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Russell TL, Tiusaba L, Smith JC, Alexander R, Mahlet Q, Ho CP, Pohl HG, Varda BK. Getting to the bottom of why children with spina bifida use the emergency department: A qualitative analysis of parent and stakeholder perspectives. J Pediatr Urol 2024:S1477-5131(24)00265-1. [PMID: 38802289 DOI: 10.1016/j.jpurol.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Children with Spina Bifida (SB) have considerable healthcare utilization, including Emergency Department use (EDU). We aimed to elicit reasons for EDU using qualitative analysis of interviews with both patient-caregiver dyads and stakeholders. METHODS A cohort of children with SB followed at our institution between 2016 and 2020 was identified and patient and clinical characteristics abstracted. Purposeful sampling by age and degree of past EDU was performed. Semi-structured interviews of dyads were performed using iteratively revised interview guides. Spanish-language interviews were conducted by a native Spanish speaker and transcripts professionally translated. Supplemental interviews with stakeholders, namely knowledgeable healthcare professionals, were also conducted. A qualitative framework approach was used for analysis, including open followed by closed independent coding with calculation of inter-rater reliability. A final interpretation of coding reports assessing convergence, divergence, and variation in themes across participant characteristics. RESULTS 116 families (4 Spanish-speaking) and 7 stakeholders were interviewed. Sampling yielded a heterogenous cohort for EDU (56% with 0-10, 44% with >10 visits) and age (25% 0-4, 44% 5-11, 31% > 11 years). IRR was optimal (κ = 0.9). Themes in perceived reasons for EDU were 1) desire for "one-stop-shop" care, 2) an emergent medical problem, 3) providers' instructions, 4) negative past healthcare experience, 5) intrinsic caregiver moderators, and 6) temporospatial influences. Themes 1, 2, and 5 predominated in dyads, whereas themes 6, 3, and 5 were most common in stakeholders. Stakeholders focused largely on negative institutional and patient characteristics. Among dyads only, theme #1 was disproportionately emphasized by Spanish-speaking patients. DISCUSSION Families desired access to coordinated expert care, testing and imaging. The ED offers this for children with SB, regardless of clinical acuity. This may be especially valued by families with inherent challenges to navigating the healthcare system. Negative experiences in community clinical settings, healthcare provider recommendations and intrinsic parental factors were themes that seemed to contribute to seeking this "one-stop-shop" type of care. Care coordination may reduce ED reliance, but themes for the interviews suggest a systems-based efforts should weave in the community care setting. CONCLUSIONS For both stakeholders and caregivers, the ED represented a valued form of immediate access to multispecialty, expert care and testing in the context of perceived lack of timely, coordinated outpatient care. This may be moderated by intrinsic caregiver factors and negative past experiences. Although stakeholders discussed ideas that fit into patient-caregiver themes, the also uniquely focused on systems-based and patient-caregiver limitations.
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Affiliation(s)
- Teresa L Russell
- Division of Urology, Children's National Hospital, Washington, DC, USA; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, DC, USA
| | - Laura Tiusaba
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, DC, USA
| | - Jacob C Smith
- Division of Urology, Children's National Hospital, Washington, DC, USA
| | - Rachel Alexander
- Division of Urology, Children's National Hospital, Washington, DC, USA
| | - Qene Mahlet
- Division of Urology, Children's National Hospital, Washington, DC, USA
| | - Christina P Ho
- Division of Urology, Children's National Hospital, Washington, DC, USA
| | - Hans G Pohl
- Division of Urology, Children's National Hospital, Washington, DC, USA
| | - Briony K Varda
- Division of Urology, Children's National Hospital, Washington, DC, USA.
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Hwang CK, Harris KT, Wood D. Barriers to Transitional Care in Spina Bifida. Urol Clin North Am 2024; 51:187-196. [PMID: 38609191 DOI: 10.1016/j.ucl.2024.01.006] [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] [Indexed: 04/14/2024]
Abstract
The health care needs children with spina bifida evolve over their lifetime; continued, regular contact with appropraitely trained, multidisciplinary providers is crucial to a patient's health and quality of life. Substantial research has been conducted to improve the transition process starting at an early age; however, there continue to be strong barriers to successful transition. This article reviews key aspects of the care of patients with spina bifida, the impact of inadequate transition to adult care, barriers to transition, and offers a potential vision for the future.
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Affiliation(s)
- Catalina K Hwang
- Division of Urology, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Aurora, CO 80045, USA
| | - Kelly T Harris
- Division of Urology, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Aurora, CO 80045, USA
| | - Dan Wood
- Division of Urology, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Aurora, CO 80045, USA.
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Mahmoudi E, Lin P, Rubenstein D, Guetterman T, Leggett A, Possin KL, Kamdar N. Use of preventive service and potentially preventable hospitalization among American adults with disability: Longitudinal analysis of Traditional Medicare and commercial insurance. Prev Med Rep 2024; 40:102663. [PMID: 38464419 PMCID: PMC10920729 DOI: 10.1016/j.pmedr.2024.102663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024] Open
Abstract
Objective Examine the association between traditional Medicare (TM) vs. commercial insurance and the use of preventive care and potentially preventable hospitalization (PPH) among adults (18+) with disability [cerebral palsy/spina bifida (CP/SB); multiple sclerosis (MS); traumatic spinal cord injury (TSCI)] in the United States. Methods Using 2008-2016 Medicare and commercial claims data, we compared adults with the same disability enrolled in TM vs. commercial insurance [Medicare: n = 21,599 (CP/SB); n = 7,605 (MS); n = 4,802 (TSCI); commercial: n = 11,306 (CP/SB); n = 6,254 (MS); n = 5,265 (TSCI)]. We applied generalized estimating equations to address repeated measures, comparing cases with controls. All models were adjusted for age, sex, race/ethnicity, and comorbid conditions. Results Compared with commercial insurance, enrolling in TM reduced the odds of using preventive services. For example, adjusted odds ratios (OR) of annual wellness visits in TM vs. commercial insurance were 0.31 (95% confidence interval (CI): 0.28-0.34), 0.32 (95% CI: 0.28-0.37), and 0.19 (95% CI: 0.17-0.22) among adults with CP/SB, TSCI, and MS, respectively. Furthermore, PPH risks were higher in TM vs. commercial insurance. ORs of PPH in TM vs. commercial insurance were 1.50 (95% CI: 1.18-1.89), 1.83 (95% CI: 1.40-2.41), and 2.32 (95% CI: 1.66-3.22) among adults with CP/SB, TSCI, and MS, respectively. Moreover, dual-eligible adults had higher odds of PPH compared with non-dual-eligible adults [CP/SB: OR = 1.47 (95% CI: 1.25-1.72); TSCI: OR = 1.61 (95% CI: 1.35-1.92), and MS: OR = 1.80 (95% CI: 1.55-2.10)]. Conclusions TM, relative to commercial insurance, was associated with lower receipt of preventive care and higher PPH risk among adults with disability.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, Michigan Medicine, University of Michigan, USA
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Dana Rubenstein
- Clinical and Translational Science Institute, Duke University School of Medicine, 701 West Main Street, Durham, NC, USA
| | - Timothy Guetterman
- Department of Family Medicine, Michigan Medicine, University of Michigan, USA
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amanda Leggett
- Institute of Gerontology & Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Katherine L. Possin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Ridosh MM, Adams W, Payne AD, Hilderbrand TL, Magaña F, Sawin KJ, Holmbeck GN. Contextual predictors of self-management and independence trajectories in adolescents and young adults with spina bifida. Dev Med Child Neurol 2024. [PMID: 38494664 DOI: 10.1111/dmcn.15900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 01/30/2024] [Accepted: 02/09/2024] [Indexed: 03/19/2024]
Abstract
AIM To examine socioeconomic, condition-related, and neuropsychological predictors of self-management trajectories in adolescents and young adults with spina bifida. METHOD In this longitudinal study, participants completed the Adolescent/Young Adult Self-Management and Independence Scale interview. Socioeconomic status (SES), shunt status, lesion level, and executive functioning were assessed. Growth in self-management was estimated using linear mixed-effects models. RESULTS Participants (n = 99) were aged 18 to 27 years. Approximately half (52.5%) were female and White; 15.2% were Black; and 32.3% Hispanic or Latino. Although none of the predictors were associated with growth in self-management from ages 18 to 27 years (p > 0.05), several factors were associated with the intercept at age 18 years for total self-management. Higher SES at baseline predicted a higher total self-management score at age 18 years (b = 0.03, standard error [SE] = 0.01; p < 0.001). On average, participants at age 18 years with a shunt scored lower than those without a shunt (b = -0.90, SE = 0.32; p = 0.01); those with a thoracic lesion scored lower than those with lower lesion levels (lumbar: b = -1.22, SE = 0.34; sacral: b = -1.20, SE = 0.36; p = 0.001 for both). Better parent-reported and teacher-reported executive functions predicted higher total self-management (metacognitive: b = -0.03, SE = 0.01; behavioral regulation: b = -0.04, SE = 0.01; p < 0.05 for both). INTERPRETATION On average, all participants improved in self-management over time. Additionally, baseline superiority in self-management for adolescents and young adults without a shunt, less severe lesions, better executive functions, and higher SES persisted over time.
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Affiliation(s)
- Monique M Ridosh
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - William Adams
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Allison D Payne
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | | | - Fabiola Magaña
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - Kathleen J Sawin
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, USA
- Self-Management Science Center, School of Nursing, College of Health Professions and Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Koch VH, Lopes M, Furusawa E, Vaz K, Barroso U. Multidisciplinary management of people with spina bifida across the lifespan. Pediatr Nephrol 2024; 39:681-697. [PMID: 37501019 DOI: 10.1007/s00467-023-06067-w] [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: 03/09/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023]
Abstract
The average worldwide prevalence of neural tube defects (NTDs) is 1.0 per 1000 births. Its development is multifactorial due to genetic and non-genetic factors. Spina bifida (SB) is one of main representatives of NTD. The spinal cord lesion level is the main determinant of the level of paralysis, numbness, and difficulties with bladder/bowel functions. Myelomeningocele prenatal repair reduces hydrocephalus and hindbrain herniation and improves motor function. The severity of hydrocephalus is associated with poorer neurodevelopmental outcomes whether operated on prenatally or after birth. People with SB tend to have a lower IQ and cognitive difficulties. Early diagnosis, proactivity, and lifelong multidisciplinary follow-up are key protective issues. Invasive urological interventions should be considered in selected patients after failure of conservative treatment. Transition to adult care should be well planned as it is challenging. Health literacy is directly associated with success at transition. Sexuality and fertility should be addressed before/during puberty. Overall, the rates of fecal and urinary continence and skin breakdown increase with age, whereas the ability to ambulate declines with age. Bowel and urinary incontinence are independent predictors of lower health-related quality of life (HRQoL) in adults with SB. Bowel incontinence has negative impact on HRQoL regardless of frequency or amount. Long-term caregiver support should be offered at diagnosis. Survival at a mean of 50 years is poor, at 32%, due to central nervous system deaths, cancer, urological disease, and sepsis. Challenges to implementation of recommended practices exist, especially in low and middle-income countries.
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Affiliation(s)
- Vera H Koch
- Pediatric Nephrology Unit, Department of Pediatrics, University of São Paulo Medical School, Children's Hospital, Hospital das Clinicas, Sau Paulo, Brazil.
| | - MarcosTomasin Lopes
- Pediatric Nephrology Unit, Department of Pediatrics, University of São Paulo Medical School, Children's Hospital, Hospital das Clinicas, Sau Paulo, Brazil
| | - Erika Furusawa
- Pediatric Nephrology Unit, Department of Pediatrics, University of São Paulo Medical School, Children's Hospital, Hospital das Clinicas, Sau Paulo, Brazil
| | - Katharinne Vaz
- Division of Urology, Federal University of Bahia - UFBA, Salvador, BA, Brazil
| | - Ubirajara Barroso
- Division of Urology - Federal University of Bahia, Bahiana School of Medicine, Salvador, BA, Brazil
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Rocchi M, Jarl J, Lundkvist Josenby A, Alriksson-Schmidt AI. Survival and causes of death in adults with spina bifida in Sweden: a population-based case-control study. J Rehabil Med 2023; 55:jrm18244. [PMID: 38010218 PMCID: PMC11064288 DOI: 10.2340/jrm.v55.18244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/26/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE To analyse survival rates and causes of death in adults with spina bifida in Sweden compared with a matched control group. DESIGN AND METHODS This population-based study included 11,900 adults born between 1950 and 1997. Three national Swedish registers were used to identify individuals with a diagnosis of spina bifida and a matched control group without spina bifida in the period 1990-2015. International Classification of Diseases codes were used to identify causes of death. Survival analysis was conducted and causes of death in the 2 groups were compared. RESULTS There was a lower probability of survival for people with spina bifida in all age groups (p < 0.001) compared with the control group. The most prevalent causes of death in people with spina bifida were congenital, respiratory, nervous, cardiovascular, genitourinary, and injuries. People with spina bifida had a higher probability of dying from congenital (p < 0.001), respiratory (p = 0.002), genitourinary (p < 0.002), and nervous-related (p < 0.001) and lower probability of injury-related deaths (p < 0.001). CONCLUSION Adults with spina bifida in Sweden have a lower survival rate compared with the general population, with the frequency of certain causes of death differing between the two groups. In order to reduce excess premature mortality, prevention and careful management of potentially fatal conditions are essential throughout a patient's lifespan.
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Affiliation(s)
- Melinda Rocchi
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
| | - Johan Jarl
- Health Economics, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Annika Lundkvist Josenby
- Department of Health Sciences, Lund University, Lund, Sweden; Children's Hospital, Skåne University Hospital, Lund, Sweden
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Reynolds RA, Vance EH, Shlobin NA, Bowman R, Rosseau G. Transitioning care for adolescents with spina bifida in the US: challenges for management. Childs Nerv Syst 2023; 39:3123-3130. [PMID: 37099139 DOI: 10.1007/s00381-023-05955-8] [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: 04/29/2022] [Accepted: 04/05/2023] [Indexed: 04/27/2023]
Abstract
Open spina bifida (OSB) is a common neural tube defect. Medical and surgical care involves addressing the baseline orthopedic, urologic, and neurological dysfunction as well as the changes or declines that may occur as the patient ages. Given the complexity of this disease, coordinated, multidisciplinary care involving specialists in neurosurgery, orthopedics, urology, rehabilitation and physical medicine, pediatrics, and psychology is necessary to establish and optimize baseline function. Traditionally in the US, pediatric multispecialty spina bifida clinics have provided the patient with a coordinated medical support system. Unfortunately, this coordinated, medical home has been difficult to establish during the transition from pediatric to adult care. Medical professionals must have a strong understanding of OSB to properly manage the disease and detect and prevent associated complications. In this manuscript, we (1) describe the changing needs and challenges of people living with OSB over a lifespan, (2) delineate current practices in the transition of care for people with OSB from childhood to adulthood, and (3) provide recommendations for best practices in navigating the transition process for clinicians who provide care for those afflicted with this most complex congenital abnormality of the nervous system compatible with long term survival.
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Affiliation(s)
- Rebecca A Reynolds
- Department of Neurological Surgery, Johns Hopkins All Children's Hospital, 601 5th Street South, Suite 511, Saint Petersburg, FL, 33705, USA.
| | - E Haley Vance
- Department of Neurological Surgery, Johns Hopkins All Children's Hospital, 601 5th Street South, Suite 511, Saint Petersburg, FL, 33705, USA
| | - Nathan A Shlobin
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robin Bowman
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gail Rosseau
- Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Barrow Neurological Institute, Phoenix, AZ, USA
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Manohar S, Staggers KA, Huang X, Castillo J, Castillo H, Fremion E. The impact of a health care transition clinic on spina bifida condition management and transition planning. Disabil Health J 2023; 16:101508. [PMID: 37541929 DOI: 10.1016/j.dhjo.2023.101508] [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: 01/10/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND To better serve the growing population of individuals with spina bifida (SB) living into adulthood, pediatric SB clinics have developed structured health care transition (HCT) supports for adolescents and young adults. Evaluating the impact of structured HCT on SB-related chronic condition outcomes and transition planning goals is needed to assess such interventions. OBJECTIVE This study explored the impact of a SB HCT Clinic on SB-related chronic condition management outcomes (e.g., reported bowel and bladder regimens and presence of pressure injury) and transition planning goals (e.g., decision-making, insurance, and transportation). METHODS A retrospective chart review was conducted of young adults with SB who did and did not participate in an SB HCT Clinic before establishing an adult clinic to compare SB-condition outcomes and HCT planning goals between groups. Associations between demographic and clinical variables and outcomes were also assessed. RESULTS The HCT group (n = 68) was more likely to use a bowel regimen (P < 0.01) compared to the non-HCT group (n = 94). There were no differences regarding bladder regimens or incidence of pressure injuries. For HCT planning, the groups differed regarding decision-making supports (P = 0.01). Additionally, the HCT group was more likely to use self-transportation (P = 0.01) or Medicaid transportation (P < 0.01). CONCLUSION This single-center HCT program improved the use of a bowel regimen at the time of transfer to adult care and impacted HCT planning regarding decision-making and transportation. These initial findings support the need for further development and assessment of HCT programs for this population.
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Affiliation(s)
- Sujal Manohar
- Student Affairs, Baylor College of Medicine, Houston, TX, USA.
| | - Kristen A Staggers
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Xiaofan Huang
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan Castillo
- Texas Children's Spina Bifida Clinic, The Meyer Center for Developmental Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Heidi Castillo
- Texas Children's Spina Bifida Clinic, The Meyer Center for Developmental Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Ellen Fremion
- Texas Children's Spina Bifida Clinic, The Meyer Center for Developmental Pediatrics, Baylor College of Medicine, Houston, TX, USA; Department of Medicine, Section of Transition Medicine, Baylor College of Medicine, Houston, TX, USA
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Bounds DT, Stiles-Shields C, Schueller SM, Odgers CL, Karnik NS. Ethical considerations for developing pediatric mhealth interventions for teens with socially complex needs. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2023; 36:7-16. [PMID: 36134754 PMCID: PMC9898213 DOI: 10.1111/jcap.12396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/03/2022] [Accepted: 09/11/2022] [Indexed: 02/06/2023]
Abstract
TOPIC Mobile Health (mHealth) stands as a potential means to better reach, assess, and intervene with teens with socially complex needs. These youth often face overlapping adversities including medical illness and a history of experiencing adverse childhood experiences (ACEs). Clinicians are faced with navigating ethical decisions when developing mHealth tools for teens who have socially complex needs. Many tools have been developed for adults from the general population. However, despite the development of thousands of mHealth interventions, developers tend to focus on designing for usability, engagement, and efficacy, with less attention on the ethical considerations of making such tools. PURPOSE To safely move mHealth interventions from research into clinical practice, ethical standards must be met during the design phase. In this paper we adapt the Four Box Model (i.e., medical indications, preferences of patients, quality of life, and contextual features) to guide mHealth developers through ethical considerations when designing mHealth interventions for teens who present with a medical diagnosis and a history of ACEs. SOURCES A review of language, inclusive features, data sharing, and usability is presented using both the Four Box Model and potential scenarios to guide each consideration. CONCLUSIONS To better support designers of mHealth tools we present a framework for evaluating applications to determine overlap with ethical design and are well suited for use in clinical practice with underserved pediatric patients.
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Affiliation(s)
- Dawn T Bounds
- Irvine, Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
- Department of Psychiatry and Behavioral Sciences, Section of Community Behavioral Health, Rush University, Chicago, Illinois, USA
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Section of Community Behavioral Health, Rush University, Chicago, Illinois, USA
- Institute for Juvenile Research, University of Illinois at Chicago, Illinois, USA
| | - Stephen M Schueller
- Department of Psychological Science, University of California-Irvine, Irvine, California, USA
| | - Candice L Odgers
- Department of Psychological Science, University of California-Irvine, Irvine, California, USA
- Social Science Research Institute, Duke University, Durham, North Carolina, USA
| | - Niranjan S Karnik
- Department of Psychiatry and Behavioral Sciences, Section of Community Behavioral Health, Rush University, Chicago, Illinois, USA
- Institute for Juvenile Research, University of Illinois at Chicago, Illinois, USA
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Cassidy M, Doucet S, Luke A, Goudreau A, MacNeill L. Improving the transition from paediatric to adult healthcare: a scoping review on the recommendations of young adults with lived experience. BMJ Open 2022; 12:e051314. [PMID: 36572498 PMCID: PMC9806082 DOI: 10.1136/bmjopen-2021-051314] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The goal of this review was to identify recommendations within the literature on how to improve the transition from paediatric to adult healthcare from the perspective of young adults (YAs) living with chronic conditions who have gone through the process. DESIGN This review was conducted in accordance with JBI methodology for scoping reviews. SEARCH STRATEGY We searched MEDLINE (Ovid), CINAHL (EBSCO), PsycINFO (EBSCO) and EMBASE (Elsevier) databases, and conducted a grey literature search for relevant material. The databases were searched in December 2019, and re-searched June 2020 and September 2020, while the grey literature was searched in April 2020. This scoping review focused on the recommendations of YAs with chronic conditions who have transitioned from paediatric to adult healthcare, in any setting (eg, hospital, clinic or community), and across all sectors (eg, health, education and social services). RESULTS Eighteen studies met inclusion criteria for this review. These studies included YAs with 14 different chronic conditions, receiving primary health services in North America (67%) and Europe (33%). YAs' recommendations for improving the transition from paediatric to adult healthcare (n=number of studies reported) included: improving continuity of care (n=12); facilitating patient-centred care (n=9); building strong support networks (n=11) and implementing transition education preparedness training (n=7). CONCLUSION Review findings can benefit service delivery by addressing important barriers to health, education, and social services for youth transitioning to adult healthcare.
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Affiliation(s)
- Monique Cassidy
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Shelley Doucet
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alison Luke
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alex Goudreau
- UNB Libraries, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Lillian MacNeill
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
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Mahmoudi E, Lin P, Khan A, Kamdar N, Peterson MD. Potentially Preventable Hospitalizations Among Adults With Pediatric-Onset Disabilities. Mayo Clin Proc 2022; 97:2226-2235. [PMID: 36336517 DOI: 10.1016/j.mayocp.2022.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/11/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the risk of any and specific potentially preventable hospitalizations (PPHs) for adults with cerebral palsy (CP) or spina bifida (SB). We hypothesize that PPH risk is greater among adults with CP/SB compared with the general population. PATIENTS AND METHODS Using January 1, 2007, to December 31, 2017, national private administrative claims data (OptumInsight) in the United States, we identified adults with CP/SB (n=10,617). Adults without CP/SB were included as controls (n=1,443,716). To ensure a similar proportion in basic demographics, we propensity-matched our controls with cases in age and sex (n=10,617). Generalized estimating equation models were applied to examine the risk of CP/SB on PPHs. All models were adjusted for age, sex, race/ethnicity, health indicators, US Census Division data, and socioeconomic variables. Adjusted odds ratios were compared within a 4-year follow-up. RESULTS Adults with CP/SB had higher risk for any PPH (odds ratio [OR], 4.10; 95% CI, 2.31 to 7.31), and PPHs due to chronic obstructive pulmonary disease/asthma (OR, 1.85; CI, 1.23 to 2.76), pneumonia (OR, 3.01; 95% CI, 2.06 to 4.39), and urinary tract infection (OR, 6.48; 95% CI, 3.91 to 10.75). Cases and controls who had an annual wellness visit had lower PPH risk (OR, 0.52; 95% CI, 0.41 to 0.67); similarly, adults with CP/SB who had an annual wellness visit compared with adults with CP/SB who did not had lower odds of PPH (OR, 0.75; 95% CI, 0.60 to 0.94). CONCLUSION Adults with pediatric-onset disabilities are at a greater risk for PPHs. Providing better access to preventive care and health-promoting services, especially for respiratory and urinary outcomes, may reduce PPH risk among this patient population.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, Michigan Medicine, University of Michigan; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anam Khan
- University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mark D Peterson
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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12
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Rague JT, Kim S, Hirsch J, Meyer T, Rosoklija I, Larson JE, Swaroop VT, Bowman R, Bowen DK, Cheng EY, Gordon EJ, Holmbeck G, Chu DI, Isakova T, Yerkes EB, Chu DI. The Association of Health Literacy with Health-Related Quality of Life in Youth and Young Adults with Spina Bifida: A Cross-Sectional Study. J Pediatr 2022; 251:156-163.e2. [PMID: 35970239 PMCID: PMC9843738 DOI: 10.1016/j.jpeds.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/08/2022] [Accepted: 08/09/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective of the study was to determine if health literacy is associated with health-related quality of life (HRQOL) in adolescents and young adults (AYAs) with spina bifida. STUDY DESIGN Between June 2019 and March 2020, the Patient-Reported Outcome Measurement Information System Pediatric Global Health-7 (PGH-7), a measure of HRQOL, and the Brief Health Literacy Screening Tool (BRIEF) were administered to patients ≥12 years old with a diagnosis of spina bifida seen in our multidisciplinary spina bifida center. Questionnaires were completed at scheduled clinic visits. The primary outcome was the PGH-7 normalized T-score. The primary exposure was the BRIEF score. Demographic and clinical characteristics were obtained from the medical record. Nested, multivariable linear regression models assessed the association between health literacy and the PGH-7 score. RESULTS Of 232 eligible patients who presented to clinic, 226 (97.4%) met inclusion criteria for this study. The median age was 17.0 years (range: 12-31). Most individuals were female (54.0%) and had myelomeningocele (61.5%). Inadequate, marginal, and adequate health literacy levels were reported by 35.0%, 28.3%, and 36.7% of individuals. In univariable analysis, higher health literacy levels were associated with higher PGH-7 scores. In nested, sequentially adjusted multivariable linear regression models, a higher health literacy level was associated with a stepwise increase in the PGH-7 score. In the fully adjusted model, adequate health literacy and marginal health literacy, compared with inadequate health literacy, were associated with increases in a PGH-7 score of 3.3 (95% CI: 0.2-6.3) and 1.1 (95% CI: -2.0 to 4.2), respectively. CONCLUSIONS Health literacy was associated with HRQOL after adjusting for demographic and clinical factors. Strategies incorporating health literacy are needed to improve HRQOL in AYAs with spina bifida.
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Affiliation(s)
- James T Rague
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Soojin Kim
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Josephine Hirsch
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Jill E Larson
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Vineeta T Swaroop
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Robin Bowman
- Division of Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Diana K Bowen
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Elisa J Gordon
- Department of Surgery-Division of Transplantation, Center of Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Grayson Holmbeck
- Department of Psychology, Loyola University of Chicago, Chicago, IL
| | - Daniel I Chu
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Tamara Isakova
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, and Division of Nephrology and Hypertension, Feinberg School of Medicine at Northwestern University, Chicago, IL
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - David I Chu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
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13
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Stockman J, Westbom L, Alriksson‐Schmidt AI. Pressure injuries are common in children with myelomeningocele: Results from a follow-up programme and register. Acta Paediatr 2022; 111:1566-1572. [PMID: 35567518 PMCID: PMC9541151 DOI: 10.1111/apa.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/20/2022] [Accepted: 05/12/2022] [Indexed: 02/02/2023]
Abstract
AIM To investigate the occurrence of pressure injuries (PIs) in children with myelomeningocele (MMC) and to investigate the association between PIs and orthoses use by disability-specific variables. METHODS Population-based registry study including participants in the Swedish multidisciplinary follow-up programme for MMC. Risks of PIs were investigated by birth cohort, country of birth, sex, type of MMC, muscle function level (MFL), and continence status. RESULTS Of 180 participants, 29% had PIs recorded. Of the 132 participants with >1 assessment records, 17.4% reported multiple PI occasions. More assessments increased the likelihood of PIs (Odds Ratio [OR] = 1.33, 95% CI 1.15-1.54) and participants born 2015-2018 had a lower OR of PIs than those born 2007-2010 (OR = 0.08, 95% CI = 0.01-0.74). Those at MFL I had lower OR of PIs than those at MFL V (OR = 0.06, 95% CI 0.01-0.64). Of the 73 participants with orthoses on the lower extremities, 47% reported skin irritations/injuries in the last 4 weeks; 30% reported that it made them stop using orthoses. CONCLUSION Pressure injuries are common even in young children with MMC. Many have recurring skin irritations. Inspecting for PIs should be part of a daily routine and tools to increase compliance are needed.
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Affiliation(s)
- Jessica Stockman
- Division of Psychiatry and DisabilityHabilitation Center Nyköping, Region SörmlandNykopingSweden,Department of Clinical Sciences Lund, OrthopedicsSkåne University Hospital, Lund UniversityLundSweden
| | - Lena Westbom
- Department of Clinical Sciences Lund, PediatricsSkåne University Hospital, Lund UniversityLundSweden
| | - Ann I. Alriksson‐Schmidt
- Department of Clinical Sciences Lund, OrthopedicsSkåne University Hospital, Lund UniversityLundSweden
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14
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Sattolo ML, Arbour L, Bilodeau-Bertrand M, Lee GE, Nelson C, Auger N. Association of Birth Defects With Child Mortality Before Age 14 Years. JAMA Netw Open 2022; 5:e226739. [PMID: 35404459 PMCID: PMC9002336 DOI: 10.1001/jamanetworkopen.2022.6739] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Causes of death in children with birth defects are poorly understood. OBJECTIVE To determine mortality rates by cause of death in children with and without birth defects. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study included a population-based sample of 1 037 688 children and was conducted in all hospitals in Quebec, Canada, with 7 700 596 person-years of follow-up between birth and age 14 years (April 1, 2006, to March 31, 2020). EXPOSURES Presence or absence of a birth defect. MAIN OUTCOMES AND MEASURES Outcomes were all-cause and cause-specific mortality. Hazard ratios (HRs) and 95% CIs were computed for the association between birth defects and mortality with Cox proportional hazards models adjusted for patient characteristics. RESULTS Among the 1 037 688 children in the cohort, 95 566 had birth defects (56.5% boys). There were 532 542 boys in the cohort (51.3%), and mean (SD) age at the end of follow-up was 7.42 (3.72) years. There were 918 deaths among children with defects, and the mean (SD) age was 0.93 (2.07) years at death; there were 1082 deaths among the 942 122 children without defects, and the mean (SD) age at death was 0.50 (1.51) years. Mortality rates were higher for children with birth defects compared with no defect (1.3 vs 0.2 deaths per 1000 person-years, respectively). Girls (HR, 5.66; 95% CI, 4.96-6.47) and boys (HR, 4.69; 95% CI, 4.15-5.29) with birth defects had an elevated risk of death before 14 years compared with unaffected children. Birth defects were associated with mortality from circulatory (HR, 26.59; 95% CI, 17.73-39.87), respiratory (HR, 23.03; 95% CI, 15.09-35.14), and digestive causes (HR, 31.77; 95% CI, 11.87-85.04), but anomalies were rarely listed as the cause of death. Compared with children with no defect, those with birth defects were at greatest risk of death between 28 and 364 days of life. CONCLUSIONS AND RELEVANCE This cohort study of 1 037 688 children suggests that birth defects were strongly associated with mortality owing to circulatory, respiratory, and digestive causes. This finding suggests that the contribution of birth defects may be underestimated in mortality statistics.
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Affiliation(s)
- Marie-Laure Sattolo
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ga Eun Lee
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Chantal Nelson
- Maternal and Infant Health Surveillance Section, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Nathalie Auger
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
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15
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Stiles-Shields C, Kritikos TK, Starnes M, Smith ZR, Holmbeck GN. The Transition from Pediatric to Adult Health Care in Young Adults with Spina Bifida: Demographic and Physician-Related Correlates. J Dev Behav Pediatr 2022; 43:e179-e187. [PMID: 34570065 PMCID: PMC8942874 DOI: 10.1097/dbp.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined the transition to adult health care for individuals with spina bifida (SB) and explored demographic and relational associations with transition status. METHOD Young adults with SB (18-30; n = 326) were recruited to complete an anonymous, online survey. Frequencies of reported experiences, behaviors, and satisfaction with the transition to adult health care were examined. Nonparametric tests and exploratory hierarchical regressions were used to examine demographic and relational factors with physicians between those (1) who had and had not yet transitioned and (2) who did and did not return to pediatric care. RESULTS Most of the sample reported having transitioned to adult health care, with three-quarters reporting that their primary physician is an adult primary care doctor. Individuals who had transitioned were more likely to be younger (p = 0.01) and to not have a shunt (p = 0.003). Beyond the effect of age and shunt status, relational factors with pediatric providers were not associated with transition (p > 0.1). After transition, over one-third reported returning to a pediatric provider. Those who did not return to pediatric care were more likely to have myelomeningocele, be a full-time student, and to not have a shunt (p < 0.001). Beyond the effect of age and shunt status, lower ratings of communication with adult providers were associated with a return to pediatric care (p = 0.04). CONCLUSION The results highlight the need for additional research about barriers and facilitators to the transition to adult health care to target interventions that support this critical milestone in young adults with SB.
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Affiliation(s)
- Colleen Stiles-Shields
- Rush University Medical Center, Department of Psychiatry and Behavioral Sciences, Section of Community Behavioral Health, 1645 W. Jackson Blvd., Chicago, IL 60612
| | - Tessa K. Kritikos
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Meredith Starnes
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Zoe R. Smith
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Grayson N. Holmbeck
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
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16
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Bradko V, Castillo H, Conklin M, Fremion E, Rocque B, Hanson D, Sanz-Cortes M, Whitehead W, Castillo J. Team Approach: The Management of Adolescents and Adults with Scoliosis and Spina Bifida. JBJS Rev 2022; 10:01874474-202203000-00004. [PMID: 35230996 DOI: 10.2106/jbjs.rvw.21.00167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
» Globally, the prevalence of myelomeningocele, the most common subtype of spina bifida, is 0.2 to 6.5 per 1,000 live births. In the U.S., adults account for >67% of the overall population with spina bifida. » With an estimated prevalence of up to 50%, scoliosis is one of the most common and severe orthopaedic conditions in patients with myelomeningocele. » The variable effects that scoliosis can have on an individual, the comorbidities associated with progressive scoliosis, and the risks associated with spine surgery call for a strong partnership and care coordination between medical and surgical teams to deliver a patient-centered approach. » A coordinated, structured, planned, and incremental team approach can help individuals achieve the overall goals of functionality and independence, as well as successful transition to adulthood. » Teams should consider a patient's social determinants of health (e.g., poverty or language barriers) and the effect of scoliosis on quality of life before proceeding with spinal deformity correction.
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Affiliation(s)
- Viachaslau Bradko
- Meyer Center for Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Heidi Castillo
- Meyer Center for Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Michael Conklin
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ellen Fremion
- Departments of Internal Medicine and Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Brandon Rocque
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Darrell Hanson
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | | | - William Whitehead
- Department of Pediatric Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Jonathan Castillo
- Meyer Center for Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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17
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Betz CL, Hudson SM, Skura AL, Rajeev ND, Smith KA, Van Speybroeck A. Exploratory study of the provision of academic and health-related accommodations to transition-age adolescents and emerging adults with spina bifida. J Pediatr Rehabil Med 2022; 15:593-605. [PMID: 36442216 DOI: 10.3233/prm-210116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this exploratory study was to investigate the types of academic and health-related accommodations provided to adolescents and emerging adults with spina bifida aged 9-20 years. METHODS Data were extracted from the paper and electronic records of transition-age youth enrolled in the study. Four open ended items involved content analysis. RESULTS The most frequently identified accommodation was enrollment in special education classes in 47.7% of the charts. Other academic accommodations that were most often reported were adaptive physical education (n = 71, 39.9%), tutoring (n = 28; 15.7%), and home schooling (n = 21; 11.8%). Clean intermittent catheterization was the most frequently identified health-related accommodation provided by the school nurse/aide (n = 57; 32%).The largest percentage of requests for additional accommodations were made during the middle school grades (15; 54.8%) followed by high school (10; 32.2%). CONCLUSION Findings demonstrated that persistent issues were identified by parents/adolescents regarding the provision of school-related accommodations. This is a relevant area for clinical practice to ensure students with special health care needs and those with spina bifida receive the academic and health-related accommodations in their Individualized Education Program/504 plans.
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Affiliation(s)
- Cecily L Betz
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Children's Hospital Los Angeles Spina Bifida Program, Los Angeles, CA, USA
| | - Sharon M Hudson
- Implementation Science and Evaluation, Alta Med Institute for Health Equity, Los Angeles, CA, USA
| | - Adam L Skura
- Chan Medical School, University of Massachusetts, Worcester, MA, USA
| | - Nithya D Rajeev
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kathryn A Smith
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Children's Hospital Los Angeles Spina Bifida Program, Los Angeles, CA, USA
| | - Alexander Van Speybroeck
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Children's Hospital Los Angeles Spina Bifida Program, Los Angeles, CA, USA
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18
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Farr SL, Riley C, Van Zutphen AR, Brei TJ, Leedom VO, Kirby RS, Pabst LJ. Prevention and awareness of birth defects across the lifespan using examples from congenital heart defects and spina bifida. Birth Defects Res 2021; 114:35-44. [PMID: 34921598 DOI: 10.1002/bdr2.1972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Sherry L Farr
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA
| | - Catharine Riley
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA
| | - Alissa R Van Zutphen
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
| | - Timothy J Brei
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA.,Spina Bifida Association of America, Arlington, Virginia, USA
| | - Vinita Oberoi Leedom
- Division of Population Health Surveillance, South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | | | - Laura J Pabst
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA
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19
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Logan LR, Sawin KJ, Bellin MH, Brei T, Woodward J. Self-management and independence guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2021; 13:583-600. [PMID: 33252094 PMCID: PMC7838981 DOI: 10.3233/prm-200734] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Self-management and independence behaviors are associated with improved health conditions common to spina bifida such as skin integrity and bowel and bladder management. While most children with spina bifida ultimately achieve basic self-care behaviors, (e.g., dressing appropriately, planning activities with peers, or cooking pre-planned meals), they often lag 2-5 years behind their typically-developing peers in these activities [1]. Valid and reliable condition-specific assessments of self-management and independence are critical to optimizing outcomes for this population. Partnerships among parents, clinicians, and youths with spina bifida are essential to implementing tailored interventions based on these assessments. The guidelines delineated in this article are informed by current self-management research for people with spina bifida and offer recommendations to promote self-management and independence across the lifespan.
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Affiliation(s)
- Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, Syracuse, NY, USA
| | - Kathleen J. Sawin
- Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Timothy Brei
- Division of Developmental Medicine, Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, USA
| | - Jason Woodward
- University of Cincinnati College of Medicine, Division of Developmental and Behavioral Pediatrics Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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20
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Bruegel K. Measuring resilience in adults with spina bifida. Dev Med Child Neurol 2021; 63:1139. [PMID: 34091887 DOI: 10.1111/dmcn.14956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Karlin Bruegel
- Adult Advisory Council Member, Spina Bifida Association of America, Arlington, VA, USA
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21
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Cohrs G, Blumenröther AK, Sürie JP, Synowitz M, Held-Feindt J, Knerlich-Lukoschus F. Fetal and perinatal expression profiles of proinflammatory cytokines in the neuroplacodes of rats with myelomeningoceles: A contribution to the understanding of secondary spinal cord injury in open spinal dysraphism. J Neurotrauma 2021; 38:3376-3392. [PMID: 34541905 DOI: 10.1089/neu.2021.0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The cellular and molecular mechanisms that presumably underlie the progressive functional decline of the myelomeningocele (MMC) placode are not well understood. We previously identified key players in posttraumatic spinal cord injury cascades in human MMC tissues obtained during postnatal repair. In this study we conducted experiments to further investigate these mediators in the prenatal time course under standardized conditions in a retinoic-acid-induced MMC rat model. A retinoic acid MMC model was established using time-dated Sprague-Dawley rats, which were gavage-fed with all-trans retinoic acid (RA; 60 mg/kg) dissolved in olive oil at E10. Control animals received olive oil only. Fetuses from both groups were obtained at E16, E18, E22. The spinal cords (SCs) of both groups were formalin-fixed or snap-frozen. Tissues were screened by real-time RT-PCR for the expression of cytokines and chemokines known to play a role in the lesion cascades of the central nervous system after trauma. MMC placodes exhibited inflammatory cells and glial activation in the later gestational stages. At the mRNA level, IL-1b, TNFa, and TNF-R1 exhibited significant induction at E22. IL1-R1 mRNA was induced significantly at E16 and E22. Double labeling experiments confirmed the costaining of these cytokines and their receptors with Iba1 (i.e., inflammatory cells), Vimentin, and Nestin in different anatomical SC areas and NeuN in ventral horn neurons. CXCL12 mRNA was elevated in control and MMC animals at E16 compared to E18 and E22. CX3CL1 mRNA was lower in MMC tissues than in control tissues on E16. The presented findings contribute to the concept that pathophysiological mechanisms, such as cytokine induction in the neuroplacode, in addition to the "first hit", promote secondary spinal cord injury with functional loss in the late fetal time course. Furthermore, these mediators should be taken into consideration in the development of new therapeutic approaches for open spinal dysraphism.
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Affiliation(s)
- Gesa Cohrs
- Universitatsklinikum Schleswig-Holstein Campus Kiel, 15056, Dept. of Neurosurgery, Arnold-Heller-Straße 3, Kiel, Germany, 24105;
| | - Ann-Kathrin Blumenröther
- Universitätsklinikum Schleswig-Holstein, 54186, Neurosurgery, Kiel, Schleswig-Holstein, Germany;
| | - Jan-Philip Sürie
- Universitätsklinikum Schleswig-Holstein, 54186, Neurosurgery, Kiel, Schleswig-Holstein, Germany;
| | - Michael Synowitz
- Universitatsklinikum Schleswig-Holstein Campus Kiel, 15056, Neurosurgery, Kiel, Schleswig-Holstein, Germany;
| | - Janka Held-Feindt
- Universitatsklinikum Schleswig-Holstein Campus Kiel, 15056, Neurosurgery, Kiel, Schleswig-Holstein, Germany;
| | - Friederike Knerlich-Lukoschus
- Universitätsklinikum Schleswig-Holstein, 54186, Neurosurgery, Kiel, Schleswig-Holstein, Germany.,Asklepios Kinderklinik Sankt Augustin, 248587, Pediatric Neurosurgery, Sankt Augustin, Nordrhein-Westfalen, Germany;
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22
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Rague JT, Kim S, Hirsch JA, Meyer T, Rosoklija I, Larson JE, Swaroop VT, Bowman RM, Bowen DK, Cheng EY, Gordon EJ, Chu DI, Isakova T, Yerkes EB, Chu DI. Assessment of Health Literacy and Self-reported Readiness for Transition to Adult Care Among Adolescents and Young Adults With Spina Bifida. JAMA Netw Open 2021; 4:e2127034. [PMID: 34581795 PMCID: PMC8479582 DOI: 10.1001/jamanetworkopen.2021.27034] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Health literacy has been shown to play an important role in transitions of care in adult populations, with low health literacy associated with adverse health outcomes. The role of health literacy in the transition from pediatric to adult care has been less well studied. Among adolescents and young adults with spina bifida, high rates of unsuccessful transition have been shown, but how patient health literacy affects transition readiness remains unknown. OBJECTIVE To determine whether health literacy is associated with transition readiness in adolescents and young adults with spina bifida. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study involved collection of patient-reported questionnaires between June 2019 and March 2020 at a multidisciplinary spina bifida center at a single, free-standing children's hospital. Patient demographic and clinical characteristics were obtained from medical record review. Patients were aged 12 years or older with a diagnosis of spina bifida (myelomeningocele and nonmyelomeningocele) whose primary language was English or Spanish. Data analysis was performed from October 2020 to March 2021. EXPOSURES Health literacy as assessed by the Brief Health Literacy Screening Tool. MAIN OUTCOMES AND MEASURES The primary outcome was total Transition Readiness Assessment Questionnaire (TRAQ) score, normalized into units of SD. Nested, multivariable linear regression models assessed the association between health literacy and TRAQ scores. RESULTS The TRAQ and Brief Health Literacy Screening Tool were completed by 200 individuals (median [range] age, 17.0 [12.0-31.0] years; 104 female participants [52.0%]). Most of the patients were younger than 18 years (110 participants [55.0%]) and White (136 participants [68.0%]) and had myelomeningocele (125 participants [62.5%]). The mean (SD) TRAQ score was 3.3 (1.1). Sixty-six participants (33.0%) reported inadequate health literacy, 60 participants (30.0%) reported marginal health literacy, and 74 participants (37.0%) reported adequate health literacy. In univariable analysis, health literacy, age, type of spina bifida, level of education, self-administration vs completion of the questionnaires with assistance, ambulatory status, and urinary incontinence were associated with total TRAQ score. In all nested, sequentially adjusted, multivariable models, higher health literacy remained a significant, stepwise, independent variable associated with higher TRAQ score. In the fully adjusted model, having adequate compared with inadequate health literacy was associated with an increase in normalized TRAQ score of 0.49 SD (95% CI, 0.19-0.79). CONCLUSIONS AND RELEVANCE Patient-reported transition readiness is associated with health literacy, even after adjustment for education level and other demographic and clinical factors. Developing and implementing health literacy-sensitive care programs during the transition process may improve patient transition readiness.
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Affiliation(s)
- James T. Rague
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Soojin Kim
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Josephine A. Hirsch
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Jill E. Larson
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Vineeta T. Swaroop
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Robin M. Bowman
- Division of Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Diana K. Bowen
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Earl Y. Cheng
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Elisa J. Gordon
- Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel I. Chu
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham
| | - Tamara Isakova
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth B. Yerkes
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - David I. Chu
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Fremion E, Bustillos P, Khavari R. Contemporary management considerations of urinary tract infections for women with spina bifida. Int Urogynecol J 2021; 33:493-505. [PMID: 34081164 DOI: 10.1007/s00192-021-04860-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary tract infections (UTIs) are one of the leading health concerns and causes of hospitalization for adults with spina bifida (SB). The risk factors, evaluation, management, and prevention of UTIs in women with SB must take into consideration their unique pelvic anatomy and function as well as the desire for pregnancy or the occurrence UTI during pregnancy. This article reviews published literature regarding this topic and offers recommendations for UTI evaluation, management, and prevention in the context of the unique pelvic floor health needs of women with SB. METHODS A systematic review was conducted using the following keywords: spinal dysraphism, spina bifida, myelomeningocele, meningocele, urinary tract infections, females, and adults. Articles were included if they were in English, published during or after 2000, peer reviewed, included women with spina bifida aged 18 or greater, and included outcomes related to urinary tract infection. RESULTS No articles met inclusion criteria. CONCLUSION As no articles were found based on the initial search criteria, articles pertaining to neurogenic bladder UTI risks, evaluation, and management were discussed to develop consensus recommendations for the unique care of UTIs in women with SB.
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Affiliation(s)
- Ellen Fremion
- Baylor College of Medicine, Departments of Internal Medicine and Pediatrics, Section of Transition Medicine, 7200 Cambridge St. Suite 8a, Houston, TX, 70330, USA.
| | - Paola Bustillos
- Houston Methodist Hospital, Department of Urology, Neurourology and Transitional Urology Clinic, Weill Cornell Medical College, Houston, TX, 77030, USA
| | - Rose Khavari
- Houston Methodist Hospital, Department of Urology, Neurourology and Transitional Urology Clinic, Weill Cornell Medical College, Houston, TX, 77030, USA
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Loftus CJ, Ahn J, Hagedorn JC, Cain M, Holt S, Merguerian P, Shnorhavorian M. The impact of the dependent care provision on individuals with spina bifida transitioning to adulthood. J Pediatr Urol 2021; 17:289.e1-289.e9. [PMID: 33563555 DOI: 10.1016/j.jpurol.2021.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Under the Affordable Care Act, the Dependent Care Provision (DCP) was enacted in 2010 and expanded healthcare coverage for millions of young adults ages 19-25 by allowing them to stay on their parents' insurance until age 26. It is unknown whether the DCP has impacted young adults with SB who are at risk for lapses in insurance coverage as they transition into adult care. OBJECTIVE Our aim was to determine the impact of the DCP on access to care (insurance status) and healthcare-quality (hospital admissions for potentially preventable conditions). METHODS Using the National Inpatient Sample (an all-payor national dataset of hospital admissions), we analyzed pre/post DCP changes for admissions of SB patients ages 19-25. Our outcomes of interest were rates of insurance coverage and proportion of admissions due to potentially preventable conditions (UTI, pyelonephritis, skin conditions, osteomyelitis, sepsis, and pneumonia). Analysis included a difference-in-differences logistic regression model which compared the pre/post DCP difference (2006-s quarter of 2010 vs. 2011-2013) in patients ages 19-25 to the difference in patients ages 26-32 who were ineligible for the DCP policy. RESULTS For admissions of SB patients ages 19-25, the DCP was not associated with improved insurance status compared to admissions ages 26-32 (0% vs. -0.4%, p = 0.10) and rates of private insurance decreased in both age groups, but more so in ages 26-32 (-2.0% vs. -3.9%, p < 0.001). Private insurance rates increased for admissions of white patients ages 19-25 but not for black and Hispanic groups. An increase in overall insurance status was also seen in young adults from high-income zip codes. Admissions for potentially preventable conditions increased in both age groups by a similar degree (+2.6% vs. +2.5%, p = 0.82). DISCUSSION Under the Affordable Care Act, the DCP failed to improve rates of private insurance or decrease rates of noninsurance for admissions of young adults with SB. Certain race and socioeconomic groups benefited more from this national healthcare policy. Meanwhile, admissions for potentially preventable conditions are common in spina bifida patients, and increased over the study period, suggesting a need for further investigation into optimizing the delivery of healthcare to this complex patient population. CONCLUSION The DCP did not result in improved overall insurance rates or in improved rates of private insurance for admissions of SB patients 18-25 years old.
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Affiliation(s)
- Christopher J Loftus
- Department of Urology, University of Washington Medical Center, 1959 NE Pacific St, Box 356510, Seattle, WA 98195, USA.
| | - Jennifer Ahn
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Judith C Hagedorn
- Department of Urology, University of Washington Medical Center, 1959 NE Pacific St, Box 356510, Seattle, WA 98195, USA
| | - Mark Cain
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Sarah Holt
- Department of Urology, University of Washington Medical Center, 1959 NE Pacific St, Box 356510, Seattle, WA 98195, USA
| | - Paul Merguerian
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Margarett Shnorhavorian
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
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25
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Stiles-Shields C, Shirkey KC, Winning AM, Smith ZR, Wartman E, Holmbeck GN. Social Skills and Medical Responsibility Across Development in Youth With Spina Bifida. J Pediatr Psychol 2021; 46:341-350. [PMID: 33236095 PMCID: PMC7977436 DOI: 10.1093/jpepsy/jsaa113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To examine the predictive role of social skills in youth with spina bifida (SB) on growth in medical responsibility across development. METHODS As part of a larger, longitudinal study, 140 youth with SB were assessed across four time points (ages 8-22 across time points). Mixed-effects models were investigated for change with: (a) no predictors (i.e., change in medical responsibility across age; time was examined using the participant's age, centered at 11.5 years); (b) social variables (i.e., observed social behaviors, parent- and teacher-reported social skills) as predictors; and (c) social variables as predictors with intelligence quotient, lesion level, and sex as covariates. RESULTS Significant growth with age was identified for medical responsibility (p < .0001). Observed, parent-reported, and teacher-reported social skills did not significantly predict this growth; however, all three predicted the intercept for medical responsibility at 11.5 years of age (ps ≤ .047). Parent-reported social skills remained a significant predictor of the intercept at 11.5 years of age when including the covariates (p = .008). CONCLUSIONS Children with SB who exhibited more positive social skills were more likely to a have higher level of medical responsibility in late childhood, but higher levels of social skills were not associated with a more rapid increase in responsibility over time. Identifying existing social strengths and promoting the practice of prosocial skills may have additional benefits to children with SB, including their acquisition of medical responsibility.
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Affiliation(s)
- Colleen Stiles-Shields
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center
| | | | | | - Zoe R Smith
- Psychology Department, Loyola University Chicago
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Management of the Transitional Urology Patient: the Role of the Adult Reconstructive Urologist. Curr Urol Rep 2021; 22:15. [PMID: 33534013 DOI: 10.1007/s11934-021-01035-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Patients with congenital urologic conditions present unique challenges as adults. Herein, we review the literature relevant to the adult reconstructive urologist confronted with complex surgical concerns affecting their patients with a history of hypospadias, spina bifida, and other syndromes affecting the genitourinary tract. RECENT FINDINGS Urethral stricture disease related to hypospadias is complex, but successful urethroplasty and penile curvature correction can be achieved with an anatomically minded approach. Multiple urinary diversion techniques can be considered in a patient-centered approach to bladder management in the adult spina bifida patient, but complications are common and revision surgeries are frequently required. Strong evidence is lacking for most surgical techniques in this population, but experiences reported by pediatric and adult urologists with genitourinary reconstruction training can help foster consensus in decision-making. Urologists trained in genitourinary reconstruction may be uniquely positioned to care for the transitional urology patient as they enter adolescence and adulthood.
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27
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Garver AE, Mohanty S, Dicianno BE, Turchi RM. Primary care providers need education and resources to provide optimal care for children and adults with spina bifida. J Pediatr Rehabil Med 2021; 14:681-689. [PMID: 34897106 DOI: 10.3233/prm-210039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The objective of this study was to describe the knowledge, attitudes, and practices related to caring for youth with SB within a statewide pediatric primary care medical home network. METHODS Health care professionals who were members of the Pennsylvania Medical Home Program (PAMHP) statewide network were surveyed on sociological demographics, confidence in and knowledge of topics that impact the spina bifida (SB) population, education on SB, designating responsibility of care, tasks completed in the office, and transition from pediatric to adult care from October 2016 through November 2016. RESULTS Among 67 respondents, 78%believed counseling families/caregivers about the impact of SB on everyday life was a shared responsibility between primary care physicians (PCP) and SB clinics. Eighty five percent of participants indicated they had exposure to SB through clinical courses or didactics in training but only 54%of participants felt knowledgeable on the impact of SB on everyday life. CONCLUSION Findings suggest a need for increased educational efforts, improved awareness of SB, and access to evidence-based guidelines for PCPs to promote accessible and coordinated care to individuals with SB.
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Affiliation(s)
- Amanda E Garver
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Salini Mohanty
- Pennsylvania Chapter of the American Academy of Pediatrics, Media, PA, USA
| | - Brad E Dicianno
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Renee M Turchi
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, PA, USA.,Drexel University College of Medicine and Dornsife School of Public Health, Philadelphia, PA, USA
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28
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Bendt M, Gabrielsson H, Riedel D, Hagman G, Hultling C, Franzén E, Eriksson M, Seiger Å. Adults with spina bifida: A cross-sectional study of health issues and living conditions. Brain Behav 2020; 10:e01736. [PMID: 32633090 PMCID: PMC7428499 DOI: 10.1002/brb3.1736] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/26/2020] [Accepted: 06/07/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To describe health issues and living conditions in a cohort of adults living with Spina bifida. MATERIAL AND METHODS A cross-sectional study was conducted by a multidisciplinary team. Adults with spina bifida (n = 219) were invited to participate. One-hundred-and-ninety-six persons (104 women and 92 men; 18-73 years, median age 33 years) were included. Structured interviews, questionnaires, and clinical assessments for medical, social, physical, and cognitive functions were used. RESULTS There was large variation among participants as regards the consequences of their spina bifida. Individuals < 46 years seemed to have more secondary conditions such as hydrocephalus, Chiari II malformation, tethered cord symptoms, and latex allergy. A higher proportion of the individuals >46 years and older was able to walk, and they had performed better in primary school and on tests of psychomotor speed and executive function. CONCLUSIONS This study demonstrates that adults with spina bifida have a complex set of physical, cognitive, and social needs that need to be addressed in order to improve their health issues and living conditions. The high prevalence of urinary and fecal incontinence, pain, and overweight underline that these issues need much attention during follow-up. The future generations of older adults may need more attention in many ways, since they at a younger age do have more complex medical conditions, lower physical and cognitive functions, and lower prerequisites for independent living and participation in society than those > 46 years today. This elucidates that adults with spina bifida need systematic follow-up services and social support throughout life.
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Affiliation(s)
- Martina Bendt
- Rehab Station Stockholm, Spinalis Outpatient Clinic, Solna, Sweden.,Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Gabrielsson
- Rehab Station Stockholm, Spinalis Outpatient Clinic, Solna, Sweden.,Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.,Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | | | - Göran Hagman
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Claes Hultling
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.,Spinalis Foundation, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Science and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.,Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Stockholms Sjukhem R&D Unit, Stockholm, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Åke Seiger
- Rehab Station Stockholm, Spinalis Outpatient Clinic, Solna, Sweden.,Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
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Janik K, Manire MA, Smith GM, Krynska B. Spinal Cord Injury in Myelomeningocele: Prospects for Therapy. Front Cell Neurosci 2020; 14:201. [PMID: 32714152 PMCID: PMC7340150 DOI: 10.3389/fncel.2020.00201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/09/2020] [Indexed: 01/10/2023] Open
Abstract
Myelomeningocele (MMC) is the most common congenital defect of the central nervous system and results in devastating and lifelong disability. In MMC, the initial failure of neural tube closure early in gestation is followed by a progressive prenatal injury to the exposed spinal cord, which contributes to the deterioration of neurological function in fetuses. Prenatal strategies to control the spinal cord injury offer an appealing therapeutic approach to improve neurological function, although the definitive pathophysiological mechanisms of injury remain to be fully elucidated. A better understanding of these mechanisms at the cellular and molecular level is of paramount importance for the development of targeted prenatal MMC therapies to minimize or eliminate the effects of the injury and improve neurological function. In this review article, we discuss the pathological development of MMC with a focus on in utero injury to the exposed spinal cord. We emphasize the need for a better understanding of the causative factors in MMC spinal cord injury, pathophysiological alterations associated with the injury, and cellular and molecular mechanisms by which these alterations are induced.
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Affiliation(s)
- Karolina Janik
- Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Meredith A Manire
- Department of Obstetrics and Gynecology, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA, United States
| | - George M Smith
- Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Barbara Krynska
- Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
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30
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Complications of Pediatric Bladder Reconstruction in the Adult Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Betz CL, Smith KA, Kysh L, Roland M, Van Speybroeck A, Castillo P, Liley F, Hudson S, Mannino JE. Psychosocial outcomes for adults with spina bifida: a scoping review protocol. JBI Evid Synth 2020; 18:1135-1143. [DOI: 10.11124/jbisrir-d-19-00072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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32
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Morley CP, Struwe S, Pratte MA, Clayton GH, Wilson PE, Dicianno BE, Formica MK, Schad LA, Thibadeau J, Turk MA. Survey of U.S. adults with spina bifida. Disabil Health J 2020; 13:100833. [DOI: 10.1016/j.dhjo.2019.100833] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/12/2019] [Accepted: 07/26/2019] [Indexed: 12/18/2022]
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Stiles-Shields C, Crowe AN, Driscoll CFB, Ohanian DM, Stern A, Wartman E, Winning AM, Wafford QE, Lattie EG, Holmbeck GN. A Systematic Review of Behavioral Intervention Technologies for Youth With Chronic Health Conditions and Physical and Intellectual Disabilities: Implications for Adolescents and Young Adults With Spina Bifida. J Pediatr Psychol 2020; 44:349-362. [PMID: 30561676 DOI: 10.1093/jpepsy/jsy097] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Behavioral intervention technologies (BITs) stand as a promising delivery mechanism that overcomes multiple condition-specific and access barriers for self-management interventions for adolescents and young adults with spina bifida (AYA-SB). The purpose of the current review was to synthesize the behavioral and self-management intervention literature in conditions that have overlapping symptoms with youth with SB and to develop a model of likely user needs for AYA-SB that promotes self-management. METHOD The search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) databases. The review was based on a systematic narrative synthesis framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092342). RESULTS In total, 18 articles were included in the current BIT review. The majority of included studies (1) targeted the management of chronic health conditions, (2) were informed by evidence-based approaches, (3) relied on content delivery, (4) were Web-based, (5) used linear or user-driven workflows, (6) included professional human support, and (7) included a control condition. CONCLUSIONS Many of the evaluated BITs resulted in acceptable usage and maintained or improved targeted symptoms. A user needs model for AYA-SB is proposed with the intention that future research will promote further refinement and ultimate deployment of a BIT for AYA-SB to promote self-management.
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Affiliation(s)
| | | | | | | | - Alexa Stern
- Psychology Department, Loyola University Chicago
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34
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Stiles-Shields C, Anderson L, Driscoll CFB, Ohanian DM, Starnes M, Stern A, Yunez J, Holmbeck GN. Technology usage and barriers to the use of behavioral intervention technologies in adolescents and young adults with spina bifida. J Pediatr Rehabil Med 2020; 13:675-683. [PMID: 32986627 DOI: 10.3233/prm-190652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The majority of behavioral intervention technologies (BITs) have been designed and targeted towards the general population (i.e., typically-developing individuals); thus, little is known about the use of BITs to aid those with special needs, such as youth with disabilities. The current study assessed adolescents and young adults with spina bifida (AYA-SB) for: 1) their technology usage, and 2) anticipated barriers to using technology to help manage their health. METHODS AYA-SB completed a survey of their media and technology usage. A card sorting task that ranked and grouped anticipated barriers to using a mobile app to manage health was also completed. Ranked means, standard deviations, and the number of times a barrier was discarded were used to interpret sample rankings. RESULTS AYA-SB reported less frequent technology and media use than the general population. However, differences emerged by age, with young adults endorsing higher usage than their younger counterparts. Top concerns focused on usability, accessibility, safety, personal barriers due to lack of engagement, technological functioning, privacy, and efficacy. CONCLUSIONS AYA-SB appear to be selective users of technology. It is therefore critical that the design of BITs address their concerns, specifically aiming to have high usability, accessibility, and engagement.
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Affiliation(s)
- Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Section of Community Behavioral Health, Rush University Medical Center, Chicago, IL, USA
| | - Lara Anderson
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | | | - Diana M Ohanian
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Meredith Starnes
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Alexa Stern
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Jessica Yunez
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
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35
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Beierwaltes P, Munoz S, Wilhelmy J. Integument: Guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2020; 13:543-548. [PMID: 33252092 PMCID: PMC7838957 DOI: 10.3233/prm-200723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Skin-related issues have a significant impact on health, activities of daily living, and quality of life among people with spina bifida. Data presented by select clinics that participate in the National Spina Bifida Patient Registry reported that 26% of individuals had a history of pressure injuries with 19% having had one in the past year. The spina bifida community lack direct guidelines on prevention of these and other skin related issues. The Integument (skin) Guidelines focus on prevention, not treatment, of existing problems. METHODS Using a consensus building methodology, the guidelines were written by experts in spina bifida and wound care. RESULTS The guidelines include age-grouped, evidence-based guidelines written in the context of an understanding of the whole person. They are presented in table format according to the age of the person with spina bifida. CONCLUSION These guidelines present a standardized approach to prevention of skin-related issues in spina bifida. Discovering what results in successful minimization of skin-related issues with testing of technology or prevention strategies is the next step in protecting this vulnerable population.
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Affiliation(s)
| | - Sharon Munoz
- Children's Hospital of Michigan, Detroit, MI, USA
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Fremion E, Kanter D, Turk M. Health promotion and preventive health care service guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2020; 13:513-523. [PMID: 33285642 PMCID: PMC7838968 DOI: 10.3233/prm-200718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Individuals with Spina Bifida (SB) have unique lifelong medical and social needs. Thus, when considering how to promote health and offer preventive care, providers must adapt general healthcare screening and counseling recommendations to their patients' physical and cognitive impairments along with discerning how to monitor secondary or chronic conditions common to the population. This article provides an update on the health promotion and preventive health care guidelines developed as part of the Spina Bifida Association's fourth edition of the Guidelines for the Care of People with Spina Bifida. The guidelines highlight accommodations needed to promote general preventive health, common secondary/chronic conditions such as obesity, metabolic syndrome, hypertension, musculoskeletal pain, and considerations for preventing acute care utilization for the SB population throughout the lifespan. Further research is needed to understand the effectiveness of preventive care interventions in promoting positive health outcomes and mitigating potentially preventable acute care utilization.
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Affiliation(s)
- Ellen Fremion
- Departments of Internal Medicine and Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - David Kanter
- Departments of Physical Medicine and Rehabilitation, Pediatrics, and Public Health and Preventive Medicine, UpstateMedical University, Syracuse, NY, USA
| | - Margaret Turk
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, Syracuse, NY, USA
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Rethlefsen S, Mueske N, Wren T, Murgai R, Bent M. The prevalence and risk factors for foot pressure ulcers in ambulatory pediatric patients with spina bifida. Disabil Rehabil 2019; 43:1287-1291. [PMID: 31480906 DOI: 10.1080/09638288.2019.1660915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM To determine prevalence, incidence and risk factors for foot pressure ulcers in ambulatory children with spina bifida. METHOD Retrospective cohort study of 72 ambulatory children (age range 0-23.9 years) with spina bifida treated at a pediatric tertiary care facility. Data on foot pressure ulcers were recorded and analyzed to determine prevalence, incidence and predictive factors. RESULTS Foot pressure ulcers occurred in 50/143 limbs (35%) over 10.5 ± 3.5 years. Average incidence was 0.10 foot pressure ulcer incidents per person-year, and prevalence in years with complete follow-up was 8.8%. Prevalence was related to age [higher for ages 11-15 (17%), than ages 0-10 (5%) and 16+ years (7%), p < 0.0001], and varus/valgus foot deformities (p < 0.001) and brace use (0.32 risk difference, p = 0.01), but not with standing foot position, deformity rigidity, body mass index, spina bifida type, lesion level, ambulatory level or co-morbidities. Most common sites were the heel (21/96, 22%), lateral malleolus (12/96, 13%), and plantar 5th metatarsal head (11/96, 12%). CONCLUSION Foot pressure ulcers occur in nearly 1 out of 10 ambulatory children with spina bifida, most often in pre-teens or young teen-agers with foot deformities, who use braces. This information can help direct skin care education and prevention to those most vulnerable.Implications for RehabilitationFoot pressure ulcers occur in children and adolescents with spina bifida, most commonly in those aged 11-15 years, with foot deformities and who use braces.Ulcer development was unrelated to stiffness of foot deformity, body mass index, lesion or functional level, or presence of comorbidities such as Arnold-Chiari malformation, syringomyelia or shunted hydrocephalus.Skin care education and preventative measures should be provided to all patients, but with particular emphasis for those with these risk factors.
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Affiliation(s)
- Susan Rethlefsen
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Nicole Mueske
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Tishya Wren
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rajan Murgai
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Melissa Bent
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Lidal IB, Lundberg Larsen K, Hoff M. 50 Years and older - born with spina bifida: participation, health issues and physical function. Disabil Rehabil 2019; 43:241-250. [PMID: 31180731 DOI: 10.1080/09638288.2019.1621953] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose: To study physical function perspectives in persons with spina bifida (SB) aged ≥50 years. In relation to this, we also wanted to survey participation perspectives, health issues and health services usage.Methods: We used predefined fixed questions to interview community-dwelling adults with SB in Norway. Physical function assessments included Timed Up and Go, the Six Minute Walk Test, and BMI was calculated. Descriptive statistics were used, and logistic regression was performed to study variables associated with community walking.Results: Eighteen women and twelve men, twenty-four of them without hydrocephalus, participated in the study. Their mean age was 57.5 years (range 51-76). The majority were well-functioning persons, with 53% employed. However, deterioration in ambulation started at a median age of 40 years in >80% of the participants. Higher odds for being a community walker were found for sacral SB, BMI < 30, and/or being more physical active per week. More than 60% of the study sample used antihypertensive medication, and 43% were obese (BMI ≥ 30). Pain was a commonly perceived health problem. About 50% had been through a comprehensive SB-specific health evaluation in adulthood.Conclusion: The striking results on obesity, hypertension, pain and deterioration in ambulatory function in middle-aged and elderly SB cases call for action. Our findings elucidate the importance of prevention and clinical follow-up throughout the lifespan, even in well-functioning SB cases.Implications for rehabilitationWeight-management and interventions to reduce hypertension are issues that need attention in follow-up and as part of secondary rehabilitation in spina bifida.Early deterioration in ambulatory function and pain in spina bifida are target areas for multidisciplinary secondary rehabilitation, and should adequately focus on maintaining or improving "real-life" functioning performance.Neurogenic bowel and fecal incontinence are important in relation to social participation in ageing spina bifida.Rehabilitation programs and research should take the level of cele and hydrocephalus into account.
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Affiliation(s)
- Ingeborg Beate Lidal
- TRS Resource Center for Rare Disorders, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | | | - Marie Hoff
- TRS Resource Center for Rare Disorders, Sunnaas Rehabilitation Hospital, Oslo, Norway
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Bennett KJ, Mann JR, Ouyang L. 30-day all-cause readmission rates among a cohort of individuals with rare conditions. Disabil Health J 2019; 12:203-208. [PMID: 30227990 PMCID: PMC6414271 DOI: 10.1016/j.dhjo.2018.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is a need to examine health care utilization of individuals with the rare conditions muscular dystrophies, spina bifida, and fragile X syndrome. These individuals have a greater need for health care services, particularly inpatient admissions. Prior studies have not yet assessed 30-day all-cause readmission rates. OBJECTIVE To estimate 30-day hospital readmission rates among individuals with three rare conditions. HYPOTHESIS Rare conditions patients will have a higher 30-day all-cause readmission rate than those without. METHODS Data from three sources (2007-2014) were combined for this case-control analysis. A cohort of individuals with one of the three conditions was matched (by age in 5 year age groups, gender, and race) to a comparison group without a rare condition. Inpatient utilization and 30-day all-cause readmission rates were compared between the two groups. Logistic regression analyses compared the odds of a 30-day all-cause readmission across the two groups, controlling for key covariates. RESULTS A larger proportion in the rare condition group had at least one inpatient visit (46.1%) vs. the comparison group (23.6%), and a higher 30-day all-cause readmission rate (Spina Bifida-46.7%, Muscular Dystrophy-39.7%, and Fragile X Syndrome-35.8%) than the comparison group (13.4%). Logistic regression results indicated that condition status contributed significantly to differences in readmission rates. CONCLUSIONS Higher rates of inpatient utilization and 30-day all-cause readmission among individuals with rare conditions vs. those without are not surprising, given the medical complexity of these individuals, and indicates an area where unfavorable outcomes may be improved with proper care coordination and post discharge care.
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Affiliation(s)
- Kevin J Bennett
- University of South Carolina, Department of Family and Preventive Medicine, Columbia, SC, USA.
| | - Joshua R Mann
- University of Mississippi Medical Center School of Medicine and John D. Bower School of Population Health, Department of Preventive Medicine, Jackson, MS, USA
| | - Lijing Ouyang
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA
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Inouye BM, Jiang R, Alkazemi MH, Wang HHS, Wolf S, Pomann GM, Tejwani R, Wiener JS, Purves JT, Routh JC. Hospital and ED charges for spina bifida care in the United States between 2006 and 2014: Over $2 billion annually. Disabil Health J 2019; 12:431-436. [PMID: 30711573 DOI: 10.1016/j.dhjo.2019.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/21/2018] [Accepted: 01/14/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND More children with spina bifida (SB) are surviving into adulthood. Unfortunately, little data exist regarding the economic implications of modern SB care. OBJECTIVE We examined economic data from two national databases to estimate the annual nationwide hospital and emergency charges of SB from 2006-14. METHODS We analyzed the 2006-2014 Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS). SB patients were defined using ICD-9-CM codes. Demographic and charge data were obtained from each database. Multiple imputation was used to estimate missing data (1.6% for NIS and 22% in NEDS). The principal outcomes were mean, median, and total charges for encounters each year. RESULTS There were 725,646 encounters for individuals with SB between 2006 and 2014. The average age of captured SB patients who were admitted to a hospital or seen in an ER was 29 years. In 2014, the median charge for inpatient encounters was $31,071 (IQR: $15,947, $63,063) and for ER encounters was $2407.02 (IQR: $1321.91, $4211.35). In total, the sum of charges from all SB-related admissions in 2014 was $1,862,016,217 (95% CI: $1.69 billion, $2.03 billion), while the sum of charges of all SB-related ER encounters in 2014 was $176,843,522 (95% CI: $158 million, $196 million). There was a steady increase in charges over the study period. CONCLUSION Charges for SB-related inpatient and emergency care in the US in 2014 was in excess of $2 billion in contrast to $1.2 billion in 2006, after adjusting for inflation; this is an impressively high figure for a relatively small number of patients.
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Affiliation(s)
- Brian M Inouye
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Ruiyang Jiang
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - M Hassan Alkazemi
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Hsin-Hsiao S Wang
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Steven Wolf
- Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA
| | - Gina-Maria Pomann
- Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA
| | - Rohit Tejwani
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - John S Wiener
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - J Todd Purves
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jonathan C Routh
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.
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Wang Y, Ouyang L, Dicianno BE, Beierwaltes P, Valdez R, Thibadeau J, Bolen J. Differences in Length of Stay and Costs Between Comparable Hospitalizations of Patients With Spina Bifida With or Without Pressure Injuries. Arch Phys Med Rehabil 2019; 100:1475-1481. [PMID: 30684491 DOI: 10.1016/j.apmr.2018.12.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To estimate differences in the length of stay and costs for comparable hospitalizations of patients with spina bifida (SB) with and without pressure injuries. DESIGN Retrospective, cross-sectional, observational study. SETTING Nationwide Inpatient Sample from years 2010-2014. PARTICIPANTS Hospitalizations of patients with SB (N=7776). Hospitalizations among patients with SB and pressure injuries (n=3888) were matched to hospitalizations among patients with SB but without pressure injuries (n=3888). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Differences in length of stay and total costs between the 2 groups. RESULTS After successful matching, multivariate modeling of costs and length of stay on matched sample showed that hospitalizations with pressure injuries had an increased 1.2 inpatient days and excess average costs of $1182 in 2014 dollars. CONCLUSIONS The estimated average cost of hospitalization increased by 10%, and the estimated average length of stay increased by 24% in the presence of pressure injuries among hospitalized patients with SB, compared with their peers without these injuries. These results highlight the substantial morbidity associated with pressure injuries, which are potentially preventable before or during hospitalizations among persons with SB.
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Affiliation(s)
- Yinding Wang
- Rare Disorders and Health Outcomes Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; McKing Consulting Corporation, Atlanta, GA
| | - Lijing Ouyang
- Rare Disorders and Health Outcomes Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Brad E Dicianno
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Patricia Beierwaltes
- School of Nursing, College of Allied Health & Nursing, Minnesota State University, Mankato, MN
| | - Rodolfo Valdez
- Rare Disorders and Health Outcomes Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Julie Bolen
- Rare Disorders and Health Outcomes Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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Abstract
With an estimated 85% of individuals with spina bifida (SB) surviving into adulthood, SB-specific transition to adult healthcare guidelines are warranted to address the diverse and complex medical, adaptive, and social needs particular to this condition. This commentary discusses the SB Transition Healthcare Guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida, reviews current transition care models in which such guidelines can be implemented, and explores further research topics in SB transition care.
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Affiliation(s)
- Ellen J Fremion
- Transition Medicine Clinic, Baylor College of Medicine, Houston, TX, USA.,Spina Bifida Transition Clinic, Texas Children's Hospital, Houston, TX, USA
| | - Nienke P Dosa
- Center for Development Behavior and Genetics, SUNY Upstate Medical University, Syracuse, NY, USA
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Kapoor R, De Carlo K, Raman L, Thibadeau J, Kancherla V. Needs assessment survey for children and adults with spina bifida in Georgia. J Pediatr Rehabil Med 2019; 12:383-392. [PMID: 31744034 DOI: 10.3233/prm-190567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE We conducted a needs assessment among parents/guardians of children and independent adults with spina bifida, served by the Spina Bifida Association of Georgia (SBAGA). The objective was to assess if SBAGA is adequately meeting the needs of its constituents and to identify challenges and opportunities to improve services. METHODS The survey targeted all members of SBAGA in 2017. Survey questions were drafted separately for parents/guardians of children, and independent adults with spina bifida. Both closed- and open-ended response options were provided. The survey was pilot-tested, and administered in English and Spanish, using email, post, or in person. RESULTS A total of 119 individuals completed the survey. For parents/guardians (n= 96), the most important needs were bladder and bowel education, social and communication skills education, medical support, and transition and independence training. Independent adults (n= 23) responded that they mostly needed bladder and bowel education, medical support, and transition and independence training. Location of the SBAGA events and transportation to the events were the most frequent limiting factors for both groups. CONCLUSIONS Our survey findings highlighted that SBAGA services are valued overall. The survey findings will be used to guide quality improvement of current programs, and develop programs addressing emerging needs and challenges.
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Affiliation(s)
- Renuka Kapoor
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Lisa Raman
- Spina Bifida Association of Georgia, Atlanta, GA, USA
| | | | - Vijaya Kancherla
- Spina Bifida Association of Georgia, Atlanta, GA, USA.,Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Riddle S, Meinzen-Derr J, Tabangin M, Woodward J, Wiley S. Emergency department utilization among pediatric spina bifida patients. J Pediatr Rehabil Med 2019; 12:375-381. [PMID: 31744029 PMCID: PMC8011457 DOI: 10.3233/prm-180561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE There is a gap in knowledge regarding the use of emergency services by pediatric spina bifida patients. The goal of this study was to describe Emergency Department utilization patterns in this population. METHODS Through a retrospective observational study, patients with spina bifida who visited the emergency department during a four-year period were identified; medical and demographic information was obtained though the Centers for Disease Control National Spina Bifida Patient Registry. Chief complaints and final diagnoses of visits were classified and related to medical needs of spina bifida to determine the appropriate care level. RESULTS Among 303 children within the registry, 161 patients (53%) accounted for 579 visits. 70% of visits were for spina bifida-related complaints. Approximately half (51.7%) had a shunt-related chief complaint, although final diagnosis was largely unrelated to the shunt. Admission rate was 39%, higher than institutional baseline, and largely represented by genitourinary (GU) complaints. CONCLUSION Pediatric patients with spina bifida presenting to a single center emergency department were most likely to present with shunt and urinary concerns; these patients were most likely to be admitted. This potentially suggests that improving outpatient care for bladder management may decrease emergency department use among this population.
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Affiliation(s)
- Stefanie Riddle
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Jareen Meinzen-Derr
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Meredith Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jason Woodward
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
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45
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Co-morbidities Associated With Early Mortality in Adults With Spina Bifida. Am J Phys Med Rehabil 2018; 97:861-865. [DOI: 10.1097/phm.0000000000000964] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Yamaki K, Wing C, Mitchell D, Owen R, Heller T. Health Service Utilization and State Costs Among Adults Aging With Early-Acquired Physical Disabilities in Medicaid Managed Care. J Aging Health 2018; 31:97S-123S. [PMID: 30442043 DOI: 10.1177/0898264318808192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: We evaluated the impact of Medicaid managed care (MMC) on health service use and state costs among adults with early-acquired physical disabilities. Method: Using claims data, we tracked utilization of the emergency department (ED), inpatient admissions, outpatient physician visits, and state expenditures on enrollees who transitioned to MMC (n = 881). The inverse propensity score weight and a difference-in-differences regression model were used to estimate the impact of MMC using their counterparts who remained in fee-for-service (n = 1,552) as the comparison group. Results: MMC reduced ED use by 3.2% points/month (p < .001). Relative to younger enrollees (age ⩽45 years), MMC reduced inpatient admissions of older enrollees (age ⩾46 years) by 3.3% points/month (p < .001), and state expenditures by US$839/month (p < .01). Discussion: MMC could reduce the hospital service use of and state spending on enrollees with early-acquired physical disabilities. This impact may vary depending on the enrollees' age.
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Mukherjee S, Pasulka J. Care for Adults with Spina Bifida: Current State and Future Directions. Top Spinal Cord Inj Rehabil 2018; 23:155-167. [PMID: 29339892 DOI: 10.1310/sci2302-155] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The care for adults with spina bifida is an important area to study. As increasing numbers of patients with spina bifida survive into adulthood, they expect to thrive and receive the best possible care into adulthood to maintain their health. Understanding the health needs in this emerging and changing population will help clinicians provide the best anticipatory care for adults with spina bifida and continue to improve outcomes. This will also impact pediatric care by improving the ability to determine preventive methods from early on and understand the impacts of pediatric care and decisions over the lifespan.
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Affiliation(s)
- Shubhra Mukherjee
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Chicago, Illinois
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48
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Crytzer TM, Keramati M, Anthony SJ, Cheng YT, Robertson RJ, Dicianno BE. Exercise Prescription Using a Group-Normalized Rating of Perceived Exertion in Adolescents and Adults With Spina Bifida. PM R 2018; 10:738-747. [PMID: 29408563 DOI: 10.1016/j.pmrj.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 01/12/2018] [Accepted: 01/20/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND People with spina bifida (SB) face personal and environmental barriers to exercise that contribute to physical inactivity, obesity, risk of cardiovascular disease, and poor aerobic fitness. The WHEEL rating of perceived exertion (RPE) Scale was validated in people with SB to monitor exercise intensity. However, the psycho-physiological link between RPE and ventilatory breakpoint (Vpt), the group-normalized perceptual response, has not been determined and would provide a starting point for aerobic exercise in this cohort. OBJECTIVES The primary objectives were to determine the group-normalized RPE equivalent to Vpt based on WHEEL and Borg Scale ratings and to develop a regression model to predict Borg Scale (conditional metric) from WHEEL Scale (criterion metric). The secondary objective was to create a table of interchangeable values between WHEEL and Borg Scale RPE for people with SB performing a load incremental stress test. DESIGN Cross-sectional observational. SETTING University laboratory. PARTICIPANTS Twenty-nine participants with SB. METHODS Participants completed a load incremented arm ergometer exercise stress test. WHEEL and Borg Scale ratings were recorded the last 15 seconds of each 1-minute test phase. OUTCOME MEASURES WHEEL and Borg Scale ratings, metabolic measures (eg, oxygen consumption, carbon dioxide production). Determined Vpt via plots of oxygen consumption and carbon dioxide production against time. RESULTS Nineteen of 29 participants achieved Vpt (Group A). The mean ± standard deviation peak oxygen consumption at Vpt for Group A was 61.76 ± 16.26. The WHEEL and Borg Scale RPE at Vpt were 5.74 ± 2.58 (range 0-10) and 13.95 ± 3.50 (range 6-19), respectively. A significant linear regression model was developed (Borg Scale rating = 1.22 × WHEEL Scale rating + 7.14) and used to create a WHEEL-to-Borg Scale RPE conversion table. CONCLUSION A significant linear regression model and table of interchangeable values was developed for participants with SB. The group-normalized RPE (WHEEL, 5.74; Borg, 13.95) can be used to prescribe and self-regulate arm ergometer exercise intensity approximating the Vpt. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Theresa M Crytzer
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Mariam Keramati
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Steven J Anthony
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Yu-Ting Cheng
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Robert J Robertson
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Brad E Dicianno
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
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Crytzer TM, Cheng YT, Bryner MJ, Wilson Iii R, Sciurba FC, Dicianno BE. Impact of neurological level and spinal curvature on pulmonary function in adults with spina bifida. J Pediatr Rehabil Med 2018; 11:243-254. [PMID: 30741703 DOI: 10.3233/prm-179451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To describe pulmonary function and determine the impact of neurological level, scoliosis, and obesity on pulmonary function in people with spina bifida (SB). METHODS Participants with SB (N= 29) (15 females; age, 30 ± 12 years) completed spirometry and body plethysmographic lung volume testing. Univariate and multivariate regression analyses were used to describe the factors associated with pulmonary function in people with SB. RESULTS Distribution of category of impairment in pulmonary function was: 55% (n= 16) restricted, 6.9% (n= 2) spirometric restricted, 1 combined obstructed and restricted, and 35.5% (n= 10) normal. In univariate analyses, neurological level was negatively associated with pulmonary function parameters, i.e., forced vital capacity (FVC) (p= 0.005), forced expiratory volume in 1 second (FEV1) (p= 0.008), total lung capacity (TLC) (p= 0.001), and degree of scoliosis were inversely associated with FVC (p= 0.005), FEV1 (p= 0.003), and TLC (p= 0.004). In multivariate models, level of lesion and degree of scoliosis independently contributed to the degree of lung function impairment. Restrictive pulmonary function was observed in 9/10 (90%) of those with thoracic neurological levels and was associated with decreased inspiratory capacity (IC) and expiratory reserve volume (ERV). Lumbar level lesions were associated with either normal lung function or an isolated reduction in FVC due to reduction in only ERV and preserved TLC representing spirometric restriction. CONCLUSIONS High prevalence of restrictive pulmonary physiology is present in people with SB, with more rostral neurological levels and greater degree of scoliosis associated with a higher degree of pulmonary function impairment.
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Affiliation(s)
- Theresa M Crytzer
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yu-Ting Cheng
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Jo Bryner
- Division of Pulmonary, Allergy, and Critical Care Medicine, Emphysema COPD Research Center, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Wilson Iii
- Division of Pulmonary, Allergy, and Critical Care Medicine, Emphysema COPD Research Center, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy, and Critical Care Medicine, Emphysema COPD Research Center, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Brad E Dicianno
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Adult Spina Bifida Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
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50
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Conklin MJ, Hopson B, Arynchyna A, Atchley T, Trapp C, Rocque BG. Skin breakdown of the feet in patients with spina bifida: Analysis of risk factors. J Pediatr Rehabil Med 2018; 11:237-241. [PMID: 30507590 PMCID: PMC6953480 DOI: 10.3233/prm-170520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Recent studies on patients with spina bifida have noted an increased incidence of skin breakdown with more proximal functional neurologic level. We hypothesized that there would be an inverse relationship between skin breakdown of the foot and severity of functional level of lesion, because patients with more caudal levels of lesion spend more time ambulating. METHODS The National Spina Bifida Patient Registry (NSBPR) at Children's of Alabama was queried for the presence of skin breakdown of the foot, ambulatory status, functional neurologic level, and diagnosis of myelomeningocoele (MMC) vs. non-myelomeningocoele (non-MMC). Univariate and multivariate analysis were performed. RESULTS Of 491 total patients, 378 were MMC and 113 were non-MMC. Eighty-five of 378 (22.5%) patients with MMC and 5 of 113 (4.4%) non-MMC patients reported skin breakdown (p= 0.009). Thoracic and lumbar levels were compared to the sacral level for statistical analysis. Skin breakdown occurred in 26.2% of thoracic (p= 0.001), 33.3% of high-lumbar (p= 0.001), 21.5% of mid-lumbar (p= 0.008), 26.2% of low-lumbar (p= 0.001), and 6.1% of sacral level patients. Ambulatory status was not significant on multivariate analysis. CONCLUSION A diagnosis of MMC is a significant, independent risk factor for skin breakdown of the foot. Compared to sacral level, thoracic and lumbar levels of function were also independently significant. Ambulatory status was not significant.
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Affiliation(s)
- Michael J Conklin
- Department of Orthopedics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Betsy Hopson
- Spina Bifida Program, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anastasia Arynchyna
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Travis Atchley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Courtney Trapp
- Department of Orthopedics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brandon G Rocque
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
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