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Tingström J, Öst E, Bergman G, Burström Å. Home monitoring of fetal heart rhythm: Lived experiences of women with anti-SSA/Ro52 autoantibodies and their co-parents. Lupus 2024; 33:685-692. [PMID: 38571373 PMCID: PMC11193317 DOI: 10.1177/09612033241244465] [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: 11/18/2023] [Accepted: 03/13/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE The aim of this study was to explore the parents' experiences of home monitoring of the fetal heart rhythm. Women with anti-SSA/Ro52 autoantibodies carry a 2%-3% risk of giving birth to a child with congenital heart block (CHB), following transplacental transfer and antibody-mediated inflammation in the fetal conduction system during 18th to 24th gestational week. Early detection and subsequent treatment have been reported to decrease morbidity and mortality. Therefore, home monitoring of the fetal heart rhythm by Doppler has been offered at our fetal cardiology center. This study was undertaken to explore the lived experience of the routine. METHODS Participants were recruited from a single fetal cardiology center. Consecutive sampling was used. The inclusion criteria were women with SSA/Ro52 antibodies who had undergone Doppler examinations within the last two and a half years at the hospital and had monitored the fetal heartbeat at home. A semi-structured questionnaire was created, and the participants were interviewed individually. The interviews were transcribed verbatim and analyzed according to qualitative content analysis. RESULTS The overall theme was defined as "walking on thin ice," with six underlying categories: reality, different strategies, gain and loss, healthcare providers, underlying tension, and conducting the examinations again, all with a focus on how to handle the home monitoring during the risk period. CONCLUSION Both the mother and the co-parent expressed confidence in their own abilities and that the monitoring provided them with the advantage of growing a bond with the expected child. However, all the participants described a feeling of underlying tension during the risk period. The results show that home monitoring is not experienced as complicated or a burden for the parents-to-be and should be considered a vital part of the chain of care for mothers at risk for giving birth to a child with CHB. However, explaining the teamwork between the different caregivers, for the patients involved, their areas of expertise, and how they collaborate with the patient continues to be a pedagogic challenge and should be developed further.
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Affiliation(s)
- Joanna Tingström
- Department of Obstetrics and Gynecology, Department of Clinical Science and Education Karolinska Institutet, Stockholm, Sweden
| | - Elin Öst
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Bergman
- Department of Women’s and Children’s Health, Karolinska Institutet and Department of Pediatric Cardiolgoy, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Burström
- Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
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Urichuk M, Singh C, Zrinyi A, Lum Min SA, Keijzer R. Mental Health Outcomes of Mothers of Children With Congenital Gastrointestinal Anomalies Are Similar to Control Mothers: A Longitudinal Retrospective Cohort Study. J Pediatr Surg 2024; 59:918-923. [PMID: 38365470 DOI: 10.1016/j.jpedsurg.2024.01.011] [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: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Mothers of infants born with congenital gastrointestinal surgical anomalies experience a unique caregiving role. Whether these challenges result in more mental health diagnoses than the general population is unknown. This study assessed mental health diagnoses in mothers of children born with congenital surgical anomalies (CSA) compared to mothers of children without CSA. METHODS A total of 780 mothers of children with CSA (case-mothers) and 6994 control-mothers were included. Mental health diagnoses were obtained using International Classification of Diseases 9 codes from an administrative database. Multivariate hazard ratios (HR) of mental health diagnoses were determined for mothers following childbirth, controlling for socioeconomic status, mental health diagnoses prior to childbirth, and age at childbirth. Subgroup analyses were completed for anxiety, depression, and post-traumatic stress disorder (PTSD). The association between a woman's mental health history and becoming a case-mother was analyzed using risk ratios (RR). RESULTS Case-mothers were not at increased risk of mental health disorders compared to controls (HR = 1.00; CI95 = 0.92-1.09). In aggregate analysis, no increased risk of anxiety, depression, or PTSD was found. Subgroup analyses revealed that congenital diaphragmatic hernia case-mothers had an increased risk of depression (HR = 1.43; CI95 = 1.08-1.88). No other case-mothers were at increased risk of mental health diagnoses, anxiety, depression, or PTSD. Only omphalocele was associated with mental health diagnoses before childbirth (RR = 1.89; CI95 = 1.58-2.26). CONCLUSIONS Collectively, mothers of children with CSAs did not have a greater risk of a mental health disorder, anxiety, depression, or PTSD compared to control-mothers. Only mothers of children with congenital diaphragmatic hernia had an increased risk of depression. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Matthew Urichuk
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Charanpal Singh
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Anna Zrinyi
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Suyin A Lum Min
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Keijzer
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
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Kruszecka-Krówka A, Cepuch G, Micek A. Stress Coping Strategies in Parents of Newborns and Infants with Congenital Cyanotic Heart Disease with Regard to Stress Levels and Negative Emotions. CHILDREN (BASEL, SWITZERLAND) 2024; 11:508. [PMID: 38790503 PMCID: PMC11120106 DOI: 10.3390/children11050508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Parents of children suffering from congenital heart disease experience high levels of stress and negative emotions. Therefore, recognition of parents' emotional states and their ways of coping with it is becoming more and more important. METHODS The study group consisted of 154 parents of newborns and infants with cyanotic congenital heart disease, before and after cardiac surgery (partial or full). To assess parental negative emotions, the level of stress, and strategies of coping with it, standardized questionnaires, such as HADS-M, PSS-10, and COPE, were used. RESULTS Stress levels in parents were high and associated with negative emotions (anxiety, depression, irritability), as well as the choice of non-constructive coping strategies, which was observed especially in younger parents. CONCLUSIONS Assessing parents' stress levels and ways of coping with stress can improve family functioning and provide better development conditions for the child.
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Affiliation(s)
- Agnieszka Kruszecka-Krówka
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, 25 Kopernik Street, 31-501 Krakow, Poland;
| | - Grażyna Cepuch
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, 25 Kopernik Street, 31-501 Krakow, Poland;
| | - Agnieszka Micek
- Statistical Laboratory, Faculty of Health Sciences, Jagiellonian University Medical College, 25 Kopernik Street, 31-501 Krakow, Poland;
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Thomas S, Ryan NP, Byrne LK, Hendrieckx C, White V. Psychological Distress Among Parents of Children With Chronic Health Conditions and Its Association With Unmet Supportive Care Needs and Children's Quality of Life. J Pediatr Psychol 2024; 49:45-55. [PMID: 37840456 PMCID: PMC10799716 DOI: 10.1093/jpepsy/jsad074] [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: 04/19/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVE To assess parent psychological distress in families of children with common chronic health conditions (CHC) and to explore relationships between parent psychological distress, unmet supportive care needs and children's quality of life (QoL). METHOD Cross-sectional study involving parents of children diagnosed with a common CHC between 0 and 12 years of age and who had received treatment within the last 5 years. Eligible parents completed an online survey, that included the Depression Anxiety Stress Scale (DASS-21) assessing distress in parents and a 34-item assessment of unmet supportive care needs across 6 domains. Parents completed ratings of their child's current functioning (QoL) using the 23-item PedsQL. Multivariable regression models examined the relative association between unmet needs, children's QoL and parents' depression, anxiety, and stress. RESULTS The sample consisted of 194 parents of children with congenital heart disease (n=97; 50%), diabetes (n=50; 26%), cancer (n=39; 20%), and asthma (n=8; 4%). A significant proportion of parents had moderate-severe symptoms of depression (26%), anxiety (38%), and stress (40%). Of the PedsQL scales, the poorest outcomes were found for emotional and school functioning. Multivariable analyses showed that both higher unmet needs and poorer child emotional functioning were associated with parent depression, anxiety, and stress symptoms. CONCLUSION Evidence linking parent distress symptoms to higher unmet needs and poorer child emotional functioning suggests these factors may be targets for interventions to alleviate parent distress. Longitudinal research using larger samples is required to replicate findings, and clarify the magnitude and direction of associations.
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Affiliation(s)
- Sangeetha Thomas
- Faculty of Health, School of Psychology, Deakin University, Australia
| | - Nicholas P Ryan
- Faculty of Health, School of Psychology, Deakin University, Australia
- Department of Paediatrics, University of Melbourne, Australia
| | - Linda K Byrne
- Faculty of Health, School of Psychology, Deakin University, Australia
- Faculty of Psychology, Counselling and Psychotherapy, The Cairnmillar Institute, Australia
| | - Christel Hendrieckx
- Faculty of Health, School of Psychology, Deakin University, Australia
- The Australian Centre for Behavioural Research in Diabetes, Australia
- Faculty of Health, Institute of Health Transformation, Deakin University, Australia
| | - Victoria White
- Faculty of Health, School of Psychology, Deakin University, Australia
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
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Rodrigues MG, Rodrigues JD, Moreira JA, Clemente F, Dias CC, Azevedo LF, Rodrigues PP, Areias JC, Areias ME. A randomized controlled trial to assess the impact of psychoeducation on the quality of life of parents with children with congenital heart defects-Quantitative component. Child Care Health Dev 2024; 50:e13199. [PMID: 37967565 DOI: 10.1111/cch.13199] [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: 02/20/2023] [Revised: 08/30/2023] [Accepted: 10/19/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE To develop, implement and assess the results of psychoeducation to improve the QoL of parents with CHD newborns. METHODS Participants were parents of inpatient newborns with the diagnosis of non-syndromic CHD. We conducted a parallel RCT with an allocation ratio of 1:1 (intervention vs. control), considering the newborns, using mixed methods research. The intervention group received psychoeducation (Parental Psychoeducation in CHD [PPeCHD]) and the usual routines, and the control group received just the regular practices. The allocation concealment was assured. PI was involved in enrolling participants, developing and implementing the intervention, data collection and data analysis. We followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. RESULTS Parents of eight newborns were allocated to the intervention group (n = 15 parents) and eight to the control group (n = 13 parents). It was performed as an intention-to-treat (ITT) analysis. In M2 (4 weeks), the intervention group presented better QoL levels in the physical, psychological, and environmental domains of World Health Organization Quality of Life instrument (WHOQOL-Bref). In M3 (16 weeks), scores in physical and psychological domains maintained a statistically significant difference between the groups. CONCLUSIONS The PPeCHD, the psychoeducational intervention we developed, positively impacted parental QoL. These results support the initial hypothesis. This study is a fundamental milestone in this research field, adding new essential information to the literature.
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Affiliation(s)
- Marisa Garcia Rodrigues
- Department of Pediatric Cardiology, University Hospital Center of São João (CHUSJ), Porto, Portugal
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University (FMUP), Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS) - EvidenS&HTA, FMUP, Porto, Portugal
| | - José Daniel Rodrigues
- Center for Health Technology and Services Research (CINTESIS) - EvidenS&HTA, FMUP, Porto, Portugal
| | - Jorge Antunes Moreira
- Department of Pediatric Cardiology, University Hospital Center of São João (CHUSJ), Porto, Portugal
| | - Fátima Clemente
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University (FMUP), Porto, Portugal
- Neonatal Intensive Care Unit, Neonatology Department, CHUSJ, Porto, Portugal
- São João Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Training Center, CHUSJ, Porto, Portugal
| | - Cláudia Camila Dias
- Knowledge Management Unit and Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), FMUP, Porto, Portugal
- RISE@CINTESIS, FMUP, Porto, Portugal
| | - Luís Filipe Azevedo
- RISE@CINTESIS, FMUP, Porto, Portugal
- Department of Community Medicine, MEDCIDS, FMUP, Porto, Portugal
- Clinical and Health Services Research (PDICSS), FMUP, Porto, Portugal
| | - Pedro Pereira Rodrigues
- RISE@CINTESIS, FMUP, Porto, Portugal
- Department of Community Medicine, MEDCIDS, FMUP, Porto, Portugal
- Health Data Science (PDCDS), FMUP, Porto, Portugal
| | | | - Maria Emília Areias
- Cardiovascular R&D Unit (UnIC), FMUP, Porto, Portugal
- University Institute of Health Sciences (IUCS), Gandra, Portugal
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Cepuch G, Kruszecka-Krówka A, Lalik A, Micek A. Toxic Stress as a Potential Factor Inducing Negative Emotions in Parents of Newborns and Infants with Cyanotic Congenital Heart Disease. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1893. [PMID: 38136095 PMCID: PMC10742307 DOI: 10.3390/children10121893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Parents who have a newborn with a congenital heart defect experience negative emotions, which may determine the emotional state of their children. METHODS The study group included 154 parents of newborns and infants with cyanotic congenital heart disease, before cardiac surgery and after the procedure. HADS m and PSS-10 questionnaires were used to assess parental anxiety, depression, aggression, and the level of stress. RESULTS High levels of depression, anxiety, total HADS and stress were diagnosed in a large group of parents, regardless of the stage of cardiac surgery treatment. A high level of stress was associated with a higher prevalence of emotional disturbance both in the total HADS (overall) and in all its individual domains. Anxiety and depression were more common in mothers. A high level of stress was a significant predictor of anxiety and depression in parents. CONCLUSIONS A high level of stress was a significant predictor of anxiety and depression in parents of infants with congenital heart disease. The parents' psychological condition is one of many potential determinants over the course of their child's treatment and recovery.
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Affiliation(s)
- Grażyna Cepuch
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland; (G.C.); (A.L.)
| | - Agnieszka Kruszecka-Krówka
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland; (G.C.); (A.L.)
| | - Anna Lalik
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland; (G.C.); (A.L.)
| | - Agnieszka Micek
- Statistical Laboratory, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland;
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Ross S, Verstappen A. The Role of Congenital Heart Disease Patient Organizations in Advocacy, Resources, and Support Across the Lifespan. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:256-266. [PMID: 38161679 PMCID: PMC10755777 DOI: 10.1016/j.cjcpc.2023.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/24/2023] [Indexed: 01/03/2024]
Abstract
Congenital heart disease patient organizations, comprising experts with lived experience, and their families and supporters, have become an essential voice for patient advocacy, resources, and support. Thanks largely to the Internet, these organizations are growing in number worldwide. Their common voice can be used to influence research, be the catalyst for advocacy efforts for new programmes and supports, and connect patients and providers in endeavours beyond the clinical setting. The result has become more active engagement with how policy decisions, research directions, and laws are decided that will shape patients' lives. From advocating for much-needed mental health support, policies to combat discrimination and the lack of access to support services, and partnerships with clinicians and others to develop educational resources and tools, congenital heart disease patient organizations are having a considerable impact on patient lives and ultimately patient outcomes.
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Affiliation(s)
- Shelagh Ross
- Global Alliance for Rheumatic & Congenital Hearts (Global ARCH), Victoria, British Columbia, Canada
| | - Amy Verstappen
- Global Alliance for Rheumatic & Congenital Hearts (Global ARCH), Philadelphia, Pennsylvania, USA
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Gerlach J, Decker ES, Plank AC, Mestermann S, Purbojo A, Cesnjevar RA, Kratz O, Eichler A. Long-Term Effects of Child Early Surgical Ventricular Septal Defect Repair on Maternal Stress. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1832. [PMID: 38136034 PMCID: PMC10741485 DOI: 10.3390/children10121832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/07/2023] [Accepted: 11/18/2023] [Indexed: 12/24/2023]
Abstract
The ventricular septal defect (VSD) represents the most common congenital heart defect (CHD). The diagnosis of and cardiac surgery for their child's VSD are highly stressful experiences for parents; especially mothers, who are at risk of developing long-lasting stress-related symptoms. This study examined long-term alterations in maternal stress including self-reported psychological and biophysiological stress levels in a case-control design. We investigated 24 mothers of children with an isolated, surgically corrected VSD compared to non-affected controls. Maternal self-reports on psychopathology, everyday stress, parenting stress and hair cortisol concentrations (HCC) were measured during children's primary school age (6-9 years, t1) and early adolescence (10-14 years, t2). In maternal self-reports, psychopathology and stress symptoms in the VSD-group and controls were comparable at t1, whereas at t2, mothers in the VSD-group even showed a decrease in psychopathology. Maternal HCC levels in the VSD-group were significantly lower (hypocortisolism) than HCC levels of controls at t1. This effect was no longer observed at t2 reflecting an approximation of HCC levels in the VSD-group to controls' levels. This study highlights the potential for improved stress hormone balance and psychological well-being in mothers following their child's surgical VSD repair. However, the need for parent-centered interventions is discussed, particularly during peri-operative phases and in early child developmental stages.
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Affiliation(s)
- Jennifer Gerlach
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Elena S. Decker
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Anne-Christine Plank
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Stefan Mestermann
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität, Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Robert A. Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität, Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Department of Pediatric Cardiovascular Surgery, Pediatric Heart Center, University Children’s Hospital, 8032 Zürich, Switzerland
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
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Machado Amazonas BA, Guerreiro Vieira da Silva DM, de Souza Ribeiro MDN. Nursing guidelines for caregivers of children with congenital heart disease after discharge: Integrative Review. INVESTIGACION Y EDUCACION EN ENFERMERIA 2023; 41:e05. [PMID: 38589305 PMCID: PMC10990581 DOI: 10.17533/udea.iee.v41n3e05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/27/2023] [Indexed: 04/10/2024]
Abstract
Objective To identify the nursing guidelines for caregivers of children with congenital heart disease (CHD) after hospital discharge. Methods This is an integrative literature review of articles published between 2016 and 2022. In order to select the studies, the controlled descriptors "Nursing Care", "Nursing", "Heart Defects, Congenital", "Caregivers" and "Child" were used in four scientific databases - LILACS, SCIELO, PUBMED and BDENF. Results The current integrative literature review analyzed 11 articles from the original sample. The main nursing care issues are those related to nutrition, oral health, leisure and physical activity, care with medication and the surgical wound, as well as the need to offer support to these children's families. The authors emphasize that nurses are present at various moments in a child's life, including at birth, but the approach to CHD is scarce in their basic training as nurses, as well as in their professional practice, and there is a shortage of continuing education proposals for the care of children with CHD. Conclusion The study showed that nursing guidelines are focused on basic care and family support for these children. Lastly, this study highlighted the important role of nurses in terms of consolidating guidelines on the care needs of these children.
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Bainton J, Trachtenberg F, McCrindle BW, Wang K, Boruta R, Brosig CL, Egerson D, Sood E, Calderon J, Doman T, Golub K, Graham A, Haas K, Hamstra M, Lindauer B, Sylvester D, Woodard F, Young-Borkowski L, Mussatto KA. Prevalence and associated factors of post-traumatic stress disorder in parents whose infants have single ventricle heart disease. Cardiol Young 2023; 33:2171-2180. [PMID: 36601959 DOI: 10.1017/s1047951122004012] [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: 01/06/2023]
Abstract
INTRODUCTION Post-traumatic stress disorder occurs in parents of infants with CHD, contributing to psychological distress with detrimental effects on family functioning and well-being. We sought to determine the prevalence and factors associated with post-traumatic stress disorder symptoms in parents whose infants underwent staged palliation for single ventricle heart disease. MATERIALS AND METHODS A large longitudinal multi-centre cohort study evaluated 215 mothers and fathers for symptoms of post-traumatic stress disorder at three timepoints, including post-Norwood, post-Stage II, and a final study timepoint when the child reached approximately 16 months of age, using the self-report questionnaire Impact of Event Scale - Revised. RESULTS The prevalence of probable post-traumatic stress disorder post-Norwood surgery was 50% of mothers and 39% of fathers, decreasing to 27% of mothers and 24% of fathers by final follow-up. Intrusive symptoms such as flashbacks and nightmares and hyperarousal symptoms such as poor concentration, irritability, and sudden physical symptoms of racing heart and difficulty breathing were particularly elevated in parents. Higher levels of anxiety, reduced coping, and decreased satisfaction with parenting were significantly associated with symptoms of post-traumatic stress disorder in parents. Demographic and clinical variables such as parent education, pre-natal diagnosis, medical complications, and length of hospital stay(s) were not significantly associated with symptoms of post-traumatic stress disorder. DISCUSSION Parents whose infants underwent staged palliation for single ventricle heart disease often reported symptoms of post-traumatic stress disorder. Symptoms persisted over time and routine screening might help identify parents at-risk and prompt referral to appropriate supports.
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Affiliation(s)
- Jessica Bainton
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ke Wang
- HealthCore, Watertown, MA, USA
| | | | - Cheryl L Brosig
- Herma Heart Institute, Children's Wisconsin, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Erica Sood
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | - Tammy Doman
- University of Michigan Health System, Ann Arbor, MI, USA
| | - Katrina Golub
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - Karen Haas
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Michelle Hamstra
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Lisa Young-Borkowski
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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Thorpe A, Delaney RK, Pinto NM, Ozanne EM, Pershing ML, Hansen LM, Lambert LM, Fagerlin A. Parents' Psychological and Decision-Making Outcomes following Prenatal Diagnosis with Complex Congenital Heart Defect: An Exploratory Study. MDM Policy Pract 2023; 8:23814683231204551. [PMID: 37920604 PMCID: PMC10619352 DOI: 10.1177/23814683231204551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/24/2023] [Indexed: 11/04/2023] Open
Abstract
Background. Parents with a fetus diagnosed with a complex congenital heart defect (CHD) are at high risk of negative psychological outcomes. Purpose. To explore whether parents' psychological and decision-making outcomes differed based on their treatment decision and fetus/neonate survival status. Methods. We prospectively enrolled parents with a fetus diagnosed with a complex, life-threatening CHD from September 2018 to December 2020. We tested whether parents' psychological and decision-making outcomes 3 months posttreatment differed by treatment choice and survival status. Results. Our sample included 23 parents (average Age[years]: 27 ± 4, range = 21-37). Most were women (n = 18), non-Hispanic White (n = 20), and married (n = 21). Most parents chose surgery (n = 16), with 11 children surviving to the time of the survey; remaining parents (n = 7) chose comfort-directed care. Parents who chose comfort-directed care reported higher distress (x ¯ = 1.51, s = 0.75 v. x ¯ = 0.74, s = 0.55; Mdifference = 0.77, 95% confidence interval [CI], 0.05-1.48) and perinatal grief (x ¯ = 91.86, s = 22.96 v. x ¯ = 63.38, s = 20.15; Mdifference = 27.18, 95% CI, 6.20-48.16) than parents who chose surgery, regardless of survival status. Parents who chose comfort-directed care reported higher depression (x ¯ = 1.64, s = 0.95 v. x ¯ = 0.65, s = 0.49; Mdifference = 0.99, 95% CI, 0.10-1.88) than parents whose child survived following surgery. Parents choosing comfort-directed care reported higher regret (x ¯ = 26.43, s = 8.02 v. x ¯ = 5.00, s = 7.07; Mdifference = 21.43, 95% CI, 11.59-31.27) and decisional conflict (x ¯ = 20.98, s = 10.00 v. x ¯ = 3.44, s = 4.74; Mdifference = 17.54, 95% CI; 7.75-27.34) than parents whose child had not survived following surgery. Parents whose child survived following surgery reported lower grief (Mdifference = -19.71; 95% CI, -39.41 to -0.01) than parents whose child had not. Conclusions. The results highlight the potential for interventions and care tailored to parents' treatment decisions and outcomes to support parental coping and well-being. Highlights Question: Do the psychological and decision-making outcomes of parents differ based on their treatment decision and survival outcome following prenatal diagnosis with complex CHD?Findings: In this exploratory study, parents who decided to pursue comfort-directed care after a prenatal diagnosis reported higher levels of psychological distress and grief as well as higher decisional conflict and regret than parents who decided to pursue surgery.Meaning: The findings from this exploratory study highlight potential differences in parents' psychological and decision-making outcomes following a diagnosis of complex CHD for their fetus, which appear to relate to the treatment approach and the treatment outcome and may require tailoring of psychological and decision support.
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Affiliation(s)
- Alistair Thorpe
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Department of Applied Health Research, University College London, London, UK
| | - Rebecca K. Delaney
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
| | - Nelangi M. Pinto
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Division of Pediatric Cardiology at Seattle Children’s Hospital, Seattle, WA, USA
| | - Elissa M. Ozanne
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mandy L. Pershing
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
| | - Lisa M. Hansen
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Linda M. Lambert
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Angela Fagerlin
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation
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Delaney RK, Thorpe A, Pinto NM, Ozanne EM, Pershing ML, Hansen LM, Lambert LM, Tanner K, Fagerlin A. Parents' quality of life and health after treatment decision for a fetus with severe congenital heart defect. J Pediatr Nurs 2023; 70:20-25. [PMID: 36791586 PMCID: PMC10182246 DOI: 10.1016/j.pedn.2023.02.001] [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: 01/03/2023] [Revised: 01/10/2023] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE This exploratory study examines differences in parents' quality of life by treatment decision and the child's survival outcome in the context of life-threatening congenital heart disease (CHD). DESIGN AND METHODS Parents of a fetus or neonate diagnosed with severe CHD enrolled in the observational control group of a clinical trial (NCT04437069) and completed quality of life (i.e., contact with clinicians, social support, partner relationship, state of mind), mental and physical health survey measures. Comparisons were made between parents who chose comfort-directed care or surgery and between those whose child did and did not survive. RESULTS Parents who chose surgery and their child did not survive reported the most contact with their clinicians. Parents who chose comfort-directed care reported lower social support than parents who chose surgery and their child did not survive as well as poorer state of mind compared to parents who chose surgery. CONCLUSIONS Some aspects of parents' quality of life differed based on their treatment decision. Parents who choose comfort-directed care are vulnerable to some negative outcomes. PRACTICE IMPLICATIONS Decision support tools and bereavement resources to assist parents with making and coping with a complex treatment decision is important for clinical care.
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Affiliation(s)
- Rebecca K Delaney
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA.
| | - Alistair Thorpe
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Nelangi M Pinto
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Elissa M Ozanne
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Mandy L Pershing
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Lisa M Hansen
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Linda M Lambert
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Kirstin Tanner
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Angela Fagerlin
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA; Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, USA.
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Freedenberg VA, Berul CI. Potential for shock leads to potential for stress. Heart Rhythm 2022; 19:1530-1531. [PMID: 35817253 DOI: 10.1016/j.hrthm.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Vicki A Freedenberg
- Children's National Hospital, Washington, District of Columbia; George Washington University School of Medicine, Washington, District of Columbia
| | - Charles I Berul
- Children's National Hospital, Washington, District of Columbia; George Washington University School of Medicine, Washington, District of Columbia.
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Simeone S, Rea T, Platone N, Guillari A, Lanzuise A, Assanta N, Da Valle P, Baratta S, Pucciarelli G. Quality of Life of Families with Children Presenting Congenital Heart Disease:Longitudinal Study Protocol. Healthcare (Basel) 2022; 10:healthcare10071273. [PMID: 35885800 PMCID: PMC9317531 DOI: 10.3390/healthcare10071273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Advances in medicine have caused a notable increase in the survival rates of children born with congenital heart disease, even in the most complicated cases, almost mitigating the disease’s pathology from lethal to chronic. The quality of life perceived by such children is influenced by the perceptions of their parents. However, the international literature has rarely considered the entire family nucleus. AIMS: This study aims to study the temporal trend of quality of life of families with children with congenital heart disease, particularly with respect to parents following a child’s hospitalization for an invasive procedure. DESIGN: A longitudinal study. METHOD: A sample of families (that is, those including a child with congenital heart disease and their parents) will be enrolled following the patient’s discharge from the hospital and examined every 3 months for 1 year. The study’s adopted hypothesis is that there is an interdependence between the subjects of the study that is capable of influencing individual perceptions of quality of life. RESULTS: This study will attempt to identify variables (and their temporal trend) that can be attributed to the family unit and—together with physical and clinical variables—that may influence the quality of life of children with congenital heart disease. CONCLUSION: Examining family quality of life with the longitudinal method will allow us to identify the predictors and interdependence of this factor with respect to children and their parents. This will help to correct and elaborate upon care guidelines, providing better assistance to patients and their caregivers.
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Affiliation(s)
- Silvio Simeone
- Clinical and Experimental Medicine Department, “Magna Graecia” University, 88100 Catanzaro, Italy;
| | - Teresa Rea
- Public Health Department, Federico II University Hospital, 80131 Naples, Italy;
| | - Nicol Platone
- Gaetano Pasquinucci Heart Hospital, 54100 Massa, Italy; (N.P.); (N.A.); (P.D.V.); (S.B.)
| | - Assunta Guillari
- Department of Public Health, University Federico II of Naples, 80145 Napoli, Italy
- Correspondence:
| | | | - Nadia Assanta
- Gaetano Pasquinucci Heart Hospital, 54100 Massa, Italy; (N.P.); (N.A.); (P.D.V.); (S.B.)
| | - Paola Da Valle
- Gaetano Pasquinucci Heart Hospital, 54100 Massa, Italy; (N.P.); (N.A.); (P.D.V.); (S.B.)
| | - Stefania Baratta
- Gaetano Pasquinucci Heart Hospital, 54100 Massa, Italy; (N.P.); (N.A.); (P.D.V.); (S.B.)
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevenion, University of Rome Tor Vergata, 00133 Rome, Italy;
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Anele CR, Goldani MZ, Schüler-Faccini L, da Silva CH. Prevalence of Congenital Anomaly and Its Relationship with Maternal Education and Age According to Local Development in the Extreme South of Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138079. [PMID: 35805738 PMCID: PMC9265685 DOI: 10.3390/ijerph19138079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 12/04/2022]
Abstract
Congenital anomalies (CA) contribute to disabilities and health conditions throughout life. Furthermore, they can cause emotional distress to the mothers and children, who may also experience limitations in individual and social development. This study investigated the prevalence of CA and the relationship with maternal education and age according to local development in the extreme south of Brazil. This is a retrospective observational study with birth data from the Live Birth Information System from 2000 to 2017. The association between age and maternal education with the presence of CA was verified using multiple Poisson regression for robust variances in models adjusted for those variables with a preliminary significant association. A total of 5131 (1.5%) had some CA identified at birth between 2000 and 2017. Only advanced age (≥36 years) was associated with CA regardless of macro-region development (p ≤ 0.001). The highest risk was observed in regions with medium development (RR = 1.60; 95% CI 1.30−1.97). Maternal education (<8 years of study) was associated with CA only in mothers from macro-regions with very high development (RR = 1.27; 95% CI 1.03−1.54). These analyses confirmed that women of advanced age are at greater risk of having children with a CA regardless of maternal education and local development, but social characteristics can also have an influence, as regions with higher development had lower prevalence of CA.
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Affiliation(s)
- Carolina Ribeiro Anele
- Postgraduate Program in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre 90035-003, RS, Brazil; (C.R.A.); (M.Z.G.); (L.S.-F.)
| | - Marcelo Zubaran Goldani
- Postgraduate Program in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre 90035-003, RS, Brazil; (C.R.A.); (M.Z.G.); (L.S.-F.)
- Pediatrics and Primary Health Care Service, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre 90620-110, RS, Brazil
- Department of Pediatrics, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre 90035-003, RS, Brazil
| | - Lavínia Schüler-Faccini
- Postgraduate Program in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre 90035-003, RS, Brazil; (C.R.A.); (M.Z.G.); (L.S.-F.)
- Department of Genetics, Universidade Federal do Rio Grande do Sul (UFRGS), Avenida Bento Gonçalves, 9500, Porto Alegre 91501-970, RS, Brazil
- Instituto Nacional de Genética Médica Populacional (INAGEMP), Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre 90035-003, RS, Brazil
| | - Clécio Homrich da Silva
- Postgraduate Program in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre 90035-003, RS, Brazil; (C.R.A.); (M.Z.G.); (L.S.-F.)
- Pediatrics and Primary Health Care Service, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre 90620-110, RS, Brazil
- Department of Pediatrics, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre 90035-003, RS, Brazil
- Correspondence: ; Tel.: +55-51-33085601
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Abstract
BACKGROUND Parents who receive a diagnosis of a severe, life-threatening CHD for their foetus or neonate face a complex and stressful decision between termination, palliative care, or surgery. Understanding how parents make this initial treatment decision is critical for developing interventions to improve counselling for these families. METHODS We conducted focus groups in four academic medical centres across the United States of America with a purposive sample of parents who chose termination, palliative care, or surgery for their foetus or neonate diagnosed with severe CHD. RESULTS Ten focus groups were conducted with 56 parents (Mage = 34 years; 80% female; 89% White). Results were constructed around three domains: decision-making approaches; values and beliefs; and decision-making challenges. Parents discussed varying approaches to making the decision, ranging from relying on their "gut feeling" to desiring statistics and probabilities. Religious and spiritual beliefs often guided the decision to not terminate the pregnancy. Quality of life was an important consideration, including how each option would impact the child (e.g., pain or discomfort, cognitive and physical abilities) and their family (e.g., care for other children, marriage, and career). Parents reported inconsistent communication of options by clinicians and challenges related to time constraints for making a decision and difficulty in processing information when distressed. CONCLUSION This study offers important insights that can be used to design interventions to improve decision support and family-centred care in clinical practice.
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17
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Sarkar S, Sen R. Insights into Cardiovascular Defects and Cardiac Epigenome in the Context of COVID-19. EPIGENOMES 2022; 6:epigenomes6020013. [PMID: 35645252 PMCID: PMC9150012 DOI: 10.3390/epigenomes6020013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023] Open
Abstract
Although few in number, studies on epigenome of the heart of COVID-19 patients show that epigenetic signatures such as DNA methylation are significantly altered, leading to changes in expression of several genes. It contributes to pathogenic cardiac phenotypes of COVID-19, e.g., low heart rate, myocardial edema, and myofibrillar disarray. DNA methylation studies reveal changes which likely contribute to cardiac disease through unknown mechanisms. The incidence of severe COVID-19 disease, including hospitalization, requiring respiratory support, morbidity, and mortality, is disproportionately higher in individuals with co-morbidities. This poses unprecedented strains on the global healthcare system. While their underlying conditions make patients more susceptible to severe COVID-19 disease, strained healthcare systems, lack of adequate support, or sedentary lifestyles from ongoing lockdowns have proved detrimental to their underlying health conditions, thus pushing them to severe risk of congenital heart disease (CHD) itself. Prophylactic vaccines against COVID-19 have ushered new hope for CHD. A common connection between COVID-19 and CHD is SARS-CoV-2’s host receptor ACE2, because ACE2 regulates and protects organs, including the heart, in various ways. ACE2 is a common therapeutic target against cardiovascular disease and COVID-19 which damages organs. Hence, this review explores the above regarding CHDs, cardiovascular damage, and cardiac epigenetics, in COVID-19 patients.
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Affiliation(s)
- Shreya Sarkar
- New Brunswick Heart Centre, Saint John Regional Hospital, Saint John, NB E2L 4L2, Canada;
| | - Rwik Sen
- Active Motif, Inc., 1914 Palomar Oaks Way, Suite 150, Carlsbad, CA 92008, USA
- Correspondence:
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Blais A, Longmuir PE, Messy R, Messy R, Lai L. "Like Any Other Camp": Experiences and lessons learned from an integrated day camp for children with heart disease. J SPEC PEDIATR NURS 2022; 27:e12371. [PMID: 35307923 DOI: 10.1111/jspn.12371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/22/2021] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Summer camps for children living with heart disease can have a profound impact on well-being. However, specialized camps often require extensive resources (i.e., 24-h medical staff supervision) and may be located in far remote settings. Integrating children with heart disease into mainstream day camps may address these barriers. The purpose of this study is to describe the experience of attending an integrated day camp from the perspectives of children with heart disease and their parents. DESIGN AND METHODS This study used a qualitative descriptive design. Among 25 eligible families, 9 participated in interviews which were held 3 months to 2 years after attending an integrated camp (mean age of children at camp was 7.3 ± 2.25 years). Interviews were audio-recorded and transcribed verbatim for an inductive thematic analysis. RESULTS Many parents chose the integrated camp as their child's first summer camp experience, citing trust in the local division of Cardiology's approval of the camp activities as an important reason for enrolling. All participants agreed the integrated camp was a valued opportunity which should continue, although not all described positive camp experiences. Participants' descriptions of the integrated camp were organized into two main themes: 1) overall expectations of the camp and 2) important opportunities afforded by the camp experience. Partaking in a typical camp experience, connecting to local children with heart disease, adequate safety precautions and activity adaptations were specific expectations held by participants. Important opportunities included greater independence and confidence, navigating disclosure of their diagnosis to peers on their own terms, and more diverse social connections. Improving communication with parents to ensure expectations match camp objectives would have enhanced the experience. PRACTICE IMPLICATIONS Practitioners looking for an alternative to specialized camps for their patients with heart disease may use these results to guide the design and promotion of an integrated camp.
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Affiliation(s)
- Angelica Blais
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Patricia E Longmuir
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Raquel Messy
- Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Roland Messy
- Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Lillian Lai
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, Canada
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19
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Geerdink LM, Verhaak CM, Kapusta L. Illness cognition and parenting stress in parents of children with Ebstein's anomaly. J Psychosom Res 2021; 151:110631. [PMID: 34634676 DOI: 10.1016/j.jpsychores.2021.110631] [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] [Received: 05/30/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Lianne M Geerdink
- Department of Paediatric Cardiology, Amalia Children's Hospital, University Medical Centre Nijmegen, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands; Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands.
| | - Chris M Verhaak
- Department of Medical Psychology, Amalia Children's Hospital, University Medical Centre Nijmegen, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Livia Kapusta
- Department of Paediatric Cardiology, Amalia Children's Hospital, University Medical Centre Nijmegen, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands; Paediatric Cardiology Unit, Department of Paediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Centre, Tel Aviv University, 6 Weizmann Street, 6423906, Israel
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Zhang QL, Lei YQ, Liu JF, Cao H, Chen Q. Using telemedicine to improve the quality of life of parents of infants with CHD surgery after discharge. Int J Qual Health Care 2021; 33:6365686. [PMID: 34490460 DOI: 10.1093/intqhc/mzab133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/25/2021] [Accepted: 09/06/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of using telemedicine to improve the quality of life of parents of infants with congenital heart disease (CHD) surgery after discharge. METHODS A prospective randomized controlled study was conducted in a provincial hospital in China from November 2020 to April 2021 to compare the quality of life of parents of infants with CHD surgery after discharge between the WeChat follow-up group and the outpatient follow-up group. A total of 84 patients (42 in each group) and 168 parents (84 in each group) participated in this study. RESULTS One month after discharge, the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores of parents in the intervention group were significantly lower than those in the control group (P < 0.05). Compared with the SAS and SDS scores at discharge, the scores of parents in the intervention group were significantly lower at 1 month after discharge (P < 0.05), while the scores of parents in the control group were similar at 1 month after discharge (P > 0.05). At discharge, in both the intervention group and the control group, the SAS and SDS scores of the mothers were higher than those of the fathers (P < 0.05). One month after discharge, in the control group, the SAS and SDS scores of the mothers were higher than those of the fathers (P < 0.05). One month after discharge, in the intervention group, the SAS and SDS scores of the mothers were similar to those of the fathers (P > 0.05). The comparison of the SAS and SDS scores of parents with different education levels showed that in both the intervention group and control group, the lower the parents' educational levels, the higher their SAS and SDS scores (P < 0.05). One month after discharge, in the control group, the lower the parents' education levels, the higher their SAS and SDS scores (P < 0.05). One month after discharge, in the intervention group, the SAS and SDS scores were similar among parents with different educational levels. The results of the World Health Organization Quality of Life Brief scale showed that the scores of the physiological, psychological, social and environmental fields at 1 month after discharge in the intervention group were significantly higher than those in the control group (P < 0.05). CONCLUSION Providing health education and medical support to the parents of infants with CHD surgery after discharge via telemedicine can effectively relieve parents' anxiety and depression and improve their quality of life.
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Affiliation(s)
- Qi-Liang Zhang
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, No.966 of Hengyu Road, Fuzhou, Fujian 350014, China.,Fujian Children's Hospital, No.966 of Hengyu Road, Fuzhou, Fujian 350014, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 of Danshan Road, Fuzhou, Fujian 350001, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, No.18 of Danshan Road, Fuzhou, Fujian 350001, China
| | - Yu-Qing Lei
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, No.966 of Hengyu Road, Fuzhou, Fujian 350014, China.,Fujian Children's Hospital, No.966 of Hengyu Road, Fuzhou, Fujian 350014, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 of Danshan Road, Fuzhou, Fujian 350001, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, No.18 of Danshan Road, Fuzhou, Fujian 350001, China
| | - Jian-Feng Liu
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, No.966 of Hengyu Road, Fuzhou, Fujian 350014, China.,Fujian Children's Hospital, No.966 of Hengyu Road, Fuzhou, Fujian 350014, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 of Danshan Road, Fuzhou, Fujian 350001, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, No.18 of Danshan Road, Fuzhou, Fujian 350001, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, No.966 of Hengyu Road, Fuzhou, Fujian 350014, China.,Fujian Children's Hospital, No.966 of Hengyu Road, Fuzhou, Fujian 350014, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 of Danshan Road, Fuzhou, Fujian 350001, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, No.18 of Danshan Road, Fuzhou, Fujian 350001, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, No.966 of Hengyu Road, Fuzhou, Fujian 350014, China.,Fujian Children's Hospital, No.966 of Hengyu Road, Fuzhou, Fujian 350014, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 of Danshan Road, Fuzhou, Fujian 350001, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, No.18 of Danshan Road, Fuzhou, Fujian 350001, China
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Quality of life of parents with children with congenital abnormalities: a systematic review with meta-analysis of assessment methods and levels of quality of life. Qual Life Res 2021; 31:991-1011. [PMID: 34482484 DOI: 10.1007/s11136-021-02986-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To quantify and understand how to assess the quality of life and health-related QoL of parents with children with congenital abnormalities. METHODS We conducted a systematic review with meta-analysis. The search was carried out in 5 bibliographic databases and in ClinicalTrials.gov. No restriction on language or date of publication was applied. This was complemented by references of the studies found and studies of evidence synthesis, manual search of abstracts of relevant congresses/scientific meetings and contact with experts. We included primary studies (observational, quasi-experimental and experimental studies) on parents of children with CA reporting the outcome quality of life (primary outcome) of parents, independently of the intervention/exposure studied. RESULTS We included 75 studies (35 observational non-comparatives, 31 observational comparatives, 4 quasi-experimental and 5 experimental studies). We identified 27 different QoL instruments. The two most frequently used individual QoL instruments were WHOQOL-Bref and SF-36. Relatively to family QoL tools identified, we emphasized PedsQL FIM, IOFS and FQOL. Non-syndromic congenital heart defects were the CA most frequently studied. Through the analysis of comparative studies, we verified that parental and familial QoL were impaired in this population. CONCLUSIONS This review highlights the relevance of assessing QoL in parents with children with CA and explores the diverse QoL assessment tools described in the literature. Additionally, results indicate a knowledge gap that can help to draw new paths to future research. It is essential to assess QoL as a routine in healthcare providing and to implement strategies that improve it.
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22
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Nonmedical Determinants of Congenital Heart Diseases in Children from the Perspective of Mothers: A Qualitative Study in Iran. Cardiol Res Pract 2021; 2021:6647260. [PMID: 34447593 PMCID: PMC8384533 DOI: 10.1155/2021/6647260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/17/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Mortality due to noncommunicable diseases has increased in the world today with the advent of demographic shifts, growing age, and lifestyle patterns in the world, which have been affected by economic and social crises. Congenital heart defects are one of the forms of diseases that have raised infant mortality worldwide. The objective of present study was to identify nonmedical determinants related to this abnormality from the mother's perspectives. Methods This research was a qualitative study and the data collection method was a semistructured interview with mothers who had children with congenital heart diseases referring to the Shahid Rajaei Heart Hospital in Tehran, Iran. A thematic analysis approach was employed to analyze transcribed documents assisted by MAXQDA Plus version 12. Results Four general themes and ten subthemes including social contexts (social harms, social interactions, and social necessities), psychological contexts (mood disorders and mental well-being), cultural contexts (unhealthy lifestyle, family culture, and poor parental health behaviors), and environmental contexts (living area and polluted air) were extracted from interviews with mothers of children with congenital heart diseases. Conclusions Results suggest that factors such as childhood poverty, lack of parental awareness of congenital diseases, lack of proper nutrition and health facilities, education, and lack of medical supervision during pregnancy were most related with the birth of children with congenital heart disease from mothers' prospective. In this regard, targeted and intersectorial collaborations are proposed to address nonmedical determinants related to the incidence of congenital heart diseases.
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23
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Callé A, Furtado MCDC, Manso PH, Fonseca LMM, Dessotte CAM, Carvalho BM. Going home after a child's cardiac surgery: education for safe care. Rev Bras Enferm 2021; 74:e20201163. [PMID: 34406274 DOI: 10.1590/0034-7167-2020-1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to validate the content and appearance of the booklet "Going home after a child's cardiac surgery" and assess family members' cognitive learning regarding its use. METHODS a methodological and quasi-experimental study of before and after type, with semi-structured interview, pre-test and reading of the booklet in a hospital; post-test and validation occurred after hospital discharge. Wilcoxon non-parametric statistics were used. RESULTS nineteen family members of children with heart disease participated. The average of correct answers increased 14 percentage points from pre- to post-test; most were medication errors. There was a significant difference (p <0.0001) in the comparison between cognitive knowledge prior to using the booklet and learning acquired from its use. All items received a positive rating, except font size. CONCLUSIONS the booklet helps family members to understand a child's needs after cardiac surgery, and can be used to prevent unwanted occurrences and enable safe care at home.
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Affiliation(s)
- Aline Callé
- Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil
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24
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Mussatto KA, Van Rompay MI, Trachtenberg FL, Pemberton V, Young-Borkowski L, Uzark K, Hollenbeck-Pringle D, Dunbar-Masterson C, Infinger P, Walter P, Sawin K. Family Function, Quality of Life, and Well-Being in Parents of Infants With Hypoplastic Left Heart Syndrome. JOURNAL OF FAMILY NURSING 2021; 27:222-234. [PMID: 33535863 PMCID: PMC8594631 DOI: 10.1177/1074840720987309] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Survival for hypoplastic left heart syndrome (HLHS) has improved dramatically. Little is known about early family function, quality of life (QOL), or well-being/adjustment for parents of infants with HLHS. Parent/family outcomes over time, predictors, and differences in 143 mothers and 72 fathers were examined. Parents reported better family function compared with published norms, but 26% experienced family dysfunction. QOL and well-being were significantly lower than adult norms. QOL scores generally declined over time, whereas self-reported well-being improved. Responses from mothers and fathers showed different trends, with mothers having worse scores on most measures and at most time points. Being a single parent was a risk factor for poorer family function, but not for lower individual QOL or well-being. Family characteristics, stress, and coping skills were predictive of outcomes. Parents' psychosocial responses to the challenges of life with infants with HLHS change over time. Individually tailored psychosocial support is needed.
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Affiliation(s)
| | | | | | | | | | - Karen Uzark
- C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | | | | | | | | | - Kathleen Sawin
- Milwaukee School of Engineering, WI, USA
- Children's Hospital of Wisconsin, Milwaukee, USA
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25
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Tesson S, Butow PN, Marshall K, Fonagy P, Kasparian NA. Parent-child bonding and attachment during pregnancy and early childhood following congenital heart disease diagnosis. Health Psychol Rev 2021; 16:378-411. [PMID: 33955329 DOI: 10.1080/17437199.2021.1927136] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Diagnosis and treatment of congenital heart disease (CHD) can present challenges to the developing parent-child relationship due to periods of infant hospitalization and intensive medical care, parent-infant separations, child neurodevelopmental delay and feeding problems, and significant parent and child distress and trauma. Yet, the ways in which CHD may affect the parent-child relationship are not well-understood. We systematically reviewed the evidence on parental bonding, parent-child interaction, and child attachment following CHD diagnosis, according to a pre-registered protocol (CRD42019135687). Six electronic databases were searched for English-language studies comparing a cardiac sample (i.e., expectant parents or parents and their child aged 0-5 years with CHD) with a healthy comparison group on relational outcomes. Of 22 unique studies, most used parent-report measures (73%) and yielded mixed results for parental bonding and parent-child interaction quality. Observational results also varied, although most studies (4 of 6) found difficulties in parent-child interaction on one or more affective or behavioural domains (e.g., lower maternal sensitivity, lower infant responsiveness). Research on parental-fetal bonding, father-child relationships, and child attachment behaviour was lacking. Stronger evidence is needed to determine the nature, prevalence, and predictors of relational disruptions following CHD diagnosis, and to inform targeted screening, prevention, and early intervention programs for at-risk dyads.
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Affiliation(s)
- Stephanie Tesson
- School of Psychology, The University of Sydney, Sydney, Australia.,Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, Australia
| | - Phyllis N Butow
- School of Psychology, The University of Sydney, Sydney, Australia.,Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, Australia
| | - Kate Marshall
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nadine A Kasparian
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, Australia.,Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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26
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Man MA, Segers EW, Schappin R, Leeden K, Wösten‐van Asperen RM, Breur H, Weerth C, Hoogen A. Parental experiences of their infant's hospital admission undergoing cardiac surgery: A systematic review. Acta Paediatr 2021; 110:1730-1740. [PMID: 33251633 PMCID: PMC8248104 DOI: 10.1111/apa.15694] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 12/31/2022]
Abstract
AIM To explore parents' experiences of parenting a child hospitalised with congenital heart disease (CHD) and undergoing surgery. METHODS Five electronic databases were systematically searched for articles describing the experiences of parents with a child with a CHD. A thematic analysis approach was used to identify the most common themes. RESULTS A total of 188 articles were identified. Eight studies were included in the review. Four themes emerged, including balancing the parental role, experiencing anticipatory grief, decreasing parental stress using coping strategies and professional support. CONCLUSION Having a child with CHD undergoing heart surgery is a stressful experience due to, among other things, the different situation-related parenting role during the hospital stay and feelings of anticipatory grief. Healthcare professionals in the PICU have an essential role in supporting parents and understanding the needs that are crucial for the parents in order to provide better support and reduce stress and anxiety. More qualitative research regarding the pathway from the prenatal diagnosis through the early childhood period is warranted.
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Affiliation(s)
- Marjorie A.C.P. Man
- Wilhelmina Children’s Hospital University Medical Centre Utrecht Utrecht The Netherlands
| | - Elisabeth W. Segers
- Wilhelmina Children’s Hospital University Medical Centre Utrecht Utrecht The Netherlands
| | - Renske Schappin
- Department of Development and Education of Youth in Diverse Societies Utrecht University Utrecht The Netherlands
| | - Kees Leeden
- Wilhelmina Children’s Hospital University Medical Centre Utrecht Utrecht The Netherlands
| | | | - Hans Breur
- Wilhelmina Children’s Hospital University Medical Centre Utrecht Utrecht The Netherlands
| | - Carolina Weerth
- Donders Institute for Brain Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - Agnes Hoogen
- Wilhelmina Children’s Hospital University Medical Centre Utrecht Utrecht The Netherlands
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27
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Abstract
Millions of children and adolescents are living with a chronic condition. It is common for mental and behavioral health challenges to arise during their courses of illness. With the complexity of care needed, pediatric subspecialty providers have recognized the need to integrate behavioral health interventions into practice. Continued research in this area has allowed for focused behavioral interventions, particularly in diabetes and asthma. Adult congenital heart programs have adapted a similar model of care and have shown promising success in promotion of health. More established programs have been in existence for childhood cancer and cystic fibrosis.
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Affiliation(s)
- Ethel Clemente
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA.
| | - Gordon Liu
- Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
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28
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Longmuir PE, Corey M, McCrindle BW. Interactions with Home and Health Environments Discourage Physical Activity: Reports from Children with Complex Congenital Heart Disease and Their Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4903. [PMID: 34064527 PMCID: PMC8124231 DOI: 10.3390/ijerph18094903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
Children with complex congenital heart disease are less active than recommended for optimal health, with social and physical environments important determinants. The purpose of this study was to examine the physical activity perceptions of children with complex congenital heart disease and their parents to identify social and physical environment intervention targets. A semi-structured discussion guide elicited physical activity perceptions from children (26 boys, 19 girls, 6.0-12.4 years) with complex congenital heart disease (single ventricle n = 42) and their parents during three child and three parent focus groups and 41 interviews. Interviews and focus groups were audio-recorded and transcribed verbatim for inductive thematic analysis. Children and parents identified home, peer and health environments as impacting on their children's physical activity participation. Peer environments, such as school or daycare, were supportive by providing physical activity facilities and enabling fun with peers and time outdoors. At home, parent and sibling interactions both encouraged and discouraged physical activity. The children's unique health environment fostered physical activity uncertainty, discouraging activity despite minimal or no physician recommendations to restrict physical activity. Children with complex congenital heart disease and their parents recognize the importance of physical activity and fun with friends. Physical activity uncertainty contributes to their inactive lifestyles despite minimal restrictions from health professionals. Positive clinical encouragement and health environment interventions that better support physical activity are required.
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Affiliation(s)
- Patricia E. Longmuir
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Mary Corey
- Child Health Evaluative Sciences, The Hospital for Sick Children and Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5G 1X8, Canada;
| | - Brian W. McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1X8, Canada
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29
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Sun KP, Xu N, Huang ST, Cao H, Chen Q. Health-Related Quality of Life in Children and Adolescents with Simple Congenital Heart Defects before and after Transcatheter Intervention Therapy: A Single-Center Study. Ann Thorac Cardiovasc Surg 2021; 27:105-111. [PMID: 32893225 PMCID: PMC8058546 DOI: 10.5761/atcs.oa.20-00078] [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: 11/16/2022] Open
Abstract
Objective: To explore the health-related quality of life (HRQoL) of children and adolescents with simple congenital heart defects before and after the transcatheter intervention. Methods: The Pediatric Quality of Life Inventory 4.0 scale was used to assess the quality of life of 78 children and adolescents before and after the transcatheter intervention and to evaluate the parents’ perception of their children’s quality of life. Results: In all, 76 patients were completed the study. The results showed that the scores of the four dimensions and the total score for the quality of life of the patients significantly improved 1 month after the intervention. At 6 months after treatment, the scores in all dimensions continued to improve. From the parents’ perspective, the scores of the patients in all dimensions improved significantly at 1 month and 6 months after treatment. In terms of the quality of life assessment, the self-assessment results of the patients were more positive than those of their parents. Conclusions: The results showed that the quality of life of children and adolescents with simple congenital heart defects can be positively affected by the transcatheter intervention. Moreover, this improvement is not transient and seems to increase over time.
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Affiliation(s)
- Kai-Peng Sun
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Ning Xu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
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30
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Roberts SD, Kazazian V, Ford MK, Marini D, Miller SP, Chau V, Seed M, Ly LG, Williams TS, Sananes R. The association between parent stress, coping and mental health, and neurodevelopmental outcomes of infants with congenital heart disease. Clin Neuropsychol 2021; 35:948-972. [PMID: 33706666 DOI: 10.1080/13854046.2021.1896037] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Caring for the complex needs of a child with congenital heart disease (CHD) can place significant burden on the family. Parent mental health and coping have important influences on resilience and neurodevelopmental outcomes in children with CHD. Objectives: To describe the uptake of a cardiac neurodevelopmental program (CNP), examine parent mental health and coping specific to parenting a child with CHD, and explore the relationship between parent mental health and child neurodevelopmental outcomes. Method: Implementation and uptake of the CNP was examined, and forty-four parents of children with CHD completed the DASS and RSQ-CHD. Results: The CNP showed significant uptake in follow-up and interventions offered including 100% completed brain MRIs of eligible patients, 35% increase in neonatal neurology consults, and 100% of families counselled on neurodevelopmental outcomes. A significant proportion of parents endorsed moderate/severe levels of anxiety (25%), depression (20%), and CHD-specific stress. Parents predominantly engaged in secondary control engagement coping (F(2,64)=75.04, p<.001, ηp2=.70). Secondary control engagement coping was associated with lower parent total stress (r=-.48, p=.006) and anxiety (r=-.47, p=.009). Higher parent stress was associated with higher anxiety (r=.45, p=.016), depression (r=.37, p=.05), more severe types of CHD (r=.35, p=.048), older child age (t(30)= -2.33, p=.03), and lower child cognitive scores (r=-.37, p=.045). More severe types of CHD were associated with lower language scores (F(3,35)=3.50, p=.03). Conclusions: This study highlights the relationship between parent mental health and early child cognitive outcomes in CHD and helps inform models of psychological care to reduce family burden and improve child outcomes.
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Affiliation(s)
- Samantha D Roberts
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,York University, Toronto, Ontario, Canada
| | - Vanna Kazazian
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Meghan K Ford
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Davide Marini
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven P Miller
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Vann Chau
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Seed
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Linh G Ly
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tricia S Williams
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Renee Sananes
- Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
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31
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Lisanti AJ, Demianczyk AC, Vaughan K, Martino GF, Ohrenschall RS, Quinn R, Chittams JL, Medoff-Cooper B. Parental role alteration strongly influences depressive symptoms in mothers of preoperative infants with congenital heart disease. Heart Lung 2021; 50:235-241. [PMID: 33340826 PMCID: PMC7969439 DOI: 10.1016/j.hrtlng.2020.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mothers of infants with congenital heart disease are at risk for depression. OBJECTIVES This study explored the influence on maternal depressive symptoms of several known factors for mothers in the pediatric cardiac intensive care unit, including perceived stressors, attachment, and anxiety. METHODS This study was a secondary analysis of 30 mothers of infants awaiting cardiac surgery. Linear regressions were calculated to determine the relationships between perceived stressors, maternal attachment, anxiety, and maternal depressive symptoms. RESULTS Nearly half of mothers reported depressive symptoms above the measure cut-off score, indicating they were at risk for likely clinical depression. Subscales of perceived stress explained 61.7% of the variance in depressive symptoms (F = 11.815, p<0.0001) with parental role alteration subscale as the strongest predictor (standardized beta=0.694, p = 0.03). CONCLUSIONS Findings underscore the importance of mental health screening and instituting nursing practices to enhance parental role for mothers of infants awaiting cardiac surgery.
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Affiliation(s)
- Amy J Lisanti
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America; University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States of America.
| | - Abigail C Demianczyk
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
| | - Kayla Vaughan
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
| | - Giordana Fraser Martino
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
| | - Rachel Schaake Ohrenschall
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
| | - Ryan Quinn
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States of America.
| | - Jesse L Chittams
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States of America.
| | - Barbara Medoff-Cooper
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States of America; Research Institute, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
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32
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McKechnie AC, Erickson K, Ambrose MB, Chen S, Miller SJ, Mathiason MA, Johnson KA, Leuthner SR. Development and testing of a self-report measure of preparing to parent in the context of a fetal anomaly diagnosis. PATIENT EDUCATION AND COUNSELING 2021; 104:666-670. [PMID: 32839046 PMCID: PMC7889754 DOI: 10.1016/j.pec.2020.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To generate a self-report instrument to capture clinically relevant variations in expectant parents' caregiving development, specified by how they are preparing to parent an infant with a major congenital anomaly. METHODS Recent literature structured domains to guide item generation. Evaluations by experts and expectant parents led to a refined instrument for field testing. Psychometric testing included exploratory factor analysis, internal consistency, and test-retest reliability. RESULTS Samples included expert evaluators (n = 9), and expectant parent evaluators (n = 20) and expectant mother field testers (n = 67) with fetal anomaly diagnoses. Preparing to Parent-Act, Relate, Engage (PreP-ARE) resulted from a three factor solution that explained 71.8 % of the total variance, with global Cronbach's α = 0.72, and sub-scales 0.81, 0.65, 0.72 respectively. Cohen's weighted kappa indicated all items were acceptably reliable, with 14 of 19 items showing moderate (≥ 0.41) or good (≥ 0.61) reliability. Convergent validity was found between the maternal antenatal attachment and Act scales (r = 0.39, p = 0.001). CONCLUSION This empirically-based instrument was demonstrated to be valid and reliable, and has potential for studying this transitional time. PRACTICE IMPLICATIONS PreP-ARE could be used to understand patient responses to the diagnosis, level of engagement, readiness to make decisions, and ability to form collaborative partnerships to manage healthcare.
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Affiliation(s)
| | - Kari Erickson
- School of Nursing, University of Minnesota, Minneapolis, USA
| | | | - Sophie Chen
- School of Nursing, University of Minnesota, Minneapolis, USA
| | - Sarah J Miller
- School of Nursing, University of Minnesota, Minneapolis, USA
| | | | - Kathy A Johnson
- College of Nursing, Chamberlain University, Downers Grove, USA
| | - Steven R Leuthner
- Department of Pediatrics and Bioethics, Children's Wisconsin Clinics, Medical College of Wisconsin, Milwaukee, USA
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Palanki R, Peranteau WH, Mitchell MJ. Delivery technologies for in utero gene therapy. Adv Drug Deliv Rev 2021; 169:51-62. [PMID: 33181188 PMCID: PMC7855052 DOI: 10.1016/j.addr.2020.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/13/2020] [Accepted: 11/04/2020] [Indexed: 12/19/2022]
Abstract
Advances in prenatal imaging, molecular diagnostic tools, and genetic screening have unlocked the possibility to treat congenital diseases in utero prior to the onset of clinical symptoms. While fetal surgery and in utero stem cell transplantation can be harnessed to treat specific structural birth defects and congenital hematological disorders, respectively, in utero gene therapy allows for phenotype correction of a wide range of genetic disorders within the womb. However, key challenges to realizing the broad potential of in utero gene therapy are biocompatibility and efficiency of intracellular delivery of transgenes. In this review, we outline the unique considerations to delivery of in utero gene therapy components and highlight advances in viral and non-viral delivery platforms that meet these challenges. We also discuss specialized delivery technologies for in utero gene editing and provide future directions to engineer novel delivery modalities for clinical translation of this promising therapeutic approach.
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Affiliation(s)
- Rohan Palanki
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - William H Peranteau
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; The Center for Fetal Research, Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Michael J Mitchell
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Institute for Regenerative Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Liu JF, Xie WP, Lin WH, Cao H, Chen Q. The Association of Positive or Negative Religious Coping Methods With Psychological Distress and Quality of Life Among Parents of Infants With Congenital Heart Disease. Front Pediatr 2021; 9:753032. [PMID: 34869108 PMCID: PMC8639691 DOI: 10.3389/fped.2021.753032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The purpose of this study was to evaluate whether positive and negative religious coping methods were associated with psychological distress and quality of life in parents of infants with congenital heart disease (CHD). Methods: This descriptive, cross-sectional study was conducted at a provincial hospital in Fujian, China. Clinical data from 115 parents of infants with CHD were collected. Chinese Sociodemographic Forms, Brief RCOPE, Beck Depression Interview (BDI), and the Short Form Health Survey (SF-36) were used in this study. Results: The sex of caregivers in infants with CHD was an independent predictor of BDI scores. The positive religious coping score and the negative religious coping score were both independent predictors of the BDI score (β = -5.365, P = 0.006 and β = 4.812, p = 0.017). The correlation between the quality-of-life scores and positive or negative religious coping scores indicated that positive religious coping scores were significantly positively correlated with Vitality, Social Functioning, and Mental Health scores. There was a significant negative correlation between negative religious coping scores and mental health scores. Conclusions: Positive or negative religious coping methods may be associated with psychological distress and quality of life among parents of infants with CHD. It is suggested that more attention should be devoted to the influence of religious coping methods on parents of infants with CHD, and the use of religious resources should be encouraged.
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Affiliation(s)
- Jian-Feng Liu
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Wen-Peng Xie
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Wen-Hao Lin
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
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Lumsden MR, Smith DM, Twigg E, Guerrero R, Wittkowski A. Children with single ventricle congenital heart defects: An interpretative phenomenological analysis of the lived parent experience. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bishop M, Cohen LL, Robbertz AS. Illness-Related Parenting Stress and Maladjustment in Congenital Heart Disease: Mindfulness as a Moderator. J Pediatr Psychol 2020; 45:1208-1215. [PMID: 33051657 DOI: 10.1093/jpepsy/jsaa081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Congenital heart disease (CHD) is characterized by structural defects to the heart or the coronary blood vessels and often requires surgical repair. Raising an infant or toddler with CHD can be challenging and lead to high parenting stress and maladjustment. The parenting literature suggests that mindfulness may buffer parenting stress. The purpose of this study was to examine whether mindfulness might moderate the relationship between illness-related parenting stress and maladjustment in parents of infants and toddlers with CHD. METHODS Parents of infants and toddlers with CHD attending an outpatient clinic provided background information and completed measures of illness-related parenting stress, mindfulness, and maladjustment. RESULTS Results indicated that illness-related parenting stress was associated with maladjustment, and mindfulness moderated this relationship. Specifically, illness-related parenting stress was related to maladjustment at low and average levels of mindfulness; at high mindfulness, there was no association between illness-related parenting stress and maladjustment. CONCLUSIONS Consistent with the broader literatures, our sample of parents of infants and toddlers with CHD reported high illness-related parenting stress and maladjustment. Building on other studies demonstrating the benefits of mindful parenting, our results suggest that engaging in mindfulness might thwart the association between illness-related parenting stress and maladjustment in parents of infants and toddlers with CHD.
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Neurodevelopmental evaluation strategies for children with congenital heart disease aged birth through 5 years: recommendations from the cardiac neurodevelopmental outcome collaborative. Cardiol Young 2020; 30:1609-1622. [PMID: 33143781 DOI: 10.1017/s1047951120003534] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper provides specific guidelines for the neurodevelopmental evaluation of children aged birth through 5 years with complex congenital heart disease. There is wide recognition that children with congenital heart disease are at high risk for neurodevelopmental impairments that are first apparent in infancy and often persist as children mature. Impairments among children with complex congenital heart disease cross developmental domains and affect multiple functional abilities. The guidelines provided are derived from the substantial body of research generated over the past 30 years describing the characteristic developmental profiles and the long-term trajectories of children surviving with complex congenital heart conditions. The content and the timing of the guidelines are consistent with the 2012 American Heart Association and the American Academy of Pediatrics scientific statement documenting the need for ongoing developmental monitoring and assessment from infancy through adolescence. The specific guidelines offered in this article were developed by a multidisciplinary clinical research team affiliated with the Cardiac Neurodevelopmental Outcome Collaborative, a not-for-profit organisation established to determine and implement best neurodevelopmental practices for children with congenital heart disease. The guidelines are designed for use in clinical and research applications and offer an abbreviated core protocol and an extended version that expands the scope of the evaluation. The guidelines emphasise the value of early risk identification, use of evidence-based assessment instruments, consideration of family and cultural preferences, and the importance of providing multidimensional community-based services to remediate risk.
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Mahatme NS, Kakunje A, Karkal R. Comparison of maternal stress and psychiatric morbidity among mothers of children having psychiatric disorders and those of typically developing children. Indian J Psychiatry 2020; 62:707-712. [PMID: 33896978 PMCID: PMC8052877 DOI: 10.4103/psychiatry.indianjpsychiatry_733_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/07/2020] [Accepted: 05/03/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Motherhood is regarded to be stressful, but when the child has a psychiatric illness, the mother is affected more than the father since she is the primary caregiver. She gets affected not only emotionally but also psychologically. Increasing severity of stress in mothers may lead to negative outcome on a child's care. AIMS The aim of this study was to evaluate the stress levels in mothers of children diagnosed with psychiatric disorder and to study the association between children having a psychiatric disorder and the psychiatric morbidity in their mothers. MATERIALS AND METHODS This was a case-control study with a total of 150 participants, in which 75 consecutive mothers of children were diagnosed with any psychiatric illness using ICD-10 criteria and compared to 75 mothers of typically developing children. The study was approved by the Institutional Ethics Committee. The Parental Stress Scale and the Mini-International Neuropsychiatric Interview-Plus questionnaire were used for assessments. RESULTS The study showed statistically significant stress scores (49.54) in mothers having children diagnosed with psychiatric illnesses as compared to scores (30.98) in mothers of normally developing children. Psychiatric morbidity in cases (n = 58; 77.3%) was statistically significant as compared to controls (n = 23; 30.6%). Depression and anxiety were among the most common psychiatric morbidities evaluated, and the highest was for mothers having children with severe mental retardation. CONCLUSION In all children with psychiatric disorders, mothers have to be screened for psychiatric morbidity to prevent, detect, and manage it at the earliest.
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Affiliation(s)
- Nupur Shashank Mahatme
- Department of Psychiatry, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Anil Kakunje
- Department of Psychiatry, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Ravichandra Karkal
- Department of Psychiatry, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
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Rotberg B, Horváth-Puhó E, Vigod S, Ray JG, Sørensen HT, Cohen E. Increased maternal new-onset psychiatric disorders after delivering a child with a major anomaly: a cohort study. Acta Psychiatr Scand 2020; 142:264-274. [PMID: 32406524 DOI: 10.1111/acps.13181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND The birth of a child with a major congenital anomaly may create chronic caregiving stress for mothers, yet little is known about their psychiatric outcomes. AIMS To evaluate the association of the birth of a child with a major congenital anomaly with subsequent maternal psychiatric risk. METHODS This Danish nationwide cohort study included mothers who gave birth to an infant with a major congenital anomaly (n = 19 220) between 1997 and 2015. Comparators were randomly selected mothers, matched on maternal age, year of delivery and parity (n = 195 399). The primary outcome was any new-onset psychiatric diagnosis. Secondary outcomes included specific psychiatric diagnoses, psychiatric in-patient admissions and redeemed psychoactive medicines. Cox models were used to estimate hazard ratios (HRs), adjusted for socioeconomic and medical variables. RESULTS Mothers of affected infants had an elevated risk for a new-onset psychiatric disorder vs. the comparison group (adjusted HR, 1.16, 95% CI 1.11-1.22). The adjusted HR was particularly elevated during the first postpartum year (1.65, 95% CI 1.42-1.90), but remained high for years, especially among mothers of children with multiorgan anomalies (1.37, 95% CI 1.18-1.57). The risk was also elevated for most specific psychiatric diagnoses, admissions and medicines. CONCLUSIONS Mothers who give birth to a child with a major congenital anomaly are at increased risk of new-onset psychiatric disorders, especially shortly after birth and for mothers of children with more severe anomalies. Our study highlights the need to screen for mental illness in this high-risk population, as well as to integrate adult mental health services and paediatric care.
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Affiliation(s)
- B Rotberg
- Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - E Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S Vigod
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - J G Ray
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Division of Epidemiology, Department of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - E Cohen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Knight Lozano R, May S, Clarkson C, Sarjeant R. Caregiver experiences of paediatric inpatient cardiac services: A qualitative systematic review. Eur J Cardiovasc Nurs 2020; 20:147-159. [PMID: 33849062 DOI: 10.1177/1474515120951974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/04/2020] [Accepted: 08/02/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Advances in paediatric care have contributed to an increasing survival of children with complex heart disease. Yet, life-saving management demands prolonged inpatient admissions, which contribute to emotional and psychological distress for parents and other caregivers in a role of main custody. AIM The purpose of this study was to identify, appraise and synthesise qualitative studies exploring caregivers' experiences of paediatric inpatient cardiac services, generating an understanding of their needs in hospital and informing priorities for change in healthcare delivery. METHODS Searches were conducted in Medline, Allied and Complimentary Medicine Database, Cumulative Index of Nursing and Allied Health Literature, EMCARE, Scopus, PsychINFO, Proquest, OpenGrey and ETHOs from 2008-2019, reflecting recent advances in cardiac healthcare. Articles were selected using predetermined eligibility criteria dictating qualitative inquiry into caregiver perspectives whilst their child received hospital-based interventions for heart disease. All eligible studies underwent quality appraisal. Framework synthesis was used to analyse and summarise findings. RESULTS Twenty-seven studies involving 689 caregivers from 11 countries were included. Three overarching themes were identified: 'emotional capacity to care', 'practicalities of caring', and 'the bigger picture of caring'. CONCLUSIONS Through analysis and summary of qualitative primary research, this review captures the emotional challenges that caregivers face and practicalities of undertaking a caregiver role, whilst looking after their child with heart disease in hospital. The results widen the context of the caregiver role, encompassing the whole family unit beyond the hospital environment. This review exposes the impact of these challenges on caregiver competence, wellbeing and attachment to their unwell child, informing priorities for development of family-centred paediatric inpatient cardiac services.
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Affiliation(s)
| | - Stephen May
- Faculty of Health and Wellbeing, Sheffield Hallam University, UK
| | - Carl Clarkson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, UK
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Silva GVD, Moraes DEBD, Konstantyner T, Leite HP. [Social support and quality of life of families with children with congenital heart disease]. CIENCIA & SAUDE COLETIVA 2020; 25:3153-3162. [PMID: 32785550 DOI: 10.1590/1413-81232020258.18402018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 11/15/2018] [Indexed: 11/22/2022] Open
Abstract
The scope of this article is to evaluate to what extent social support for families with children with congenital disease impacts their quality of life. It involved a cross-sectional study with 254 parents of children with congenital heart disease. A semi-structured interview was conducted with the parents, using the Ecomap and the quality of life (World Health Organization Quality of Life Bref) and social support (Medical Outcomes Study) scales. Receiving social support was positively correlated with quality of life (r=0.535; p<0.001). A 10-point increase in the social support scale led to a 3-point increase in the total score of the quality of life scale (β=0.30; CI95%: 0.23; 0.37). Socioeconomic conditions were associated with quality of life (β=0.27; CI95%: 0.11; 0.43) and caregivers who reported not having leisure activity (β=-3.27; CI95% -5.55; -1.12) and who were undergoing health treatment (β=-2.86; CI95%: -5.55; -0.17) had a lower perception of quality of life. Negative consequences to the quality of life of caregivers taking care of a child with congenital heart disease can be intensified by a lack of leisure activity and having health problems. Adequate social support and socioeconomic resources positively influence the quality of life of these caregivers.
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Affiliation(s)
- Gisele Vilella da Silva
- Departamento de Pediatria, Universidade Federal de São Paulo. R. Botucatu 598, Vila Clementino. 04023-062 São Paulo SP Brasil.
| | - Denise Ely Bellotto de Moraes
- Departamento de Pediatria, Universidade Federal de São Paulo. R. Botucatu 598, Vila Clementino. 04023-062 São Paulo SP Brasil.
| | - Tulio Konstantyner
- Departamento de Pediatria, Universidade Federal de São Paulo. R. Botucatu 598, Vila Clementino. 04023-062 São Paulo SP Brasil.
| | - Heitor Pons Leite
- Departamento de Pediatria, Universidade Federal de São Paulo. R. Botucatu 598, Vila Clementino. 04023-062 São Paulo SP Brasil.
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Clubfoot treatment with Ponseti method-parental distress during plaster casting. J Orthop Surg Res 2020; 15:271. [PMID: 32680553 PMCID: PMC7368756 DOI: 10.1186/s13018-020-01782-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background Clubfoot is one of the most prevalent musculoskeletal congenital defects. Gold standard treatment of idiopathic clubfoot is the conservative Ponseti method, including the reduction of deformity with weekly serial plaster casting and percutaneous Achilles tenotomy. It is well known that parents of children with severe and chronic illnesses are mentally stressed, but in recent studies regarding clubfoot treatment, parents were only asked about their satisfaction with the treatment. Largely unknown is parental distress before and during plaster casting in clubfoot. Therefore, we want to determinate first, how pronounced the parents’ worries are before treatment and if they decrease during the therapy. Second, we hypothesized that parents faced with an extreme deformity (high Pirani score), reveal more distress, than parents whose children have a less pronounced deformity (low Pirani score). Therefore, we wanted to investigate whether the Pirani score correlates with the parents’ mental resilience in relation to the therapy of the child as a global distress parameter. Methods To answer this question, we developed a questionnaire with the following emphases: Physical capacity, mental resilience, motion score, parents score, and child score with point scores 1 (not affected) to 6 (high affected). Subsequently, we interviewed 20 parents whose children were treated with clubfeet and determined the Pirani score of the infants at the beginning (T0) and at the end (TE) of the treatment with plaster casting. Results High values were obtained in child score (Mean (M) = 3.11), motion score (M = 2.63), and mental resilience (M = 2.25). During treatment, mental resilience improved (p = 0.015) significantly. Spearman correlation coefficient between Pirani score (T0) and mental resilience (T0) is 0.21, so the initial hypothesis had to be rejected. Conclusion The issues of the children are in the focus of parental worries concerning clubfoot treatment, especially the assumed future motion and the assumed ability to play with other children. Particular emphasis should be placed on educating parents about the excellent long-term results in the function of the treated feet especially as this topic shows the greatest parental distress.
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McKechnie AC, Johnson KA, Baker MJ, Docherty SL, Leuthner SR, Thoyre S. Adaptive Leadership in Parents Caring for their Children Born with Life-Threatening Conditions. J Pediatr Nurs 2020; 53:41-51. [PMID: 32438191 PMCID: PMC7362670 DOI: 10.1016/j.pedn.2020.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to chronicle the adaptive challenges and adaptive work, including emerging leadership behaviors, recounted over time by the parents of very young children diagnosed before birth with life threatening conditions. DESIGN AND METHODS A descriptive, follow-up study design was used for the current study. Following the original grounded dimensional analysis study completed in 2012, the corpus for this analysis was collected in 2014. In-depth, audio-recorded interviews were conducted with 15 families (8 couples, 7 mothers). The 15 children, born with cardiac, abdominal, and cerebrospinal anomalies, were 14 - 37 months or deceased at follow-up. A directed content analysis of transcribed verbatim interviews was structured by the Adaptive Leadership framework. RESULTS Parents described behaviors that indicated a non-linear development towards adaptive leadership as they accomplished the adaptive work within intra- and interpersonal domains that was necessary to address challenges over time. Not all parents described abilities and/or a willingness to mobilize others to do adaptive work, suggesting that adaptive leadership remained an unrealized potential. CONCLUSIONS Understood as a complex adaptive system, parents of medically at-risk children hold potential for development towards adaptive leadership and collaborative partnership within the family and with healthcare providers. PRACTICE IMPLICATIONS Due to improved survival rates, parents face ongoing challenges related to their children's unpredictable and often chronic health needs. Study findings illustrate parents' adaptive work and leadership behaviors, which can inform nursing assessments, as well as the type and timing for intervention.
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Affiliation(s)
- Anne C McKechnie
- Child and Family Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, MN, United States of America.
| | - Kathy A Johnson
- College of Nursing, Chamberlain University, Downers Grove, IL, United States of America
| | - Maureen J Baker
- MSN Division, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Sharron L Docherty
- School of Nursing, Duke University, Durham, NC, United States of America
| | - Steven R Leuthner
- Division of Neonatology, Department of Pediatrics and Bioethics, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Suzanne Thoyre
- PhD Division, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Readiness for Hospital Discharge, Stress, and Coping in Mothers of Children Undergoing Cardiac Surgeries: A Single-Center Prospective Study. Pediatr Crit Care Med 2020; 21:e301-e310. [PMID: 32168300 DOI: 10.1097/pcc.0000000000002276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the relationship between stress, coping, and discharge readiness in mothers of children undergoing congenital heart surgeries. DESIGN Quantitative descriptive study at three time points: pre surgery (time point I), day of hospital discharge (time point II) and 2 weeks following discharge (time point III). SETTING Tertiary care pediatric hospital in Singapore. PARTICIPANTS One hundred mothers whose children had undergone congenital heart surgeries. MEASUREMENTS AND MAIN RESULTS Data collection included self-reported questionnaires of the Pediatric Inventory for Parents and the Coping Health Inventory for Parents across three time points. Readiness for Hospital Discharge Scale was administered at hospital discharge (time point II). The utilization of health services and support was reported at post discharge (time point III). One-hundred mothers participated in this study between May 2016 and July 2017. Their mean age was 35.8 years (SD = 7.0), and the mean age of their children was 3.7 years (SD = 4.6). There was significant reduction in mean stress difficulty (Pediatric Inventory for Parents) of mothers (F = 4.58; p = 0.013) from time point I to III. No significant changes were found in the overall mean coping score (Coping Health Inventory for Parents) of mothers across time. The mean overall score for the readiness for discharge (Readiness for Hospital Discharge Scale) of mothers at hospital discharge was 207.34 (SD = 29.22). Coping through family integration subscale and communication stress predicted discharge readiness of mothers (adjusted R = 0.11; p = 0.034). Mothers who reported higher overall stress (Pediatric Inventory for Parents) 2 weeks post discharge were more likely to call a friend or family member, visit the emergency department, or have their child readmitted to hospital following hospital discharge. CONCLUSIONS We identified coping by family integration and communication-related stress as predictors of readiness for discharge. Strategies targeted at communication and family integration for discharge preparation may improve caregivers' readiness for hospital discharge.
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Majmudar IK, Engel L, Muscara F, Stevenson C, McCarthy M, Anderson V, Mihalopoulos C. Exploring health state utility values of parents of children with a serious illness. Qual Life Res 2020; 29:1947-1959. [PMID: 32335816 DOI: 10.1007/s11136-020-02466-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE In cost-utility analysis, outcomes are usually measured in terms of quality-adjusted life years, where length of life is adjusted by levels of health-related quality of life (HRQoL) using a single value, known as a health state utility value (HSUV). This study explores the HSUVs of parents of children with a serious illness admitted within three hospital departments (cardiology, oncology and paediatric intensive care) across four time points, compares HSUVs with Australian population norms and examines predictors of parental HSUVs. METHODS Data were obtained from the Take a Breath study, where parental HSUVs were measured using the Assessment of Quality of Life-8 Dimensions (AQoL-8D). Descriptive statistics and t-tests compared the AQoL-8D scores with population norms, while repeated measures ANOVA was used to compare parental HSUVs of children treated across illness groups over time. Regression analysis was performed to determine predictors of parental HSUVs. RESULTS Parental HSUVs were not significantly different from the general Australian population norms (p = 0.939), as measured by the AQoL-8D. However, statistically significant differences were observed in the psychosocial super-dimension (p < 0.01) and in all eight AQoL-8D dimensions, except for senses and self-worth. No significant differences were observed across illness groups. Parental HSUVs were associated with psychosocial risk factors of trait anxiety (p < 0.001), depression (p < 0.001) and family beliefs (p = 0.024). CONCLUSION Having a child with a severe illness has an impact on the psychosocial aspects of parental HRQoL regardless of the type of illness. Psychosocial health factors of trait anxiety, depression and family beliefs were important predictors of parental HSUV.
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Affiliation(s)
- Ishani K Majmudar
- Faculty of Health, School for Health and Social Development, Institute for Health Transformation, Deakin Health Economics, Deakin University, Geelong, VIC, Australia.
| | - Lidia Engel
- Faculty of Health, School for Health and Social Development, Institute for Health Transformation, Deakin Health Economics, Deakin University, Geelong, VIC, Australia
| | - Frank Muscara
- Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052, Australia
| | - Christopher Stevenson
- Faculty of Health, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Maria McCarthy
- Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052, Australia
| | - Cathrine Mihalopoulos
- Faculty of Health, School for Health and Social Development, Institute for Health Transformation, Deakin Health Economics, Deakin University, Geelong, VIC, Australia
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Affiliation(s)
- Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Belgium.,Department of Paediatrics and Child Health, University of Cape Town, South Africa
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Molala W, Downing C. Experiences of newly qualified critical care nurses caring for post-cardiothoracic surgery paediatric patients in a private hospital in gauteng. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Children and adolescents with VACTERL association: health-related quality of life and psychological well-being in children and adolescents and their parents. Qual Life Res 2019; 29:913-924. [PMID: 31741214 PMCID: PMC7142056 DOI: 10.1007/s11136-019-02364-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 12/15/2022]
Abstract
Purpose VACTERL association is a rare and complex condition of congenital malformations, often requiring repeated surgery and entailing various physical sequelae. Due to scarcity of knowledge, the study aim was to investigate self-reported health-related quality of life (HRQoL), anxiety, depression and self-concept in children and adolescents with VACTERL association and self-reported anxiety and depression in their parents. Methods Patients aged 8–17 years with VACTERL association and their parents were recruited from three of four Swedish paediatric surgical centres during 2015–2019. The well-established validated questionnaires DISABKIDS, Beck Youth Inventories, Beck Anxiety Inventory and Beck Depression Inventory were sent to the families. Data were analysed using descriptives, t tests and multivariable analysis. Results were compared with norm groups and reference samples. Results The questionnaires were returned by 40 patients, 38 mothers and 33 fathers. The mean HRQoL was M = 80.4, comparable to children with asthma (M = 80.2) and diabetes (M = 79.5). Self-reported psychological well-being was comparable to the norm group of Swedish school children, and was significantly higher than a clinical sample. Factors negatively influencing children’s HRQoL and psychological well-being were identified. The parents’ self-reports of anxiety and depression were comparable to non-clinical samples. Conclusions Although children and adolescents with VACTERL association reported similar HRQoL to those of European children with chronic conditions, their psychological well-being was comparable to Swedish school children in general. Nevertheless, some individuals among both children and parents were in need of extra support. This attained knowledge is valuable when counselling parents regarding the prognosis for children with VACTERL association.
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Jackson AC, Frydenberg E, Koey XM, Fernandez A, Higgins RO, Stanley T, Liang RPT, Le Grande MR, Murphy BM. Enhancing Parental Coping with a Child's Heart Condition: A Co-production Pilot Study. Compr Child Adolesc Nurs 2019; 43:314-333. [PMID: 31584303 DOI: 10.1080/24694193.2019.1671915] [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: 10/25/2022]
Abstract
Families of children with congenital heart disease (CHD) can have difficulties coping with the stress of their child's condition and would benefit from assistance to cope better. To address the needs of these parents, the Australian Center for Heart Health/HeartKids Australia/Melbourne Graduate School of Education co-produced Family Coping Project was initiated. This project involved two systematic literature reviews, interviews with parents of children with CHD, and the development and piloting of a manualised parental coping program. The primary aims of the pilot study were to determine whether the program would: attract high needs families; enhance the coping self-efficacy of parents; and be acceptable to parents in terms of content and mode of delivery. The secondary aims were to investigate whether the program would impact on parental coping, parental stress and general stress. Parents completed pre-, post-program and 6-month follow up assessment measures, with parent stress scores being compared to stress scores reported for other chronic condition parent carer groups. Twenty-one parents participated and provided baseline data. They were found to be significantly more stressed than other parent carer groups. Eleven parents completed post-program data and 13 completed 6-month follow-up data. There was a significant increase in parents' coping self-efficacy from pre- to post-program, and from pre- to 6-months. Parents' use of productive coping styles increased significantly from pre- to post-program. The program was rated as highly acceptable in terms of content and delivery mode. The pilot provides strong evidence for upscaling the program in conjunction with individualized psychological support for parents to extend knowledge acquisition and attitude change into enhanced coping skills and demonstrated the benefits of a co-production process.
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Affiliation(s)
- Alun C Jackson
- Australian Centre for Heart Health , Melbourne, Australia.,Faculty of Health, Deakin University , Geelong, Australia.,Melbourne Graduate School of Education, University of Melbourne , Melbourne, Australia.,Centre on Behavioural Health, Hong Kong University , Hong Kong, People's Republic of China
| | - Erica Frydenberg
- Melbourne Graduate School of Education, University of Melbourne , Melbourne, Australia
| | - Xui Min Koey
- Melbourne Graduate School of Education, University of Melbourne , Melbourne, Australia
| | - Amanda Fernandez
- Melbourne Graduate School of Education, University of Melbourne , Melbourne, Australia
| | - Rosemary O Higgins
- Australian Centre for Heart Health , Melbourne, Australia.,Faculty of Health, Deakin University , Geelong, Australia.,Department of Physiotherapy, University of Melbourne , Melbourne, Australia
| | - Tracy Stanley
- HeartKids Australia Family Support Program, Royal Children's Hospital , Melbourne, Australia
| | - Rachel Pui-Tak Liang
- Melbourne Graduate School of Education, University of Melbourne , Melbourne, Australia
| | - Michael R Le Grande
- Australian Centre for Heart Health , Melbourne, Australia.,Faculty of Health, Deakin University , Geelong, Australia
| | - Barbara M Murphy
- Australian Centre for Heart Health , Melbourne, Australia.,Faculty of Health, Deakin University , Geelong, Australia.,Department of Psychology, University of Melbourne , Melbourne, Australia
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Biber S, Andonian C, Beckmann J, Ewert P, Freilinger S, Nagdyman N, Kaemmerer H, Oberhoffer R, Pieper L, Neidenbach RC. Current research status on the psychological situation of parents of children with congenital heart disease. Cardiovasc Diagn Ther 2019; 9:S369-S376. [PMID: 31737543 DOI: 10.21037/cdt.2019.07.07] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Congenital heart diseases (CHD) are a leading cause of morbidity in children with a high impact on the psychological health of parents. Possible short-term and long-term psychological problems among parents are addressed in the current paper. The diagnosis of CHD paired with subsequent surgical and interventional treatment and prolonged hospital stays cause acute psychological distress and can lead to posttraumatic stress disorders (PTSD). As the disease course progresses, the impact on parents' health tends to decrease, but the risk of developing long-term psychological issues remains high. Studies have focused mainly on stress and other distressing symptoms without explicitly addressing the effects of a CHD diagnosis on the family system. Since the social environment may play an important role in parent's life, it may be useful to conduct studies to address these issues. In particular, the psychological situation of the father and the impact of the child's disease on the different dimensions of the father's life, such as parenting skills and influences on the parental relationship, have been largely neglected. Recent research has also disregarded the impact of CHD on siblings of the affected child. Research on chronic diseases in general has shown that the children's age and severity of the disease are related to an increased level of stress. Given the severity of CHD, anxiety and depression were higher in parents with children with more severe conditions. In addition, the results suggest that a positive construction of the parent-child relationship (attachment and bonding) is impaired, especially in mothers. Mothers reported worries and concerns about the challenging tasks they would face after learning about their child's CHD and how they can deal with their child's needs. It has also been shown that the child's illness has a negative impact on the whole family system, including the parent's relationship. Impairments on the parental relationship were perceived differently among mothers and fathers. Thus, there is high need for major changes to be identified, developed and implemented in the psychological care of parents with chronically ill children. So far, research has focused more on the psychological status of parents with chronically ill children, but less research has closely examined the effects of a child's CHD on its parent's mental health even though there is a high demand in additional support. A holistic treatment approach should include professional parental support, especially during children's hospitalization, information on the home care resources and services (especially respite services) and psychological support for parents.
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Affiliation(s)
- Sabina Biber
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Caroline Andonian
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.,Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Jürgen Beckmann
- Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Peter Ewert
- Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Sebastian Freilinger
- Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Nicole Nagdyman
- Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Harald Kaemmerer
- Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Renate Oberhoffer
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.,Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Lars Pieper
- Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Germany
| | - Rhoia Clara Neidenbach
- Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
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