Body mass index and health related quality of life in elementary school children: a pilot study

Association of Socioeconomic Factors and Physical Activity with Health-Related Quality of Life in Italian Middle School Children: An Exploratory Cross-Sectional Study

Health-related quality of life (HRQoL) provides a broad assessment of an individual's well-being and can serve as a good prognosticator of life's outcomes later for children and adolescents. Understanding the factors associated with HRQoL is crucial for promoting better health and life satisfaction. This study investigated the cross-sectional association of socioeconomic status, cardio fitness, and physical activity levels with HRQoL in 224 Italian early adolescents attending secondary school in the Emilia-Romagna region located in Northern Italy. In a multivariate path regression model, younger students and females reported a higher quality of life (β = -0.139, p = 0.015, 95% CI: -0.254--0.023 and β = 0.142, p = 0.019, 95% CI: 0.011-0.273, respectively). Having both parents employed and having a higher familiar educational status were also associated with a higher quality of life (β = 0.142, p = 0.013, 95% CI 0.027-0.257 and β = 0.133, p = 0.017, 95% CI 0.022-0.244, respectively). Greater engagement in routine physical activity levels from moderate to vigorous intensity was positively associated with quality of life (β = 0.429, p < 0.001, 95% CI: 0.304-0.554). Endurance (speed) was positively associated with quality of life (β = 0.221, p = 0.001, 95% CI: 0.087-0.355), and students with longer times on the shuttle run reported less quality of life (β = -0.207, p = 0.002, 95% CI: -0.337--0.077). These relations remained intact even when controlling for socioeconomic factors. The current findings reinforce the importance of promoting regular physical activity among younger children and also addressing socioeconomic status disparities to improve children's well-being. Future studies may want to consider expanding the array of measures used to assess physical activity and include additional measures assessing nutrition, cultural factors, and family functioning, all of which can influence a child's willingness to engage in physical activity and their well-being. The emphasis on fitness and physical activity and their contribution to a child's well-being should be the prime focus for stakeholders who work in the education, public health, and health policy sectors.

Adverse Influences of Nonstrabismic Amblyopia on Quality of Life of Teenagers in China

The aim of this study was to explore the influences of nonstrabismic amblyopia on quality of life in adolescents. Health-related quality of life (HRQoL) scale, a multidimensional construct that indicates a fundamental health outcome, was used to measure physical and psychosocial functioning of the adolescents. Forty teenagers with nonstrabismic amblyopia and 40 control teenagers without nonstrabismic amblyopia were recruited between April 2019 and July 2021. The anthropometric measures, body image, physical activity outcome, and HRQoL scores including physical health, emotional functioning, social functioning, and school functioning were compared between the two groups. The results revealed that teenagers with nonstrabismic amblyopia had less weekly sedentary time (P < 0.001), weekly total steps (P < 0.001), and worse school functioning (P = 0.0211) than control teenagers. No significant difference was found in anthropometric measures and body image between the two groups (P > 0.05). This study implied the needs for teenagers with nonstrabismic amblyopia to enhance physical activities. Teachers and parents are encouraged to pay more attention to teenagers with nonstrabismic amblyopia to improve their school functioning.

Postoperative recovery assessment after appendectomy in children - laparoscopic versus open technique

Introduction/Objective. Surgery is a ?gold standard? in treating the acute appendicitis in pediatric patients. The aim of the study was to determine the effect of open and laparoscopic appendectomy on postoperative recovery, return to everyday activities and quality of life in patients operated for the acute appendicitis. Methods. This prospective study was performed at the Institute for Children and Youth Healthcare of Vojvodina, during a period of ten months. This study was approved by Ethic committee of the Institute. All patients treated for the acute appendicitis by surgery were divided into two basic groups: open or laparoscopic appendectomy and into three subgroups, depending on the degree of appendicitis. We analyzed length of surgery, oral intake, establishing peristalsis, hospital stay, return to everyday activities and quality of life after surgery. Results. Laparoscopic technique was performed in 60 patients (48%), and the open method in 65 (52%). In laparoscopically treated patients (66.7%), peristalsis occurred earlier (p < 0.001), length of hospital stay was shorter (5.95 ? 1.21 days) (Z = -3.054; p = 0.002), the total score of daily activities showed a statistically significantly better score (Z = -7.667; p = 0.000), and they achieved a high level of quality of life significantly earlier (t = 2.773; p = 0.007). Conclusion. The advantage of minimally invasive surgery in the treatment of acute appendicitis in children is reflected in the faster re-establishment of every day functioning, faster recovery, and a good quality of life.

The Determinants of Health-Related Quality of Life in a Sample of Primary School Children: A Cross-Sectional Analysis

Background: Health-related quality of life (HRQoL) in childhood is a multidimensional construct with many sub dimensions of subjective experience, including physical activity (PA), psychological well-being, social interaction, and school performance, that represents a fundamental health outcome to assess a child’s physical and psycho-social functioning. Our study aims to explore the potential predictors of children’s health-related quality of life, using a convenience sample from the Imola Active Break Study (I-MOVE), considering demographic, anthropometric measures, PA level measured by Actigraph accelerometers, parent-reported/self-reported HRQoL, and body image. Methods: A cross-sectional analysis was conducted among 151 primary school children in Italy. HRQoL was assessed using the Italian version 4.0 of the Paediatric Quality of Life (PedsQL) questionnaire. Results: Children who spent more time partaking in moderate PA were associated with a higher total PedsQL score (p < 0.03). Mother’s body mass index (BMI) was the only variable statistically significant associated with the physical health domain of PedsQL. Parent’s proxy-report perception concerning children’s psychosocial health was statistically relevant. The children’s gender, age, and BMI had no association with any of the HRQoL outcomes. Discussion: Parent proxy-report psychosocial health and mother’s BMI should be considered as predictors of HRQoL for the psychosocial and physical domain. PA should be implemented in order to improve the HRQoL of primary school children.

Impaired parent-reported health-related quality of life of underweight and obese children at elementary school entry

PURPOSE

Examine the health-related quality of life of 5-6-year-old underweight, overweight and obese children.

METHODS

Our cross-sectional study included 3,227 parent-child dyads from the "Be active, eat right" study. Parents completed questionnaires regarding child and parental characteristics. Health-related quality of life of the child was measured using the Child Health Questionnaire Parent Form 28. Children were classified normal weight, overweight, obese, severely obese, and underweight according to the international age and gender BMI cutoff points. Bootstrap analyses were performed for general linear models corrected for potential confounding variables.

RESULTS

Severely obese children (β, -2.60; 95% CI, -4.80 to -0.57, p < 0.01) and underweight children (β, -1.11; 95% CI, -1.85 to -0.39, p < 0.01) had lower parent-reported scores on the physical summary scale. On the physical functioning profile scale parents of overweight and severely obese children also reported statistically significant lower scores (p < 0.05 and p < 0.01, respectively).There were no significant differences regarding the psychosocial summary scale scores between the different weight categories.

CONCLUSION

Underweight and overweight children experience impaired health-related quality of life on the physical functioning domain. Physicians, teachers and parents should be aware of the possible negative impact on health-related quality of life in underweight and overweight 5-6-year-old children.

Quality of life in overweight and obese young Chinese children: a mixed-method study

BACKGROUND

Obesity among young children in Hong Kong has become a public health problem. This study explored associations between Chinese parent reported children's quality of life (QoL), socio-demographics and young children's weight status from 27 preschool settings.

METHODS

A mixed-method approach, including quantitative and qualitative tools, was employed for this cross-sectional study. Quantitative data were collected from 336 Chinese parents of children aged 2-7 years. Paediatric Quality of Life Inventory 4.0 (PedsQL, v 4.0) and a questionnaire about parents' socio-demographics were used. In-depth interviews with mothers, teachers and children from a larger sample were the basis of 10 case studies. Quantitative data were analysed using chi-square analysis, one-way ANOVA and logistic regression. Qualitative data were analysed according to a multi-level framework that established linkages with quantitative data.

RESULTS

The children's Body Mass Index (BMI) ranged from 11.3 to 28.0 kg/m(2) and was classified into four weight groups. ANOVAs showed that the normal-weight children had significantly higher PedsQL scores in Physical Functioning than obese children (mean difference = 14.19, p < .0083) and significantly higher scores in School Functioning than overweight children (mean difference = 10.15, p < .0083). Results of logistic regression showed that relative to normal-weight children, obese children had a 2-5 times higher odds of showing problems in Physical, Social Functioning and School Performance. Overweight children had 2 times higher odds of problems in Social Functioning, and underweight children had a 2 times higher odds of problems in Physical Functioning. Children's age (χ(2) = 21.71, df = 3, p < 0.01), and housing (χ(2) = 33.00, df = 9, p < 0.01) were associated with their weight. The case studies further act as a supplement to the quantitative data that children showed emotional problems across different abnormal weight statues; and the association between children's weight status and well-being might be affected by multiple childcare arrangements and familial immigration status.

CONCLUSIONS

This study is one of only a few studies that have examined parents', teachers' and young children's own perceptions of the children's quality of life across different weight statuses. The results are discussed in terms of their implications for intervention.

Bioprosthetic pulmonary valve replacement: contemporary analysis of a large, single-center series of 170 cases

OBJECTIVE

The present study was designed to compare stented porcine and bovine pericardial valves used for pulmonary valve replacement to better define valve performance and postoperative quality of life.

METHODS

A retrospective review of all patients who underwent pulmonary valve replacement with a stented bioprosthesis from 1992 to 2008 was conducted. The medical records, imaging results, and quality of life questionnaires were analyzed. Differences in reintervention by valve type were determined using Cox proportional hazards models, controlling for subject age.

RESULTS

A total of 170 consecutive pulmonary valve replacements (73 stented porcine, group 1; 97 bovine pericardial, group 2) were reviewed. No significant differences were seen in patient age or implanted valve size between the groups. Surgical mortality was 1.2%. The median follow-up was 48.2 months and was longer for group 2. No significant difference was seen in the risk of reintervention by valve type (hazard ratio, 0.64; 95% confidence interval, 0.18-2.34; P = .51). After 39 months of follow-up, pulmonary stenosis and pulmonary insufficiency that was moderate or worse were more common in patients who had undergone pulmonary valve replacement at younger than 15 years (pulmonary stenosis, 30.9% vs 10.0%, P = .003; pulmonary insufficiency, 46.2% vs 3.8%, P < .001), regardless of valve type. All patients performed well mentally and physically on the quality of life surveys.

CONCLUSIONS

The present large series of stented bioprosthetic pulmonary valve replacements has demonstrated good results, particularly in adults, at intermediate follow-up. Freedom from reintervention was similar for the porcine and pericardial valves, and our finding did not clearly demonstrate the superiority of 1 type of valve. However, the stented bioprosthetic valves were less durable in younger patients.

The impact of BMI on direct costs in children and adolescents: empirical findings for the German Healthcare System based on the KiGGS-study

BACKGROUND

Childhood obesity is a growing public health burden. Among German children and adolescents, 15% are overweight (including obese) and 6.3% are obese according to a national reference. This is the first German study to assess aspects of the economic burden associated with overweight and obesity in children and adolescents based on a representative cross-sectional survey.

METHODS

Based on the German Interview and Examination Survey for Children and Adolescents (KiGGS), direct costs induced by utilisation of healthcare services (physician and therapist visits, hospital stays) were assessed using a bottom-up approach. To investigate the impact of body mass index (BMI) on costs, univariate analyses were performed and multivariate generalised mixed models were estimated.

RESULTS

Average annual total costs were estimated to be €442 (95% CI [402-486]). Bivariate analysis showed considerable differences between BMI groups in physician costs, but not for hospital or therapist costs. High socioeconomic status, residence in west Germany and underweight had a significant negative impact on total costs in multivariate analysis. The effect of overweight on total costs is positive but not significant; neither is the effect of obesity. However, overweight and obese children exhibit significantly higher physician costs and a higher probability of being high utilisers of healthcare services.

DISCUSSION

The economic implications of overweight and obesity are, to some extent, already visible in childhood. The results suggest that obese children should be classified as priority group for prevention. Despite limitations, this study provides important information concerning the relevance of childhood obesity as a health problem.

The effect of body mass on health-related quality of life among Singaporean adolescents: results from the SCORM study

PURPOSE

To investigate the relationship between body mass and health-related quality of life (HRQOL) among Singaporean adolescents. Variation in this relationship by age, gender and ethnicity, and association of HRQOL with change in body mass over time and with demographic, socioeconomic and health variables were also assessed.

METHODS

HRQOL was assessed for Singaporean adolescents aged 11-18 from their own (N=1,249) and their parent’s (N=948) perspective using PedsQLTM 4.0 generic core scales. Body mass, measured as body mass index z-score based on the WHO Reference 2007, was categorized as thin, healthy weight, overweight and obese. Multiple linear regression models assessed the relationship between current body mass and HRQOL, adjusting for demographic, socioeconomic and health variables. Differences between adolescent and parent-proxy reported HRQOL were also investigated.

RESULTS

Obese adolescents (and their parents) reported significantly lower HRQOL, overall and in most domains, compared to healthy weight adolescents. Parents tended to report lower HRQOL for their adolescents than the adolescents did themselves; however, this difference was much larger and statistically significant for obese adolescents.

CONCLUSIONS

Obesity is associated with reduced HRQOL among adolescents. The effect in these Singaporean adolescents is similar to that in populations with higher rates of obesity. Awareness of this relationship can make it easier for health professionals, teachers, parents and peers to be supportive of obese adolescents.

Predictors of health-related quality of life in a sample of children and adolescents: a school survey

AIM

The aim is to study the health-related quality of life in a school sample of children and adolescents aged 8-18 years and to examine the relationship between health-related quality of life and the following variables; age, gender, perceived pain, body image, body mass index and bullying.

BACKGROUND

The study of health-related quality of life in children and adolescents have received little attention compared with adults in health care research and still little is known about the associations between health-related quality of life and other variables.

DESIGN

A cross-sectional design was chosen.

METHOD

We measured the health-related quality of life using the generic questionnaire KIDSCREEN-10. We administered the KIDSCREEN 52-item, and the 10 items were selected from this according to the KIDSCREEN manual. Multilevel regression models were used to evaluate the associations between health-related quality of life and the independent variables.

RESULTS

The sample included 1066 children and adolescents, 576 girls and 490 boys, with a response rate of 74%. The results show that body mass index was not significant associated with health-related quality of life in full model. However, in addition to age, being bullied, pain and body image were significant associated with health-related quality of life. Of these predictors, body image has the strongest impact in terms of explained variance in health-related quality of life.

CONCLUSION

The subjective sense of satisfaction or dissatisfaction with one's body, perceived body image, is a powerful predictor of health-related quality of life.

RELEVANCE TO CLINICAL PRACTICE

Knowledge about predictors of health-related quality of life is especially important for public health nurses. Health promotion and intervention programmes that aim to strengthen psychosocial well-being, especially those that strengthen body image, should be developed for both genders.

Obesity: the new childhood disability?

This review addresses the impact of obesity on paediatric physical functioning utilizing the World Health Organization International Classification of Functioning, Disability and Health Framework (ICF). The ICF encompasses functioning (as it relates to all body functions and structures), activities (undertaking a particular task) and participation (in a life situation) with disability referring to impairments in body functions/structures, activity restrictions or participation limitations. Electronic databases were searched for peer-reviewed studies published in English prior to May 2009 that examined aspects of physical functioning in children (≤18 years). Eligible studies (N = 104) were ranked by design and synthesized descriptively. Childhood obesity was found to be associated with deficits in function, including impaired cardiorespiratory fitness and performance of motor tasks; and there was some limited evidence of increased musculoskeletal pain and decrements in muscle strength, gait and balance. Health-related quality of life and the subset of physical functioning was inversely related to weight status. However, studies investigating impacts of obesity on wider activity and participation were lacking. Further research utilizing the ICF is required to identify and better characterize the effects of paediatric obesity on physical function, activity and participation, thereby improving targets for intervention to reduce disability in this population.

The association of health-related fitness with indicators of academic performance in Texas schools

This study examined the associations between indicators of health-related physical fitness (cardiovascular fitness and body mass index) and academic performance (Texas Assessment of Knowledge and Skills). Partial correlations were generally stronger for cardiovascular fitness than body mass index and consistently stronger in the middle school grades. Mixed-model regression analyses revealed modest associations between fitness and academic achievement after controlling for potentially confounding variables. The effects of fitness on academic achievement were positive but small. A separate logistic regression analysis indicated that higher fitness rates increased the odds of schools achieving exemplary/recognized school status within the state. School fitness attainment is an indicator of higher performing schools. Direction of causality cannot be inferred due to the cross-sectional nature of the data.