Psychische Gesundheit von übergewichtigen und adipösen Jugendlichen unter Berücksichtigung von Sozialstatus und Schulbildung

Background

International studies showed that overweight and obese adolescents are more likely to have mental health problems compared to normal weight peers.

Objectives

This study analyses the relation between overweight/obesity and mental health problems among adolescents in Germany as well as potential modifying factors of this relation.

Materials and Methods

Data base was a subsample of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS, n?=?6,813, 11–17 years) which was conducted by the Robert Koch Institute from May 2003 to May 2006. Body height and weight were measured in a standardised manner and body mass index (BMI) was calculated. Indications of mental health problems and strengths were collected with the Strengths and Difficulties Questionnaire (SDQ) in the following areas: emotional symptoms, conduct problems, hyperactivity, peer relationship problems and prosocial behaviour. Socio-economic status (SES) and education are analysed as modifying variables. Prevalence and odds ratios with 95?% confidence intervals were calculated by binary logistic regression.

Results

Obese boys and overweight and obese girls showed more indications of mental health problems compared to normal weight peers. The most common problem areas were conduct problems and peer relationship problems. Obese girls were also more likely to show indications of emotional symptoms compared to normal weight girls. The age stratified analysis showed that the differences in the occourrence of mental health problems between normal weight and obese boys as well as between normal weight and overweight/obese girls are more pronounced aged 11 to 13 years than aged 14 to 17 years. The results on the impact of SES and education showed that in girls, SES had a modyfying impact on the relation between overweight/obesity and mental health problems in favour of the high SES group. In boys, SES only had a modifying impact on the relation between overweight and mental health problems, but here in favour of the low SES group. Only in girls education had a modifying impact on the relation between obesity and mental health problems in favour of the low education group.

Conclusion

In adolescence, overweight and especially obesity go along with a higher risk for mental health problems. In the context of prevention measures and care services for overweight and obesity at a young age, psychosocial aspects should be considered.     

Sleep characteristics and health-related quality of life among a national sample of American young adults: assessment of possible health disparities

Purpose

The aim of the study is to examine the associations of sleep characteristics with health-related quality of life (HRQOL) and sleep health disparities among US young adults using national survey data.

Methods

The study sample consisted of 2,391 young adults aged 20–39 years from the National Health and Nutrition Examination Survey 2005–2008. HRQOL was assessed using the Centers for Disease Control and Prevention’s HRQOL-4 scale. Multivariable logistic regression models were applied to evaluate the sleep–HRQOL associations. Stratified analyses were conducted to examine whether the associations varied by sociodemographic characteristics.

Results

Approximately 35.6 % of young adults slept <7 h, 41.9 % had insomnia, 4.4 % had sleep disorder, and 8.5 % had sleep apnea. More females had insomnia than males (48.6 vs. 35.9 %, P < 0.001). US-born young adults had more sleep disturbances than their foreign-born counterparts. Compared with those sleeping 7–8 h, the adjusted odds ratio of poor general health was 1.60 (95 % confidence interval, 1.08–2.35) for individuals sleeping 6–7 h and 1.88 (1.23–2.86) for those sleeping <6 h. Similar results were found for low mental HRQOL and overall HRQOL. Insomnia, long sleep latency, troubling falling asleep, daytime sleepiness, and frequent sleeping pill use were significantly associated with low mental HRQOL and overall HRQOL. The associations between sleep disturbances and low HRQOL varied little by sex, race/ethnicity, and country of birth.

Conclusions

Sleep disturbances are common among US young adults and are significantly associated with low HRQOL. Objective measures of sleep are warranted to confirm our findings.     

Impact of hepatitis B and C co-infection on health-related quality of life in HIV positive individuals

Purpose

Concurrent infection with HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) often occurs due to the commonality in risk factors for acquisition. Few studies have examined the effect of co-infection on health-related quality of life (HRQOL) in HIV positive individuals.

Methods

Ontario HIV Treatment Network Cohort Study (OCS) participants who completed an annual interviewer-administered questionnaire on up to three occasions were included. Generalized estimating equations (GEE) were used to assess the impact of HBV and HCV co-infection on physical and mental HRQOL component summary scores (range 0–100) as measured by the Medical Outcomes SF-36 health survey.

Results

As of March 2010, 1,223 participants had completed the questionnaire; 964 were HIV mono-infected, 128 were HIV–HBV co-infected, 112 were HIV–HCV co-infected, and 19 were HIV–HBV–HCV tri-infected. Eighty percent were male, median age 46 (IQR 40–53) years, 61 % Caucasian, median CD4 count 464 (IQR 319–636) cells/mm³, and 74 % had undetectable HIV viremia. Physical HRQOL was lower in HIV–HBV and HIV–HCV co-infected individuals (49.4 (IQR 42.0–53.9) and 48.1 (IQR 36.9–52.8) vs. 51.5 (IQR 45.0–55.4); p = 0.01 and <0.0001) compared to mono-infected individuals. In the multivariable GEE model, the negative impact of HCV remained significant (?2.18; p = 0.01) after adjusting for drug use, smoking, age, and gender. Unadjusted mental HRQOL was lower in HIV–HCV co-infected individuals (44.6 (IQR 34.6–54.0) vs. 48.9 (IQR 36.8–55.9); p = 0.03) compared to mono-infected individuals but no association of mental HRQOL with either co-infection was observed in multivariable GEE models.

Conclusions

HCV appears to negatively impact physical HRQOL suggesting a greater health burden for co-infected individuals. HBV and HCV co-infections were not related to lower mental HRQOL among people living with HIV/AIDS.     

The association between motor vehicle injuries and health-related quality of life: a longitudinal study of a population-based sample in the United States

Purpose

As many as 3 million US residents are injured in traffic-related incidents every year leaving many victims with disabling conditions. To date, limited numbers of studies have examined the effects of traffic-related injuries on self-reported health. This study aims to examine the association between health-related quality of life (HRQOL) and traffic-related injuries longitudinally in a nationally representative sample of US adult population.

Methods/approach

This is a longitudinal study of adult participants (age ≥18) from seven panels (2000–2007) of the Medical Expenditure Panel Survey. The dependent variables included the physical and mental components of the SF-12, a measure of self-reported health. The outcome was assessed twice during the follow-up period: round 2 (~4–5 months into the study) and round 4 (~18 months into the study) for 62,298 individuals. Two methods estimate the association between traffic-related injuries and HRQOL: a within person change using paired tests and a between person change using multivariable regression adjusting for age, sex, income and educational level.

Results

Nine hundred and ninety-three participants reported traffic-related injuries during the follow-up period. Compared to their pre-crash HRQOL, these participants lost 2.7 of the physical component score while their mental component did not change. Adjusted results showed significant deficits in the physical component (?2.84, p value = <.001) but not the mental component (?0.07, p value = .83) of HRQOL after controlling for potential confounders.

Conclusion

Traffic injuries were significantly associated with the physical component of HRQOL. These findings highlight the individual and societal burden associated with motor vehicle crash-related disability in the United States.     

Health-related quality of life in rural children living in four European countries: the GABRIEL study

Objective

Measuring children’s health-related quality of life (HRQOL) is of growing importance given increasing chronic diseases. By integrating HRQOL questions into the European GABRIEL study, we assessed differences in HRQOL between rural farm and non-farm children from Germany, Austria, Switzerland and Poland to relate it to common childhood health problems and to compare it to a representative, mostly urban German population sample (KIGGS).

Methods

The parents of 10,400 school-aged children answered comprehensive questionnaires including health-related questions and the KINDL-R questions assessing HRQOL.

Results

Austrian children reported highest KINDL-R scores (mean: 80.9; 95 % CI [80.4, 81.4]) and Polish children the lowest (74.5; [73.9, 75.0]). Farm children reported higher KINDL-R scores than non-farm children (p = 0.002). Significantly lower scores were observed in children with allergic diseases (p < 0.001), with sleeping difficulties (p < 0.001) and in overweight children (p = 0.04). The German GABRIEL sample reported higher mean scores (age 7–10 years: 80.1, [79.9, 80.4]; age 11–13 years: 77.1, [74.9, 79.2]) compared to the urban KIGGS study (age 7–10 years: 79.0, [78.7–79.3]; age 11–13 years: 75.1 [74.6–75.6]). Socio-demographic or health-related factors could not explain differences in HRQOL between countries.

Conclusions

Future increases in chronic diseases may negatively impact children’s HRQOL.     

Environmental risk and protective factors of adolescents’ and youths’ mental health: differences between parents’ appraisal and self-reports

Purpose

We investigated the effect of parents’ mental health, life events, and home life (among other factors) on adolescents’/youths’ mental health, whether such an effect varies when several variables are assessed jointly, and also whether the informant source of the mental health problem modifies the estimations.

Methods

We studied a representative sample of 454 Spanish adolescents/youths studied longitudinally (2 assessments, 3 years apart). We considered factors associated with adolescents’/youths’ mental health (conduct, emotional, and hyperactivity scores [SDQ]): risk factors (parents’ mental health and life events) and mediators (social and financial support). Structural equation modeling was applied. We constructed two models: (a) with parents’ SDQ responses and (b) with self-reported SDQ responses (in a subsample of N = 260).

Results

Model fit was adequate for parents’ appraisal. Parents’ mental health (p < 0.05) and undesirable life events (p < 0.05) were the most important risk factors. The same model showed poorer fit when self-reported measures were used. Home life exerted a stronger protective effect on adolescents’/youths’ mental health when reported by adolescents/youths. The negative effect of parents’ mental health was significantly protected by home life in emotional [?0.14 (0.07)] and hyperactivity scores [?0.2 (0.08)].

Conclusions

Even in the presence of other factors, parents’ mental health has an important effect on adolescents’/youths’ mental health. Good levels of home life are protective, especially when adolescents’/youths’ mental health is self-reported.     

Subjective social status in association with various health and socioeconomic indicators in Tehran

Aim

Socioeconomic status (SES) is one of the most important determinants of health. Subjective social status (SSS) is a popular SES indicator. The objective of this study is to compare the associations between health and various SES indicators in order to examine whether SSS is a proper SES indicator.

Subject and methods

In this 2013 cross-sectional study, 1,995 Tehrani residents were selected through multi-stage random sampling. The questionnaires included items on subjective and objective SES, self-rated health (SRH) and objective health status. The crude and adjusted associations between health and SES indicators were assessed using bivariate and multiple logistic regressions.

Results

The crude associations between SSS and all assessed health outcomes were significant. After adjustment of the wealth index, consumption, education and occupation, the associations between SSS and SRH (OR?=?0.69, CI 95 %: 0.55–0.86) and having cardiovascular (OR?=?0.73, CI 95 %: 0.58–0.92), musculoskeletal (OR?=?0.81, CI 95 %: 0.70–0.94), asthma and other respiratory diseases (OR?=?0.71, CI 95 %: 0.54–0.92) still remained significant. The adjusted associations between SSS and having hypertension and diabetes were not significant. SSS had a stronger correlation with the wealth index (Spearman r?=?0.42) compared to other SES indicators.

Conclusion

SSS showed a significant association with most of the health outcomes, independent of other SES indicators; therefore, it can be used in health research, though it is not an exact alternative for other objective SES indicators.

     

Health-related quality of life and body mass index among US adolescents

Purpose

To examine the magnitude of differences in health-related quality of life (HRQOL) by body mass index (BMI) in a population-based sample of United States adolescents overall and by sex, and to provide national prevalence estimates of reported HRQOL outcomes for not only obese and overweight but also underweight adolescents.

Methods

From the 2001 through 2010 cross-sectional National Health and Nutrition Examination Surveys, we estimated the percentages of four HRQOL outcomes—self-rated health, physically unhealthy days, mentally unhealthy days, and activity limitation days—in four BMI categories—obese, overweight, normal weight, and underweight—of approximately 6,000 US adolescents aged 12–17 years. We also estimated the percentages for boys and girls separately.

Results

Substantial gaps in self-rated health exist between normal-weight adolescents and those who are obese and overweight, but not underweight. Eighteen percent (95 % CI 15–22) of obese adolescents reported fair or poor health compared to only 5 % (95 % CI 4–7) of normal-weight adolescents. Thirty-seven percent (95 % CI 33–42) of obese adolescents reported excellent or very good health, compared to 65 % (94 % CI 63–67) of normal-weight adolescents. However, all BMI groups reported similar percentages of physically unhealthy days, mentally unhealthy days, and activity limitation days. The associations between HRQOL and BMI groups did not vary by sex. Boys generally reported significantly better self-rated health and mental health than girls. Specifically, obese boys reported better self-rated health, mental health, and fewer activity limitation days than obese girls.

Conclusions

Substantially, significant differences in some domains of HRQOL are found between above normal-weight and normal-weight US adolescents. This relationship between BMI and HRQOL is robust and observed among both boys and girls.     

Evolution of educational inequalities in mortality among young adults in an urban setting

Objectives

To gain insight into the evolution in educational inequalities in adolescent and young adult all-cause and cause-specific mortality in the urban setting of the Brussels-Capital Region.

Methods

Data were derived from record linkage between the censuses of 1991 and 2001 and register data on all-cause and cause-specific mortality and emigration in the respective periods of 1st October 1991 to 1st January 1996 and 1st October 2001 to 1st January 2006. Both directly and indirectly standardised mortality rates and the relative index of inequality (RII) were computed.

Results

Mortality rates among adolescents and young adults have dropped significantly, especially infections and traffic accidents. However, educational inequalities among men have slightly increased: men with a maximum primary education are four times more likely to die than those who are higher educated [RII = 4.09 (2.78–6.03)]. Among women, no social gradient is observed in either period, but a clear split between the lowest educated and other educational groups is apparent in the 2000s.

Conclusions

There is a positive evolution towards lower mortality among adolescents and young adults, but educational inequalities remain a public health concern.     

Income-related health inequalities: does perceived discrimination matter?

Objectives

Because of their meritocratic ideology, Western countries might promote the belief that every individual is responsible for his or her socioeconomic position. These beliefs might enhance discrimination which, in turn, might affect health. Therefore, the aim of the study was to investigate the role of perceived discrimination within income-related health inequalities.

Methods

Two-year follow-up data (2008–2010) from the Dutch Longitudinal Internet Studies for the Social sciences panel (N = 2,139) were used to examine the relation between income, perceived discrimination, and self-rated health and feeling hindered by health problems.

Results

Results showed that poor health was more prevalent in the low income and in the discriminated group. Participants from the low income group were also more likely to perceive discrimination (OR = 1.57, 95 % CI = 1.03–2.42). However, there was no substantial evidence for a mediating effect of perceived discrimination on the income–health association.

Conclusions

The results emphasise the importance of a more in-depth study of discrimination in relation to socioeconomic health inequalities. Since ethnicity was a major confounder, it is recommended to take account of the complex interplay between discrimination and both the socioeconomic and ethnic background.     

The impact of ethnicity, place of residence and socioeconomic status on health-related quality of life: results from a Greek health survey

Objectives

The impact of socioeconomic status (SES) on health previously studied demonstrates that low SES relates to lower health. In Greece, related studies are limited and focused on native population. The aim of this study was to assess the influence of residence, ethnicity and SES on health-related quality of life (HRQoL).

Methods

The study was carried out in Thessaly using a sample of 1,372 individuals (18+ years old, response rate 91.4%) via face-to-face interview. Multiple stepwise linear regression analyses were performed investigating the impact of the above factors on HRQoL, measured by SF-36. Interaction effects between socioeconomic and demographic variables were performed.

Results

Disadvantage of SES, i.e. primary education and low income, was associated with impaired HRQoL in physical and mental health. Albanians reported better HRQoL compared to Greeks but after controlling for SES factors health disparities became insignificant. Rural residents were related to better general and mental health.

Conclusions

SES is an independent predictor of HRQoL, but ethnicity and place of residence had weak impact. Investigating the underline mechanisms that impair HRQoL, so as to take policies that will elucidate the risk of poor health in disadvantage groups, is important.     

Critically examining diversity in end-of-life family caregiving: implications for equitable caregiver support and Canada’s Compassionate Care Benefit

Background

Mental health is of special importance regarding socioeconomic inequalities in health. On the one hand, mental health status mediates the relationship between economic inequality and health; on the other hand, mental health as an "end state" is affected by social factors and socioeconomic inequality. In spite of this, in examining socioeconomic inequalities in health, mental health has attracted less attention than physical health. As a first attempt in Iran, the objectives of this paper were to measure socioeconomic inequality in mental health, and then to untangle and quantify the contributions of potential determinants of mental health to the measured socioeconomic inequality.

Methods

In a cross-sectional observational study, mental health data were taken from an Urban Health Equity Assessment and Response Tool (Urban HEART) survey, conducted on 22 300 Tehran households in 2007 and covering people aged 15 and above. Principal component analysis was used to measure the economic status of households. As a measure of socioeconomic inequality, a concentration index of mental health was applied and decomposed into its determinants.

Results

The overall concentration index of mental health in Tehran was -0.0673 (95% CI = -0.070 - -0.057). Decomposition of the concentration index revealed that economic status made the largest contribution (44.7%) to socioeconomic inequality in mental health. Educational status (13.4%), age group (13.1%), district of residence (12.5%) and employment status (6.5%) also proved further important contributors to the inequality.

Conclusions

Socioeconomic inequalities exist in mental health status in Iran's capital, Tehran. Since the root of this avoidable inequality is in sectors outside the health system, a holistic mental health policy approach which includes social and economic determinants should be adopted to redress the inequitable distribution of mental health.     

Exposure to traumatic events and health-related quality of life in preschool-aged children

Purpose

To examine the association of lifetime exposure to traumatic events with health-related quality of life (HRQOL) and psychosocial health in children aged 3 through 5 years.

Methods

This study is a community-based, cross-sectional survey of 170 children and their parents. Traumatic events were assessed by the Traumatic Events Screening Inventory—Parent Report Revised using criteria for potentially traumatic events in young childhood outlined by the Zero to Three working group. HRQOL of young children was measured using the 97-item Infant/Toddler Quality of Life Questionnaire, and psychosocial health was measured using the Child Behavior Checklist 1.5–5.

Results

One hundred and twenty-three (72 %) of children had experienced at least one type of trauma event. Children who had been exposed to 1–3 types of trauma and those exposed to 4 or more types of trauma had significantly worse HRQOL and psychosocial health than children not exposed to trauma. Significant effect sizes between children exposed to low levels or high levels of traumatic events and children not exposed to trauma ranged from small to large.

Conclusions

Exposure to traumatic events in early childhood is associated with less positive HRQOL and psychosocial health. Cumulative trauma exposure led to significant effects in outcome variables in this population. Interventions to decrease trauma exposure and to reduce significant stress in early childhood associated with exposure to trauma may be appropriate strategies for preventing negative health conditions throughout the life span.     

Explaining educational inequalities in adolescent life satisfaction: do health behaviour and gender matter?

Objectives

There is little evidence on the explanation of health inequalities based on a gender sensitive perspective. The aim was to investigate to what extent health behaviours mediate the association between educational inequalities and life satisfaction of boys and girls.

Methods

Data were derived from the German part of the Health Behaviour in School-aged Children (HBSC) study 2010 (n = 5,005). Logistic regression models were conducted to investigate educational inequalities in life satisfaction among 11- to 15-year-old students and the relative impact of health behaviour in explaining these inequalities.

Results

Educational inequalities in life satisfaction were more pronounced in boys than in girls from lower educational tracks (OR 2.82, 95 % CI 1.97–4.05 and OR 2.30, 95 % CI 1.68–3.14). For adolescents belonging to the lowest educational track, behavioural factors contributed to 18 % (boys) and 39 % (girls) in the explanation of educational inequalities in life satisfaction.

Conclusions

The relationship between educational track and life satisfaction is substantially mediated by health-related behaviours. To tackle inequalities in adolescent health, behavioural factors should be targeted at adolescents from lower educational tracks, with special focus on gender differences.     

The psychosocial work environment and mental health of teachers: a comparative study between the United Kingdom and Hong Kong

Purpose

There is limited research on teachers’ psychosocial work environment and mental health, and most has been conducted in predominantly Western countries that share a number of important common characteristics that distinguish them from countries in many other regions of the world. Within the framework of the effort–reward imbalance (ERI) theoretical model, the relationship between the psychosocial work environment and mental health of teachers in the United Kingdom (UK) and Hong Kong (HK) was investigated.

Methods

Full-time qualified teachers from both the UK and HK (N = 259) participated in the research. They were asked to fill in a set of questionnaires that measured their perceived stress, mental health, psychosocial work environment and demographic information.

Results

Perceived stress was found to predict teachers’ mental health. Overcommitment, the intrinsic component of the ERI model, predicted mental health among HK teachers. There were significant differences in the psychosocial variables between UK and HK teachers.

Conclusion

The results showed support for the ERI model and in particular for the relationship between stress and mental health and demonstrated the role of overcommitment in the teaching profession. Some implications are discussed for combating cultural differences in managing the psychosocial work environment of teachers.     

Mapping scores from the Strengths and Difficulties Questionnaire (SDQ) to preference-based utility values

Purpose

Quality of life mapping methods such as “Transfer to Utility” can be used to translate scores on disease-specific measures to utility values, when traditional utility measurement methods (e.g. standard gamble, time trade-off, preference-based multi-attribute instruments) have not been used. The aim of this study was to generate preliminary ordinary least squares (OLS) regression-based algorithms to transform scores from the Strengths and Difficulties Questionnaires (SDQ), a widely used measure of mental health in children and adolescents, to utility values obtained using the preference-based Child Health Utility (CHU9D) instrument.

Methods

Two hundred caregivers of children receiving community mental health services completed the SDQ and CHU9D during a telephone interview. Two OLS regressions were run with the CHU9D utility value as the dependent variable and SDQ subscales as predictors. Resulting algorithms were validated by comparing predicted and observed group mean utility values in randomly selected subsamples.

Results

Preliminary validation was obtained for two algorithms, utilising five and three subscales of the SDQ, respectively. Root mean square error values (.124) for both models suggested poor fit at an individual level, but both algorithms performed well in predicting mean group observed utility values.

Conclusion

This research generated algorithms for translating SDQ scores to utility values and providing researchers with an additional tool for conducting health economic evaluations with child and adolescent mental health data.     

Health-related quality of life and comorbidity among older women veterans in the United States

Purpose

This paper examines the predictors of quality of life among older women (≥65 years of age) veterans in the United States focusing on the effect of comorbidity on health-related quality of life (HRQOL).

Methods

Data from the National Survey of Women Veterans, a cross-sectional nationally representative population-based, stratified random sample of women veterans, were used with an analytic sample size of 1,379 older women veterans. The SF12 physical and mental composite scores (PCS and MCS) were used as outcome measures, and a weighted comorbidity index was used as a covariate.

Results

Older women veterans who are married, employed, with higher income, and higher education have better physical health (PCS). For mental health, education is positively correlated, whereas depression and posttraumatic stress disorder are negatively correlated with MCS. After adjusting for socio-demographic, mental health, and chronic health indicators, the results showed that SF12 PCS varied by VA use status for each level of Seattle Index of Comorbidity. The same pattern was not found for MCS.

Conclusion

For each level of comorbidity, VA users have worse HRQOL which might suggest that case mix adjustments comparing VA users and non-VA users must take into account more than comorbidity alone.     

Reliability and validity of the Thai version of the Pediatric Quality of Life Inventory 4.0

Purpose

The study aimed to evaluate the reliability and validity of the Thai version of the Pediatric Quality of Life Inventory? 4.0 Core Scales (PedsQL) as a measure of health-related quality of life (HRQOL).

Methods

The PedsQL items were completed by 2,086 pupils aged 8–15 years and 1,914 parents from four schools, and 100 pediatric outpatients and 100 parents from a University Hospital. Test–retest reliability was conducted in a randomly selected of 150 pupils at a 1-month interval.

Results

Internal consistency reliability for the Total Scale score (α = 0.84 self-report, 0.88 proxy-report), Physical Health Summary score (α = 0.76 self-report, 0.79 proxy-report), and Psychosocial Health Summary score (α = 0.74 self-report, 0.85 proxy-report) exceeded the minimum reliability standard of 0.70. School children had significantly higher mean HRQOL scores compared to those with chronic health conditions for all subscales with the mean differences of 3.1–12.4 for self-report (p < 0.03) and 7.7–15.6 for proxy-report (p < 0.001). Test–retest reliability showed intraclass correlation coefficients above 0.60 in all subscales (p < 0.001).

Conclusions

The Thai version of PedsQL had adequate reliability and validity and could be used as an outcome measure of HRQOL in Thai children aged 8–15 years.     

Health-related quality of life in fathers of children with or without developmental disability: the mediating effect of parental stress

Purpose

The aims of this study were to compare parental stress and health-related quality of life (HRQOL) between Taiwanese fathers of children with and without developmental disabilities (DDs) and to examine the mediating effect of parental stress on the association between having a child with DD and paternal HRQOL within Chinese culture.

Method

This cross-sectional, prospective, unmatched case–control study included 206 fathers of children with DDs and 207 fathers of healthy children. HRQOL was assessed by the SF-36 short-form questionnaire, and parental stress was assessed by the Chinese version Parental Stress Scale.

Results

Fathers of children with DDs experienced poorer mental and physical HRQOL and higher parental stress than fathers of healthy children. Parental stress acted as a complete mediator for paternal physical HRQOL, while parental stress had a partial mediating effect on the relationship between having a child with DD and paternal mental HRQOL. Having a child with DD also directly affected paternal mental HRQOL.

Conclusions

Fathers of children with DDs should be monitored for parental stress and HRQOL, and interventions should be provided to empower them with the knowledge and skills to reduce their stress and to enhance their HRQOL.     

The health-related quality-of-life impact of nocturnal awakenings in the middle-aged and older Finnish population

Purpose

The aim of the study is to examine the health-related quality-of-life (HRQOL) impact of the nocturnal awakenings and the duration of the sleep in the Finnish middle-aged and older population.

Methods

Cross-sectional sample consisted of 823 community-dwelling persons aged 55–75 living in a single municipality in a rural area of Eastern Finland. Frequency of the nocturnal awakenings was dichotomized as reporting “frequent,” if the participant reported subjectively awakening “often” or “very often,” and “infrequent” if the participant reported awakening “sometimes” or less frequently. HRQOL was measured with a preference-based HRQOL-index instrument, 15D. Analyses were adjusted for gender, BMI, morbidities, depression, employment and marital status, current smoking and drinking, exercise, recommendation to exercise from a health care professional, and subjective opinion about own exercise habits.

Results

Frequent nocturnal awakenings had statistically and clinically significant negative impact on HRQOL, the mean (SE) adjusted marginal HRQOL impact being ?0.0416 (0.006). More than 10 and less than 6.5 h of daily sleep were associated with higher probability of having low HRQOL, adjusted odd ratios (95 % CI) being 2.65 (1.11–6.33) and 2.65 (1.55–4.52), respectively. However, the changes in daily sleep duration did not have noticeable influence on the significance or magnitude of the negative HRQOL impact of the frequent nocturnal awakenings.

Conclusions

Nocturnal awakenings displayed a strong independent association with decreased HRQOL. The findings suggest that both clinicians and researchers should pay closer attention to nocturnal awakenings and other sleep problems in order to find ways to improve the quality of life in individuals with such conditions.