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DeLone AM, Fisher RS, Traino KA, Basile NL, Buchanan CL, Cheng EY, Poppas DP, Baraldi AN, Wisniewski AB, Mullins LL. Exploratory factor analysis of the Illness Intrusiveness Rating Scale for parents of children with atypical genital appearance due to differences of sex development (DSD). J Pediatr Psychol 2024:jsae027. [PMID: 38578612 DOI: 10.1093/jpepsy/jsae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE Illness intrusiveness refers to the subjective cognitive appraisal of a chronic health condition interfering in daily, valued activities and may be highly relevant for parents of children with atypical genital appearance due to differences of sex development (DSD). However, a measure of illness intrusiveness has not been validated for this population. The current study aimed to evaluate the factor structure of the Illness Intrusiveness Scale for Parents (IIS-P) and examine convergent validity. METHODS Participants included 102 parents (Mage = 33.39 years, SD = 6.48; 58% mothers) of 65 children (<2 years old) diagnosed with DSD participating in a larger, longitudinal study. Parents completed the IIS-P as well as self-report measures of stigma, and anxious and depressive symptoms. An exploratory factor analysis (EFA) was conducted. RESULTS EFA results supported a 1-factor intrusiveness solution (α = .93), as well as a 2-factor solution measuring intrusiveness on daily living (α = .92) and community connectedness (α = .85). The 1-factor solution and both factors of the 2-factor solution demonstrated significant convergent validity with stigma as well as anxious and depressive symptoms. CONCLUSIONS Support emerged for both 1- and 2-factor solutions of the IIS-P in parents of children with DSD. The decision to evaluate illness intrusiveness as a total score or to examine the subscales of daily living and community connectedness should be tailored to the unique aims of researchers and clinicians. Future research should conduct a confirmatory factor analysis with both 1- and 2-factor models with larger, more diverse samples of caregivers.
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Affiliation(s)
- Alexandra M DeLone
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, United States
| | - Rachel S Fisher
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, United States
| | - Katherine A Traino
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, United States
| | - Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, United States
| | - Cindy L Buchanan
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, United States
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States
| | - Dix P Poppas
- James Buchanan Brady Department of Urology, Komansky Children's Hospital, New York Presbyterian Hospital-Weill Cornell Medicine, New York, United States
| | - Amanda N Baraldi
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, United States
| | - Amy B Wisniewski
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, United States
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, United States
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Traino KA, Fisher RS, Basile NL, Dattilo TM, Baskin LS, Buchanan CL, Chan YM, Cheng EY, Coplen DE, Kolon TF, Lakshmanan Y, Palmer BW, Mullins LL, Ciciolla LM, Wisniewski AB. Adverse Birth Experiences and Parent Adjustment Associated With Atypical Genital Appearance Due to Differences of Sex Development. J Pediatr Psychol 2023; 48:759-767. [PMID: 37500595 PMCID: PMC10516460 DOI: 10.1093/jpepsy/jsad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Differences/disorders of sex development (DSDs) are rare, congenital conditions involving discordance between chromosomes, gonads, and phenotypic sex and are often diagnosed in infancy. A key subset of parents of children newly diagnosed with a DSD experience clinically elevated distress. The present study examines the relationship between perinatal factors (i.e., gestational age, delivery method) and trajectories of parental adjustment. METHODS Parent participants (mothers = 37; fathers = 27) completed measures at baseline, 6- and 12-month follow-up. Multilevel linear regression controlled for clustering of the data at three levels (i.e., time point, parent, and family) and examined the relationship between perinatal factors and trajectories of depressive and anxious symptoms. Two-way interactions between perinatal factors and parent type were evaluated. RESULTS Overall depressive and anxious symptoms decreased over time. There were significant interactions between gestational age and parent type for depressive and anxious symptoms, with younger gestational age having a stronger negative effect on mothers vs. fathers. There was a significant interaction between time and gestational age for depressive symptoms, with 36 weeks' gestational age demonstrating a higher overall trajectory of depressive symptoms across time compared to 38 and 40 weeks. Findings for the delivery method were not significant. CONCLUSIONS Findings uniquely demonstrated younger gestational age was associated with increased depressive symptoms, particularly for mothers compared to fathers. Thus, a more premature birth may predispose parents of infants with DSD to distress. Psychosocial providers should contextualize early diagnosis-related discussions within stressful birth experiences when providing support.
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Affiliation(s)
- Katherine A Traino
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Rachel S Fisher
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Taylor M Dattilo
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Laurence S Baskin
- Department of Urology, University of California San Francisco Medical Center, USA
| | - Cindy L Buchanan
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, USA
| | - Yee-Ming Chan
- Division of Endocrinology, and Harvard Medical School, Boston Children’s Hospital, USA
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | - Douglas E Coplen
- Division of Urologic Surgery, St. Louis Children’s Hospital, USA
| | - Thomas F Kolon
- Division of Urology, Children’s Hospital of Philadelphia, USA
| | | | - Blake W Palmer
- Department of Pediatric Urology, Cook Children’s Medical Center, USA
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Lucia M Ciciolla
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Amy B Wisniewski
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
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Traino KA, Basile NL, Chang HF, Fisher RS, Dattilo TM, Mullins LL, Ediati A, Wisniewski AB. Cross-Cultural Disparities in Psychosocial Research with Individuals with Classical Congenital Adrenal Hyperplasia: A Scoping Review. Horm Res Paediatr 2023; 97:99-105. [PMID: 37552959 DOI: 10.1159/000531167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/10/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION There are increased calls to address psychosocial needs among individuals with classical congenital adrenal hyperplasia (CAH). However, cross-cultural disparities exist in treatment practices and psychosocial outcomes that impact the generalizability of evidence-based recommendations. To date, this disparity has not been quantified. The present scoping review uses a dual approach to contrast rates of CAH diagnosis with CAH psychosocial research rates across countries. METHODS Six electronic database searches were conducted for: (1) CAH incidence/birth/prevalence rates; and (2) psychosocial research with affected individuals and their families. Two authors reviewed each abstract for inclusion criteria. RESULTS Sixty-eight and 93 full-text articles, respectively, were evaluated for incidence and country. The countries/regions with the highest reported CAH rates are Thailand, Ghana, and India. Those with the greatest portion of psychosocial publications are the USA, Germany, and the UK. CONCLUSION A discrepancy exists between those countries with the highest CAH rates and those publishing psychosocial research. Specifically, increased rates of CAH are seen in non-Western countries/regions, whereas most psychosocial research arises out of Western Europe and the USA. Due to cultural differences between these regions, increased global collaboration is needed to both inform psychosocial research and translate findings in ways that are representative worldwide.
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Affiliation(s)
- Katherine A Traino
- Psychology Department, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Nathan L Basile
- Psychology Department, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Hui-Fen Chang
- William E. Brock Memorial Library, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Rachel S Fisher
- Psychology Department, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Taylor M Dattilo
- Psychology Department, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Larry L Mullins
- Psychology Department, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | | | - Amy B Wisniewski
- Psychology Department, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
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Basile NL, Dattilo TM, DeLone AM, Kraft JD, Edwards CS, Buchanan CL, Cheng EY, Poppas DP, Wisniewski AB, Mullins LL. Parental Uncertainty Scale Factor Structure in Pediatric DSD With Ambiguous Genitalia. J Pediatr Psychol 2023; 48:386-395. [PMID: 36728708 PMCID: PMC10118853 DOI: 10.1093/jpepsy/jsad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Illness uncertainty is a salient experience for caregivers of children with disorders/differences of sex development (DSD) presenting with ambiguous genitalia; however, no validated measure of illness uncertainty exists for this unique population. Thus, the current study aimed to preliminarily identify the factor structure of the Parental Perception of Uncertainty Scale (PPUS) in caregivers of children with DSD presenting with ambiguous genitalia and examine the convergent validity of the PPUS. METHODS Participants included 115 caregivers (Mage = 32.12 years, SD = 6.54; 57% mothers) of children (<2-year-olds) diagnosed with DSD participating in a larger, longitudinal study. Caregivers completed the PPUS as well as self-report measures of anxious, depressive, and posttraumatic stress symptoms. An exploratory factor analysis was conducted. RESULTS Exploratory factor analysis results indicated that a 23-item 1-factor solution was the most parsimonious and theoretically sound factor structure (α = 0.92). Convergent validity analyses demonstrated further support for the use of the 23-item 1-factor solution over the original PPUS factor structure. CONCLUSION These results demonstrate the preliminary clinical and research utility of the PPUS with caregivers of children with DSD presenting with ambiguous genitalia. The PPUS may benefit from further refinement through qualitative research and item adaptation to capture uncertainties unique to DSD presenting with ambiguous genitalia. In addition, future research should replicate the proposed factor structure using confirmatory factor analysis with a separate, larger sample of caregivers of children with DSD to confirm the factor structure.
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Affiliation(s)
- Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Taylor M Dattilo
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Alexandra M DeLone
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Jacob D Kraft
- Department of Psychiatry, University of Michigan, USA
| | - Clayton S Edwards
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Cindy L Buchanan
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, USA
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | - Dix P Poppas
- Institute for Pediatric Urology, Komansky Children’s Hospital, New York Presbyterian Hospital-Weill Cornell Medicine, USA
| | - Amy B Wisniewski
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
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Fisher RS, Datillo TM, Baskin LS, Buchanan CL, Cheng EY, Kolon T, Nokoff NJ, Poppas DP, Reyes KJ, Mullins LL, Wisniewski AB. Decisional Regret Among Caregivers of Infants with Differences of Sex Development Reared as Male. J Dev Behav Pediatr 2023; 44:e225-e230. [PMID: 36729523 PMCID: PMC10065892 DOI: 10.1097/dbp.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/25/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Differences of sex development (DSD) are congenital conditions in which individuals are discordant in their chromosomal, phenotypic, and/or gonadal sex. Treatment of DSD can involve surgical intervention to external genitalia to make anatomy seem male-typical (i.e., male genitoplasty). Caregiver-perceived decisional regret regarding young boys with DSD was explored quantitatively and qualitatively. METHOD Participants (N = 39) were caregivers of infants (N = 23) diagnosed with DSD (mean age = 8.9 months, standard deviation = 5.9 months) reared male participating in a longitudinal investigation of psychosocial outcomes. Qualitative data were collected at 6 to 12 months after baseline enrollment to evaluate caregiver decision-making corresponding to levels of regret concerning their child's treatment. All but one infant received genital surgery before caregiver reporting on their decisional regret. Quantitative exploratory analyses evaluated longitudinal predictors of decisional regret at 6 to 12 months. RESULTS When completing a write-in item inquiring about decision-making and potential regret, most caregivers (n = 16, 76%) reported that their child's genital surgery was their first medical decision. Two caregivers referenced gender assignment as a decision point. One-third of caregivers reported some level of decisional regret (33%), with 67% reporting no regret. No hypothesized predictors of decisional regret were statistically significant. CONCLUSION Many caregivers of infants with DSD reared male view genital surgery as a first health care decision. Approximately one-third of caregivers reported some level of decisional regret. Further research is warranted to explore long-term decisional regret; it will be particularly important to investigate the decisional regret of patients with DSD.
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Affiliation(s)
- Rachel S. Fisher
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA
| | - Taylor M. Datillo
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA
| | - Laurence S. Baskin
- University of California San Francisco Medical Center, Department of Urology, San Francisco, CA, USA
| | - Cindy L. Buchanan
- University of Colorado Anschutz Medical Campus, Department of Psychiatry, Aurora, CO, USA
| | - Earl Y. Cheng
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Department of Urology, Chicago, IL, USA
| | - Thomas Kolon
- Children’s Hospital of Philadelphia, Division of Urology, Philadelphia, PA, USA
| | - Natalie J. Nokoff
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Division of Endocrinology, Aurora, CO, USA
| | - Dix P. Poppas
- New York Presbyterian Weill Cornell Medicine, Department of Urology, Komansky Children’s Hospital, New York, NY, USA
| | - Kristy J. Reyes
- Cook Children’s Medical Center, Department of Pediatric Urology, Fort Worth, TX, USA
| | - Larry L. Mullins
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA
| | - Amy B. Wisniewski
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA
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Kremen J, Harris RM, Aston CE, Perez M, Austin PF, Baskin L, Cheng EY, Fried A, Kolon T, Kropp B, Lakshmanan Y, Nokoff NJ, Palmer B, Paradis A, Poppas D, Reyes KJS, Wolfe-Christensen C, Diamond DA, Tishelman AC, Mullins LL, Wisniewski AB, Chan YM. Exploring Factors Associated with Decisions about Feminizing Genitoplasty in Differences of Sex Development. J Pediatr Adolesc Gynecol 2022; 35:638-646. [PMID: 35948206 PMCID: PMC9701156 DOI: 10.1016/j.jpag.2022.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/24/2022] [Accepted: 08/04/2022] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVE Infants with genital development considered atypical for assigned female sex may undergo feminizing genitoplasty (clitoroplasty and/or vaginoplasty) in early life. We sought to identify factors associated with parent/caregiver decisions regarding genitoplasty for their children with genital virilization. DESIGN Longitudinal, observational study SETTING: Twelve pediatric centers in the United States with multidisciplinary differences/disorders of sex development clinics, 2015-2020 PARTICIPANTS: Children under 2 years old with genital appearance atypical for female sex of rearing and their parents/caregivers INTERVENTIONS/OUTCOME MEASURES: Data on the child's diagnosis and anatomic characteristics before surgery were extracted from the medical record. Parents/caregivers completed questionnaires on psychosocial distress, experience of uncertainty, cosmetic appearance of their child's genitalia, and demographic characteristics. Urologists rated cosmetic appearance. For 58 patients from the study cohort with genital virilization being raised as girls or gender-neutral, we compared these data across 3 groups based on the child's subsequent surgical intervention: (i) no surgery (n = 5), (ii) vaginoplasty without clitoroplasty (V-only) (n = 15), and (iii) vaginoplasty and clitoroplasty (V+C) (n = 38). RESULTS Fathers' and urologists' ratings of genital appearance were more favorable in the no-surgery group than in the V-only and V+C groups. Clitorophallic length was greater in the V+C group compared with the V-only group, with substantial overlap between groups. Mothers' depressive and anxious symptoms were lower in the no-surgery group compared with the V-only and V+C groups. CONCLUSIONS Surgical decisions were associated with fathers' and urologists' ratings of genital appearance, the child's anatomic characteristics, and mothers' depressive and anxious symptoms. Further research on surgical decision-making is needed to inform counseling practices.
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Affiliation(s)
- Jessica Kremen
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Rebecca M Harris
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Paul F Austin
- Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Laurence Baskin
- University of California San Francisco Medical Center, UCSF School of Medicine, San Francisco, California
| | - Earl Y Cheng
- Lurie Children's Hospital of Chicago, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Allyson Fried
- John R. Oishei Children's Hospital, Buffalo, New York
| | - Thomas Kolon
- Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bradley Kropp
- Oklahoma State University, Stillwater, Oklahoma; OKC Kids, Oklahoma City, Oklahoma
| | - Yegappan Lakshmanan
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Natalie J Nokoff
- Childrens Hospital of Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Blake Palmer
- Cook Children's Medical Center, University of Oklahoma, College of Medicine, Oklahoma City, Oklahoma
| | - Alethea Paradis
- St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Dix Poppas
- New York Presbyterian Hospital, Weill Cornell Medical College, New York City, New York
| | - Kristy J Scott Reyes
- Cook Children's Medical Center, University of Oklahoma, College of Medicine, Oklahoma City, Oklahoma
| | - Cortney Wolfe-Christensen
- Cook Children's Medical Center, University of Oklahoma, College of Medicine, Oklahoma City, Oklahoma
| | - David A Diamond
- Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Amy C Tishelman
- Boston College, Morrissey College of Arts and Sciences, Boston, Massachusetts
| | | | - Amy B Wisniewski
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Yee-Ming Chan
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Traino KA, Roberts CM, Fisher RS, Delozier AM, Austin PF, Baskin LS, Chan YM, Cheng EY, Diamond DA, Fried AJ, Kropp B, Lakshmanan Y, Meyer SZ, Meyer T, Buchanan C, Palmer BW, Paradis A, Reyes KJ, Tishelman A, Williot P, Wolfe-Christensen C, Yerkes EB, Mullins LL, Wisniewski AB. Stigma, Intrusiveness, and Distress in Parents of Children with a Disorder/Difference of Sex Development. J Dev Behav Pediatr 2022; 43:e473-e482. [PMID: 35353771 PMCID: PMC9474682 DOI: 10.1097/dbp.0000000000001077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The impact of parent-reported stigma due to their child's disorder/difference of sex development (DSD) on parent psychosocial adjustment is poorly understood. In other pediatric populations, perceived interference of medical conditions into daily activities (i.e., illness intrusiveness ) mediates the relationship of stigma to adjustment. This study assessed relationships between parent-focused and child-focused stigma → illness intrusiveness → depressive and anxious symptoms . Exploratory analyses sought to identify patient characteristics associated with stigma. METHOD Caregivers (59 women and 43 men) of 63 children diagnosed with a DSD up to age 4 years completed measures of demographics, parent-focused and child-focused stigma, illness intrusiveness, and depressive and anxious symptoms. RESULTS Increased parent-focused and child-focused stigma were associated with increased illness intrusiveness, which, in turn, was associated with increased depressive and anxious symptoms for parents nested within dyads. Among children with DSD family histories, parents reported greater child-focused stigma. CONCLUSION Parents who experience DSD-related stigma report greater interference of their child's DSD into their daily activities, which is associated with poorer psychosocial adjustment. Findings support developing clinical interventions related to parents' perceptions of stigma and illness intrusiveness to improve parent adjustment.
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Affiliation(s)
- Katherine A. Traino
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, Stillwater, OK
| | - Caroline M. Roberts
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, Stillwater, OK
| | - Rachel S. Fisher
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, Stillwater, OK
| | - Alexandria M. Delozier
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, Stillwater, OK
| | - Paul F. Austin
- Texas Children’s Hospital, Department of Urology Houston, TX
| | - Laurence S. Baskin
- University of California San Francisco Medical Center, Department of Urology, San Francisco, CA
| | - Yee-Ming Chan
- Boston Children’s Hospital, Division of Endocrinology, and Harvard Medical School, Boston, MA
| | - Earl Y. Cheng
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Department of Urology, Chicago, IL
| | - David A. Diamond
- Harvard Medical School, Boston Children’s Hospital, Department of Urology, Boston, MA
| | - Allyson J. Fried
- John R. Oishei Children’s Hospital, Pediatric Urology of Western New York, Buffalo, NY
| | | | | | - Sabrina Z. Meyer
- John R. Oishei Children’s Hospital, Pediatric Urology of Western New York, Buffalo, NY
| | - Theresa Meyer
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Department of Urology, Chicago, IL
| | - Cindy Buchanan
- University of Colorado Anschutz Medical Campus, Department of Psychiatry, Aurora, CO
| | - Blake W. Palmer
- Cook Children’s Medical Center, Department of Pediatric Urology, Fort Worth, TX
| | - Alethea Paradis
- St. Louis Children’s Hospital, Division of Urologic Surgery, St. Louis, MO
| | - Kristy J. Reyes
- Cook Children’s Medical Center, Department of Pediatric Urology, Fort Worth, TX
| | - Amy Tishelman
- Harvard Medical School, Boston Children’s Hospital, Department of Urology, Boston, MA
- Boston College, Boston Children’s Hospital, Department of Psychiatry, Boston, MA
| | - Pierre Williot
- John R. Oishei Children’s Hospital, Pediatric Urology of Western New York, Buffalo, NY
| | | | - Elizabeth B. Yerkes
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Department of Urology, Chicago, IL
| | - Larry L. Mullins
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, Stillwater, OK
| | - Amy B. Wisniewski
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, Stillwater, OK
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Fisher RS, Espeleta HC, Baskin LS, Buchanan CL, Chan YM, Cheng EY, Coplen DE, Diamond DA, Nokoff NJ, Palmer BW, Poppas DP, Scott Reyes KJ, Tishelman A, Wolfe-Christensen C, Mullins LL, Wisniewski AB. Decisional regret about surgical and non-surgical issues after genitoplasty among caregivers of female infants with CAH. J Pediatr Urol 2022; 18:27-33. [PMID: 34742644 PMCID: PMC8983419 DOI: 10.1016/j.jpurol.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Caregivers of female infants with congenital adrenal hyperplasia (CAH) often confront complex medical decision-making (e.g., early feminizing genitoplasty). OBJECTIVE This study aimed to evaluate the relevant medical decisions and subsequent decisional regret of caregivers following their child's genitoplasty. STUDY DESIGN Caregivers (N = 55) were recruited from multidisciplinary treatment programs for participation in a longitudinal study. Qualitative data was collected at 6-12 months following feminizing genitoplasty to evaluate caregiver-reported decision points across their child's treatment. Quantitative exploratory analysis evaluated pre-operative predictors of subsequent decisional regret. DISCUSSION When prompted about their decision-making and potential regret, most caregivers (n = 32, 80%) reported that their daughter's genital surgery was their primary medical decision. Specific themes regarding genital surgery included the timing and type of surgery. Most caregivers reported no decisional regret (62%), with 38% reporting some level of regret. Greater pre-operative illness uncertainty predicted heightened decisional regret at follow-up, p = .001. CONCLUSION Two-thirds of caregivers of female infants with CAH reported not regretting their decision-making. Nevertheless, over one-third of caregivers reported some level of regret, suggesting the need for improvements in shared decision-making processes. Many, but not all, families reported that this regret was related to surgical decision-making. Reducing caregiver illness uncertainty (e.g., providing clear information to families) may increase their satisfaction with decision-making. Further research is needed to determine how the evolving care practices surrounding early genitoplasty will impact families.
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Affiliation(s)
- Rachel S Fisher
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA
| | - Hannah C Espeleta
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Laurence S Baskin
- University of California San Francisco Medical Center, Department of Urology, San Francisco, CA, USA
| | - Cindy L Buchanan
- University of Colorado Anschutz Medical Campus, Department of Psychiatry, Aurora, CO, USA
| | - Yee-Ming Chan
- Boston Children's Hospital, Division of Endocrinology, Department of Pediatrics, Harvard Medical School, Department of Pediatrics, Boston, MA, USA
| | - Earl Y Cheng
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Urology, Chicago, IL, USA
| | - Douglas E Coplen
- St. Louis Children's Hospital, Division of Urologic Surgery, St. Louis, MO, USA
| | | | - Natalie J Nokoff
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Division of Endocrinology, Aurora, CO, USA
| | - Blake W Palmer
- Cook Children's Medical Center, Department of Pediatric Urology, Fort Worth, TX, USA
| | - Dix P Poppas
- New York Presbyterian Weill Cornell Medicine, Department of Urology, Komansky Children's Hospital, New York, NY, USA
| | - Kristy J Scott Reyes
- Cook Children's Medical Center, Department of Pediatric Urology, Fort Worth, TX, USA
| | | | | | - Larry L Mullins
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA
| | - Amy B Wisniewski
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA.
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Traino KA, Baudino MN, Kraft JD, Basile NL, Dattilo TM, Davis MP, Buchanan C, Cheng EY, Poppas DP, Wisniewski AB, Mullins LL. Factor Analysis of the Stigma Scale-Parent Version in Pediatric Disorders/Differences of Sex Development. Stigma Health 2021; 6:390-396. [PMID: 35497259 PMCID: PMC9053364 DOI: 10.1037/sah0000346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Stigma is a salient experience for both caregivers/parents and individuals with Disorders/Differences of Sex Development (DSD) as evidenced through qualitative and preliminary quantitative reports. However, few validated measures of associative stigma (i.e., vicarious stigma experienced through close association with someone who is socially stigmatized) for parents of children with DSD exist. The present study aims to (1) determine the factor structure of the adapted Stigma Scale - Parent, and (2) examine convergent validity of the factor structure with measures of parent psychosocial adjustment. Confirmatory factor analytic results revealed two factors: a parent-focused factor and a child-focused factor. The parent-focused factor demonstrated convergent validity with parent adjustment measures, but the child-focused factor did not. Together, these results indicate that parent-focused and child-focused stigma are distinct factors, with parent-focused associative stigma being related to parent adjustment following DSD diagnosis. Future research should further refine this measure to determine predictive validity and clinical value.
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Affiliation(s)
| | | | - Jacob D. Kraft
- Psychology Department, Oklahoma State University, Stillwater, OK
| | - Nathan L. Basile
- Psychology Department, Oklahoma State University, Stillwater, OK
| | | | - Morgan P. Davis
- Psychology Department, Oklahoma State University, Stillwater, OK
| | - Cindy Buchanan
- University of Colorado Anschutz Medical Campus, Department of Psychiatry, Aurora, CO
| | - Earl Y. Cheng
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Department of Urology, Chicago, IL
| | - Dix P. Poppas
- Phyllis & David Komansky Center for Children’s Health of New York Presbyterian Hospital Weill Cornell Medical Center
| | | | - Larry L. Mullins
- Psychology Department, Oklahoma State University, Stillwater, OK
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10
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Long CJ, Van Batavia J, Wisniewski AB, Aston CE, Baskin L, Cheng EY, Lakshmanan Y, Meyer T, Kropp B, Palmer B, Nokoff NJ, Paradis A, VanderBrink B, Scott Reyes KJ, Yerkes E, Poppas DP, Mullins LL, Kolon TF. Post-operative complications following masculinizing genitoplasty in moderate to severe genital atypia: results from a multicenter, observational prospective cohort study. J Pediatr Urol 2021; 17:379-386. [PMID: 33726972 PMCID: PMC8713352 DOI: 10.1016/j.jpurol.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. A phenotype of severe genital atypia in patients raised as male is a relatively rare occurrence and standards for management are lacking. Decision making for early surgical planning in these rare cases includes, but is not limited to, degree of atypia, location of testes, and presence of Mϋllerian remnants. In this study we describe surgical approaches and short-term outcomes for masculinizing genitoplasty in moderate to severe genital atypia in young patients raised male, for whom parents opted for early surgery. METHODS This NIH-sponsored study is an ongoing, observational, multicenter investigation assessing medical, surgical and psychological outcomes in children and their parents affected by atypical genitalia due to DSD. Participants were prospectively enrolled from 12 children's hospitals across the United States that specialize in DSD care. Criteria for child enrollment were a Quigley score of 3-6 in those with a 46, XY or 45,X/46, XY chromosome complement, age <3 years with no previous genitoplasty; patients were included independent of whether genitoplasty was performed. Cosmesis was graded according to a 4-point Likert scale and complications per the Clavian-Dindo classification. RESULTS Of the 31 participants, 30 underwent hypospadias repair and 1 patient did not undergo a genitoplasty procedure. The majority of participants (22) received a staged hypospadias repair. Seventeen complications were identified in 12 of the 31 children (41%) at 12 months of follow up. Glans dehiscence and urethrocutaneous fistula were the most common complications. Orchiopexy was performed in 14 (44%) and streak gonads were removed in 4 (13%) participants. Both parents and surgeons reported improved cosmesis after surgery when compared to baseline. CONCLUSION Genitoplasty was chosen by parents for the majority of children eligible for study. No single surgical approach for masculinizing moderate to severe genital ambiguity in young patients with 46, XY or 45,X/46, XY DSD was adopted by all surgeons. Complications occurred in 41% of those who underwent genitoplasty for severe hypospadias. Overall, appearance of the genitals, as determined by parents and surgeons, improved following genitoplasty. Outcomes of early genitoplasty are needed to guide families when making decisions about such procedures for their young children.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dix P Poppas
- New York Presbyterian Hospital/Weill Cornell Medicine, USA.
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11
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Roberts CM, Sharkey CM, Bakula DM, Perez MN, Delozier AJ, Austin PF, Baskin LS, Chan YM, Cheng EY, Diamond DA, Fried AJ, Kropp B, Lakshmanan Y, Meyer SZ, Meyer T, Nokoff NJ, Palmer BW, Paradis A, Reyes KJS, Tishelman A, Williot P, Wolfe-Christensen C, Yerkes EB, Aston C, Wisniewski AB, Mullins LL. Illness Uncertainty Longitudinally Predicts Distress Among Caregivers of Children Born With DSD. J Pediatr Psychol 2021; 45:1053-1062. [PMID: 32929478 DOI: 10.1093/jpepsy/jsaa069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE A subset of parents of children with disorders/differences of sex development (DSD) including ambiguous genitalia experience clinically elevated levels of anxious and depressive symptoms. Research indicates that uncertainty about their child's DSD is associated with parent psychosocial distress; however, previous studies have been cross-sectional or correlational in nature. The current study is the first to examine the longitudinal trajectory of the relationship between caregiver-perceived uncertainty about their child's DSD and caregiver anxious and depressive symptoms across the first 12 months following genital surgery in young children, or if surgery was not performed, the first 12 months following study entry. METHODS One hundred and thirteen caregivers (Mage = 32.12; 57.5% mothers; 72.6% Caucasian) of children (N = 70; Mage = 9.81 months; 65.7% female) with DSD were recruited from 12 DSD specialty clinics in the United States. Caregivers completed psychosocial measures at baseline, 6 and 12 months following genitoplasty, or study entry if parents elected not to have surgery for their child. RESULTS Caregiver illness uncertainty and both anxious and depressive symptoms were highest at baseline and decreased over time (ps < .05). Caregiver illness uncertainty predicted symptoms of anxious and depressive symptoms across all time points (ps < .05). CONCLUSIONS Caregivers' perceptions of uncertainty about their child's DSD are highest soon after diagnosis, and uncertainty continues to predict both anxious and depressive symptoms across time. Thus, the initial diagnostic period is a critical time for psychological assessment and intervention, with parent illness uncertainty being an important clinical target.
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Affiliation(s)
- Caroline M Roberts
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | - Christina M Sharkey
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | - Dana M Bakula
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | - Megan N Perez
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | | | | | - Laurence S Baskin
- Department of Urology, University of California San Francisco Medical Center
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - David A Diamond
- Department of Urology, Boston Children's Hospital, Harvard Medical School
| | - Allyson J Fried
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | | | | | - Sabrina Z Meyer
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | - Theresa Meyer
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Natalie J Nokoff
- Department of Endocrinology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus
| | - Blake W Palmer
- Department of Pediatric Urology, Cook Children's Medical Center
| | | | | | - Amy Tishelman
- Department of Urology, Boston Children's Hospital, Harvard Medical School.,Department of Psychiatry, Boston Children's Hospital, Harvard Medical School
| | - Pierre Williot
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | | | - Elizabeth B Yerkes
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Christopher Aston
- Department of Pediatrics, University of Oklahoma Health Sciences Center
| | - Amy B Wisniewski
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | - Larry L Mullins
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
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12
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Perez MN, Clawson AH, Baudino MN, Austin PF, Baskin LS, Chan YM, Cheng EY, Coplen D, Diamond DA, Fried AJ, Kolon T, Kropp B, Lakshmanan Y, Meyer T, Nokoff NJ, Palmer BW, Paradis A, Poppas DP, Reyes KJS, Williot P, Wolfe-Christensen C, Yerkes EB, Wisniewski AB, Mullins LL. Distress Trajectories for Parents of Children With DSD: A Growth Mixture Model. J Pediatr Psychol 2021; 46:588-598. [PMID: 33594414 DOI: 10.1093/jpepsy/jsab004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/06/2020] [Accepted: 01/09/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study identifies trajectories of parent depressive symptoms after having a child born with genital atypia due to a disorder/difference of sex development (DSD) or congenital adrenal hyperplasia (CAH) and across the first year postgenitoplasty (for parents who opted for surgery) or postbaseline (for parents who elected against surgery for their child). Hypotheses for four trajectory classes were guided by parent distress patterns previously identified among other medical conditions. METHODS Participants included 70 mothers and 50 fathers of 71 children diagnosed with a DSD or CAH with reported moderate to high genital atypia. Parents were recruited from 11 US DSD specialty clinics within 2 years of the child's birth and prior to genitoplasty. A growth mixture model (GMM) was conducted to identify classes of parent depressive symptoms over time. RESULTS The best fitting model was a five-class linear GMM with freely estimated intercept variance. The classes identified were termed "Resilient," "Recovery," "Chronic," "Escalating," and "Elevated Partial Recovery." Four classes have previously been identified for other pediatric illnesses; however, a fifth class was also identified. The majority of parents were classified in the "Resilient" class (67.6%). CONCLUSIONS This study provides new knowledge about the trajectories of depressive symptoms for parents of children with DSD. Future studies are needed to identify developmental, medical, or familial predictors of these trajectories.
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Affiliation(s)
- Megan N Perez
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Ashley H Clawson
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Marissa N Baudino
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | | | - Laurence S Baskin
- Department of Urology, University of California San Francisco Medical Center
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Harvard Medical School and Boston Children's Hospital
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | | | - David A Diamond
- Department of Urology, Boston Children's Hospital, Harvard Medical School
| | - Allyson J Fried
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | - Thomas Kolon
- Division of Urology, Children's Hospital of Philadelphia
| | - Bradley Kropp
- Department of Pediatric Urology, Cook Children's Medical Center
| | | | - Theresa Meyer
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Natalie J Nokoff
- Department of Endocrinology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus
| | - Blake W Palmer
- Department of Pediatric Urology, Cook Children's Medical Center
| | | | - Dix P Poppas
- Department of Urology, New York Presbyterian Weill Cornell Medicine
| | | | - Pierre Williot
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | | | - Elizabeth B Yerkes
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Amy B Wisniewski
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Larry L Mullins
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
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13
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Baskin A, Wisniewski AB, Aston CE, Austin P, Chan YM, Cheng EY, Diamond DA, Fried A, Kolon T, Lakshmanan Y, Williot P, Meyer S, Meyer T, Kropp B, Nokoff N, Palmer B, Paradis A, Poppas D, VanderBrink B, Scott Reyes KJ, Tishelman A, Wolfe-Christensen C, Yerkes E, Mullins LL, Baskin L. Post-operative complications following feminizing genitoplasty in moderate to severe genital atypia: Results from a multicenter, observational prospective cohort study. J Pediatr Urol 2020; 16:568-575. [PMID: 32624410 PMCID: PMC7735165 DOI: 10.1016/j.jpurol.2020.05.166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/17/2020] [Accepted: 05/23/2020] [Indexed: 12/14/2022]
Abstract
Disorders/differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. While there remains controversy around the traditionally binary concept of sex, most patients with DSD are reared either male or female depending on their genetic sex, gonadal sex, genital phenotype and status of their internal genital tract. This study uses prospective data from 12 institutions across the United States that specialize in DSD care. We focused on patients raised female. Eligible patients had moderate to severe genital atypia (defined as Prader score >2), were ≤2 years of age at entry, and had no prior genitoplasty. The aim of this study is to describe early post operative complications for young patients undergoing modern approaches to feminizing genitoplasty. Of the 91 participants in the cohort, 57 (62%) were reared female. The majority had congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (n = 52), 1 had ovo-testicular syndrome, 2 had mixed gonadal dysgenesis and 2 had partial androgen insensitivity syndrome (PAIS). Of the 50 participants who received early genitoplasty, 43 (86%) had follow-up at 6-12 months post-surgery. Thirty-two participants (64%) received a clitoroplasty, 31 (62%) partial urogenital mobilization and 4 (8%) total urogenital sinus mobilization. Eighteen percent (9/50) experienced post-surgical complications with 7 (14%) being rated as Clavien-Dindo grade III. Both parents and surgeons reported improved satisfaction with genital appearance of participants following surgery compared to baseline. This information on post-operative complications associated with contemporary approaches to feminizing genitoplasty performed in young children will help guide families when making decisions about whether or not to proceed with surgery for female patients with moderate to severe genital atypia.
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Affiliation(s)
- Avi Baskin
- University of California San Francisco Medical Center, United States.
| | | | | | - Paul Austin
- Texas Children's Hospital and Baylor College of Medicine, United States.
| | | | - Earl Y Cheng
- Lurie Children's Hospital of Chicago, United States.
| | | | | | - Thomas Kolon
- Children's Hospital of Philadelphia, United States.
| | | | | | | | - Theresa Meyer
- Lurie Children's Hospital of Chicago, United States.
| | | | | | | | | | - Dix Poppas
- New York Presbyterian Hospital/Weill Cornell Medicine, United States.
| | | | | | | | | | | | | | - Laurence Baskin
- University of California San Francisco Medical Center, United States.
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14
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Wisniewski AB, Batista RL, Costa EMF, Finlayson C, Sircili MHP, Dénes FT, Domenice S, Mendonca BB. Management of 46,XY Differences/Disorders of Sex Development (DSD) Throughout Life. Endocr Rev 2019; 40:1547-1572. [PMID: 31365064 DOI: 10.1210/er.2019-00049] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022]
Abstract
Differences/disorders of sex development (DSD) are a heterogeneous group of congenital conditions that result in discordance between an individual's sex chromosomes, gonads, and/or anatomic sex. Advances in the clinical care of patients and families affected by 46,XY DSD have been achieved since publication of the original Consensus meeting in 2006. The aims of this paper are to review what is known about morbidity and mortality, diagnostic tools and timing, sex of rearing, endocrine and surgical treatment, fertility and sexual function, and quality of life in people with 46,XY DSD. The role for interdisciplinary health care teams, importance of establishing a molecular diagnosis, and need for research collaborations using patient registries to better understand long-term outcomes of specific medical and surgical interventions are acknowledged and accepted. Topics that require further study include prevalence and incidence, understanding morbidity and mortality as these relate to specific etiologies underlying 46,XY DSD, appropriate and optimal options for genitoplasty, long-term quality of life, sexual function, involvement with intimate partners, and optimizing fertility potential.
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Affiliation(s)
- Amy B Wisniewski
- Psychology Department, Oklahoma State University, Stillwater, Oklahoma
| | - Rafael L Batista
- Division of Endocrinology, Department of Internal Medicine, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Elaine M F Costa
- Division of Endocrinology, Department of Internal Medicine, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Courtney Finlayson
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Maria Helena Palma Sircili
- Division of Endocrinology, Department of Internal Medicine, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Francisco Tibor Dénes
- Division of Urology, Department of Surgery, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Sorahia Domenice
- Division of Endocrinology, Department of Internal Medicine, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Berenice B Mendonca
- Division of Endocrinology, Department of Internal Medicine, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
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15
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Perez MN, Delozier AM, Aston CE, Austin P, Baskin L, Chan YM, Cheng EY, Diamond DA, Fried A, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Nokoff N, Palmer B, Paradis A, Poppas D, Scott Reyes KJ, Swartz JM, Tishelman A, Wisniewski AB, Wolfe-Christensen C, Yerkes E, Mullins LL. Predictors of Psychosocial Distress in Parents of Young Children with Disorders of Sex Development. J Urol 2019; 202:1046-1051. [PMID: 31268850 DOI: 10.1097/ju.0000000000000424] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluated demographic, financial and support predictors of distress for parents of young children with disorders of sex development including atypical genital development, and characterized early parental experiences. This work extends our previous findings to identify those parents at risk for distress. MATERIALS AND METHODS Participants included mothers (76) and fathers (63) of a child (78) diagnosed with disorders of sex development characterized by moderate to severe genital atypia. Parents completed a demographic questionnaire, measures of anxious and depressive symptoms, quality of life, illness uncertainty and posttraumatic stress symptoms, and rated their satisfaction with the appearance of their child's genitalia. RESULTS Depressive and posttraumatic stress symptoms of caregivers were comparable to standardized norms while levels of anxious symptoms were below norms. A subset of parents reported clinically elevated symptoms. Overall 26% of parents reported anxious symptoms, 24% reported depressive symptoms and 17% reported posttraumatic stress symptoms. Levels of illness uncertainty were lower than those of parents of children with other chronic illnesses. Differences by parent sex emerged, with mothers reporting greater distress. Lower income, increased medical care and travel expenses, and having no other children were related to increased psychosocial distress. CONCLUSIONS Early psychosocial screening is recommended for parents of children with disorders of sex development. Clinicians should be aware that financial burden and lack of previous parenting experience are risk factors for distress.
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Affiliation(s)
| | | | | | - Paul Austin
- Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Laurence Baskin
- University of California San Francisco Medical Center, San Francisco, California
| | | | - Earl Y Cheng
- Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Allyson Fried
- John R. Oishei Children's Hospital, Buffalo, New York
| | | | - Thomas Kolon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Sabrina Meyer
- John R. Oishei Children's Hospital, Buffalo, New York
| | - Theresa Meyer
- Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Blake Palmer
- Cook Children's Medical Center, Ft. Worth, Texas
| | | | - Dix Poppas
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
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16
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Delozier AM, Gamwell KL, Sharkey C, Bakula DM, Perez MN, Wolfe-Christensen C, Austin P, Baskin L, Bernabé KJ, Chan YM, Cheng EY, Diamond DA, Ellens REH, Fried A, Galan D, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Nokoff NJ, Reyes KJ, Palmer B, Poppas DP, Paradis A, Tishelman AC, Yerkes EB, Chaney JM, Wisniewski AB, Mullins LL. Uncertainty and Posttraumatic Stress: Differences Between Mothers and Fathers of Infants with Disorders of Sex Development. Arch Sex Behav 2019; 48:1617-1624. [PMID: 31144217 PMCID: PMC7265677 DOI: 10.1007/s10508-018-1357-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/13/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
Parents of children with disorders of sex development (DSD) report significant psychological distress, including posttraumatic stress symptoms (PTSS), with mothers consistently reporting higher rates of psychological distress than fathers. However, psychological factors contributing to PTSS in both parents are not well understood. The present study sought to fill this gap in knowledge by examining PTSS and illness uncertainty, a known predictor of psychological distress, in parents of children recently diagnosed with DSD. Participants were 52 mothers (Mage = 32.55 years, SD = 5.08) and 41 fathers (Mage = 35.53 years, SD = 6.78) of 53 infants (Mage = 9.09 months, SD = 6.19) with DSD and associated atypical genital development. Participants were recruited as part of a larger, multisite study assessing parents' psychosocial response to their child's diagnosis of DSD. Parents completed measures of illness uncertainty and PTSS. Mothers reported significantly greater levels of PTSS, but not illness uncertainty, than fathers, and were more likely than fathers to report clinical levels of PTSS (21.2% compared to 7.3%). Hierarchical regression revealed that parent sex, undiagnosed or unclassified DSD status, and illness uncertainty were each associated with PTSS. The overall model accounted for 23.5% of the variance associated with PTSS. Interventions targeting illness uncertainty may be beneficial for parents of children with newly diagnosed DSD.
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Affiliation(s)
| | - Kaitlyn L Gamwell
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Christina Sharkey
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Dana M Bakula
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Megan N Perez
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Cortney Wolfe-Christensen
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Paul Austin
- Department of Urology, Texas Children's Hospital, Houston, TX, USA
| | - Laurence Baskin
- Department of Urology, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Kerlly J Bernabé
- Department of Urology, Komansky Children's Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY, USA
| | - Yee-Ming Chan
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - David A Diamond
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Rebecca E H Ellens
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Allyson Fried
- Department of Pediatric Urology, Oishei Children's Hospital, Buffalo, NY, USA
| | - Denise Galan
- Department of Urology, Komansky Children's Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY, USA
| | - Saul Greenfield
- Department of Pediatric Urology, Oishei Children's Hospital, Buffalo, NY, USA
| | - Thomas Kolon
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bradley Kropp
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Yegappan Lakshmanan
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Sabrina Meyer
- Department of Pediatric Urology, Oishei Children's Hospital, Buffalo, NY, USA
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Natalie J Nokoff
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Section of Endocrinology, Aurora, CO, USA
| | - Kristy J Reyes
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Blake Palmer
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Dix P Poppas
- Department of Urology, Komansky Children's Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY, USA
| | - Alethea Paradis
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Amy C Tishelman
- Department of Endocrinology, Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - John M Chaney
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Amy B Wisniewski
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
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17
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Finlayson C, Rosoklija I, Aston CE, Austin P, Bakula D, Baskin L, Chan YM, Delozier AM, Diamond DA, Fried A, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Nokoff N, Mullins LL, Palmer B, Perez MN, Poppas DP, Reddy P, Reyes KJS, Schulte M, Sharkey CM, Yerkes E, Wolfe-Christensen C, Wisniewski AB, Cheng EY. Baseline Characteristics of Infants With Atypical Genital Development: Phenotypes, Diagnoses, and Sex of Rearing. J Endocr Soc 2018; 3:264-272. [PMID: 30623164 PMCID: PMC6320240 DOI: 10.1210/js.2018-00316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/07/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose Little is known about the phenotypes, diagnoses, and sex of rearing of infants with atypical genital development in the United States. As part of a multicenter study of these infants, we have provided a baseline report from US difference/disorder of sex development clinics describing the diagnoses, anatomic features, and sex of rearing. We also determined whether consensus guidelines are followed for sex designation in the United States. Methods Eligible participants had moderate-to-severe genital atypia, were aged <3 years, and had not undergone previous genitoplasty. Karyotype, genetic diagnosis, difference/disorder of sex development etiology, family history, and sex of rearing were collected. Standardized examinations were performed. Results Of 92 subjects, the karyotypes were 46,XX for 57%, 46,XY for 34%, and sex chromosome abnormality for 9%. The median age at the baseline evaluation was 8.8 months. Most 46,XX subjects (91%) had congenital adrenal hyperplasia (CAH) and most 46,XY subjects (65%) did not have a known diagnosis. Two individuals with CAH underwent a change in sex of rearing from male to female within 2 weeks of birth. The presence of a uterus and shorter phallic length were associated with female sex of rearing. The most common karyotype and diagnosis was 46,XX with CAH, followed by 46,XY with an unknown diagnosis. Phenotypically, atypical genitalia have been most commonly characterized by abnormal labioscrotal tissue, phallic length, and urethral meatus location. Conclusions An increased phallic length was positively associated with rearing male. Among the US centers studied, sex designation followed the Consensus Statement recommendations. Further study is needed to determine whether this results in patient satisfaction.
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Affiliation(s)
- Courtney Finlayson
- Division of Endocrinology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ilina Rosoklija
- Division of Endocrinology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Paul Austin
- Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Dana Bakula
- Oklahoma State University, Stillwater, Oklahoma
| | - Laurence Baskin
- University of California San Francisco, San Francisco, California
| | - Yee-Ming Chan
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - David A Diamond
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Allyson Fried
- Women and Children's Hospital of Buffalo, Buffalo, New York
| | | | - Thomas Kolon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Sabrina Meyer
- Women and Children's Hospital of Buffalo, Buffalo, New York
| | - Theresa Meyer
- Division of Endocrinology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | | | - Dix P Poppas
- The Comprehensive Center for Congenital Adrenal Hyperplasia, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Pramod Reddy
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Marion Schulte
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Elizabeth Yerkes
- Division of Endocrinology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Earl Y Cheng
- Division of Endocrinology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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18
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Bernabé KJ, Nokoff NJ, Galan D, Felsen D, Aston CE, Austin P, Baskin L, Chan YM, Cheng EY, Diamond DA, Ellens R, Fried A, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Delozier AM, Mullins LL, Palmer B, Paradis A, Reddy P, Reyes KJS, Schulte M, Swartz JM, Yerkes E, Wolfe-Christensen C, Wisniewski AB, Poppas DP. Preliminary report: Surgical outcomes following genitoplasty in children with moderate to severe genital atypia. J Pediatr Urol 2018; 14:157.e1-157.e8. [PMID: 29398588 PMCID: PMC5970022 DOI: 10.1016/j.jpurol.2017.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/23/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Prior studies of outcomes following genitoplasty have reported high rates of surgical complications among children with atypical genitalia. Few studies have prospectively assessed outcomes after contemporary surgical approaches. OBJECTIVE The current study reported the occurrence of early postoperative complications and of cosmetic outcomes (as rated by surgeons and parents) at 12 months following contemporary genitoplasty procedures in children born with atypical genitalia. STUDY DESIGN This 11-site, prospective study included children aged ≤2 years, with Prader 3-5 or Quigley 3-6 external genitalia, with no prior genitoplasty and non-urogenital malformations at the time of enrollment. Genital appearance was rated on a 4-point Likert scale. Paired t-tests evaluated differences in cosmesis ratings. RESULTS Out of 27 children, 10 were 46,XY patients with the following diagnoses: gonadal dysgenesis, PAIS or testosterone biosynthetic defect, severe hypospadias and microphallus, who were reared male. Sixteen 46,XX congenital adrenal hyperplasia patients were reared female and one child with sex chromosome mosaicism was reared male. Eleven children had masculinizing genitoplasty for penoscrotal or perineal hypospadias (one-stage, three; two-stage, eight). Among one-stage surgeries, one child had meatal stenosis (minor) and one developed both urinary retention (minor) and urethrocutaneous fistula (major) (Summary Figure). Among two-stage surgeries, three children developed a major complication: penoscrotal fistula, glans dehiscence or urethral dehiscence. Among 16 children who had feminizing genitoplasty, vaginoplasty was performed in all, clitoroplasty in nine, external genitoplasty in 13, urethroplasty in four, perineoplasty in five, and total urogenital sinus mobilization in two. Two children had minor complications: one had a UTI, and one had both a mucosal skin tag and vaginal mucosal polyp. Two additional children developed a major complication: vaginal stenosis. Cosmesis scores revealed sustained improvements from 6 months post-genitoplasty, as previously reported, with all scores reported as good or satisfied. DISCUSSION In these preliminary data from a multi-site, observational study, parents and surgeons were equally satisfied with the cosmetic outcomes 12 months after genitoplasty. A small number of patients had major complications in both feminizing and masculinizing surgeries; two-stage hypospadias repair had the most major complications. Long-term follow-up of patients at post-puberty will provide a better assessment of outcomes in this population. CONCLUSION In this cohort of children with moderate to severe atypical genitalia, preliminary data on both surgical and cosmetic outcomes were presented. Findings from this study, and from following these children in long-term studies, will help guide practitioners in their discussions with families about surgical management.
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Affiliation(s)
- K J Bernabé
- The Comprehensive Center for Congenital Adrenal Hyperplasia, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - N J Nokoff
- Children's Hospital Colorado, Aurora, CO, USA
| | - D Galan
- The Comprehensive Center for Congenital Adrenal Hyperplasia, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - D Felsen
- The Comprehensive Center for Congenital Adrenal Hyperplasia, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - C E Aston
- University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, OK, USA
| | - P Austin
- St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - L Baskin
- University of California San Francisco, San Francisco, CA, USA
| | - Y-M Chan
- Children's Hospital Boston, Department of Urology, Boston, MA, USA
| | - E Y Cheng
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - D A Diamond
- Children's Hospital Boston, Department of Urology, Boston, MA, USA
| | - R Ellens
- Children's Hospital of Michigan, Detroit, MI, USA
| | - A Fried
- Women and Children's Hospital of Buffalo, Buffalo, NY, USA
| | - S Greenfield
- Women and Children's Hospital of Buffalo, Buffalo, NY, USA
| | - T Kolon
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - B Kropp
- Genitourinary Institute, Cook Children's Hospital, Fort Worth, TX, USA
| | - Y Lakshmanan
- Children's Hospital of Michigan, Detroit, MI, USA
| | - S Meyer
- Women and Children's Hospital of Buffalo, Buffalo, NY, USA
| | - T Meyer
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - A M Delozier
- Oklahoma State University, College of Arts and Sciences, Stillwater, OK, USA
| | - L L Mullins
- Oklahoma State University, College of Arts and Sciences, Stillwater, OK, USA
| | - B Palmer
- Genitourinary Institute, Cook Children's Hospital, Fort Worth, TX, USA
| | - A Paradis
- St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - P Reddy
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - K J Scott Reyes
- Genitourinary Institute, Cook Children's Hospital, Fort Worth, TX, USA
| | - M Schulte
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J M Swartz
- Children's Hospital Boston, Department of Urology, Boston, MA, USA
| | - E Yerkes
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - C Wolfe-Christensen
- Genitourinary Institute, Cook Children's Hospital, Fort Worth, TX, USA; Children's Hospital of Michigan, Detroit, MI, USA
| | - A B Wisniewski
- Genitourinary Institute, Cook Children's Hospital, Fort Worth, TX, USA
| | - D P Poppas
- The Comprehensive Center for Congenital Adrenal Hyperplasia, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
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19
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Sharkey CM, Bakula DM, Wolfe-Christensen C, Austin P, Baskin L, Bernabé KJ, Chan YM, Cheng EY, Delozier AM, Diamond DA, Ellens RE, Fried A, Galan D, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Nokoff NJ, Scott Reyes KJ, Palmer B, Poppas DP, Paradis A, Tishelman A, Yerkes EB, Chaney JM, Wisniewski AB, Mullins LL. Parent-Rated Severity of Illness and Anxiety among Caregivers of Children Born with a Disorder of Sex Development Including Ambiguous Genitalia. Horm Res Paediatr 2018; 90:308-313. [PMID: 30566934 PMCID: PMC6421083 DOI: 10.1159/000495422] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/14/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Parents of children born with disorders of sex development (DSD) often experience anxiety, but risk factors, including parental perception of the severity of their child's DSD, have not been examined. We hypothesized that severity of illness (SOI) ratings would relate to parental anxiety, and would be higher for parents of children with a potentially life-threatening DSD (e.g., 21-hydroxylase deficiency). METHODS Eighty-nine parents (Mage = 33.0, 56.2% mothers) of 51 children (Mage in months = 8.7) with a DSD including ambiguous genitalia were recruited from 12 specialized DSD clinics. Parents completed questionnaires prior to genitoplasty, 6 months post-genitoplasty, and 12 months post-genitoplasty (if completed). Data were analyzed with linear mixed modeling. RESULTS Parental anxiety decreased over time, χ2(1) = 10.14, p < 0.01. A positive relationship between SOI and anxiety was found, with SOI being a strong predictor of anxiety (b = 0.53, p < 0.01; χ2[1] = 5.33, p < 0.05). An SOI by time interaction indicated SOI had an increasing effect on anxiety over time, b = 0.06, p < 0.05; χ2(1) = 6.30, p < 0.05. There was no diagnosis by SOI interaction. CONCLUSION Parental anxiety decreased over time, but those with higher SOI ratings reported greater initial anxiety followed by slower resolution over time. Underlying etiology of DSD had no effect on the relationship between SOI and anxiety.
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Affiliation(s)
| | | | | | | | - Laurence Baskin
- University of California San Francisco Medical Center, San Francisco, CA
| | - Kerlly J. Bernabé
- Komansky Children’s Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY
| | | | - Earl Y. Cheng
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | | | | | | | | | - Denise Galan
- Komansky Children’s Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY
| | | | - Thomas Kolon
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | - Theresa Meyer
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | | | | | | | - Dix P. Poppas
- Komansky Children’s Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY
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20
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Bakula DM, Mullins AJ, Sharkey CM, Wolfe-Christensen C, Mullins LL, Wisniewski AB. Gender identity outcomes in children with disorders/differences of sex development: Predictive factors. Semin Perinatol 2017; 41:214-217. [PMID: 28478086 DOI: 10.1053/j.semperi.2017.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Disorders/differences of sex development (DSD) comprise multiple congenital conditions in which chromosomal, gonadal, and/or anatomical sex are discordant. The prediction of future gender identity (i.e., self-identifying as male, female, or other) in children with DSD can be imprecise, and current knowledge about the development of gender identity in people with, and without DSD, is limited. However, sex of rearing is the strongest predictor of gender identity for the majority of individuals with various DSD conditions. When making decisions regarding sex of rearing biological factors (e.g., possession of a Y chromosome, degree and duration of pre- and postnatal androgen exposure, phenotypic presentation of the external genitalia, and fertility potential), social and cultural factors, as well as quality of life should be considered. Information on gender identity outcomes across a range of DSD diagnoses is presented to aid in sex of rearing assignment.
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Affiliation(s)
- Dana M Bakula
- Department of Psychology, Oklahoma State University, 305 North Murray Hall, Stillwater, OK 74074.
| | - Alexandria J Mullins
- Department of Psychology, Oklahoma State University, 305 North Murray Hall, Stillwater, OK 74074
| | - Christina M Sharkey
- Department of Psychology, Oklahoma State University, 305 North Murray Hall, Stillwater, OK 74074
| | | | - Larry L Mullins
- Department of Psychology, Oklahoma State University, 305 North Murray Hall, Stillwater, OK 74074
| | - Amy B Wisniewski
- Department of Pediatric Urology, Genitourinary Program, Cook Children's Hospital, Fort Worth, TX
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21
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Ellens REH, Bakula DM, Mullins AJ, Scott Reyes KJ, Austin P, Baskin L, Bernabé K, Cheng EY, Fried A, Frimberger D, Galan D, Gonzalez L, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Mullins LL, Nokoff NJ, Palmer B, Poppas D, Paradis A, Yerkes E, Wisniewski AB, Wolfe-Christensen C. Psychological Adjustment of Parents of Children Born with Atypical Genitalia 1 Year after Genitoplasty. J Urol 2017; 198:914-920. [PMID: 28504212 DOI: 10.1016/j.juro.2017.05.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE We examined the psychological adjustment of parents of children born with moderate to severe genital atypia 12 months after their child underwent genitoplasty. MATERIALS AND METHODS Parents were recruited longitudinally from a multicenter collaboration of 10 pediatric hospitals with specialty care for children with disorders/differences of sex development and/or congenital adrenal hyperplasia. Parents completed measures of depressive and anxious symptoms, illness uncertainty, quality of life, posttraumatic stress and decisional regret. RESULTS Compared to levels of distress at baseline (before genitoplasty) and 6 months after genitoplasty, data from 25 mothers and 20 fathers indicated significant improvements in all psychological distress variables. However, a subset of parents continued endorsing clinically relevant distress. Some level of decisional regret was endorsed by 28% of parents, although the specific decision that caused regret was not specified. CONCLUSIONS Overall the majority of parents were coping well 1 year after their child underwent genitoplasty. Level of decisional regret was related to having a bachelor's level of education, increased levels of illness uncertainty preoperatively and persistent illness uncertainty at 12 months after genitoplasty but was unrelated to postoperative complications.
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Affiliation(s)
| | | | | | | | - Paul Austin
- St. Louis Children's Hospital, St. Louis, Missouri
| | - Laurence Baskin
- University of California San Francisco Medical Center, San Francisco, California
| | - Kerlly Bernabé
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Earl Y Cheng
- Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Allyson Fried
- Women and Children's Hospital of Buffalo, Buffalo, New York
| | | | - Denise Galan
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Lynette Gonzalez
- University of California San Francisco Medical Center, San Francisco, California
| | | | - Thomas Kolon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Sabrina Meyer
- Women and Children's Hospital of Buffalo, Buffalo, New York
| | - Theresa Meyer
- Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | - Blake Palmer
- Cook Children's Medical Center, Fort Worth, Texas
| | - Dix Poppas
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | | | | | | | - Cortney Wolfe-Christensen
- Children's Hospital of Michigan, Detroit, Michigan; Cook Children's Medical Center, Fort Worth, Texas
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22
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Nokoff NJ, Palmer B, Mullins AJ, Aston CE, Austin P, Baskin L, Bernabé K, Chan YM, Cheng EY, Diamond DA, Fried A, Frimberger D, Galan D, Gonzalez L, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Mullins LL, Paradis A, Poppas D, Reddy P, Schulte M, Reyes KJS, Swartz JM, Wolfe-Christensen C, Yerkes E, Wisniewski AB. Prospective assessment of cosmesis before and after genital surgery. J Pediatr Urol 2017; 13:28.e1-28.e6. [PMID: 27887913 PMCID: PMC5894813 DOI: 10.1016/j.jpurol.2016.08.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/31/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Little data exist about the surgical interventions taking place for children with disorders of sex development (DSD). Most studies that have evaluated cosmetic outcomes after genitoplasty have included retrospective ratings by a physician at a single center. OBJECTIVE The present study aimed to: 1) describe frequency of sex assignment, and types of surgery performed in a cohort of patients with moderate-to-severe genital ambiguity; and 2) prospectively determine cosmesis ratings by parents and surgeons before and after genital surgery. STUDY DESIGN This prospective, observational study included children aged <2 years of age, with no prior genitoplasty at the time of enrollment, moderate-to-severe genital atypia, and being treated at one of 11 children's hospitals in the United States of America (USA). Clinical information was collected, including type of surgery performed. Parents and the local pediatric urologist rated the cosmetic appearance of the child's genitalia prior to and 6 months after genitoplasty. RESULTS Of the 37 children meeting eligibility criteria, 20 (54%) had a 46,XX karyotype, 15 (40%) had a 46,XY karyotype, and two (5%) had sex chromosome mosaicism. The most common diagnosis overall was congenital adrenal hyperplasia (54%). Thirty-five children had surgery; 21 received feminizing genitoplasty, and 14 had masculinizing genitoplasty. Two families decided against surgery. At baseline, 22 mothers (63%), 14 fathers (48%), and 35 surgeons (100%) stated that they were dissatisfied or very dissatisfied with the appearance of the child's genitalia. Surgeons rated the appearance of the genitalia significantly worse than mothers (P < 0.001) and fathers (P ≤ 0.001) at baseline. At the 6-month postoperative visit, cosmesis ratings improved significantly for all groups (P < 0.001 for all groups). Thirty-two mothers (94%), 26 fathers (92%), and 31 surgeons (88%) reported either a good outcome, or they were satisfied (see Summary Figure); there were no significant between-group differences in ratings. DISCUSSION This multicenter, observational study showed surgical interventions being performed at DSD centers in the USA. While parent and surgeon ratings were discordant pre-operatively, they were generally concordant postoperatively. Satisfaction with postoperative cosmesis does not necessarily equate with satisfaction with the functional outcome later in life. CONCLUSION In this cohort of children with genital atypia, the majority had surgery. Parents and surgeons all rated the appearance of the genitalia unfavorably before surgery, with surgeons giving worse ratings than parents. Cosmesis ratings improved significantly after surgery, with no between-group differences.
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Affiliation(s)
- N J Nokoff
- Department of Pediatrics, Section of Pediatric Endocrinology, University of Colorado Denver School of Medicine, 13123 East 16th Ave Box B265, Aurora 80045, CO, USA.
| | - B Palmer
- Department of Urology, The University of Oklahoma College of Medicine, 920 Stanton L Young Blvd, WP 3150, Oklahoma City 72104, OK, USA
| | - A J Mullins
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater 74078, OK, USA
| | - C E Aston
- Department of Pediatrics, The University of Oklahoma College of Medicine, 920 Stanton L Young Blvd, WP 3150, Oklahoma City 72104, OK, USA
| | - P Austin
- Department of Surgery, Division of Urology, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8242, St. Louis 63110, MO, USA
| | - L Baskin
- Department of Urology, University of California San Francisco, 400 Parnassus Ave, San Francisco 94143, CA, USA
| | - K Bernabé
- Department of Urology, Weill Cornell Medicine, 525 East 68th St., Box 94, New York 10065, NY, USA
| | - Y-M Chan
- Department of Pediatrics, Division of Endocrinology, Harvard Medical School, 300 Longwood Ave, Boston 02115, MA, USA
| | - E Y Cheng
- Department of Urology, Northwestern University, Feinberg School of Medicine, 225 E Chicago Ave, Box 24, Chicago 60611, IL, USA
| | - D A Diamond
- Department of Urology, Harvard Medical School, 300 Longwood Ave, Boston 02115, MA, USA
| | - A Fried
- Department of Pediatric Urology, Women and Children's Hospital of Buffalo, Buffalo 14222, NY, USA
| | - D Frimberger
- Department of Urology, The University of Oklahoma College of Medicine, 920 Stanton L Young Blvd, WP 3150, Oklahoma City 72104, OK, USA
| | - D Galan
- Department of Urology, Weill Cornell Medicine, 525 East 68th St., Box 94, New York 10065, NY, USA
| | - L Gonzalez
- Pediatric Nephrology and Urology, University of California San Francisco, 400 Parnassus Ave, San Francisco 94143, CA, USA
| | - S Greenfield
- Department of Pediatric Urology, Women and Children's Hospital of Buffalo, Buffalo 14222, NY, USA
| | - T Kolon
- Department of Urology, Perelman School of Medicine, University of Pennsylvania, 34th Street & Civic Center Blvd., Philadelphia 19104, PA, USA
| | - B Kropp
- Department of Urology, The University of Oklahoma College of Medicine, 920 Stanton L Young Blvd, WP 3150, Oklahoma City 72104, OK, USA
| | - Y Lakshmanan
- Department of Urology, Wayne State University School of Medicine, 3901 Beaubien, Detroit 48201, MI, USA
| | - S Meyer
- Department of Pediatric Urology, Women and Children's Hospital of Buffalo, Buffalo 14222, NY, USA
| | - T Meyer
- Department of Urology, Northwestern University, Feinberg School of Medicine, 225 E Chicago Ave, Box 24, Chicago 60611, IL, USA
| | - L L Mullins
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater 74078, OK, USA
| | - A Paradis
- Department of Surgery, Division of Urology, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8242, St. Louis 63110, MO, USA
| | - D Poppas
- Department of Urology, Weill Cornell Medicine, 525 East 68th St., Box 94, New York 10065, NY, USA
| | - P Reddy
- Department of Pediatrics, Division of Pediatric Urology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, MLC 5037, 3333 Burnet Ave, Cincinnati, OH, USA
| | - M Schulte
- Department of Pediatrics, Division of Pediatric Urology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, MLC 5037, 3333 Burnet Ave, Cincinnati, OH, USA
| | - K J Scott Reyes
- Department of Urology, The University of Oklahoma College of Medicine, 920 Stanton L Young Blvd, WP 3150, Oklahoma City 72104, OK, USA
| | - J M Swartz
- Department of Pediatrics, Division of Endocrinology, Harvard Medical School, 300 Longwood Ave, Boston 02115, MA, USA
| | - C Wolfe-Christensen
- Department of Pediatrics, The University of Oklahoma College of Medicine, 920 Stanton L Young Blvd, WP 3150, Oklahoma City 72104, OK, USA; Department of Urology, Wayne State University School of Medicine, 3901 Beaubien, Detroit 48201, MI, USA
| | - E Yerkes
- Department of Urology, Northwestern University, Feinberg School of Medicine, 225 E Chicago Ave, Box 24, Chicago 60611, IL, USA
| | - A B Wisniewski
- Department of Urology, The University of Oklahoma College of Medicine, 920 Stanton L Young Blvd, WP 3150, Oklahoma City 72104, OK, USA; Department of Pediatrics, The University of Oklahoma College of Medicine, 920 Stanton L Young Blvd, WP 3150, Oklahoma City 72104, OK, USA
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23
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Wolfe-Christensen C, Wisniewski AB, Mullins AJ, Reyes KJ, Austin P, Baskin L, Bernabé K, Cheng E, Fried A, Frimberger D, Galan D, Gonzalez L, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Nokoff NJ, Palmer B, Poppas D, Paradis A, Yerkes E, Mullins LL. Changes in levels of parental distress after their child with atypical genitalia undergoes genitoplasty. J Pediatr Urol 2017; 13:32.e1-32.e6. [PMID: 28041823 PMCID: PMC5889974 DOI: 10.1016/j.jpurol.2016.10.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The birth of a child with a disorder of sex development (DSD) and atypical genitalia can be traumatizing and isolating for families. Parents of children with DSD are at risk for increased levels of psychological distress, including depression, anxiety, illness uncertainty (IU), post-traumatic stress symptoms (PTSS), and impairments in quality of life (QOL). Our previous report indicated that although the majority of parents of children with atypical genitalia were coping well prior to the child's genitoplasty, approximately 25% of them reported experiencing some type of psychological distress. OBJECTIVE The current study sought to examine the trajectory of parental psychological distress prior to, and 6 months after their child underwent genitoplasty. METHODS Parents were recruited as part of an ongoing, prospective, multi-site study involving 10 pediatric hospitals with specialized care for children with atypical genitalia. Results from 49 parents (27 mothers, 22 fathers) of 28 children (17 female sex of rearing, 11 male sex of rearing) born with atypical genitalia (Prader rating of 3-5 in 46,XX DSD or by a Quigley rating of 3-6 in 46,XY DSD or 45,XO/46,XY) were included in the study. RESULTS There were no significant changes in level of depressive or anxious symptoms or quality of life between baseline and 6-month post-operative follow-up, although mothers continued to report significantly higher levels of depressive symptoms than fathers, and as a group, these parents reported lower QOL than published norms. The level of PTSS significantly decreased for all parents, suggesting that parents may have come through the acute stress phase associated with their child's diagnosis. Finally, while there were no significant changes in IU over the time period, the level of IU for parents of boys actually increased, while parents of girls reported no change (Figure). CONCLUSION Six months after their child has undergone genitoplasty, the majority of parents report minimal levels of psychological distress. However, a subset of these parents continue to experience significant distress related to their child's diagnosis. Specifically, parents of boys appear to be at increased risk for difficulties, which may be related to either the lack of clinical diagnosis for almost half of these children or the necessity of two-stage surgeries for the majority of them. We will continue collecting data on these families to better understand the trajectory of these adjustment variables.
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Affiliation(s)
- Cortney Wolfe-Christensen
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Children's Hospital of Michigan, Detroit, MI, USA.
| | - Amy B Wisniewski
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Kristy J Reyes
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Paul Austin
- St. Louis Children's Hospital, St. Louis, MO, USA
| | - Laurence Baskin
- University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Kerlly Bernabé
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Earl Cheng
- Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Allyson Fried
- Women and Children's Hospital of Buffalo, Buffalo, NY, USA
| | | | - Denise Galan
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Lynette Gonzalez
- University of California San Francisco Medical Center, San Francisco, CA, USA
| | | | - Thomas Kolon
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bradley Kropp
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Sabrina Meyer
- Women and Children's Hospital of Buffalo, Buffalo, NY, USA
| | - Theresa Meyer
- Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Blake Palmer
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Dix Poppas
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
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Towner RA, Wisniewski AB, Wu DH, Van Gordon SB, Smith N, North JC, McElhaney R, Aston CE, Shobeiri SA, Kropp BP, Greenwood-Van Meerveld B, Hurst RE. A Feasibility Study to Determine Whether Clinical Contrast Enhanced Magnetic Resonance Imaging can Detect Increased Bladder Permeability in Patients with Interstitial Cystitis. J Urol 2016; 195:631-8. [PMID: 26307161 PMCID: PMC4760854 DOI: 10.1016/j.juro.2015.08.077] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Interstitial cystitis/bladder pain syndrome is a bladder pain disorder associated with voiding symptomatology and other systemic chronic pain disorders. Currently diagnosing interstitial cystitis/bladder pain syndrome is complicated as patients present with a wide range of symptoms, physical examination findings and clinical test responses. One hypothesis is that interstitial cystitis symptoms arise from increased bladder permeability to urine solutes. This study establishes the feasibility of using contrast enhanced magnetic resonance imaging to quantify bladder permeability in patients with interstitial cystitis. MATERIALS AND METHODS Permeability alterations in bladder urothelium were assessed by intravesical administration of the magnetic resonance imaging contrast agent Gd-DTPA (Gd-diethylenetriaminepentaacetic acid) in a small cohort of patients. Magnetic resonance imaging signal intensity in patient and control bladders was compared regionally and for entire bladders. RESULTS Quantitative assessment of magnetic resonance imaging signal intensity indicated a significant increase in signal intensity in anterior bladder regions compared to posterior regions in patients with interstitial cystitis (p <0.01) and significant increases in signal intensity in anterior bladder regions (p <0.001). Kurtosis (shape of probability distribution) and skewness (measure of probability distribution asymmetry) were associated with contrast enhancement in total bladders in patients with interstitial cystitis vs controls (p <0.05). Regarding symptomatology interstitial cystitis cases differed significantly from controls on the SF-36®, PUF (Pelvic Pain and Urgency/Frequency) and ICPI (Interstitial Cystitis Problem Index) questionnaires with no overlap in the score range in each group. ICSI (Interstitial Cystitis Symptom Index) differed significantly but with a slight overlap in the range of scores. CONCLUSIONS Data suggest that contrast enhanced magnetic resonance imaging provides an objective, quantifiable measurement of bladder permeability that could be used to stratify bladder pain patients and monitor therapy.
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Affiliation(s)
- Rheal A Towner
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma; Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
| | - Amy B Wisniewski
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Dee H Wu
- Department of Radiological Sciences, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Samuel B Van Gordon
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Nataliya Smith
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Justin C North
- Department of Radiological Sciences, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Rayburt McElhaney
- Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Christopher E Aston
- Department of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Bradley P Kropp
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Robert E Hurst
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma; Department of Biochemistry and Molecular Biology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma; Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
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Mohammadi E, Prusator DK, Healing E, Hurst R, Towner RA, Wisniewski AB, Greenwood-Van Meerveld B. Sexually dimorphic effects of early life stress in rat pups on urinary bladder detrusor muscle contractility in adulthood. Biol Sex Differ 2016; 7:8. [PMID: 26823967 PMCID: PMC4730611 DOI: 10.1186/s13293-016-0062-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background Painful bladder syndrome/interstitial cystitis (PBS/IC) is a chronic disorder that is commonly seen in women who report a history of adversity in early life. Here, we test the hypothesis that early life stress (ELS) induces sexually dimorphic abnormalities in urinary bladder smooth muscle function in adulthood. Methods Male and female rat pups were conditioned on postnatal (PN) days 8–12 with either a “predictable or “unpredictable” odor-shock, or odor only control treatment. In adulthood, urinary bladder function was assessed in vivo via urine spot analysis and in vitro via contractile responses to electrical field stimulation (EFS) and membrane depolarization with potassium chloride (KCl). Results In adulthood, we found that female rats exposed to unpredictable ELS showed a significant (p < 0.05) increase in urine voiding volume compared to predictable ELS or controls. We also found that detrusor muscle contractile responses to EFS were significantly (p < 0.001) decreased following unpredictable ELS in adult female rats compared to the predictable ELS or controls. In male rats exposed to ELS, there was no difference in voiding volume or EFS-induced contractility between groups. In adulthood, the myogenic smooth muscle response to KCl was not significantly different between groups. Histological analysis from adult female and male rats revealed no differences in the appearance of the urinary bladder in rats exposed to ELS. Conclusions In summary, our findings provide evidence to support abnormalities in the nerve-mediated contractile responses of the detrusor smooth muscle in adult female rats following ELS. We speculate that these sexually dimorphic alterations in urinary bladder function may account, at least in part, for the female predominance of PBS/IC.
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Affiliation(s)
- Ehsan Mohammadi
- Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, OK USA
| | - Dawn K Prusator
- Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, OK USA
| | - Eleanor Healing
- Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, OK USA
| | - Robert Hurst
- Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, OK USA ; Department of Urology, University of Oklahoma Health Science Center, Oklahoma City, OK USA
| | - Rheal A Towner
- Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, OK USA ; Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma City, OK USA
| | - Amy B Wisniewski
- Department of Urology, University of Oklahoma Health Science Center, Oklahoma City, OK USA
| | - Beverley Greenwood-Van Meerveld
- VA Medical Center, Oklahoma City, OK USA ; Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK USA ; Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, OK USA
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Towner RA, Smith N, Saunders D, Van Gordon SB, Tyler KR, Wisniewski AB, Greenwood-Van Meerveld B, Hurst RE. Assessment of colon and bladder crosstalk in an experimental colitis model using contrast-enhanced magnetic resonance imaging. Neurogastroenterol Motil 2015; 27:1571-9. [PMID: 26303228 PMCID: PMC4624485 DOI: 10.1111/nmo.12654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/17/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) consists of two chronic remitting-relapsing inflammatory disorders in the colon referred to as ulcerative colitis and Crohn's disease (CD). Inflammatory bowel disease affects about 1.4 million Americans. 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis is a widely used model of experimental intestinal inflammation with characteristic transmural and segmental lesions that are similar to CD. METHODS Here, we report on the use of contrast-enhanced magnetic resonance imaging (CE-MRI) to monitor in vivo bladder permeability changes resulting from bladder crosstalk following colon TNBS exposure, and TNBS-induced colitis. Changes in MRI signal intensities and histology were evaluated for both colon and bladder regions. KEY RESULTS Uptake of contrast agent in the colon demonstrated a significant increase in signal intensity (SI) for TNBS-exposed rats (p < 0.01) compared to controls. In addition, a significant increase in bladder SI for colon TNBS-exposed rats (p < 0.001) was observed compared to saline controls. Histological damage within the colon was observed, however, bladder histology indicated a normal urothelium in rats with TNBS-induced colitis, despite increased permeability seen by CE-MRI. CONCLUSIONS & INFERENCES Contrast-enhanced MRI was able to quantitatively measure inflammation associated with TNBS-induced colitis, and assess bladder crosstalk measured as an increase in urothelial permeability. Although CE-MRI is routinely used to assess inflammation with IBD, currently there is no diagnostic test to assess bladder crosstalk with this disease, and our developed method may be useful in providing crosstalk information between organ and tissue systems in IBD patients, in addition to colitis.
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Affiliation(s)
- Rheal A. Towner
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA,Corresponding Author: Rheal A. Towner, Ph.D., Director, Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104 USA, , Phone: 405-272-7383
| | - Nataliya Smith
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Debra Saunders
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Samuel B. Van Gordon
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Karl R. Tyler
- Department of Physiology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Amy B. Wisniewski
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | | | - Robert E. Hurst
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
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Suorsa KI, Mullins AJ, Tackett AP, Reyes KJS, Austin P, Baskin L, Bernabé K, Cheng E, Fried A, Frimberger D, Galan D, Gonzalez L, Greenfield S, Kropp B, Meyer S, Meyer T, Nokoff N, Palmer B, Poppas D, Paradis A, Yerkes E, Wisniewski AB, Mullins LL. Characterizing Early Psychosocial Functioning of Parents of Children with Moderate to Severe Genital Ambiguity due to Disorders of Sex Development. J Urol 2015. [PMID: 26196734 DOI: 10.1016/j.juro.2015.06.104] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE We examined the psychosocial characteristics of parents of children with disorders of sex development at early presentation to a disorders of sex development clinic. Parental anxiety, depression, quality of life, illness uncertainty and posttraumatic stress symptoms were assessed. Additionally we evaluated the relationship of assigned child gender to parental outcomes. MATERIALS AND METHODS A total of 51 parents of children with ambiguous or atypical genitalia were recruited from 7 centers specializing in treatment of disorders of sex development. At initial assessment no child had undergone genitoplasty. Parents completed the Cosmetic Appearance Rating Scale, Beck Anxiety Inventory, Beck Depression Inventory, SF-36, Parent Perception of Uncertainty Scale and Impact of Event Scale-Revised. RESULTS A large percentage of parents (54.5%) were dissatisfied with the genital appearance of their child, and a small but significant percentage reported symptoms of anxiety, depression, diminished quality of life, uncertainty and posttraumatic stress. Few gender differences emerged. CONCLUSIONS Although many parents function well, a subset experience significant psychological distress around the time of diagnosis of a disorder of sex development in their child. Early screening to assess the need for psychosocial interventions is warranted.
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Affiliation(s)
- Kristina I Suorsa
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | | | - Alayna P Tackett
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Kristy J Scott Reyes
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Paul Austin
- Department of Surgery, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri
| | - Laurence Baskin
- Department of Urology, University of California San Francisco Medical Center, San Francisco, California
| | - Kerlly Bernabé
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Earl Cheng
- Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Allyson Fried
- Pediatric Urology, Woman and Children's Hospital of Buffalo, Buffalo, New York
| | - Dominic Frimberger
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Denise Galan
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Lynette Gonzalez
- Department of Urology, University of California San Francisco Medical Center, San Francisco, California
| | - Saul Greenfield
- Pediatric Urology, Woman and Children's Hospital of Buffalo, Buffalo, New York
| | - Bradley Kropp
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Sabrina Meyer
- Pediatric Urology, Woman and Children's Hospital of Buffalo, Buffalo, New York
| | - Theresa Meyer
- Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Natalie Nokoff
- University of Colorado Denver/Children's Hospital Colorado, Denver, Colorado
| | - Blake Palmer
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Dix Poppas
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Alethea Paradis
- Department of Surgery, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri
| | - Elizabeth Yerkes
- Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Amy B Wisniewski
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma.
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Abstract
Syndromes resulting in Disorders of Sex Development (DSD) are individually rare. Historically, this fact has hindered both clinical research and the delivery of evidence-based care. Recognizing the need for advancement, members of European and North American medical societies produced policy statements, notably the Consensus Statement on Management of Intersex Disorders, which recognize that optimal healthcare in DSD requires multidisciplinary teams in conjunction with networking of treatment centers and continued development of patient registries. This paper summarizes efforts in Europe and the U.S. toward creating networks focused on expanding discovery and improving healthcare and quality of life outcomes in DSD. The objectives and function of registry-based networks (EuroDSD/I-DSD), learning collaboratives (DSD-net), clinical outcomes research (DSD-Life), and networking hybrids (DSD-TRN) are reviewed. Opportunities for, and barriers to standardization in research and care are highlighted in light of practical considerations, for example, limitations in reliably classifying anatomic phenotypes and gaps in behavioral health staffing resources. The role of patient-reported outcomes is considered, with emphasis on integrating patient perspectives, given findings of limited agreement in outcome ratings by healthcare providers and patients. Finally, the characteristics of clinical centers likely to deliver the highest quality outcomes are discussed.
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Affiliation(s)
- D E Sandberg
- Department of Pediatrics & Communicable Diseases and the Child Health Evaluation and Research (CHEAR) Unit, University of Michigan Medical School, Ann Arbor, USA
| | - N Callens
- Department of Pediatrics & Communicable Diseases and the Child Health Evaluation and Research (CHEAR) Unit, University of Michigan Medical School, Ann Arbor, USA
| | - A B Wisniewski
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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Abstract
Advances in therapeutics for specific conditions have contributed to a categorical psychological approach to chronic diseases that affect children. Consensus statements and clinical guidelines recognize stress associated with disorders of sex development (DSD) for patients and their caregivers - yet much remains to be learned concerning the social adjustment, mental health, and quality of life of affected children and their families. We present preliminary data on the psychosocial comorbidities of caregivers of children with DSD, including stigma, isolation, stress, anxiety, and depressive symptomatology. Evidence is offered in support of individualized psychological approaches for families according to such variables as: 1) gender of the caregiver, 2) gender of the affected child and 3) presence of genital ambiguity at birth. Development of feasible, targeted interventions to ameliorate psychosocial comorbidities among caregivers is needed to optimize social adjustment, mental health, and health-related quality of life (HRQoL) for children with DSD.
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Affiliation(s)
- A B Wisniewski
- Departmernt of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - D E Sandberg
- Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor, USA
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Malm-Buatsi E, Aston CE, Ryan J, Tao Y, Palmer BW, Kropp BP, Klein J, Wisniewski AB, Frimberger D. Mental health and parenting characteristics of caregivers of children with spina bifida. J Pediatr Urol 2015; 11:65.e1-7. [PMID: 25802105 DOI: 10.1016/j.jpurol.2014.09.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/04/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Within the chronic medical illness literature, associations exist between caring for an affected child and parent mental health. The few studies examining both mothers and fathers provide mixed results. The purpose of this study is to examine associations between caregiver anxiety, depression, and parenting variables in caregivers of youth with SB as these relate to marital status, age, education, household income, work status, and child's severity of SB. OBJECTIVE The aim of this study is to examine associations between anxiety, depression, and parenting variables in caregivers of youth with spina bifida and how they relate to demographic and disease variables. Exploratory analyses examined the relationship between participation in support activities and depressive and anxious symptomatology and parenting characteristics. STUDY DESIGN Eighty-four primary caregivers (49 mothers) of 51 youth with spina bifida completed measures of depressive and anxious symptomology, parenting stress, parent overprotection, and perceived child vulnerability. RESULTS There were differences between mothers and fathers on several parenting characteristics; however, these were related more to marital status and employment than to gender of the caretaker per se. In the 33 married/remarried couples for whom both spouses participated, stress for the mothers was correlated with stress for the fathers. This correlation was strongest in the 12 married couples in which the mother works. Higher perceived vulnerability scores were reported in parents of SB patients in the younger age group, especially preschoolers (0-4 years). Parents of children with shunts reported more anxiety, depression and perceived child vulnerability. Both male and female caregivers of younger children reported significantly higher protectiveness scores. Involvement in recreational activities with other families affected by SB was associated with more positive parenting characteristics for mothers. DISCUSSION Stress and protectiveness were found to be positively correlated (r > 0.6); depression, anxiety, and perceived vulnerability were not (0.3 < r < -0.3). Overall, mothers reported more stress and anxiety than fathers. Higher perceived vulnerability scores were reported in parents of SB patients in the younger age group, especially preschoolers (0-4 years). Parents of children with shunts reported more anxiety, depression and perceived child vulnerability. Both male and female caregivers of younger children reported significantly higher protectiveness scores compared to caregivers of older children. Involvement in recreational activities with other families affected by SB was associated with more positive parenting characteristics for mothers. There were differences between mothers and fathers on several parenting characteristics; however, these were related more to marital status and employment than to gender of the caretaker per se. Limitations to the current study qualify our results and conclusions. Associations do not prove causation. Our measure of parent protection had a lower Cronbach's alpha score for male caregivers (0.68) than female caregivers (0.83), consistent with an examination of the factor structure of the PPS that found the measure to have a poor factor structure and limited reliability in samples with a chronic medical condition. CONCLUSION Anxiety, depression, and parenting characteristics were differentially impacted by variables such as caregiver and child age, shunt status, and employment status/income for parents of youth with SB. Interventions to improve parenting skills and mental health of these caregivers can be designed to target specific needs of parents. Groups such as the Greater Oklahoma Disabled Sports Association (GODSA) offer real-world support to improve the lives of caregivers of SB children, and should be studied further to optimize outcomes for children.
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Affiliation(s)
- Elizabeth Malm-Buatsi
- Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Christopher E Aston
- Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Jamie Ryan
- Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, OH, USA
| | - Yeun Tao
- Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Blake W Palmer
- Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Bradley P Kropp
- Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Jake Klein
- Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Amy B Wisniewski
- Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Dominic Frimberger
- Department of Urology, Section of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
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Lee PA, Wisniewski AB, Baskin L, Vogiatzi MG, Vilain E, Rosenthal SM, Houk C. Advances in diagnosis and care of persons with DSD over the last decade. Int J Pediatr Endocrinol 2014. [DOI: 10.1186/1687-9856-2014-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Wisniewski AB, Espinoza-Varas B, Aston CE, Edmundson S, Champlin CA, Pasanen EG, McFadden D. Otoacoustic emissions, auditory evoked potentials and self-reported gender in people affected by disorders of sex development (DSD). Horm Behav 2014; 66:467-74. [PMID: 25038289 PMCID: PMC4163528 DOI: 10.1016/j.yhbeh.2014.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 07/07/2014] [Accepted: 07/09/2014] [Indexed: 11/17/2022]
Abstract
Both otoacoustic emissions (OAEs) and auditory evoked potentials (AEPs) are sexually dimorphic, and both are believed to be influenced by prenatal androgen exposure. OAEs and AEPs were collected from people affected by 1 of 3 categories of disorders of sex development (DSD) - (1) women with complete androgen insensitivity syndrome (CAIS); (2) women with congenital adrenal hyperplasia (CAH); and (3) individuals with 46,XY DSD including prenatal androgen exposure who developed a male gender despite initial rearing as females (men with DSD). Gender identity (GI) and role (GR) were measured both retrospectively and at the time of study participation, using standardized questionnaires. The main objective of this study was to determine if patterns of OAEs and AEPs correlate with gender in people affected by DSD and in controls. A second objective was to assess if OAE and AEP patterns differed according to degrees of prenatal androgen exposure across groups. Control males, men with DSD, and women with CAH produced fewer spontaneous OAEs (SOAEs) - the male-typical pattern - than control females and women with CAIS. Additionally, the number of SOAEs produced correlated with gender development across all groups tested. Although some sex differences in AEPs were observed between control males and females, AEP measures did not correlate with gender development, nor did they vary according to degrees of prenatal androgen exposure, among people with DSD. Thus, OAEs, but not AEPs, may prove useful as bioassays for assessing early brain exposure to androgens and predicting gender development in people with DSD.
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Affiliation(s)
- Amy B Wisniewski
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | - Blas Espinoza-Varas
- Department of Communication Sciences and Disorders, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126, USA.
| | - Christopher E Aston
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | - Shelagh Edmundson
- Department of Communication Sciences and Disorders, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126, USA.
| | - Craig A Champlin
- Department of Communication Sciences and Disorders, University of Texas at Austin, TX 78712, USA.
| | - Edward G Pasanen
- Department of Psychology and Center for Perceptual Systems, University of Texas at Austin, TX 78712, USA.
| | - Dennis McFadden
- Department of Psychology and Center for Perceptual Systems, University of Texas at Austin, TX 78712, USA.
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Wolfe-Christensen C, Fedele DA, Mullins LL, Lakshmanan Y, Wisniewski AB. Differences in anxiety and depression between male and female caregivers of children with a disorder of sex development. J Pediatr Endocrinol Metab 2014; 27:617-21. [PMID: 24859514 DOI: 10.1515/jpem-2014-0102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/01/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE/BACKGROUND To examine whether male and female caregivers of children with a disorder of sex development (DSD) differ in levels of anxious and depressive symptoms. MATERIALS/METHODS Participants included 80 caregivers (40 males, 40 females) of 40 children with a DSD. Children were categorized based on illness characteristics including ambiguous genitalia, life-threatening, and life-threatening with ambiguous genitalia. Caregivers completed measures of anxious and depressive symptoms. RESULTS A significant caregiver × diagnosis interaction for anxious symptoms emerged, with male caregivers of children with both ambiguous genitalia and a life-threatening condition reporting significantly lower levels of anxious symptoms than female caregivers of the same children. CONCLUSIONS The findings are surprising because of the low level of anxious symptoms reported by male caregivers of children with a complex DSD. It is possible that they have disengaged themselves from the child and/or diagnosis, causing their female counterparts to take on more responsibility.
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Wolfe-Christensen C, Fedele DA, Kirk K, Mullins LL, Lakshmanan Y, Wisniewski AB. Caregivers of children with a disorder of sex development: associations between parenting capacities and psychological distress. J Pediatr Urol 2014; 10:538-43. [PMID: 24613141 DOI: 10.1016/j.jpurol.2013.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Caregivers of children with a disorder of sex development (DSD) are at increased risk for maladaptive parenting capacities, such as high levels of parental overprotection and perceived vulnerability of their child, in addition to parenting stress. The current study aims to examine whether there are relationships between these parenting capacities and psychological distress, including depressive and anxious symptoms. PATIENTS AND METHODS Participants included 134 caregivers of 90 children with a DSD. Caregivers completed measures of parental overprotection, perceived vulnerability, parenting stress, anxiety, and depression. RESULTS Hierarchical regression analyses revealed that higher levels of parenting stress were related to more anxious and depressive symptoms in caregivers. Higher levels of perceived vulnerability were related to more anxious symptoms. Levels of parental overprotection were unrelated to anxious or depressive symptoms. CONCLUSIONS There is a relationship between parenting capacities and mental health outcomes in caregivers of children with DSD, although the direction of this relationship is not clear. Given the strong relationships between parenting stress and anxious and depressive symptoms, targeting parenting stress and/or psychological distress in these caregivers could result in better functioning overall.
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Affiliation(s)
- Cortney Wolfe-Christensen
- Department of Pediatric Urology, Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201, USA.
| | - David A Fedele
- University of Florida, Department of Health and Clinical Psychology, Gainesville, FL, USA
| | - Katherine Kirk
- University of Oklahoma College of Nursing, Oklahoma City, OK, USA
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Yegappan Lakshmanan
- Department of Pediatric Urology, Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201, USA
| | - Amy B Wisniewski
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Abstract
Transition of medical care is a multifaceted, active process that attends to the medical, psychosocial, educational and vocational needs of adolescents and young adults as they move from child- to adult-centred care. Transition from paediatric to adult services is recognized as an important part of continuous care for young people with disorders of sex development (DSD), just as it is for all young people affected by chronic medical conditions. There is evidence that the medical community is failing to transition young people with DSD safely, the result being that young people are lost to care and not receiving appropriate services into adulthood. To support transition more effectively, healthcare professionals should provide developmentally appropriate care. To accomplish this, healthcare professionals must understand, recognize and address the real-life challenges faced by young people in general, as well as those challenges specific to having DSD. Communication between paediatric and adult services, individual healthcare professionals, young people and their families is necessary for the successful transition of care.
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Affiliation(s)
- Helena Gleeson
- Department of Endocrinology, University Hospitals of Leicester, Leicester, UK
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Zilbermint MF, Wisniewski AB, Xu X, Selnes OA, Dobs AS. Relationship between sex hormones and cognitive performance in men with substance use. Drug Alcohol Depend 2013; 128:250-4. [PMID: 23021515 PMCID: PMC3637021 DOI: 10.1016/j.drugalcdep.2012.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 07/17/2012] [Accepted: 08/20/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hypogonadism is common with opiate-like drug use and may contribute to cognitive abnormalities. With the increasing epidemic of HIV and substance use (SU) worldwide, it is important to understand the impact of these conditions on cognition, which may affect quality of life and possibly decrease adherence to treatment. We hypothesized that men with SU, by virtue of hypogonadism secondary to HIV and/or SU, may demonstrate impaired cognition. METHODS We recruited men aged 18-50 from a population of low income, inner-city individuals. Details of HIV and SU status, serum blood levels of total testosterone (TT), free testosterone (FT) and estradiol (E2) were assessed. All subjects were administered ten neuropsychological tests. RESULTS Our sample consisted of 68 men (mean age: 43.2 years (SD 5.8), African Americans: 86.6%). The recruited population was primarily from low socioeconomic status and unemployed. The mean level of TT was 553.9 ng/dL (SD 262.0), the mean level of FT was 69.5 pg/mL (SD 34.8), mean E2 was 3.2 pg/mL (SD 4.4). We found that 30.9% were hypogonadal and it was associated with higher SU. We observed some relationships between sex hormones and cognitive domains, however, after adjustment for age, drug use category, education, depression, HIV, there was no statistically significant correlation between cognitive performance and sex hormone levels. CONCLUSIONS In this cross-sectional study of men with a high prevalence of SU and hypogonadism, endogenous levels of TT, FT or E2 were not related to cognitive performance. Other factors need to be identified which may contribute to poor cognitive function in the setting of SU.
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Affiliation(s)
- Mihail F. Zilbermint
- Program on Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health Building 10/CRC 1-3140, 10 Center Drive, Bethesda, Maryland 20892-1109 USA
| | - Amy B. Wisniewski
- Department of Urology, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard WP 3150 Oklahoma City, Oklahoma 73104 USA
| | - Xiaoqiang Xu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287 USA
| | - Ola A. Selnes
- Department of Neurology, Cognitive Neuroscience Division, Johns Hopkins University School of Medicine Reed Hall East, Suite 2206, 1620 McElderry Street, Baltimore, Maryland 21287 USA
| | - Adrian S. Dobs
- Corresponding author Johns Hopkins Clinical Research Network, The Johns Hopkins University School of Medicine Division of Endocrinology and Metabolism 1830 Monument Street, Suite 328, Baltimore, Maryland 21287 USA Tel: +1 410 955 2130 Fax: +1 410 955 8172
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Lu W, Tao Y, Wisniewski AB, Frimberger D, Kropp BP. Different outcomes of hypospadias surgery between north america, europe and china: is patient age a factor? Nephrourol Mon 2012; 4:609-12. [PMID: 23573500 PMCID: PMC3614301 DOI: 10.5812/numonthly.1853] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 07/21/2011] [Accepted: 07/30/2011] [Indexed: 11/16/2022] Open
Abstract
Background and Objects The patient’s age at the first hypospadias repair may be an important factor for determining postoperative outcomes. Age at the first procedure differs between Western countries and medical centers in China. This review examines the differences between the incidence of surgical complications and surgical age in boys receiving hypospadias repairs in North America, Europe and China. Materials and Methods Literature reports were reviewed in PubMed and WanFang databases using the key terms and phrases; ‘hypospadias outcomes’, ‘complications of hypospadias repair’ and ‘timing of hypospadias repair’. All peer-reviewed articles published over the past decade (2001-2011) were considered if; a full text was available, the article included age at the first hypospadias procedure and surgical complications. Results In total, 16 131 patients were reported in 113 papers from North America, Europe and China according to our inclusion criteria. There was a significant difference in age at the first hypospadias surgery (P < 0.0005) and in the incidence of complications (P <0.001) between the different global regions investigated, with the earliest surgeries occurring in North American patients. Urethral fistulas were the most common complication reported in all of the regions included in this study. Conclusions Fellowship training in pediatric urology could improve surgical outcomes, particularly in young children. Younger children experience fewer complications following hypospadias surgeries, independent of training and access to resources.
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Affiliation(s)
- Wenli Lu
- Department of Pediatrics, Shanghai Ruijin Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
- Corresponding author: Wenli Lu, Department of Pediatrics, Shanghai Ruijin Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China. Tel.: +86-4052273185, Fax: E-mail:
| | - Yuehong Tao
- Department of Pediatrics, Subei People’s Hospital of Jiangsu Province, Jiangsu, China
| | - Amy B. Wisniewski
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Dominic Frimberger
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Brad P. Kropp
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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Wisniewski AB. Gender Development in 46,XY DSD: Influences of Chromosomes, Hormones, and Interactions with Parents and Healthcare Professionals. Scientifica (Cairo) 2012; 2012:834967. [PMID: 24278745 PMCID: PMC3820494 DOI: 10.6064/2012/834967] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 09/18/2012] [Indexed: 06/02/2023]
Abstract
Variables that impact gender development in humans are difficult to evaluate. This difficulty exists because it is not usually possible to tease apart biological influences on gender from social variables. People with disorders of sex development, or DSD, provide important opportunities to study gender within individuals for whom biologic components of sex can be discordant with social components of gender. While most studies of gender development in people with 46,XY DSD have historically emphasized the importance of genes and hormones on gender identity and gender role, more recent evidence for a significant role for socialization exists and is considered here. For example, the influence of parents' perceptions of, and reactions to, DSD are considered. Additionally, the impact of treatments for DSD such as receiving gonadal surgeries or genitoplasty to reduce genital ambiguity on the psychological development of people with 46,XY DSD is presented. Finally, the role of multi-disciplinary care including access to peer support for advancing medical, surgical and psychosexual outcomes of children and adults with 46,XY DSD, regardless of sex of rearing, is discussed.
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Affiliation(s)
- Amy B Wisniewski
- Department of Urology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Wolfe-Christensen C, Fedele DA, Kirk K, Phillips TM, Mazur T, Mullins LL, Chernausek SD, Lakshmanan Y, Wisniewski AB. Degree of external genital malformation at birth in children with a disorder of sex development and subsequent caregiver distress. J Urol 2012; 188:1596-600. [PMID: 22910249 DOI: 10.1016/j.juro.2012.02.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Indexed: 01/28/2023]
Abstract
PURPOSE We determined whether the degree of genital malformation at birth in children with a disorder of sex development is related to subsequent caregiver distress, specifically symptoms of depression and anxiety. MATERIALS AND METHODS A total of 66 caregivers of children with disorders of sex development were recruited from 3 centers that specialize in disorders of sex development medicine. The caregivers completed the Beck Depression Inventory, 2nd Edition and the Beck Anxiety Inventory. The child's Prader score at birth was determined by the child's treating pediatric endocrinologist and/or pediatric urologist at each institution. RESULTS Results from the current study revealed that for caregivers of male children, under masculinization of the child's genitals at birth was significantly related to higher levels of subsequent caregiver depression. In contrast, over masculinization of the genitals of female children at birth was unrelated to caregiver depression or anxiety. CONCLUSIONS These findings suggest that caregivers of male children with disorders of sex development may be at increased risk for psychological distress and could benefit from family based psychosocial interventions.
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Hullmann SE, Chalmers LJ, Wisniewski AB. Transition from pediatric to adult care for adolescents and young adults with a disorder of sex development. J Pediatr Adolesc Gynecol 2012; 25:155-7. [PMID: 22530227 DOI: 10.1016/j.jpag.2011.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Over the past twenty years, there has been an increasing awareness of the transition to adult-oriented health care in adolescents and young adults with a chronic illness. While general guidelines for health care transition have been established, some have called for illness-specific guidelines which are tailored to the needs of specific illness populations. The current paper sought to outline illness-specific guidelines for health care transition in adolescents and young adults with disorders of sex development based upon the recent American Academy of Pediatrics guidelines. We also suggest indicators of successful transition for adolescents and young adults with disorders of sex development as well as areas for future research.
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Palmer BW, Wisniewski AB, Schaeffer TL, Mallappa A, Tryggestad JB, Krishnan S, Chalmers LJ, Copeland K, Chernausek SD, Reiner WG, Kropp BP. A model of delivering multi-disciplinary care to people with 46 XY DSD. J Pediatr Urol 2012; 8:7-16. [PMID: 22078657 DOI: 10.1016/j.jpurol.2011.08.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 08/31/2011] [Indexed: 11/17/2022]
Abstract
In 2006, a consensus statement was jointly produced by the Lawson Wilkins Pediatric Endocrine Society (LWPES) and the European Society of Paediatric Endocrinology (ESPE) concerning the management of disorders of sex development (DSD) [1]. A recommendation provided by this consensus was that evaluation and long-term care for people affected by DSD should be performed at medical centers with multi-disciplinary teams experienced in such conditions. Here we provide our team's interpretation of the 2006 consensus statement recommendations and its translation into a clinical protocol for individuals affected by 46 XY DSD with either female, or ambiguous, genitalia at birth. Options for medical and surgical management, transitioning of care, and the use of mental health services and peer support groups are discussed. Finally, we provide preliminary data to support the application of our model for delivering multi-disciplinary care and support to patients and their families.
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Affiliation(s)
- Blake W Palmer
- Pediatric Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
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Kirk KD, Fedele DA, Wolfe-Christensen C, Phillips TM, Mazur T, Mullins LL, Chernausek SD, Wisniewski AB. Parenting characteristics of female caregivers of children affected by chronic endocrine conditions: a comparison between disorders of sex development and type 1 diabetes mellitus. J Pediatr Nurs 2011; 26:e29-36. [PMID: 21911316 DOI: 10.1016/j.pedn.2010.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 10/14/2010] [Accepted: 10/17/2010] [Indexed: 10/18/2022]
Abstract
Rearing a child with a chronic illness is stressful and can potentially affect parenting style, which may result in poorer outcomes for children. The purpose of this study was to compare parenting characteristics of female caregivers rearing children with a disorder of sex development (DSD) to female caregivers rearing children with type 1 diabetes mellitus (T1DM). Caregivers of both groups were matched according to age and compared on measures of stress and parenting practices. Both groups demonstrated significant levels of stress and negative parenting practices. Children with T1DM and male children with non-life-threatening DSD were perceived as more vulnerable by their caregivers. Better understanding of parenting experiences of female caregivers rearing children with DSD, particularly male children, will facilitate the development of individualized interventions to ameliorate negative parenting practices and stress, with the long-term goal of improved health outcomes for their children.
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Affiliation(s)
- Katherine D Kirk
- University of Oklahoma College of Nursing, Oklahoma City, OK, USA.
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Hullmann SE, Fedele DA, Wolfe-Christensen C, Mullins LL, Wisniewski AB. Differences in adjustment by child developmental stage among caregivers of children with disorders of sex development. Int J Pediatr Endocrinol 2011; 2011:16. [PMID: 22074416 PMCID: PMC3229437 DOI: 10.1186/1687-9856-2011-16] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 11/10/2011] [Indexed: 11/10/2022]
Abstract
Background The current study sought to compare levels of overprotection and parenting stress reported by caregivers of children with disorders of sex development at four different developmental stages. Methods Caregivers (N = 59) of children with disorders of sex development were recruited from specialty clinics and were asked to complete the Parent Protection Scale and Parenting Stress Index/Short Form as measures of overprotective behaviors and parenting stress, respectively. Results Analyses of covariance (ANCOVAs) were conducted to examine differences between caregiver report of overprotection and parenting stress. Results revealed that caregivers of infants and toddlers exhibited more overprotective behaviors than caregivers of children in the other age groups. Further, caregivers of adolescents experienced significantly more parenting stress than caregivers of school-age children, and this effect was driven by personal distress and problematic parent-child interactions, rather than having a difficult child. Conclusions These results suggest that caregivers of children with disorders of sex development may have different psychosocial needs based upon their child's developmental stage and based upon the disorder-related challenges that are most salient at that developmental stage.
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Affiliation(s)
- Stephanie E Hullmann
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, 74078, USA.
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Mellis AM, Palmer BW, Wisniewski AB, Slobodov G. Ovarian adrenal rest tumour in a patient with chronically untreated congenital adrenal hyperplasia (CAH). ACTA ACUST UNITED AC 2011. [DOI: 10.1002/bjuiw-2011-041-web] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chalmers LJ, Doherty P, Migeon CJ, Copeland KC, Bright BC, Wisniewski AB. Normal sex differences in prenatal growth and abnormal prenatal growth retardation associated with 46,XY disorders of sex development are absent in newborns with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Biol Sex Differ 2011; 2:5. [PMID: 21545705 PMCID: PMC3113712 DOI: 10.1186/2042-6410-2-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 05/05/2011] [Indexed: 11/20/2022] Open
Abstract
Background Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is the most common presentation of a disorder of sex development (DSD) in genetic females. A report of prenatal growth retardation in cases of 46,XY DSD, coupled with observations of below-optimal final height in both males and females with congenital adrenal hyperplasia due to 21-hydroxylase deficiency, prompted us to investigate prenatal growth in the latter group. Additionally, because girls with congenital adrenal hyperplasia are exposed to increased levels of androgens in the absence of a male sex-chromosome complement, the presence or absence of typical sex differences in growth of newborns would support or refute a hormonal explanation for these differences. Methods In total, 105 newborns with congenital adrenal hyperplasia were identified in our database. Gestational age (weeks), birth weight (kg), birth length (cm) and parental heights (cm) were obtained. Mid-parental height was considered in the analyses. Results Mean birth weight percentile for congenital adrenal hyperplasia was 49.26%, indicating no evidence of a difference in birth weight from the expected standard population median of 50th percentile (P > 0.05). The expected sex difference in favor of heavier males was not seen (P > 0.05). Of the 105 subjects, 44 (27%; 34 females, 10 males) had birth length and gestational age recorded in their medical chart. Mean birth length for this subgroup was 50.90 cm (63rd percentile), which differed from the expected standard population median of 50th percentile (P = 0.0082). The expected sex difference in favor of longer males was also not seen (P > 0.05). Conclusion The prenatal growth retardation patterns reported in cases of 46,XY disorders of sex development do not generalize to people with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Sex differences in body weight and length typically seen in young infants were not seen in the subjects who participated in this study. We speculate that these differences were ameliorated in this study because of increased levels of prenatal androgens experienced by the females infants.
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Affiliation(s)
- Laura J Chalmers
- Department of Pediatrics, The University of Oklahoma College of Medicine-Tulsa, Tulsa, OK 74135, USA.
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Schaeffer TL, Tryggestad JB, Mallappa A, Hanna AE, Krishnan S, Chernausek SD, Chalmers LJ, Reiner WG, Kropp BP, Wisniewski AB. An Evidence-Based Model of Multidisciplinary Care for Patients and Families Affected by Classical Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency. Int J Pediatr Endocrinol 2010; 2010:692439. [PMID: 20339513 PMCID: PMC2842898 DOI: 10.1155/2010/692439] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 01/19/2010] [Indexed: 11/18/2022]
Abstract
In 2002 a consensus statement pertaining to the management of classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency was jointly produced by the Lawson Wilkins Pediatric Endocrine Society and the European Society of Pediatric Endocrinology. One of the recommendations of this consensus was that centers should maintain multidisciplinary teams for providing care and support to these patients and their families. However, the specifics for how this should be accomplished were not addressed in the original consensus statement. Here we interpret and translate the 2002 consensus statement recommendations into medical, surgical and mental health protocols. Additionally, we provide preliminary evidence that such protocols result in improved care and support for patients and families.
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Affiliation(s)
- Traci L. Schaeffer
- Pediatric Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Jeanie B. Tryggestad
- Pediatric Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Ashwini Mallappa
- Pediatric Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Adam E. Hanna
- Pediatric Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Sowmya Krishnan
- Pediatric Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Steven D. Chernausek
- Pediatric Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Laura J. Chalmers
- Pediatric Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - William G. Reiner
- Pediatric Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Brad P. Kropp
- Pediatric Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Amy B. Wisniewski
- Pediatric Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Ball ER, Caniglia MK, Wilcox JL, Overton KA, Burr MJ, Wolfe BD, Sanders BJ, Wisniewski AB, Wrenn CC. Effects of genistein in the maternal diet on reproductive development and spatial learning in male rats. Horm Behav 2010; 57:313-22. [PMID: 20053350 PMCID: PMC2834867 DOI: 10.1016/j.yhbeh.2009.12.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 12/27/2009] [Accepted: 12/29/2009] [Indexed: 10/20/2022]
Abstract
Endocrine disruptors, chemicals that disturb the actions of endogenous hormones, have been implicated in birth defects associated with hormone-dependent development. Phytoestrogens are a class of endocrine disruptors found in plants. In the current study we examined the effects of exposure at various perinatal time periods to genistein, a soy phytoestrogen, on reproductive development and learning in male rats. Dams were fed genistein-containing (5 mg/kg feed) food during both gestation and lactation, during gestation only, during lactation only, or during neither period. Measures of reproductive development and body mass were taken in the male offspring during postnatal development, and learning and memory performance was assessed in adulthood. Genistein exposure via the maternal diet decreased body mass in the male offspring of dams fed genistein during both gestation and lactation, during lactation only, but not during gestation only. Genistein decreased anogenital distance when exposure was during both gestation and lactation, but there was no effect when exposure was limited to one of these time periods. Similarly, spatial learning in the Morris water maze was impaired in male rats exposed to genistein during both gestation and lactation, but not in rats exposed during only one of these time periods. There was no effect of genistein on cued or contextual fear conditioning. In summary, the data indicate that exposure to genistein through the maternal diet significantly impacts growth in male offspring if exposure is during lactation. The effects of genistein on reproductive development and spatial learning required exposure throughout the pre- and postnatal periods.
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Affiliation(s)
- Evan R. Ball
- Department of Pharmaceutical, Biomedical & Administrative Sciences, College of Pharmacy and Health Sciences, Drake University, Des Moines, IA, 50311 USA
| | | | - Jenna L. Wilcox
- Neuroscience Program, Drake University, Des Moines, IA, 50311 USA
| | - Karla A. Overton
- Neuroscience Program, Drake University, Des Moines, IA, 50311 USA
| | - Marra J. Burr
- Department of Pharmaceutical, Biomedical & Administrative Sciences, College of Pharmacy and Health Sciences, Drake University, Des Moines, IA, 50311 USA
- Neuroscience Program, Drake University, Des Moines, IA, 50311 USA
| | - Brady D. Wolfe
- Department of Pharmaceutical, Biomedical & Administrative Sciences, College of Pharmacy and Health Sciences, Drake University, Des Moines, IA, 50311 USA
| | - Brian J. Sanders
- Neuroscience Program, Drake University, Des Moines, IA, 50311 USA
- Department of Psychology, Drake University, Des Moines, IA 50311 USA
| | - Amy B. Wisniewski
- Section of Pediatric Diabetes/Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117 USA
| | - Craige C. Wrenn
- Department of Pharmaceutical, Biomedical & Administrative Sciences, College of Pharmacy and Health Sciences, Drake University, Des Moines, IA, 50311 USA
- Neuroscience Program, Drake University, Des Moines, IA, 50311 USA
- To whom correspondence should be addressed: Craige C. Wrenn, Ph.D., 109 Fitch Hall, 2507 University Avenue, College of Pharmacy and Health Sciences, Drake University, Des Moines, IA 50311, Voice: 515-271-3326, Fax: 515-271-1867,
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Abstract
BACKGROUND The prevalence of obesity among children in the United States represents a pool of latent morbidity. Though the prevalence of obesity has increased in both boys and girls, the causes and consequences differ between the sexes. Thus, interventions proposed to treat and prevent childhood obesity will need to account for these differences. OBJECTIVE This review examines gender differences in the presentation of obesity in children and describes environmental, hormonal, and genetic factors that contribute to observed gender differences. METHODS A search of peer-reviewed, published literature was performed with PubMed for articles published from January 1974 through October 2008. Search terms used were obesity, sex, gender, hormones, family environment, body composition, adiposity, and genes. Studies of children aged 0 to 18 years were included, and only articles published in English were reviewed for consideration. Articles that illustrated gender differences in either the presentation or underlying mechanisms of obesity in children were reviewed for content, and their bibliographies were used to identify other relevant literature. RESULTS Gender differences in childhood obesity have been understudied partially because of how we define the categories of overweight and obesity. Close examination of studies revealed that gender differences were common, both before and during puberty. Boys and girls differ in body composition, patterns of weight gain, hormone biology, and the susceptibility to certain social, ethnic, genetic, and environmental factors. CONCLUSION Our understanding of how gender differences in pediatric populations relate to the pathogenesis of obesity and the subsequent development of associated comorbid states is critical to developing and implementing both therapeutic and preventive interventions.
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Affiliation(s)
- Amy B Wisniewski
- Section of Diabetes and Endocrinology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73117, USA.
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Yang D, Kim KH, Phimister A, Bachstetter AD, Ward TR, Stackman RW, Mervis RF, Wisniewski AB, Klein SL, Kodavanti PRS, Anderson KA, Wayman G, Pessah IN, Lein PJ. Developmental exposure to polychlorinated biphenyls interferes with experience-dependent dendritic plasticity and ryanodine receptor expression in weanling rats. Environ Health Perspect 2009; 117:426-35. [PMID: 19337518 PMCID: PMC2661913 DOI: 10.1289/ehp.11771] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2008] [Accepted: 09/11/2008] [Indexed: 05/02/2023]
Abstract
BACKGROUND Neurodevelopmental disorders are associated with altered patterns of neuronal connectivity. A critical determinant of neuronal connectivity is the dendritic morphology of individual neurons, which is shaped by experience. The identification of environmental exposures that interfere with dendritic growth and plasticity may, therefore, provide insight into environmental risk factors for neurodevelopmental disorders. OBJECTIVE We tested the hypothesis that polychlorinated biphenyls (PCBs) alter dendritic growth and/or plasticity by promoting the activity of ryanodine receptors (RyRs). METHODS AND RESULTS The Morris water maze was used to induce experience-dependent neural plasticity in weanling rats exposed to either vehicle or Aroclor 1254 (A1254) in the maternal diet throughout gestation and lactation. Developmental A1254 exposure promoted dendritic growth in cerebellar Purkinje cells and neocortical pyramidal neurons among untrained animals but attenuated or reversed experience-dependent dendritic growth among maze-trained littermates. These structural changes coincided with subtle deficits in spatial learning and memory, increased [3H]-ryanodine binding sites and RyR expression in the cerebellum of untrained animals, and inhibition of training-induced RyR upregulation. A congener with potent RyR activity, PCB95, but not a congener with negligible RyR activity, PCB66, promoted dendritic growth in primary cortical neuron cultures and this effect was blocked by pharmacologic antagonism of RyR activity. CONCLUSIONS Developmental exposure to PCBs interferes with normal patterns of dendritic growth and plasticity, and these effects may be linked to changes in RyR expression and function. These findings identify PCBs as candidate environmental risk factors for neurodevelopmental disorders, especially in children with heritable deficits in calcium signaling.
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Affiliation(s)
- Dongren Yang
- Center for Research on Occupational and Environmental Toxicology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kyung Ho Kim
- Veterinary Molecular Biosciences and Center for Children’s Environmental Health, University of California, Davis, California, USA
| | - Andrew Phimister
- Veterinary Molecular Biosciences and Center for Children’s Environmental Health, University of California, Davis, California, USA
| | - Adam D. Bachstetter
- Neurostructural Research Labs and Center for Aging and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Thomas R. Ward
- Neurotoxicology Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Robert W. Stackman
- Department of Psychology, Florida Atlantic University, Boca Raton, Florida, USA
| | - Ronald F. Mervis
- Neurostructural Research Labs and Center for Aging and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Amy B. Wisniewski
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Sabra L. Klein
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Prasada Rao S. Kodavanti
- Neurotoxicology Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Kim A. Anderson
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, Oregon; USA
| | - Gary Wayman
- Department of Veterinary and Comparative Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Isaac N. Pessah
- Veterinary Molecular Biosciences and Center for Children’s Environmental Health, University of California, Davis, California, USA
| | - Pamela J. Lein
- Center for Research on Occupational and Environmental Toxicology, Oregon Health & Science University, Portland, Oregon, USA
- Veterinary Molecular Biosciences and Center for Children’s Environmental Health, University of California, Davis, California, USA
- Department of Environmental Health Science, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Address correspondence to P.J. Lein, University of California Davis, Department of Molecular Biosciences, 1120 Haring Hall, One Shields Ave., Davis, CA 95616 USA. Telephone: (530) 752-1970. Fax: (530) 752-4698. E-mail:
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