Agreement between self-, mother and father proxy-reports on health-related quality of life in adolescents with Tourette syndrome

This study aimed to investigate agreement and discrepancies between parent proxy- and adolescent self-reports on assessments of adolescents' health-related quality of life (HRQoL), and the role that individual factors may play in parent-adolescent agreement, in a sample of adolescents with Tourette syndrome (TS) compared to a control group of healthy adolescents. Adolescents aged 12-18 years diagnosed with TS were recruited with their parents from primary and secondary referral centres. Adolescent healthy controls were matched for gender and age. Adolescents and each of their parents completed a set of questionnaires including a HRQoL evaluation of adolescent, the 'Vécu et Santé Perçue de l'Adolescent'. Mother-adolescent, father-adolescent and mother-father agreements on adolescents' HRQoL scores were investigated at individual and group level, both in TS and control groups. Data were available for 75 adolescents, 75 mothers and 63 fathers, in the TS group. Agreement between mother, father proxy-reports and TS adolescents self-reports of HRQoL varied from poor to good, without significant difference with the control group. In TS group, mothers and fathers underestimated adolescents' HRQoL in 'Psychological well-being' subscale and mothers underestimated it in 'Physical 'well-being' subscale, while controls overestimated adolescents' HRQoL in these subscales. Larger mother-adolescent discrepancies for 'Psychological well-being' and 'Physical well-being' subscales were associated with internalizing symptoms. Regarding future studies, comprehensive evaluation of the various dimensions of adolescents' HRQoL with TS requires the integration of the perspectives of both adolescents, mothers and fathers. Clinicians should take into account this point to provide comprehensive care and services.

Feasibility and effectiveness of communication tools for addressing intimacy and sexuality in patients with cancer: a systematic review

PURPOSE

Patients diagnosed with cancer might experience changes in intimacy and sexuality due to the illness itself, treatment, or psychological and social factors. Healthcare professionals (HCPs) often feel reluctant to discuss these changes. This study aimed to provide an overview of the feasibility and effectiveness of communication tools that support communication regarding changes in intimacy or sexuality among patients with cancer.

METHODS

This is a systematic review. Databases are PubMed, Embase, CINAHL, PsycInfo, Web of Science and Cochrane Library from inception to June 2023. The Mixed Methods Appraisal Tool was used to assess included studies. Data were summarized in data charting forms.

RESULTS

In total 35 studies were included, published between 2001 and 2023. Most had a quantitative design and moderate methodological quality. In 11 studies, the PLISSIT model (Permission, Limited Information, Specific Suggestions, Intensive Therapy) was used. Tools were integrated in counselling sessions or training programmes for individual patients, couples, groups of patients, or HCPs. All tools were considered feasible by patients or HCPs. Twenty studies reported significant improvement in sexual functioning, quality of life, quality of care or combined outcomes.

CONCLUSION

Tools to support communication about changes in intimacy and sexuality among patients with cancer seem feasible and effective. The most commonly used tool, the PLISSIT model, proved to be feasible for HCPs and to have a positive effect on patients' and partners' sexual functioning and quality of life. Giving attention to changes in intimacy and sexuality seems to be important in itself, regardless of the communication tool or approach used.

Highlighting successes and challenges of the mental health system in Tunisia: an overview of services, facilities, and human resources

BACKGROUND

Tunisia is a lower-middle-income country located in North Africa with strengths and challenges to its mental health system.

AIMS

We present an overview of available services, facilities, and human resources to offer mental health care in Tunisia.

METHODS

We conducted a cross-sectional study, where data for the year 2017 was collected between May 2018 and May 2019 by consulting stakeholders involved in the health field in Tunisia. We compare this information with data published in the WHO-AIMS report (2008), which presents mental health data in Tunisia for the year 2004.

RESULTS

Successes of the mental health system in Tunisia include an increase in the ratios of psychiatrists and psychologists, with these ratios being higher than those of other lower-middle-income countries; a flourishing child-psychiatry practice; and an increase in people being treated for mental health conditions. Challenges include psychiatrists being over-represented in large cities along the coastline and in the private sector, and most people receiving treatment in specialized mental health facilities.

CONCLUSIONS

The further operationalization of the National Strategy for Mental Health Promotion is envisioned, through the training of non-specialists in mental health care and incentives offered to psychiatrists to work in the country's interior and the public sector.

Perceived strengths and weaknesses of paediatric physiotherapy services: Results from an international survey

BACKGROUND AND PURPOSE

Ensuring access to high quality services in paediatric physiotherapy (PT) is important to respond to the diverse needs of children. The accessibility and quality of paediatric PT services has however never been explored internationally. The purpose of this study is to explore the perceived strengths, weaknesses, opportunities, and threats (SWOT) of paediatric PT services offered around the world.

METHOD

A cross-sectional survey design method was used with a subsample of physiotherapists (PTs) who had previously participated in an online survey. The survey used for this study included close- and open-ended questions about access to services and the SWOT of PT services within participants' country. Descriptive statistics were used to summarize quantitative data and a content analysis was performed on open-ended questions.

RESULTS

Overall, 47 PTs from 47 countries completed the survey; 36% of participants reported that free access was available to all children in their country while 34% stated that a referral was always required when accessing services. Lack of direct access, insufficient specialized PT, financial and geographical issues were the main perceived barriers to access services. Access also emerged as one of the nine themes following the SWOT analysis. Other themes included education, quality of PT approaches, PT practices, communication and cooperation, teamwork, government, resources, and attitudes of PTs.

DISCUSSION

Despite variations in accessing services and how services are delivered across countries, some similar themes influencing PTs practices were found. Future opportunities for PTs working with children should aim at optimizing the initial training and professional development of PTs in paediatrics, increasing access to services for all children and advocating for sustainable and well-coordinated models of care building on best practices.

Correlation between the assessment of family relations and psychological factors in mothers of children diagnosed with autism and Asperger’s syndrome

The aim

The aim of the work was to analyze correlation between the assessment of family relations and the assessment of the child’s functioning and psychological factors (stress-coping style, burnout, adaptation level, coherence, a sense of social suport, and mental health) in mothers of children with Asperger’s syndrome and childhood autism.

Participants and methods

The study included 70 mothers of children treated in mental health clinic (52 mothers of children with Asperger’s syndrome and 18 mothers of children with autism). The study used a battery of psychological tests.

Results

In the group of mothers of children with autism, there are significant correlations between the assessment of relations in the family and stress-coping styles and burnout. In the group of mothers of children with Asperger’s Syndrome, there are significant correlations between the assessment of family relations and the assessment of the child’s disorder, burnout, a sense of coherence, emotional support and mental resilience.

Conclusions

Based on the statical analyzes, the following conclusions were formulated: 1. Positive assessment of family relations by women raising children with autism is associated with the use of a task-oriented stress-coping style, whereas negative assessment – with the loss of personal involvement.2. Positive assessment of family relations by women raising children with Asperger’s syndrome is associated with a sense of control, instrumental support, mental resilience, and negative – with the assessment of the child’s disorder as a threat, burnout, loss of efficacy, personal involvement and decreased emotional control.

Magnitude of Satisfaction and Associated Factors Among Caregivers of Children with Disabilities Towards Community-Based Rehabilitation Service in Central and North Gondar Zone, Northwest Ethiopia: A Community-Based Cross-Sectional Study

Introduction

Community-based rehabilitation service (CBR) is a community development strategy set for persons with disabilities and their families. Measuring caregivers’ satisfaction is a recommended approach to know the overall satisfaction of rehabilitation service. Therefore, this study aimed to assess the magnitude of satisfaction and associated factors among caregivers of children with disabilities towards community-based rehabilitation in Central and North Gondar zone, North West Ethiopia.

Methods

A community-based cross-sectional study was conducted from March to September 2020. The data were collected by socio-demographic variables, types of services, types of disabilities, and Client Satisfaction Questionnaire (CSQ-8). Data analysis was done by SPSS Version-20 statistical software. Descriptive statistics, bi-variable, and multivariable logistic regression analysis were computed. The multivariable logistic regression analysis model a P-value <0.05 was used to identify the associated factors with caregivers’ satisfaction.

Results

The study showed that the overall caregivers’ satisfaction with community-based rehabilitation service among caregivers of children with disabilities was 60.9% (95% CI; 55–66%). Female gender (AOR: 0.19, 95% CI: 0.05–0.68), older age (AOR: 0.160, 95% CI: 0.03–0.85), being farmer (AOR: 0.14, 95% CI: 0.05–0.42), North Gondar zone residence (AOR: 7.02, 95% CI: 6.78–8.59), high monthly income (AOR: 2.48, 95% CI: 1.09–5.61), got two or more type of service (AOR: 3.65, 95% CI: 2.64–12.39), service duration 8–14 years (AOR: 4.36, 95% CI: 1.44–7.04) and service frequency 5–8 times per month (AOR: 3.91, 95% CI 2.18–7.01) were factors associated with the caregivers’ satisfaction on community based-rehabilitation service.

Conclusion and Recommendation

The magnitude of caregivers’ satisfaction with community-based rehabilitation services in the study area was more than half. Female gender, older age, being farmer, high monthly income, North Gondar zone residence, the high number of services, duration of services started and frequency of follow-up were factors significantly associated with caregiver’s satisfaction.

[Impact of an educational video on the representations of electroconvulsive therapy among psychiatrists in Hauts-de-France and Occitanie]

INTRODUCTION

Despite its effectiveness and good tolerance, electro-convulsive therapy (ECT) is under-used in current clinical practice probably because of stigma and the negative image of this treatment. The main objective of this study was to evaluate the impact of an educational video on the representations of ECT among psychiatrists and psychiatric residents in the North and in Occitanie districts of France.

METHOD

We evaluated the representations of ECT through the Questionnaire on Attitudes and Knowledge of ECT (QuAKE) before (T0) and after (T1) viewing a short educational video. Scores at T0 and T1 were compared with a paired t-test. Factors associated with the improvement of the representations were investigated using a logistic regression model.

RESULTS

In all, 195 responses were obtained. The QuAKE score at T1 was significantly better than at T0 (29.4 at T1 vs. 31.5 at T0, P<0.001). The more negative the representations were at T0, the higher the probability of a decrease in the score at T1 (OR=1.07 [1.02-1.13], P=0.003).

DISCUSSION

Our study showed a beneficial effect of a short educational video on psychiatrists' representations of ECT. The wide use of this type of media, allowing information and destigmatization, could considerably optimize access to ECT for patients.

Building capacity in mental health care in low- and middle-income countries by training primary care physicians using the mhGAP: a randomized controlled trial

To address the rise in mental health conditions in Tunisia, a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) was offered to primary care physicians (PCPs) working in the Greater Tunis area. Non-specialists (such as PCPs)' training is an internationally supported way to target untreated mental health symptoms. We aimed to evaluate the programme's impact on PCPs' mental health knowledge, attitudes, self-efficacy and self-reported practice, immediately following and 18 months after training. We conducted an exploratory trial with a combination of designs: a pretest-posttest control group design and a one-group pretest-posttest design were used to assess the training's short-term impact; and a repeated measures design was used to assess the training's long-term impact. The former relied on a delayed-intervention strategy: participants assigned to the control group (Group 2) received the training after the intervention group (Group 1). The intervention consisted of a weekly mhGAP-based training session (totalling 6 weeks), comprising lectures, discussions, role plays and a support session offered by trainers. Data were collected at baseline, following Group 1's training, following Group 2's training and 18 months after training. Descriptive, bivariate and ANOVA analyses were conducted. Overall, 112 PCPs were randomized to either Group 1 (n = 52) or Group 2 (n = 60). The training had a statistically significant short-term impact on mental health knowledge, attitudes and self-efficacy scores but not on self-reported practice. When comparing pre-training results and results 18 months after training, these changes were maintained. PCPs reported a decrease in referral rates to specialized services 18 months after training in comparison to pre-training. The mhGAP-based training might be useful to increase mental health knowledge and self-efficacy, and decrease reported referral rates and negative mental health attitudes among PCPs in Tunisia and other low- and middle-income countries. Future studies should examine relationships among these outcome variables.

Quality of life and associated factors in parents of children with late diagnosed phenylketonuria. A cross sectional study in a developing country (Tunisia)

Objectives We investigated the quality of life (QOL) in parents of children with late treated phenylketonuria (PKU) and its associated factors. Methods We conducted a cross sectional study in the reference center of inherited metabolic disease in Tunisia. We used the Tunisian version of the 36-item short-form health survey questionnaire (SF-36). We compared variables in the groups with and without impaired QOL and the SF-36 scores between subgroups of parents and children and between our sample and the Tunisian general population based on published data. We looked for associations between SF-36 scores and quantitative variables. Linear regression and logistic binary regression were used for multivariate analysis. Results Sixty-five parents from 42 families participated. QOL was impaired in 61% of them. The mean SF-36 score was 55.3 ± 25.07. The physical component sub-score was higher than that reported in the Tunisian general population (63.66 ± 27.77 vs. 50.11 ± 8.53; p<0.001). The mental component sub-score was comparable to that reported in the Tunisian general population (46.99 ± 25.94 vs. 47.96 ± 9.82; p=0.830). Gender (mothers) (p=0.008), low monthly income (p = 0.027), low education (p=0.011), and autism in PKU children (p = 0.001) were associated with impaired QOL. Conclusions We identified at risk parents for altered quality of life among parents of PKU children. Our findings were used to develop a psychological and social support strategy for at-risk parents and to promote the implementation of newborn screening of this treatable disease in our low-income country.

Connaissances, attitudes et pratiques des étudiants en médecine en matière de sexualité

La sexualité est un aspect central de la personne humaine qui, devant des problèmes sexuels, va fréquemment se tourner vers une source qu'elle considère compétente et bien informée, son médecin. Les objectifs de notre étude étaient d’évaluer les connaissances, les attitudes et les pratiques des étudiants en médecine en termes de sexualité et d’identifier les principaux déterminants du manque de connaissances basiques à ce sujet. Notre étude était descriptive et analytique, menée auprès des étudiants à la faculté de médecine de Sfax (Tunisie). Le questionnaire, rempli individuellement et de manière anonyme par chaque étudiant, recueillait les données sociodémographiques, les connaissances en matière de sexualité ainsi que leurs sources, les attitudes adoptées par les étudiants vis-à-vis de la sexualité et les pratiques sexuelles. La note totale moyenne relative aux questions de sexologie était de 11,05/20. Les facteurs corrélés à un score moyen élevé aux questions de sexologie étaient le sexe masculin (p=0,003), le statut de marié (p=0,012), le niveau socio-économique élevé (p=0,02), les livres comme source d’informations (p=0,041) et la présence de pratiques sexuelles (p<0,001). Ces pratiques étaient toutes significativement plus fréquentes chez les étudiants de sexe masculin (p<0,001). Des lacunes dans les connaissances en matière de sexualité existent chez les étudiants en médecine, du moins dans certains de ses aspects. Un programme d'enseignement complet et uniforme sur la sexualité humaine, surtout dans ses aspects physiologiques, peut sensiblement améliorer la capacité des futurs médecins à fournir des soins optimaux à leurs patients.

"We find what we look for, and we look for what we know": factors interacting with a mental health training program to influence its expected outcomes in Tunisia

BACKGROUND

Primary care physicians (PCPs) working in mental health care in Tunisia often lack knowledge and skills needed to adequately address mental health-related issues. To address these lacunas, a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) was offered to PCPs working in the Greater Tunis area between February and April 2016. While the mhGAP-IG has been used extensively in low- and middle-income countries (LMICs) to help build non-specialists' mental health capacity, little research has focused on how contextual factors interact with the implemented training program to influence its expected outcomes. This paper's objective is to fill that lack.

METHODS

We conducted a case study with a purposeful sample of 18 trained PCPs. Data was collected by semi-structured interviews between March and April 2016. Qualitative data was analyzed using thematic analysis.

RESULTS

Participants identified more barriers than facilitators when describing contextual factors influencing the mhGAP-based training's expected outcomes. Barriers were regrouped into five categories: structural factors (e.g., policies, social context, local workforce development, and physical aspects of the environment), organizational factors (e.g., logistical issues for the provision of care and collaboration within and across healthcare organizations), provider factors (e.g., previous mental health experience and personal characteristics), patient factors (e.g., beliefs about the health system and healthcare professionals, and motivation to seek care), and innovation factors (e.g., training characteristics). These contextual factors interacted with the implemented training to influence knowledge about pharmacological treatments and symptoms of mental illness, confidence in providing treatment, negative beliefs about certain mental health conditions, and the understanding of the role of PCPs in mental health care delivery. In addition, post-training, participants still felt uncomfortable with certain aspects of treatment and the management of some mental health conditions.

CONCLUSIONS

Findings highlight the complexity of implementing a mhGAP-based training given its interaction with contextual factors to influence the attainment of expected outcomes. Results may be used to tailor structural, organizational, provider, patient, and innovation factors prior to future implementations of the mhGAP-based training in Tunisia. Findings may also be used by decision-makers interested in implementing the mhGAP-IG training in other LMICs.

[Sexual violence against women in Tunisia]

BACKGROUND

Sexual violence exists everywhere in the world. It depends mainly on the cultural and religious norms conveyed in the various societies. This is a neglected area of research. Available data are insufficient, especially in Arab-Muslim context.

METHODS

In this paper, we comprehensively review the scientific literature in order to clarify the cultural, religious and legal aspects of the concept of sexual violence against women in Tunisia, and ask the question of the urgent need to put in place strategies to counter this problem.

RESULTS

The National Office for Family and Population published in 2011 the results of the national survey on violence against women in Tunisia, including data on sexual violence and its impact on women's health and well-being. According to this survey, 14.2% of women reported having been sexually abused by an intimate partner during their lifetime and 9.0% reported having experienced it during the last 12 months. One out of every six Tunisian women has been the victim of a sexual violence in a conjugal setting. More men than women legitimized violence against women in contexts where family control, especially conjugal control, is exercised over them. In a study examining the impact of culture and religion on experiences and sexual practice of women in Tunisian society, the majority of respondents thought that sexuality in women was a religious duty and that they do not have the right to refuse their husbands or to rebel. Thus, women would be doubly sanctioned having neither the right to express their desire nor not to respond to their husband's desire. A survey of a representative sample of Tunisian women found that 56.9% of the participants reported being victims of domestic violence, particularly sexual violence (10.7%) consisting mainly of rape and sodomy, at least once in their lifetime. This survey showed that those victims expressed dissatisfaction with overall quality of life. Moreover, contrary to Western literature, sexual violence was the least reported form of violence by teenage girls in Tunisian schools. Indeed, cultural values of modesty, virginity and honor are socially much more demanded for girls, in Arab countries in general, reinforcing staggering silence and inaction around violence experienced by school-aged adolescents. In Tunisian society, the cultural "solution" to rape wants the woman to marry her rapist which safeguards her family's integrity by legitimizing the union.

CONCLUSION

Sexual violence has detrimental effects on female victims' physical and mental health. Even if the information on this form of violence is not easy to obtain in our environment, and that rates of subjects reporting sexual violence in their lifetimes are not important, the problem of sexual violence must be considered as a public health problem requiring urgent interventions and a greater institutional will.

Pratique de l'électroconvulsivothérapie dans un hôpital universitaire Tunisien

This study aimed to describe the practice of electroconvulsivotherapy (ECT) at the University Hospital of Monastir (Tunisia). We conducted a retrospective study of all patients treated by ECT at the University Hospital of Monastir between 2002 and 2013. 80 patients were enrolled in the study (60 men and 20 women, with an average age of 42.1±15.7 years), accounting for 1.4% of all patients hospitalized in Psychiatry Department during the study period. The total number of ECT sessions was 784. In 50% of patients, the primary diagnosis was a major isolated or recurring depressive disorder. The majority of patients (78.8%) had undergone only one ECT session, with an average number of sessions of 8.1 ± 4.9. The most used anesthetic product was the propofol (97.4%). In 71% of cases the energy delivered was between 40 and 80 joules and it was positively correlated with patients' age. The average duration of the motor seizure was 22.3 ± 7.2 seconds and it was negatively correlated with patients' age. The highest response rate was found in depression scores (64.3%). Immediate adverse effects occurred in 51.2% of patients. Finally, 20% of patients continued to undergo maintenance ECT sessions on a weekly or a biweekly basis. The practice of ECT at the University Hospital of Monastir has been little developed in terms of number of patients and ECT sessions. Efforts should be made to promote the use of this method.

Detection of early symptoms of cumulativetrauma disorders among mothers of handicapped children: a pilot study

[Purpose] This study aimed to establish a scientific and clinical basis for the development of a method for the early diagnosis of cumulative trauma disorders experienced by mothers of disabled children. [Subjects and Methods] Ten volunteer mothers who came to a rehabilitation centre for the treatment of their children were included in this study. Surface electromyography measurements were taken during maximum isometric contraction through the extensor muscle motor point of the wrist of the mothers, and hand grip strength was measured. [Results] In the electromyography measurements, the mean electromyogram signal value obtained from the wrist extensor muscle motor point of the mothers of the healthy children was 0.3 ± 0.08 mV and the crude handgrip strength was 28.5 ± 2.08 kg. In mothers of rehabilitated children, the crude hand grip strength was 7.0 ± 1.1 kg, and the mean electromyogram signal value from the extender muscle motor point was 0.1 ± 0.02 mV. There was a significant difference between the mothers with healthy and disabled children with respect to handgrip strength and electromyography. [Conclusion] The result obtained may be important in the development of health protection programs. Further research may lead to the development of protective rehabilitation programs and the improvement of social rights for mothers with disabled children.

Perurethral transvesical route for oocytes retrieval: an old technique for a new indication in oncofertility

We aimed to evaluate the safety and efficiency of the peruretheral transvesical oocyte retrieval in oncofertility. We conducted a retrospective comparative study in our assisted reproductive technologies center.

STUDY GROUP

28 pubertal young women affected by malignancies, referred for fertility preservation and refusing transvaginal (TV) procedure.

CONTROL GROUP

28 infertile patients, aged less than 25 years, who have undergone in vitro fertilization with TV oocyte retrieval. The ovarian stimulation was significantly longer on the study group. There was no difference between the two groups regarding mean number of collected metaphase II oocytes. One patient of the study group had a transient dysuria. These preliminary data suggest that, in oncofertility, peruretheral transvesical oocyte retrieval is an alternative when the TV route is refused or not feasible.

Seizure disorders and developmental disorders: impact on life of affected families-a structured interview

Seizure disorder and developmental disorder are two of the most common chronic disorders in childhood. Data on perceived parental burden and specific effects on daily life is scarce. We performed a structured interview, consecutively talking to all parents of pediatric outpatients of our university hospital diagnosed with seizure or developmental disorder. Three hundred seven parents (of 317 affected children: 53 with seizure disorder, 44 with specific developmental disorder, 35 with learning disorder, 71 with intellectual disability, 15 with seizure + specific developmental disorder, 23 with seizure + learning disorder, 76 with seizure disorder + intellectual disability) were interviewed. Parents of children with both seizure disorder and intellectual disability stated the highest constraints in daily life, regarding friends, hobbies, emotional pressure, occupation, partnership, habitation, and financial burden. Due to diagnosis of seizure or developmental disorder, 155/307 (51%) parents reduced their working hours/stopped working, 62/307 (20%) changed their habitation, and 46/307 (15%) broke up. As judged by parents, 148/317 (47%) children are being discriminated against, even own family/friends and educators are held responsible.

CONCLUSION

Parents perceive changes in their daily life and discrimination of their children due to their children's seizure and developmental disorders. An intellectual disability combined with seizure disorder caused the highest constraint. What is Known: • Seizure and/or developmental disorders of children may adversely influence quality of life for affected parents. • Caring for a child with special health care needs can take complete attention and own parental needs may therefore be difficult to meet. What is New: • Two out of three parents stated changes of their daily life such as quitting work, change of habitation, or breakup of partnership due to their child's diagnosis. • As judged by the parents, one in two children with developmental disorder of any kind is being discriminated against, even teachers and own family are held responsible.

Health-related quality of life, anxiety and depression in parents of adolescents with Gilles de la Tourette syndrome: a controlled study

Our objectives were to assess health-related quality of life (HRQoL), anxiety, depression of Gilles de la Tourette syndrome (GTS) adolescents' parents compared to controls; to assess GTS adolescents' HRQoL compared to controls; to investigate which parental and adolescent variables are associated with poorer parental HRQoL. The controlled study involved GTS outpatients and their parents, adolescent healthy controls matched for gender and age and their parents. Parents' HRQoL was assessed using SF-36 and WHOQOL-BREF; anxiety, depression using HADS. Adolescents' HRQoL was assessed by adolescents using VSP-A instrument and by their parents using VSP-P. A total of 75 GTS adolescents, 75 mothers, 63 fathers were compared to 75 control adolescents, 75 mothers, 62 fathers. GTS mothers had worse HRQoL than controls on 5 of the 8 SF-36 dimensions and 1 of the 4 WHOQOL-BREF dimensions, while GTS fathers had worse HRQoL on 2 of the WHOQOL-BREF dimensions. GTS mothers had poorer HRQoL than fathers. GTS mothers had more depression than control mothers and GTS fathers had more anxiety than control fathers. GTS adolescents had worse HRQoL than controls on 5 of the 9 VSP-A dimensions. Factors significantly related to parental HRQoL were anxiety, depression, GTS adolescents' HRQoL and, concerning mothers, behavioural and emotional adolescents' problems; concerning fathers, severity of vocal tics, duration since first symptoms. This study provides a better understanding of poorer HRQoL and psychiatric morbidity of GTS adolescents' parents. Clinicians should pay attention to their emotional well-being and HRQoL and be aware that mothers and fathers are differently affected.

Parental stress and support of parents of children with spina bifida in Uganda

Background

Children with disabilities in Sub-Saharan Africa depend for a large part of their functioning on their parent or caregiver. This study explores parental stress and support of parents of children with spina bifida in Uganda.

Objectives

The study aimed to explore perceived stress and support of parents of children with spina bifida living in Uganda and the factors that influence them.

Methods

A total of 134 parents were interviewed. Focus group discussions were held with four parent support groups in four different regions within the country. The Vineland Adaptive Behaviour Scales, Daily Functioning Subscales and Parental Stress Index Short Form (PSI/SF) were administered to measure the child’s daily functioning level and parental stress levels.

Results

Parental stress was high in our study population with over half of the parents having a > 90% percentile score on the PSI/SF. Stress outcomes were related to the ability to walk (Spearman’s correlation coefficient [ρ] = −0.245), continence (ρ = −0.182), use of clean intermittent catheterisation (ρ = −0.181) and bowel management (ρ = −0.213), receiving rehabilitative care (ρ = −0.211), household income (ρ = −0.178), geographical region (ρ = −0.203) and having support from another parent in taking care of the child (ρ = −0.234). Linear regression showed parental stress was mostly explained by the child’s inability to walk (β = −0.248), practicing bowel management (β = −0.468) and having another adult to provide support in caring for the child (β = −0.228). Parents in northern Uganda had significantly higher scores compared to parents in other regions (Parental Distress, F = 5.467*; Parent–Child Dysfunctional Interaction, F = 8.815**; Difficult Child score, F = 10.489**).

Conclusion

Parents of children with spina bifida experience high levels of stress. To reduce this stress, rehabilitation services should focus on improving mobility. Advocacy to reduce stigmatisation and peer support networks also need to be strengthened and developed.