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Chen PY, Jia F, Wu W, Wang MH, Chao TY. Dealing with missing data in multi-informant studies: A comparison of approaches. Behav Res Methods 2024; 56:6498-6519. [PMID: 38418689 DOI: 10.3758/s13428-024-02367-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
Multi-informant studies are popular in social and behavioral science. However, their data analyses are challenging because data from different informants carry both shared and unique information and are often incomplete. Using Monte Carlo Simulation, the current study compares three approaches that can be used to analyze incomplete multi-informant data when there is a distinction between reference and nonreference informants. These approaches include a two-method measurement model for planned missing data (2MM-PMD), treating nonreference informants' reports as auxiliary variables with the full-information maximum likelihood method or multiple imputation, and listwise deletion. The result suggests that 2MM-PMD, when correctly specified and data are missing at random, has the best overall performance among the examined approaches regarding point estimates, type I error rates, and statistical power. In addition, it is also more robust to data that are not missing at random.
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Affiliation(s)
- Po-Yi Chen
- Department of Educational Psychology and Counseling, National Taiwan Normal University, Taipei, Taiwan, 106308.
| | - Fan Jia
- Department of Psychological Sciences, University of California Merced, Merced, CA, USA
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | | | - Tzi-Yang Chao
- Department of Educational Psychology and Counseling, National Taiwan Normal University, Taipei, Taiwan, 106308
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Albatati S, Alnasser Y, Alomar O, Alsharidi T, Almousa H, Almezel S, Alabdulwahid A. Social determinants of health and quality of life in children with chronic kidney disease: insights from Saudi Arabia. BMC Nephrol 2024; 25:272. [PMID: 39182016 PMCID: PMC11344921 DOI: 10.1186/s12882-024-03710-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Social determinants of health (SDoH) are increasingly recognized as crucial factors affecting the well-being of pediatric chronic kidney disease (CKD) patients. This study explores the impact of SDoH on the quality of life (QoL) of children with CKD in Saudi Arabia. METHODS This observational, descriptive, cross-sectional study included 50 participants with CKD stages three to five, as well as children with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) or hemodialysis (HD) in Riyadh, Saudi Arabia. Data were collected from children and their caregivers using a validated Arabic-adapted version of the Pediatric Quality of Life Inventory (PedsQL) 3.0 and an SDoH survey. RESULTS The study revealed that access to education significantly affects pediatric QoL (H/Z score 2.825; P-value 0.005), and the lack of dietary recommendations was identified as a critical factor (H/Z score 1.441; P-value 0.029). ESRD patients on PD from larger families reported better QoL, whereas lower family income was associated with reduced QoL in PD patients (P-value 0.048). Compared to those in earlier stages of CKD, ESRD patients showed lower QoL (H/Z score 2.154; P-value 0.031). CONCLUSION Our study provides initial insights into the relationship between SDoH and the QoL of children with CKD in Saudi Arabia. It calls for a comprehensive approach that includes these determinants in care strategies to improve patient outcomes and QoL.
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Affiliation(s)
- Sawsan Albatati
- Section of Nephrology, Department of Pediatrics, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Yossef Alnasser
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Department, Bronxcare Health System, New York, NY, USA
- George Washington Milken School of Public Health, Washington, DC, USA
| | - Omar Alomar
- Section of Nephrology, Department of Pediatrics, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | | | - Hamad Almousa
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Shahd Almezel
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Chaichana U, Pooliam J, Jantongsree M, Chantaratin S, Sumboonnanonda A, Pattaragarn A, Supavekin S, Piyaphanee N, Lomjansook K, Thunsiribuddhichai Y, Tinnabut I, Chaiyapak T. Quality of life in children at different stages of chronic kidney disease in a developing country. Pediatr Nephrol 2024:10.1007/s00467-024-06442-1. [PMID: 39126495 DOI: 10.1007/s00467-024-06442-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/09/2024] [Accepted: 06/17/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Children with chronic kidney disease (CKD) require comprehensive assessments, including medical and quality of life (QoL) evaluations. Few studies have been conducted in developing countries. METHODS This cross-sectional study included 2-18-year-old patients who were categorized into 4 groups: the CKD stage 2-3, stage 4-5, stage 5 with dialysis (D), and kidney transplantation (KT) groups. QoL was measured using the Pediatric Quality of Life Inventory™ (PedsQL™) version 4.0; relationships between different factors and QoL were determined using multivariable linear regression analysis. RESULTS Eighty-seven patients (mean age: 13.3 (4.1) years) were included. The self-reported total scores were 77.5 (12.5), 78.9 (11.2), 77.4 (16.2), and 76.1 (10.9) in the stage 2-3, stage 4-5, stage 5D and KT groups, respectively. Parent-reported scores showed a weak-to-moderate correlation with self-reported scores (r = 0.12-0.42), with total scores of 71.8 (12.7), 69.5 (14.9), 63.4 (14.8), and 70.8 (18.1) in the stage 2-3, 4-5, 5D and KT groups, respectively. Multivariable linear regression revealed that the parent-reported score in the stage 5D group was 15.92 points lower than that in the stage 2-3 group (p = 0.02); the score in the low maternal education group was 10.13 points lower than that in the high maternal education group (p = 0.04). CONCLUSIONS Parent-reported scores showed weak-to-moderate correlation with self-reported scores. Patients with CKD stage 5D and patients with low maternal education had lower QoL. Regular QoL assessment is recommended for patients with advanced CKD and those with socioeconomic vulnerabilities.
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Affiliation(s)
- Urapee Chaichana
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Julaporn Pooliam
- Research Development Division, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Maturin Jantongsree
- Research Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasitorn Chantaratin
- Division of Psychiatry, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Achra Sumboonnanonda
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anirut Pattaragarn
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suroj Supavekin
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nuntawan Piyaphanee
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kraisoon Lomjansook
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yarnarin Thunsiribuddhichai
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Intraparch Tinnabut
- Division of Pediatric Nursing, Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thanaporn Chaiyapak
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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House TR, Marks SD, Freeman MA. Holistic care and symptom management for pediatric kidney transplant recipients. Pediatr Nephrol 2024; 39:1759-1769. [PMID: 37851087 DOI: 10.1007/s00467-023-06175-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/16/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023]
Abstract
While many aspects of life may improve substantially for children and young people undergoing kidney transplant, there may be new challenges including symptoms that can be detrimental to health-related quality of life. Addressing symptoms requires attention to patient and family perspectives and a holistic approach grounded in symptom management. The interdisciplinary pediatric nephrology transplant team should be attuned to the prevalence of common symptoms including fatigue, anxiety, depression, post-traumatic stress, pain, and sleep disturbances, as well as poor body image and sexual health. These common symptoms require regular assessment with a focus on appropriate interventions and how care may be impacted by transplant status.
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Affiliation(s)
- Taylor R House
- Division of Nephrology, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, 53792, USA
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Michael A Freeman
- Division of Pediatric Nephrology and Hypertension, Departments of Pediatrics and Humanities, Penn State College of Medicine, Penn State Health Children's Hospital, 90 Hope Drive, PO Box 855, Hershey, PA, 17036, USA.
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Doshi K, Raina R, Ng KH, Koch V, Bhatt GC, Nada A, Foresi B, Kamalakkannan SS, McCulloch M, Sethi S, de Ferris MDG. Health-related quality of life for pediatric patients with end-stage kidney disease: A systematic review and meta-analysis of the Pediatric Quality of Life Inventory (PedsQL). Hemodial Int 2024; 28:198-215. [PMID: 38468403 DOI: 10.1111/hdi.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/17/2023] [Accepted: 01/30/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Health-related quality of life (HRQoL) studies demonstrate the impact of end-stage renal disease (ESRD) on the physical and psychosocial development of children. While several instruments are used to measure HRQoL, few have standardized domains specific to pediatric ESRD. This review examines current evidence on self and proxy-reported HRQoL among pediatric patients with ESRD, based on the Pediatric Quality of Life Inventory (PedsQL) questionnaires. METHODS Following PRISMA guidelines, we conducted a systematic review and meta-analysis on HRQoL using the PedsQL 4.0 Generic Core Scale (GCS) and the PedsQL 3.0 ESRD Module among 5- to 18-year-old patients. We queried PubMed, Embase, Web of Science, CINAHL, and Cochrane databases. Retrospective, case-controlled, and cross-sectional studies using PedsQL were included. FINDINGS Of 435 identified studies, 14 met inclusion criteria administered in several countries. Meta-analysis demonstrated a significantly higher total HRQoL for healthy patients over those with ESRD (SMD:1.44 [95% CI: 0.78-2.09]) across all dimensional scores. In addition, kidney transplant patients reported a significantly higher HRQoL than those on dialysis (PedsQL GCS, SMD: 0.33 [95% CI: 0.14-0.53]) and (PedsQL ESRD, SMD: 0.65 [95% CI: 0.39-0.90]) concordant with parent-proxy reports. DISCUSSION Patients with ESRD reported lower HRQoL in physical and psychosocial domains compared with healthy controls, while transplant and peritoneal dialysis patients reported better HRQoL than those on hemodialysis. This analysis demonstrates the need to identify dimensions of impaired functioning and produce congruent clinical interventions. Further research on the impact of individual comorbidities in HRQoL is necessary for developing comprehensive, integrated, and holistic treatment programs.
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Affiliation(s)
- Kush Doshi
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA
| | - Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA
- Department of Nephrology, Akron Children's Hospital, Akron, Ohio, USA
| | - Kar Hui Ng
- Department of Paediatrics, National University of Singapore, Singapore
| | - Vera Koch
- Department of Pediatrics, University of Sao Paulo Medical School, Pediatric Nephrology Unit Instituto da Criança, Hospital das Clinicas University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Girish C Bhatt
- Division of Pediatric Nephrology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Arwa Nada
- Department of Pediatrics, Division of Nephrology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Brian Foresi
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | | | - Mignon McCulloch
- Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa
| | - Sidharth Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, India
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Ritschl V, Stamm T, Selzer A, Boesendorfer A, Eibensteiner F, Kaltenegger L, Mosor E, Omara M, Vachuda N, Sperl L, Masel EK, Aufricht C, Boehm M. Life outcomes after paediatric kidney transplantation: a qualitative, biographical study in long-term survivors. Arch Dis Child 2024; 109:240-246. [PMID: 38212079 PMCID: PMC10894829 DOI: 10.1136/archdischild-2023-326432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE The objective of this study was to analyse the narrative life stories of children with end-stage kidney disease (ESKD) and their families to determine how health professionals can effectively support these children to achieve better life outcomes. DESIGN Qualitative narrative biographic study. SETTING We invited every long-term survivor of paediatric kidney transplants and their families at the Medical University of Vienna between 2008 and 2013 to participate in this study. PARTICIPANTS Nineteen patients (women: n=8, 42%) and 34 family members (women: n=22, 65%) were interviewed. The patients had a mean age of 7.6 (SD±5.6) years at the time of transplantation and 22.2 (SD±5.4) at the time of interview. MAIN OUTCOMES MEASURES A qualitative narrative biographical analysis was combined with computational structured topic models using the Latent Dirichlet Allocation. RESULTS The overarching finding was the desire for normality in daily life in long-term survivors and their families but with different perceptions of what normality looks like and predominance of this aspect evolving. Different strategies were used by patients (focused on their advancement) and caregivers (normality for all family members). Siblings played a major role in supporting survivors' social inclusion. CONCLUSIONS The strong desire for normality confirms recent findings of the Standardised Outcomes in Nephrology Group initiative, which proposes survival and life participation as core outcomes in children with chronic kidney disease. Our study should be a starting point for an international effort to identify typologies and stratified interventions for children with ESKD and their families, particularly siblings.
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Affiliation(s)
- Valentin Ritschl
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Tanja Stamm
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Axana Selzer
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Anna Boesendorfer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Wien, Austria
| | - Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Lukas Kaltenegger
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Erika Mosor
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Maisa Omara
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
| | - Natalie Vachuda
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Lisa Sperl
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Eva K Masel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Wien, Austria
| | - Christoph Aufricht
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Michael Boehm
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
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Patel R, Wong C. Illness-related parental stress and quality of life in children with kidney diseases. Pediatr Nephrol 2023; 38:2911-2913. [PMID: 37330454 DOI: 10.1007/s00467-023-06041-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 06/19/2023]
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De Bruyne E, Willem L, Van Hoeck K, Reynaert S, Vankerckhove S, Adams B, Leroi S, Collard L, Michaux A, Godefroid N, Mekahli D, Knops N, Eloot S, Raes A, Walle JV, Van Hoecke E, Snauwaert E, Levtchenko E. Illness-related parental stress and quality of life in children with kidney diseases. Pediatr Nephrol 2023; 38:2719-2731. [PMID: 36929385 DOI: 10.1007/s00467-023-05911-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND This cross-sectional study investigated quality of life (QoL) and illness-related parental stress in children with kidney diseases by (1) comparing mean levels of these two variables between several kidney disease categories; (2) exploring correlations between QoL and parental stress; and (3) describing which disease category reports lowest QoL and highest parental stress. METHODS We included 295 patients with a kidney disease (0-18 years) and their parents, followed at 6 reference centers for pediatric nephrology. Children's QoL was assessed by the PedsQL™ 4.0 Generic Core Scales, and illness-related stress by the Pediatric Inventory for Parents. All patients were divided into 5 kidney disease categories according to the multidisciplinary care program criteria prescribed by the Belgian authorities: (1) structural kidney diseases, (2) tubulopathies and metabolic diseases, (3) nephrotic syndrome, (4) acquired diseases with proteinuria and hypertension, and (5) kidney transplantation. RESULTS Child self-reports showed no differences in QoL between kidney disease categories, in contrast to parent proxy reports. Parents of transplant patients reported lower QoL in their child and more parental stress compared with the 4 non-transplant categories. QoL and parental stress were negatively correlated. Lowest QoL and highest parental stress scores were mainly found in transplant patients. CONCLUSIONS This study showed lower QoL and higher parental stress in pediatric transplant patients compared with non-transplants, based on parent reports. Higher parental stress is associated with worse QoL in the child. These results highlight the importance of multidisciplinary care for children with kidney diseases, with special attention to transplant patients and their parents. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Elke De Bruyne
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium.
| | - Lore Willem
- Department of Child Nephrology and Organ Transplantation, Leuven University Hospital, Louvain, Belgium.
| | - Koen Van Hoeck
- Department of Pediatric Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Sarah Reynaert
- Department of Pediatric Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Sylvie Vankerckhove
- Department of Pediatric Nephrology, Queen Fabiola Children's University Hospital Brussels, Brussels, Belgium
| | - Brigitte Adams
- Department of Pediatric Nephrology, Queen Fabiola Children's University Hospital Brussels, Brussels, Belgium
| | - Stéphanie Leroi
- Department of Pediatric Nephrology, CHC-MontLégia, Health Group CHC Liège, Liege, Belgium
| | - Laure Collard
- Department of Pediatric Nephrology, CHC-MontLégia, Health Group CHC Liège, Liege, Belgium
| | - Aline Michaux
- Department of Pediatric Nephrology, Saint-Luc Brussels University Hospital, Brussels, Belgium
| | - Nathalie Godefroid
- Department of Pediatric Nephrology, Saint-Luc Brussels University Hospital, Brussels, Belgium
| | - Djalila Mekahli
- Department of Child Nephrology and Organ Transplantation, Leuven University Hospital, Louvain, Belgium
| | - Noël Knops
- Department of Child Nephrology and Organ Transplantation, Leuven University Hospital, Louvain, Belgium
| | - Sunny Eloot
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Ann Raes
- Department of Pediatric Nephrology & Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology & Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Eline Van Hoecke
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Evelien Snauwaert
- Department of Pediatric Nephrology & Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Elena Levtchenko
- Department of Child Nephrology and Organ Transplantation, Leuven University Hospital, Louvain, Belgium
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Enabling flourishing: novel approaches in palliative medicine for children with advanced kidney disease. Curr Opin Nephrol Hypertens 2023; 32:41-48. [PMID: 36250456 DOI: 10.1097/mnh.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Paediatric kidney disease results in considerable burden on children and their families. Paediatric palliative care is a holistic, family-centred care approach intended to enable flourishing and address the many impediments to life participation which advanced kidney disease can impose. To date, palliative care resources have been underutilized in paediatric nephrology. This review will highlight recent literature targeting the engagement and life participation of children with advanced kidney disease through implementation of novel palliative care approaches and propose directions for future research. RECENT FINDINGS Children with advanced kidney disease and their families highly value incorporation of their perspectives, particularly on life participation, within care plan development; but what it means to participate in life can be variable, and clinicians need improved tools to ascertain and incorporate these perspectives. Novel palliative care interventions developed for application in comparable disease states offer potential opportunities for paediatric nephrologists to support this goal. SUMMARY Children with advanced kidney disease and their families will benefit from incorporation of their perspectives and values, facilitated by palliative interventions.
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House TR, Rosenberg AR, Zimmerman CT, Barton KS, Wightman A. Caregiver perspectives of dialysis initiation for children with kidney disease: a qualitative study. Pediatr Nephrol 2022; 37:2457-2469. [PMID: 35181825 PMCID: PMC10433404 DOI: 10.1007/s00467-022-05472-x] [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: 12/08/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND To better support family-centered care surrounding dialysis initiation, greater understanding of caregiver experience is necessary. METHODS Using thematic analysis, we conducted a secondary analysis of semi-structured interview data from a qualitative study of caregivers of children receiving dialysis recruited from 3 pediatric centers. Prominent themes in caregiver experience of caring for a child initiating dialysis were identified. RESULTS Thirty-five caregivers participated. Three major themes emerged from qualitative analysis: (1) parenting disrupted - caregivers experienced an acute disruption in their parenting role due to the unexpected, emergent circumstances and vast information accompanying their child's diagnosis; (2) redefining parenting - caregivers sought to reestablish their innate parental role and foster their evolving medical provider role through reassurance that their child could survive, communication with the medical team, and engaging in care plan development; and (3) leveraging dual identities - to positively impact their child's experience and enable flourishing, caregivers leveraged their established caregiver role and newly realized medical provider role through voicing their perspectives, watching over their child's care, and preparing for future changes in their child's health. If caregivers' evolution was not nurtured and enabled, acute fluctuations in their child's care could contribute to future disruption and need to restore their parental role. However, if caregiver development was fostered, caregivers acquired increased ability to prepare for vacillations in their child's care. CONCLUSIONS Improving delivery of family-centered care and support of caregivers at dialysis initiation will require directed efforts by nephrology care teams to foster caregiver evolution and resilience and respond to the family's changing experience of kidney disease. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Taylor R House
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA.
| | - Abby R Rosenberg
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA
| | - Cortney T Zimmerman
- Department of Pediatric Psychology, Texas Children's Hospital, 6701 Fannin Street 16th Floor, Houston, TX, 77030, USA
| | - Krysta S Barton
- Seattle Children's Research Institute, 1920 Terry Ave, M/S CURE-4, PO Box 5371, Seattle, WA, 98145, USA
| | - Aaron Wightman
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA
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Fatigue and Quality of Life in Children with Chronic Kidney Disease. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091414. [PMID: 36138723 PMCID: PMC9497575 DOI: 10.3390/children9091414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 12/02/2022]
Abstract
Background: This study investigates the effect of chronic kidney disease (CKD) stage on fatigue and health-related quality of life (HRQoL) in the pediatric population. Material and Methods: The PedsQL (Pediatric Quality of Life Inventory) Multidimensional Fatigue Scale (subcategories: general, sleep/rest, and cognitive fatigue) and HRQoL Generic Core Scales (subcategories: physical, emotional, social, and school functioning) questionnaires were completed by 30 patients aged from 7 to 18 years old with CKD stage 2−4, CKD stage 5 on dialysis (CKD 5D), and kidney transplantation (KTx), as well as their parents. Results: Both low “Total Fatigue” and “Total HRQoL” scores were reported in 16.7% of patients. “Sleep/Rest Fatigue”, “Emotional Functioning”, and “School functioning” were the lowest scored subcategories. CKD 5D/KTx patients presented lower “Sleep/Rest Fatigue” (p = 0.022) and, more frequently, low “School Functioning” scores (p = 0.029). The “Total HRQoL” score was correlated to the “Total Fatigue” score (rs = 0.625, p < 0.001). A low “Sleep/Rest Fatigue” score was associated with low “Physical Functioning”, “School Functioning”, and “Total HRQoL” scores (p = 0.016, p = 0.001, and p = 0.047 respectively). Parents’ HRQoL score was lower than patients’ score on “Physical Functioning” (p = 0.040) and “School Functioning” subcategories (p = 0.045). Conclusions: Fatigue and disturbed HRQoL are mostly observed in CKD 5D and KTx pediatric patients, and are associated with sleep disorders and school dysfunction. Fatigue affects HRQoL, which is perceived as more deteriorated by the patients’ parents.
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De Bruyne E, Eloot S, Vande Walle J, Raes A, Van Biesen W, Goubert L, Vervoort T, Snauwaert E, Van Hoecke E. Validity and reliability of the Dutch version of the PedsQL™ 3.0 End Stage Renal Disease Module in children with chronic kidney disease in Belgium. Pediatr Nephrol 2022; 37:1087-1096. [PMID: 34599378 DOI: 10.1007/s00467-021-05224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/10/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children with chronic kidney disease (CKD) have a low quality of life (QoL). The PedsQL™ 4.0 Generic Core Scales are widely used to assess general QoL in children. The aim of this cross-sectional study was to translate the original version of the CKD-specific PedsQL™ 3.0 End Stage Renal Disease Module into a Dutch version and to evaluate its validity and reliability. METHODS The forward-backward translation method based on the guidelines from the original developer was used to produce the Dutch version of the PedsQL™ 3.0 ESRD Module. Fifty-eight CKD patients (aged 8-18 years) and their parents (n = 31) filled in both generic and disease-specific modules. The non-clinical control group consisted of the same number of healthy children (matched for gender and age) and their parents. RESULTS Cronbach's alpha coefficients (α's) for the PedsQL™ 3.0 ESRD Module demonstrated excellent reliability for the Total Scale scores. For all 7 subscales, α's were greater than 0.60, except for Perceived Physical Appearance. Overall, intercorrelations with the PedsQL™ 4.0 Generic Core Scales were in the medium to large range, supporting construct validity. Parent proxy reports showed lower generic QoL for all domains in CKD patients compared to healthy children. Child self-reports only demonstrated lower QoL on the domain School Functioning in children with CKD compared to healthy children. CONCLUSIONS This study shows good validity and reliability for the Dutch version of the PedsQL™ 3.0 ESRD Module. However, testing with a larger study group is recommended in order to make final conclusions about the psychometric qualities of this measure. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Elke De Bruyne
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium.
| | - Sunny Eloot
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology & Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Ann Raes
- Department of Pediatric Nephrology & Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Liesbet Goubert
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Tine Vervoort
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | | | - Eline Van Hoecke
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
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ERDUR E, YILDIRIM ÖA, KÖMEK H, POYRAZ K, ÇELİK M, YAMAN M. Evaluation of caregiver burden of cancer patients and impact of this burden on caregiver's quality of life. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1025215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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14
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YİLDİRİM OA, POYRAZ K, ERDUR E, CAN C, GUNDOGAN C, YERLİKAYA H, YİLDİRİM S, GUZEL Y, KÖMEK H. Evaluation of caregiver burden and quality of life in metastatic prostate cancer patients; Effects of clinical and socioeconomic factors. DICLE MEDICAL JOURNAL 2021. [DOI: 10.5798/dicletip.1037634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Ye M, Hu Y, Xue Q, Liang A, Lu Z. Understanding and change - Parents' perspectives of their self-poisoning children: A phenomenological study. Int Emerg Nurs 2021; 59:101074. [PMID: 34597866 DOI: 10.1016/j.ienj.2021.101074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 08/04/2021] [Accepted: 08/19/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE This study aimed to describe the experiences of parents of self-poisoning in Wenzhou, China. BACKGROUND Self-poisoning by a child results in severe trauma, placing parents at great risk for psychological and physical problems. However, few studies have examined the experiences of parents following the attempted suicide of their child through self-poisoning, limiting the ability to guide effective services through empirical research. METHODS The study adopted a qualitative design and 11 parents whose children harmed themselves through self-poisoning were included. Semi-structure, face-to-face interviews were conducted and Colaizzi's analysis method was followed. RESULTS Colaizzi's method identified three key themes: against expectations, sense of guilt, and self-growth. CONCLUSIONS The findings highlight the need to understand experiences of parents with self-poisoning children. Nursing staff play an important role in creating a pathway to connect parents with their children. There is a need to include the voices of parents so as to not only care for self-poisoning children but also understand their suicidal behavior.
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Affiliation(s)
- Minghui Ye
- Nursing Administration Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yingying Hu
- Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qindan Xue
- Cardiology Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Andong Liang
- Nursing Department, Wenzhou Medical University, Wenzhou, China
| | - Zhongqiu Lu
- Emergency department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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16
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Ruidiaz-Gómez KS, Higuita-Gutiérrez LF. Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis. J Pediatr (Rio J) 2021; 97:478-489. [PMID: 33340460 PMCID: PMC9432262 DOI: 10.1016/j.jped.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To meta-analyze health-related quality of life in pediatric patients with chronic kidney disease in comparison to healthy patients according to the dimensions of the PedsQL instrument. SOURCES OF DATA A systematic review was performed with meta-analysis for the mean difference in each of the health-related quality of life dimensions. The authors searched for ten scientific databases including PubMed, Scopus, SciELO, Science Direct, ProQuest, Google Scholar. Reproducibility by the Kappa index was evaluated, and Dersimonian and Laird's tests, RI coefficient, Begg statistic, Forest Plot, and sensitivity analysis were carried out. SUMMARY OF THE FINDINGS 17 investigations were included in the qualitative synthesis and 7 in the quantitative synthesis with a population of 1214 of both healthy and sick pediatric patients with 3-5 chronic kidney disease stages. The health-related quality of life in pediatric chronic kidney disease patients presented lower scores in all the evaluated dimensions: in the physical dimension the difference is of 13.6 points, in the emotional dimension 7.8, in the social dimension 8.2, in the school dimension 20.8, with the total difference being 17.7 points. CONCLUSION The findings of this study show that pediatric patients have lower health-related quality of life in all the evaluated dimensions, with the "school" dimension being the most affected and the "emotional" one the least. In this sense, we suggest monitoring the health-related quality of life of pediatric patients with chronic kidney disease so that interventions can be oriented to strengthen the affected dimensions, including adjustments to daily life and prevention of complications related to the disease.
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Affiliation(s)
- Keydis Sulay Ruidiaz-Gómez
- University of Antioquia, Faculty of Nursing, Medellin, Colombia; Sinú University Elías Bechara Zainúm, Nursing Program, Cartagena, Colombia.
| | - Luis Felipe Higuita-Gutiérrez
- Cooperative University of Colombia, Faculty of Medicine, Medellin, Colombia; University of Antioquia, School of Microbiology, Medellin, Colombia
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17
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House TR, Wightman A. Adding Life to Their Years: The Current State of Pediatric Palliative Care in CKD. KIDNEY360 2021; 2:1063-1071. [PMID: 35373080 PMCID: PMC8791371 DOI: 10.34067/kid.0000282021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/05/2021] [Indexed: 01/16/2023]
Abstract
AbstractDespite continued advances in medical treatment, pediatric CKD remains an unremitting, burdensome condition characterized by decreased quality of life and earlier death. These burdens underscore the need for integration of pediatric palliative care (PPC) into nephrology practice. PPC is an evolving field that strives to (1) relieve physical, psychologic, social, practical, and existential suffering; (2) improve quality of life; (3) facilitate decision making; and (4) assist with care coordination in children with life-threatening or life-shortening conditions. Integration of palliative care into routine care has already begun for adults with kidney disease and children with other chronic diseases; however, similar integration has not occurred in pediatric nephrology. This review serves to provide a comprehensive definition of PPC, highlight the unmet need in pediatric nephrology and current integration efforts, discuss the state of palliative care in adult nephrology and analogous chronic pediatric disease states, and introduce future opportunities for study.
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18
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Kerklaan J, Hannan E, Baumgart A, Manera KE, Ju A, McCulloch M, Admani B, Dominello A, Esezobor C, Foster B, Hamilton A, Jankauskiene A, Johnson RJ, Liu I, Marks SD, Neu A, Schaefer F, Sutton S, Wolfenden S, Craig JC, Groothoff J, Howell M, Tong A. Patient- and parent proxy-reported outcome measures for life participation in children with chronic kidney disease: a systematic review. Nephrol Dial Transplant 2021; 35:1924-1937. [PMID: 32743664 DOI: 10.1093/ndt/gfaa132] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The burden of chronic kidney disease (CKD) and its treatment may severely limit the ability of children with CKD to do daily tasks and participate in family, school, sporting and recreational activities. Life participation is critically important to affected children and their families; however, the appropriateness and validity of available measures used to assess this outcome are uncertain. The aim of this study was to identify the characteristics, content and psychometric properties of existing measures for life participation used in children with CKD. METHODS We searched MEDLINE, Embase, PsychINFO, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Kidney and Transplant register to August 2019 for all studies that used a measure to report life participation in children with CKD. For each measure, we extracted and analyzed the characteristics, dimensions of life participation and psychometric properties. RESULTS From 128 studies, we identified 63 different measures used to assess life participation in children with CKD. Twenty-five (40%) of the measures were patient reported, 7 (11%) were parent proxy reported and 31 (49%) had both self and parent proxy reports available. Twenty-two were used in one study only. The Pediatric Quality of Life Inventory version 4.0 generic module was used most frequently in 62 (48%) studies. Seven (11%) were designed to assess ability to participate in life, with 56 (89%) designed to assess other constructs (e.g. quality of life) with a subscale or selected questions on life participation. Across all measures, the three most frequent activities specified were social activities with friends and/or family, leisure activities and self-care activities. Validation data in the pediatric CKD population were available for only 19 (30%) measures. CONCLUSIONS Life participation is inconsistently measured in children with CKD and the measures used vary in their characteristics, content and validity. Validation data supporting these measures in this population are often incomplete and are sparse. A meaningful and validated measure for life participation in children with CKD is needed.
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Affiliation(s)
- Jasmijn Kerklaan
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Elyssa Hannan
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Amanda Baumgart
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Karine E Manera
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Angela Ju
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Mignon McCulloch
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Bashir Admani
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Amanda Dominello
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Christopher Esezobor
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Bethany Foster
- Department of Pediatrics, Division of Nephrology, Montreal Children's Hospital of the McGill University Health Centre, Montreal, QB, Canada
| | | | - Augustina Jankauskiene
- Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Rebecca J Johnson
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Isaac Liu
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Alicia Neu
- Division of Pediatric Nephrology, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Shanna Sutton
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Sebastian Wolfenden
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
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Gezgin Yıldırım D, Bakkaloğlu SA, Soysal Acar AŞ, Çelik B, Buyan N. Evaluation of caregiver burden and coping strategies in parents of paediatric familial Mediterranean fever patients in relation to illness severity, therapy and health-related quality of life. Qual Life Res 2021; 30:1347-1354. [PMID: 33447957 DOI: 10.1007/s11136-020-02739-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The study aimed to determine the caregiver burden and coping strategies in caregivers of familial Mediterranean fever (FMF) patients in relation to illness severity, therapy and health-related quality of life (HRQoL). METHODS The study included 171 paediatric FMF patients and their caregivers (parents). The caregivers were asked to complete a socio-demographic form, the Zarit caregiver burden interview (ZCBI) and the Brief COPE. The patients and their caregivers were asked to complete the KINDer Lebensqualitätsfragebogen questionnaire (self-report and proxy report, respectively) for assessing HRQoL. The patients were categorised according to their disease activity (mild, moderate or severe) and the presence or absence of anti-IL-1 therapy. RESULTS The mean ZCBI score of the caregivers was 44.7 ± 13.5. ZCBI and COPE scores did not differ significantly between the caregivers of FMF patients receiving and not receiving anti-IL-1 therapy. However, dysfunctional COPE (p = 0.039) and ZCBI (p = 0.021) scores showed a significant difference between the caregivers in relation to patient's disease severity. ZCBI scores were positively correlated with dysfunctional coping (p = 0.01). Self-reported HRQoL disease module scores were lower for the patients who received anti-IL-1 therapy than for those did not (p = 0.009). Proxy-reported (p < 0.001) and self-reported (p = 0.043) HRQoL disease module scores were lower for the patients with severe disease activity. CONCLUSIONS As the caregiver burden increases, parents tend to use a dysfunctional coping strategy. Good control of disease activity with administration of medical therapy can reduce the disease severity, thereby decrease the caregiver burden, and secondly help to reduce the usage of dysfunctional coping in caregivers.
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Affiliation(s)
- Deniz Gezgin Yıldırım
- Department of Paediatric Rheumatology, Gazi University Faculty of Medicine, 06560, Ankara, Turkey.
| | - Sevcan A Bakkaloğlu
- Department of Paediatric Rheumatology, Gazi University Faculty of Medicine, 06560, Ankara, Turkey
| | | | - Bülent Çelik
- Department of Biostatistics, Gazi University Faculty of Science, Ankara, Turkey
| | - Necla Buyan
- Department of Paediatric Rheumatology, Gazi University Faculty of Medicine, 06560, Ankara, Turkey
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Kasemy ZA, Hathout HM, Omar ZA, Samir MA, Bahbah WA. Effect of Omega-3 supplements on quality of life among children on dialysis: A prospective cohort study. Medicine (Baltimore) 2020; 99:e22240. [PMID: 33019398 PMCID: PMC7535790 DOI: 10.1097/md.0000000000022240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Children with end stage renal disease (ESRD) are liable to various health disorders that possibly impair their quality of life (QoL). Low dietary intake of Omega-3 fatty acids also called marine n-3 fatty acid (n-3 FA) may be associated with health problems which are among the leading causes of impaired QoL.The objective of this study was to assess the effect of omega-3 Fatty acid (n-3 FA) supplements on quality of life among children on dialysis and to evaluate its use regarding adequacy of dialysis and inflammatory markers.A prospective cohort study was conducted on 31 hemodialysis children. Quality of life was measured for patients and an equal number of matched controls using the PedsQL Inventory where the higher the score the poorer is the quality of life. n-3FA supplementation had been given to the patients for 3 months to study its effects on QoL. Laboratory investigations like hemoglobin, lipid profile, inflammatory markers, and tests for adequacy of dialysis had been carried out.Patients had significantly higher QoL scores (42.22 ± 13.31) than controls (22.70 ± 1.31) (P < .001). Young ages showed higher score of physical functioning (18.23 ± 4.22) than older ones (13.92 ± 6.84) (P = .049). Females had significantly higher total QoL score (25.53 ± 6.61) than males (20.06 ± 7.09) (P = .010). The total QoL score was significantly lower post than pre administration of n-3FA (35.41 ± 10.36 vs 42.22 ± 13.31) (P < .001). Triglycerides and CRP were significantly lower post than pre n-3FA supplementation (160.64 ± 32.55 vs 169.35 ± 31.82) (P < .001) and (10.29 ± 4.39 vs 11.19 ± 4.83) (P = .006) respectively. Means of Kt/V and urea reduction ratio (URR) were significantly higher post (1.37 ± 0.09, 70.0 ± 5.99 respectively) than pre n-3FA (1.31 ± 0.07 and 65.25 ± 6.06 respectively) (P = .005, .001 respectively).Quality of life and adequacy of dialysis get improved after n-3FA supplementation among children on dialysis which encourages its testing for more patients to evaluate its long term effects and support its routine use.
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Affiliation(s)
| | | | - Zein A. Omar
- Pediatrics department, Menoufia Faculty of Medicine, Egypt
| | | | - Wael A. Bahbah
- Pediatrics department, Menoufia Faculty of Medicine, Egypt
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Psychosocial considerations and recommendations for care of pediatric patients on dialysis. Pediatr Nephrol 2020; 35:767-775. [PMID: 30895367 DOI: 10.1007/s00467-019-04227-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/22/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
Dialysis treatment has evolved to enable children to live longer and transition to adulthood. Thus, the focus of care shifts to a consideration of pediatric patients' quality of life and psychosocial functioning across childhood, adolescence, and young adulthood. Despite well-documented concerns in various domains (including depression/anxiety, self-esteem and social functioning, behavior problems, and academic and cognitive functioning), limited literature exists regarding psychosocial guidelines for children and adolescents undergoing dialysis. This article aims to address this gap by providing a review of the pediatric literature examining psychosocial functioning in patients treated with dialysis, as well as recommendations for specific psychosocial concerns. Overall recommendations for care include screening for anxiety and depression, referral to pediatric psychologists for evidence-based intervention, utilization of child life specialists, opportunities to promote social functioning, neuropsychological evaluation and school programming, ongoing support in preparing for transition to adult care, and periodic measure of quality of life. Together, these suggestions promote a holistic approach to patient-centered care by supporting both physical and psychosocial well-being.
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Anthony SJ, Stinson H, Lazor T, Young K, Hundert A, Santana MJ, Stinson J, West L. Patient-reported outcome measures within pediatric solid organ transplantation: A systematic review. Pediatr Transplant 2019; 23:e13518. [PMID: 31210404 DOI: 10.1111/petr.13518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/09/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023]
Abstract
Subjective evaluation of medical care and disease outcomes from patients' perspectives has become increasingly important. Patient-reported outcome measures (PROMs) play a prominent role in engaging patients, capturing their experiences and improving patient care. This systematic review sought to identify PROMs that are used in the field of pediatric solid organ transplantation, with the aim to inform the implementation of PROMs into clinical practice for this population. A systematic review of English language, peer-reviewed articles was performed on key health science databases to identify publications using PROMs in pediatric solid organ transplantation. The search yielded 3670 articles, with a final data set of 62 articles that included 47 different PROMs. The three most frequently used PROMs included the following: (a) PedsQL™ Generic Core Scales (n = 25); (b) Children's Depression Inventory (n = 6); and (c) Child Health Questionnaire (n = 6). Of the 47 PROMs, 42 were generic and five were disease-specific; only six PROMS had a documented psychometric evaluation within a pediatric solid organ transplant population. This review outlines the attributes of the instruments (eg, domains captured), as well as the psychometric properties of those evaluated. PROMs are increasingly used in the field of pediatric transplantation; however, there are limited details in the current literature about their conceptual underpinnings and psychometric properties. This review highlights the need for additional psychometric evaluation of identified measures to establish the necessary foundation to inform the implementation of PROMs into clinical care for pediatric solid organ transplant patients.
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Affiliation(s)
- Samantha J Anthony
- Hospital for Sick Children, Toronto, Ontario, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | | | - Tanya Lazor
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Amos Hundert
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maria J Santana
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Stinson
- Hospital for Sick Children, Toronto, Ontario, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Lori West
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada.,Cardiac Transplantation, Pediatrics, Surgery and Immunology, University of Alberta, Edmonton, Alberta, Canada
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Clavé S, Tsimaratos M, Boucekine M, Ranchin B, Salomon R, Dunand O, Garnier A, Lahoche A, Fila M, Roussey G, Broux F, Harambat J, Cloarec S, Menouer S, Deschenes G, Vrillon I, Auquier P, Berbis J. Quality of life in adolescents with chronic kidney disease who initiate haemodialysis treatment. BMC Nephrol 2019; 20:163. [PMID: 31088395 PMCID: PMC6515621 DOI: 10.1186/s12882-019-1365-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 04/30/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To describe the quality of life of adolescents initiating haemodialysis, to determine the factors associated with quality of life, and to assess coping strategies and their impact on quality of life. METHODS All adolescents initiating haemodialysis between September 2013 and July 2015 in French paediatric haemodialysis centres were included. Quality of life data were collected using the "Vécu et Santé Perçue de l'Adolescent et l'Enfant" questionnaire, and coping data were collected using the Kidcope questionnaire. Adolescent's quality of life was compared with age- and sex-matched French control. RESULTS Thirty-two adolescents were included. Their mean age was 13.9 ± 2.0 years. The quality of life score was lowest in leisure activities and highest in relationships with medical staff. Compared with the French control, index, energy-vitality, relationships with friends, leisure activities and physical well-being scores were significantly lower in haemodialysis population. In multivariate analyses, active coping was positively associated with quality of life and especially with energy-vitality, relationships with parents and teachers, and school performance. In contrast, avoidant and negative coping were negatively associated with energy-vitality, psychological well-being and body image for avoidant coping, and body image and relationships with medical staff for negative coping. CONCLUSIONS The quality of life of haemodialysis adolescents, and mainly the dimensions of leisure activities, physical well-being, relationships with friends and energy-vitality, were significantly altered compared to that of the French population. The impact of coping strategies on quality of life seems to be important. Given the importance of quality of life and coping strategies in adolescents with chronic disease, health care professionals should integrate these aspects into care management.
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Affiliation(s)
- Stéphanie Clavé
- Department of Multidisciplinary Pediatrics, Hôpital de la Timone Enfant, Assistance Publique des Hôpitaux de Marseille, Marseille, France. .,Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: - CEReSS Health Service Research and Quality of Life Center, Marseille, France.
| | - Michel Tsimaratos
- Department of Multidisciplinary Pediatrics, Hôpital de la Timone Enfant, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Mohamed Boucekine
- Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: - CEReSS Health Service Research and Quality of Life Center, Marseille, France
| | - Bruno Ranchin
- Department of Pediatric Nephrology, Hôpital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France
| | - Rémi Salomon
- Department of Pediatric Nephrology, Assistance Publique des Hôpitaux de Paris, University Hospital Necker-Enfants Malades, Paris, France
| | - Olivier Dunand
- Department of Pediatrics, Hôpital Félix Guyon, University Hospital La Réunion, Saint-Denis, La Réunion, France
| | - Arnaud Garnier
- Department of Pediatric Nephrology, Children Hospital Toulouse, Toulouse, France
| | - Annie Lahoche
- Department of Pediatric Nephrology, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France
| | - Marc Fila
- Department of Pediatric Nephrology, hôpital Arnaud-de-Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Gwenaelle Roussey
- Department of Pediatrics, University Hospital of Nantes, Nantes, France
| | - Francoise Broux
- Department of Pediatrics, Pediatric Nephrology and Hemodialysis Unit, University Hospital Charles Nicolle, Rouen, France
| | - Jérome Harambat
- Department of Pediatrics, Hôpital Pellegrin-Enfants, University Hospital of Bordeaux, Bordeaux, France
| | - Sylvie Cloarec
- Department of Pediatric Nephrology and Hemodialysis, Clocheville Hospital, University Hospital of Tours, Tours, France
| | - Soraya Menouer
- Department of Pediatrics 1, University Hospital of Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Georges Deschenes
- Department of Pediatric Nephrology, Assistance publique des Hôpitaux de Paris, University Hospital Robert Debré, Paris, France
| | - Isabelle Vrillon
- Department of Pediatric Nephrology, Hôpital d'Enfants Brabois, Nancy, France
| | - Pascal Auquier
- Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: - CEReSS Health Service Research and Quality of Life Center, Marseille, France
| | - Julie Berbis
- Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: - CEReSS Health Service Research and Quality of Life Center, Marseille, France
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Wightman A, Bradford MC, Smith J. Health-related quality of life changes following renal transplantation in children. Pediatr Transplant 2019; 23:e13333. [PMID: 30548760 PMCID: PMC10762692 DOI: 10.1111/petr.13333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Studies of HRQoL after kidney transplant have yielded conflicting results. We sought to assess the impact of kidney transplant on HRQoL. METHODS We performed a retrospective study using the PedsQL3.0ESRD module during dialysis and at 3 and 12 months following kidney transplant in 56 recipients. For the entire cohort, we described HRQoL scores at each time point and used ANOVA models to test for associations between demographic and transplant-related factors and post-transplant scores. We used linear mixed models to investigate interactions between transplant and demographic and transplant-related factors and to estimate differences between mean pre- and post-transplant scores. Longitudinal changes in HRQoL were assessed by t test. RESULTS We found increases in all mean total scores, including subscales, at each assessed time period from dialysis to 3 months post-transplant to 12 months post-transplant. Post-transplant total scores did not differ by gender, race, proximity to hospital, allograft source, or dialysis modality, but did differ by recipient age. Among participants with both pre- and post-transplant observations, total scores increased for both recipients and parent-proxies. CONCLUSIONS This study affirms the association between kidney transplant and improvement in HRQoL in the first year following transplant. Future research should further explore outcomes over the longer-term and factors contributing to HRQoL among this population.
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Affiliation(s)
- Aaron Wightman
- Division of Nephrology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Division of Nephrology, Seattle Children’s Hospital, Seattle, WA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA
| | - Miranda C. Bradford
- Core for Biomedical Statistics, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA
| | - Jodi Smith
- Division of Nephrology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Division of Nephrology, Seattle Children’s Hospital, Seattle, WA
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Pardede S, Rafli A, Gunardi H. Quality of Life in Chronic Kidney disease children using assessment Pediatric Quality Of Life Inventory™. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2019; 30:812-818. [DOI: 10.4103/1319-2442.265456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Araújo NSS, Pereira RRF, Fram D, Hino P, Longo MCB, Taminato M. Quality of life in children with kidney transplant: Systematic review. Rev Bras Enferm 2018; 71:2818-2823. [PMID: 30540061 DOI: 10.1590/0034-7167-2018-0464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/30/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify in the literature studies that evaluate the quality of life in pediatric patients with kidney transplant through use of specific, validated instruments in Pediatrics. METHOD Systematic review of the literature with searches conducted in the following databases: Medline, PubMed, LILACS, CINAHL, SciELO and Cochrane Library. Main keywords: Quality of life, Kidney transplantation and Pediatrics. RESULTS A total of 366 studies were selected and eight observational studies were included that evaluated the quality of life of children with kidney transplant by means of evaluation instruments of quality of life. CONCLUSION The quality of life of children with kidney transplant is inferior compared to healthy children. The post-transplant period presents better results compared to pre-transplant children. The identification of mental, physical and social conditions related to the quality of life of this population allows for better planning the assistance provided to them.
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Affiliation(s)
| | | | - Dayana Fram
- Universidade Federal de São Paulo, Paulista Nursing School. São Paulo, São Paulo, Brazil
| | - Paula Hino
- Universidade Federal de São Paulo, Paulista Nursing School. São Paulo, São Paulo, Brazil
| | | | - Monica Taminato
- Universidade Federal de São Paulo, Paulista Nursing School. São Paulo, São Paulo, Brazil
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Assessment of Quality of Life among Children with End-Stage Renal Disease: A Cross-Sectional Study. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2018; 2018:8565498. [PMID: 30305825 PMCID: PMC6165587 DOI: 10.1155/2018/8565498] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/12/2018] [Accepted: 07/31/2018] [Indexed: 01/18/2023]
Abstract
Background Measuring health-related quality of life is considered an important outcome indicator in evaluating health-care interventions and treatments and in understanding the burden of diseases. Objectives This study aimed at assessing quality of life among children with end-stage renal disease, either undergoing hemodialysis or had renal transplantation therapy and comparing it with healthy controls. Methods A cross-sectional study was conducted between December 2016 and May 2017 in Abo El-Reesh Pediatric Hospital using parent/child reports of generic module for QoL assessment: PedsQLTM Inventory version 4 for both cases and controls. Disease-specific module: PedsQLTM ESRD version 3 was used for ESRD cases. 55 ESRD cases and 86 controls were enrolled in the study. Results Statistically significant difference between ESRD cases and controls regarding all aspects of QoL was found; total QoL mean score was 58.4 ± 15.3 and 86.8 ± 10 among cases and controls, respectively. All individual QoL domains were significantly worse in ESRD cases. Transplantation group had better Spearman's correlation between child and parents' scores which showed significant positive moderate correlation. Conclusions ESRD and its treatment modalities are affecting negatively all aspects of quality of life; incorporating QoL assessment and management is highly recommended.
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The Adaptation and Psychometric Properties of the Kid-KINDL R for Hospitalized Children in Chile. J Pediatr Nurs 2018; 41:e8-e15. [PMID: 29477451 DOI: 10.1016/j.pedn.2018.02.007] [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] [Received: 07/11/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE The impact of hospitalization on a child's well-being leads one to consider the health-related quality of life (HRQoL) measure as a fundamental aspect of pediatric care. The aims of the study were to adapt the Spanish version of the Kid-KINDL® to hospitalized children in Chile, to obtain a reduced version of the instrument and to analyze the psychometric properties of the reduced version. DESIGN AND METHODS An expert committee and interviews were carried out for the cross-cultural adaptation process. An exploratory factor analysis was conducted to examine the validity of the construct and to select the items for the reduced version. Cronbach's alpha was used to estimate the internal consistency of the adapted version of the Kid-KINDL® and the reliability of each component. Convergent validity was based on correlations with a pain scale. RESULTS This adapted and shorter instrument, similar to the original version, comprises five components that include the principal dimensions of HRQoL. Evaluating the School dimension in hospitalized children was considered inappropriate in Chilean public hospitals. The study replicates the relationship found between a child with high pain and low reported HRQoL. CONCLUSIONS The hospitalization process impacted the children's perceptions of their HRQoL. The reduced version of the Kid-KINDL® was found to be a valid instrument for assessing children's HRQoL in hospital units. PRACTICE IMPLICATIONS Finding effective ways to measure HRQoL and ultimately mitigate barriers and foster resilience are important clinical and research priorities in the pursuit of HRQoL for hospitalized children and their families.
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Splinter A, Tjaden LA, Haverman L, Adams B, Collard L, Cransberg K, van Dyck M, Van Hoeck KJ, Hoppe B, Koster-Kamphuis L, Lilien MR, Raes A, Taylan C, Grootenhuis MA, Groothoff JW. Children on dialysis as well as renal transplanted children report severely impaired health-related quality of life. Qual Life Res 2018; 27:1445-1454. [PMID: 29374855 PMCID: PMC5951873 DOI: 10.1007/s11136-018-1789-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 11/26/2022]
Abstract
Objectives To assess health-related quality of life (HRQoL) across three renal replacement therapy modalities (preemptive transplant, non-preemptive transplant, and dialysis) in comparison with the healthy norm and other chronic health conditions, and to explore related patient factors. Study design All prevalent end-stage renal disease (ESRD) patients aged 8–18 years who spent at least 6 months on their current treatment modality in the Netherlands, Belgium, and part of Germany were approached to complete the Pediatric Quality of Life Inventory 4.0 (PedsQL™) questionnaire. We determined the differences between groups on PedsQL™ mean scores, the proportion of children with an impaired HRQoL (≥ 1 SD lower than the healthy norm), the proportion of problems on individual items of the PedsQL™, and the effect of time on current treatment. Linear regression models were used to explore determinants of HRQoL. Results 192 out of 278 patients (20% preemptive transplant, 58% non-preemptive transplant, 22% dialysis) filled in the PedsQL™ (response rate 69%). Independent of treatment modality, patients had significantly lower mean scores and consequently higher proportions of impaired HRQoL on almost all domains compared to the healthy norm and other chronic health conditions. Patients with a preemptive transplant only reported higher scores on physical health compared to the other treatment modalities. Having comorbidities was the most important determinant associated with lower HRQoL scores. Conclusion Dialysis and renal transplantation both have a severe impact on the HRQoL of children with ESRD. Physicians should be aware of this continuous burden. Furthermore, to develop tailored interventions for children with ESRD, qualitative studies are needed to gain more insight in the determinants of HRQoL in the different treatment modalities.
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Affiliation(s)
- Anouck Splinter
- Psychosocial Department, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Lidwien A Tjaden
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Lotte Haverman
- Psychosocial Department, Emma Children's Hospital, Amsterdam, The Netherlands.
| | - Brigitte Adams
- Department of Pediatric Nephrology, Hôpital Universitaire des Enfants-Reine Fabiola, Brussels, Belgium
| | - Laure Collard
- Department of Pediatric Nephrology, Centre Hospitalier Universitaire de Liège, Liege, Belgium
| | - Karlien Cransberg
- Department of Pediatric Nephrology, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Maria van Dyck
- Department of Pediatric Nephrology, University Hospital Leuven, Leuven, Belgium
| | - Koen J Van Hoeck
- Department of Pediatric Nephrology, University Hospital Antwerp, Antwerp, Belgium
| | - Bernd Hoppe
- Department of Pediatrics, University Medical Centre, Bonn, Germany
| | - Linda Koster-Kamphuis
- Department of Pediatric Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Marc R Lilien
- Department of Pediatric Nephrology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ann Raes
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Christina Taylan
- Department of Pediatric Nephrology, University Hospital Cologne, Cologne, Germany
| | | | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam, The Netherlands
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Baek HS, Kang HG, Choi HJ, Cheong HI, Ha IS, Han KH, Kim SH, Cho HY, Shin JI, Park YS, Lee JH, Lee J, Ahn C, Cho MH. Health-related quality of life of children with pre-dialysis chronic kidney disease. Pediatr Nephrol 2017; 32:2097-2105. [PMID: 28685173 DOI: 10.1007/s00467-017-3721-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/05/2017] [Accepted: 06/08/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The goal of this study was to evaluate the quality of life (QOL) of Asian children with pre-dialysis chronic kidney disease (CKD) and to reveal the factors influencing the QOL of children with CKD. METHODS We performed a cross-sectional study of the PedsQL 4.0 Generic Core Scale Module in the KNOW-PedCKD (KoreaN cohort study for Outcome in patients with Pediatric Chronic Kidney Disease) cohort, and compared the child self-reported and parent proxy-reported QOL of the pediatric cohort. From 2011 through 2016, a total of 376 children with CKD were enrolled after informed consent was obtained from parents or caregivers in seven pediatric nephrology centers. RESULTS In parent proxy-reports, male patients had a better QOL than female patients in the Physical Functioning category. In child self-reports, male patients had better QOL than female patients in the Physical, Emotional, and School Functioning categories. According to CKD stage, there were significant differences in the QOL score in all categories of parent proxy-reports, and patients with higher CKD stage (lower glomerular filtration rate) had a worse QOL. Growth parameters showed a significantly positive correlation with the QOL score in all categories. CONCLUSIONS The QOL of children with predialysis CKD is affected by various factors, including sex, glomerular filtration rate (GFR), socio-economic status, existence of co-morbidities, anemia, growth retardation, and behavioral disorders. To improve their QOL, it is important to objectively understand the respective effects of these factors and attempt early intervention.
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Affiliation(s)
- Hee Sun Baek
- Department of Pediatrics, Kyungpook National University Children's Hospital, 807, Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hyun Jin Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Il Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Kyung Hee Han
- Department of Pediatrics, Jeju University Hospital, Jeju, South Korea
| | - Seong Heon Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, South Korea
| | - Hee Yeon Cho
- Department of Pediatrics, Samsung Medical Center, Seoul, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Severance Children's Hospital, Seoul, South Korea
| | - Young Seo Park
- Department of Pediatrics, Asan Medical Center, Seoul, South Korea
| | - Joo Hoon Lee
- Department of Pediatrics, Asan Medical Center, Seoul, South Korea
| | - Joongyub Lee
- Department of Preventive Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Min Hyun Cho
- Department of Pediatrics, Kyungpook National University Children's Hospital, 807, Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea.
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Long-term health-related quality of life and psychological adjustment in children after haemolytic-uraemic syndrome. Pediatr Nephrol 2017; 32:869-878. [PMID: 28012007 DOI: 10.1007/s00467-016-3569-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND In children after haemolytic-uraemic syndrome (HUS), little is known about long-term health-related quality of life (HRQoL) and psychological adjustment as defined by behavioural problems, depressive symptoms and post-traumatic stress symptoms. METHODS Sixty-two paediatric patients with a history of HUS were included in this study. Medical data of the acute HUS episode were retrieved retrospectively from hospital records. Data on the clinical course at study investigation were assessed by clinical examination and laboratory evaluation. HRQoL and psychological adjustment data were measured by standardised, parent- and self-reported questionnaires. RESULTS Haemolytic-uraemic syndrome was diagnosed at a mean of 6.5 years before the initiation of the study (standard deviation 2.9, range 0.1-15.7) years. Among the preschool children, parents reported that their child was less lively and energetic (HRQoL emotional dimension), while no increased behavioural problems were reported. In the school-age children, self- and proxy-reported HRQoL was well within or even above the norms, while increased total behavioural problems were found. The school-age children reported no increased depression scores. Also none of the children met the criteria for full or partial HUS-associated posttraumatic stress disorder. CONCLUSIONS Healthcare providers should be particularly alert to behavioural problems in school-age children with a history of HUS and to lower HRQoL in preschool children.
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Medyńska A, Zwolińska D, Grenda R, Miklaszewska M, Szczepańska M, Urzykowska A, Zachwieja K, Kiliś-Pstrusińska K. Psychosocial aspects of children and families treated with hemodialysis. Hemodial Int 2017; 21:557-565. [PMID: 28111890 DOI: 10.1111/hdi.12526] [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] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The aim of this study was to analyze the selected psychosocial aspects of chronic kidney disease in children treated with hemodialysis (HD). METHODS The study included 25 children treated with HD aged 2 to 18 years and their parents. Data concerning the illness and socio-demographic parameters was collected. We used the Paediatric Quality of Life Inventory (PedsQL) for patients and for their parents the PedsQL-proxy version, General Health Questionnaire (GHQ-12), Berlin Social Support Scales (BSSS), and the Caregivers Burden Scale (CBS) to evaluate health-related quality of life (QoL) of HD children and their primary caregivers. FINDINGS In the PedsQL test, the QoL of HD children was lower than in healthy children. Children treated with HD assessed their QoL on the PedsQL questionnaire higher than the primary caregivers, on all subscales as well as an overall health-related QoL. Scoring below 2 on the GHQ-12 test was reported in 56% of mothers, which may indicate that psychological symptoms have intensified. There was no correlation between BSSS, CBS, and GHQ-12. DISCUSSION The assessment of QoL in pediatric patients would allow for the earliest possible identification of their nonsomatic problems and irregularities. This could, consequently, contribute to improving QoL in both children with chronic kidney disease and their families.
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Affiliation(s)
- Anna Medyńska
- Department of Pediatric Nephrology, Wroclaw Medical University, Wroclaw, Poland
| | - Danuta Zwolińska
- Department of Pediatric Nephrology, Wroclaw Medical University, Wroclaw, Poland
| | - Ryszard Grenda
- Department of Nephrology, Kidney Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| | - Monika Miklaszewska
- Polish-American Children's Hospital, Jagiellonian University, Krakow, Poland
| | - Maria Szczepańska
- Clinic of Pediatrics, Nephrology and Endocrinology, Silesian Medical University, Zabrze, Poland
| | - Agnieszka Urzykowska
- Department of Nephrology, Kidney Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| | - Katarzyna Zachwieja
- Polish-American Children's Hospital, Jagiellonian University, Krakow, Poland
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Dotis J, Pavlaki A, Printza N, Stabouli S, Antoniou S, Gkogka C, Kontodimopoulos N, Papachristou F. Quality of life in children with chronic kidney disease. Pediatr Nephrol 2016; 31:2309-2316. [PMID: 27677977 DOI: 10.1007/s00467-016-3457-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 05/17/2016] [Accepted: 06/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Progressive chronic kidney disease (CKD), irrespective of the underlying etiology, affects the quality of life (QoL) of children due to the need for regular follow-up visits, a strict medication program and diet intake. METHODS The Greek version of the KIDSCREEN-52 multidimensional questionnaire was used in children with CKD, renal transplantation (RT) and in a control group (CG) of healthy children. RESULTS Fifty-five patients between 8 and 18 years, with CKD (n = 25), RT (n = 16) and with end-stage renal disease (ESRD) on peritoneal dialysis (PD) (n = 14) were included. Each group of studied children was compared with the CG (n = 55), the validation sample (VS) (n = 1200) and the parent proxy scores. Physical well-being of all studied children was significantly lower compared to CG (p = 0.004). In contrast, all studied children between 8 and 11 years showed better social acceptance compared to VS (p = 0.0001). When QoL of children with CKD was compared with parent proxy QoL, conflicting opinions were observed in several dimensions, such as self-perception (p = 0.023), autonomy (p = 0.012), school environment (p = 0.012) and financial resources (p = 0.03). CONCLUSIONS QoL and mainly the dimension of physical well-being, may be affected dramatically in children with CKD unrelated to disease stage. In early school years children with CKD seem to feel higher social acceptance than the healthy controls, exhibiting better score in this dimension. Optimal care requires attention not only to medical management, but also to an assessment of QoL factors, that may help promote pediatric patient's health.
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Affiliation(s)
- John Dotis
- First Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. .,Open University of Cyprus, Latsia, Nicosia, Cyprus.
| | - Antigoni Pavlaki
- First Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikoleta Printza
- First Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Stabouli
- First Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stamatia Antoniou
- Department of Pediatrics, General Hospital of Xanthi, Xanthi, Greece
| | - Chrysa Gkogka
- First Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Fotios Papachristou
- First Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tjaden LA, Grootenhuis MA, Noordzij M, Groothoff JW. Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice. Pediatr Nephrol 2016; 31:1579-91. [PMID: 26310616 PMCID: PMC4995226 DOI: 10.1007/s00467-015-3186-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 11/14/2022]
Abstract
Health-related quality of life (HRQoL) is increasingly recognized as a key outcome in both clinical and research settings in the pediatric population with end-stage renal disease (ESRD). This review aims to: (1) summarize the current knowledge on HRQoL and socioprofessional outcomes and (2) provide strategies for incorporation of HRQoL assessment into clinical practice. Studies report that pediatric patients with ESRD have significantly lower HRQoL scores compared with children with other chronic diseases. Patients treated by dialysis are at particularly high risk for impaired HRQoL. Furthermore, patients more often have impaired neurocognitive functioning and lower academic achievement. Important determinants of impaired HRQoL include medical factors (i.e., receiving dialysis, disabling comorbidities, cosmetic side effects, stunted growth), sociodemographic factors (i.e., female gender, non-Western background) and psychosocial factors (i.e., noneffective coping strategies). Contrary to the situation in childhood, adult survivors of pediatric ESRD report a normal mental HRQoL. Despite this subjective feeling of well-being, these patients have on average experienced significantly more difficulties in completing their education, developing intimate relationships, and securing employment. Several medical and psychosocial strategies may potentially improve HRQoL in children with ESRD. Regular assessment of HRQoL and neurocognitive functioning in order to identify areas in which therapies and interventions may be required should be part of standard clinical care.
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Affiliation(s)
- Lidwien A Tjaden
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Marlies Noordzij
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
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Wightman AG, Freeman MA. Update on Ethical Issues in Pediatric Dialysis: Has Pediatric Dialysis Become Morally Obligatory? Clin J Am Soc Nephrol 2016; 11:1456-1462. [PMID: 27037272 PMCID: PMC4974893 DOI: 10.2215/cjn.12741215] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Improvements in pediatric dialysis over the past 50 years have made the decision to proceed with dialysis straightforward for the majority of pediatric patients. For certain groups, however, such as children with multiple comorbid conditions, children and families with few social and economic resources, and neonates and infants, the decision of whether to proceed with dialysis remains much more controversial. In this review, we will examine the best available data regarding the outcomes of dialysis in these populations and analyze the important ethical considerations that should guide decisions regarding dialysis for these patients. We conclude that providers must continue to follow a nuanced and individualized approach in decision making for each child and to recognize that, regardless of the decision reached about dialysis, there is a continued duty to care for patients and families to maximize the remaining quality of their lives.
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Affiliation(s)
- Aaron G Wightman
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, Washington; and
| | - Michael A Freeman
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
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Abstract
Advancements in paediatric heart failure management have resulted in improved survival and a focus on long-term outcomes including health-related quality of life. We compared health-related quality of life in children with heart failure with healthy patients, children with chronic conditions, and children with cardiovascular disease. Families (n=63) and children (n=73) aged 2-20 years with heart failure were enrolled and compared with data previously published for healthy patients (n=5480), those with chronic conditions (n=247), and those with cardiovascular disease (n=347). Patients and parents completed the PedsQL 4.0 and the Cardiac 3.0 Module health-related quality-of-life questionnaires. PedsQL scores including Total, Psychosocial Health Summary, and Physical were compared between groups. In general, patients with heart failure had lower scores than the healthy population (p=0.001), and comparable scores with those with chronic conditions. Parents perceived no difference in physical scores for children with heart failure when compared with healthy children, and perceived higher scores for children with heart failure when compared with those with chronic conditions (p⩽0.003). Furthermore, children with heart failure had decremental health-related quality-of-life scores as the American Heart Association stage of heart failure increased, such that patients with stage C heart failure had scores similar to children with severe cardiovascular disease. Children with heart failure reported significantly impaired health-related quality of life compared with healthy children and similar scores compared with children with chronic conditions. Parental perceptions appear to underestimate these impairments. Children with heart failure appear to have progressive impairment of health-related quality of life with advancing stage of heart failure.
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BÜYÜKKARAGÖZ B, BUYAN N, DOĞRUCAN N, ÇELİK B. Health-related quality of life of pediatric renal transplant recipientsand their parents: the role of associated factors and clinical counseling. Turk J Med Sci 2016; 46:1481-1485. [DOI: 10.3906/sag-1505-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 01/22/2016] [Indexed: 11/03/2022] Open
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Bijsmans ES, Jepson RE, Syme HM, Elliott J, Niessen SJM. Psychometric Validation of a General Health Quality of Life Tool for Cats Used to Compare Healthy Cats and Cats with Chronic Kidney Disease. J Vet Intern Med 2015; 30:183-91. [PMID: 26567089 PMCID: PMC4913638 DOI: 10.1111/jvim.13656] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 08/19/2015] [Accepted: 09/30/2015] [Indexed: 11/28/2022] Open
Abstract
Background Numerous validated psychometric tools are available to assess impact of disease on a human's quality of life (QoL). To date, no psychometrically validated general health‐related QoL tool exists for cats. Hypothesis/Objectives To develop and validate a tool for assessment of owner‐perceived QoL in cats (CatQoL) and to use this tool to compare QoL between healthy cats and those with chronic kidney disease (CKD). Animals/Subjects Total of 204 owners of young healthy cats (YH, n = 99; <9 years), older healthy cats (OH, n = 35), and cats diagnosed with CKD (CKD, n = 70) completed the CatQoL. Methods Discussions with a focus group and 2 pilot surveys informed design of 16 QoL questions grouped into 4 domains. Each item scored according to frequency and importance, and item‐weighted‐impact‐scores were calculated. The validity of the tool was assessed using principal components analysis and Cronbach's α. The average item‐weighted‐impact‐score (AWIS) was compared among groups and domains. Results Sixteen‐item CatQoL showed good internal consistency reliability (Cronbach's α, 0.77) and unidimensionality with significant loadings (0.2–0.7) and communalities (>0.3). Young healthy cats had significantly higher AWIS (median [IQR], 1.25 [0.63, 1.88]) than OH (0.56 [−0.06, 1.00]) and CKD cats (−0.06 [−0.81, 0.88]), P < .001). CKD cats had significantly lower AWIS for eating domain (YH: 2.00 [1.00, 3.00]; OH: 2.00 [0.67, 3.00]; CKD : 1.00 [0.00, 2.67]) when compared with the YH group and OH group, and all groups differed significantly in their management domain (YH: −0.50 [−1.00, 0.00]; OH: −1.00 [−1.88, −0.50]; CKD : −1.50 [−2.50, −1.00], P < .001). Conclusions and Clinical Importance The CatQoL was validated for use in cats, and can be used as additional assessment parameter in clinical and research settings.
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Affiliation(s)
- E S Bijsmans
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK
| | - R E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, University of London, North Mymms, Hatfield, Hertfordshire, UK
| | - H M Syme
- Department of Clinical Science and Services, Royal Veterinary College, University of London, North Mymms, Hatfield, Hertfordshire, UK
| | - J Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK
| | - S J M Niessen
- Department of Clinical Science and Services, Royal Veterinary College, University of London, North Mymms, Hatfield, Hertfordshire, UK
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Kilicoglu AG, Mutlu C, Bahali MK, Adaletli H, Gunes H, Duman HM, Toz HI, Uneri OS. Impact of enuresis nocturna on health-related quality of life in children and their mothers. J Pediatr Urol 2014; 10:1261-6. [PMID: 25164391 DOI: 10.1016/j.jpurol.2014.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 07/11/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Nocturnal enuresis (NE) is a common childhood disorder. As children age and NE persists, it may become more stressful for both them and their caregivers. The aim of the present study was to assess the impact of NE on the quality of life of children who were diagnosed with NE, and their mothers, and to compare the results with a healthy control group. SUBJECTS AND METHOD Eighty-two children with NE, and their mothers, and 93 healthy children and their mothers were enrolled in the study. The sociodemographic data were evaluated. The Pediatric Quality of Life Inventory 4.0 Scales (PedsQL 4.0) were used to assess the children's health-related quality of life (HRQoL); and the World Health Organization Quality of Life Instrument; short form (WHOQOL-BREF) was used for the mothers' HRQoL. RESULTS The PedsQL 4.0 mean scores for the children with NE group were as follows: total score, 68.74; physical health score, 72.79; psychosocial health score, 66.56. The scores for the children in the control group were as follows: total score, 80.98; physical health score, 81.11; psychosocial health score, 80.88. The WHOQOL-BREF scores for the mothers of the children with NE were as follows: physical health score, 67.90; psychosocial health score, 62.66; social relationships score, 60.90; environmental area score, 61.04. The WHOQOL-BREF scores for the mothers in the control group were as follows: physical health score, 75.96; psychosocial health score, 72.39; social relationships score, 72.18; environmental area score, 67.44. CONCLUSIONS Nocturnal enuresis negatively affects the quality of life of both children and their mothers. Therefore, when physicians see children with enuresis, they should also be aware of the effect of NE on the mothers' quality of life.
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Affiliation(s)
- A G Kilicoglu
- Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
| | - C Mutlu
- Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
| | - M K Bahali
- Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
| | - H Adaletli
- Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
| | - H Gunes
- Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
| | - H Metin Duman
- Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
| | - H Ipek Toz
- Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
| | - O S Uneri
- Ankara Pediatric and Pediatric Hematology and Oncology Training and Research Hospital, Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji EAH, Çocuk Psikiyatri Polikliniği Dışkapı, Ankara, Turkey.
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Annunziato RA, Parbhakar M, Helcer J, Kapoor K, Henkel K, Arnon R. Strategies for Measuring Quality of Life among Pediatric Solid-Organ Transplant Recipients. Prog Transplant 2014; 24:247-56. [DOI: 10.7182/pit2014171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Quality of life (QoL) has become a mainstay in the outcome assessment of pediatric solid-organ transplant recipients. Yet, how QoL is operationalized and measured varies drastically. It may be very difficult for clinicians and researchers to determine which methods of QoL assessment best meet the needs of their patients or study. The purpose of this literature review is to describe and evaluate the current status of QoL measurement in studies of pediatric solid-organ transplant recipients. Data Sources Searches of PubMed and PsycINFO from January 1985 to February 2012. Study Selection English peer-reviewed publications that described a method for measuring QoL whether it was a standardized questionnaire, qualitative approach, or another way of operationalizing the construct. Data Extraction QoL measurement strategies were extracted from 43 studies that met inclusion criteria. Data Synthesis Each article was reviewed and summarized by 2 study team members. Conclusions Many different strategies were used for measurement, and some were not consistent with established conceptualizations of QoL. Overall recommendations for best practices are offered. Detailed information about specific measures is included, and measures that seem to capture the construct well are recommended. Additionally, our review highlighted the importance of using a “battery approach,” including child and parent report as well as considering other variables, such as patient's age, when selecting a QoL measurement strategy.
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Affiliation(s)
- Rachel A. Annunziato
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Meera Parbhakar
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Jacqueline Helcer
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Kathryn Kapoor
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Kristen Henkel
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Ronen Arnon
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
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Watson AR. Psychosocial support for children and families requiring renal replacement therapy. Pediatr Nephrol 2014; 29:1169-74. [PMID: 23963710 DOI: 10.1007/s00467-013-2582-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/04/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
Chronic kidney disease (CKD) and the need for renal replacement therapy (RRT) can place a great strain on the child and family. As well as the medical and nutritional prescription, each child and family requires an individual psychosocial prescription that requires input from multiprofessional team members. The information needs of each child and family need to be constantly evaluated as well as the choice of therapy in relation to social, psychological and economic factors. Many tertiary units lack adequate "time" to deliver such assessments and coordinate the support and respite care for those on long-term dialysis, especially when significant numbers of children are now accepted onto RRT programmes with co-morbidities. National and international standards are needed for the staffing of comprehensive tertiary paediatric renal units as well as studies evaluating supportive care to families.
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Affiliation(s)
- Alan R Watson
- Children's Renal and Urology Unit, Nottingham Children's Hospital, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK,
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Lopes M, Ferraro A, Koch VH. Health-related quality of life of children and adolescents with CKD stages 4-5 and their caregivers. Pediatr Nephrol 2014; 29:1239-47. [PMID: 24577804 DOI: 10.1007/s00467-014-2769-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 12/28/2013] [Accepted: 01/20/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Renal replacement therapies may affect the quality of life of patients and their primary caregivers (PC). METHODS This study describes the perception of health-related quality of life (HRQoL) of children/adolescents with CKD stages 4-5, as well as of their PC (n = 64), in comparison to healthy peers and their PC (n = 129), respectively, based on the Peds QL™ 4.0 and Short Form-36 (SF-36) questionnaires and selected biomarkers. RESULTS Patients reported a deleterious impact on physical capacity and on social and school activities. A negative influence on emotional aspects was reported by older patients, but not by their PC. Hemodialysis, followed by peritoneal dialysis, had a more negative impact on patients' physical functioning domain. PC HRQol proxy reports differed from those of their children, especially in older patients. PC of both groups presented similar SF-36 scores. An association was demonstrated between the magnitude of treatment target inadequacies, lower specific dominion scores in the patients/PC proxy reports and PC SF-36 general health scores. CONCLUSION The HRQoL of patients with CKD stages 4-5 is negatively affected to different degrees depending on age and treatment modality. The results suggest an association between worsening HRQoL parameters and inadequate control of recognized therapeutic CKD treatment targets.
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Affiliation(s)
- Marcos Lopes
- Department of Pediatrics, Pediatric Nephrology Unit, Instituto da Criança Hospital das Clinicas of the University of Sao Paulo Medical School, Rua das Mangabeiras 91/81, 01233-010, São Paulo, Brazil
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van der Velde JL, Dubois AEJ, Flokstra-de Blok BMJ. Food allergy and quality of life: what have we learned? Curr Allergy Asthma Rep 2014; 13:651-61. [PMID: 24122150 DOI: 10.1007/s11882-013-0391-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Health-related quality of life (HRQL) has become an emerging focus of interest in food allergy. Food allergy is a disease characterized by low mortality and symptoms which only occur during an allergic reaction. However, food-allergic patients continuously need to be alert when eating in order to prevent potentially severe allergic reactions, which may be fatal. Fear of such reactions and the need to be continuously vigilant may seriously compromise their HRQL. During the last decade, numerous studies have been published on food allergy and HRQL. The development of reliable, valid and responsive instruments for measuring HRQL in food allergic patients has facilitated this research even further. Such instruments have given insight into the specific problems a patient may face and the impact of food allergy-related interventions from the patient's perspective. This paper focuses on the most significant findings regarding this topic since its first appearance in the literature in 2000.
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Kiliś-Pstrusińska K, Medyńska A, Chmielewska IB, Grenda R, Kluska-Jóźwiak A, Leszczyńska B, Niedomagała J, Olszak-Szot I, Miklaszewska M, Szczepańska M, Tkaczyk M, Urzykowska A, Wasilewska A, Zachwieja K, Zajączkowska M, Ziółkowska H, Zagożdżon I, Zwolińska D. Perception of health-related quality of life in children with chronic kidney disease by the patients and their caregivers: multicentre national study results. Qual Life Res 2013; 22:2889-97. [PMID: 23595412 PMCID: PMC3853413 DOI: 10.1007/s11136-013-0416-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to analyse the health-related quality of life (HRQoL) in Polish children with chronic kidney disease (CKD) dependant on the CKD stage, treatment modality and selected social life elements in families of the patients. Furthermore, potential differences between self-report and parent/proxy reports and the factors influencing them were assessed. METHODS A total of 203 CKD children (on haemodialysis (HD), peritoneal dialysis (PD) and conservative treatment (CT)) and their 388 parent/proxies were enrolled into a cross-sectional national study. The demographic and social data were evaluated. We used the Paediatric Quality of Life Inventory 4.0 Generic Core Scales to assess the HRQoL in children. RESULTS Health-related quality of life scores for all CKD groups were significantly lower in all domains compared with population norms, the lowest one being in the HD group. In CT children, HRQoL did not depend on the CKD stage. Both parents assessed the HRQoL of their children differently depending on their involvement in the care. There are differences between the HRQoL scores of the children and their parents. CONCLUSION The HRQoL in children with CKD is lower than in healthy children. This is already observed in the early stages of the disease. The disease itself influences the child's mental state. Children on HD require special support on account of the lowest demonstrated overall HRQoL. Children's lower rating of the quality of life observed by their parents may render the patients unmotivated and adversely affect their adjustment to life in later years. It may also create conflicts between the parents and the children.
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Watson AR, Hayes WN, Vondrak K, Ariceta G, Schmitt CP, Ekim M, Fischbach M, Edefonti A, Shroff R, Holta T, Zurowska A, Klaus G, Bakkaloglu S, Stefanidis CJ, Van de Walle J. Factors influencing choice of renal replacement therapy in European paediatric nephrology units. Pediatr Nephrol 2013; 28:2361-8. [PMID: 23843162 DOI: 10.1007/s00467-013-2555-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 05/28/2013] [Accepted: 06/18/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many factors may impact upon choice of renal replacement therapy (RRT) for children and adolescents, including patient and family choice, patient size and distance from the renal centre as well as logistic issues such as facilities and staffing at the unit. We report a survey of factors influencing treatment choice in 14 European paediatric nephrology units. METHODS A questionnaire was developed by consensus and completed by 14 members of the European Paediatric Dialysis Working Group on facilities, staffing and family assessments impacting on choice of therapy as well as choice of therapy for 97 patients commencing initial RRT in 2011. RESULTS All units offered all modalities of RRT, but there were limitations for pre-emptive transplantation (PET) and largely adult surgical dependence for creation of arteriovenous fistulae and transplantation. The average waiting time for a deceased donor kidney was 18.5 (range 3-36) months. Full time dietetic support was available in six of the 14 units. There was no social worker, psychology, play therapy or teaching support in three, two, seven and four units, respectively. Assessment by other members of the multidisciplinary team and home visits before choice of therapy was carried out in 50 % of units, and although all patients were discussed at team meetings, the medical opinion predominated. In terms of types of RRT, 50 % of patients were commenced on chronic peritoneal dialysis (PD), 34 % on haemodialysis (HD) and 16 % underwent pre-emptive transplantation (PET). Chronic PD predominated in patients aged <5 years and HD predominated in those aged >10 years. Patient and family choice and age or size of patient were predominant factors in choice of therapy with a predictable decline in renal function favouring PET and social factors HD. CONCLUSIONS Chronic peritoneal dialysis predominated as primary choice of RRT, especially in younger children. The PET rates remain low. The influence of surgeons predominanted, and national transplant rules may be significant. Most units had insufficient multiprofessional support, which may impact upon initial choice of therapy as well as sustaining families through RRT.
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Affiliation(s)
- Alan R Watson
- Children's Renal & Urology Unit, Nottingham Children's Hospital, QMC Campus, Derby Road, Nottingham, NG7 2UH, UK,
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Kiliś-Pstrusińska K, Wasilewska A, Medyńska A, Bałasz-Chmielewska I, Grenda R, Kluska-Jóźwiak A, Leszczyńska B, Olszak-Szot I, Miklaszewska M, Szczepańska M, Tkaczyk M, Urzykowska A, Zachwieja K, Zajączkowska M, Ziółkowska H, Zagożdżon I, Zwolińska D. Psychosocial aspects of children and families of children treated with automated peritoneal dialysis. Pediatr Nephrol 2013; 28:2157-67. [PMID: 23949628 PMCID: PMC3824203 DOI: 10.1007/s00467-013-2532-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/21/2013] [Accepted: 05/31/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to analyze psychosocial aspects of chronic kidney disease (CKD) in children treated with automated peritoneal dialysis (APD). METHODS The study assessed 41 children > 2 (range 2.1-18) years of age and their parents. Data concerning the illness and sociodemographic parameters were collected. Patients completed the Paediatric Quality of Life Inventory (PedsQL) and their parents the PedsQL-proxy version, General Health Questionnaire (GHQ-12), Berlin Social Support Scales (BSSS), and Caregiver's Burden Scale (CBS). RESULTS Parents rated their children's overall health-related quality of life (QoL) as well as their physical and emotional functioning lower than the patients themselves. The majority of primary caregivers had a medium level of the total burden index in the CBS and higher values in the scales need for support and perceived available support than in the received support (BSSS). In the GHQ-12, 51.2% of primary caregivers had scores >2 points, which indicated the possible occurrence of abnormal mental functioning. CONCLUSIONS Financial support for patients' families is necessary. Parents who provide primary care to children on PD require, above all, emotional support and assistance in self-fulfilment. More than half of them may have impaired mental function. There is the strong need to provide continuous psychological care for caregivers. Differences in perception of the children's activity in varied areas by the patients themselves and their caregivers may contribute to further problems within families.
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Cho MH. Clinical approach to quality of life in children with end-stage renal disease. KOREAN JOURNAL OF PEDIATRICS 2013; 56:323-6. [PMID: 24019841 PMCID: PMC3764255 DOI: 10.3345/kjp.2013.56.8.323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/09/2013] [Indexed: 11/27/2022]
Abstract
Quality of life in addition to various medical problems in children with end-stage renal disease (ESRD) should be objectively assessed to accomplish normal growth and development during childhood. However, unfortunately, studies of quality of life (QoL) in children with ESRD have been not popular yet and there are only fewer suitable assessment tools compared with adults. Recently, disease-specific modules to evaluate QoL in children with chronic disease such as ESRD have been developed. This review was made to introduce these QoL instruments for children and help the clinical application of them.
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Affiliation(s)
- Min Hyun Cho
- Department of Pediatrics, Kyungpook National University Medical Center, Daegu, Korea
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Maca SM, Amirian A, Prause C, Gruber K, Mejdoubi L, Barisani-Asenbauer T. Understanding the impact of uveitis on health-related quality of life in adolescents. Acta Ophthalmol 2013; 91:e219-24. [PMID: 23280117 DOI: 10.1111/aos.12016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE A reduction in quality of life (QoL) during an active phase of disease has been shown for patients with uveitis of various age groups. Adult uveitis patients were shown to also have reduced QoL-values despite disease being quiescent, but adolescents have not been investigated in this respect. METHODS This clinic-based, cross-sectional pilot study assessed the overall health-related quality of life (HRQoL) in adolescents (11-18 years) with a history of inactive uveitis and good visual function. Two independent generic (non-disease-specific) instruments were applied, the Inventory for Assessing the Quality of Life and the German KINDL-R-questionnaire. RESULTS Thirty-seven adolescents, 20 females (54%) and 17 males with a mean age of 15 ± 3 years and diagnosis since 5 ± 2 years participated. Subgroups with a reduced HRQoL were those with anterior and intermediate localization of uveitis, bilateral disease, application of immunosuppressive therapy, a short time since diagnosis, and a high number of recurrences. CONCLUSION Even despite quiescence of disease and good visual function, certain risk factors may result in a decreased HRQoL in juvenile uveitis patients. Our findings support the need of further evaluation of HRQoL in this patient group, the validation of specific psychometric inventories for this disease and the establishment of interdisciplinary collaboration including psychological counselling.
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Affiliation(s)
- Saskia M Maca
- Department of Ophthalmology, Hietzing Hospital, Vienna, Austria
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Czosek RJ, Bonney WJ, Cassedy A, Mah DY, Tanel RE, Imundo JR, Singh AK, Cohen MI, Miyake CY, Fawley K, Marino BS. Impact of Cardiac Devices on the Quality of Life in Pediatric Patients. Circ Arrhythm Electrophysiol 2012; 5:1064-72. [DOI: 10.1161/circep.112.973032] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Richard J. Czosek
- From the Heart Institute, Division of Cardiology (R.J.C., K.F., B.S.M.) and Division of Biostatistics and Epidemiology (W.J.B.), Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Division of Cardiology, the Children’s Hospital of Philadelphia, Philadelphia, PA (A.C.); Department of Pediatrics, Department of Cardiology, Children’s Hospital Boston, Boston, MA (D.Y.M.); Department of Pediatrics, Division of Cardiology, University of
| | - William J. Bonney
- From the Heart Institute, Division of Cardiology (R.J.C., K.F., B.S.M.) and Division of Biostatistics and Epidemiology (W.J.B.), Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Division of Cardiology, the Children’s Hospital of Philadelphia, Philadelphia, PA (A.C.); Department of Pediatrics, Department of Cardiology, Children’s Hospital Boston, Boston, MA (D.Y.M.); Department of Pediatrics, Division of Cardiology, University of
| | - Amy Cassedy
- From the Heart Institute, Division of Cardiology (R.J.C., K.F., B.S.M.) and Division of Biostatistics and Epidemiology (W.J.B.), Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Division of Cardiology, the Children’s Hospital of Philadelphia, Philadelphia, PA (A.C.); Department of Pediatrics, Department of Cardiology, Children’s Hospital Boston, Boston, MA (D.Y.M.); Department of Pediatrics, Division of Cardiology, University of
| | - Douglas Y. Mah
- From the Heart Institute, Division of Cardiology (R.J.C., K.F., B.S.M.) and Division of Biostatistics and Epidemiology (W.J.B.), Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Division of Cardiology, the Children’s Hospital of Philadelphia, Philadelphia, PA (A.C.); Department of Pediatrics, Department of Cardiology, Children’s Hospital Boston, Boston, MA (D.Y.M.); Department of Pediatrics, Division of Cardiology, University of
| | - Ronn E. Tanel
- From the Heart Institute, Division of Cardiology (R.J.C., K.F., B.S.M.) and Division of Biostatistics and Epidemiology (W.J.B.), Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Division of Cardiology, the Children’s Hospital of Philadelphia, Philadelphia, PA (A.C.); Department of Pediatrics, Department of Cardiology, Children’s Hospital Boston, Boston, MA (D.Y.M.); Department of Pediatrics, Division of Cardiology, University of
| | - Jason R. Imundo
- From the Heart Institute, Division of Cardiology (R.J.C., K.F., B.S.M.) and Division of Biostatistics and Epidemiology (W.J.B.), Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Division of Cardiology, the Children’s Hospital of Philadelphia, Philadelphia, PA (A.C.); Department of Pediatrics, Department of Cardiology, Children’s Hospital Boston, Boston, MA (D.Y.M.); Department of Pediatrics, Division of Cardiology, University of
| | - Anoop K. Singh
- From the Heart Institute, Division of Cardiology (R.J.C., K.F., B.S.M.) and Division of Biostatistics and Epidemiology (W.J.B.), Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Division of Cardiology, the Children’s Hospital of Philadelphia, Philadelphia, PA (A.C.); Department of Pediatrics, Department of Cardiology, Children’s Hospital Boston, Boston, MA (D.Y.M.); Department of Pediatrics, Division of Cardiology, University of
| | - Mitchell I. Cohen
- From the Heart Institute, Division of Cardiology (R.J.C., K.F., B.S.M.) and Division of Biostatistics and Epidemiology (W.J.B.), Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Division of Cardiology, the Children’s Hospital of Philadelphia, Philadelphia, PA (A.C.); Department of Pediatrics, Department of Cardiology, Children’s Hospital Boston, Boston, MA (D.Y.M.); Department of Pediatrics, Division of Cardiology, University of
| | - Christina Y. Miyake
- From the Heart Institute, Division of Cardiology (R.J.C., K.F., B.S.M.) and Division of Biostatistics and Epidemiology (W.J.B.), Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Division of Cardiology, the Children’s Hospital of Philadelphia, Philadelphia, PA (A.C.); Department of Pediatrics, Department of Cardiology, Children’s Hospital Boston, Boston, MA (D.Y.M.); Department of Pediatrics, Division of Cardiology, University of
| | - Kara Fawley
- From the Heart Institute, Division of Cardiology (R.J.C., K.F., B.S.M.) and Division of Biostatistics and Epidemiology (W.J.B.), Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Division of Cardiology, the Children’s Hospital of Philadelphia, Philadelphia, PA (A.C.); Department of Pediatrics, Department of Cardiology, Children’s Hospital Boston, Boston, MA (D.Y.M.); Department of Pediatrics, Division of Cardiology, University of
| | - Bradley S. Marino
- From the Heart Institute, Division of Cardiology (R.J.C., K.F., B.S.M.) and Division of Biostatistics and Epidemiology (W.J.B.), Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Division of Cardiology, the Children’s Hospital of Philadelphia, Philadelphia, PA (A.C.); Department of Pediatrics, Department of Cardiology, Children’s Hospital Boston, Boston, MA (D.Y.M.); Department of Pediatrics, Division of Cardiology, University of
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