Adverse childhood experiences in children and adolescents with sickle cell disease: A retrospective cohort study.
Adverse childhood experiences in children and adolescents with sickle cell disease: A retrospective cohort study.
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患有镰状细胞病的儿童和青少年的不良童年经历：一项回顾性队列研究。
DOI：
10.1002/pbc.29494
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发表时间：
2022
影响因子：
3.2
通讯作者：
Pachter,LeeM
中科院分区：
文献类型：
--
作者：
Pernell,Brandi;Nagalapuram,Vishnu;Lebensburger,Jeffrey;Lin,CheePaul;Baskin,MonicaL;Pachter,LeeM
BackgroundAdverse childhood experiences（ACE）与不良的健康结果有关;然而，在已发表的文献中，ACE与镰状细胞病（SCD）儿童和青少年健康结果之间的关系有限。ProcedureThis回顾性队列研究涉及45名儿童和30名青少年。参与者使用青年健康中心ACE问卷进行筛选。家长填写了孩子的问卷。青少年提供自我报告。ACE被视为连续和分类量表：0-1 vs ≥2起原始ACE（个体和/或家族水平）; 0-1 vs ≥2起其他ACE（社区水平）; 0-3 vs ≥4起扩展ACE（原始+其他）。使用Wilcoxon秩和检验比较疼痛和急性胸部综合征事件，并使用斯皮尔曼相关性将其与累积ACE评分相关。多变量模型进行了拟合，以检查ACE和疼痛/急性胸部syndrome.ResultsThe累积数量的原始ACE与急性胸部综合征事件（rho = 0.53，p = 0.003）和疼痛（rho = 0.40，p = 0.028）在青少年之间呈正相关。与0-1例初始ACE相比，≥2例初始ACE的青少年发生急性胸部综合征事件的数量更高（4.9 ± 2.6 vs. 1.6 ± 2.2，p = 0.002）;然而，这种相关性受到哮喘的混淆。急性胸部综合征事件和因疼痛住院在儿童ACE组之间没有差异。急诊科（艾德）疼痛就诊率在发生≥4次扩展ACE的儿童中高于0-3次扩展ACE的儿童（1.6 ± 2.8 vs. 3.3 ± 3.2，p = 0.042），即使在控制SCD基因型、哮喘、疾病改善治疗和随访年数后（p= 0.027）。需要进行前瞻性研究以进一步了解这种关系并测试ACE保护措施。
BackgroundAdverse childhood experiences (ACEs) are linked to poor health outcomes; however, the relationship between ACEs and health outcomes among children and adolescents with sickle cell disease (SCD) has limited documentation in the published literature.ProcedureThis retrospective cohort study involved 45 children and 30 adolescents. Participants were screened using the Center for Youth Wellness ACE Questionnaire. Parents completed the questionnaire for children. Adolescents provided self‐report. ACEs were treated as continuous and categorical scales: 0–1 verus ≥2 original ACEs (individual and/or familial level); 0–1 versus ≥2 additional ACEs (community level); and 0–3 versus ≥4 expanded ACEs (original + additional). Pain and acute chest syndrome events were compared using Wilcoxon rank‐sum tests, and correlated with cumulative ACE scores using Spearman's correlation. Multivariable models were fitted to examine the association between ACEs and pain/acute chest syndrome.ResultsThe cumulative number of original ACEs positively correlated with acute chest syndrome events (rho = .53,p= .003) and pain (rho = .40,p= .028) among adolescents. Adolescents with ≥2 versus 0–1 original ACEs had a higher number of acute chest syndrome events (4.9 ± 2.6 vs. 1.6 ± 2.2,p= .002); however, this association was confounded by asthma. Acute chest syndrome events and hospitalizations for pain did not differ among child ACE groups. Emergency department (ED) pain visits were higher among children with ≥4 versus 0–3 expanded ACEs (1.6 ± 2.8 vs. 3.3 ± 3.2,p= .042), even after controlling for SCD genotype, asthma, disease‐modifying treatment, and follow‐up years (p= .027).ConclusionACEs are linked to increased morbidity among children and adolescents with SCD. Prospective studies are needed to further understand this relationship and test ACE‐protective remedies.