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Khangura SD, Potter BK, Davies C, Ducharme R, Bota AB, Hawken S, Wilson K, Karaceper MD, Klaassen RJ, Little J, Simpson E, Chakraborty P. Health services use by children identified as heterozygous hemoglobinopathy mutation carriers via newborn screening. BMC Pediatr 2021; 21:296. [PMID: 34210267 PMCID: PMC8247172 DOI: 10.1186/s12887-021-02751-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/26/2021] [Indexed: 11/11/2022] Open
Abstract
Background Newborn screening (NBS) for sickle cell disease incidentally identifies heterozygous carriers of hemoglobinopathy mutations. In Ontario, Canada, these carrier results are not routinely disclosed, presenting an opportunity to investigate the potential health implications of carrier status. We aimed to compare rates of health services use among children identified as carriers of hemoglobinopathy mutations and those who received negative NBS results. Methods Eligible children underwent NBS in Ontario from October 2006 to March 2010 and were identified as carriers or as screen-negative controls, matched to carriers 5:1 based on neighbourhood and timing of birth. We used health care administrative data to determine frequencies of inpatient hospitalizations, emergency department (ED) visits, and physician encounters through March 2012, using multivariable negative binomial regression to compare rates of service use in the two cohorts. We analyzed data from 4987 carriers and 24,935 controls. Results Adjusted incidence rate ratios (95% CI) for service use in carriers versus controls among children < 1 year of age were: 1.11 (1.06–1.17) for ED visits; 0.97 (0.89–1.06) for inpatient hospitalization; and 1.02 (1.00–1.04) for physician encounters. Among children ≥1 year of age, adjusted rate ratios were: 1.03 (0.98–1.07) for ED visits; 1.14 (1.03–1.25) for inpatient hospitalization and 0.92 (0.90–0.94) for physician encounters. Conclusions While we identified statistically significant differences in health services use among carriers of hemoglobinopathy mutations relative to controls, effect sizes were small and directions of association inconsistent across age groups and health service types. Our findings are consistent with the assumption that carrier status is likely benign in early childhood.
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Affiliation(s)
- Sara D Khangura
- School of Epidemiology and Public Health, University of Ottawa, 415 Smyth Road, Ottawa, Ontario, K1H 8M8, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, 415 Smyth Road, Ottawa, Ontario, K1H 8M8, Canada.,Newborn Screening Ontario, Ottawa, Ontario, Canada.,ICES, University of Ottawa campus, Ottawa, Ontario, Canada
| | | | - Robin Ducharme
- ICES, University of Ottawa campus, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - A Brianne Bota
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Steven Hawken
- School of Epidemiology and Public Health, University of Ottawa, 415 Smyth Road, Ottawa, Ontario, K1H 8M8, Canada.,ICES, University of Ottawa campus, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, 415 Smyth Road, Ottawa, Ontario, K1H 8M8, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Maria D Karaceper
- School of Epidemiology and Public Health, University of Ottawa, 415 Smyth Road, Ottawa, Ontario, K1H 8M8, Canada.,Newborn Screening Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert J Klaassen
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, 415 Smyth Road, Ottawa, Ontario, K1H 8M8, Canada
| | - Ewurabena Simpson
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Ottawa, Ontario, Canada. .,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. .,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
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Middleton J, Calam R, Ulph F. Communication with children about sickle cell disease: A qualitative study of parent experience. Br J Health Psychol 2018; 23:685-700. [PMID: 29885041 DOI: 10.1111/bjhp.12311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 02/13/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to explore how parents communicate with children affected by sickle cell disease, a condition associated with social and cultural complexities that pose risks to open parent-child communication. DESIGN A contextualist approach informed the qualitative exploration of parent experience using an individual interview design. METHODS Twelve semi-structured interviews were conducted with parents whose child had a diagnosis of sickle cell disease. Interviews were audio-recorded, transcribed verbatim, and analysed using inductive thematic analysis. RESULTS Parental communication was aimed at educating and protecting children from the physical and emotional effects of SCD in an age appropriate way. Parents commonly described avoidant communication and a small number described using this as a more predominant approach. This appeared to relate to fears about SCD, stigma, and uncertainty about how to best to respond. CONCLUSIONS As a known mediator of child outcomes, communication offers a promising target for intervention. The findings of this study suggest that parents of children with SCD are likely to benefit from formal support to adapt their communication to their child's needs. Parenting interventions should, in future, include the SCD parent population as a specific group to benefit child outcomes. Statement of contribution What is already known on this subject? Talking openly with children who have genetic conditions is known to promote acceptance and adjustment to illness. Sickle cell disease (SCD) is a genetic condition that is surrounded by various sociocultural issues that may act as barriers to parent-child communication. For example, it is condition that affects only Black and Minority Ethnic (BME) groups and is associated with longstanding stigma within BME communities due to the hereditary nature of the disease. What does this study add? It adds a unique focus on communication in the SCD parent population (previous work has tended to study this group alongside parents of various other genetic conditions). The findings provide a rich insight into parent experience of communication with children about SCD. It reveals that many parents find it difficult to talk openly with children and often avoid sensitive issues such as inheritance, physical limitations, and risk of death which has important implications for child coping and adjustment. It is therefore recommended that health care services are designed to support parents with communication about SCD with their child.
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Affiliation(s)
- Joanne Middleton
- Department of Healthcare Psychology, Airedale General Hospital, West Yorkshire, UK
| | - Rachel Calam
- Division of Psychology and Mental Health, The University of Manchester, UK
| | - Fiona Ulph
- Division of Psychology and Mental Health, The University of Manchester, UK
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Genetic Counselors' Experience with and Opinions on the Management of Newborn Screening Incidental Carrier Findings. J Genet Couns 2018; 27:1328-1340. [PMID: 29687313 PMCID: PMC6209045 DOI: 10.1007/s10897-018-0258-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 04/04/2018] [Indexed: 11/25/2022]
Abstract
Newborn screening (NBS) is a public health program whose aim is to identify infants who will be clinically affected with a serious metabolic, genetic, or endocrine disorder; however, the technology utilized by many NBS programs also detects infants who are heterozygous carriers for autosomal recessive conditions. Discussion surrounding disclosure of these incidental carrier findings remains controversial. The purpose of this study was to assess genetic counselors’ attitudes about disclosure of carrier status results generated by NBS and to gather data on their experiences with incidental carrier findings. An electronic survey was distributed to genetic counselors of all specialties via the NSGC listserv, and a total of 235 survey responses were analyzed. Quantitative data were analyzed using IBM SPSS v24, and qualitative data were manually analyzed for thematic analysis. Results show that the counselor participants were overall in favor of routine disclosure. Those with experience in NBS were much more likely to strongly agree with one or more reasons for disclosure (p < 0.001), whereas those with five or fewer years of experience were more likely to strongly agree with one or more reasons for non-disclosure (p = 0.031). Qualitative analysis identified key motivating factors for disclosure, including helping parents to understand a positive screen, parents may otherwise be unaware of reproductive risk and they may not otherwise have access to this information, and, while genetic testing is inherently a complex and ambiguous process, this does not justify non-disclosure. The main motivating factor for non-disclosure was the need for better counseling and informed consent. The data suggest that implementation of an “opt-in/out” policy for parents to decide whether or not to receive incidental findings would be beneficial. The results of this study support the continued disclosure of incidental carrier findings; however, additional research is necessary to further determine and implement the most effective disclosure practices.
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Bombard Y, Miller FA, Barg CJ, Patton SJ, Carroll JC, Chakraborty P, Potter BK, Tam K, Taylor L, Kerr E, Davies C, Milburn J, Ratjen F, Guttmann A, Hayeems RZ. A secondary benefit: the reproductive impact of carrier results from newborn screening for cystic fibrosis. Genet Med 2016; 19:403-411. [PMID: 27608173 PMCID: PMC5319861 DOI: 10.1038/gim.2016.125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/12/2016] [Indexed: 12/03/2022] Open
Abstract
Purpose Newborn screening (NBS) for cystic fibrosis (CF) can identify carriers, which is considered a benefit that enables reproductive planning. We examined the reproductive impact of carrier result disclosure from NBS for CF. Methods We surveyed mothers of carrier infants after NBS (Time-1) and one-year later (Time-2) to ascertain intended and reported communication of their infants’ carrier results to relatives, carrier testing for themselves/other children and reproductive decisions. A sub-sample of mothers was also interviewed at Time-1 and Time-2. Results Response rate was 54%. Just over half (55%) of mothers carrier tested at Time-1; a further 40% of those who intended to test at Time-1 tested at Time-2. Carrier result communication to relatives was high (92%), but a majority of participants did not expect the results to influence family planning (65%). All interviewed mothers valued learning their infants’ carrier results. Some had carrier testing and shared results with family. Others did not use the results or used them in unintended ways. Conclusion While mothers valued learning carrier results from NBS, they reported moderate uptake of carrier testing and limited influence on family planning. Our study highlights the secondary nature of the benefit from disclosing carrier results from NBS.
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Affiliation(s)
- Yvonne Bombard
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn J Barg
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sarah J Patton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - June C Carroll
- Department of Family and Community Medicine, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Beth K Potter
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen Tam
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Louise Taylor
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Kerr
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christine Davies
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jennifer Milburn
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Paediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Robin Z Hayeems
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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