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Varni JW, Zebracki K, Hwang M, Mulcahey MJ, Vogel LC. Pain, pain interference, social and school/work functioning in youth with spinal cord injury: A mediation analysis. J Spinal Cord Med 2024; 47:504-510. [PMID: 36149340 DOI: 10.1080/10790268.2022.2120232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
CONTEXT/OBJECTIVE The objective of the present study was to investigate the effects of pain severity, pain interference and social functioning in a serial multiple mediator model predicting school/work functioning in youth with spinal cord injury (SCI) from their perspective. DESIGN Explanatory or mechanistic study. SETTING Pediatric specialty hospital. PARTICIPANTS 125 youth with SCI ages 8-24. OUTCOME MEASURES The Pain Severity Item and Pain Interference Scale from the PedsQL™ Spinal Cord Injury Module, and the Social Functioning and School/Work Functioning Scales from the PedsQL™ 4.0 Generic Core Scales Short Form SF15 were completed. RESULTS Hierarchical multiple regression and serial multiple mediator model analyses were conducted to test the percent variability accounted for and the mediating effects of pain interference and social functioning in the association between pain severity and school/work functioning. Pain predictive effects on school/work functioning were serially mediated by pain interference and social functioning. In a predictive analytics model conducted with hierarchical multiple regression analysis, age, sex, pain, pain interference and social functioning accounted for 45% of the variance in youth-reported school/work functioning (P < 0.001), demonstrating a large effect size. CONCLUSION The mechanisms of the predictive effects of pain severity on school/work functioning in youth with SCI are explained in part by the serial multiple mediator effects of pain interference and social functioning. Identifying the multiple mediators of SCI pain on school/work functioning from the perspective of youth with SCI may facilitate future clinical research and practice to ameliorate impaired daily functioning and improve overall well-being.
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Affiliation(s)
- James W Varni
- Department of Pediatrics, College of Medicine, Texas A&M University, College Station, Texas, USA
- Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Texas, USA
| | - Kathy Zebracki
- Shriners Children's Chicago, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Miriam Hwang
- Shriners Children's Chicago, Chicago, Illinois, USA
| | - M J Mulcahey
- Department of Physical Medicine, Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lawrence C Vogel
- Shriners Children's Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Rush Medical College, Chicago, Illinois, USA
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Mpundu-Kaambwa C, Bulamu NB, Lines L, Chen G, Whitehurst DGT, Dalziel K, Devlin N, Ratcliffe J. Exploring the Use of Pictorial Approaches in the Development of Paediatric Patient-Reported Outcome Instruments: A Systematic Review. PHARMACOECONOMICS 2024; 42:9-37. [PMID: 38349590 PMCID: PMC11168995 DOI: 10.1007/s40273-024-01357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Children may find self-reporting health-related quality of life (HRQoL) using patient-reported outcome measures (PROMs) presented in text-based formats difficult, particularly younger children and children with developmental delays or chronic illness. In such cases, pictorial PROMs (where pictorial representations are used alongside or to replace text) may offer a valid alternative. AIM This systematic literature review focused on identifying and describing paediatric PROMs that incorporate pictorial approaches, providing children with more effective means to express their HRQoL. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Seven electronic databases were searched from inception to 1 March 2022. There were no country restrictions applied to the search; all English-language studies were considered for inclusion in the review. Characteristics and development methods of the identified pictorial PROMs were evaluated against context-specific good practice guidelines published by The Professional Society for Health Economics and Outcomes Research (ISPOR). RESULTS A total of 22 paediatric pictorial PROMs, comprising 28 unique versions, were identified. These PROMs were predominantly developed in the USA and the UK, targeting children aged 3-18 years. Likert scales with pictorial anchors, particularly happy-sad faces, were commonly used for response options, appearing in 15 (54%) of the PROMs. Various graphic methods, such as happy-sad faces, cartoons, and thermometers, were adapted to specific content domains. These PROMs covered a wide range of domains, including physical and emotional health and social functioning. Emphasis was placed on content validity, including active child participation in developing pictorial elements. Notably, children's participation was sought during the development of the pictorial elements for 13 (46%) of the PROMs. Various development methods were employed, with 43% of paediatric PROMs using literature reviews, 43% using focus groups, and 32% involving expert consultation. Interviews emerged as the primary method, being employed in 61% of the studies. Additionally, three measures specifically addressed cross-cultural considerations. CONCLUSION Paediatric pictorial PROMs offer child-friendly tools for assessing HRQoL for application with children who find reading and understanding text-based PROMs challenging. There is some evidence that pictorial PROMs facilitate self-report in this population and improve measurement properties compared to text-only PROMs. Further research is needed to develop, validate, and test paediatric pictorial PROMs, with an emphasis on including children from the inception in the co-design process.
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Affiliation(s)
- Christine Mpundu-Kaambwa
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia.
| | - Norma B Bulamu
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Lauren Lines
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | | | - Kim Dalziel
- Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nancy Devlin
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia
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Shi Z, Cao A, Li S, Wang J, Zhang J, Ratcliffe J, Chen G. Health-related quality of life and subjective well-being among children aged 9-12 years in Shandong Province, China. Health Qual Life Outcomes 2024; 22:41. [PMID: 38816861 PMCID: PMC11140898 DOI: 10.1186/s12955-024-02258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/14/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE To investigate the health-related quality of life (HRQoL) and subjective well-being (SWB) of children aged 9-12 years in eastern China, and examine concordance within child self-reported and parent proxy-assessed. METHODS Data was collected from 9 to 12 years old children (including their parents) in Shandong Province in 2018. Participants self-completed a hard-copy questionnaire including Child Health Utility 9D (CHU9D), Pediatric Quality of Life Inventory (PedsQL)™ 4.0 Short Form 15 Generic Core Scales (hereafter the PedsQL™), Student's Life Satisfaction Scale (SLSS), as well as information on socio-demographic characteristics and self-report health status. Spearman's correlation coefficients and the difference between sub-groups were conducted to assess and compare the agreement on HRQoL and SWB instruments. Exploratory factor analysis (EFA) was used to ascertain the number of unique underlying latent factors that were associated with the items covered by the two generic HRQoL and the SWB instruments. The concordance of child self-reported and parent proxy-assessed was analyzed using weighted kappa coefficient and Bland-Altman plots. RESULTS A total of 810 children and 810 parents were invited to participate in the survey. A valid sample of 799 (98.6%) children and 643 (79.4%) parents completed the questionnaire. The child self-reported mean scores were CHU9D = 0.87, PedsQL™ = 83.47, and SLSS = 30.90, respectively. The parent proxy-assessed mean scores were PedsQL™ = 68.61 and SLSS = 31.23, respectively. The child self-reported PedsQL™ was moderately correlated with the CHU9D (r = 0.52). There was a weak correlation between CHU9D and SLSS (r = 0.27). The EFA result found 3 factors whilst seven SLSS items grouped into a standalone factor (factor 3), and the nine dimensions of CHU9D shared two common factors with the PedsQL™ (factor 1 and factor 2). A low level of concordance was observed across all comparisons and in all domains (weighted kappa < 0.20) between parents and their children. Furthermore, a high level of discordance was observed between child self-reported and father proxy-assessed. CONCLUSIONS CHU9D and PedsQL™ instruments have a higher agreement in measuring the HRQoL in children. CHU9D/PedsQL™ and SLSS instruments showed a low agreement and EFA result suggested that measuring SWB in children potentially may provide further information, which might be overlooked by using HRQoL instruments exclusively. Concordance of child self-reported and parent proxy-assessed was poor. Overall, mother-child concordance was higher than father-child concordance.
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Affiliation(s)
- Zhao Shi
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
| | - Aihua Cao
- Department of Pediatric, Qilu Hospital, Shandong University, Jinan, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.
- Center for Health Preference Research, Shandong University, Jinan, China.
| | - Jianglin Wang
- Shandong Electric Power Central Hospital, Jinan, China
| | - Jin Zhang
- Qingdao Municipal Hospital, Qingdao, China
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
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Olival MG, Vilela TS, Hankins JS, Bendo CB, Lobo CL, Maioli MCP, Bandeira FM, Werneck GL, Soares AR. Translation, transcultural adaptation, and validation of PedsQL 3.0 Sickle Cell Disease Module into Brazilian Portuguese. Pediatr Blood Cancer 2024; 71:e30862. [PMID: 38287205 DOI: 10.1002/pbc.30862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/04/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Despite the high prevalence of sickle cell disease (SCD) in Brazil, no studies have described the validation of an SCD-specific health-related quality-of-life (HRQoL) instrument in children. We validated PedsQL 3.0 Sickle Cell Disease Module (PedsQL-SCD) for Brazilian Portuguese, and cross-validated it with PedsQL 4.0 Generic Core Scale (PedsQL-GCS) in children with SCD. METHODS PedsQL-SCD was translated and culturally adapted using forward and reverse translations. PedsQL-SCD and PedsQL-GCS were tested in children and adolescents with SCD aged 2-18 years and their caregivers. Validity was assessed using the Pearson and intraclass correlation coefficients, and reliability measured with Cronbach's alpha. RESULTS PedsQL-SCD was validated in 206 children with SCD (median age 14 years, range: 8-18) and 201 caregivers. Among patients and caregivers, the mean total score for PedsQL-SCD was 65.7 and 64.1, respectively. The mean total score for PedsQL-GCS was 73.1 and 68.9 among patients and caregivers, respectively. The internal consistency for PedsQL-SCD and PedsQL-GCS was good; Cronbach's alpha coefficients ranged from .59-.93 to .64-.83 among patients and from .60-.95 to .65-.85 among caregivers, respectively. Most intercorrelations between PedsQL-SCD and PedsQL-GCS, for patients and caregivers, had medium to large effect sizes (range: .23-.63 and .27-.64, respectively). Pain and pain impact domains of PedsQL-SCD and physical dimension of PedsQL-GCS had the highest cross-correlation (.63 and .6 for patients; .63 and .64 for caregivers, respectively), confirming convergent construct validity. CONCLUSION PedsQL-SCD is a valid, culturally appropriate measure to assess HRQoL in children with SCD in Brazil and is well-correlated PedsQL-GCS.
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Affiliation(s)
- Maristela G Olival
- Clinical Hematology and Research Division, Instituto de Hematologia Arthur de Siqueira Cavalcanti--HEMORIO, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thiago S Vilela
- Pediatric Hematology Sector, Pediatrics Department, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Jane S Hankins
- Departments of Global Pediatric Medicine and Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Cristiane B Bendo
- Department of Pediatric Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Clarisse L Lobo
- Clinical Hematology and Research Division, Instituto de Hematologia Arthur de Siqueira Cavalcanti--HEMORIO, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Christina P Maioli
- Hematology Service, Pedro Ernesto University Hospital/Medical Sciences Faculty/Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávia M Bandeira
- Hematology Service, Pedro Ernesto University Hospital/Medical Sciences Faculty/Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Guilherme L Werneck
- Department of Epidemiology, Social Medicine Institute/Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andréa R Soares
- Hematology Service, Pedro Ernesto University Hospital/Medical Sciences Faculty/Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
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Cummings K, Dias RP, Hart R, Welham A. Behavioural, developmental and psychological characteristics in children with germline PTEN mutations: a carer report study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024. [PMID: 38505951 DOI: 10.1111/jir.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND PTEN is primarily known as a tumour suppressor gene. However, research describes higher rates of difficulties including intellectual disability and difficulties relating to autism spectrum conditions (ASCs) in people with germline PTEN mutations. Other psychological characteristics/experiences are less often reported and are explored in this study. METHODS The parents of 20 children with PTEN mutations completed an online survey exploring adaptive behaviour, ASC-associated behaviours, anxiety, mood, hypermobility, behaviours that challenge, sensory experiences, quality of life and parental wellbeing. Published normative data and data from groups of individuals with other genetic neurodevelopmental conditions were used to contextualise findings. RESULTS Overall levels of adaptive behaviour were below the 'typical' range, and no marked relative differences were noted between domains. Higher levels of ASC-related difficulties, including sensory experiences, were found in comparison with 'typically developing' children, with a possible peak in restrictive/repetitive behaviour; ASC and sensory processing atypicality also strongly correlated with reported joint hypermobility. A relative preservation of social motivation was noted. Anxiety levels were found to be elevated overall (and to relate to sensory processing and joint hypermobility), with the exception of social anxiety, which was comparable with normative data. Self-injurious behaviour was common. CONCLUSIONS Results suggest a wide range of possible difficulties in children with PTEN mutations, including elevated anxiety. Despite elevated ASC phenomenology, social motivation may remain relatively strong. Firm conclusions are restricted by a small sample size and potential recruitment bias, and future research is required to further explore the relationships between such characteristics.
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Affiliation(s)
- K Cummings
- Department of Psychological Services, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - R P Dias
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - R Hart
- Department of Genetics, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - A Welham
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
- School of Psychology, University of Birmingham, Birmingham, UK
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Viana da Silva P, Kamper SJ, Hall A, Yamato TP, Hestbaek L, Lauridsen HH, Williams CM. Developing and assessing the measurement properties of an instrument to assess the impact of musculoskeletal pain in children aged 9 to 12-the pediatric musculoskeletal pain impact summary score. Braz J Phys Ther 2024; 28:101052. [PMID: 38636288 PMCID: PMC11039311 DOI: 10.1016/j.bjpt.2024.101052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 02/07/2024] [Accepted: 03/05/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Despite the high prevalence of musculoskeletal (MSK) pain in children, there is a lack of instruments to measure the impact of MSK pain on children's activity and participation. OBJECTIVE To assess the reliability and construct validity of the Pediatric MSK Pain Impact summary score in school children (aged 9 to 12) with MSK pain. METHODS We used a pragmatic approach in a reflective framework to assess internal consistency, structural validity, convergent validity, and discriminative validity in a sample of 615 children with MSK pain. RESULTS The confirmatory factor analysis results indicate that the summary score has limited internal consistency and construct validity. The estimated Cronbach's alpha was 0.63, and most goodness of fit indices met the recommended thresholds (SRMR = 0.030; GFI = 0.993, CFI = 0.955, RMSEA 0.073), although they were close to the lower bounds of the thresholds. The convergent validity showed appropriate correlation of the summary score with quality of life (r = -0.33), care-seeking (r = 0.45), and medication intake (r = 0.37). Discriminative validity showed that the instrument can discriminate between the impact of pain on children with frequent and infrequent (2.93; 95% CI: 2.36 - 3.50) MSK pain. CONCLUSION The Pediatric MSK Pain Impact summary showed limited internal consistency and construct validity; however, it can discriminate between children with frequent and infrequent pain. The results are promising for clinical and research practices as it is a short and convenient tool to be used in school-aged children.
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Affiliation(s)
- Priscilla Viana da Silva
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia; Hunter New England Population Health, NSW, Australia; Hunter Medical Research Institute, School of Medicine and Public Health University of Newcastle, NSW, Australia.
| | - Steven J Kamper
- Nepean Blue Mountains Local Health District, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia; Hunter New England Population Health, NSW, Australia; Hunter Medical Research Institute, School of Medicine and Public Health University of Newcastle, NSW, Australia; Priority Research Centre for Health Behaviour, NSW, Australia
| | - Tie P Yamato
- Nepean Blue Mountains Local Health District, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, SP, Brazil
| | - Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; The Chiropractic Knowledge Hub, Odense, Denmark
| | - Henrik H Lauridsen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Christopher M Williams
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Research and Knowledge Translation Directorate Mid North Coast Local Health District, NSW, Australia
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Minneci PC, Gil LA, Cooper JN, Asti L, Nishimura L, Lutz CM, Deans KJ. Laser Epilation as an Adjunct to Standard Care in Reducing Pilonidal Disease Recurrence in Adolescents and Young Adults: A Randomized Clinical Trial. JAMA Surg 2024; 159:19-27. [PMID: 37938854 PMCID: PMC10633416 DOI: 10.1001/jamasurg.2023.5526] [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: 06/01/2023] [Accepted: 08/07/2023] [Indexed: 11/10/2023]
Abstract
Importance Recurrence continues to be a significant challenge in the treatment and management of pilonidal disease. Objective To compare the effectiveness of laser epilation (LE) as an adjunct to standard care vs standard care alone in preventing recurrence of pilonidal disease in adolescents and young adults. Design, Setting, and Participants This was a single-institution, randomized clinical trial with 1-year follow-up conducted from September 2017 to September 2022. Patients aged 11 to 21 years with pilonidal disease were recruited from a single tertiary children's hospital. Intervention LE and standard care (improved hygiene and mechanical or chemical depilation) or standard care alone. Main Outcomes and Measures The primary outcome was the rate of recurrence of pilonidal disease at 1 year. Secondary outcomes assessed during the 1-year follow-up included disability days, health-related quality of life (HRQOL), health care satisfaction, disease-related attitudes and perceived stigma, and rates of procedures, surgical excisions, and postoperative complications. Results A total of 302 participants (median [IQR] age, 17 [15-18] years; 157 male [56.1%]) with pilonidal disease were enrolled; 151 participants were randomly assigned to each intervention group. One-year follow-up was available for 96 patients (63.6%) in the LE group and 134 (88.7%) in the standard care group. The proportion of patients who experienced a recurrence within 1 year was significantly lower in the LE treatment arm than in the standard care arm (-23.2%; 95% CI, -33.2 to -13.1; P < .001). Over 1 year, there were no differences between groups in either patient or caregiver disability days, or patient- or caregiver-reported HRQOL, health care satisfaction, or perceived stigma at any time point. The LE group had significantly higher Child Attitude Toward Illness Scores (CATIS) at 6 months (median [IQR], 3.8 [3.4-4.2] vs 3.6 [3.2-4.1]; P = .01). There were no differences between groups in disease-related health care utilization, disease-related procedures, or postoperative complications. Conclusions and Relevance LE as an adjunct to standard care significantly reduced 1-year recurrence rates of pilonidal disease compared with standard care alone. These results provide further evidence that LE is safe and well tolerated in patients with pilonidal disease. LE should be considered a standard treatment modality for patients with pilonidal disease and should be available as an initial treatment option or adjunct treatment modality for all eligible patients. Trial Registration ClinicalTrials.gov Identifier: NCT03276065.
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Affiliation(s)
- Peter C. Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatric Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
- Department of Surgery, Nemours Children’s Health, Delaware Valley, Wilmington
| | - Lindsay A. Gil
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatric Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | - Jennifer N. Cooper
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - Lindsey Asti
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - Leah Nishimura
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - Carley M. Lutz
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - Katherine J. Deans
- Department of Surgery, Nemours Children’s Health, Delaware Valley, Wilmington
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Behrendt P, Boettcher M, Zierke KT, Najem S, Zapf H, Reinshagen K, Wößmann W, Boettcher J. Health-Related Quality of Life and Mental Health of Children with Embryonal Abdominal Tumors. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1720. [PMID: 37892383 PMCID: PMC10605597 DOI: 10.3390/children10101720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/12/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023]
Abstract
(1) Background: Embryonal abdominal tumors are one of the most common entities of solid childhood cancer. The present study investigates the Health-Related Quality of Life (HRQoL) and the mental health of children to obtain a comprehensive picture of their health status and uncover a possible gap in healthcare. (2) Methods: The sample consisted of 54 children who were treated for embryonal abdominal tumors and a control group of 46 children who received uncomplicated outpatient surgery. The HRQoL and the mental health were assessed by the parent proxy reports of the questionnaires Pediatric Quality of Life Inventory (PedsQL) and Strengths and Difficulties Questionnaire (SDQ). (3) Results: Children with embryonal abdominal tumors showed significantly lower HRQoL and mental health values compared to the norm data. The index group showed lower values in the social subscales of HRQoL and mental health compared to the control group. (4) Conclusions: Embryonal abdominal tumors affect the well-being of children. There is still a gap in healthcare due to children's HRQoL and mental health, especially regarding social development. It is essential to further advance the psychological care of children and improve their chances to develop social relationships.
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Affiliation(s)
- Paulina Behrendt
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (M.B.); (S.N.); (K.R.)
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (M.B.); (S.N.); (K.R.)
- Department of Pediatric Surgery, University Medical Center Mannheim, University Heidelberg, Theodor-Kutzner-Ufer 1-3, 68167 Mannheim, Germany
| | - Kira Tabea Zierke
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (M.B.); (S.N.); (K.R.)
| | - Safiullah Najem
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (M.B.); (S.N.); (K.R.)
| | - Holger Zapf
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (W.W.)
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (M.B.); (S.N.); (K.R.)
| | - Wilhelm Wößmann
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (W.W.)
| | - Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Arleo TL, Swerdlin RF, Gill AE, Goudy SL, Meisel JA, Briones MA, Shah JH, Wright A, Hawkins CM. Baseline Quality of Life in Pediatric Patients With Low-flow Vascular Malformations. J Pediatr Hematol Oncol 2023; 45:e847-e856. [PMID: 37539995 DOI: 10.1097/mph.0000000000002740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/29/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE The aim of this study was to quantify and describe baseline patient and parent-proxy health-related quality of life scores in patients with low-flow vascular malformations at a single, tertiary-care vascular anomalies clinic. STUDY DESIGN This is a retrospective study of data collected on patients with low-flow vascular malformations between the ages of 2 to 25 who were seen at a single, tertiary-care center vascular anomalies clinic. A total of 266 patients are included in this study. RESULTS Patients with lymphatic malformations report decreased quality of life scores as compared with venous malformations in the emotional, psychological, school, and social domains. Patients with lower extremity malformation report decreased quality of life scores as compared with head/neck, trunk, upper extremity, and multifocal malformations; most notably in the physical domain. CONCLUSIONS Treatment of low-flow vascular malformations should aim to improve patient quality of life. The use of standardized health-related quality of life measures in this study quantifies baseline quality of life scores among patients with low-flow vascular malformations.
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Affiliation(s)
| | | | - Anne E Gill
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
- Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta, Emory University
| | - Steven L Goudy
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Healthcare of Atlanta, Emory University
| | - Jonathan A Meisel
- Pediatric Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine
| | - Michael A Briones
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
- Division of Pediatric Hematology-Oncology, Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, GA
| | - Jay H Shah
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
- Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta, Emory University
| | - Allyson Wright
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
| | - Clifford Matthew Hawkins
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
- Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta, Emory University
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10
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Willems J, Pechmann A, Wider S, Ambs R, Meyer SAN, Cascante I, Sproß J, Mund A, Farin-Glattacker E, Langer T. Evaluating case management for caregivers of children with spinal muscular atrophy type I and II-an exploratory, controlled, mixed-methods trial. Front Pediatr 2023; 11:1212012. [PMID: 37808564 PMCID: PMC10552854 DOI: 10.3389/fped.2023.1212012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Spinal muscular atrophy (SMA) is a rare neuromuscular disease requiring various clinical specialists and therapists to provide care. Due to the disease's dynamic nature and the long distances between specialized centers and local providers, integrating care between disciplines can be challenging. Care that is inadequately integrated can compromise the quality of care and become a burden for patients and families. This trial aimed to improve the care of patients through a case management (CM) intervention. Methods We conducted an exploratory, controlled, two-arm trial with pre-, post-, and follow-up measures (process and outcome evaluation). Proof of efficacy based on statistical significance was not our primary study objective since we were investigating a rare disease. Primary outcomes were caregivers' HRQoL and caregiver-rated quality of care integration. Our secondary outcome was the children's HRQoL. Results Questionnaires and semi-structured interviews yielded heterogeneous results depending on caregivers' level of experience and desire (or possibility) to delegate care tasks. Discussion Despite differing perceptions, all participants supported the establishment of a care coordination model. We recommend CM immediately after diagnosis to provide the greatest benefit to families. We hope that our trial will support the further development of CM interventions that can be customized for specific diseases.
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Affiliation(s)
- Jana Willems
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Astrid Pechmann
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Sabine Wider
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Rita Ambs
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Sylvia A. N. Meyer
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Isabel Cascante
- Children’s Hospital, Klinikum Esslingen, Esslingen am Neckar, Germany
| | - Joachim Sproß
- Deutsche Gesellschaft für Muskelkranke, Waltershofen, Germany
| | | | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Thorsten Langer
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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11
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Lorthe E, Richard V, Dumont R, Loizeau A, Perez-Saez J, Baysson H, Zaballa ME, Lamour J, Pullen N, Schrempft S, Barbe RP, Posfay-Barbe KM, Guessous I, Stringhini S. Socioeconomic conditions and children's mental health and quality of life during the COVID-19 pandemic: An intersectional analysis. SSM Popul Health 2023; 23:101472. [PMID: 37560087 PMCID: PMC10407575 DOI: 10.1016/j.ssmph.2023.101472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Children and adolescents are highly vulnerable to the impact of sustained stressors during developmentally sensitive times. We investigated how demographic characteristics intersect with socioeconomic dimensions to shape the social patterning of quality of life and mental health in children and adolescents, two years into the COVID-19 pandemic. METHODS We used data from the prospective SEROCoV-KIDS cohort study of children and adolescents living in Geneva (Switzerland, 2022). We conducted an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy by nesting participants within 48 social strata defined by intersecting sex, age, immigrant background, parental education and financial hardship in Bayesian multilevel logistic models for poor health-related quality of life (HRQoL, measured with PedsQL) and mental health difficulties (measured with the Strengths and Difficulties Questionnaire). RESULTS Among participants aged 2-17 years, 240/2096 (11.5%, 95%CI 10.1-12.9) had poor HRQoL and 105/2135 (4.9%, 95%CI 4.0-5.9) had mental health difficulties. The predicted proportion of poor HRQoL ranged from 3.4% for 6-11 years old Swiss girls with highly educated parents and no financial hardship to 34.6% for 12-17 years old non-Swiss girls with highly educated parents and financial hardship. Intersectional strata involving adolescents and financial hardship showed substantially worse HRQoL than their counterparts. Between-stratum variations in the predicted frequency of mental health difficulties were limited (range 4.4%-6.5%). CONCLUSIONS We found considerable differences in adverse outcomes across social strata. Our results suggest that, post-pandemic, interventions to address social inequities in HRQoL should focus on specific intersectional strata involving adolescents and families experiencing financial hardship, while those aiming to improve mental health should target all children and adolescents.
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Affiliation(s)
- Elsa Lorthe
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics Paris (CRESS), Paris, France
| | - Viviane Richard
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Roxane Dumont
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Andrea Loizeau
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Javier Perez-Saez
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Hélène Baysson
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Maria-Eugenia Zaballa
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Julien Lamour
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nick Pullen
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stephanie Schrempft
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Rémy P. Barbe
- Division of Child and Adolescent Psychiatry, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Klara M. Posfay-Barbe
- Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Pediatrics, Gynecology & Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Idris Guessous
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
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12
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Varni JW, Zebracki K, Hwang M, Mulcahey MJ, Vogel LC. Bladder and bowel function effects on emotional functioning in youth with spinal cord injury: a serial multiple mediator analysis. Spinal Cord 2023; 61:415-421. [PMID: 37414836 DOI: 10.1038/s41393-023-00912-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
STUDY DESIGN Preliminary explanatory or mechanistic cross-sectional study. OBJECTIVES This preliminary cross-sectional study investigates the hypothesized serial mediating effects of bladder/bowel worry, social worry, and social participation in the relationship between bladder function or bowel function and emotional functioning in youth with spinal cord injury (SCI) from their perspective. METHODS The Bladder Function, Bowel Function, Worry Bladder Bowel, Worry Social, and Social Participation Scales from the PedsQL™ Spinal Cord Injury Module and the Emotional Functioning Scale from the PedsQL™ 4.0 Generic Core Scales Short Form SF15 were completed by 127 youth with SCI ages 8-24. Serial multiple mediator model analyses were conducted to test the hypothesized sequential mediating effects of bladder/bowel worry, social worry, and social participation as intervening variables separately for the cross-sectional association between bladder function or bowel function and emotional functioning. RESULTS The separate cross-sectional negative association of bladder function and bowel function with emotional functioning were serially mediated by bladder/bowel worry, social worry and social participation, accounting for 28% and 31%, respectively, of the variance in youth-reported emotional functioning (p < 0.001), representing large effect sizes. CONCLUSIONS In this preliminary study, bladder/bowel worry, social worry, and social participation explain in part the cross-sectional negative association of bladder function and bowel function with emotional functioning in youth with SCI from the youth perspective. Identifying the hypothesized associations of bladder function and bowel function, bladder/bowel worry, social worry, and social participation with emotional functioning may help inform future clinical research and practice for youth with SCI.
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Affiliation(s)
- James W Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX, USA.
| | - Kathy Zebracki
- Shriners Children's Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Mary Jane Mulcahey
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Department of Physical Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lawrence C Vogel
- Shriners Children's Chicago, Chicago, IL, USA
- Department of Pediatrics, Rush Medical College, Chicago, IL, USA
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13
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Boettcher M, Hauck M, Fuerboeter M, Elrod J, Vincent D, Boettcher J, Reinshagen K. Clinical outcome, quality of life, and mental health in long-gap esophageal atresia: comparison of gastric sleeve pull-up and delayed primary anastomosis. Pediatr Surg Int 2023; 39:166. [PMID: 37014441 PMCID: PMC10073059 DOI: 10.1007/s00383-023-05448-4] [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] [Accepted: 03/16/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Pediatric surgeons have yet to reach a consensus whether a gastric sleeve pull-up or delayed primary anastomosis for the treatment of esophageal atresia (EA), especially of the long-gap type (LGEA) should be performed. Thus, the aim of this study was to evaluate clinical outcome, quality of life (QoL), and mental health of patients with EA and their parents. METHODS Clinical outcomes of all children treated with EA from 2007 to 2021 were collected and parents of affected children were asked to participate in questionnaires regarding their Quality of Life (QoL) and their child's Health-Related Quality of Life (HRQoL), as well as mental health. RESULTS A total of 98 EA patients were included in the study. For analysis, the cohort was divided into two groups: (1) primary versus (2) secondary anastomosis, while the secondary anastomosis group was subdivided into (a) delayed primary anastomosis and (b) gastric sleeve pull-up and compared with each other. When comparing the secondary anastomosis group, significant differences were found between the delayed primary anastomosis and gastric sleeve pull-up group; the duration of anesthesia during anastomosis surgery (478.54 vs 328.82 min, p < 0.001), endoscopic dilatation rate (100% vs 69%, p = 0.03), cumulative time spent in intensive care (42.31 vs 94.75 days, p = 0.03) and the mortality rate (0% vs 31%, p = 0.03). HRQoL and mental health did not differ between any of the groups. CONCLUSION Delayed primary anastomosis or gastric sleeve pull-up appear to be similar in patients with long-gap esophageal atresia in many key aspects like leakage rate, strictures, re-fistula, tracheomalacia, recurrent infections, thrive or reflux. Moreover, HrQoL was comparable in patients with (a) gastric sleeve pull-up and (b) delayed primary anastomosis. Future studies should focus on the long-term results of either preservation or replacement of the esophagus in children.
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Affiliation(s)
- Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Marie Hauck
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mareike Fuerboeter
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Elrod
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Deirdre Vincent
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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14
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Richard V, Dumont R, Lorthe E, Loizeau A, Baysson H, Zaballa ME, Pennacchio F, Barbe RP, Posfay-Barbe KM, Guessous I, Stringhini S. Impact of the COVID-19 pandemic on children and adolescents: determinants and association with quality of life and mental health-a cross-sectional study. Child Adolesc Psychiatry Ment Health 2023; 17:17. [PMID: 36726179 PMCID: PMC9891202 DOI: 10.1186/s13034-023-00563-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/20/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The medium-term impact of the COVID-19 pandemic on the wellbeing of children and adolescents remains unclear. More than 2 years into the pandemic, we aimed to quantify the frequency and determinants of having been severely impacted by the COVID-19 pandemic and estimate its impact on health-related quality of life (HRQoL) and mental health. METHODS Data was drawn from a population-based cohort of children and adolescents, recruited between December 2021 and June 2022, in Geneva, Switzerland. The Coronavirus impact scale was used to assess the multidimensional impact of the pandemic on children through parent's report. A score higher than one standard deviation above the mean was deemed a severe impact. Parents additionally reported about their offspring HRQoL and mental health with validated scales. Determinants of having been severely impacted were assessed with logistic models, as were the associations between having experienced a severe impact and poor HRQoL or mental health. RESULTS Out of 2101 participants aged 2-17, 12.7% had experienced a severe pandemic impact. Having a lasting health condition, a pandemic-related worsening of lifestyle habits or an unfavorable family environment were associated with having been severely impacted by the pandemic, while a previous anti-SARS-CoV-2 infection was not. Participants who had experienced a severe pandemic impact were more likely to present poor HRQoL (aOR = 3.1; 95% CI 2.3-4.4) and poor mental health (aOR = 3.9; 95% CI 2.5-6.2). CONCLUSION The COVID-19 pandemic may have persistent consequences on the wellbeing of children and adolescents, especially among those with health and family vulnerabilities.
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Affiliation(s)
- Viviane Richard
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205 Geneva, Switzerland
| | - Roxane Dumont
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205 Geneva, Switzerland
| | - Elsa Lorthe
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205 Geneva, Switzerland
| | - Andrea Loizeau
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205 Geneva, Switzerland
| | - Hélène Baysson
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205 Geneva, Switzerland ,grid.8591.50000 0001 2322 4988Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - María-Eugenia Zaballa
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205 Geneva, Switzerland
| | - Francesco Pennacchio
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205 Geneva, Switzerland
| | - Rémy P. Barbe
- grid.150338.c0000 0001 0721 9812Division of Child and Adolescent Psychiatry, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Klara M. Posfay-Barbe
- grid.150338.c0000 0001 0721 9812Division of General Pediatrics, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- grid.8591.50000 0001 2322 4988Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205, Geneva, Switzerland. .,Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland.
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15
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Bakshi N, Astles R, Chou E, Hurreh A, Sil S, Sinha CB, Sanders KA, Peddineni M, Gillespie SE, Keesari R, Krishnamurti L. Multimodal phenotyping and correlates of pain following hematopoietic cell transplant in children with sickle cell disease. Pediatr Blood Cancer 2023; 70:e30046. [PMID: 36322607 PMCID: PMC9820671 DOI: 10.1002/pbc.30046] [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] [Received: 02/22/2022] [Revised: 08/24/2022] [Accepted: 09/19/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION There is limited understanding of pain, patient-reported outcomes (PROs) of health-related quality of life (HRQoL), psychological factors, and experimental pain sensitivity before and following hematopoietic cell transplant (HCT) in children with sickle cell disease (SCD). METHODS Individuals aged 8 years and older, English speaking, and scheduled for a HCT were invited to participate in an observational study where they completed assessments of pain, PROs, psychological factors, and qualitative interviews before and around 3 months, 6 months, 1 year, and 2 years post-HCT. An optional substudy of experimental pain sensitivity before and around 6 month, 1 year, and 2 years post-HCT was also offered. RESULTS Data from eight participants (median age 13.5 years, 25% female) with sickle cell anemia (SCA) or similarly severe genotype, and successful donor-derived erythropoiesis post-HCT are reported. We found that collection of pain, PROs, psychological factors, and qualitative data were feasible in the context of HCT. We found moderate to large differences in pain and some PROs between baseline to 1 year and baseline to 2 year post-HCT based on effect sizes, but only some differences were statistically significant. We found moderate to large differences in pressure pain threshold and moderate differences in cold pain threshold between baseline to 1 year and baseline to 2 year post-HCT based on effect sizes, but these differences were not statistically significant. Qualitative data indicated an improvement in pain and HRQoL post-HCT. CONCLUSION This study provides a framework for the conduct of multimodal pain assessments before and after HCT, which is feasible but faced with unique barriers.
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Affiliation(s)
- Nitya Bakshi
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Rachel Astles
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eric Chou
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Asha Hurreh
- James T. Laney School of Graduate Studies, Emory University, Atlanta, Georgia, USA
| | - Soumitri Sil
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Cynthia B Sinha
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kolanda Ackey Sanders
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Manasa Peddineni
- Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida, USA
| | - Scott E Gillespie
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Rohali Keesari
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Lakshmanan Krishnamurti
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
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16
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Kavookjian J, LaManna JB, Davidson P, Davis JW, Fahim SM, McDaniel CC, Ekong G, Todd A, Yehl K, Cox C. Impact of Diabetes Self-Management Education/Support on Self-Reported Quality of Life in Youth With Type 1 or Type 2 Diabetes. Sci Diabetes Self Manag Care 2022; 48:406-436. [PMID: 35899815 DOI: 10.1177/26350106221115450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The persistent requirement of self-management for diabetes impacts quality of life (QoL), yet the literature for impact of diabetes self-management education and support (DSMES) on QoL in youth has not been synthesized and reported. The purpose of this review was to systematically identify and describe the state of the science exploring the impact of DSMES on self-reported QoL in youth with type 1 diabetes (T1DM) or type 2 diabetes (T2DM). METHODS A modified Cochrane review was conducted. Retained studies were published in the English language between January 1, 2007, and March 31, 2020. Included studies specified that the intervention had diabetes education addressing at least 1 or more of The Association of Diabetes Care & Education Specialists' ADCES7 Self-Care BehaviorsTM (ADCES7™) and used an established self-reported QoL measure. Retained studies were assessed for risk of bias. RESULTS Eleven studies reported in 12 articles were retained. The interventions were primarily delivered to youth with T1DM or T2DM and included caregivers/families in some studies. The ADCES7™ were addressed across the retained studies. Five of the 11 studies assessed QoL as the primary outcome and 6 studies as a secondary outcome. CONCLUSION To enhance the QoL outcomes and to provide insight into how to positively impact self-perceptions of QoL, ongoing generic and diabetes-specific QoL assessments are warranted for youth with T1DM or T2DM. Further research is needed in structured DSMES programs to help reduce variability in research designs, methods, measures, and outcomes to generate evidence for best practices that can be translated and disseminated into real-world settings.
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Affiliation(s)
- Jan Kavookjian
- Auburn University Harrison College of Pharmacy, Auburn University, Auburn, Alabama
| | | | | | - Jean W Davis
- College of Nursing, University of Central Florida, Orlando, Florida
| | | | - Cassidi C McDaniel
- Auburn University Harrison College of Pharmacy, Auburn University, Auburn, Alabama
| | - Gladys Ekong
- Western New England University, Springfield, Massachusetts
| | - Andrew Todd
- College of Nursing, University of Central Florida, Orlando, Florida
| | - Kirsten Yehl
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
| | - Carla Cox
- Mountain Vista Medicine, South Jordan, Utah
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17
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Ellyson AM, Gordon G, Zhou C, Rabbitts JA. Trajectories, Risk Factors, and Impact of Persistent Pain After Major Musculoskeletal Surgery in Adolescents: A Replication Study. THE JOURNAL OF PAIN 2022; 23:995-1005. [PMID: 34974171 PMCID: PMC9232895 DOI: 10.1016/j.jpain.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 06/03/2023]
Abstract
Studies have identified high rates of chronic postsurgical pain in adolescents. Characterizing patterns of pain in the transition from acute to chronic following major surgery may pinpoint critical periods of recovery. This observational study modelled pain trajectories over 1-year following surgery to attempt replication of prior work and evaluate baseline psychosocial factors and 12-month health outcomes. Adolescents 10 to 18 years completed electronic daily pain reporting for 7 days and self-reported health outcomes, at 5 assessment timepoints. Group-based trajectory modelling identified two trajectories with similar starting points in-hospital but distinct recovery courses at home. Pain declined steadily in one group across the study period ("Declining Pain"; estimated probability,18.9%), but pain increased after hospital discharge and remained high through 12-months in the other group ("High and Persistent Pain"; estimated probability,81.1%). Pre-surgery pain (Aor = 1.86, P = .001) and sleep quality (Aor = 0.49, P = .029) were associated with the High and Persistent pain trajectory in multivariate regressions. This trajectory was associated with lower total quality of life (B=-9.79, P = .002), physical health (B = -15.93, P < .001), psychosocial health (B = -6.73, P = .06), and greater fatigue (B = -13.61, P = .001). This study replicated prior findings identifying two post-surgical pain trajectories with diverging pain in the first two weeks. Clinical detection of those with increasing pain and early intervention may interrupt persistence of pain. PERSPECTIVE: This article replicates a prior study identifying distinct post-surgical pain trajectories, Declining Pain and High and Persistent Pain. The High and Persistent pain trajectory is associated with pre-surgery pain, pre-surgery sleep quality, and lower quality of life (total, physical, and psychosocial health as well as fatigue) at 12-month follow-up.
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Affiliation(s)
- Alice M Ellyson
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Grace Gordon
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; University of Washington College of Arts and Sciences, Seattle, Washington
| | - Chuan Zhou
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Jennifer A Rabbitts
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington.
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Zhang Y, Clegg JL, Keith S, McFadden S, Symonds T, Kumar R, Khan AH, Kamat S, Chao J. Content validity of a newly developed observer-reported measure for pediatric asthma in children aged 2-5 years. J Patient Rep Outcomes 2022; 6:55. [PMID: 35633412 PMCID: PMC9148329 DOI: 10.1186/s41687-022-00461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background An observer-reported outcome (ObsRO) measure assessing both symptom control and health-related quality of life (HRQoL) in children with asthma younger than 6 years is lacking. The objective of this study was to evaluate the content validity of the Pediatric Asthma Questionnaire (PAQ), a newly developed 6-item ObsRO measure for caregivers of children aged 2–5 years diagnosed with asthma. Results In-depth, qualitative interviews were conducted with 15 parents or caregivers. The first part of the interview was an open-ended discussion whereby participants were asked to describe their observations of their child’s asthma symptoms and HRQoL impacts followed by a cognitive debriefing of a draft version of the PAQ. The most frequently reported symptoms were coughing (n = 15, 100%), wheezing (n = 14, 93%), and trouble breathing (n = 10, 67%). Overall, participants found the PAQ easy to complete and relevant to their child’s experience with asthma, with most reporting the instructions, response scales, and recall period for the items to be appropriate. The majority of participants (93%) believed they could accurately report on the items included in the PAQ based on their observations of their child’s asthma symptoms and impacts, or reliably get the information from the child’s teacher, school, or caregiver when their child was not in their presence. One item was modified based on feedback about the phrase “oral steroids” to clarify modes of administration. A few other minor changes were incorporated into the PAQ following suggestions from participants, including replacing the phrase “how often” with “how many days” in one of the items to improve clarity and overall consistency with the response options. Conclusion Qualitative data support the content validity of the PAQ as a fit-for-purpose and well-understood 6-item observer-reported outcome measure to evaluate both symptoms and asthma-specific HRQoL impacts experienced by pediatric asthma patients aged 2–5 years for use in clinical and real-world studies.
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Affiliation(s)
- Yi Zhang
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Jennifer L Clegg
- Clinical Outcomes Assessment, Clinical Outcomes Solutions, 53 W Jackson Blvd, Suite 1150, Chicago, IL, 60604, USA.
| | - Shannon Keith
- Clinical Outcomes Assessment, Clinical Outcomes Solutions, 53 W Jackson Blvd, Suite 1150, Chicago, IL, 60604, USA
| | - Shehan McFadden
- Clinical Outcomes Assessment, Clinical Outcomes Solutions, 53 W Jackson Blvd, Suite 1150, Chicago, IL, 60604, USA
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Kwon J, Freijser L, Huynh E, Howell M, Chen G, Khan K, Daher S, Roberts N, Harrison C, Smith S, Devlin N, Howard K, Lancsar E, Bailey C, Craig J, Dalziel K, Hayes A, Mulhern B, Wong G, Ratcliffe J, Petrou S. Systematic Review of Conceptual, Age, Measurement and Valuation Considerations for Generic Multidimensional Childhood Patient-Reported Outcome Measures. PHARMACOECONOMICS 2022; 40:379-431. [PMID: 35072935 PMCID: PMC9007803 DOI: 10.1007/s40273-021-01128-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND AIMS Patient-reported outcome measures (PROMs) for children (aged ≤ 18 years) present methodological challenges. PROMs can be categorised by their diverse underlying conceptual bases, including functional, disability and health (FDH) status; quality of life (QoL); and health-related quality of life (HRQoL). Some PROMs are designed to be accompanied by preference weights. PROMs should account for childhood developmental differences by incorporating age-appropriate health/QoL domains, guidance on respondent type(s) and design. This systematic review aims to identify generic multidimensional childhood PROMs and synthesise their characteristics by conceptual basis, target age, measurement considerations, and the preference-based value sets that accompany them. METHODS The study protocol was registered in the Prospective Register of Systematic Reviews (CRD42021230833), and reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted systematic database searches for generic multidimensional childhood PROMs covering the period 2012-2020, which we combined with published PROMs identified by an earlier systematic review that covered the period 1992-2011. A second systematic database search identified preference-based value sets for generic multidimensional PROMs. The PROMs were categorised by conceptual basis (FDH status, QoL and HRQoL) and by target age (namely infants and pre-schoolers aged < 5 years, pre-adolescents aged 5-11, adolescents aged 12-18 and multi-age group coverage). Descriptive statistics assessed how PROM characteristics (domain coverage, respondent type and design) varied by conceptual basis and age categories. Involvement of children in PROM development and testing was assessed to understand content validity. Characteristics of value sets available for the childhood generic multidimensional PROMs were identified and compared. RESULTS We identified 89 PROMs, including 110 versions: 52 FDH, 29 QoL, 12 HRQoL, nine QoL-FDH and eight HRQoL-FDH measures; 20 targeted infants and pre-schoolers, 29 pre-adolescents, 24 adolescents and 37 for multiple age groups. Domain coverage demonstrated development trajectories from observable FDH aspects in infancy through to personal independence and relationships during adolescence. PROMs targeting younger children relied more on informant report, were shorter and had fewer ordinal scale points. One-third of PROMs were developed following qualitative research or surveys with children or parents for concept elicitation. There were 21 preference-based value sets developed by 19 studies of ten generic multidimensional childhood PROMs: seven were based on adolescents' stated preferences, seven were from adults from the perspective of or on behalf of the child, and seven were from adults adopting an adult's perspective. Diverse preference elicitation methods were used to elicit values. Practices with respect to anchoring values on the utility scale also varied considerably. The range and distribution of values reflect these differences, resulting in value sets with notably different properties. CONCLUSION Identification and categorisation of generic multidimensional childhood PROMs and value sets by this review can aid the development, selection and interpretation of appropriate measures for clinical and population research and cost-effectiveness-based decision-making.
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Affiliation(s)
- Joseph Kwon
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Louise Freijser
- Centre for Health Policy, University of Melbourne, Melbourne, Australia
| | - Elisabeth Huynh
- Department of Health Services Research and Policy, Australian National University, Canberra, Australia
| | - Martin Howell
- School of Public Health, University of Sydney, Sydney, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Kamran Khan
- Centre for Health Economics at Warwick, University of Warwick, Coventry, England, UK
| | - Shahd Daher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, England, UK
| | - Conrad Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, UK
| | - Sarah Smith
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England, UK
| | - Nancy Devlin
- Centre for Health Policy, University of Melbourne, Melbourne, Australia
| | - Kirsten Howard
- School of Public Health, University of Sydney, Sydney, Australia
| | - Emily Lancsar
- Department of Health Services Research and Policy, Australian National University, Canberra, Australia
| | - Cate Bailey
- Centre for Health Policy, University of Melbourne, Melbourne, Australia
| | - Jonathan Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kim Dalziel
- Health Economics Unit, University of Melbourne, Melbourne, Australia
| | - Alison Hayes
- School of Public Health, University of Sydney, Sydney, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, Australia
| | - Julie Ratcliffe
- Caring, Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
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20
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Gandhi CK, Thomas NJ, Meixia Y, Spear D, Fu C, Zhou S, Wu R, Keim G, Yehya N, Floros J. SNP–SNP Interactions of Surfactant Protein Genes in Persistent Respiratory Morbidity Susceptibility in Previously Healthy Children. Front Genet 2022; 13:815727. [PMID: 35401703 PMCID: PMC8989419 DOI: 10.3389/fgene.2022.815727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/21/2022] [Indexed: 01/10/2023] Open
Abstract
We studied associations of persistent respiratory morbidity (PRM) at 6 and 12 months after acute respiratory failure (ARF) in previously healthy children with single-nucleotide polymorphisms (SNPs) of surfactant protein (SP) genes. Of the 250 enrolled subjects, 155 and 127 were followed at 6 and 12 months after an ARF episode, respectively. Logistic regression analysis and SNP–SNP interaction models were used. We found that 1) in the multivariate analysis, an increased risk at 6 and 12 months was associated with rs1124_A and rs4715_A of SFTPC, respectively; 2) in a single SNP model, increased and decreased risks of PRM at both timepoints were associated with rs1124 of SFTPC and rs721917 of SFTPD, respectively; an increased risk at 6 months was associated with rs1130866 of SFTPB and rs4715 of SFTPC, and increased and decreased risks at 12 months were associated with rs17886395 of SFTPA2 and rs2243639 of SFTPD, respectively; 3) in a two-SNP model, PRM susceptibility at both timepoints was associated with a number of intergenic interactions between SNPs of the studied SP genes. An increased risk at 12 months was associated with one intragenic (rs1965708 and rs113645 of SFTPA2) interaction; 4) in a three-SNP model, decreased and increased risks at 6 and 12 months, respectively, were associated with an interaction among rs1130866 of SFTPB, rs721917 of SFTPD, and rs1059046 of SFTPA2. A decreased risk at 6 months was associated with an interaction among the same SNPs of SFTPB and SFTPD and the rs1136450 of SFTPA1. The findings revealed that SNPs of all SFTPs appear to play a role in long-term outcomes of ARF survivors and may serve as markers for disease susceptibility.
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Affiliation(s)
- Chintan K. Gandhi
- Center for Host Defense, Inflammation, and Lung Disease (CHILD) Research, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Neal J. Thomas
- Center for Host Defense, Inflammation, and Lung Disease (CHILD) Research, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Ye Meixia
- Center for Computational Biology, College of Biological Sciences and Technology, Beijing Forestry University, Beijing, China
| | - Debbie Spear
- Center for Host Defense, Inflammation, and Lung Disease (CHILD) Research, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Chenqi Fu
- Public Health Science, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Shouhao Zhou
- Public Health Science, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Rongling Wu
- Public Health Science, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Garrett Keim
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Nadir Yehya
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Joanna Floros
- Center for Host Defense, Inflammation, and Lung Disease (CHILD) Research, Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA, United States
- Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey, PA, United States
- *Correspondence: Joanna Floros,
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21
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Lukács A, Bettina Zagraj V, Bartkóné Kovács A, Soós A, Török A, Barkai L. Health-related quality of life of preschool-aged children with type 1 diabetes in the context of family and maternal functioning. J Child Health Care 2022; 26:31-41. [PMID: 33599524 DOI: 10.1177/1367493521995320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In this study, generic health-related quality of life (HRQoL) of young children with type 1 diabetes (T1D) was compared to healthy peers taken in consideration of family functioning and psychological well-being of mothers. A total of 113 mothers provided data (28 mothers had a preschool-aged child with T1D). There were no significant differences in background parameters of two investigated groups. No significant differences between children with and without T1D were detected either in HRQoL or in family functioning. Moreover, mothers of children with diabetes reported lower levels of resilience and more depressive symptoms than mothers of healthy peers. In the regression analysis, mothers' depressive symptoms and the family functioning significantly affected children's HRQoL regardless of the presence of diabetes. These results suggest that parents of children with T1D handle the burden of diabetes well and integrate into the daily activities of the families. Mothers experience distress, presumably because diabetes management is burdensome; however, the family can function well and the young children can live in a similar way to their healthy peers.
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Affiliation(s)
- Andrea Lukács
- Faculty of Healthcare, Institute of Theoretical Health Sciences, 547530University of Miskolc, Hungary
| | - Veronika Bettina Zagraj
- Faculty of Healthcare, Institute of Applied Health Sciences, 547530University of Miskolc, Miskolc, Hungary
| | - Anett Bartkóné Kovács
- 125749Borsod-Abaúj-Zemplén County Central and University Teaching Hospital, Miskolc, Hungary
| | - Andrea Soós
- 125749Borsod-Abaúj-Zemplén County Central and University Teaching Hospital, Miskolc, Hungary
| | - András Török
- 125749Borsod-Abaúj-Zemplén County Central and University Teaching Hospital, Miskolc, Hungary
| | - László Barkai
- Faculty of Healthcare, Institute of Theoretical Health Sciences, 547530University of Miskolc, Hungary.,Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, 37862Pavol Jozef Šafárik University, Kosice, Slovakia
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22
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Hamsho NF, Kopec J, Morton M, Rieger BP. Examining the association between psychosocial functioning and concussion symptom severity in youth. Brain Inj 2022; 36:375-382. [PMID: 35108146 DOI: 10.1080/02699052.2022.2034178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Guidelines recommend examining psychosocial variables as contributors to postconcussive symptoms. However, few studies examined this relation in a clinic-referred sample and fewer accounted for parent perspective, limiting practitioners implementation of this guidance. Therefore, this longitudinal study examined youth and parent-reported psychosocial variables and their association with concussion symptom severity in a clinic-referred sample of youth receiving treatment for concussion. METHODS Youth (n = 121; mean age = 15.3 years) with a recent concussion and their parents completed measures assessing youth depression, anxiety, academic stress, quality of life and concussion symptom severity at the initial treatment appointment and again approximately three-months later or at discharge, whichever came first. RESULTS Differences were observed in psychosocial functioning across parent and youth report. Youth-reported depression was strongly associated with concussion symptom severity whereas parent-reported depression, academic stress, and quality of life were significantly related to concussion symptom severity. Exploratory findings of the relation between psychosocial variables at initial evaluation and concussion symptom severity at follow-up are offered. CONCLUSION Results offer guidance on the underlying psychosocial variables that may be useful to consider when developing interventions for youth recovering from concussion, especially those with a prolonged recovery.
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Affiliation(s)
- Narmene F Hamsho
- Department of Psychology, University of Massachusetts Boston, Massachusetts, USA
| | - Justin Kopec
- Behavioral Science Division, Upmc Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Melissa Morton
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Brian P Rieger
- Department of Physical Medicine Rehabilitation, SUNY Upstate Medical University, Syracuse, New York, USA
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23
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Fremed MA, Farooqi KM. Longitudinal Outcomes and Monitoring of Patients With Multisystem Inflammatory Syndrome in Children. Front Pediatr 2022; 10:820229. [PMID: 35433557 PMCID: PMC9010503 DOI: 10.3389/fped.2022.820229] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/28/2022] [Indexed: 12/15/2022] Open
Abstract
The acute manifestations and short-term outcomes of multisystem inflammatory syndrome (MIS-C) have been extensively described; however, our understanding of the longitudinal outcomes associated with this condition continue to evolve. Here we review the existing literature on outcomes of MIS-C up to 1 year following diagnosis and summarize current published expert recommendations for management and follow up of these patients.
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Affiliation(s)
- Michael A Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian-Morgan Stanley Children's Hospital, New York, NY, United States
| | - Kanwal M Farooqi
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian-Morgan Stanley Children's Hospital, New York, NY, United States
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24
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Zebracki K, Hwang M, Vogel LC, Mulcahey MJ, Varni JW. PedsQL™ Spinal Cord Injury Module: Reliability and Validity. Top Spinal Cord Inj Rehabil 2022; 28:64-77. [PMID: 35145336 PMCID: PMC8791414 DOI: 10.46292/sci21-00057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The objective was to report on the initial measurement properties of the Pediatric Quality of Life Inventory™ (PedsQL™) Spinal Cord Injury (SCI) Module in youth with SCI from the youth and parent perspectives. METHODS PedsQL™ SCI Module and PedsQL™ 4.0 Generic Core Scales SF15 were completed in a multisite national study by 166 youth ages 8 to 25 years and 128 parents of youth ages 5 to 23 years. Data from the PedsQL™ Generic Core Scales were compared with an age- and sex-matched healthy control sample. Factor analysis was conducted to determine the factor structure of the items. RESULTS In addition to a Total Scale Score, nine unidimensional scales were derived measuring daily activities, mobility, bladder function, bowel function, pressure injury, pain interference, social participation, worry bladder bowel, and worry social. The PedsQL™ SCI Module evidenced excellent reliability for Total Scale Scores (youth self-report, α = 0.93; parent proxy-report, α = 0.93) and acceptable reliability for the nine individual scales (youth self-report, α = 0.71-0.83; parent proxy-report, α = 0.67-0.87). Intercorrelations with the Generic Core Scales supported construct validity with medium to large effect sizes (most ps < .001). Factor analysis supported the unidimensionality of the nine individual scales. PedsQL™ Generic Core Scales comparisons to healthy controls demonstrated significantly impaired generic health-related quality of life in youth with SCI with large effect sizes. CONCLUSION The PedsQL™ SCI Module Scales demonstrated acceptable measurement properties and may be utilized as standardized scales to assess SCI-specific concerns and problems in clinical research and practice in youth with SCI.
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Affiliation(s)
- Kathy Zebracki
- Shriners Children’s Chicago, Illinois
,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Lawrence C. Vogel
- Shriners Children’s Chicago, Illinois
,Rush Medical College, Chicago, Illinois
| | - MJ Mulcahey
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Department of Physical Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James W. Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Texas
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25
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Młyńczyk J, Abramowicz P, Stawicki MK, Konstantynowicz J. Non-disease specific patient-reported outcome measures of health-related quality of life in juvenile idiopathic arthritis: a systematic review of current research and practice. Rheumatol Int 2021; 42:191-203. [PMID: 34971434 PMCID: PMC8719533 DOI: 10.1007/s00296-021-05077-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
Juvenile idiopathic arthritis (JIA), as a chronic condition, is associated with symptoms negatively impacting health-related quality of life (HRQL). Regarding growing interest in the implementation of the patient-reported outcome measures (PROMs), we aimed to review the non-disease specific PROMs addressing HRQL assessment, potentially useful in the clinical care of JIA and daily practice. A systematic literature search was conducted using MEDLINE/PubMed, Google Scholar, Scopus and Embase databases (1990 to 2021), with a focus on the recent 5-years period. Entry keywords included the terms: “children”, “adolescents”, “JIA”, “chronic diseases”, “HRQL”, “PROMs” and wordings for the specific tools. Several available PROMs intended to measure HRQL, non-specific to JIA, were identified. The presented outcomes differed in psychometric properties, yet all were feasible in assessing HRQL in healthy children and those with chronic diseases. Both EQ-5D-Y and PedsQL have already been tested in JIA, showing relevant reliability, validity, and similar efficiency as disease-specific measurements. For PROMIS® PGH-7 and PGH-7 + 2, such validation and cross-cultural adaptation need to be performed. Considering the future directions in pediatric rheumatology, the large-scale implementation of PROMIS® PGH-7 and PGH-7 + 2 in JIA offers a particularly valuable opportunity. The PROMs reflect the patient perception of the chronic disease and allow to understand child’s opinions. The PROMs may provide an important element of the holistic medical care of patients with JIA and a standardized tool for clinical outcomes, monitoring disease severity and response to treatment.
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Affiliation(s)
- Justyna Młyńczyk
- Department of Pediatrics, Rheumatology, Immunology, and Metabolic Bone Diseases, University Children's Hospital, Medical University of Bialystok, Waszyngtona Street 17, 15-274, Bialystok, Poland
| | - Paweł Abramowicz
- Department of Pediatrics, Rheumatology, Immunology, and Metabolic Bone Diseases, University Children's Hospital, Medical University of Bialystok, Waszyngtona Street 17, 15-274, Bialystok, Poland
| | - Maciej K Stawicki
- Department of Pediatrics, Rheumatology, Immunology, and Metabolic Bone Diseases, University Children's Hospital, Medical University of Bialystok, Waszyngtona Street 17, 15-274, Bialystok, Poland
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology, and Metabolic Bone Diseases, University Children's Hospital, Medical University of Bialystok, Waszyngtona Street 17, 15-274, Bialystok, Poland.
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26
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Smyth M, Jacobson K. Pediatric Quality of Life Inventory TM version 4.0 short form generic core scale across pediatric populations review data. Data Brief 2021; 39:107599. [PMID: 34901340 PMCID: PMC8639391 DOI: 10.1016/j.dib.2021.107599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
The Pediatric Quality of Life InventoryTM Version 4.0 Short Form Generic Core Scale (PedsQLTM) is a validated and widely used tool assessing the quality of life (QoL) of children and youth. It has been used extensively across healthy populations as well as those with chronic and acute illnesses, allowing for comparison of the psychosocial impact of chronic illness between pediatric disease cohorts. As part of the QoL initiative undertaken at the British Columbia Children's Hospital (BCCH) Inflammatory Bowel Disease (IBD) program and published in the Journal of Pediatrics titled “Cross-Sectional Analysis of Quality of Life in Pediatric Patients with IBD in British Columbia, Canada,” a limited literature review was conducted using Embasse and Ovid. Studies using the English version of the PedsQLTM short form generic scale (not a disease specific scale) were identified. Studies with populations greater than 50 patients with robust subgroup sample size were included, with an emphasis on studies with well-defined patients with chronic disease. These data were compared to the BCCH population, as discussed in the aforementioned journal article. Analysis within the BCCH cohort is described separately. Comparison between different populations from the existing literature was qualitative only, with no statistical analysis done given the heterogeneity of populations and studies. In a study of patients from the emergency department at BCCH (n=178), the mean (SD) QoL scores of the healthy patients was 89.2 (10.3). In a group of self-identified healthy patients in California (n=5079), their mean QoL score was 83.9 (12.5). Separating the BCCH IBD population by disease activity, those in remission (n=220, 84.4 (12.8)) have similar QoL scores to these healthy cohorts, though their scores remain slightly below the previously published BCCH cohort. For children with any degree of active IBD (n=98, 75.6 (15.8)), their QoL scores are below the healthy means and are lower than other groups with self-identified “chronic illnesses” (n=367, 77.2 (15.5)), diabetes (n=418, 82.3 (13.5)), mild asthma (n=281, 85.5 (13.3)), or Canadian patients 4 weeks post-concussion (n=1157, 80.3). BCCH IBD patients with moderately to severely active disease have QoL scores well below the other disease groups (n=33, 63.1 (18.8)); lower than oncology patients on induction chemotherapy regimens (n=105, 68.9 (16.0)), acute inpatients (n=359, 63.9 (20.3)), and asthmatics with moderate-severe, persistent asthma (n=86, 67.1 (18.6)). This data is useful for clinicians treating pediatric patients looking at how QoL is influenced by chronic illness and by factors such as disease type and severity.
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Affiliation(s)
- Matthew Smyth
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital, University of British Columbia, British Columbia, Canada.,British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Kevan Jacobson
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital, University of British Columbia, British Columbia, Canada.,British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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27
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Postacute/Long COVID in Pediatrics: Development of a Multidisciplinary Rehabilitation Clinic and Preliminary Case Series. Am J Phys Med Rehabil 2021; 100:1140-1147. [PMID: 34793374 PMCID: PMC8594395 DOI: 10.1097/phm.0000000000001896] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT The long-term sequelae after SARS-CoV-2 infections in children is unknown. Guidance is needed on helpful models of care for an emerging subset of pediatric patients with postacute/long COVID who continue to experience persistent symptoms after initial COVID-19 diagnosis. Here, we describe a pediatric multidisciplinary post-COVID-19 rehabilitation clinic model as well as a case series of the initial cohort of patients who presented to this clinic. A consecutive sample of nine patients (pediatric patients <21 yrs of age) who presented to our clinic are included. The most common presenting symptoms were fatigue (8 of 9 patients), headaches (6 of 9), difficulty with schoolwork (6 of 8), "brain fog" (4 of 9), and dizziness/lightheadedness (4 of 9). Most patients had decreased scores on self-reported quality-of-life measures compared with healthy controls. In the patients who participated in neuropsychological testing, a subset demonstrated difficulties with sustained auditory attention and divided attention; however, most of these patients had preexisting attention and/or mood concerns. There were also some who self-reported elevated depression and anxiety symptoms. Pediatric patients with postacute/long COVID may present with a variety of physical, cognitive, and mood symptoms. We present a model of care to address these symptoms through a multidisciplinary rehabilitation approach.
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28
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Murray CB, Bartlett A, Meyyappan A, Palermo TM, Aaron R, Rabbitts J. A pilot feasibility and acceptability study of an internet-delivered psychosocial intervention to reduce postoperative pain in adolescents undergoing spinal fusion. Can J Pain 2021; 6:12-23. [PMID: 35434455 PMCID: PMC9009921 DOI: 10.1080/24740527.2021.2009334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Spinal fusion surgery is a common and painful musculoskeletal surgery performed in the adolescent population. Despite the known risk for developing chronic postsurgical pain, few perioperative psychosocial interventions have been evaluated in this population, and none have been delivered remotely (via the Internet) to improve accessibility. Aims The aim of this single-arm pilot study was to evaluate the feasibility and acceptability of the first Internet-based psychological intervention delivered during the perioperative period to adolescents undergoing major spinal fusion surgery and their parents. Methods Thirteen adolescents (M age = 14.3; 69.2% female) scheduled for spine fusion surgery and their parents were provided access to the online psychosocial intervention program. The program included six lessons delivering cognitive-behavioral therapy skills targeting anxiety, sleep, and acute pain management during the month prior to and the month following surgery. Feasibility indicators included recruitment rate, intervention engagement, and measure completion. Acceptability was assessed via quantitative ratings and qualitative interviews. Results Our recruitment rate was 81.2% of families approached for screening. Among participating adolescent–parent dyads, high levels of engagement were demonstrated (100% completed all six lessons). All participants completed outcome measures. High treatment acceptability was demonstrated via survey ratings and qualitative feedback, with families highlighting numerous strengths of the program as well as areas for improvement. Conclusions These findings suggest that this online psychosocial intervention delivered during the perioperative period is feasible and acceptable to adolescents and their parents. Given favorable feasibility outcomes, an important next step is to evaluate the intervention in a full-scale randomized controlled trial.
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Affiliation(s)
- Caitlin B. Murray
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
- Center for Child Health, Behavior and Development, Seattle Children’s Hospital, Seattle, WA, USA
| | - Anthea Bartlett
- School of Social and Political Science, The University of Edinburgh, Edinburgh, UK
| | | | - Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
- Center for Child Health, Behavior and Development, Seattle Children’s Hospital, Seattle, WA, USA
| | - Rachel Aaron
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Rabbitts
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
- Center for Clinical and Translational Research
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Fuerboeter M, Boettcher J, Barkmann C, Zapf H, Nazarian R, Wiegand-Grefe S, Reinshagen K, Boettcher M. Quality of life and mental health of children with rare congenital surgical diseases and their parents during the COVID-19 pandemic. Orphanet J Rare Dis 2021; 16:498. [PMID: 34838064 PMCID: PMC8626760 DOI: 10.1186/s13023-021-02129-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background COVID-19 has affected our society at large, particularly vulnerable groups, such as children suffering from rare diseases and their parents. However, the psychosocial influences of COVID-19 on these have yet to be investigated. As such, the study’s goal was to evaluate the health-related quality of life (HRQoL), quality of life (QoL), and mental health of children with rare congenital surgical diseases and their parents during the COVID-19 pandemic and lockdown measures. Methods A survey of n = 210 parents of children with rare congenital surgical diseases and a control group of n = 88 parents of children without rare diseases was conducted cross-sectionally between April 2020 to April 2021. Data on HRQoL, QoL, and mental health was collected using standardized psychometric questionnaires for children and parents presenting to the pediatric surgery department at a university hospital. Results Mothers of children with rare pediatric surgical diseases showed significantly lower QoL and significantly higher impairment in mental health than a control group and norm data. For fathers, this was solely the case for their QoL. Children’s parent-reported HRQoL and mental health were partially impaired. Social and disease-specific risk factors of the respective outcomes in affected families were identified through regression analysis models. Conclusion Parents of children with rare diseases report severe psychosocial impairment regarding themselves and their children during the COVID-19 pandemic. Therefore, affected families should receive attention and supportive care in the form of a family-center approach to alleviate the additional burden of the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02129-0.
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Affiliation(s)
- Mareike Fuerboeter
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Holger Zapf
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Rojin Nazarian
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Pediatric Surgery, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Soley-Bori M, Lingam R, Satherley RM, Forman J, Cecil L, Fox-Rushby J, Wolfe I. Children and Young People's Health Partnership Evelina London Model of Care: economic evaluation protocol of a complex system change. BMJ Open 2021; 11:e047085. [PMID: 34819278 PMCID: PMC8614147 DOI: 10.1136/bmjopen-2020-047085] [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: 11/04/2022] Open
Abstract
INTRODUCTION The Children and Young People's Health Partnership (CYPHP) Evelina London Model of Care is a new approach to integrated care delivery for children and young people (CYP) with common health complaints and chronic conditions. CYPHP includes population health management (services shaped by data-driven understanding of population and individual needs, applied in this case to enable proactive case finding and tailored biopsychosocial care), specialist clinics with multidisciplinary health teams and training resources for professionals working with CYP. This complex health system strengthening programme has been implemented in South London since April 2018 and will be evaluated using a cluster randomised controlled trial with an embedded process evaluation. This protocol describes the within-trial and beyond-trial economic evaluation of CYPHP. METHODS AND ANALYSIS The economic evaluation will identify, measure and value resources and health outcome impacts of CYPHP compared with enhanced usual care from a National Health Service/Personal Social Service and a broader societal perspective. The study population includes 90 000 CYP under 16 years of age in 23 clusters (groups of general practitioner (GP) practices) to assess health service use and costs, with more detailed cost-effectiveness analysis of a targeted sample of 2138 CYP with asthma, eczema or constipation (tracer conditions). For the cost-effectiveness analysis, health outcomes will be measured using the Paediatric Quality of Life Inventory and quality-adjusted life years (QALYs) using the Child Health Utility 9 Dimensions (CHU-9D) measure. To account for changes in parental well-being, the Warwick-Edinburg Mental Well-being Scale will be integrated with QALYs in a cost-benefit analysis. The within-trial economic evaluation will be complemented by a novel long-term model that expands the analytical horizon to 10 years. Analyses will adhere to good practice guidelines and National Institute for Health and Care Excellence public health reference case. ETHICS AND DISSEMINATION The study has received ethical approval from South West-Cornwall and Plymouth Research Ethics Committee (REC Reference: 17/SW/0275). Results will be submitted for publication in peer-reviewed journals, made available in briefing papers for local decision-makers, and provided to the local community through website and public events. Findings will be generalisable to community-based models of care, especially in urban settings. TRIAL REGISTRATION NUMBER NCT03461848.
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Affiliation(s)
- Marina Soley-Bori
- Department of Population Health Sciences, King's College London, London, UK
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | | | - Julia Forman
- Department of Women's and Children's Health, King's College London, London, UK
| | - Lizzie Cecil
- Department of Women's and Children's Health, King's College London, London, UK
| | - Julia Fox-Rushby
- Population Health Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and Saint Thomas' NHS Foundation Trust and King's College, London, UK
| | - Ingrid Wolfe
- Department of Women's and Children's Health, King's College London, London, UK
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Cross-Sectional Analysis of Quality of Life in Pediatric Patients with Inflammatory Bowel Disease in British Columbia, Canada. J Pediatr 2021; 238:57-65.e2. [PMID: 34293367 DOI: 10.1016/j.jpeds.2021.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To evaluate quality of life (QoL) in a large cohort of pediatric patients with inflammatory bowel disease (IBD) and to identify the clinical factors that influence QoL. STUDY DESIGN This cross-sectional study analyzes a quality improvement initiative in 351 pediatric patients with IBD in British Columbia, Canada using the self-reported Pediatric Quality of Life Inventory (PedsQL) 4.0 generic scale. The questionnaire was completed at outpatient clinic and biologic infusion appointments. Statistical analysis included the t test, ANOVA, and multilinear regressions to evaluate the relationships between clinical factors and QoL. RESULTS Mean (SE) QoL scores (79.95 [0.84]) fell between previously described healthy and chronically ill populations. Disease activity was the most significant predictor of QoL, with patients in remission scoring similar (84.42 [0.87]) to well established healthy norms, and those with moderately or severely active disease having some of the lowest published PedsQL scores (63.13 [3.27]), lower than most other chronic pediatric conditions. Twenty-five patients with moderately or severely active disease at the time of survey completion had follow-up surveys identified 1 year later and had a significant improvement of both their disease activity (P < .005) and their PedsQL scores (follow-up survey mean 76.13 [3.11]). Additional clinical factors independently associated with poor QoL were school nonattendance (15.5% decrease in QoL, P < .001), immune-modulator selection (methotrexate conferring a 9.5% lower mean QoL score than azathioprine, P = .005), and female gender (P = .031). CONCLUSION Pediatric patients with IBD experience a QoL significantly impacted by multiple clinical factors including current severity of IBD symptoms.
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Nelson S, Beveridge JK, Mychasiuk R, Noel M. Adverse Childhood Experiences (ACEs) and Internalizing Mental Health, Pain, and Quality of Life in Youth With Chronic Pain: A Longitudinal Examination. THE JOURNAL OF PAIN 2021; 22:1210-1220. [PMID: 33798732 DOI: 10.1016/j.jpain.2021.03.143] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/16/2021] [Accepted: 03/26/2021] [Indexed: 12/11/2022]
Abstract
The aims of this longitudinal study were to 1) identify categories of adverse childhood experiences (ACEs) (ie, neglect, abuse, household dysfunction in childhood) that increase risk for internalizing mental health problems, pain-related impairment, and poorer quality of life and 2) examine the moderating role of posttraumatic stress symptoms (PTSS) in these associations, in a clinical sample of youth with chronic pain. At 2 timepoints, youth (N = 155; aged 10-18 years) completed measures of exposure to ACEs, PTSS, depressive and anxiety symptoms, pain intensity, pain interference, and quality of life. Multivariate analyses of variance, linear mixed modeling, and moderation analyses were conducted. Results from cross-sectional and longitudinal analyses were similar; youth with a history of 3+ ACEs reported significantly higher PTSS, depressive and anxiety symptoms, and poorer quality of life than youth with no ACE history. Results also revealed differences in functioning between youth exposed to different types of ACEs (ie, maltreatment only, household dysfunction only, both, none). Finally, PTSS was found to moderate the association between ACEs and anxiety and depressive symptoms. Findings underscore the influence that ACEs can have on the long-term functioning of youth with chronic pain as well as the important role of current PTSS in this association. PERSPECTIVE: This study found that the risk of poorer outcomes imposed by ACEs at baseline remains longitudinally and that posttraumatic stress symptoms (PTSS) moderate the relationship between ACEs and anxiety and depressive symptoms in youth with chronic pain. These results underscore the importance of assessing for ACEs and PTSS alongside chronic pain in youth.
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Affiliation(s)
- Sarah Nelson
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jaimie K Beveridge
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Richelle Mychasiuk
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada; Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada.
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NIH's Helping to End Addiction Long-term SM Initiative (NIH HEAL Initiative) Clinical Pain Management Common Data Element Program. THE JOURNAL OF PAIN 2021; 23:370-378. [PMID: 34508905 DOI: 10.1016/j.jpain.2021.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/22/2021] [Accepted: 08/11/2021] [Indexed: 12/20/2022]
Abstract
The Helping to End Addiction Long-term Initiative (NIH HEAL Initiative) is an aggressive trans-NIH effort to speed solutions to stem the national opioid public health crisis, including through improved pain management. Toward this end, the NIH HEAL Initiative launched a common data element (CDE) program to ensure that NIH-funded clinical pain research studies would collect data in a standardized way. NIH HEAL Initiative staff launched a process to determine which pain-related core domains should be assessed by every clinical pain study and what questionnaires are required to ensure that the data is collected uniformly. The process involved multiple literature reviews, and consultation with experts inside and outside of NIH and the investigators conducting studies funded by the initiative. Ultimately, 9 core pain domains, and questionnaires to measure them, were chosen for studies examining acute pain and chronic pain in adults and pediatric populations. These were augmented with dozens of study-specific supplemental questionnaires to enable uniform data collection methods of outcomes outside of the core domains. The selection of core domains will ensure that valuable clinical pain data generated by the initiative is standardized, useable for secondary data analysis, and useful for guiding future research, clinical practice decisions, and policymaking. PERSPECTIVE: The NIH HEAL Initiative launched a common data element program to ensure that NIH-funded clinical pain research studies would collect data in a standardized way. Nine core pain domains and questionnaires to measure them were chosen for studies examining acute pain and chronic pain in adults and pediatric populations.
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Battison EAJ, Wilson AC, Holley AL. Perceived Injustice Is Associated With Pain-related Function and Mood in Youth With Acute Musculoskeletal Pain. Clin J Pain 2021; 37:575-582. [PMID: 34008507 PMCID: PMC8273116 DOI: 10.1097/ajp.0000000000000947] [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: 12/04/2020] [Accepted: 04/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Perceived injustice (PI), which is one's appraisal of justice or fairness regarding the pain experience, is an emerging area of interest in pediatric pain research. No previous studies have investigated PI in youth with acute pain. To fill this gap, this study examined (1) associations among PI, pain-related function, and psychological function in treatment-seeking youth with acute musculoskeletal (MSK) pain, and (2) the impact of parent-child PI discordance on children's pain and psychosocial function. MATERIALS AND METHODS Participants were youth (aged 11 to 17, 55% male) with acute pain (onset <1 mo) recruited from emergency departments or outpatient clinics and participating parents (102 parent-child dyads). Dyads completed study questionnaires within 1 month of the child's pain onset. RESULTS Youth-reported PI was significantly correlated with poorer physical and psychosocial quality of life, higher pain catastrophizing, higher fear of pain, increased pain-related disability, and greater depression and anxiety. Furthermore, PI was significantly associated with the physical quality of life, psychosocial quality of life, and pain-related disability. Moreover, discordance in youth and parent ratings of PI was associated with children's psychological and pain-related function. Specifically, compared with Concordant dyads, youth in the Discordant dyads (youth high PI/parent low PI) reported significantly poorer physical quality of life, psychosocial quality of life, higher pain-related disability, depression, anxiety, and pain catastrophizing. DISCUSSION These findings reveal that PI in youth with acute MSK pain is associated with quality of life and pain-related disability. Furthermore, results highlight the importance of discordance between youth and parent reports of PI on pain-related functioning.
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Affiliation(s)
- Eleanor A J Battison
- Department of Pediatrics, Division of Psychology, Oregon Health & Science University, Portland, OR
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Rabbitts JA, Zhou C, de la Vega R, Aalfs H, Murray CB, Palermo TM. A digital health peri-operative cognitive-behavioral intervention to prevent transition from acute to chronic postsurgical pain in adolescents undergoing spinal fusion (SurgeryPal TM): study protocol for a multisite randomized controlled trial. Trials 2021; 22:506. [PMID: 34330321 PMCID: PMC8325315 DOI: 10.1186/s13063-021-05421-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/03/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Spinal fusion surgery is associated with severe acute postsurgical pain and high rates of chronic postsurgical pain in adolescents. Psychological distress, sleep disturbance, and low pain self-efficacy predict higher acute pain and likelihood of developing chronic postsurgical pain. Interventions targeting baseline psychosocial risk factors have potential to interrupt a negative trajectory of continued pain and poor health-related quality of life (HRQL) over time but have not yet been developed and evaluated. This randomized controlled trial will test effectiveness of a digital peri-operative cognitive-behavioral intervention (SurgeryPalTM) vs. education-control delivered to adolescents and their parents to improve acute and chronic pain and health outcomes in adolescents undergoing spine surgery. METHODS Adolescents 12-18 years of age undergoing spinal fusion for idiopathic conditions, and their parent, will be recruited from pediatric centers across the USA, for a target complete sample of 400 dyads. Adolescents will be randomized into 4 study arms using a factorial design to SurgeryPalTM or education control during 2 phases of treatment: (1) pre-operative phase (one-month before surgery) and (2) post-operative phase (1 month after surgery). Acute pain severity and interference (primary acute outcomes) and opioid use will be assessed daily for 14 days following hospital discharge. Chronic pain severity and interference (primary acute outcomes), as well as HRQL, parent and adolescent distress, sleep quality, and opioid use/misuse (secondary outcomes), will be assessed at 3 months and 6 months post-surgery. DISCUSSION Demonstration of effectiveness and understanding optimal timing of perioperative intervention will enable implementation of this scalable psychosocial intervention into perioperative care. Ultimately, the goal is to improve pain outcomes and reduce reliance on opioids in adolescents after spine surgery. TRIAL REGISTRATION NCT04637802 ClinicalTrials.gov. Registered on November 20, 2020.
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Affiliation(s)
- Jennifer A. Rabbitts
- Center for Clinical and Translational Research (CCTR), Seattle Children’s Hospital, 4800 Sand Point Way NE MB.11.500.3, Seattle, WA 98105 USA
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
| | - Chuan Zhou
- Center for Child Health Behavior and Development (CHBD), Seattle Children’s Hospital, 1920 Terry Avenue, Seattle, WA USA
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105 USA
| | - Rocio de la Vega
- Department of Psychology, University of Málaga, Campus de Teatinos, s/n, 29071 Málaga, Spain
| | - Homer Aalfs
- Center for Child Health Behavior and Development (CHBD), Seattle Children’s Hospital, 1920 Terry Avenue, Seattle, WA USA
| | - Caitlin B. Murray
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
- Center for Child Health Behavior and Development (CHBD), Seattle Children’s Hospital, 1920 Terry Avenue, Seattle, WA USA
| | - Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
- Center for Child Health Behavior and Development (CHBD), Seattle Children’s Hospital, 1920 Terry Avenue, Seattle, WA USA
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105 USA
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Steineck A, Barton KS, Bradford MC, Yi-Frazier JP, Rosenberg AR. Tincture of Time: The Evolution of Goals in Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2021; 10:703-710. [PMID: 33960833 DOI: 10.1089/jayao.2020.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: A diagnosis of cancer often derails an individual's goals. The purpose of this mixed-methods analysis was to describe the evolution of adolescent and young adult (AYA)-reported goals in the year after a diagnosis of new or advanced cancer. Methods: As part of the Promoting Resilience in Stress Management (PRISM) phase 2 randomized controlled trial, AYAs with cancer (ages 12-25 years) were asked at baseline, 6 months, and 12 months: "Please give an example of a goal you hope to accomplish over the next month/year." We used content analysis to categorize goals as follows: life milestones, physical health, mental/emotional health, cancer specific, and hobbies/interests. We summarized goal categories at each time point: for the entire cohort, by baseline diagnosis status (new vs. advanced cancer), treatment status (on-therapy vs. off-therapy), and baseline health-related quality of life (high vs. low). Results: Eighty-six participants completed the study and were included in the analysis (control: n = 41, PRISM: n = 45); 69 reported their goals at 6 months, and 54 at 12 months. Participants submitted a total of 169 goals at baseline, 148 at 6 months, and 126 at 12 months. At baseline, cancer-specific goals were most common for the short-term (35%), whereas milestone goals were most common for the long-term (46%). At 6 months, milestone goals were most common in both short- (38%) and long-term (51%) categories. A similar pattern was seen at 12 months. Conclusion: AYAs' goals change over the first year of their cancer experience, with a shift in short-term goals from cancer-specific goals at baseline to milestone goals at later time points. ClinicalTrials.gov (NCT02340884).
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Affiliation(s)
- Angela Steineck
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Krysta S Barton
- Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Miranda C Bradford
- Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Joyce P Yi-Frazier
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Abby R Rosenberg
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
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Parent C, Pokhvisneva I, de Mendonça Filho EJ, O'Donnell KJ, Meaney MJ, Kee MZL, Thng G, Wing H, Adler NE, Keeton V, Pantell MS, Hessler D, Gottlieb LM, Silveira PP. Salivary cytokine cluster moderates the association between caregivers perceived stress and emotional functioning in youth. Brain Behav Immun 2021; 94:125-137. [PMID: 33662503 DOI: 10.1016/j.bbi.2021.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/14/2021] [Accepted: 02/24/2021] [Indexed: 10/22/2022] Open
Abstract
Some individuals exposed to early life stress show evidence of enhanced systemic inflammation and are at greater risk for psychopathology. In the current study, caregivers and their offspring (0-17 years) were recruited at a pediatric clinic visit at the University of California, San Francisco (UCSF). Mothers and seven-year-old children from the Growing Up inSingaporeTowards healthy Outcomes (GUSTO) prospective birth cohort were used as a replication cohort. Caregivers perceived stress was measured to determine potential intergenerational effects on the children's functioning and inflammation levels. Children's emotional functioning in the UCSF cohort was evaluated using the Pediatric Quality of Life (PedsQL) inventory. Child emotional and behavioral functioning was measured using the Child Behavior Checklist (CBCL) in GUSTO. Saliva was collected from the children and salivary levels of IL-6, IL-1β, IL-8 and TNF-α were measured using an electrochemiluminescent cytokine multiplex panel. Child IL-6, IL-1β, IL-8 cytokine levels were clustered into low, average, and high cytokine cluster groups using hierarchical cluster analysis. We did not find that salivary cytokine clusters were significantly associated with children's emotional or behavioral function. However, cytokine clusters did significantly moderate the association between increased caregiver perceived stress and reduced child emotional functioning (UCSF cohort) and increased Attention-Deficit-Hyperactivity (ADH) problems (GUSTO cohort, uncorrected Cohen's F2 = 0.02). Using a cytokine clustering technique may be useful in identifying those children exposed to increased caregiver perceived stress that are at risk of emotional and attention deficit hyperactivity problems.
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Affiliation(s)
- Carine Parent
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
| | - Irina Pokhvisneva
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
| | | | - Kieran J O'Donnell
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada; Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada; CIFAR, Toronto, ON, Canada; Yale Child Study Center & Department of Obstetrics Gynecology & Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Michael J Meaney
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada; Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Republic of Singapore; CIFAR, Toronto, ON, Canada
| | - Michelle Z L Kee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Republic of Singapore
| | - Gladi Thng
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Republic of Singapore
| | - Holly Wing
- University of California, San Francisco, Center for Health and Community, San Francisco, CA, United States
| | - Nancy E Adler
- University of California, San Francisco, Department of Psychiatry and Pediatrics, San Francisco, CA, United States
| | - Victoria Keeton
- University of California, San Francisco, Family Health Care Nursing, School of Nursing, San Francisco, CA, United States
| | - Matthew S Pantell
- University of California, San Francisco, Department of Pediatrics, School of Medicine, San Francisco, CA, United States
| | - Danielle Hessler
- University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA, United States
| | - Laura M Gottlieb
- University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA, United States
| | - Patricia P Silveira
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada; Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada.
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Zhu X, Wang F, Geng Y. Machiavellianism on quality of life: The role of lifestyle, age, gender, social support. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2020.110609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Rabbitts JA, Holley AL, Zhou C, Chen L. Physical Activity as a Predictor of Chronic Pain Following Pediatric Spinal Surgery. Clin J Pain 2021; 37:186-193. [PMID: 33273273 PMCID: PMC7867602 DOI: 10.1097/ajp.0000000000000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES (1) Characterize objective physical activity patterns via actigraphy over 4 months postspinal fusion surgery, and (2) examine associations between activity patterns at 2-week and chronic postsurgical pain (CPSP) status at 4 months. MATERIALS AND METHODS Data from 109 youth (10 to 18 y) who underwent spinal fusion surgery at a children's hospital in the Northwestern United States were analyzed. Youth completed questionnaires and actigraphic assessment of physical activity presurgery, and 2 weeks and 4 months postsurgery. RESULTS Eighteen percent of youth developed CPSP at 4 months. Presurgery physical activity was similar for youth with and without CPSP. At 2 weeks postsurgery, daily activity levels were lower for youth who developed CPSP as compared with those who did not, including lower mean activity (168 vs. 212 counts/min, P=0.01), fewer activity bouts (n=1.7 vs. 2.6, P=0.02), and shorter bout duration (27 vs. 40 min, P=0.02). Differences in activity were maintained at 4 months such that youth with CPSP had lower mean activity (284 vs. 334 counts/min, P=0.03), as well as greater proportion time spent sedentary and lower proportion time in light activity than youth without CPSP. In adjusted models examining 2-week actigraphy as a predictor of 4-month pain status, mean activity (odds ratio=0.99, P=0.04) and number of activity bouts (odds ratio=0.79, P=0.02) were associated with subsequent CPSP status over and above 2-week pain intensity. DISCUSSION Lower activity engagement during the initial weeks following spinal fusion surgery was associated with development of CPSP, suggesting early physical activity limitations as a risk factor for CPSP in youth. Understanding recovery patterns is critical for identifying those at risk for chronic pain and implementing early interventions.
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Affiliation(s)
- Jennifer A. Rabbitts
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children’s Hospital, Seattle, WA, USA
| | - Amy L. Holley
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Child Health, Behavior and Development, Seattle Children’s Hospital, Seattle, WA, USA
| | - Lucas Chen
- Center for Clinical and Translational Research, Seattle Children’s Hospital, Seattle, WA, USA
- University of Washington College of Arts and Sciences, Seattle, WA
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Hollenbach J, Simoneau T, Sun Y, Becene I, Almeida S, Langton C, Flores G. Design, methods, and baseline characteristics of a pilot, randomized, controlled trial of the effects of an electronic monitoring device on medication adherence in children with asthma. Contemp Clin Trials Commun 2021; 21:100706. [PMID: 33644492 PMCID: PMC7887642 DOI: 10.1016/j.conctc.2021.100706] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/11/2020] [Accepted: 01/01/2021] [Indexed: 11/18/2022] Open
Abstract
Non-adherence to medication is common Current methods of assessing adherence are inaccurate. Electronic monitoring devices (EMDs) may more accurately assess adherence, but are not currently used in practice. The design, methods, and participant baseline characteristics are described for a pilot trial of the effects of an EMD on asthma medication adherence in a pediatric population. This was a pilot, randomized, controlled trial of children with persistent asthma managed with daily inhaled corticosteroids (ICS). Seventy-five children were randomized 2:1 to receive either two EMDs (one for ICS and one for rescue) linked via Bluetooth to a mobile application (app) or standard of care (controls). EMDs recorded dates and times of inhaler actuations and the app sent daily medication reminders to participants. Controls were provided standard care. Medication adherence was measured using pharmacy refill records and self-report, whereas EMD data were used to measure adherence in the intervention group. Secondary outcomes included asthma control, pulmonary function, and quality of life. Results One hundred sixty children were screened for eligibility, with 123 individuals excluded. Seventy-five children were enrolled, with 25 allocated to the control group and 50 to the intervention. The mean age of participants is 12 years old (±2.9), with equal proportions of male and female children; 45% are Latinx and 19% African-American; 77% report Medicaid or CHIP coverage. Half of participants have moderate persistent asthma and 48% had marginally controlled asthma at time of enrollment. There were no significant inter-group differences in baseline sociodemographic characteristics. Conclusion This pilot successfully reached target populations and met recruitment and enrollment goals. It is addressing an important knowledge gap by evaluating the effects of an EMD with a mobile app on adherence rates, findings which could prove useful in determining whether routine use of EMDs in clinical practice help children achieve better asthma control and outcomes. Clinical Trials.gov NCT03734861.
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Affiliation(s)
- JessicaP. Hollenbach
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
- Department of Pediatrics, Uconn Health School of Medicine, Farmington, CT, 06030, USA
- Corresponding author. Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA.
| | - Tregony Simoneau
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Ye Sun
- Children's Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY, 10467, USA
| | - Iris Becene
- Tufts University, 419 Boston Ave, Medford, MA, 02155, USA
| | - Sigrid Almeida
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
| | - Christine Langton
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
| | - Glenn Flores
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
- Department of Pediatrics, Uconn Health School of Medicine, Farmington, CT, 06030, USA
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Turner KM, Wilcox G, Nordstokke DW, Dick B, Schroeder M, Noel M. Executive Functioning in Youth With and Without Chronic Pain: A Comparative Analysis. Clin J Pain 2021; 37:102-117. [PMID: 33165021 DOI: 10.1097/ajp.0000000000000895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/26/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Preliminary research in youth with chronic pain suggests differences in attention and working memory, which has been similarly demonstrated in adults with chronic pain. There has been little research on other aspects of executive functioning (EF) in this population despite its critical role in problem solving, school functioning, and coping. This study aimed to examine differences in several aspects of EF between youth with chronic pain and a nonchronic pain comparison group using performance-based neuropsychological tests and a behavior rating scale. MATERIALS AND METHODS Participants completed ratings of pain; physical, emotional, social, and school functioning; sleep quality; medication; and a general intelligence screener. Standardized neuropsychological tests were used to examine EF with a focus on working memory, divided and alternating attention, inhibition, flexibility, incidental memory, and planning. A parent-report and self-report behavior rating of EF was also administered. RESULTS Recruitment from 2 tertiary-care pain clinics resulted in a sample of 26 youth with chronic pain (80.8% girls) and their parents. A comparison group of 30 youth without chronic pain and their parents were recruited from the community. Participants with chronic pain had significantly lower scores on several performance-based tests of working memory/divided attention, inhibition, and flexibility/alternating attention than the comparison group. Statistically significant group differences were also found on behavior ratings of emotion control, shifting, task initiation and completion, working memory, planning and organization, overall emotion and cognitive regulation as well as global EF. Covariate analysis was conducted in all analyses where there were significant group differences and several observed group differences remained. DISCUSSION This study is one of few multidimensional examinations of EF in youth with chronic pain, using a comprehensive neuropsychological test battery combined with behavior ratings. Our findings suggest EF differences in youth with chronic pain, across a variety of domains and may suggest risk for specific cognitive processing weaknesses in this population. Medical and educational teams should work toward identification, treatment, and compensatory support for EF within individualized pain management for youth.
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Affiliation(s)
- Kailyn M Turner
- Werklund School of Education, Educational Psychology
- Alberta Children's Hospital Research Institute, Alberta Children's Hospital
| | - Gabrielle Wilcox
- Werklund School of Education, Educational Psychology
- Hotchkiss Brain Institute
- Alberta Children's Hospital Research Institute, Alberta Children's Hospital
- Mathison Centre for Mental Health Research & Education, Calgary, AB
| | | | - Bruce Dick
- Departments of Anesthesiology & Pain Medicine
- Psychiatry
- Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Melanie Noel
- Hotchkiss Brain Institute
- Department of Psychology, University of Calgary, Calgary
- Alberta Children's Hospital Research Institute, Alberta Children's Hospital
- Mathison Centre for Mental Health Research & Education, Calgary, AB
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Grandjean C, Ullmann P, Marston M, Maitre MC, Perez MH, Ramelet AS. Sources of Stress, Family Functioning, and Needs of Families With a Chronic Critically Ill Child: A Qualitative Study. Front Pediatr 2021; 9:740598. [PMID: 34805041 PMCID: PMC8600118 DOI: 10.3389/fped.2021.740598] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022] Open
Abstract
PICU hospitalization is particularly stressful for families. When it is prolonged and the prognostic is uncertain, it can significantly and negatively affect the whole family. To date, little is known on how families with a chronic critically ill (CCI) child are affected. This national study explored the specific PICU-related sources of stress, family functioning and needs of families of CCI patients during a PICU hospitalization. This descriptive qualitative study was conducted in the eight pediatric intensive care units in Switzerland. Thirty-one families with a child meeting the CCI criteria participated in semi-structured interviews. Interviews, including mothers only (n = 12), fathers only (n = 8), or mother and father dyads (n = 11), were conducted in German, French, or English by two trained researchers/clinical nurses specialists. Interviews were recorded, transcribed verbatim, and analyzed using deductive and inductive content analyses. Five overarching themes emerged: (1) high emotional intensity, (2) PICU-related sources of stress, (3) evolving family needs, (4) multi-faceted family functioning, and (5) implemented coping strategies. Our study highlighted the importance of caring for families with CCI children. Parents reported high negative emotional responses that affect their family functioning. Families experience was highly dependent on how HCPs were able to meet the parental needs, provide emotional support, reinforce parental empowerment, and allow high quality of care coordination.
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Affiliation(s)
- Chantal Grandjean
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Pediatric Intensive Care Unit, Department Woman-Mother-Child, Department Woman-Mother-Child, Lausanne, Switzerland
| | - Pascale Ullmann
- School of Healthcare, University of Applied Sciences and Arts, Fribourg, Switzerland
| | - Mark Marston
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Pediatric Intensive Care Unit, Department Woman-Mother-Child, Department Woman-Mother-Child, Lausanne, Switzerland.,University Children's Hospital Basel, Basel, Switzerland
| | - Marie-Christine Maitre
- Pediatric Intensive Care Unit, Department Woman-Mother-Child, Department Woman-Mother-Child, Lausanne, Switzerland
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Department Woman-Mother-Child, Department Woman-Mother-Child, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Pediatric Intensive Care Unit, Department Woman-Mother-Child, Department Woman-Mother-Child, Lausanne, Switzerland
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Willems J, Farin-Glattacker E, Langer T. Evaluation of a Case Management to Support Families With Children Diagnosed With Spinal Muscular Atrophy-Protocol of a Controlled Mixed-Methods Study. Front Pediatr 2021; 9:614512. [PMID: 34414138 PMCID: PMC8369478 DOI: 10.3389/fped.2021.614512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/12/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Spinal muscular atrophy (SMA) is a rare neuromuscular disease characterized by degeneration of the anterior horn cells in the spinal cord, resulting in muscle atrophy, and proximal muscle weakness. SMA presents with a wide range of symptoms requiring multiple clinical specialists and therapists. Integrating care between disciplines can be challenging due to the dynamic course of the disease, and great distances between specialist centers and local providers. Insufficient care integration can lead to suboptimal quality of care and more difficulties for patients and families. This study aims to improve care integration through a Case Management intervention, and taking a mixed-methods approach, to evaluate its impact. Methods: An exploratory, controlled, two-armed study with baseline, post- and follow-up measurement and process evaluation is conducted to evaluate our intervention compared to usual care. Through a multi-perspective state analysis, we investigate the experiences of caregivers and healthcare providers concerning the actual healthcare quality of patients with SMA I and II. Semi-structured interviews and care diaries are used. We apply that data to conceive a tailored Case Management intervention supplemented by a digital platform. The intervention's effect is examined in comparison to a control group taking a mixed-methods approach. As primary endpoints, we investigate the caregivers' health-related quality of life and the quality of care integration. Secondary endpoints are the use of healthcare services (patients and caregivers) and costs. We assess the process quality from the perspectives of caregivers and healthcare providers through semi-structured interviews. Discussion: This is an exploratory, controlled study to assess the impact of a tailored Case Management intervention to improve the care of patients with SMA I and II. After the evaluation, results on feasibility, expected effect sizes, and process quality will be available. On this basis, future randomized controlled trials can be planned. If demonstrated beneficial, the experience gained within this study may also be valuable for care strategies in other regions and other (non-pediatric) patient groups with rare diseases and/or chronic, complex conditions. Clinical Trial registration:https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00018778, identifier: DRKS00018778.
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Affiliation(s)
- Jana Willems
- Section of Healthcare Research and Rehabilitation Research, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thorsten Langer
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Rabbitts JA, Groenewald CB, Zhou C. Subacute Pain Trajectories following major musculoskeletal surgery in adolescents: A Pilot Study. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2020; 4:3-12. [PMID: 33415314 PMCID: PMC7787390 DOI: 10.1080/24740527.2020.1765692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Adolescents who undergo major surgery experience high rates of disabling acute and chronic postsurgical pain (CPSP). However, little is known about the subacute period when acute to chronic pain transition occurs. Aims: The aims of this study were to examine feasibility of electronic daily monitoring of pain and opioid use in adolescents during the first 30 days at home following major surgery and identify target features of subacute pain curves associated with CPSP at 4 months. Methods: Twenty-five youth (10–18 years) undergoing major musculoskeletal surgery reported daily pain severity, interference, and opioid use on the Brief Pain Inventory each evening for 30 days after hospital discharge to form short time series trajectories. At 4 months, youth reported on pain intensity and health-related quality of life. Characteristics of subacute pain severity and interference curves were compared by 4-month CPSP status. Results: At 4 months, 20.8% of youth met criteria for CPSP. During the 30-day monitoring period, youth who went on to develop CPSP reported high pain severity on 45.9% of days compared to 2.9% of days in youth who recovered (P = 0.005) and high pain interference on 49.4% of days vs. 9.7% in youth who recovered (P = 0.01). Pain variability and rate of change were not significantly associated with CPSP in our pilot sample. Conclusions: We found it feasible to collect daily pain data in youth recovering at home after major surgery. Pilot findings suggest that daily electronic monitoring may identify early recovery problems at home after surgery. Larger studies are needed to validate subacute pain trajectory features to identify risk for CPSP.
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Affiliation(s)
- Jennifer A Rabbitts
- Department of Anesthesiology & Pain Medicine.,Center for Clinical and Translational Research
| | - Cornelius B Groenewald
- Department of Anesthesiology & Pain Medicine.,Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, WA, USA
| | - Chuan Zhou
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, WA, USA
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Fazeli S, Mohammadi Zeidi I, Lin CY, Namdar P, Griffiths MD, Ahorsu DK, Pakpour AH. Depression, anxiety, and stress mediate the associations between internet gaming disorder, insomnia, and quality of life during the COVID-19 outbreak. Addict Behav Rep 2020; 12:100307. [PMID: 33110934 PMCID: PMC7581367 DOI: 10.1016/j.abrep.2020.100307] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND For many individuals, the COVID-19 outbreak has increased their psychological distress, changed their behaviors, and impacted their health. With more time spent indoors, many individuals have engaged in increased videogame playing. However, the associations between such behaviors during the COVID-19 outbreak period is unclear. OBJECTIVE The present study examined the mediating role of psychological distress (depression, anxiety, and stress) in the association between internet gaming disorder (IGD) and two health outcomes (insomnia quality of life) among adolescents during this COVID-19 pandemic. METHODS A cross-sectional study comprising adolescents (N = 1512) aged 13-18 years (mean age = 15.51 years) was utilized to assess measures on insomnia, depression, anxiety, and stress, IGD, and quality of life during the COVID-19 pandemic. RESULTS There were small to large significant relationships between the variables. Psychological distress (i.e., depression, anxiety, and stress) served as a strong mediator in the association between IGD and insomnia and quality of life. IGD directly influenced insomnia and quality of life among the participants. CONCLUSIONS IGD is associated with different psychosocial outcomes comprising multiple pathways. Parents need to pay special attention to how much time and how frequently their children play videogames. Parents may need to assist their children in coping with psychological distress during the ongoing COVID-19 pandemic period.
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Affiliation(s)
- Sara Fazeli
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Isa Mohammadi Zeidi
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Peyman Namdar
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Daniel Kwasi Ahorsu
- Department of Rehabilitation Sciences, Faculty of Health & Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Amir H. Pakpour
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Diagnostic uncertainty in pediatric chronic pain: nature, prevalence, and consequences. Pain Rep 2020; 5:e871. [PMID: 33251472 PMCID: PMC7690765 DOI: 10.1097/pr9.0000000000000871] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction Diagnostic uncertainty (DU), which is the perception that a label or explanation for a patient's health problem is missing or inaccurate, has been linked to distress, anxiety, and difficulty coping among adults with pain. This study examined the prevalence of DU among youth with chronic pain and their parents and the relation of parent and youth DU with youth pain, pain-related constructs, and health-related quality of life (HRQoL). Methods Participants included 174 youth with chronic pain (M age = 14.28 years; 73% female) and one of their parents (91% mothers) recruited from a tertiary-level pediatric chronic pain program in Canada. Youth and parent DU was assessed using a brief measure of 3 empirically derived yes/no questions regarding whether the youth and parent had received a clear diagnosis/explanation for their/their child's pain and whether they believed there was something else happening with their/their child's pain that doctors had not yet found. Youth reported on their pain intensity, pain interference, pain catastrophizing, fear of pain, and HRQoL. Results Thirty-one percent of youth and 28% of parents experienced DU. Seventy percent of parents and youth were in agreement regarding their experience of DU. Youth DU was linked to higher youth catastrophic thinking about their pain. Parent DU was linked to greater youth pain interference and intensity and lower youth HRQoL. Conclusion Diagnostic uncertainty is experienced by nearly a third of youth with chronic pain and their parents and is linked to worse youth pain, pain catastrophizing, and HRQoL.
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Scott SR, O'Daffer AG, Bradford MC, Fladeboe K, Lau N, Steineck A, Taylor M, Yi-Frazier JP, Rosenberg AR. Adverse childhood experiences (ACEs) and medically traumatic events (TEs) in adolescents and young adults (AYAs) with cancer: a report from the Promoting Resilience in Stress Management (PRISM) randomized controlled trial. Support Care Cancer 2020; 29:3773-3781. [PMID: 33219407 DOI: 10.1007/s00520-020-05888-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In adolescents and young adults (AYAs) with cancer, we examined (1) the distribution and type of traumatic events (TEs) experienced prior to baseline assessment and (2) how a resilience intervention, Promoting Resilience in Stress Management (PRISM), impacted changes in patient-reported outcomes (PROs) for AYAs with and without TEs. METHODS AYAs (12-25 years) within 1-10 weeks of diagnosis of new malignancy or ever diagnosed with advanced cancer were enrolled and randomly assigned to usual care (UC) with or without PRISM. To assess TEs, we screened medical records for traditionally defined adverse childhood experiences (ACEs) and medical traumatic events. Age-validated PROs assessed resilience, benefit-finding, hope, generic health-related quality of life (QoL), cancer-specific QoL, depression, and anxiety at enrollment and 6 months later. We calculated effect sizes (Cohen's d) for PRISM vs. UC effect on PRO score change at 6 months for 1+ TEs and 0 TE groups. RESULTS Ninety-two AYAs enrolled and completed baseline surveys (44-UC, 48-PRISM; N = 74 at 6 months, 38-UC, 36-PRISM); 60% experienced 1+ TEs. PROs at baseline were similar across groups. PRISM's effect on score change was greater (Cohen's d ≥ 0.5) for the 1+ TE group on domains of benefit-finding and hope; and similar (d < 0.5) on domains of resilience, depression, anxiety, and both generic and cancer-specific QoL. CONCLUSIONS In AYAs with cancer, TEs occurred at similar rates as the general population. PRISM may be particularly helpful for improving benefit-finding and hope for those who have experienced TEs.
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Affiliation(s)
- Samantha R Scott
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Psychology, University of Denver, Denver, CO, USA
| | - Alison G O'Daffer
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA
| | - Miranda C Bradford
- Children's Core for Biomedical Statistics, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kaitlyn Fladeboe
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA
| | - Nancy Lau
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA
| | - Angela Steineck
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mallory Taylor
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joyce P Yi-Frazier
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA
| | - Abby R Rosenberg
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA. .,University of Washington School of Medicine, Seattle, WA, USA. .,Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Mohamed D, Abd Alazim F, Salem E, Ali N, Elgalaly D. Aerobic training versus strength exercises on muscle strength and quality of life for children with acute lymphoblastic leukemia. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2020. [DOI: 10.1186/s43161-020-00007-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The treatment for children and adolescents with acute lymphoblastic leukemia (ALL) can lead to multiple adverse effects, including poor physical capacity and muscle weakness. This study aimed to determine which is more effective, aerobic exercises or modified strength training program, on muscle strength and quality of life (QOL) for children with ALL.
Results
In terms of muscle strength, there was a significant difference (P < 0.05) in selected group of muscles elbow flexors, shoulder abductors, hip flexors, knee extensors, and ankle dorsiflexors at both sides in group B compared with group A, whereas there was no significant difference (P > 0.05) between groups on QOL.
Conclusion
The outcomes of the study showed that there was a significant difference in the selected group of muscles at both sides in group B compared with group A; thus, the modified strength training program is more effective for muscle strength of children with ALL than aerobic training, but there was no significant difference between them on QOL.
Trial registration
The clinical trial registered in clinicaltrials.gov with an identifier number NCT03147365
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Minneci PC, Hade EM, Lawrence AE, Sebastião YV, Saito JM, Mak GZ, Fox C, Hirschl RB, Gadepalli S, Helmrath MA, Kohler JE, Leys CM, Sato TT, Lal DR, Landman MP, Kabre R, Fallat ME, Cooper JN, Deans KJ. Association of Nonoperative Management Using Antibiotic Therapy vs Laparoscopic Appendectomy With Treatment Success and Disability Days in Children With Uncomplicated Appendicitis. JAMA 2020; 324:581-593. [PMID: 32730561 PMCID: PMC7385674 DOI: 10.1001/jama.2020.10888] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Nonoperative management with antibiotics alone has the potential to treat uncomplicated pediatric appendicitis with fewer disability days than surgery. Objective To determine the success rate of nonoperative management and compare differences in treatment-related disability, satisfaction, health-related quality of life, and complications between nonoperative management and surgery in children with uncomplicated appendicitis. Design, Setting, and Participants Multi-institutional nonrandomized controlled intervention study of 1068 children aged 7 through 17 years with uncomplicated appendicitis treated at 10 tertiary children's hospitals across 7 US states between May 2015 and October 2018 with 1-year follow-up through October 2019. Of the 1209 eligible patients approached, 1068 enrolled in the study. Interventions Patient and family selection of nonoperative management with antibiotics alone (nonoperative group, n = 370) or urgent (≤12 hours of admission) laparoscopic appendectomy (surgery group, n = 698). Main Outcomes and Measures The 2 primary outcomes assessed at 1 year were disability days, defined as the total number of days the child was not able to participate in all of his/her normal activities secondary to appendicitis-related care (expected difference, 5 days), and success rate of nonoperative management, defined as the proportion of patients initially managed nonoperatively who did not undergo appendectomy by 1 year (lowest acceptable success rate, ≥70%). Inverse probability of treatment weighting (IPTW) was used to adjust for differences between treatment groups for all outcome assessments. Results Among 1068 patients who were enrolled (median age, 12.4 years; 38% girls), 370 (35%) chose nonoperative management and 698 (65%) chose surgery. A total of 806 (75%) had complete follow-up: 284 (77%) in the nonoperative group; 522 (75%) in the surgery group. Patients in the nonoperative group were more often younger (median age, 12.3 years vs 12.5 years), Black (9.6% vs 4.9%) or other race (14.6% vs 8.7%), had caregivers with a bachelor's degree (29.8% vs 23.5%), and underwent diagnostic ultrasound (79.7% vs 74.5%). After IPTW, the success rate of nonoperative management at 1 year was 67.1% (96% CI, 61.5%-72.31%; P = .86). Nonoperative management was associated with significantly fewer patient disability days at 1 year than did surgery (adjusted mean, 6.6 vs 10.9 days; mean difference, -4.3 days (99% CI, -6.17 to -2.43; P < .001). Of 16 other prespecified secondary end points, 10 showed no significant difference. Conclusion and Relevance Among children with uncomplicated appendicitis, an initial nonoperative management strategy with antibiotics alone had a success rate of 67.1% and, compared with urgent surgery, was associated with statistically significantly fewer disability days at 1 year. However, there was substantial loss to follow-up, the comparison with the prespecified threshold for an acceptable success rate of nonoperative management was not statistically significant, and the hypothesized difference in disability days was not met. Trial Registration ClinicalTrials.gov Identifier: NCT02271932.
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Affiliation(s)
- Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Erinn M Hade
- Departments of Biomedical Informatics and Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Amy E Lawrence
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Yuri V Sebastião
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Grace Z Mak
- Section of Pediatric Surgery, Department of Surgery, University of Chicago Medicine and Biologic Sciences, Chicago, Illinois
| | - Christa Fox
- Section of Pediatric Surgery, Department of Surgery, University of Chicago Medicine and Biologic Sciences, Chicago, Illinois
| | - Ronald B Hirschl
- Division of Pediatric Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor
| | - Samir Gadepalli
- Division of Pediatric Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor
| | - Michael A Helmrath
- Division of Pediatric Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan E Kohler
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Thomas T Sato
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis
| | - Rashmi Kabre
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mary E Fallat
- Division of Pediatric Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jennifer N Cooper
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Katherine J Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
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50
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Keim G, Yehya N, Spear D, Hall MW, Loftis LL, Alten JA, McArthur J, Patwari PP, Freishtat RJ, Willson DF, Straumanis JP, Thomas NJ. Development of Persistent Respiratory Morbidity in Previously Healthy Children After Acute Respiratory Failure. Crit Care Med 2020; 48:1120-1128. [PMID: 32697481 PMCID: PMC7490803 DOI: 10.1097/ccm.0000000000004380] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Acute respiratory failure is a common reason for admission to PICUs. Short- and long-term effects on pulmonary health in previously healthy children after acute respiratory failure requiring mechanical ventilation are unknown. The aim was to determine if clinical course or characteristics of mechanical ventilation predict persistent respiratory morbidity at follow-up. DESIGN Prospective cohort study with follow-up questionnaires at 6 and 12 months. SETTING Ten U.S. PICUs. PATIENTS Two-hundred fifty-five children were included in analysis after exclusion for underlying chronic disease or incomplete data. One-hundred fifty-eight and 130 children had follow-up data at 6 and 12 months, respectively. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Pulmonary dysfunction at discharge a priori defined as one of: mechanical ventilation, supplemental oxygen, bronchodilators or steroids at 28 days or discharge. Persistent respiratory morbidity a priori defined as a respiratory PedsQL, a pediatric quality of life measure, greater than or equal to 5 or asthma diagnosis, bronchodilator or inhaled steroids, or unscheduled clinical evaluation for respiratory symptoms. Multivariate backward stepwise regression using Akaike information criterion minimization determined independent predictors of these outcomes. Pulmonary dysfunction at discharge was present in 34% of patients. Positive bacterial respiratory culture predicted pulmonary dysfunction at discharge (odds ratio, 4.38; 95% CI, 1.66-11.56). At 6- and 12-month follow-up 42% and 44% of responders, respectively, had persistent respiratory morbidity. Pulmonary dysfunction at discharge was associated with persistent respiratory morbidity at 6 months, and persistent respiratory morbidity at 6 months was strongly predictive of 12-month persistent respiratory morbidity (odds ratio, 18.58; 95% CI, 6.68-52.67). Positive bacterial respiratory culture remained predictive of persistent respiratory morbidity in patients at both follow-up points. CONCLUSIONS Persistent respiratory morbidity develops in up to potentially 44% of previously healthy children less than or equal to 24 months old at follow-up after acute respiratory failure requiring mechanical ventilation. This is the first study, to our knowledge, to suggest a prevalence of persistent respiratory morbidity and the association between positive bacterial respiratory culture and pulmonary morbidity in a population of only previously healthy children with acute respiratory failure.
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Affiliation(s)
- Garrett Keim
- Division of Anesthesia and Critical Care Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania
| | - Nadir Yehya
- Division of Anesthesia and Critical Care Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania
| | - Debbie Spear
- Department of Pediatrics, Penn State University College of Medicine, Hershey, PA
| | - Mark W Hall
- Division of Critical Care Medicine, Nationwide Children’s Hospital, The Ohio State University College of Medicine
| | - Laura L Loftis
- Pediatrics and Medical Ethics, Baylor College of Medicine, Pediatric Critical Care Medicine, Texas Children’s Hospital
| | - Jeffrey A Alten
- Department of Pediatrics, University of Cincinnati College of Medicine; Division of Cardiology, Cincinnati Children’s Hospital Medical Center
| | - Jennifer McArthur
- Medical College of Wisconsin, Division of Pediatric Critical Care Medicine, Milwaukee, WI and St. Jude Children’s Research Hospital, Department of Pediatrics, Division of Critical Care
| | | | - Robert J Freishtat
- Emergency Medicine, Children’s National Health System, Pediatrics, Emergency Medicine, and Genomics and Precision Medicine
| | | | - John P Straumanis
- George Washington University School of Medicine and Health Sciences Department of Pediatrics at the University of Maryland Baltimore Washington Medical Center
| | - Neal J Thomas
- Department of Pediatrics, Penn State University College of Medicine, Hershey, PA
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