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Dale NJ, Sakkalou E, O'Reilly MA, Springall C, Sakki H, Glew S, Pissaridou E, De Haan M, Salt AT. Home-based early intervention in infants and young children with visual impairment using the Developmental Journal: longitudinal cohort study. Dev Med Child Neurol 2019; 61:697-709. [PMID: 30421462 DOI: 10.1111/dmcn.14081] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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] [Accepted: 09/01/2018] [Indexed: 12/13/2022]
Abstract
AIM To investigate the effects of home-based early intervention in children with severe visual impairment (SVI) using the Developmental Journal for babies and young children with visual impairment (DJVI). METHOD A longitudinal observational study was undertaken with a national cohort (OPTIMUM) of infants with congenital disorders of the peripheral visual system (CDPVS) and profound-SVI; and followed up after 12 months and 24 months. Intervention was categorized according to the practitioner diary records of their usual practice over 12 months from baseline comparing those receiving the DJVI and those receiving 'Other Support'. Outcome measures of cognition and language, behaviour difficulties, parenting stress, and satisfaction with parent-practitioner partnership were collected. RESULTS In the 54 children (26 males, 28 females, baseline mean age 13.5mo, SD 2.3mo, range 8-17mo) with 'total' CDPVS (including 16 'complex' and 38 'simple' with or without known brain disorder respectively), linear mixed effects pointed towards acceleration in sensorimotor understanding and expressive language especially in the 'simple' subsample (11.72 developmental quotient, 95% confidence interval -1.17 to 24.61, p>0.05) in those receiving the DJVI. Vision level also predicted outcomes (p<0.05). The DJVI group showed improvements in behavioural withdrawal (η2 =0.20, p=0.02, 'simple') and parenting stress (d=0.78, d=0.92, p=0.02 total and 'simple' respectively) and perceived practitioner-parent relationship (η2 =0.16, p=0.01). INTERPRETATION Infants and young children with visual impairment receiving home-based early intervention using the DJVI with a structured developmental approach had better outcomes than those receiving 'other' home-based early interventions. Moderate to large effect improvements were found in child cognition and language, behaviour and parenting stress and the perceived practitioner-parent relationship, although cognition did not reach 5% significance level. WHAT THIS PAPER ADDS Early intervention using the Developmental Journal for babies and young children with visual impairment was associated with enhanced developmental outcomes compared to other approaches. Improvements were also found in child behaviour, parenting stress, and perceived parent practitioner outcomes. Type and complexity of visual impairment also influenced outcomes.
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Affiliation(s)
- Naomi J Dale
- Neurodisability Service, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Elena Sakkalou
- Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Michelle A O'Reilly
- Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Clare Springall
- Neurodisability Service, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Hanna Sakki
- Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sarah Glew
- Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Eleni Pissaridou
- Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Michelle De Haan
- Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alison T Salt
- Neurodisability Service, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
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Best S, Shoemark A, Rubbo B, Patel MP, Fassad MR, Dixon M, Rogers AV, Hirst RA, Rutman A, Ollosson S, Jackson CL, Goggin P, Thomas S, Pengelly R, Cullup T, Pissaridou E, Hayward J, Onoufriadis A, O'Callaghan C, Loebinger MR, Wilson R, Chung EM, Kenia P, Doughty VL, Carvalho JS, Lucas JS, Mitchison HM, Hogg C. Risk factors for situs defects and congenital heart disease in primary ciliary dyskinesia. Thorax 2018; 74:203-205. [PMID: 30166424 DOI: 10.1136/thoraxjnl-2018-212104] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 05/23/2018] [Revised: 07/04/2018] [Accepted: 07/23/2018] [Indexed: 11/04/2022]
Abstract
Primary ciliary dyskinesia (PCD) is associated with abnormal organ positioning (situs) and congenital heart disease (CHD). This study investigated genotype-phenotype associations in PCD to facilitate risk predictions for cardiac and laterality defects. This retrospective cohort study of 389 UK patients with PCD found 51% had abnormal situs and 25% had CHD and/or laterality defects other than situs inversus totalis. Patients with biallelic mutations in a subset of nine PCD genes had normal situs. Patients with consanguineous parents had higher odds of situs abnormalities than patients with non-consanguineous parents. Patients with abnormal situs had higher odds of CHD and/or laterality defects.
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Affiliation(s)
- Sunayna Best
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, UK.,PCD Diagnostic Team, Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK
| | - Amelia Shoemark
- PCD Diagnostic Team, Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK.,School of Medicine, University of Dundee, Dundee, UK
| | - Bruna Rubbo
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mitali P Patel
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, UK
| | - Mahmoud R Fassad
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, UK.,Human Genetics Department, Alexandria University, Alexandria, Egypt
| | - Mellisa Dixon
- PCD Diagnostic Team, Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK
| | - Andrew V Rogers
- PCD Diagnostic Team, Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK.,Host Defence Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Robert A Hirst
- Department of Infection, Immunity and Inflammation, Centre for PCD Diagnosis and Research, RKCSB, University of Leicester, Leicester, UK
| | - Andrew Rutman
- Department of Infection, Immunity and Inflammation, Centre for PCD Diagnosis and Research, RKCSB, University of Leicester, Leicester, UK
| | - Sarah Ollosson
- PCD Diagnostic Team, Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK
| | - Claire L Jackson
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Patricia Goggin
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Simon Thomas
- Human Genetics and Genomic Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury District Hospital, Salisbury, UK
| | - Reuben Pengelly
- Human Genetics and Genomic Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Thomas Cullup
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, London, UK
| | - Eleni Pissaridou
- Population, Policy and Practice Programme, University College London (UCL) Great Ormond Street Institute of Child Health, London, UK
| | - Jane Hayward
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, UK.,North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, London, UK
| | - Alexandros Onoufriadis
- Division of Genetics and Molecular Medicine, Department of Medical and Molecular Genetics, King's College London School of Medicine, Guy's Hospital, London, UK
| | - Christopher O'Callaghan
- Department of Infection, Immunity and Inflammation, Centre for PCD Diagnosis and Research, RKCSB, University of Leicester, Leicester, UK.,Department of Respiratory, Critical Care and Anaesthesia, University College London (UCL) Great Ormond Street Institute of Child Health, London, UK
| | | | - Robert Wilson
- Host Defence Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Eddie Mk Chung
- Population, Policy and Practice Programme, University College London (UCL) Great Ormond Street Institute of Child Health, London, UK
| | - Priti Kenia
- Department of Respiratory Paediatrics, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Victoria L Doughty
- Brompton Centre for Fetal Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
| | - Julene S Carvalho
- Brompton Centre for Fetal Cardiology, Royal Brompton and Harefield NHS Trust, London, UK.,Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.,Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Hannah M Mitchison
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, UK
| | - Claire Hogg
- PCD Diagnostic Team, Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK
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Shafran R, Wroe A, Nagra S, Pissaridou E, Coughtrey A. Cognitive behaviour treatment of co-occurring depression and generalised anxiety in routine clinical practice. PLoS One 2018; 13:e0201226. [PMID: 30048513 PMCID: PMC6062076 DOI: 10.1371/journal.pone.0201226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/11/2018] [Indexed: 11/19/2022] Open
Abstract
Background Anxiety and depression are closely associated. However, they are typically treated separately and there is a dearth of information on tackling them together. Aims The study’s purpose was to establish how best to treat co-occurring anxiety and depression in a routine clinical service—specifically, to compare cognitive behaviour therapy (CBT) focusing only on depression (CBT-D) to a broader CBT focusing on both depression and anxiety (CBT-DA). Method Case notes of 69 patients with equally severe clinical levels of depression and anxiety seen in a routine clinical service were randomly selected to review from a pool of 990 patients. The mean age was 44.61 years (SD = 12.97). 65% of the sample were female and 88% reported their ethnicity white. The content of electronic records reporting techniques used and scores on a measure of depression (The Patient Health Questionnaire) and anxiety (The Generalized Anxiety Disorder Assessment) were reviewed to categorise therapy as CBT-D or CBT-DA. Results Results indicated significant overall improvement with CBT; 70% and 77% of the sample met criteria for reliable improvement on The Patient Health Questionnaire and The Generalized Anxiety Disorder Assessment respectively. Fewer patients who received CBT-DA met The Generalized Anxiety Disorder Assessment recovery criteria at the end of treatment than those who received CBT-D. Mean post treatment PHQ-9 and GAD-7 scores remained above threshold for those receiving CBT_DA but not those receiving CBT-D. There was no evidence suggesting CBT-DA was superior to CBT-D. Conclusions In patients with equally severe clinical levels of depression and anxiety, a broader treatment addressing both anxiety and depression does not appear to be associated with improved outcomes compared to treatment focused on depression.
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Affiliation(s)
- Roz Shafran
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, London, United Kingdom
- * E-mail:
| | - Abigail Wroe
- Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Sasha Nagra
- Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Eleni Pissaridou
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, London, United Kingdom
| | - Anna Coughtrey
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, London, United Kingdom
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Norrish G, Cantarutti N, Pissaridou E, Ridout DA, Limongelli G, Elliott PM, Kaski JP. Risk factors for sudden cardiac death in childhood hypertrophic cardiomyopathy: A systematic review and meta-analysis. Eur J Prev Cardiol 2017; 24:1220-1230. [PMID: 28482693 DOI: 10.1177/2047487317702519] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [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: 12/21/2022]
Abstract
Aims To perform a systematic literature review and meta-analysis of clinical risk factors for sudden cardiac death (SCD) in childhood hypertrophic cardiomyopathy. Methods Medline and PubMed databases were searched for original articles published in English from 1963 through to December 2015 that included patients under 18 years of age with a primary or secondary end-point of either SCD or SCD-equivalent events (aborted cardiac arrest or appropriate implantable cardioverter-defibrillator discharge) or cardiovascular death (CVD). Results Twenty-five studies (3394 patients) met the inclusion criteria. We identified four conventional major risk factors that were evaluated in at least four studies and that we found to be statistically associated with an increased risk of death in at least two studies: previous adverse cardiac event (pooled hazard ratio [HR] 5.4, 95% confidence interval [CI] 3.67-7.95, p < 0.001); non-sustained ventricular tachycardia (pooled HR 2.13, 95% CI 1.21-3.74, p = 0.009); unexplained syncope (pooled HR 1.89, 95% CI 0.69-5.16, p = 0.22); and extreme left ventricular hypertrophy (pooled HR 1.80, 95% CI 0.75-4.32, p = 0.19). Left atrial diameter did not meet the major risk factor criteria; however, this is likely to be an additional significant risk factor. 'Minor' risk factors included a family history of SCD, gender, age, symptoms, electrocardiogram changes, abnormal blood pressure response to exercise and left ventricular outflow tract obstruction. Conclusions A lack of well-designed, large, population-based studies in childhood hypertrophic cardiomyopathy means that the evidence base for individual risk factors is not robust. We have identified four clinical parameters that are likely to be associated with increased risk of SCD, SCD-equivalent events or CVD. Multi-centre prospective studies are needed in order to further determine the relevance of these factors in predicting SCD in childhood hypertrophic cardiomyopathy and to identify novel risk markers. Condensed abstract A systematic review and meta-analysis of clinical risk factors predicting sudden cardiac death in childhood hypertrophic cardiomyopathy was performed, identifying four 'major' factors: previous adverse cardiac event; non-sustained ventricular tachycardia; syncope; and extreme left ventricular hypertrophy. Well-designed multi-centre studies are required in the future in order to confirm these findings.
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Affiliation(s)
- Gabrielle Norrish
- 1 Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK.,2 University College London Institute of Cardiovascular Science, London, UK
| | - Nicoletta Cantarutti
- 1 Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK.,3 Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Eleni Pissaridou
- 4 Population, Policy and Practice Programme, UCL-Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Deborah A Ridout
- 4 Population, Policy and Practice Programme, UCL-Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Perry M Elliott
- 2 University College London Institute of Cardiovascular Science, London, UK.,6 Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Juan Pablo Kaski
- 1 Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK.,2 University College London Institute of Cardiovascular Science, London, UK
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