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Williams CEC, Bracken L, Gill A, Oni L. Themes associated with uncollected paediatric prescriptions at a large tertiary children's hospital: a retrospective, observational study. BMJ Paediatr Open 2024; 8:e002366. [PMID: 38977354 DOI: 10.1136/bmjpo-2023-002366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/18/2024] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVE This study aimed to assess the number of prescriptions that were uncollected by caregivers to identify any predisposing systemic themes that may act as barriers to children receiving medications. STUDY DESIGN AND SETTING Data were retrospectively collected on uncollected prescriptions at a single, tertiary paediatric centre over a 2-month period. This included type and classification of the drug, prescriber specialty, the timing of prescription and the child's registered postcode. Key themes were identified. RESULTS A total of 124 uncollected prescriptions involving 94 patients were included. 103 (83%) of these were clinic prescriptions, and azathioprine was the most frequently uncollected prescription (n=6, 5%). The uncollected prescriptions most commonly fell under the 'gastrointestinal system' (n=26, 21%) and 'skin' (n=24, 19%) categories, and similarly, 24 (19%) were prescribed by the gastroenterology department and 18 (15%) by dermatology. The mean distance from the child's registered postcode was 8.5±11.8 miles (range 0.5-73.4) with a considerable number of children having a registered postcode greater than 10 miles from the hospital (n=24, 27%). Many children lived in areas corresponding to the lowest decile of the Index of Multiple Deprivation (IMD) (n=38, 42%). CONCLUSION Urgent interventions and further prospective studies are needed to minimise the barriers that caregivers face in collecting their child's prescription.
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Affiliation(s)
- Chloe Elizabeth Charlotte Williams
- Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
- Department of Women's and Children's Health, University of Liverpool Institute of Life Course and Medical Sciences, Liverpool, UK
| | - Louise Bracken
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Andrea Gill
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Louise Oni
- Department of Women's and Children's Health, University of Liverpool Institute of Life Course and Medical Sciences, Liverpool, UK
- Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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2
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Oates GR, Schechter MS. Aiming to Improve Equity in Pulmonary Health: Cystic Fibrosis. Clin Chest Med 2023; 44:555-573. [PMID: 37517835 PMCID: PMC10458995 DOI: 10.1016/j.ccm.2023.03.011] [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] [Indexed: 08/01/2023]
Abstract
This review summarizes the evidence of health disparities in cystic fibrosis (CF), an autosomal recessive genetic disorder with substantial variation in disease progression and outcomes. We review disparities by race, ethnicity, socioeconomic status, geographic location, gender identity, or sexual orientation documented in the literature. We outline the mechanisms that generate and perpetuate such disparities across levels and domains of influence and assess the implications of this evidence. We then recommend strategies for improving equity in CF outcomes, drawing on recommendations for the general population and considering approaches specific to people living with CF.
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Affiliation(s)
- Gabriela R Oates
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michael S Schechter
- Division of Pulmonary Medicine, Department of Pediatrics, Virginia Commonwealth University and Children's Hospital of Richmond at VCU, Richmond, VA, USA
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3
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Velvin G, Dammann B, Haagensen T, Johansen H, Strømme H, Geirdal AØ, Bathen T. Work participation in adults with rare genetic diseases - a scoping review. BMC Public Health 2023; 23:910. [PMID: 37208707 DOI: 10.1186/s12889-023-15654-3] [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: 11/09/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Work participation is a crucial aspect of health outcome and an important part of life for most people with rare genetic diseases. Despite that work participation is a social determinant of health and seems necessary for understanding health behaviours and quality of life, it is an under-researched and under-recognized aspect in many rare diseases. The objectives of this study was to map and describe existing research on work participation, identify research gaps, and point to research agendas in a selection of rare genetic diseases. METHODS A scoping review was performed by searching relevant literature in bibliographic databases and other sources. Studies addressing work participation in people with rare genetic diseases published in peer reviewed journals were assessed using EndNote and Rayyan. Data were mapped and extracted based on the research questions concerning the characteristics of the research. RESULTS Of 19,867 search results, 571 articles were read in full text, and 141 satisfied the eligibility criteria covering 33 different rare genetic diseases; 7 were reviews and 134 primary research articles. In 21% of the articles the primary aim was to investigate work participation. The extent of studies varied between the different diseases. Two diseases had more than 20 articles, but most had only one or two articles. Cross-sectional quantitative studies were predominant, with few utilizing prospective or qualitative design. Nearly all articles (96%) reported information about work participation rate, and 45% also included information about factors associated with work participation and work disability. Due to differences in methodologies, cultures and respondents, comparison between and within diseases are difficult. Nevertheless, studies indicated that many people with different rare genetic diseases experience challenges related to work, closely associated to the symptoms of the disease. CONCLUSION While studies indicate high prevalence of work disability in many patients with rare diseases, the research is scarce and fragmented. More research is warranted. Information about the unique challenges of living with different rare diseases is crucial for health and welfare systems to better facilitate work participation. In addition, the changing nature of work in the digital age, may also open up new possibilities for people with rare genetic diseases and should be explored.
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Affiliation(s)
- Gry Velvin
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway.
| | - Brede Dammann
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Trond Haagensen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Heidi Johansen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Hilde Strømme
- Library of Medicine and Science, University of Oslo, Oslo, Norway
| | - Amy Østertun Geirdal
- Department of Social Work, Child Welfare and Social Policy, Faculty of Social Science, Oslo Metropolitan University, Oslo, Norway
| | - Trine Bathen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
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4
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Blair JC, Aitken C, Smith J, Ghatak A, Jones CA, Thursfield R, Oni L. Socioeconomic barriers preventing children and young people living with long-term health conditions from achieving optimal outcomes. Arch Dis Child 2023:archdischild-2023-325671. [PMID: 37142334 DOI: 10.1136/archdischild-2023-325671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Joanne C Blair
- Department of Paediatric Endocrinology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Cath Aitken
- Health Junction, UK Community interest company No. 08057979, Liverpool, UK
| | - John Smith
- Health Junction, UK Community interest company No. 08057979, Liverpool, UK
| | - Atrayee Ghatak
- Department of General Paediatrics, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Caroline Ann Jones
- Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Rebecca Thursfield
- Department of Paediatric Respiratory Medicine, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Louise Oni
- Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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5
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Schlüter DK, Griffiths R, Akbari A, Taylor-Robinson D. Educational achievements of children aged 10-11 years with cystic fibrosis. A data linkage study in Wales. Int J Popul Data Sci 2022; 7:1725. [PMID: 35909577 PMCID: PMC9284509 DOI: 10.23889/ijpds.v7i1.1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Introduction As people with cystic fibrosis (CF) lead longer, healthier lives, educational qualifications and employment prospects are increasingly important. However, little is known about the social consequences of CF, in particular, any impact on educational achievements and the support children with CF receive in schools. Objectives To assess the educational achievements of children with CF in Wales compared to the general Welsh population, and the additional learning support children with CF receive in schools. Methods We conducted a population-scale data linkage study of all children born in Wales using the Secure Anonymised Information Linkage (SAIL) Databank. We used anonymised individual-level population-scale health and administrative data sources to identify children with CF born between 2000 - 2015, linked to educational attainment records. We calculated the percentage of children that reached expected levels in statutory assessment at age 10-11, Key Stage 2 (KS2), and compared this to educational outcomes in the general population. We also assessed the percentage of children with CF that received extra learning support. Results Out of 150 eligible children, 119 had KS2 results. 77% (95% CI: 69%-84%) of children achieved expected levels in English, 81% (95% CI: 73% -87%) in Mathematics and 82% (95% CI: 75% - 88%) in Science. In the comparable general Welsh population, 83.4% to 91.1% achieved the expected level in English, 84.9% to 91.6% in Maths, and 87.1% to 92.2% in Science across the years of the study. 70% of children with CF received extra learning support. Conclusions Children with CF in Wales may have worse educational achievements than the general population. More research is needed to inform policies and interventions to better support children with CF to reach their full educational potential and employment opportunities.
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Affiliation(s)
- Daniela K Schlüter
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Rowena Griffiths
- Population Data Science, Health Data Research UK, Swansea University, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Health Data Research UK, Swansea University, Swansea, UK
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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6
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Leso V, Romano R, Santocono C, Caruso M, Iacotucci P, Carnovale V, Iavicoli I. The impact of cystic fibrosis on the working life of patients: A systematic review. J Cyst Fibros 2021; 21:361-369. [PMID: 34470710 DOI: 10.1016/j.jcf.2021.08.011] [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: 03/11/2021] [Revised: 06/30/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
Advances in the treatment and management of cystic fibrosis (CF) have led to a substantial increase in patient life expectancy, thus facilitating healthier lives and labour force participation. This review aimed to address the impact of CF on the occupational functioning of patients. A significant proportion of patients were reported to retain a job on a full- or part-time schedule. Less physically demanding occupations were most frequently performed, perhaps due to CF-related inability to sustain a heavy workload. Disease severity parameters (e.g., lung function measurements, or personal, psycho-social, or economic conditions) have been reported as determinant or co-determinant factors for the development of work-related disability. Although further research is necessary, our results may be useful to inform interdisciplinary CF healthcare management, including the assessment of work function, and to define career counselling plans and workplace risk assessment and management strategies to support the personal, social and professional lives of patients.
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Affiliation(s)
- Veruscka Leso
- Section of Occupational Medicine, Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Rosaria Romano
- Section of Occupational Medicine, Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Carolina Santocono
- Section of Occupational Medicine, Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Marilisa Caruso
- Section of Occupational Medicine, Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Paola Iacotucci
- Adult Cystic Fibrosis Center, Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Vincenzo Carnovale
- Adult Cystic Fibrosis Center, Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Ivo Iavicoli
- Section of Occupational Medicine, Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy.
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7
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Sepahzad A, Morris-Rosendahl DJ, Davies JC. Cystic Fibrosis Lung Disease Modifiers and Their Relevance in the New Era of Precision Medicine. Genes (Basel) 2021; 12:genes12040562. [PMID: 33924524 PMCID: PMC8069009 DOI: 10.3390/genes12040562] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
Our understanding of cystic fibrosis (CF) has grown exponentially since the discovery of the cystic fibrosis transmembrane conductance regulator (CFTR) gene in 1989. With evolving genetic and genomic tools, we have come to better understand the role of CFTR genotypes in the pathophysiology of the disease. This, in turn, has paved the way for the development of modulator therapies targeted at mutations in the CFTR, which are arguably one of the greatest advances in the treatment of CF. These modulator therapies, however, do not target all the mutations in CFTR that are seen in patients with CF and, furthermore, a variation in response is seen in patients with the same genotype who are taking modulator therapies. There is growing evidence to support the role of non-CFTR modifiers, both genetic and environmental, in determining the variation seen in CF morbidity and mortality and also in the response to existing therapies. This review focusses on key findings from studies using candidate gene and genome-wide approaches to identify CF modifier genes of lung disease in cystic fibrosis and considers the interaction between modifiers and the response to modulator therapies. As the use of modulator therapies expands and we gain data around outcomes, it will be of great interest to investigate this interaction further. Going forward, it will also be crucial to better understand the relative influence of genomic versus environmental factors. With this understanding, we can truly begin to deliver personalised care by better profiling the likely disease phenotype for each patient and their response to treatment.
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Affiliation(s)
- Afsoon Sepahzad
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield Hospitals, London SW3 6NP, UK;
| | | | - Jane C. Davies
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield Hospitals, London SW3 6NP, UK;
- National Heart & Lung Institute, Imperial College London, Emmanuel Kay Building, 1b Manresa Rd, London SW3 6LR, UK
- Correspondence:
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8
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Szczesniak R, Rice JL, Brokamp C, Ryan P, Pestian T, Ni Y, Andrinopoulou ER, Keogh RH, Gecili E, Huang R, Clancy JP, Collaco JM. Influences of environmental exposures on individuals living with cystic fibrosis. Expert Rev Respir Med 2020; 14:737-748. [PMID: 32264725 DOI: 10.1080/17476348.2020.1753507] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Natural, social, and constructed environments play a critical role in the development and exacerbation of respiratory diseases. However, less is known regarding the influence of these environmental/community risk factors on the health of individuals living with cystic fibrosis (CF), compared to other pulmonary disorders. AREAS COVERED Here, we review current knowledge of environmental exposures related to CF, which suggests that environmental/community risk factors do interact with the respiratory tract to affect outcomes. Studies discussed in this review were identified in PubMed between March 2019 and March 2020. Although the limited data available do not suggest that avoiding potentially detrimental exposures other than secondhand smoke could improve outcomes, additional research incorporating novel markers of environmental exposures and community characteristics obtained at localized levels is needed. EXPERT OPINION As we outline, some environmental exposures and community characteristics are modifiable; if not by the individual, then by policy. We recommend a variety of strategies to advance understanding of environmental influences on CF disease progression.
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Affiliation(s)
- Rhonda Szczesniak
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati , Cincinnati, OH, USA
| | - Jessica L Rice
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University School of Medicine , Baltimore, MD, USA
| | - Cole Brokamp
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati , Cincinnati, OH, USA
| | - Patrick Ryan
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati , Cincinnati, OH, USA
| | - Teresa Pestian
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA
| | - Yizhao Ni
- Department of Pediatrics, University of Cincinnati , Cincinnati, OH, USA.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA
| | | | - Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine , London, UK
| | - Emrah Gecili
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA
| | - Rui Huang
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA.,Department of Mathematical Sciences, University of Cincinnati , Cincinnati, OH, USA
| | - John P Clancy
- Department of Pediatrics, University of Cincinnati , Cincinnati, OH, USA.,Department of Clinical Research, Cystic Fibrosis Foundation , Bethesda, MD, USA
| | - Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University School of Medicine , Baltimore, MD, USA
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9
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Rocha V, Soares S, Stringhini S, Fraga S. Socioeconomic circumstances and respiratory function from childhood to early adulthood: a systematic review and meta-analysis. BMJ Open 2019; 9:e027528. [PMID: 31227536 PMCID: PMC6597002 DOI: 10.1136/bmjopen-2018-027528] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Disadvantaged socioeconomic circumstances in early life have the potential to impact lung function. Thus, this study aimed to summarise evidence on the association between socioeconomic circumstances and respiratory function from childhood to young adulthood. DESIGN Systematic review and meta-analysis. METHODS Following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines, Medline, ISI-Web of Science and Scopus were searched from inception up to January 2018. Original studies on the association between socioeconomic circumstances and respiratory function in early ages (ie, participants younger than 25 years of age) were investigated. Two investigators independently evaluated articles, applied the exclusion criteria, extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale. A meta-analysis of the standardised mean difference and 95% CI in respiratory function between participants from different socioeconomic circumstances was conducted, using a random-effects model. RESULTS Thirty-three papers were included in this review and 23 showed that disadvantaged socioeconomic circumstances were significantly associated with reduced respiratory function. The meta-analysis including seven papers showed a significant difference of -0.31 (95% CI -0.42 to -0.21) litres in forced expiratory volume in the first second between children, adolescents and young adults from disadvantaged versus advantaged socioeconomic circumstances. Specifically a difference of -0.31 (95% CI -0.51 to -0.10) litres in girls and -0.43 (95% CI -0.51 to -0.35) litres in boys was observed. CONCLUSIONS Children, adolescents and young adults from disadvantaged socioeconomic circumstances had lower respiratory function, and boys presented higher respiratory health inequalities. This information contributes to explain the social patterning of respiratory diseases, and might enable health policy makers to tackle respiratory health inequalities at early ages.
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Affiliation(s)
- Vânia Rocha
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Sara Soares
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
- Population Epidemiology Unit, Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Sílvia Fraga
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Universidade do Porto Faculdade de Medicina, Porto, Portugal
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10
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A weekend/weekday comparison of adherence to daily treatment regimens in adults with cystic fibrosis. HEALTH PSYCHOLOGY REPORT 2018. [DOI: 10.5114/hpr.2018.72331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Krivchenia K, Hayes D, Tobias JD, Tumin D. Long-term work participation among cystic fibrosis patients undergoing lung transplantation. J Cyst Fibros 2016; 15:846-849. [DOI: 10.1016/j.jcf.2016.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/12/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
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12
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Salvatore D, Buzzetti R, Mastella G. An overview of international literature from cystic fibrosis registries. Part 5: Update 2012-2015 on lung disease. Pediatr Pulmonol 2016; 51:1251-1263. [PMID: 27163867 DOI: 10.1002/ppul.23473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 04/21/2016] [Accepted: 05/02/2016] [Indexed: 01/01/2023]
Abstract
Patient registry data is a tool for defining the clinical course and risk factors in patients with less common diseases like Cystic Fibrosis. Forty-one registry-based reports on lung disease in Cystic Fibrosis were published between 2011 and 2015. The aim of this review is to describe and discuss the results of these reports, focusing on the risk factors for lung disease progression, specific microbiologic pathogens (e.g., non-tuberculous mycobacteria), disease complications, comparisons between registries of different countries, the impact of socio-economic status, and evaluation of benefits and costs of therapies. Techniques for improved clinical trial design were also studied. Pediatr Pulmonol. 2016;51:1251-1263. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Roberto Buzzetti
- Italian Cystic Fibrosis Research Foundation, Ospedale Maggiore, Verona, Italy
| | - Gianni Mastella
- Italian Cystic Fibrosis Research Foundation, Ospedale Maggiore, Verona, Italy
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13
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Wickham S, Anwar E, Barr B, Law C, Taylor-Robinson D. Poverty and child health in the UK: using evidence for action. Arch Dis Child 2016; 101:759-66. [PMID: 26857824 PMCID: PMC4975805 DOI: 10.1136/archdischild-2014-306746] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/07/2016] [Indexed: 11/06/2022]
Abstract
There are currently high levels of child poverty in the UK, and for the first time in almost two decades child poverty has started to rise in absolute terms. Child poverty is associated with a wide range of health-damaging impacts, negative educational outcomes and adverse long-term social and psychological outcomes. The poor health associated with child poverty limits children's potential and development, leading to poor health and life chances in adulthood. This article outlines some key definitions with regard to child poverty, reviews the links between child poverty and a range of health, developmental, behavioural and social outcomes for children, describes gaps in the evidence base and provides an overview of current policies relevant to child poverty in the UK. Finally, the article outlines how child health professionals can take action by (1) supporting policies to reduce child poverty, (2) providing services that reduce the health consequences of child poverty and (3) measuring and understanding the problem and assessing the impact of action.
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Affiliation(s)
- Sophie Wickham
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Elspeth Anwar
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Ben Barr
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Catherine Law
- Institute of Child Health, University College London, London, UK
| | - David Taylor-Robinson
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK Institute of Child Health, University College London, London, UK
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14
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Country to country variation: what can be learnt from national cystic fibrosis registries. Curr Opin Pulm Med 2016; 21:585-90. [PMID: 26390334 DOI: 10.1097/mcp.0000000000000208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW This review will address the evolving science involving international comparisons of populations of persons living with cystic fibrosis. Understanding the current clinical outcomes in cystic fibrosis is critical prior to assessing such comparisons. Countries that differ in clinical approaches provide natural experiments to assess those approaches. RECENT FINDINGS Recent studies have highlighted that the population of persons with cystic fibrosis is changing; estimates predict a continued growth of cystic fibrosis populations with substantial increases in persons with cystic fibrosis who are adults. Additional work highlighted differences in subpopulations (i.e. children); US cystic fibrosis children appear to have better lung function, but similar nutritional status, compared to UK cystic fibrosis children. These differences were associated with differences in intensity of care, with a higher proportion of US children receiving more cystic fibrosis-specific therapies. Additional research raises important questions regarding potential sampling bias in different patient registries and differing rates of unconfirmed cases of cystic fibrosis. These and other limitations are highlighted. SUMMARY Differences in both demographics and clinical outcomes in cystic fibrosis between nations can be informative, but, like many types of observational research, are at risk of unrecognized bias. Despite this limitation, these comparisons can lead to substantive improvements in care in cystic fibrosis.
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15
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Elborn JS, Bell SC, Madge SL, Burgel PR, Castellani C, Conway S, De Rijcke K, Dembski B, Drevinek P, Heijerman HGM, Innes JA, Lindblad A, Marshall B, Olesen HV, Reimann AL, Solé A, Viviani L, Wagner TOF, Welte T, Blasi F. Report of the European Respiratory Society/European Cystic Fibrosis Society task force on the care of adults with cystic fibrosis. Eur Respir J 2015; 47:420-8. [PMID: 26453627 DOI: 10.1183/13993003.00592-2015] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/01/2015] [Indexed: 12/14/2022]
Abstract
The improved survival in people with cystic fibrosis has led to an increasing number of patients reaching adulthood. This trend is likely to be maintained over the next decades, suggesting a need to increase the number of centres with expertise in the management of adult patients with cystic fibrosis. These centres should be capable of delivering multidisciplinary care addressing the complexity of the disease, in addition to addressing the psychological burden on patients and their families. Further issues that require attention are organ transplantation and end of life management.Lung disease in adults with cystic fibrosis drives most of the clinical care requirements, and major life-threatening complications, such as respiratory infection, respiratory failure, pneumothorax and haemoptysis, and the management of lung transplantation require expertise from trained respiratory physicians. The taskforce therefore strongly reccommends that medical leadership in multidisciplinary adult teams should be attributed to a respiratory physician adequately trained in cystic fibrosis management.The task force suggests the implementation of a core curriculum for trainees in adult respiratory medicine and the selection and accreditation of training centres that deliver postgraduate training to the standards of the HERMES programme.
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Affiliation(s)
- J Stuart Elborn
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University of Belfast, Belfast, UK
| | - Scott C Bell
- Dept of Thoracic Medicine, The Prince Charles Hospital and QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Susan L Madge
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Pierre-Regis Burgel
- Dept of Respiratory Medicine, Cochin Hospital, Assistance Publique Hôpitaux de Paris and Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Carlo Castellani
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Steven Conway
- Paediatric and Adult CF Units, Leeds Teaching Hospitals Trust, Leeds, UK
| | | | | | - Pavel Drevinek
- Dept of Medical Microbiology, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Harry G M Heijerman
- Haga Teaching Hospital, Dept of Pulmonology and Cystic Fibrosis, The Hague, The Netherlands
| | - J Alistair Innes
- Scottish Adult Cystic Fibrosis Service, Western General Hospital, Edinburgh, UK
| | - Anders Lindblad
- Dept of Paediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | | | - Ampara Solé
- Lung Transplant and Adult Cystic Fibrosis, Dept of Pneumology, University Hospital la FE, Valencia, Spain
| | - Laura Viviani
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Thomas O F Wagner
- Christiane Herzog CF Centre, Dept of Respiratory Diseases, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Tobias Welte
- Dept of Respiratory Medicine, Hannover Medical School, Hanover, Germany
| | - Francesco Blasi
- Dept of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Cà Granda, Milan, Italy
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16
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Taylor-Robinson DC, Thielen K, Pressler T, Olesen HV, Diggle PJ. Low socioeconomic status and lung function. Eur Respir J 2015; 45:857-8. [PMID: 25726542 DOI: 10.1183/09031936.00232014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Karsten Thielen
- Dept of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tania Pressler
- Cystic Fibrosis Center, Rigshospitalet, Copenhagen, Denmark
| | - Hanne V Olesen
- Pediatric Dept A, Cystic Fibrosis Center, Aarhus University Hospital, Aarhus, Denmark
| | - Peter J Diggle
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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17
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Goss CH, MacNeill SJ, Quinton HB, Marshall BC, Elbert A, Knapp EA, Petren K, Gunn E, Osmond J, Bilton D. Children and young adults with CF in the USA have better lung function compared with the UK. Thorax 2015; 70:229-36. [PMID: 25256255 PMCID: PMC4838510 DOI: 10.1136/thoraxjnl-2014-205718] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND People with cystic fibrosis (CF) are managed differently in the USA and UK providing an opportunity to learn from differences in practice patterns. OBJECTIVES To compare cross-sectional demographics, practice patterns and clinical outcomes between US and UK CF patients. METHODS This was a cross-sectional study using 2010 data from patients in the US Cystic Fibrosis Foundation and the UK Cystic Fibrosis patient registries. The a priori outcome measures of interest were lung function and nutritional status. Descriptive statistics and two sample comparisons were performed. Stratification and multivariable linear regression were used to adjust for confounding. RESULTS The study cohort included 13 777 children and 11 058 adults from the USA and 3968 children and 3965 adults from the UK. In children, mean body mass index centiles were similar. Lung function (FEV1 and FVC% predicted) was significantly higher in US patients ages 6-25 years of age. In a regression model adjusted for only age, FEV1% predicted was on average 3.31% of predicted (95% CI 2.65 to 3.96) higher in the USA compared with the UK. When adjusted for age, age at diagnosis, gender, pancreatic insufficiency and genotype, FEV1% predicted was on average 3.03% of predicted (95% CI 2.37 to 3.69) higher in the USA compared with the UK These differences persisted despite adjustment for possible confounders. Hypertonic saline and dornase alfa were much more commonly prescribed in US children. CONCLUSIONS Children and young adults with CF have better lung function in the USA compared with the UK despite similar nutritional status.
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Affiliation(s)
- Christopher H Goss
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Stephanie J MacNeill
- Department of Occupational and Environmental Medicine, Imperial College London, London, UK
| | - Hebe B Quinton
- Value Reporting and Analytics, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire, USA
| | | | | | | | | | | | | | - Diana Bilton
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
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18
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Bonner R, Bountziouka V, Stocks J, Harding S, Wade A, Griffiths C, Sears D, Fothergill H, Slevin H, Lum S. Birth data accessibility via primary care health records to classify health status in a multi-ethnic population of children: an observational study. NPJ Prim Care Respir Med 2015; 25:14112. [PMID: 25612149 PMCID: PMC4353844 DOI: 10.1038/npjpcrm.2014.112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/02/2014] [Accepted: 11/11/2014] [Indexed: 01/25/2023] Open
Abstract
Background: Access to reliable birth data (birthweight (BW) and gestational age (GA)) is essential for the identification of individuals who are at subsequent health risk. Aims: This study aimed to explore the feasibility of retrospectively collecting birth data for schoolchildren from parental questionnaires (PQ) and general practitioners (GPs) in primary care clinics, in inner city neighbourhoods with high density of ethnic minority and disadvantaged populations. Methods: Attempts were made to obtain birth data from parents and GPs for 2,171 London primary schoolchildren (34% White, 29% Black African origin, 25% South Asians, 12% Other) as part of a larger study of respiratory health. Results: Information on BW and/or GA were obtained from parents for 2,052 (95%) children. Almost all parents (2,045) gave consent to access their children’s health records held by GPs. On the basis of parental information, GPs of 1,785 children were successfully contacted, and GPs of 1,202 children responded. Birth data were retrieved for only 482 children (22% of 2,052). Missing birth data from GPs were associated with non-white ethnicity, non-UK born, English not the dominant language at home or socioeconomic disadvantage. Paired data were available in 376 children for BW and in 407 children for GA. No significant difference in BW or GA was observed between PQ and GP data, with <5% difference between sources regardless of normal or low birth weight, or term or preterm status. Conclusions: Parental recall of birth data for primary schoolchildren yields high quality and rapid return of data, and it should be considered as a viable alternative in which there is limited access to birth records. It provides the potential to include children with an increased risk of health problems within epidemiological studies.
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Affiliation(s)
- Rachel Bonner
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK
| | - Vassiliki Bountziouka
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK
| | - Janet Stocks
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK
| | - Seeromanie Harding
- MRC/CSO, Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow, UK
| | - Angela Wade
- Clinical Epidemiology, Nutrition and Biostatistics Section, UCL, Institute of Child Health, London, UK
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - David Sears
- 1] Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK [2] Lung Function Unit, Royal Brompton Hospital, London, UK
| | - Helen Fothergill
- 1] Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK [2] Torbay Hospital, South Devon NHS Trust, Torquay, Devon, UK
| | - Hannah Slevin
- 1] Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK [2] Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sooky Lum
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK
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19
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Health Trajectories in People with Cystic Fibrosis in the UK: Exploring the Effect of Social Deprivation. A LIFE COURSE PERSPECTIVE ON HEALTH TRAJECTORIES AND TRANSITIONS 2015. [DOI: 10.1007/978-3-319-20484-0_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Taylor-Robinson DC, Thielen K, Pressler T, Olesen HV, Diderichsen F, Diggle PJ, Smyth R, Whitehead M. Low socioeconomic status is associated with worse lung function in the Danish cystic fibrosis population. Eur Respir J 2014; 44:1363-6. [PMID: 25186272 PMCID: PMC4216452 DOI: 10.1183/09031936.00063714] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Karsten Thielen
- Dept of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tania Pressler
- Cystic Fibrosis Center, Rigshospitalet, Copenhagen, Denmark
| | - Hanne V Olesen
- Paediatric Dept A, Cystic Fibrosis Center, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Diderichsen
- Dept of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter J Diggle
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | - Margaret Whitehead
- Dept of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool, UK
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21
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Doull I. Cystic fibrosis papers of the year 2013. Paediatr Respir Rev 2014; 15 Suppl 1:10-2. [PMID: 24821549 DOI: 10.1016/j.prrv.2014.04.014] [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: 11/25/2022]
Abstract
Studies published in the last year have highlighted the need for age and disease severity appropriate outcome measures. There is conflicting evidence on the usefulness of CT scans in infancy, but increasingly lung clearance index (LCI) appears a sensitive and repeatable measure in those with milder CF lung disease. The number of well designed appropriately powered intervention studies continues to increase.
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Affiliation(s)
- Iolo Doull
- Department of Paediatric Respiratory Medicine and Paediatric Cystic Fibrosis Centre, Children's Hospital for Wales, Cardiff, CF14 4XN, UK.
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