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Giles ML, Ball GDC, Bonder R, Buchholz A, Gorter JW, Morrison KM, Perez A, Walker M, McPherson AC. Exploring the complexities of weight management care for children with spina bifida: a qualitative study with children and parents. Disabil Rehabil 2024; 46:3440-3448. [PMID: 37665663 DOI: 10.1080/09638288.2023.2251878] [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: 04/04/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE 1) To explore how children with spina bifida (SB) and their parents understand bodyweight, health and weight management; and 2) To identify what services and supports children with SB and their families feel are most appropriate to help them manage their health and weight. METHODS The study used interpretive description within a qualitative design. Participants were children with SB (aged 10-18) attending two Canadian SB clinics and their parents. Data were collected through individual interviews and analyzed using inductive thematic analysis. RESULTS Five children and five parents participated in the study. Children and parents had a weight-centric approach to health, which was related to the child's mobility. Weight was considered to be under individual control and mostly through diet. Trusting relationships between healthcare providers, children and families were important to discuss weight in a non-judgemental manner. Children should be involved in setting meaningful and achievable weight management goals. CONCLUSION Greater knowledge of how children with SB and their families understand weight and health offers opportunities for non-judgemental discussions about their needs and wishes. Helping families to place more value on health over weight may reduce feelings of stigma, while allowing children to develop some autonomy over health-related decisions.
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Affiliation(s)
- Madison L Giles
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Revi Bonder
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Annick Buchholz
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Jan Willem Gorter
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands. Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- CanChild, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Katherine M Morrison
- Centre for Metabolism, Obesity and Diabetes Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Arnaldo Perez
- Educational Research & Scholarship Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Meaghan Walker
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Amy C McPherson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Mtutu RS, Alriksson-Schmidt AI, Jarl J. Oral contraceptive use in women with spina bifida in Sweden. Disabil Health J 2024; 17:101627. [PMID: 38637232 DOI: 10.1016/j.dhjo.2024.101627] [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: 11/22/2023] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Thanks to improved medical care, individuals with spina bifida (SB) live well into adulthood and go through the process of reproductive maturation and the development of sexual desires. However, access to reproductive counselling and contraceptive use has been reported to be lower for women with physical and intellectual disabilities compared to the general population. OBJECTIVE We investigated oral contraceptive use in women with SB, residing in Sweden and how use varies based on the level of lesion and demographic factors. METHODS This was a population-based case-control study using annual data from national registers from 2006 to 2015. The sample consisted of 7045 women aged 15-49 years, of which 1173 had a diagnosis of SB. χ2 tests and logistic regression were used to investigate the study objective. RESULTS The rate of oral contraceptive use in women with SB was 24.6 % compared to 34.5 % among the general population. After adjusting for potential confounders women with SB were found to have a lower probability of using oral contraceptives (OR 0.63 95 % CI 0.56-0.71) compared to women without SB. Among women with SB, those with diagnoses Q05.8 (Sacral SB without hydrocephalus) and Q05.9 (SB unspecified) had a higher likelihood of using oral contraceptives compared to other Q05 diagnoses. CONCLUSION Women with SB had a lower likelihood of being on oral contraceptives compared to the control group. Further research should investigate if the lower use indicates that oral contraceptives are not an inappropriate method of contraception for women with SB.
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Affiliation(s)
- R Samu Mtutu
- Department of Health Sciences, Lund University, Lund, Sweden.
| | | | - Johan Jarl
- Department of Clinical Sciences Malmö, Health Economics Unit, Lund University, Malmö, Sweden
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Clark OE, Smith ZR, Hilderbrand T, Holmbeck GN. Growth of condition-related knowledge among youth with spina bifida: associations with neurocognitive functioning and self-management skills. J Pediatr Psychol 2024; 49:449-458. [PMID: 38216130 PMCID: PMC11258814 DOI: 10.1093/jpepsy/jsad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/28/2023] [Accepted: 12/21/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE This study aims to characterize the growth in condition-related knowledge in youth with spina bifida (SB), identify neurocognitive predictors of growth, and examine associations between growth in knowledge and subsequent levels of medical self-management skills. METHODS Participants were recruited from a larger longitudinal study involving 140 youth with SB and caregivers, who completed questionnaires and interviews every 2 years over 8 years. The current study included the youth report of condition-related knowledge and medical self-management skills. Youth attention and executive functioning were assessed via parent and teacher reports and performance-based assessment. Latent growth curves were conducted in Mplus Version 8 (Múthen, L. K., & Múthen, B. O. [1998]. Mplus User's Guide. [Eighth]. Muthén & Muthén) to examine change over time in youth-reported condition-related knowledge. Neurocognitive variables were included as predictors of growth in knowledge and regression analyses were used to predict medical self-management skills from growth in condition-related knowledge. RESULTS Youth condition-related knowledge increased linearly. Better youth performance on working memory and attention performance-based tasks predicted a higher intercept for condition-related knowledge at T1, but not slope. Teacher and parent reports of inattention and executive dysfunction were not consistent predictors of intercept and growth. Slope of condition-related knowledge was not predictive of subsequent youth self-management skills. CONCLUSIONS Youth with SB gain condition-related knowledge over time. However, executive dysfunction and inattention may impede gains in condition-related knowledge. Thus, executive functioning supports, attention-related interventions, and psychoeducation may support condition-related knowledge gains and later medical self-management skills, but further research assessing family and cultural factors is needed.
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Affiliation(s)
- Olivia E Clark
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Zoe R Smith
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
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Yang SH, Ji Y, Lee YS, Bae E, Park J, Yun H, Szymanski KM, Park CG, Kim SW, Choi EK. Translation and validation of the Korean version of the QUAlity of Life Assessment in Spina bifida for Teenagers (QUALAS-T-K). Disabil Rehabil 2024; 46:3156-3163. [PMID: 37528767 DOI: 10.1080/09638288.2023.2241820] [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: 01/29/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE The Quality of Life Assessment in Spina bifida for Teenagers (QUALAS-T) is a tool used to evaluate health-related quality of life (HRQOL) in adolescents with spina bifida (SB). The purpose of this study was to translate the QUALAS-T into Korean and validate its Korean version (QUALAS-T-K). METHODS Translation and validation processes were carried out in accordance with a specified protocol, including forward and back translation, a content validity study, and a main study. The tool's reliability was evaluated based on its internal consistency and stability. Factor analysis was conducted, and convergent validity was confirmed using the KIDSCREEN-27. RESULTS Of the 59 participants, 35 had lipomyelomeningoceles. Confirmatory factor analysis confirmed that QUALAS-T-K had the same structure as QUALAS-T. The QUALAS-T-K showed excellent internal consistency (α: 0.872-0.893, ω: 0.875-0.885), test-retest reliability (ICC:0.84-0.92), and weak to strong correlations with the KIDSCREEN-27. CONCLUSIONS The QUALAS-T-K, developed by reflecting on the characteristics of SB and considering the applicability of Korean cultural characteristics and clinical practice, is a convenient and reliable tool with excellent internal consistency and stability. This could be a useful tool in clinical and research settings for HRQOL evaluation of adolescents with SB.
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Affiliation(s)
- Seung Hyeon Yang
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
- Department of Nursing, Yonsei University Graduate School, Seoul, South Korea
| | - Yoonhye Ji
- Department of Nursing, Yonsei University Graduate School, Seoul, South Korea
- Department of Pediatric Urology, Bladder-Urethra Rehabilitation Clinic, Severance Children's Hospital, Yonsei University Healthcare System, Seoul, South Korea
| | - Yong Seung Lee
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Eunjeong Bae
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
- Department of Nursing, Yonsei University Graduate School, Seoul, South Korea
| | - Jieun Park
- Department of Pediatric Urology, Bladder-Urethra Rehabilitation Clinic, Severance Children's Hospital, Yonsei University Healthcare System, Seoul, South Korea
- Graduate School of Nursing, Yonsei University, Seoul, South Korea
| | - Hyeseon Yun
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
- Department of Nursing, Yonsei University Graduate School, Seoul, South Korea
| | - Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Chang Gi Park
- Department of Population Health Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Sang Woon Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Kyoung Choi
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
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Öhrvall AM, Hofgren C, Lindquist B, Bergqvist L, Himmelmann K, Opheim A, Sjöwall D, Brock K, Peny-Dahlstrand M. Intervention with the CO-OP Approach leads to a transfer effect over time to untrained goals for children with cerebral palsy or spina bifida. Disabil Rehabil 2024; 46:2512-2521. [PMID: 37353883 DOI: 10.1080/09638288.2023.2225875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 06/09/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE This study aims to investigate whether the treatment effects, in terms of goal attainment, transfer effects and impact on executive functions, of an intervention in children with cerebral palsy or spina bifida using the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach are maintained over time, from immediately after the intervention to three months afterwards. METHOD A three-month follow-up study, from an intervention using CO-OP. Thirty-four children (7-16 years) each identified four goals (one untrained to examine transfer) and participated in an eleven-session intervention. Assessments were performed at baseline, immediately after the intervention and at a three-month follow-up using the Canadian Occupational Performance Measure and the Performance Quality Rating Scale. Executive function and self-rated competence were assessed at the same timepoints. RESULTS Statistically significant and clinically relevant improvements in goal achievement were demonstrated for both trained and untrained goals after the intervention and were maintained at follow-up. The clinically relevant improvement in untrained goals continued to increase until follow-up. Self-rated competence increased after the intervention and was maintained at follow-up. CONCLUSION The CO-OP intervention was effective in achieving and maintaining the children's own goals over time. The transfer effect was confirmed by higher goal attainment for the untrained goals.
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Affiliation(s)
- Ann-Marie Öhrvall
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Caisa Hofgren
- Region Västra Götaland, Habilitation & Health, Gothenburg, Sweden
- Department of Rehabilitation Medicine, Institute of Neuroscience and Physiology Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Barbro Lindquist
- Department of Habilitation, Halmstad County Hospital, Halmstad, Sweden
| | - Lena Bergqvist
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Occupational Therapy Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kate Himmelmann
- Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Regional Rehabilitation Centre, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Arve Opheim
- Region Västra Götaland, Habilitation & Health, Gothenburg, Sweden
| | - Douglas Sjöwall
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Karolinska Institutet, Stockholm, Sweden
- Habilitation and Health, Region Stockholm, Sweden
| | - Katarina Brock
- The Sachsska, Children's and Adolescents' clinic, assessment team Nacka, Sweden
| | - Marie Peny-Dahlstrand
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Occupational Therapy Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Regional Rehabilitation Centre, Gothenburg, Sweden
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Dellenmark-Blom M, Andersson M, Szymanski KM, Andréasson CL, Vu Minh Arnell M, Sjöström S, Abrahamsson K. Linguistic, Content and Face Validity of the Swedish Version of a Quality-of-Life Assessment for Children, Teenagers and Adults with Spina Bifida. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:624. [PMID: 38791838 PMCID: PMC11121182 DOI: 10.3390/ijerph21050624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/04/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
Spina bifida includes a spectrum of different neural tube defects. Myelomeningocele is the most serious type and is associated with a risk of paralysis and sensory dysfunction below the affected level, bladder/bowel dysfunction, brain dysmorphology, and impaired health-related quality of life (HRQoL). The aim of this study was to describe the establishment of linguistic, content and face validity of the Swedish version of a Quality-of-Life Assessment for children (QUALAS-C, n = 10 items), teenagers (QUALAS-T, n = 10 items) and adults with spina bifida (QUALAS-A, n = 15 items) based on the original US English versions. The process included close collaboration with the original instrument developer and complied with international standards on patient-reported outcome measurements. The procedure includes forward translation, expert and patient/parent review and reconciliation, back translation, back translation review and cognitive debriefing interviews with 16 people with spina bifida aged 8 to 33, providing them with the possibility of evaluating the clarity, adequacy, and comprehensiveness of QUALAS-C, QUALAS-T and QUALAS-A, respectively. The interviews lasted a median of 15 min (range 8-16) for QUALAS-C, 10 min (range 9-15) for QUALAS-T and 24 min (range 9-38) for QUALAS-A. Four main issues/topics needed attention and discussion after both the forward and back translation. Following the back translation review, all issues were resolved. The patient feedback revealed recognition of the HRQoL issues included in QUALAS, and also difficulties in understanding some questions. After the patients' evaluation, four items were reworded for clarity. No study participant reported a wish to add to or remove questions from QUALAS. Hence, the Swedish versions of QUALAS became conceptually equivalent to the original US English versions and achieved linguistic, content and face validity. While empowering the voices of people with spina bifida, these results also enable their HRQoL to be properly assessed in research and clinical care in Sweden and in international studies.
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Affiliation(s)
- Michaela Dellenmark-Blom
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, 416 85 Gothenburg, Sweden; (M.A.); (M.V.M.A.); or (S.S.); or (K.A.)
- Department of Pediatric Surgery, Sahlgrenska University Hospital, Queen Silvia Children’s Hospital, 416 85 Gothenburg, Sweden;
| | - Marie Andersson
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, 416 85 Gothenburg, Sweden; (M.A.); (M.V.M.A.); or (S.S.); or (K.A.)
- Department of Pediatric Surgery, Sahlgrenska University Hospital, Queen Silvia Children’s Hospital, 416 85 Gothenburg, Sweden;
| | - Konrad M. Szymanski
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University Health, Indianapolis, IN 46202, USA;
| | - Charlotta Levén Andréasson
- Department of Pediatric Surgery, Sahlgrenska University Hospital, Queen Silvia Children’s Hospital, 416 85 Gothenburg, Sweden;
| | - Magdalena Vu Minh Arnell
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, 416 85 Gothenburg, Sweden; (M.A.); (M.V.M.A.); or (S.S.); or (K.A.)
- Department of Pediatric Surgery, Sahlgrenska University Hospital, Queen Silvia Children’s Hospital, 416 85 Gothenburg, Sweden;
| | - Sofia Sjöström
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, 416 85 Gothenburg, Sweden; (M.A.); (M.V.M.A.); or (S.S.); or (K.A.)
- Department of Pediatric Surgery, Sahlgrenska University Hospital, Queen Silvia Children’s Hospital, 416 85 Gothenburg, Sweden;
| | - Kate Abrahamsson
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, 416 85 Gothenburg, Sweden; (M.A.); (M.V.M.A.); or (S.S.); or (K.A.)
- Department of Pediatric Surgery, Sahlgrenska University Hospital, Queen Silvia Children’s Hospital, 416 85 Gothenburg, Sweden;
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Hwang CK, Harris KT, Wood D. Barriers to Transitional Care in Spina Bifida. Urol Clin North Am 2024; 51:187-196. [PMID: 38609191 DOI: 10.1016/j.ucl.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
The health care needs children with spina bifida evolve over their lifetime; continued, regular contact with appropraitely trained, multidisciplinary providers is crucial to a patient's health and quality of life. Substantial research has been conducted to improve the transition process starting at an early age; however, there continue to be strong barriers to successful transition. This article reviews key aspects of the care of patients with spina bifida, the impact of inadequate transition to adult care, barriers to transition, and offers a potential vision for the future.
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Affiliation(s)
- Catalina K Hwang
- Division of Urology, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Aurora, CO 80045, USA
| | - Kelly T Harris
- Division of Urology, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Aurora, CO 80045, USA
| | - Dan Wood
- Division of Urology, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Aurora, CO 80045, USA.
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Roth JD, Miller MA, O'Neil JO, Wiener JS, Wood HM. Transitioning young adults with spina bifida: Challenges and paths to success. J Pediatr Urol 2024; 20:200-210. [PMID: 37788943 DOI: 10.1016/j.jpurol.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION AND BACKGROUND Recent medical advances, including closure of myelomeningocele defects, shunting of hydrocephalus, and focusing on renal preservation have led to many individuals with spina bifida (SB) living into adulthood. This has led to more individuals with SB transitioning their care from pediatric-based to adult-based care models. OBJECTIVE We seek to explore the process of transition, with a focus on difficulties in transitioning individuals with SB. Additionally, we explore new problems that arise during the period of transition related to sexual function and dysfunction. We also discuss some of the difficulties managing neurogenic bladder and the sequalae of their prior urologic surgeries. STUDY DESIGN Each of the authors was asked to provide a summary, based on current literature, to highlight the challenges faced in their area of expertise. CONCLUSIONS Transitioning care for individuals with SB is especially challenging due to associated neurocognitive deficits and neuropsychological functioning issues. Sexual function is an important component of transition that must be addressed in young adults with SB. Management of neurogenic bladder in adults with SB can be challenging due to the heterogeneity of the population and the sequelae of their prior urologic surgeries. The aim is to ensure that all individuals with SB receive appropriate, evidence-based care throughout their lifetime.
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Affiliation(s)
- Joshua D Roth
- Department of Urology, Riley Hospital for Children, Indiana University School of Medicine, United States.
| | - Matthew A Miller
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, United States
| | - Joseph O O'Neil
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, United States
| | - John S Wiener
- Division of Urology, Duke University School of Medicine, United States
| | - Hadley M Wood
- Department of Urology, Cleveland Clinic, United States
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Koch VH, Lopes M, Furusawa E, Vaz K, Barroso U. Multidisciplinary management of people with spina bifida across the lifespan. Pediatr Nephrol 2024; 39:681-697. [PMID: 37501019 DOI: 10.1007/s00467-023-06067-w] [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: 03/09/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023]
Abstract
The average worldwide prevalence of neural tube defects (NTDs) is 1.0 per 1000 births. Its development is multifactorial due to genetic and non-genetic factors. Spina bifida (SB) is one of main representatives of NTD. The spinal cord lesion level is the main determinant of the level of paralysis, numbness, and difficulties with bladder/bowel functions. Myelomeningocele prenatal repair reduces hydrocephalus and hindbrain herniation and improves motor function. The severity of hydrocephalus is associated with poorer neurodevelopmental outcomes whether operated on prenatally or after birth. People with SB tend to have a lower IQ and cognitive difficulties. Early diagnosis, proactivity, and lifelong multidisciplinary follow-up are key protective issues. Invasive urological interventions should be considered in selected patients after failure of conservative treatment. Transition to adult care should be well planned as it is challenging. Health literacy is directly associated with success at transition. Sexuality and fertility should be addressed before/during puberty. Overall, the rates of fecal and urinary continence and skin breakdown increase with age, whereas the ability to ambulate declines with age. Bowel and urinary incontinence are independent predictors of lower health-related quality of life (HRQoL) in adults with SB. Bowel incontinence has negative impact on HRQoL regardless of frequency or amount. Long-term caregiver support should be offered at diagnosis. Survival at a mean of 50 years is poor, at 32%, due to central nervous system deaths, cancer, urological disease, and sepsis. Challenges to implementation of recommended practices exist, especially in low and middle-income countries.
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Affiliation(s)
- Vera H Koch
- Pediatric Nephrology Unit, Department of Pediatrics, University of São Paulo Medical School, Children's Hospital, Hospital das Clinicas, Sau Paulo, Brazil.
| | - MarcosTomasin Lopes
- Pediatric Nephrology Unit, Department of Pediatrics, University of São Paulo Medical School, Children's Hospital, Hospital das Clinicas, Sau Paulo, Brazil
| | - Erika Furusawa
- Pediatric Nephrology Unit, Department of Pediatrics, University of São Paulo Medical School, Children's Hospital, Hospital das Clinicas, Sau Paulo, Brazil
| | - Katharinne Vaz
- Division of Urology, Federal University of Bahia - UFBA, Salvador, BA, Brazil
| | - Ubirajara Barroso
- Division of Urology - Federal University of Bahia, Bahiana School of Medicine, Salvador, BA, Brazil
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Ji H, Payette K, Speckert A, Tuura R, Grehten P, Kottke R, Ochseinbein-Kölble N, Hagmann C, Mazzone L, Meuli M, Padden B, Hackenberg A, Wille DA, Moehrlen U, Latal B, SPINA BIFIDA STUDY GROUP ZURICH, Jakab A. Thalamic connectivity topography in newborns with spina bifida: association with neurological functional level but not developmental outcome at 2 years. Cereb Cortex 2024; 34:bhad438. [PMID: 37991274 PMCID: PMC10793566 DOI: 10.1093/cercor/bhad438] [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: 07/20/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023] Open
Abstract
Spina bifida affects spinal cord and cerebral development, leading to motor and cognitive delay. We investigated whether there are associations between thalamocortical connectivity topography, neurological function, and developmental outcomes in open spina bifida. Diffusion tensor MRI was used to assess thalamocortical connectivity in 44 newborns with open spina bifida who underwent prenatal surgical repair. We quantified the volume of clusters formed based on the strongest probabilistic connectivity to the frontal, parietal, and temporal cortex. Developmental outcomes were assessed using the Bayley III Scales, while the functional level of the lesion was assessed by neurological examination at 2 years of age. Higher functional level was associated with smaller thalamo-parietal, while lower functional level was associated with smaller thalamo-temporal connectivity clusters (Bonferroni-corrected P < 0.05). Lower functional levels were associated with weaker thalamic temporal connectivity, particularly in the ventrolateral and ventral anterior nuclei. No associations were found between thalamocortical connectivity and developmental outcomes. Our findings suggest that altered thalamocortical circuitry development in open spina bifida may contribute to impaired lower extremity function, impacting motor function and independent ambulation. We hypothesize that the neurologic function might not merely be caused by the spinal cord lesion, but further impacted by the disruption of cerebral neuronal circuitry.
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Affiliation(s)
- Hui Ji
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Kelly Payette
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Anna Speckert
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University Research Priority Program (URPP), Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zurich, Zurich 8006, Switzerland
| | - Ruth Tuura
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Patrice Grehten
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Raimund Kottke
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Nicole Ochseinbein-Kölble
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Department of Obstetrics, University Hospital of Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
| | - Cornelia Hagmann
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Neonatology, University Children's Hospital Zurich, Zurich 8032, Switzerland
| | - Luca Mazzone
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich 8032, Switzerland
| | - Martin Meuli
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
| | - Beth Padden
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Division of Pediatric Rehabilitation, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Annette Hackenberg
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
- Department of Pediatric Neurology, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - David-Alexander Wille
- Department of Pediatric Neurology, Cantonal Hospital of Baden, Baden 5404, Switzerland
| | - Ueli Moehrlen
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich 8032, Switzerland
| | - Beatrice Latal
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University Research Priority Program (URPP), Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zurich, Zurich 8006, Switzerland
- University of Zurich, Zurich 8006, Switzerland
- Child Development Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | | | - Andras Jakab
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- University Research Priority Program (URPP), Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zurich, Zurich 8006, Switzerland
- University of Zurich, Zurich 8006, Switzerland
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11
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Bertapelli F, Baptista CRDJAD, Mattiello-Sverzut AC. Height and body mass index distribution in children and adolescents with and without spina bifida. J Pediatr (Rio J) 2024; 100:46-52. [PMID: 37524313 PMCID: PMC10751691 DOI: 10.1016/j.jped.2023.07.002] [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: 05/10/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE Children with spina bifida (SB) are at risk for stunting and overweight. However, height and Body Mass Index (BMI) z-score distribution in children and adolescents with SB are unclear. The aim of this study was to examine height and BMI z-score distribution in Brazilian children and adolescents with and without SB. This study further aimed to examine whether height and BMI z-scores differ between individuals with and without SB. METHOD This study included 101 participants (SB: n = 18; non-SB: n = 83, aged 7-16 years). The World Health Organization (WHO) AnthroPlus software was used to calculate height and BMI z-scores. AnthroPlus z-score distribution graphs were used to examine individual z-scores based on the 2007 WHO normal distribution curve. Effects of the group (SB vs non-SB) on height and BMI z-scores were examined with sequential regression. RESULTS In the WHO distribution graph analysis, height z-scores of participants with SB were slightly left-shifted compared to the WHO normal distribution curve. In the regression analysis, group (SB vs non-SB) was a significant predictor of height z-scores after controlling for sex and age (ΔR2 = 0.064, p = 0.010). BMI z-scores of participants with SB were right-shifted compared to the WHO normal curve. However, there was no contribution of the group to BMI z-scores (ΔR2 = 0.011, p = 0.301). CONCLUSIONS These findings suggest that Brazilian children and adolescents with SB may be at risk for reduced height and increased BMI.
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Affiliation(s)
- Fabio Bertapelli
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Ciências da Saúde, Ribeirão Preto, SP, Brazil
| | | | - Ana Claudia Mattiello-Sverzut
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Ciências da Saúde, Ribeirão Preto, SP, Brazil.
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12
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Gunnett M, Rocque BG, Nourani A, Beltran-Ale G. Impact of Spina Bifida on Sleep Quality: Current Insights. Nat Sci Sleep 2023; 15:967-978. [PMID: 38034043 PMCID: PMC10685378 DOI: 10.2147/nss.s401269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
Spina bifida (SB) is one of the most common birth defects in children. The care for patients with SB continues to evolve, and there has been notable improvement in survival outcomes, degree of disability and quality of life for these children. However, patients with SB continue to remain at higher risk for sleep-related breathing disorders (SRBD), unexplained sudden death, and potential alterations in their sleep chronotype. Previous studies report on abnormalities in the spinal cord, brainstem function, and dysfunction of upper airway maintenance as the likely mechanisms behind SRBD that is commonly seen in SB. Most studies looking at prevalence of SRBD in SB have been retrospective studies. A recent prospective study identified a prevalence as high as 42% when a polysomnography (PSG) was completed on all patients regardless of symptomatology. Treatment options vary depending on the type and severity of SRBD and can range widely. Despite advances in care for patients with SB and SRBD, a subset of these patients with myelomeningocele (MMC) continue to experience sudden unexplained death. Studies continue to evaluate ways to stratify which of these patients may be at higher risk of this devastating outcome. Given that SRBD is potentially treatable, early assessment and intervention could become an integral part of a multidisciplinary treatment strategy to optimize long-term medical and neurodevelopmental outcomes for this patient population. By understanding the impact that SB may have on a patient's sleep quality, their biological chronotype and their potential of developing SRBD, a provider may help to optimize the care a patient with SB receives from birth into adulthood.
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Affiliation(s)
- Mohini Gunnett
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Brandon G Rocque
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Anis Nourani
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Guillermo Beltran-Ale
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
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13
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Yang SH, Ji Y, Lee YS, Kim SW, Bae E, Park J, Yun H, Szymanski KM, Choi EK. Cross-cultural adaptation and validation of the Korean modified version of the QUAlity of Life Assessment in Spina bifida for Young Adults (QAULAS-YA-Km). Disabil Rehabil 2023; 45:3359-3365. [PMID: 36073860 DOI: 10.1080/09638288.2022.2118378] [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: 01/27/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The QUAlity of Life Assessment in Spina bifida (QUALAS) for adults (QUALAS-A) evaluates the health-related quality of life (HRQOL), reflecting the condition specificity of adults with spina bifida (SB). The study's purpose was to translate and cross-culturally adapt the QUALAS-A into Korean and validate a Korean-modified version of the QUALAS for Young Adults (QUALAS-YA-Km). METHOD Face and content validity were evaluated in the pilot study. Internal consistency and test-retest reliability were confirmed in the main study. Factor analysis was performed, and convergent and divergent validity was verified using the World Health Organization Quality of Life assessment instrument abbreviated version (WHOQOL-BREF). RESULTS Forty-seven adults had myelomeningocele. Five items with low communality were deleted through the factor analysis, and the domains were renamed. The QUALAS-YA-Km showed good internal consistency (Cronbach's alpha 0.73-0.83) and excellent test-retest reliability (intraclass correlation coefficient 0.84-0.89). The QUALAS-YA-Km showed good convergent and divergent validity, with weak to strong correlations with the WHOQOL-BREF. CONCLUSIONS Developed with consideration of Korea's cultural characteristics, the QUALAS-YA-Km is a convenient and reliable instrument, with good internal consistency, stability, and construct validity. This can be a useful tool in clinical and research settings for HRQOL optimization in young adults with SB.Implications for RehabilitationOptimizing health-related quality of life (HRQOL) is one of the goals of people with spina bifida (SB), which requires HRQOL measurements that reflect the condition specificity of SBThe QUAlity of Life Assessment of Spina bifida for Adults (QUALAS-A) is a self-reported HRQOL questionnaire for adults with SB developed in the United States, which is used in research and clinical practiceThe present study revealed that the Korean modified version of the QUAlity of Life Assessment of Spina bifida for Young Adults (QUALAS-YA-Km), developed in consideration of the cultural characteristics of Korea, is a valid, convenient, and reliable toolThe QUALAS-YA-Km, is a useful tool that can be used in clinical and research settings for HRQOL optimization in adults with SB.
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Affiliation(s)
- Seung Hyeon Yang
- Department of Nursing, Yonsei University Graduate School, Seoul, South Korea
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Yoonhye Ji
- Department of Nursing, Yonsei University Graduate School, Seoul, South Korea
- Bladder-Urethra Rehabilitation Clinic, Department of Pediatric Urology, Severance Children's Hospital, Yonsei University Healthcare System, Seoul, South Korea
| | - Yong Seung Lee
- Department of Urology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Woon Kim
- Department of Urology, Yonsei University College of Medicine, Seoul, South Korea
| | - Eunjeong Bae
- Department of Nursing, Yonsei University Graduate School, Seoul, South Korea
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Jieun Park
- Bladder-Urethra Rehabilitation Clinic, Department of Pediatric Urology, Severance Children's Hospital, Yonsei University Healthcare System, Seoul, South Korea
- Graduate School of Nursing, Yonsei University, Seoul, South Korea
| | - Hyeseon Yun
- Department of Nursing, Yonsei University Graduate School, Seoul, South Korea
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Eun Kyoung Choi
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
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14
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Bent MA, Padilla AN, Wimmer SP, Lopez K, Beltran V, Wren TA. Feasibility of temperature monitoring smart socks in adolescents and young adults with spina bifida. J Pediatr Rehabil Med 2023; 16:649-655. [PMID: 38143398 PMCID: PMC10789320 DOI: 10.3233/prm-230030] [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: 06/22/2023] [Accepted: 11/15/2023] [Indexed: 12/26/2023] Open
Abstract
PURPOSE The purpose of the study was to determine if the use of continuous temperature monitoring smart socks is feasible in adolescents with spina bifida (SB) by obtaining user feedback on comfort. METHODS Participants were provided temperature monitoring socks and a 4 G hub. Follow-up phone calls were performed to answer questions or discuss barriers. Sock temperatures were monitored throughout four weeks. Following sock wear, participants were asked to complete a satisfaction survey. RESULTS Seventeen of the 33 participants enrolled (eight males, nine females) with a mean age of 14.8 years completed the study. Average sock wear was 8.0 hours per day for four weeks. The mean temperature was 83.4°F with a mean temperature differential between feet of -0.74°F (left-right). The duration of sock wear varied from 14.6 to 595.9 hours over the four-week period. Lastly, eleven participants (84.6%) reported that the socks were comfortable and very easy to put on. CONCLUSION Continuous temperature monitoring smart socks are an option for monitoring risk for developing pressure injuries in adolescents with SB. Future directions would include increasing sample size, obtaining normative data for temperature ranges in this population, and correlating to clinical outcomes.
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Affiliation(s)
- Melissa A. Bent
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Abigail N. Padilla
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Sam P. Wimmer
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Kelleen Lopez
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Veronica Beltran
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Tishya A.L. Wren
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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