Abstract Background Adult congenital heart disease (ACHD) patients face unique medical and social challenges that may contribute to psychological difficulties. The goals of this study were to ...identify predictors of symptoms of depression and anxiety and evaluate the prevalence of mood and anxiety disorders among North American ACHD patients. Methods In this cross-sectional study, consecutive patients were recruited from two ACHD outpatient clinics. All patients completed self-report psychosocial measures and a subset was randomly selected to participate in structured clinical interviews. Linear regression models were used to predict symptoms of depression and anxiety. Results A total of 280 patients (mean age = 32 years; 52% female) completed self-report measures. Sixty percent had defects of moderate complexity and 31% had defects of great complexity. Significant predictors of depressive symptoms were loneliness ( p < 0.001), perceived health status ( p < 0.001), and fear of negative evaluation ( p = 0.02). Predictors of anxiety symptoms were loneliness ( p < 0.001) and fear of negative evaluation ( p < 0.001). Disease severity and functional class did not predict mood or anxiety symptoms. Fifty percent of interviewed patients (29/58) met diagnostic criteria for at least one lifetime mood or anxiety disorder, of whom 39% had never received any mental health treatment. Conclusions The results confirm an increased risk and under-treatment of mood and anxiety disorders in ACHD patients. Social adjustment and patient-perceived health status were more predictive of depression and anxiety than medical variables. These factors are modifiable and therefore a potential focus of intervention.
The corona virus disease -2019 (COVID-19) is a recently described infectious disease caused by the severe acute respiratory syndrome corona virus 2 with significant cardiovascular implications. Given ...the increased risk for severe COVID-19 observed in adults with underlying cardiac involvement, there is concern that patients with pediatric and congenital heart disease (CHD) may likewise be at increased risk for severe infection. The cardiac manifestations of COVID-19 include myocarditis, arrhythmia and myocardial infarction. Importantly, the pandemic has stretched health care systems and many care team members are at risk for contracting and possibly transmitting the disease which may further impact the care of patients with cardiovascular disease. In this review, we describe the effects of COVID-19 in the pediatric and young adult population and review the cardiovascular involvement in COVID-19 focusing on implications for patients with congenital heart disease in particular.
Abstract Translation outside the context of Language Service Providers (LSPs) represents a sizeable share of the translation market. However, this facet of the activity remains less visible and less ...open to monitoring. This study investigates translation as a situated practice in the context of Oman within institutions where the translation activity does not represent a primary purpose. Adopting a quantitative approach, the study employed an online survey to investigate indicators of the institutionalization of translation, such as resourcing, working conditions, distribution of work, interaction, workflows, and quality management policies. The findings show that translation activities within institutions in Oman are thriving. However, the study revealed that translation practices are subject to considerable variation and that, despite notable exceptions, translation is frequently affected by challenges related to inadequate staffing, resources, and quality assurance procedures. These practices are mainly ad hoc, providing little evidence that translation needs are treated as an integral part of the institution’s functioning. These findings align with observations in other contexts and underscore the need to recognise the significant role translation plays in the functioning of the institution and the need to effectively integrate translation activities within their institutional environments to enhance quality standards in this often-overlooked segment of the translation industry. More generally, the findings confirm the necessity for Translation Studies to appreciate the significance of institutional translation as a facet of translation as a situated activity.
Objectives To analyze adherence to guidelines to prevent respiratory syncytial virus hospitalization and to a monthly immunoprophylaxis schedule in the absence of prior authorization requirements. ...Study design Among Florida Medicaid fee-for-service recipients 0 to 2 years of age from the 1998/1999 season through the 2004/2005 season with available birth certificates, we identified indications for palivizumab prophylaxis based on claims data. At least 4 doses of palivizumab in the 5 core season-months were considered full season coverage. Results Of 302 101 children-seasons, 6089 were associated with 24 469 doses of palivizumab. In the 2004/2005 season, 73.6% of children with chronic lung disease received immunoprophylaxis, 67.6% children with gestational age <32 weeks, 37% with congenital heart disease, 26.4% with cystic fibrosis, and 19.4% with severe immunodeficiency. Multiple indications increased the likelihood for prophylaxis from 34.9% to 80.4%. Full season coverage was consistent across indications at approximately 70%. From the 1998/1999 season through the 2004/2005 season, 8038 doses were administered during 2051 children-seasons without any indication; mostly (69.6%) where premature children had exceeded the recommended age range for prophylaxis. Conclusions High utilization rates were found in children with multiple indications, and compliance with a monthly schedule was consistently high. One third of doses were administered outside of guidelines, suggesting suboptimal utilization of resources in the absence of prior authorization.
Approximately 1% of all newborns display some form of congenital heart disease (CHD). Successful medical and surgical management of CHD has allowed 85% of these children to survive into adulthood and ...produced a new set of challenges for both patients and doctors with an emphasis on quality of life and psychosocial functioning.
The current paper has 3 aims: (1) to summarize the research literature examining the emotional adjustment among this population, (2) to detail the psychological, social, and quality-of-life factors that might result in an increased risk of psychological maladjustment, and (3) to provide clinical management strategies to optimize health outcomes.
Current empirical evidence has suggested that compared with same aged reference norms in US studies, adults with CHD had scores indicative of worse emotional functioning as assessed by both clinical interviews and self-report measures. Similar European studies have generally not demonstrated such differences. Additional research suggests that areas of functioning that may be particularly affected include neurocognitive functioning, body image, social and peer relationships, and mild delays in developmental functioning.
These studies suggest that patients with CHD are successfully engaging in full adult responsibilities and roles but do experience specific psychosocial challenges that may impact emotional functioning, self-perception, and peer relationships. Lifestyle considerations in young adulthood are significant and impinge on pregnancy considerations and exercise capabilities. Clinical management strategies include increased awareness and dialogue between patients with CHD and physicians regarding psychosocial concerns.
Evidence from medicine and other fields has shown that gender diversity results in better decision making and outcomes. The incoming workforce of congenital heart specialists (especially in pediatric ...cardiology) appears to be more gender balanced, but past studies have shown many inequities. Gender-associated differences in leadership positions, opportunities presented for academic advancement, and recognition for academic contributions to the field persist. In addition, compensation packages remain disparate if evaluated based on gender with equivalent experience and expertise. This review explores these inequities and has suggested individual and institutional changes that could be made to recruit and retain women, monitor the climate of the institution, and identify and eliminate bias in areas like salary and promotions.
The objective of this study was to explore the current practice and attitudes of pediatric cardiologists in the United States and Europe on the transfer and transition of children with congenital ...heart disease (CHD). A survey among pediatric cardiology programs in the United States and Europe was undertaken. Sixty-nine centers completed and returned the 61-item questionnaire that was specifically devised for this survey. Of 69 participating centers, 74% reported that they transfer their patients to adult-focused care. When a center transfers its patients, 80% transfer them to a formalized Adult Congenital Heart Disease Program. The median age of transfer is 18 years. Comorbidities, pregnancy, and patient/family request to leave pediatric cardiology were identified as initiators for transfer. Complexity of the heart defect was relatively less important when deciding whether to transfer patients. Only one-third of the centers that transfer their patients provide a structured preparation for patients and family. Development of a formal transition program is planned at 59% of the centers that transfer patients. In conclusion, timely transfer and a structured transition process of children with CHD are not implemented in all pediatric cardiology programs. Health-care providers working in pediatric cardiology should make their transfer policies explicit and transition programs ought to be developed.
A smooth transition of patients from pediatric to adult care is the first step in ACHD care, and in most medical systems, that responsibility lies with the pediatric providers. ...education on the ...transition process, awareness of the needs of ACHD patients, systems available for care of ACHD patients, and resources to ensure adequate cardiac care are all important parts of the pediatric cardiology curriculum in ACHD. Name Employment Representation Consultant Speakers Bureau Ownership/Partnership/Principal Personal Research Institutional/Organizational or Other Financial Benefit Expert Witness Regina Lantin-Hermoso Texas Children's Hospital ACC ACPC Council None None None None None None Carole Warnes Mayo Clinic--Professor, Medicine ACC BOT None None None None None None Eric Williams Indiana University School of Medicine--Professor (Cardiology) and Associate Dean; Indiana University Health, Cardiology Service Line Leader ACC CMC Lead Reviewer None None None None None None Table 3 Advanced Training in Adult Congenital Heart Disease: Proposed Requirements Applicable to Trainees From a Pediatric Cardiology Training Background CHD indicates congenital heart disease.
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