Encouraging greater empowerment for adolescents in consent procedures in social science research and policy projects

The United Nations Convention on the Rights of the Child emphasizes the importance of allowing children and adolescents to influence decisions that are important to them following their age and maturity. This paper explores the principles, practices, and implications around using parental versus child/adolescent consent when participating in social science research and policy development. Experiences from two studies are presented: The Confronting Obesity: Co-creating policy with youth (CO-CREATE) and the Health Behaviour in School-aged Children (HBSC) study, a World Health Organization (WHO) Collaborative Cross-National study. Although parental consent may be an important gatekeeper for protecting children and adolescents from potentially harmful research participation, it may also be considered an obstacle to the empowerment of children and adolescents in case they want to share their views and experiences directly. This paper argues that evaluation of possible harm should be left to ethics committees and that, if no harm related to the research participation processes is identified and the project has a clear perspective on collaborating with the target group, adolescents from the age of 12 years should be granted the legal capacity to give consent to participate in the research project. Collaboration with adolescents in the development of the research project is encouraged.

[Exercise Behavior, Costs of Physical Inactivity, and Physical Activity Promotion in Austria]

Dem Dreischritt „Status quo – Konsequenzen – Maßnahmen“ folgend werden Daten zum Ausmaß körperlicher Aktivität und deren Einflussfaktoren, mögliche gesellschaftliche Kosten mangelnder körperlicher Aktivität sowie Einflussebenen und Maßnahmen zur Bewegungsförderung in Österreich präsentiert. In Österreich ist der Anteil an Personen, die die Bewegungsempfehlungen nicht erfüllen, hoch und es besteht diesbezüglich klar Verbesserungspotenzial, insbesondere in Bezug auf muskelkräftigende Aktivitäten bei Erwachsenen. Je nach Datenquelle erfüllen von den Erwachsenen 42–50% die Empfehlungen für ausdauerorientierte Bewegung und 18–33% die für muskelkräftigende Aktivitäten. Gleichzeitig ist die österreichische Bevölkerung im internationalen Vergleich aktiver als jene vieler anderer Länder. Große Unterschiede bestehen im Bewegungsverhalten hinsichtlich demografischer, sozioökonomischer und geografischer Determinanten. Die gesellschaftlichen Folgen durch mangelnde körperliche Aktivität sind beträchtlich, sowohl hinsichtlich verlorener Lebensjahre durch vorzeitigen Tod, als auch den Kosten, die der Allgemeinheit entstehen, beispielsweise an Gesundheitskosten und Produktivitätsverlusten. Die für das Jahr 2017 hochgerechnete Summe von 248 Mio. Euro stellt aufgrund methodischer Schwierigkeiten wahrscheinlich eine Unterschätzung dar. Wissenschaftlich abgesicherte Einflussebenen auf das Bewegungsverhalten umfassen im Sinne der lebens(um)weltortientierten Herangehensweise die Lebenswelten Kindergarten und Schule, Betriebe, Gemeinde/Städte, Pflegewohnheime und die Natur.

[Austrian Physical Activity Recommendations for Women during and after Pregnancy, Children of Kindergarten age, Children, and Adolescents]

Basierend auf bereits dargelegten internationalen Empfehlungen werden in diesem Beitrag die Österreichischen Bewegungsempfehlungen für Frauen während der Schwangerschaft und danach, für Kinder im Kindergartenalter sowie für Kinder und Jugendliche in diesem Beitrag vorgestellt. Für Frauen in der Schwangerschaft und in den ersten Monaten nach der Entbindung weichen die Bewegungsempfehlungen nicht von jenen der Erwachsenen ab. Lediglich bei vorliegenden gesundheitlichen Problemen, kann es zu Bewegungseinschränkungen kommen. Kindern unter 6 Jahren sollten so oft wie möglich Bewegungsgelegenheiten geboten werden und sich bis zu 3 Stunden täglich mit mittlerer und hoher Intensität auf vielfältige Weise bewegen können, um ein gesundes Aufwachsen zu ermöglichen. In der Altersgruppe der 6 bis 18-Jährigen wird tägliche Bewegung im Umfang von mindestens einer Stunde empfohlen. Bei der Auswahl der Bewegungsformen sollte der Entwicklungsstand und das Aktivitätsausmaß von Kindern und Jugendlichen beachtet werden, um ein freudvolles überdauerndes Bewegungsverhalten zu garantieren. Die Bewegungsempfehlungen dienen der Verbreitung im Bereich der Gesundheitsförderung und stellen eine Grundlage für die Entwicklung und Evaluation von gesundheitswirksamen Bewegungsprogrammen dar.

The Assessment of School Climate

School climate measurement is a long-standing topic in educational research. This review article provides an overview and appraisal of school climate measures published between 2003 and 2013 in scientific journals. A search for published school climate instruments for secondary school students was made in three databases. Twelve articles meeting the inclusion criteria were identified and included. Each measure is described in terms of contents, and psychometric and formal quality criteria. Most of the reviewed measures showed good or acceptable results in reliability analyses but insufficient validity testing. Theory-grounding for measurement development is often missing. All instruments include items addressing the relationship among students and between students and teachers while the environmental-structural area is considered the least. This review provides a compact overview of recently published studies using school climate instruments that have also been tested psychometrically. This may be useful for schools, practitioners, and researchers.

Does the school performance variable used in the International Health Behavior in School-Aged Children (HBSC) Study reflect students' school grades?

BACKGROUND

Given the pressure that educators and policy makers are under to achieve academic standards for students, understanding the relationship of academic success to various aspects of health is important. The international Health Behavior in School-Aged Children (HBSC) questionnaire, being used in 41 countries with different school and grading systems, has contained an item assessing perceived school performance (PSP) since 1986. Whereas the test-retest reliability of this item has been reported previously, we determined its convergent and discriminant validity.

METHODS

This cross-sectional study used anonymous self-report data from Austrian (N = 266), Norwegian (N = 240), and Canadian (N = 9,717) samples. Students were between 10 and 17 years old. PSP responses were compared to the self-reported average school grades in 6 subjects (Austria) or 8 subjects (Norway), respectively, or to a general, 5-category-based appraisal of most recent school grades (Canada).

RESULTS

Correlations between PSP and self-reported average school grade scores were between 0.51 and 0.65, representing large effect sizes. Differences between the median school grades in the 4 categories of the PSP item were statistically significant in all 3 samples. The PSP item showed predominantly small associations with some randomly selected HBSC items or scales designed to measure different concepts.

CONCLUSIONS

The PSP item seems to be a valid and useful question that can distinguish groups of respondents that get good grades at school from those that do not. The meaning of PSP may be context-specific and may have different connotations across student populations from different countries with different school systems.

[Chemonucleolysis and intradiscal electrothermal therapy: what is the current evidence?]

We evaluated the efficacy and safety of chemonucleolysis and intradiscal electrothermal therapy (IDET) on the basis of the data presented in recently published papers with respect to pain relief, function, and complication rates. Detailed searches for English and German articles published between 2003 and 2008 were performed in a number of electronic databases. Further publications were identified by manual search. For summarizing the evidence, we considered only systematic reviews and controlled studies. The internal validity of reviews and studies was judged by two authors independently. Data extraction was performed by one author, and the extracted data was checked for completeness and correctness by a second author. The evidence of the efficacy of chemonucleolysis using chymopapain or collagenase is summarized in two recent, high-quality systematic reviews. We found 5 controlled studies evaluating nucleolysis using an oxygen-ozone mixture (O (2)O (3)-nucleolysis). Some of those studies were of limited methodological quality, but all showed the efficacy of O (2)O (3)-nucleolysis in comparison to microdiscectomy or the use of alternative substances. There is hardly any data regarding O (2)O (3)-nucleolysis complications. Regarding IDET, the authors of the 6 identified systematic reviews come to different conclusions about the efficacy of the procedure. The results of the 3 included controlled IDET studies, of which 2 are of high methodological quality, are also conflicting. The complication rates range from 0 to 15 %. In summary, the evidence of efficacy is presently more compelling for chemonucleolysis than for IDET. This may also be because indications for chemonucleolysis are more firmly established. However, safety aspects should be better evaluated and presented in the literature.

[Endovascular deployment of stent graft in the ascending aorta. A systematic review]

The endovascular deployment of stent graft in the ascending aorta was proposed for inclusion in the benefit catalogue of the Austrian Federal Ministry of Health. The efficacy and safety of this intervention was unclear, and therefore a systematic review was performed to support evidence-based decision making. Detailed searches for English- or German-language articles published between 2002 and 2008 were performed in a number of electronic databases. Internal validity of studies was judged by two authors independently. A total of 11 case reports but no prospective studies were identified through literature search. The case reports showed the technical feasibility of this intervention but allow no conclusions about its efficacy and safety. Therefore the endovascular deployment of stent graft in the ascending aorta must be considered as experimental and its inclusion in the benefit catalogue cannot be recommended.

Glucocorticoids in the treatment of children with acute lymphoblastic leukemia and hodgkin's disease: a pilot study on the adverse psychological reactions and possible associations with neurobiological, endocrine, and genetic markers

PURPOSE

We did a controlled study to assess adverse psychological reactions (APR) associated with high-dose glucocorticoid therapy and tried to detect somatic correlates for the observed reactions.

PATIENTS AND METHODS

Our study included 37 patients with acute lymphoblastic leukemia (ALL) and 11 patients with Morbus Hodgkin (MH) disease, who were treated with high-dose glucocorticoid therapy, and 26 control patients with other types of malignancies. APRs were assessed with a standardized measure via parent-report. Patients with ALL and MH were further analyzed for signs of neuronal cell death in the cerebrospinal fluid, polymorphisms of the glucocorticoid receptor gene, as well as cortisol, adrenocorticorticotropic hormone, and dehydroepiandrosterone sulfate blood levels.

RESULTS

Fifty-four percent of ALL, 36% of MH, and 23% of control patients developed APR in the first few weeks of therapy. Approximately 3.5 months later, the majority of patients with ALL showed no APR, similar to control patients. Patients demonstrating a higher, nonsuppressible secretion of cortisol and/or adrenocorticorticotropic hormone during glucocorticoid therapy were found to be more likely to develop APR. No sign of neuronal cell destruction and no correlation of APR with specific glucocorticoid receptor polymorphisms were found.

CONCLUSION

Our results suggest that the development of APR due to glucocorticoid therapy is measurable and correlates with hormonal reaction patterns.

Trocar-site hernia as a typical postoperative complication of minimally invasive surgery among preschool children

BACKGROUND

Minimally invasive surgery (MIS) in preschool children (<5 years of age) is not common yet, and few reports evaluating typical complications are available. Trocar site hernias are well described in adult patients but also have been reported for preschool children. The goal of our study was to determine incidence and relevance of trocar site hernias as complications of minimally invasive surgery in preschool children.

METHODS

Retrospective analysis of all pediatric patients who underwent minimally invasive surgery at a single institution. Review of the literature.

RESULTS

Trocar site hernias are significantly more frequent in preschool children than in older ones (p = 0.006). Complication rates at all are not significantly different. Trocar site hernias in infants are mainly of type 3 (omental protrusion) and occur within the first postoperative week.

CONCLUSION

Meticulous suturing of all layers (particularly the peritoneum) even in small incisions (2 mm) is recommended to prevent omental protrusion at trocar site in children up to 5 years of age.

Quality of life from research and clinical perspectives: an example from paediatric psycho-oncology

In clinical oncology and research, health-related quality of life (HRQL) of patients has increasingly gained attention. Although there is agreement that HRQL is a multidimensional construct incorporating primarily the patient's evaluation of his/her life, the construct lacks a uniform model of conceptualization. This article briefly outlines definitions and methods of assessing quality of life in children and adolescents. The case report of a 10-year-old boy who underwent hematopoietic stem cell transplantation views HRQL from various perspectives. Self- and proxy assessments are compared, and the expertise of psychotherapeutic work is combined with data gathered by standardized questionnaires.

Health-related quality of life of pediatric patients receiving allogeneic stem cell or bone marrow transplantation: results of a longitudinal, multi-center study

The results of a 5-year longitudinal prospective study about the health-related quality of life (HRQL) of pediatric patients receiving allogeneic bone marrow or stem cell transplantation (BMT) are described. The patients' HRQL was assessed twice before, and five times after BMT, the end point being 1 year after BMT. For the measurement of HRQL, standardized questionnaires were completed by patients, parents and physicians. The final sample consisted of 68 patients aged 4-18 years, of which 19 were lost in the course of the study owing to relapse, transplant rejection and/or death. The worst HRQL was seen shortly after transplant and HRQL thereafter improved steadily, although the improvement was not always linear and not all patients drew benefit from this average positive evolution. Compromised emotional functioning, a high level of worry and reduced communication during the acute phase of treatment had a negative impact on HRQL 1 year after BMT. Nausea and pain during the acute phase of treatment did not have an effect on later HRQL. The interobserver agreement of HRQL reports between parents and their children was moderate to good, and generally better than child-physician and parent-physician agreement.

[Evidence-based radiology: a new approach to evaluate the clinical practice of radiology]

Over the last several years, the concept and methodology of Evidence-Based Medicine (EBM) have received significant attention in the scientific community. However, compared to therapeutic medical disciplines, EBM-based radiological publications are still underrepresented. This article summarizes the principles of EBM and discusses the possibilities of their application in radiology. The presented topics include the critical appraisal of studies on the basis on EBM principles, the explanation of EBM-relevant statistical outcome parameters (e. g., "likelihood ratio" for diagnostic and "number needed to treat" for interventional procedures), as well as the problems facing evidence-based radiology. Evidence-based evaluation of radiological procedures does not only address aspects of cost-effectiveness, but is also particularly helpful in identifying patient-specific usefulness. Therefore it should become an integral part of radiologist training.

Quality of life in long-term childhood cancer survivors and the relation of late effects and subjective well-being

GOALS

The purpose of the present study was the assessment of health-related quality of life in adult long-term survivors of childhood cancer and the detection of possible treatment- and cancer-related late effects. The relation of objective medical data and subjective appraisal was also examined by combining the doctor's and the patient's views of the perceived health status.

PATIENTS AND METHODS

Seventy-eight young adults at the age of at least 18 years who had been diagnosed with cancer in the years 1975-1995 and were off therapy at least 5 years with no evidence of disease participated. Cancer survivors completed self-rating instruments [SF-36 Health Survey, Nottingham Health Profile (NHP), Beck's Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) trait-anxiety scale]; the doctor assessed the patient's health by means of the Common Toxicity Criteria (CTCv2).

MAIN RESULTS

The cancer survivors showed a mostly higher-than-average positive subjective rating of the various areas of quality of life. In comparison to the general population, the cancer survivors showed lower extents of depression. In 64.1% of the cancer survivors, medical rating and self-assessment regarding the perceived health status corresponded. Cancer survivors who felt severely impaired regarding their subjectively perceived well-being showed worse results in some dimensions of quality of life than persons who subjectively felt mildly impaired. The so-called "unfortunate" persons showed the worst assessment of quality of life and the highest extent of depression and anxiety.

CONCLUSIONS

The results of the present study may be helpful in planning an appropriate multidisciplinary, long-term follow-up of childhood cancer survivors.

Validation of the German version of the Pediatric Quality of Life Inventory (PedsQL) in childhood cancer patients off treatment and children with epilepsy

The Pediatric Quality of Life Inventory (PedsQL) is a relatively new instrument developed in the US to assess health-related quality of life (HRQL) in healthy and ill children and adolescents. It is quick and easy to use, suitable for assessment by children and parents and based on a modular approach with a generic measure addressing all general domains of HRQL and disease-specific modules. We report here the results of translating the original US generic core instrument and the cancer module into German and testing the German PedsQL in samples of paediatric patients who have been treated for cancer or epilepsy. Like in studies with the original instrument, score distributions tended to be skewed toward higher HRQL, but a full response range was demonstrated for each item. The German PedsQL is reliable in terms of internal consistency with the majority of scales exceeding a Cronbach's alpha of 0.70. Clinical validity was confirmed by differences between the cancer and epilepsy groups in the expected direction and by the ability of the PedsQL to discriminate between subjects with different degrees of medical and psychosocial sequelae. Comparing our findings to US results, the German PedsQL seems to be equivalent to the original version. Future methodologic research should evaluate construct validity, sensitivity and responsiveness, and test the usefulness of the instrument in other clinical populations and healthy children.

The TCCS—A short measure to evaluate treatment-related coping and compliance in hospitalised childhood cancer patients and their primary caregivers

GOALS

This report describes the development and validation of a short rating system to assess treatment-related coping and compliance (TCC) in childhood cancer patients and their primary caregivers.

PATIENTS AND METHODS

The initial system contained 21 items referring to supportive parenting style of the caregiver, treatment-related attitudes and behaviour of both caregiver and child, communicative skills of the child and relationships with the health care team. This questionnaire was completed independently by a nurse, a nursery-school teacher, a psychologist and a physician who are all working full time at the oncology unit. The sample under study included 111 patients aged 3-18 years who were on treatment, as well as their caregivers (in most cases the mother).

RESULTS

Using defined rules for item reduction, the questionnaire was reduced to 14 items, of which seven were referring to the TCC of the child and seven to the TCC of the caregiver. Cronbach's alpha coefficients ranged from 0.81 to 0.91 across the different assessments, indicating high internal consistency reliability. There was moderate to high agreement amongst observers (intra-class correlation coefficients ranged between 0.50 and 0.68). Construct validity was confirmed by a significant association between a global rating of TCC and the instrument's summary scores in the four assessments.

CONCLUSIONS

Our system may be used for clinical trials and clinical monitoring. Further testing of psychometric properties is recommended.

Using a children's book to prepare children and parents for elective ENT surgery: results of a randomized clinical trial

OBJECTIVE

We evaluated the effects of surgery preparation using a children's book on pre- and postoperative anxiety and distress in 2-10 years old children undergoing tonsillectomy and/or adenoidectomy and their mothers.

METHODS

Parents of the experimental group were given the preparation book during the preoperative visit at the hospital, whilst control subjects did not receive the book. Data collection was conducted on the evening prior to surgery (T1), and the evening post surgery (T2). At these two points in time, mothers completed a self-designed feeling states checklist and the state anxiety scale of the State and Trait Anxiety Inventory to assess their perceptions of the child's distress and their own level of anxiety. At T2, nurses were asked to give ratings of patient-caregiver variables, such as level of anxiety, cooperation with care or level of information. The sample under study consisted of 160 mother/child dyads in the experimental group and 240 controls.

RESULTS

We found that mothers who received the book exhibited less self-reported state anxiety prior to the operation compared to mothers who did not. Simultaneously, children of the experimental group showed less distress in 4 of 11 feeling states. Nurses assessed the mothers of the experimental group to participate more in the child's care than control mothers.

CONCLUSIONS

The results demonstrated that our preparation book can provide educational and anxiety-reducing benefits. Given the relatively low production costs and its easy administration, it can be recommended as a popular, practical and cost-efficient tool to prepare children and parents for surgery and hospitalization.

US as a primary diagnostic tool in relation to negative appendectomy: six years experience

PURPOSE

To evaluate the effect of ultrasonography (US) on the rate of appendectomy after false-positive diagnosis of acute appendicitis (negative appendectomy).

MATERIALS AND METHODS

Data were analyzed in 736 pediatric patients (mean age, 13.2 years) who had undergone appendectomy between 1995 and 2000. Histologic data were compared in patients who underwent US with those who did not undergo imaging prior to surgery. US was performed by a radiologist or a pediatric surgeon or both.

RESULTS

A total of 643 (87.4%) of the 736 pediatric patients underwent preoperative US, and 93 (12.6%) of the 736 did not undergo preoperative US. Of the 736 patients, 97 (13.2%) underwent negative appendectomy. Thirty-four (36.6%) of the 93 patients who underwent appendectomy with no preoperative US and 63 (9.8%) of the 643 patients who underwent preoperative US underwent negative appendectomy. There was a significant association between US and positive appendectomy (P <.001).

CONCLUSION

US in pediatric patients suspected of having appendicitis can significantly lower the negative appendectomy rate.

German cross-cultural adaptation of the Health Utilities Index and its application to a sample of childhood cancer survivors

Steady progress in developing effective treatments for childhood cancer and other severe pediatric diseases has established the need to consider the nature and frequency of late physical and psychological effects. The Health Utilities Index Mark 2 and Mark 3 (HUI2/3) systems were developed by Feeny, Furlong, Torrance et al. in Canada. These systems are generic multi-attribute measures of a person's health status and health-related quality of life. The first German version of the Canadian HUI2/3 questionnaire was created in our clinic, following recommended guidelines for cross-cultural adaptation of health-related quality of life measures. The usefulness of the resultant version was investigated using a sample of 142 patients who presented to our oncological outpatients' department for a routine health care visit after completion of treatment. The 15 items of the HUI2/3-questionnaire were answered independently by three groups of assessors--nurses, physicians, and parents or patients. Two additional questions covered ratings of the severity of treatment effects and the specification of these effects. The questionnaire was both easy to use and acceptable to the assessors. Percentage agreement between observers about levels for individual attributes ranged from 56% to 100%, with the lowest agreement on the subjective attributes of emotion, pain and cognition. These results are in accordance with previous studies using the original instrument. HUI2 global utility scores were significantly related to ratings of treatment sequelae, giving support to the discriminant validity of the measure.

CONCLUSION

The German version of HUI2/3 is a useful instrument with generally high inter-observer agreement and good suitability for outcome measurement in childhood cancer patients. Further research is needed to assess the usefulness of the instrument in other clinical populations and its sensitivity in longitudinal studies.

Psychosocial adjustment of pediatric patients after allogeneic stem cell transplantation

The purpose of this study was to assess the psychosocial adjustment of patients who had been treated with allogeneic stem cell transplantation (SCT) in our clinic. Selection criteria for patients were to be aged 14-30 years at the time of the follow-up, to be at least 2 years post-SCT and to have a very good knowledge of German. Among 31 eligible patients, 26 participated (84% response rate). The patients were between 15 and 27 years old and were on average 7 years (range 2-13) post-SCT. Research instruments consisted of a demographic questionnaire and various subscales of established psychological measures for which data from a sample of bone cancer survivors and population norms were available. About 35% of patients showed high levels of anxiety, 62% appeared to be extremely sensitive and vulnerable, and 35% showed strong, unfulfilled needs in their love lives. In the other domains tested (self-esteem, family and peer relationships, school/vocational performance, etc), no noticeable differences were found between the subjects and comparable populations. There was no significant association between psychosocial outcome and demographic features or clinical data. Our results suggest that patients who underwent SCT in their childhood or adolescence are at risk of developing long-term emotional or social problems. Due to the retrospective design of our study and the small sample size, no predictive factors for psychosocial distress could be identified.

Quality of life and psychosocial adjustment of young patients after treatment of bone cancer

BACKGROUND

The aim of this study was to collect information about the psychosocial situation of young patients after multimodality therapy for bone cancer.

METHODS

Selection criteria for patients were ages 15-30 years, tumor localization at the extremities, and an interval of at least 1 year since the end of treatment. Of 110 patients, 60 were willing to participate. Evaluation of psychosocial quality of life included assessment of psychosocial adjustment and age-appropriate achievements as well as identification of problems typical for this patient group.

RESULTS

Approximately 80% of patients revealed, at the very most, only minor psychosocial problems. They were able to adapt well to their new living conditions, although strong efforts were necessary for them to deal with problems such as restricted mobility, catching up with school, or changing jobs or job orientation. Differences between patients and control subjects emerged in the areas of marital status, independent living, and parenthood. The most recently determined levels of education and income were similar. Neither clinical data nor physical or functional sequelae affected psychosocial adjustment, with one exception: patients diagnosed in adolescence had significantly more problems, especially in the area of social well-being, than patients diagnosed in childhood or early adulthood.

CONCLUSIONS

Given the limitations of this study, the findings suggest that survivors of bone cancer are not necessarily at risk of developing long term emotional or social problems and are not precluded from leading active and independent lives.