were subjected to a two-step meta-synthesis. RESULTS Initial reports of negative emotional experiences and disease perceptions were mixed with gradual acceptances of their diseases and positive coping strategies. Children and adolescents with non-communicable disease all desired a normal life, but physical limitations often led to social exclusions and self-imposed restrictions. Although most were highly appreciative of the support received from family, friends, and healthcare providers, they still struggled with disease management, the need for autonomy, and the fear of illness disclosure. CONCLUSIONS The impacts of non-communicable disease on children and adolescent's lives suggest a need for joint efforts between parents, clinicians, and educators to ensure children and adolescents' positive development of the self, acceptance and positive coping. IMPLICATIONS This review is able to inform the development of future educational and psychosocial intervention programs in the school and healthcare setting, and also encourages a revision of education policies to be more flexible and accommodating.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Esperanza Debby Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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40
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Xiang L, Su Z, Liu Y, Huang Y, Zhang X, Li S, Zhang H. Impact of Family Socioeconomic Status on Health-Related Quality of Life in Children With Critical Congenital Heart Disease. J Am Heart Assoc 2020; 8:e010616. [PMID: 30563422 PMCID: PMC6405710 DOI: 10.1161/jaha.118.010616] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Socioeconomic status (SES) is associated with health‐related quality of life (HRQOL) for children with critical congenital heart disease; however, literature from newly industrialized countries is scarce. Methods and Results This cross‐sectional study included 2037 surviving patients operated on for critical congenital heart disease at a tertiary hospital in China between May 2012 and December 2015. All eligible patients were aged 2 to 12 years. HRQOL was measured by the Pediatric Quality of Life Inventory 4.0 generic and 3.0 cardiac modules. Family SES was assessed by a composite of household income in the past year and occupation and education level of each parent in the family. Mean scores of major domains in HRQOL were significantly lower in the low‐SES group than in the medium‐ and high‐SES groups (total generic scores: 71.2±7.9 versus 75.0±8.0 and 76.0±7.9, respectively [P<0.001]; psychosocial functioning: 70.8±9.0 versus 74.4±8.4 and 75.3±8.4 [P<0.001]; physical functioning: 71.6±10.4 versus 76.0±9.7 and 77.1±9.4 [P<0.001]; heart symptoms: 71.9±11.6 versus 75.7±11.0 and 76.8±10.3 [P<0.001]; cognitive problems: 65.4±11.1 versus 69.4±12.1 and 74.6±13.6 [P<0.001]). After adjustment for other clinical and demographic variables in the multivariable linear regression model, family SES significantly affected all dimensions of HRQOL except for treatment barriers, treatment anxiety, physical appearance and communication. Conclusions Family SES is an important factor associated with HRQOL in patients with critical congenital heart disease. Further targeted interventions to improve HRQOL that consider the family and environmental issues confronted by those who are economically disadvantaged might help these patients have better outcomes.
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Affiliation(s)
- Li Xiang
- 1 State Key Laboratory of Cardiovascular Disease and Key Laboratory of Cardiac Regenerative Medicine Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,2 Center for Pediatric Cardiac Surgery Fuwai Hospital National Clinical Research Center for Cardiovascular Diseases Beijing China
| | - Zhanhao Su
- 1 State Key Laboratory of Cardiovascular Disease and Key Laboratory of Cardiac Regenerative Medicine Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,2 Center for Pediatric Cardiac Surgery Fuwai Hospital National Clinical Research Center for Cardiovascular Diseases Beijing China
| | - Yiwei Liu
- 1 State Key Laboratory of Cardiovascular Disease and Key Laboratory of Cardiac Regenerative Medicine Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,2 Center for Pediatric Cardiac Surgery Fuwai Hospital National Clinical Research Center for Cardiovascular Diseases Beijing China
| | - Yuan Huang
- 1 State Key Laboratory of Cardiovascular Disease and Key Laboratory of Cardiac Regenerative Medicine Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,2 Center for Pediatric Cardiac Surgery Fuwai Hospital National Clinical Research Center for Cardiovascular Diseases Beijing China
| | - Xiaoling Zhang
- 1 State Key Laboratory of Cardiovascular Disease and Key Laboratory of Cardiac Regenerative Medicine Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shoujun Li
- 2 Center for Pediatric Cardiac Surgery Fuwai Hospital National Clinical Research Center for Cardiovascular Diseases Beijing China
| | - Hao Zhang
- 1 State Key Laboratory of Cardiovascular Disease and Key Laboratory of Cardiac Regenerative Medicine Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,2 Center for Pediatric Cardiac Surgery Fuwai Hospital National Clinical Research Center for Cardiovascular Diseases Beijing China
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Svensson MK, Wahlberg A, Gislason GH. Chronic Paradoxes: A Systematic Review of Qualitative Family Perspectives on Living With Congenital Heart Defects. QUALITATIVE HEALTH RESEARCH 2020; 30:119-132. [PMID: 31526075 DOI: 10.1177/1049732319869909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There have been substantial advances in the diagnostics and treatment of congenital heart defects (CHDs) in recent decades, and this has improved survival significantly. Consequently, there is a growing interest in how CHDs affect the daily lives of children and youth. We examine life with CHDs as a particular kind of living from the perspectives of both children and youth with CHDs and their families through a systematic review of existing qualitative research. Based on a meta-ethnographic analysis of 20 articles (identified through PubMed, EMBASE, EBSCOhost, PSYCHinfo, Scopus, and Web of Science from January 7 to 12, 2016), we argue that living with CHDs is characterized by chronic paradoxes arising out of the transitions, normalities, and futures that families have to navigate.
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Affiliation(s)
- Marie Kofod Svensson
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Ayo Wahlberg
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar H Gislason
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
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Morton L. Using psychologically informed care to improve mental health and wellbeing for people living with a heart condition from birth: A statement paper. J Health Psychol 2019; 25:197-206. [DOI: 10.1177/1359105319826354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Over the last few decades, medical and surgical advances have led to a growing population of individuals living with congenital heart disease. The challenges of this condition can reach beyond physical limitations to include anxiety, depression and post-traumatic stress disorder. To date, these psychological outcomes have been neglected; yet, they need not be inevitable. The factors contributing to these difficulties are considered here, drawing on current evidence and neuropsychological theories including the novel application of polyvagal theory. Suggestions for developing psychologically informed medical and social care to improve mental health, wellbeing and recovery and influence policy and training are proposed (See supplemental material for video abstract).
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