Assessment of children's health-related quality of life in the United States with a multidimensional index

Determinants of health-related quality of life in healthy children and adolescents during the COVID-19 pandemic: Results from a prospective longitudinal cohort study

Understanding health-related quality of life (HRQOL) in children and adolescents, during a pandemic and afterwards, aids in understanding how circumstances in their lives impact their well-being. We aimed to identify determinants of HRQOL from a broad range of biological, psychological, and social factors in a large longitudinal population-based sample. Data was taken from a longitudinal sample (n = 1843) of children and adolescents enrolled in the prospective school-based cohort study Ciao Corona in Switzerland. The primary outcome was HRQOL, assessed using the KINDL total score and its subscales (each from 0, worst, to 100, best). Potential determinants, including biological (physical activity, screen time, sleep, etc.), psychological (sadness, anxiousness, stress), and social (nationality, parents' education, etc.) factors, were assessed in 2020 and 2021 and HRQOL in 2022. Determinants were identified in a data-driven manner using recursive partitioning to define homogeneous subgroups, stratified by school level. Median KINDL total score in the empirically identified subgroups ranged from 68 to 83 in primary school children and from 69 to 82 in adolescents in secondary school. The psychological factors sadness, anxiousness, and stress in 2021 were identified as the most important determinants of HRQOL in both primary and secondary school children. Other factors, such as physical activity, screen time, chronic health conditions, or nationality, were determinants only in individual subscales.

CONCLUSION

Recent mental health, more than biological, physical, or social factors, played a key role in determining HRQOL in children and adolescents during pandemic times. Public health strategies to improve mental health may therefore be effective in improving HRQOL in this age group.

WHAT IS KNOWN

• Assessing health-related quality of life (HRQOL) in children and adolescents aids in understanding how life circumstances impact their well-being. • HRQOL is a complex construct, involving biological, psychological, and social factors. Factors driving HRQOL in children and adolescents are not often studied in longitudinal population-based samples.

WHAT IS NEW

• Mental health (stress, anxiousness, sadness) played a key role in determining HRQOL during the coronavirus pandemic, more than biological or social factors. • Public health strategies to improve mental health may be effective in improving HRQOL in children.

Adapting a quality of life scale for children and young people with Down syndrome in Chile

In Chile, there are no validated instruments for the evaluation of quality of life (QoL) of people with Down syndrome (DS). To analyze construct validity and reliability of the KidsLife-Down scale in Chile to measure QoL in people with DS aged from 4 to 21 years. Families of boys, girls, and young people with DS between 4 and 21 years were invited to participate. The scale was answered by relatives or caregivers. To assess the internal consistency, reliability tests were performed using Cronbach's alpha coefficient. A confirmatory factor analysis was performed. The scale was answered by 531 relatives or caregivers. Cronbach's coefficient was greater than 0.7 in all the items. The confirmatory factor analysis of the scale allowed its validation for clinical use in the Chilean population. "Kids Life Down-Chile" scale has adequate psychometric properties to be used in clinical practice and to help us improve QoL with better support strategies.

Quality of life in children suffering from headaches: a systematic literature review

BACKGROUND

Headaches are the most common complaints among pediatric populations. Determining the cause and appropriate treatment for headaches may be challenging and costly, and the impact of headaches on the lives of patients and their families is not well understood.

OBJECTIVE

A systematic literature review was conducted to examine what PROMs are currently used, and to identify quality of life (QoL) concepts important to children suffering from headaches and any known determinants of QoL.

METHODS

Embase, Medline, Web of Science, CINAHL, EBSCOhost, PsychINFO, Cochrane CENTRAL and Google Scholar were searched from their inception through to June 2021. Studies investigating QoL, using a validated outcome measure in pediatric patients with headaches, were included. Relevant studies were identified through title and abstract screening and full text review by two independent reviewers. A citation review of included studies was performed. QoL concepts were extracted from the outcome measures that were used in each study to develop a preliminary conceptual model of QoL in children suffering from headaches. Determinants of QoL were also identified and categorized.

RESULTS

A total of 5421 studies were identified in the search. Title and abstract screening resulted in the exclusion of 5006 studies. Among the 415 studies included for full text review, 56 were eligible for final analysis. A citation review resulted in the addition of five studies. Most studies were conducted in high-income countries and included a patient-sample accordingly (n = 45 studies). Sixteen different PROMs were identified in the included studies, of which the PedsQL was used the most often (n = 38 studies). The most common health concepts reported were physical functioning (n = 113 items), social and psychological wellbeing (N = 117, n = 91 resp.). Twenty-five unique determinants of QoL were extracted from the included studies.

CONCLUSION

There is a need for a condition-specific PROM to facilitate the measurement of QoL outcomes in the pediatric headache population. A conceptual model was developed based on the findings from the health concepts. Findings from this review could be used for future qualitative interviews with pediatric patients with headaches to elicit and refine important QoL concepts.

Depression and oral health-related quality of life: A longitudinal study

Objectives

Geriatric oral health-related quality of life is a relatively new but rapidly growing concept as it is directly related to the general wellbeing and self-esteem of older adults. This study assessed the impact of worsening depression symptoms on oral health-related quality of life using representative nationwide data of Korean older adults.

Methods

This study comprised a longitudinal sample of older adults aged ≥60 from the Korean Longitudinal Study of Aging (2016-2020). After applying the exclusion criteria, 3,286 participants were included in the study. Depression status was determined through the biennial assessment of the short-form Center for Epidemiologic Studies Depression Scale (CESD-10); oral health was measured using the Geriatric Oral Health Assessment Index (GOHAI). We employed the lagged general estimating equations to assess the temporal effect of the CESD-10 score change on the GOHAI score.

Results

A decrease in CESD-10 score over a 2-year period was significantly associated with a decrease in GOHAI score in men and women: β = -1.810 and β = -1.278, respectively (p-values < 0.0001). Furthermore, compared to the same or improved CESD-10 score, worsening of the score on 1-2 points detected the β = -1.793 in men and β = -1.356 in women, and worsening on ≥3 points: β = -3.614 in men and β = -2.533 in women.

Conclusions

This study found that depression exacerbation is negatively associated with oral health-related quality of life in later life. Further, a more significant worsening of depression symptoms was correlated with lower scores for oral health-related quality of life in our study population.

Health-Related Quality of Life in Children: The Roles of Age, Gender and Interpersonal Trust

Health-related quality of life (HRQoL) is an interesting topic in health care sciences and psychology. Deeper insight into the internal mechanism of this effect through large samples is crucial to further understanding HRQoL and making targeted suggestions to improve HRQoL. The present study aims to investigate the mediating role of interpersonal trust between age and HRQoL from a developmental lens. The purpose of this study was to profile the Pediatric Quality of Life Inventory 4.0 generic scale in China and test the relationship between age and health-related quality of life, as well as the mediating role of interpersonal trust and the moderating role of gender. A sample of 6248 children completed measures of demography, health-related quality of life, and interpersonal trust. Regression analyses were performed to test the mediating role of interpersonal trust and the moderating role of gender. Age was associated with lower health-related quality of life and lower interpersonal trust. Similarly, gender differences were also noted, with boys reporting higher health-related quality of life and lower interpersonal trust than girls. Additionally, the health-related quality of life of girls declined more than that of boys with increasing age. Regression analyses revealed that age could predict decreased health-related quality of life via lower levels of interpersonal trust. What is more, the mediation effect was moderated by gender, with the observed mediation effect being stronger among boys than girls. The current study replicates age and gender differences in health-related quality of life and interpersonal trust. Moreover, this study explained how and when age affected the health-related quality of life of children, and provided a deeper understanding of the relation between age and health-related quality of life.

Health-related quality of life profile of Indonesian children and its determinants: a community-based study

Background

Assessing health-related quality of life (HRQOL) and its determinants in children may provide a comprehensive view of child health. The study aimed to assess the HRQOL in Indonesian children and its determinants.

Methods

We conducted a community-based cross-sectional study in the Sleman District of Yogyakarta Special Province, Indonesia, from August to November 2019. We recruited children aged 2 to 18 years old using the Sleman Health and Demography Surveillance System sample frame. We used the validated Indonesian version of Pediatric Quality of life Inventory™ (Peds QL™) 4.0 Generic core scale, proxy-reports, and self-reports, to assess the HRQOL.

Results

We recruited 633 proxies and 531 children aged 2–18 years. The mean total score of self-report and proxy-report were 89.9+ 8.5 and 93.3 + 6.4. There was a fair to moderate correlation between self-reports and proxy-reports, with intra-class correlation ranging from 0.34 to 0.47, all p < 0.001. Half of the children (49.4% from proxy-report and 50.1% from self-report) reported having acute illness during the last month. Based on proxy-reports, multivariate regression analysis demonstrated lower HRQOL for children with acute health problems, younger age, history of low birth weight, abnormal delivery, lower fathers’ educational level, and government-paid insurance for low-income families.

Conclusion

Sociodemographic determinants of a child’s HRQOL, acute health problems, and low birth weight were associated with lower HRQOL in the general pediatric population. In low- and middle-income countries where acute infections and low birth weight are still prevalent, its prevention and appropriate interventions should improve child health.

Association of Socioeconomic Status With Postdischarge Pediatric Resource Use and Quality of Life

OBJECTIVES

Socioeconomic factors may impact healthcare resource use and health-related quality of life, but their association with postcritical illness outcomes is unknown. This study examines the associations between socioeconomic status, resource use, and health-related quality of life in a cohort of children recovering from acute respiratory failure.

DESIGN

Secondary analysis of data from the Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial.

SETTING

Thirty-one PICUs.

PATIENTS

Children with acute respiratory failure enrolled whose parent/guardians consented for follow-up.

MEASUREMENTS AND MAIN RESULTS

Resource use included in-home care, number of healthcare providers, prescribed medications, home medical equipment, emergency department visits, and hospital readmission. Socioeconomic status was estimated by matching residential address to census tract-based median income. Health-related quality of life was measured using age-based parent-report instruments. Resource use interviews with matched census tract data (n = 958) and health-related quality of life questionnaires (n = 750/958) were assessed. Compared with high-income children, low-income children received care from fewer types of healthcare providers (β = -0.4; p = 0.004), used less newly prescribed medical equipment (odds ratio = 0.4; p < 0.001), and had more emergency department visits (43% vs 33%; p = 0.04). In the youngest cohort (< 2 yr old), low-income children had lower quality of life scores from physical ability (-8.6 points; p = 0.01) and bodily pain/discomfort (+8.2 points; p < 0.05). In addition, health-related quality of life was lower in those who had more healthcare providers and prescribed medications. In older children, health-related quality of life was lower if they had prescribed medications, emergency department visits, or hospital readmission.

CONCLUSIONS

Children recovering from acute respiratory failure have ongoing healthcare resource use. Yet, lower income children use less in-home and outpatient services and use more hospital resources. Continued follow-up care, especially in lower income children, may help identify those in need of ongoing healthcare resources and those at-risk for decreased health-related quality of life.

Identifying the Needs of Prekindergarten Children: A Focus on Health, Wellbeing, and Family Environment

The impact of children's health, wellbeing, and family environment on their learning and development is evident. Identifying the needs of children and their families is the first step to effectively developing and implementing programs that promote child development. This research employed a convergent mixed methods design and incorporated multiple data collection and analysis techniques to explore the needs of prekindergarten children related to their health, wellbeing, and family environment. A large-scale survey, regional meetings, and focus groups were conducted among a total of 4615 parents/caregivers, organizational representatives, and community members in the state of South Carolina, in the United States. Understanding child development, getting services for children and families, making childcare accessible and affordable, having enough family time, building strong relationships with children, and community support for families were identified as priorities. Parents/caregivers of different socio-demographic backgrounds prioritized different needs.

Quality of life in children and adolescents with overweight or obesity: Impact of obstructive sleep apnea

OBJECTIVES

To investigate the association between obstructive sleep apnea (OSA) and health related quality of life (HRQOL) in children and adolescents referred to an obesity treatment clinic. In addition, we examined the association between body mass index standard deviation score (BMI SDS) and HRQOL comparing children and adolescents with overweight or obesity without OSA with a control group of children and adolescents with normal weight without OSA.

METHODS

This cross-sectional study included 130 children and adolescents with overweight or obesity (BMI SDS > 1.28) aged 7-18 years recruited from an obesity treatment clinic. The control group consisted of 28 children and adolescents with normal weight (BMI SDS ≤ 1.28) aged 7-18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor, Nox T3. OSA was defined as apnea-hypopnea index (AHI) ≥ 2. HRQOL was measured by the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic core scale.

RESULTS

A total of 56 children and adolescents with overweight or obesity were diagnosed with OSA (43%). The children and adolescents with OSA were older (p = 0.01) and had higher BMI SDS (p = 0.04) than children and adolescents without OSA. In generalized linear regression analyses adjusted for age, sex, BMI SDS and pubertal development stage there was no association between OSA or AHI and HRQOL in children and adolescents with overweight or obesity. In the analysis, including children and adolescents without OSA and the normal-weight control group, the generalized linear regression adjusted for age, sex and AHI revealed an association between BMI SDS and HRQOL (p < 0.001).

CONCLUSION

We found no association between AHI or OSA and HRQOL in children and adolescents with overweight or obesity. However, we found an association between BMI SDS and HRQOL in children and adolescents without OSA.

Health-related quality of life after injury: examining the roles of perceived daily-life stress and injury perceptions

PURPOSE

The present study aimed to examine the effects of injury perceptions and perceived daily stress on health-related quality of life (HRQL) of individuals affected by a physical injury.

METHODS

Two hundred and forty injured individuals completed questionnaires assessing HRQL (Medical Outcome Health Survey short-form 36), perceived daily-life stress (Perceived Stress Scale), and injury perceptions (Brief-InjPQ).

RESULTS

The direct effects of stress on HRQL scores were not moderated by gender. Emotional representation of the injury significantly mediated the links between PSS and all HRQL subscales only among women, but not among men. However, the mediation of the HRQL total score by emotional representations was significant for both genders. In addition, treatment control perceptions of the injury mediated the link between PSS and self-assessed health among men but not women, and injury-self perceptions mediated the link between PSS and physical functioning among men but not women.

CONCLUSION

These findings underscore the importance of perceived daily stress, gender, and injury perceptions as key factors for explaining variance in HRQL following injury. In addition to their conceptual contributions, the findings have clinical implications for treating injured populations.

Assessing health related quality of life of school aged Saudi children in western province using the validated Arabic version of child health questionaire-parent form-50

Objectives:

To assess the health-related quality of life (HRQOL) of children from a community in Jeddah, Saudi Arabia, excluding those with known chronic illnesses.

Methods:

Four schools in Jeddah participated in this cross-sectional study, which was conducted from February 2018 to February 2019. The parents of 5-14 year-old children were surveyed using the validated Arabic version of the Child Health Questionnaire-Parent Form 50 (CHQ-PF50). It consisted of 50 items divided into 15 scales (namely, 11 multi-item and 4 single-item scales) and expressed as scores of 0-100, with higher scores indicating better HRQOL. The levels of HRQOL were analyzed and compared.

Results:

The parents of 498 children answered the questionnaire. The mean scores of CHQ-PF50 subscales were relatively high (>80) in 8 out of 15 domains. However, relatively low scores were observed for general health perception (70.01), behavior (73.70), and mental health (75.65). Boys scored lower in behavior (difference of means = -5.80), global behavior (-4.47), mental health (-4.81), general health perception (−2.59), parental impact-emotional (-5.11), family activities (-1.77), and family cohesion (-2.19). Furthermore, adolescent boys scored lower in global health, mental health, global behavior, and parental impact.

Conclusion:

This study showed globally adequate levels of HRQOL among Saudi children, with some limitations in behavior and mental health, especially in boys and adolescents.

Social Disadvantage, Access to Care, and Disparities in Physical Functioning Among Children Hospitalized with Respiratory Illness

BACKGROUND AND OBJECTIVES

Understanding disparities in child health-related quality of life (HRQoL) may reveal opportunities for targeted improvement. This study examined associations between social disadvantage, access to care, and child physical functioning before and after hospitalization for acute respiratory illness.

METHODS

From July 1, 2014, to June 30, 2016, children ages 8-16 years and/or caregivers of children 2 weeks to 16 years admitted to five tertiary care children's hospitals for three common respiratory illnesses completed a survey on admission and within 2 to 8 weeks after discharge. Survey items assessed social disadvantage (minority race/ ethnicity, limited English proficiency, low education, and low income), difficulty/delays accessing care, and baseline and follow-up HRQoL physical functioning using the Pediatric Quality of Life Inventory (PedsQL, range 0-100). We examined associations between these three variables at baseline and follow-up using multivariable, mixed-effects linear regression models with multiple imputation sensitivity analyses for missing data.

RESULTS

A total of 1,325 patients and/or their caregivers completed both PedsQL assessments. Adjusted mean baseline PedsQL scores were significantly lower for patients with social disadvantage markers, compared with those of patients with none (78.7 for >3 markers versus 85.5 for no markers, difference -6.1 points (95% CI: -8.7, -3.5). The number of social disadvantage markers was not associated with mean follow-up PedsQL scores. Difficulty/delays accessing care were associated with lower PedsQL scores at both time points, but it was not a significant effect modifier between social disadvantage and PedsQL scores.

CONCLUSIONS

Having social disadvantage markers or difficulty/delays accessing care was associated with lower baseline physical functioning; however, differences were reduced after hospital discharge.

Parental quality of life and self-efficacy in pediatric asthma

Objective: Self-efficacy is the personal belief that a behavior can produce a desired result; and in asthma, self-efficacy in asthma care has been related to improvements in asthma outcomes and children's quality of life. To appreciate the full burden of asthma on families, the relationship between parental self-efficacy and quality of life also needs further study. We aim to characterize this relationship.Methods: Secondary analysis of measurements of parents of children with persistent asthma (n = 252; ages 4-17 years) from a large urban area were identified from a randomized trial; the association between baseline assessments of parental quality of life, measured by the Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), and parental self-efficacy, measured through the Parental Asthma Management Self-Efficacy Scale (PAMSES), were examined through multivariable linear regression.Results: Parental self-efficacy in asthma was positively associated with quality of life among parents of racially and ethnically diverse children (p = 0.01). Confidence in using medications correctly (p = 0.03), having inhalers during a child's serious breathing problem (p = 0.02), and knowing which medications to use during a child's serious breathing problem (p = 0.04) were associated with a clinically meaningful difference in parental quality of life. Other significant factors associated with parental quality of life included Hispanic/Latino ethnicity (p < 0.01) of the child and Asthma Control Test scores (p < 0.01).Conclusion: The findings suggest that improving parental confidence on when and how to use their child's asthma medications, particularly during an asthma attack, might be clinically meaningful in enhancing parent's quality of life.

Changes in Quality of Life in Elementary School Children-The Health Oriented Pedagogical Project (HOPP)

Background: Quality of life (QoL) studies may provide information of change in health status in the population. Few studies have followed up previous cross-sectional studies to investigate any change in the QoL status of healthy children. The aim of the current study is to compare QoL in children 6–12 years old in two large cross-sectional studies of healthy children completed a decade apart. Methods: In the current study children and parents from nine elementary schools (n = 2816) were included in a cross-sectional study investigating children’s QoL. Using the Life Quality in Children and Adolescents (ILC), completed by both children and parents, the global QoL-score was estimated for 2297 children and 1639 parental reports. These results were compared to a similar study performed in 2004. The scores from both studies were divided into categories of below average, average and above average QoL. The percentage change of QoL between the two studies is presented. Results: Our results show that parents report that more children have below and above average QoL in 2015 compared to 2004. In contrast, more children scored in the average and above average QoL category in 2015 than in 2004. Conclusion: Parents reported lower QoL and children higher QoL in 2015 compared to 2004.

Evaluation of the PROMIS pediatric global health scale (PGH-7) in children with asthma

OBJECTIVE

To evaluate the reliability and validity of the PROMIS Pediatric Global Health scale, a 7-item measure of perceived physical, mental, and social health, in children with asthma.

METHODS

From February 2014 to February 2015, convenience samples of 8-17 year-old children (n = 182) and parents of 5-17 year-old children (n = 328) visiting an emergency department for treatment of asthma were enrolled. The Asthma Control Test was used to characterize children as controlled versus not controlled, and the PROMIS Asthma Impact Scale was used to assess asthma symptoms' impact on functional status. We conducted longitudinal analyses among 92 children and 218 parents at 3 weeks, and 74 children and 171 parents at 8 weeks after enrollment.

RESULTS

The PGH-7 reliability ranged from 0.66 to 0.81 for child-report and 0.76 to 0.82 for parent-proxy. In cross-sectional analyses, children with controlled asthma had PGH-7 scores 0.40-0.95 standard deviation units higher than those who were uncontrolled. The PGH-7 was responsive to changes in overall general health between time points, with moderate effect sizes (0.5-0.6 standard deviation units). In longitudinal analyses, PGH-7 scores were no different between those who stayed uncontrolled versus became controlled at 3 weeks of follow-up; however, by 8 weeks of follow-up, the differences between these groups were 0.7-0.8 standard deviation units, indicative of large effects.

CONCLUSIONS

The PGH-7 is a reliable and valid patient-reported outcome for assessing general health among children with asthma. It is a useful complement to other asthma-specific outcome measures.

Quality of life improves in children and adolescents during a community-based overweight and obesity treatment

PURPOSE

The quality of life is compromised in children and adolescents with overweight or obesity. The aim of this study was to evaluate whether the quality of life improves during a community-based overweight and obesity treatment, and whether improvements depend on reductions in the degree of obesity.

METHODS

Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 in children and adolescents aged 3-18 years with overweight or obesity [body mass index (BMI) ≥85th percentile] upon entry into a community-based chronic care overweight and obesity treatment based upon The Children's Obesity Clinic's Treatment protocol, and upon follow-up after 10-30 months of treatment. Height and weight were measured at each consultation and converted into a BMI standard deviation score (SDS).

RESULTS

Upon entry, 477 children (212 boys) completed a PedsQL, and 317 (143 boys) completed another PedsQL after a median of 13 months of treatment. Quality of life improved (p < 0.001), regardless of sex, age, and pubertal development stage upon entry (p ≥ 0.108). Greater reductions in BMI SDS and high socioeconomic status were associated with greater improvements in the quality of life (p ≤ 0.047). However, improvements also occurred in children and adolescents with low socioeconomic status or who increased their BMI SDS (p < 0.001).

CONCLUSIONS

Improvements in quality of life occurred in children and adolescents during a community-based overweight and obesity treatment, even in children and adolescents who increased their BMI SDS. Thus, improvements may be due to the treatment itself and not exclusively to reductions in BMI SDS.

TRIAL REGISTRATION

Clinicaltrials.gov, ID-no.: NCT02013843.

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.

Victimisation, poly-victimisation and health-related quality of life among high school students in Vietnam: a cross-sectional survey

Background

In high and upper-middle income countries poly-victimisation (exposure to multiple forms of victimisation) is associated with worse health-related quality of life (HRQoL) among adolescents. There is a lack of empirical evidence about these associations from low- and lower-middle income countries. The aims of this study were to examine the associations between exposure to 1) individual forms of victimisation and 2) poly-victimisation and the HRQoL of adolescents in Vietnam.

Method

A cross-sectional, anonymously-completed survey of high school students in Hanoi, Vietnam. Lifetime exposure to eight individual forms of victimisation and poly-victimisation were assessed using the Juvenile Victimisation Questionnaire Revised-2 (JVQ R2). Health-related quality of life was assessed using the Duke Health Profile Adolescent Version (DHP-A). Bi-variate analyses and multiple linear regressions were conducted to assess the associations between individual forms of victimisation, poly-victimisation and HRQoL among girls and boys.

Results

In total 1616/1745 students (92.6 %) completed the questionnaire. Adolescent girls had significantly worse HRQoL than boys in all domains, except disability. Different forms of victimisation were associated with different HRQoL domains among girls and boys. Cyber victimisation was the most detrimental to girls’ HRQoL while for boys maltreatment was the most detrimental. Experiences of poly-victimisation were associated with worse HRQoL in physical, mental, social and general health, lower levels of self-esteem and increased levels of anxiety, depression and pain domains among both sexes.

Conclusions

Among Vietnamese adolescents, experiences of individual forms of victimisation were associated with poorer HRQoL in specific domains; the most detrimental forms of victimisation varied for girls and boys. However, it was experiences of poly-victimisation that had the most detrimental impacts on the HRQoL of both sexes. Recognition of violence, including poly-victimisation, is still low in Vietnam. These data indicate that community education, prevention and early intervention programs to reduce violent victimisation and assist adolescents who have experienced it, with attention to gender differences, are needed in Vietnam.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-016-0558-8) contains supplementary material, which is available to authorized users.

Evidence in immunotherapy for paediatric respiratory allergy: Advances and recommendations

Allergic respiratory diseases are major health problems in paediatric population due their high level of prevalence and chronicity, and to their relevance in the costs and quality of life. One of the most important risk factors for the development of airway diseases in children and adolescents is atopy. The mainstays for the treatment of these diseases are avoiding allergens, controlling symptoms, and preventing them through sustained desensitization by allergen immunotherapy (AIT). AIT is a treatment option that consists in the administration of increasing amounts of allergens to modify the biological response to them, inducing long-term tolerance even after treatment has ended. This treatment approach has shown to decrease symptoms and improve quality of life, becoming cost effective for a large number of patients. In addition, it is considered the only treatment that can influence the natural course of the disease by targeting the cause of the allergic inflammatory response. The aim of this publication is to reflect the advances of AIT in the diagnosis and treatment of allergic respiratory diseases in children and adolescents reviewing articles published since 2000, establishing evidence categories to support the strength of the recommendations based on evidence. The first part of the article covers the prerequisite issues to understand how AIT is effective, such as the correct etiologic and clinical diagnosis of allergic respiratory diseases. Following this, the article outlines the advancements in understanding the mechanisms by which AIT achieve immune tolerance to allergens. Administration routes, treatment regimens, dose and duration, efficacy, safety, and factors associated with adherence are also reviewed. Finally, the article reviews future advances in the research of AIT.

Adverse Childhood Experiences, the Medical Home, and Child Well-Being

OBJECTIVES

To examine the relationship between adverse childhood experiences (ACE), access to a medical home and a global measure of well-being among children ages 6-17 using the 2011-2012 National Survey of Children's Health.

METHODS

Multivariate linear regressions assessed the associations between each adverse experience and an index of child well-being with and without the impact of other events. The number of ACE was summed for each respondent and the analyses were repeated with the cumulative score as a continuous variable. The cumulative model was repeated with the addition of an interaction term between ACE score and medical home access. All analyses were conducted separately for children ages 6-11 and adolescents 12-17.

RESULTS

Over half (53 %) of US children ages 6-17 have experienced some adverse experience during childhood. Over a quarter (28 %) has experienced at least two adverse experiences, while 15 % have experienced three or more hardships. Results suggest that the accumulation of ACE reduces well-being in children. The associations remained significant after controlling for gender, race/ethnicity, age, parental education, special health condition, and medical home access. Medical home access was consistently associated with higher levels of child well-being and was a significant moderator of the relationship between the total ACE and child well-being among children ages 6-11. Children with ACE exposure and access to a medical home have higher levels of well-being than comparable children without access to a medical home.

CONCLUSIONS FOR PRACTICE

Children exposed to adverse experiences have measurably lower levels of well-being, although younger children with access to a medical home are protected at increasing exposure.

Wellness among US adolescents ages 12-17 years

BACKGROUND

Wellness is a multidimensional construct related to an individual's physical, emotional, intellectual and social well-being. We present estimates of wellness among US adolescents aged 12-17 years and explore how demographic characteristics are associated with wellness.

METHODS

All respondents aged 12 to 17 years (n = 34,601) from the 2011-2012 National Survey of Children's Health were included in the sample. Survey items were coded to operationalize an overall wellness score, comprised of four subdimensions (physical, intellectual, emotional and social).

RESULTS

The mean adjusted overall wellness score was 30.2 (out of 40). Mean raw subdimensions scores were: social = 3.14 (out of 4), emotional = 4.79 (out of 6), intellectual = 4.80 (out of 8) and physical = 6.57 (out of 8). Older adolescents, those with special health needs, those in lower income families and those whose mother or father report fair-poor mental health status had lower wellness scores.

CONCLUSIONS

US adolescents have wellness scores towards the upper or higher end of our scale. Several adolescent and family characteristics were associated with either lower overall wellness and/or lower wellness on multiple subdimensions. Assessing wellness during critical developmental periods of adolescence is a first step towards promoting behaviours that support increased wellness into adulthood.

Parental Perceptions of Health-Related Quality of Life of Albanian Children with Epilepsy

Epilepsy adversely affects the health-related quality of life (HRQoL) of children living with it. Even though almost 80% of children with epilepsy live in developing countries very little research has been conducted with the specific population. The present study took place in Albania and aimed to investigate parental perceptions of the HRQoL of their children with epilepsy. Considering the well-defined gender roles in the Albanian traditional family it was expected that mothers and fathers reports of their children's HRQoL would differ. Results showed no differences in maternal and paternal reports; instead there was a moderate correspondence between the reports across all dimensions. Parents also reported the highest scores of HRQoL in the interpersonal dimension and the lowest scores in the intrapersonal dimension. The findings have implications in the context of future research and also medical care for children with epilepsy in Albania.

Self-reported health-related quality of life in kindergarten children: psychometric properties of the Kiddy-KINDL

OBJECTIVES

To assess the psychometric properties of the German self-reported version of the Kiddy-KINDL that measures Health Related Quality of Life (HRQoL) in 3 to 5 year old kindergarten children.

STUDY DESIGN

The population of the study comprised baseline data of a longitudinal study whose main aim is to investigate self-reported health outcomes in young children (N = 317).

METHODS

Missing values, the distribution of data, internal consistency (Cronbach's alpha and Guttman's lambda), and reliability (split half and two weeks test-retest) were analysed. To assess discriminant validity, mean differences were tested splitting the sample regarding socio-emotional competences (VBV 3-6), age and gender. Structural validity was investigated with Confirmatory Factor Analysis (CFA).

RESULTS

Mean HRQoL was 69.79 (SD 16.84). Overall missing values were 8.1%, overall Cronbach's alpha was 0.75 and overall Guttman's lambda was 0.77; for the whole scale Spearman-Brown test for split half reliability resulted in 0.80 and ICC for test-retest in 0.83. Discriminant validity investigation differentiated groups with high and low socio-emotional competence and those children who were 4.5 years or older, compared to the younger ones. Differences between boys and girls were also found. CFA suggested two main dimensions: physical and socio-emotional.

CONCLUSION

This preliminary validation of the Kiddy-KINDL in very young children shows satisfactory psychometric properties. However, results of the Cronbach's alpha, Guttman's lambda and the CFA depicted problems, mainly in the psychological dimension. Due to these we recommend to use the Kiddy-KINDL as an instrument with only two dimensions. Further studies in general population samples are needed.

Weight, Weight Perceptions, and Health-Related Quality of Life Among a National Sample of US Girls

OBJECTIVE

To examine associations between 3 weight indices (weight status, perceived weight, and weight status perception accuracy) and heath-related quality of life (HRQOL).

METHODS

Data are for girls in the 2009 Health Behaviors in School-Age Children survey, a nationally representative sample of students in Grades 5 to 10 during the 2009/2010 school year (n = 5018). Controlling for sociodemographics, multivariate linear regressions examined associations between self-reported weight status (underweight/normal/overweight/obese), perceived weight (how children categorize their weight), weight status perception accuracy (underestimate/accurate perception/overestimate), and dimensions of HRQOL, including physical, emotional, social, and school functioning.

RESULTS

Although obesity was only associated with poor physical and emotional HRQOL, perceptions of being overweight were associated with worse physical, emotional, school, and social HRQOL. Furthermore, girls who overestimated their weight reported poorer HRQOL than those with accurate weight perceptions. Associations of perceptions of being overweight and weight status overestimation with poor HRQOL despite, in most instances, the absence of associations between weight status and HRQOL suggest that weight status perceptions may not merely be a mediator of a weight status-HRQOL association but a significant independent correlate of poor HRQOL.

CONCLUSION

These findings raise the issue of whether there is a need to prioritize intervention efforts to promote better HRQOL by redefining the population of girls most at risk. Parents, teachers, and clinicians should be aware that, rather than overweight status, perceptions of being overweight (accurately or not) are associated with a poor HRQOL among girls. Future research should examine the potential negative effect of using specific body image terminologies on adolescents' psychological health.

Determinants of health-related quality of life in school-aged children: a general population study in the Netherlands

Background

Health related quality of life is the functional effect of a medical condition and/or its therapy upon a patient, and as such is particularly suitable for describing the general health of children. The objective of this study was to identify and confirm potential determinants of health-related quality of life in children aged 4-11 years in the general population in the Netherlands. Understanding such determinants may provide insights into more targeted public health policy.

Methods

As part of a population based cross sectional study, the Child Health Questionnaire (CHQ) Parental Form 28 was used to measure health-related quality of life in school-aged children in a general population sample. Parents of 10,651 children aged 4-11 years were interviewed from January 2001 to December 2009.

Results

Multivariate and regression analyses demonstrated a declined CHQ Physical Summary score for children who had >1 conditions, disorders or acute health complaints and who were greater consumers of healthcare; children with a non-western immigrant background; and children whose parents did not work. Lower CHQ Psychosocial Summary score was reported for children who had >1 conditions, disorders or acute health complaints, boys, children of single parents and obese children.

Conclusion

The best predictors of health-related quality of life are variables that describe use of health care and the number of disorders and health complaints. Nonetheless, a number of demographic, socio-economic and family/environmental determinants contribute to a child’s health-related quality of life as well.

Health-related quality of life following pediatric critical illness

PURPOSE

The aims of this focused review of the literature on children surviving critical illness were to (1) determine whether health-related quality of life (HRQL) represents a clinically meaningful outcome measure for children surviving critical illness and (2) evaluate the HRQL measures implemented in pediatric critical care studies to date.

METHODS

This was a focused review of the literature from 1980 to 2015 based on a search of EMBASE/PubMed, MEDLINE and PsycInfo assessing trends and determinants of HRQL outcomes in children surviving critical illness. We also evaluated the psychometric properties of the HRQL instruments used in the studies identified by examining each measure's reported reliability, validity and sensitivity to clinical change.

RESULTS

The literature search identified 253 pediatric articles for potential inclusion in the review, among which data from 78 studies were ultimately selected for inclusion. Of the 22 measures utilized in the studies reviewed, only four demonstrated excellent psychometric properties for use in pediatric critical care trials. Trends in HRQL identified in the studies reviewed suggest significant ongoing morbidity for children surviving critical illness. Key determinants of poor HRQL outcomes include reason for PICU admission (sepsis, meningoencephalitis, trauma), antecedents (chronic comorbid conditions), treatments received (prolonged cardiopulmonary resuscitation, long-stay patients, invasive technology), psychological outcomes (post-traumatic stress disorder, parent anxiety/depression) and social and environmental characteristics (low socioeconomic status, parental education and functioning).

CONCLUSIONS

Validated pediatric HRQL instruments are now available. Significant impact on HRQL has been demonstrated in acute and acute on chronic critical illness. Future pediatric critical care interventional trials should include both mortality as well as long-term HRQL measurements to truly ascertain the full impact of critical illness in children.

Correlates of wellness among youth with functional disabilities

BACKGROUND

The literature is more informative on the impediments to wellness among youth with functional limitations and less instructive on the state of wellness for this population.

OBJECTIVE

To explore overall wellness, and each sub-dimension of wellness, in a national sample of youth with functional limitations and to determine how demographic characteristics are associated with wellness.

METHODS

Using a previously validated screening instrument, we identify youth with functional limitations aged 12 to 17 represented in the 2011/12 National Survey of Children's Health. Survey items were coded to operationalize an overall wellness score comprised of four sub-dimensions of wellness (i.e., physical, intellectual, emotional, and social).

RESULTS

The mean overall wellness score was 26.7 (out of 40) and had an approximate normal distribution. Mean raw scores for each sub-dimension were as follows: social = 2.79 (out of 4; 69.7%); emotional = 4.09 (out of 6; 68.2%); intellectual = 3.79 (out of 8; 47.4%); and physical = 6.30 (out of 8; 78.7%). Lower wellness scores were associated with older age among youth, increasing number of chronic health conditions, lower income, single mother homes, and youth whose mother reported fair or poor mental health status (all p < 0.05). Higher wellness scores were positively associated with mother's education (p < 0.001).

CONCLUSIONS

Program planners should consider interventions that target youth with functional limitations shown to be at particular risk for lower overall wellness and promote family involvement and comprehensive supports, including maternal educational attainment, mental health screening, and referral.

Pediatric health-related quality of life: a structural equation modeling approach

Objectives

One of the most referenced theoretical frameworks to measure Health Related Quality of Life (HRQoL) is the Wilson and Cleary framework. With some adaptions this framework has been validated in the adult population, but has not been tested in pediatric populations. Our goal was to empirically investigate it in children.

Methods

The contributory factors to Health Related Quality of Life that we included were symptom status (presence of chronic disease or hospitalizations), functional status (developmental status), developmental aspects of the individual (social-emotional) behavior, and characteristics of the social environment (socioeconomic status and area of education). Structural equation modeling was used to assess the measurement structure of the model in 214 German children (3–5 years old) participating in a follow-up study that investigates pediatric health outcomes.

Results

Model fit was χ2 = 5.5; df = 6; p = 0.48; SRMR  = 0.01. The variance explained of Health Related Quality of Life was 15%. Health Related Quality of Life was affected by the area education (i.e. where kindergartens were located) and development status. Developmental status was affected by the area of education, socioeconomic status and individual behavior. Symptoms did not affect the model.

Conclusions

The goodness of fit and the overall variance explained were good. However, the results between children' and adults' tests differed and denote a conceptual gap between adult and children measures. Indeed, there is a lot of variety in pediatric Health Related Quality of Life measures, which represents a lack of a common definition of pediatric Health Related Quality of Life. We recommend that researchers invest time in the development of pediatric Health Related Quality of Life theory and theory based evaluations.

Development of the PROMIS ® pediatric global health (PGH-7) measure

PURPOSE

To develop a practical, efficient, and reliable pediatric global health (PGH) measure that would be useful for clinical, quality improvement, and research applications.

METHODS

Using the Patient Reported Outcome Measurement Information System (PROMIS) mixed-methods approach for item bank development, we identified an item pool that was well understood by children as young as age 8 years and tested its psychometric properties in an internet panel sample of 3,635 children 8-17 years old and 1,807 parents of children 5-17 years old.

RESULTS

The final version of the PGH measure included 7 items assessing general, physical, mental, and social health. Four of these items had the same wording as the PROMIS adult global health measure. Internal consistency was 0.88 for the child-report form and 0.84 for the parent form; both had excellent test-retest reliability. The measures showed factor invariance across age categories. There was no differential item functioning by age, gender, race, or ethnicity. Because the measure includes the general health rating question, it is possible to estimate the PGH scale using this widely used single item.

CONCLUSIONS

The PROMIS PGH-7 measure is a brief and reliable 7-item measure of a child's global health.

A qualitative study of diverse experts' views about barriers and strategies to improve the diets and health of Supplemental Nutrition Assistance Program (SNAP) beneficiaries

The Supplemental Nutrition Assistance Program (SNAP), the largest federal food assistance program, currently serves 44.7 million Americans with a budget of $75 billion in 2011. This study engaged leading experts for in-depth, semi-structured interviews to explore their opinions concerning the existing challenges and barriers to eating nutritiously in SNAP. Experts also proposed strategies for improving nutritional status among SNAP recipients. Twenty-seven individuals were interviewed from advocacy, government, industry, and research organizations. Interviews were recorded, transcribed, coded, and analyzed for thematic content. The high cost of nutrient-rich foods, inadequate SNAP benefits, limited access to purchasing healthy foods, and environmental factors associated with poverty were identified as barriers that influence nutrition among low-income households in the United States. Six themes emerged among respondents from diverse sectors about how to address these challenges, including providing SNAP participants with incentives to purchase nutrient-rich food consistent with the 2010 Dietary Guidelines for Americans, restricting the purchase of nutrient-poor foods and beverages with program benefits, modifying the frequency of SNAP benefit distribution, enhancing nutrition education, improving the SNAP retailer environment, and increasing state and federal level coordination and consistency of program implementation. Given the recent dramatic increase in SNAP enrollment, policymakers must address existing barriers as well as consider new strategies to improve nutrition policies in SNAP so that the program can continue to address food insecurity needs as well as provide a healthful diet for SNAP beneficiaries.

Systematic review of health-related quality of life models

Background

A systematic literature review was conducted to (a) identify the most frequently used health-related quality of life (HRQOL) models and (b) critique those models.

Methods

Online search engines were queried using pre-determined inclusion and exclusion criteria. We reviewed titles, abstracts, and then full-text articles for their relevance to this review. Then the most commonly used models were identified, reviewed in tables, and critiqued using published criteria.

Results

Of 1,602 titles identified, 100 articles from 21 countries met the inclusion criteria. The most frequently used HRQOL models were: Wilson and Cleary (16%), Ferrans and colleagues (4%), or World Health Organization (WHO) (5%). Ferrans and colleagues’ model was a revision of Wilson and Cleary’s model and appeared to have the greatest potential to guide future HRQOL research and practice.

Conclusions

Recommendations are for researchers to use one of the three common HRQOL models unless there are compelling and clearly delineated reasons for creating new models. Disease-specific models can be derived from one of the three commonly used HRQOL models. We recommend Ferrans and colleagues’ model because they added individual and environmental characteristics to the popular Wilson and Cleary model to better explain HRQOL. Using a common HRQOL model across studies will promote a coherent body of evidence that will more quickly advance the science in the area of HRQOL.

Racial/ethnic disparities in health-related quality of life and health in children are largely mediated by family contextual differences

OBJECTIVE

To examine (1) racial/ethnic disparities in health-related quality of life (HRQOL), and overall health status among African-American, Hispanic, and white 5th graders in the general population and (2) the extent to which socioeconomic status (SES) and other family contextual variables mediate any disparities.

METHODS

A total of 4824 African-American, Hispanic, and white fifth-graders participating in a population-based, cross-sectional survey conducted in 3 U.S. metropolitan areas reported their own HRQOL by using the Pediatric Quality of Life Inventory Version 4.0 and supplemental personal and social well-being scales. Parents reported these children's overall health status. SES was indexed by parent education and household income. Other family contextual variables included family structure and degree to which English is spoken at home.

RESULTS

Marked racial/ethnic disparities were observed across all measures of HRQOL and health status, favoring white children and especially disfavoring Hispanic children. Most of these disparities were no longer significant after adjusting for SES and other family contextual differences that were observed among these racial/ethnic groups. Only disparities in parent-reported overall health status and self-reported global self-worth remained.

CONCLUSIONS

Racial/ethnic disparities in children's health status are substantial but may be mediated by corresponding disparities in SES and other family contextual variables. Race/ethnicity and family context are related to one another and should be considered jointly in efforts to reduce health disparities in children.

Social inequalities in mental health and health-related quality of life in children in Spain

OBJECTIVES

To assess mental health and health-related quality of life (HRQoL) of children and adolescents in Spain and to investigate the existence of a social gradient in mental health and HRQoL.

METHODS

Within the Spanish National Health Survey (2006), the parents' version of the Strengths and Difficulties Questionnaire was administered to a population aged 4 to 15 years, and the parents' version of the modified KIDSCREEN-10 Index was given to a population aged 8 to 15 years. Sociodemographic data and information on family structure, socioeconomic status, health status, and discrimination were collected. Regression models were developed to analyze associations of socioeconomic status with mental health and HRQoL.

RESULTS

A total of 6414 children and adolescents aged 4 to 15 years participated. Mean Strengths and Difficulties Questionnaire score was 9.38 (SD, 5.84) and mean KIDSCREEN-10 Index score (n = 4446) was 85.21 (SD, 10.73). Children whose mothers had a primary school education (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 1.29-1.46) or a secondary education (OR: 1.21; 95% CI: 1.14-1.29) presented poorer mental health than those whose mothers had a university degree. Children from disadvantaged social classes (IV-V) showed slightly poorer HRQoL scores (OR: 0.98; CI: 0.97-0.99) than the remaining children.

CONCLUSIONS

There is a social gradient in the mental health of children and young adolescents in Spain. No social gradient was found for HRQoL, although children from families of disadvantaged social classes had slightly worse HRQoL scores than their counterparts from more advantaged classes.

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.

Developing a new self-reported scale of oral health outcomes for 5-year-old children (SOHO-5)

Background

Information on the impact of oral health on quality of life of children younger than 8 years is mostly based on parental reports, as methodological and conceptual challenges have hindered the development of relevant validated self-reported measures. This study aimed to develop and assess the reliability and validity of a new self-reported oral health related quality of life measure, the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5), in the UK.

Methods

A cross-sectional study of two phases. First, consultation focus groups (CFGs) with parents of 5-year-olds and review by experts informed the development of the SOHO-5 questionnaire. The second phase assessed its reliability and validity on a sample of grade 1 (5-year-old) primary schoolchildren in the Greater Glasgow and Clyde area, Scotland. Data were linked to available clinical oral health information and analysis involved associations of SOHO-5 with subjective and clinical outcomes.

Results

CFGs identified eating, drinking, appearance, sleeping, smiling, and socialising as the key oral impacts at this age. 332 children participated in the main study and for 296 (55% girls, mean d₃mft: 1.3) clinical data were available. Overall, 49.0% reported at least one oral impact on their daily life. The most prevalent impacts were difficulty eating (28.7%), difficulty sleeping (18.5%), avoiding smiling due to toothache (14.9%) and avoiding smiling due to appearance (12.5%). The questionnaire was quick to administer, with very good comprehension levels. Cronbach’s alpha was 0.74 and item-total correlation coefficients ranged between 0.30 and 0.60, demonstrating the internal consistency of the new measure. For validity, SOHO-5 scores were significantly associated with different subjective oral health outcomes (current toothache, toothache lifetime experience, satisfaction with teeth, presence of oral cavities) and an aggregate measure of clinical and subjective oral health outcomes. The new measure also discriminated between different clinical groups in relation to active caries, pulp involvement, and dental sepsis.

Conclusions

This is the first study to develop and validate a self-reported oral health related quality of life measure for 5-year-old children. Initial reliability and validity findings were very satisfactory. SOHO-5 can be a useful tool in clinical studies and public health programs.

Association of family stressful life-change events and health-related quality of life in fifth-grade children

OBJECTIVE

To examine the association of recent family-related stressful life-change events (SLEs) with health-related quality of life (HRQOL) in fifth graders.

DESIGN

Population-based, cross-sectional survey.

SETTING

Three US metropolitan areas; 2004-2006.

PARTICIPANTS

A total of 5147 fifth graders and their parents.

MAIN EXPOSURES

Nine recent family-related SLEs: a parent's death, another family member's death, a family member's injury/illness, a family member's alcohol/drug problems, loss of a pet, recent change of residence, addition of a new baby or child to the household, parental separation, and parental divorce.

MAIN OUTCOME MEASURE

The HRQOL measured using the 23-item Pediatric Quality of Life Inventory.

RESULTS

Twenty-four percent of children had no reported recent SLEs; 33% had 1, 25% had 2, 12% had 3, and 6% had 4 or more. Mean HRQOL scores (total, physical, and psychosocial scales) were lower for children with more SLEs. The mean total HRQOL score was 80.4 (95% confidence interval, 79.4-81.3) for children with no recent SLEs and 71.8 (70.2-73.5) for children with 4 or more SLEs (P < .001). In adjusted logistic regression analyses, children with more SLEs had greater odds of impaired HRQOL compared with children without any SLEs. Psychosocial HRQOL fully mediated the relationship between SLEs and physical HRQOL.

CONCLUSIONS

The occurrence of multiple family-related SLEs in children is associated with less positive HRQOL. By incorporating the needs of families as part of comprehensive, high-quality care, health care professionals can identify these types of family-level needs and assist families in accessing community resources for support.

Economic burden of impairment in children with severe or difficult-to-treat asthma

BACKGROUND

The cost associated with asthma impairment in children with severe asthma has not been determined.

OBJECTIVE

To assess the asthma cost burden in children with severe or difficult-to-treat asthma based on asthma impairment.

METHODS

Children aged 6 to 12 years in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study with available data at baseline (n = 628), month 12 (n = 385), and month 24 (n = 280) corresponding to the National Heart, Lung, and Blood Institute asthma guidelines' impairment domain were included. Children were categorized as either very poorly controlled (VPC), not well controlled (NWC), or well controlled (WC) and assessed cross-sectionally and longitudinally. Mean total asthma costs based on direct (medication usage, unscheduled office visits, emergency department visits, hospitalizations) and indirect (school/work days lost) asthma costs were assessed.

RESULTS

Mean annual total asthma costs were more than twice as high in the VPC group compared with NWC and WC groups (baseline: $7,846, $3,526, $3,766.44, respectively; month 12: $7,326, $2,959, $2,043, respectively; month 24: $8,879, $3,308, $1,861, respectively (all P < .001). Indirect costs accounted for approximately half the total asthma costs for VPC asthma patients at each time point. Significantly lower costs were observed for patients whose impairment status improved or temporarily improved from VPC after baseline.

CONCLUSION

The economic burden of severe or difficult-to-treat asthma in children is associated with VPC asthma and improvement in asthma control and is associated with reducing cost. Further attention to patients with poorly controlled asthma, through better management strategies or more effective medications, may significantly reduce this burden of illness.

A national and state profile of leading health problems and health care quality for US children: key insurance disparities and across-state variations

BACKGROUND

Parent/consumer-reported data is valuable and necessary for population-based assessment of many key child health and health care quality measures relevant to both the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 and the Patient Protection and Affordable Care Act of 2010 (ACA).

OBJECTIVES

The aim of this study was to evaluate national and state prevalence of health problems and special health care needs in US children; to estimate health care quality related to adequacy and consistency of insurance coverage, access to specialist, mental health and preventive medical and dental care, developmental screening, and whether children meet criteria for having a medical home, including care coordination and family centeredness; and to assess differences in health and health care quality for children by insurance type, special health care needs status, race/ethnicity, and/or state of residence.

METHODS

National and state level estimates were derived from the 2007 National Survey of Children's Health (N = 91,642; children aged 0-17 years). Variations between children with public versus private sector health insurance, special health care needs, specific conditions, race/ethnicity, and across states were evaluated using multivariate logistic regression and/or standardized statistical tests.

RESULTS

An estimated 43% of US children (32 million) currently have at least 1 of 20 chronic health conditions assessed, increasing to 54.1% when overweight, obesity, or being at risk for developmental delays are included; 19.2% (14.2 million) have conditions resulting in a special health care need, a 1.6 point increase since 2003. Compared with privately insured children, the prevalence, complexity, and severity of health problems were systematically greater for the 29.1% of all children who are publicly insured children after adjusting for variations in demographic and socioeconomic factors. Forty-five percent of all children in the United States scored positively on a minimal quality composite measure: 1) adequate insurance, 2) preventive care visit, and 3) medical home. A 22.2 point difference existed across states and there were wide variations by health condition (autism, 22.8, to asthma, 39.4). After adjustment for demographic and health status differences, quality of care varied between children with public versus private health insurance on all but the following 3 measures: not receiving needed mental health services, care coordination, and performance on the minimal quality composite. A 4.60 fold (gaps in insurance) to 1.27 fold (preventive dental and medical care visits) difference in quality scores was observed across states. Notable disparities were observed among publicly insured children according to race/ethnicity and across all children by special needs status and household income.

CONCLUSIONS

Findings emphasize the importance of health care insurance duration and adequacy, health care access, chronic condition management, and other quality of care goals reflected in the 2009 CHIPRA legislation and the ACA. Despite disparities, similarities for public and privately insured children speak to the pervasive nature of availability, coverage, and access issues for mental health services in the United States, as well as the system-wide problem of care coordination and accessing specialist care for all children. Variations across states in key areas amenable to state policy and program management support cross-state learning and improvement efforts.

Profile of subjective quality of life and its correlates in a nation-wide sample of high school students in an Arab setting using the WHOQOL-Bref

BACKGROUND

The upsurge of interest in the quality of life (QOL) of children is in line with the 1989 Convention on the Rights of the Child, which stressed the child's right to adequate circumstances for physical, mental, and social development. The study's objectives were to: (i) highlight how satisfied Kuwaiti high school students were with life circumstances as in the WHOQOL-Bref; (ii) assess the prevalence of at risk status for impaired QOL and establish the QOL domain normative values; and (iii) examine the relationship of QOL with personal, parental, and socio-environmental factors.

METHOD

A nation-wide sample of students in senior classes in government high schools (N = 4467, 48.6% boys; aged 14-23 years) completed questionnaires that included the WHOQOL-Bref.

RESULTS

Using Cummins' norm of 70% - 80%, we found that, as a group, they barely achieved the well-being threshold score for physical health (70%), social relations (72.8%), environment (70.8%) and general facet (70.2%), but not for psychological health (61.9%). These scores were lower than those reported from other countries. Using the recommended cut-off of <1SD of population mean, the prevalence of at risk status for impaired QOL was 12.9% - 18.8% (population age-adjusted: 15.9% - 21.1%). In all domains, boys had significantly higher QOL than girls, mediated by anxiety/depression; while the younger ones had significantly higher QOL (p < 0.001), mediated by difficulty with studies and social relations. Although poorer QOL was significantly associated with parental divorce and father's low socio-economic status, the most important predictors of poorer QOL were perception of poor emotional relationship between the parents, poor self-esteem and difficulty with studies.

CONCLUSION

Poorer QOL seemed to reflect a circumstance of social disadvantage and poor psychosocial well-being in which girls fared worse than boys. The findings indicate that programs that address parental harmony and school programs that promote study-friendly atmospheres could help to improve psychosocial well-being. The application of QOL as a school population health measure may facilitate risk assessment and the tracking of health status.

Racial disparities in health-related quality of life in a cohort of very-low-birth-weight 2- and 3-year-olds with and without asthma

BACKGROUND

Children born very low birth weight (VLBW) are at risk for low health-related quality of life (HRQoL), compared with normal-birth-weight peers, and racial disparities may compound the difference. Asthma is the most pervasive health problem among VLBW children and is also more common among black than white children, partly due to unfavourable environmental exposures. This study explores racial disparities in HRQoL among VLBW children and examines whether potential disparities can be explained by asthma and neighbourhood disadvantage.

METHODS

The study population was the Newborn Lung Project, a cohort of infants (n=660) born VLBW in 2003-2004 in Wisconsin, USA, who were followed up at age 2-3. Multilevel linear regression models were used to examine the contributions of asthma, neighbourhood disadvantage, and other child and family socio-demographic covariates, to racial disparities in HRQoL at age 2-3. A child's HRQoL was measured using the Paediatric Quality of Life Inventory 4.0.

RESULTS

VLBW, black, non-Hispanic children, on average, score nearly 4 points lower (p<0.01) on HRQoL than do white, non-Hispanic children. Including asthma reduces the difference between black and white children from -3.6 (p<0.01) to 0.08 (p>0.05). The authors found no evidence that the relationship between asthma and HRQoL differs by race. The interaction between neighbourhood disadvantage and asthma is statistically significant, with further examination suggesting that racial disparities are particularly pronounced in the most advantaged neighbourhoods.

CONCLUSION

The authors found that the black disadvantage in HRQoL among 2-3-year-old VLBW children likely stems from a high prevalence of asthma. Neighbourhood attributes did not further explain the disparity, as the racial difference was particularly pronounced in advantaged neighbourhoods.

Health related quality of life among adolescents with sickle cell disease in Saudi Arabia

INTRODUCTION

Increased life expectancy due to recent medical advances has increased the need to understand more fully the quality of life (QoL) in patients with sickle cell disease (SCD) and factors predicting disease adaptation .The objectives of this study were to assess the impairment of health related quality of life (HRQoL) domains in a sample of Saudi Arabian adolescents with SCD.

METHODS

A non-probability sample composed of Saudi adolescents with SCD (n=180) aged 14-18 years and comparable age and gender matched healthy controls (n=202). Socio-demographics and disease related data were obtained through personal interview with parents/legal guardians and reviewing patients' medical records. Self-administered 'Short Form-36' questionnaire was used to assess HRQoL of the included groups.

RESULTS

HRQoL showed significant deterioration in adolescents with SCD especially in role physical, general health, and bodily pain domains irrespective of the gender, while female adolescents with SCD demonstrated significant deterioration in emotional wellbeing. Those with SCD-complications showed worse scores along the physical, general health, and emotional wellbeing domains. HRQol scores were negatively associated with increasing age, female gender, rural residence, low family income, presence of disease-related complications and frequent hospital admissions as revealed by multivariate regression analysis.

CONCLUSION

Saudi adolescents with SCD experience deterioration along all domains of HRQoL especially the physical. Disease related complications and sociodemographic correlates are significant determinants to worse HRQoL among the included adolescents with SCD.

The Serbian version of the pediatric asthma quality of life questionnaire in daily practice

Asthma is the most common chronic disease in children and adolescents and a serious global health problem, thus severely affecting the health related quality of life (HRQL). This study was aimed at exploring the potential role of the Serbian, self administered version of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) in the routine clinical evaluation of children suffering from bronchial asthma. One hundred Serbian children and adolescents (62 males and 38 females), aged 7 to 17 years, affected by allergic asthma, were enrolled. Each patient was evaluated once, and asthma control and severity were assessed, spirometry was performed, FeNO measurements were performed and the patients completed the self-administered version of the PAQLQ. PAQLQ differed according to asthma severity, NO variation and Asthma Control Test (ACT) score. No correlations were found between the questionnaire's score and FEV(1) percent of predicted. The Serbian version of the PAQLQ is a feasible aid to clinical measurements and used in routine practice gives a good insight into asthma control and severity.

Use of the Italian version of the Pediatric Asthma Quality of Life Questionnaire in the daily practice: results of a prospective study

BACKGROUND

Asthma is a serious global health problem and its prevalence is increasing, especially among children. It represents a significant social and economic burden, and it can severely affect the health-related quality of life (HRQL) of patients. Among the numerous questionnaires aiming at evaluating asthma HRQL in children, the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) has proved to have good measurement properties.The present study was aimed at investigating the possible role of the Italian, self-administered version of the PAQLQ in the routine clinical evaluation of children affected by bronchial asthma.

METHODS

52 Italian children and adolescents (40 males and 12 females), aged 6 to 17 years, affected by allergic asthma, were enrolled. Each patient was evaluated twice, and at each visit asthma control and severity were assessed, spirometry was performed and the patients completed the self-administered version of the PAQLQ.

RESULTS

The questionnaire was well-accepted and understood by the children. Children showed an overall good quality of life, with mild impairment in the activity and emotional function domains. The PAQLQ showed an overall good correlation with the clinical and functional indexes that are normally evaluated in follow-up visits of asthmatic patients. The PAQLQ appeared to be strongly related to asthma control, both at the first (p < 0.01) and second (p < 0.001) time of the study. The PAQLQ was also seen to decrease with increasing asthma severity. The results suggest a better compliance of the children towards completion of the questionnaire at t1. Finally, the PAQLQ does not appear to discriminate HRQL in patients with good lung function.

CONCLUSION

The Italian version of the PAQLQ is a quick-to-administer aid to clinical activity and can add valuable information to symptom reports, objective measurements and clinical assessment of asthma control and severity in daily clinical practice. Re-administration at each follow-up visit allows HRQL to be monitored over time.

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.