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pregnant hispanic woman

Significant health disparities in detection of critical congenital heart disease

pregnant hispanic woman

Mothers who are Hispanic or who come from rural or low socioeconomic status neighborhoods are less likely to have their child’s critical heart condition diagnosed before birth, according to a new study in the journal Circulation.

Mothers who are Hispanic or who come from rural or low socioeconomic status neighborhoods are less likely to have their child’s critical heart condition diagnosed before birth, according to a new study in the journal Circulation.

This is the largest and most geographically diverse study of these challenges to date. The study compared patient data of more than 1,800 children from the United State and Canada diagnosed with two of the most common, and the most serious, critical congenital heart defects: hypoplastic left heart syndrome (HLHS), when the left side of the heart is not developed completely, and transposition of the great arteries (TGA), when the two main arteries that carry blood away from the heart are reversed.

“The earlier we diagnose a heart defect, especially a serious one such as HLHS or TGA, the sooner we can make a plan for how to safely deliver the infant and reduce the impacts of that heart defect on the rest of the body,” says Anita Krishnan, M.D., first author and cardiologist at Children’s National Hospital. “Early detection and diagnosis of these conditions is crucial to ensuring the best possible outcome for the child, especially in protecting the brain.”

Even when infants’ heart defects were detected before birth, babies from neighborhoods with lower socioeconomic status were detected later in gestation than others.

“The COVID-19 pandemic has brought the idea of significant disparities in health care to the forefront of our national attention,” says Dr. Krishnan. “Even though many health care providers have seen these inequities firsthand in their own clinical experience, it was still surprising to see the strength of the association between socioeconomic position and the care available to mothers.”

In both the United States and Canada, expectant mothers are first screened as part of routine prenatal care in the first trimester for early signs of congenital heart defects and other genetic disorders via blood screen and ultrasound. In the second trimester, a comprehensive ultrasound evaluation for structural anomalies is routine. If any issues are detected, the mother is referred for a fetal echocardiogram and counseling.

The authors suggest that decreased linkages between neighborhoods and people identified in the study and subspecialists could contribute to the disparities found in the study.

“Prenatal detection rates may improve if we are able to leverage outreach and telehealth to strengthen the relationships between these specialties and the groups we identified in the study,” Dr. Krishnan says.

The study included a total of 1,862 patients, including 1,171 patients with HLHS (91.8% prenatally diagnosed) and 691 with TGA (58% prenatally diagnosed). The study group included prenatally diagnosed fetuses with HLHS or TGA and postnatally diagnosed infants less than two months old with HLHS or TGA. Data was collected from institutions participating in the Fetal Heart Society, a non-profit 501(c) multicenter research collaborative with a mission to advance the field of fetal cardiovascular care and science. Mary Donofrio, M.D., director of Prenatal Cardiology at Children’s National, is society president and served as a senior author on this study.

Read the AHA’s press release: Prenatal detection of heart defects lower in rural, poor areas and among Hispanic women.

Alexandra M. Sim

Alexandra M. Sims, M.D., FAAP, counsels grads to know their who, how and why

Alexandra M. Sim

Alexandra M. Sims, M.D., FAAP, general academic pediatrics fellow at Children’s National, tells newly minted George Mason social sciences graduates the concrete and abstract skills they learned during their collegiate experience are exceedingly valuable.

As a 10-year-old growing up in the suburbs of Richmond, Virginia, lip syncing with friends as they pretended to be Destiny’s Child, Alexandra M. Sims, M.D., FAAP, predicted her future: She would become a doctor.

“Ten is a really funny age,” Dr. Sims told members of the 2019 graduating class from George Mason University College of Humanities and Social Sciences, the school and department from which she received her undergraduate degree in Anthropology. “I was old enough to feel compelled to contribute to the world meaningfully, but too young to know the weight of this undertaking. I was old enough to be intrigued by the science of the human body, but too young to be intimidated by the fact that there were no doctors in my family.”

Dr. Sims’ youngest sister, Bria, was born four weeks premature and died a few weeks after birth. The sting of that tragedy instilled in her a commitment to serve others and informed a lifelong passion to help society’s most marginalized.

Ten years after graduating George Mason herself, she invited this year’s newly minted graduates to distill their college experience into three terms: who, how and why:

  • Who means the family members and mentors who helped them enter college and persevere toward graduation.
  • How is their plan to change the world. The general academics pediatrics fellow at Children’s National asks kids about their unique superpower during visits to the primary care clinic at Children’s Health Center Anacostia. “I get a range of responses, and some of them are quite funny,” she told 800 social sciences graduates gathered for their degree celebration. “Some really surprise me in other ways. ‘I want to be kind.’ ‘I want to help people.’ ‘I want to take care of my parents.’ ”
  • Why is the reason they continue to do what they’re doing. For Dr. Sims, that’s service and mitigating health disparities, a mission that has led her to travel around the globe conducting HIV/AIDS outreach and building coalitions near and far. Her current work is domestic, as she seeks advocates for at-risk communities through health services research.

“So, come back to these when you’re feeling unsure or uneasy: your WHO, your HOW and your WHY. Know that your time here at Mason is time well spent, and that the skills that you’ve gained, both the concrete and the abstract, are exceedingly valuable,” she advised the group.

CASD Posters

Bridging gaps in autism care through technology

CASD Posters

CASD Faculty Member and Clinical Psychologist, Dr. Allison Ratto (top left); Postdoctoral Fellow, Dr. Marissa Miller, (top right); and Research Assistants, Eleonora Sadikova (bottom left) and Laura Saldana (bottom right) presented posters at ABCT.

Technology’s potential to improve care delivery and reduce human suffering were the key focus of discussion at the recent Annual Convention of the Association for Behavioral and Cognitive Therapies (ABCT), held in Washington, D.C.

Within ABCT’s Autism Spectrum and Developmental Disabilities Special Interest Group (ASDD SIG), presentations showcased tools that leverage technology to better meet the needs of both autistic people and the clinicians who care for them. Researchers from the Center for Autism Spectrum Disorders (CASD) at Children’s National took center stage at the ASD focused group to share information about novel developments underway that harness technology for children and families.

Lauren Kenworthy, Ph.D., director of CASD, served as the keynote speaker for the ASDD SIG Meeting. She also chaired a panel, “Leveraging Technology to Improve Autism Acceptance and Treatment” and presented, ” Online Parent Training Modules to Improve Executive Function in Autistic Children” about the e-Unstuck and On Target Parent Training Study, which adapts CASD’s successful classroom-based Unstuck and On Target toolkit for children ages 5 to 10 to an online platform so more families can benefit from the program’s skills and strategies.

Dr. Kenworthy was honored with the 2018 Transformative Contribution Award from the ABCT Autism Spectrum and Developmental Disabilities Special Interest Group for her lifetime of contributions to better understanding and better interventions for young people with ASD.

“It was a special honor to receive this recognition from ABCT this year, when the annual meeting is here in our home city,” says Dr. Kenworthy. “The Center for Autism Spectrum Disorders is focused on developing technology solutions that deliver therapies to everyone who needs them, no matter where they live, and technology is one powerful and promising way we can bridge care gaps both in the Washington, D.C. region and really, around the world.”

CASD Talks

Dr. Lauren Kenworthy presenting during the panel she chaired (top); presenting to the ASDD SIG (bottom left); and receiving the ASDD SIG Transformative Award from ASDD SIG Awards Committee Chair, Dr. Tyler Hassenfeldt (bottom right).

In addition to Dr. Kenworthy, several other CASD researchers presented research during panels and poster presentations, including:

  • Panel Presentation: Efficacy of a Parent-Mediated Sexual Education Curriculum for Youth With ASD”– Cara Pugliese, Ph.D.
  • Poster presentations:
    • “Evidence of Enhanced Social Skills in Young Dual-Language Learners on the Autism Spectrum”- Allison Ratto, Ph.D. (first author)
    • “Exploring Contributors to Parents’ Ideal and Realistic Goals for Involvement in School Training”-Marissa Miller, Ph.D. (first author)
    • “Examining Caregiver Well-Being and Service Use between Latino and Non-Latino Caregivers”-Laura Saldana (first author)
    • “Pre-Pubertal Signs of Future Gender Dysphoria in Youth with ASD”-Eleonora Sadikova (first author)

The Association for Behavioral and Cognitive Therapies Annual Convention has been held for more than half a century. The gathering includes 3,500-plus mental health professionals and students who specialize in cognitive and behavioral therapies.