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Dowling-Cullen C, Sakellariou D. Decision-making regarding accessing paediatric unscheduled healthcare during the COVID-19 pandemic: a mixed methods rapid review and thematic synthesis. BMJ Open 2024; 14:e085796. [PMID: 39053956 DOI: 10.1136/bmjopen-2024-085796] [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] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE Reductions in paediatric unscheduled healthcare utilisation were seen during the COVID-19 pandemic, with concerns around their impact on children's health. The reasons for these changes are not well described. This review aims to explore the factors reported by parents that influenced their decision-making around accessing paediatric unscheduled healthcare during the COVID-19 pandemic. DESIGN Mixed methods rapid review and thematic synthesis based on the Enhancing Transparency of Reporting the Synthesis of Qualitative research framework. DATA SOURCES MEDLINE, Embase, Web of Science, PsycEXTRA, PsycINFO, Global Health, Global Index Medicus, Dissertations and Theses Global, Google Scholar and OAISter. Studies published from January 2020 to July 2023 were included. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Qualitative, quantitative and mixed methods studies that assessed the perspectives of parents on decisions to access or delay or avoid accessing paediatric unscheduled healthcare during the COVID-19 pandemic. DATA EXTRACTION AND SYNTHESIS Nvivo 14.23.0 was used to code results the of the primary studies and develop themes, following a thematic synthesis approach. RESULTS Twelve studies were included, all from high-income settings, mainly in Europe. The studies were conducted across varying times and levels of COVID-19-related restrictions. The principal descriptive themes identified were (i) concerns about COVID-19 infection, (ii) balancing and navigating risks, (iii) perception of healthcare service status and conditions and (iv) perception of information and advice. These were developed into analytic themes to further describe the decision-making process. CONCLUSIONS Parents balanced a range of risks, concerns, advice and responsibilities when considering accessing paediatric unscheduled healthcare during the COVID-19 pandemic. External sources of advice and information were important; misconceptions around public health advice may reflect the multitude of information sources and the rapidly changing circumstances of the pandemic. Public health policy and planning should consider parent perspectives when developing measures to ensure equitable access to appropriate paediatric healthcare services.
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Davis KA, Mazzenga M, Hall PB, Buchbinder D, Alderfer MA, Oberoi AR, Sharkey CM, Blakey AO, Long KA. Development of a blueprint for sibling psychosocial services: A nationwide study. Pediatr Blood Cancer 2024; 71:e30993. [PMID: 38605546 DOI: 10.1002/pbc.30993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Siblings of youth with cancer have heightened risk for poor long-term psychosocial outcomes. Although sibling psychosocial care is a standard in pediatric oncology, this standard is among those least likely to be met. To address barriers to providing sibling services, a blueprint for systematic psychosocial screening and support of siblings was developed based on feedback from a national sample of psychosocial providers. PROCEDURE Semi-structured interviews were conducted with a purposive sample of psychosocial care providers (N = 27) of various disciplines working in US pediatric cancer centers, varied in size, type, and extent of sibling support. Interviews queried providers' suggestions for the future of sibling psychosocial care and impressions of a blueprint for sibling service delivery, which was iteratively refined based on respondents' feedback. Interviews were analyzed using applied thematic analysis. RESULTS Based on existing literature and refined according to providers' recommendations, the Sibling Services Blueprint was developed to provide a comprehensive guide for systematizing sibling psychosocial care. The blueprint content includes: (i) a timeline for repeated sibling screening and assessment; (ii) a stepped model of psychosocial support; (iii) strategies for circumventing barriers to sibling care; and (iv) recommendations for how centers with varying resources might accomplish sibling-focused care. The blueprint is available online, allowing providers to easily access and individualize the content. Providers indicated enthusiasm and high potential utility and usability of the blueprint. CONCLUSIONS The Sibling Services Blueprint may be a useful tool for systematizing sibling psychosocial care, promoting wider availability of sibling-focused services, and addressing siblings' unmet needs.
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Affiliation(s)
- Kathryn A Davis
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Marcella Mazzenga
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Phoebe Brosnan Hall
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - David Buchbinder
- Division of Hematology, Children's Hospital of Orange County, Orange, California, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, Delaware, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anjali R Oberoi
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Christina M Sharkey
- Department of Psychology, The Catholic University of America, Columbia, Washington, USA
| | - Ariel O Blakey
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Kristin A Long
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
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Tseng TC, Wang TM, Hsu YC, Hsu CT, Lin YH, Lin MC. Impact of COVID-19 pandemic on neurodevelopmental outcomes of premature infants: a retrospective national cohort study. BMJ Paediatr Open 2024; 8:e002493. [PMID: 38823798 PMCID: PMC11149170 DOI: 10.1136/bmjpo-2024-002493] [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: 01/03/2024] [Accepted: 05/05/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVE To compare the neurodevelopmental outcomes of preterm infants before and during the COVID-19 pandemic. DESIGN Premature infants born in 2018 were assigned to the pre-pandemic group, while those born in 2019 were assigned to the during-pandemic group. SETTING Nationwide cohort study. PATIENTS Very low birthweight premature infants registered in the Taiwan Premature Infant Follow-up Network database. INTERVENTIONS Anti-epidemic measures, including quarantine and isolation protocols, social distancing, the closure of public spaces and restrictions on travel and gatherings during COVID-19 pandemic. MAIN OUTCOME MEASURES Outcomes were measured by Bayley Scales of Infant and Toddler Development Third Edition at corrected ages of 6, 12 and 24 months old. Generalised estimating equation (GEE) was applied to incorporate all measurements into a single model. RESULTS Among the 1939 premature infants who were enrolled, 985 developed before the pandemic, while 954 developed during the pandemic. Premature infants whose development occurred during the pandemic exhibited better cognitive composite at the corrected age of 6 months (beta=2.358; 95% CI, 1.07 to 3.65; p<0.001), and motor composite at corrected ages of 12 months (beta=1.680; 95% CI, 0.34 to 3.02; p=0.014). GEE analysis showed that infants who had grown during the pandemic achieved higher scores in cognitive composite (beta=1.416; 95% CI, 0.36 to 2.48; p=0.009). CONCLUSION Premature infants in Taiwan who developed during the pandemic showed better neurodevelopment compared with those born before the pandemic.
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Affiliation(s)
- Tzu-Cheng Tseng
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Teh-Ming Wang
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ya-Chi Hsu
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Ting Hsu
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yi-Hsuan Lin
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Chih Lin
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Food and Nutrition, Providence University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Hilberath J, Mast AS, Holweg M, Kränkel L, Remppis J, Renk H, Lang P, Schulte J, Fuchs J, Slavetinsky C. Quality of life and healthcare utilization during the COVID-19 pandemic are more restricted in chronically ill than in healthy children: a tertiary care children's hospital experience. Eur J Pediatr 2024; 183:1801-1810. [PMID: 38253757 PMCID: PMC11001739 DOI: 10.1007/s00431-023-05382-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/05/2023] [Accepted: 12/10/2023] [Indexed: 01/24/2024]
Abstract
The global COVID-19 pandemic forced changes in everyday life of children and adolescents due to government containment measures, an altered healthcare accessibility and utilization, and public concern about SARS-CoV-2 transmission. Data on the challenges and impact on children and their families with chronic diseases are limited. The primary objectives of this study were to assess (i) concerns for SARS-CoV-2 infection, (ii) perceived effects on health-related and overall quality of life (HRQoL and QoL), and (iii) accessibility and utilization of healthcare, comparing families with chronically ill children to families with healthy children during the second SARS-CoV-2 infection wave in Germany. A caregiver questionnaire was designed and participation offered in the emergency department and outpatient clinic of a German tertiary care children's hospital. 45.9% of the 205 participants were majorly concerned about their children contracting a SARS-CoV-2 infection. Caregivers of chronically ill children (128/205, 62.4%) stated significantly more often a negative impact on their child's QoL (w = 0.17; p = 0.014), while caregivers of chronically ill adolescents over the age of 13 expressed significantly more frequent a negative impact on their child's HRQoL (w = 0.21; p = 0.016). Outpatient appointments for chronically ill children were significantly more often canceled (w = 0.17; p = 0.025). Caregivers of chronically ill children were significantly more likely to report that they would actively delay hospital visits for emerging health issues due to the pandemic (w = 0.12; p = 0.049). Conclusion: Our findings underscore the importance of identifying families with chronically ill children as a vulnerable patient group with higher burdens during the COVID-19 pandemic and potential future pandemics. Healthcare providers may mitigate such burdens by ensuring reliable appointment allocation, offering contactless healthcare options, and providing tailored advice regarding vulnerabilities and preventive measures specific to their chronically ill children. What is Known: • The SARS-CoV-2 pandemic has led to significant restrictions in everyday life and both accessibility and utilization of healthcare for children and adolescents. • Chronically ill children faced exceptional challenges as they depend on regular and functioning medical care, but data comparing the pandemic's impact between chronically ill and healthy children are lacking. What is New: • The perceived impact of the SARS-CoV-2 pandemic on quality of life is more negative for chronically ill children and their health-related quality of life is more often affected compared to healthy children. • Caregivers of chronically ill children would more often delay a visit to their child's doctor during the SARS-CoV-2 pandemic and their medical appointments are more often postponed which both could increase health burdens for such vulnerable patients.
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Affiliation(s)
- Johannes Hilberath
- Department of Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Straße 1, 72076, Tübingen, Germany
| | - Anna-Sophia Mast
- Department of Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Straße 1, 72076, Tübingen, Germany.
| | - Maximilian Holweg
- Pediatric Surgery and Urology, University Children's Hospital Tübingen, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Lara Kränkel
- Pediatric Surgery and Urology, University Children's Hospital Tübingen, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
- Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany
| | - Jonathan Remppis
- Department of Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Straße 1, 72076, Tübingen, Germany
| | - Hanna Renk
- University Children's Hospital Tübingen, Hoppe-Seyler-Straße 1, 72076, Tübingen, Germany
| | - Peter Lang
- Department of Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Straße 1, 72076, Tübingen, Germany
| | - Johannes Schulte
- Department of Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Straße 1, 72076, Tübingen, Germany
| | - Jörg Fuchs
- Pediatric Surgery and Urology, University Children's Hospital Tübingen, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Christoph Slavetinsky
- Pediatric Surgery and Urology, University Children's Hospital Tübingen, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
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Geweniger A, Barth M, Haddad A, Högl H, Insan S, Mund A, Langer T. Perceived social support and characteristics of social networks of families with children with special healthcare needs following the COVID-19 pandemic. Front Public Health 2024; 12:1322185. [PMID: 38487183 PMCID: PMC10937572 DOI: 10.3389/fpubh.2024.1322185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
Background Children with special healthcare needs (CSHCN) require more support than the average of their peers. Support systems for CSHCN were particularly affected by pandemic control measures. Perceived social support is a resource for health and wellbeing for CSHCN and their families. Associations of social support, mental health and socioeconomic status (SES) have been described. This study aims to (1) assess perceived social support in families with and without CSHCN; (2) describe structure and types of social networks of families with and without CSHCN; and (3) explore associations between perceived social support, disease complexity, child and caregiver mental health, and SES. Methods This is the third of a sequential series of cross-sectional online surveys conducted among caregivers of children ≤ 18 years in Germany since the beginning of the COVID-19 pandemic, administered between 1st December 2022 and 10 March 2023. The Brief Social Support Scale (BS6) assessed perceived social support. Child and parental mental health were assessed using the Strengths and Difficulties Questionnaire (SDQ) and WHO-5 Wellbeing index. The CSHCN-Screener identified CSHCN. Descriptive statistics and linear regression modeling assessed associations between perceived social support, parent-reported child mental health problems, disease complexity, caregiver mental wellbeing and SES. Results The final sample included 381 participants, among them 76.6% (n = 292) CSHCN. 46.2% (n = 176) of caregivers reported moderate, i.e., at least occasional social support. Social support was largely provided by informal social networks consisting of partners, relatives and neighbors/friends. Linear regression modeling revealed associations of lower perceived social support with higher disease complexity of the child, lower caregiver mental wellbeing, lower SES and increasing caregiver age. Conclusion The results of this study describe inequalities in perceived social support according to disease complexity of the child, caregiver mental health and socioeconomic status. They highlight the importance of social support and support networks as a resource for wellbeing of caregivers and CSHCN. Moving on from the COVID-19 pandemic, recovery strategies should focus on low-threshold interventions based in the community to improve social support for families with CSHCN and actively involve caregivers in identifying needs and co-creating new approaches.
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Affiliation(s)
- Anne Geweniger
- Department of Neuropediatrics and Muscle Disease, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
| | - Michael Barth
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
| | - Anneke Haddad
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
| | | | - Shrabon Insan
- Department of Neuropediatrics and Muscle Disease, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
| | | | - Thorsten Langer
- Department of Neuropediatrics and Muscle Disease, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
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Zybarth D, Brandt M, Mundlos C, Inhestern L. [Consequences of a pandemic for people living with rare diseases and recommendations for maintaining healthcare and participation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:57-65. [PMID: 38019314 PMCID: PMC10776713 DOI: 10.1007/s00103-023-03810-4] [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: 03/30/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Rare diseases are often characterized by complex symptoms and usually require coordination of multiprofessional treatment during the diagnostic and healthcare processes. In the wake of the COVID-19 pandemic, the healthcare situation and daily life of people with rare diseases and the caregivers of children with rare diseases changed drastically. The aim of the research project RESILIENT-SE-PAN was to assess the situation of people with rare diseases and caregivers during COVID-19 and to develop recommendations based on the findings. METHODS We conducted a mixed methods study including the perspective of people with rare diseases, caregivers and representatives from patient organizations and conducted a concluding workshop. RESULTS The findings indicate an impact on healthcare and daily life of participants. Moreover, mental burden, supportive needs, COVID-19-specific aspects but also positive aspects were mentioned. Based on the findings from our mixed methods study, we developed 21 recommendations referring to the following topics: medical diagnostics and healthcare of the rare diseases, additional therapies and aids, access to COVID-19 information and vaccination, psychosocial support, participation and activities, patient organisations and others. DISCUSSION The recommendations can provide an orientation for the organisation of healthcare in future crises or pandemics in order to adequately take the situations of people with rare diseases into account and consider the needs of this patient group.
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Affiliation(s)
- David Zybarth
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Maja Brandt
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Christine Mundlos
- Allianz Chronischer Seltener Erkrankungen (ACHSE) e. V., Berlin, Deutschland
| | - Laura Inhestern
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Harris BN, Bauer CM, Carr JA, Gabor CR, Grindstaff JL, Guoynes C, Heppner JJ, Ledon-Rettig CC, Lopes PC, Lynn SE, Madelaire CB, Neuman-Lee LA, Palacios MG, Soto P, Terry J. COVID-19 as a chronic stressor and the importance of individual identity: A data-driven look at academic productivity during the pandemic. Gen Comp Endocrinol 2024; 345:114394. [PMID: 37871848 DOI: 10.1016/j.ygcen.2023.114394] [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: 09/06/2023] [Revised: 10/04/2023] [Accepted: 10/15/2023] [Indexed: 10/25/2023]
Abstract
The COVID-19 pandemic impacted personal and professional life. For academics, research, teaching, and service tasks were upended and we all had to navigate the altered landscape. However, some individuals faced a disproportionate burden, particularly academics with minoritized identities or those who were early career, were caregivers, or had intersecting identities. As comparative endocrinologists, we determine how aspects of individual and species-level variation influence response to, recovery from, and resilience in the face of stressors. Here, we flip that framework and apply an integrative biological lens to the impact of the COVID-19 chronic stressor on our endocrine community. We address how the pandemic altered impact factors of academia (e.g., scholarly products) and relatedly, how factors of impact (e.g., sex, gender, race, career stage, caregiver status, etc.) altered the way in which individuals could respond. We predict the pandemic will have long-term impacts on the population dynamics, composition, and landscape of our academic ecosystem. Impact factors of research, namely journal submissions, were altered by COVID-19, and women authors saw a big dip. We discuss this broadly and then report General and Comparative Endocrinology (GCE) manuscript submission and acceptance status by gender and geographic region from 2019 to 2023. We also summarize how the pandemic impacted individuals with different axes of identity, how academic institutions have responded, compile proposed solutions, and conclude with a discussion on what we can all do to (re)build the academy in an equitable way. At GCE, the first author positions had gender parity, but men outnumbered women at the corresponding author position. Region of manuscript origin mattered for submission and acceptance rates, and women authors from Asia and the Middle East were the most heavily impacted by the pandemic. The number of manuscripts submitted dropped after year 1 of the pandemic and has not yet recovered. Thus, COVID-19 was a chronic stressor for the GCE community.
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Affiliation(s)
- Breanna N Harris
- Texas Tech University, Department of Biological Science, Lubbock, TX 79409, USA.
| | - Carolyn M Bauer
- Swarthmore College, Department of Biology, Swarthmore, PA 19081 USA
| | - James A Carr
- Texas Tech University, Department of Biological Science, Lubbock, TX 79409, USA
| | | | - Jennifer L Grindstaff
- Oklahoma State University, Department of Integrative Biology, Stillwater, OK 74078, USA
| | | | | | - Cris C Ledon-Rettig
- Indiana University Bloomington, Department of Biology, Bloomington, IN 47405, USA
| | - Patricia C Lopes
- Schmid College of Science and Technology, Chapman University, Orange, CA 92866, USA
| | - Sharon E Lynn
- The College of Wooster, Department of Biology, Wooster, OH 44691, USA
| | - Carla B Madelaire
- Beckman Center for Conservation Research, San Diego Zoo Wildlife Alliance, Escondido, CA 92025, USA
| | | | - Maria G Palacios
- Centro Para el Estudio de Sistemas Marinos, CCT CONICET-CENPAT, Blvd. Brown 2915, Puerto Madryn, Chubut, Argentina
| | - Paul Soto
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Jennifer Terry
- Arkansas State University, State University, AR 72467, USA
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Thomas S, Byrne LK, Ryan NP, Hendrieckx C, White V. Unmet supportive care needs in families of children with chronic health conditions: an Australian cross-sectional study. World J Pediatr 2023; 19:1181-1191. [PMID: 37246167 PMCID: PMC10225288 DOI: 10.1007/s12519-023-00730-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/01/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND The aim of this study was to identify similarities and differences in the unmet supportive care needs (USCN) of families of children with major chronic health conditions (CHCs) using a universal need assessment tool. METHODS A cross-sectional online survey involving parents of children with congenital heart disease (CHD), type 1 diabetes mellitus (T1D), cancer, and asthma diagnosed within the last 5 years recruited via social media and support organizations. Thirty-four items assessing the USCN across six domains (care needs, physical and social needs, informational needs, support needs, financial needs, child-related emotional needs) were responded to on a 4-point Likert scale [no need (1) to high need (4)]. Descriptive statistics identified the level of need, and linear regressions identified factors associated with higher need domain scores. Due to small numbers, the asthma group was excluded from comparisons across CHCs. RESULTS One hundred and ninety-four parents completed the survey (CHD: n = 97, T1D: n = 50, cancer: n = 39, and asthma: n = 8). Parents of children with cancer were most likely to report at least one USCN (92%), followed by parents of children with T1D (62%). The five most commonly reported USCN across CHCs were drawn from four domains: child-related emotional, support, care, and financial. Three need items were included in the top five needs for all conditions. A higher USCN was associated with a greater frequency of hospital visits and the absence of parental support. CONCLUSIONS Using a universal need assessment tool, this is one of the first studies to characterize USCN in families of children diagnosed with common CHCs. While proportions endorsing different needs varied across conditions, the most endorsed needs were similar across the illness groups. This suggests that support programs or services could be shared across different CHCs. Video Abstract.
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Affiliation(s)
- Sangeetha Thomas
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia.
| | - Linda K Byrne
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia
| | - Nicholas P Ryan
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Christel Hendrieckx
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia
- Australian Centre for Behavioural Research in Diabetes, Melbourne, VIC, Australia
- Institute of Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Victoria White
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia.
- Cancer Council Victoria, Melbourne, VIC, Australia.
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von Mackensen S, Santaella ME, Nichols CD, Khair K, Lambing AY, Witkop ML. Cross-cultural assessment of the influence of the COVID-19 pandemic on the perceived mental health and medical experiences of persons with inherited bleeding disorders and their parents/guardians. Expert Rev Hematol 2023; 16:1107-1123. [PMID: 38099480 DOI: 10.1080/17474086.2023.2277323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 10/19/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Objectives were to 1) assess COVID-19-associated medical and psychological challenges facing persons with inherited bleeding disorders (PIBD) and their parents/guardians (PG) in Germany, the US, and the UK; 2) describe similarities and differences among these countries; 3) identify needs and opportunities for intervention by patient advocacy organizations (PAGs). RESEARCH DESIGN & METHODS A cross-sectional, international survey was conducted in three countries using validated psychometric instruments and investigator-developed items. RESULTS Five hundred and four surveys were included. Significant differences between countries were found including experiences with medical care, specific thoughts, and concerns about COVID-19, anxiety, and other mental health measures, as well as resources used to cope with stress. Age, education, income, race, IBD diagnosis, PIBD vs. BD group, and gender had moderating effects on resources used. Communication with friends/relatives and use of PAG and HTCs as resources for information/coping decreased in all countries during the pandemic. CONCLUSIONS There were similarities and differences between respondents across the country in the perceived impact of the pandemic, mental health scores, and strategies used to cope with stress. Recommendations: strategies to increase PAG access for PIBD and their PG during pandemics and natural disasters, ongoing assessment and adaptation to provide supportive resources to specific patient subgroups.
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Affiliation(s)
- Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Cynthia D Nichols
- Munson Medical Center, Quality & Safety Department, Traverse City, MI and National Bleeding Disorders Foundation, consultant to the Research Department, New York, NY, USA
| | | | | | - Michelle L Witkop
- National Bleeding Disorders Foundation at time of research, consultant at time of publication, Traverse City, MI, USA
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Struckmeyer N, Biester T, Kordonouri O, Weiner C, Sadeghian E, Guntermann C, Kapitzke K, Weiskorn J, Galuschka L, von Stuelpnagel K, Meister D, Lange K, Danne T, Reschke F. Alterations in Dietary Behavior, Appetite Regulation, and Health-Related Quality of Life in Youth with Obesity in Germany during the COVID-19 Pandemic. Nutrients 2023; 15:2936. [PMID: 37447261 DOI: 10.3390/nu15132936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the impact of the COVID-19 pandemic on the nutritional patterns, eating behavior, dietary content, and health-related quality of life (HrQoL) of adolescents with preexisting obesity. METHODS Anthropometric and metabolic parameters were measured, and validated questionnaires on eating habits, nutritional content, and HrQoL were administered to 264 adolescents with obesity during the COVID-19 pandemic (June 2020-June 2022) and 265 adolescents with obesity before the pandemic (from June 2017 to June 2019). RESULTS Both study cohorts were comparable in age and sex distribution. Significant differences were found between the COVID-19 and pre-COVID-19 cohorts in HOMA-index (3.8 (interquartile range [IQR])): 3.3; 4.1) vs. 3.2 (IQR: 2.8; 3.5, p < 0.001), total cholesterol (208.8 mg/dL (IQR: 189.9; 214.5) vs. 198.5 mg/dL (IQR: 189.5; 207.4), p < 0.001), and GPT (93.4 (IQR 88.7; 96.5) vs. 72.8 U/L (IQR 68.9; 75.7), p < 0.001). The COVID-19 cohort reported significantly higher consumption of obesity-promoting food components, such as soft drinks, meat, sausages, fast food and delivery food, chocolate, and sweets. There was also a significant decrease in cognitive hunger control (p = 0.002) and an increase in distractibility potential (p = 0.001) while eating. HrQoL was significantly lower in the COVID-19 cohort (p = 0.001). CONCLUSIONS This study reveals the adverse associations of exposure to the public health measures during the COVID-19 pandemic with nutrition, dietary content, and HrQoL in adolescents with preexisting obesity. These findings underscore the importance of tailored preventive and treatment strategies for addressing the specific challenges of disruptive events such as pandemics, especially in population-based context.
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Affiliation(s)
- Nora Struckmeyer
- Center for Pediatric Diabetology, Endocrinology, and Metabolism, Children's Hospital AUF DER BULT, 30173 Hannover, Germany
| | - Torben Biester
- Center for Pediatric Diabetology, Endocrinology, and Metabolism, Children's Hospital AUF DER BULT, 30173 Hannover, Germany
| | - Olga Kordonouri
- Center for Pediatric Diabetology, Endocrinology, and Metabolism, Children's Hospital AUF DER BULT, 30173 Hannover, Germany
| | - Chantal Weiner
- Center for Pediatric Diabetology, Endocrinology, and Metabolism, Children's Hospital AUF DER BULT, 30173 Hannover, Germany
| | - Evelin Sadeghian
- Center for Pediatric Diabetology, Endocrinology, and Metabolism, Children's Hospital AUF DER BULT, 30173 Hannover, Germany
| | - Cathrin Guntermann
- Center for Pediatric Diabetology, Endocrinology, and Metabolism, Children's Hospital AUF DER BULT, 30173 Hannover, Germany
| | - Kerstin Kapitzke
- Center for Pediatric Diabetology, Endocrinology, and Metabolism, Children's Hospital AUF DER BULT, 30173 Hannover, Germany
| | - Jantje Weiskorn
- Center for Pediatric Diabetology, Endocrinology, and Metabolism, Children's Hospital AUF DER BULT, 30173 Hannover, Germany
| | - Laura Galuschka
- Center for Pediatric Diabetology, Endocrinology, and Metabolism, Children's Hospital AUF DER BULT, 30173 Hannover, Germany
| | - Kisa von Stuelpnagel
- Center for Pediatric Diabetology, Endocrinology, and Metabolism, Children's Hospital AUF DER BULT, 30173 Hannover, Germany
- Department for Sports Science, University of Hildesheim, 31141 Hildesheim, Germany
| | - Daniela Meister
- Center for Pediatric Diabetology, Endocrinology, and Metabolism, Children's Hospital AUF DER BULT, 30173 Hannover, Germany
| | - Karin Lange
- Medical Psychology, Hannover Medical School, 30625 Hannover, Germany
| | - Thomas Danne
- Center for Pediatric Diabetology, Endocrinology, and Metabolism, Children's Hospital AUF DER BULT, 30173 Hannover, Germany
| | - Felix Reschke
- Center for Pediatric Diabetology, Endocrinology, and Metabolism, Children's Hospital AUF DER BULT, 30173 Hannover, Germany
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Zybarth D, Brandt M, Mundlos C, Inhestern L. Impact of the COVID-19 pandemic on health care and daily life of patients with rare diseases from the perspective of patient organizations - a qualitative interview study. Orphanet J Rare Dis 2023; 18:154. [PMID: 37344904 DOI: 10.1186/s13023-023-02771-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/04/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic people affected by rare diseases (RD) or caregiver of affected children have faced additional challenges. The pandemic has affected physical and mental health, social life and has led to financial consequences. Our objectives were to identify the impact of COVID-19 (1) on health care and (2) on daily life and participation of patients with RDs or caregivers from the perspective of representatives of patient organizations. Moreover, we explored their perspective on experiences of pandemic stress and resources during the pandemic. RESULTS We conducted 18 semi-structured interviews with representatives of patient organizations (e.g. chairperson, members of the steering committee), who were asked about the experiences of their members. The interviews were transcribed verbatim and analyzed using the framework approach. We contextualized our findings on the basis of the International Classification of Functioning, Disability and Health (ICF) model and adapted it according to identified subthemes. Patients and caregivers were confronted with aspects of pandemic stress such as lack of information, access and information regarding vaccination and being a risk group for COVID-19 infection. Physical and mental functioning was reported to be negatively impacted. Lock downs and contact restrictions led, e.g., to increasing lack of nursing services or lack of necessary informal support. Participation e.g. in social life and work was reduced. Health care services including medical care and supportive care as well as additional therapies were disrupted and greater effort was necessary to organize care. According to participants, central resources were informal support networks, digitalization, patient organizations and individual characteristics. CONCLUSIONS Our study highlights the consequences of the COVID-19 pandemic on the situation of people affected by RDs and caregivers. Contextualization of the results into the biopsychosocial model reinforces the impact of the pandemic on health care as well as daily life and participation. Major challenges and difficulties were experienced during lockdowns and contact restrictions. Depending on the risk of an infection with COVID-19, certain patient groups were still isolated and reduced social contacts or still followed strict hygienic measures (e.g., wearing medical masks). Future pandemic control measures, e.g. on lockdowns and closing facilities, should consider the challenges of people with RDs and caregivers of affected children.
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Affiliation(s)
- David Zybarth
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maja Brandt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Mundlos
- Allianz Chronischer Seltener Erkrankungen (ACHSE) e.V, Berlin, Germany
| | - Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Flynn A, Whittaker K, Donne AJ, Bray L, Carter B. Feeling stretched: Parents' narratives about challenges to resilience when their child has a tracheostomy. J Child Health Care 2023:13674935231169409. [PMID: 37050871 DOI: 10.1177/13674935231169409] [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: 04/14/2023]
Abstract
This study aimed to examine how parents develop personal resilience when facing the challenges of caring for a child with tracheostomy. This study employed a longitudinal qualitative design. Unstructured narrative interviews with 12 parents (from nine families) whose child had a new tracheostomy were undertaken at three time points over 12 months. Data were analysed using a socio-narratology method. Findings reveal the journey parents experienced, how their feelings changed and the processes involved in developing resilience over the first 12 months of their child having a tracheostomy. Stories told by parents early in their journey revealed emotional upheaval, negative emotions, stress and shock. Due to medical need, parents had little or no choice for their child to have a tracheostomy. Once their child's life was out of danger, parents started to reframe their experiences and beliefs. Resilience played a major part in how parents perceived and faced their situation, allowing them to deal with what came their way and to move forward with their lives. Different aspects of resilience such as self-awareness, grit, gratitude, internal locus of control and reframing came to the fore at different time points. Parents talked feeling stretched by the challenges they faced and how they reframed their perspectives about their child's tracheostomy. Parents' resilience and reframing is discussed in relation to the ABC-X model. This study identifies a theoretical model that explains this process of change, this results in transferable knowledge, useful for understanding and explaining the experience of other parents and families.
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Affiliation(s)
- Alison Flynn
- Alder Hey Children's NHS Foundation Trust Liverpool, Merseyside, UK
| | - Karen Whittaker
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Adam J Donne
- Alder Hey Children's NHS Foundation Trust Liverpool, Merseyside, UK
| | - Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
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Bhatt KJ, Schulder T, Rudenstine S, McNeal K, Ettman CK, Galea S. Understanding the Mental Health Impact of the COVID-19 Pandemic Among Individuals With Chronic Illness. Psychol Rep 2023:332941231164338. [PMID: 36932930 PMCID: PMC10028451 DOI: 10.1177/00332941231164338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
People with chronic illnesses are vulnerable to stress and psychopathology during population-level disasters, as a subset of individuals with disabilities. We aimed to examine the relationships between chronic illness, cumulative and specific stressors, and probable depression, probable anxiety, and post-traumatic stress in an under-resourced urban population in New York City during the COVID-19 pandemic. Using cross-sectional survey data collected in April 2020, we utilized bivariate chi-square analyses and multivariable logistic regression models to estimate differences in and adjusted odds of stressor endorsement and diagnostic prevalence between people with and without chronic illness. We also assessed effect modification of the relationship between stressor exposure and psychopathology by chronic illness status. Compared to people without chronic illness, those who reported having a chronic illness experienced increased odds of probable depression, probable anxiety, and post-traumatic stress. They were also more likely to report high cumulative COVID-19-related stress exposure, death of someone close to them due to coronavirus or COVID-19, family problems, feeling alone, supply shortages, and financial problems. Chronic illness was found to be an effect modifier in the relationship between the death of someone close due to coronavirus or COVID-19 and probable depression and between household job loss and probable anxiety.
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Affiliation(s)
- Krish J Bhatt
- Mailman School of Public Health, 33638Columbia University, New York, NY, USA
| | - Talia Schulder
- City University of New York, 14770The City College of New York, New York, NY, USA
| | - Sasha Rudenstine
- City University of New York, 14770The City College of New York, New York, NY, USA
| | - Kat McNeal
- City University of New York, 14770The City College of New York, New York, NY, USA
| | | | - Sandro Galea
- School of Public Health, 1846Boston University, Boston, MA, USA
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