Changes in health-related quality of life (HRQoL) in a population-based sample of children and adolescents after 3 years of follow-up

Changes in health-related quality of life and sleep habits after a 6-month non-randomised cluster-controlled trial among children with overweight or obesity

Being overweight or obese can have severe negative psychological impacts and reduce health-related functioning. To improve health-related quality of life (HRQoL) and sleep habits for children with overweight or obesity, it is important to design and implement effective interventions. The aim of this study was to evaluate the effects of a 6-month family-based lifestyle intervention on HRQoL and sleep habits in Norwegian children with overweight or obesity in a primary-care setting. This 6-month, non-randomised, cluster-controlled trial included Norwegian children aged 5-13 years with overweight or obesity and their parents. A questionnaire was filled out by the parents. A total of 33 and 52 children in the control group and 41 and 78 children in the intervention group answered the HRQoL and sleep habits questions, respectively, and were included. The intervention group received individual family counselling and participated in physical activity groups and nutrition courses. The Children's Sleep Habits Questionnaire (CSHQ) and Kidscreen-10 index were used to assess sleep habits and HRQoL. At baseline, the mean average scores for HRQoL were 50.0 [standard deviation (SD) 8.1] for the intervention group and 49.0 (SD 10.1) for the control group. For sleep habits at baseline, the mean average scores were 45.2 (SD 11.8) for the intervention group and 46.0 (SD 11.9) for the control group. No significant changes in HRQoL and sleep habits after the intervention were revealed. Overall, the family-based lifestyle intervention targeting overweight and obese children in a primary-care setting showed no significant effect on HRQoL or sleep quality.

Gender differences in trajectories of health-related quality of life from childhood to adolescence in a 7-year follow-up study in a urban socially disadvantaged sample from Argentina

PURPOSE

The transition from childhood to adolescence is a period of developmental changes, with social influences. Few previous studies have analyzed changes in health-related quality of life (HRQoL) during childhood and adolescence based on longitudinal studies in high-income countries. This study aimed to describe the evolution of HRQoL scores by gender in a school sample over a 7-year period in Argentina.

METHODS

Prospective cohort of children attending fourth grade in public schools. HRQoL was measured using the KIDSCREEN-52 questionnaire. Trajectories of HRQoL were estimated for girls and boys through multilevel models, adjusted by socioeconomic status (SES).

RESULTS

The study began in 2014 with a sample of 494 school children, reaching an 85.6% response rate in 2016, 31.4% in 2018, and 41.9% in 2021. Most of the predicted scores are negatively associated with linear age or/and quadratic age, suggesting a decrease in scores over the 7-year follow-up. Interactions between gender and age denote an increase in the differences in scores between girls and boys over time in favor of the latter. For the Index, Physical Well-being, Psychological Well-being, Autonomy, Parent relations, Social support and peers and Financial resources, individuals with medium or high SES have significantly higher scores than those with low SES.

CONCLUSIONS

HRQoL scores decrease during the transition period from childhood to adolescence, with girls showing the greatest decrease. There were also socioeconomic inequalities in the evolution of HRQoL in a context characterized by social segregation and economic crisis, possibly aggravated by the COVID-19 pandemic.

Independent and combined effects of lifestyle behaviors on adolescent health-related quality of life

OBJECTIVE

To investigate the independent and combined effects of lifestyle behaviors, including physical activity, sedentary behavior, sleep duration and food intake, in the health-related quality of life (HRQoL) of Brazilian adolescents.

METHODS

Cross-sectional school-based study, with the participation of 306 adolescents aged 14 to 18 years. A questionnaire was applied with structured questions to collect lifestyle behaviors data. Perception of the HRQoL was identified using the Kidscreen-27. The study used covariance analysis and linear regression models for statistical analysis.

RESULTS

Adolescents who reported ≤ 2 hours/day of screen-based sedentary behavior and sleep duration equivalent to 8-10 hours/night presented significantly higher HRQoL. Adolescents who reported joint adherence ≥ 3 healthy lifestyle behaviors demonstrated approximately two [OR=2.12] to three times [OR=3.04] more chance of presenting higher perceptions of HRQoL.

CONCLUSION

Although healthy lifestyle behaviors had a positive independent effect on HRQoL, joint adherence to healthy behaviors enhances the cumulative effect.

A Comparison Quality of Life of Children of Seasonal Agricultural Workers and Local Residents in Turkey

OBJECTIVES

Children of seasonal agricultural workers (SAW) live in the worst conditions of agricultural labor and, consequently, face many health risks. Therefore, it is essential to evaluate the quality of life (QoL) of these children. This study aimed to compare the QoL between children of SAW and local residents in semi-rural areas of Eskisehir, Turkey, and determine the factors affecting them.

METHODS

In this cross-sectional study, we included children of SAW living in temporary camp areas and those of local residents visiting the Family Health Center close to the camp areas. Basic sociodemographic data collection forms and the Pediatric Quality of Life (PedsQL) scale were employed for data collection. Univariate and multivariate analyses were used to determine factors that had a significant effect on the QoL.

RESULTS

We included 324 children of SAW and 256 local children. As per the multivariate analysis, QoL was lower in children aged between 8 and 12 years, with physician-diagnosed chronic diseases, and children of SAW. Also, there was no significant association between gender, parental education levels, family income, number of siblings, school attendance status, and QoL level.

CONCLUSION

The QoL of children of SAW families was significantly lower than their peer local children. Therefore, the appropriate authorities must prioritize the planning and implementation of health services for SAW families.

[Properties of the CP-QOL-PCQ to measure health-related quality of life in children and adolescents with cerebral palsy in Argentina]

Introduction

The impact of cerebral palsy (CP) on quality of life requires the incorporation of subjective assessments of health, functional status, and well-being. A specific health-related quality of life (HRQoL) measure for CP is the Australian CP-QOL questionnaire, whose version for caregivers (PCQ) was adapted in Argentina. This study aimed to achieve the final structure and evaluate the reliability and validity of the CP-QOL-PCQ for the Argentine child and adolescent population.

Methods

100 caregivers of people from 3 to 24 years old with a diagnosis of CP from Argentina participated. In addition to the CP-QOL-PCQ, the KIDSCREEN-27 questionnaire was applied. Analysis of response distributions of all items, inter-item correlations, and internal consistency of the scales were performed using Cronbach's alpha. The convergent validity of the instrument was tested through the correlation with scales of similar content from the KIDSCREEN and through a priori hypotheses in groups of different ages and functional impairment.

Results

A final structure of the CP-QOL-PCQ was achieved with 8 multidimensional scales, with satisfactory inter-item correlations (>0.30) and internal consistency (>0.70). Moderate and high correlations (r>0.30) were obtained between similar dimensions of the CP-QOL-PCQ and the KIDSCREEN with similar concepts. Higher HRQoL scores were confirmed at a younger age and at a lower level of functional impairment (Cohen's d >0.20).

Conclusion

This provides evidence of reliability and validity to be expected for a HRQoL measurement instrument that can be implemented in the Argentine child and adolescent population with CP.

Distinct developmental trajectories of health-related quality of life for boys and girls throughout childhood and adolescence; a national level longitudinal study

BACKGROUND

To identify and describe distinct developmental trajectories of health-related quality of life (HRQoL) in a national level Australian population sample, overall and separately for boys and girls.

METHODS

Data were from the Longitudinal Study of Australian Children (LSAC). Participants were children aged 4-5 years recruited in 2004 and followed through to age 16-17 years in 2016, and their caregivers. Group-based trajectory modelling was used to identify groups of children that follow qualitatively distinct developmental trajectories of HRQoL.

RESULTS

Three distinct trajectories were identified for the total sample: (1) high-stable (52.2% of children); (2) middle-stable (38.0%); and (3) low-declining (9.8%). These trajectories differed for boys, who saw increasing HRQoL in the highest trajectory group; a middle-stable trajectory; and declining and rebounding HRQoL in the lowest trajectory group. In contrast, girls saw no increasing or rebounding trajectories; approximately half of girls had high-stable HRQoL and the remaining half had either steadily or rapidly declining HRQoL from age 4-5 to 16-17 years.

CONCLUSIONS

Our results highlight the importance of considering the distinct trajectories for girls and boys and not relying on population mean levels of HRQoL for decision-making. The presence of developmentally distinct trajectories of HRQoL, and differences in the trajectories faced by boys and girls, should be considered when assessing the effectiveness of treatments and interventions impacting upon HRQoL throughout childhood and adolescence. Failure to account for these pre-existing trajectories may over- or under-estimate treatment effects.

Longitudinal relationship between quality of life and negative life events among adolescents during COVID-19 pandemic: a cross-lagged panel analysis

BACKGROUND

The negative association of quality of life (QoL) and negative life evens (NLEs) among adolescents has been proved by cross-sectional studies, without exploring sex differences. This study aimed to explore the longitudinal associations between QoL and NLEs among adolescents during novel coronavirus disease 2019 (COVID-19) pandemic and whether there are sex or age differences.

METHODS

A stratified cluster sampling was used to select 1421 students in primary school and middle school in Chongqing, China. From November 2020 (T0) to December 2021 (T2), the Adolescent Self-Rating Life Events Checklist and the Adolescent Quality of Life Scale were used to collect 3 waves of data. The correlations between study variables were conducted by the Pearson correlation analyses. The direction and strength of the longitudinal associations were analyzed using cross-lagged panel analyses.

RESULTS

Results showed significant changes in both variables during COVID-19 pandemic (P < 0.001). Cross-sectional analyses showed stable negative correlations between NLEs and QoL stratified by sex or by age (P < 0.001). Sex and age differences in longitudinal relationships were shown by cross-lagged panel analyses. For males, NLEs had a short-term bi-directional association with QoL [βA-D = -(0.091-0.340), P < 0.05]; for females, QoL had a short-term correlation with NLEs [βA = -0.119), βC = -0.109), P < 0.001]. In the youngest age group, NLEs had a short-term bi-directional correlation with QoL [βA-D = -(0.098-0.428), P < 0.05]. There was a short-term association between total QoL and NLEs among students except the 14∼15 year group [βA = -(0.071-0.149), βC = -(0.086-0.119), P < 0.05], the long-term association between total QoL and NLEs was only significant in adolescents aged 14∼15 years (βE = -0.132, P < 0.05). The strength of NLEs was slightly higher than that of total QoL, but lower than that of QoL in each dimension.

CONCLUSION

There were negative longitudinal relationships between NLEs and QoL during COVID-19 pandemic, and the strength of the associations varied across sex or age. Strengthening QoL in different dimensions may be a promising way to reduce NLEs during the pandemic among adolescents, and interventions should be tailored according different sex and ages.

Changes in health-related quality of life in adolescents and the impact of gender and selected variables: a two-year longitudinal study

BACKGROUND

Increased knowledge about factors that can impact changes in adolescents' health-related quality of life (HRQOL) is needed. The present study aimed to investigate possible HRQOL changes in adolescents at 14 and 16 years, and assess the impact of sociodemographic factors, gender, pain, self-esteem, self-efficacy, loneliness, and stress on HRQOL changes over time. Further, to assess HRQOL stratified by gender.

METHODS

A longitudinal study involving 211 adolescents was conducted. Sociodemographic variables, pain, self-esteem, self-efficacy, loneliness, and stress were all assessed with well-validated instruments. KIDSCREEN-27 was used to measure HRQOL. Data were analyzed using independent t-tests, paired samples t-tests, and linear mixed models for repeated measures.

RESULTS

When all variables were added to the linear mixed models, stress, loneliness, and pain were significantly, independently associated with a reduction in HRQOL change scores for four of the five KIDSCREEN subscales. Time was significantly associated with a reduction in physical and psychological well-being. Self-efficacy and self-esteem were significantly associated with an increase in HRQOL change scores for four and two subscales, respectively. Male gender was significantly negatively associated with changes in social support and peers compared to female gender.

CONCLUSION

Our results demonstrated a significant decline in adolescents' HRQOL regarding physical and psychological well-being for the age range 14-16 years. Furthermore, we found that stress, loneliness, and pain have a significant negative impact on HRQOL changes, whereas self-esteem and self-efficacy have a significant positive impact. Our results highlight the importance of increased understanding regarding factors associated with changes in adolescents' HRQOL to enable accurate and strategic interventions.

Normative Values for Adolescent Quality of Life in Plastic Surgery: A Longitudinal, Cohort Study

Background:

Adolescence is a challenging time, and an increasing number of young people are seeking plastic surgery. With the rise of health-related quality of life studies in plastic surgery, it is critical to understand the natural variation and changes in health-related quality of life for this population.

Methods:

In this longitudinal, cohort study validated surveys were administered to cisgender participants aged 12–21 years: Short-Form 36v2, Rosenberg Self-Esteem Scale, Breast-Related Symptoms Questionnaire, and Eating-Attitudes Test-26. Surveys were administered at baseline and up to 9 years follow-up. At the time of enrollment, participants were in a current state of good health with no considerable past or current medical, surgical, or psychological history.

Results:

A total of 149 female and 75 male participants were included, with a median (interquartile range) baseline age of 16.0 (4.4) years and follow-up time of 3.3 (4.1) years. Over the study period, girls who were not overweight or obese experienced significant declines in five SF-36 domains (general health, vitality, social functioning, role-emotional, and mental health) and on the Rosenberg Self-Esteem Scale, Breast-Related Symptoms Questionnaire, and Eating-Attitudes Test-26 (P < 0.05). In contrast, boys’ and overweight/obese girls’ health-related quality of life largely remained stable (P > 0.05).

Conclusions:

Adolescence is a challenging time, on which plastic surgery-related concerns are superimposed. Our findings suggest that girls may be more at risk for developing psychosocial deficits that worsen over adolescence and young adulthood. This observation is critical for the interpretation and contextualization of health-related quality of life in adolescent plastic surgery patients.

Patient-reported outcome measures in Arabic-speaking populations: a systematic review

PURPOSE

This research aimed, first, to identify, summarize, and synthesize the studies reporting the development, translation, and/or psychometric evaluation of PROMs in Arabic-speaking populations and, second, to evaluate the psychometric properties and the translation process of a sample 26 PROMs.

METHODS

In 2019, PubMed, Web of Science, and SCOPUS were searched for studies reporting the development, translation, or cross-cultural adaptation of patient-reported outcome measures in Arabic-speaking populations, and those including the assessment of one or more psychometric properties as PROMs (including validity, reliability, responsiveness, interpretability) in our target populations were included. The review protocol registration number is CRD42018088991.

RESULTS

The search strategy outlined above yielded a total of 3179 titles in the three databases. Of these, 174 English language studies met the inclusion criteria. One hundred thirty-six PROMs were identified. The methodological quality and translation process of PROMs reported by at least two studies (26 PROM instruments, 63 studies) were examined. Internal consistency, reliability, and construct validity were the most frequently reported psychometric properties. Structural validity, cross-cultural validity, responsiveness, and measurement error were largely unreported. The process of developing at least two independent forward translations and back translation of the instrument into the source language were reported by 32 and 43 studies, respectively.

CONCLUSION

There is a need for further investigation of measurement properties of Arabic PROMs measures before routine use can be recommended in clinical practice.

Health-Related Quality of Life and Frequency of Physical Activity in Spanish Students Aged 8-14

The study of health-related quality of life (HRQoL) in children and adolescents has important implications in terms of policy, education, and health. Data on the time spent in physical activity (PA) and in sedentary activities in this population are worrying. We aim to analyze possible differences in HRQoL and PA levels between sexes and age groups in Spanish students aged between 8 and 14 years, as well as to assess the relationship between HRQoL and the frequency of PA in this population. A total of 3197 participants (1610 boys and 1587 girls) from 8 to 14 years old were recruited. Mquality and Mapping Child Health Utility instrument (Chu9d) were used as HRQoL indicators. A medium positive association between PA and HRQoL concerning the Spanish school population was found. HRQoL was higher among students aged 8 to 12 than 13 to 14. Moreover, when children start secondary education, both sexes seem to lose the quality of life. Similarly, PA decreases among girls over the years, although it seems to increase among boys. Thus, PA levels and HRQoL are directly associated in Spanish schoolchildren aged between 8 and 14 years. However, this HRQoL decreases in children over the years. Practical implications include the need to support education and physical activity programs to improve HRQoL in children and adolescents.

Health-related quality of life of perinatally HIV-infected young people: a longitudinal study

Young people perinatally infected with HIV (pHIV) are at risk of a lowered health-related quality of life (HRQOL). Previous evaluation of the NeurOlogical, VIsual and Cognitive performance in HIV-infected Children (NOVICE)-cohort showed no difference in HRQOL between pHIV and matched HIV-uninfected controls (HIV-), yet a higher percentage of pHIV had impaired HRQOL. The aim of this study is to compare the change over time in HRQOL of pHIV to HIV- over a 5-year period. We used the Pediatric Quality of Life Inventory (PedsQL)™ 4.0 to repeat HRQOL assessment. High PedsQL scores indicate good HRQOL. Fifteen/33 (45.5%) pHIV and 17/37 (45.9%) HIV- completed both assessments. At the first assessment, the mean age was 13.1 years (range 8.0-18.4). PHIV scored higher than HIV- on Emotional functioning and on Total scale score. After five years, the mean age was 17.6 years (range 12.1-22.8). PHIV scored higher than HIV- on all scales, except Social functioning. PHIV did not differ significantly from the Dutch norm on either time-point. LMEM showed no difference in change over time for any of the PedsQL scales. In this study, young people with pHIV receiving high-quality health care, including monitoring of HRQOL, remain to experience a good HRQOL.

Disparity of child/parent-reported quality of life in cerebral palsy persists into adolescence

AIM

To examine the evolution of child-parent discrepancy in reporting quality of life (QoL) between childhood and adolescence in children with cerebral palsy (CP) and to investigate potential factors associated with such a discrepancy.

METHOD

We used data from the SPARCLE (Study of PARticipation of Children with CP Living in Europe) study, a population-based cohort study of children with CP, aged 8 to 12 years at baseline (in 2004-2005), in nine European centres, who were followed up at the age of 13 to 17 years. The KIDSCREEN-52 Quality of Life measure was used at baseline and follow-up; 354 child-parent dyads out of 500 eligible dyads were followed up (201 males, 153 females). We used intraclass correlation coefficients (ICCs) to examine agreement between parent proxy-reports and self-reported QoL. We used linear regression to examine factors associated with child-parent discrepancy in QoL reporting.

RESULTS

Agreement was low to moderate (ICC=0.16-0.48) in childhood and in adolescence across all QoL domains. In four domains (moods and emotions, self-perception, relationship with parents and home life, and social support and peers), the extent of the discrepancy increased significantly between childhood and adolescence. Parenting stress, child pain, and child behaviour problems influenced parent proxy-reports during both childhood and adolescence.

INTERPRETATION

The points of view of the child and their parents should be treated as complementary to obtain better knowledge regarding the QoL of children and adolescents with CP.

Association of academic performance, general health with health-related quality of life in primary and high school students in China

Purpose

To explore the association of academic performance and general health status with health-related quality of life (HRQoL) in school-aged children and adolescents in China.

Methods

In this cross-sectional study conducted in 2018, students (grade 4–12) were randomly chosen from primary and high schools in Nanjing, China. HRQoL, the outcome measure, was recorded using the Child Health Utility 9D, while self-rated academic performance and general health were the independent variables. Mixed-effects regression models were applied to compute mean difference (MD) and 95% confidence interval (CI) of HRQoL utility score between students with different levels of academic performance and general health.

Results

Totally, 4388 participants completed the study, with a response rate of 97.6%. The mean HRQoL utility score was 0.78 (SD: 0.17). After adjustment for socio-demographic attributes, physical activity, sedentary behavior, dietary patterns, body weight status and class-level clustering effects, students with fair (MD = 0.048, 95% CI 0.019, 0.078) and good (MD = 0.082, 95% CI 0.053, 0.112) self-rated academic performance reported higher HRQoL utility scores than those with poor academic performance, respectively. Meanwhile, students with fair (MD = 0.119, 95% CI 0.083, 0.154) and good (MD = 0.183, 95% CI 0.148, 0.218) self-assessed general health also recorded higher HRQoL utility scores than those with poor health, separately. Consistent findings were observed for participants by gender, school type and residential location.

Conclusions

Both self-rated academic performance and general health status were positively associated with HRQoL among Chinese students, and such relationships were independent of lifestyle-related behaviors and body weight status.

Changes in Self-Reported Physical Activity Predict Health-Related Quality of Life Among South African Schoolchildren: Findings From the DASH Intervention Trial

Introduction: Regular physical activity is associated with multiple health benefits for children. Evidence from cross-sectional studies suggests that physical activity is positively associated with health-related quality of life (HRQoL). The promotion of physical activity, and hence HRQoL, through a school-based intervention is therefore an important endeavor, particularly in disadvantaged areas of low- and middle-income countries, including South Africa.

Methods: We designed a multicomponent physical activity intervention that was implemented over a 20-week period in 2015 in eight disadvantaged primary schools of Port Elizabeth, South Africa. Overall, 758 children aged 8–13 years participated. HRQoL was measured with the 27-item KIDSCREEN questionnaire. Self-reported physical activity was assessed with a single item of the Health-Behavior of School-Aged Children test, and cardiorespiratory fitness with the 20-m shuttle run test. Post-intervention scores were predicted with mixed linear regression models, taking into consideration the clustered nature of the data.

Results: Higher baseline levels as well as increasing levels of self-reported physical activity predicted all dimensions of children's HRQoL. Baseline levels and increases in cardiorespiratory fitness predicted children's self-perceived physical well-being (one of the HRQoL subscales). Participation in the multicomponent physical activity intervention did not affect children's HRQoL.

Conclusion: Higher and increasing self-reported physical activity predict all assessed HRQoL dimensions, which underlines that the promotion of regular physical activity among children living in disadvantaged settings is an important public health measure. Policy makers should encourage schools to create physical activity friendly environments, while schools should implement regular physical education as proposed by the school curriculum.

The Relationship between Weight Status, Health-Related Quality of Life, and Life Satisfaction in a Sample of Spanish Adolescents

Excess weight has been associated with numerous psychosocial problems and is considered to be one of the most important health problems of today. The aim of this study is to analyze the relationship between weight status, which is evaluated by means of the body mass index (BMI), and the health-related quality of life (HRQoL) and life satisfaction (LS) variables in Spanish adolescents, as well as to examine whether gender influences this interrelationship. A total of 1197 subjects studying in their 1st and 4th years of high school (mean age: 14.4 years, SD: 1.69) participated in the study by completing the Health Behavior in School-Aged Children (HBSC) questionnaire. Then, the participants were grouped into the following categories: underweight, normal weight, overweight, and obese. The results show that boys have significantly higher HRQoL as well as higher levels of LS. On the other hand, only the obese group shows significantly lower scores in both HRQoL and LS than those in the normal-weight group. The interaction of weight category and gender does not have a significant impact on the variables that have been analyzed (HRQoL or LS).

Examining boys' and girls' health-related quality of life from the first to the third year of upper secondary school: A prospective longitudinal study

AIM

To examine differences in health-related quality of life between boys and girls in the first and third years of upper secondary school.

DESIGN

Prospective longitudinal study.

METHODS

The KIDSCREEN-10 was used to assess health-related quality of life. Differences in health-related quality of life over time were estimated using a linear mixed-effects model for correlated measurements.

RESULTS

In the first-year boys (N = 168) and girls (N = 228) reported a mean health-related quality of life score of 76.3 (SD 10.7) and 69.8 (SD 11.5), respectively. In the third year, the mean health-related quality of life score for boys and girls was 73.5 (SD 12.4) and 65.7 (SD 13.3), respectively. Boys had a significant decrease in health-related quality of life mean score of -2.6 and girls a significant decrease of -3.8 (p < .001) over the 3-year period. There was no significant difference between boys' and girls' health-related quality of life changes (p = .39).

The impacts of peer education based on adolescent health education on the quality of life in adolescents: a randomized controlled trial

PURPOSE

During adolescence, adolescents are more susceptible to internalizing and externalizing problems influencing quality of life (QoL). The purpose of the study is to verify the effectiveness of a peer education on improving QoL of adolescents.

METHODS

A cluster randomized controlled trial (RCT) was conducted involving 1564 subjects who were divided into an intervention group (n = 714) and a control group (n = 850). The intervention group received 1-year peer education. Their QoL and basic information were assessed using a Adolescent Quality of Life Scale and a self-designed basic situation questionnaire.

RESULTS

After the intervention, significant increases were found in the psychological, and social, pubertal dimensions, and in total QoL (P < 0.05) in the intervention group relative to the control group. Significant decrease was found in physical dimension (P < 0.05), but the change in the intervention group (0.74 decrease) was much less than that in the control group (1.94 decrease). The improvements of physical (B = 1.215, SE = 0.305, P < 0.001), psychological (B = 1.496, SE = 0.598, P = 0.013), pubertal (B = 0.828, SE = 0.244, P = 0.001), and total (B = 3.455, SE = 1.429, P = 0.016) QoL in the intervention group were higher than in the control group in mixed model.

CONCLUSIONS

The peer education based on adolescent health education is effective in improving the physical, psychological, pubertal, and total QoL of adolescents, but no social QoL.

A Rights-Based Approach for Service Providers to Measure the Quality of Life of Children with a Disability

BACKGROUND

This paper identifies the best instruments for service providers to measure the quality of life (QoL) of children with a disability, with a focus on their alignment with the Convention on the Rights of Persons with a Disability (CRPD).

METHODS

This study reviewed systematic reviews to identify generic QoL instruments for children and adolescents, followed by an appraisal process using newly developed criteria. QoL instruments with a health status, functioning, and condition-specific focus were excluded.

RESULTS

Twenty generic QoL instruments for children were identified from existing systematic reviews to undergo further review. Only 2 of the 20 instruments were recommended for service providers to measure the QoL of children with a disability (KIDSCREEN and KINDL). Many pediatric QoL instruments (N = 9) focus on functioning and are not consistent with the CRPD, confounding a child's functioning with their feelings about their life. KIDSCREEN and KINDL have self-report and parent report versions, are applicable for childhood and adolescence, demonstrate adequate reliability and validity, involved children in their development, focus on wellbeing, are likely to be able to be completed by a child with a disability, and are low in cost.

CONCLUSIONS

Many instruments focus on functioning rather than wellbeing and thus may not capture the QoL of children with a disability. A child's functional limitations may not be consistent with their feelings about life. Two instruments that assess wellbeing and meet the criteria important for service providers now require further testing to explore their usefulness and validity for children with varying abilities.

Health-related quality of life (HRQoL) in children of ill or substance abusing parents: examining factor structure and sub-group differences

PURPOSE

Health-related quality of life (HRQoL) may be helpful in identifying children at risk of developing adjustment problems. Few studies have focused on HRQoL among children of ill or substance abusing parents despite their considerable risk status. In the present study, we used the KIDSCREEN-27 to assess self-reported HRQoL in children and adolescents living in families with parental illness, or substance dependence. First, we tested whether the factor structure of the KIDSCREEN-27 was replicated in this population of children. Next, we examined differences in HRQoL according to age, gender, and type of parental illness. Finally, we compared levels of HRQoL in our sample to a normative reference population.

METHOD

Two hundred and forty-six children and adolescents aged 8-17 years and their ill parents participated. The construct validity of the KIDSCREEN-27 questionnaire was examined by confirmatory factor analysis (CFA). T-tests and ANOVA were used to test differences in HRQoL levels according to age, gender, and parental patient groups, and for comparisons with reference population.

RESULTS

The KIDSCREEN-27 fit the theoretical five-factor model of HRQoL reasonably well. Boys and younger children reported significantly greater well-being on physical well-being, psychological well-being, and peers and social support, compared to girls and older children. Younger children also reported significantly greater well-being at school than did older children. There were no significant differences in HRQoL between groups of children living with different type of parental illness. The children in our sample reported their physical well-being significantly lower than the reference population.

CONCLUSION

The KIDSCREEN-27 questionnaire appears to work satisfactorily among children of ill or substance abusing parents.

Cross-cultural validation of the "DISABKIDS" questionnaire for quality of life among Colombian children with chronic diseases

Objective:

to describe the cross-cultural validation process of the “DISABKIDS” questionnaire in Colombia, for both the children and adolescents’ version and the parents’ version, an instrument intended to measure the health-related quality of life of Colombian children and adolescents with chronic diseases.

Method:

the cross-cultural validation process was conducted according to an international consensual systematic methodology, called standardized linguistic validation, to ensure linguistic equivalence with the original questionnaire.

Results:

the pretest’s cognitive interviews revealed a need to adjust the questionnaire, which consisted of asking for “health condition” rather than only asking for “condition”. Due to the cultural context, the word “condition” used in the original version, when translated to Spanish, refers to socioeconomic conditions rather than health conditions. For this reason, 11 items in the children’s version and eight items in the parents’ version were adjusted.

Conclusions:

the Colombian version of DISABKIDS-37 to measure health-related quality of life among children and adolescents with chronic diseases in both the children’s and parents’ versions is equivalent to the original version and is appropriate for use in Colombia. Future studies can assess the questionnaire’s psychometric properties.

Relationship between cyberbullying and health-related quality of life in a sample of children and adolescents

PURPOSE

Health-related quality of life (HRQoL) is a well-known construct that refers to a state of complete physical, mental, and social well-being. Its relationship with multiple forms of violence, including bullying, has been widely explored, but this is not the case for cyberbullying. The main objective is to analyze how HRQoL varies depending on the role played in cyberbullying, its temporal stability, and gender and age differences.

METHOD

An analytical and longitudinal study was conducted at two temporal moments. At Time 1 (December 2015), 920 Spanish students aged between 11 and 18 years participated (M_age = 13.36, SD = 1.83: 48.9% boys and 51.1% girls). At Time 2 (April 2016), there were 313 participants (M_age 12.81 years, SD = 1.59: 53.4% boys and 46.6% girls). We used the Cyberbullying Test (technological scale) and the Spanish version of the KIDSCREEN-52.

RESULTS

Cybervictims and cyberbully-victims present worse scores in all dimensions of the KIDSCREEN-52 (p < .001), compared to cyberbystanders or uninvolved individuals. There are gender differences only in cyberaggression and cyberbystanding. There are significant inverse correlations between all the dimensions of the KIDSCREEN-52 and cybervictimization, with Bullying (r = - .603, p < .001), Mood (r = - .329, p < .001), and School environment (r = - .327, p < .001) being particularly relevant. There were statistically significant differences between T1 and T2 for cyberbystanding (lower scores at T2).

CONCLUSION

Cybervictims and cyberbully-victims have worse quality of life in all the dimensions than uninvolved individuals, especially in Psychological well-being, School environment, and Bullying.

Health-related quality of life of Portuguese children and adolescents according to their biological maturation and volume of physical activity

PURPOSE

The purpose of this study was to analyze the relationship between biological maturation and health-related quality of life (HRQoL) in Portuguese children and adolescents of both sexes when the effect of chronological age (CA) and volume of physical activity (VPA) were removed.

METHODS

HRQoL, biological maturation, CA, and VPA were assessed in 750 children and adolescents, 11-17 years old, from 3 schools in Lisbon, Portugal. The KIDSCREEN-52 was used to assess HRQoL. Maturity indicator was bone age (BA), using Tanner-Whitehouse III method (TW3). The participants were classified into three different maturity categories: late, on time, and early maturers. VPA was assessed by questionnaire (RAPIL II). An analysis of covariance (ANCOVA), using the CA and the VPA as covariates was completed. The level of significance was set at p ≤ 0.05.

RESULTS

Analysis of covariance suggested an influence of biological maturation in physical well-being dimension in both sexes, with early-maturing girls and boys having worst perception. Maturity groups were also influent in moods and emotions for girls. CA seems to be particularly important in self-perception and parent relation and home life for girls and in school environment for boys.

CONCLUSION

Biological maturation and CA have relevant impact on some HRQoL dimensions. These variables, due to their nature and effect should be considered particularly when working with specific domains of HRQoL as physical well-being in both sexes, moods and emotions and self-perception and parent relation and home life for girls and in school environment for boys.

Risk and protective factors of health-related quality of life in children and adolescents: Results of the longitudinal BELLA study

AIMS

Cross-sectional studies demonstrated associations of several sociodemographic and psychosocial factors with generic health-related quality of life (HRQoL) in children and adolescents. However, little is known about factors affecting the change in child and adolescent HRQoL over time. This study investigates potential psychosocial risk and protective factors of child and adolescent HRQoL based on longitudinal data of a German population-based study.

METHODS

Data from the BELLA study gathered at three measurement points (baseline, 1-year and 2-year follow-ups) were investigated in n = 1,554 children and adolescents aged 11 to 17 years at baseline. Self-reported HRQoL was assessed by the KIDSCREEN-10 Index. We examined effects of sociodemographic factors, mental health problems, parental mental health problems, as well as potential personal, familial, and social protective factors on child and adolescent HRQoL at baseline as well as over time using longitudinal growth modeling.

RESULTS

At baseline, girls reported lower HRQoL than boys, especially in older participants; low socioeconomic status and migration background were both associated with low HRQoL. Mental health problems as well as parental mental health problems were negatively, self-efficacy, family climate, and social support were positively associated with initial HRQoL. Longitudinal analyses revealed less increase of HRQoL in girls than boys, especially in younger participants. Changes in mental health problems were negatively, changes in self-efficacy and social support were positively associated with the change in HRQoL over time. No effects were found for changes in parental mental health problems or in family climate on changes in HRQoL. Moderating effects for self-efficacy, family climate or social support on the relationships between the investigated risk factors and HRQoL were not found.

CONCLUSION

The risk factor mental health problems negatively and the resource factors self-efficacy and social support positively affect the development of HRQoL in young people, and should be considered in prevention programs.

[Psychosomatic symptoms as an expression of the deterioration of the health-related quality of life in adolescents]

Objetivo

Analizar, en una población de adolescentes escolarizados, la relación entre síntomas psicosomáticos y calidad de vida relacionada con la salud (CVRS) diferenciando por sexo y grupo de edad.

Diseño

Estudio transversal.

Emplazamiento

Cinco Institutos de Educación Secundaria.

Participantes

Ochocientos cuarenta y cuatro adolescentes de entre 15 y 18 años que cursaban 3.° y 4.° de Educación Secundaria Obligatoria y Bachillerato.

Mediciones principales

CVRS mediante KIDSCREEN-52 y síntomas psicosomáticos con la escala de problemas psicosomáticos (PSP).

Resultados

Las chicas y los adolescentes de 17-18 años presentaron síntomas psicosomáticos significativamente más altos, ambos grupos también puntuaron peor en todas las dimensiones de CVRS aunque solo alcanzaron significación las dimensiones relacionadas con bienestar físico, bienestar mental y estado de ánimo y estrés. Todos los síntomas psicosomáticos se asociaron de forma inversa con las 10 dimensiones del KIDSCREEN-52. Los modelos de regresión realizados mostraron que tristeza, dificultad de concentración y dificultad para dormir fueron los predictores de peor CVRS en ambos sexos y grupos de edad, y estas variables explicaron entre un 30 y un 41% de la varianza de la CVRS de los adolescentes.

Conclusiones

Los síntomas psicosomáticos son más frecuentes en las chicas y en los adolescentes mayores, y predictores de peor CVRS. Es importante diferenciarlos de afecciones médicas para evitar intervenciones innecesarias. Como expresiones de malestar emocional deben ser evaluados y tratados de forma integral porque interfieren en la vida cotidiana y aumentan la vulnerabilidad propia de la adolescencia.

Contribution of speech and language difficulties to health-related quality-of-life in Australian children: A longitudinal analysis

PURPOSE

The trajectory of health-related quality-of-life (HRQoL) for children aged 4-9 years and its relationship with speech and language difficulties (SaLD) was examined using data from the Longitudinal Study of Australian Children (LSAC).

METHOD

Generalized linear latent and mixed modelling was used to analyse data from three waves of the LSAC across four HRQoL domains (physical, emotional, social and school functioning). Four domains of HRQoL, measured using the Paediatric Quality-of-Life Inventory (PedsQL™), were examined to find the contribution of SaLD while accounting for child-specific factors (e.g. gender, ethnicity, temperament) and family characteristics (social ecological considerations and psychosocial stressors).

RESULT

In multivariable analyses, one measure of SaLD, namely parent concern about receptive language, was negatively associated with all HRQoL domains. Covariates positively associated with all HRQoL domains included child's general health, maternal mental health, parental warmth and primary caregiver's engagement in the labour force.

CONCLUSION

Findings suggest that SaLD are associated with reduced HRQoL. For most LSAC study children, having typical speech/language skills was a protective factor positively associated with HRQoL.

Predictors of parent-reported quality of life of adolescents with cerebral palsy: A longitudinal study

AIM

Parent-reporting is needed to examine Quality of Life (QoL) of children with cerebral palsy (CP) across all severities. This study examines whether QoL changes between childhood and adolescence, and what predicts adolescent QoL.

METHOD

SPARCLE is a European cohort study of children with CP, randomly sampled from population databases. Of 818 8-12-year-olds joining the study, 594 (73%) were revisited as 13-17-year-olds. The subject of this report is the 551 (316 boys, 235 girls) where the same parent reported QoL on both occasions using KIDSCREEN-52 (transformed Rasch scale, mean 50, SD 10 per domain). Associations were assessed using linear regression.

RESULTS

Between childhood and adolescence, average QoL reduced in six domains (1.3-3.8 points, p<0.01) and was stable in three (Physical wellbeing, Autonomy, Social acceptance). Socio-demographic factors had little predictive value. Childhood QoL was a strong predictor of all domains of adolescent QoL. Severe impairments of motor function, IQ or communication predicted higher adolescent QoL on some domains; except that severe motor impairment predicted lower adolescent QoL on the Autonomy domain. More psychological problems and higher parenting stress in childhood and their worsening by adolescence predicted lower QoL in five and eight domains respectively; contemporaneous pain in seven domains. The final model explained 30%-40% of variance in QoL, depending on domain.

INTERPRETATION

In general, impairment severity and socio-demographic factors were not predictors of lower adolescent QoL. However, pain, psychological problems and parenting stress were predictors of lower adolescent QoL in most domains. These are modifiable factors and addressing them may improve adolescent QoL.

Longitudinal changes in health related quality of life in children with migrant backgrounds

Background

Little is known about longitudinal changes in the Health Related Quality of Life (HRQoL) among children with migrant backgrounds.

Methods

The sample comprised 350 children with predominantly migrant backgrounds enrolled in 7 kindergartens in Frankfurt and Darmstadt, Germany. At baseline, the participants’ mean age was 4.4 years (SD 0.9). Data collection started in May 2009. Two waves of data were collected one year apart (94% response rate). HRQoL was evaluated with the Kiddy-KINDL. The other variables under study were sex, age, socioeconomic status, country of origin, developmental status (WET) and individual behavior (VBV). Data were collected from the children, parents and teachers. Structural equation modeling (SEM) was used to assess the Wilson and Cleary theoretical framework on changes in HRQoL and Generalized Estimated Equations (GEE) to model the longitudinal trend in HRQoL.

Results

Overall HRQoL remained stable between baseline and follow-up. SEM model fit was χ2 = 8.51; df = 5; p = 0.13; SRMR = 0.02 RMSEA = 0.06 and indicated that there were differences in kindergarten activities (p<0.05). The GEE model elucidated that the differences in HRQoL between the baseline and follow-up varied according to kindergarten activities that the children were assigned to (music, art, or no activities) (p<0.05), but that there were no differences in terms of country of origin. On average, girls reported better HRQoL.

Conclusion

Overall HRQoL scores remained stable over follow-up in a sample of migrant children and there were no differences in terms of origin. However, there was heterogeneity in the results depending on the kindergarten activities that the children were assigned to.

Adolescents' health-related quality of life (HRQoL) changes over time: a three year longitudinal study

BACKGROUND

Adolescence is a significant developmental stage marked by physical, psychological and social changes. While adolescents are generally perceived to be healthy, this stage of development is also associated with an emergence of risk factors that may have long-term consequences for their wellbeing. The aim of this study was to assess health related quality of life (HRQoL), and possible gender and age differences, in a sample of secondary school-aged adolescents over a three-year time period.

METHODS

Australian adolescents (n = 403, aged 12-15 at baseline) across six New South Wales high schools completed the KIDSCREEN-27 Questionnaire at three time points. The KIDSCREEN-27 measures five HRQoL domains (physical wellbeing, psychological wellbeing, autonomy and parents relations, social support and peers, and school environment). Mixed-between-within-subjects ANOVA analyses were employed to examine HRQoL over time and across age and gender.

RESULTS

HRQoL rates were comparable to the European-based KIDSCREEN norms with the exception of psychological wellbeing, which was considerably lower in this study's sample. Over time, for the total sample, there were significant changes on only one of the five dimensions (social support and peers). However, gender differences were found to be significant across three dimensions (physical wellbeing, psychological wellbeing, and autonomy and parents relations), with females reporting lower scores than males (i.e. lower HRQoL). Females' scores also declined over the three time points across two of the five HRQoL dimensions (social support and peers, and school environment), indicating reductions in HRQoL over time. Age differences were found across all but one dimension (autonomy and parents relations).

CONCLUSIONS

Although statistically significant, the changes in HRQoL may not be clinically significant, as the effect sizes were small and therefore those changes would not be readily noticeable. Those changes, however, suggest that, while HRQoL is predominantly stable over time, fluctuations and declines, such as those found for females, may be early indicators of physical and psychological vulnerabilities. If such vulnerabilities are detected timely; they may be addressed with preventative measures or appropriate interventions.

Verlauf gesundheitsbezogener Lebensqualität

Zusammenfassung. Gesundheitsbezogene Lebensqualität (gLQ) als Parameter zur Beschreibung der subjektiven Gesundheit von Kindern und Jugendlichen wird zunehmend auch in der Gesundheitsberichterstattung berücksichtigt. In der vorliegenden prospektiven Kohortenstudie wurde der zweijährige Verlauf bei N = 1 597 repräsentativ aus der Allgemeinbevölkerung rekrutierten 11- bis 17-Jährigen im Selbstbericht untersucht und durch gesundheitsbezogene und soziodemographische Merkmale vorhergesagt. Die gLQ wurde mit Hilfe des mehrdimensionalen KIDSCREEN-27 gemessen. Die gLQ sank mit zunehmendem Alter auf allen Skalen außer bei der Skala Gleichaltrige und soziale Unterstützung leicht und Mädchen hatten meist etwas niedrigere Werte als Jungen. Signifikante Prädiktoren der gLQ waren psychische Auffälligkeiten und körperliche Probleme des Kindes, psychische Auffälligkeiten der Eltern sowie Alter, Geschlecht, Migrationshintergrund und sozioökonomischer Status. Die Ergebnisse bieten eine Orientierung zur Beurteilung der Verläufe von einzelnen Patienten und Patientengruppen und geben Hinweise auf mögliche Zielgrößen zur Verbesserung der gLQ durch präventive Maßnahmen.

A systematic review of mental health outcome measures for young people aged 12 to 25 years

BACKGROUND

Mental health outcome measures are used to monitor the quality and effectiveness of mental health services. There is also a growing expectation for implementation of routine measurement and measures being used by clinicians as a feedback monitoring system to improve client outcomes. The recent focus in Australia and elsewhere targeting mental health services to young people aged 12-25 years has meant that outcome measures relevant to this age range are now needed. This is a shift from the traditional divide of child and adolescent services versus adult services with a transitioning age at 18 years. This systematic review is the first to examine mental health outcome measures that are appropriate for the 12 to 25 year age range.

METHODS

MEDLINE and PsychINFO databases were systematically searched to identify studies using mental health outcome measures with young people aged 12 to 25 years. The search strategy complied with the relevant sections of the PRISMA statement.

RESULTS

A total of 184 published articles were identified, covering 29 different outcome measures. The measures were organised into domains that consisted of eight measures of cognition and emotion, nine functioning measures, six quality of life measures, and six multidimensional mental health measures. No measures were designed specifically for young people aged 12 to 25 years and only two had been used by clinicians as a feedback monitoring system. Five measures had been used across the whole 12 to 25 year age range, in a range of mental health settings and were deemed most appropriate for this age group.

CONCLUSIONS

With changes to mental health service systems that increasingly focus on early intervention in adolescence and young adulthood, there is a need for outcome measures designed specifically for those aged 12 to 25 years. In particular, multidimensional measures that are clinically meaningful need to be developed to ensure quality and effectiveness in youth mental health. Additionally, outcome measures can be clinically useful when designed to be used within routine feedback monitoring systems.

Preventing alcohol misuse in young people: an exploratory cluster randomised controlled trial of the Kids, Adults Together (KAT) programme

Background

Involvement of parents/carers may increase the effectiveness of primary school-based alcohol-misuse prevention projects. However, few interventions have been designed for pre-adolescent children, or specifically involve parents/carers. The Kids, Adults Together (KAT) programme in primary schools aimed to reduce alcohol misuse through such an approach.

Objective

To determine the value and feasibility of conducting an effectiveness trial of KAT.

Design

Parallel-group cluster randomised exploratory trial with an embedded process evaluation. Schools were the unit of randomisation.

Setting

Primary schools (n = 9) in south Wales, UK.

Participants

Pupils in Year 5/6 (aged 9–11 years) and their parents/carers; school staff.

Intervention

The Kids, Adults Together programme consisted of (1) classwork addressing the effects of alcohol; (2) a family event for children and parents/carers; and (3) a ‘goody bag’ containing fun items, including a digital versatile disc (DVD) for families to watch together. The intervention comprised KAT plus existing alcohol-related activities and lessons. Control-group schools continued with existing alcohol-related lessons and activities.

Main outcome measures

Key outcomes related to the progression criteria for a potential future effectiveness trial. These included the acceptability, participation equity, feasibility and implementation of KAT; the recruitment and retention of research participants; and the acceptability and feasibility of research processes, including data collection methods and outcome measures.

Results

Nine schools (free school meal entitlement ranging from 1% to 37.2%) participated. Two of five intervention schools withdrew but all four control schools were retained, and these seven schools facilitated all research data collections. Programme acceptability and participation rates were high in all three intervention schools (parent/carer participation rates ranged from 45.1% to 65.7%), although implementation quality varied. At baseline, approximately 75% of eligible children (n = 418) provided data, of whom 257 also provided data at follow-up. Only 27 parents/carers (estimated response rate 6.5%) completed interviews. Most children were willing to complete questionnaires but measures were not appropriate for this age group. Measures of alcohol consumption produced inconsistent responses. Intermediate outcomes on family communication showed no evidence of intervention effectiveness.

Conclusions

In the three schools that received the KAT intervention, it was found to be acceptable to schools and pupils and there were good levels of participation from parents/carers from across a range of socioeconomic groups. However, two intervention schools withdrew from the trial. Findings from intermediate outcomes on family communication did not support programme theory. In addition, the study highlighted challenges in identifying suitable outcome measures for children aged 9–11 years and the feasibility of long-term follow-up via secondary schools.

Future work

It would not be appropriate to proceed to an effectiveness trial of KAT. There are doubts/uncertainties about the potential effects of KAT; suitability of measures; the large number of schools which would be required for an effectiveness trial of KAT, and the cost of this; feasibility of follow-up in secondary schools; and programme implementation and theory. There is a need to develop and validate measures for children aged 9–11 years; to test the feasibility of follow-up data collection methods in secondary schools; and to further consider sample size requirements and feasibility.

Trial registration

Current Controlled Trials ISRCTN80672127.

Funding

The exploratory trial of this project was funded by the National Institute for Health Research Public Health Research programme and the process evaluation was funded by the Economic and Social Research Council. The work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. This project will be published in full inPublic Health Research; Vol. 3, No. 15. See the NIHR Journals Library website for further project information.

Maturity-associated variation in physical activity and health-related quality of life in British adolescent girls: moderating effects of peer acceptance

BACKGROUND

Using a Biocultural Model of Maturity-Associated Variance in physical activity (PA) as a conceptual framework, the main and interactive effects of biological maturity status and perceived peer acceptance on PA and health-related quality of life (HRQoL) in adolescent girls were examined.

METHODS

Three hundred forty-two female British students in years 7 to 9 (13.2±0.83 years) participated in the study. All participants completed the PA Questionnaire for Adolescents and KIDSCREEN-10, a measure of HRQoL. Self-reported perceptions of peer acceptance were measured by items from the National Longitudinal Study of Adolescent Health.Maturity status was estimated as the percentage of predicted adult (mature) height attained at the time of observation.

RESULTS

Analysis of covariance suggested an influence of peer acceptance on maturity-associated differences in PA, but not on HRQoL. Girls early and "on time" in maturation with higher perceptions of peer acceptance reported greater involvement in PA than girls early and "on time" in maturation with lower perceptions of peer acceptance. A reverse association was observed for late-maturing girls.

CONCLUSIONS

Peer acceptance is an important moderator of maturity-associated variation in PA.

Factors influencing quality of life of obese students in Hangzhou, China

Objective

To evaluate the quality of life (QOL) of overweight and obese middle or high school students and identify relevant factors influencing their QOL scores.

Methods

716 students were recruited from 6 middle or high schools in Hangzhou, China. The Chinese version of the Youth Quality of Life Instrument–Weight Module (YQOL-W) was self administered. The YQOL-W scores were compared among different BMI groups, gender, educational status, annual household income, parental education and recruitment community using t test or one-way analysis of variance. The independent association of these variables with QOL among overweight and obese students was examined using multivariable linear regression modeling.

Results

Overweight and obese students reported lower total scores, self, social and environment scores than their normal weight peers (all P<0.001). The QOL of overweight and obese middle and high school students was associated with BMI value, gender, educational status, parental education, and recruitment community. Girls had lower total scores, self, social and environment domain scores than boys (all P<0.001); high school students had lower total and three domain scores than middle school students (all P<0.05). Students whose fathers had higher education reported higher total scores, self and social scores than students with less educated fathers (all P<0.05). Students whose mothers had higher education reported higher environment scores than students with less educated mothers (P = 0.01). Students from migrant communities reported significantly lower total scores, self and social scores than those from rural communities (all P<0.05), but comparable scores with those from urban communities (P>0.05). Students from migrant communities reported comparable environment scores with those from rural and urban communities (P>0.05).

Conclusions

Overweight and obesity have negative effects on students’ quality of life. Therefore weight specific QOL could be included in weight reduction interventions as a relevant outcome.

Reliability and validity of the Japanese version of the KIDSCREEN-52 health-related quality of life questionnaire for children/adolescents and parents/proxies

OBJECTIVES

The present study aimed to assess the reliability and validity of the Japanese version of KIDSCREEN-52 (J-KIDSCREEN-52), a generic questionnaire used to assess health-related quality of life (HRQOL) among children/adolescents and parents/proxies.

METHODS

We conducted a school-based study, in which 1564 children and adolescents aged 8-18 years and their 1326 parents participated from five schools. They were asked to complete two questionnaires (the J-KIDSCREEN-52 and the Pediatric Quality of Life Inventory (PedsQL)), and the Oslo 3-Item Social Support (OSS-3) scale. Internal consistency reliability was measured using the Cronbach's alpha coefficient. Test-retest reliability was assessed by the Intraclass Correlation Coefficient (ICC) in the one-way random effects model in sub-samples taken approximately three to four weeks apart. Agreement between the ratings of the child and parent was evaluated using the ICC in the two-way mixed effects model among 681 pairs.

RESULTS

For the overall sample, Cronbach's alpha values of 10 dimensions were ≥0.70, except for one dimension. Test-retest ICCs were ≥0.60 for nearly all dimensions. Correlation coefficients between the J-KIDSCREEN-52 and the PedsQL dimensions indicated a reasonable convergent validity. Parent ratings corresponded well with child ratings (ICC = 0.38-0.62). Statistically significant differences in mean T scores were dependent on gender for seven dimensions, age group for all dimensions, and health status for two dimensions.

CONCLUSIONS

The J-KIDSCREEN-52 questionnaires child/adolescent and parent/proxy versions demonstrated acceptable levels of reliability and validity.

The effect of dance mat exergaming systems on physical activity and health-related outcomes in secondary schools: results from a natural experiment

BACKGROUND

Exergaming has been proposed as an innovative method for physical activity promotion. However, large effectiveness studies are rare. In January 2011, dance mat systems were introduced in secondary schools in two districts in England with the aim of promoting an innovative opportunity for physical activity. The aim of this natural experiment was to examine the effect of introducing the dance mat exergaming systems on physical activity and health-related outcomes in 11-13 year old students using a non-randomised controlled design and mixed methods.

METHODS

Participants were recruited from five schools in intervention districts (n = 280) and two schools in neighbouring control districts (n = 217). Data on physical activity (accelerometer), anthropometrics (weight, BMI and percentage of body fat), aerobic fitness (20-m multistage shuttle run test), health-related quality of life (Kidscreen questionnaire), self-efficacy (children's physical activity self-efficacy survey), school attendance, focus groups with children and interviews with teachers were collected at baseline and approximately 12 months follow-up.

RESULTS

There was a negative intervention effect on total physical activity (-65.4 cpm CI: -12.6 to -4.7), and light and sedentary physical activity when represented as a percentage of wear time (Light: -2.3% CI: -4.5 to 0.2; Sedentary: 3.3% CI: 0.7 to 5.9). However, compliance with accelerometers at follow-up was poor. There was a significant positive intervention effect on weight (-1.7 kg, 95% CI: -2.9 to -0.4), BMI (-0.9 kg/m2, 95% CI: -1.3 to -0.4) and percentage of body fat (-2.2%, 95% CI: -4.2 to -0.2). There was also evidence of improvement in some health-related quality of life parameters: psychological well-being (2.5, 95% CI: 0.1 to 4.8) and autonomy and parent relation (4.2, 95% CI: 1.4 to 7.0).

CONCLUSIONS

The implementation of a dance mat exergaming scheme was associated with improvement in anthropometric measurements and parameters of health-related quality of life. However, the mechanisms of these benefits are unclear as there was insufficient data from physical activity to draw robust conclusions. Qualitative findings suggest that there was declining support for the initiative over time, meaning that potential benefits may not have been achieved.

Health related quality of life of immigrant children: towards a new pattern in Germany?

BACKGROUND

To study Health related quality of life (HRQoL) of a sample of kindergarten children with migration background.

METHODS

Five kindergartens in Frankfurt/Main and Darmstadt (Germany) participated. HRQoL was measured with the Kiddy-KINDL (KK) in 3 to 5 year old children. We examined the associations of HRQoL with socio-demographic variables, positive development and resilience, socio-emotional and motor development. Linear regression models were applied to examine differences in HRQoL between migrant and native-born German children.

RESULTS

The response rate was 90.5% (N = 283). The children had predominantly migrant background (81.35%). Perceived health was slightly higher in migrants (69.85, SD 17.00) compared to native-born German children (68.33, SD 17.31, p > 0.05), even though migrant children were characterized by a lower socio-economic status (p < 0.01).

CONCLUSIONS

Results suggest that HRQoL at early ages in our study exhibits a different pattern than reported previously in studies among older individuals. We attribute the discrepancy partly to a possible changing pattern of migration in Europe with more migrants capable to migrate with healthy profiles, and to the age of our population. Our findings underscore the need to study the life course trajectory of HRQoL among young immigrants and replication in representative samples.

The relationship between body mass index and health-related quality of life in urban disadvantaged children

INTRODUCTION

The study's aim was to establish, for children living in urban disadvantage, the nature and extent of the relationship between body mass index (BMI) and health-related quality of life (HRQoL), including the role of individual and family factors in influencing this relationship.

METHODS

Within the context of a longitudinal design, 255 children aged 7-12 years (50 % male) self-reported their HRQoL (Kidscreen-27) and had their height and weight measured at year one and two. One parent/guardian for each child was also assessed at year one with the OSLO Social Support Scale and Hospital Anxiety and Depression Scale. Regression analysis was also conducted.

RESULTS

BMI was weakly inversely associated with 'total HRQoL' (r = -.15, p < .05), 'physical well-being' and 'autonomy and parent relations'. Significant differences were found between normal weight and obese children on all but the latter dimension. Neither weight group, however, fell below the average European HRQoL range. BMI predicted physical well-being a year later and vice versa, whilst autonomy and parent relations also predicted BMI a year later. In terms of 'overweight' children (38 %), those approaching adolescence had poorer physical and school well-being than younger children, and those whose parents had moderate-to-severe levels of depression fared worse on school well-being than children whose parents were not depressed.

CONCLUSION

The findings suggest that obesity programmes could aim to prevent/reduce obesity and optimise HRQoL in urban disadvantaged preadolescent children whilst also targeting parental mental health difficulties. Future research should examine mediators of the effect of BMI on HRQoL.

Parent-child agreement on health-related quality of life (HRQOL): a longitudinal study

Background

Few studies have evaluated changes on parent–child agreement in HRQOL over time. The objectives of the study were to assess parent–child agreement on child’s HRQOL in a 3-year longitudinal study, and to identify factors associated with possible disagreement.

Methods

A sample of Spanish children/adolescents aged 8–18 years and their parents both completed the KIDSCREEN-27 questionnaire. Data on age, gender, family socioeconomic status (SES), and mental health (Strengths and Difficulties Questionnaire, SDQ) was also collected at baseline (2003), and again after 3 years (2006). Changes in family composition were collected at follow-up. Agreement was assessed through intraclass correlation coefficient (ICC), and Bland and Altman plots. Generalizing Estimating Equation (GEE) models were built to analyze factors associated with parent–child disagreement.

Results

A total of 418 parent–child pairs were analyzed. At baseline the level of agreement on HRQOL was low to moderate and it was related to the level of HRQOL reported. Physical well-being at baseline showed the highest level of parent–child agreement (ICC=0.59; 0.53-0.65) while less “observable” dimensions presented lower levels of agreement, (i.e. Psychological well-being: ICC= 0.46; 0.38-0.53). Agreement parent–child was lower at follow-up. Some interactions were found between rater and child’s age; with increasing age, child scored lower than parents on Parents relationships and Autonomy (Beta [B] -0.47; -0.71 / -0.23) and the KIDSCREEN-10 (−0.49; -0.73 /-0.25).

Conclusions

Parent–child agreement on child’s HRQOL is moderate to low and tends to diminish with children age. Measuring HRQOL of children/adolescents mainly in healthy population samples might require direct self-assessments.

The European KIDSCREEN approach to measure quality of life and well-being in children: development, current application, and future advances

PURPOSE

The KIDSCREEN questionnaires were developed by a collaborative effort of European pediatric researchers for use in epidemiologic public health surveys, clinical intervention studies, and research projects. The article gives an overview of the development of the tool, summarizes its extensive applications in Europe, and describes the development of a new computerized adaptive test (KIDS-CAT) based on KIDSCREEN experiences.

METHODS

The KIDSCREEN versions (self-report and proxy versions with 52, 27, and 10 items) were simultaneously developed in 13 different European countries to warrant cross-cultural applicability, using methods based on classical test theory (CTT: descriptive statistics, CFA and MAP, internal consistency, retest reliability measures) and item response theory (IRT: Rasch modeling, DIF analyses, etc.). The KIDS-CAT was developed (in cooperation with the US pediatric PROMIS project) based on archival data of European KIDSCREEN health surveys using IRT more extensively (IRC).

RESULTS

Research has shown that the KIDSCREEN is a reliable, valid, sensitive, and conceptually/linguistically appropriate QoL measure in 38 countries/languages by now. European and national norm data are available. New insights from KIDSCREEN studies stimulate pediatric health care. Based on KIDSCREEN, the Kids-CAT promises to facilitate a very efficient, precise, as well as reliable and valid assessment of QoL.

CONCLUSIONS

The KIDSCREEN has standardized QoL measurement in Europe in children as a valid and cross-cultural comparable tool. The Kids-CAT has the potential to further advance pediatric health measurement and care via Internet application.

Morningness-Eveningness and Health-Related Quality of Life among Adolescents

Accumulating evidence suggests that evening-type adolescents are exposed to a number of determinants that might have a negative impact on their health condition. Given that few studies have investigated the association between chronotype and quality of life measures in large samples of adolescents, the aim of this study was to assess the relationship between morningness-eveningness and health-related quality of life among 1600 adolescents (aged 12-16 years). Adolescents completed the Veçú et Santé Perçue de L'adolescent (VSP-A) and the Morningness-Eveningness Scale for Children (MESC). Girls and older adolescents reported worse health indicators and were more evening oriented. Evening-type adolescents obtained lower scores on vitality, physical and psychological well-being, body image, relations with parents, relations with teachers, school work and global health scale.

How robust is the evidence of an emerging or increasing female excess in physical morbidity between childhood and adolescence? Results of a systematic literature review and meta-analyses

For asthma and psychological morbidity, it is well established that higher prevalence among males in childhood is replaced by higher prevalence among females by adolescence. This review investigates whether there is evidence for a similar emerging female ‘excess’ in relation to a broad range of physical morbidity measures. Establishing whether this pattern is generalised or health outcome-specific will further understandings of the aetiology of gender differences in health. Databases (Medline; Embase; CINAHL; PsycINFO; ERIC) were searched for English language studies (published 1992–2010) presenting physical morbidity prevalence data for males and females, for at least two age-bands within the age-range 4–17 years. A three-stage screening process (initial sifting; detailed inspection; extraction of full papers), was followed by study quality appraisals. Of 11 245 identified studies, 41 met the inclusion criteria. Most (n = 31) presented self-report survey data (five longitudinal, 26 cross-sectional); 10 presented routinely collected data (GP/hospital statistics). Extracted data, supplemented by additional data obtained from authors of the included studies, were used to calculate odds ratios of a female excess, or female:male incident rate ratios as appropriate. To test whether these changed with age, the values were logged and regressed on age in random effects meta-regressions. These showed strongest evidence of an emerging/increasing female excess for self-reported measures of headache, abdominal pain, tiredness, migraine and self-assessed health. Type 1 diabetes and epilepsy, based on routinely collected data, did not show a significant emerging/increasing female excess. For most physical morbidity measures reviewed, the evidence broadly points towards an emerging/increasing female excess during the transition to adolescence, although results varied by morbidity measure and study design, and suggest that this may occur at a younger age than previously thought.

Health-related quality of life, obesity, and fitness in schoolchildren: the Cuenca study

PURPOSE

The purpose of this study was to analyze the association of weight status and physical fitness with health-related quality of life (HRQoL) and to examine the independent association of body mass index (BMI), cardiorespiratory fitness (CRF) and musculoskeletal fitness (MF) with HRQoL in schoolchildren.

METHODS

Cross-sectional study of 1,158 schoolchildren, 8-11 years, from 20 schools in the Cuenca province, Spain. We measured weight, height, and physical fitness, measured by CRF (20-m shuttle run test) and MF index by summing the age-sex z scores of handgrip strength test/weight + standing broad jump test. Self-reported HRQoL was measured by KIDSCREEN-52 questionnaire.

RESULTS

Normal weight boys scored better in physical well-being, mood and emotions, autonomy, and social support and peers dimensions than overweight/obese boys. The mean in self-perception dimensions was lower in obese girls compared to normal weight or overweight girls. Higher levels of CRF and MF were associated with better physical well-being in both genders. Multiple linear regression models showed that the influence of MF in boys and CRF in girls on HRQoL was greater than that of overweight.

CONCLUSIONS

This is one of the first studies that assess the association of CRF and MF with HRQoL while controlling for BMI. CRF and MF are closely related to HRQoL, in particular to physical well-being. Improving fitness could be a strategy of particular interest for improving the HRQoL of schoolchildren.

Self-reported adolescent health status of extremely low birth weight children born 1992-1995

OBJECTIVES

To compare the self-reported health of extremely low birth weight (ELBW, <1 kg) adolescents with that of normal birth weight (NBW) controls and the children's assessments of their general health at ages 8 versus 14 years.

METHODS

One hundred sixty-eight ELBW children and 115 NBW controls of similar gender and sociodemographic status completed the Child Health and Illness Profile-Adolescent Edition at age 14 years. It includes 6 domains: Satisfaction, Comfort, Resilience, Risk Avoidance, Achievement, and Disorders. At age 8 years, the children had completed the Child Health and Illness Profile-Child Edition. Results were compared between ELBW and NBW subjects adjusting for gender and sociodemographic status.

RESULTS

ELBW adolescents rated their health similar to that of NBW adolescents in the domains of Satisfaction, Comfort, Resilience, Achievement and Disorders but reported more Risk Avoidance (effect size [ES] 0.6, P < .001). In the subdomain of Resilience, they also noted less physical activity (ES -0.58, P < .001), and in the subdomain of Disorders, more long-term surgical (ES -0.49) and psychosocial disorders (ES -0.49; both P < .01). Both ELBW and NBW children reported a decrease in general health between ages 8 and 14 years, which did not differ significantly between groups.

CONCLUSIONS

ELBW adolescents report similar health and well-being compared with NBW controls but greater risk avoidance. Both ELBW and NBW children rate their general health to be poorer at age 14 than at age 8 years, possibly due to age-related developmental changes.

Assessing the association between low back pain, quality of life, and life events as reported by schoolchildren in a population-based study

Low back pain (LBP) is prevalent in teenagers but not necessarily detrimental to their quality of life (QoL). This population-based study evaluated a global QoL score and the association between LBP and life events and/or health problems affecting QoL. Schoolchildren were investigated in Fribourg-Switzerland and Barcelona-Spain. In addition to the KIDSCREEN, a health-related QoL questionnaire, two Numerical Rating Scales were used to assess QoL in general, and the influence of LBP on QoL. Open questions explored life events and health problems affecting QoL; responses were submitted to content analysis. Adolescents were stratified: Pain-free, Other pain (OP), isolated LBP (IsoLBP), LBP + other pains (LBP + OP), and LBP + whole-body pain (LBP + WBP). Between-group comparisons were performed using Chi-squared tests and ANOVA. Linear regression analysis was performed to assess between-group differences in the impact of LBP on QoL. Schoolchildren (1,470) (mean age = 15.05 years, 52.6% = boys) completed the questionnaire. LBP lasting >1 day in the last month was reported by 39.8% (N = 560): of them, 242 (43.2%) reported IsoLBP, 268 (47.9%) LBP + OP, and 50 (9.1%) LBP + WBP. QoL was lower in LBP + WBP (mean = 6.44 vs. LBP + OP = 7.8; IsoLBP = 7.6, OP = 7.96, Pain-free = 8.1; p < 0.001). There were 18.5% who reported health problems and 15.3% life events with a perceived impact on QoL. Prevalence was higher in LBP + WBP with >30% of this group identifying life events and/or health problems vs. 10-12% in PFree or IsoLBP groups (p < 0.001). IsoLBP affected QoL marginally (mean = 2.4 ± 2.2) compared to LBP + WBP (mean = 4.9 ± 2.4) (p < 0.001). LBP affected QoL marginally. These results stress the distinction between disease and common life experience. They also indicate the potential value of global QoL assessments in clinical settings.

Health-related quality of life measurement in children and adolescents in Ibero-American countries, 2000 to 2010

OBJECTIVES

To analyze the characteristics of instruments designed to assess the health-related quality of life (HRQOL) in children, developed or adapted from 2000 to 2010 in Argentina, Chile, Mexico, Spain, and Uruguay.

METHODS

The protocol-led literature review included database searching (e.g., Medline, ISI Science Citation Index) and manual searching to retrieve studies focused on measures of HRQOL, health status, or well-being addressed to children and adolescents. Country-specific filters were applied to identify studies carried out in the participating countries. The characteristics of the instruments and type of studies were analyzed. Descriptive characteristics and psychometric properties were analyzed following the guidelines of the Scientific Advisory Committee of the Medical Outcomes Trust.

RESULTS

Ninety-nine documents were included. Thirty-one questionnaires were identified, 24 instruments were adapted, and the psychometric properties of 20 HRQOL instruments were reported in the study period. There was substantial variability in the number and characteristics of the dimensions included. Reliability was generally acceptable, and the majority of instruments provided data on internal consistency (n = 18) and, to a lesser extent, on test-retest reliability (n = 12). Nearly all studies reported construct validity, but only four analyzed sensitivity to change.

CONCLUSIONS

There is a scarcity of instruments to measure HRQOL of children and adolescents in the countries analyzed. Certain psychometric characteristics have been reasonably well tested, but others, most notably sensitivity to change, have not been tested in most instruments. Extension of this study to other Latin American countries would help to further identify gaps in this area and promote the use of HRQOL measurement in children and adolescents in Spanish-speaking cultures.