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Kamoun C, Largent EA, Grimberg A. Heightism, growth hormone treatment, and social functioning: a holistic approach to a persistent clinical challenge. Curr Opin Pediatr 2024; 36:442-448. [PMID: 38747208 DOI: 10.1097/mop.0000000000001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW Use of recombinant human growth hormone (rhGH) treatment to increase height in children with non-growth hormone deficient short stature is becoming more common. Yet, the evidence to support the notion that augmenting height directly leads to increased well being, specifically psychosocial well being, is inconsistent, with high-quality evidence lacking. RECENT FINDINGS Review of recent studies demonstrates that the association between height augmentation and psychosocial well being is complex. The direct contribution of height to well being may be less than the current model of clinical care of short stature assumes. Rather, the new studies provide evidence to support a role for psychosocial factors, including height-related beliefs, social support, and coping skills, in promoting psychosocial well being, specifically quality of life and self-esteem. SUMMARY Clinical care of short stature would benefit from incorporating a holistic model of care that considers psychosocial interventions in addition to, or instead of, rhGH treatment.
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Affiliation(s)
- Camilia Kamoun
- Department of Pediatrics, Division of Endocrinology, University of North Carolina, Chapel Hill, North Carolina
| | - Emily A Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine
- Leonard Davis Institute of Health Economics, University of Pennsylvania
| | - Adda Grimberg
- Leonard Davis Institute of Health Economics, University of Pennsylvania
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kamoun C, Miller VA, Feudtner C, Friedrich EA, Grimberg A. Views on Short Stature of Female vs Male Endocrine Pediatric Patients Undergoing Provocative Growth Hormone Testing and Their Parents. Endocr Pract 2023; 29:517-524. [PMID: 37088146 PMCID: PMC10330208 DOI: 10.1016/j.eprac.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/08/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Boys outnumber girls in short stature evaluations and growth hormone treatment despite absence of gender differences in short stature prevalence. Family views on short stature influence medical management, but gender-based analysis of these views is lacking. This study explored endocrine patients' and their parents' perceptions of short stature and its impact on quality of life by patient gender. METHODS Patients aged 8 to 14 years undergoing provocative growth hormone testing and 1 parent each completed semistructured interviews. Clinical data were extracted by chart review. RESULTS Twenty-four patient-parent dyads (6 female patients, 22 mothers; predominantly non-Hispanic White) participated. Six major themes emerged: (1) patients' perceptions of their short stature were similar by gender, (2) physical experiences of short stature were similar by gender, (3) social experiences of short stature were both similar and different by gender, (4) parental perceptions of short stature as a factor limiting their child's functionality were similar by gender, (5) concern about societal stigma related to short stature arose for both genders, and (6) patients' perceptions of parental messaging about the import of their short stature were similar by gender. CONCLUSION Our data reveal more similarities than differences between genders in patient perceptions and patient and parent-reported experiences of short stature. Worry about stature-related stigma was noted for patients of both genders. Parental messaging about short stature emerged as an important area to explore further by patient gender. Our findings suggest that clinicians should be wary of making gender or stigma-based assumptions when evaluating children with short stature.
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Affiliation(s)
- Camilia Kamoun
- Division of Endocrinology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina.
| | - Victoria A Miller
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medical Ethics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth A Friedrich
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adda Grimberg
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Aryayev M, Senkivska L, Lowe JB. Psycho-Emotional and Behavioral Problems in Children With Growth Hormone Deficiency. Front Pediatr 2021; 9:707648. [PMID: 34631612 PMCID: PMC8495251 DOI: 10.3389/fped.2021.707648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/17/2021] [Indexed: 12/04/2022] Open
Abstract
Objective: To identify psychosocial problems and self-esteem in children with growth hormone deficiency (GHD) and define the role of some clinical and sociodemographic determinants in the conceptualization of internalizing and externalizing problems as criteria for psychosocial functioning. Materials and Methods: A GHD sample (46 prepubescent children) was selected and compared to a matched control group (80 healthy children). Psychosocial functioning in children with GHD was investigated using Goodman's "Strengths and Difficulties Questionnaire (SDQ)." The study of children's self-esteem was carried out by the Dembo-Rubinstein method. Results: This study reveals that the GHD sample has more internalizing problems and lower self-esteem. Higher score and frequency of assessment in the abnormal score for "total difficulties," "emotional problem," and "peer problem" were found in children with GHD. The SDQ score and the frequency of assessment in the abnormal score for all SDQ scales in children with more pronounced growth deficit (height SDS < -3) did not exceed the same indicators in children with less growth retardation (-3 < height SDS < -2). A comparison of psychosocial features in children with isolated growth hormone deficiency and multiple pituitary hormones deficiency did not reveal differences in SDQ score and the frequency of assessment in the abnormal score for all SDQ scales. It was found that children with GHD have a reduced level of assertions, low self-esteem, and a weak discrepancy between the level of assertions and self-esteem. Some sociodemographic determinants (male gender, age < 9 years, and low family income) and clinical determinants (low compliance and suboptimal growth response after 1 year of rGHh therapy) have an impact on the overall assessment of psychological problems in children with GHD. The internalizing difficulties are associated with certain clinical determinants (growth status and treatment status) and sociodemographic determinants (female gender, age < 9 years). Conclusions: The identification of low self-esteem and the high SDQ score for scales "total difficulties," "emotional problems," and "peer problems" indicates psychosocial maladjustment and conceptualization of internalizing problems in children with GHD.
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Affiliation(s)
- Mykola Aryayev
- Department of Paediatrics, Odessa National Medical University, Odessa, Ukraine
| | - Liudmyla Senkivska
- Department of Paediatrics, Odessa National Medical University, Odessa, Ukraine
| | - John B Lowe
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD, Australia
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Quitmann J, Bloemeke J, Dörr HG, Bullinger M, Witt S, Silva N. First-year predictors of health-related quality of life changes in short-statured children treated with human growth hormone. J Endocrinol Invest 2019; 42:1067-1076. [PMID: 30840207 DOI: 10.1007/s40618-019-01027-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/20/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Little attention has been directed towards examining the impact of predictors on change in health-related quality of life (HRQOL) within the course of growth hormone (GH) treatment in pediatric short stature. We aimed to assess changes in HRQOL and its sociodemographic, clinical and psychosocial predictors in children and adolescents diagnosed with growth hormone deficiency (GHD), and born short for gestational age (SGA) before and 12-month after start of GH treatment from the parents' perspective. Results were compared with an untreated group with idiopathic short stature (ISS). In this prospective multicenter study, 152 parents of children/adolescents (aged 4-18 years) provided data on their children's HRQOL at baseline and at 12-month follow-up. METHOD Repeated-measures multivariate analyses of covariance were performed to examine parent-reported HRQOL changes from baseline to 1-year after treatment and hierarchical linear regressions to identify the predictors of HRQOL changes. RESULTS Results showed that parents of children that were treated with GH report an increase in their children's HRQOL after 1 year. Changes in HRQOL were mostly explained by psychosocial predictors followed by sociodemographic and clinical variables. Specifically, the diagnosis SGA significantly predicted a greater increase in parent-reported HRQOL. Furthermore, a lower caregiving burden significantly predicted a decrease in parent-reported HRQOL. CONCLUSION In conclusion, a substantial percentage of explained variance in HRQOL relates to psychosocial and sociodemographic predictors. However, there appears to be other important factors that are predictors of HRQOL, which need to be determined in large, population-based samples.
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Affiliation(s)
- J Quitmann
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - J Bloemeke
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - H-G Dörr
- Division Paediatric Endocrinology, Hospital for Children and Adolescents, University Erlangen-Nürnberg, Erlangen, Germany
| | - M Bullinger
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - S Witt
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - N Silva
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Faculty of Psychology and Education Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
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Shemesh-Iron M, Lazar L, Lebenthal Y, Nagelberg N, Tenenbaum A, Ezra R, Leffler N, Yackobovitch-Gavan M, Schoenberg-Taz M, Phillip M. Growth hormone therapy and short stature-related distress: A randomized placebo-controlled trial. Clin Endocrinol (Oxf) 2019; 90:690-701. [PMID: 30721549 DOI: 10.1111/cen.13944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/11/2019] [Accepted: 01/31/2019] [Indexed: 01/19/2023]
Abstract
CONTEXT Growth hormone (GH) treatment of short healthy children is based on the belief that short stature is associated with psychosocial problems and a diminished quality of life. OBJECTIVE To determine the impact of GH therapy on psychosocial well-being and the ability of psychological metrics to define short stature-related distress. METHODS Sixty prepubertal boys with idiopathic short stature (age: 10.0 ± 1.4 years, height-SDS: -2.38 ± 0.3) were enrolled in this 4-year intervention study (1-year double-blinded, randomized, placebo-controlled [GH/placebo-2:1] and 3-year open-labelled GH therapy). Explicit (conscious/voluntary) psychological metrics (Pediatric Quality of Life Inventory [PedsQL], Silhouette Apperception Test [SAT], Rosenberg Self-Esteem Scale [RSES], Child Behavior Checklist [CBCL]) and implicit (unconscious/involuntary) psychological metrics (Single-Category Implicit Association Test for height [SC-IAT-H], Height Perception Picture Test [HPPT]). Psychosocial evaluations were performed at study entry, after 1 and 4 years. RESULTS At study entry, PedsQL of boys with idiopathic short stature was lower than Israeli norms (P = 0.001). After 1-year blinded intervention, only the GH-treated boys improved their actual and anticipated adult height perception (SAT, P < 0.001 and P = 0.022) with reduced short stature-related distress (SC-IAT-H, P < 0.001). At study end, RSES and SC-IAT-H improved significantly (P < 0.001), with no change in PedsQL and CBCL. CONCLUSIONS Our finding of improved psychosocial functioning only in the GH-treated boys after 1-year blinded intervention suggests that it was the GH therapy, rather than being enrolled in a clinical trial, which contributed to the outcome. Long-term open-labelled GH treatment significantly improved height perception and self-esteem. Future studies are needed to fully assess the relevance of complementing the routinely used explicit self-report measures with the implicit measures.
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Affiliation(s)
- Moran Shemesh-Iron
- The Jesse Z and Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Liora Lazar
- The Jesse Z and Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Lebenthal
- The Jesse Z and Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nessia Nagelberg
- The Jesse Z and Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Ariel Tenenbaum
- The Jesse Z and Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Revital Ezra
- The Jesse Z and Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Nir Leffler
- The Jesse Z and Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Michal Yackobovitch-Gavan
- The Jesse Z and Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Michal Schoenberg-Taz
- The Jesse Z and Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Moshe Phillip
- The Jesse Z and Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Drosatou C, Vlachopapadopoulou EA, Bullinger M, Quitmann J, Silva N, Salemi G, Pavlopoulou I, Michalacos S, Tsoumakas K. Validation of the Greek version of the Quality of Life in Short Stature Youth (QoLISSY) questionnaire. J Pediatr Endocrinol Metab 2019; 32:215-224. [PMID: 30735483 DOI: 10.1515/jpem-2018-0403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/16/2018] [Indexed: 11/15/2022]
Abstract
Background The Quality of Life in Short Stature Youth (QoLISSY) questionnaire is a condition-specific instrument for measuring the health-related quality of life (HRQoL) in short statured children/adolescents from patients' and parents' perspectives. The aim of this study was to investigate the psychometric properties of the Greek version of the QoLISSY questionnaire. Methods The original European QoLISSY scales were translated into Greek following the guidelines for linguistic validation and applied to 184 dyads of children 8-18 years old and their parents, as well as to 14 parents of children 4-7 years old in Greece. The field testing responses to the Greek version of QoLISSY were analyzed. Results The qualitative analysis of the Greek data provided results consistent with the European sample. The subsequent field test showed acceptable internal consistency (Cronbach α between 0.67-0.93) and high test-retest reliability (intraclass correlation coefficients [ICC] ≥0.70). Correlations with the generic KIDSCREEN questionnaire indicated good convergent validity. Confirmatory factor analysis (CFA) also yielded acceptable results. Higher HRQoL for taller children suggests that QoLISSY was able to detect significant height-related differences. Conclusions The Greek version of the QoLISSY questionnaire is psychometrically sound and its use is recommended in further clinical research to ascertain the impact of short stature (SS) and treatments in Greek children/adolescents and families.
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Affiliation(s)
- Chrysoula Drosatou
- Department of Endocrinology-Growth and Development, Athens General Children's Hospital "P. & A. Kyriakou", Thivon & Levadeias str., Athens 11527, Greece.,Nursing Department, National and Kapodistrian University of Athens, Athens, Greece, Phone: +302132009527
| | | | - Monika Bullinger
- Department of Medical Psychology, University Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Quitmann
- Department of Medical Psychology, University Hamburg-Eppendorf, Hamburg, Germany
| | - Neuza Silva
- Department of Medical Psychology, University Hamburg-Eppendorf, Hamburg, Germany.,Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Georgia Salemi
- Department of Nursing Administration, Athens General Children's Hospital "P. & A. Kyriakou", Athens, Greece
| | - Ioanna Pavlopoulou
- Nursing Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Michalacos
- Department of Endocrinology-Growth and Development, Athens General Children's Hospital "P. & A. Kyriakou", Athens, Greece
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Collins L, Athale U, Cranston A, Barr R. Impact of short stature on health-related quality of life in long-term survivors of acute lymphoblastic leukemia in childhood and adolescence. J Patient Rep Outcomes 2018; 2:59. [PMID: 30535818 PMCID: PMC6286289 DOI: 10.1186/s41687-018-0084-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/06/2018] [Indexed: 02/08/2023] Open
Abstract
Purpose Some survivors of acute lymphoblastic leukemia (ALL) in childhood and adolescence exhibit short stature, especially if their treatment included cranial irradiation. The impact of this outcome on health-related quality of life (HRQL) is uncertain and so formed the basis for the investigation reported here. Methods This study examined the association between self-reported HRQL and measured height in a cohort (n = 75) of survivors of ALL more than 10 years from diagnosis. HRQL was expressed as utility scores generated from a multi-attribute preference-based measure, the Health Utilities Index (HUI) which includes the complementary systems HUI2 and HUI3. For single attributes the range is from 1.00 (no limitations) to 0.00 (lowest level of function). For overall HRQL the range is 1.00 (perfect health) to 0.00 (equivalent to being dead). A negative score is associated with states of health worse than being dead. Results There were no statistically significant differences in overall HRQL between subjects <25th (n = 16, 21%), 15th (n = 11, 15%) and 10th (n = 10, 13%) centiles. A greater amount of emotional morbidity, focused on anger and depression, was manifest in those <25th and 15th centiles, with clinically important differences of 0.07 (p = 0.03) and 0.077 (p = 0.016) respectively, but not in the shortest group who were < 10th centile. Conclusions Studies in large cohorts of young adults in the general population has reported an inconsistent relationship between height and HRQL. Results from the current study suggest that no such relationship exists in long-term survivors of ALL in childhood and adolescence.
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Affiliation(s)
- Laura Collins
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Uma Athale
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Room 3N27, Health Sciences Centre, 1200 Main Street West, Hamilton, Ontario, L8S 4J9, Canada
| | - Amy Cranston
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ronald Barr
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada. .,Department of Pediatrics, McMaster University, Room 3N27, Health Sciences Centre, 1200 Main Street West, Hamilton, Ontario, L8S 4J9, Canada.
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Dhamayanti M, Deliana PH, Bukkar F. Association of stature and mental problems among adolescents in Jatinangor District, West Java. MEDICAL JOURNAL OF INDONESIA 2018. [DOI: 10.13181/mji.v27i3.2467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Background: The prevalence of short stature during adolescence in Indonesia remains high. Adolescents are very concerned about their stature. Most adolescent health problems are related to psychosocial issues. The prevalence of mental disorders among adolescents in Indonesia is 6.0%, and West Java is 9.3%. The aim of this study was to analyze the association between stature and mental problems during middle adolescence.Methods: This analytical cross-sectional study was performed at three high schools in Jatinangor, West Java, Indonesia. The subjects were students, age of 16–17 years old without physical abnormalities other than short stature and weight problems. Mental problems were screened using a self-report Strength and Difficulties Questionnaire (SDQ). Data were analyzed using the chi-square test with prevalence risk.Results: Of the 150 respondents, 116 subjects met the inclusion and exclusion criteria. The prevalence of short stature was 55 cases (47.4%) and more predominant in females. Among the behavioral and emotional problems assessed, the emotional symptom was associated significantly with short stature; prevalence ratio 1.87 (95% CI=1.14; 3.08). There was no significant association of short stature with other attributes such as conduct, hyperactivity, peer problems, and total difficulties (p>0.05).Conclusion: Stature in adolescence is associated with emotional problems.
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Horne VE, Sandberg DE, Gardner M, Lantos JD, Allen DB. Growth Hormone Therapy for a Child With Severe Cognitive Impairment. Pediatrics 2018; 142:peds.2017-3938. [PMID: 30237229 DOI: 10.1542/peds.2017-3938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 11/24/2022] Open
Abstract
The expansion of growth hormone therapy over the last 3 decades has allowed for treatment of short stature for more children, resulting in increased height for many. However, treatment of idiopathic short stature remains controversial. Treatment decisions for disabled children with idiopathic short stature are even more complicated. We discuss a specific case of short stature in a disabled child and grapple with the ethical issues involved in the use of growth hormone.
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Affiliation(s)
- Vincent E Horne
- Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - David E Sandberg
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
| | - Melissa Gardner
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
| | - John D Lantos
- Children's Mercy Hospital Kansas City, Kansas City, Missouri; and
| | - David B Allen
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Sommer R, Bullinger M, Chaplin J, Do JK, Power M, Pleil A, Quitmann J. Experiencing health-related quality of life in paediatric short stature - a cross-cultural analysis of statements from patients and parents. Clin Psychol Psychother 2017; 24:1370-1376. [PMID: 28675583 DOI: 10.1002/cpp.2105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 05/21/2017] [Accepted: 05/24/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Direct assessment of the patient perspective is necessary to thoroughly understand patients' experiences of disease. We aimed to examine information from children with short stature on their perceived HrQoL within 5 European countries. METHODS Patients, identified through clinical databases, were approached by their clinicians according to the inclusion criteria regarding a diagnosis of growth hormone deficiency or idiopathic short stature and age requirements. A focus group methodology was applied in 84 children and 112 parents. Based on a category system, individual statements were allocated to domains. To evaluate the emerging topics, qualitative content analysis was conducted. Domains and respective coding frequencies per category were compared across countries and respondents. RESULTS The highest number of statements produced by the children and parents were related to social (29%) and emotional needs and concerns (28%). In particular, children stressed their experience of social exclusion but also their perception of social support. Regarding emotional needs, they stated mainly the desire to be taller in order to be less teased by peers. National differences were identified, for example, Swedish (22%) and British (16%) children and their parents (Sweden 26%; Britain 23%) stressed physical HrQoL aspects, whereas German children (21%) strongly focused on treatment aspects, mainly the benefit of treatment. CONCLUSION Comprehensive knowledge of the impact of a chronic condition such as short stature on wellbeing is an important precondition of effective treatment. Because socioemotional topics were rated in all the countries to be most important, interventions aimed at improving HrQoL should target social and emotional responses to short stature.
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Affiliation(s)
- Rachel Sommer
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Bullinger
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - John Chaplin
- Department of Pediatrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ju-Ky Do
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mick Power
- Clinical Psychology Programmes, National University of Singapore, Singapore
| | | | - Julia Quitmann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Jafari-Adli S, Qorbani M, Heshmat R, Ranjbar SH, Taheri E, Motlagh ME, Noorozi M, Safari O, Shafiee G, Rezaei F, Safiri S, Kelishadi R. Association of short stature with life satisfaction and self-rated health in children and adolescents: the CASPIAN-IV study. J Pediatr Endocrinol Metab 2016; 29:1299-1306. [PMID: 27754967 DOI: 10.1515/jpem-2016-0215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 08/29/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Data on stature in Iranian children and adolescents at national level are limited. The purpose of this study was to investigate the association of short stature with life satisfaction (LS) and self-rated health (SRH) in children and adolescents. METHODS Data were obtained from a nationwide survey entitled childhood and adolescence surveillance and prevention of adult non-communicable disease (CASPIAN IV). Participants were 14,880 children and adolescents, aged 6-18 years, who were selected using multistage, cluster sampling method from rural and urban areas of 30 provinces of Iran. LS and SRH were evaluated for every participant by the validated questionnaire prepared based on the global school-based student health survey of the World Health Organization (WHO). Height was measured according to the standard protocol. Short stature was defined as height less than -2 standard deviation (SD) below the mean height for age and sex. RESULTS Overall, 13,484 participants with a mean (SD) age of 12.5 (3.36) years (49.24% girls, 50.75% boys) completed the study (response rate 90.6%). The prevalence of short stature, poor SRH and life dissatisfaction was 9%, 20.04% and 20.09%, respectively. Although in the univariate model, participants with short stature had significantly lower odds of LS [odds ratio (OR): 0.83, 95% confidence interval (CI): 0.71-0.97] and good SRH (OR: 0.79, 95% CI: 0.68-0.92), in the multivariate model, only the association of short stature with good SRH remained statistically significant (OR: 0.82, 95% CI: 0.69-0.98). CONCLUSIONS Results of the present study show that participants with short stature are at the greater risk of poor SRH and decreased LS in comparison with the subjects with normal height.
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12
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Quitmann JH, Bullinger M, Sommer R, Rohenkohl AC, Bernardino Da Silva NM. Associations between Psychological Problems and Quality of Life in Pediatric Short Stature from Patients' and Parents' Perspectives. PLoS One 2016; 11:e0153953. [PMID: 27097033 PMCID: PMC4838264 DOI: 10.1371/journal.pone.0153953] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/06/2016] [Indexed: 11/19/2022] Open
Abstract
Short stature has been associated with psychosocial impairments, but whether treatments and achieved height impact on health-related quality of life (HrQoL) and psychological functioning of children/adolescents is still controversial. This study aimed to examine the effects of height deviation and treatment status on psychosocial adaptation outcomes and to identify clinical and psychosocial determinants of internalizing/externalizing problems in a large cohort of short statured children/adolescents from seven European countries. Participants were 345 children aged 8–18 years with a clinical diagnosis of short stature and 421 parents of 4–18 year-old patients. Children and parents reported on psychological problems (Strengths and Difficulties Questionnaire), generic (KIDSCREEN) and condition-specific HrQoL (QoLISSY). According to analyses of covariance, children/adolescents with current short stature presented more parent-reported internalizing problems and lower self- and parent-reported condition-specific HrQoL, compared to patients with an achieved height above -2SD. Treated children self-reported better HrQoL than the untreated group. Hierarchical regression analysis showed that, rather than height–related clinical variables, children’s sex, younger age and poorer HrQoL were the best predictors of psychological problems, explaining 39% of the variance in patient- and 42% in parent-reported internalizing problems, and 22% of the variance in patient- and 24% in parent-reported externalizing problems. Treatment status also moderated the negative links between patient-reported HrQoL and internalizing problems, explaining 2% of additional variance. These results suggest that children with current short stature are at greater risk for internalizing problems. Routine assessment of HrQoL in pediatric healthcare may help identify children for referral to specialized psychological assessment and intervention.
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Affiliation(s)
- Julia Hannah Quitmann
- University Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
- * E-mail:
| | - Monika Bullinger
- University Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | - Rachel Sommer
- University Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | | | - Neuza Maria Bernardino Da Silva
- University Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
- University of Coimbra, Cognitive and Behavioral Center for Research and Intervention, Coimbra, Portugal
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Health-Related Quality of Life of Young Adults Treated with Recombinant Human Growth Hormone during Childhood. PLoS One 2015; 10:e0140944. [PMID: 26474398 PMCID: PMC4608786 DOI: 10.1371/journal.pone.0140944] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/30/2015] [Indexed: 02/02/2023] Open
Abstract
Background Since recombinant human growth hormone (rhGH) became available in 1985, the spectrum of indications has broadened and the number of treated patients increased. However, long-term health-related quality of life (HRQoL) after childhood rhGH treatment has rarely been documented. We assessed HRQoL and its determinants in young adults treated with rhGH during childhood. Methodology/Principal Findings For this study, we retrospectively identified former rhGH patients in 11 centers of paediatric endocrinology, including university hospitals and private practices. We sent a questionnaire to all patients treated with rhGH for any diagnosis, who were older than 18 years, and who resided in Switzerland at time of the survey. Three hundred participants (58% of 514 eligible) returned the questionnaire. Mean age was 23 years; 56% were women; 43% had isolated growth hormone deficiency, or idiopathic short stature; 43% had associated diseases or syndromes, and 14% had growth hormone deficiency after childhood cancer. Swiss siblings of childhood cancer survivors and the German norm population served as comparison groups. HRQoL was assessed using the Short Form-36. We found that the Physical Component Summary of healthy patients with isolated growth hormone deficiency or idiopathic short stature resembled that of the control group (53.8 vs. 54.9). Patients with associated diseases or syndromes scored slightly lower (52.5), and former cancer patients scored lowest (42.6). The Mental Component Summary was similar for all groups. Lower Physical Component Summary was associated with lower educational level (coeff. -1.9). Final height was not associated with HRQoL. Conclusions/Significance In conclusion, HRQoL after treatment with rhGH in childhood depended mainly on the underlying indication for rhGH treatment. Patients with isolated growth hormone deficiency/idiopathic short stature or patients with associated diseases or syndromes had HRQoL comparable to peers. Patients with growth hormone deficiency after childhood cancer were at high risk for lower HRQoL. This reflects the general impaired health of this vulnerable group, which needs long-term follow-up.
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