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Hu G, Zhao Y, Fu X, Hu D, Liang X. Maternal body mass index and cerebral palsy in children: A systematic review and dose-response meta-analysis. Paediatr Perinat Epidemiol 2024; 38:345-356. [PMID: 38146616 DOI: 10.1111/ppe.13033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/20/2023] [Accepted: 12/07/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Accumulating studies indicate that maternal obesity is associated with the risk of cerebral palsy (CP); however, their conclusions have been inconsistent. OBJECTIVES To quantitatively estimate the association between maternal body mass index (BMI) and CP in offspring. DATA SOURCES PubMed, Embase and Web of Science. STUDY SELECTION AND DATA EXTRACTION Articles published up to 18 September 2022 were searched that reported the correlation between maternal BMI and CP in children. Two reviewers independently extracted data and critically assessed articles. SYNTHESIS Pooled relative risks (RR) and 95% confidence intervals (CI) were estimated by the random-effects model. Subgroup analysis and meta-regression were performed to explore sources of heterogeneity. RESULTS In total, 11 articles (8,407,668 participants) were identified for inclusion in our meta-analysis. For maternal underweight, no significant association was found with CP risk (RR 1.11, 95% CI 0.90, 1.38). The risk of CP was increased by 25% (RR 1.25, 95% CI 1.06, 1.47), 38% (RR 1.38, 95% CI 1.18, 1.61) and 127% (RR 2.27, 95% CI 1.82, 2.83) for maternal overweight, obesity and obesity grade 3, respectively. In addition, we observed a positive linear dose-response relationship, with the pooled risk of cerebral palsy in offspring increasing by 3% with each unit increase in maternal BMI. CONCLUSION This meta-analysis indicates that the risk of CP in offspring grew with maternal overweight or obesity grades increasing, and was positively correlated with maternal BMI.
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Affiliation(s)
- Guomin Hu
- The Second Department of pediatrics, The First People's Hospital of Nanyang City, Nanyang, Henan, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Xueru Fu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Dongsheng Hu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Xin Liang
- Administration Department of Nursing Affairs, The First People's Hospital of Nanyang City, Nanyang, Henan, People's Republic of China
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Pu C, Hou CH. Ophthalmic health care needs of children with disabilities. Eye (Lond) 2024; 38:481-487. [PMID: 37640829 PMCID: PMC10858193 DOI: 10.1038/s41433-023-02707-5] [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: 11/07/2022] [Revised: 07/25/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUNDS Although vision care is crucial for pediatric eye health, research on vision care utilization by children with disabilities remains limited. Furthermore, no study has investigated the variations among various disability types and the interaction between disability status and age. METHODS All children with disabilities listed in the Taiwan National Disability Registry during the study period (2015-2019) were matched by age and sex at a 1:4 ratio with children without disabilities. Vision care needs were measured on the basis of (1) the number of outpatient ophthalmology visits, (2) total medical costs associated with outpatient ophthalmology visits, and (3) whether ophthalmic care was provided. Generalized estimating equation models were estimated to determine the relationships between utilization, disability status, and age. RESULTS Significant differences in needs between various disability types were identified. Other than children with visual disability, children with facial disability and balance abnormalities also had considerable needs. Children with intellectual disabilities, which constituted the most common disability type (29.4% in 2019), had fewer visits (mean = 1.38, SD = 2.12) and lower medical costs, compared with the averages for all children with disabilities. Care utilization shared an inverted U-shaped relationship with age. CONCLUSIONS Children with disabilities have higher vision care needs, which vary by disability type and age. Such needs are greater at younger ages and decreases after the ages of 9-10 years. Policies should be specific to disability type and age to ensure vision care needs are met.
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Affiliation(s)
- Christy Pu
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chiun-Ho Hou
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
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Zhuo H, Ritz B, Warren JL, Liew Z. Season of Conception and Risk of Cerebral Palsy. JAMA Netw Open 2023; 6:e2335164. [PMID: 37738049 PMCID: PMC10517373 DOI: 10.1001/jamanetworkopen.2023.35164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/16/2023] [Indexed: 09/23/2023] Open
Abstract
Importance Cerebral palsy (CP) is the most prevalent neuromotor disability in childhood, but for most cases the etiology remains unexplained. Seasonal variation in the conception of CP may provide clues for their potential etiological risk factors that vary across seasons. Objective To evaluate whether the month or season of conception is associated with CP occurrence. Design, Setting, and Participants This statewide cohort study examined more than 4 million live births that were registered in the California birth records during 2007 to 2015 and were linked to CP diagnostic records (up to year 2021). Statistical analyses were conducted between March 2022 and January 2023. Exposures The month and season of conception were estimated based on the child's date of birth and the length of gestation recorded in the California birth records. Main Outcomes and Measures CP status was ascertained from the diagnostic records obtained from the Department of Developmental Services in California. Poisson regression was used to estimate the relative risk (RR) and 95% CI for CP according to the month or the season of conception, adjusting for maternal- and neighborhood-level factors. Stratified analyses were conducted by child's sex and neighborhood social vulnerability measures, and the mediating role of preterm birth was evaluated. Results Records of 4 468 109 children (51.2% male; maternal age: 28.3% aged 19 to 25 years, 27.5% aged 26 to 30 years; maternal race and ethnicity: 5.6% African American or Black, 13.5% Asian, 49.8% Hispanic or Latinx of any race, and 28.3% non-Hispanic White) and 4697 with CP (55.1% male; maternal age: 28.3% aged 19 to 25 years, 26.0% aged 26 to 30 years; maternal race and ethnicity: 8.3% African American or Black, 8.6% Asian, 54.3% Hispanic or Latinx of any race, and 25.8% non-Hispanic White) were analyzed. Children conceived in winter (January to March) or spring (April to June) were associated with a 9% to 10% increased risk of CP (winter: RR, 1.09 [95% CI, 1.01-1.19]; spring: RR, 1.10 [95% CI, 1.02-1.20]) compared with summer (July to September) conceptions. Analyses for specific months showed similar results with children conceived in January, February, and May being at higher risk of CP. The associations were slightly stronger for mothers who lived in neighborhoods with a high social vulnerability index, but no child sex differences were observed. Only a small portion of the estimated association was mediated through preterm birth. Conclusions and Relevance In this cohort study in California, children conceived in winter and spring had a small increase in CP risk. These findings suggest that seasonally varying environmental factors should be considered in the etiological research of CP.
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Affiliation(s)
- Haoran Zhuo
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
- Department of Neurology, School of Medicine, University of California, Los Angeles
| | - Joshua L. Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Zeyan Liew
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut
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Xu Y, Zheng X, Li Y, Ye X, Cheng H, Wang H, Lyu J. Exploring patient medication adherence and data mining methods in clinical big data: A contemporary review. J Evid Based Med 2023; 16:342-375. [PMID: 37718729 DOI: 10.1111/jebm.12548] [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: 07/04/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Increasingly, patient medication adherence data are being consolidated from claims databases and electronic health records (EHRs). Such databases offer an indirect avenue to gauge medication adherence in our data-rich healthcare milieu. The surge in data accessibility, coupled with the pressing need for its conversion to actionable insights, has spotlighted data mining, with machine learning (ML) emerging as a pivotal technique. Nonadherence poses heightened health risks and escalates medical costs. This paper elucidates the synergistic interaction between medical database mining for medication adherence and the role of ML in fostering knowledge discovery. METHODS We conducted a comprehensive review of EHR applications in the realm of medication adherence, leveraging ML techniques. We expounded on the evolution and structure of medical databases pertinent to medication adherence and harnessed both supervised and unsupervised ML paradigms to delve into adherence and its ramifications. RESULTS Our study underscores the applications of medical databases and ML, encompassing both supervised and unsupervised learning, for medication adherence in clinical big data. Databases like SEER and NHANES, often underutilized due to their intricacies, have gained prominence. Employing ML to excavate patient medication logs from these databases facilitates adherence analysis. Such findings are pivotal for clinical decision-making, risk stratification, and scholarly pursuits, aiming to elevate healthcare quality. CONCLUSION Advanced data mining in the era of big data has revolutionized medication adherence research, thereby enhancing patient care. Emphasizing bespoke interventions and research could herald transformative shifts in therapeutic modalities.
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Affiliation(s)
- Yixian Xu
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xinkai Zheng
- Department of Dermatology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yuanjie Li
- Planning & Discipline Construction Office, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xinmiao Ye
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hongtao Cheng
- School of Nursing, Jinan University, Guangzhou, China
| | - Hao Wang
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China
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Partner Violence Hospitalizations Among Adults With Intellectual Disabilities. Am J Prev Med 2023; 64:117-121. [PMID: 36163121 DOI: 10.1016/j.amepre.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/06/2022] [Accepted: 08/08/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The objective of this study is to determine the RR of intimate partner violence‒related hospitalization among men and women with and without intellectual disabilities. METHODS This is a retrospective cohort study using Healthcare Cost and Utilization Project, National Inpatient Sample, 2013-2019. Adults with intellectual disabilities were identified using diagnosis codes. A control group without intellectual disabilities was matched in a 1:5 ratio. A total of 1,179,282 hospitalization records were analyzed, with identified cases of 112,565 men and 83,982 women with intellectual disabilities. Analyses were conducted in 2021 and 2022. RESULTS Men with intellectual disabilities (RR=6.00; 95% CI=4.43, 8.13; p<0.001) were at higher risk for intimate partner violence‒related hospitalizations than men without intellectual disabilities, as were women without intellectual disabilities (RR=3.36; 95% CI=2.57, 4.39; p<0.001). Women with intellectual disabilities experienced the highest risk of intimate partner violence‒related hospitalizations (RR=16.44; 95% CI=12.60, 21.45; p<0.001). Risks remained robust after adjusting for sociodemographic and hospital characteristics. CONCLUSIONS Intellectual disability and female sex compound to elevate the risk of intimate partner violence‒related hospitalizations. This study underscores the need for improved and specialized service provision across healthcare, legal, criminal, and other systems to promote safety and healing for people with disabilities (especially for those with intellectual disabilities) who are survivors of intimate partner violence.
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Schwartz MH, Ries AJ, Georgiadis AG. Short-term causal effects of common treatments in ambulatory children and young adults with cerebral palsy: three machine learning estimates. Sci Rep 2022; 12:7818. [PMID: 35551496 PMCID: PMC9098860 DOI: 10.1038/s41598-022-11875-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/29/2022] [Indexed: 12/11/2022] Open
Abstract
Orthopedic and neurological impairments (e.g., muscle contractures, spasticity) are often treated in children and young adults with cerebral palsy (CP). Due to challenges arising from combinatorics, research funding priorities, and medical practicalities, and despite extensive study, the evidence base is weak. Our goal was to estimate the short-term effectiveness of 13 common orthopedic and neurological treatments at four different levels of outcome in children and young adults diagnosed with CP. The outcome levels considered were body structures, specific gait kinematic deviations, overall gait kinematic deviations, and functional mobility. We used three well-establish causal inference approaches (direct matching, virtual twins, and Bayesian causal forests) and a large clinical gait analysis database to estimate the average treatment effect on the treated (ATT). We then examined the effectiveness across treatments, methods, and outcome levels. The dataset consisted of 2851 limbs from 933 individuals (some individuals underwent multiple treatment episodes). Current treatments have medium effects on body structures, but modest to minimal effects on gait and functional mobility. The median ATT of 13 common treatments in children and young adults with CP, measured as Cohen's D, bordered on medium at the body structures level (median [IQR] = 0.42 [0.05, 0.60]) and became smaller as we moved along the causal chain through specific kinematic deviations (0.21 [0.01, 0.33]), overall kinematic deviations (0.09 [0.03, 0.19]), and functional mobility (-0.01 [-0.06, 0.13]). Further work is needed to understand the source of heterogeneous treatment effects, which are large in this patient population. Replication or refutation of these findings by other centers will be valuable to establish the generalizability of these results and for benchmarking of best practices.
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Affiliation(s)
- Michael H Schwartz
- Gillette Children's Specialty Healthcare, St. Paul, USA. .,Department of Orthopedic Surgery, University of Minnesota, Minneapolis, USA. .,Center for Gait and Motion Analysis, 205 University Ave. SE, St. Paul, MN, 55101, USA.
| | - Andrew J Ries
- Gillette Children's Specialty Healthcare, St. Paul, USA
| | - Andrew G Georgiadis
- Gillette Children's Specialty Healthcare, St. Paul, USA.,Department of Orthopedic Surgery, University of Minnesota, Minneapolis, USA
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Hu Y, Bian X, Wu C, Wang Y, Wu Y, Gu X, Zhuo S, Sun S. Genome-wide analysis of circular RNAs and validation of hsa_circ_0086354 as a promising biomarker for early diagnosis of cerebral palsy. BMC Med Genomics 2022; 15:13. [PMID: 35062922 PMCID: PMC8783515 DOI: 10.1186/s12920-022-01163-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background Cerebral palsy (CP) is a spectrum of non-progressive motor disorders caused by brain injury during fetal or postnatal periods. Current diagnosis of CP mainly relies on neuroimaging and motor assessment. Here, we aimed to explore novel biomarkers for early diagnosis of CP. Methods Blood plasma from five children with CP and their healthy twin brothers/sisters was analyzed by gene microarray to screen out differentially expressed RNAs. Selected differentially expressed circular RNAs (circRNAs) were further validated using quantitative real-time PCR. Receiver operating characteristic (ROC) curve analysis was used to assess the specificity and sensitivity of hsa_circ_0086354 in discriminating children with CP and healthy controls. Results 43 up-regulated circRNAs and 2 down-regulated circRNAs were obtained by difference analysis (fold change > 2, p < 0.05), among which five circRNAs related to neuron differentiation and neurogenesis were chosen for further validation. Additional 30 pairs of children with CP and healthy controls were recruited and five selected circRNAs were further detected, showing that hsa_circ_0086354 was significantly down-regulated in CP plasma compared with control, which was highly in accord with microarray analysis. ROC curve analysis showed that the area under curve (AUC) to discriminate children with CP and healthy controls using hsa_circ_0086354 was 0.967, the sensitivity was 0.833 and the specificity was 0.966. Moreover, hsa_circ_0086354 was predicted as a competitive endogenous RNA for miR-181a, and hsa_circ_0086354 expression was negatively correlated to miR-181a expression in children with CP. Conclusion Hsa_circ_0086354 was significantly down-regulated in blood plasma of children with CP, which may be a novel competent biomarker for early diagnosis of CP. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01163-6.
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Nemkova S, Boldyrev V. Complex diagnostics and treatment of cognitive dysfunctions in cerebral palsy. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:51-61. [DOI: 10.17116/jnevro202212209251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ismail A, Sk Abd Razak R, Suddin LS, Mahmud A, Kamaralzaman S, Yusri G. The Economic Burden and Determinant Factors of Parents/Caregivers of Children with Cerebral Palsy in Malaysia: A Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010475. [PMID: 35010732 PMCID: PMC8744799 DOI: 10.3390/ijerph19010475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 02/04/2023]
Abstract
The economic burden is a major concern for parents/caregivers of children with cerebral palsy (CP). This study used the sequential explanatory mixed-method approach to explorethe economic burden on parents/caregivers with a CP child in Malaysia and the factors associated with the economic burden. The study period spanned April 2020 and December 2020. A total of 106 questionnaire respondents were selected for the quantitative part, and 15 were interviewed to obtain qualitative input. A retrospective costing analysis was conducted based on the cost data obtained from the questionnaire. The majority of the children were GrossMotor Function Classification System (GMFCS) Level 5 (71%), quadriplegic (63%), and aged >4 years (90%). The estimated annual median total economic burden on the parents/caregivers per child in 2020 was RM52,540.00 (~USD12,515.03), with indirect cost being the greatest cost (RM28,800.00, ~USD6860.16), followed by developmental cost (RM16,200.00, ~USD3858.84), direct healthcare cost (RM4540.00, ~USD1081.43) and direct non-healthcare cost (RM3000.00, ~USD714.60). The annual household income was identified as a significant determinant factor (p=0.019, 95% CI: 0.04, 0.40) of the economic burden. The participants’ responses during the in-depth interview in the qualitative part of the study supported the premise that socioeconomic factors play a substantial role in determining the total economic burden. Our findings may aid local policymakers when planning the greater provision of support to the affected families in the future, especially for the parents/caregivers of children with CP, who are facing socioeconomic challenges.
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Affiliation(s)
- Aniza Ismail
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
| | - Ruhana Sk Abd Razak
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
- Correspondence: ; Tel.: +60-193009537
| | - Leny Suzana Suddin
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh 47000, Malaysia;
| | - Aidalina Mahmud
- Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia;
| | - Sazlina Kamaralzaman
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia;
| | - Ghazali Yusri
- Academy of Language Studies, Universiti Teknologi MARA, Shah Alam 40450, Malaysia;
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Nemkova S. Modern application possibilities hopanthenic acid (Pantocalcin) in treatmentdiseases of the nervous system in children. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:69-77. [DOI: 10.17116/jnevro202212205169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Oguntade HA, Nishath T, Owusu PG, Papadimitriou C, Sakyi KS. Barriers to providing healthcare to children living with cerebral palsy in Ghana: A qualitative study of healthcare provider perspectives. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001331. [PMID: 36962893 PMCID: PMC10021210 DOI: 10.1371/journal.pgph.0001331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/30/2022] [Indexed: 12/14/2022]
Abstract
Children with neurodevelopmental disabilities in low- and middle-income countries (LMICs) experience profound health and social inequities. While challenges faced by children living with disabilities and their caregivers have been widely documented, little is known about barriers faced by healthcare providers (HCPs) who serve these children. This study seeks to understand the barriers to testing, diagnosing, referral, and treatment of children living with cerebral palsy (CLWCP) from the perspectives of HCPs in Ghana. This qualitative study was conducted in the Greater Accra region of Ghana. A snowball sampling strategy was used to recruit HCPs from major hospitals, education centers, and health facilities. Data were collected through 11 semi-structured in-depth interviews (IDIs) with HCPs. Using an adapted version of the Sweat & Denison socio-ecological framework (SDSF), barriers to providing healthcare to CLWCPs were organized into superstructural, structural, environmental, relational, individual, and technological levels. We found that barriers to providing healthcare to CLWCPs exist at all levels of the adapted framework. The most salient barriers were identified at the superstructural, structural, and environmental levels. All HCPs expressed frustration with Ghana's health insurance policies and inadequacies of the health systems infrastructures, such as patient assessment rooms, health information systems, and pharmaceutical products for CP care. HCPs also reported that disability-related stigma often discourages providers in training from specializing in the area of developmental disabilities. HCPs emphasized critical challenges related to local perceptions of disability, gender norms and ideologies, and health system policies and infrastructure. Findings highlight the importance of identifying multi-level factors that can influence testing, diagnosing, referral, treatment, and provision of care for CLWCPs in Ghana. Addressing identified challenges from each level of influence may improve CLWCP's experiences throughout the care continuum.
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Affiliation(s)
- Habibat A Oguntade
- Center for Learning and Childhood Development-Ghana, Accra, Ghana
- Division of Epidemiology and Community Health, School of Public Health, Minneapolis, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Thamanna Nishath
- University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Prince G Owusu
- Center for Learning and Childhood Development-Ghana, Accra, Ghana
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, United States of America
| | - Christina Papadimitriou
- Department of Interdisciplinary Health Sciences and Sociology, School of Health Sciences, Oakland University, Rochester, Michigan, United States of America
| | - Kwame S Sakyi
- Center for Learning and Childhood Development-Ghana, Accra, Ghana
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, Michigan, United States of America
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Casseus M, Cheng J. Children with Cerebral Palsy and Unmet Need for Care Coordination. J Dev Behav Pediatr 2021; 42:605-612. [PMID: 33990510 DOI: 10.1097/dbp.0000000000000950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/15/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the physical and functional health of children with cerebral palsy (CP) and determine the prevalence and correlates of unmet need for health care coordination among this population. METHODS We analyzed data from the 2016 to 2018 National Survey of Children's Health (n = 102,341). Bivariate and multivariable analyses were conducted to compare the prevalence of chronic health conditions, functional disabilities, and care coordination among children with and without CP. Multivariable logistic regression models were used to estimate the adjusted odds ratio of comorbid conditions, functional disabilities, and unmet need for care coordination. Associations between select sociodemographic factors and unmet need for care coordination were assessed. RESULTS Children with CP had significantly higher prevalence of all the comorbid conditions and functional disabilities examined. The most prevalent health conditions among children with CP were allergies (34.2%), anxiety (26.5%), and asthma (25.1%). Notably, children with CP had higher odds of autism spectrum disorder (adjusted odds ratio [aOR] = 2.97; 95% confidence interval [CI] 1.40-6.30) and mental health conditions (aOR = 3.65; 95% CI 2.15-6.21). More than half (53.8%) of children with CP had unmet need for care coordination. They also had higher odds of unmet need for care coordination than children without CP (aOR = 2.63; 95% CI 1.69-4.10). CONCLUSION Children with CP have high prevalence of chronic health conditions and are also more likely to have unmet need for care coordination. Given the complexity of CP, our study supports the need for robust efforts to ensure that all children with CP have effective care coordination.
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Affiliation(s)
- Myriam Casseus
- Research Department, Children's Specialized Hospital, New Brunswick, NJ
| | - JenFu Cheng
- Physiatry Section, Children's Specialized Hospital, Mountainside, NJ
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Lin JL, Tawfik DS, Gupta R, Imrie M, Bendavid E, Owens DK. Health and Economic Outcomes of Posterior Spinal Fusion for Children With Neuromuscular Scoliosis. Hosp Pediatr 2021; 10:257-265. [PMID: 32079619 DOI: 10.1542/hpeds.2019-0153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Neuromuscular scoliosis (NMS) can result in severe disability. Nonoperative management minimally slows scoliosis progression, but operative management with posterior spinal fusion (PSF) carries high risks of morbidity and mortality. In this study, we compare health and economic outcomes of PSF to nonoperative management for children with NMS to identify opportunities to improve care. METHODS We performed a cost-effectiveness analysis. Our decision analytic model included patients aged 5 to 20 years with NMS and a Cobb angle ≥50°, with a base case of 15-year-old patients. We estimated costs, life expectancy, quality-adjusted life-years (QALYs), and incremental cost-effectiveness from published literature and conducted sensitivity analyses on all model inputs. RESULTS We estimated that PSF resulted in modestly decreased discounted life expectancy (10.8 years) but longer quality-adjusted life expectancy (4.84 QALYs) than nonoperative management (11.2 years; 3.21 QALYs). PSF costs $75 400 per patient. Under base-case assumptions, PSF costs $50 100 per QALY gained. Our findings were sensitive to quality of life (QoL) and life expectancy, with PSF favored if it significantly increased QoL. CONCLUSIONS In patients with NMS, whether PSF is cost-effective depends strongly on the degree to which QoL improved, with larger improvements when NMS is the primary cause of debility, but limited data on QoL and life expectancy preclude a definitive assessment. Improved patient-centered outcome assessments are essential to understanding the effectiveness of NMS treatment alternatives. Because the degree to which PSF influences QoL substantially impacts health outcomes and varies by patient, clinicians should consider shared decision-making during PSF-related consultations.
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Affiliation(s)
- Jody L Lin
- Divisions of Pediatric Hospital Medicine and .,Clinical Excellence Research Center, Stanford University, Stanford, California.,Division of Inpatient Medicine, Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, Utah; and
| | | | - Ribhav Gupta
- Division of Biomechanical Engineering, School of Engineering.,Divisions of Infectious Diseases and Geographic Medicine, and
| | | | - Eran Bendavid
- Primary Care and Population Health, Departments of Medicine and
| | - Douglas K Owens
- VA Palo Alto Health Care System, Palo Alto, California.,Stanford Health Policy, Freeman Spogli Institute for International Studies, School of Medicine, and
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14
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Ross MG. Forensic Analysis of Umbilical and Newborn Blood Gas Values for Infants at Risk of Cerebral Palsy. J Clin Med 2021; 10:1676. [PMID: 33919691 PMCID: PMC8069793 DOI: 10.3390/jcm10081676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/30/2021] [Accepted: 04/10/2021] [Indexed: 12/18/2022] Open
Abstract
Cerebral palsy litigation cases account for the highest claims involving obstetricians/gynecologists, a specialty that ranks among the highest liability medical professions. Although epidemiologic studies indicate that only a small proportion of cerebral palsy (10-20%) is due to birth asphyxia, negligent obstetrical care is often alleged to be the etiologic factor, resulting in contentious medical-legal conflicts. Defense and plaintiff expert opinions regarding the etiology and timing of injury are often polarized, as there is a lack of established methodology for analysis. The objective results provided by umbilical cord and newborn acid/base and blood gas values and the established association with the incidence of cerebral palsy provide a basis for the forensic assessment of both the mechanism and timing of fetal neurologic injury. Using established physiologic and biochemical principles, a series of case examples demonstrates how an unbiased expert assessment can aid in both conflict resolution and opportunities for clinical education.
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Affiliation(s)
- Michael G. Ross
- Department of Obstetrics and Gynecology, Geffen School of Medicine at UCLA, Torrance, CA 90509, USA;
- Department of Community Health Sciences, Fielding School of Public Health at UCLA, Torrance, CA 90509, USA
- Institute for Women’s and Children’s Health, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA 90509, USA
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15
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Rebbe R, Brown SE, Matter RA, Mienko JA. Prevalence of Births and Interactions with Child Protective Services of Children Born to Mothers Diagnosed with an Intellectual and/or Developmental Disability. Matern Child Health J 2021; 25:626-634. [PMID: 33242207 PMCID: PMC8035239 DOI: 10.1007/s10995-020-03105-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Concerns have been raised that parents with intellectual and/or developmental disabilities (IDD) interact with child protective services (CPS) at disproportionate rates than the general population as a result of bias and discrimination. However, there has been little empirical evidence to ascertain if these concerns are grounded. This study's objectives were to identify (a) the prevalence and sociodemographic characteristics of children born to mothers diagnosed with IDD diagnoses, (b) how many of these children interact with CPS (reports and removals) and (c) when these CPS interactions are occurring. METHODS The dataset was comprised of linked administrative birth, hospital discharge, and CPS records for all children born in one U.S. state between 1999 and 2013 (N = 1,271,419). CPS records were available through the first quarter of 2018 and CPS reports and removals at the child's first and fourth birthdays were identified. We conducted chi-square tests and multivariate survival Cox regression models. RESULTS A total of 567 children were identified as born to mothers with IDD diagnoses, which is 4.5 per 10,000 births. Of these children, 21.7% were the subject of a CPS report within 1 year and 35.8% within 4 years. In terms of removals, 6.5% experienced removals by 1 year and 8.6% by 4 years. CONCLUSIONS FOR PRACTICE This study provides population-based knowledge about how and when the children born to mothers diagnosed with IDD interact with CPS. These children have higher rates of CPS interactions than the general population, but these rates are not as high as previously reported.
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Affiliation(s)
- Rebecca Rebbe
- Suzanne Dwoark-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Suite 1400, Los Angeles, CA, 90015, USA.
| | - Sharan E Brown
- University Center for Excellence in Developmental Disabilities, University of Washington College of Education, Box 357920, Seattle, WA, 98195, USA
| | - Rebecca A Matter
- School of Public Health and Family Medicine, University of Cape Town, University of Cape Town Observatory, Cape Town, 7925, South Africa
| | - Joseph A Mienko
- Center for Social Sector Analytics & Technology, University of Washington School of Social Work, 4101 15th Avenue NE, Seattle, WA, 98105, USA
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16
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Glasgow MJ, Edlin R, Harding JE. Cost burden and net monetary benefit loss of neonatal hypoglycaemia. BMC Health Serv Res 2021; 21:121. [PMID: 33546675 PMCID: PMC7863541 DOI: 10.1186/s12913-021-06098-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 01/18/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Neonatal hypoglycaemia is a common but treatable metabolic disorder that affects newborn infants and which, if not identified and treated adequately, may result in neurological sequelae that persist for the lifetime of the patient. The long-term financial and quality-of-life burden of neonatal hypoglycaemia has not been previously examined. METHODS We assessed the postnatal hospital and long-term costs associated with neonatal hypoglycaemia over 80 year and 18 year time horizons, using a health-system perspective and assessing impact on quality of life using quality-adjusted life year (QALYs). A decision analytic model was used to represent key outcomes in the presence and absence of neonatal hypoglycaemia. RESULTS The chance of developing one of the outcomes of neonatal hypoglycaemia in our model (cerebral palsy, learning disabilities, seizures, vision disorders) was 24.03% in subjects who experienced neonatal hypoglycaemia and 3.56% in those who do did not. Over an 80 year time horizon a subject who experienced neonatal hypoglycaemia had a combined hospital and post-discharge cost of NZ$72,000 due to the outcomes modelled, which is NZ$66,000 greater than a subject without neonatal hypoglycaemia. The net monetary benefit lost due to neonatal hypoglycaemia, using a value per QALY of NZ$43,000, is NZ$180,000 over an 80 year time horizon. CONCLUSIONS Even under the most conservative of estimates, neonatal hypoglycaemia contributes a significant financial burden to the health system both during childhood and over a lifetime. The combination of direct costs and loss of quality of life due to neonatal hypoglycaemia means that this condition warrants further research to focus on prevention and effective treatment.
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Affiliation(s)
- Matthew J Glasgow
- Liggins Institute, University of Auckland, Private Bag 92019, Grafton, Auckland, 1142, New Zealand
| | - Richard Edlin
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Private Bag 92019, Grafton, Auckland, 1142, New Zealand.
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17
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Smith KJ, Peterson MD, Victor C, Ryan JM. Risk of dementia in adults with cerebral palsy: a matched cohort study using general practice data. BMJ Open 2021; 11:e042652. [PMID: 33495255 PMCID: PMC7839844 DOI: 10.1136/bmjopen-2020-042652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Determine the risk of incident dementia in adults with cerebral palsy (CP) compared with age, sex and general practice (GP) matched controls. DESIGN Retrospective cohort study. SETTING UK GPs linked into the Clinical Practice Research Datalink (CPRD). PARTICIPANTS CPRD data were used to identify adults aged 18 or older with a diagnosis of CP. Each adult with CP was matched to three controls who were matched for age, sex and GP. In total, 1703 adults with CP and 5109 matched controls were included in the analysis. The mean baseline age of participants was 33.30 years (SD: 15.48 years) and 46.8% of the sample were female. PRIMARY OUTCOME New diagnosis of dementia during the follow-up period (earliest date of 1987 to latest date of 2015). RESULTS During the follow-up, 72 people were identified with a new diagnosis of dementia. The overall proportion of people with and without CP who developed dementia was similar (CP: n=19, 1.1%; matched controls n=54, 10.0%). The unadjusted HR suggested that people with CP had an increased hazard of being diagnosed with dementia when compared with matched controls (HR 2.69, 95% CI 1.44 to 5.00). This association was attenuated when CP comorbidities (sensory impairment, intellectual disability and epilepsy) were accounted for (HR 1.92, 95% CI 0.92 to 4.02). CONCLUSIONS There was no difference in the proportion of people with CP and matched controls who were diagnosed with dementia during the follow-up. Furthermore, while there was evidence for an increased hazard of dementia among people with CP, the fact that this association was attenuated after controlling for comorbidities indicates that this association may be explained by comorbidities rather than being a direct result of CP. Findings should be interpreted with caution due to the low number of incident cases of dementia.
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Affiliation(s)
| | - Mark D Peterson
- Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Christina Victor
- College of Medical Health and Life sciences, Brunel University College of Health and Life Sciences, Uxbridge, UK
| | - Jennifer M Ryan
- Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
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18
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Zeidan J, Joseph L, Camden C, Shevell M, Oskoui M, Lamotte P, Shikako-Thomas K. Look Around Me: Environmental and Socio-Economic Factors Related to Community Participation for Children with Cerebral Palsy in Québec. Phys Occup Ther Pediatr 2021; 41:429-446. [PMID: 33487079 DOI: 10.1080/01942638.2020.1867693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Aims: This study aimed at gaining a deeper understanding of the environmental and socio-economic factors affecting participation outcomes in community and leisure activities for children with disabilities, as well as the trajectories of participation for these children to promote their health and guarantee their rights are respected.Methods: A participatory action research (PAR) approach and linear regression analysis were employed to identify contextual factors associated with the community participation of children with cerebral palsy (CP) living in Quebec, Canada. Stakeholders engaged through the entire research process supported the development of questionnaires, data collection, analysis and interpretation of results.Results: Neighborhood outings were ranked among the most practiced activities by children with CP. Only in a few cases (9%) did children participate in more than two types of activities outside of school. Factors limiting children's participation were predominantly extrinsic in origin, including financial burden and lack of information about existing opportunities.Conclusions: There is a serious need for communities and local governments to inform parents about available resources, programs and policies that can support their child's participation. Rehabilitation professionals could partner with stakeholders to inform the development of public policies that target the identified barriers and promote children's integration and fulfillment.
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Affiliation(s)
- Jinan Zeidan
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Lawrence Joseph
- Department of Epidemiology and Statistics, McGill University, Montreal, Canada
| | - Chantal Camden
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Michael Shevell
- Department of Neurology, McGill University Health Center, Montreal, Canada
| | - Maryam Oskoui
- Department of Pediatrics, McGill University, Montreal, Canada
| | - Patricia Lamotte
- Office des Personnes Handicapées du Québec (OPHQ), Drummondville, Québec, Canada
| | - Keiko Shikako-Thomas
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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MHlthMgt MJG, Edlin R, Harding JE. Cost-Utility Analysis of Prophylactic Dextrose Gel vs Standard Care for Neonatal Hypoglycemia in At-Risk Infants. J Pediatr 2020; 226:80-86.e1. [PMID: 32634402 PMCID: PMC7779688 DOI: 10.1016/j.jpeds.2020.06.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the long-term costs and impact on quality of life of using prophylactic dextrose gel in patients at increased risk of developing neonatal hypoglycemia. STUDY DESIGN A cost-utility analysis was performed from the perspective of the health system, using a decision tree to model the long-term clinical outcomes of neonatal hypoglycemia, including cerebral palsy, epilepsy, vision disturbances, and learning disabilities, in patients at increased risk of neonatal hypoglycemia who received prophylactic dextrose gel vs standard care. Model parameters including likelihoods of hypoglycemia and admission to a neonatal intensive care unit, were based on the pre-Hypoglycemia Prevention with Oral Dextrose Study. Estimations of the likelihood of long-term condition(s), and their costs, were based on review of published literature. RESULTS Patients who received prophylactic dextrose gel incurred costs to the health system of around US $14 000 over an 18-year time horizon, accruing 11.25 quality-adjusted life-years, whereas those who did not receive prophylactic treatment incurred cost of around $16 000 and experienced a utility of 11.10 quality-adjusted life-years. CONCLUSIONS A prophylactic strategy of using dextrose gel in infants at increased risk of neonatal hypoglycemia is likely to be cost effective compared with standard care, to reduce the direct costs to the health system over an 18-year time horizon, and improve quality of life.
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Affiliation(s)
| | - Richard Edlin
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand.
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20
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Bertule D, Vetra A. Needs of Families with Children with Cerebral Palsy in Latvia and Factors Affecting These Needs. J Pers Med 2020; 10:E139. [PMID: 32971768 PMCID: PMC7563296 DOI: 10.3390/jpm10030139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022] Open
Abstract
In order to provide targeted support to families who are raising children with developmental disorders, it is important to study the family needs and to understand circumstances that may affect them. The aim of this study was to identify the needs of the families with preschool children with cerebral palsy, and study how these needs relate to factors associated with families, children and rehabilitation services. Descriptive analysis showed that families living in Latvia most often need information, social and financial support and coordination of services, and they also need financial support to cover the costs of child care and treatment. The results of the data analysis support the hypothesis that factors characterising families, children with cerebral palsy and rehabilitation services affect the needs of the families with preschool children with cerebral palsy living in Latvia, and the unique impact of these factors depends on the type of needs. Regression analysis revealed that the most important factors affecting the needs of families were related with the socio-economic situation, as well as the support of peers and professionals. The availability and regularity of rehabilitation services, limitations to the child's functions and health impairments were factors that affected family needs to a lesser extent.
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Affiliation(s)
- Dace Bertule
- Department of Rehabilitation, Riga Stradins University, LV-1007 Riga, Latvia;
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21
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Johnston K, Danchenko N, Hansen R, Dinet J, Liovas A, Armstrong A, Bains S, Sullivan SD. Cost effectiveness and impact on quality of life of abobotulinumtoxinA and onabotulinumtoxinA in the treatment of children with lower limb spasticity in Canada. J Med Econ 2020; 23:631-640. [PMID: 31985313 DOI: 10.1080/13696998.2020.1722138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Injectable botulinum neurotoxins are a mainstay of treatment for pediatric spasticity. AbobotulinumtoxinA and onabotulinumtoxinA are both injectable toxin therapies used to treat pediatric lower limb (PLL) spasticity in Canada. The objective of this study was to assess the cost-effectiveness of abobotulinumtoxinA vs. onabotulinumtoxinA in the treatment of PLL spasticity in Canada.Methods: A probabilistic Markov cohort model with a 2-year time horizon was developed, with health states defined by response to therapy, as characterized by the goal attainment scale (GAS). Based on randomized controlled trial evidence, response to therapy was similar or higher for abobotulinumtoxinA relative to onabotulinumtoxinA; uncertainty was incorporated into model parameters, however, as the two therapies have not been compared head-to-head. Canadian resource use and cost data were incorporated.Results: In the base case, abobotulinumtoxinA generated 1.48 quality-adjusted life years over the model time horizon, compared to 1.47 for onabotulinumtoxinA. AbobotulinumtoxinA was associated with cost savings of $123 CAD, reflecting lower costs in both medication acquisition and health services. The estimated improvement to quality of life and reduced costs result in an estimate of economic dominance for abobotulinumtoxinA over onabotulinumtoxinA. This dominant result persisted across probabilistic and scenario analyses.Key points for decision makersBased on a review of available clinical evidence, abobotulinumtoxinA was found to have significant and/or numerical efficacy benefits to onabotulinumtoxinA on functional outcomes (Goal Attainment Scale) and tone (Modified Ashworth Scale) and in the treatment of pediatric lower limb spasticityIn this cost-effectiveness analysis, abobotulinumtoxinA was found to be associated with greater quality-adjusted life years and lower costs than onabotulinumtoxinA (economically dominant)A limitation of this analysis was the uncertainty around key parameters. Specifically, the lack of head-to-head comparison data for the two therapies, and variable data regarding likely onabotulinumtoxinA dosing in PLL in clinical practice. However, across a range of plausible scenarios, the economic dominant result remained.
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Affiliation(s)
- Karissa Johnston
- Broadstreet Health Economics and Outcomes Research, Vancouver, Canada
| | | | - Ryan Hansen
- Choice Institute, University of Washington, Seattle, WA, USA
| | - Jerome Dinet
- Ipsen Biopharmaceuticals Canada, Mississauga, Canada
| | - Anna Liovas
- Ipsen Biopharmaceuticals Canada, Mississauga, Canada
| | - Ava Armstrong
- Ipsen Biopharmaceuticals Canada, Mississauga, Canada
| | | | - Sean D Sullivan
- Choice Institute, University of Washington, Seattle, WA, USA
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Abstract
Cerebral palsy (CP), defined as a group of nonprogressive disorders of movement and posture, is the most common cause of severe neurodisability in children. The prevalence of CP is the same across the globe, affecting approximately 17 million people worldwide. Cerebral Palsy is an umbrella term used to describe the disease due to its inherent heterogeneity. For instance, CP has multiple (1) causes; (2) clinical types; (3) patterns of neuropathology on brain imaging and (4) it's associated with several developmental pathologies such as intellectual disability, autism, epilepsy, and visual impairment. Understanding its physiopathology is crucial to developing protective strategies. Despite its importance, there is still insufficient progress in the areas of CP prediction, early diagnosis, treatment, and prevention. Herein we describe the current risk factors and biomarkers used for the diagnosis and prediction of CP. With the advancement in biomarker discovery, we predict that our understanding of the etiopathophysiology of CP will also increase, lending to more opportunities for developing novel treatments and prognosis.
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Affiliation(s)
- Zeynep Alpay Savasan
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Beaumont Health System, Royal Oak, MI, United States; Oakland University-William Beaumont School of Medicine, Beaumont Health, Royal Oak, MI, United States.
| | - Sun Kwon Kim
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Beaumont Health System, Royal Oak, MI, United States; Oakland University-William Beaumont School of Medicine, Beaumont Health, Royal Oak, MI, United States
| | - Kyung Joon Oh
- Beaumont Research Institute, Beaumont Health, Royal Oak, MI, United States; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea; Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Stewart F Graham
- Oakland University-William Beaumont School of Medicine, Beaumont Health, Royal Oak, MI, United States; Beaumont Research Institute, Beaumont Health, Royal Oak, MI, United States
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Abstract
Objective To apply practice-based evidence to clinical management of cerebral palsy (CP). The process of establishing purpose, structure, logistics, and elements of a multi-institutional registry and the baseline characteristics of initial enrollees are reported. Design A consensus-building process among consumers, clinicians, and researchers used a participatory action process. Setting Community, hospitals, and universities. Participants More than 100 clinicians, researchers, and consumers and more than 1858 enrollees in the registry. Main Outcome Measures Not applicable. Results Consensus was that the purpose of registry was to (1) quantify practice variation, (2) facilitate quality improvement (QI), and (3) perform comparative effectiveness research (CER). Collecting data during routine clinical care using the electronic medical record was determined to be a sustainable plan for data acquisition and management. Clinicians from multiple disciplines defined salient characteristics of individuals and interventions for the registry elements. The registry was central to the clinical research network, and a leadership structure was created. A leading electronic health record platform adopted the registry elements. Twenty-four sites have initiated the data collection process and agreed to export data to the registry. Currently 12 are collecting data. Number of enrollees and characteristics were similar to other population registers. Conclusions This is the first multi-institutional CP registry that contains the patient and treatment characteristics needed for QI and CER. The Cerebral Palsy Research Network registry elements are implemented in a versatile electronic platform and minimize burden to clinicians. The resultant registry is available for any institution to participate and is growing rapidly.
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Key Words
- CDE, common data element
- CER, comparative effectiveness research
- CP, cerebral palsy
- CPRN, Cerebral Palsy Research Network
- Cerebral palsy
- Comparative effectiveness research
- EHR, electronic health record
- GMFCS, Gross Motor Function Classification System
- HCRN, Hydrocephalus Clinical Research Network
- IRB, Institutional Review Board
- LFEP, Learn from Every Patient
- NCH, Nationwide Children’s Hospital
- NINDS, National Institute of Neurological Disorders and Stroke
- OT, occupational therapy
- PT, physical therapy
- QI, quality improvement
- Quality improvement
- REDCap, Research Electronic Data Capture
- Rehabilitation
- SLP, speech language pathology
- VON, Vermont Oxford Network
- registries
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Doble B, Schofield D, Evans CA, Groza T, Mattick JS, Field M, Roscioli T. Impacts of genomics on the health and social costs of intellectual disability. J Med Genet 2020; 57:479-486. [PMID: 31980565 DOI: 10.1136/jmedgenet-2019-106445] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/17/2019] [Accepted: 01/03/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study provides an integrated assessment of the economic and social impacts of genomic sequencing for the detection of monogenic disorders resulting in intellectual disability (ID). METHODS Multiple knowledge bases were cross-referenced and analysed to compile a reference list of monogenic disorders associated with ID. Multiple literature searches were used to quantify the health and social costs for the care of people with ID. Health and social expenditures and the current cost of whole-exome sequencing and whole-genome sequencing were quantified in relation to the more common causes of ID and their impact on lifespan. RESULTS On average, individuals with ID incur annual costs in terms of health costs, disability support, lost income and other social costs of US$172 000, accumulating to many millions of dollars over a lifetime. CONCLUSION The diagnosis of monogenic disorders through genomic testing provides the opportunity to improve the diagnosis and management, and to reduce the costs of ID through informed reproductive decisions, reductions in unproductive diagnostic tests and increasingly targeted therapies.
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Affiliation(s)
- Brett Doble
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia .,Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Deborah Schofield
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,GenImpact, School of Economics, Faculty of Business and Economics, Macquarie University, Sydney, New South Wales, Australia
| | - Carey-Anne Evans
- Neuroscience Research Australia, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Tudor Groza
- Pryzm Health, Gold Coast, Queensland, Australia
| | - John S Mattick
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Mike Field
- The Genetics of Learning Disability Service, Waratah, New South Wales, Australia
| | - Tony Roscioli
- Neuroscience Research Australia, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia.,NSW Health Pathology East Laboratory, Prince of Wales Private Hospital, Randwick, New South Wales, Australia
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Bahrampour M, Downes M, Boyd RN, Scuffham PA, Byrnes J. Using Rasch and factor analysis to develop a Proxy-Reported health state classification (descriptive) system for Cerebral Palsy. Disabil Rehabil 2020; 43:2647-2655. [DOI: 10.1080/09638288.2019.1709565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Mina Bahrampour
- Centre for Applied Health Economics, School of Medicine & Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Martin Downes
- Centre for Applied Health Economics, School of Medicine & Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Roslyn N. Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children’s Health Research, The University of Queensland, Brisbane, Australia
| | - Paul A. Scuffham
- Centre for Applied Health Economics, School of Medicine & Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine & Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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Gannotti ME, Wilson JL, Bagley AM, Oeffinger D. Adults with cerebral palsy rank factors associated with quality of life and perceived impact of childhood surgery on adult outcomes. Disabil Rehabil 2019; 43:2431-2438. [PMID: 31881158 DOI: 10.1080/09638288.2019.1701718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mary E. Gannotti
- Department of Rehabilitation, University of Hartford, West Hartford, CT, USA
| | | | - Anita M. Bagley
- Shriners Hospital for Children Sacramento, Sacramento, CA, USA
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Ottolenghi S, Rubino FM, Sabbatini G, Coppola S, Veronese A, Chiumello D, Paroni R. Oxidative Stress Markers to Investigate the Effects of Hyperoxia in Anesthesia. Int J Mol Sci 2019; 20:ijms20215492. [PMID: 31690051 PMCID: PMC6862279 DOI: 10.3390/ijms20215492] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 12/15/2022] Open
Abstract
Oxygen (O2) is commonly used in clinical practice to prevent or treat hypoxia, but if used in excess (hyperoxia), it may act as toxic. O2 toxicity arises from the enhanced formation of Reactive Oxygen Species (ROS) that exceed the antioxidant defenses and generate oxidative stress. In this study, we aimed at assessing whether an elevated fraction of inspired oxygen (FiO2) during and after general anesthesia may contribute to the unbalancing of the pro-oxidant/antioxidant equilibrium. We measured five oxidative stress biomarkers in blood samples from patients undergoing elective abdominal surgery, randomly assigned to FiO2 = 0.40 vs. 0.80: hydroperoxides, antioxidants, nitrates and nitrites (NOx), malondialdehyde (MDA), and glutathionyl hemoglobin (HbSSG). The MDA concentration was significantly higher 24 h after surgery, and the body antioxidant defense lower, in the FiO2 = 0.80 group with respect to both the FiO2 = 0.40 group and the baseline values (p ≤ 0.05, Student’s t-test). HbSSG in red blood cells was also higher in the FiO2 = 0.80 group at the end of the surgery. NOx was higher in the FiO2 = 0.80 group than the FiO2 = 0.40 group at t = 2 h after surgery. MDA, the main end product of the peroxidation of polyunsaturated fatty acids directly influenced by FiO2, may represent the best marker to assess the pro-oxidant/antioxidant equilibrium after surgery.
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Affiliation(s)
- Sara Ottolenghi
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy.
| | - Federico Maria Rubino
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy.
| | - Giovanni Sabbatini
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, 20142 Milan, Italy.
| | - Silvia Coppola
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, 20142 Milan, Italy.
| | - Alice Veronese
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, 20142 Milan, Italy.
| | - Davide Chiumello
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy.
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, 20142 Milan, Italy.
- Coordinated Research Center on Respiratory Failure, University of Milan, 20123 Milan, Italy.
| | - Rita Paroni
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy.
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Lucas A, Sinha A, Fowler KB, Mladsi D, Barnett C, Samant S, Gibson L. A framework for assessing the lifetime economic burden of congenital cytomegalovirus in the United States. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2019; 17:21. [PMID: 31592087 PMCID: PMC6775673 DOI: 10.1186/s12962-019-0189-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/23/2019] [Indexed: 11/26/2022] Open
Abstract
Background In the United States (US), congenital cytomegalovirus infection (cCMVi) is a major cause of permanent disabilities and the most common etiology of non-genetic sensorineural hearing loss. Evaluations of prevention strategies will require estimates of the economic implications of cCMVi. We aimed to develop a conceptual framework to characterize the lifetime economic burden of cCMVi in the US and to use that framework to identify data gaps. Methods Direct health care, direct non-health care, indirect, and intangible costs associated with cCMVi were considered. An initial framework was constructed based on a targeted literature review, then validated and refined after consultation with experts. Published costs were identified and used to populate the framework. Data gaps were identified. Results The framework was constructed as a chance tree, categorizing clinical event occurrence to form patient profiles associated with distinct economic trajectories. The distribution and magnitude of costs varied by patient life stage, cCMVi diagnosis, severity of impairment, and developmental delays/disabilities. Published studies could not fully populate the framework. The literature best characterized direct health care costs associated with the birth period. Gaps existed for direct non-health care, indirect, and intangible costs, as well as health care costs associated with adult patients and those severely impaired. Conclusions Data gaps exist concerning the lifetime economic burden of cCMVi in the US. The conceptual framework provides the basis for a research agenda to address these gaps. Understanding the full lifetime economic burden of cCMVi would inform clinicians, researchers, and policymakers, when assessing the value of cCMVi interventions.
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Affiliation(s)
- Aaron Lucas
- 1RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Anushua Sinha
- 2Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ USA
| | - Karen B Fowler
- 3University of Alabama at Birmingham, Birmingham, AL USA
| | - Deirdre Mladsi
- 1RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Christine Barnett
- 1RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Salome Samant
- 2Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ USA
| | - Laura Gibson
- 4University of Massachusetts Medical School, Worcester, MA USA
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Badaru UM, Abdulrahman H, Ahmad RY, Lawal IU, Zakari MK. Analysis of Direct Monthly Cost of Outpatient Hospital-Based Care for Children With Cerebral Palsy in Kano, Nigeria. Value Health Reg Issues 2019; 19:145-150. [PMID: 31472422 DOI: 10.1016/j.vhri.2019.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/04/2019] [Accepted: 07/15/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children with cerebral palsy require effective, accessible and affordable medical and rehabilitation care. OBJECTIVE The aim of this study was to evaluate the direct monthly cost of outpatient hospital-based care for children with cerebral palsy (CP) in Kano City, Nigeria. METHODS The study was a cross-sectional survey. Consenting participants were recruited using the purposive sampling technique. Data on cost of medical and physiotherapy consultations, number of consultations per month, cost of diagnostic investigations, and out-of-pocket expenditures were captured using a researcher-designed questionnaire. Data were analyzed with descriptive statistics using Microsoft Excel and SPSS version 20. RESULTS A total of 106 children with CP and their caregivers participated in this study. The mean age of the children was 3.18 ± 1.90 years and that of their caregivers was 27.32 ± 4.63 years. The average direct cost of outpatient care per month was ₦14 295.38 (Nigerian naira) ($46.87) ± ₦13 211.52 ($43.32). The average monthly cost of physiotherapy was ₦503.77 ($1.65) ± ₦220.79 ($0.72), whereas those for transportation and radiological investigations were ₦1861.49 ($6.10) ± ₦1435.06 ($4.71) and ₦3771.46 ($12.37) ± ₦5135.32 ($16.84), respectively. CONCLUSION The average direct monthly cost of providing outpatient hospital-based care for children with CP in Kano City, Nigeria may not be affordable because most of the participants earned very meager monthly incomes. The highest medical cost was incurred from radiological investigation, whereas transportation was the most important out-of-pocket cost. The Nigerian government should make a policy decision for the automatic enrollment of all children diagnosed with CP into the National Health Insurance Scheme.
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Affiliation(s)
- Umaru M Badaru
- Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria.
| | - Hassan Abdulrahman
- Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria
| | - Rufai Y Ahmad
- Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria
| | - Isa U Lawal
- Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria
| | - Musa K Zakari
- Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria
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Carter B, Verity Bennett C, Bethel J, Jones HM, Wang T, Kemp A. Identifying cerebral palsy from routinely-collected data in England and Wales. Clin Epidemiol 2019; 11:457-468. [PMID: 31239784 PMCID: PMC6556471 DOI: 10.2147/clep.s200748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/19/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose: An observational study using routinely-collected health care data to describe the extent to which children and young people (CYP) with cerebral palsy (CP) can be identified and the prevalence of CP can be estimated. Patients and methods: Routinely-collected anonymized data, for CYP (aged 0–25 years old between 1 January 2004 and 31 December 2014) were analyzed in two linked datasets, from England and Wales respectively. Datasets included National Health Service; General Practitioner (GP), inpatients, outpatients, and national mortality records. CP was identified using ICD-10 codes G80.0–G83.3 and equivalent Read v2 codes. Ascertainment rates of CP were identified for each data source and compared between countries. Frequency and consistency of coding were investigated, and prevalence of CP estimated. Results: A total of 7,113 and 5,218 CYP with CP were identified in the English and Welsh datasets respectively. Whilst the majority of CYP with CP would be expected to attend their GP, 65.3% (4,646/7,113) of English and 65.1% (3,396/5,218) of Welsh cases were ascertained from GP datasets. Further cases were identified solely in inpatient datasets (2,410 in England, 1,813 in Wales). Few cases were coded for CP within outpatient datasets. Four character codes that specified CP type were rarely used; one in five health care records were coded both with G80 codes (explicitly CP) and with G81–83 codes (other paralytic syndromes) or equivalent Read codes. Estimated period prevalence of CYP with CP was 2.5–3.4 per 1,000 in England and 2.4–3.2 per 1,000 in Wales. Conclusion: In England and Wales, coding of CP in routine data is infrequent, inconsistent, non-specific, and difficult to isolate from conditions with similar physical signs. Yet the prevalence estimates of CP were similar to those reported elsewhere. To optimize case recognition we recommend improved coding quality and the use of both primary and secondary care datasets as a minimum.
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Affiliation(s)
- Bethan Carter
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - C Verity Bennett
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Jackie Bethel
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Hywel M Jones
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Ting Wang
- Swansea Medical School, Swansea University, Swansea, UK
| | - Alison Kemp
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Intranasal Delivery of Mesenchymal Stromal Cells Protects against Neonatal Hypoxic⁻Ischemic Brain Injury. Int J Mol Sci 2019; 20:ijms20102449. [PMID: 31108944 PMCID: PMC6566762 DOI: 10.3390/ijms20102449] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 01/05/2023] Open
Abstract
Cerebral palsy (CP) is a permanent motor disorder that results from brain injury and neuroinflammation during the perinatal period. Mesenchymal stromal cells (MSCs) have been explored as a therapy in multiple adult neuroinflammatory conditions. Our study examined the therapeutic benefits of intranasal delivery of human umbilical cord tissue (UC) derived-MSCs in a rat model of neonatal hypoxic–ischemic (HI) brain injury. To do this, HI was performed on postnatal day 10 Sprague-Dawley rat pups via permanent ligation of the left carotid artery, followed by a hypoxic challenge of 8% oxygen for 90 min. A total of 200,000 UC-MSCs (10 million/kg) were administered intranasally 24 h post-HI. Motor control was assessed after seven days, followed by post-mortem. Analysis included brain immunohistochemistry, gene analysis and serum cytokine measurement. Neonatal HI resulted in brain injury with significant loss of neurons, particularly in the hippocampus. Intranasal administration of UC-MSCs significantly reduced the loss of brain tissue and increased the number of hippocampal neurons. HI significantly upregulated brain inflammation and expression of pro-inflammatory cytokines, while intranasal UC-MSCs significantly reduced markers of neuroinflammation. This study demonstrated that a clinically relevant dose (10 million/kg) of UC-MSCs was neuroprotective following HI by restoring neuronal cell numbers and reducing brain inflammation. Therefore, intranasal delivery of UC-MSCs may be an effective therapy for neonatal brain injury.
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LI QING, KINSMAN STEPHENL, JENKINS DOROTHEAD, HOVELL MELBOURNEF, RYAN RITAM. Decreasing prevalence of cerebral palsy in birth cohorts in South Carolina using Medicaid, disability service, and hospital discharge data, 1996 to 2009. Dev Med Child Neurol 2019; 61:593-600. [PMID: 30417338 PMCID: PMC6450726 DOI: 10.1111/dmcn.14085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 11/27/2022]
Abstract
AIM Since cross-sectional trends of 8-year-old cerebral palsy (CP) birth prevalence based on record review were stable from 1985 to 2002 in Metropolitan Atlanta, we examined birth cohort trends using administrative data sets promptly. METHOD Among 755 433 live births from 1996 to 2009 in South Carolina, 2080 received CP diagnosis by age 4 years from linked Medicaid claims with International Classification of Diseases, Ninth Revision codes 343.X (contributing 1061 [51%] unique cases), hospital discharge data (57 [3%] unique cases), and Department of Disabilities and Special Needs program (64 [3%] unique cases). Trends were assessed using negative binominal regression. RESULTS Including 3.7 percent of cases who died before age 4 years, CP prevalence per 1000 live births decreased significantly from 3.6 in 1996 to 2.1 in 2006 (-3.0% average annual change; 95% confidence interval -4.4 to -1.6). The overall prevalence was 2.8 per 1000 live births, 46.0 per 1000 very-low-birthweight (VLBW) live births, and 53.0 per 1000 VLBW 1-year survivors. Disparities and downward trends persisted across subgroups with higher rates among non-Hispanic black infants than non-Hispanic white and among males compared to females. INTERPRETATION Downward CP prevalence rates and persistent disparities remain in South Carolina. Further research should validate this methodology, including early deaths, and develop broad surveillance systems to inform clinical practices and etiology. WHAT THIS PAPER ADDS Birth cohort cerebral palsy (CP) prevalence decreased in South Carolina from 1996 to 2009. CP prevalence was higher in very-low-birthweight infants, non-Hispanic blacks, and males. Three administrative data sets captured 2080 patients with CP in South Carolina. Medicaid claims contributed 51% of unique cases of CP to the cohort. CP diagnoses included 76 patients who died before age 4 years.
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Affiliation(s)
- QING LI
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA,Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - STEPHEN L. KINSMAN
- Department of Pediatrics, Division of Pediatric Neurology, Medical University of South Carolina, Charleston, SC
| | - DOROTHEA D JENKINS
- Department of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC, USA
| | - MELBOURNE F HOVELL
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA
| | - RITA M RYAN
- Department of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC, USA
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Holland H, Blazek K, Haynes MP, Dallman A. Improving postural symmetry: The effectiveness of the CATCH (Combined Approach to Treatment for Children with Hemiplegia) protocol. J Pediatr Rehabil Med 2019; 12:139-149. [PMID: 31227666 DOI: 10.3233/prm-180550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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 evaluate postural symmetry in sitting and standing for children with hemiplegic cerebral palsy (hCP) following the Combined Approach to Treatment for Children with Hemiplegia (CATCH) protocol, an intervention combining Constraint Induced Movement Therapy, Bimanual Intensive Therapy and Neuro-Developmental Treatment. METHODS The study included 10 children with a diagnosis of hCP and 10 typically developing age-matched peers. Subjects participated in a CATCH camp for six hours daily for eight consecutive days. Postural symmetry measurements in quiet sitting and standing were obtained using a Boditrak pressure-mapping system at four time points: prior to start of camp (T1), first day of camp (T2), last day of camp (T3), and one month post-camp (T4). RESULTS Significant differences (p< 0.05) were found in quiet sitting when comparing postural symmetry pre-intervention and one-month post camp. In quiet standing, significant differences (p< 0.05) were found when pre-intervention was compared to one-month post-intervention. One month post-intervention, the intervention group showed no significant difference from the comparison group. CONCLUSIONS Children with hCP demonstrate improvement in postural symmetry in sitting and standing following participation in a CATCH camp. Following the intervention, children with hCP continued to improve postural symmetry and approach age-matched peers.
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Affiliation(s)
- Holly Holland
- Rehabilitation Therapies, University of North Carolina Health Care, Chapel Hill, NC, USA
| | - Kerry Blazek
- Rehabilitation Therapies, University of North Carolina Health Care, Chapel Hill, NC, USA
| | - Margo Prim Haynes
- NDT Pediatric Therapy, Adjunct Faculty UNC-CH in the Division of Physical Therapy, Rockingham, NC, USA
| | - Aaron Dallman
- Occupational Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Korzeniewski SJ, Slaughter J, Lenski M, Haak P, Paneth N. The complex aetiology of cerebral palsy. Nat Rev Neurol 2018; 14:528-543. [PMID: 30104744 DOI: 10.1038/s41582-018-0043-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cerebral palsy (CP) is the most prevalent, severe and costly motor disability of childhood. Consequently, CP is a public health priority for prevention, but its aetiology has proved complex. In this Review, we summarize the evidence for a decline in the birth prevalence of CP in some high-income nations, describe the epidemiological evidence for risk factors, such as preterm delivery and fetal growth restriction, genetics, pregnancy infection and other exposures, and discuss the success achieved so far in prevention through the use of magnesium sulfate in preterm labour and therapeutic hypothermia for birth-asphyxiated infants. We also consider the complexities of disentangling prenatal and perinatal influences, and of establishing subtypes of the disorder, with a view to accelerating the translation of evidence into the development of strategies for the prevention of CP.
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Affiliation(s)
- Steven J Korzeniewski
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Jaime Slaughter
- Department of Health Systems and Sciences Research and Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, USA
| | - Madeleine Lenski
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Peterson Haak
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Tonmukayakul U, Shih STF, Bourke-Taylor H, Imms C, Reddihough D, Cox L, Carter R. Systematic review of the economic impact of cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 80:93-101. [PMID: 29981952 DOI: 10.1016/j.ridd.2018.06.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 03/08/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Cerebral palsy (CP) and its associated conditions can pose a significant economic burden on families, the health care system and the general economy. The boundary for inclusion of costs in research can vary substantially across studies. AIMS To summarize the evidence for burden of disease for CP including the impacts on the health system, the community and carers. METHODS Literature was identified from Ovid Medline, Embase, CINHAL, PsyInfo, Econlit, Health Economic Evaluation Database (HEED) and NHS Economic Evaluation Database (NHS EED) in the Cochrane Library. The search was restricted to articles published in English between 1970 and April 2016. All costs were converted to $USD 2016 price. RESULTS Twenty-two articles were included. Studies varied from snapshot cost descriptions to more complex lifetime estimates, from prevalence-based to incidence-based studies, and from inclusion to exclusion of non-medical costs. There was a strong positive relationship between CP severity and expenditure. Significant costs were incurred by families and the welfare system to facilitate school and community engagement. CONCLUSION Facilitating participation for people with CP involves substantial expense. The size, nature and distribution of the economic burden emphasises the importance of finding effective strategies to reduce the risk and severity of CP, together with how it is financed.
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Affiliation(s)
- Utsana Tonmukayakul
- Deakin University, Geelong, Centre for Population Health Research, Locked Bag 20000, Geelong, Victoria, 3220, Australia.
| | - Sophy T F Shih
- Deakin University, Geelong, Centre for Population Health Research, Locked Bag 20000, Geelong, Victoria, 3220, Australia
| | - Helen Bourke-Taylor
- School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Building G, McMahons Road, Frankston, Victoria, 3199, Australia
| | - Christine Imms
- Centre for Disability and Development Research, Australian Catholic University, Level 2, Daniel Mannix Building, 11 Young Street, Fitzroy, Victoria, 3065, Australia
| | - Dinah Reddihough
- Murdoch Children's Research Institute, The University of Melbourne, Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Liz Cox
- Victoria Managed Insurance Authority, Level 10 South, 161 Collins Street, Melbourne, Victoria, 3000, Australia
| | - Rob Carter
- Deakin University, Geelong, Centre for Population Health Research, Locked Bag 20000, Geelong, Victoria, 3220, Australia
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Crowgey EL, Marsh AG, Robinson KG, Yeager SK, Akins RE. Epigenetic machine learning: utilizing DNA methylation patterns to predict spastic cerebral palsy. BMC Bioinformatics 2018; 19:225. [PMID: 29925314 PMCID: PMC6011336 DOI: 10.1186/s12859-018-2224-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 05/29/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Spastic cerebral palsy (CP) is a leading cause of physical disability. Most people with spastic CP are born with it, but early diagnosis is challenging, and no current biomarker platform readily identifies affected individuals. The aim of this study was to evaluate epigenetic profiles as biomarkers for spastic CP. A novel analysis pipeline was employed to assess DNA methylation patterns between peripheral blood cells of adolescent subjects (14.9 ± 0.3 years old) with spastic CP and controls at single CpG site resolution. RESULTS Significantly hypo- and hyper-methylated CpG sites associated with spastic CP were identified. Nonmetric multidimensional scaling fully discriminated the CP group from the controls. Machine learning based classification modeling indicated a high potential for a diagnostic model, and 252 sets of 40 or fewer CpG sites achieved near-perfect accuracy within our adolescent cohorts. A pilot test on significantly younger subjects (4.0 ± 1.5 years old) identified subjects with 73% accuracy. CONCLUSIONS Adolescent patients with spastic CP can be distinguished from a non-CP cohort based on DNA methylation patterns in peripheral blood cells. A clinical diagnostic test utilizing a panel of CpG sites may be possible using a simulated classification model. A pilot validation test on patients that were more than 10 years younger than the main adolescent cohorts indicated that distinguishing methylation patterns are present earlier in life. This study is the first to report an epigenetic assay capable of distinguishing a CP cohort.
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Affiliation(s)
- Erin L Crowgey
- Nemours Biomedical Research, Nemours - Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA
| | - Adam G Marsh
- Genome Profiling LLC, 4701 Ogletown Stanton Rd #4300, Newark, DE, 19713, USA.,Center for Bioinformatics and Computational Biology and The School of Marine Science and Policy, University of Delaware, Newark, DE, 19713, USA
| | - Karyn G Robinson
- Nemours Biomedical Research, Nemours - Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA
| | - Stephanie K Yeager
- Nemours Biomedical Research, Nemours - Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA
| | - Robert E Akins
- Nemours Biomedical Research, Nemours - Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA.
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Schaible B, Colquitt G, Caciula MC, Carnes A, Li L, Moreau N. Comparing impact on the family and insurance coverage in children with cerebral palsy and children with another special healthcare need. Child Care Health Dev 2018; 44:370-377. [PMID: 29327378 DOI: 10.1111/cch.12547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 11/14/2017] [Accepted: 12/18/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Families and caregivers of children with special healthcare needs (CSHCN) often experience financial difficulties, have unmet physical and mental health needs, and are at increased risk of marital problems due to the stress caused by carrying for their child. Within the larger population of CHSCN, young people with cerebral palsy (CP) have more unmet needs due to the complexity and potential severity of the disability. The purpose of this study was to identify factors associated with differences in insurance coverage and impact on the family of children with CP and other CHSCN. METHODS The data were taken from the National Survey of Children with Special Health Care Needs, which was designed to examine state- and national-level estimates of CSHCN. Three variables examined differences in insurance coverage between those children diagnosed with CP versus all other CSHCN: insurance coverage for the previous year, current insurance coverage, and adequacy of insurance coverage. Four variables representing different indicators of family impact were used to assess differences between children with CP versus all other CSHCN: out-of-pocket expenses for healthcare, family financial burden, hours per week that family members spent caring for the child, and impact on family work life. RESULTS The results of this study showed significant differences between households with a child with CP and a child with another health special need in terms of insurance coverage, indicating a tendency of children with CP to be insured the entire year. As for the impact on the family in households with children with CP versus other CSHCN, there were significant differences in all four variables that were analysed. CONCLUSIONS There is limited evidence highlighting differences between the impact of caring for a child with CP and caring for other CSHCN. Caring for a child with CP has a significant impact on the family, despite insurance coverage.
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Affiliation(s)
- B Schaible
- School of Health and Kinesiology, Georgia Southern University, Statesboro, GA, USA
| | - G Colquitt
- School of Health and Kinesiology, Georgia Southern University, Statesboro, GA, USA
| | - M C Caciula
- Department of Biobehavioral Sciences, Teachers College, Columbia University, Columbia University, New York, NY, USA
| | - A Carnes
- School of Health and Kinesiology, Georgia Southern University, Statesboro, GA, USA
| | - L Li
- School of Health and Kinesiology, Georgia Southern University, Statesboro, GA, USA
| | - N Moreau
- Department of Physical Therapy, Louisiana State University Health Sciences, New Orleans, LA, USA
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Lapcharoensap W, Lee HC, Nyberg A, Dukhovny D. Health Care and Societal Costs of Bronchopulmonary Dysplasia. Neoreviews 2018; 19:e211-e223. [PMID: 33384574 DOI: 10.1542/neo.19-4-e211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite significant technological advances and increasing survival of premature infants, bronchopulmonary dysplasia (BPD) continues to be the most prevalent major morbidity in surviving very low-birthweight infants. Infants with BPD are often sicker, require longer stays in the NICU, and accumulate greater hospital costs. However, care of the infant with BPD extends beyond the time spent in the NICU. This article reviews the costs of BPD in the health-care setting, during the initial hospitalization and beyond, and the long-term neurodevelopmental impact of BPD, as well as the impact on a family caring for a child with BPD.
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Affiliation(s)
| | - Henry C Lee
- Department of Pediatrics, Stanford University, Stanford, CA
| | - Amy Nyberg
- March of Dimes NICU Family Support Coordinator, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health and Science University, Portland, OR
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Fujiura GT, Li H, Magaña S. Health Services Use and Costs for Americans With Intellectual and Developmental Disabilities: A National Analysis. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2018; 56:101-118. [PMID: 29584559 DOI: 10.1352/1934-9556-56.2.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Health services and associated costs for adults with intellectual and developmental disabilities (IDD) were nationally profiled and the predictors of high expense users statistically modeled. Using linked data from the National Health Interview Survey and Medical Expenditure Panel Survey for the years 2002 through 2011, the study found a mixed pattern of differences in rates of service use and costs when compared to the general population depending upon personal characteristics, health status, and type of health care service. Prescription medication costs were the primary driver of total health care expenditures for Americans with IDD. The presence of secondary chronic health conditions and poor mental health status were the consistent predictors of high expense users across types of health care. Study results are discussed in terms of implications for more nuanced evaluations of health care costs and need for recurring surveillance of health care for Americans with IDD in the years following passage of the Patient Protection and Affordable Care Act.
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Affiliation(s)
- Glenn T Fujiura
- Glenn T. Fujiura, University of Illinois, Chicago; Henan Li, Brandeis University, and Sandy Magaña, University of Texas
| | - Henan Li
- Glenn T. Fujiura, University of Illinois, Chicago; Henan Li, Brandeis University, and Sandy Magaña, University of Texas
| | - Sandy Magaña
- Glenn T. Fujiura, University of Illinois, Chicago; Henan Li, Brandeis University, and Sandy Magaña, University of Texas
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Pessoa A, van der Linden V, Yeargin-Allsopp M, Carvalho MDCG, Ribeiro EM, Van Naarden Braun K, Durkin MS, Pastula DM, Moore JT, Moore CA. Motor Abnormalities and Epilepsy in Infants and Children With Evidence of Congenital Zika Virus Infection. Pediatrics 2018; 141:S167-S179. [PMID: 29437050 DOI: 10.1542/peds.2017-2038f] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 11/24/2022] Open
Abstract
Initial reports of congenital Zika virus (ZIKV) infection focused on microcephaly at birth with severe brain anomalies; the phenotype has broadened to include microcephaly that develops after birth and neurodevelopmental sequelae. In this narrative review, we summarize medical literature describing motor abnormalities and epilepsy in infants with evidence of congenital ZIKV infection and provide information on the impact of these conditions. Specific scenarios are used to illustrate the complex clinical course in infants with abnormalities that are consistent with congenital Zika syndrome. A search of the English-language medical literature was done to identify motor abnormalities and epilepsy in infants with evidence of congenital ZIKV infection by using Medline and PubMed, Embase, Scientific Electronic Library Online, Scopus, the OpenGrey Repository, and the Grey Literature Report in Public Health. Search terms included "Zika" only and "Zika" in combination with any of the following terms: "epilepsy," "seizure," "motor," and "cerebral palsy." Clinical features of motor abnormalities and epilepsy in these children were reviewed. Thirty-six publications were identified; 8 were selected for further review. Among infants with clinical findings that are consistent with congenital Zika syndrome, 54% had epilepsy and 100% had motor abnormalities. In these infants, impairments that are consistent with diagnoses of cerebral palsy and epilepsy occur frequently. Pyramidal and extrapyramidal motor abnormalities were notable for their early development and co-occurrence. Prompt identification of potential disabilities enables early intervention to improve the quality of life for affected children. Long-term studies of developmental outcomes and interventions in children with congenital ZIKV infection are needed.
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Affiliation(s)
- André Pessoa
- Hospital Infantil Albert Sabin, Fortaleza, Brazil.,Department of Pediatrics and Neurology, Universidade Estadual do Ceará, Fortaleza, Brazil
| | - Vanessa van der Linden
- Association for Assistance of Disabled Children, Recife, Brazil.,Hospital Barāo de Lucena, Recife, Brazil
| | | | | | | | | | - Maureen S Durkin
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin; and
| | - Daniel M Pastula
- Departments of Neurology, Medicine (Infectious Diseases), and Epidemiology, University of Colorado, Denver, Colorado
| | - Jazmyn T Moore
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cynthia A Moore
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Guo T, Zhu B, Zhang X, Xu N, Wang H, Tai X. Tuina for children with cerebral palsy: A protocol for a systematic review. Medicine (Baltimore) 2018; 97:e9697. [PMID: 29369196 PMCID: PMC5794380 DOI: 10.1097/md.0000000000009697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 01/02/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) describes a group of permanent disorders of movement and posture causing activity limitations, leading the most common movement disorder to children. On recovery of various aspects of CP, massotherapy has a good effect in a great many of Chinese clinical trials. Therefore, we plan to conduct a protocol of systematic review aimed at systematically reviewing all the clinical evidence on the effectiveness of massotherapy for treating CP in children. METHODS The following electronic databases will be searched from inception to October 1, 2017: Cochrane Library, Web of Science, EBASE, Springer, World Health Organization International Clinical Trials Registry Platform, China National Knowledge Infrastructure, Wan-fang database, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, and other sources. All published English and Chinese articles randomized controlled trials (RTCs) will be included. All types of CP of children in the trials will be included in this study and these individuals will be involved as coresearchers to evaluate the efficacy of massothreapy. RevMan V.5.3.5 software will be implemented for the assessment of bias risk, data synthesis, subgroup analysis, and meta-analyses if inclusion conditions are met. Continuous outcomes will be presented as mean difference (MD) or standard mean difference (SMD), while dichotomous data will be expressed as a relative risk. RESULTS A high-quality synthesis of current evidence of massothreapy for children with CP will be provided from several aspects, including motor function improvement, intellectual development, improvement of self-care ability, and daily living. CONCLUSION This protocol will present the evidence of whether Tuina threapy is an effective intervention for children with CP. ETHICS AND DISSEMINATION There is no requirement of ethical approval and it will be in print or disseminated by electronic copies. PROSPERO REGISTRATION NUMBER CRD42017080342.
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Affiliation(s)
- Tainpin Guo
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province
| | - Bowen Zhu
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province
| | - Xinghe Zhang
- School of Acupuncture-Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Na Xu
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province
| | - Hourong Wang
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province
| | - Xiantao Tai
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province
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Functional maturation in preterm infants measured by serial recording of cortical activity. Sci Rep 2017; 7:12969. [PMID: 29021546 PMCID: PMC5636845 DOI: 10.1038/s41598-017-13537-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/25/2017] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive, automated cot-side tools for monitoring early neurological development can be used to guide individual treatment and benchmark novel interventional studies. We develop an automated estimate of the EEG maturational age (EMA) for application to serial recordings in preterm infants. The EMA estimate was based on a combination of 23 computational features estimated from both the full EEG recording and a period of low EEG activity (46 features in total). The combination function (support vector regression) was trained using 101 serial EEG recordings from 39 preterm infants with a gestational age less than 28 weeks and normal neurodevelopmental outcome at 12 months of age. EEG recordings were performed from 24 to 38 weeks post-menstrual age (PMA). The correlation between the EMA and the clinically determined PMA at the time of EEG recording was 0.936 (95%CI: 0.932-0.976; n = 39). All infants had an increase in EMA between the first and last EEG recording and 57/62 (92%) of repeated measures within an infant had an increasing EMA with PMA of EEG recording. The EMA is a surrogate measure of age that can accurately determine brain maturation in preterm infants.
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Mpundu-Kaambwa C, Chen G, Huynh E, Russo R, Ratcliffe J. Protocol for a systematic review of instruments for the assessment of quality of life and well-being in children and adolescents with cerebral palsy. BMJ Open 2017; 7:e015924. [PMID: 28899888 PMCID: PMC5640099 DOI: 10.1136/bmjopen-2017-015924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Cerebral palsy is the most common cause of physical disability in children and adolescents and is associated with impairments that may reduce the quality of life (QOL) of this population. Patient-reported outcome measures (PROMs) can facilitate the assessment of the effect of disease and treatment on QOL, from a patient viewpoint. The purpose of this systematic review is to identify PROMs that are used to measure QOL and subjective well-being (SWB) outcomes in young people with cerebral palsy and to evaluate the suitability of these PROMs for application in economic evaluations within this population. METHODS AND ANALYSIS MEDLINE, Scopus, the Cochrane Library, Web of Science Core Collection, EconLit, PsycINFO, CINAHL, EMBASE and Informit will be systematically searched from inception to date of search. Published peer-reviewed, English-language articles reporting PROMs measuring QOL or SWB outcomes in children and adolescents with cerebral palsy will be included. One reviewer will conduct the initial search and screen titles and abstracts for potentially eligible studies. The search will be performed in November 2017. To reduce the likelihood of reviewer selection bias, two other reviewers will independently screen a randomly selected subsample (10%) of the citations. Two reviewers will then retrieve full texts of potentially eligible studies and assess them against predefined inclusion criteria. The suitability of selected PROMs for use in economic evaluations of young people with cerebral palsy will be assessed using the International Society of Quality of Life Research recommended Minimum Standards and the Patient-Centered Outcomes and Comparative Effectiveness Research checklist. A narrative synthesis of extracted data will be presented including study descriptive data, PROMs measurement properties, settings in which they were applied and the valuation methods. Recommendations for practice on the selection of PROMs for use in economic evaluations of children and adolescents with cerebral palsy will be presented. ETHICS AND DISSEMINATION Ethical approval is not required as the proposed systematic review will not use primary data. The results of this study will be widely disseminated through publication in a peer-reviewed journal and conference presentation(s). SYSTEMATIC REVIEW REGISTRATION NUMBER International Prospective Register of Systematic Reviews number: CRD42016049746.
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Affiliation(s)
- Christine Mpundu-Kaambwa
- Institute for Choice, University of South Australia Business School, University of South Australia, Adelaide, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Elisabeth Huynh
- Institute for Choice, University of South Australia Business School, University of South Australia, Adelaide, Australia
| | - Remo Russo
- Faculty of Health Sciences, School of Medicine, Flinders University, Adelaide, Australia
- Department of Paediatric Rehabilitation, Women’s and Children’s Hospital, Adelaide, Australia
| | - Julie Ratcliffe
- Institute for Choice, University of South Australia Business School, University of South Australia, Adelaide, Australia
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Terraneo L, Samaja M. Comparative Response of Brain to Chronic Hypoxia and Hyperoxia. Int J Mol Sci 2017; 18:ijms18091914. [PMID: 28880206 PMCID: PMC5618563 DOI: 10.3390/ijms18091914] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/01/2017] [Accepted: 09/03/2017] [Indexed: 12/25/2022] Open
Abstract
Two antithetic terms, hypoxia and hyperoxia, i.e., insufficient and excess oxygen availability with respect to needs, are thought to trigger opposite responses in cells and tissues. This review aims at summarizing the molecular and cellular mechanisms underlying hypoxia and hyperoxia in brain and cerebral tissue, a context that may prove to be useful for characterizing not only several clinically relevant aspects, but also aspects related to the evolution of oxygen transport and use by the tissues. While the response to acute hypoxia/hyperoxia presumably recruits only a minor portion of the potentially involved cell machinery, focusing into chronic conditions, instead, enables to take into consideration a wider range of potential responses to oxygen-linked stress, spanning from metabolic to genic. We will examine how various brain subsystems, including energetic metabolism, oxygen sensing, recruitment of pro-survival pathways as protein kinase B (Akt), mitogen-activated protein kinases (MAPK), neurotrophins (BDNF), erythropoietin (Epo) and its receptors (EpoR), neuroglobin (Ngb), nitric oxide (NO), carbon monoxide (CO), deal with chronic hypoxia and hyperoxia to end-up with the final outcomes, oxidative stress and brain damage. A more complex than expected pattern results, which emphasizes the delicate balance between the severity of the stress imposed by hypoxia and hyperoxia and the recruitment of molecular and cellular defense patterns. While for certain functions the expectation that hypoxia and hyperoxia should cause opposite responses is actually met, for others it is not, and both emerge as dangerous treatments.
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Affiliation(s)
- Laura Terraneo
- Department of Health Science, University of Milan, I-20142 Milano, Italy.
| | - Michele Samaja
- Department of Health Science, University of Milan, I-20142 Milano, Italy.
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Abstract
BACKGROUND Information on diabetes-related excess medical expenditures for youth is important to understand the magnitude of financial burden and to plan the health care resources needed for managing diabetes. However, diabetes-related excess medical expenditures for youth covered by Medicaid program have not been investigated recently. OBJECTIVE To estimate excess diabetes-related medical expenditures among youth aged below 20 years enrolled in Medicaid programs in the United States. METHODS We analyzed data from 2008 to 2012 MarketScan multistate Medicaid database for 6502 youths with diagnosed diabetes and 6502 propensity score matched youths without diabetes, enrolled in fee-for-service payment plans. We stratified analysis by Medicaid eligibility criteria (poverty or disability). We used 2-part regression models to estimate diabetes-related excess medical expenditures, adjusted for age, sex, race/ethnicity, year of claims, depression status, asthma status, and interaction terms. RESULTS For poverty-based Medicaid enrollees, estimated annual diabetes-related total medical expenditure was $9046 per person [$3681 (no diabetes) vs. $12,727 (diabetes); P<0001], of which 41.7%, 34.0%, and 24.3% were accounted for by prescription drugs, outpatient, and inpatient care, respectively. For disability-based Medicaid enrollees, the estimated annual diabetes-related total medical expenditure was $9944 per person ($14,149 vs. $24,093; P<0001), of which 41.5% was accounted for by prescription drugs, 31.3% by inpatient, and 27.3% by outpatient care. CONCLUSIONS The per capita annual diabetes-related medical expenditures in youth covered by publicly financed Medicaid programs are substantial, which is larger among those with disabilities than without disabilities. Identifying cost-effective ways of managing diabetes in this vulnerable segment of the youth population is needed.
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46
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Bailes AF, Gannotti M, Fenchel M. Using the electronic medical record to study the association of child and environmental characteristics on the type of physical therapy services delivered to individuals with cerebral palsy. Physiother Theory Pract 2017; 33:644-652. [DOI: 10.1080/09593985.2017.1328717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amy F. Bailes
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Mary Gannotti
- Department of Rehabilitation Sciences, University of Hartford, Hartford, CT, USA
| | - Matthew Fenchel
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Lowes LP, Noritz GH, Newmeyer A, Embi PJ, Yin H, Smoyer WE. 'Learn From Every Patient': implementation and early results of a learning health system. Dev Med Child Neurol 2017; 59:183-191. [PMID: 27545839 DOI: 10.1111/dmcn.13227] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 01/17/2023]
Abstract
AIM The convergence of three major trends in medicine, namely conversion to electronic health records (EHRs), prioritization of translational research, and the need to control healthcare expenditures, has created unprecedented interest and opportunities to develop systems that improve care while reducing costs. However, operationalizing a 'learning health system' requires systematic changes that have not yet been widely demonstrated in clinical practice. METHOD We developed, implemented, and evaluated a model of EHR-supported care in a cohort of 131 children with cerebral palsy that integrated clinical care, quality improvement, and research, entitled 'Learn From Every Patient' (LFEP). RESULTS Children treated in the LFEP Program for a 12-month period experienced a 43% reduction in total inpatient days (p=0.030 vs prior 12mo period), a 27% reduction in inpatient admissions, a 30% reduction in emergency department visits (p=0.001), and a 29% reduction in urgent care visits (p=0.046). LFEP Program implementation also resulted in reductions in healthcare costs of 210% (US$7014/child) versus a Time control group, and reductions of 176% ($6596/child) versus a Program Activities control group. Importantly, clinical implementation of the LFEP Program has also driven the continuous accumulation of robust research-quality data for both publication and implementation of evidence-based improvements in clinical care. INTERPRETATION These results demonstrate that a learning health system can be developed and implemented in a cost-effective manner, and can integrate clinical care and research to systematically drive simultaneous clinical quality improvement and reduced healthcare costs.
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Affiliation(s)
| | - Garey H Noritz
- Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Amy Newmeyer
- Children's Hospital of the King's Daughters, Norfolk, VA, USA
| | - Peter J Embi
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Han Yin
- Nationwide Children's Hospital, Columbus, OH, USA
| | - William E Smoyer
- Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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48
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Estimating functional brain maturity in very and extremely preterm neonates using automated analysis of the electroencephalogram. Clin Neurophysiol 2016; 127:2910-2918. [DOI: 10.1016/j.clinph.2016.02.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/25/2016] [Accepted: 02/12/2016] [Indexed: 01/29/2023]
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49
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Massaro AN, Murthy K, Zaniletti I, Cook N, DiGeronimo R, Dizon MLV, Hamrick SEG, McKay VJ, Natarajan G, Rao R, Richardson T, Smith D, Mathur AM. Intercenter Cost Variation for Perinatal Hypoxic-Ischemic Encephalopathy in the Era of Therapeutic Hypothermia. J Pediatr 2016; 173:76-83.e1. [PMID: 26995699 DOI: 10.1016/j.jpeds.2016.02.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/14/2016] [Accepted: 02/09/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To quantify intercenter cost variation for perinatal hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia across children's hospitals. STUDY DESIGN Prospectively collected data from the Children's Hospitals Neonatal Database and Pediatric Health Information Systems were linked to evaluate intercenter cost variation in total hospitalization costs after adjusting for HIE severity, mortality, length of stay, use of extracorporeal support or nitric oxide, and ventilator days. Secondarily, costs for intensive care unit bed, electroencephalography (EEG), and laboratory and neuroimaging testing were also evaluated. Costs were contextualized by frequency of favorable (survival with normal magnetic resonance imaging) and adverse (death or need for gastric tube feedings at discharge) outcomes to identify centers with relative low costs and favorable outcomes. RESULTS Of the 822 infants with HIE treated with therapeutic hypothermia at 19 regional neonatal intensive care units, 704 (86%) survived to discharge. The median cost/case for survivors was $58 552 (IQR $32 476-$130 203) and nonsurvivors $29 760 (IQR $16 897-$61 399). Adjusting for illness severity and select interventions, intercenter differences explained 29% of the variation in total hospitalization costs. The widest cost variability across centers was EEG use, although low cost and favorable outcome centers ranked higher with regards to EEG costs. CONCLUSIONS There is marked intercenter cost variation associated with treating HIE across regional children's hospitals. Our investigation may help establish references for cost and enhance quality improvement and resource utilization projects related to HIE.
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Affiliation(s)
- An N Massaro
- Children's National Health System and the Department of Pediatrics, George Washington University School of Medicine, Washington, DC.
| | - Karna Murthy
- Ann and Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; Children's Hospitals Neonatal Consortium, Inc
| | | | - Noah Cook
- Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Robert DiGeronimo
- Department of Pediatrics, University of Utah and the Primary Children's Medical Center, Salt Lake City, UT
| | - Maria L V Dizon
- Ann and Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Shannon E G Hamrick
- Department of Pediatrics and Children's Healthcare of Atlanta at Egleston, Emory University, Atlanta, GA
| | | | - Girija Natarajan
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI
| | - Rakesh Rao
- Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
| | | | - Danielle Smith
- Children's Hospital of Colorado and Department of Pediatrics, University of Colorado, Aurora, CO
| | - Amit M Mathur
- Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
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50
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Leigh JP, Grosse SD, Cassady D, Melnikow J, Hertz-Picciotto I. Spending by California's Department of Developmental Services for Persons with Autism across Demographic and Expenditure Categories. PLoS One 2016; 11:e0151970. [PMID: 27015098 PMCID: PMC4807877 DOI: 10.1371/journal.pone.0151970] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 03/07/2016] [Indexed: 11/18/2022] Open
Abstract
Background Few autism spectrum disorder (ASD) studies have estimated non-medical costs for treatment or addressed possible differences in provision of services across gender, race-ethnic, age or demographic or expenditure categories, especially among adults. Methods The California Department of Developmental Services (CDDS) provides services to residents with developmental disabilities. CDDS provided aggregate data on primarily non-medical spending for fiscal year 2012–2013 for persons with ASD with or without intellectual disability (ID) (main sample, n = 42,274), and two sub-samples: ASD only (n = 30,164), and ASD+ID (n = 12,110). Demographic variables included sex, age and race-ethnicity. Spending categories included Employment Support, Community Care Facilities, Day Care, Transportation, and in-home and out-of-home Respite. Results Per-person spending for males and females were approximately the same: $10,488 and $10,791 for males and females for ages 3–17 and $26,491 and $26,627 for ages 18+. Among race/ethnicity categories, the ranking from highest to lowest among ages 3–17 was white non-Hispanics ($11,480), Asian non-Hispanics ($11,036), “Others” ($11,031), Hispanics ($9,571), and African-American non-Hispanics ($9,482). For ages 18+, the ranking was whites ($31,008), African-Americans ($26,831), “Others” ($25,395), Asians ($22,993), and Hispanics ($18,083). The ASD+ID sub-sample exerted disproportionate influence on findings from the main sample for persons 18+. Combining all ages, the top two expenditure categories for per-person spending were Community Care Facilities ($43,867) and Day Care ($11,244). For most adult age groups, the percentage of recipients participating were highest for Day Care (44.9% - 62.4%) and Transportation (38.6% - 50.9%). Per-person spending for Day Care, Transportation, and Employment Support was relatively low for children but relatively high for adults. Conclusion White non-Hispanics received the highest per-person spending and Hispanics among the least. Amounts within spending categories varied considerably across age groups. Our estimates may be useful as baseline measures for stakeholders preparing for increasing ASD prevalence, especially among adults.
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Affiliation(s)
- J. Paul Leigh
- Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, California, United States of America
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, California, United States of America
- * E-mail:
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Diana Cassady
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, California, United States of America
| | - Joy Melnikow
- Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, California, United States of America
- Department of Family Medicine, University of California Davis, School of Medicine, Sacramento, California, United States of America
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, California, United States of America
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