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Kim SW, Tian X, Andronis L, Maier RF, Varendi H, Seppänen AV, Siljehav V, Draper ES, Zeitlin J, Petrou S. Health-related quality of life at 5 years of age for children born very preterm with congenital anomalies: a multi-national cohort study. Pediatr Res 2024:10.1038/s41390-024-03521-9. [PMID: 39242941 DOI: 10.1038/s41390-024-03521-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/25/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND This study aimed to investigate the health-related quality of life (HRQoL) at 5 years of age of European children born very preterm across multi-dimensional outcomes by presence and severity of congenital anomalies. METHODS The study used data from a European cohort of children born very preterm (<32 weeks of gestation) and followed up to 5 years of age (N = 3493). Multilevel Ordinary Least Squares (OLS) regression were used to explore the associations between the presence and severity of congenital anomalies. RESULTS The mean total PedsQL™ GCS score for children with a mild congenital anomaly was lower than the respective value for children without a congenital anomaly by 3.7 points (p < 0.05), controlling for socioeconomic variables only; this effect was attenuated when accumulatively adjusting for perinatal characteristics (3.3 points (p < 0.05)) and neonatal morbidities (3.1 (p < 0.05)). The mean total PedsQL™ GCS scores for children who had a severe congenital anomaly were lower by 7.1 points (p < 0.001), 6.6 points (p < 0.001) and 6.0 points (p < 0.001) when accumulatively adjusting for socioeconomic, perinatal and neonatal variables, respectively. CONCLUSION This study revealed that the presence and severity of congenital anomalies are significant predictors of HRQoL outcomes in children born very preterm. IMPACT Children born very preterm with congenital anomalies experience poorer health-related quality of life (HRQoL) than their very preterm counterparts born without congenital anomalies. Increased severity of these anomalies compounds the negative impacts on HRQoL. Our findings can be used by stakeholders for clinical and planning purposes.
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Affiliation(s)
- Sung Wook Kim
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | | | - Lazaros Andronis
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rolf F Maier
- Children's Hospital, Philipps University of Marburg, Marburg, Germany
| | - Heili Varendi
- Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Anna-Veera Seppänen
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Veronica Siljehav
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth S Draper
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Jennifer Zeitlin
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Godara N, Nayak G, Tripathy BB. Quality of life and level of burden for caregivers of Indian children with post-operative congenital anorectal malformations. Bioinformation 2024; 20:566-570. [PMID: 39132234 PMCID: PMC11309102 DOI: 10.6026/973206300200566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 08/13/2024] Open
Abstract
Parenting starts much before the baby is born. It always comes with mixed feelings during parenting. Therefore, it is of interest to report the quality of life and caregiver burden for Indian children with post-operative congenital anorectal malformations. We recruited total 56 caregivers for the present study. Data shows that the highest caregiver burden in economical and the lowest in psychological. Quality of life (QOL) was highest in physical domain and there was moderate negative correlation among caregiver burden, psychological health, and social relationship.
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Affiliation(s)
- Nitu Godara
- College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Geetarani Nayak
- College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Bikasha Bihary Tripathy
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
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Urichuk M, Singh C, Zrinyi A, Lum Min SA, Keijzer R. Mental Health Outcomes of Mothers of Children With Congenital Gastrointestinal Anomalies Are Similar to Control Mothers: A Longitudinal Retrospective Cohort Study. J Pediatr Surg 2024; 59:918-923. [PMID: 38365470 DOI: 10.1016/j.jpedsurg.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Mothers of infants born with congenital gastrointestinal surgical anomalies experience a unique caregiving role. Whether these challenges result in more mental health diagnoses than the general population is unknown. This study assessed mental health diagnoses in mothers of children born with congenital surgical anomalies (CSA) compared to mothers of children without CSA. METHODS A total of 780 mothers of children with CSA (case-mothers) and 6994 control-mothers were included. Mental health diagnoses were obtained using International Classification of Diseases 9 codes from an administrative database. Multivariate hazard ratios (HR) of mental health diagnoses were determined for mothers following childbirth, controlling for socioeconomic status, mental health diagnoses prior to childbirth, and age at childbirth. Subgroup analyses were completed for anxiety, depression, and post-traumatic stress disorder (PTSD). The association between a woman's mental health history and becoming a case-mother was analyzed using risk ratios (RR). RESULTS Case-mothers were not at increased risk of mental health disorders compared to controls (HR = 1.00; CI95 = 0.92-1.09). In aggregate analysis, no increased risk of anxiety, depression, or PTSD was found. Subgroup analyses revealed that congenital diaphragmatic hernia case-mothers had an increased risk of depression (HR = 1.43; CI95 = 1.08-1.88). No other case-mothers were at increased risk of mental health diagnoses, anxiety, depression, or PTSD. Only omphalocele was associated with mental health diagnoses before childbirth (RR = 1.89; CI95 = 1.58-2.26). CONCLUSIONS Collectively, mothers of children with CSAs did not have a greater risk of a mental health disorder, anxiety, depression, or PTSD compared to control-mothers. Only mothers of children with congenital diaphragmatic hernia had an increased risk of depression. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Matthew Urichuk
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Charanpal Singh
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Anna Zrinyi
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Suyin A Lum Min
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Keijzer
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
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Maraschin FG, Adella FJ, Nagraj S. A scoping review of the post-discharge care needs of babies requiring surgery in the first year of life. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002424. [PMID: 37992047 PMCID: PMC10664918 DOI: 10.1371/journal.pgph.0002424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023]
Abstract
Congenital anomalies are among the leading causes of under-5 mortality, predominantly impacting low- and middle-income countries (LMICs). A particularly vulnerable group are babies with congenital disorders requiring surgery in their first year. Addressing this is crucial to meet SDG-3, necessitating targeted efforts. Post-discharge, these infants have various care needs provided by caregivers, yet literature on these needs is scant. Our scoping review aimed to identify the complex care needs of babies post-surgery for critical congenital cardiac conditions and non-cardiac conditions. Employing the Joanna Briggs Institute's methodological framework for scoping reviews we searched Pubmed, EMBASE, CINAHL, PsychINFO, and Web of Science databases. Search terms included i) specific congenital conditions (informed by the literature and surgeons in the field), ii) post-discharge care, and iii) newborns/infants. English papers published between 2002-2022 were included. Findings were summarised using a narrative synthesis. Searches yielded a total of 10,278 papers, with 40 meeting inclusion criteria. 80% of studies were conducted in High-Income Countries (HICs). Complex care needs were shared between cardiac and non-cardiac congenital conditions. Major themes identified included 1. Monitoring, 2. Feeding, and 3. Specific care needs. Sub-themes included monitoring (oxygen, weight, oral intake), additional supervision, general feeding, assistive feeding, condition-specific practices e.g., stoma care, and general care. The post-discharge period poses a challenge for caregivers of babies requiring surgery within the first year of life. This is particularly the case for caregivers in LMICs where access to surgical care is challenging and imposes a financial burden. Parents need to be prepared to manage feeding, monitoring, and specific care needs for their infants before hospital discharge and require subsequent support in the community. Despite the burden of congenital anomalies occurring in LMICs, most of the literature is HIC-based. More research of this nature is essential to guide families caring for their infants post-surgical care.
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Affiliation(s)
- Francesca Giulia Maraschin
- Health Systems Collaborative, Centre for Global Health Research, The Nuffield Department of Medicine, The University of Oxford, Oxford, United Kingdom
| | - Fidelis Jacklyn Adella
- Health Systems Collaborative, Centre for Global Health Research, The Nuffield Department of Medicine, The University of Oxford, Oxford, United Kingdom
| | - Shobhana Nagraj
- Health Systems Collaborative, Centre for Global Health Research, The Nuffield Department of Medicine, The University of Oxford, Oxford, United Kingdom
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Roorda D, van der Steeg AFW, van Dijk M, Derikx JPM, Gorter RR, Rotteveel J, van Goudoever JB, van Heurn LWE, Oosterlaan J, Haverman L. Distress and post-traumatic stress in parents of patients with congenital gastrointestinal malformations: a cross-sectional cohort study. Orphanet J Rare Dis 2022; 17:353. [PMID: 36089585 PMCID: PMC9465926 DOI: 10.1186/s13023-022-02502-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Congenital gastrointestinal malformation (CGIM) require neonatal surgical treatment and may lead to disease-specific sequelae, which have a potential psychological impact on parents. The aim of this study is to assess distress and symptoms of post-traumatic stress disorder (PTSD) in parents of patients with CGIM. In this cross-sectional study, seventy-nine parents (47 mothers and 32 fathers) of 53 patients with CGIM completed the Distress Thermometer for Parents (DT-P) and the Self Rating Scale for Posttraumatic Stress Disorders (SRS-PTSD) as part of the multidisciplinary follow-up of their children (aged 5–35 months). Group differences were tested between parents and representative Dutch reference groups with regard to rates of (clinical) distress and PTSD, and severity of overall distress and PTSD, for mothers and fathers separately. Mixed model regression models were used to study factors associated with the risk of (clinical) distress, PTSD and with severity of symptoms of PTSD (intrusion, avoidance and hyperarousal).
Results
Prevalence of clinical distress was comparable to reference groups for mothers (46%) and fathers (34%). There was no difference in severity of overall distress between both mothers as well as fathers and reference groups. Prevalence of PTSD was significantly higher in mothers (23%) compared to the reference group (5.3%) (OR = 5.51, p < 0.001), not in fathers (6.3% vs 2.2.%). Symptoms of intrusion were commonly reported by all the parents (75%). Longer total length of child’s hospital stay was associated with more severe symptoms of intrusion, avoidance and hyperarousal. Child’s length of follow-up was negatively associated with severity of intrusion.
Conclusions
Having a child with CGIM has a huge impact on parents, demonstrated by a higher prevalence of PTSD in mothers, but not fathers, compared to parents in the general population. Monitoring of symptoms of PTSD of parents in follow-up is necessary.
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Wy S, Choe S, Lee YJ, Bak E, Jang M, Lee SC, Ha A, Jeoung JW, Park KH, Kim YK. Decision Tree Algorithm-Based Prediction of Vulnerability to Depressive and Anxiety Symptoms in Caregivers of Children With Glaucoma. Am J Ophthalmol 2022; 239:90-97. [PMID: 35172169 DOI: 10.1016/j.ajo.2022.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Development and validation of a decision tree model (DTM) for prediction of mental health status in Korean caregivers of children with glaucoma. DESIGN Cross-sectional study. METHODS Caregivers of children younger than 18 years with diagnosed primary childhood glaucoma (n = 42), secondary childhood glaucoma (n = 51), and glaucoma suspect (GS; n = 36) were prospectively enrolled at Seoul National University Children's Hospital, Seoul, Korea. The participants completed 2 questionnaires, the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder (GAD-7) Assessment. A DTM analysis for discrimination of those with moderate-to-severe depressive (PHQ-9 score ≥10) and anxiety (GAD-7 score ≥11) symptoms was performed with recursive partitioning algorithms based on the obtained clinical, demographic, and socioeconomic data. RESULTS The mean PHQ-9 and GAD-7 scores did not significantly differ among the 3 groups (P = .823 for PHQ-9 score; P = .730 for GAD-7 score). The DTM's balanced accuracies were 0.875 (95% CI = 0.778-0.972) for the PHQ-9 score and 0.880 (95% CI = 0.800-0.960) for theGAD-7 score. The DTM of the PHQ-9 revealed that in caregivers of children with glaucoma, depressive symptoms should be strongly suspected when (1) the child has undergone more than 2 glaucoma surgeries; or (2) the visual acuity (VA, converted to logarithm of minimum angle of resolution [logMAR]) in the better eye is worse than 0.4 if the child has had only 1 or no surgery. CONCLUSIONS Evaluation of the number of glaucoma surgeries and VA in the better eye can be a useful decision support tool in predicting mental illness in caregivers of children with glaucoma.
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Affiliation(s)
- Seoyoung Wy
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Sooyeon Choe
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Yun Jeong Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Eunoo Bak
- Department of Ophthalmology, Uijeongbu Eulji Medical Center, Uijeongbu, Korea
| | - Mirinae Jang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Seung Chan Lee
- Department of Ophthalmology, Doctor Lee's Eye Clinic, Suwon-si, Korea
| | - Ahnul Ha
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Korea; Department of Ophthalmology, Jeju National University School of Medicine, Jeju-si, Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea; Department of Pediatric Ophthalmology, Seoul National University Children's Hospital, Seoul, Korea.
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Acaster S, Williams K, Skrobanski H, Buesch K. Using the EQ-5D to measure caregiver health-related quality of life in rare pediatric disease: a study in aromatic L-amino acid decarboxylase deficiency. FUTURE NEUROLOGY 2022. [DOI: 10.2217/fnl-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aims: To evaluate how well the EQ-5D-5L, a generic preference-based measure of health-related quality of life, captures caregiver burden in a rare pediatric neurotransmitter disease. Materials & methods: Caregivers (n = 14) of individuals with aromatic L-amino acid decarboxylase (AADC) deficiency completed qualitative interviews on their experience as a caregiver, the EQ-5D-5L and a background questionnaire. Qualitative and quantitative data were compared to determine whether there was concordance or discordance in the findings. Results: No caregivers reported problems with mobility and self-care in either the qualitative interviews or on the EQ-5D-5L, and there was general concordance for pain/discomfort and anxiety/depression. However, discordance was found for usual activities, with 79% reporting no problems with this dimension on the EQ-5D-5L, compared with 100% describing substantial limitations during the interviews. Conclusion: The EQ-5D-5L may not be appropriate to evaluate caregiver burden in AADC deficiency, where caregivers' perceptions of “usual activities” differ substantially from the general population.
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Affiliation(s)
- Sarah Acaster
- Acaster Lloyd Consulting Ltd. 8th Floor, Lacon House, 84 Theobalds Road, London, WC1X 8NL, UK
| | - Kate Williams
- Acaster Lloyd Consulting Ltd. 8th Floor, Lacon House, 84 Theobalds Road, London, WC1X 8NL, UK
| | - Hanna Skrobanski
- Acaster Lloyd Consulting Ltd. 8th Floor, Lacon House, 84 Theobalds Road, London, WC1X 8NL, UK
| | - Katharina Buesch
- PTC Therapeutics Switzerland GmbH, Tower 2, Turmstrasse 28, CH-6312 Steinhausen/Zug, Switzerland
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Patient-reported outcome measures in pediatric surgery - A systematic review. J Pediatr Surg 2022; 57:798-812. [PMID: 35123787 DOI: 10.1016/j.jpedsurg.2021.12.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE With improved long-term survival rates, measuring the quality of surgical care has gradually shifted from clinical morbidity and mortality to patient-reported outcome measures (PROMs). Since the use of PROMs in pediatric surgery is still limited, we undertook a study to identify current PROMs, assess their characteristics, and identify gaps and areas for improvement. METHODS A search was conducted in eight databases from their inception until May 2021 to identify PROMs that have been used in pediatric surgical patients. PRISMA standards were followed, and screening was completed by two independent reviewers. The quality of the included studies was appraised using the AXIS and the Mixed Methods Appraisal Tool. RESULTS Of 8282 studies screened, 101 articles met the inclusion criteria. Most of the studies (99%) were cross-sectional. We identified 85 different PROMs among the studies, 53 being disease-specific and the rest generic. The PedsQL™ was the most frequently used tool (42 studies). Almost half of the instruments (41 studies) were not validated, and 28% were developed ad hoc for each specific study. Significantly, all PROMs encountered were standardized (consisting of pre-determined domains), with no individualized tools currently in use. The overall quality of the included studies was good. CONCLUSIONS PROMs are increasingly used in pediatric surgery. Disease-specific PROMs predominate the field, yet validated and especially individualized PROMs are notably absent. Future efforts are needed to develop robust tools that reflect individual patient and family needs, preferences, and values, with the aim of furthering family-centered pediatric surgical care.
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Fuerboeter M, Boettcher J, Barkmann C, Zapf H, Nazarian R, Wiegand-Grefe S, Reinshagen K, Boettcher M. Quality of life and mental health of children with rare congenital surgical diseases and their parents during the COVID-19 pandemic. Orphanet J Rare Dis 2021; 16:498. [PMID: 34838064 PMCID: PMC8626760 DOI: 10.1186/s13023-021-02129-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background COVID-19 has affected our society at large, particularly vulnerable groups, such as children suffering from rare diseases and their parents. However, the psychosocial influences of COVID-19 on these have yet to be investigated. As such, the study’s goal was to evaluate the health-related quality of life (HRQoL), quality of life (QoL), and mental health of children with rare congenital surgical diseases and their parents during the COVID-19 pandemic and lockdown measures. Methods A survey of n = 210 parents of children with rare congenital surgical diseases and a control group of n = 88 parents of children without rare diseases was conducted cross-sectionally between April 2020 to April 2021. Data on HRQoL, QoL, and mental health was collected using standardized psychometric questionnaires for children and parents presenting to the pediatric surgery department at a university hospital. Results Mothers of children with rare pediatric surgical diseases showed significantly lower QoL and significantly higher impairment in mental health than a control group and norm data. For fathers, this was solely the case for their QoL. Children’s parent-reported HRQoL and mental health were partially impaired. Social and disease-specific risk factors of the respective outcomes in affected families were identified through regression analysis models. Conclusion Parents of children with rare diseases report severe psychosocial impairment regarding themselves and their children during the COVID-19 pandemic. Therefore, affected families should receive attention and supportive care in the form of a family-center approach to alleviate the additional burden of the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02129-0.
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Affiliation(s)
- Mareike Fuerboeter
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Holger Zapf
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Rojin Nazarian
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Pediatric Surgery, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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10
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Quality of life of parents with children with congenital abnormalities: a systematic review with meta-analysis of assessment methods and levels of quality of life. Qual Life Res 2021; 31:991-1011. [PMID: 34482484 DOI: 10.1007/s11136-021-02986-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To quantify and understand how to assess the quality of life and health-related QoL of parents with children with congenital abnormalities. METHODS We conducted a systematic review with meta-analysis. The search was carried out in 5 bibliographic databases and in ClinicalTrials.gov. No restriction on language or date of publication was applied. This was complemented by references of the studies found and studies of evidence synthesis, manual search of abstracts of relevant congresses/scientific meetings and contact with experts. We included primary studies (observational, quasi-experimental and experimental studies) on parents of children with CA reporting the outcome quality of life (primary outcome) of parents, independently of the intervention/exposure studied. RESULTS We included 75 studies (35 observational non-comparatives, 31 observational comparatives, 4 quasi-experimental and 5 experimental studies). We identified 27 different QoL instruments. The two most frequently used individual QoL instruments were WHOQOL-Bref and SF-36. Relatively to family QoL tools identified, we emphasized PedsQL FIM, IOFS and FQOL. Non-syndromic congenital heart defects were the CA most frequently studied. Through the analysis of comparative studies, we verified that parental and familial QoL were impaired in this population. CONCLUSIONS This review highlights the relevance of assessing QoL in parents with children with CA and explores the diverse QoL assessment tools described in the literature. Additionally, results indicate a knowledge gap that can help to draw new paths to future research. It is essential to assess QoL as a routine in healthcare providing and to implement strategies that improve it.
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11
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Dong W, Zwi AB, Shen C, Wu Y, Gao J. Exploring the relationship between functional limitations of the older adults and the health-related quality of life of their spouse in Shaanxi Province, China. Health Qual Life Outcomes 2021; 19:209. [PMID: 34461921 PMCID: PMC8404336 DOI: 10.1186/s12955-021-01835-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With trends towards longer life expectancy, lifetime with disability has also been prolonged. It is increasingly recognized that not only the person with disability but also those around them are affected. The relationship between functional limitation (FL) of the older adults and health-related quality of life (HRQoL) of their spouse is of interest. So too is the determination of the factors aside from FL that influence HRQoL. METHODS The sample was derived from the 2013 National Health Service Survey conducted in Shaanxi Province in China. Married couples aged ≥ 60 years were selected (n = 3463). The European quality of life five dimensions (EQ-5D) and visual analogue scale were used to measure HRQoL. RESULTS Both wife and husband reported lower HRQoL if either the male or female partner had some or serious FLs (P < 0.001). Other factors associated with lower HRQoL of the spouse included age, lower educational level, presence of chronic disease, and lower household economic status. Family size was associated with wife's HRQoL only when the male had no FL and lived with another 1-2 persons, or when the male had some FLs and lived in a larger family (n ≥ 5). Residential status did not relate to the HRQoL of spouses regardless of FL status. CONCLUSIONS Older adults in Shaanxi province who have partners with FLs tend to report poorer EQ-5D, suggesting that couples amongst whom one has FL may be particularly vulnerable to lower HRQoL.
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Affiliation(s)
- Wanyue Dong
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Anthony B Zwi
- School of Social Sciences, The University of New South Wales, Sydney, Australia.
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Yue Wu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Jianmin Gao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
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Al Baroudi S, Collaco JM, Nies MK, Rice JL, Jelin EB. Health-related quality of life of caregivers of children with congenital diaphragmatic hernia. Pediatr Pulmonol 2021; 56:1659-1665. [PMID: 33634600 DOI: 10.1002/ppul.25339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Congenital diaphragmatic hernia (CDH) is a congenital defect associated with significant mortality and morbidity. We sought to assess the health-related quality of life (HRQoL) for caregivers of infants/children with CDH and determine risk factors for poorer HRQoL. METHODS Families were recruited from a CDH-specific outpatient clinic and HRQoL was assessed by a validated HRQoL instrument (PedsQLTM Family Impact Module) at several time points. Mixed models were used to identify demographic and clinical factors associated with worse HRQoL for caregivers. RESULTS A total of 29 subjects were recruited at a mean age of 2.4 ± 2.3 years. In terms of defect size, 6.9% had a Type A, 37.9% a Type B, 31.0% a Type C, and 24.1% a Type D. The mean HRQoL score at the first encounter was 67.6 ± 18.3; scores are reported from 0 to 100 with higher scores representing the higher reported quality of life. Lower median household incomes (p = .021) and use of extracorporeal membrane oxygenation (p = .013) were associated with poorer HRQoL scores. The presence of respiratory symptoms decreased HRQoL for caregivers, including daytime symptoms (p < .001) and nighttime symptoms (p < .001). While emergency department visits were not associated with a decrease in HRQoL, hospital admissions (p = .002), and reoperations for CDH (p < .001) were. CONCLUSION Our study found a reduced quality of life associated with socioeconomic factors and severity of ongoing disease. Further study is needed to confirm these findings and identify strategies for aiding families cope with the chronicity of this congenital disease.
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Affiliation(s)
- Sahar Al Baroudi
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph M Collaco
- Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Melanie K Nies
- Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Jessica L Rice
- Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Eric B Jelin
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Quality of Life and Concerns in Parent Caregivers of Adult Children Diagnosed with Intellectual Disability: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228690. [PMID: 33238511 PMCID: PMC7709017 DOI: 10.3390/ijerph17228690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022]
Abstract
Background: Previous studies have confirmed that parenting a child diagnosed with an intellectual disability (ID) can negatively affect the parents’ quality of life in several dimensions. However, fewer have assessed its impact years after the initial diagnosis. The objective of this work was to carry out an in-depth analysis of the current quality of life and concerns of both mothers and fathers of adults diagnosed with ID, having as a reference the moment of the diagnosis. Methods: 16 parents of adult children with ID were evaluated using a semi-structured interview format. A thematic qualitative analysis was carried out by employing ATLAS.ti software. Results: The results suggested that both the emotional and physical well-being of parents, as well as their interpersonal relationships, had declined. In addition, the multiple life changes that had occurred over the time considered in this study, as well as day-to-day worries, had prevented improvements in their quality of life. Conclusions: Several dimensions of the parents’ quality of life were affected years after a child is diagnosed with ID. These included poor physical and psychological health, economic difficulties, lack of social and family support, and lack of time for self-care.
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Toledano-Toledano F, Moral de la Rubia J, Nabors LA, Domínguez-Guedea MT, Salinas Escudero G, Rocha Pérez E, Luna D, Leyva López A. Predictors of Quality of Life among Parents of Children with Chronic Diseases: A Cross-Sectional Study. Healthcare (Basel) 2020; 8:healthcare8040456. [PMID: 33153086 PMCID: PMC7712866 DOI: 10.3390/healthcare8040456] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022] Open
Abstract
Quality of life (QOL) is a key aspect of the health care process for children with chronic diseases and their families. Although clinical evidence regarding the impact of chronic disease on children exists, few studies have evaluated the effects of the interaction between sociodemographic and psychosocial factors on the family caregiver's QOL, indicating a significant gap in the research literature. The present study aimed to identify the predictors of the QOL of parents of children with chronic diseases. Three parental sociodemographic predictors (age, schooling, and family income) and four psychosocial predictors (family functioning, social support, depression, and resilience) were examined. In this cross-sectional study, 416 parents of children with chronic diseases who were hospitalized at a National Institute of Health in Mexico City were interviewed. The participants completed a sociodemographic variables questionnaire (Q-SV) designed for research on family caregivers of children with chronic disease. The predicted variable was assessed through the World Health Organization Quality of Life Questionnaire. The four psychosocial predictors were assessed through the Family Functioning Scale, Social Support Networks Scale, Beck Depression Inventory, and Measurement Scale of Resilience. The regression model explained 42% of the variance in parents' QOL. The predictors with positive weights included age, schooling, monthly family income, family functioning, social support networks, and parental resilience. The predictors with negative weights included depression. These findings suggest that strong social relationships, a positive family environment, family cohesion, personal resilience, low levels of depression, and a family income twice the minimum wage are variables associated with better parental QOL.
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Affiliation(s)
- Filiberto Toledano-Toledano
- Evidence-Based Medicine Research Unit, Hospital Infantil de Mexico Federico Gómez, National Institute of Health, Márquez 162, Doctores, Cuauhtémoc, Mexico City 06720, Mexico
- Correspondence: ; Tel.: +52-55-8009-4677
| | - José Moral de la Rubia
- Facultad de Psicología, Universidad Autónoma de Nuevo León, Carlos Canseco, 110, Esq. Aguirre Pequeño, Col. Mitras Centro, Monterrey 64460, Mexico;
| | - Laura A. Nabors
- School of Human Services, College of Education, Criminal Justice, and Human Services, University of Cincinnati, Cincinnati, OH 45221-0068, USA;
| | - Miriam Teresa Domínguez-Guedea
- Department of Psychology and Communication Sciences, University of Sonora, Blvd. Luis Encinas y Rosales, Col. Centro S/N Hermosillo, Sonora 83000, Mexico;
| | - Guillermo Salinas Escudero
- Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de Mexico Federico Gómez, National Institute of Health, Márquez 162, Doctores, Cuauhtémoc, Mexico City 06720, Mexico;
| | - Eduardo Rocha Pérez
- Servicio Nacional de Sanidad, Inocuidad y Calidad Agroalimentaria (Senasica), Anillo Perif. 5010, Insurgentes Cuicuilco, Coyoacán, Mexico City 04530, Mexico;
| | - David Luna
- Comisión Nacional de Arbitraje Médico, Mitla No. 250-8° Piso, esq. Eje 5 Sur (Eugenia), Vertiz Narvarte, Benito Juárez, Mexico City 03020, Mexico;
| | - Ahidée Leyva López
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca Morelos 62100, Mexico;
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Verstraete J, Scott D. Does the child's health influence the caregiver's health using the EQ-5D instruments? SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1343. [PMID: 32161825 PMCID: PMC7059443 DOI: 10.4102/sajp.v76i1.1343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022] Open
Abstract
Background Health- related quality of life (HRQoL) is an important aid in medical decision making. The child’s health may influence the caregiver’s health due to their intimate relationship. Objectives The aim of this study was to investigate the influence of the child’s health on the caregiver’s health as measured on the EuroQoL Youth and Adult instruments. Method A sample of 50 caregivers and their acutely-ill children, aged 3–6 years, was recruited from a paediatric hospital. Each caregiver completed the EQ-5D-Y, a proxy rating of their child’s HRQoL, and the EQ-5D-3L, a self-report measure of their own HRQoL, at baseline, 24 and 48 hours. The correlation between the caregiver and the child’s health over time was established. Forward stepwise multiple regression analysis was performed to establish the relative contribution of the child’s VAS score to the caregiver’s VAS score. Results The results indicated that the child’s and the caregiver’s VAS ratings were significantly correlated over time, with an improvement in HRQoL scores over 48 hours. The child’s proxy VAS rating accounted for 21% and 18% of the variance in the caregiver’s VAS score at baseline and 24 hours, respectively, which was higher than self-reported problems on the caregivers EQ-5D-3L dimensions. Conclusion The health of the caregiver is reported to improve as the perceived health of the child improves. The proxy rating of the child’s health influences the caregiver’s self-reported health more than their reported problems on the EQ-5D-3L. Clinical implications Improving the HRQoL of the child will lead to improved HRQoL in the caregiver.
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Affiliation(s)
- Janine Verstraete
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, University of Cape Town, Cape Town, South Africa
| | - Des Scott
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, University of Cape Town, Cape Town, South Africa
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Quality of Life of Caregivers of Children With Glaucoma in an Arab Population: A Cross-Sectional Study. J Glaucoma 2019; 28:965-968. [DOI: 10.1097/ijg.0000000000001357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wittenberg E, James LP, Prosser LA. Spillover Effects on Caregivers' and Family Members' Utility: A Systematic Review of the Literature. PHARMACOECONOMICS 2019; 37:475-499. [PMID: 30887469 DOI: 10.1007/s40273-019-00768-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND A growing body of research has identified health-related quality-of-life effects for caregivers and family members of ill patients (i.e. 'spillover effects'), yet these are rarely considered in cost-effectiveness analyses (CEAs). OBJECTIVE The objective of this study was to catalog spillover-related health utilities to facilitate their consideration in CEAs. METHODS We systematically reviewed the medical and economic literatures (MEDLINE, EMBASE, and EconLit, from inception through 3 April 2018) to identify articles that reported preference-based measures of spillover effects. We used keywords for utility measures combined with caregivers, family members, and burden. RESULTS Of 3695 articles identified, 80 remained after screening: 8 (10%) reported spillover utility per se, as utility or disutility (i.e. utility loss); 25 (30%) reported a comparison group, either population values (n = 9) or matched, non-caregiver/family member or unaffected individuals' utilities (n = 16; 3 reported both spillover and a comparison group); and 50 (63%) reported caregiver/family member utilities only. Alzheimer's disease/dementia was the most commonly studied disease/condition, and the EQ-5D was the most commonly used measurement instrument. CONCLUSIONS This comprehensive catalog of utilities showcases the spectrum of diseases and conditions for which caregiver and family members' spillover effects have been measured, and the variation in measurement methods used. In general, utilities indicated a loss in quality of life associated with being a caregiver or family member of an ill relative. Most studies reported caregiver/family member utility without any comparator, limiting the ability to infer spillover effects. Nevertheless, these values provide a starting point for considering spillover effects in the context of CEA, opening the door for more comprehensive analyses.
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Affiliation(s)
- Eve Wittenberg
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Lyndon P James
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
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Simon NJ, Richardson J, Ahmad A, Rose A, Wittenberg E, D'Cruz B, Prosser LA. Health utilities and parental quality of life effects for three rare conditions tested in newborns. J Patient Rep Outcomes 2019; 3:4. [PMID: 30671727 PMCID: PMC6342747 DOI: 10.1186/s41687-019-0093-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/04/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Measurement of health utilities is required for economic evaluations. Few studies have evaluated health utilities for rare conditions; even fewer have incorporated disutility that may be experienced by caregivers. This study aimed to (1) estimate health utilities for three rare conditions currently recommended for newborn screening at the state or federal level, and (2) estimate the disutility, or spillover, experienced by parents of patients diagnosed with a rare, heritable disorder. METHODS A stated-preference survey using a time trade-off approach elicited health utilities for Krabbe disease, phenylketonuria, and Pompe disease at varying stages (mild, moderate, severe) and onset of disease symptoms (infancy, childhood, and adulthood). We recruited respondents from a nationally representative community sample (n = 862). Respondents valued disease specific health states in three consecutive question frames: (1) adult health state (> = 18 years of age), (2) child health state (< 18 years of age), and (3) as a parent of a child with a condition (parent spillover state). Corresponding mean utilities were calculated for plausible disease states in adulthood and childhood. Mean disutility was estimated for parental spillover. Predictors of utilities were evaluated using a negative binomial regression model. RESULTS More severe conditions and infant health states received lower estimated utility and greater estimated disutility among parents. Conditions with the lowest estimated health utilities were severe infantile Pompe disease (0.40, CI: 0.34-0.46) and infantile Krabbe disease (0.37, CI: 0.32-0.43). Disutility was evident for all conditions evaluated (range: 0.07-0.19). CONCLUSIONS Rare childhood conditions are associated with substantial estimated losses in quality of life. Evidence of disutility among parents further warrants the inclusion of spillover effects in cost-effectiveness analyses. Continued research is needed to assess and measure the effects of childhood disease from a family perspective.
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Affiliation(s)
- Norma-Jean Simon
- Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Chicago, IL, 60611, USA
| | - John Richardson
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Ayesha Ahmad
- Division of Pediatric Genetics, Metabolism and Genomic Medicine, Department of Pediatrics, The University of Michigan Medical School, 4810 Jackson Road, Ann Arbor, MI, 48103, USA
| | - Angela Rose
- Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, 300 North Ingalls Building, Ann Arbor, MI, 48109, USA
| | - Eve Wittenberg
- Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Brittany D'Cruz
- Center for the Evaluation of Value & Risk in Health, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Lisa A Prosser
- Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, 300 North Ingalls Building, Ann Arbor, MI, 48109, USA. .,Health Management and Policy, The University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
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Yau CWH, Pizzo E, Prajapati C, Draycott T, Lenguerrand E. Obstetric brachial plexus injuries (OBPIs): health-related quality of life in affected adults and parents. Health Qual Life Outcomes 2018; 16:212. [PMID: 30442125 PMCID: PMC6238314 DOI: 10.1186/s12955-018-1039-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/29/2018] [Indexed: 11/10/2022] Open
Abstract
Background Obstetric brachial plexus injuries (OBPIs) are rare but can have significant implications for those affected, their caregivers and the health system. Symptoms can range from restricted movement to complete paralysis of the arm. We investigated health-related quality of life in adults with OBPIs and parents of children with permanent OBPIs, compared these with population norms, and investigated whether certain socio-demographic or clinical factors were associated with the quality of life in these cohorts. Methods A cross-sectional study examined 50 affected adults and 78 parents. Participants completed EQ-5D-5 L and characteristics questionnaires. EQ-5D-5 L responses were mapped onto an EQ-5D-3 L value set to generate utility scores. Mean utility scores were compared with English population norms. Univariable and multivariable linear regression models were conducted to assess for associations between participant characteristics and the utility scores. Results The overall mean utility scores for affected adults and parents were 0.56 (SD 0.28) and 0.80 (SD 0.19) respectively. Affected adults (95% CI (− 0.38, − 0.22), p < 0.001) and parents of children with permanent OBPIs (95% CI (− 0.10, − 0.02), p = 0.007) had lower mean utility scores, and therefore quality of life, compared to English population norms. For affected adults, previous OBPI surgery (95% CI (0.01, 0.25), p = 0.040), employment in non-manual work (95% CI (0.06, 0.30), p = 0.005) and having a partner (95% CI (0.04, 0.25), p = 0.009) appeared to be positively associated with the utility score. Affected adults receiving disability benefits related to OBPIs appeared to have worse utility scores than those not receiving any disability benefits (95% CI (− 0.31, − 0.06), p = 0.005). For parents, employment was associated with better utility scores (95% CI (0.02, 0.20), p = 0.024) but the presence of one or more medical condition appeared to be associated with worse utility scores (95% CI (− 0.16, − 0.04), p = 0.001). Conclusions Adults with OBPIs and parents of children with permanent OBPIs reported worse utility scores, and therefore quality of life, compared to the English general population. We also identified certain characteristics as possible factors to consider when dealing with utility scores in these cohorts. The utility scores in this study can be used in future economic evaluations related to OBPIs. Electronic supplementary material The online version of this article (10.1186/s12955-018-1039-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher W H Yau
- The Chilterns, Southmead Hospital, Bristol, BS10 5NB, UK. .,Translational Health Sciences, University of Bristol, Bristol, BS2 8DZ, UK.
| | - Elena Pizzo
- Department of Applied Health Research, University College London, London, WC1E 7HB, UK
| | | | - Tim Draycott
- The Chilterns, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Erik Lenguerrand
- Translational Health Sciences, University of Bristol, Bristol, BS2 8DZ, UK
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Pacheco Barzallo D. Spillover Effects of Long-Term Disabilities on Close Family Members. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:347-355. [PMID: 29651776 DOI: 10.1007/s40258-018-0391-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Care and support of people dealing with long-term disabilities involves the entire family. OBJECTIVE This paper evaluates the effect of living with a relative dealing with a long-term disability on the health status of all family members in the household. METHODS Using information from the Swiss household panel from the year 1999 to 2003 (n = 18,030), a linear regression is implemented to compare the health status of family members cohabiting with individuals dealing with a long-term disability with the health status of individuals of similar characteristics in the general population. Additionally, a non-parametric graphical analysis estimates the smooth patterns of the results over time. RESULTS Family members who cohabit with a person dealing with a long-term disability have a consistently reduced health status. The size of the impact depends on the sex and the role in the family. In general, women show the most negative effects. For children, the impact depends on the relationship with the disabled person. CONCLUSIONS Recognizing the presence of health spillovers can help to design policies to better support families. Being the perceived health status a good indicator of the use of health services and mortality, the health system should focus on the entire family, and not only on the patient or the main caregiver.
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Affiliation(s)
- Diana Pacheco Barzallo
- Health Services, Statistics and Economics Unit, Swiss Paraplegic Research, Nottwil, Switzerland.
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21
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Verstraete J, Ramma L, Jelsma J. Influence of the child's perceived general health on the primary caregiver's health status. Health Qual Life Outcomes 2018; 16:8. [PMID: 29321017 PMCID: PMC5763523 DOI: 10.1186/s12955-018-0840-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In estimating the impact of an intervention, ignoring the effect of improving the health of one member of the caregiver/child dyad on the Health Related Quality of Life (HRQoL) of the other member may lead to an underestimation of the utility gained. This may be particularly true for infants/young children and their caregivers. The aim of this study was to quantify the interaction between the child's perceived general health as assessed by the newly developed Toddler and Infant Questionnaire (TANDI) on the reporting of the caregiver's own HRQoL as assessed by the EQ-5D-3 L. METHODS A sample of 187 caregivers participated. A total of 60 caregivers of acutely-ill (AI) and 60 caregivers of chronically-ill (CI) children were recruited from a children's hospital. The 67 caregivers of general population (GP) children were recruited at a pre-school. Each caregiver completed the proxy rating of their child's HRQoL on the TANDI (The TANDI is an experimental HRQoL instrument, modelled on the EQ-5D-Y proxy, for children aged 1-36 months), which comprises of six dimensions of health and a rating of general health on a Visual Analogue Scale (VAS). The caregiver completed the EQ-5D-3 L, a self-report measure of their own HRQoL. Forward stepwise regression models were developed with 1) the VAS score of the caregiver and 2) the VAS score of the child as dependent variables. The independent variables for the caregiver included dummy variables for the presence or absence of problems on the EQ-5D-3 L and the VAS score of the child. The independent variables for the child included dummy variables for each TANDI dimension and the VAS of the caregiver. RESULTS The TANDI results indicated that in five of the six dimensions AI children had more problems than the other two groups and the GP children were reported to have a significantly higher VAS than the other two groups. The child's VAS was significantly correlated with the caregiver's VAS in all groups, but most strongly in the AI group. The preference based scores (using the UK TTO tariff) were only correlated in the AI group. The inclusion of the child's VAS increased the variance accounted for 11% of the VAS score of the caregiver. Anxiety and depression was the only dimension which accounted for more variance (18%). Similarly the perceived health state, VAS of the caregiver accounted for 14% of the variance in the child's VAS, second only to problems with play (25%). CONCLUSION There does indeed appear to be a strong relationship between the VAS scores of the children and their caregivers. The perceived general health of the child influences the caregivers reporting of their general health, more than their own report of experiencing pain or discomfort or problems with mobility. Thus, improving the HRQoL of the very young child may improve the caregiver's HRQoL as well. Conversely, if the caregiver has a lower perceived HRQoL this may result in a decrement in the reported VAS of the child, independent of the presence or absence of problems in the different dimensions. This improvement is not currently captured by Cost Utility Analysis (CUA). It is recommended that future research investigates this effect with regards to CUA calculations.
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Affiliation(s)
- Janine Verstraete
- Department of Physiotherapy, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700 South Africa
- Faculty of Health and Rehabilitation Sciences, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Lebogang Ramma
- Faculty of Health and Rehabilitation Sciences, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Jennifer Jelsma
- Faculty of Health and Rehabilitation Sciences, Anzio Road, Observatory, Cape Town, 7925 South Africa
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Lamsal R, Zwicker JD. Economic Evaluation of Interventions for Children with Neurodevelopmental Disorders: Opportunities and Challenges. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:763-772. [PMID: 28822113 PMCID: PMC5701958 DOI: 10.1007/s40258-017-0343-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Economic evaluation is a tool used to inform decision makers on the efficiency of comparative healthcare interventions and inform resource allocation decisions. There is a growing need for the use of economic evaluations to assess the value of interventions for children with neurodevelopmental disorders (NDDs), a population that has increasing demands for healthcare services. Unfortunately, few evaluations have been conducted to date, perhaps stemming from challenges in applying existing economic evaluation methodologies in this heterogeneous population. Opportunities exist to innovate methods to address key challenges in conducting economic evaluations of interventions for children with NDDs. In this paper, we discuss important considerations and highlight areas for future work. This includes the paucity of appropriate instruments for measuring outcomes meaningful to children with NDDs and their families, difficulties in the measurement of costs due to service utilization in a wide variety of sectors, complexities in the measurement of caregiver and family effects and considerations in estimating long-term productivity costs. Innovation and application of evaluation approaches in these areas will help inform decisions around whether the resources currently spent on interventions for children with NDDs represent good value for money, or whether greater benefits for children could be generated by spending money in other ways.
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Affiliation(s)
- Ramesh Lamsal
- School of Public Policy, University of Calgary, 906-8th Avenue SW, Calgary, AB T2P 1H9, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, 906-8th Avenue SW, Calgary, AB T2P 1H9, Canada.
- Faculty of Kinesiology, University of Calgary, Calgary, Canada.
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Abstract
Increased survival of patients with congenital diaphragmatic hernia has created a unique cohort of children, adolescent, and adult survivors with complex medical and surgical needs. Disease-specific morbidities offer the opportunity for multiple disciplines to unite together to provide long-term comprehensive follow-up, as well as an opportunity for research regarding late outcomes. These children can exhibit impaired pulmonary function, altered neurodevelopmental outcomes, nutritional insufficiency, musculoskeletal changes, and specialized surgical needs that benefit from regular monitoring and intervention, particularly in patients with increased disease severity. Below we aim to characterize the specific challenges that these survivors face as well as present an algorithm for a multidisciplinary long-term follow-up program.
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Affiliation(s)
- Laura E Hollinger
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, Texas 77030
| | - Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, Texas 77030
| | - Kevin P Lally
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, Texas 77030.
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Bhadhuri A, Jowett S, Jolly K, Al-Janabi H. A Comparison of the Validity and Responsiveness of the EQ-5D-5L and SF-6D for Measuring Health Spillovers: A Study of the Family Impact of Meningitis. Med Decis Making 2017; 37:882-893. [DOI: 10.1177/0272989x17706355] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Arjun Bhadhuri
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, UK (AB, SJ, HA)
- Department of Public Health, Institute of Applied Health Research, University of Birmingham, UK (KJ)
| | - Sue Jowett
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, UK (AB, SJ, HA)
- Department of Public Health, Institute of Applied Health Research, University of Birmingham, UK (KJ)
| | - Kate Jolly
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, UK (AB, SJ, HA)
- Department of Public Health, Institute of Applied Health Research, University of Birmingham, UK (KJ)
| | - Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, UK (AB, SJ, HA)
- Department of Public Health, Institute of Applied Health Research, University of Birmingham, UK (KJ)
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Measuring hemophilia caregiver burden: validation of the Hemophilia Caregiver Impact measure. Qual Life Res 2017; 26:2551-2562. [PMID: 28444553 PMCID: PMC5548839 DOI: 10.1007/s11136-017-1572-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 01/02/2023]
Abstract
Aims The purpose of this article is to describe the psychometric development of the Hemophilia Caregiver Impact measure. Methods Qualitative interviews (n = 22) and a cross-sectional web-based study (n = 458) were implemented with caregivers of people with hemophilia. Classical test theory and item response theory analyses were implemented to evaluate the psychometric characteristics of the measure. Results The study sample had a mean age of 39 and a median level of college education. It was predominantly female (88%), and had an average of two children. 85% of this study sample had at least one child with hemophilia. The final 36-item Hemophilia Caregiver Impact measure is composed of seven subscales assessing relevant negative aspects of caregiver impact (Burden Summary) as well as one subscale reflecting a positive aspect of caregiver impact (Positive Emotions). These two summary scores are orthogonal and can be used together in analyses examining negative and positive aspects of caregiver impact. The items included within each subscale reflect a unidimensional construct, demonstrate good item information and trace lines, and lack of local dependence. The resulting subscales demonstrate high reliability, and good construct validity. They show moderate incremental and discriminant validity. Conclusions The Hemophilia Caregiver Impact measure is a useful new tool for clinical research on hemophilia. In addition to having eight relevant subscales, the measure can also be summarized with two scores. This versatility can be useful in analyzing studies with very small samples, which is to be expected when dealing with a rare condition like hemophilia. Electronic supplementary material The online version of this article (doi:10.1007/s11136-017-1572-y) contains supplementary material, which is available to authorized users.
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Al‐Janabi H, Van Exel J, Brouwer W, Trotter C, Glennie L, Hannigan L, Coast J. Measuring Health Spillovers for Economic Evaluation: A Case Study in Meningitis. HEALTH ECONOMICS 2016; 25:1529-1544. [PMID: 26464311 PMCID: PMC5111598 DOI: 10.1002/hec.3259] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 04/02/2015] [Accepted: 09/02/2015] [Indexed: 05/22/2023]
Abstract
The health of carers and others close to the patient will often be relevant to economic evaluation, but it is very rarely considered in practice. This may reflect a lack of understanding of how the spillover effect of illness can be appropriately quantified. In this study we used three different approaches to quantify health spillovers resulting from meningitis. We conducted a survey of 1218 family networks affected by meningitis and used regression modelling to estimate spillover effects. The findings show that meningitis had long-term effects on family members' health, particularly affecting the likelihood of family members reporting anxiety and depression. These effects extended beyond a single close family member. These findings suggest that vaccinating against meningitis will bring significant health benefits not just to those that might have contracted the illness but also to their family networks. In methodological terms, different approaches for quantifying health spillovers provided broadly consistent results. The choice of method will be influenced by the ease of collecting primary data from family members in intervention contexts. © 2015 The Authors. Health Economics published by John Wiley & Sons Ltd.
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Affiliation(s)
- Hareth Al‐Janabi
- Health Economics Unit, School of Health and Population SciencesUniversity of BirminghamBirminghamUK
| | - Job Van Exel
- Institute of Health Policy and ManagementErasmus University RotterdamRotterdamNetherlands
| | - Werner Brouwer
- Institute of Health Policy and ManagementErasmus University RotterdamRotterdamNetherlands
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary MedicineUniversity of CambridgeCambridgeUK
| | | | | | - Joanna Coast
- Health Economics Unit, School of Health and Population SciencesUniversity of BirminghamBirminghamUK
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Gravdal Kvarme L, Albertini-Früh E, Brekke I, Gardsjord R, Halvorsrud L, Liden H. On duty all the time: health and quality of life among immigrant parents caring for a child with complex health needs. J Clin Nurs 2016; 25:362-71. [PMID: 26818363 DOI: 10.1111/jocn.13056] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To provide knowledge about how immigrant parents of children with complex health needs manage their family lives and how this affects their own health and quality of life. BACKGROUND Caregivers of children with complex health needs have additional risk for general health problems and mental health problems and immigrant parents may be more vulnerable to mental distress and failing health and quality of life. DESIGN This qualitative study used an exploratory design with individual and focus group interviews. Data collection and analysis followed phenomenological hermeneutic guidelines. METHODS Individual and group interviews with 27 parents: 18 mothers and 9 fathers from Pakistan, Poland and Vietnam. RESULTS Immigrant parents of children with complex health needs experience their own health and quality of life challenges. They described the burden of dealing with their child's needs and special care, which affects their sleep and physical and mental health. Single mothers are particularly vulnerable. CONCLUSION Parents reported positive and negative effects of their caregiving experience that may affect their health and quality of life. Mothers were the primary caregivers and reported more health problems than did fathers. The lack of respite care, social networks and support impacted maternal health. Immigrant parents struggle to access resources for their child with complex health needs. RELEVANCE TO CLINICAL PRACTICE Hospital nurses, schools and community health care can play a valuable role in supporting the parents of children with complex health needs. It is important that parents are informed about their rights and receive a coordinator and interdisciplinary group to ensure that their needs are met with assistance and respite care. That maternal health was worse in this sample implies that health care professionals should pay more attention to reducing stress among these caregivers.
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Affiliation(s)
| | | | | | - Ragnhild Gardsjord
- Women and Children's Division, Department of Clinical Neurosciences for Children Section for Child Neurology, Oslo university Hospital, Oslo, Norway
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Wang Z, Hu L, Jin X, Li X, Xu L. Evaluation of postoperative anal functions using endoanal ultrasonography and anorectal manometry in children with congenital anorectal malformations. J Pediatr Surg 2016; 51:416-20. [PMID: 26563525 DOI: 10.1016/j.jpedsurg.2015.09.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 09/07/2015] [Accepted: 09/19/2015] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to assess the postoperative anorectal anatomy and function in children with congenital anorectal malformations (ARM) using endoanal ultrasonography (EUS) and anorectal manometry. METHODS This study included 47 children who had undergone posterior sagittal anorectoplasty (PSARP) or transperineal anorectoplasty for the repair of an ARM. Children were grouped according to symptoms of defecation disorder, including normal defecation, fecal soiling, fecal incontinence, and constipation. Ten children with no history of anal or rectal diseases served as healthy controls. A well-established scoring system was used for the evaluation of anal function and defecation disorder. RESULTS EUS showed significant differences in the thickness of the interior sphincter between the ARM patients and the healthy controls (P<0.05). However, no significant difference was found in the thickness of the interior sphincters between the PSARP group and transperineal anorectoplasty group (P>0.05). Anorectal manometry showed that the balloon volumes were significantly different between the surgical group and the control group (P<0.01), and between the low defect group and the intermediate-high defect group (P=0.022). Balloon volume was significantly correlated with anal function scores (r=-0.30, P<0.05). CONCLUSIONS EUS and anorectal manometry can provide objective assessment of postoperative anorectal anatomy and function in children with ARM.
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Affiliation(s)
- Zhichao Wang
- Department of Neonatal Gastrointestinal Surgery, Chongqing Medical University Children's Hospital, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Key Laboratory of Pediatrics in Chongqing, Chongqing 400014, China; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China
| | - Lijun Hu
- Department of Neonatal Gastrointestinal Surgery, Chongqing Medical University Children's Hospital, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Key Laboratory of Pediatrics in Chongqing, Chongqing 400014, China; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China.
| | - Xianqing Jin
- Department of Neonatal Gastrointestinal Surgery, Chongqing Medical University Children's Hospital, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Key Laboratory of Pediatrics in Chongqing, Chongqing 400014, China; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China
| | - Xiaoqing Li
- Department of Neonatal Gastrointestinal Surgery, Chongqing Medical University Children's Hospital, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Key Laboratory of Pediatrics in Chongqing, Chongqing 400014, China; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China
| | - Lixia Xu
- Department of Neonatal Gastrointestinal Surgery, Chongqing Medical University Children's Hospital, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Key Laboratory of Pediatrics in Chongqing, Chongqing 400014, China; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China
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Thompson R, Kerr M, Glynn M, Linehan C. Caring for a family member with intellectual disability and epilepsy: Practical, social and emotional perspectives. Seizure 2014; 23:856-63. [DOI: 10.1016/j.seizure.2014.07.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/08/2014] [Accepted: 07/14/2014] [Indexed: 11/26/2022] Open
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Tu HAT, Deeks SL, Morris SK, Strifler L, Crowcroft N, Jamieson FB, Kwong JC, Coyte PC, Krahn M, Sander B. Economic evaluation of meningococcal serogroup B childhood vaccination in Ontario, Canada. Vaccine 2014; 32:5436-46. [PMID: 25131732 DOI: 10.1016/j.vaccine.2014.07.096] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 07/18/2014] [Accepted: 07/30/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Invasive Neisseria meningitidis serogroup B (MenB) disease is a low incidence but severe infection (mean annual incidence 0.19/100,000/year, case fatality 11%, major long-term sequelae 10%) in Ontario, Canada. This study assesses the cost-effectiveness of a novel MenB vaccine from the Ontario healthcare payer perspective. METHODS A Markov cohort model of invasive MenB disease based on high quality local data and data from the literature was developed. A 4-dose vaccination schedule, 97% coverage, 90% effectiveness, 66% strain coverage, 10-year duration of protection, and vaccine cost of C$75/dose were assumed. A hypothetical Ontario birth cohort (n=150,000) was simulated to estimate expected lifetime health outcomes, quality-adjusted life years (QALYs), and costs, discounted at 5%. RESULTS A MenB infant vaccination program is expected to prevent 4.6 invasive MenB disease cases over the lifetime of an Ontario birth cohort, equivalent to 10 QALYs gained. The estimated program cost of C$46.6 million per cohort (including C$318,383 for treatment of vaccine-associated adverse events) were not offset by healthcare cost savings of C$150,522 from preventing MenB cases, resulting in an incremental cost of C$4.76 million per QALY gained. Sensitivity analyses showed the findings to be robust. CONCLUSIONS An infant MenB vaccination program significantly exceeds commonly used cost-effectiveness thresholds and thus is unlikely to be considered economically attractive in Ontario and comparable jurisdictions.
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Affiliation(s)
- Hong Anh T Tu
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6 Toronto, Ontario, Canada.
| | - Shelley L Deeks
- Public Health Ontario, 480 University Avenue Suite 300, M5G 1V2 Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street 6F, M5T 3M7 Toronto, Ontario, Canada.
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, 555 University Avenue, M5G 1X8 Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, 555 University Avenue Room 1436D, M5G 1X8 Toronto, Ontario, Canada.
| | - Lisa Strifler
- Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, M5B 1T8 Toronto, Ontario, Canada.
| | - Natasha Crowcroft
- Public Health Ontario, 480 University Avenue Suite 300, M5G 1V2 Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street 6F, M5T 3M7 Toronto, Ontario, Canada.
| | - Frances B Jamieson
- Public Health Ontario, 480 University Avenue Suite 300, M5G 1V2 Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, 27 King's College Circle, M5S 1A1 Toronto, Ontario, Canada.
| | - Jeffrey C Kwong
- Public Health Ontario, 480 University Avenue Suite 300, M5G 1V2 Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street 6F, M5T 3M7 Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue Room G1 06, M4N 3M5 Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, Ontario, Canada; University Health Network, 190 Elizabeth Street, M5G 2C4 Toronto, Ontario, Canada.
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6 Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, 144 College Street 6F, M5S 3M2 Toronto, Ontario, Canada.
| | - Murray Krahn
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6 Toronto, Ontario, Canada; University Health Network, 190 Elizabeth Street, M5G 2C4 Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, 144 College Street 6F, M5S 3M2 Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, 144 College Street, M5S 3M2 Toronto, Ontario, Canada.
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6 Toronto, Ontario, Canada; Public Health Ontario, 480 University Avenue Suite 300, M5G 1V2 Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue Room G1 06, M4N 3M5 Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, 144 College Street 6F, M5S 3M2 Toronto, Ontario, Canada.
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Dennett KV, Tracy S, Oliver Taylor L, Zurakowski D, Chen C. Prenatally-counseled congenital diaphragmatic hernia parents exhibit positive well-being before and after surgical repair. J Pediatr Surg 2014; 49:700-5. [PMID: 24851751 DOI: 10.1016/j.jpedsurg.2014.02.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 02/13/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this paper was to examine the effect of prenatal counseling in the Advanced Fetal Care Center (AFCC) on the well-being of parents of infants with congenital diaphragmatic hernia (CDH). METHODS From 2008 through 2012, 26 mothers and fathers of surgically repaired CDH patients who received prenatal counseling at our institution, and 15 who received no prenatal counseling, each completed the Short-Form 36 version 1 (SF-36v1) at the appropriate time points: prenatal, two weeks, and six months post-surgery. RESULTS Parents in both groups did not differ by demographic characteristics. Patients who received prenatal counseling had significantly longer ventilatory time and length of stay (LOS) in the ICU and in the hospital compared to those who did not receive prenatal counseling (all P<.01). Mothers and fathers had similar SF-36v1 mental and physical component summary (MCS, PCS) post-surgery scores when compared by counseling status. Prenatal MCS scores for mothers and fathers (47 vs. 41; P=.24) were similar to those at six months post-surgery (47 vs. 47; P=.90). CONCLUSIONS When hospital LOS was controlled between groups stratified by AFCC counseling status, MCS scores were comparable prenatally and were sustained at six months post-surgery for both parents. These findings may reflect the support services parents received beginning in the prenatal period.
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Affiliation(s)
- Kate V Dennett
- Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Sarah Tracy
- Department of Surgery, Boston Children's Hospital, Boston, MA
| | | | - David Zurakowski
- Department of Anesthesia, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Catherine Chen
- Department of Surgery, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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Lavelle TA, Wittenberg E, Lamarand K, Prosser LA. Variation in the spillover effects of illness on parents, spouses, and children of the chronically ill. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:117-24. [PMID: 24590611 PMCID: PMC4307398 DOI: 10.1007/s40258-014-0079-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Given the broad scope of the spillover effects of illness, it is important to characterize the variability in these outcomes to identify relationship types in which secondary impacts of illness are particularly important to include in health economic evaluations. PURPOSE To examine heterogeneity in spillover effects of chronic conditions on family members by type of familial relationship with patient. METHODS Adults (aged ≥18 years) and adolescents (aged 13-17 years) who had a parent, spouse, or child in their household with a chronic condition (Alzheimer's disease/dementia, arthritis, cancer, or depression) were recruited from a US national panel to participate in an on-line survey. Respondents were asked to rate the spillover effect of their family member's illness on their own health on a 0-100 scale, with lower scores indicating greater spillover. Regression analysis was used to evaluate the association between rating scale scores and relationship with an ill family member (ill parent, child, or spouse) for each illness separately, controlling for caregiving responsibility and the health status of the ill family member. RESULTS 1,267 adults and 102 adolescents met inclusion criteria. In adjusted analyses, having a sick child was significantly (p < 0.05) associated with lower rating scale scores compared with having a spouse with the same condition (cancer: -24.2; depression -9.7). Having a non-elderly or elderly adult parent with a condition, compared with a spouse, was significantly associated with lower rating scale scores for arthritis (-3.8) and depression (-5.3), but not for Alzheimer's disease/dementia or cancer. CONCLUSIONS The impact of illness on family members, measured with a rating scale, varies by relationship type for certain illnesses. Having a child with cancer, a parent with arthritis, or either with depression, is significantly associated with greater spillover, compared with having a spouse with one of these conditions.
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Affiliation(s)
- Tara A Lavelle
- University of Michigan Medical School, Ann Arbor, MI, USA,
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Hoefman RJ, van Exel J, Brouwer W. How to include informal care in economic evaluations. PHARMACOECONOMICS 2013; 31:1105-19. [PMID: 24218135 DOI: 10.1007/s40273-013-0104-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Economic evaluations of health interventions aim to support decision making in healthcare. To effectively do so, evaluations need to include all relevant costs and effects of an intervention. Informal care provided by family or friends is an important element of care for many patients, but can have a profound impact on the health and well-being of carers. Therefore, informal care should be considered in economic evaluations of health interventions. Different methods to do so exist. This paper provides an overview of state-of-the-art methods available for this purpose, illustrated with practical examples. Since the choice of measurement and valuation technique depends on the type and perspective of the economic evaluation, this paper supports researchers in choosing the appropriate techniques to include informal care in their economic evaluation of a health intervention. We discuss the different approaches to measuring and valuing informal care, covering both partial and full valuation methods, allowing inclusion as costs or effects.
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Affiliation(s)
- Renske J Hoefman
- Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands,
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Wittenberg E, Prosser LA. Disutility of illness for caregivers and families: a systematic review of the literature. PHARMACOECONOMICS 2013; 31:489-500. [PMID: 23572441 PMCID: PMC3674134 DOI: 10.1007/s40273-013-0040-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Caring for an ill or disabled family member imposes a well-documented burden on the caregiver. The benefits of a health intervention may be underestimated if "spillover" effects on family members are not captured, resulting in inaccurate conclusions of economic evaluations. OBJECTIVE To provide an estimate of, and to summarize measurement approaches for, the spillover disutility of illness on family members, relatives, and caregivers, through a systematic review of the literature. METHODS The medical (PubMED), psychology (PsycINFO), and economics (EconLit) literatures were searched from inception through February 2012 for published studies measuring spillover disutility of illness on family members and caregivers. Inclusion criteria were (1) studies using preference-based measures of health-related quality of life, and (2) studies reporting spillover disutility, or (3) studies reporting data from which a spillover disutility could be inferred. RESULTS Fifteen studies were included in this review: seven reported estimates of spillover disutility and eight reported data from which disutility could be inferred. Three studies found no disutility associated with spillover, whereas 12 found measurable effects as large as -0.718 (and two found evidence of positive spillover in subsets of their samples). Generic (indirect) utility instruments were primarily used to measure spillover, including the EQ-5D, QWB, and HUI (n = 13), though two studies used modified versions of the time trade-off technique. Illnesses studied included childhood disorders (e.g., spina bifida, congenital malformations), diseases of the elderly (e.g., Alzheimer's disease and dementia), physically disabling conditions (e.g., arthritis, multiple sclerosis), and medical conditions such as cancer and stroke. The persons affected by spillover included parents, grandparents, spouses/partners, other family caregivers, and household members. CONCLUSIONS There is a limited literature on the spillover disutility of illness on family members and caregivers, providing some specific estimates of a generally small, negative effect for particular conditions and individuals. Measurement methods vary across studies and a consensus approach has not yet been reached. Evidence suggests that the inclusion of spillover effects in economic evaluations would increase the relative effectiveness of interventions that address conditions with spillover compared to those without, though such differential benefits may be limited to such specific circumstances.
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Affiliation(s)
- Eve Wittenberg
- Center for Health Decision Science, Harvard School of Public Health, 718 Huntington Ave, Boston, MA 02115, USA.
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