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

Impact of Digital Media, School Problems, and Lifestyle Factors on Youth Psychosomatic Health: A Cross-Sectional Survey

BACKGROUND

Post-pandemic psychosomatic complaints in children and adolescents have been underreported. This study investigated psychosomatic complaints in children and adolescents in Northern Italy in 2023, with the aim of identifying changes in predictors and vulnerable subgroups.

METHODS

Cross-sectional data representative of scholars from a northern Italian province were analyzed using the Health Behavior in School-aged Children (HBSC) checklist. The sum scores, count data, and dichotomized data were examined, and predictor effects were expressed using a linear regression model for the sum scores.

RESULTS

Data from 4525 participants (aged 7-19 years, 50.5% girls) were analyzed. Psychosomatic symptoms remained unchanged after the pandemic. Significant gender differences were noted, especially in older age groups, with girls reporting more complaints. Factors such as children's health, digital media use, and school problems significantly influence psychosomatic outcomes. While migration background negatively affected girls' psychosomatic well-being, boys showed improvement through sports.

CONCLUSION

The psychosomatic well-being of children and adolescents did not improve after the pandemic. These findings indicate the need for targeted interventions, improved health literacy, and ongoing monitoring to support the mental well-being of this vulnerable population. Reducing screen time remains a critical strategy for enhancing youth well-being.

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.

Effects of different surgical approaches on health-related quality of life in pediatric and adolescent patients with papillary thyroid carcinoma

OBJECTIVE

We aimed to compare the health-related quality of life (HRQOL) in pediatric and adolescent patients with papillary thyroid carcinoma who underwent bilateral or unilateral thyroidectomy.

METHODS

This prospective observational study recruited children and adolescents diagnosed with papillary thyroid carcinoma at low risk of recurrence. Participants were categorized into bilateral or unilateral thyroidectomy groups. They were asked to complete one questionnaire regarding basic information and three others regarding quality of life. HRQOL data from patients who underwent different procedures at various time points were compared.

RESULTS

Thirty patients underwent unilateral thyroidectomy and 54 bilateral thyroidectomy (median age = 14.27 years). HRQOL of the unilateral thyroidectomy group was higher than the bilateral group.

CONCLUSION

For children and adolescents with papillary thyroid carcinoma at low risk of recurrence, bilateral thyroidectomy is associated with a lower HRQOL than unilateral thyroidectomy. Surgeons should consider tumor impact and HRQOL when selecting the most appropriate surgical method.

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.

Health-Related Quality of Life and Adherence to Physical Activity and Screen Time Recommendations in Schoolchildren: Longitudinal Cohort Ciao Corona

Objectives: We investigated changes in adherence to physical activity (PA) and screen time (ST) recommendations of children and adolescents throughout the pandemic, and their association with health-related quality of life (HRQOL). Methods: 1,769 primary (PS, grades 1-6) and secondary (SS, 7-9) school children from Ciao Corona, a school-based cohort study in Zurich, Switzerland, with five questionnaires 2020-2022. HRQOL was assessed using the KINDL questionnaire. PA (≥60 min/day moderate-to-vigorous PA) and ST (≤2 h/day ST) recommendations followed WHO guidelines. Results: Adherence to PA recommendations dropped in 2020 (83%-59% PS, 77%-52% SS), but returned to pre-pandemic levels by 2022 (79%, 66%). Fewer children met ST recommendations in 2020 (74% PS, 29% SS) and 2021 (82%, 37%) than pre-pandemic (95%, 68%). HRQOL decreased 3 points between 2020 and 2022, and was 9.7 points higher (95% CI 3.0-16.3) in March 2021 in children who met both versus no recommendations. Conclusion: Adherence to WHO guidelines on PA and ST during the pandemic had a consistent association with HRQOL despite longitudinal changes in behavior.

Health-Related Quality of Life in Children with Overweight and Obesity: An Explorative Study Focused on School Functioning and Well-being

Overweight and obesity in childhood has reached epidemic levels, and their roles in physical and psychological health are now recognized. Recently, researchers have focused on the impact of these weight problems in health-related quality of life (HRQoL) domains, which are less investigated in children. This exploratory study examined the differences in HRQoL domains between a clinical group who were overweight/obesity treatment-seeking (n = 58) and a normal-weight group (n = 44) in a sample of 102 children, with a specific focus on school functioning and well-being. The second aim explored the link between our findings and other HRQoL dimensions. After controlling for sex and age, a multivariate analysis of variance showed lower levels in school functioning and well-being dimensions between overweight/obesity than normal-weight (F = 4.72; p < 0.05). Correlation analyses highlighted positive links between lower school functioning and well-being and lower levels of self-esteem (r = 0.308; p < 0.01) and social domains in terms of friendships (r = 0.522 ; p < 0.001) and family relationships (r = 0.561; p < 0.001) in children who were with overweight and obesity. This study discusses the implications of these findings in educational research and practices.

Effects of fundamental movement skills on health-related quality of life in Chinese school-age children: the mediating role of physical fitness level

Background

The primary purpose of this study is to analyze the relationship between school-age children's fundamental movement skills (FMS), physical fitness levels, and the health-related quality of life (HRQoL); To explore the mediating role of physical fitness levels between school-age children's FMS and HRQoL.

Methods

In the cross-sectional survey in 2021, 334 school-age children aged 6-10 (8.20 ± 1.16) were recruited from primary schools in Jinhua City, Zhejiang Province, China. Test of Gross Motor Development 2 (TGMD-2), National Standards for Students' Physical Health, and Pediatric Quality of Life Inventory TM Version 4.0 (PedsQL™ 4.0) were used to investigate the FMS, physical fitness level, and HRQoL of school-age children. Hierarchical regression was used to analyze the relationship among FMS, physical fitness levels, and HRQoL. Bootstrap is used to evaluate the mediating role of physical fitness levels in the relationship between FMS and HRQoL.

Results

The higher the FMS and physical fitness, the higher the school-age children's HRQoL, physical functioning, social functioning, and school functioning (r = 0.244-0.301, p < 0.01). In addition, developing children's FMS promotes physical fitness levels (r = 0.358, p < 0.01). The regression analysis results of controlling gender, age, and body mass index z (BMI-z) scores showed that FMS significantly positively predicted the physical functioning (β = 0.319, p < 0.01), social functioning (β = 0.425, p < 0.01), and school functioning (β = 0.333, p < 0.01) of school-age children. When the physical fitness level enters the regression equation, the absolute value of the regression coefficient of FMS decreases. However, it can still significantly predict the physical functioning (β = 0.211, p < 0.01) and school functioning (β = 0.142, p < 0.05) of school-age children. Simple intermediary analysis shows that physical fitness level plays an intermediary role between FMS, physical functioning (indirect effect = 0.089 [95% Confidence interval (CI) = 0.015,0.195]), and school functioning (indirect effect = 0.065 [95% CI = 0.007,0.150]).

Conclusion

This study shows that physical fitness levels mediate the relationship between FMS and HRQoL. Encouraging the development of FMS and promoting physical fitness levels of school-age children can effectively improve the HRQoL of school-age children.

Prospective Association between Adherence to the Mediterranean Diet and Health-Related Quality of Life in Spanish Children

Health-Related Quality of Life (HRQoL) is gaining attention in children and adolescents because it is an important outcome of their health status and well-being. Therefore, it is important to identify determinants for HRQoL. Currently, there is scarce and mainly cross-sectional evidence on the relationship between adherence to the Mediterranean diet and HRQoL in children and adolescents. Therefore, the objective of the present study was to assess the prospective association between adherence to the Mediterranean diet and HRQoL in Spanish children. The study was carried out in 1371 children aged 8 to 10 from different Catalan elementary schools with a medium follow-up of 15 months. The KidMed and KIDSCREEN-10 questionnaires were used to assess the relationship between diet and HRQoL, respectively. The KidMed score at baseline was positively associated with HRQoL (β = 0.320; 95% CI 0.101−0.540) after adjusting for confounders. Additionally, the logistic regression analysis showed positive associations between baseline consumption of fruit, vegetables, pulses, and high adherence to the Mediterranean diet and HRQoL at follow-up (p < 0.05 for all) while the consumption of fast-food, pasta or rice, baked good or pastries, and sweets were negatively correlated (p < 0.05 for all) with HRQoL at follow-up. In conclusion, adherence of the Mediterranean diet was predictive for HRQoL in Spanish children, but further prospective studies are needed to confirm this result.

Basic Motor Competencies of (Pre)School Children: The Role of Social Integration and Health-Related Quality of Life

In (pre)school, children acquire and deepen their basic motor competencies (BMCs) and interact with peers and friends. BMCs are a central developmental goal in childhood and the prerequisite for participation in sportive aspects of social life. Both motor competencies and social integration are linked to children's health-related quality of life (HRQoL). The aim of the present study was to describe the connection between BMCs, social relationships, and aspects of HRQoL in (pre)school children. In this study, the BMCs of N = 1163 preschool children (M = 5.7 years, SD = 0.57, 52% boys) and N = 880 first and second graders (M = 7.5 years, SD = 0.58, 51% boys) were tested. The children's social integration was assessed by the teachers; the HRQoL was recorded from the parents' perspective. In both preschool and primary school, children with better BMCs also showed higher values in their social integration. Moreover, the results indicated a connection between BMCs and general HRQoL in primary school and BMCs and physical well-being in preschool. As BMCs, social integration, and HRQoL seem to be connected in (pre)school, this should be considered both from developmental and health-oriented perspectives, as well as for physical education (PE) lessons.

Factors Associated with Discrepancy of Child-Adolescent/Parent Reported Quality of Life in the Era of COVID-19

Billions of children/adolescents experienced unprecedented changes in their daily lives that impacted their health-related quality of life (HRQoL) during the first wave of the coronavirus disease 2019. The purpose of this study was to describe child-parent discrepancies in reporting on HRQoL and explore factors associated with such discrepancies at the end of the first lockdown in France. A cross-sectional study was conducted among French school-aged children from 8 to 18 years and their parents living in the Grand Est region in France during the first wave of the epidemic. The impact of individual, self-reported health status and environmental data on discrepant parent-child reports of HRQoL was assessed by multinomial multivariable logistic regression models. A total of 471 parent-child pairs were included. Among 50% of the discordant pairs, parents underestimated HRQoL more frequently than they overestimated it. Home location, social support score, children's education level, parents' education level, tensions and conflicts with neighbors reported by children, whether they had access to a garden, and parents' professional activity were significantly associated with parental overestimation (_adjustedOR from 2.08 to 11.61; p < 0.05). Factors associated with parental underestimation were children's education level, SF12 score, home location, the child's gender, parent's level of education, the presence of noise in the residence reported by children, whether a household member was infected with COVID-19, whether they had access to a garden, and family structure (_adjustedOR from 1.60 to 4.0; p < 0.05). This study revealed differences between child-reported and parent-reported HRQoL. The COVID-19 pandemic accentuated the discrepancies in observable dimensions and attenuated them in unobservable dimensions of HRQoL but did not impact the directional discrepancy; parents underestimated their child's HRQoL more. These discrepancies appear to be explained by parent and child sociodemographic factors.

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.

Children Are Back to School, but Is Play Still in Lockdown? Play Experiences, Social Interactions, and Children's Quality of Life in Primary Education in the COVID-19 Pandemic in 2020

The right to play is crucial for the overall development of children. Several studies highlight the need to have time and space to play, especially at school where children spend much of their time. Unfortunately, in formal education the obsession with academic achievements sidelines and ignores the importance of play. The neglection of play had already reached a critical stage before the pandemic, so data are needed to realize how the right to play in school is presently affected. This paper aims to understand children’s play experience in primary education during the pandemic. It investigates what activities children participated in and what materials were used, and provides insight into the social interactions between peers. Furthermore, children’s quality of life is explored. A group of 370 Portuguese children answered a questionnaire on play and social interactions, alongside with Peds 4.0^TM on health-related quality of life (HRQOL). The results showed that recess still emerges as a significant element of children’s daily lives, but COVID-19 has brought limitations on play experiences and peer-interaction. It might also have impacted HRQOL, especially in emotional functioning. Since play, health and well-being are closely connected, play opportunities at school are crucial in helping children to thrive in the pandemic, and should be invested in.

The Role of Physical Activity in the Relationship between Satisfaction with Life and Health-Related Quality of Life in School-Age Adolescents

(1) Background: Adolescence is a critical stage in the development of healthy habits. In this regard, physical activity has emerged as a useful tool to improve satisfaction with life and health-related quality of life in adolescents. Therefore, the aim of the present study was to examine the mediating role of physical activity in the relationship between satisfaction with life and health-related quality of life in adolescent boys and girls. Also, we aimed to investigate the differences between sexes in the HRQoL, physical activity level, and satisfaction with life. (2) Methods: A total of 297 adolescents, ranging in age from 11 to 12 years (11.46 ± 1.63), participated in this cross-sectional study. The Satisfaction with life scale, Physical activity Questionnaire for Adolescents and the KIDSCREEN-10 questionnaires were employed. (3) Results: The estimated indirect effect showed that physical activity level was a mediator of the positive effect of satisfaction with life on health-related quality of life (β = 0.105, 95% CI = 0.031; 0.202). However, the index of moderated mediation showed that sex is not a significant moderator of the mediating role of physical activity in the relationship between satisfaction with life and HRQoL (β = -0.033, 95% CI = -0.023, 0.136). Furthermore, significant differences in satisfaction with life were found, with girls manifesting lower values (p-value = 0.026). (4) Conclusion: This study shows the importance of physical activity during adolescence and the association of this behavior with the health-related quality of life of adolescents.