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Jones MN, Simpson SL, Beck AF, Cortezzo DE, Thienprayoon R, Corley AMS, Thomson J. Racial Inequities in Palliative Referral for Children with High-Intensity Neurologic Impairment. J Pediatr 2024; 268:113930. [PMID: 38309525 DOI: 10.1016/j.jpeds.2024.113930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/05/2023] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To evaluate whether racial and socioeconomic inequities in pediatric palliative care utilization extend to children with high-intensity neurologic impairment (HI-NI), which is a chronic neurological diagnosis resulting in substantial functional morbidity and mortality. STUDY DESIGN We conducted a retrospective study of patients with HI-NI who received primary care services at a tertiary care center from 2014 through 2019. HI-NI diagnoses that warranted a palliative care referral were identified by consensus of a multidisciplinary team. The outcome was referral to palliative care. The primary exposure was race, categorized as Black or non-Black to represent the impact of anti-Black racism. Additional exposures included ethnicity (Hispanic/non-Hispanic) and insurance status (Medicaid/non-Medicaid). Descriptive statistics, bivariate analyses, and multivariable logistic regression models were performed to assess associations between exposures and palliative care referral. RESULTS A total of 801 patients with HI-NI were included; 7.5% received a palliative referral. There were no differences in gestational age, sex, or ethnicity between patients who received a referral and those who did not. In multivariable analysis, adjusting for ethnicity, sex, gestational age, and presence of complex chronic conditions, Black children (aOR 0.47, 95% CI 0.26, 0.84) and children with Medicaid insurance (aOR 0.40, 95% CI 0.23, 0.70) each had significantly lower odds of palliative referral compared with their non-Black and non-Medicaid-insured peers, respectively. CONCLUSIONS We identified inequities in pediatric palliative care referral among children with HI-NI by race and insurance status. Future work is needed to develop interventions, with families, aimed at promoting more equitable, antiracist systems of palliative care.
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Affiliation(s)
- Margaret N Jones
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Samantha L Simpson
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew F Beck
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - DonnaMaria E Cortezzo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rachel Thienprayoon
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Alexandra M S Corley
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joanna Thomson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Blakey AO, Lavarin C, Brochier A, Amaro CM, Eilenberg JS, Kavanagh PL, Garg A, Drainoni ML, Long KA. Effects of Experienced Discrimination in Pediatric Sickle Cell Disease: Caregiver and Provider Perspectives. J Racial Ethn Health Disparities 2023; 10:3095-3106. [PMID: 36536165 PMCID: PMC10645630 DOI: 10.1007/s40615-022-01483-4] [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: 08/10/2022] [Revised: 11/19/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
For Black children with sickle cell disease (SCD) and their families, high disease stigmatization and pervasive racism increase susceptibility to discrimination in healthcare settings. Childhood experiences of discrimination can result in medical nonadherence, mistrust of healthcare providers, and poorer health outcomes across the lifespan. Caregivers and medical providers are essential to childhood SCD management and are therefore well-positioned to provide insight into discrimination in the context of pediatric SCD. This mixed-methods study sought caregivers' and providers' perspectives on processes underlying discrimination and potential solutions to mitigate the negative effects of perceived discrimination among children with SCD. Caregivers (N = 27) of children with SCD (≤ 12 years old) and providers from their hematology clinics (N = 11) participated in individual semi-structured interviews exploring experiences of discrimination and daily SCD management and completed a quantitative measure of discrimination. Qualitative data were collected until themes reached saturation and subsequently transcribed verbatim, coded, and analyzed using applied thematic analysis. Quantitative and qualitative data converged to suggest the pervasiveness of discrimination in healthcare settings. Three qualitative themes emerged: (1) healthcare system factors underlie discrimination, (2) families' challenging interactions with providers lead to perceptions of discrimination, and (3) experiences of discrimination impact caregiver-provider interactions. Both caregivers and providers highlighted building trusting patient-provider relationships and encouraging patients' self-advocacy as means to reduce experiences and impacts of discrimination. These findings offer potential approaches to tangibly mitigate occurrences of discrimination in pediatric healthcare settings by trust building, accountability keeping, and fostering rapport to improve quality of care and pediatric SCD health outcomes.
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Affiliation(s)
- Ariel O Blakey
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Claudine Lavarin
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.
| | | | - Christina M Amaro
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- Department of Behavioral Health and the Center for Healthcare Delivery Science, Nemours Children's Hospital, Delaware, Wilmington, DE, USA
| | | | - Patricia L Kavanagh
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Pediatrics, University of Massachusetts Memorial Health, Worcester, MA, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Kristin A Long
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Gonzalez VJ, Kimbro RT, Shabosky JC, Kostelyna S, Fasipe T, Villafranco N, Cutitta KE, Lopez KN. Racial Disparities in Mental Health Disorders in Youth with Chronic Medical Conditions. J Pediatr 2023; 259:113411. [PMID: 37030612 PMCID: PMC10524229 DOI: 10.1016/j.jpeds.2023.113411] [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: 06/08/2022] [Revised: 02/15/2023] [Accepted: 03/25/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVE To evaluate the association between race/ethnicity, poverty, and mental health in youth with chronic conditions. STUDY DESIGN A cross-sectional comparative study was performed using the records of a tertiary care center from 2011 to 2015. INCLUSION CRITERIA children aged 4-17 years with ≥1 hospitalization or emergency department visit. Exclusion criteria were those with arrhythmias or treatment with clonidine/benzodiazepines. The primary outcome variable was diagnosis or medication for anxiety, depression, or attention deficit hyperactivity disorder. The primary predictor variable was diagnosis of cystic fibrosis (CF), sickle cell disease (SCD), or congenital heart disease (CHD). RESULTS We identified 112 313 patients, 0.2% with CF, 0.4% with SCD, and 1.0% with CHD. Patients with CF had the highest prevalence (23%) and odds (OR, 4.21; 95% CI, 3.07-5.77) of anxiety or depression, whereas patients with SCD had the lowest prevalence (7%) and odds (OR, 1.54; 95% CI, 1.11-2.14). Those with CHD had a prevalence of up to 17%, with 3-4 times higher odds of anxiety or depression (OR, 3.70; 95% CI, 2.98-4.61). All non-White participants were less likely to be diagnosed or treated for anxiety or depression and attention deficit hyperactivity disorder. Although poverty increased the probability of anxiety or depression in patients with CHD, this finding was not seen in patients with CF or SCD. CONCLUSIONS Children with CF, SCD, and CHD are at increased risk of anxiety or depression; however non-White patients are likely being underdiagnosed and undertreated. Increased screening and recognition in minority children are needed to decrease disparities in mental health outcomes.
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Affiliation(s)
- Vincent J Gonzalez
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX.
| | | | - John C Shabosky
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX
| | - Stefan Kostelyna
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX
| | - Titilope Fasipe
- Department of Pediatrics, Section of Hematology/Oncology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX
| | - Natalie Villafranco
- Department of Pediatrics, Section of Pulmonology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX
| | - Katherine E Cutitta
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX
| | - Keila N Lopez
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX
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Shih S, Donati MR, Cohen LL, Shneider C, Sil S. A dyadic analysis of parent and child pain catastrophizing and health-related quality of life in pediatric sickle cell disease. Pain 2023; 164:1537-1544. [PMID: 36645172 DOI: 10.1097/j.pain.0000000000002848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/05/2022] [Indexed: 01/17/2023]
Abstract
ABSTRACT The purpose of this study was to examine the dyadic and individual level effects of parent and child pain catastrophizing on child health-related quality of life (HRQOL) in pediatric sickle cell disease. Questionnaires assessing child pain frequency, child and parent pain catastrophizing, and child HRQOL were completed by youth and their primary caregiver. A Common Fate Model was estimated to test the dyadic level relationship between parent and child pain catastrophizing and child HRQOL. An Actor-Partner-Common Fate Model hybrid was estimated to test the relationship between child HRQOL and individual-level child pain catastrophizing and parent pain catastrophizing, respectively. In each model, child HRQOL was modelled as a dyadic variable by factoring parent and child ratings. Patients (N = 100, M age = 13.5 years, 61% female) and their caregivers (M age = 41.8 years, 86% mothers) participated. Dyad-level pain catastrophizing was negatively associated with child HRQOL, demonstrating a large effect (β = -0.809). Individual-level parent and child pain catastrophizing were each uniquely negatively associated with child HRQOL, demonstrating small to medium effects (β = -0.309, β = -0.270). Individual level effects were net of same-rater bias, which was significant for both parents and children. Both the unique and the overlapping aspects of parent and child pain catastrophizing are significant contributors to associations with child HRQOL, such that higher levels of pain catastrophizing are associated with worse child HRQOL. Findings suggest the need for multipronged intervention targeting factors common to parent-child dyads and factors unique to parents and children, respectively.
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Affiliation(s)
- Sharon Shih
- Georgia State University, Atlanta, GA, United States
| | | | - Lindsey L Cohen
- Georgia State University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | | | - Soumitri Sil
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Emory University School of Medicine, Atlanta, GA, United States
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Benedetti DJ, Marron JM, Thomas SM, Brown AEC, Pyke-Grimm KA, Johnson LM, Unguru Y, Kodish E. The role of ethicists in pediatric hematology/oncology: Current status and future needs. Pediatr Blood Cancer 2023; 70:e30132. [PMID: 36495529 DOI: 10.1002/pbc.30132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022]
Abstract
As pediatric hematology/oncology (PHO) becomes more complex and sub-subspecialized, dedicated PHO ethicists have emerged as sub-subspecialists focused on addressing ethical issues encountered in clinical and research practices. PHO physicians and other clinicians with advanced training in bioethics contribute to the field through ethics research, education, and ethics consultation services. Furthermore, there exists a newer generation of PHO trainees interested in bioethics. This review details the experiences of current PHO ethicists, providing a blueprint for future educational, research and service activities to strengthen the trajectory of the burgeoning sub-subspecialty of PHO ethics. Creating an American Society of Pediatric Hematology/Oncology (ASPHO) ethics Special Interest Group, enhancing clinical ethics education for pediatric hematologists/oncologists (PHOs), developing multi-institutional research collaborations, and increasing attention to ethical issues germane to nonmalignant hematology will serve the interests of the entire field of PHO, enhancing the care of PHO patients and careers of PHOs.
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Affiliation(s)
- Daniel J Benedetti
- Division of Pediatric Hematology/Oncology, and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan M Marron
- Division of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, and Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
| | - Stefanie M Thomas
- Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Amy E Caruso Brown
- Division of Pediatric Hematology/Oncology, and Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Kimberly A Pyke-Grimm
- Department of Nursing Research and Evidence-Based Practice, Stanford Children's Health and Division of Pediatric Hematology/Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Liza-Marie Johnson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yoram Unguru
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, Maryland, USA.,Johns Hopkins University Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - Eric Kodish
- Departments of Pediatrics, Oncology, and Bioethics, Cleveland Clinic Children's and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio, USA
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Khan H, Krull M, Hankins JS, Wang WC, Porter JS. Sickle cell disease and social determinants of health: A scoping review. Pediatr Blood Cancer 2023; 70:e30089. [PMID: 36495544 PMCID: PMC9790038 DOI: 10.1002/pbc.30089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/27/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
Social determinants of health (SDoH) may impact outcomes in sickle cell disease (SCD). We conducted a comprehensive literature review of five electronic databases to elucidate the relationship between SDoH and SCD, and identify gaps in the literature. Our search yielded 59 articles, which we organized into five SDoH areas: Neighborhood and Built Environment, Health and Healthcare, Social and Community Context, Education, and Economic Stability. We found that social determinants, such as access to healthcare, were inconsistently evaluated. Improved recognition and understanding of SDoH should enhance the development of programs that directly address its detrimental effects on patients with SCD.
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Affiliation(s)
- Hamda Khan
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Mathew Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane S. Hankins
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Winfred C. Wang
- Departments of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jerlym S. Porter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
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U.S. Health Resources & Services Administration. Dela J Public Health 2022; 8:6. [PMID: 36751620 PMCID: PMC9894050 DOI: 10.32481/djph.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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8
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Peer Mediated Groups:. Dela J Public Health 2022; 8:8-11. [PMCID: PMC9621580 DOI: 10.32481/djph.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Gibler RC, Abelson E, Williams SE, Lynch-Jordan AM, Kashikar-Zuck S, Jastrowski Mano KE. Establishing the Content Validity of a Modified Bank of School Anxiety Inventory Items for Use Among Adolescents With Chronic Pain. J Pediatr Psychol 2022; 47:1044-1056. [PMID: 35582894 PMCID: PMC9801705 DOI: 10.1093/jpepsy/jsac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE School anxiety is a prevalent mental health concern that drives school-related disability among youth with chronic pain. The only available measure of school anxiety-the School Anxiety Inventory, Short Version (SAI-SV)-lacks content specificity for measuring school anxiety in pediatric pain populations. We aimed to refine the SAI-SV by obtaining qualitative data about unique school situations that are anxiety-provoking for youth with pain and characterizing the nature of symptoms experienced in these situations. METHODS Adolescents with chronic pain (n = 16) completed a semistructured interview focused on experiences with anxiety in school-related academic and social contexts. We employed thematic analysis to extend the empirical understanding of school anxiety from the perspective of patients suffering from pain and to generate new item content. The content was refined with iterative feedback from a separate group of adolescents with chronic pain (n = 5) and a team of expert pain psychologists (n = 3). RESULTS We identified six themes within the data and generated new items designed to capture anxiety related to negative interactions with teachers and peers, falling behind with schoolwork, and struggles with concentration and fatigue. Participants and experts rated new item content as highly relevant for use among youth with pain. The updated item bank was named the School Anxiety Inventory for Chronic Pain. CONCLUSIONS Future research is needed to complete the psychometric evaluation of the item bank and finalize items to be included in a measure that can be used in research and clinical settings. Implications for treating school-related anxiety among youth with pain are also discussed.
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Affiliation(s)
- Robert C Gibler
- All correspondence concerning this article should be addressed to Robert C. Gibler, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 7039, Cincinnati, OH 45229, USA. E-mail:
| | - Elana Abelson
- Department of Psychology, University of Cincinnati, USA
| | - Sara E Williams
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Anne M Lynch-Jordan
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Susmita Kashikar-Zuck
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA,Department of Pediatrics, University of Cincinnati College of Medicine, USA
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Stokoe M, Zwicker HM, Forbes C, Abu-Saris NEH, Fay-McClymont TB, Désiré N, Guilcher GM, Singh G, Leaker M, Yeates KO, Russel KB, Cho S, Carrels T, Rahamatullah I, Henry B, Dunnewold N, Schulte F. Health related quality of life in children with sickle cell disease: A systematic review and meta-analysis. Blood Rev 2022; 56:100982. [DOI: 10.1016/j.blre.2022.100982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/27/2022] [Accepted: 05/16/2022] [Indexed: 11/02/2022]
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Rodigari F, Brugnera G, Colombatti R. Health-related quality of life in hemoglobinopathies: A systematic review from a global perspective. Front Pediatr 2022; 10:886674. [PMID: 36090573 PMCID: PMC9452907 DOI: 10.3389/fped.2022.886674] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/18/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Sickle cell disease (SCD) and thalassemia are inherited blood disorders, which can lead to life-threatening events and chronic organ damage. Recent advances in treatments have increased life expectancy, and hemoglobinopathies have become chronic illnesses with social and emotional impairments. Thus, health-related quality of life (HRQOL) assessment has a fundamental role in disease management and treatment, and generic and disease-specific questionnaires are reliable and validated measures to estimate disease burden. The heterogeneous distribution of treatment opportunities worldwide influences physical, social, and emotional disease perception. OBJECTIVES To review publications concerning HRQOL for SCD and thalassemia in different areas of the world in order to gather a global perspective of questionnaires used and outcomes evaluated. METHODS A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Medline databases were searched on 29 September 2021. Inclusion criteria were as follows: (1) studies of HRQOL assessment in SCD and thalassemia patients by using the PROMIS, the SF-36, the SCSES, the PedsQL-SCD, the PedsQOL generic core scale, the ASCQ-Me, and the TranQoL; and (2) every article type, including non-English studies. We excluded studies that were not limited to SCD or thalassemia and studies that were not specific to hemoglobinopathies, and not consistent with the topic of HRQOL assessment. We did not include the gray literature. A total of 102 out of 124 articles from PubMed, Cochrane Library, and Google Scholar were eligible for inclusion (66 SCD articles and 36 thalassemia articles). The quality of studies was assessed through Critical Appraisal tools for use in JBI Systematic Reviews. Data extraction was conducted using a standardized data collection form (authors, year and country of publication, study design, age and number of patients, HRQOL questionnaires, questionnaire language, and clinical outcomes). RESULTS The evaluation of HRQOL was conducted on all continents, but differences in the worldwide frequency of HRQOL assessment were observed. HRQOL of SCD patients was less investigated in Europe. HRQOL of thalassemia patients was less investigated in South-East Asia and Africa. Generic HRQOL questionnaires (PROMIS, SF-36, and PedsQL) were frequently adopted, while disease-specific ones (ASCQ-Me, SCSES for SCD, and TranQoL for thalassemia) were less used. Translation into local languages has been often performed. CONCLUSION Health-related quality of life is a complex outcome that has been increasingly incorporated in clinical research and clinical practice worldwide, although with regional differences. Disease-specific outcomes (pain for SCD and transfusion burden for thalassemia) and healthcare system characteristics, particularly in low-income countries, have an impact on HRQOL and should be considered in healthcare plans.
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Affiliation(s)
- Francesca Rodigari
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
| | - Giorgia Brugnera
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
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Umaretiya PJ, Tsai JW. Learning to listen: A plea to our profession. Pediatr Blood Cancer 2021; 68:e29150. [PMID: 34061423 DOI: 10.1002/pbc.29150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/12/2021] [Accepted: 05/18/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Puja J Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jessica W Tsai
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
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13
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Colombatti R, Casale M, Russo G. Disease burden and quality of life of in children with sickle cell disease in Italy: time to be considered a priority. Ital J Pediatr 2021; 47:163. [PMID: 34325732 PMCID: PMC8323323 DOI: 10.1186/s13052-021-01109-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/18/2021] [Indexed: 01/12/2023] Open
Abstract
The objective of the present article is to highlight the need for attention to Quality of Life of patients with Sickle Cell Disease living in Italy. The transformation of sickle cell disease from a severe life-threatening disease of childhood into a chronic, lifelong condition due to the significant improvements in care and treatment options, imposes increasing new challenges to health care providers and patients. Patients now face physical, psychosocial and emotional challenges throughout their lives. They generally have to receive chronic treatments and regular multidisciplinary monitoring which increase social and emotional burden rendering adherence to treatment sometimes complicated. A chronic disease impacts all aspects of patients’ lives, not only the physical one, but also the social and emotional aspects as well as the educational and working life. The entire “Quality of Life” is affected and recent evidence demonstrates the importance quality of life has for patients with chronic illness. The results of this review focus on emerging data regarding quality of life across the lifespan of patients with Sickle Cell Disease, and highlight the need for more action in this field in Italy, where recent immigration and improved care determine an increasing population of children with sickle cell disease being taken into long term care.
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Affiliation(s)
- Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Maddalena Casale
- Department of Women, Child and General and Specialized Surgery, University "Luigi Vanvitelli", Naples, Italy
| | - Giovanna Russo
- Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
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Morse BL, Carmichael AE, Bradford VA, Pollard AL. Sickle Cell Disease Care Planning for School Nurses. NASN Sch Nurse 2021; 37:48-54. [PMID: 34292091 DOI: 10.1177/1942602x211025079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Schoolchildren with sickle cell disease (SCD) experience physiologic and psychologic stress that can affect school functioning, mental well-being, and physical health. Student needs are unique and individualized; however, school nurses can support students and families with SCD through comprehensive and thorough care planning efforts. In addition to components specific to individual prescriptions and other nonpharmacological therapies, school nurses should consider school access and inclusion, pain management, racism, and disease self-management when care planning. As a healthcare provider who may have several continuous years of near-daily contact with students, the school nurse is an imperative provider, educator, and advocate for students learning to manage their SCD and avoid the related complications and challenges.
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Wright LA, Cohen LL, Gise J, Shih S, Sil S, Carter S. Pain and QOL in Pediatric Sickle Cell Disease: Buffering by Resilience Processes. J Pediatr Psychol 2021; 46:1015-1024. [PMID: 34131745 DOI: 10.1093/jpepsy/jsab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Sickle cell disease (SCD) is a group of inherited blood disorders. The central feature of this chronic condition is pain. Several identified risk factors exacerbate the impact of pain on quality of life (QOL) in SCD; however, there are relatively fewer investigations of strengths-based resilience variables that might buffer the influence of pain on living with SCD. The purpose of this study was to examine strength-based resilience processes in youth with SCD and their parents. Grounded in an ecological resilience-risk model, we evaluated whether adolescent and parent protective factors (pain acceptance, mindfulness, and psychological flexibility) moderated the relation between adolescent-reported pain burden and QOL. METHODS Ninety-three 12- to 18-year-old adolescents with SCD and their parents participated. Adolescents completed assessments of pain characteristics, pain acceptance, mindfulness, and QOL. Parents completed instruments measuring demographic and disease variables and parent psychological flexibility. RESULTS Pain variables were associated with protective factors in predicted directions. Adolescent acceptance and mindfulness were positively correlated with QOL. Parent psychological flexibility and adolescent QOL were not related. After controlling for demographic, pain, and disease variables, moderation analyses indicated that adolescent pain acceptance buffered the relation between SCD pain burden and QOL. Moderation analyses were not significant for adolescent mindfulness or parent psychological flexibility. CONCLUSIONS Results suggest that strengths-based factors may play an important role for adolescents' QOL within the context of SCD pain. Interventions that enhance teenagers' ability to accept pain might be particularly useful to improve QOL in adolescents living with SCD pain.
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Affiliation(s)
- Laura A Wright
- Department of Neuropsychology, Children's Healthcare of Atlanta
| | | | - Jensi Gise
- Department of Psychology, Georgia State University
| | - Sharon Shih
- Department of Psychology, Georgia State University
| | - Soumitri Sil
- Department of Neuropsychology, Children's Healthcare of Atlanta.,Department of Pediatrics, Emory University School of Medicine
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Valrie C, Thurston I, Santos M. Introduction to the Special Issue: Addressing Health Disparities in Pediatric Psychology. J Pediatr Psychol 2020; 45:833-838. [PMID: 32791524 PMCID: PMC7454754 DOI: 10.1093/jpepsy/jsaa066] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 01/10/2023] Open
Abstract
This introduction to the special issue on Addressing Health Disparities in Pediatric Psychology provides context for why this special issue is needed, reviews key findings of the accepted articles, and discusses future directions for advancing the field. This special issue, one of three on this topic area that has been put forth in the history of this journal, comes at a critical point in our world. This is a time when the COVID-19 pandemic is systematically infecting Black, Indigenous, and People of Color and when there has been increased attention to systemic racism and intersecting violence inherent in multiple systems, including the justice, health, and educational systems. Using Kilbourne et al. (2016) framework, this special issue focuses on Phase 2 and Phase 3 research. Rather than only identifying health disparities (Phase 1), this issue focuses on understanding mechanisms and translating such understanding into interventions and policy changes. The accepted articles span a wide gamut from obesity to autism to rural populations. Furthermore, the articles provide methods for advancing the field beyond simply noting that systematic differences exist toward strategies to address these inequities. We conclude this introduction by discussing next steps for future research, with hopes that it inspires the next generation to study issues of disparities and inequity in deeper, more meaningful, and impactful ways.
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Affiliation(s)
- Cecelia Valrie
- Department of Psychology, Virginia Commonwealth University.,Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University
| | - Idia Thurston
- Department of Psychological and Brain Sciences, Texas A&M University.,Department of Health Promotion and Community Health Sciences, Texas A&M Health
| | - Melissa Santos
- Pediatric Obesity Center, Connecticut Children's.,Department of Pediatrics, University of Connecticut School of Medicine
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