Abstract 4370542: Strength Amidst Strain: Determinants of Resilience in Pediatric and Young Adult Fontan Circulatory Failure
Bibliographic record
Abstract
Background: Resilience describes an individual’s ability to leverage internal strengths, external support, and acquired skills to maintain wellbeing amidst stressors. Individuals with Fontan-palliated congenital heart disease (CHD) often face physical and psychological stressors, yet some report resilience amidst these circumstances. While resilience is linked to important physical and psychological outcomes in other chronic illnesses, it is underexplored in pediatric and young adult CHD. Research Question: This prospective study aimed to 1) characterize self-reported resilience in a multi-center sample of children and young adults with Fontan circulatory failure (FCF) and 2) identify demographic, physical, and psychological factors correlated with resilience. Methods: Pediatric and young adult patients with Fontan circulation referred for heart failure evaluation at 20 North American pediatric heart centers were eligible. Participants completed the Connor-Davidson Resilience Scale (CD-RISC©). CD-RISC© scores range from 0-40. In adults, scores < 29 represent the lowest quartile. In pediatric cancer and adult CHD, mean scores of 29 have been reported. Participants also completed a measure of disease burden/benefit and NIH PROMIS surveys assessing life satisfaction, purpose in life, depression, and anxiety. Medical data was obtained from chart reviews, and frailty was assessed using the Lurz-Wilde pediatric frailty criteria. Results: The study included 131 participants (60% male, 78% White, median age 16.1 years) with a mean CD-RISC score of 27.2 (SD=7.2; Figure 1). Lower resilience was associated with younger age (p<0.0001), female sex (p=0.01), and hypoplastic left heart syndrome (HLHS; p=0.049). Lower resilience (p=0.001), higher anxiety (p=0.01), and high self-reported disease burden (p=0.02) correlated with frailty. Few objective FCF comorbidities were associated with resilience. In univariate analysis, protein losing enteropathy (PLE; p=0.04) and clinical cyanosis (p=0.053) were associated with lower resilience. In multivariate analysis including age, sex, HLHS diagnosis, and PLE, only younger age and female sex remained independently associated with lower resilience. Conclusion: Although young people with FCF report high resilience, many indicate opportunities for intervention. The study underlines resilience as a modifiable, critical target for intervention in complex CHD, highlighted by its strong link with frailty over less modifiable comorbidities.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".