Validity of the Spanish version of the Child Health and Illness Profile-Adolescent Edition (CHIP-AE)

Virtual reality as a non-medical tool in the treatment of anxiety, pain, and perception of time in children in the maintenance phase of acute lymphoblastic leukemia treatment

Introduction

Management of pediatric cancer patients involves invasive procedures such as punctures, injections, catheter placements, and chemotherapy which can generate fatigue, nausea, vomiting, anxiety, and pain. Virtual Reality (VR) is a nonpharmacological intervention classified as a cognitive-behavioral method to relieve symptoms.

Methods

We designed a crossover protocol and included 20 patients between 9 and 12 years old; ten were male. All patients had acute lymphoblastic leukemia diagnosis and were treatedwith St. Jude's XV protocol in the maintenance phase. Pain and anxiety were measured with validated scales in the pediatric population.

Results

Although we used a small group of patients, we found statistical difference in the reduction of anxiety and perception of time.

Discussion

These results open a window to non-pharmacological treatments and show a strategy to improve quality of life in children inside the hospital.

Metabolic syndrome, adiposity, diet, and emotional eating are associated with oxidative stress in adolescents

Background

Metabolic syndrome (MS), a condition related to adiposity and oxidative stress, can develop in adolescence, a critical stage in life that impacts health in adulthood. However, there is scarce scientific research about the relationship between lifestyle factors, emotion management, and oxidative stress in this phase of life.

Aim

To analyze whether nutritional parameters, lifestyle factors, emotion management, and MS in adolescents are associated with oxidative stress measured by the biomarker 8-isoprostane.

Methods

A cross-sectional study was carried out in 132 adolescents (48.5% girls, aged 12 ± 0.48 years) and data were collected on nutritional parameters (anthropometric measurements, biochemical analyzes, and blood pressure), lifestyle factors (physical activity, sleep, and diet), and emotion management (self-esteem, emotional eating, and mood). 8-isoprostane was analyzed in spot urine samples. The study population was categorized in three groups (healthy, at-risk, and with MS) using the International Diabetes Federation definition of MS in adolescents. To capture more complex interactions, a multiple linear regression was used to analyze the association between 8-isoprostane and the aforementioned variables.

Results

Urinary 8-isoprostane levels were significantly higher in the MS group compared to the healthy group (1,280 ± 543 pg./mg vs. 950 ± 416 pg./mg respectively). In addition, univariable analysis revealed positive significant associations between 8-isoprostane and body mass index, waist circumference, waist-to-height ratio, body fat percentage, blood lipid profile and glucose, emotional eating, and refined cereal intake. Conversely, a negative significant association was found between 8-isoprostane and sleep duration and fish intake. The multiple linear regression analysis revealed associations between 8-isoprostane and LDL-c (β = 0.173 value of p = 0.049), emotional eating (low β = 0.443, value of p = 0.036; high β = 0.152, value of p = 0.470), refined cereal intake (β =0.191, value of p = 0.024), and fish intake (β = -0.187, value of p = 0.050).

Conclusion

The MS group, LDL-c, emotional eating, and high refined cereals and low fish intakes were associated with higher levels of oxidative stress in an adolescent population.

[Health impact of the community intervention programme "Health education in adolescence"]

OBJECTIVE

To measure the impact of the community health programme "Education for health in adolescence" carried out in the Parquesol neighborhood, Valladolid (Spain), during the years 2015-2019.

METHOD

Community-based quasi-experimental pre- and post-test analytical intervention trial with control group. A total of 407 adolescent surveys were collected. The CHIP-AE test validated for Spain was used. Pre- and post-test results were analyzed and compared with the control group.

RESULTS

Improvements were found in the female intervention group compared to the control group in the variables resilience (3.68 vs. 3.41; p <0.01), health and safety at home (4.30 vs. 4.00; p <0.01), physical activities (3.16 vs. 2.60; p <0.01) and self-esteem (3.17 vs. 2.79; p <0.05).

CONCLUSIONS

The community intervention carried out improves the health profile of adolescents. The baseline perception of health presents differences by gender, with higher scores in males. Post-intervention improvement is substantial in females in resilience, physical activities and health and safety at home. In addition, the worsening due to the passage of time described in previous studies is corrected in the variables self-esteem, satisfaction and well-being.

Risk taking, sensation seeking and personality as related to changes in substance use from adolescence to young adulthood

INTRODUCTION

This study examined changes in substance use from adolescence to young adulthood as related to adolescents' risk taking, sensation seeking, antisocial activities, and personality traits.

METHODS

Chilean youth (N = 890, 52% female) were studied in adolescence (14.5 and 16.2 years) and young adulthood (M age 21.3 years). Risk taking was assessed via a laboratory-based performance task (Balloon Analogue Risk Task), and self-administered questionnaires assessed sensation seeking, antisocial behaviors, personality and substance use.

RESULTS

Frequent involvement in sensation seeking and antisocial activities were associated with increased odds of continued marijuana use from adolescence to young adulthood and of illicit substance use at young adulthood. High risk taking was associated with a reduced likelihood of discontinuing marijuana use at young adulthood, and high agreeableness and conscientiousness were associated with reduced likelihood of new onset marijuana use and illicit substance use at young adulthood.

CONCLUSIONS

Results highlight specific risk-taking tendencies and personality characteristics that relate to initiating, continuing, or discontinuing substance use at entry into adulthood. Sensation seeking and involvement in antisocial activities were the two foremost risk factors for continued use, which is a forecaster of drug dependence. Findings suggest potential prevention and intervention targets for abstaining from or discontinuing substance use as youth transition to adulthood.

Rationale and design of the school-based SI! Program to face obesity and promote health among Spanish adolescents: A cluster-randomized controlled trial

Unhealthy habits in adolescents are increasing at an alarming rate. The school offers a promising environment in which to implement effective preventive strategies to improve adolescents' lifestyle behaviors. The SI! Program is a multilevel multicomponent school-based health-promotion intervention aimed at all stages of compulsory education in Spain. We present the study design of the SI! Program for Secondary Schools, targeting adolescents aged 12 to 16 years.

AIM

The main goal of this study is to evaluate the impact of the SI! Program educational intervention on adolescent lifestyle behaviors and health parameters.

METHODS

The study was designed as a cluster-randomized controlled intervention trial and enrolled 1326 adolescents from 24 public secondary schools in Spain, together with their parents/caregivers. Schools and their students were randomly assigned to the intervention group (the SI! curriculum-based educational program over 2 or 4 academic years) or to the control group (usual curriculum). The primary endpoint will be the change from baseline at 2-year and 4-year follow-up in the composite Ideal Cardiovascular Health (ICH) score, consisting of four health behaviors (body mass index, dietary habits, physical activity, and smoking) and three health factors (blood pressure, total cholesterol, and glucose). Secondary endpoints will include 2-year and 4-year changes from baseline in ICH score subcomponents, the Fuster-BEWAT health scale, adiposity markers (waist circumference and body composition), polyphenol and carotenoid intake, and emotion management.

DISCUSSION

The overarching goal of the SI! Program is to instill healthy behaviors in children and adolescents that can be sustained into adulthood. The SI! Program for Secondary School is a comprehensive health-promotion intervention targeting 12-16-year-old adolescents and their immediate environment. The present study addresses the optimal timing and impact of the educational intervention on health in adolescence.

Spanish validation of the Spence Preschool Anxiety Scale

BACKGROUND

The Preschool Anxiety Scale (PAS) is a 28-item measure designed to assess anxiety symptoms in preschoolers aged 31 to 83 months.

METHODS

The present study aims to extend the literature by examining the psychometric properties and factorial structure of the PAS in a Spanish community sample of 274 preschoolers aged 3 to 7 years.

RESULTS

Factor analysis confirmed the five-factor original model after removing eight items, suggesting a shorter 20-item version for the Spanish preschoolers. The scale demonstrated to have good internal consistency (Cronbach's α = 0.84). Moderate but significant correlations with a measure of health-related quality of life supported the convergent validity of the PAS.

CONCLUSIONS

The Spanish version of the PAS demonstrated to have good psychometric properties, providing these results initial support to its use for assessing a broad range of anxiety symptoms in Spanish-speaking preschoolers.

Associations Among Infant Iron Deficiency, Childhood Emotion and Attention Regulation, and Adolescent Problem Behaviors

This study examined whether iron deficiency (ID) in infancy contributes to problem behaviors in adolescence through its influence on poor regulatory abilities in childhood. Chilean infants (N = 1,116) were studied when there was no national program for iron fortification (1991-1996), resulting in high rates of ID (28%) and iron-deficiency anemia (IDA, 17%). Infants (54% male) were studied at childhood (Mage  = 10 years) and adolescence (Mage  = 14 years). IDA in infancy was related to excessive alcohol use and risky sexual behavior in adolescence through its effect on poor emotion regulation in childhood. Attentional control deficits at age 10 were also related to both infant IDA and heightened risk taking in adolescence. Findings elucidate how poor childhood regulatory abilities associated with infant IDA compromise adjustment in adolescence.

The Associations of Age and Ethnicity on Substance Use Behaviors of Adolescent and Young Adult Childhood Cancer Survivors

OBJECTIVE

The aim of this study was to examine the associations between age and ethnicity on the development of substance use behaviors among Hispanic and non-Hispanic White (NHW) adolescent and young adult (AYA) childhood cancer survivors.

METHODS

Participants were recruited from a single institution through the CHOC Children's Hospital Cancer Registry and included 55 Hispanic and 61 NHW AYA childhood cancer survivors, ages 12 to 33 years (Mean age ± SD: 19 ± 4.2). Smoking, alcohol, and drug use were measured using the Child Health Illness Profile - Adolescent Edition.

RESULTS

Hispanic AYA survivors were less likely to be medically insured and reported lower household income than their NHW counterparts (P < 0.001 and P < 0.001, respectively). After controlling for socioeconomic differences and gender, age and ethnicity were significant predictors of substance use among AYA survivors. Hispanic survivors reported less lifetime use of cigarette smoking compared with NHW survivors (OR 0.17, 95% CI, 0.03-0.80). Older age, for both Hispanic and NHW survivors, was found to be a risk factor for lifetime substance use and current alcohol/hard liquor consumption and binge drinking (P < 0.05).

CONCLUSIONS

Young adult childhood cancer survivors and NHW survivors are at greatest risk for developing substance use behaviors. The frequency of substance use among AYA survivors appears to increase as they transition into adulthood. These findings emphasize the need to improve long-term health behavior screening and develop effective interventions on reducing substance use behaviors in this vulnerable population.

[Preferences in the format of questionnaires and use of the Internet by schoolchildren]

OBJECTIVES

To describe the preferences to complete questionnaires via the internet by schoolchildren, as well as to analyze the attitude towards the use of internet to communicate with health professionals.

METHODS

Cross-sectional study of a school population in Palafolls (Barcelona, n=923) was conducted in October and November 2013. Participants completed both internet and paper versions on a single school day, in random order, and with at least an interval of 2 hours. Preferences to answer internet vs paper version were recorded, along with the willingness to share information with health professionals. Percentages of use preferences and attitudes were estimated, and logistic regression models were fitted to analyze the association with the preferences and willingness to share information with health professionals.

RESULTS

Participation rates were 77% (n=715), of whom 42.4% (38.7 to 46.0) preferred the internet version, and 20.6% (17.6 to 23.6) the paper version. Older children (odds ratio [OR]=0.89, 0.84 to 0.95 for age), and those from families with secondary school (OR=0.63, 0.43 to 0.93), and university degree (OR=0.61, 0.38 to 0.97) were less likely to prefer the internet version, while boys (OR=1.55, 1.10 to 2.16) and those children reporting sedentary habits (OR=1.78, 1.06 to 3.0) were more likely to prefer the internet version. Those scoring higher quality of life (OR=1.03, 1.01-1.05) and not reporting sedentary habits (OR=0.33, 0.15 to 0.73) were factors associated with a positive attitude to share information with health professionals.

CONCLUSIONS

Younger children prefer to use the internet. Although Internet use is very widespread, it is less used to communicate with health professionals.

Long-term quality-of-life and functioning comparison of atomoxetine versus other standard treatment in pediatric attention-deficit/hyperactivity disorder

Psychopharmacological agents were shown to be important for improving the quality of life (QoL) of patients with attention-deficit/hyperactivity disorder (ADHD). A short-term, 10-week study found atomoxetine (ATX) to be effective in improving QoL of ADHD patients. We compared, for the first time, long-term treatment outcomes of ATX and other early standard therapy (OEST, any pharmacological ADHD treatment except ATX) in QoL and functional impairment in pharmacologically naive children/ adolescents in a randomized, controlled, open-label study at 6 and 12 months. Patients received ATX (0.5-1.8 mg/kg per day) or OEST (mainly methylphenidate). Quality of life and functioning were assessed by the Child Health and Illness Profile-Child Edition, Parent Rating Form and the Weiss Functional Impairment Rating Scale-Parent Report. Three hundred ninety-eight patients (79.4% male; mean age, 9.3 years) received study treatment. The Child Health and Illness Profile-Child Edition, Parent Rating Form achievement domain t scores significantly improved from baseline to 6 months from means of 28.0 to 37.1 for ATX and from 28.3 to 40.7 for OEST. Mean t scores at 12 months were 40.0 for ATX and 41.0 for OEST. The Weiss Functional Impairment Rating Scale-Parent Report total score improved from baseline to 6 months in both groups (ATX: mean 1.02 to 0.63; OEST: 0.96 to 0.59). Both treatments were safe with no statistically significant difference in the overall rate of adverse events. Overall, the improvements in QoL and functional impairment observed over time for ATX and OEST were meaningful and stable over the study period of 12 months. Between-group differences were small but sometimes statistically significant, providing the first-time long-term comparative symptomatic and QoL analysis between ATX and OEST.

Impact of the economic crisis on children's health in Catalonia: a before-after approach

OBJECTIVES

To analyse changes in the family living conditions of children in Catalonia between 2006 and the 2010-2012 period, and to study associations between these changes and health outcomes.

DESIGN

A before-after analysis of two cross-sectional surveys.

SETTING

Population younger than 15 years of age from Catalonia, Spain.

PARTICIPANTS

Representative samples of children in the 2006 Catalan Health Survey (ESCA), baseline, before the crisis; n=2200) and the first four waves of ESCA 2010-2012 (after start of the crisis, n=1967).

MAIN OUTCOME MEASURES

Overweight/obesity, health behaviour, mental health and health-related quality of life (HRQOL). Logistic regression and multiple linear regression models were used to analyse the influence of changes in family conditions on outcome measures, including interaction terms to describe the potential influence of the study period on the results.

RESULTS

The percentage of unemployed families rose from 9.1% (2006) to 20.6% (2010-2012), with inequalities by level of education. Overweight/obesity increased from 18.4% (95% CI 16.5% to 20.4%) to 26.9% (24.6% to 29.2%) in 2010-2012, and inequalities related to maternal education and employment status persisted. Eating habits have improved in 2010-2012 in disadvantaged families (ie, junk food consumption improved in families with a maternal primary education level; beta (B)=2.85; 0.83 to 4.88, for the survey interaction by primary education level). An improvement in HRQOL was found in the second survey (B=6.07; 4.15 to 7.99), although children whose mothers had a primary education showed poorer HRQOL scores in this survey than in 2006 (B=-4.14; -7.17 to -1.12).

CONCLUSIONS

Although some health-related behaviour improved during the study period, childhood obesity increased and inequalities in HRQOL appeared. Policy measures that fight against these inequalities should be urgently implemented to avoid their negative impact on the health of future generations of Catalans.

Surviving Childhood Cancer: Relationship between Exercise and Coping on Quality of Life

This research assesses Health-Related Quality of Life (HRQoL) in a Spanish sample of adolescent cancer survivors, and analyzes the relationship between HRQoL, coping styles and physical exercise. Forty-two survivors (12–19 years), who were ≥ 1 year of remission, completed standardized measures of HRQoL (CHIP-AE), coping strategies (ACS) and physical exercise (AECEF). Mean scores in all HRQoL domains were within normative values. Multiple regression analysis revealed that physical exercise and productive coping were related to higher HRQoL, whereas non-productive coping was related to lower HRQoL. This sample of survivors reported good levels of HRQoL, which are mediated by coping styles and physical exercise.

[Health-related quality of life and factors associated with overweight and obesity in the pediatric population of Catalonia, Spain]

The aim of this work is to describe the health-related quality of life (HRQOL), and to analyze the associated factors to overweight/obesity in a representative sample of the Catalan population 0-14 years old. Proxyrespondents answered the child's questionnaire of the Encuesta de Salud de Cataluna (ESCA) 2006 (n = 2.200). Variables analyzed were weight and height, the KIDSCREEN-10 HRQOL questionnaire, and also scales on risky behaviors, physical activity, frequency of fast food consumption, and number of hours of television viewing. Logistic regression models were adjusted. In 31% of children HRQOL was excellent/very good. Risky behaviors and restriction of activity were the associated factors to the best and the worst HRQOL. Maternal level of education and some habits and behaviors were associated to overweight/obesity. The ESCA contributes with useful information to monitor and to assess interventions addressed to the children population.

Spanish validation of the Spence Children's Anxiety Scale

The purpose of this study was to investigate the factorial structure and psychometric properties of the Spence Children's Anxiety Scale (SCAS) in a sample of 1,708 Spanish children aged between 8 and 12 years. The SCAS was demonstrated to have satisfactory internal consistency with the Spanish sample, and factor analysis confirmed the six-factor original model. Convergent validity was supported by correlations with the State-Trait Anxiety Inventory for Children and the welfare dimension of the Child Health and Illness Profile-Children Edition. Low correlations between the SCAS and the Children's Depression Inventory supported the divergent validity. Analysis suggested that anxiety scores decrease with age, and girls reported higher scores than boys. Overall, the SCAS was shown to have good psychometric properties for use with Spanish children by clinicians and researchers.

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.

Reliability and validity of the Spanish version of the Child Health and Illness Profile Child-Edition/Child Report Form (CHIP-CE/CRF)

OBJECTIVES

To assess the reliability and validity of the Spanish version of the CHIP-CE/CRF.

METHODS

Cross-sectional study was conducted in a representative sample of primary school children in Spain. Children were administered the Spanish version of the CHIP-CE/CRF. The Achenbach Child Behavioral Checklist was given to parents.

RESULTS

The overall response rate was 75% (n = 979). Internal consistency was >0.70 for 3 out of 5 domains, and the intraclass correlation coefficient for test-retest stability ranged from 0.69 to 0.80. Confirmatory factor analysis replicated the original model. Younger children scored higher in Satisfaction than older children. Girls scored lower in Comfort but higher in Risk Avoidance than boys.

CONCLUSIONS

The Spanish version of the CHIP-CE/CRF has shown acceptable reliability and validity, similar to the properties of the original US version. Future studies should analyze the instrument's sensitivity to change.

[Social inequalities in child health. SESPAS report 2010]

There is considerable evidence of the impact of poverty and social exclusion on child health. In the last few years, interest has grown in the concept of social gradients in health, according to social position, family educational level, gender, and ethnic background. Several cohort studies have demonstrated an association between maternal socioeconomic position during the prenatal period and adult health. The Commission on Social Determinants of Health of the World Health Organization proposed closing the health gap in a generation by giving a major role to early child development. Family educational level and academic achievement are fundamental determinants of health inequalities. There is scarce empirical evidence on the effectiveness of interventions to reduce child health inequalities. Most of the interventions in children and adolescents aim to change individual behavior, and very few have been critically evaluated. The present manuscript provides a review of initiatives and recent interventions aimed at reducing social inequalities, as well as a checklist to be taken into account in interventions on health promotion and disease prevention in schools from the perspective of social and gender inequalities. Strategies for data collection, research and health and educational policies are proposed.

Reliability and validity of the Spanish version of the Child Health and Illness Profile (CHIP) Child-Edition, Parent Report Form (CHIP-CE/PRF)

BACKGROUND

The objectives of the study were to assess the reliability, and the content, construct, and convergent validity of the Spanish version of the CHIP-CE/PRF, to analyze parent-child agreement, and compare the results with those of the original U.S. version.

METHODS

Parents from a representative sample of children aged 6-12 years were selected from 9 primary schools in Barcelona. Test-retest reliability was assessed in a convenience subsample of parents from 2 schools. Parents completed the Spanish version of the CHIP-CE/PRF. The Achenbach Child Behavioural Checklist (CBCL) was administered to a convenience subsample.

RESULTS

The overall response rate was 67% (n = 871). There was no floor effect. A ceiling effect was found in 4 subdomains. Reliability was acceptable at the domain level (internal consistency = 0.68-0.86; test-retest intraclass correlation coefficients = 0.69-0.85). Younger girls had better scores on Satisfaction and Achievement than older girls. Comfort domain score was lower (worse) in children with a probable mental health problem, with high effect size (ES = 1.45). The level of parent-child agreement was low (0.22-0.37).

CONCLUSIONS

The results of this study suggest that the parent version of the Spanish CHIP-CE has acceptable psychometric properties although further research is needed to check reliability at sub-domain level. The CHIP-CE parent report form provides a comprehensive, psychometrically sound measure of health for Spanish children 6 to 12 years old. It can be a complementary perspective to the self-reported measure or an alternative when the child is unable to complete the questionnaire. In general, the results are similar to the original U.S. version.

Development of the healthy pathways child-report scales

PURPOSE

The Child Health and Illness Profile (CHIP) has separate child (6-11 years) and adolescent (12-21 years) editions that measure youth's self-assessed health, illness, and well-being. The purpose of this study was to revise the CHIP by combining the two editions to create the Healthy Pathways Child-Report Scales.

METHODS

We modified the original CHIP domains of Comfort, Risk Avoidance, Satisfaction, and Resilience to reflect advances in child health conceptualization. Classical test and item response theory psychometric analyses were conducted using data collected from 2,095 children (49% boys, 80% White, 17% African-American, 3% Hispanic, Age: M = 10.6, SD = 1.0) in grades 4-6 at 34 schools.

RESULTS

After minor revisions, 16 of the 17 scales were found to measure unidimensional self-assessed health, illness, and well-being constructs comprehensively, but with a minimal number of items. Scales were unbiased by age, gender, survey modality, and geographic location. Construct validity was demonstrated by the instrument's capacity to differentiate among children with and without chronic illnesses and to detect expected age and gender differences.

CONCLUSIONS

The Healthy Pathways Child-Report Scales may be used to reliably and accurately assess unidimensional aspects of health, illness, and well-being in clinical and population-based research studies involving youth in transition from childhood to adolescence.

Evaluation of patients' and parents' quality of life in a randomized placebo-controlled atomoxetine study in attention-deficit/hyperactivity disorder

OBJECTIVE

The aim of this study was to demonstrate the superior efficacy of atomoxetine with respect to placebo and to compare parent and child perceptions of health-related quality of life (HRQoL).

METHOD

This randomized, placebo-controlled, 12-week parallel clinical trial included 151 untreated children/adolescents with newly diagnosed attention-deficit/hyperactivity disorder (ADHD). Parents' and patients' reports of HRQoL were obtained separately using the Child Health and Illness Profile and compared using analysis of covariance.

RESULTS

The ADHD Rating Scale baseline mean score was 39.21. Baseline HRQoL was perceived as considerably compromised by parents, especially in the risk avoidance and achievement domains (mean t-scores, 32.47 and 33.16, respectively), but less by children, and restricted to the achievement domain (mean t-score, 41.54). Atomoxetine improved HRQoL with respect to placebo in these two domains as assessed by parents (difference between adjusted mean changes and 95% confidence interval, 8.53, 4.05-13.00 and 3.39, 0.13-6.65) and in the risk avoidance domain by patients (3.56, 1.04-6.07). A modest correlation of clinical severity with HRQoL was found in this clinical population.

CONCLUSIONS

This study confirms prior reports the impact of ADHD on the HRQoL of patients as assessed by their parents. The patients' perspective is of a lesser impact. Atomoxetine improved HRQoL as assessed by both parents and patients.

Validity of the health profile-types of the Spanish Child Health and Illness Profile-Adolescent Edition (CHIP-AE)

OBJECTIVE

To develop and validate a simplified, easy to interpret scoring system based on the health profile-types taxonomy for the Spanish version of the Child Health and Illness Profile-Adolescent Edition (CHIP-AE).

METHODS

The CHIP-AE was administered to a 1453 Spanish adolescents. Hierarchic and nonhierarchical cluster analyses, as well as conceptual considerations, were used to identify exhaustive, mutually exclusive health profile-types based in four CHIP-AE domain scores: Satisfaction, Discomfort, Resilience, and Risks. Validity of the health profile-types was assessed by testing expected differences among adolescents according to sex, age, socioeconomic status, and self-reported conditions. Logistic models were built.

RESULTS

A total of 13 health profile-types (10 that best fitted the data and three additional considered conceptually necessary) were identified. The largest group of adolescents was in the "Excellent health" or "Good health" types (43.4%), although 11.2% were in the "Worst health" profile. According to a priori hypotheses, being a girl (OR = 1.81; 95% CI = 1.26-2.60), older age (OR = 1.80; 1.26-2.57), and self-reported recurrent (OR = 2.49; 1.72-3.60) and psychosocial disorders (OR = 4.38; 2.92-6.56) were associated to the likelihood of a "Worst health" profile-type.

CONCLUSIONS

The Spanish CHIP-AE health profile-types offer a simplified method to describe adolescents' patterns of health, which is valid and similar to the original US taxonomy. This can facilitate interpreting the instrument scores and using it for needs assessment, although additional research is required.

Self-reported social class in adolescents: validity and relationship with gradients in self-reported health

BACKGROUND

Analyzing social differences in the health of adolescents is a challenge. The accuracy of adolescent's report on familial socio-economic position is unknown. The aims of the study were to examine the validity of measuring occupational social class and family level of education reported by adolescents aged 12 to 18, and the relationship between social position and self-reported health.

METHODS

A sample of 1453 Spanish adolescents 12 to 18 years old from urban and rural areas completed a self-administered questionnaire including the Child Health and Illness Profile-Adolescent Edition (CHIP-AE), and data on parental occupational social class (OSC) and level of education (LE). The responsible person for a sub-sample of teenagers (n = 91) were interviewed by phone. Kappa coefficients were estimated to analyze agreement between adolescents and proxy-respondents, and logistic regression models were adjusted to analyze factors associated with missing answers and disagreements. Effect size (ES) was calculated to analyze the relationship between OSC, LE and the CHIP-AE domain scores.

RESULTS

Missing answers were higher for father's (24.2%) and mother's (45.7%) occupational status than for parental education (8.4%, and 8.1% respectively), and belonging to a non-standard family was associated with more incomplete reporting of social position (OR = 4,98; 95%CI = 1,3-18,8) as was agreement between a parent and the adolescent. There were significant social class gradients, most notably for aspects of health related to resilience to threats to illness.

CONCLUSION

Adolescents can acceptably self-report on family occupation and level of education. Social class gradients are present in important aspects of health in adolescents.

Field testing of a European quality of life instrument for children and adolescents with chronic conditions: the 37-item DISABKIDS Chronic Generic Module

OBJECTIVES

The aim of this study was to shorten the Health-Related Quality of Life (HRQL) DISABKIDS Chronic Generic Measure (DCGM) for children and adolescents and to test its reliability, construct, and external validity.

STUDY DESIGN

1153 children and adolescents (8-16 years) with chronic health conditions (asthma, arthritis, epilepsy, cerebral palsy, diabetes, atopic dermatitis, cystic fibrosis) and their family were recruited from different paediatric clinical settings in seven European countries. A two-time assessment comprised reports on sociodemographics, health status and HRQL of children/adolescents.

RESULTS

The 37-item DCGM describes six dimensions (Independence, Physical Limitation, Emotion, Social Inclusion, Social Exclusion and Treatment) confirmed by Confirmatory Factor Analysis, multi-item scaling and item-goodness of fit to Rasch model. Internal consistency (Cronbach's alpha: 0.70-0.87) and test-retest reliability (ICC: 0.71-0.83) were satisfactory. Correlations between DCGM-37 and other HRQL instruments were the highest between dimensions evaluating similar concepts. Regarding discriminant validity of the DCGM-37, girls and older adolescents reported lower emotional we ll-being. Children belonging to families with low level of affluence and those with severe health conditions were found to have worse HRQL in all domains.

CONCLUSION

Reliability, construct validity as well as convergent and discriminant validity of the DCGM-37 were shown.

[Anxiety in adolescents of a Madrid neighbourhood]

OBJECTIVES

To determine the degree of state-trait anxiety in adolescents and its possible association with several socio-demographic variables.

DESIGN

Descriptive cross-sectional study.

SETTING

First semester of 2004. Two state secondary schools in Area 7, Madrid, Spain.

PARTICIPANTS

Five hundred fifty nine students from the first to third years of secondary education.

MAIN MEASUREMENTS

Two anonymous multiple-choice tests were given out to fill in during class time: STAIC (State-Trait Anxiety Inventory for Children) and a questionnaire of socio-demographic variables (age, sex, immigration, toxic habits, socio-economic and family situation, relationships, view of life, and school results).

RESULTS

Four hundred forty five tests were valid. Mean age, 13.8 (SD, 1.2); 53.5% were girls, 18.7% immigrants, 20.7% took drugs (alcohol, tobacco, or illegal drugs), 32.8% had repeated at least 1 year, 14.3% considered their relationship with their family "bad," 15% referred to a "bad" relation with their class mates and 29.5% had a "bad" view of life. A statistically significant association was established between all these variables and anxiety.

CONCLUSIONS

It is important to know what risk factors are associated with anxiety in order to detect it early and prevent its development to other serious mental disorders. In this study, higher levels of anxiety were found in immigrants, in girls, in drug users, in students in a worse socio-economic situation and in students who have had to repeat a year. This study corroborates the classic risk factors associated with anxiety, but shows that we should take into account a further one: immigration. It also suggests the importance of good family and personal relationships for psychological balance.

Versión española del perfil de salud infantil, cuestionario para padres y madres: Child Health and Illness Profile-Child Edition Parent Report Form (CHIP-CE/PRF)

OBJECTIVES

To analyze the reliability and validity of the domains of the Child Health and Illness Profile-Child Edition Parent Report Form (CHIP-CE/PRF) included in the Barcelona Health Survey conducted in 2000 and to obtain population-based reference values.

METHODS

Data were obtained from proxy-respondent interviews of children aged 5-14 years old (n = 836) participating in the Barcelona Health Survey 2000. The 4 subdomains of the parent version of the CHIP-PRF included in the health survey were: satisfaction with health, and physical discomfort, emotional discomfort, and limitation of activities of the discomfort domain. Internal consistency was assessed using Cronbach's alpha coefficients. An exploratory factor analysis was carried out and analysis of covariance was performed to assess the construct validity of the subdomains.

RESULTS

In all the subdomains assessed, Cronbach's alpha was above 0.70 (range, 0.76-0.98). In the factorial analysis, almost all the items (31/35) presented the highest load in their corresponding subdomain. Most of the expected mean differences among groups were confirmed. Girls aged 10-14 years old scored the lowest, both in satisfaction with health (48.93; 95% confidence interval [CI 95%], 47.40-50.47) and in discomfort (48.87; CI 95%, 47.51-50.22). No differences were found according to the social class of the head of the family.

CONCLUSIONS

The present study provides a useful measure of perceived health status in a child health survey.

Adaptación de la versión española del Perfil de Salud Infantil (Child Health and Illness Profile-Child Edition, CHIP-CE)

OBJECTIVES

To obtain a Spanish version of the CHIP-CE semantically and culturally equivalent to the original version.

METHOD

The methodology used was based on the forward-backward method. Two translations into Spanish were performed. After the first reconciled version, 44 cognitive interviews were carried out with children aged 6-11 years old, selected from two schools in Barcelona. The interviews were recorded and transcribed. A qualitative content analysis of the textual data was carried out. A panel of experts developed the second reconciled version taking into account the children's comments. A back-translation into English was carried out and was compared with the original version.

RESULTS

Of a total of 45 items induced in the first reconciled version, 21 were considered equivalent, 23 required changes and 1 was considered not equivalent. Comprehension of abstract concepts differed according to age. Older children differentiated among concepts and gave different examples of experiences related to these concepts, while younger children (6 to 7-year olds) provided similar examples for different concepts. The children's comments were used in the reformulation of the items. An illustrative figure reinforced understanding. Children aged 7 or more started to use an adequate recall period and used the response options correctly.

CONCLUSIONS

The Spanish version of the CHIP-CE seems appropriate for children aged 6-11 in Spain. The present study shows that children from the age of 6 years onwards are able to describe the health concepts included in the CHIP-CE.

[Reference population values for the Spanish Child Health and Illness Profile-Adolescent Edition (CHIP-AE) using a representative school-based sample]

AIM

The Child Health and Illness Profile (CHIP-AE) is a generic health status instrument for adolescents aged 12-19 years adapted for use in Spain. The aim of this study was to obtain reference population values of the Spanish version of the CHIP-AE.

METHODS

The CHIP-AE was administered to a representative sample of adolescents from schools in Barcelona. The sample was selected by using cluster-sampling, stratified by type of school (public or private) and an ecological socioeconomic index (Indice de Capacidad Familiar: low, middle, and high). The CHIP-AE scores were standardized to a mean of 20 and a standard deviation (SD) of 5. Means and percentiles were computed. Means were compared by age, gender, and socioeconomic status using analysis of variance.

RESULTS

The response rate was 81% (n = 902). The distribution of the CHIP-AE scores presented a wide range with scores generally skewed toward positive health status. Nevertheless, the results suggest that the sample selected from a general population was not free of health problems. Twenty-five percent of adolescents presented scores below 17.2 in the domain of discomfort, indicating an effect size of 0.56 standardized SD units. The distribution of scores in the reference samples from Barcelona was similar to the original results in Baltimore (USA), with some marginal differences in individual risks.

CONCLUSIONS

The CHIP-AE systematically gathers information on health domains in adolescents. The results from this reference sample will allow comparisons with adolescents from other regions, and/or with different health problems, as well as description of inequalities in health during adolescence.