We conducted a cross‐sectional study of patients who underwent pediatric liver transplant (LT) between 1988 and 1992 to evaluate long‐term health status. Survivors completed socio‐demographic, ...medical and Health‐Related Quality of Life (HRQOL) surveys by mail including the SF‐36v2, PedsQL™4.0 Generic Core Scale, PedsQL™ Cognitive Functioning Scale and PedsQL™3.0 Transplant Module. SF‐36 scores were converted to SF6D‐based utilities and risk factors for lower outcomes were assessed.
Eighty‐five of 171 patients had survived. Fifty‐six were contacted with a response rate of 66%. Median age at LT was 0.86 years (IQR 0.58–3.0) and 64.3% had biliary atresia. Mean age at survey was 23.0 ± 4.4 years: 62% attended college, 68% lived with parents and 80% of those over 23 were employed. Patient health utilities were lower than norms (0.75 ± 0.12 vs. 0.82 ± 0.18, p < 0.01) and correlated with unemployment (p < 0.042), hospitalizations (p < 0.005) and lower education level (p < 0.016). Lower PedsQL™3.0 Transplant Module and PedsQL™ 4.0 Generic Core Scale scores correlated with unemployment (p = 0.006, p = 0.009) and hospitalizations (p = 0.006, p = 0.02). Pediatric transplant recipients who survive to adulthood have lower physical HRQOL, measurable transplant‐related disability and lower health utility. Transplantation is life saving; however, physical and psychological sequelae continue to affect health status up to two decades later.
In a survey of long‐term survivors of pediatric liver transplantation, the authors discover that despite significant comorbidities, lower physical quality of life and lower than expected health utilities, recipients' overall quality of life, employment status and attainment of higher education are comparable to their healthy peers. See editorial by McDiarmid on page 1367.
This multicenter study examined prevalence of cognitive and academic delays in children following liver transplant (LT). One hundred and forty‐four patients ages 5–7 and 2 years post‐LT were ...recruited through the SPLIT consortium and administered the Wechsler Preschool and Primary Scale of Intelligence, 3rd Edition (WPPSI‐III), the Bracken Basic Concept Scale, Revised (BBCS‐R), and the Wide Range Achievement Test, 4th edition (WRAT‐4). Parents and teachers completed the Behavior Rating Inventory of Executive Function (BRIEF). Participants performed significantly below test norms on intelligence quotient (IQ) and achievement measures (Mean WPPSI‐III Full Scale IQ = 94.7 ± 13.5; WRAT‐4 Reading = 92.7 ± 17.2; WRAT‐4 Math = 93.1 ± 15.4; p < 0001). Twenty‐six percent of patients (14% expected) had ‘mild to moderate’ IQ delays (Full Scale IQ = 71–85) and 4% (2% expected) had ‘serious’ delays (Full Scale IQ ≤ 70; p < 0.0001). Reading and/or math scores were weaker than IQ in 25%, suggesting learning disability, compared to 7% expected by CDC statistics (p < 0.0001). Executive deficits were noted on the BRIEF, especially by teacher report (Global Executive Composite = 58; p < 0.001). Results suggest a higher prevalence of cognitive and academic delays and learning problems in pediatric LT recipients compared to the normal population.
Results of this multicenter study of pediatric liver transplant recipients during the early primary grades suggest a higher prevalence of cognitive and academic delays, executive function deficits and learning disabilities as compared to a normal population.
Health perceptions of adolescent transplant patients should be considered in providing appropriate healthcare. Objectives: (i) quantify health‐related quality of life (HRQOL) in adolescent liver and ...kidney transplant patients, (ii) compare caregiver ratings of their children's HRQOL to adolescent self‐reports and (iii) examine the relationship between HRQOL and disease‐specific disability (DSD). Adolescent liver (n = 51) and kidney (n = 26) transplant recipients and caregivers were surveyed using the CHQ‐CF87 and CHQ‐PF50. DSD scores were calculated for each patient. The response rate was >70%. Adolescent's psychological and physical health was similar to a healthy population, but general health poorer (p = 0.0006). Caretakers reported lower physical functioning and general health (p = 0.0001) but similar psychological health to a normative population. All caregivers expressed negative emotional impact of their child's health on themselves and family activities (p = 0.0001). Positive correlations were found between liver transplant recipients and caregivers: perceptions of behavior (ICC = 0.55, p < 0.001), mental health (ICC = 0.56, p < 0.001), self‐esteem (ICC = 0.68, p ≤0.001). Positive correlations were found for kidney transplant patients and caregivers: physical function (ICC = 0.85, p < 0.001), bodily pain (ICC = 0.70, p < 0.001), behavior (ICC = 0.67, p < 0.01). Kidney transplant recipients showed negative correlations between physical functioning (R =−0.76, p = 0.0003) and general health (R =−0.60, p = 0.008) with overall DSD. Physical and psychological functioning of adolescent liver and kidney transplant patients is high. Caregivers may serve as adequate proxies of psychological but not physical health.
Adolescent liver and kidney transplant recipients have a high level of overall physical and psychological functioning after transplantation.
Group B Streptococcus (GBS) causes disease in newborns, pregnant women, and adults with underlying medical conditions, but it is also a commensal organism that commonly colonizes the bowel. In this ...study, the prevalence of colonization was high among 241 women (34%) and 211 men (20%) living in a college dormitory; sexually experienced subjects had twice the colonization rates of sexually inexperienced participants. Other predictors of colonization varied by colonization site. Only 10 of the 142 roommate pairs had roommates who were both colonized with GBS, and 20% of these pairs shared identical strains, which is the same rate predicted by the population distribution. By contrast, a previous report found that 86% of co-colonized sex partners shared identical strains. GBS is likely transmitted by intimate contact, but transmission modes may vary by colonization site. Large prospective studies are needed to better understand colonization site-specific factors for GBS and to clarify potential transmission modes.
The functional status and health-related quality of life (HRQOL) of children who survive liver transplantation (LT) have not been well documented. The purpose of this study was to determine the ...functional status and HRQOL in this population using a validated measure for children, the Child Health Questionnaire-Parent Form 50 (CHQ-PF50).
The CHQ-PF50 instrument was completed by the parents of 55 children who agreed to participate in a mailing survey. Subscale scores for the sample were compared with those of a published normal population (n = 391).
Study sample characteristics were: 87% Caucasian, 54.5% female, mean age at survey was 9.6 years (range, 5-17 years). Responding caregivers were 95% biologic parents and 93% female. Compared with the normal population, LT recipients had lower subscale scores for general health perceptions (P < 0.0005), emotional impact on parents (<0.0005) and disruption of family activities (0.0005). The mean physical summary score of the LT recipients was lower than that of the normal population 48.1 +/- 12.1 (P = 0.005), but the mean psychosocial summary score was similar 48.8 +/- 11.9 (P = 0.156). Within the LT population, the original diagnosis (biliary atresia vs. other), type of LT (living donor vs. cadaveric), age at LT, z score for height, and hospital days did not significantly influence any of the subscale scores.
Children who have survived LT have functional outcomes in the physical domain that are lower than those of normal children. Self-esteem and mental health in this group appeared normal. The parents in this sample experienced more emotional stress and disruption of family activities than did parents in a normal population.
This study assesses the effects of daily beta-hydroxy beta-methylbutyrate (HMB) supplementation on muscular strength (bench press, squats, and power cleans) and body composition (body weight and body ...fat) among collegiate football players undergoing a strenuous exercise program. Subjects were collegiate football players (n = 35) training under the supervision of certified strength coaches averaging 20 hours of weekly exercise. In the first supplementation period, 16 of the 35 subjects were supplemented with 3 g of HMB per day for 4 weeks; the other 19 received a placebo followed by a 1-week washout period and then a second supplementation period in a randomized double-blind crossover, placebo design. There were no significant changes (p > 0.05) in muscular strength, including bench press, squats, and power cleans, among the subjects. There were also no significant changes (p > 0.05) in body composition, including body fat and body weight. Very little clinical evidence exists for supplementing HMB in athletic populations.
The Pediatric End‐Stage Liver Disease (PELD) score was designed to reduce subjectivity in liver allocation and to advantage patients with a higher probability of waiting list mortality. The aims of ...this study were to determine the impact of PELD implementation for children with chronic liver disease and to assess whether PELD met its goal of standardization of liver allocation for children. This study used data reported to the United Network for Organ Sharing (UNOS) registry for children with chronic liver disease receiving primary cadaveric liver transplant between January 2000 and December 2001 (pre‐PELD) and March 2002 and July 2003 (PELD). PELD reduced the percentage of children transplanted while in an intensive care unit and as status 1. A calculated PELD score was used for allocation in only 52% of recipients. Thirty percent were status 1 at transplant and PELD scores granted by exception were used for allocation in 18% of patients. There was regional variation in PELD score at allocation and use of exception scores with a significant relationship between PELD score and percentage of exception cases. Regional variation suggests that PELD has not resulted in standardization of listing practices in pediatric liver transplantation.
Objectives. To assess the usefulness of three sources (faith-based organizations (FBOs) health system and community) for recruitment of African Americans with type 2 diabetes to a randomized ...controlled trial (RCT). Design. African Americans with type 2 diabetes were recruited to a diabetes self-management program at four FBO sites. An observational study of a multifaceted recruitment strategy to enroll subjects in the RCT that evaluated the effectiveness of a diabetes self-management program and the effect of recruitment source on retention after enrollment. Self-administered demographic surveys and weekly class attendance records were collected. Results. Of 184 interested individuals 109 (59.2%) were enrolled. Of those enrolled 60.6% recruited through the health system 13.8% FBOs and 19.2% the community. The highest yield was achieved through the health system. However for both the intervention (I) and control (C) groups respectively participants recruited from FBOs (85.7% I; 62.5% C) were more likely to attend four or more sessions than those from the health system (75.0% I; 43.3% C) and community (55.6% I; 25.0% C). Despite similar class size participants in the intervention group (74.5%; n = 41) were more likely to attend four or more of the seven classes than those in the delayed intervention (control group) (40.7%; n = 22). Conclusions. The findings suggest that African American adults with diabetes can be successfully recruited and retained in a racially targeted RCT conducted in FBOs. Key elements to consider are the use of a multifaceted approach for participant recruitment particularly the benefit of health system physician involvement in recruitment since the highest yield was achieved through health system providers and importance of site location for retention.