Health-related quality of life in children with asthma from different ethnic origins

Higher perceived HRQoL in Moroccan children with asthma and their parents

We explored the differences in the perceived HRQoL between children with asthma from Moroccan and Dutch descent and their parents. In total 33 children (aged 6-18 years) from Moroccan (16) and Dutch descent (17) and their parents participated. All children were currently under treatment in a general hospital in the Netherlands. Generic and asthma specific HRQoL were assessed (DUX-25, DISABKIDS, PAQLQ). Significant differences were found on the DUX-25 subscales physical, emotional and home functioning. Children and parents from Dutch descent reported a lower HRQoL. The findings of this study are contrary with previous research. Results can be explained by the individualistic-collectivistic dimension, socially desirability, language and the feeling of miscomprehension. If this explanation makes sense health care workers have to invest in a good relationship with especially immigrant children and their parents, so they will have enough confidence to talk more openly about their physical as well as their psycho-social complaints.

Analyzing Fallacies in Argumentation to Enhance Effectiveness of Educational Interventions: The Case of Care Providers' Arguments Against Using Professional Interpretation

INTRODUCTION

Although research has shown that professional interpreters improve health care to patients who do not speak the same language as their care provider, care providers underuse professional interpretation services. To get more insight into the reasons of care providers to underuse professional interpreters, we studied fallacies in their arguments. Fallacies in reasoning may explain why care providers avoid changing their behavior even if they are aware of evidence in favor of such behavior.

METHODS

We did a secondary analysis of interviews about immigrant patients with care providers collected in two studies on in-hospital pediatric care. Interviews (N = 37) were held in 2009, in the Netherlands. Interviews were analyzed using a contextual approach to fallacious argumentation: a method that can identify fallacies as "wrong" arguments compared with the context in they are made.

RESULTS

We identified six main fallacies that care providers used to argue that they prefer not to use a professional interpreter while having free access to professional interpreters: 1) There are also some negative side effects to using professional interpreters, 2) there is no language problem, 3) it is such an enormous hassle to organize it, 4) I am a good doctor, 5) my medical information is not complex, and 6) patients do not want it.

DISCUSSION

Familiarizing care providers with these fallacies can raise their awareness of the wrong arguments to defend their underuse of professional interpreters and can be made part of their training.

Quality of life in children with asthma in Rio de Janeiro, Brazil

OBJECTIVES

To evaluate the impact of asthma on activity limitation, symptoms and emotional function in the health-related quality of life (HRQL) of asthmatic children.

METHODS

A cross-sectional study involving 59 children of 7 to 12 y of age. A standardized version of the Pediatric Asthma Quality of Life Questionnaire was used to evaluate HRQL and the current criteria for socioeconomic stratification in Brazil were used to assess socioeconomic status. Independent variables evaluated included clinical and sociodemographic characteristics. The association between mean HRQL scores and the independent variables was evaluated using the Mann-Whitney, Kruskal-Wallis and Dunn tests. Statistical significance was defined as a p-value < 0.05.

RESULTS

Thirty-two families (56.1 %) had a total household income of more than two minimum wages, while 37 families (62.7 %) were considered lower middle class. Mean overall HRQL score was 4.8 ± 1.3 (out of a maximum score of 7), suggesting reasonable HRQL. There was a weak association between independent variables and mean overall HRQL scores and the mean scores in the emotional function domain. Higher socioeconomic status was related to higher scores for the symptoms domain (p = 0.041). Furthermore, children exposed to indoor mould reported greater impairment in the symptoms domain(p = 0.022). The severity of asthma was associated with the activity limitation domain (p = 0.025).

CONCLUSIONS

These results showed a reasonable mean HRQL score and an association between the severity of asthma and the activity limitation domain.

Qualidade de vida na asma pediátrica: revisão da literatura

OBJETIVO: Analisar as produções científicas que abordam a temática da qualidade de vida em crianças e adolescentes com asma, objetivando discutir o instrumento de pesquisa Pediatric Asthma Quality of Life Questionnaire (PAQLQ). FONTES DE DADOS: Revisão não sistemática da literatura incluindo artigos nos idiomas inglês, português e espanhol, a partir das bases de dados Medline, SciELO e Lilacs, no período de 1997 a 2009. Foram utilizados os termos "quality of life", "asthma pediatrics", "asthma quality of life" e "PAQLQ". SÍNTESE DOS DADOS: Os 26 artigos encontrados foram organizados em duas seções, a saber: estudos de validação do PAQLQ (n=12) e estudos de avaliação da qualidade de vida na asma pediátrica usando o questionário PAQLQ (n=14). CONCLUSÕES: A avaliação da qualidade de vida deve ser incorporada à avaliação clínica, uma vez que a doença crônica repercute nas diversas dimensões da vida dos pacientes. O PAQLQ é de fácil aplicação, reprodutível e constitui-se em instrumento para avaliar a qualidade de vida de crianças e adolescentes com asma.

Predicting moderate improvement and decline in pediatric asthma quality of life over 24 months

OBJECTIVE

To determine factors associated with 24-month change in quality of life in children with asthma and their parents during the Childhood Asthma Management Program (CAMP).

METHODS

Participants from 4 CAMP clinical centers were administered the Pediatric Asthma Quality of Life questionnaire and protocol measures of asthma symptoms, lung function, and psychological measures.

RESULTS

Multivariate logistic regression analyses determined predictors of moderate change in quality of life. Subclinical levels of depression predicted moderate improvement in child-reported quality of life. Level of depressed affect together with clinical asthma features predicted moderate decline. Improvement in parent quality of life was predicted by perception of illness burden, whereas family features and a child missing school predicted moderate decline.

CONCLUSIONS

This ancillary study provided an opportunity to examine the determinants of 24-month change in parent and child of quality of life within a subset of the CAMP participants. Moderate changes in quality of life occur in clinical studies and have both psychosocial correlates and illness characteristics.

Health-related quality of life of children with mild to moderate chronic kidney disease

OBJECTIVE

To compare the health-related quality of life (HRQoL) of children with chronic kidney disease (CKD) with healthy children; to evaluate the association between CKD severity and HRQoL; and to identity demographic, socioeconomic, and health-status variables that are associated with impairment in HRQoL in children with mild to moderate CKD.

METHODS

This was a cross-sectional assessment of HRQoL in children who were aged 2 to 16 and had mild to moderate CKD using the Pediatric Inventory of Quality of Life Core Scales (PedsQL). Overall HRQoL and PedsQL domain means for parents and youth were compared with previously published norms by using independent sample t tests. Study participants were categorized by kidney disease stage (measured by iohexol-based glomerular filtration rate [iGFR]), and group differences in HRQoL were evaluated by using analysis of variance and Cuzick trend tests. The association between hypothesized predictors of HRQoL and PedsQL scores was evaluated with linear and logistic regression analyses.

RESULTS

The study sample comprised 402 participants (mean age: 11 years, 60% male, 70% white, median iGFR: 42.5 mL/min per 1.73 m(2), median CKD duration: 7 years). Youth with CKD had significantly lower physical, school, emotional, and social domain scores than healthy youth. iGFR was not associated with HRQoL. Longer disease duration and older age were associated with higher PedsQL scores in the domains of physical, emotional, and social functioning. Older age was associated with lower school domain scores. Maternal education > or =16 years was associated with higher PedsQL scores in the domains of physical, school, and social functioning. Short stature was associated with lower scores in the physical functioning domain.

CONCLUSIONS

Children with mild to moderate CKD, in comparison with healthy children, reported poorer overall HRQoL and poorer physical, school, emotional, and social functioning. Early intervention to improve linear growth and to address school functioning difficulties is recommended.

Predicting changes in clinical status of young asthmatics: clinical scores or objective parameters?

Preventing asthma exacerbation is an important goal of asthma management. The existing clinical tools are not good in predicting asthma exacerbations in young children. Childhood Asthma Control Test (C-ACT) was recently published to be a simple tool for assessing disease control in young children. This study investigated C-ACT and other disease-related factors for indicating longitudinal changes in asthma status and predicting asthma exacerbations. During the same clinic visit, asthma patients aged 4-11 years completed the Chinese version of C-ACT and underwent exhaled nitric oxide and spirometric measurements. Blinded to these results, the same investigator assigned Disease Severity Score (DSS) and rated asthma control according to Global Initiative for Asthma. Asthma exacerbations during the next 6 months were recorded. Ninety-seven patients were recruited, with their mean (standard deviation [SD]) age being 9.2 (2.0) years. Thirty-six (37.1%) patients had uncontrolled asthma at baseline. C-ACT, DSS, and FEV(1) differed among patients with different control status (P < 0.001 for C-ACT and DSS; P = 0.028 for FEV(1)). Thirty-two patients had asthma exacerbations during the 6-month follow-up. Changes in patients' C-ACT scores correlated with changes in asthma control status, DSS, and FEV(1) (P = 0.019, 0.034, and 0.020, respectively). C-ACT score was lower among patients with asthma exacerbations (mean [SD]: 22.9 [4.2] vs. 24.5 [2.1]; P = 0.015). Logistic regression confirmed that the occurrence of asthma exacerbations was associated only with baseline C-ACT (B = -0.203, P = 0.042). In conclusion, C-ACT is better than DSS and objective parameters in reflecting changes in asthma status and predicting asthma exacerbations in young children.

Identifying uncontrolled asthma in young children: clinical scores or objective variables?

OBJECTIVE

Several international asthma guidelines emphasize the importance of assessing asthma control. However, there is limited data on the usefulness of available assessment tools in indicating disease control in young asthmatics. This study investigated the ability of Chinese version of Childhood Asthma Control Test (C-ACT) and other disease-related factors in identifying uncontrolled asthma (UA) in young children.

METHODS

During the same clinic visit, asthma patients 4 to 11 years of age completed C-ACT and underwent exhaled nitric oxide and spirometric measurements. Blinded to these results, the same investigator assigned Disease Severity Score (DSS) and rated asthma control according to Global Initiative for Asthma.

RESULTS

The mean (SD) age of 113 recruited patients was 9.1 (2.0) years, and 35% of them had UA. C-ACT, DSS and forced expiratory volume in 1 second (FEV(1)) differed among patients with different control status (p < 0.001 for C-ACT and DSS; p = 0.014 for FEV(1)). Logistic regression confirmed that UA was associated with DSS (p < 0.001), PEF (p = 0.002), C-ACT (p = 0.011), and FEV(1) (p = 0.012). By ROC analysis, C-ACT and DSS were the best predictors for UA (p < 0.001), followed by PEF (p = 0.006) and FEV(1) (p = 0.007). When analyzed by the Classification and Regression Tree (CART) approach, the sequential use of DSS and C-ACT had 77% sensitivity and 84% specificity in identifying UA.

CONCLUSIONS

C-ACT is better than objective parameters in identifying young Chinese children with UA.

Quality of life in asthmatic adolescents: an overall evaluation of disease control

OBJECTIVE

to evaluate the relative impact of reported symptoms, school absenteeism, hospital admission, medical visits, and the presence of emotional and behavioral disorders on the health-related quality of life (HRQL) of low income asthmatic adolescents.

METHODS

Asthmatic adolescents were randomly selected among public schools in Belo Horizonte/MG, Brazil. Asthma severity was rated according to the Global Initiative for Asthma (GINA) classification. Emotional and behavior disorders (EBDs) were evaluated through the Strengths and Difficulties Questionnaire. HRQL was assessed through the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). PAQLQ score was analyzed for each intervening variable. Multivariate regression analysis was conducted.

RESULTS

One hundred and forty-six adolescents participated in the present study, 45% being male and age ranging from 14 to 16 years old. Mean PAQLQ score was 5.7 +/- 1.3 SD, with no significant difference regarding sociodemographic characteristics, except for gender (p = 0.001). The regression equation of the final model for the multivariate analysis was as follows: Mean PAQLQ score = 1.88 (Constant) - 0.42 gender + 1.14 nighttime symptoms + 0.69 medical visits in the past 12 months + 0.95 EBDs. Therefore, if the other variables remained constant, PAQLQ score: reduced in 0.42 points for females (p = 0.01); increased in 1.14 when there were no nighttime symptoms (p < 0.01); increased in 0.69 when there was no medical visit for respiratory problems within the past 12 months (p < 0.01); and increased in 0.95 when no EBDs were present (p < 0.01). This model was able to explain approximately half of the variation found in PAQLQ score (R-Sq = 49.4%).

CONCLUSIONS

HRQL of asthmatic adolescents is influenced by the complex interaction among several factors: the severity of clinical symptoms, morbidity, gender, and the psychological resources available so as to deal with such difficulties. A careful evaluation of HRQL is essential in order to capture feelings and subjective perceptions, which are not investigated by the conventional evaluation of asthma control.

Development and initial validation of a pictorial quality of life measure for young children with asthma

OBJECTIVE

To develop and assess the psychometric properties of a pictorial version of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ).

METHODS

A pictorial PAQLQ was administered to 101 children with mild to severe asthma between 5 and 7 years of age. A subgroup of 48 children followed longitudinally completed the established version of the PAQLQ.

RESULTS

A confirmatory factor analysis with modifications supported the factor structure of the established PAQLQ. The pictorial measure exhibited internal consistency reliability and convergent, discriminant, and predictive validity.

CONCLUSIONS

Results suggest that the pictorial version of the PAQLQ has an underlying factor structure that is similar to that of the established PAQLQ. Future research with larger and diverse samples is needed to confirm the factor structure of the pictorial PAQLQ.

Impact of family income and sickle cell disease on the health-related quality of life of children

PURPOSE

The objective of this study was to determine the impact of family income and sickle cell disease on the health-related quality of life (HRQL) of children.

METHODS

This was a cross-sectional study of children with and without sickle cell disease. Participants completed the PedsQL generic core scales parent-proxy or child self-report questionnaire during a routine clinic visit. HRQL was the primary outcome measured. Family income and sickle cell disease were the primary independent variables of interest.

RESULTS

A total of 104 children with sickle cell disease and 74 without disease participated in the study. After adjusting for family income, patient age, and the presence of co-morbidities, children with severe sickle cell disease had increased odds of worse overall HRQL (parent-proxy HRQL report odds ratio [OR] 4.0) and physical HRQL (parent-proxy report OR 5.67, child self-report OR 3.33) compared to children without sickle cell disease.

CONCLUSIONS

Children with sickle cell disease have significantly impaired HRQL, even after considering the potential detrimental effect of family income on HRQL. Targeted interventions to improve these children's HRQL are warranted.