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Madkhali MA, Abusageah F, Hakami F, Zogel B, Hakami KM, Alfaifi S, Alhazmi E, Zaalah S, Trabi S, Alhazmi AH, Mohrag M, Malhan H. Adherence to Hydroxyurea and Patients' Perceptions of Sickle Cell Disease and Hydroxyurea: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:124. [PMID: 38256385 PMCID: PMC10819561 DOI: 10.3390/medicina60010124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Hydroxyurea is a crucial treatment for sickle cell disease (SCD), but some patients' adherence to it remains suboptimal. Understanding patients' perspectives on SCD and HU is essential for improving adherence. This study aimed to assess hydroxyurea adherence and patients' perceptions of SCD and hydroxyurea among SCD patients in the Jazan region of Saudi Arabia. Materials and Methods: This cross-sectional study collected data from 217 SCD patients using self-administered questionnaires from August 2022 to January 2023. The survey covered patient demographics, SCD consequences, and other clinical data. We used the Brief Illness Perception Questionnaire (B-IPQ) to measure patients' disease perception and the 8-item Morisky Medication Adherence Scale (MMAS-8) to evaluate patients' adherence to HU. Data were analysed using descriptive, t-test, and chi-square tests, and the p-value was set at <0.05 for significance. Results: More than half of the patients were male, with a mean age of 28.09 ± 8.40 years. About 57.6% of the patients were currently using HU. About 81.6% of HU users reported low adherence. The adherence was lower among individuals with infections/recurrent infections and in patients who received repeated blood transfusions. ICU admission, blood transfusion, and certain SCD complications were associated with HU use. Male patients had a higher perception of SCD consequences, concern, and understanding. ICU-admitted and recurrent hospitalized patients had a higher perception of the SCD-related consequences, symptoms, concerns, and emotional responses. Conclusions: HU seems a well-established and efficacious disease-modifying agent, but its underutilization for SCD patients remains challenging. To overcome the adherence challenges, healthcare providers must educate SCD patients about the role of hydroxyurea in lowering disease severity and addressing side effects to obtain maximum benefits. Healthcare providers may consider tailored educational interventions to improve adherence, particularly for patients with infections, recurrent hospitalizations, or repeated blood transfusions. Further research is needed to identify strategies for improving hydroxyurea adherence and patient education among SCD patients.
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Affiliation(s)
- Mohammed Ali Madkhali
- Department of Internal Medicine, Division of Hematology and Oncology, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Faisal Abusageah
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Faisal Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Basem Zogel
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Khalid M. Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Samar Alfaifi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Essam Alhazmi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Shaden Zaalah
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Shadi Trabi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Abdulaziz H. Alhazmi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Mostafa Mohrag
- Department of Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Hafiz Malhan
- Department of Hematology, Prince Mohammed Bin Nasser Hospital, Jazan 82943, Saudi Arabia;
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King LG, Ali SB, Chang SM, Reid ME, Soares DP. Academic performance in Jamaican children with sickle cell disease. J Natl Med Assoc 2023; 115:475-481. [PMID: 37550160 DOI: 10.1016/j.jnma.2023.07.005] [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: 03/23/2022] [Revised: 05/09/2023] [Accepted: 07/23/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE Children with sickle cell disease (SCD) are at risk for neurocognitive deficits that can affect school performance, and psychosocial functioning. The aim of this study was to assess the academic performance of school-aged children with SCD in Jamaica compared to their school peers. METHOD A cross-sectional survey of academic performance was done in a group of children 11 to 13 years of age, using a standardized state administered examination, the Grade Six Achievement Test (GSAT), covering 5 subjects. Scores were obtained from the Ministry of Education (MOE) for eligible children with SCD, as well as mean scores with standard deviation for unaffected classmates by gender. Socio-demographic and clinical data were obtained from our sickle cell clinic database and an interview administered questionnaire. RESULTS Sixty-four children satisfied eligibility criteria. Children with SCD had lower percentage scores and significantly lower mean z-scores for 4 of 5 subjects (p < 0.05). Males had significantly lower mean z-scores compared with females. Thirty-seven children (57.8%) were classified as underperformers. Haemoglobin level was a significant predictor of subject score rank. CONCLUSION Children with SCD in Jamaica perform worse in standardized school examinations than their class peers with boys being particularly vulnerable.
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Affiliation(s)
- Lesley G King
- Sickle Cell Unit, Caribbean Institute for Health Research (CAIHR), University of the West Indies, Mona, Kingston 7, Jamaica
| | - Susanna Bortolusso Ali
- Sickle Cell Unit, Caribbean Institute for Health Research (CAIHR), University of the West Indies, Mona, Kingston 7, Jamaica
| | - Susan M Chang
- Child Health Research Group, Epidemiology Research Unit, CAIHR, University of the West Indies, Mona, Kingston 7, Jamaica
| | - Marvin E Reid
- Tropical Metabolism Research Unit, CAIHR, University of the West Indies, Mona, Kingston 7, Jamaica
| | - Deanne P Soares
- Radiology Section, Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica.
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McGlynn MC, Gilliam A, Pierson SK, Hulbert ML. Education Liaison improves implementation of school accommodations for students with sickle cell disease. Pediatr Blood Cancer 2023; 70:e30602. [PMID: 37539974 DOI: 10.1002/pbc.30602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Children with sickle cell disease (SCD) have lower academic attainment than healthy peers. Many benefit from neuropsychological testing (NPT) and educational accommodations, including Individualized Education Programs (IEPs) and Section 504 plans (504s). Despite medical barriers to academic attainment, many children with SCD do not receive indicated NPT or accommodations. OBJECTIVE We hypothesize that a dedicated Education Liaison (EL) embedded in the SCD team increases implementation of NPT and accommodations. STUDY DESIGN This retrospective study included children aged 5-20 years with SCD receiving care at a single center from 2017 through 2020. Univariate analysis and multiple logistic regression were performed. RESULTS Total 316 children with SCD were included. At baseline, 52.8% had accommodations (IEP: 24.4%, 504: 38.0%). The EL interacted with 62.0% of children. Children with EL contact were more likely to undergo NPT (odds ratio [OR]: 5.385), have an IEP (OR: 4.580), and have a 504 (OR: 2.038) (p < .001 for all). At the end of the study period, 64.6% had accommodations (IEP: 33.5%, 504: 54.4%), which increased from baseline (p < .001 for all). EL interaction was associated with overt or silent stroke history (OR: 1.911), acute chest syndrome history (OR: 2.257), hospitalizations since age 5 (OR: 3.216), and hospitalization for vaso-occlusive pain since age 5 (OR: 2.226) (p < .001 for all). CONCLUSION EL interaction improves access to NPT and educational accommodations among children with SCD. SCD centers should incorporate ELs in comprehensive care teams to improve access to appropriate educational accommodations.
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Affiliation(s)
- Mary Claire McGlynn
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Aisha Gilliam
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Suzanne K Pierson
- Division of Psychology, Department of Psychiatry and Behavioral Neurosciences, St. Louis University School of Medicine, St. Louis, Missouri, USA
| | - Monica L Hulbert
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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MacEwan JP, King AA, Nguyen A, Mubayi A, Agodoa I, Smith-Whitley K. Cognition and education benefits of increased hemoglobin and blood oxygenation in children with sickle cell disease. PLoS One 2023; 18:e0289642. [PMID: 37552696 PMCID: PMC10409269 DOI: 10.1371/journal.pone.0289642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/22/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Among individuals with sickle cell disease (SCD), decreased hemoglobin is associated with lower oxygen saturation (SpO2) and increased risk of stroke, both of which are associated with lower intelligence quotient (IQ) scores. Thus, increasing hemoglobin and SpO2 in individuals with SCD may increase IQ and educational attainment. METHODS A cohort simulation model was built to determine academic performance and educational attainment based on cognitive function (measured by IQ) of a pediatric SCD cohort randomly assigned to treatment and control groups. The model contained two key stages: childhood (<10 years) and adolescence (≥10 years). In stage 1, increased hemoglobin and increased SpO2 (assigned to the treatment group) were determinants of higher IQ, prevention of IQ deterioration over time. Increased hemoglobin was also a determinant of decreased stroke risk. In stage 2, improvement in adolescent IQ as a result of treatment was a determinant of academic performance. RESULTS In a simulated cohort of 2000 children and adolescents with SCD (52.5% female, 50% treated), stroke incidence was predicted to be 44.4% lower among the treated group than the untreated group (4.5% versus 8.1%, respectively). The average IQ among the treated group was estimated to be 91.1 compared with 82.9 in the untreated group (a 9.9% difference; P<0.001). Finally, high school (≥12 years of education) completion rates were estimated to be 64.7% higher among the treated group: 76.1% of the treated group was projected to complete high school compared with 46.2% of the untreated group. CONCLUSIONS Our model predicts that an average improvement in hemoglobin of 1.1 g/dL (11 g/L) among individuals with SCD may be associated with improved neurocognition and educational outcomes. These improvements may also generate benefits not captured by our model, including improved quality of life, employment, and income.
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Affiliation(s)
| | - Allison A. King
- Division of Pediatric Hematology/Oncology, Washington University and St. Louis Children’s Hospital, St. Louis, Missouri, United States of America
| | - Andy Nguyen
- Global Blood Therapeutics, Inc., South San Francisco, California, United States of America
| | - Anuj Mubayi
- PRECISIONheor, Los Angeles, California, United States of America
| | - Irene Agodoa
- Global Blood Therapeutics, Inc., South San Francisco, California, United States of America
| | - Kim Smith-Whitley
- Global Blood Therapeutics, Inc., South San Francisco, California, United States of America
- Division of Hematology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
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Heitzer AM, Schreiber JE, Yuan X, Wang F, Pan H, Graff JC, Murphy L, Rupff R, Russell K, Wang W, Estepp JH, Hankins JS, Porter JS, Jacola LM. Working memory and school readiness in preschool children with sickle cell disease compared to demographically matched controls. Br J Haematol 2023; 200:358-366. [PMID: 36264030 PMCID: PMC9852012 DOI: 10.1111/bjh.18507] [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: 07/01/2022] [Revised: 09/07/2022] [Accepted: 09/28/2022] [Indexed: 01/22/2023]
Abstract
Children diagnosed with sickle cell disease (SCD) are at risk of the development of neurobehavioural problems early in life. Specific impairments in executive function skills, including working memory, have been documented in school-aged children with SCD. These executive skills are known to strongly contribute to early academic skills and preparedness for entering kindergarten. This study examined working memory and school readiness in preschool children with SCD compared to a healthy control group matched for race, sex and parent education. A total of 84 patients diagnosed with SCD (61.9% haemoglobin [Hb]SS/HbSβ0 -thalassaemia) and 168 controls completed testing. The mean (SD) ages of patients and controls at testing were 4.53 (0.38) and 4.44 (0.65) years respectively. The SCD group performed worse than controls on measures of executive function, working memory and school readiness (p < 0.01; Cohen's D range: 0.32-0.39). Measures of working memory were associated with school readiness after accounting for early adaptive development. Multiple linear regression models among patients diagnosed with SCD revealed that college education of the primary caregiver was positively associated with school readiness (p < 0.001) after controlling for sex, genotype, age and early adaptive development. These results highlight the need to implement school readiness interventions in young children diagnosed with SCD emphasising executive function skills.
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Affiliation(s)
- Andrew M. Heitzer
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane E. Schreiber
- Child & Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Xiaomeng Yuan
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Fang Wang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - J. Carolyn Graff
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN
| | - Laura Murphy
- Department of Psychiatry, University of Tennessee Health Science Center, Memphis, TN
| | - Rebecca Rupff
- Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - Kathryn Russell
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Winfred Wang
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jeremie H. Estepp
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jerlym S. Porter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Lisa M. Jacola
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
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Neurodevelopmental Outcomes in Preterm Children with Sickle Cell Disease. J Int Neuropsychol Soc 2022; 28:1039-1049. [PMID: 34839840 PMCID: PMC9148381 DOI: 10.1017/s1355617721001338] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To explore the combined effect of pediatric sickle cell disease (SCD) and preterm birth on cognitive functioning. METHODS Cognitive functioning was examined in children ages 6-8 with high risk SCD genotypes born preterm (n = 20) and full-term (n = 59) and lower risk SCD genotypes/no SCD born preterm (n = 11) and full-term (n = 99) using tests previously shown to be sensitive to SCD-related neurocognitive deficits. Factorial ANOVAs and log linear analyses were conducted to examine the relationship between SCD risk, preterm birth status, and cognitive outcomes. Continuous scores were examined for specific tests. Children were categorized as having an abnormal screening outcome if at least one cognitive score was ≥1.5 standard deviations below the population mean. RESULTS Children with elevated risk due to high risk SCD and preterm birth performed worse than other groups on a test of expressive language but not on tests that emphasize processing speed and working memory. There was a three-way interaction between preterm status, SCD risk, and abnormal screening outcome, which was largely driven by the increased likelihood of abnormal cognitive scores for children with high risk SCD born preterm. CONCLUSIONS The combination of SCD and preterm birth may confer increased risk for language deficits and elevated rates of abnormal cognitive screenings. This suggests that neurodevelopmental risk imparted by comorbid SCD and preterm birth may manifest as heterogenous, rather than specific, patterns of cognitive deficits. Future studies are needed to clarify the domains of cognitive functioning most susceptible to disease-related effects of comorbid SCD and preterm birth.
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Heitzer AM, Longoria J, Rampersaud E, Rashkin SR, Estepp JH, Okhomina VI, Wang WC, Raches D, Potter B, Steinberg MH, King AA, Kang G, Hankins JS. Fetal hemoglobin modulates neurocognitive performance in sickle cell anemia ✰,✰✰. Curr Res Transl Med 2022; 70:103335. [PMID: 35303690 PMCID: PMC9086114 DOI: 10.1016/j.retram.2022.103335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/20/2022] [Accepted: 01/30/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE OF THE STUDY Fetal hemoglobin (HbF) is a modifier of the clinical and hematologic phenotype of sickle cell anemia (SCA). Three quantitative trait loci (QTL) modulate HbF expression. The neurocognitive effects of variants in these QTL have yet to be explored. We evaluated the relation between 11 SNPs in the three HbF QTL: BCL11A, MYB, the HBB gene cluster, and full-scale intelligence (IQ) in SCA. PATIENTS AND METHODS The prospective longitudinal cohort study, Sickle Cell Clinical Research and Intervention Program, was used as a discovery cohort (n = 166). The genotypes for 11 SNPs were extracted through whole genome sequencing and were analyzed using an additive model. A polygenic score for HbF (PGSHbF) integrating the numbers of low HbF alleles from 11 SNPs was analyzed as a continuous variable. The Cooperative Study of Sickle Cell Disease (n = 156) and the Silent Cerebral Infarction Transfusion (n = 114) Trial were used as two independent replication cohorts. Benjamini and Hochberg approach was used to calculate false discovery rate adjusted p-value (pFDR). RESULTS HbF was positively associated with IQ (minimum raw p = 0·0018) at pFDR<0·05. HbF mediated the relationship between two BCL11A SNPs, rs1427407 and rs7606173, HBS1L-MYB: rs9494142, and PGSHbF with IQ (minimum raw p = 0·0035) at pFDR<0·05. CONCLUSION As the major modulator of the severity of SCA, HbF also influences neurocognition, which is done through mediation of its QTL. These findings have implications for early identification of neurocognitive risk and targeted intervention.
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Affiliation(s)
- Andrew M Heitzer
- Departments of Psychology, St. Jude Children's Research Hospital, Memphis, TN.
| | - Jennifer Longoria
- Departments of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Evadnie Rampersaud
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, TN
| | - Sara R Rashkin
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, TN; Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | | | | | - Winfred C Wang
- Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Darcy Raches
- Departments of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Brian Potter
- Departments of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Martin H Steinberg
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Allison A King
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, MO
| | - Guolian Kang
- Biostatistics, St. Jude Children's Research Hospital, Memphis, TN; Departments of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jane S Hankins
- Hematology, St. Jude Children's Research Hospital, Memphis, TN
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Hoyt CR, Varughese TE, Erickson J, Haffner N, Luo L, L'Hotta AJ, Yeager L, King AA. Developmental delay in infants and toddlers with sickle cell disease: a systematic review. Dev Med Child Neurol 2022; 64:168-175. [PMID: 34535892 PMCID: PMC10413179 DOI: 10.1111/dmcn.15048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 01/03/2023]
Abstract
AIM To summarize developmental delay among infants and toddlers with sickle cell disease (SCD). METHOD This systematic review included studies that reported developmental outcomes of children with SCD between 0 months and 48 months of age and followed standards set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Ten studies were included, describing 596 unique developmental assessments. The rate of developmental delay ranged from 17.5% to 50% and increased with age. Cognition was the only domain included in all studies and the most frequently identified delay. One study reported that more severe SCD genotypes predicted worse development, while five studies reported no difference in rates of developmental delay across genotypes. INTERPRETATION These findings emphasize the need for standardized screening to identify children with SCD at risk of delay at a young age to facilitate appropriate referrals for therapeutic intervention. Frequent and comprehensive developmental screening is necessary among all SCD genotypes.
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Affiliation(s)
- Catherine R Hoyt
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Taniya E Varughese
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeni Erickson
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Natalie Haffner
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Lingzi Luo
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Allison J L'Hotta
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Lauren Yeager
- Becker Medical Library, Washington University School of Medicine, St. Louis, MO, USA
| | - Allison A King
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Education, Washington University School of Medicine, St. Louis, MO, USA
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Alhazmi A, Hakami K, Abusageah F, Jaawna E, Khawaji M, Alhazmi E, Zogel B, Qahl S, Qumayri G. The Impact of Sickle Cell Disease on Academic Performance among Affected Students. CHILDREN (BASEL, SWITZERLAND) 2021; 9:children9010015. [PMID: 35053640 PMCID: PMC8773889 DOI: 10.3390/children9010015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/08/2021] [Accepted: 12/21/2021] [Indexed: 01/01/2023]
Abstract
Background: Sickle cell disease (SCD) is a genetic disease that is highly prevalent in Jazan Province, Saudi Arabia, and is mostly characterized by many complications such as vaso-occlusive crises (VOC), acute chest syndrome (ACS) and well-documented neurological complications. These complications may affect patients’ academic performance. Methods: An observational, cross-sectional, retrospective study was conducted in Jazan Province. General and demographic data were collected and questions about academic performance of students with SCD were answered. Both t-tests and chi-square tests, along with multiple logistic regression, were used for analysis. Results: 982 participants were selected for this study with a mean age of 23 years (SD: 7). Most of the participants were female (64%). The number of participants with SCD was 339 (36%), of whom 42% were male. Students with SCD recorded lower grade point averages (GPA) and more absences compared to healthy participants. Further, about 60% of students with SCD thought they performed better than 40% of the participants without SCD during the COVID-19 pandemic when most of the educational activities were online. Conclusion: As has been previously reported, this study suggested that the academic performance of students with SCD is negatively affected compared to healthy individuals, and this is mostly due to complications associated with the disease. Further, students with SCD acknowledged better performance with online education, an option that should be considered to improve their academic performance. National studies on a larger population are required by health and education officials, and supportive online educational programs are warranted to enhance the academic performance of this population.
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Affiliation(s)
- Abdulaziz Alhazmi
- Department of Microbiology and Parasitology, College of Medicine, Jazan University, Jazan 45142, Saudi Arabia
- Emerging and Epidemic Infectious Diseases Research Unit, Medical Research Center, Jazan University, Jazan 45142, Saudi Arabia
- Correspondence: ; Tel.: +966-7-3295000
| | - Khalid Hakami
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (K.H.); (F.A.); (E.J.); (M.K.); (E.A.); (B.Z.); (S.Q.); (G.Q.)
| | - Faisal Abusageah
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (K.H.); (F.A.); (E.J.); (M.K.); (E.A.); (B.Z.); (S.Q.); (G.Q.)
| | - Essa Jaawna
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (K.H.); (F.A.); (E.J.); (M.K.); (E.A.); (B.Z.); (S.Q.); (G.Q.)
| | - Meshal Khawaji
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (K.H.); (F.A.); (E.J.); (M.K.); (E.A.); (B.Z.); (S.Q.); (G.Q.)
| | - Essam Alhazmi
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (K.H.); (F.A.); (E.J.); (M.K.); (E.A.); (B.Z.); (S.Q.); (G.Q.)
| | - Basem Zogel
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (K.H.); (F.A.); (E.J.); (M.K.); (E.A.); (B.Z.); (S.Q.); (G.Q.)
| | - Salman Qahl
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (K.H.); (F.A.); (E.J.); (M.K.); (E.A.); (B.Z.); (S.Q.); (G.Q.)
| | - Ghadeer Qumayri
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (K.H.); (F.A.); (E.J.); (M.K.); (E.A.); (B.Z.); (S.Q.); (G.Q.)
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10
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Economic evaluation of regular transfusions for cerebral infarct recurrence in the Silent Cerebral Infarct Transfusion Trial. Blood Adv 2021; 5:5032-5040. [PMID: 34607344 PMCID: PMC9153054 DOI: 10.1182/bloodadvances.2021004864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/18/2021] [Indexed: 12/03/2022] Open
Abstract
Children with preexisting silent cerebral infarcts on regular transfusion therapy had 50% lower hospitalization costs than standard care. The incremental cost-effectiveness ratio for transfusion therapy to prevent infarct recurrence was $22 025 for every infarct prevented.
In 2020, the American Society of Hematology published evidence-based guidelines for cerebrovascular disease in individuals with sickle cell anemia (SCA). Although the guidelines were based on National Institutes of Health–sponsored randomized controlled trials, no cost-effectiveness analysis was completed for children with SCA and silent cerebral infarcts. We conducted a cost-effectiveness analysis comparing regular blood transfusion vs standard care using SIT (Silent Cerebral Infarct Transfusion) Trial participants. This analysis included a modified societal perspective with direct costs (hospitalization, emergency department visit, transfusion, outpatient care, and iron chelation) and indirect costs (special education). Direct medical costs were estimated from hospitalizations from SIT hospitals and unlinked aggregated hospital and outpatient costs from SIT sites by using the Pediatric Health Information System. Indirect costs were estimated from published literature. Effectiveness was prevention of infarct recurrence. An incremental cost-effectiveness ratio using a 3-year time horizon (mean SIT Trial participant follow-up) compared transfusion vs standard care. A total of 196 participants received transfusions (n = 90) or standard care (n = 106), with a mean age of 10.0 years. Annual hospitalization costs were reduced by 54% for transfusions vs standard care ($4929 vs $10 802), but transfusion group outpatient costs added $22 454 to $137 022 per year. Special education cost savings were $2634 over 3 years for every infarct prevented. Transfusion therapy had an incremental cost-effectiveness ratio of $22 025 per infarct prevented. Children with preexisting silent cerebral infarcts receiving blood transfusions had lower hospitalization costs but higher outpatient costs, primarily associated with the oral iron chelator deferasirox. Regular blood transfusion therapy is cost-effective for infarct recurrence in children with SCA. This trial is registered at www.clinicaltrials.gov as #NCT00072761.
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11
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Karkoska K. Neuroprotection: further evidence for the early and universal use of hydroxyurea in children with sickle cell disease. Br J Haematol 2021; 195:158-159. [PMID: 34340262 DOI: 10.1111/bjh.17702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Kristine Karkoska
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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12
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Miller M, Landsman R, Scott JP, Heffelfinger AK. Fostering equity in education and academic outcomes in children with sickle cell disease. Clin Neuropsychol 2021; 36:245-263. [PMID: 34218732 DOI: 10.1080/13854046.2021.1945147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Children with Sickle Cell Disease (SCD), who are predominantly Black, face academic disparities in part because of the impact of longstanding racially biased education systems. Adverse systemic factors in addition to neurologic complications put children with SCD at risk for poor academic outcomes. Providing caregivers with information on how to select quality schools and advocate for their child's specific educational needs may influence academic outcomes and reduce educational disparities. We aimed to provide information to caregivers of children with SCD on school selection/quality, enrollment, and special education options. METHODS Forty-six caregivers of children with SCD between the ages of 2 and 5:11 years participated in a structured informational session. Caregivers' sense of empowerment regarding educational options for their child was assessed via survey before and after the structured informational session. RESULTS Caregivers reported feeling more informed and empowered following their participation in an informational session on school selection/quality, enrollment, and special education options for their child than before the informational session. CONCLUSIONS It is essential that families of children with SCD have the knowledge, skills, and sense of empowerment to access quality schools beginning in early childhood. Future research will determine if this intervention will improve children's access to academic support and academic outcomes. We theorize improvements in academic outcomes along with addressing systemic disparities may ultimately create a positive impact on vocational and quality of life outcomes in the lives of children with SCD.
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Affiliation(s)
- Meghan Miller
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.,Children's Wisconsin, Milwaukee, WI, USA
| | - Rachel Landsman
- Children's Wisconsin, Milwaukee, WI, USA.,Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Paul Scott
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.,Children's Wisconsin, Milwaukee, WI, USA
| | - Amy K Heffelfinger
- Children's Wisconsin, Milwaukee, WI, USA.,Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
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13
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Connolly ME, Bills SE, Hardy SJ. Cognitive Functioning and Educational Support Plans in Youth With Sickle Cell Disease. J Pediatr Hematol Oncol 2021; 43:e666-e676. [PMID: 33625087 DOI: 10.1097/mph.0000000000002092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/31/2020] [Indexed: 11/26/2022]
Abstract
Children with sickle cell disease (SCD) face academic challenges because of direct and indirect disease-related events. This study examined the proportion of youth with SCD with educational plans and whether cognitive functioning is associated with educational support. Ninety-one youth (7 to 16 y) with SCD completed the WISC-V; caregivers reported educational support (504 Plan/Individualized Education Program) and completed the Behavior Rating Inventory of Executive Function. χ2 square and t test analyses explored whether overall intelligence (full-scale intelligence quotient [FSIQ]), relative weaknesses in processing speed and working memory (> 1SD below FSIQ), and parent-reported executive functioning were associated with educational plans. Participants with a FSIQ<90 were more likely to have support (74%) compared with youth with a FSIQ≥90 (47%; P=0.012). Those with FSIQ≥90 and FSIQ=80 to 89 were less likely to have support (47%, 58%, respectively) compared with those with FSIQ≤79 (89%; P=0.004). Relative weaknesses in processing speed were associated with educational support (83% vs. 52%, P=0.018) as well as behavioral aspects of executive functioning (Ps<0.05). Despite universal eligibility for a 504 Plan, 42% of youth with SCD in our sample did not have educational support. Significant deficits in intellectual functioning, processing speed, and parent-observed executive functioning are associated with having a plan, but children with subtle deficits seem less likely to be identified for educational support.
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Affiliation(s)
- Megan E Connolly
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, DC
| | - Sarah E Bills
- Department of Psychology, University of South Carolina, Columbia, SC
| | - Steven J Hardy
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, DC
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14
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Hardy SJ, Bills SE, Meier ER, Schatz JC, Keridan KJ, Wise S, Hardy KK. A Randomized Controlled Trial of Working Memory Training in Pediatric Sickle Cell Disease. J Pediatr Psychol 2021; 46:1001-1014. [PMID: 33824980 DOI: 10.1093/jpepsy/jsab030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Youth with sickle cell disease (SCD) are at risk for neurocognitive deficits including problems with working memory (WM), but few interventions to improve functioning exist. This study sought to determine the feasibility and efficacy of home-based, digital WM training on short-term memory and WM, behavioral outcomes, and academic fluency using a parallel group randomized controlled trial design. METHODS 47 children (7-16 years) with SCD and short-term memory or WM difficulties were randomized to Cogmed Working Memory Training at home on a tablet device (N = 24) or to a standard care Waitlist group (N = 23) that used Cogmed after the waiting period. Primary outcomes assessed in clinic included performance on verbal and nonverbal short-term memory and WM tasks. Secondary outcomes included parent-rated executive functioning and tests of math and reading fluency. RESULTS In the evaluable sample, the Cogmed group (N = 21) showed greater improvement in visual WM compared with the Waitlist group (N = 22; p = .03, d = 0.70 [CI95 = 0.08, 1.31]). When examining a combined sample of participants, those who completed ≥10 training sessions exhibited significant improvements in verbal short-term memory, visual WM, and math fluency. Adherence to Cogmed was lower than expected (M = 9.07 sessions, SD = 7.77), with 19 participants (41%) completing at least 10 sessions. Conclusions: Visual WM, an ability commonly affected by SCD, is modifiable with cognitive training. Benefits extended to verbal short-term memory and math fluency when patients completed a sufficient training dose. Additional research is needed to identify ideal candidates for training and determine whether training gains are sustainable and generalize to real-world outcomes.
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Affiliation(s)
- Steven J Hardy
- Division of Hematology, Children's National Hospital.,Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences
| | - Sarah E Bills
- Division of Hematology, Children's National Hospital
| | | | | | | | - Shane Wise
- Division of Hematology, Children's National Hospital
| | - Kristina K Hardy
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences.,Division of Neuropsychology, Children's National Hospital
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15
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Knight LM, King AA, Strouse JJ, Tanabe P. Pediatric Neurodevelopmental Delays in Children 0 to 5 Years of Age With Sickle Cell Disease: A Systematic Literature Review. J Pediatr Hematol Oncol 2021; 43:104-111. [PMID: 33560086 PMCID: PMC8254873 DOI: 10.1097/mph.0000000000002091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/28/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is the most common abnormal genetic blood disease that affects ∼100,000 Americans. Approximately 20% to 37% of children with sickle cell anemia have silent cerebral infarcts by the age of 14 years old. Neurocognitive deficits are identified in infants and preschool children with SCD. The purpose of this systematic literature review is to provide a comprehensive understanding of the prevalence, severity, and the associated risk factors for neurodevelopmental delays (NDDs) in children with SCD 5 years of age and younger. METHODS Systematic search of 6 databases identified 2467 potentially relevant publications and 8 were identified through a manual search. Only 24 articles met the inclusion criteria. RESULTS We identified an increased prevalence of NDDs (cognitive, motor, or both). Children experienced deficits with language, attention and behavior, executive functioning, school readiness and/or academic performance, and motor skills (fine and gross motor functioning). Risk factors include silent cerebral infarcts and strokes, SCD genotype (HbSS>HbSC), other biologic, and social factors. CONCLUSION NDDs are common in children ages 0 to 5 years old with SCD. There is an opportunity to improve adherence to national guideline recommendations and early detection practices by pediatricians, hematologists, and other health care providers.
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16
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Karkoska KA, Haber K, Elam M, Strong S, McGann PT. Academic Challenges and School Service Utilization in Children with Sickle Cell Disease. J Pediatr 2021; 230:182-190. [PMID: 33275983 PMCID: PMC7914200 DOI: 10.1016/j.jpeds.2020.11.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To describe the academic concerns and risk strata of children with sickle cell disease (SCD) as identified through a parent-directed screening tool and to compare the rates of these concerns with actual school service utilization in the clinic population. STUDY DESIGN We completed a retrospective review of patients with SCD referred to the school intervention program during the 2017-2018 and 2018-2019 school years because of a school-related concern raised by parents or noted by the clinical team. All parents completed the Brief School Needs Inventory (BSNI), a validated parent-response tool used to stratify academic risk. Rates of special education services, grade retention, and results from neuropsychologic testing were captured. Clinical history, the use of disease-modifying therapy, and results from laboratory and neuroimaging studies were also obtained. Descriptive statistics were performed to examine demographic information, clinical history, and BSNI results. RESULTS In total, 137 unique patients (age range, 14 months to 19 years) completed the BSNI during the study period, for 181 events. According to BSNI risk-stratification, 45% of patients were deemed low, 36% moderate, and 19% high academic risk. Over one-half of parents were concerned about their ability to advocate for their child's needs. Despite legal qualification for a Section 504 accommodation plan, only 20% had established plans. Academic concerns were common with 31% of children reporting an individualized education program and 20% with grade retention/remediation. CONCLUSIONS Concerns for academic challenges remain high among parents of children with SCD; however, school service utilization remains disproportionately low attributable to numerous reasons.
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Affiliation(s)
- Kristine A Karkoska
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH; University of Cincinnati College of Medicine, Cincinnati, OH.
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17
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Basu A. A welfare-theoretic model consistent with the practice of cost-effectiveness analysis and its implications. JOURNAL OF HEALTH ECONOMICS 2020; 70:102287. [PMID: 31972535 DOI: 10.1016/j.jhealeco.2020.102287] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/25/2019] [Accepted: 01/03/2020] [Indexed: 05/19/2023]
Abstract
I look at three debates in the health economics literature in the context of cost-effectiveness analysis (CEA): 1) inclusion of future costs, 2) discounting, and 3) consistency with a welfare-economic perspective. These debates thus far have been studied in isolation leading to confusion and lingering questions. I look at these three debates holistically and present a welfare theoretic model that is consistent with the practice of CEA and can help inform all of these three debates. It shows rationales for the recommendations of the Second Panel and clarifies some nuanced implications for the practice of CEA when taking a societal perspective in the context of distributional CEA and multi-sectorial budgets.
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Affiliation(s)
- Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle WA, United States; The National Bureau of Economic Research, Cambridge MA, United States.
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18
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Tusuubira SK, Naggawa T, Nakamoga V. To Join Or Not To Join? A Case Of Sickle Cell Clubs, Stigma And Discrimination In Secondary Schools In Butambala District, Uganda. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2019; 10:145-152. [PMID: 31632168 PMCID: PMC6778728 DOI: 10.2147/ahmt.s223956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/18/2019] [Indexed: 11/23/2022]
Abstract
Background People living with sickle cell face a lot of stigma and discrimination in Uganda. This stigma is as a result of the lack of the general conceptualization of this condition. For students, the stigma is often due to their differences like jaundice, delayed sexual maturation, and physical growth. This makes individuals with SCD targets for teasing and bullying. This study assessed the knowledge and perception among secondary school students in a rural district of Butambala at nine selected schools. The study also evaluated the use of sickle cell clubs as a tool for behavior change towards the associated stigma and discrimination. Methods A school-based cross-sectional study design was used to assess knowledge and perception towards sickle cell disease in secondary schools in Butambala district using self-administered questionnaires prior to and after set up of the sickle cell clubs. Results Out of the 375 student participants (59.5% female, 40.5% male) the majority (87.5%) were below 18 years; 68% of the respondents did not know that sickle cell is a genetic condition; 87.5% of the respondents highlighted that it is important for people with SCD to attend school; 54.4% of the respondents reported that people with SCD should not be given equal rights, while 56.0% of the respondents noted that people with SCD should not socialize. Conclusion It is evident the there is a big gap in sickle cell awareness among secondary school students coupled with a high level of stigma and discrimination. Sickle cell clubs have a positive effect towards behavior change while providing SCD knowledge and information.
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Affiliation(s)
- Sharifu K Tusuubira
- Uganda Sickle Cell Rescue Foundation, Kampala, Uganda.,Clarke International University, Kampala, Uganda
| | - Tracy Naggawa
- Uganda Sickle Cell Rescue Foundation, Kampala, Uganda
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19
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Ghafuri DL, Sanger M, Rodeghier M, DeBaun MR. Integrated psychology support and comprehensive cognitive evaluation improves access to special education services for children with sickle cell disease. Pediatr Blood Cancer 2019; 66:e27755. [PMID: 31044487 DOI: 10.1002/pbc.27755] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/27/2019] [Accepted: 03/14/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at risk for cognitive deficits. Limited data describe whether comprehensive cognitive evaluation improves education resources and whether caregivers perceive the assessment as beneficial. We tested our two hypotheses: (a) an integrated comprehensive cognitive evaluation program in children with SCD results in increased special education services allocation; and (b) caregivers will value comprehensive cognitive evaluation services provided. PROCEDURE In a tertiary care medical facility, as part of quality improvement project, in a before-and-after evaluation between March 2011 and July 2014, we examined the impact of targeted comprehensive cognitive evaluation on change in special education services. We also evaluated the caregiver's perception regarding the utility of the provided services. RESULTS A total of 21% (42 of 196) students (median age 11 years, range 3-18) with SCD were referred for cognitive assessment due to overt stroke (n = 11), silent stroke (n = 14), or concerns about cognitive or academic functioning without evidence of strokes (n = 17). At baseline, 45.2% received special education services and after the comprehensive cognitive evaluation 86.7% received special education services (P < 0.001). Among 33 caregivers who completed the survey, 97% reported that the assessment was helpful and 60% indicated that assessment led to beneficial changes for their children at school. CONCLUSION Education advocacy coupled with comprehensive cognitive assessment in students with SCD improved access to special education services, and caregivers uniformly endorse this service as having added value.
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Affiliation(s)
- Djamila Labib Ghafuri
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Maureen Sanger
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Michael Rutledge DeBaun
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee
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20
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Barton-Gooden A, Grindley M, Knight-Madden J, Asnani M. Gender influences on the health of adolescents with sickle cell disease. PSYCHOL HEALTH MED 2018; 24:470-480. [PMID: 30318923 DOI: 10.1080/13548506.2018.1533985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Barton-Gooden
- UWI School of Nursing, Faculty of Medical Sciences, The University of the West Indies, Kingston, Jamaica
| | - M Grindley
- Caribbean Institute of Health Research- Sickle Cell Unit, The University of the West Indies, Kingston, Jamaica
| | - J Knight-Madden
- Caribbean Institute of Health Research- Sickle Cell Unit, The University of the West Indies, Kingston, Jamaica
| | - M Asnani
- Caribbean Institute of Health Research- Sickle Cell Unit, The University of the West Indies, Kingston, Jamaica
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Abstract
BACKGROUND Children with sickle cell disease (SCD) demonstrate deficits in cognitive and academic functioning. This study compared the visual motor integration (VMI) skills of children with SCD to non-SCD sibling controls. PROCEDURE In total, 105 participants (67 patients with SCD, 38 controls) were recruited during a routine clinic visit. Each participant was administered the Grooved Pegboard Test, a test of manual dexterity and the Beery-Buktenica Developmental Test of VMI, a measure of graphomotor skills. RESULTS Children with SCD demonstrated average (M=89.61, SE=3.08) fine manual dexterity and speed, but more complex fine motor functioning (graphomotor skills) (M=77.61, SE=1.65) was impaired. Relative to healthy siblings, children with SCD were not found to have different fine manual dexterity and speed (P=0.617). Patients with SCD were found to have significantly worse graphomotor skills (P=0.04). CONCLUSIONS Children with SCD were found to have average basic fine motor dexterity and speed, but impaired VMI, a more complex fine motor skill. This finding is significant given the functional importance of complex fine motor skills in early academic activities.
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Olatunya OS, Oke OJ, Kuti BP, Ajayi IA, Olajuyin O, Omotosho-Olagoke O, Taiwo AB, Faboya OA, Ajibola A. Factors Influencing the Academic Performance of Children with Sickle Cell Anaemia in Ekiti, South West Nigeria. J Trop Pediatr 2018; 64:67-74. [PMID: 28549163 DOI: 10.1093/tropej/fmx034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is a paucity of information on factors that influence the school performance of children with sickle cell anaemia (SCA) in Nigeria, despite her huge burden of the disease. METHODS In total, 101 children with SCA were recruited at a paediatric clinic in Nigeria. Their socio-demographic-matched classmates were the controls. Academic performance and cognitive functioning were obtained from school reports and Ziler's Draw-a-Person Test, respectively. Factors influencing the academic performance were determined. RESULTS Children with SCA had higher rates of school absence and lower haemoglobin concentration (p < 0.05). There was no difference in overall school performance between children with SCA and controls (59.0 vs. 60.6%; p = 0.256). School absenteeism > 1 week independently predicts poor school performance among the study participants (odds ratio = 15.71; 95% confidence interval = 5.93-41.66; p =0.000). Most SCA children with poor performance were absent from school for > 1 week. CONCLUSION There is need to address causes of school absenteeism among children with SCA.
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Affiliation(s)
| | | | - Bankole Peter Kuti
- Department of Paediatrics, Obafemi Awolowo University, 220282 Ile-Ife, Nigeria
| | | | - Oyebanji Olajuyin
- Department of Otolaryngology, Ekiti State University, 360101 Ado Ekiti, Nigeria
| | | | - Adekunle Bamidele Taiwo
- Department of Paediatrics, Ekiti State University Teaching Hospital, 360101 Ado Ekiti, Nigeria
| | - Opeyemi Ayodeji Faboya
- Department of Paediatrics, Ekiti State University Teaching Hospital, 360101 Ado Ekiti, Nigeria
| | - Ayodeji Ajibola
- Department of Paediatrics, Ekiti State University Teaching Hospital, 360101 Ado Ekiti, Nigeria
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Asnani MR, Barton-Gooden A, Grindley M, Knight-Madden J. Disease Knowledge, Illness Perceptions, and Quality of Life in Adolescents With Sickle Cell Disease: Is There a Link? Glob Pediatr Health 2017; 4:2333794X17739194. [PMID: 29152543 PMCID: PMC5680938 DOI: 10.1177/2333794x17739194] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 01/12/2023] Open
Abstract
Disease knowledge, illness perceptions, and quality of life (QOL) were examined in 150 adolescents (mean age = 16.1 years, SD = 1.9; 49.3% males) with sickle cell disease (SCD). Females had higher knowledge (P = .004), lower QOL (P = .02), and perceived their illness to be more unpredictable (P = .03). Those with more severe disease perceived their illness to be unpredictable with worse outcomes. Those with higher knowledge scores perceived their illness to be chronic, made more sense of their illness, and perceived greater personal and treatment control. Final hierarchical regression model showed that secondary education as compared to primary education level (P < .001) was positively correlated whereas disease severity (P < .001), perceived unpredictability (P = .024), and negative emotions (P < .001) were negatively correlated with QOL. Health practitioners should assess adolescents’ illness perceptions and encouraging continuing schooling and addressing emotional/psychological problems could improve their QOL.
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Senbanjo IO, Oshikoya KA, Salisu M, Diaku-Akinwumi IN. Head circumference of children with sickle cell disease in Lagos, Nigeria. Pan Afr Med J 2016; 25:4. [PMID: 28154697 PMCID: PMC5268792 DOI: 10.11604/pamj.2016.25.4.8030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 06/21/2016] [Indexed: 11/11/2022] Open
Abstract
Introduction Growth retardation and under-nutrition are common in children with sickle cell disease (SCD). The aim of this study was to compare the head circumference (HC) of SCD children and non-SCD children and to determine the effect of malnutrition on head circumference of children with SCD. Methods This was a prospective case-control study conducted at the Lagos State University Teaching Hospital, Nigeria, involving SCD children (subject, n = 118) and non-SCD children (control, n = 118) matched for age, sex, and socioeconomic status. Weight, height and HC were measured using standard techniques. Results The mean ages of children with and without SCD were 7.46 ± 3.69 years and 7.01 ± 3.58 years, respectively. The HC increased significantly with age in both males and females (r = 0.75, p = < 0.001; r = 0.70, p < 0.001 respectively). There was no significant difference in HC between males and females (p > 0.05). At all ages, the mean head circumference of SCD children was not significantly (p > 0.05) different from non-SCD children. The In the age group 11-15 years, the prevalence of stunting was significantly higher among SCD children than non-SCD children. The mean HC of SCD children with stunting was significantly lower than those not stunted (51.7 vs. 53.5; P= 0.006) in age group 11.15 years. Conclusion The head circumference of children with SCD is not significantly different from that of non-SCD children. Therefore, the HC chart for the general population is also applicable for monitoring head growth in children with SCD. The effect of malnutrition on head circumference of SCD children is most marked in age group 11-15 years.
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Affiliation(s)
- Idowu Odunayo Senbanjo
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, PMB 21266, Ikeja, Lagos, Nigeria
| | - Kazeem Adeola Oshikoya
- Department of Pharmacology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Mohammed Salisu
- Department of Pharmacology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Ijeoma Nnenna Diaku-Akinwumi
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, PMB 21266, Ikeja, Lagos, Nigeria
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Hardy SJ, Hardy KK, Schatz JC, Thompson AL, Meier ER. Feasibility of Home-Based Computerized Working Memory Training With Children and Adolescents With Sickle Cell Disease. Pediatr Blood Cancer 2016; 63:1578-85. [PMID: 27227457 DOI: 10.1002/pbc.26019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/03/2016] [Accepted: 03/25/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at increased risk for neurocognitive deficits, yet the literature describing interventions to ameliorate these problems and promote academic achievement is limited. We evaluated the feasibility and preliminary efficacy of a home-based computerized working memory (WM) training intervention (Cogmed) in children with SCD. PROCEDURE Youth with SCD between the age of 7 and 16 years completed an initial neuropsychological assessment; those with WM deficits were loaned an iPad on which they accessed Cogmed at home. Participants were instructed to work on Cogmed 5 days each week for 5 weeks (25 training sessions). We examined Cogmed usage characteristics and change on WM assessment scores following the intervention. RESULTS Of the 21 participants (M age = 11.38, SD = 2.78; Mdn age = 10.00, interquartile range [IQR] = 5.00; 52% female) screened, 60% exhibited WM deficits (n = 12) and received the intervention and 50% (n = 6) completed Cogmed. The mean number of sessions completed was 15.83 (SD = 7.73; Mdn = 17.00, IQR = 16.00); females were more likely to complete Cogmed, χ(2) (1) = 6.00, P = 0.01. Participants who reported lower SCD-related pain impact completed more sessions (r = 0.71, P = 0.01). Children who completed Cogmed exhibited improvements in verbal WM, visuospatial short-term memory, and visuospatial WM. CONCLUSIONS Initial findings suggest Cogmed is associated with WM improvement in youth with SCD; however, adherence was lower than expected. Home-based WM interventions may ameliorate SCD-related WM deficits but strategies are needed to address barriers to program completion.
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Affiliation(s)
- Steven J Hardy
- Departments of Pediatrics and Psychiatry & Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Kristina K Hardy
- Children's National Health System, Washington, District of Columbia.,Departments of Pediatrics and Psychiatry & Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jeffrey C Schatz
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Amanda L Thompson
- Children's National Health System, Washington, District of Columbia.,Departments of Pediatrics and Psychiatry & Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Emily R Meier
- Children's National Health System, Washington, District of Columbia.,Departments of Pediatrics and Psychiatry & Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Kawadler JM, Clayden JD, Clark CA, Kirkham FJ. Intelligence quotient in paediatric sickle cell disease: a systematic review and meta-analysis. Dev Med Child Neurol 2016; 58:672-9. [PMID: 27038278 DOI: 10.1111/dmcn.13113] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2016] [Indexed: 11/29/2022]
Abstract
AIM Sickle cell disease (SCD) is the commonest cause of childhood stroke worldwide. Magnetic resonance imaging (MRI) is routinely used to detect additional silent cerebral infarction (SCI), as IQ is lower in SCI as well as stroke. This review assesses the effect of infarction on IQ, and specifically whether, compared to healthy controls, IQ differences are seen in children with SCI with no apparent MRI abnormality. METHOD A systematic review was conducted to include articles with an SCD paediatric population, MRI information, and Wechsler IQ. A meta-analysis of 19 articles was performed to compare IQ in three groups: stroke vs SCI; SCI vs no SCI; and no SCI vs healthy controls. RESULTS Mean differences in IQ between all three groups were significant: stroke patients had lower IQ than patients with SCI by 10 points (six studies); patients with SCI had lower IQ than no patients with SCI by 6 points (17 studies); and no patients with SCI had lower IQ than healthy controls by 7 points (seven studies). INTERPRETATION Children with SCD and no apparent MRI abnormality have significantly lower IQ than healthy controls. In this chronic condition, other biological, socioeconomic, and environmental factors must play a significant role in cognition.
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Affiliation(s)
- Jamie M Kawadler
- Developmental Neurosciences, Institute of Child Health, University College London, London, UK
| | - Jonathan D Clayden
- Developmental Neurosciences, Institute of Child Health, University College London, London, UK
| | - Chris A Clark
- Developmental Neurosciences, Institute of Child Health, University College London, London, UK
| | - Fenella J Kirkham
- Developmental Neurosciences, Institute of Child Health, University College London, London, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK
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Ladd RJ, Valrie CR, Walcott CM. Risk and resilience factors for grade retention in youth with sickle cell disease. Pediatr Blood Cancer 2014; 61:1252-6. [PMID: 24519984 PMCID: PMC4020345 DOI: 10.1002/pbc.24974] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 01/16/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Youth with sickle cell disease (SCD) are at higher risk for grade retention than healthy peers. This is salient because research suggests grade retention is ineffective and places youth at additional risk for negative outcomes. The aims of the present study were to identify possible risk factors for grade retention in youth with SCD and to examine positive family functioning as a possible resilience factor. PROCEDURE Data were extracted from phase 3 of the Cooperative Study of Sickle Cell Disease, a multisite, longitudinal study of individuals with SCD. Participants were 370 youth, aged 6-16 years, with complete data on history of grade retention. Collected data included demographics, history of grade retention, disease severity factors, evidence of stroke, family functioning, and academic achievement. A logistic regression model predicting grade retention was calculated. RESULTS Increasing age, lower reading achievement, and lower family cohesion were predictive of higher likelihood of grade retention. Also, high family achievement-orientation moderated the negative effects of increasing age on likelihood of grade retention, such that at increasing levels of family achievement-orientation, the relationship between age and grade retention decreased. CONCLUSIONS These findings suggest the need for interventions that promote connectedness and achievement-orientation in families of youth with SCD. Research is also needed to further explore other possible risk or resilience factors for grade retention in this population, such as school absenteeism.
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Iampietro M, Giovannetti T, Tarazi R. Hypoxia and inflammation in children with sickle cell disease: implications for hippocampal functioning and episodic memory. Neuropsychol Rev 2014; 24:252-65. [PMID: 24744195 DOI: 10.1007/s11065-014-9259-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 04/01/2014] [Indexed: 01/02/2023]
Abstract
Children with sickle cell disease (SCD) suffer from systemic processes (e.g., chronic anemia, recurrent hypoxic-ischemic events, chronic inflammation) that have been associated with neurocognitive impairment in a range of clinical populations, but which have been largely understudied in relation to specific domains of cognitive functioning in children with SCD. This review focuses on episodic memory, as the hippocampus may be especially vulnerable to the systemic processes associated with SCD. The first part of the paper outlines the pathophysiology of SCD and briefly reviews the extant literature on academic and cognitive functioning in children with SCD, emphasizing the dearth of research on episodic memory. Next, the complex systemic processes of hypoxia and inflammation associated with SCD are reviewed, along with research that has associated these processes with hippocampal damage and memory impairment. The paper concludes with suggestions for future research that are informed, in part, by the literature on developmental amnesia.
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Affiliation(s)
- Mary Iampietro
- Department of Psychology, Weiss Hall, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
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