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Aghaei A, Herran K, Fanaei SA, Khalili M, Jayadev P. Lived experiences of neurofibromatosis type 1 patients: Social life, stigma, and intervention strategies. J Health Psychol 2024; 29:811-824. [PMID: 37933158 DOI: 10.1177/13591053231208619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is a neurogenetic disorder associated with visual-spatial problems, executive dysfunction, and language deficits, making patients experience social isolation, stigma, anxiety, and depression. Here, we explored NF1 patients' lived experiences by conducting semi-structured, in-depth interviews with 21 NF1 patients and 16 care providers. The thematic analysis uncovered dimensions of NF1 patients' social lives at different ecological levels, including their relationships with family, friends, teachers, coworkers, providers, and society. Positive dimensions of NF1 patients' social life (e.g. familial support and sacrifice, responsibility, and self-sufficiency, supportive friends, and professors) counter negative dimensions (e.g. the vulnerability in sexual relationships, social interactions, discriminatory professors, misconceptions about abilities, appearance bias, internalized and social stigma, violence, and low self-esteem). Adaptive strategies used or suggested by NF1 patients at personal (e.g. supportive network, positive reframing, acceptance of their bodies) and social levels (e.g. psychological support, group therapy, public awareness, and governmental support) were identified.
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2
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Kallionpää RA, Johansson E, Böckerman P, Peltonen J, Peltonen S. The contribution of morbidity and unemployment for the reduced labor market participation of individuals with neurofibromatosis 1 in Finland. Eur J Hum Genet 2024; 32:83-90. [PMID: 37460655 PMCID: PMC10772102 DOI: 10.1038/s41431-023-01426-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/24/2023] [Accepted: 06/29/2023] [Indexed: 01/09/2024] Open
Abstract
Neurofibromatosis 1 (NF1) is a multisystem disorder associated with, for example, a high risk for cancer, a variety of behavioral and cognitive deficits, low educational attainment and decreased income. We now examined the labor market participation of individuals with NF1. We analyzed the numbers of days of work, unemployment, and sickness allowance among 742 Finnish individuals with NF1 aged 20-59 years using nationwide register data from Statistics Finland and the Social Insurance Institution of Finland. The individuals with NF1 were compared with a control cohort of 8716 individuals matched with age, sex, and the area of residence. Individuals with NF1 had a significantly lower number of working days per year than the controls (rate ratio [RR] 0.93, 95% CI 0.91-0.95). Unemployment (RR 1.79, 95% CI 1.58-2.02), and sickness absence (RR 1.44, 95% CI 1.25-1.67) were more frequent in the NF1 than in the control group. The causes of sickness allowances were highly concordant with the previously reported morbidity profile of NF1 including neoplasms, cardiovascular disease, mental and behavioral diseases, and neurological diseases. In conclusion, NF1 significantly interferes with labor market participation via both unemployment and morbidity. Unemployment seems to cause more days of not working than sickness absence.
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Affiliation(s)
- Roope A Kallionpää
- Cancer Research Unit and FICAN West Cancer Centre, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Edvard Johansson
- Faculty of Social Sciences, Business, and Economics, Åbo Akademi University, Turku, Finland
| | - Petri Böckerman
- Jyväskylä University School of Business and Economics, Jyväskylä, Finland
- Labour Institute for Economic Research LABORE, Helsinki, Finland
- IZA Institute of Labor Economics, Bonn, Germany
| | - Juha Peltonen
- Cancer Research Unit and FICAN West Cancer Centre, Institute of Biomedicine, University of Turku, Turku, Finland.
| | - Sirkku Peltonen
- Department of Dermatology and Venereology, University of Turku, Turku, Finland
- Department of Dermatology, Turku University Hospital, Turku, Finland
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Dermatology and Allergology, University of Helsinki, Helsinki, Finland
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
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3
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de Blank P, Nishiyama A, López-Juárez A. A new era for myelin research in Neurofibromatosis type 1. Glia 2023; 71:2701-2719. [PMID: 37382486 PMCID: PMC10592420 DOI: 10.1002/glia.24432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023]
Abstract
Evidence for myelin regulating higher-order brain function and disease is rapidly accumulating; however, defining cellular/molecular mechanisms remains challenging partially due to the dynamic brain physiology involving deep changes during development, aging, and in response to learning and disease. Furthermore, as the etiology of most neurological conditions remains obscure, most research models focus on mimicking symptoms, which limits understanding of their molecular onset and progression. Studying diseases caused by single gene mutations represents an opportunity to understand brain dys/function, including those regulated by myelin. Here, we discuss known and potential repercussions of abnormal central myelin on the neuropathophysiology of Neurofibromatosis Type 1 (NF1). Most patients with this monogenic disease present with neurological symptoms diverse in kind, severity, and onset/decline, including learning disabilities, autism spectrum disorders, attention deficit and hyperactivity disorder, motor coordination issues, and increased risk for depression and dementia. Coincidentally, most NF1 patients show diverse white matter/myelin abnormalities. Although myelin-behavior links were proposed decades ago, no solid data can prove or refute this idea yet. A recent upsurge in myelin biology understanding and research/therapeutic tools provides opportunities to address this debate. As precision medicine moves forward, an integrative understanding of all cell types disrupted in neurological conditions becomes a priority. Hence, this review aims to serve as a bridge between fundamental cellular/molecular myelin biology and clinical research in NF1.
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Affiliation(s)
- Peter de Blank
- Department of Pediatrics, The Cure Starts Now Brain Tumor Center, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Akiko Nishiyama
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, Connecticut, USA
| | - Alejandro López-Juárez
- Department of Health and Biomedical Sciences, University of Texas Rio Grande Valley, Brownsville, Texas, USA
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Kenborg L, Frederiksen LE, Galanakis M, Doser K, Nielsen TT, Doherty MA, Hove H, Østergaard JR, Handrup MM, Ejerskov C, Mulvihill JJ, Winther JF. Employment, occupation, and income in adults with neurofibromatosis 1 in Denmark: a population- and register-based cohort study. Orphanet J Rare Dis 2023; 18:346. [PMID: 37932779 PMCID: PMC10629102 DOI: 10.1186/s13023-023-02965-2] [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: 09/21/2022] [Accepted: 10/30/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Little is known about employment status, occupation, and disposable income in adults with NF1. METHODS From the Danish National Patient Registry and database of two national Centers for Rare Diseases, we identified 1469 adults with NF1, who were matched to 11,991 randomly selected population comparisons on sex and birth year and month. Annual information on employment, occupation and disposable income was ascertained from national registries in 1980-2019. RESULTS Adults with NF1 had a lower odds ratio (OR) for employment [OR 0.71, 95% confidence interval (CI) 0.61-0.83] and higher OR for health-related unemployment (OR 2.94, 95% CI 2.16-3.96) at age 30 years than population comparisons, which persisted at age 40 and 50 years. Somatic diagnoses were associated with a higher OR for health-related unemployment in adults with NF1 than in the population comparisons. Adults with NF1 had a slightly lower disposable income, with a 14% (0.82-0.89) reduction observed among the youngest birth cohort. Furthermore, adults with NF1 were less likely to be in a high skilled occupation at ages 30, 40 and 50 years. CONCLUSION Adults with NF1 have a lower employment rate, which was mainly due to health-related reasons and a slightly lower disposable income than adults without NF1. Thus, anticipation guidance for employment should be part of the management of NF1 families.
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Affiliation(s)
- Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Line E Frederiksen
- Childhood Cancer Research Group, Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Michael Galanakis
- Statistics and Data Analysis, Danish Cancer Institute, Copenhagen, Denmark
| | - Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Thomas T Nielsen
- Childhood Cancer Research Group, Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Mia Aagaard Doherty
- Childhood Cancer Research Group, Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Hanne Hove
- Department of Pediatrics, Center for Rare Diseases, University Hospital at Rigshospitalet, Copenhagen, Denmark
- The RAREDIS Database, Center for Rare Diseases, Copenhagen University Hospital and Aarhus University Hospital, Copenhagen, Denmark
| | - John R Østergaard
- Center for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Mette M Handrup
- Center for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Cecilie Ejerskov
- Center for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma, Oklahoma City, OK, USA
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
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5
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Kenborg L, Ebbehoj A, Ejerskov C, Handrup MM, Østergaard JR, Hove H, Doser K, Krøyer A, Mulvihill JJ, Winther JF, Stochholm K. Endocrine morbidity in neurofibromatosis 1: a nationwide, register-based cohort study. Eur J Endocrinol 2023; 189:190-198. [PMID: 37542520 DOI: 10.1093/ejendo/lvad101] [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: 04/17/2023] [Revised: 06/30/2023] [Accepted: 07/17/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Previous studies have found that neurofibromatosis 1 (NF1) is associated with an increased risk for endocrine disorders, but no comprehensive overview of the risk for specific endocrine disorders has been published. We assessed endocrine morbidity in individuals with NF1 from information on hospital admissions, surgery for endocrine disorders, and relevant medication. DESIGN A nationwide population registry-based cohort study. METHODS We identified 2467 individuals with NF1 diagnosed between 1977 and 2013 from the Danish National Patient Register and the RAREDIS database and 20 132 randomly sampled age- and sex-matched population comparisons. Information on endocrine diseases was identified using registrations of discharge diagnoses, surgery, and medication prescriptions. The rates of endocrine disorders in individuals with NF1 were compared with those in the comparison cohort in Cox proportional hazard models. RESULTS Individuals with NF1 had a higher rate than the comparison group of any endocrine discharge diagnosis (hazard ratio [HR] 1.72, 95% confidence interval [CI]: 1.58-1.87), endocrine-related surgery (2.03, 1.39-2.96), and prescribed medications (1.32, 1.23-1.42). Increased HRs were observed for diseases and surgical operations of several glands, including pheochromocytoma, and for osteoporosis, and osteoporotic fractures. Decreased rates were observed with drugs for type 2 diabetes. Women with NF1 had higher HRs for surgery of the ovaries, uterus, and sterilization, but lower rates of surgeries of cervix and prescriptions for birth control pills. CONCLUSIONS Neurofibromatosis 1 is associated with a variety of endocrine disorders, surgery, and medication related to endocrine disease. Awareness of endocrine morbidity is important in the clinical follow-up of individuals with NF1.
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Affiliation(s)
- Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen E, Denmark
| | - Andreas Ebbehoj
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Cecilie Ejerskov
- Centre for Rare Diseases, Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Mette Møller Handrup
- Centre for Rare Diseases, Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - John R Østergaard
- Centre for Rare Diseases, Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Hanne Hove
- The RAREDIS Database, Centre for Rare Diseases, Department of Paediatrics, Copenhagen University Hospital, 2100 Copenhagen E, Denmark
- Centre for Rare Diseases, Department of Paediatrics, Rigshospitalet, 2100 Copenhagen E, Denmark
| | - Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen E, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen E, Denmark
| | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma, Norman, OK 73019-3073, United States
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen E, Denmark
- Faculty of Health, Department of Clinical Medicine, Aarhus University and University Hospital, 8200 Aarhus N, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
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6
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Doser K, Belmonte F, Andersen KK, Østergaard JR, Hove H, Handrup MM, Ejerskov C, Mulvihill JJ, Winther JF, Kenborg L. School performance of children with neurofibromatosis 1: a nationwide population-based study. Eur J Hum Genet 2022; 30:1405-1412. [PMID: 35859011 PMCID: PMC9712673 DOI: 10.1038/s41431-022-01149-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/24/2022] [Accepted: 07/04/2022] [Indexed: 11/09/2022] Open
Abstract
Children with neurofibromatosis 1 (NF1) may have a high burden of somatic disease and cognitive impairments, which can lead to poor academic performance. We evaluated school grades from exams ending mandatory schooling (usually around age 15 or 16 years) of children with NF1 in a population-based registry study using a within-school matched design. The study included 285 children with NF1 and 12,000 NF1-free peers who graduated from the same school and year during 2002-2015. We estimated overall and gender-specific grades by subject and compared the grades of children with NF1 with those of NF1-free peers in linear regression models. We also examined the effect of social and socioeconomic factors (immigration status and parental education, income and civil status) on grades and age at finalizing ninth grade. School grades varied considerably by socioeconomic stratum for all children; however, children with NF1 had lower grades by an average of 11-12% points in all subjects. In the adjusted models, children with NF1 had significantly lower grades than their NF1-free peers, with largest negative differences in grades observed for girls with NF1. Finally, children with NF1 were 0.2 (CI 0.1-0.2) years older than their peers on graduating from ninth grade, but only maternal educational modified the age at graduating. In conclusion, students with NF1 perform more poorly than their peers in all major school subjects. Gender had a strong effect on the association between NF1 and school grades; however, socioeconomic factors had a similar effect on grades for children with NF1 and their peers.
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Affiliation(s)
- Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Federica Belmonte
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Klaus Kaae Andersen
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - John R Østergaard
- Center for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Hove
- The RAREDIS Database, Center for Rare Diseases, Copenhagen University Hospital and Aarhus University Hospital, Aarhus, Denmark
| | - Mette M Handrup
- Center for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Cecilie Ejerskov
- Center for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.
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7
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Doser K, Hove H, Østergaard JR, Bidstrup PE, Dalton SO, Handrup MM, Ejerskov C, Krøyer A, Doherty MA, Møllegaard Jepsen JR, Mulvihill JJ, Winther JF, Kenborg L. Cohort profile: life with neurofibromatosis 1 - the Danish NF1 cohort. BMJ Open 2022; 12:e065340. [PMID: 36127120 PMCID: PMC9490603 DOI: 10.1136/bmjopen-2022-065340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The Danish neurofibromatosis 1 (NF1) cohort was initiated to study health-related, socioeconomic and psychological consequences of living with the monogenetic disorder NF1 using a nationwide and population-based approach. PARTICIPANTS The cohort includes all 2467 individuals in Denmark who were hospitalised with or due to NF1 from 1977 to 2013 or registered in the RAREDIS Database (1995-2013), a national clinical database for rare diseases, or both. A comparison cohort matched to individuals with NF1 on sex and date of birth was identified in the Civil Registration System (n=20 132). FINDINGS TO DATE All cohort members were linked to the unique Danish registries to obtain information on hospital contacts, birth outcomes, education and partnership. A questionnaire was completed by 244 of the 629 adult cohort members with NF1 registered in the RAREDIS Database to evaluate the psychosocial and emotional burden. Further, neuropsychological tests were performed on 103 adult cohort members with NF1 and 38 adult population comparisons. To date, six studies have been published. Individuals with NF1 had an increased risk for (1) hospitalisation for disorders affecting all organ systems of the body throughout all decades of life, (2) psychiatric disorders, (3) attaining a short or medium long education and (4) not forming a life partner. Women with NF1 had an increased risk for spontaneous abortions and stillbirths. Finally, adults with NF1 had an impaired quality of life and a high need for professional support for physical, psychological and work-related problems, which was partly associated with disease severity and visibility. FUTURE PLANS The cohort will regularly be updated with newly diagnosed patients in the RAREDIS Database as well as with outcome information in the Danish registries. New studies are in progress to assess other medical and socioeconomic dimensions of living with NF1.
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Affiliation(s)
- Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Hanne Hove
- Center for Rare Diseases, Department of Pediatrics and Adolescents, Rigshospitalet, Copenhagen, Denmark
- The RAREDIS Database, Section of Rare Diseases, Department of Pediatrics and Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - John R Østergaard
- Centre for Rare Diseases, Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Pernille E Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Susanne O Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital Naestved, Naestved, UK
| | - Mette Møller Handrup
- Centre for Rare Diseases, Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Cecilie Ejerskov
- Centre for Rare Diseases, Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mia Aagaard Doherty
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention, Mental Health Services, Copenhagen University Hospital Glostrup, Glostrup, Denmark
- Child and Adolescent Mental Health Center, Mental Health Services, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
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8
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Fertitta L, Bergqvist C, Armand ML, Moryousef S, Ferkal S, Jannic A, Ravaud P, Tran VT, Ezzedine K, Wolkenstein P. Quality of life in neurofibromatosis 1: development and validation of a tool dedicated to cutaneous neurofibromas in adults. J Eur Acad Dermatol Venereol 2022; 36:1359-1366. [PMID: 35412677 DOI: 10.1111/jdv.18140] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/10/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cutaneous neurofibromas (cNF), present in 95% of individuals with neurofibromatosis 1 (NF1), are considered as one of the greatest medical burden because of physical disfigurement. No specific score evaluates their impact on quality of life (QoL). OBJECTIVE To develop a specific score assessing cNF-related QoL. METHODS Through a multidisciplinary workshop including 10 patients, 3 expert-in-NF1 physicians, 3 health care workers (nurses and psychologist) and 1 methodologist, the French version of the Skindex-16 was modified by adding 3 items. The new cNF-Skindex was validated among patients with NF1 recruited in the ComPaRe online cohort, in France (N=284). Construct validity was assessed by comparing it with the EQ-5D-5L, its visual analog scale and the MYMOP2 and by assessing its association with patients' characteristics. Reliability was assessed by a test-retest. An English version of the tool was developed using a back forward translation. RESULTS A total of 228 individuals with NF1, with cNF answered the 19-item questionnaire. These items fitted into 3 domains: emotions, symptoms, functioning. One was dropped during analysis because >90% responders were not concerned. The cNF-Skindex significantly correlated with the EQ-5D-5L (N=193) and MYMOP2 (N=210) indicating good external validity: rs 0.38 (p<0.001), and 0.58 (p<0.001) respectively. Having >50 cNF was the only independent variable associated with the total score cNF-Skindex (β=15.88, 95%CI 6.96 - 24.81, p=0.001), and with the 3 sub-scores: "functioning" (β=2.65, 95%CI 0.71 - 4.59, p=0.008), "emotions" (β=17.03, 95%CI 4.11 - 29.96, p=0.010) and "symptoms" (β=3.90, 95%CI 1.95 - 5.85, p<0.001). Test-retest reliability (N=133) found an ICC at 0.96 demonstrating good reproducibility. CONCLUSION The cNF-Skindex demonstrated excellent psychometric properties. The global and sub-scores were increased with higher number of cNF arguing for its use in further trials aiming to reduce their number or prevent their development. Cross-cultural validation and evaluation of its responsiveness are the next steps.
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Affiliation(s)
- L Fertitta
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - C Bergqvist
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - M L Armand
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - S Moryousef
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - S Ferkal
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, National Referral Center for Neurofibromatoses, Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP), 94010, Créteil, France
| | - A Jannic
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France
| | - P Ravaud
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Université de Paris, CRESS, INSERM, INRA, F-75004, Paris, France
| | - V T Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Université de Paris, CRESS, INSERM, INRA, F-75004, Paris, France
| | - K Ezzedine
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France.,Université Paris-Est Créteil (UPEC), 94010, Créteil, France
| | - P Wolkenstein
- Dept. of Dermatology, National Referral Center for Neurofibromatoses, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 94010, Créteil, France.,Université Paris-Est Créteil (UPEC), 94010, Créteil, France.,INSERM U955, 94010, Créteil, France
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9
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Kenborg L, Boschini C, Bidstrup PE, Dalton SO, Doser K, Nielsen TT, Krøyer A, Johansen C, Frederiksen K, Sørensen SA, Hove H, Østergaard JR, Mulvihill JJ, Winther JF. Pregnancy outcomes in women with neurofibromatosis 1: a Danish population-based cohort study. J Med Genet 2022; 59:237-242. [PMID: 33495305 DOI: 10.1136/jmedgenet-2020-107201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/21/2020] [Accepted: 12/21/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND The probability of a pregnancy, live birth, stillbirth and abortion has never been assessed in women with neurofibromatosis 1 (NF1) in a large population-based study. METHODS We included 1006 women (15-49 years) registered with NF1 in the Danish National Patient Registry or followed in two national Centers for Rare Diseases and 10 020 women from the Danish population. Information on pregnancy outcomes was ascertained from health registries. Cumulative incidence, mean cumulative count, hazard ratios (HRs) and proportion ratios (PRs) with 95% CIs were calculated. RESULTS The cumulative incidence of a first pregnancy at age 50 years was slightly lower in women with NF1 (74%; 95% CI 70 to 77) than in population comparisons (78%; 95% CI 77 to 79). When all pregnancies were included, two pregnancies were expected per woman at age of 50 years, irrespective of a NF1 diagnosis. The hazard of a pregnancy did not differ between women with NF1 (HR 1.03; 95% CI 0.95 to 1.11) and the comparisons after adjustment for somatic and psychiatric disease. The proportion of pregnancies that resulted in a live birth was 63% (783/1252) among women NF1 and 68% (8432/12 465) among the comparisons, yielding a PR of 0.95 (95% CI 0.90 to 1.00). The proportions of stillbirths (PR 2.83; 95% CI 1.63 to 4.93) and spontaneous abortions (PR 1.40; 95% CI 1.09 to 1.79) were increased in women with NF1. CONCLUSIONS A similar hazard for pregnancy was observed for women with NF1 and population comparisons after adjustment for potential medical consequences of NF1. However, women with NF1 experienced more spontaneous abortions and stillbirths.
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Affiliation(s)
- Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Cristina Boschini
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Pernille E Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne O Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Thomas T Nielsen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Sven Asger Sørensen
- Department of Neurogenetics, Institute of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Hove
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John R Østergaard
- Center for Rare Diseases, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma, Oklahoma City, OK, USA
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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10
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Johansson E, Kallionpää RA, Böckerman P, Peltonen S, Peltonen J. The rare disease neurofibromatosis 1 as a source of hereditary economic inequality: Evidence from Finland. Genet Med 2021; 24:870-879. [PMID: 34955382 DOI: 10.1016/j.gim.2021.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE This study investigated whether individuals with neurofibromatosis 1 (NF1) fare worse than individuals without NF1 in terms of economic well-being. NF1 is relatively common in the population and provides an informative case of a rare hereditary disease. METHODS We examined a subset of 692 individuals with verified NF1 from the Finnish total population-based NF1 cohort and compared that with 7407 control individuals matched for age, sex, and municipality during 1997-2014. Economic well-being was operationalized with annual work earnings and total income, including social income transfers. RESULTS NF1 significantly worsened economic well-being. Low education, increased morbidity, and reduced labor market participation partly explained the effect of NF1. Yet, NF1 was independently associated with lower income even after adjusting for these factors. Furthermore, NF1 had a larger negative effect on income from work than it had on total income, which indicated that the Finnish social security system partly compensated the labor market losses suffered by individuals with NF1. NF1 had a larger impact on economic inequality for men than for women. CONCLUSION NF1 contributes to economic inequality. A hereditary disease may convey worse economic well-being over several generations.
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Affiliation(s)
- Edvard Johansson
- Faculty of Social Sciences, Business, and Economics, Åbo Akademi University, Turku, Finland
| | - Roope A Kallionpää
- Institute of Biomedicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Petri Böckerman
- Jyväskylä University School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland; Labour Institute for Economic Research, Helsinki, Finland; IZA Institute of Labor Economics, Bonn, Germany
| | - Sirkku Peltonen
- Department of Dermatology and Venereology, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland; Department of Dermatology, Turku University Hospital, Turku, Finland; Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Juha Peltonen
- Institute of Biomedicine, Faculty of Medicine, University of Turku, Turku, Finland.
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11
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Wolters PL, Reda S, Martin S, Al Ghriwati N, Baker M, Berg D, Erickson G, Franklin B, Merker VL, Oberlander B, Reeve S, Rohl C, Rosser T, Toledo-Tamula MA, Vranceanu AM. Impact of the coronavirus pandemic on mental health and health care in adults with neurofibromatosis: Patient perspectives from an online survey. Am J Med Genet A 2021; 188:71-82. [PMID: 34536052 PMCID: PMC8652613 DOI: 10.1002/ajmg.a.62490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/19/2021] [Accepted: 08/10/2021] [Indexed: 01/25/2023]
Abstract
The coronavirus pandemic increased anxiety and stress and prevented access to health care worldwide; it is unclear how COVID-19 affected adults with a multisystem genetic disorder such as neurofibromatosis (NF). An anonymous online survey was distributed through an international registry and foundations to adults with NF (June-August 2020) to assess the impact of the pandemic on mental health and NF health care. Six hundred and thirteen adults (18-81 years; M = 45.7) with NF1 (77.8%), NF2 (14.2%), and schwannomatosis (7.8%) provided complete responses. Respondents rated moderate-to-high amounts of worry about the impact of COVID-19 on their emotional (46.3%) and physical health (46.7%), and 54.8% endorsed moderate-to-high pandemic-related stress. Adults with diagnosed/suspected mental health disorders or moderate-to-severe NF symptom impact as well as females endorsed higher COVID-19 stress (ps < 0.01). Less than half who missed a doctor's appointment for their NF care (43.4%) used telehealth. Of these, 33.3% and 46.2% reported that telehealth met their needs to a moderate or high degree, respectively. Results indicated that subgroups of adults with NF experience higher COVID-19-related worries and stress and may need additional support. Furthermore, telehealth is under-utilized and could help NF providers connect with patients, although improved delivery and patient training may facilitate expanded use of these services.
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Affiliation(s)
- Pamela L Wolters
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephanie Reda
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nour Al Ghriwati
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Melissa Baker
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Dale Berg
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration
| | - Gregg Erickson
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration.,NF Network, Wheaton, Illinois, USA
| | - Barbara Franklin
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration
| | - Vanessa L Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Beverly Oberlander
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration.,NF Network, Wheaton, Illinois, USA
| | - Stephanie Reeve
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration
| | - Claas Rohl
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration.,NF Kinder, NF Patients United, Vienna, Austria
| | - Tena Rosser
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Mary Anne Toledo-Tamula
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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12
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Kenborg L, Andersen EW, Duun-Henriksen AK, Jepsen JRM, Doser K, Dalton SO, Bidstrup PE, Krøyer A, Frederiksen LE, Johansen C, Østergaard JR, Hove H, Sørensen SA, Riccardi VM, Mulvihill JJ, Winther JF. Psychiatric disorders in individuals with neurofibromatosis 1 in Denmark: A nationwide register-based cohort study. Am J Med Genet A 2021; 185:3706-3716. [PMID: 34327813 DOI: 10.1002/ajmg.a.62436] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/01/2021] [Accepted: 07/10/2021] [Indexed: 12/19/2022]
Abstract
The aim of this study was to assess the risks of psychiatric disorders in a large cohort of 905 individuals with NF1 and 7614 population comparisons matched on sex and year of birth. The cohort was linked to the Danish Psychiatric Central Research Register to ascertain information on hospital contacts for psychiatric disorders based on the International Classification of Diseases version 8 and 10. The hazard ratio (HR) for a first psychiatric hospital contact was higher in girls (4.19, 95% confidence interval [CI] 1.81-9.69) and boys with NF1 (5.02, 95% CI 3.27-7.69) <7 years of age than in the population comparisons. Both sexes had increased HRs for developmental disorders, including attention deficit/hyperactivity disorders, autism spectrum disorders, and intellectual disabilities in childhood. Females with NF1 had also increased HRs for unipolar depression, other emotional and behavioral disorders, and severe stress reaction and adjustment disorders in early adulthood. The HRs for psychoses, schizophrenia, bipolar disorders, and substance abuse were similar in individuals with NF1 and the population comparisons. Finally, the cumulative incidence of a first hospital contact due to any psychiatric disorder by age 30 years was 35% (95% CI 29-41) in females and 28% (95% CI 19-37) in males with NF1. Thus, screening for psychiatric disorders may be important for early diagnosis and facilitation of appropriate and effective treatment in individuals with NF1.
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Affiliation(s)
- Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Elisabeth W Andersen
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Jens R M Jepsen
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research and Center for Neuropsychiatric Schizophrenia Research, Mental Health Service Capital Region, University of Copenhagen, Copenhagen, Denmark.,Child and Adolescent Mental Health Centre, Mental Health Services Capital Region, University of Copenhagen, Copenhagen, Denmark
| | - Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne O Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Pernille E Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Line E Frederiksen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John R Østergaard
- Department of Pediatrics, Centre for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Hove
- Department of Pediatrics, Centre for Rare Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,The RareDis Database, Section of Rare Diseases, Department of Clinical Genetics and Pediatrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sven Asger Sørensen
- Department of Neurogenetics, Institute of Cellular and Molecular Medicine, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | | | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
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13
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Kallionpää RA, Valtanen M, Auranen K, Uusitalo E, Rinne JO, Peltonen S, Peltonen J. Increased risk for dementia in neurofibromatosis type 1. Genet Med 2021; 23:2219-2222. [PMID: 34257422 PMCID: PMC8553610 DOI: 10.1038/s41436-021-01261-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine the risk for dementia in neurofibromatosis type 1 (NF1) using a Finnish nationwide cohort of individuals with NF1, and data from national registries. METHODS A Finnish cohort of 1,349 individuals with confirmed NF1 according to the US National Institutes of Health (NIH) diagnostic criteria was compared with a control cohort of 13,870 individuals matched for age, sex, and area of residence. Dementia-related hospital visits were retrieved from the Finnish Care Register for Health Care using International Classification of Diseases, 10th revision (ICD-10) diagnosis codes G30 and F00-F03. Purchases of antidementia drugs were queried with Anatomical Therapeutic Chemical (ATC) classification code N06D from the drug reimbursement register maintained by the Social Insurance Institution of Finland. The follow-up spanned 1998-2014. RESULTS Totals of 16 and 165 individuals with at least two dementia-related diagnoses or drug purchases were identified in the NF1 and control cohorts, respectively. The hazard ratio for dementia in NF1 was 1.67 (95% confidence interval [CI] 1.00-2.80, P = 0.050). In an analysis stratified by the type of dementia, the risk for Alzheimer disease was increased in NF1 compared to controls with a hazard ratio of 2.88 (95% CI 1.47-5.66, P = 0.002). CONCLUSION Dementia and especially Alzheimer disease are previously unrecognized neurological complications of NF1.
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Affiliation(s)
| | - Mikko Valtanen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Department of Dermatology and Venereology, University of Turku, Turku, Finland.,Department of Dermatology, Turku University Hospital, Turku, Finland.,Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Kari Auranen
- Department of Mathematics and Statistics, University of Turku, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Elina Uusitalo
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Juha O Rinne
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Turku PET Centre, University of Turku, Turku, Finland
| | - Sirkku Peltonen
- Department of Dermatology and Venereology, University of Turku, Turku, Finland.,Department of Dermatology, Turku University Hospital, Turku, Finland.,Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Juha Peltonen
- Institute of Biomedicine, University of Turku, Turku, Finland.
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14
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Johansson E, Kallionpää RA, Böckerman P, Peltonen J, Peltonen S. A rare disease and education: Neurofibromatosis type 1 decreases educational attainment. Clin Genet 2021; 99:529-539. [PMID: 33368180 PMCID: PMC8247857 DOI: 10.1111/cge.13907] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022]
Abstract
Rare heritable syndromes may affect educational attainment. Here, we study education in neurofibromatosis 1 (NF1) that is associated with multifaceted medical, social and cognitive consequences. Educational attainment in the Finnish population‐based cohort of 1408 individuals with verified NF1 was compared with matched controls using Cox proportional hazards model with delayed entry and competing risk for death. Moreover, models accounting for the effects of cancer at age 15–30 years, parental NF1 and developmental disorders were constructed. Overall, the attainment of secondary education was reduced in individuals with NF1 compared to controls (hazard ratio 0.83, 95%CI 0.74–0.92). History of cancer and developmental disorders were major predictors of lack of secondary education. Individuals with NF1 obtained vocational secondary education more often than general upper secondary education. Consequently, NF1 decreased the attainment of Bachelor's and Master's degrees by 46%–49% and 64%–74%, respectively. Surprisingly, the non‐NF1 siblings of individuals with NF1 also had lower educational attainment than controls, irrespective of parental NF1. In conclusion, NF1 is associated with reduced educational attainment and tendency for affected individuals to obtain vocational instead of academic education. Individuals living with NF1, especially those with cancer, developmental disorders or familial NF1, need effective student counseling and learning assistance.
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Affiliation(s)
- Edvard Johansson
- Faculty of Social Sciences, Business, and Economics, Åbo Akademi University, Turku, Finland
| | | | - Petri Böckerman
- Jyväskylä University School of Business and Economics, Jyväskylä, Finland.,Labour Institute for Economic Research, Helsinki, Finland.,IZA Institute of Labor Economics, Bonn, Germany
| | - Juha Peltonen
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Sirkku Peltonen
- Department of Dermatology and Venereology, University of Turku, Turku, Finland.,Department of Dermatology, Turku University Hospital, Turku, Finland.,Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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15
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Hamoy-Jimenez G, Kim R, Suppiah S, Zadeh G, Bril V, Barnett C. Quality of life in patients with neurofibromatosis type 1 and 2 in Canada. Neurooncol Adv 2020; 2:i141-i149. [PMID: 32642740 PMCID: PMC7317053 DOI: 10.1093/noajnl/vdaa003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is scarce data on the quality of life of people with neurofibromatosis type 1 (NF1) and type 2 (NF2) in Canada. METHODS A cross-sectional study of adults with NF1 and NF2 attending a tertiary center. Patients completed generic measures (SF-36, EQ-5D-5L, and PROMIS pain interference) and disease-specific questionnaires (PedsQL NF1 module and the NFTI-QOL for NF2). We compared generic scores between NF1 and NF2 individuals and used regression models to assess factors associated with quality of life. RESULTS Hundred and eighty-four participants were enrolled. Mean age was 33 years in NF1 and 40 years in NF2. NF1 and NF2 individuals had lower employment rates and lower scores in all domains of the SF-36 compared to the general Canadian population (P < .005). Using the EQ-5D-5L, there was a high proportion of pain (64% in NF1 and 74% in NF2) and anxiety/depression (60% in NF1 and 68% in NF2). Pain interference correlated with poor quality of life in NF1 and NF2; perceived physical appearance was the main predictor of mental well-being in NF1. CONCLUSIONS Individuals with NF1 and NF2 have low quality of life, and this correlates with pain, anxiety, and depression, which are prevalent in NF1 and NF2. Perceived physical appearance predicts quality of life in NF1. A multidisciplinary approach is necessary for patients with NF1 and NF2, including mental health and pain management.
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Affiliation(s)
- Geohana Hamoy-Jimenez
- Division of Neurology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Raymond Kim
- Division of Medical Oncology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Suganth Suppiah
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Vera Bril
- Division of Neurology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Carolina Barnett
- Division of Neurology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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16
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Doser K, Andersen EW, Kenborg L, Dalton SO, Jepsen JRM, Krøyer A, Østergaard J, Hove H, Sørensen SA, Johansen C, Mulvihill J, Winther JF, Bidstrup PE. Clinical characteristics and quality of life, depression, and anxiety in adults with neurofibromatosis type 1: A nationwide study. Am J Med Genet A 2020; 182:1704-1715. [PMID: 32484306 DOI: 10.1002/ajmg.a.61627] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/20/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a genetic condition characterized by numerous somatic manifestations. The psychosocial burden in adults has rarely been studied. We examined the prevalence of self-reported impairment of quality of life (QoL), symptoms of anxiety and depression and need for support, associated with disease severity and visibility. We conducted a nationwide cross-sectional study of all 467 adults with NF1 diagnosed between 1977 and 2016 at one of the two national centers for rare diseases in Denmark. A total of 244 (56% response rate) completed a questionnaire that included standard measures of QoL, symptoms of depression and anxiety, indicators of disease-related severity, visibility, and need for professional support. Associations between disease severity and visibility and psychosocial burden were analyzed in descriptive and multivariate models. We observed impaired QoL (mean = 81.3; 95% CI, 76.2; 86.4); 19% reported symptoms of depression (mean = 5.7; SD = 5.4), and 15% reported anxiety (mean = 5.1; SD = 5.2) at a clinical level. Adults with NF1 also reported requiring professional support for physical, psychological, and work-related problems. Disease severity and (partly) visibility were significantly (p < .0001) associated with psychosocial well-being and a requirement for support. This study provides new understanding of the factors associated with impaired QoL, indicating that follow-up care should be optimized into adult life.
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Affiliation(s)
- Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Jens Richardt Møllegaard Jepsen
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research and Center for Neuropsychiatric Schizophrenia Research, Mental Health Services, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.,Child and Adolescent Mental Health Center, Mental Health Services Capital Region Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - John Østergaard
- Center for Rare Disease, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Hove
- The RAREDIS Database, Center for Rare Diseases, Copenhagen University Hospital and Aarhus University, Copenhagen, Denmark
| | - Sven Asger Sørensen
- Department of Neurogenetics, Institute of Cellular and Molecular Medicine, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Oncology Clinic, Finsen Center, Copenhagen, Denmark
| | - John Mulvihill
- Department of Pediatrics, University of Oklahoma, Norman, Oklahoma, USA
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Faculty of Health, Department of Clinical Medicine, Aarhus University and University Hospital, Aarhus, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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17
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Forming and ending marital or cohabiting relationships in a Danish population-based cohort of individuals with neurofibromatosis 1. Eur J Hum Genet 2020; 28:1028-1033. [PMID: 32424325 DOI: 10.1038/s41431-020-0645-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 11/09/2022] Open
Abstract
Individuals with neurofibromatosis 1 (NF1) may have problems in managing the transition between childhood and adulthood, such as forming a relationship or finding a partner. We aimed to determine the association between NF1 and forming and ending marital or cohabiting relationships by comparing a large Danish population of adults with NF1 with population comparisons. In this population-based cohort study, we compared a population of Danish adults who were hospitalized for or with complications to prior diagnosed NF1 (n = 787) with population comparisons matched on gender and birth year (n = 7787) through nationwide registries with annually updated information on marriage and cohabitation. Discrete-time survival models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the formation and termination of relationships, with adjustment for birth year, gender, and somatic and psychiatric comorbidities at entry. Individuals with NF1 were significantly less likely to form a relationship (HR = 0.65; 95% CI: 0.58-0.73), with the lowest association for individuals ≥33 years (HR 0.40; 95% CI: 0.25-0.63) and the highest for those aged 18-20 years (HR 0.82; 95% CI: 0.70-0.96). No significant difference was found for ending relationships (HR 1.00; 95% CI: 0.86-1.16). In conclusion, individuals who were hospitalized for NF1 are less likely to engage in marital or cohabiting relationships than population comparisons and are older when they form their first relationship. Once a relationship has been established, however, couples with a NF1-individual are not at greater risk of ending the relationship.
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