{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T19:44:40Z","timestamp":1791834280841,"version":"4.3.4"},"reference-count":30,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Elexacaftor\/tezacaftor\/ivacaftor (ETI) has been associated with improvements in physical health and well\u2010being. However, there are growing concerns about side\u2010effects related to sleep, cognition and new, or worsening mental health in a subset. This study assessed healthcare providers' perceptions of the positive and negative impacts of ETI and compared provider ratings in Europe to the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The European CF Society's Mental Health Working Group adapted and distributed the survey developed by the CF Foundation's Mental Health Advisory Committee. It assessed healthcare providers' observations of the impacts of ETI in these domains: (1) positive and negative physical and psychological effects, (2) sleep difficulties, (3) cognitive difficulties, (4) worsening mental health, and (5) concerns about the future and finances.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventy\u2010eight healthcare providers across 21 European (EU) countries responded, endorsing similar percentages of positive physical and psychological effects as US providers. However, in Europe lower percentages of MH side\u2010effects (e.g., increased depression\/anxiety, suicidal ideation, body image), and concerns about the future (e.g., copays, food insecurity) were found.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Across international providers similar positive results were reported. A substantial proportion of PWCF across EU and United States experienced ETI side\u2010effects related to sleep, cognition, and new or worsening mental health. However, EU providers reported significantly fewer side\u2010effects related to mental health, negative body image, planning for the future and finances. MH side\u2010effects led to dosing changes in ETI and in the United States, they led to changes in MH medications. These international data document the importance of systematically assessing and managing these side\u2010effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ppul.71367","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T11:46:24Z","timestamp":1762947984000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Multidimensional Impacts of Elexacaftor\/Tezacaftor\/Ivacaftor: Comparisons of Physical and Mental Health Providers' Observations in Cystic Fibrosis in Europe and the United States"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7478-8414","authenticated-orcid":false,"given":"Sonia","family":"Graziano","sequence":"first","affiliation":[{"name":"Psychology Unit, Child &amp; Adolescent Psychiatry Unit Bambino Ges\u00f9 Children's Hospital, IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8002-9708","authenticated-orcid":false,"given":"Edwina C.","family":"Landau","sequence":"additional","affiliation":[{"name":"The Graub CF Center, Schneider Children's Medical Center Pulmonary Institute Petah Tikva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horst","family":"Mitmansgrubert","sequence":"additional","affiliation":[{"name":"Department of Psychiatry II Medical University Innsbruck Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2787-5440","authenticated-orcid":false,"given":"Marieke","family":"Verkleij","sequence":"additional","affiliation":[{"name":"Emma Children's Hospital, Child and Adolescent Psychiatry &amp; Psychosocial Care Amsterdam UMC Location University of Amsterdam Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0924-4031","authenticated-orcid":false,"given":"Anna M.","family":"Georgiopoulos","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urszula","family":"Borawska\u2010Kowalczyk","sequence":"additional","affiliation":[{"name":"Cystic Fibrosis Department Institute of Mother and Child Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth A.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Jacobs School of Medicine and Biomedical Sciences Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7120-2799","authenticated-orcid":false,"given":"Christina J.","family":"Bathgate","sequence":"additional","affiliation":[{"name":"Department of Medicine National Jewish Health Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4139-6983","authenticated-orcid":false,"given":"Alexandra L.","family":"Quittner","sequence":"additional","affiliation":[{"name":"Joe DiMaggio Cystic Fibrosis Pulmonary and Sleep Center Hollywood USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1908639"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32597-8"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2023.10.043"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2022.08.018"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2021.10.002"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2022.05.001"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10010023"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psym.2017.04.001"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2017.05.008"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psym.2020.06.021"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2023.01.015"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2024.11.006"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1101\/2025.07.02.662194"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2024.12.002"},{"key":"e_1_2_9_16_1","volume-title":"Symbol Digits Modalities Test","author":"Smith A.","year":"1982"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458517690821"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2021.102950"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.26527"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2014.03.012"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2022.04.011"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2023.12.002"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1159\/000525792"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1159\/000511023"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40519-018-0544-8"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1569-1993(24)01396-1"},{"key":"e_1_2_9_27_1","doi-asserted-by":"crossref","unstructured":"A.Quittner A. 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