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Mrakotsky C, Walsh KS, Buranahirun Burns C, Croteau SE, Markert A, Geybels M, Hannemann C, Rajpurkar M, Shapiro KA, Wilkening GN, Ventola P, Cooper DL. The eTHINK Study: Cognitive and Behavioral Outcomes in Children with Hemophilia. J Pediatr 2024; 272:114089. [PMID: 38734133 DOI: 10.1016/j.jpeds.2024.114089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/12/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE To assess cognitive, behavioral, and adaptive functions in children and young adults with hemophilia treated according to contemporary standards of care. STUDY DESIGN Evolving Treatment of Hemophilia's Impact on Neurodevelopment, Intelligence, and Other Cognitive Functions (eTHINK) is a US-based, prospective, cross-sectional, observational study (September 2018 through October 2019). Males (aged 1-21 years) with hemophilia A or B of any severity, with or without inhibitors, were eligible. Participants underwent neurologic examinations and age-appropriate neuropsychological assessments, including standardized tests/ratings scales of early development, cognition, emotional/behavioral adjustment, and adaptive skills. RESULTS Five hundred and fifty-one males with hemophilia A (n = 433) or B (n = 101) were enrolled. Performance on cognitive tests was largely comparable with that of age-matched US population norms, although participants in certain age groups (4-5 and 10-21 years) performed worse on measures of attention and processing speed. Furthermore, adolescents and young adults and those with comorbid attention-deficit/hyperactivity disorder (ADHD; n = 64) reported more adaptive and executive function problems in daily life. Incidence of ADHD in adolescents (21%) was higher than expected in the general population. CONCLUSIONS In general, males with hemophilia demonstrated age-appropriate intellectual, behavioral, and adaptive development. However, specific patient/age groups showed poorer attention performance and concerns for executive and adaptive development. This study established a normative data set for monitoring neurodevelopment in individuals with hemophilia and highlight the importance of screening and intervention for challenges with cognitive and adaptive skills in this population. CLINICAL TRIAL REGISTRATION Evolving Treatment of Hemophilia's Impact on Neurodevelopment, Intelligence, and Other Cognitive Functions (eTHINK); NCT03660774; https://clinicaltrials.gov/ct2/show/NCT03660774.
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Affiliation(s)
| | - Karin S Walsh
- Children's National Hospital and The George Washington University School of Medicine, Washington, DC
| | - Cathy Buranahirun Burns
- Keck School of Medicine, University of Southern California/Children's Hospital Los Angeles, Los Angeles, CA
| | - Stacy E Croteau
- Boston Children's Hospital/Harvard Medical School, Boston, MA
| | - Anja Markert
- Novo Nordisk Health Care AG, Zurich, Switzerland
| | | | - Cara Hannemann
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN
| | - Madhvi Rajpurkar
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan/Wayne State University, Detroit, MI
| | | | - Greta N Wilkening
- University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO
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Asad F, Jahangarad S, Dorgalaleh A. Psychological complications among patients with congenital bleeding disorders. Blood Coagul Fibrinolysis 2023; 34:138-143. [PMID: 36719804 DOI: 10.1097/mbc.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Congenital bleeding disorders (CBDs), including inherited platelet function disorders and rare and common bleeding disorders, are a heterogeneous group of bleeding disorders with a wide range of clinical presentations, including psychological complications. Due to the chronic nature of CBDs, psychological complications are relatively common in these patients, which can affect treatment adherence, quality of life, and even the frequency of bleeding episodes. Chronic pain causes many psychological problems in CBDs, disrupting their social interactions, affecting all aspects of their lives, including their emotional functioning and behavior, and eventually leading to social exclusion. About one-third of patients with severe hemophilia A suffer from anxiety, 64% from depression, and 60% from other minor psychological complications such as withdrawal/depression, anxiety/depression, attention problems, and emotional problems. Anxiety, depression, and uncontrolled pain interfere with treatment adherence. For this reason, psychological interventions are needed in people with CBDs. Psychological interventions increase quality of life and treatment adherence. Therefore, early recognition of psychological complications in CBD patients may increase treatment adherence, leading to a reduction in bleeding episodes and thus an improvement in quality of life.
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Affiliation(s)
- Fatemeh Asad
- Department of Psychology, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, Iran
| | - Sara Jahangarad
- Department of Psychology, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, Iran
| | - Akbar Dorgalaleh
- Hematology and Blood Transfusion, Hamin Tis Research Institute, Tehran, Iran
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Boggs JE, Pullen A, Molnar AE, Hodges J, Reiss UM. Screening for inattention, hyperactivity and impulsivity in children with haemophilia: A quality improvement intervention. Haemophilia 2023; 29:210-218. [PMID: 36112768 DOI: 10.1111/hae.14656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/20/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Children with haemophilia have been reported with increased rates of inattention (IN) and hyperactivity/impulsivity (HI) and, therefore, are particularly vulnerable to poor social and academic outcomes. AIM To examine the benefit of utilizing a formal screening process for IN/HI in children with haemophilia during comprehensive clinic visits using a quality improvement approach. METHODS At a single haemophilia treatment centre, screening for psychosocial issues was expanded and formalised to include (1) the Conners 3rd Edition (Conners3) screening tool for IN/HI symptoms administered during the standard psychosocial assessment (SPA) by the social worker and school advocacy coordinator, (2) formal pathways to diagnosis and intervention as indicated including psychology consultation, psychological testing, or referral to community-based mental health professionals, and in-person advocacy assistance in the patient's community school. RESULTS Forty-four patients, age 9.9 ± 4.8 years (range 3-16) were targeted. The initial screening approach was modified to improve the communication with caretakers during assessments and streamline diagnostic pathways if no, moderate or significant behavioural concerns were identified. Eleven patients had pre-existing mental health diagnoses. Thirteen of the remaining 33 patients (39.4%) received a new mental health diagnosis, ADHD in 8/33 (24.2%). Of the total cohort, 54.5% were found to have a mental health diagnosis. The rate of ADHD (29.5%) was significantly higher than reported in the general population. CONCLUSION The described process, developed through a QI approach, allowed formal and objective screening for IN/HI, streamlined a pathway to diagnosis and intervention, and identified undiagnosed disabilities in children with haemophilia improving their access to services.
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Affiliation(s)
- Jacklyn E Boggs
- Department of Hematology, St. Jude Children's Research, Hospital, Memphis, Tennessee, USA
| | - Amanda Pullen
- Department of Social Work, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew E Molnar
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason Hodges
- Department of Hematology, St. Jude Children's Research, Hospital, Memphis, Tennessee, USA
| | - Ulrike M Reiss
- Department of Hematology, St. Jude Children's Research, Hospital, Memphis, Tennessee, USA
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Whitaker S, Aiston H, Hung WT, Pink R, Mangles S. Haemophilia Carriers Experience Study (CARES): A mixed method exploration into the experience of women who are carriers of Haemophilia. Haemophilia 2021; 27:848-853. [PMID: 34146374 DOI: 10.1111/hae.14360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/22/2021] [Accepted: 06/01/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Haemophilia research has traditionally focused on patients diagnosed with haemophilia and although research priorities are rapidly changing, there is still a lot more we need to understand about the experiences and psychosocial issues facing women who are diagnosed as carriers of haemophilia (Haemophilia, https://doi.org/10.1111/hae.14043). One study noted that the understanding of carriers' experience of bleeding by healthcare professionals is limited and that many women have had negative experiences of healthcare (Haemophilia, 17, 2011, 237). The carrier population does not typically receive much support for themselves as individuals as they are often not registered at Haemophilia Centres in their own right. AIM This study aimed to look at the emotional wellbeing of carriers in more detail. METHOD This was initially investigated through the use of focus groups and individual interviews with 16 participants (Stage 1) and then widening the study using an online questionnaire battery developed from the themes identified from these interviews (Stage 2). The questionnaire battery was completed by 226 participants. RESULTS Descriptive statistics are reported on the endorsement of themes identified in Stage 1 and around participants' experiences of their carriership and healthcare. Results demonstrated that the participants have had a number of difficulties with accessing helpful information and support during key times in their lives, for example, at diagnosis and when deciding whether to start a family. They also showed that although participants endorsing a higher number of bleeding symptoms scored statistically significantly higher in measures of depression, anxiety and negative affect, this difference was not clinically significant. CONCLUSION These results lend support to the growing evidence base that women who are carriers of haemophilia have a distinct set of (currently unmet) needs that need assessing and treating.
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Affiliation(s)
- Sarah Whitaker
- Haemophilia Department, Southern Haemophilia Network, Uplands House, Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, UK
| | - Helen Aiston
- Department of Psychological Medicine, Clinical Health Psychology, Princess Anne Hospital, Southampton, UK
| | | | - Ruth Pink
- NHS Greater Glasgow & Clyde, Research & Innovation, Dykebar Hospital, Paisley, UK
| | - Sarah Mangles
- Haemophilia Department, Southern Haemophilia Network, Uplands House, Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, UK
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Al-Huniti A, Hernandez MR, Eyck PT, Staber JM. Mental health disorders in haemophilia: Systematic literature review and meta-analysis. Haemophilia 2020; 26:431-442. [PMID: 32307801 PMCID: PMC8475067 DOI: 10.1111/hae.13960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/11/2020] [Accepted: 02/24/2020] [Indexed: 12/28/2022]
Abstract
AIM Despite significant advances in morbidity and mortality outcomes, quality of life for people with haemophilia (PWH) remains compromised. Underrecognized and undertreated mental health disorders decrease quality of life; however, reports are inconsistent regarding the true prevalence of mental health disorders in PWH. METHODS We conducted a systematic literature search of Ovid MEDLINE, EMBASE, Psychinfo and the Cochrane Library, and hand searched the journal Haemophilia to identify records and subsequently conducted a meta-analysis to determine the prevalence of depression, anxiety and attention deficit hyperactivity disorder (ADHD) in patients with congenital haemophilia. RESULTS Our search strategy identified 2315 records, and 28 studies met eligibility criteria. Meta-analysis demonstrated that PWH are at increased risk of depression (odds ratio (OR) 2.45; 95% confidence interval (CI) 1.64-3.68), anxiety (OR 1.74, 95% CI 1.01-3.00), anxiety/depression (OR 2.60, 95% CI 2.35-2.87) and ADHD (OR 3.48, 95% CI 1.74-6.96). We found considerable heterogeneity among the studies likely due to differences in assessment tools, populations studied and year of publication. This suggests that standardized tools to diagnose mental health disorders in PWH are needed. Additionally, high-quality studies investigating mental health disorders in PWH are necessary to adequately document the prevalence of these disorders. CONCLUSION Overall, our meta-analysis suggests that the prevalence of depression, anxiety and ADHD across decades is significantly increased in PWH compared to the general population.
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Affiliation(s)
- Ahmad Al-Huniti
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Melanie Reyes Hernandez
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA
| | - Janice M. Staber
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA
- Pappajohn Biomedical Institute, University of Iowa, Iowa City, IA
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Towner S, Berger ZE, Titman P, New HV, Theodore K, Brown G, Sibson KR. Fatigue, executive function and psychological effects in children with immune thrombocytopenia: a cross-sectional study. Br J Haematol 2020; 189:534-542. [PMID: 31978938 DOI: 10.1111/bjh.16387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/17/2019] [Indexed: 01/19/2023]
Abstract
Childhood ITP is often considered to be a relatively mild haematological disorder, with only a minority of patients requiring treatment for troublesome bleeding. Over recent years, wider effects of the condition have been identified in some adults, particularly relating to fatigue and cognitive impairment. In this study, we sought to investigate such effects in a group of children with ITP and further our understanding of their psychological profile. Children attending routine haematology outpatient clinics and their parents were asked to complete standardised questionnaires designed to assess a range of psychological and cognitive factors. Although the majority of children had some scores within the normal range, a significantly high proportion had difficulties with fatigue (70·6%), emotional and behavioural symptoms (25·7%) or executive functioning (19·4%). Quality of life and subjective evaluation of the illness (appraisal) correlated significantly with each of these domains, but bleeding severity and platelet count did not. Our findings provide valuable insight into the broader impact of childhood ITP, which could aid in providing holistic care, potentially contribute to decisions regarding medical treatment, and guide future research.
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Affiliation(s)
- Sarah Towner
- Department of Clinical Psychology, Royal Holloway, University of London, Egham, UK
| | - Zoe E Berger
- Psychological Services, Great Ormond Street Hospital, London, UK
| | - Penny Titman
- Psychological Services, Great Ormond Street Hospital, London, UK
| | - Helen V New
- Department of Paediatrics, Imperial College Healthcare NHS Trust, NHS Blood and Transplant, London, UK
| | - Kate Theodore
- Department of Clinical Psychology, Royal Holloway, University of London, Egham, UK
| | - Gary Brown
- Department of Clinical Psychology, Royal Holloway, University of London, Egham, UK
| | - Keith R Sibson
- Haematology Department, Great Ormond Street Hospital, London, UK
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Buranahirun C, Walsh KS, Mrakotsky C, Croteau SE, Rajpurkar M, Kearney S, Hannemann C, Wilkening GN, Shapiro KA, Cooper DL. Neuropsychological function in children with hemophilia: A review of the Hemophilia Growth and Development Study and introduction of the current eTHINK study. Pediatr Blood Cancer 2020; 67:e28004. [PMID: 31595670 DOI: 10.1002/pbc.28004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 11/12/2022]
Abstract
Almost all of what is known about neurologic and cognitive development in hemophilia derives from the Hemophilia Growth and Development Study, conducted during an era when treatment regimens and comorbidities differed significantly from the current environment. Results suggested hemophilia and human immunodeficiency virus had independent effects, and hemophilia negatively impacts academic achievement, attention, and behavior. The introduction of prophylaxis treatment in hemophilia has created the need for re-evaluation of the effects of hemophilia on neurodevelopment and cognition. We outline the Evolving Treatment of Hemophilia's Impact on Neurodevelopment, Intelligence, and Other Cognitive Functions (NCT03660774) study, which aims to meet this need.
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Affiliation(s)
- Cathy Buranahirun
- Keck School of Medicine, University of Southern California/Children's Hospital Los Angeles, Los Angeles, California
| | - Karin S Walsh
- Children's National Health System, Washington, District of Columbia
| | - Christine Mrakotsky
- Division of Hematology-Oncology, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Stacy E Croteau
- Division of Hematology-Oncology, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Madhvi Rajpurkar
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan
| | | | - Cara Hannemann
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana
| | - Greta N Wilkening
- Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado
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Factor VIII: Long-established role in haemophilia A and emerging evidence beyond haemostasis. Blood Rev 2019; 35:43-50. [DOI: 10.1016/j.blre.2019.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/01/2019] [Accepted: 03/01/2019] [Indexed: 12/20/2022]
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