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Long-Term outcome of infantile onset pompe disease patients treated with enzyme replacement therapy
(2024)
Background: Enzyme replacement therapy (ERT) with recombinant human alglucosidase alfa (rhGAA) was approved in Europe in 2006. Nevertheless, data on the long-term outcome of infantile onset Pompe disease (IOPD) patients at school age is still limited.
Objective: We analyzed in detail cardiac, respiratory, motor, and cognitive function of 15 German-speaking patients aged 7 and older who started ERT at a median age of 5 months.
Results: Starting dose was 20 mg/kg biweekly in 12 patients, 20 mg/kg weekly in 2, and 40 mg/kg weekly in one patient. CRIM-status was positive in 13 patients (86.7%) and negative or unknown in one patient each (6.7%). Three patients (20%) received immunomodulation. Median age at last assessment was 9.1 (7.0–19.5) years. At last follow-up 1 patient (6.7%) had mild cardiac hypertrophy, 6 (42.9%) had cardiac arrhythmias, and 7 (46.7%) required assisted ventilation. Seven patients (46.7%) achieved the ability to walk independently and 5 (33.3%) were still ambulatory at last follow-up. Six patients (40%) were able to sit without support, while the remaining 4 (26.7%) were tetraplegic. Eleven patients underwent cognitive testing (Culture Fair Intelligence Test), while 4 were unable to meet the requirements for cognitive testing. Intelligence quotients (IQs) ranged from normal (IQ 117, 102, 96, 94) in 4 patients (36.4%) to mild developmental delay (IQ 81) in one patient (9.1%) to intellectual disability (IQ 69, 63, 61, 3x < 55) in 6 patients (54.5%). White matter abnormalities were present in 10 out of 12 cerebral MRIs from 7 patients.
Objectives: The MetabQoL 1.0 is the first disease-specific health related quality of life (HrQoL) questionnaire for patients with intoxication-type inherited metabolic disorders. Our aim was to assess the validity and reliability of the MetabQoL 1.0, and to investigate neuropsychiatric burden in our patient population. Methods: Data from 29 patients followed at a single center, aged between 8 and 18 years with the diagnosis of methylmalonic acidemia (MMA), propionic acidemia (PA) or isovaleric acidemia (IVA), and their parents were included. The Pediatric Quality of Life Inventory (PedsQoL) was used to evaluate the validity and reliability of MetabQoL 1.0.
Results: The MetabQoL 1.0 was shown to be valid and reliable (Cronbach's alpha: 0.64–0.9). Fourteen out of the 22 patients (63.6%) formally evaluated had neurological findings. Of note, 17 out of 20 patients (85%) had a psychiatric disorder when evaluated formally by a child and adolescent psychiatrist. The median mental scores of the MetabQoL 1.0 proxy report were significantly higher than those of the self report (p = 0.023). Patients with neonatal-onset disease had higher MetabQoL 1.0 proxy physical (p = 0.008), mental (p = 0.042), total scores (p = 0.022); and self report social (p = 0.007) and total scores (p = 0.043) than those with later onset disease.
Conclusions: This study continues to prove that the MetabQoL 1.0 is an effective tool to measure what matters in intoxication-type inherited metabolic disorders. Our results highlight the importance of clinical assessment complemented by patient reported outcomes which further expands the evaluation toolbox of inherited metabolic diseases.
In Bewegung kommen
(2023)
Das Modellprojekt „Caritas Care – Betreuung zuhause“ wurde 2012 in einer Kooperation der Caritas Schweiz und der Caritas Alba Iulia (Transsylvanien/Rumänien) ins Leben gerufen. Damit sollte ein Modell geschaffen werden, welches einerseits dem wachsenden Markt der „Betreuung zuhause“ in der Schweiz entgegenkommt, aber andererseits fairere Arbeitsbedingungen für die Betreuungspersonen vorsieht. Fairness sollte durch einen Versicherungsschutz der Arbeitskräfte, Weiterbildungsmöglichkeiten und ein Entgelt, das mit anderen Arbeitsverhältnissen vergleichbar ist, sowie dank klar abgegrenzter Arbeits-, Präsenz- und Freizeit erreicht werden. Die Umsetzung erfolgt folgendermaßen: Angestellte Betreuungs- und Pflegefachkräfte der Caritas Alba Iulia können für sechs Wochen bis zu drei Monaten in die Schweiz gehen, um dort in Privathaushalten hilfsbedürftige Menschen zu unterstützen (Live-in-Betreuungen). Sie werden während dieser Zeit von der Caritas Schweiz angestellt. Danach kehren die Betreuenden wieder in ihr Anstellungsverhältnis bei der Caritas Alba Iulia zurück. Es wird sozusagen Personal „verliehen“. Damit soll einem Verlust von qualifiziertem Betreuungs- und Pflegepersonal durch Abwanderung aus Rumänien entgegengewirkt werden. Im Rahmen des studiengangsübergreifenden, interdisziplinären Kontextstudiums der Masterstudiengänge der Fachhochschule Vorarlberg (Österreich) hat sich eine Gruppe Forschender zum Ziel gesetzt, dieses Modellprojekt forscherisch zu erkunden. Wir wollten wissen, wie dieses Live-in-Betreuungsangebot nach zehn Jahren Laufzeit funktioniert. Insbesondere interessierten uns die Erfahrungen der rumänischen Betreuer:innen und ihrer Angehörigen sowie der projektverantwortlichen Leitungspersonen in der Caritas Alba Iulia und der Caritas Schweiz. Im Rahmen einer Feldforschungswoche im Juli 2022 in Transsylvanien/Siebenbürgen wurden 28 formelle Interviews mit Projektverantwortlichen, Betreuern/Betreuerinnen und deren Angehörigen durchgeführt. Zusätzlich wurden Dokumente und Feldnotizen sowie Gedächtnisprotokolle von informellen Gesprächen mit Personen der extramuralen Einrichtungen in Rumänien in die Auswertung integriert. Die Auswertung erfolgte inhaltsanalytisch.
Organic acidurias (OAs), urea-cycle disorders (UCDs), and maple syrup urine disease (MSUD) belong to the category of intoxication-type inborn errors of metabolism (IT-IEM). Liver transplantation (LTx) is increasingly utilized in IT-IEM. However, its impact has been mainly focused on clinical outcome measures and rarely on health-related quality of life (HRQoL). Aim of the study was to investigate the impact of LTx on HrQoL in IT-IEMs. This single center prospective study involved 32 patients (15 OA, 11 UCD, 6 MSUD; median age at LTx 3.0 years, range 0.8–26.0). HRQoL was assessed pre/post transplantation by PedsQL-General Module 4.0 and by MetabQoL 1.0, a specifically designed tool for IT-IEM. PedsQL highlighted significant post-LTx improvements in total and physical functioning in both patients' and parents' scores. According to age at transplantation (≤3 vs. >3 years), younger patients showed higher post-LTx scores on Physical (p = 0.03), Social (p < 0.001), and Total (p =0.007) functioning. MetabQoL confirmed significant post-LTx changes in Total and Physical functioning in both patients and parents scores (p ≤ 0.009). Differently from PedsQL, MetabQoL Mental (patients p = 0.013, parents p = 0.03) and Social scores (patients p = 0.02, parents p = 0.012) were significantly higher post-LTx. Significant improvements (p = 0.001–0.04) were also detected both in self- and proxy-reports for almost all MetabQoL subscales. This study shows the importance of assessing the impact of transplantation on HrQoL, a meaningful outcome reflecting patients' wellbeing. LTx is associated with significant improvements of HrQol in both self- and parentreports. The comparison between PedsQL-GM and MetabQoL highlighted that MetabQoL demonstrated higher sensitivity in the assessment of diseasespecific domains than the generic PedsQL tool.
Armut im Blick?
(2023)
Praxisanleiter:innen nehmen eine entscheidende Rolle in der Ausbildung von Pflegepersonen wahr. Die Tätigkeit fordert eine Vielzahl von Kompetenzen. Die Weiterbildung Praxisanleitung bietet eine wichtige Grundlage für die Entwicklung dieser Kompetenzen – deren Rahmenbedingungen, Methoden und Inhalte in Österreich werden in dieser Studie untersucht.
Pooled data from published reports on infants with clinically diagnosed vitamin B12 (B12) deficiency were analyzed with the purpose of describing the presentation, diagnostic approaches, and risk factors for the condition to inform prevention strategies. An electronic (PubMed database) and manual literature search following the PRISMA approach was conducted (preregistration with the Open Science Framework, accessed on 15 February 2023). Data were described and analyzed using correlation analyses, Chi-square tests, ANOVAs, and regression analyses, and 102 publications (292 cases) were analyzed. The mean age at first symptoms (anemia, various neurological symptoms) was four months; the mean time to diagnosis was 2.6 months. Maternal B12 at diagnosis, exclusive breastfeeding, and a maternal diet low in B12 predicted infant B12, methylmalonic acid, and total homocysteine. Infant B12 deficiency is still not easily diagnosed. Methylmalonic acid and total homocysteine are useful diagnostic parameters in addition to B12 levels. Since maternal B12 status predicts infant B12 status, it would probably be advantageous to target women in early pregnancy or even preconceptionally to prevent infant B12 deficiency, rather than to rely on newborn screening that often does not reliably identify high-risk children.