Canadian-French, German and UK versions of the Child Health Questionnaire: methodology and preliminary item scaling results

Health-Related Quality of Life Among Child and Adolescent Survivors of Childhood Cancer

Purpose

The main objective was to compare parent-reported health-related quality of life (HRQL) of child and adolescent survivors of childhood cancer to that of controls who had no history of cancer.

Methods

We assessed HRQL of 800 child and adolescent survivors younger than 16 years and 923 randomly selected, age- and sex-matched controls from the general population in a national multicenter retrospective cohort study using the Child Health Questionnaire parent report. Participation was 69% among survivors and 57% among controls.

Results

Survivors had means that were consistently lower than controls on the HRQL physical summary (PH; 49.9 v 55.3; P <.005), psychosocial summary (PS; 49.4 v 52.6; P < .005), and all but one of the eight subscale scores. Clinically important survivor-control differences in means on PH were found for survivors of CNS tumors, bone tumors, lymphoma, leukemia, soft tissue sarcoma and Wilms' tumor (differences: −8.7, −7.0, −6.3, −5.4, −4.4, −3.8/100, respectively); on PS, survivors of CNS tumors were most compromised (−6.1/100). Survivor-control differences in both PH and PS were also large for survivors treated with radiation only (−5.8 and −11.9/100, respectively), or radiation combined with surgery (−6.6 and −5.9/100, respectively), or radiation combined with both surgery and chemotherapy (−7.8 and −5.1/100, respectively). Cranial radiation was associated with the most compromised HRQL.

Conclusion

According to parents, HRQL for survivors was somewhat poorer, overall, than for controls. Survivors of CNS tumors, lymphoma, and leukemia and those patients treated with cranial radiation were reported to have poorest HRQL. These findings support development of guidelines for levels of follow-up care for particular groups of survivors.

Improvements in quality of life in children after surgical therapy for sinonasal disease

OBJECTIVES

To study changes in quality of life in children with chronic sinonasal disease after surgical therapy.

STUDY DESIGN AND SETTING

Prospective, nonrandomized quality of life study of children with sinonasal disease who undergo adenoidectomy or functional endoscopic sinus surgery (FESS) at an academic institution. Caregivers completed a preoperative SN-5 quality of life survey and a second survey within 6 months after surgery.

RESULTS

Twenty-two children were enrolled in the study (mean, 6.5 years; range, 1.4 to 15.9). The majority (59%) of children underwent adenoidectomy. The mean total score was 25.8 at initial presentation and 12.0 at follow-up (P>0.001). Postoperative scores for all domains were significantly different from preoperative scores. The domains with the greatest change in mean score were nasal obstruction and emotional distress. There were no significant differences in outcome between children who underwent adenoidectomy and those who underwent FESS.

CONCLUSIONS

After either adenoidectomy or FESS, caregivers report a dramatic improvement in the quality of life of children with sinonasal disease.

EBM RATING

B-3b.

Health-related quality of life in a Norwegian sample of healthy adolescents: some psychometric properties of CHQ-CF87-N in relation to KINDL-N

PURPOSE

As part of a large investigation of Norwegian adolescents, with an overall aim of developing methods to promote health-related quality of life (HRQOL), an adequate generic measure of HRQOL was needed. Hence the purpose of the study was to compare some of the psychometric qualities of the CHQ-CF87-N and KINDL-N in a sample of healthy adolescents and to discuss the feasibility of the 2 instruments in research and clinical settings.

METHODS

Two hundred twenty-nine healthy adolescents completed the questionnaires. The internal consistency reliability and the distributional properties of the CHQ-N and KINDL-N were compared. Factor analysis was performed for the CHQ-N scales separately, as well as for the CHQ-N and KINDL-N scales combined.

RESULTS

The reliability of the scales of the CHQ-N was satisfactory, and generally was better for the CHQ-N scales than for the KINDL-N scales. The distributional properties of the KINDL-N scales were on average better than the CHQ-N scales. Factor analysis of the CHQ-N scales resulted in 3 interpretable factors, while analysis of the CHQ-N and KINDL-N scales combined comprised 4 interpretable factors. A 1-factor solution was in both cases interpreted as a general health-related quality of life factor.

CONCLUSIONS

The CHQ-N and KINDL-N may be regarded as adequate instruments to measure HRQOL in healthy adolescents, but to some extent they cover different dimensions of health and quality of life. The KINDL-N focuses on the psychosocial aspects, while CHQ-N covers more dimensions and has stronger focus on the physical aspects. Thus the instruments have different applications in both research and clinical settings.

Health-related quality of life in children diagnosed with asthma, diabetes, juvenile chronic arthritis or short stature

AIM

1) To assess the reliability and validity of the Swedish version of the Child Health Questionnaire (CHQ), 2) to determine the correlation between children's and parents' responses to the CHQ, and 3) to describe and compare responses to the CHQ of four diagnostic groups.

METHODS

A total of 199 Swedish children aged 9-16 with diagnoses of asthma (n = 53), diabetes (n = 48), short stature (n = 51) and juvenile chronic arthritis (JCA, n = 47) and their parents answered the CHQ and relevant validation instruments at a clinic check-up. Coefficient alphas were determined for all dimensions of the instrument, and all but four had acceptable to very good reliability (0.75-0.94).

RESULTS

Concerning construct validity, the CHQ correlated significantly with appropriate dimensions of the validation instruments. In general, there were significant correlations between the children's and parents' responses. Comparisons between the diagnostic groups showed several significant differences. The short stature group had the highest quality of life and the JCA group the lowest. There were no sex differences, but children who had not reached puberty scored better on the dimensions of mental health and self-esteem.

CONCLUSION

The Swedish version of the CHQ is a reliable and valid instrument. Furthermore, it is recommended to ask children themselves about their health-related quality of life.

[Principles of managing chemotherapy-induced nausea and vomiting]

Chemotherapy-induced nausea and vomiting (emesis) can significantly affect a patient's quality of life, leading to poor compliance with further chemotherapy treatment. For patients treated with emetogenic chemotherapy, it is very important to prevent nausea and vomiting completely. The incidence and severity of nausea and/or vomiting in patients receiving chemotherapy are affected by numerous factors, including: 1) the specific chemotherapeutic agents used; 2) their dosage; 3) the schedule and route of administration; and 4) individual patient variability. Approximately 70 to 80% of all cancer patients receiving chemotherapy experience emesis, whereas 10% to 44% experience anticipatory emesis. The following general principles are recommended. 1) A 5-HT3 receptor antagonist should be administered prior to each day's 1st dose of moderately or highly emetogenic chemotherapy. 2) Dexamethasone should be administered once daily either orally or intravenously for every day of moderately or highly-emetogenic chemotherapy and for 2-3 days after chemotherapy for regimens that are likely to cause significant delayed-emesis. 3) The most effective way to treat anticipatory nausea and/or vomiting is to prevent it by using optimal antiemetic therapy during every cycle of treatment.

Generic health-related quality-of-life assessment in children and adolescents: methodological considerations

The health-related quality of life (HR-QOL) of children and adolescents is increasingly considered a relevant topic for research. Instruments to assess quality of life in children and adolescents of a generic as well as disease- or condition-specific nature are being developed and applied in epidemiological surveys, clinical studies, quality assurance and health economics. This paper attempts to give an overview on the state of the art of HR-QOL assessment in children as it relates to methodological and conceptual challenges. Instruments available in international or cross-cultural research to assess HR-QOL in generic terms were identified and described according to psychometric data provided and the width of application. In an initial literature search, several challenges in the assessment of child and adolescent HR-QOL were identified, ranging from conceptual and methodological to practical aspects. Seven specific major issues were considered: (i) What are the dimensions of HR-QOL relevant for children and adolescents, and do suitable instruments for their measurement exist? (ii) Can these dimensions be collected in a cross-culturally comparable way? (iii) What advantages and disadvantages do self-rated versus externally evaluated HR-QOL measurements of children and adolescents have? (iv) How can HR-QOL be assessed in an age-appropriate way? (v) What are the advantages and disadvantages of disease-specific and generic data collection? (vi) What advantages and disadvantages do profile and index instruments have? (vii) How can HR-QOL be connected with utility- preference values? In a second literature search we identified nine generic HR-QOL instruments and four utility health state classification systems that complied with the prespecified inclusion criteria. It was concluded that (i) HR-QOL instruments are available to assess the dimensions of the construct relevant to children and adolescents; (ii) provided that an instrument was constructed in an appropriate way, the dimensions of HR-QOL can be measured in an interculturally comparable manner; (iii) the HR-QOL of children and adolescents can and should be ascertained by self-rating; (iv) the measurement instruments used have to consider maturity and cognitive development; (v) only generic quality-of-life instruments allow for an assessment of HR-QOL in both healthy and chronically ill children and adolescents; (vi) the representation of HR-QOL achieved through a singular index value is connected to strict psychometric conditions: the index instrument has to be tailored to these psychometric conditions; (vii) how far utility measures are employable with children and adolescents has to be investigated in further studies. The problem aspects identified indicate the necessity for further research. Nevertheless, instruments for assessing the HR-QOL of children and adolescents can be identified that meet the requirements mentioned above.

Quality of Life in Adolescents Born Small for Gestational Age: Does Growth Hormone Make a Difference?

BACKGROUND/AIMS

To evaluate quality of life (QoL) in adolescents born SGA without spontaneous catch-up growth, treated with and without long-term growth hormone (GH) therapy. Additionally, to assess whether GH treatment has a positive effect on QoL, besides improving adult height and height SDS during childhood.

METHODS

Two groups of adolescents born SGA without spontaneous catch-up growth participated in the QoL evaluation; a GH-treated group (n = 44, mean GH duration: 8.8 (1.7) years) and an untreated group (n = 28), both mean age 15.8 (2.1) years. QoL was measured by self-reports of the TACQOL-S, a disorder-specific questionnaire, and the CHQ, a generic questionnaire.

RESULTS

The GH group scored significantly better health status and health-related QoL on several scales of the TACQOL-S. On all TACQOL-S scales the GH group scored better QoL than the untreated group, with effect sizes of moderate to large, not all differences reaching statistical significance. The generic CHQ did not reveal significant differences in QoL between the GH group and the untreated group.

CONCLUSIONS

Firstly, adolescents born SGA, with a GH-induced improved height, had in many aspects a better QoL than untreated adolescents born SGA, according to the disorder-specific questionnaire. Secondly, we advise to use, in addition to a generic questionnaire, a disorder-specific questionnaire for measuring QoL in children treated for short stature, as the generic CHQ did not reveal such differences.

[Atomoxetine: a new treatment for Attention Deficit/Hyperactivity Disorder (ADHD) in children and adolescents]

This paper provides a review of safety and efficacy data as well as of pharmacological characteristics of atomoxetine, a new drug treatment for the Attention Deficit/Hyperactivity Disorder (ADHD). To date, the only pharmacological treatment available in France for children and adolescents diagnosed with ADHD is methylphenidate, a psychostimulant drug. However, the clinical response to methylphenidate may be absent or insufficient in about 20-30% drug-treated children while the occurrence of adverse effects with methylphenidate (sleep disturbances, loss of appetite, tics increase...) may sometimes require a dose reduction or even the discontinuation of the treatment. Atomoxetine is an alternative candidate drug for the treatment of ADHD. The drug has been developed with respect to the actual standards of investigation of drugs intended to a -pediatric use. Atomoxetine has been recently licensed in the USA for the treatment of ADHD. Atomoxetine is a potent inhibitor of the norepinephrine transporter that shows only mini-mal affinity for other neurotransmitter systems. Although pharmacokinetics of atomoxetine is influenced by the polymorphism of the CYP2D6 metabolic pathway, safety and -tolerability data reported during clinical trials did not show any difference in poor versus extensive metabolizers. In addition, atomoxetine does not inhibit nor induce the CYP2D6 enzymatic function. The major metabolite of atomoxetine is 4-hydroxyatomoxetine, a pharmacologically active metabolic found in very low plasma concentrations in pediatric patients, suggesting that it plays only a minor role in the norepinephrine reuptake inhibition. Preliminary studies were aimed to assess the effective dose range of atomoxetine and to evaluate its safety and efficacy on the reduction of ADHD symptoms in adults and children diagnosed with ADHD. Main data on the child and adolescent population were obtained in four double-blind, randomized, placebo-controlled trials: two identical pivotal trials, a multiple dose study, a once-daily dose study. The first two pivotal trials were carried out in ADHD children aged 7-13 years, treated with atomoxetine vs placebo for a duration of 9 weeks. Patients presenting comorbidities (ie conduct disorder, -anxiety, depression) as well as a history of previous treatment with methylphenidate were also eligible to participate. The primary outcome was the reduction of the score on the ADHD rating scale, ADHD-RS ; secondary criteria included the responder's rate (patients with an ADHD-RS score reduction of 25% or above), the Clinical Global Impression Scale and the Conners Parent Rating Scale. With a mean dose of 1.5 mg/kg/day, atomoxetine showed a significant reduction of mean ADHD-RS scores at endpoint (ANOVA, p<0.001) (table II). Yet, the clinical significance of both studies is limited since efficacy was scored only in a social/familial setting and not in classroom conditions. In addition, intermediate results from baseline to endpoint were not presented in the publication. The multiple dose trial showed a significant reduction of the symptom score at the 1.2 and 1.8 mg/kg/day doses. The objective of the last study was to assess the efficacy of a single daily dose of atomoxetine versus placebo during a 6 week-treatment. Patients were evaluated by parents, investigators, as well as by teachers. The superiority of atomoxetine was demonstrated as compared to the placebo and the effect size of the daily dosing was similar to that reported with multiple doses. Preliminary data on ADHD patients presenting comorbidities showed that atomoxetine alone signi-ficantly reduced the symptom scores of anxiety and depression and similarly to atomoxetine associated with fluoxetine. In ADHD children with the oppositional defiant disorder, oppositional symptoms were reduced in the group receiving atomoxetine 1.8 mg/kg/day. Preliminary results in children with ADHD and chronic tics or Tourette syndrome showed a significant reduction of ADHD symptoms and a tendency to the decrease of tics. Tolerance and safety data pooled from the child and adolescent trials were acceptable. Study discontinuations due to adverse events in the four registration studies were only 2.8%. The most frequent adverse effects reported were gastrointestinal symptoms and decreased appetite. Weight loss reported early in clinical studies tended to stabilize during the open-label extension phases lasting up to 9 months. A retrospective comparison showed that the adverse event profile of poor metabolizers was similar to that of extensive metabolizers. In summary, data presented suggest that atomoxetine is a safe and effective drug for the treatment of ADHD in children and adolescents. Further studies are expected to accurately define the place of atomoxetine in the treatment strategy of ADHD, a chronic and invalidating disorder affecting 3 to 7% of school-aged children.

Quality of Life in Families of Children with Congenital Heart Disease

Within a family perspective on quality of life (QL) with congenital heart disease, the study investigates parental QL, and patients' health-related QL as reported by themselves and by their parents. We examined the hypotheses that parental QL moderates the parental proxy reports. Sixty-nine patients (7-20 years, 61% male) and their caregivers participated in a computer-assisted QL-assessment. Children's self-rated and proxy-rated QL correlated moderately, with the highest intra-class correlation on the subscale psychological well-being/functioning (r = 0.61; p < 0.001), less convergence in physical well-being/functioning (r = 0.49; p < 0.001) and absent correlation in the evaluation of intra-family relationships. Parental QL was correlated both with the children's self-rated QL (r = 0.42; p < 0.05) and children's parent-rated QL (r = 0.60; p < 0.001). Support for the moderator hypotheses is indicated by the results of regression analyses demonstrating a significant interaction effect of parental QL and patients' self-reported QL in predicting parental proxy reports on their children's QL. Post-hoc tests reveal that parents with low own QL agree significantly more with their children than parents with high QL. Parent-child agreement on the children's QL is limited and reflects complementary subjective viewpoints. Psychosocial interventions should be family-focused and provide support for patients' and their caregivers' QL.

Preliminary evidence on the measurement properties of the Chinese version of the child health questionnaire, parent form (CHQ-PF50) and child form (CHQ-CF87)

The objective of this study was to evaluate the reliability and construct validity of the Chinese parent form (PF50) and child form (CF87) of the Child Health Questionnaire (CHQ).

METHODS

To assess the construct validity and reliability of the Chinese versions, we invited 1099 parents of healthy children and 816 school children to complete the Chinese CHQ-PF50 and CHQ-CF87, respectively.

RESULTS

Psychometric analysis on item convergent validity and discriminant validity showed > or = 99% rates of success for all 10 scales in the CF87 and > or = 94% for all but one scale in the PF50, the exception being general health scale (86%). We observed minimal floor effects for both questionnaires, but substantial ceiling effects for five scales in both the PF50 and CF87 (physical functioning, role-emotional/behavioral, role-physical, bodily pain and family activities). A substantially lower ceiling effect was observed for the physical scale and bodily pain in the CF87 (19% and 25%, respectively) relative to the PF50 (46% and 42%, respectively). The median alpha coefficient for CF87 and PF50 was 0.90 (range, 0.80-0.94) and 0.78 (range, 0.44-0.88), respectively.

CONCLUSIONS

Our findings suggest that the Chinese CHQ-PF50 and CHQ-CF87 are robust and sufficiently reliable for group comparisons and perhaps also for use in other Chinese populations.

Psychometric validation of the child health questionnaire (CHQ) in a sample of children and adolescents with attention-deficit/hyperactivity disorder

Measuring health-related quality of life (HRQL) in children with attention-deficit/hyperactivity disorder (ADHD) in clinical trials can complement efficacy measures, offering a complete picture of the impact of disease and treatment on overall well-being. The purpose of the current study was to psychometrically validate a multidimensional, generic HRQL instrument completed by parents of children with ADHD. A total of 921 children and adolescents with ADHD participated in a clinical study of atomoxetine. Subjects' parents completed the 50-item Child Health Questionnaire-Parent Version (CHQ-PF50) at baseline and week 10. ADHD symptoms and behavioral problems were assessed using parent and clinician rating scales. Internal consistency reliability at baseline was 0.88 for the CHQ-PF50 Psychosocial Summary Score, ranging from 0.53 to 0.91 for subscale scores. Construct validity was supported by statistically significant correlations between CHQ-PF50 psychosocial scores and parent and clinician symptom ratings. Several methods were used to determine clinically meaningful differences in patient outcomes: inter- and intra-patient mean CHQ-PF50 change scores were tested and standard error of measurement (SEM) and effect sizes were calculated. Study results indicate the CHQ-PF50 is reliable, valid, and responsive to change in ADHD symptoms, suggesting it may provide a means of assessing HRQL outcomes associated with treatments for ADHD.

Assessment of health state utilities for attention-deficit/hyperactivity disorder in children using parent proxy report

This study used standard gamble (SG) utility interviews to assess parent preferences for health states of childhood attention-deficit/hyperactivity disorder (ADHD). Health state utilities are needed to calculate quality-adjusted life years (QALYs), a critical outcome measure in cost-effectiveness studies of new treatments. Parents (n = 43) of children diagnosed with ADHD completed SG utility interviews, rating their child's current health and 11 hypothetical health states describing untreated ADHD and ADHD treated with a stimulant or non-stimulant. Parents completed questionnaires on their children's symptoms and health-related quality of life (HRQL). Parents' SG rating of their child's current health state (mean of 0.74 on a utility scale ranging from 0 to 1) was significantly correlated with inattentive, hyperactive, and overall ADHD symptoms (r = 0.37, 0.36, and 0.40 respectively; p < 0.05) and psychosocial HRQL domains. Hypothetical health state utilities ranged from 0.48 (severe untreated ADHD) to 0.88 (effective and tolerable non-stimulant treatment). Comparisons between health states found expected differences between untreated mild, moderate, and severe ADHD health states. When both treatments were effective and tolerable, parents preferred the non-stimulant health state over the stimulant health state (p < 0.03). Results suggest that parent SG interviews are a feasible and useful method for obtaining utility scores that can be used in cost-effectiveness models of ADHD treatment.

Development and pilot-testing of a health-related quality of life chronic generic module for children and adolescents with chronic health conditions: a European perspective

Health-related quality of life (HRQOL) assessment in children and adolescents with chronic health conditions is increasingly considered as a relevant topic. The aim of the EU-funded DISABKIDS project is to develop, test, and implement European instruments for the assessment of HRQOL of children and adolescents with disabilities and their families. The current paper describes the development and pilot testing of a chronic generic HRQOL measure. Using literature searches, expert consulting and focus groups with children/adolescents and their families, items of the instruments were developed and translated into the respective languages. A pilot test with 360 children and adolescents was conducted. Children and adolescents (8-12, 13-16 years) with different chronic health conditions (asthma, epilepsy, diabetes, arthritis, atopic dermatitis, cerebral palsy, and cystic fibrosis) as well as their families were included. Data were analysed according to predefined psychometric and content criteria. Psychometric analyses resulted in a 56-item chronic generic HRQOL questionnaire with six domains ('Medication', 'Physical', 'Emotion', 'Independence', 'Social Inclusion', 'Social Exclusion') with acceptable internal consistency.

Quality of life of patients treated during childhood for a bone tumor: assessment by the Child Health Questionnaire

To determine which factors impact on quality of life of patients with bone tumor, we used the Children Health Questionnaire French version. Thirty-seven patients (25 males, 19 osteosarcoma, 18 Ewing sarcoma) were studied. At assessment, median age was 15 years, median follow-up was 4 years. Mean scores were 60, 81, 76, 74, 70, 87 for general health, physical functioning, pain, mental health, self-esteem, and family activity, respectively. Lower results were observed for mental health in girls, for physical functioning, and self-esteem in patients with endoprosthesis, and for family activity and pain in patients who had relapsed.

Health-related quality of life in children with otitis media

BACKGROUND

Growing interest in health-related quality of life (HRQoL) in children with otitis media has brought the need to study the currently available HRQoL instruments with respect to their results and their applicability in clinical practice and research of otitis media.

OBJECTIVE

To review existing literature on health-related quality of life research in children with otitis media with respect to: (1) the measured impact of otitis media on HRQoL; and (2) the applicability of HRQoL instruments used in research and clinical practice based on their characteristics and contents.

METHODS

A search was performed in EMBASE (1988-November 2004) and on NLM Gateway (1966-November 2004) for studies assessing health-related quality of life or functional health status by means of disease-specific or generic questionnaires in children aged 0-18 years with chronic or recurrent otitis media with effusion or acute otitis media. The bibliographies of the selected articles were searched manually.

RESULTS

Only 13 of the 141 retrieved articles retrieved fulfilled the criteria for inclusion. In these studies, physical suffering (pain, high fever, etc.), difficulties with hearing or speech, behavioural problems, or emotional distress were reported to be the most important problems experienced by children with otitis media. Almost all instruments applied in these studies measure functional health status instead of health-related quality of life. Data on validity and reliability of these instruments are incomplete.

CONCLUSIONS

Recurrent or chronic otitis media is reported to have a substantial and negative effect on various domains of functional health status and health-related quality of life of children. The OM-6 appears to be the best available instrument to assess functional health status in children with OM in a research setting. However, the lack of true HRQoL instruments as well as incomplete data on their reliability and validity, limit both our current knowledge of HRQoL in OM and the application of current instruments in both research and clinical practice.

Child or family assessed measures of activity performance and participation for children with cerebral palsy: a structured review

BACKGROUND

There is a need to measure children's 'activity performance and participation' as defined in the World Health Organization's International Classification of Functioning, Disability and Health for Children and Youth (WHO ICF). The aim of this review is to identify instruments that are suitable for use in postal surveys with families of children with cerebral palsy.

METHODS

We conducted a structured review of instruments that use child or family self-assessment of 'activity performance and participation'. The review involved a systematic search for instruments using multiple published sources. Appraisal of the instruments used the predefined criteria of appropriateness, validity, reliability, responsiveness, precision, interpretability, acceptability and feasibility.

RESULTS

There are relatively few child or family assessed instruments appropriate for measuring children's activities and participation. Seven instruments were identified that could potentially be administered by mail. The Assessment of Life Habits for Children (LIFE-H) was the most appropriate instrument as assessed by its content but the reliability of child or family self-assessment is not known. If the LIFE-H were shown to be a reliable self-report measure then the LIFE-H would be the recommended choice. Currently, the Activities Scale for Kids and the condition-specific Lifestyle Assessment Questionnaire for cerebral palsy (LAQ-CP) provide the broadest description of what and how frequently children with cerebral palsy perform a range of activities and thereby indicate participation. The LAQ-CP also provides additional contextual information on the impact of any disability on the participation of the family unit.

CONCLUSION

There remains much scope for developing valid and reliable self-assessed measures corresponding to the WHO ICF dimensions of activities and participation.

Role of afterload reduction in the prevention of late anthracycline cardiomyopathy

Afterload reduction is useful for treating and preventing adult congestive heart failure outside the realm of anthracycline toxicity. Afterload reducers are commonly used as treatment for acute heart failure associated with anthracyclines. However, the use of afterload reduction for the prevention of anthracycline associated late cardiomyopathy remains a controversial area, with strong opinions expressed concerning the potential risks and benefits of such an approach. This article will define "afterload" and the tools utilized to measure afterload. The study will then describe the theory for the use of afterload reduction in patients with anthracycline exposure who show signs of anthracycline cardiotoxicity, and will present data from the ACE-Inhibitor After Anthracyclines (AAA) Trial to help answer the question, "Should an afterload reducer be used to aid in preventing late anthracycline cardiotoxicity?" Finally, recommendations for future research will be presented.

Reliability and validity of the short form of the child health questionnaire for parents (CHQ-PF28) in large random school based and general population samples

STUDY OBJECTIVES

This study assessed the feasibility, reliability, and validity of the 28 item short child health questionnaire parent form (CHQ-PF28) containing the same 13 scales, but only a subset of the items in the widely used 50 item CHQ-PF50.

DESIGN

Questionnaires were sent to a random regional sample of 2040 parents of schoolchildren (4-13 years); in a random subgroup test-retest reliability was assessed (n = 234). Additionally, the study assessed CHQ-PF28 score distributions and internal consistencies in a nationwide general population sample of (parents of) children aged 4-11 (n = 2474) from Statistics Netherlands.

MAIN RESULTS

Response was 70%. In the school and general population samples seven scales showed ceiling effects. Both CHQ summary measures and one multi-item scale showed adequate internal consistency in both samples (Cronbach's alpha>0.70). One summary measure and one scale showed excellent test-retest reliability (intraclass correlation coefficient >0.70); seven scales showed moderate test-retest reliability (intraclass correlation coefficient 0.50-0.70). The CHQ could discriminate between a subgroup with no parent reported chronic conditions (n = 954) and subgroups with asthma (n = 134), frequent headaches (n = 42), and with problems with hearing (n = 38) (Cohen's effect sizes 0.12-0.92; p<0.05 for 39 of 42 comparisons).

CONCLUSIONS

This study showed that the CHQ-PF28 resulted in score distributions, and discriminative validity that are comparable to its longer counterpart, but that the internal consistency of most individual scales was low. In community health applications, the CHQ-PF28 may be an acceptable alternative for the longer CHQ-PF50 if the summary measures suffice and reliable estimates of each separate CHQ scale are not required.

Health state utilities for childhood attention-deficit/hyperactivity disorder based on parent preferences in the United kingdom

OBJECTIVES

The purpose of this study was to use standard gamble (SG) utility interviews to assess parent preferences for health states of childhood attention-deficit/hyperactivity disorder (ADHD).

METHODS

The study was conducted in August 2003 in London, England. Parents (N=83) of children diagnosed with ADHD completed SG utility interviews, rating their child's current health and 14 hypothetical health states describing untreated ADHD and ADHD treated with a nonstimulant, immediate-release stimulant, or extended-release stimulant. Raw temporary utilities ranging from 0 (worst health) to 1 (best health) were adjusted to a chronic utility scale ranging from 0 (death) to 1 (best health) using a linear transformation. Parents rated the severity of their children's ADHD symptoms using the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS) and their children's health-related quality of life using the EuroQol EQ-5D.

RESULTS

Raw and adjusted SG ratings of hypothetical health states ranged from 0.63-0.90 and 0.88-0.96, respectively. Parents' raw SG scores of their child's current health state (mean=0.72) were significantly correlated with inattentive, hyperactive, and overall ADHD symptoms (r=-0.25, -0.27, -0.27; P <0.05) and the EQ-5D visual analogue scale (r=0.26; P <0.05).

CONCLUSION

This UK-based study suggests that parent SG interviews are a valid method for obtaining utilities for child ADHD-related health states. The utilities obtained in this study would be appropriate for use in a cost-utility analysis evaluating the costs and benefits of childhood ADHD treatments in the United Kingdom.

Health-Related Quality of Life in Childhood Cerebral Palsy

OBJECTIVE

To describe the health-related quality of life (HRQOL) of a cross-section of children with cerebral palsy (CP) using the Child Health Questionnaire.

DESIGN

Survey of the parents or guardians of children with CP.

SETTING

Outpatient clinics at a tertiary care children's hospital.

PARTICIPANTS

Children (N=177; 98 boys, 79 girls; mean age +/- standard deviation [SD], 8.6+/-4.2y) with CP were enrolled as a convenience sample. Study subjects were stratified by severity of CP using the Gross Motor Function Classification System.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

HRQOL scores, as determined by the Child Health Questionnaire-Parent Form 50.

RESULTS

Parents reported reduced HRQOL for their children with CP. In the physical function domain, most children scored over 3 SDs below a normative sample, and scores in parental impact domains were at least 1 SD below the normative sample. Psychosocial domains were less impaired. Most of the effects on physical and parent impact domains were greater in children with more severe CP, although they were significant in most strata of severity.

CONCLUSIONS

Children with CP have reduced HRQOL and the degree to which it is reduced is related to the severity of their CP.

Reliability and validity of the VSP-A, a health-related quality of life instrument for ill and healthy adolescents

PURPOSE

To report the preliminary validation results of a generic self-administered measure for adolescents the VSP-A (Vecu et Sante Percue de l'Adolescent).

METHODS

The validation survey of the 37-item VSP-A involved 1938 adolescents: 1758 adolescents attending school (90.7%) and 180 inpatient youths (9.3%) with medical, surgical, or psychiatric conditions; mean age was 14.8 years (SD = 2.1; range = 10-17) and 1018 (52.5%) were girls. Ten dimensions scores were computed: psychological well-being, body image, physical well-being, vitality, friends, parents, teachers, school performance, medical staff, and a global HRQL index. Construct validity was tested using inter-item correlations, item-dimension correlations, and principal component analysis. The unidimensionality of the scales was studied using Rasch rating scale model and the internal consistency of the scales using Cronbach alpha. Known group comparisons were performed and effect sizes computed to assess the clinical validity and sensitivity of the instrument.

RESULTS

VSP-A, completed in less than 15 minutes, is consistent (Cronbach alpha = 0.74-0.91). Content and construct validity are good. Factorial validity, item-internal consistency, item-discriminant validity, and inter-dimension correlations support the item grouping in 10 dimensions. The results of the comparison of the VSP-A scores according to external criteria (sociodemographics, health status) show they are in accordance with the literature and previous works.

CONCLUSIONS

These preliminary results support the reliability and validity of the VSP-A as a multidimensional adolescent report of HRQL in healthy and patient populations. The next phase of the research consists of testing the sensitivity to changes of the VSP-A.

Health-related quality of life assessment in hematologic disease

Evaluating health-related quality of life (HRQL) for children who have benign hematologic disorders can: (1) aid in the evaluation of different therapies and emerging new technologies; (2) serve as an invaluable source of anticipatory guidance, for current and future patients; and (3) serve an important evaluative function of clinical services or programs to identify potential areas in which additional services, supports, or interventions are needed. The past 20 years have been marked by the dramatic growth in the field of HRQL research, although much of the progress in conceptualization, instrument development, and refinement has occurred in adults. Pediatric health services researchers and their clinical colleagues have had to grapple with the methodologic challenges in evaluating HRQL in children. This article includes a discussion of instrumentation, respondent selection, and study design consideration in the evaluation of HRQL in children who have benign hematologic disorders.

Atomoxetine treatment in children and adolescents with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder

OBJECTIVE

To examine (1) moderating effects of oppositional defiant disorder (ODD) on attention-deficit/hyperactivity disorder (ADHD) treatment response and (2) responses of ODD symptoms to atomoxetine.

METHOD

Children and adolescents (ages 8-18) with ADHD were treated for approximately 8 weeks with placebo or atomoxetine (fixed dosing: 0.5, 1.2, or 1.8 mg/kg/day, b.i.d.) under randomized, double-blind conditions. Among patients with lifetime diagnostic information (n = 293), 39% were diagnosed with comorbid ODD and 61% were not. Treatment-group differences and differences between patients with and without comorbid ODD were examined post hoc for changes on the Attention-Deficit/Hyperactivity Disorder Rating Scale IV-Parent version, investigator-administered and -scored; Conners' Parent Rating Scale-Revised Short Form; Clinical Global Impressions Severity of ADHD Scale; and the parent-rated Child Health Questionnaire.

RESULTS

Youths with ADHD and comorbid ODD showed statistically significant improvement in ADHD, ODD, and quality-of-life measures. Treatment response was similar in youths with and without ODD, except that the comorbid group showed improvement compared with placebo at 1.8 mg/kg/day but not 1.2 mg/kg/day. In contrast, youths without ODD showed improvement at 1.2 mg/kg/day and no incremental benefit at 1.8 mg/kg/day.

CONCLUSIONS

Atomoxetine treatment improves ADHD and ODD symptoms in youths with ADHD and ODD, although the comorbid group may require higher doses.

The Functional Mobility Scale (FMS)

We devised a new Functional Mobility Scale (FMS) to describe functional mobility in children with cerebral palsy, as an aid to communication between orthopaedic surgeons and health professionals. The unique feature of the FMS is the freedom to score functional mobility over three distinct distances, chosen to represent mobility in the home, at school and in the wider community. We examined the construct, content, and concurrent validity of the FMS in a cohort of 310 children with cerebral palsy by comparing the FMS to existing scales and to instrumented measures of physical function. We demonstrated the scale to be both valid and reliable in a consecutive population sample of 310 children with cerebral palsy seen in our tertiary referral center. The FMS was useful for discriminating between large groups of children with varying levels of disabilities and functional mobility and sensitive to detect change after operative intervention.

Uptime in children with cerebral palsy

Quantitative evaluation of function, in children with physical disabilities, has to date been mainly focused on laboratory-based measures. However, the measurement of activity in the community may have a more direct relationship with physical function, health, and well-being. We assessed the utility of a remote activity monitor, the Uptimer (National Aging Research Institute of Melbourne, Melbourne, Australia), to measure one aspect of physical function, time spent in the upright position, in a consecutive cohort of 300 children with cerebral palsy who attended an orthopedic outpatient department. The Uptimer was found to be a valid and reliable tool to measure the amount of time children spent on their feet each day. Uptime was closely related to the severity of cerebral palsy and had excellent correlations with validated instruments including the Pediatric Orthopaedic Data Collection Instrument (PODCI), the Child Health Questionnaire (CHQ), and the Functional Mobility Scale (FMS). Uptime complements any quantitative functional assessment of impairments in children with cerebral palsy.

The Revised-Perceived Illness Experience Scale (R-PIE): data from the Barretstown studies

The Perceived Illness Experience Scale (PIE) was developed to measure children's perception of their illness experience. In this article, the authors examine the previously uninvestigated factor structure of the PIE using the responses of 184 European children (mean age = 11.61 years, SD = 2.31) with life-threatening illnesses. The findings showed a 6-factor solution: (1) School/Peer Rejection, (2) Thinking About Illness, (3) Physical Appearance, (4) Interference With Activity, (5) Parental Responses, and (6) Manipulation. Children's mean scores on each subscale and for the composite Revised PIE (R-PIE) were generally low, suggesting that as a group, children do not perceive that their illness has an especially negative impact on their lives. There were differences between the children's mean scores on some subscales depending on their gender nationality grouping, and type of illness. These findings provide empirical support for the R-PIE and suggest its usefulness in measuring children's experience of different illnesses in multinational settings.

Auto-évaluation de la qualité de vie d'enfants de 6 à 12 ans : construction et premières étapes de validation du KidIQol, outil générique présenté sur ordinateur

The KidlQol is a self-evaluation computer-based instrument to assess the quality of life of children aged 6 to 12 years old. This self-evaluation comprises three areas of their subjective quality of life: physical, psychological and social. A computer-assisted tool, composed of 62 items, was developed and set up based upon the results from the evaluation of the initial prototype tool which underwent a series validation steps, tested among children with and without psychological problems. This evaluation lead to the production of a final tool called KidlQuol, which is composed of 44 items. This tool, which utilises computer images to represent real-life situations, is adapted for and accessible to children with a French cultural background aged between 6 and 12 years old. As a generic tool, it could be used among a population of children with various types of handicaps, chronic diseases or psycho-social difficulties.

One month after diagnosis: quality of life, coping and previous functioning in siblings of children with cancer

BACKGROUND

The aim of the present study is to describe the quality of life (QoL) of siblings of children with cancer and to predict it according to their health before the diagnosis of cancer in the ill child and their ways of coping with the illness.

METHODS

Participants were 83 siblings from 56 families-46 girls and 37 boys, aged 7-18. The assessment took place 1 month to 8 weeks after the diagnosis of cancer in the ill child. The siblings' QoL was assessed with the TNO-AZL children's quality of life questionnaire (TACQOL). Coping strategies were assessed with the Cognitive Coping Strategies Scale for siblings (CCSS-s). Physical problems and eating and sleeping problems that existed before the ill child was diagnosed were determined in a structured interview with the parents.

RESULTS

A substantial number of siblings reported impaired cognitive and emotional QoL compared to the reference group. School-aged siblings (7-11 years) reported more trouble with motor functioning than peers. The coping strategy 'predictive control' (maintaining positive expectations regarding the illness) positively predicted siblings' QoL. The presence of health problems before diagnosis was negatively associated with siblings' QoL. Older siblings reported more negative emotions, while girls reported lower social QoL and reliance on 'interpretative control' (trying to understand the illness) was associated with fewer positive emotions.

CONCLUSIONS

During the first 2 months after the diagnosis of cancer in a brother or sister, siblings have relatively lower QoL than peers. Health problems that existed before diagnosis may be a predictor of later adjustment problems. Positive expectations about the course of the illness appear to protect siblings from distress. Information about the illness is a delicate issue that requires parental guidance.

Parent-proxy EQ-5D ratings of children with attention-deficit hyperactivity disorder in the US and the UK

BACKGROUND

The symptoms of attention-deficit hyperactivity disorder (ADHD) are associated with impairment in multiple domains of health-related quality of life (HR-QOL). HR-QOL of children with ADHD has been assessed by relatively long multidimensional questionnaires. A review of the literature found no studies using the brief, well established EuroQoL Five-Dimension Questionnaire (EQ-5D) to estimate the HR-QOL of children with ADHD. The objective of this study was to assess the HR-QOL of children with ADHD using parents' responses to the proxy version of the EQ-5D.

METHODS

Participants were recruited in the midwestern US and in the vicinity of London, England. All parents completed three questionnaires: the EQ-5D proxy version; a measure of ADHD symptoms based on Diagnostic and Statistical Manual of Mental Disorders (4th Edition) [DSM-IV] criteria (the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV - Parent Version [ADHD-RS]); and either the Child Health Questionnaire - Parent Form 50 (CHQ-PF50) or the Child Health and Illness Profile - Child Edition (CHIP-CE), which are both generic multidimensional paediatric HR-QOL questionnaires.

RESULTS

A total of 126 parents of children with ADHD participated in the study: 43 in the US and 83 in the UK. On the EQ-5D, participants indicated that 78.6% of their children experienced some problems or extreme problems performing usual activities, while 64.8% believed their child demonstrated some or extreme anxiety or depression. The mean EQ-5D index score was 0.75 and the mean visual analogue scale (VAS) score was 73.9. The EQ-5D index and VAS scores were found to be significantly correlated (p < 0.05) with several domains of the CHQ-PF50 (e.g. Mental Health, Self-Esteem, Family Activities, Psychosocial Summary Score) and the CHIP-CE (e.g. Satisfaction, Comfort, Academic Performance, Peer Relations). The EQ-5D scales were also significantly correlated with the ADHD-RS scales (p < 0.001).

CONCLUSION

The proxy version of the EQ-5D, completed by parents, was able to detect impairment in children diagnosed with ADHD in the US and the UK. Furthermore, the EQ-5D index and VAS scores demonstrated construct validity among this sample through significant correlations with an ADHD symptom measure and previously validated multidimensional QOL instruments. These results suggest that parent-proxy EQ-5D ratings are feasible and valid for use as part of an overall health outcomes assessment in clinical studies of childhood ADHD.

Parent-Reported Health-Related Quality of Life in Children With Congenital Hearing Loss: A Population Study

OBJECTIVE

To report 1) health-related quality of life (HRQoL) in 7- to 8-year-old children with congenital hearing loss and 2) effects of severity and age of diagnosis on parent-reported child HRQoL.

METHODS

SETTING

State of Victoria, Australia.

DESIGN

Two population-based cohorts of 7- to 8-year-old children.

PARTICIPANTS

Cohort 1 consisted of 83 children (51 boys) fitted with hearing aids or cochlear implants for congenital hearing loss by 4.5 years, born before universal newborn hearing screening, and without intellectual disability (the Children with Hearing Impairment in Victoria OUTCOME Study). Cohort 2 consisted of 895 children representative of the Victorian 7- to 8-year-old school population (the 1997 Health of Young Victorians Study).

OUTCOME

The 28-item parent-proxy Child Health Questionnaire measure of HRQoL.

RESULTS

Response rate for cohort 1 was 67%; 22% had mild, 33% had moderate, 17% had severe, and 29% had profound hearing loss; and the mean nonverbal IQ was 105.4 (SD = 16.5). Children with hearing loss scored significantly more poorly than the normative sample on 6 Child Health Questionnaire scales (Role/Social-Physical, Behavior, Mental Health, Parent Impact-Emotional, Parent Impact-Time, and Family Activities) and on the Psychosocial Summary Score. HRQoL was poorer with milder losses, accounting for 10% and 11% of variance in the Physical and Psychosocial Summary scores, respectively. Age at diagnosis did not contribute significantly to the Summary scores, but only 11 children were diagnosed <6 months of age.

CONCLUSIONS

Parent-reported psychosocial well-being of 7- to 8-year-old children with hearing loss is poorer than that of their hearing peers. Future studies should determine whether HRQoL has improved after introduction of universal newborn hearing screening.

Development of an instrument to assess vision-related quality of life in young children

PURPOSE

Quality of life (QOL) instruments are increasingly utilized in ophthalmological research. Measuring vision-related QOL in young children is complicated by constantly evolving abilities related to normal growth and development. Our aim was to develop vision-related QOL instruments for children in different age ranges <==7 years, and to provide initial validation of these instruments.

DESIGN

Cross-sectional study.

METHODS

SETTING

Multicenter.

PATIENTS

773 pediatric patients (age <==7 years) with a wide range of ophthalmological diagnoses.

PROCEDURE

Questionnaire. A 61-item prototype instrument with a wide variety of items was applied to 403 consecutive patients. The usefulness of items was evaluated as a function of age in order to derive two age-group specific instruments and to find the age limit dividing the age groups. Thus, age-specific versions of a Children's Visual Function Questionnaire (CVFQ) were defined for ages <3 years and >/=3 years, and applied to a convenience sample of patients.

OUTCOME

Subscale scores. Factor analysis helped identify underlying dimensions of the data, and corresponding subscales were defined. Validation was provided by examining the internal consistency reliability and by exploring the associations between scores and clinical characteristics.

RESULTS

Subscales for General health, General vision, Competence, Personality, Family impact, and Treatment were defined, with internal consistency reliabilities ranging from 0.60 to 0.86. The association between subscales scores and age was weak, whereas strong correlations were found with the level of visual impairment and type of visual diagnosis.

CONCLUSION

The CVFQ assesses the impact of visual impairment on children and their families, and is expected to become a useful tool for the pediatric vision research community.

The link between health-related quality of life and clinical symptoms among children with attention-deficit hyperactivity disorder

Clinical research on attention-deficit hyperactivity disorder (ADHD) has begun to integrate measures of health-related quality of life (HRQL) as part of the overall assessment of treatment outcomes. This study examines the association between HRQL and measures of clinical symptoms of ADHD. Data were gathered from 297 children and adolescents in an 8-week, randomized, double-blind, placebo-controlled, clinical trial of atomoxetine treatment for ADHD. HRQL was assessed with the Child Health Questionnaire 50-item Parent Form. ADHD symptoms were assessed with the ADHD Rating Scale-IV; Parent Version and Clinical Global Impressions-ADHD-Severity. Associations between HRQL and clinical symptoms were assessed with correlations, analyses of variance with post hoc comparisons, and t tests. The Child Health Questionnaire 50-item Parent Form scales assessing psychosocial domains of HRQL were significantly negatively correlated with clinical measures. Improvement in clinical symptoms was associated with corresponding improvement in psychosocial aspects of HRQL. The findings suggest that HRQL instruments can add important information to efficacy measures in clinical trials of ADHD treatment.

Measurement Adequacy of Parenting and Children’s Functional Status in African American and Latino Families

To examine the psychometric adequacy of two existing instruments, the Functional Status Questionnaire (FS IIR) and the Parent Behavior Checklist (PBC), in two ethnic minority groups. Age-specific items that were not relevant for children ages 1 to 5 were removed from the FS IIR and PBC. Measures were administered to 196 Latino and African American parents of children aged 1 to 5. Reliability, variability, item-convergence, and factor structure were examined. The results highlight common pitfalls in using existing measures in populations other than those on which they were originally developed. Both measures were modified resulting in all scales having low or acceptable reliability. Construct validity was supported for both the FS IIR and the PBC through confirmation of hypothesized relationships. In both ethnic groups, factor analyses supported the hypothesized factor solutions for the FS IIR and the PBC. Use of measures in minority groups requires researchers to be cognizant of the issues of psychometric adequacy in all groups. The psychometric properties of the FS IIR and the PBC were generally acceptable for Hispanics and African Americans, but each had some problems in at least one psychometric characteristic in one or both groups. Different factor loadings for some items for Hispanics and African Americans suggest different interpretation of items between the two cultural groups.

Measuring the neuro-cognitive side-effects of irradiation in children with brain tumors

BACKGROUND

Reduction of the treatment-related side effects has become one of the main goals of the recent study protocols for brain tumor therapies. When the treatment burden is decreased in patients with good prognostic features, the potential increased risk of relapse has to be counterbalanced by a significantly improved cognitive outcome. This objective is always clearly stated but comprehensive data on the neuropsychological outcomes are seldom reported.

PROCEDURES AND RESULTS

The appropriate means to measure the long-term morbidity need to be clarified. Health Status and Quality of Life (QOL) questionnaires can be easily administered but these questionnaires represent usually a composite evaluation where cognition is analyzed along with other items such as mood or pain. However, none of these questionnaires has ever been used to measure a difference in cognitive outcome when comparing two different therapeutic strategies in children. Complete neuropsychological evaluations are time consuming, need specialized psychologists and most of the tests have not been rigourously validated. In this respect, Wechsler scales are, however, robust and objective methods to evaluate intelligence. Several studies have been able to show meaningful differences in IQ scores between treatments in children with posterior fossa tumors, even with small numbers of patients.

CONCLUSIONS

In order to evaluate any refinement in the treatment of these patients, widely accepted evaluation tools are needed. Ideally, these methods will have to be sensitive, reproducible, and widely applicable. None of the available tools fullfil all of these criteria but their development should be a major endeavour in modern neuro-oncology.

Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery

BACKGROUND

Measuring health-related quality of life (QoL) after surgery is essential for decision making by patients, surgeons, and payers. The aim of this consensus conference was twofold. First, it was to determine for which diseases endoscopic surgery results in better postoperative QoL than open surgery. Second, it was to recommend QoL instruments for clinical research.

METHODS

An expert panel selected 12 conditions in which QoL and endoscopic surgery are important. For each condition, studies comparing endoscopic and open surgery in terms of QoL were identified. The expert panel reached consensus on the relative benefits of endoscopic surgery and recommended generic and disease-specific QoL instruments for use in clinical research.

RESULTS

Randomized trials indicate that QoL improves earlier after endoscopic than open surgery for gastroesophageal reflux disease (GERD), cholecystolithiasis, colorectal cancer, inguinal hernia, obesity (gastric bypass), and uterine disorders that require hysterectomy. For spleen, prostate, malignant kidney, benign colorectal, and benign non-GERD esophageal diseases, evidence from nonrandomized trials supports the use of laparoscopic surgery. However, many studies failed to collect long-term results, used nonvalidated questionnaires, or measured QoL components only incompletely. The following QoL instruments can be recommended: for benign esophageal and gallbladder disease, the GIQLI or the QOLRAD together with SF-36 or the PGWB; for obesity surgery, the IWQOL-Lite with the SF-36; for colorectal cancer, the FACT-C or the EORTC QLQ-C30/CR38; for inguinal and renal surgery, the VAS for pain with the SF-36 (or the EORTC QLQ-C30 in case of malignancy); and after hysterectomy, the SF-36 together with an evaluation of urinary and sexual function.

CONCLUSIONS

Laparoscopic surgery provides better postoperative QoL in many clinical situations. Researchers would improve the quality of future studies by using validated QoL instruments such as those recommended here.

Validation of the German version of the Pediatric Quality of Life Inventory (PedsQL) in childhood cancer patients off treatment and children with epilepsy

The Pediatric Quality of Life Inventory (PedsQL) is a relatively new instrument developed in the US to assess health-related quality of life (HRQL) in healthy and ill children and adolescents. It is quick and easy to use, suitable for assessment by children and parents and based on a modular approach with a generic measure addressing all general domains of HRQL and disease-specific modules. We report here the results of translating the original US generic core instrument and the cancer module into German and testing the German PedsQL in samples of paediatric patients who have been treated for cancer or epilepsy. Like in studies with the original instrument, score distributions tended to be skewed toward higher HRQL, but a full response range was demonstrated for each item. The German PedsQL is reliable in terms of internal consistency with the majority of scales exceeding a Cronbach's alpha of 0.70. Clinical validity was confirmed by differences between the cancer and epilepsy groups in the expected direction and by the ability of the PedsQL to discriminate between subjects with different degrees of medical and psychosocial sequelae. Comparing our findings to US results, the German PedsQL seems to be equivalent to the original version. Future methodologic research should evaluate construct validity, sensitivity and responsiveness, and test the usefulness of the instrument in other clinical populations and healthy children.

Assessing the impact of oral health on the life quality of children: implications for research and practice

Traditionally, child oral health has been assessed using clinical parameters of disease and deformity. However, there is a growing interest in the psychosocial impact of oral health among children. This commentary outlines the value and need for assessing child oral health-related quality of life (COHQoL). COHQoL has implications for oral health needs assessment (at an individual and population level) and for evaluating outcomes from specific treatments, initiatives and dental services overall. In addition, it could prove to be a useful adjunct tool for evidence-based dentistry research and practice. Theoretical and practical considerations in assessing the complex psychosocial construct of oral health among children are discussed: the use of general versus oral health-specific measures, the development of tools for children, the use of generic versus condition-specific measures, and the measurement of 'positive' oral health. Recommendations for research and practice are presented.

Enalapril to prevent cardiac function decline in long-term survivors of pediatric cancer exposed to anthracyclines

PURPOSE

To determine whether an angiotensin-converting enzyme (ACE) inhibitor, enalapril, prevents cardiac function deterioration (defined using maximal cardiac index [MCI] on exercise testing or increase in left ventricular end-systolic wall stress [LVESWS]) in long-term survivors of pediatric cancer.

PATIENTS AND METHODS

This was a randomized, double-blind, controlled clinical trial comparing enalapril to placebo in 135 long-term survivors of pediatric cancer who had at least one cardiac abnormality identified at any time after anthracycline exposure.

RESULTS

There was no difference in the rate of change in MCI per year between enalapril and placebo groups (0.30 v 0.18 L/min/m(2); P =.55). However, during the first year of treatment, the rate of change in LVESWS was greater in the enalapril group than in the placebo group (-8.59 v 1.85 g/cm(2); P =.033) and this difference was maintained over the study period, resulting in a 9% reduction in estimated LVESWS by year 5 in the enalapril group. Six of seven patients removed from random assignment to treatment because of cardiac deterioration were initially treated with placebo (P =.11), and one has died as a result of heart failure. Side effects from enalapril included dizziness or hypotension (22% v 3% in the placebo group; P =.0003) and fatigue (10% v 0%; P =.013).

CONCLUSION

Enalapril treatment did not influence exercise performance, but did reduce LVESWS in the first year; this reduction was maintained over the study period. Any theoretical benefits of LVESWS reduction in this anthracycline-exposed population must be weighed against potential side effects from ACE inhibitors when making treatment decisions.

Coping, commitment, and attitude: quantifying the everyday burden of enuresis on children and their families

OBJECTIVE

To develop and evaluate a parent-completed questionnaire for use by clinicians as part of routine care to assess the burden of diurnal and nocturnal enuresis on children and their families.

METHODS

The questionnaire consisted of items that measure the impact on the child and his/her parent, the child's coping ability and commitment to treatment, previous treatment success, family frustration and overall cohesion, and parental attitudes about enuresis and its treatment. Questionnaires (n = 208) were completed by parents during the child's scheduled office visit for enuresis at 5 specialty clinics across the United States. Traditional criteria were used to assess reliability and validity of the questionnaire, including analysis of variance.

RESULTS

Success rates provide evidence that many of the items in the child scale (79%) and all items in the parent scale (100%) met stringent criteria. alpha values were.62 and.77, respectively. Statistically significant differences were observed for the scales across responses on all but 1 global item, the majority of parental attitude items, whether the child urinated at bedtime, and the number of pads used. These findings suggest that the child's coping ability and commitment and the family's overall cohesion and frustration with the problem influence parental perceptions about the impact of enuresis on the child and the family.

CONCLUSIONS

Findings about the performance of the new measure were satisfactory and suggest that, after further refinement, it should prove as a useful tool for clinicians treating enuresis in children.

Monitoring the quality-of-life in allergic disorders

PURPOSE OF REVIEW

To review the results from recent studies that assessed the burden of allergic diseases on the patients' every-day life, or contributed to new advances in monitoring quality-of-life in allergic disorders. This review will not report the numerous clinical trials that included quality-of-life as an outcome.

RECENT FINDINGS

Quality-of-life impairment was investigated in patients with asthma, allergic rhinitis, atopic dermatitis or food allergy. A new questionnaire was validated for patients with yellow jacket allergy. At the same time, the properties of formerly developed questionnaires were further investigated and tools were developed to assess factors related to quality-of-life, such as work functioning, or perceived control of the disease.

SUMMARY

Allergic disorders are associated with a variety of limitations in the patients' daily life. The relative burden of concomitant disorders, however, has not been thoroughly investigated. When monitoring quality-of-life, investigators should ensure that the results are not biased by confounding factors that may affect quality-of-life. Moreover, the uncertainty around estimates of change in health status related to treatment and around standard thresholds for clinical significance should be taken into account before drawing inference as regards the treatment worthiness.

Health-related quality of life in children assessed by their parents: evaluation of the psychometric properties of the CHQ-PF50 in two German clinical samples

The aim of the study was to evaluate the psychometric properties of the German translation of the Child Health Questionnaire (CHQ). Parents of two clinical samples were asked to rate the quality of life of their children using the German version of the CHQ. Item internal consistency (item-scale correlation) and internal consistency of scales were tested; quartiles and factor analysis were conducted. The results of the German clinical samples were compared with US clinical samples (t-test). The two clinical German sub-groups were compared using multivariate analysis (MANOVA). The psychometric testing of the CHQ showed good results. Internal consistency of the hypothesized scales were all higher than 0.70. The results of the factor analysis confirmed the results of the US norm sample: As expected, the subscales loaded on two factors explaining 57.4% of the total variance. The group comparison supported the discriminative properties of the CHQ. Preliminary psychometric findings support use of the German version of the CHQ. The next step will be the testing of healthy German samples and development of norm scores.

The association of backpack use and back pain in adolescents

STUDY DESIGN

A cross-sectional study comprising the first phase of an ongoing, longitudinal prospective study was conducted.

OBJECTIVE

To investigate the relation between backpack use and back pain in adolescents.

SUMMARY OF BACKGROUND DATA

The prevalence of nonspecific back pain increases dramatically during adolescence from less than 10% in the pre-teen-age years up to 50% in 15- to 16-year-olds. There is widespread concern that heavy backpacks carried by adolescents contribute to the development of back pain.

METHODS

A total of 1126 children, ages 12 to 18 years, participated by completing a questionnaire about their health, activities, and backpack use. Each child's body weight, height, and backpack weight were measured. A child was classified as having back pain if one or more of the following were reported during the preceding month: neck or back pain that had interfered with school or leisure, neck or back pain with a severity rating of 2 or more on a scale 0 to 10, a visit to a physician or therapist for neck or back pain, or exemption from physical education or sports because of neck or back pain.

RESULTS

Of 1122 backpack users, 74.4% were classified as having back pain, validated by significantly poorer general health, more limited physical functioning, and more bodily pain. As compared with no or low use of backpacks at school, heavy use (odds ratio, 1.98; P < 0.0001) was independently associated with back pain. Female gender and larger body mass index also were significantly associated with back pain. As compared with adolescents who had no back pain, adolescents with back pain carried significantly heavier backpacks that represented a significantly greater percentage of their body weights.

CONCLUSION

The use of backpacks during the school day and backpack weights are independently associated with back pain.

Health-related quality of life as outcome parameter in haemophilia treatment

Health-related quality of life (HRQoL) is increasingly used as an outcome parameter in haemophilia treatment. Currently, only generic HRQoL instruments are used, as disease-specific instruments for haemophilia are not available. The most widely used generic instruments are the descriptive SF-36 questionnaire and the EQ-5D questionnaire for assessment of utilities, ie preference-based HRQoL. Results of both instruments show significant correlation. All haemophilia prophylaxis studies using HRQoL as an outcome report a decreased HRQoL compared with the general population, a positive effect of prophylactic treatment and a negative effect of age. Generic instruments for measuring HRQoL are able to pick up differences between groups of patients with haemophilia and enable us to make comparisons across diseases. However, in order to establish the optimal treatment strategy for severe haemophilia, further information is needed on the long-term effects of different strategies on HRQoL. In addition, haemophilia-specific HRQoL instruments should be developed in order to provide detailed information for adjustment and evaluation of treatment in individual patients.

Confirmatory factor analysis of the Child Health Questionnaire-Parent Form 50 in a predominantly minority sample

The Child Health Questionnaire-Parent Form 50 (CHQ-PF50; Landgraf JM et al., The CHQ User's Manual. Boston, MA: The Health Institute, New England Medical Centre, 1996) appears to be a useful method of assessing children's health. The CHQ-PF50 is designed to measure general functional status and well-being and is available in several versions to suit the needs of the health researcher. Several publications have reported favorably on the psychometric properties of the CHQ. Landgraf et al. reported the results of an exploratory factor analysis at the scale level that provided evidence for a two-factor structure representing physical and psychosocial dimensions of health. In order to cross-validate and extend these results, a confirmatory factor analysis was conducted with an independent sample of generally healthy, predominantly minority children. Results of the analysis indicate that a two-factor model provides a good fit to the data, confirming previous exploratory analyses with this questionnaire. One additional method factor seems likely because of the substantial similarity of three of the scales, but that does not affect the substantive two-factor interpretation overall.

Assessing quality of life of children with chronic health conditions and disabilities: a European approach

Quality of life has been used as a synonym for a subject-centred or individually appraised perspective on health. Despite the increase in quality of life research in adults, quality of life in children is relatively neglected. While generic measures begin to emerge now, methods to assess the quality of life of children with chronic conditions are still in development. The design of such an assessment tool for different age groups and different levels of disabilities is the objective of a European-Union-funded study: the DISABKIDS project. In addition, it addresses the psychosocial determinants of quality of life in children with disabilities. A major aim of the project is to develop and test instruments for children and adolescents with disabilities (as well as for their families) in seven countries, to assess the impact of the chronic health conditions on quality of life and to provide a tool for systematic monitoring of the quality of care given to children with disabilities. Assessment and monitoring will allow identification of unmet health care needs and, it is hoped, ultimately, the fostering of the development of effective intervention strategies.

Reliability and validity of the child health questionnaire-child form (CHQ-CF87) in a Dutch adolescent population

Feasibility, reliability, and discriminative validity of the cross-culturally adapted Dutch version of the originally US child health questionnaire-child form (CHQ-CF87), an 87-item generic pediatric health-related quality of life instrument, were assessed. The success criterion in this first evaluation was the equivalence of psychometric properties of the adapted and the original CHQ. A total of 466 schoolchildren (9-17 years) were invited to complete the questionnaire in the classroom. Test-retest reliability was measured after 14 days in a subgroup (n = 71). Response was 96%. Four scales had ceiling effects (>50%), as was reported in an Australian study. Cronbach alpha-values were adequate (>0.70), except for 'physical functioning' (0.56). Test-retest correlations, not previously reported, were not statistically significant for two CHQ-scales, whereas average retest scores indicated better health for five scales (p < 0.01). The CHQ scales discriminated significantly (p < 0.01) between children without (n = 281) and children with two or more self-reported chronic diseases (n = 59). This is in correspondence with US and Australian reports.

CONCLUSIONS

The current data support application of the Dutch CHQ-CF in predominantly healthy populations, e.g. in school settings. Given the limitations of this study and some less favorable results (score distributions, internal consistency, test-retest reliability), further evaluation of the CHQ-CF is recommended, preferably by analyses of item performance and scale validity in international data sets that include varied clinical subgroups.