Predicting moderate improvement and decline in pediatric asthma quality of life over 24 months

Objective  

To determine factors associated with 24-month change in quality of life in children with asthma and their parents during the Childhood Asthma Management Program (CAMP).     

Depression, anxiety and quality of life in pediatric asthma

Aims: The study's objective was to examine depression, anxiety and quality of life according to age and asthma status in pediatric asthma in a pediatric university department. Methods: 108 patients, age: 11.75 +/- 3.10 (mean +/- SD) years (boys 11.6 +/- 2.8 years and girls 12.1 +/- 3.7 years) completed the Child Depression Inventory, the State Trait Anxiety Inventory for Children, the Pediatric Asthma Quality of Life Questionnaire, and a symptom score. Forced expiratory volume in one second was also measured. Results: Mean forced expiratory volume in one second percent was 97.4 +/- 12.8. 23 patients (21%) had intermittent asthma, 40 patients (37%) had mild persistent, 43 patients (40%) had moderate persistent, 2 patients (2%) had severe persistent asthma. Pediatric asthma patients scored 9.36 +/- 5.57 points in the depression questionnaire. Patients showed as many depressive symptoms as the Hungarian average population, pre-adolescent boys with asthma showed even less. Children with asthma scored 31.16 +/- 4.61 points on the anxiety questionnaire; (boys 30.64 +/- 4.29, girls 32.67 +/- 5.27). Children with asthma have the same anxiety level as their healthy peers. On the quality of life questionnaire asthmatic children reached 6.18 +/- 1.00 (2.87-7.00); adolescent girls scored the worst (5.62 +/- 1.28). Adolescent asthmatic girls have the worst quality of life. Boys reach better quality of life scores as they grow older ( p = 0.02). Girls with adolescence have a tendency of decreasing quality of life, although the difference is not significant. In adolescence, asthmatic girls experience more quality of life deprivation than boys ( p = 0.013). Depression score, anxiety, or quality of life showed no difference between the intermittent and persistent asthmatic groups. Children in the symptomatic subgroup experienced poorer quality of life. Depression and anxiety were not affected by current asthma symptoms. There was no significant difference in depression, anxiety or quality of life scores according to age. Conclusion: The psychological status of children with asthma is fairly good. One should concentrate more on the quality of life of girls in adolescence. The good pediatric care of childhood asthmatics helps to avoid the psychological consequences of the disease.     

Health-related quality of life in asthma: A comparison between the St George's respiratory questionnaire and the asthma quality of life questionnaire

The aim of the study is to compare the performance of the Juniper Asthma Quality of Life Questionnaire (AQLQ) and the St George's Respiratory Questionnaire (SGRQ) in a sample of asthmatic patients, representative of a broad spectrum of asthma severity. We studied 116 patients with a mean age (SD) of 42.6 (18.3) year. Patients were assessed twice, at recruitment and after 2 months, to determine the reliability, validity and responsiveness of the AQLQ and the SGRQ. Both questionnaires showed good reliability coefficients (0.70) which reached the standards for comparison at individual level (0.90) in the case of activity, impacts and overall SGRQ scores as well as symptoms, activities and overall AQLQ scores. Both AQLQ and SGRQ were able to discriminate among groups of patients based on asthma severity and control and showed, except for the symptoms domain of the SGRQ, large (standardized response means >0.8) and significant changes in the group of patients that improved at follow-up. We conclude that the AQLQ and SGRQ have shown high reliability and validity and, with the exception of the SGRQ symptoms, a high level of responsiveness. In overall terms, not one of these instruments seems to behave better than the other.     

Validity of two common asthma-specific quality of life questionnaires: Juniper mini asthma quality of life questionnaire and Sydney asthma quality of life questionnaire

Background

The aim of this study was to evaluate the association between experienced physical violence and health-related quality of life (HRQoL) by comparing self-reported health status for individuals with and without experience of physical violence. Our hypothesis was that individuals exposed to violence would experience worse HRQoL than non-exposed individuals. We tested whether men and women and different age groups experience similar reductions in HRQoL, and the extent to which such differences might be associated with social circumstances and lifestyle conditions. Finally, we explored the HRQoL consequences of exposure to violence in a longer time perspective.

Methods

We used data from self-completed questionnaires in two Danish nationally representative, cross-sectional health interview surveys. Exposure to violence was indicated through specific survey questions (Straus?? conflict tactics scale) enquiring about different types of violence during the last 12?months. Health status of respondents was elicited by the EQ-5D and SF-36 questionnaires. The health status profiles were converted to health score indexes using the Danish algorithm for EQ-5D and the revised Brazier algorithm for SF-6D. Differences in score indexes between the exposed and non-exposed individuals were explored separately for men and women using ordinary least square regression with four age categories as explanatory variables.

Results

In the 2000 and 2005 surveys, respectively, 4.9% and 5.7% of respondents indicated that they had been exposed to physical violence within the last 12?months. Exposure to violence was more prevalent in the younger age groups and more prevalent for men than women. Respondents exposed to violence had lower score indexes on both the EQ-5D and the SF-6D compared with the non-exposed. Respondents who reported exposure to violence in both 2000 and 2005 reported lower HRQoL than individuals who only reported exposure in one of the surveys.

Conclusions

The results of this study provide evidence for an association between exposure to physical violence and reduction in health-related quality of life.     

Validity of two common asthma-specific quality of life questionnaires: Juniper mini asthma quality of life questionnaire and Sydney asthma quality of life questionnaire

ABSTRACT: BACKGROUND: This study explored the psychometric properties (internal consistency, construct validity, discriminative ability) of the Juniper Mini Asthma Quality of Life Questionnaire (Mini AQLQ-J) and the Sydney Asthma Quality of Life Questionnaire (AQLQ-S). METHODS: One hundred fourty-six adults (18-45 years) with asthma requiring regular inhaled corticosteroids were recruited to a trial of written emotional disclosure. Correlational analyses were performed to understand the relationship of the two measures with each other, with symptoms, lung function, asthma control, asthma bother and generic quality of life. Median quality of life scores were compared according to gender, health care usage and levels of asthma severity. RESULTS: AQLQ-J and AQLQ-S total scores correlated strongly with each other (rho = -0.80) and moderately with the EuroQol Current Health Status Scale (AQLQ-J: rho = 0.35; AQLQ-S: rho = -0.40). Domain score correlations between AQLQ-J and AQLQ-S were mostly moderate (0.5 < rho < 0.8). Both QoL measures were significantly correlated with symptom score. Correlations with the symptom score asthma module (AQLQ-J: rho = -0.69; AQLQ-S: rho = 0.50) were stronger compared with the total symptom score and the symptom score rhinitis module (AQLQ-J: rho = -0.41; AQLQ-M: rho =0.31). Neither QoL measure was significantly correlated with FEV1 % predicted at the total or the domain level. Total scores of both measures were significantly correlated with subjective asthma control (AQLQ-J: rho = 0.68; AQLQ-S: rho = -0.61) and asthma bother (AQLQ-J: rho = -0.73; AQLQ-M: rho = 0.73). CONCLUSIONS: This study provides further evidence for the validity of the AQLQ-J and the AQLQ-S in a British population of adult patients with asthma managed in primary care. Correlations with lung function parameters were weak or absent. Correlations with generic quality of life were moderate, those with asthma symptoms, asthma control and asthma bother were strong. Both measures are able to discriminate between levels of asthma severity.     

The role of coping strategies in quality of life of adolescents with asthma

This study aimed to determine which coping strategies are associated with better quality of life (QOL) in adolescents with asthma. Furthermore, because coping can mediate the effects of health stressors on QOL, this study also examined the indirect effect of asthma severity on QOL via coping. Between January and May 2003, 553 Dutch adolescents with asthma (aged 12–16 years) completed questionnaires assessing coping strategies, symptom severity, overall QOL and positive QOL domain (positive effects of asthma domain). The relations between symptom severity, coping strategies and QOL were tested with structural equation modelling (SEM). Symptom severity affected overall and positive QOL, both directly and indirectly via coping. The coping strategies restricted lifestyle and worrying about asthma were associated with poorer overall QOL. The use of the coping strategies restricted lifestyle, positive reappraisal, and information seeking was related to increased scores on the positive QOL domain, whereas hiding asthma was related to lower scores on the positive QOL domain. The findings of this study suggest that coping mediates the effect of symptoms of asthma on QOL among adolescents with asthma. Several suggestions for interventions to improve asthma-specific QOL are discussed.     

Predicting young children's quality of life

This paper represents an investigation into the determinants of young children's quality of life (QOL) in Thailand. The empirical work is based upon a sample of 498 children (aged 5-8); 220 were urban children and 278 children of construction workers in Bangkok. Their QOL was assessed using a new self-report QOL measure for children. Multiple regression analyses indicated that the father's income and education, type of school, mode of transportation to school, and the amount of time that the child spent on extra study courses were significant explanatory variables. It was found that these factors had different influences on the QOL of urban children and those of construction workers. Extra sport-related activities and extra work (other than housework) improved the QOL of urban children, while the QOL of construction workers' children was directly linked to father's education and income. This result is consistent with income having a diminishing marginal effect on the QOL of children. There is also evidence that amongst construction workers' children, boys have a lower QOL than girls. The different causal explanations for the QOL of urban and construction workers' children suggests that it is context specific, and what impacts one group of children's QOL within a particular context may not impact another group in a different situation. This has important policy implications. Throughout the study we could find no significant impact of health on QOL-neither chronic, acute nor severe illness has any significant impact on QOL. This is consistent with the hypothesis that QOL is influenced by expectations (Social Science and Medicine 41 (10) (1995) 1403). Findings of the effects of social and environmental factors on children's QOL are new in this field and should be further investigated.     

The role of personality, coping style and social support in health-related quality of life in HIV infection

Objective: To determine the role of health status, personality and coping style, on self-report health-related quality of life (QoL). Methods: Participants were HIV seropositive individuals at all disease stages from three samples (a) gay/bisexual men from the UK, (b) injecting drug users from the UK, (c) injecting drug users from Italy. All participants completed questionnaires evaluating QoL, personality, coping style and social support. Explicit models of the relationships between the measured variables based on a review of the literature were tested using structural equation modelling. Results: Health status was modestly associated with the physical but not the psychological aspects of QoL ( = 0.44). Neuroticism was strongly associated with psychological QoL ( = –0.73) but only weakly with physical QoL ( = –0.21). The samples did not differ in either the pattern or the magnitude of these relationships. Mediating factors such as coping style, social support and other personality variables had only a weak influence on the role of Neuroticism. Conclusions: Neuroticism had a strong influence on health-related QoL that was independent of health status. Neuroticism was more strongly associated with the psychological aspects of QoL than health status. Coping styles and the other psychological variables assessed had only a weak mediating influence on this relationship.     

Predicting parent health-related quality of life: evaluating conceptual models

Purpose

Parents of children with chronic illnesses are at risk for poor health-related quality of life (HRQoL), with numerous identified risk factors, but the most informative statistical model considering their combined impact is unclear. The authors conceptualized risk for poor HRQoL using a summed model, comprehensive multivariate model, and latent profile analysis (LPA).

Methods

Community parents completed an online survey, providing information about demographics, child’s chronic illness, family functioning, and parent and child HRQoL. Parents reported that their children had a variety of chronic conditions (e.g., asthma, headaches, attention deficit/hyperactivity disorder, neurofibromatosis).

Results

The summed model did not account for a significant proportion of variance in parent HRQoL. The comprehensive multivariate model (R ² ?=?0.614) and LPA (R ² ?=?0.305) both significantly predicted parent HRQoL. The LPA identified two risk profiles for lower HRQoL: parents who reported milder illnesses, but poorer family functioning; and parents who reported greater disease severity, but better family functioning.

Conclusions

Comprehensive multivariate models or LPAs best conceptualize patterns of risk for poor parental HRQoL in the community; though the findings in the current community sample may not extend to parents recruited from specialty clinics whose children may have more severe chronic illnesses. Parents of children with mild chronic conditions are still at risk for poor HRQoL, warranting attention from health care providers.

     

Measuring quality of life in children with asthma

The Paediatric Asthma Quality of Life Questionnaire contains 23 items that children with asthma have identified as troublesome in their daily lives. The aim was to evaluate the measurement properties of the questionnaire. The study design consisted of a 9 week single cohort study with assessments at 1, 5 and 9 weeks. Patients participating in the study were fifty-two children, 7–17 years of age, with a wide range of asthma severity. At each clinic visit, a trained interviewer administered the Paediatric Asthma Quality of Life Questionnaire, the Feeling Thermometer, a clinical asthma control questionnaire and measured spirometry. For 1 week before each clinic visit, patients recorded morning peak flow rates, medication use and symptoms in a diary. The Paediatric Asthma Quality of Life Questionnaire was able to detect quality of life changes in those patients who altered their health status either as a result of treatemnt or natural fluctuations in their asthma (p<0.001) and to differentiate these patients from those who remained stable (p<0.0001). It was reproducible in patients who were stable (ICC=0.95), which also indicates the instrument's strength to discriminate between subjects of different impairment levels. The questionnaire showed good levels of both longitudinal and cross-sectional correlations with the conventional asthma indices and with general quality of life. The results were consistent across individual domains and different age strata. The Paediatric Asthma Quality of Life Questionnaire has good measurement properties and is valid both as an evaluative and a discriminative instrument. It captures aspects of asthma most important to the patient and adds additional information to conventional clinical outcomes.Supported through a grant from Fisons Canada     

Health-related quality of life in Australian children with asthma: lessons for the cross-cultural use of quality of life instruments

The development of Australian forms of the Childhood Asthma Questionnaires (CAQs) is reported. Focus group methods and psychometric analyses were used to establish the conceptual, semantic and technical equivalence of these forms with the UK versions. Both versions also provide for data collection from non-asthmatic youngsters. The internal consistency was found to be acceptable (Cronbach's 0.52–0.90) and the health-related quality of life (HRQoL) scores were found to vary with asthma severity (p<0.05). Comparison with the UK data revealed that the non-asthmatic scores were higher for Australian than British children (p<0.001) but that the scores for children with asthma did not differ between the two countries. It was only in the Australian sample that the group with asthma reported impaired HRQoL when compared to their healthy peers. These findings were interpreted in the context of cultural expectations of life quality and conclusions are presented regarding the importance of the gap between experience and expectations. The difficulties raised by the developmental and cultural issues inherent in paediatric HRQoL research were discussed.     

The relationship between parental overprotection and health-related quality of life in pediatric cancer: the mediating role of perceived child vulnerability

Purpose  

The current study sought to examine the relation of parental overprotection and perceived child vulnerability to parent-reported health-related quality of life in parents of children with cancer.     

Health-related quality of life and emotional problems in juvenile idiopathic arthritis

Purpose

Children with juvenile idiopathic arthritis (JIA) are at an increased risk of developing emotional problems. This study evaluated the associations between levels of depressive and anxiety symptoms and health-related quality of life (HRQOL) in these children.

Methods

Sixty-seven children with JIA, together with one parent, participated. Anxiety symptoms were identified using the Screen for Child Anxiety Related Emotional Disorders Questionnaire (SCARED), while depressive symptoms were identified using the Mood and Feeling Questionnaire (MFQ). The Pediatric Quality of Life Inventory (PedsQL) was used for HRQOL assessments. Using hierarchical multiple-regression analysis, demographics, clinical factors, and pain were control variables, while anxiety (the SCARED score) and depressive symptoms (the MFQ score) were HRQOL (the PedsQL score) predictors.

Results

The regression model emerged with specified variables explaining 63 % of the variance in the PedsQL score (F = 11.92, p < 0.01) among children. Among parents, the same set of variables accounted for 49 % the variance (F = 6.99, p < 0.01). The MFQ score, but not the SCARED, added most to the variance.

Conclusions

Depressive symptoms, but not anxiety, accounted for substantial variability in levels of HRQOL when considered with demographics, clinical factors, and pain. Thus, screening for depression needs to be considered as a part of multimodal assessment and treatment approaches in JIA.     

人格特征与乳腺癌患者生存质量的相关性研究

目的　探讨哈尔滨市乳腺癌患者生存质量与人格特征的相关性。方法　普通住院乳腺癌患者 5 2例 ,癌症康复协会乳腺癌患者 6 7例 ,共 119例 ,均使用世界卫生组织生存质量调查问卷 (WHOQOL 10 0 )、艾森克人格问卷(EPQ)、Zung’s抑郁自评问卷和Zung’s焦虑自评问卷进行调查。 结果　EPQ测量中的N因子与总的生存质量和生存质量的心理领域呈负相关 (P <0 0 5 )。乳腺癌患者的生存质量低于常模 ,焦虑、抑郁高于常模。结论　乳腺癌患者人格中情绪不稳定性高 ,降低生存质量 ,因此 ,必须把心理治疗和躯体治疗相结合来提高整体的疗效。     

生命早期使用抗生素与儿童哮喘的关联性研究

目的探讨生命早期0~1岁时使用抗生素对6~10岁时儿童发生哮喘的影响。方法采用回顾性研究方法,以2015年10月至2018年10月在某院确诊的350例哮喘儿童作为病例组,以同期进行健康体检的350例非哮喘儿童作为对照组。结果生命早期应用抗生素是儿童发生哮喘的危险因素。病例组中哮喘儿童的抗生素使用率为84.3%,对照组为52.0%。χ2检验结果显示当抗生素使用疗程次数大于2次时,或当使用大环内酯类和头孢类的抗生素时,均会明显引起儿童哮喘发病风险增大(P<0.05)。多项分类logistic回归分析结果显示重度和轻度发病相比,抗生素使用疗程次数≥4更容易重度发病(OR=3.012,95%CI=1.084~8.370)。中度和轻度发病相比,抗生素使用疗程次数为≥4和3次更容易中度发病(OR=2.813,95%CI=1.358~5.826)和(OR=2.337,95%CI=1.139~4.796);抗生素类型为大环内酯类更容易中度发病(OR=2.870,95%CI=1.483~5.555)。结论生命早期应用抗生素会增大儿童哮喘发病的风险,且抗生素使用疗程次数、类型与哮喘发病的严重程度具有一定相关性。     

Determinants of quality of life in type 2 diabetes population: the inclusion of personality

Objective  

The identification of factors that affect quality of life (QoL) is crucial to ameliorate the increasing burden of diabetes. This study tested a multi-dimensional model that consisted of factors across three domains (personal, medical, and lifestyle factors) to understand determinants of QoL in adults with type 2 diabetes.     

Measuring quality of life in the parents of children with asthma

Parents and primary caregivers of children with asthma are limited in normal daily activities and experience anxieties and fears due to the child's illness. We have developed the Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ) to measure these impairments. The objective of this study was to evaluate the measurement properties of the PACQLQ. A 9-week single cohort study was conducted with assessments at 1, 5 and 9 weeks. Participants in the study were primary caregivers of 52 children (age 7–17 years) with symptomatic asthma, recruited from notices in the local media and paediatric asthma clinics. Caregivers completed the PACQLQ, Impact-on-Family Scale and Global Rating of Change Questionnaires. Patients completed the Paediatric Asthma Quality of Life Questionnaire and an asthma control questionnaire. Spirornetry and -agonist use were recorded. The PACQLQ was able to detect quality of life changes in those caregivers who changed (p<0.001) and to differentiate these from the caregivers whose quality of life remained stable (p<0.0001). The PACQLQ is reproducible in subjects who are stable (ICC=0.84), and showed acceptable levels of longitudinal and cross-sectional correlations with the child's asthma status and health-related quality of life and with other measures of caregiver health-related quality of life. The PACQLQ functions well as both an evaluative and a discriminative instrument.     

The role of coping resources and coping style in quality of life of patients with asthma or COPD

OBJECTIVE: Sufficient psychosocial coping resources and an adequate coping style may have a beneficial influence on quality of life in patients with a chronic disease. Until now little research has been directed at these associations and particularly not among patients with asthma or chronic obstructive pulmonary disease (COPD). The objective of this study is to examine the association between psychosocial coping resources and coping style with HRQoL, for asthma and COPD separately. METHODS: Fourteen general practitioners in The Netherlands recruited 273 adult patients with asthma (n = 220) or COPD (n = 53). Data were collected by a pulmonary function assessment, a face-to-face interview and validated questionnaires about psychosocial coping resources (self-efficacy, mastery, self-esteem, and social support), coping style (avoidant, rational and emotional), and health related quality of life (HRQoL). RESULTS: A more emotional coping style (p < 0.01) was independently associated with poor HRQoL in both asthma and COPD patients. Furthermore, in asthma patients, less self-efficacy feelings (p < 0.01), less mastery feelings (p = 0.05), a more avoidant coping style (p = 0.04) and poor pulmonary function (p < 0.01) were independently associated with poor HRQoL. In COPD patients, a more rational coping style (p = 0.02) was independently associated with poor HRQoL. CONCLUSION: Our findings suggest that psychosocial coping resources and coping style are independently associated with HRQoL in patients with asthma or COPD. Further research should explore the possibilities of intervening on these factors, aiming to improve HRQoL in patients with asthma or COPD.     

Health-related quality of life in obesity: the role of eating behaviour

A poor health-related quality of life (HRQL) has been repeatedly documented in obesity. Overweight per se and associated diseases affect physical fitness, whereas mental well-being depends on social, cultural and behavioural components. Very few studies are available on HRQL in obese persons in relation to eating behaviour. We measured HRQL by means of Short-Form-36 questionnaire in 183 obese subjects, seeking specific treatment at a University-based weight management center. Only half had a Body Mass Index exceeding 35 kg/m2. Data were compared to age- and gender-adjusted normative values of the Italian population (2031 subjects). The Binge Eating Scale (BES) and the Three-Factor Eating Questionnaire (TFEQ) were used to assess eating behaviour. Most domains of HRQL were impaired in obese subjects, more severely in younger subjects and in females. The severity of overweight progressively affected physical fitness, but had a minor effect on mental status. In over 50% of subjects, BES and TFEQ identified a binge eating pattern, more frequently in females. A positive BES, as well as lower restriction, higher disinhibition and hunger values at TFEQ, identified subjects with poorer HRQL. Logistic regression analysis identified in a positive BES the variable more closely associated with low scores in mental domains of perceived HRQL. Waist-to-hip ratio, degree of obesity, osteoarticular and respiratory diseases, but also positive BES, were selected as variables more closely associated with poor physical fitness. HRQL is variably impaired in obese persons seeking treatment for their disease, mainly in patients with binge eating. Treatment of binge eating may be as important as any weight-reducing intervention for the overall well-being of the majority of obese persons.     

Daily activities mediate the relationship between personality and quality of life in middle-aged women

Purpose  

The aim of this study was to test a model proposing that the relationship between personality factors and women’s quality of life (QoL) is mediated by degree of depression and the way in which every day activity and general health were appraised. Specifically, the paper addressed the mediating contribution of activity.