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Auger N, Paradis G, Healy-Profitós J, Lewin A, Malik M, Potter BJ. Non-cardiac birth defects and long-term risk of cardiovascular hospitalisation. Heart 2024; 110:892-898. [PMID: 38772572 DOI: 10.1136/heartjnl-2023-323632] [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: 10/26/2023] [Accepted: 05/04/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Patients with heart defects are at risk of developing cardiovascular disease. Our objective was to determine if non-cardiac birth defects are associated with the risk of cardiovascular hospitalisation. METHODS We conducted a longitudinal cohort study of 1 451 409 parous women in Quebec, Canada. We compared patients with cardiac and non-cardiac birth defects of the urinary, central nervous and other systems against patients without defects between 1989 and 2022. The main outcome was hospitalisation for coronary artery disease, ischaemic stroke and other cardiovascular outcomes during 33 years of follow-up. We computed cardiovascular hospitalisation rates and used Cox proportional hazards regression models to measure the association (HR; 95% CI) between non-cardiac defects and later risk of cardiovascular hospitalisation, adjusted for patient characteristics. RESULTS Women with any birth defect had a higher rate of cardiovascular hospitalisation than women without defects (7.0 vs 3.3 per 1000 person-years). Non-cardiac defects overall were associated with 1.61 times the risk of cardiovascular hospitalisation over time, compared with no defect (95% CI 1.56 to 1.66). Isolated urinary (HR 3.93, 95% CI 3.65 to 4.23), central nervous system (HR 3.33, 95% CI 2.94 to 3.76) and digestive defects (HR 2.39, 95% CI 2.16 to 2.65) were associated with the greatest risk of cardiovascular hospitalisation. These anomalies were associated with cardiovascular hospitalisation whether they presented alone or clustered with other defects. Nevertheless, heart defects were associated with the greatest risk of cardiovascular hospitalisation (HR 10.30, 95% CI 9.86 to 10.75). CONCLUSION The findings suggest that both cardiac and non-cardiac birth defects are associated with an increased risk of developing cardiovascular disease among parous women.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Institut national de santé publique du Québec, Montreal, Québec, Canada
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Institut national de santé publique du Québec, Montreal, Québec, Canada
| | - Jessica Healy-Profitós
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Institut national de santé publique du Québec, Montreal, Québec, Canada
| | - Antoine Lewin
- Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Québec, Canada
- Medical Affairs and Innovation, Hema-Quebec, Montreal, Québec, Canada
| | - Mariyam Malik
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Institut national de santé publique du Québec, Montreal, Québec, Canada
| | - Brian J Potter
- Division of Cardiology, Department of Medicine, University of Montreal Hospital Centre, Montreal, Québec, Canada
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Brownrigg N, Lorenzo AJ, Rickard M, Dos Santos J. The urological evaluation and management of neurogenic bladder in children and adolescents-what every pediatric nephrologist needs to know. Pediatr Nephrol 2024; 39:409-421. [PMID: 37518419 DOI: 10.1007/s00467-023-06064-z] [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: 02/27/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 08/01/2023]
Abstract
Neurogenic bladder (NGB) is an encompassing term that includes multiple causes of bladder dysfunction linked to a congenital or acquired neurological condition that adversely impacts the innervation of the lower urinary tract. Multiple static or progressive conditions can be associated with NGB in pediatric and adolescent patients. Currently, spinal dysraphism (i.e., spina bifida) is one of the most common etiologies, which occurs in 3-4 per 10,000 live births in developed nations. Abnormal bladder dynamics can lead to kidney damage secondary to high pressures or recurrent infections, as well as urinary incontinence. The current management paradigm centers on a proactive approach to preserving kidney function and achieving continence through behavioral, pharmacological, and surgical means. This educational review highlights the key components of urological management to maximize collaboration with pediatric nephrologists.
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Affiliation(s)
- Natasha Brownrigg
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Armando J Lorenzo
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Mandy Rickard
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Joana Dos Santos
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Sattoe JNT, Hilberink SR. Impairments and comorbidities in adults with cerebral palsy and spina bifida: a meta-analysis. Front Neurol 2023; 14:1122061. [PMID: 37533474 PMCID: PMC10390785 DOI: 10.3389/fneur.2023.1122061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/30/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction Aging with a childhood-onset disability, such as cerebral palsy (CP), spina bifida (SB), and muscular diseases (MD), comes along with significant impairments and comorbidities. Despite the increasing evidence an overall picture is lacking. This study aimed to review the literature about adults with CP/SB/MD and impairments and comorbidities to perform a meta-analysis. Materials and methods Embase, PubMed, Cinahl, and Google Scholar were searched (2000-2020). Search terms included adults with one of the aforementioned disabilities combined with impairments and comorbidities. If specific impairments or comorbidities were reported by at least four studies, these were included in the study. Pooled prevalence (95% Confidence Interval) of impairments/comorbidities were calculated. Results The search yielded 7,054 studies of which 95 were included in the meta-analysis (64 CP, 31 SB, 0 MD). In total estimates were calculated for 26 (CP) and 11 (SB) outcomes. In adults with CP, pain [56.4% (95%CI 48.8-63.8)], deformities [44.2% (95%CI 12.9-78.4)], intellectual disability [37.2% (95%CI 26.7-48.3)], and fatigue [36.9% (95%CI 24.6-50.1)] were most prevalent; renal disease [3.0% (95%CI 2.1-4.2)] and stroke/rheumatic diseases {4.8% (95%CI 3.4-6.5; 4.8% (95%CI 1.5-9.9)] respectively} were least prevalent. For adults with SB, bladder incontinence [60.0% (95%CI 50.5-69.2)], bowel incontinence [49.2% (95%CI 34.5-64.0)], pain [44.1% (95%CI 27.4-61.5)], and sleeping problems [30.3% (95%CI 4.7-65.8)] were most prevalent; diabetes [4.8% (95%CI 2.8-7.3)] and renal disease [8.7% (95%CI 2.0-19.9)] were least prevalent. The included studies showed large heterogeneity. Conclusions More research is needed to study health issues in adults with MD. Adults with CP or SB deal with a variety of health issues. More attention for the mental health of these adults is needed. There also is a need for accessible and adequate screening, preventive measures and clinical follow-up.
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4
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Woodhouse C. Congenital urinary obstruction and renal failure: has fetal ultrasound improved the prognosis? TRENDS IN UROLOGY & MEN'S HEALTH 2023. [DOI: 10.1002/tre.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Sciscent BY, Bhanja D, Daggubati LC, Ryan C, Hallan DR, Rizk EB. Pregnancy in spina bifida patients: a comparative analysis of peripartum procedures and complications. Childs Nerv Syst 2023; 39:625-632. [PMID: 36278978 DOI: 10.1007/s00381-022-05705-2] [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: 08/23/2022] [Accepted: 10/13/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Spina bifida (SB) is caused by a failure in neural tube closure that can present with lower extremity sensory deficits, paralysis, and hydrocephalus. Medical advances have allowed increased pregnancies among SB patients, but management and pregnancy-associated complications have not been thoroughly investigated. The objective is to delineate peripartum procedures and complications in patients with SB. METHODS A national de-identified database, TriNetX, was retrospectively queried to evaluate pregnant SB patients and the general population. Procedures and complications were investigated using corresponding ICD-10 and CPT codes within 1 year of pregnancy diagnosis. RESULTS 11,405 SB patients were identified and compared to 9,269,084 non-SB patients. SB patients were significantly more likely to undergo cesarean delivery (1.200; 95% CI [1.133-1.271]) and less likely to receive neuraxial analgesia (0.406; 95% CI [0.383-0.431]). Additionally, patients with SB had an increased risk of seizures (3.922; 95% CI [3.529-4.360]) and venous thromboembolism (VTE) (3.490; 95% CI [3.070-3.969]). Risks of preeclampsia and hemorrhage were comparable. SB patients with hydrocephalus and Chiari malformation type 1 (CM-1) or type 2 (CM-2) were compared to patients without these comorbid conditions. This sub-group analysis showed a significantly increased risk of having cesarean deliveries (SB with hydrocephalus: 12.55%, S.B. with CM-1 or CM-2: 12.81% vs. SB without hydrocephalus or CM, 6.16%) and VTE (3.74%, 2.43% vs. 0.81%). There were also increased risks of hemorrhage and seizures and decreased use of neuraxial analgesia, but the sample size was insufficient. CONCLUSION SB patients were more likely to undergo cesarean section and exhibit peripartum complications compared to those without SB.
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Affiliation(s)
- Bao Y Sciscent
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA.
- Penn State College of Medicine, 700 HMC Crescent Rd, Hershey, PA, 17033, USA.
| | - Debarati Bhanja
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA
- Penn State College of Medicine, 700 HMC Crescent Rd, Hershey, PA, 17033, USA
| | | | - Casey Ryan
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA
| | - David R Hallan
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA
| | - Elias B Rizk
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA
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Rocque BG, Maddox MH, Hopson BD, Shamblin IC, Aban I, Arynchyna AA, Blount JP. Prevalence of Sleep Disordered Breathing in Children With Myelomeningocele. Neurosurgery 2021; 88:785-790. [PMID: 33370814 DOI: 10.1093/neuros/nyaa507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/26/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Retrospective studies have shown high rates of sleep disordered breathing in children with myelomeningocele. However, most patients included in those studies underwent polysomnography because of symptoms, so the prevalence of sleep disordered breathing in this population is unknown. OBJECTIVE To determine the prevalence of sleep disordered breathing in children with myelomeningocele using screening polysomnography. METHODS In this cross-sectional study, all children with myelomeningocele seen in a multi-disciplinary spina bifida clinic between 2016 and 2020 were referred for polysomnography regardless of clinical symptoms. Included children had not previously undergone polysomnography. The primary outcome for this study was presence of sleep disordered breathing, defined as Apnea-Hypopnea Index (AHI, number of apnea or hypopnea events per hour of sleep) greater than 2.5. Clinical and demographic variables relevant to myelomeningocele were also prospectively collected and tested for association with presence of sleep apnea. RESULTS A total of 117 participants underwent polysomnography (age 1 mo to 21 yr, 49% male). The majority were white, non-Hispanic. Median AHI was 1.9 (interquartile range 0.6-4.2). A total of 49 children had AHI 2.5 or greater, yielding a sleep disordered breathing prevalence of 42% (95% CI 33%-51%). In multivariable logistic regression analysis, children with more rostral neurological lesion levels had higher odds of sleep disordered breathing (OR for thoracic, mid-lumbar, and low-lumbar: 7.34, 3.70, 4.04, respectively, compared to sacral level, P = .043). CONCLUSION Over 40% of a sample of children with myelomeningocele, who underwent screening polysomnography, had significant sleep disordered breathing. Routine screening polysomnography may be indicated in this population.
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Affiliation(s)
- Brandon G Rocque
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mary Halsey Maddox
- Division of Pediatric Pulmonary and Sleep Medicine. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Betsy D Hopson
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Isaac C Shamblin
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Inmaculada Aban
- Department of Biostatistics, Department of Pediatrics, UAB School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anastasia A Arynchyna
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
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Abstract
PURPOSE Given the increasing prevalence of chronic kidney disease in people with spina bifida, we sought to determine if this is associated with an increase in end stage kidney disease. We examined population based data to measure the frequency of procedures to establish renal replacement therapy-a marker for end stage kidney disease-among patients with spina bifida. MATERIALS AND METHODS We used the Healthcare Cost and Utilization Project State Inpatient Database and State Ambulatory Surgery and Services Database from Florida, Kentucky, Maryland and New York (2000 to 2014), which include encounter level data. With a diagnosis code based algorithm we identified all procedural encounters made by patients with spina bifida. We determined the percentage of these encounters that were for facilitating renal replacement therapy (ie arteriovenous anastomosis, renal transplantation). We assessed for changes over time in this percentage with the Cochran-Armitage trend test. Bivariate analysis was performed using chi-square test. RESULTS Of all procedures performed on patients with spina bifida over this time the proportion of procedures performed to establish renal replacement therapy significantly decreased in both the inpatient and outpatient settings (p=0.042 and p <0.001, respectively). People with spina bifida undergoing procedures to establish renal replacement therapy were, on average, young adults (mean age 34.5 and 36.0 years) with a high prevalence hypertension (75.8% of inpatients, 68.6% of outpatients). CONCLUSIONS The frequency of surgeries to initiate renal replacement therapy among people with spina bifida undergoing procedures is low and is not increasing. This highlights the importance of consistent care throughout adolescence and young adulthood, and hypertension screening.
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Abstract
The incidence of prehypertension (blood pressure 120-139 and/or 80-89 mm Hg) in young adults worldwide ranges from ~37.5% to 77.1%. Identifying high-risk groups of prehypertension in young adults is helpful for early and effective interventions and treatments to reduce the occurrence of future hypertension and organ damage. This review summarized the epidemiological characteristics, disease intervention measures, and disease progression characteristics of prehypertension to provide a basis for the development of targeted intervention measures for young adults with prehypertension.
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Affiliation(s)
- Ma Jun
- Xiangya Nursing School, Central South University, Changsha, China. E-mail.
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9
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Fremion E, Kanter D, Turk M. Health promotion and preventive health care service guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2020; 13:513-523. [PMID: 33285642 PMCID: PMC7838968 DOI: 10.3233/prm-200718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Individuals with Spina Bifida (SB) have unique lifelong medical and social needs. Thus, when considering how to promote health and offer preventive care, providers must adapt general healthcare screening and counseling recommendations to their patients' physical and cognitive impairments along with discerning how to monitor secondary or chronic conditions common to the population. This article provides an update on the health promotion and preventive health care guidelines developed as part of the Spina Bifida Association's fourth edition of the Guidelines for the Care of People with Spina Bifida. The guidelines highlight accommodations needed to promote general preventive health, common secondary/chronic conditions such as obesity, metabolic syndrome, hypertension, musculoskeletal pain, and considerations for preventing acute care utilization for the SB population throughout the lifespan. Further research is needed to understand the effectiveness of preventive care interventions in promoting positive health outcomes and mitigating potentially preventable acute care utilization.
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Affiliation(s)
- Ellen Fremion
- Departments of Internal Medicine and Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - David Kanter
- Departments of Physical Medicine and Rehabilitation, Pediatrics, and Public Health and Preventive Medicine, UpstateMedical University, Syracuse, NY, USA
| | - Margaret Turk
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, Syracuse, NY, USA
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Chu DI, Balmert LC, Arkin CM, Meyer T, Rosoklija I, Li B, Hodgkins KS, Furth SL, Cheng EY, Yerkes EB, Isakova T. Estimated kidney function in children and young adults with spina bifida: A retrospective cohort study. Neurourol Urodyn 2019; 38:1907-1914. [PMID: 31286557 DOI: 10.1002/nau.24092] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/17/2019] [Indexed: 11/08/2022]
Abstract
AIMS Current estimated glomerular filtration rate (eGFR) equations may be inaccurate in patients with spina bifida (SB) because of reduced muscle mass and stature. Cross-sectional and longitudinal variability of eGFR were analyzed in these patients across multiple equations, hypothesizing greater variability in creatinine-based than cystatin-C (Cys-C)-based equations. METHODS This retrospective cohort study included children (age, 1-17.9 years) and adults (≥18 years) with SB from 2002-2017 at a large SB clinic. Those without all data needed to calculate eGFR were excluded. Four pediatric and three adult eGFR equations were compared for cross-sectional outcomes of eGFR and elevated office blood pressures using chronic kidney disease (CKD) stage classification, and for longitudinal outcome of eGFR slope over time using covariance pattern models accounting for repeated measures. RESULTS One hundred and eighty two children and 75 adults had greater than or equal to 1 set of data measurements; 118 and 52, respectively, had greater than or equal to 2 sets. The pediatric bedside Schwartz equation had the highest median eGFR and coefficient of variation. CKD stage classification by eGFR showed large differences across equations in children, with rates of eGFR < 60 and <90 ml/min/1.73 m2 ranging from 2%-9% and 5%-69%, respectively. Only one equation showed a significant inverse association between eGFR and blood pressure. Longitudinally, eGFR slopes over time were different across pediatric equations (P < .001) but not adult equations. The bedside Schwartz equation had a positive eGFR slope; the other Cys-C-containing equations had negative slopes. CONCLUSIONS Creatinine-based equations in children with SB vary considerably from cystatin-C-containing equations in calculating both single point-in-time eGFR values and eGFR trends over time.
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Affiliation(s)
- David I Chu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Lauren C Balmert
- Division of Biostatistics, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Cameron M Arkin
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Belinda Li
- Department of Urology, Loyola School of Medicine, Hines, Illinois
| | - Kavita S Hodgkins
- Division of Kidney Disease, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Susan L Furth
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Feinberg School of Medicine at Northwestern University, Chicago, Illinois.,Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
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Sivarajah K, Relph S, Sabaratnam R, Bakalis S. Spina bifida in pregnancy: A review of the evidence for preconception, antenatal, intrapartum and postpartum care. Obstet Med 2019; 12:14-21. [PMID: 30891087 PMCID: PMC6416695 DOI: 10.1177/1753495x18769221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Women with spina bifida in pregnancy require complex multi-disciplinary management. Most women have uncomplicated pregnancies; however, complications are more frequent than in 'low risk' pregnancies. Careful antenatal planning and management of the complications can optimise outcome. There are currently no guidelines on the management of pregnant women with spina bifida, but there is a growing body of evidence from case reports and series examining the antenatal and postnatal course of these women. In this review, we examine the available literature and provide a framework on the prenatal counselling, antenatal, intrapartum and postnatal management of pregnant women with spina bifida.
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Affiliation(s)
- Kenga Sivarajah
- Department of Obstetrics and Gynaecology,
The
Royal London Hospital, London, UK
| | - Sophie Relph
- Department of Obstetrics and Gynaecology,
The
Royal London Hospital, London, UK
| | - Radha Sabaratnam
- Department of Anaesthetics,
The
Royal London Hospital, London, UK
| | - Spyros Bakalis
- Department of Obstetrics, Maternal and Fetal Medicine, St
Thomas’ Hospital, London, UK
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Mukherjee S, Pasulka J. Care for Adults with Spina Bifida: Current State and Future Directions. Top Spinal Cord Inj Rehabil 2018; 23:155-167. [PMID: 29339892 DOI: 10.1310/sci2302-155] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The care for adults with spina bifida is an important area to study. As increasing numbers of patients with spina bifida survive into adulthood, they expect to thrive and receive the best possible care into adulthood to maintain their health. Understanding the health needs in this emerging and changing population will help clinicians provide the best anticipatory care for adults with spina bifida and continue to improve outcomes. This will also impact pediatric care by improving the ability to determine preventive methods from early on and understand the impacts of pediatric care and decisions over the lifespan.
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Affiliation(s)
- Shubhra Mukherjee
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Chicago, Illinois
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13
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Renal Outcomes in Children with Operated Spina Bifida in Uganda. Int J Nephrol 2018; 2018:6278616. [PMID: 30174953 PMCID: PMC6106852 DOI: 10.1155/2018/6278616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/25/2018] [Indexed: 01/23/2023] Open
Abstract
Background To describe the extent of renal disease in Ugandan children surviving at least ten years after spina bifida repair and to investigate risk factors for renal deterioration in this cohort. Patients and Methods Children who had undergone spina bifida repair at CURE Children's Hospital of Uganda between 2000 and 2004 were invited to attend interview, physical examination, renal tract ultrasound, and a blood test (creatinine). Medical records were retrospectively reviewed. The following were considered evidence of renal damage: elevated creatinine, hypertension, and ultrasound findings of hydronephrosis, scarring, and discrepancy in renal size >1cm. Female sex, previous UTI, neurological level, mobility, detrusor leak point pressure, and adherence with clean intermittent catheterisation (CIC) were investigated for association with evidence of renal damage. Results 65 of 68 children aged 10-14 completed the assessment. The majority (83%) reported incontinence. 17 children (26%) were performing CIC. One child had elevated creatinine. 25 children (38%) were hypertensive. There was a high prevalence of ultrasound abnormalities: hydronephrosis in 10 children (15%), scarring in 42 (64%), and >1cm size discrepancy in 28 (43%). No children with lesions at S1 or below had hydronephrosis (p = 0.025), but this group had comparable prevalence of renal size discrepancy, scarring, and hypertension to those children with higher lesions. Conclusions Incontinence, ultrasound abnormalities, and hypertension are highly prevalent in a cohort of Ugandan children with spina bifida, including those with low neurological lesions. These findings support the early and universal initiation of CIC with anticholinergic therapy in a low-income setting.
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Renal scarring on DMSA scan is associated with hypertension and decreased estimated glomerular filtration rate in spina bifida patients in the age of transition to adulthood. J Pediatr Urol 2018; 14:317.e1-317.e5. [PMID: 30262238 DOI: 10.1016/j.jpurol.2018.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/25/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Improved management for spina bifida (SB) has increased the number of patients transitioning to adult care. This trend increases the importance of maintaining renal function concurrently with bladder function in patients with SB. Dimercaptosuccinic acid (DMSA) renal scanning is an optimal tool for investigating renal insufficiency in children with SB; however, the benefits of DMSA scans in adulthood are unclear. The role of DMSA renal scans for patients with SB during the transition to adulthood (15-25 years of age) to reveal their association with current renal function was investigated. MATERIALS AND METHODS DMSA renal scanning was routinely performed patients with SB aged 15-25 years concurrently with examination of serum creatinine, serum cystatin C, urinalysis, and blood pressure between January 2006 and August 2016. Hypertension was defined as systolic or diastolic pressure above the age-specific normal range. The estimated glomerular filtration rate (eGFR) using serum creatinine or cystatin C was calculated; decreased eGFR was defined as eGFR below 90 mL/min/1.73 m2. Patients were divided into two groups according to the absence or presence of renal scarring on DMSA scan. Factors associated with renal function, including hypertension, decreased eGFR, and proteinuria, were compared between groups. RESULTS Eighty-seven patients (36 males and 51 females) were analyzed. Median age was 19 years (range 15-24 years); 28 patients (32%) had renal scarring. Patients with renal scarring had significantly higher rates of hypertension (n = 13, 46%) and decreased eGFR (n = 5, 18%). However, there was no difference in proteinuria between the groups (Table). The group with renal scarring had significantly lower eGFR. DISCUSSION This study showed that DMSA scans in patients with SB aged between 15 and 25 years were useful for assessing renal scarring despite a history of febrile urinary tract infection. DMSA scans could be performed in all patients with SB in the transition to adulthood to detect renal scarring. This study also showed that renal scarring was associated with hypertension and decreased eGFR in this age group. Treatment with antihypertensive drugs should be considered for patients with SB with renal scarring in this age range to protect renal function. CONCLUSION Spina bifida patients in the age of transition to adulthood with renal scarring already showed signs of chronic kidney disease, suggesting that DMSA renal scans could be useful to identify patients who require close monitoring of renal function.
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Crytzer TM, Keramati M, Anthony SJ, Cheng YT, Robertson RJ, Dicianno BE. Exercise Prescription Using a Group-Normalized Rating of Perceived Exertion in Adolescents and Adults With Spina Bifida. PM R 2018; 10:738-747. [PMID: 29408563 DOI: 10.1016/j.pmrj.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 01/12/2018] [Accepted: 01/20/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND People with spina bifida (SB) face personal and environmental barriers to exercise that contribute to physical inactivity, obesity, risk of cardiovascular disease, and poor aerobic fitness. The WHEEL rating of perceived exertion (RPE) Scale was validated in people with SB to monitor exercise intensity. However, the psycho-physiological link between RPE and ventilatory breakpoint (Vpt), the group-normalized perceptual response, has not been determined and would provide a starting point for aerobic exercise in this cohort. OBJECTIVES The primary objectives were to determine the group-normalized RPE equivalent to Vpt based on WHEEL and Borg Scale ratings and to develop a regression model to predict Borg Scale (conditional metric) from WHEEL Scale (criterion metric). The secondary objective was to create a table of interchangeable values between WHEEL and Borg Scale RPE for people with SB performing a load incremental stress test. DESIGN Cross-sectional observational. SETTING University laboratory. PARTICIPANTS Twenty-nine participants with SB. METHODS Participants completed a load incremented arm ergometer exercise stress test. WHEEL and Borg Scale ratings were recorded the last 15 seconds of each 1-minute test phase. OUTCOME MEASURES WHEEL and Borg Scale ratings, metabolic measures (eg, oxygen consumption, carbon dioxide production). Determined Vpt via plots of oxygen consumption and carbon dioxide production against time. RESULTS Nineteen of 29 participants achieved Vpt (Group A). The mean ± standard deviation peak oxygen consumption at Vpt for Group A was 61.76 ± 16.26. The WHEEL and Borg Scale RPE at Vpt were 5.74 ± 2.58 (range 0-10) and 13.95 ± 3.50 (range 6-19), respectively. A significant linear regression model was developed (Borg Scale rating = 1.22 × WHEEL Scale rating + 7.14) and used to create a WHEEL-to-Borg Scale RPE conversion table. CONCLUSION A significant linear regression model and table of interchangeable values was developed for participants with SB. The group-normalized RPE (WHEEL, 5.74; Borg, 13.95) can be used to prescribe and self-regulate arm ergometer exercise intensity approximating the Vpt. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Theresa M Crytzer
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Mariam Keramati
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Steven J Anthony
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Yu-Ting Cheng
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Robert J Robertson
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Brad E Dicianno
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
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16
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Crytzer TM, Cheng YT, Bryner MJ, Wilson Iii R, Sciurba FC, Dicianno BE. Impact of neurological level and spinal curvature on pulmonary function in adults with spina bifida. J Pediatr Rehabil Med 2018; 11:243-254. [PMID: 30741703 DOI: 10.3233/prm-179451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To describe pulmonary function and determine the impact of neurological level, scoliosis, and obesity on pulmonary function in people with spina bifida (SB). METHODS Participants with SB (N= 29) (15 females; age, 30 ± 12 years) completed spirometry and body plethysmographic lung volume testing. Univariate and multivariate regression analyses were used to describe the factors associated with pulmonary function in people with SB. RESULTS Distribution of category of impairment in pulmonary function was: 55% (n= 16) restricted, 6.9% (n= 2) spirometric restricted, 1 combined obstructed and restricted, and 35.5% (n= 10) normal. In univariate analyses, neurological level was negatively associated with pulmonary function parameters, i.e., forced vital capacity (FVC) (p= 0.005), forced expiratory volume in 1 second (FEV1) (p= 0.008), total lung capacity (TLC) (p= 0.001), and degree of scoliosis were inversely associated with FVC (p= 0.005), FEV1 (p= 0.003), and TLC (p= 0.004). In multivariate models, level of lesion and degree of scoliosis independently contributed to the degree of lung function impairment. Restrictive pulmonary function was observed in 9/10 (90%) of those with thoracic neurological levels and was associated with decreased inspiratory capacity (IC) and expiratory reserve volume (ERV). Lumbar level lesions were associated with either normal lung function or an isolated reduction in FVC due to reduction in only ERV and preserved TLC representing spirometric restriction. CONCLUSIONS High prevalence of restrictive pulmonary physiology is present in people with SB, with more rostral neurological levels and greater degree of scoliosis associated with a higher degree of pulmonary function impairment.
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Affiliation(s)
- Theresa M Crytzer
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yu-Ting Cheng
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Jo Bryner
- Division of Pulmonary, Allergy, and Critical Care Medicine, Emphysema COPD Research Center, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Wilson Iii
- Division of Pulmonary, Allergy, and Critical Care Medicine, Emphysema COPD Research Center, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy, and Critical Care Medicine, Emphysema COPD Research Center, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Brad E Dicianno
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Adult Spina Bifida Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
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17
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Fremion E, Morrison-Jacobus M, Castillo J, Castillo H, Ostermaier K. A chronic care model for spina bifida transition. J Pediatr Rehabil Med 2017; 10:243-247. [PMID: 29125512 DOI: 10.3233/prm-170451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Providing comprehensive transition care for adolescents and young adults with spina bifida (AYASB) requires a structured approach to addressing chronic condition management, self-management, care coordination, and health care navigation that is adaptable to the various levels of cognitive ability, physical function, and family/community environments within the population. This commentary (1) highlights AYASB transition program needs identified in the literature and within a local community, (2) analyzes advantages and limitations of published AYASB transition care models in addressing these needs, (3) demonstrates how a spina bifida (SB) transition clinic used the Chronic Care Model (CCM) to develop a comprehensive AYASB transition program, and (4) examines the potential feasibility in adapting this model to other SB clinics. A SB-specific transition clinic based on the CCM model facilitates the complex chronic care management and transition planning for AYASB. Further study is needed to evaluate health care outcomes using the CCM for SB transition.
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Affiliation(s)
- Ellen Fremion
- Center for Transition Medicine, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital Spina Bifida Transition Clinic, Houston, TX, USA
| | | | - Jonathan Castillo
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Heidi Castillo
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Kathryn Ostermaier
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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18
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Trinh A, Wong P, Sakthivel A, Fahey MC, Hennel S, Brown J, Strauss BJ, Ebeling PR, Fuller PJ, Milat F. Fat-Bone Interactions in Adults With Spina Bifida. J Endocr Soc 2017; 1:1301-1311. [PMID: 29264455 PMCID: PMC5686646 DOI: 10.1210/js.2017-00258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/15/2017] [Indexed: 12/13/2022] Open
Abstract
Context: Spina bifida (SB) can lead to changes in body composition and bone mineral density (BMD) through diminished ambulation, renal impairment, and anticonvulsant medication. With increased life expectancy, diseases such as obesity and osteoporosis are emerging comorbidities in SB, with limited data to guide management. Objective: To examine the relationship between cardiometabolic factors, body composition, BMD, and minimal trauma fractures (MTFs) in adults with SB. Design: Retrospective cross-sectional study. Setting and Participants: Forty-nine adults with SB (median age, 32.7 years; interquartile range, 22.6 to 39.0) who had undergone dual-energy x-ray absorptiometry imaging at a single tertiary hospital from 2004 to 2015. Results: The mean body mass index was 31.7 ± 7.5 kg/m2; 26 (53.1%) were obese. Using age- and sex-matched fat percentiles from the National Health and Nutrition Examination Survey III, 62.5% had a total body percentage fat greater than the 95th percentile. Low bone mass (defined as a Z-score of ≤−2.0) was present in 21.9% at the L1 vertebra and in 35.1% at the femoral neck. Ten (20.4%) had a history of MTFs. A BMD or Z-score at L1, femoral neck, or total body site did not correlate with the occurrence of MTF. Fat mass was significantly and positively associated with BMD after adjustment for age, sex, and height and accounted for 18.6% of the variance in BMD (P = 0.005). The prevalence of metabolic comorbidities, such as hypertension (20.4%) and obstructive sleep apnea (16.3%), was high. Conclusions: Obesity and low BMD are common in young adults with SB. An increased fat mass correlated significantly with BMD. The prevalence of metabolic complications in patients with SB is increased and deserves further study.
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Affiliation(s)
- Anne Trinh
- Department of Endocrinology, Monash Health, Melbourne, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Melbourne, Victoria 3168, Australia.,Department of Medicine, Monash University, Melbourne, Victoria 3168, Australia
| | - Phillip Wong
- Department of Endocrinology, Monash Health, Melbourne, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Melbourne, Victoria 3168, Australia.,Department of Medicine, Monash University, Melbourne, Victoria 3168, Australia
| | - Anuradha Sakthivel
- Department of General Medicine and Endocrinology, Eastern Health, Melbourne, Victoria 3168, Australia
| | - Michael C Fahey
- Hudson Institute of Medical Research, Clayton, Melbourne, Victoria 3168, Australia.,Department of Paediatrics, Monash Health, Melbourne, Victoria 3168, Australia
| | - Sabine Hennel
- Department of Paediatrics, Monash Health, Melbourne, Victoria 3168, Australia
| | - Justin Brown
- Department of Paediatrics, Monash Health, Melbourne, Victoria 3168, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia
| | - Boyd J Strauss
- Department of Medicine, Monash University, Melbourne, Victoria 3168, Australia
| | - Peter R Ebeling
- Department of Endocrinology, Monash Health, Melbourne, Victoria 3168, Australia.,Department of Medicine, Monash University, Melbourne, Victoria 3168, Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Melbourne, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Melbourne, Victoria 3168, Australia.,Department of Medicine, Monash University, Melbourne, Victoria 3168, Australia
| | - Frances Milat
- Department of Endocrinology, Monash Health, Melbourne, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Melbourne, Victoria 3168, Australia.,Department of Medicine, Monash University, Melbourne, Victoria 3168, Australia
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19
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Dicianno BE, Kinback N, Bellin MH, Chaikind L, Buhari AM, Holmbeck GN, Zabel TA, Donlan RM, Collins DM. Depressive symptoms in adults with spina bifida. Rehabil Psychol 2015; 60:246-53. [PMID: 26147238 DOI: 10.1037/rep0000044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To examine the prevalence of depressive symptoms in adults with spina bifida and identify contributing factors for depressive symptomatology. METHOD Retrospective Cohort Study. Data collection was conducted at a regional adult spina bifida clinic. A total of 190 charts from adult patients with spina bifida were included. The main outcome measures were the Beck Depression Inventory-II (BDI-II) and the mobility domain of the Craig Handicap Assessment Reporting Technique-Short Form (CHART-SF). RESULTS Of the 190 participants, 49 (25.8%) had BDI-II scores (14+) indicative of depressive symptomatology. Sixty-nine (36.3%) were on antidepressants to treat depressive symptoms, and 31 (63.3%) of those with clinical symptoms of depression were on antidepressants. Participants with a history of depressive symptoms may be as high as 45.7% if both participants with BDI-II scores 14+ and those with antidepressant use specifically for the purposes of depression treatment are combined. In this population, lower CHART-SF mobility score, expressing "emotional concerns" as a reason for the visit on an intake sheet, and use of antidepressant medications were significantly associated with depressive symptoms. CONCLUSIONS Depressive symptomatology appears to be common and undertreated in this cohort of adults with spina bifida, which may warrant screening for emotional concerns in routine clinic appointments. Significant depressive symptoms are associated with fewer hours out of bed and fewer days leaving the house. Additional research is needed to assess the impact of interventions directed toward mobility on depression and in the treatment of depression in this patient population.
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Affiliation(s)
| | | | | | | | | | | | - T Andrew Zabel
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | | | - Diane M Collins
- Department of Occupational Therapy, University of Texas Medical Branch
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20
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Mann JR, Royer JA, Turk MA, McDermott S, Holland MM, Ozturk OD, Hardin JW, Thibadeau JK. Inpatient and emergency room visits for adolescents and young adults with spina bifida living in South Carolina. PM R 2015; 7:499-511. [PMID: 25511690 PMCID: PMC4469995 DOI: 10.1016/j.pmrj.2014.11.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/20/2014] [Accepted: 11/29/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare emergency room (ER) and inpatient hospital (IP) use rates for persons with spina bifida (SB) to peers without SB, when transition from pediatric to adult health care is likely to occur; and to analyze those ER and IP rates by age, race, socioeconomic status, gender, and type of residential area. DESIGN A retrospective cohort study. SETTING Secondary data analysis in South Carolina. PARTICIPANTS We studied individuals who were between 15 and 24 years old and enrolled in the State Health Plan (SHP) or state Medicaid during the 2000-2010 study period. METHODS Individuals with SB were identified using ICD-9 billing codes (741.0, 741.9) in SHP, Medicaid, and hospital uniform billing (UB) data. ER and IP encounters were identified using UB data. Multivariable Generalized Estimating Equation (GEE) Poisson models were estimated to compare rates of ER and IP use among the SB group to the comparison group. MAIN OUTCOME MEASURES Total ER rate and IP rate, in addition to cause-specific rates for ambulatory care sensitive conditions (ACSC) and other condition categories. RESULTS We found higher rates of ER and IP use in persons with SB compared to the control group. Among individuals with SB, young adults (those 20-24 years old) had higher rates of ER use due to all ACSC (P = .023), other ACSC (P = .04), and urinary tract infections (UTI; P = .002) compared to adolescents (those 15-19 years old). CONCLUSIONS Young adulthood is associated with increased ER use overall, as well as in specific condition categories (most notably UTI) in individuals 15-24 years old with SB. This association may be indicative of changing healthcare access as people with SB move from adolescent to adult health care, and/or physiologic changes during the age range studied.
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Affiliation(s)
- Joshua R Mann
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, 3209 Colonial Drive, Columbia, SC 29203(∗).
| | - Julie A Royer
- South Carolina Revenue and Fiscal Affairs Office, Columbia, SC(†)
| | - Margaret A Turk
- Department of Physical Medicine and Rehabilitation, State University of New York Upstate Medical University, Columbia, SC(‡)
| | - Suzanne McDermott
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC(§)
| | - Margaret M Holland
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC(‖)
| | - Orgul D Ozturk
- Department of Economics University of South Carolina Darla Moore School of Business, Columbia, SC(¶)
| | - James W Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC(#)
| | - Judy K Thibadeau
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA(∗∗)
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21
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Crytzer TM, Dicianno BE, Robertson RJ, Cheng YT. Validity of a Wheelchair Perceived Exertion Scale (Wheel Scale) for Arm Ergometry Exercise in People with Spina Bifida. Percept Mot Skills 2015; 120:304-22. [DOI: 10.2466/15.08.pms.120v12x8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study assessed the concurrent and construct validity of the Borg 6–20 Scale and WHEEL Scale during arm ergometry exercise stress testing in ( n = 24) adolescents and adults with spina bifida. Significant, moderate, positive correlations were observed between power output and relative heart rate and power output to relative VO2peak. Further, a moderate, significant correlation between physiologic criterion variables and the rating of perceived exertion derived from the Borg Scale and the WHEEL Scale was found. Concurrent validity was supported by the following findings: (1) relative heart rate was significantly correlated with the Borg (Kendall's τ = .41) and WHEEL Scales (τ = .44), and relative VO2 was significantly correlated with the Borg (τ = .46) and WHEEL Scales (τ = .47); (2) content validity was supported by the finding that the Borg and WHEEL Scales shared significant variance (τ = .70), demonstrating internal consistency. The WHEEL Scale shows strong potential for use in this cohort subsequent to further testing and validation.
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Affiliation(s)
- T. M. Crytzer
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, School of Health and Rehabilitation Sciences, Department of Rehabilitation Science and Technology, University of Pittsburgh, Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - B. E. Dicianno
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Adult Outpatient Spina Bifida Clinic, UPMC Mercy Hospital, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
| | - R. J. Robertson
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh
| | - Yu-Ting Cheng
- School of Physical Therapy, Chung Shan Medical University
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22
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Apkon SD, Grady R, Hart S, Lee A, McNalley T, Niswander L, Petersen J, Remley S, Rotenstein D, Shurtleff H, Warner M, Walker WO. Advances in the care of children with spina bifida. Adv Pediatr 2014; 61:33-74. [PMID: 25037124 DOI: 10.1016/j.yapd.2014.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Susan D Apkon
- Rehabilitation Medicine, University of Washington, Seattle, WA, USA; Rehabilitation Medicine, Seattle Children's Hospital, 4800 Sand Point Way Northeast, M/S OB-8414, Seattle, WA 98105, USA.
| | - Richard Grady
- Section of Pediatric Urology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Solveig Hart
- Rehabilitation Services, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Amy Lee
- Pediatric Neurosurgery, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way Northeast, M/S W7729, PO Box 5371, Seattle, WA 98105, USA
| | - Thomas McNalley
- Rehabilitation Medicine, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way Northeast, M/S OB-8404, Seattle, WA 98105, USA
| | - Lee Niswander
- Department of Pediatrics, Children's Hospital Colorado, Howard Hughes Medical Institute, University of Colorado School of Medicine, Mail Stop 8133, Building RC1 South, Room L18-12106, 12801 East 17th Avenue, Aurora, CO 80045, USA
| | - Juliette Petersen
- Molecular Biology Program, University of Colorado Denver Anschutz Medical Campus, Mail Stop 8133, Building RC1 South, L18-12400D, 12801 East 17th Avenue, Aurora, CO 80045, USA
| | - Sheridan Remley
- Rehabilitation Services, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Deborah Rotenstein
- Pediatric Endocrinology, Endocrine Division, Pediatric Alliance, 1789 South Braddock Avenue, Suite 294, Pittsburgh, PA 15218, USA
| | - Hillary Shurtleff
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA; Department of Child Psychiatry, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Molly Warner
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA; Neuropsychology Consult Service, Department of Psychiatry, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - William O Walker
- Division of Developmental Medicine, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way Northeast, M/S OC.9.940, Seattle, WA 98105, USA
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23
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Advances in spina bifida care: from the womb to adulthood. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0046-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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