The Linkage between Pediatric Quality of Life and Health Conditions: Establishing Clinically Meaningful Cutoff Scores for the PedsQL

Objective:  To link pediatric health-related quality of life (HRQOL) and health conditions by establishing clinically meaningful cutoff scores for an HRQOL instrument, the Pediatric Quality of Life Inventory (PedsQL).
Methods:  We conducted telephone interviews with 1745 parents whose children were between 2 and 18 years old and enrolled in the Florida KidCare program and Children's Medical Services Network in 2006. Two anchors, the Children with Special Health Care Needs (CSHCN) Screener and the Clinical Risk Groups (CRGs), were used to identify children with special health-care needs or chronic conditions. We established cutoff scores for the PedsQL's physical, emotional, social, school, and total functioning using the areas under the curves (AUCs) to determine the discriminative property of the PedsQL referring to the anchors.
Results:  The discriminative property of the PedsQL was superior, especially in total functioning (AUC > 0.7), between children with special health-care needs (based on the CSHCN Screener) and with moderate and major chronic conditions (based on the CRGs) as compared to healthy children. For children <8 years, the recommended cutoff scores for using total functioning to identify CSHCN were 83, 79 for moderate, and 77 for major chronic conditions. For children ≥8 years, the cutoff scores were 78, 76, and 70, respectively.
Conclusions:  Pediatric HRQOL varied with health conditions. Establishing cutoff scores for the PedsQL's total functioning is a valid and convenient means to potentially identify children with special health-care needs or chronic conditions. The cutoff scores can help clinicians to conduct further in-depth clinical assessments.     

Health-Related Quality of Life in Adolescents With Chronic Illness in Jamaica: Adolescent and Parent Reports

PurposeThe aim of this study is to assess the level of agreement between adolescents’ self-assessment and parent-proxy reports on health-related quality of life (HRQOL) in Jamaican adolescents with chronic illness.MethodsA cross-sectional study was conducted, recruiting adolescents living with a chronic illness (ALCIs)—asthma, human immunodeficiency virus, insulin-dependent diabetes mellitus, or sickle cell disease and age/sex-matched healthy adolescents. Data were collected on HRQOL from adolescents and parents using the Pediatric Quality of Life Scale. Parent-adolescent agreement was determined at group level (Wilcoxon signed-rank test) and individual level (intraclass correlation coefficient).ResultsTwo hundred twenty-six (226) parent/adolescent pairs participated: 130 ALCIs and 96 healthy peers; mean age 14.9 ± 2.8 years; 58% females. Adolescents with and without chronic illness reported similar HRQOL; parent-proxies reported better HRQOL for healthy adolescents compared to ALCIs. Intraclass correlation demonstrated higher levels of parent-adolescent correlation for ALCIs than healthy adolescents (ALCIs: 0.11–0.34; healthy adolescents: 0.01–0.10). At group level, analyses demonstrated better parent-proxy rating of QOL in all of the scores with the exception of the general health score. Parent-proxies overestimated QOL for asthma and insulin-dependent diabetes mellitus but not for sickle cell disease and human immunodeficiency virus. Linear regression modeling revealed that female sex and living with chronic illness were significant predictors of agreement.DiscussionParent-proxies overestimated adolescents’ QOL compared to adolescents’ report regardless of whether the adolescent was living with a chronic illness or not. As such, health care providers should elicit feedback from the adolescent wherever possible and proxy reports should be used as complementary information rather than primary source.     

Deterioration of Quality of Life of High-Risk Breast Cancer Patients Treated with High-Dose Chemotherapy: The PEGASE 01 Quality of Life Study

Objective:  The aim of this study was to compare the quality of life (QOL) of high-risk breast cancer patients included in a randomized clinical trial (PEGASE 01) comparing conventional chemotherapy versus adding an additional high-dose chemotherapy (HDC) cycle with blood stem cell support.
Methods:  A total of 314 patients were included in the clinical trial. QOL evaluations were available for 199 patients. QOL was assessed over a 1-year follow-up period, using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30. The results were analyzed using a linear mixed-effects model.
Results:  Toxicity of HDC has a strong negative impact on patients' QOL during the treatment phase. This negative impact tended to last longer in the HDC group, as for most of the QLQ-C30 scales, the QOL scores of HDC patients tend to improve at a slower rate than that of patients receiving standard chemotherapy. In particular, physical functioning remains deteriorated 1 year after inclusion for HDC patients comparatively to conventional chemotherapy patients (85.99 vs. 76.65, P  = 0.021), and the pain score was still higher in the HDC group at that time (28.32 vs. 15.97, P  = 0.004).
Conclusion:  HDC has a negative impact on QOL even after treatment phase. In the absence of an overall survival benefit of using HDC for high-risk breast cancer patients, QOL studies with a longer follow-up play an important role in informing the complex trade-off implied by HDC between higher toxicity, reduced risk of relapse, and QOL decrease after the active phase of treatment.     

Health-related quality of life of adolescents with overweight or obesity in the north of Jordan

Background Previous studies showed that overweight and obesity in children and adolescents are associated with impaired health‐related quality of life (QOL). The objective of this study was to describe health‐related QOL among Jordanian adolescents who were overweight or obese. Methods This is a cross‐sectional study conducted among Jordanian students aged between 13 and 18 years in three educational directorates in Irbid City in the north of Jordan. Using simple random sampling, two male schools and two female schools were selected from the list of each directorate to represent all schools in north of Jordan. In each selected school, all adolescents aged 13–18 years were visited in their classes and were invited to participate in the study. Of the total number of 1561 subjects, 1433 (91.8%) agreed to participate in the study. The short‐form 15‐item Pediatric Quality of Life Inventory version 4.00 was used to measure health‐related QOL among participants. Body mass index (BMI) was calculated and interpreted according to the BMI‐for‐age growth charts of the Center for Disease Control and Prevention guidelines. Results This study included 707 boys and 726 girls; 17.6% of participants were overweight and 7.8% were obese. For boys and girls, adolescents who were overweight or obese had significantly lower average scores for psychosocial health summary scale and physical functioning scale. Female gender, age of 16–18 years, fathers' education of high school or less and unemployed fathers (for social functioning and physical functioning) were significantly associated with decreased average scores of all scales and subscales of Pediatric Quality of Life Inventory. Conclusions Compared with healthy adolescents, adolescents who were overweight or obese reported significantly lower health‐related QOL in all domains. Girls reported greater effect of overweight and obesity on their health‐related QOL.     

The relationship between proxy reported health-related quality of life and parental distress: gender differences

Objective Although primary caregiver proxy reports of health‐related quality of life (HRQOL) are often used for healthcare decision making when child self‐reports are unable to be collected (because of a variety of reasons such as child illness, disability or age), we have little understanding of the correlates of parent‐proxy reports. The aim of this study was to examine the relationship between parental depression and parent‐proxy reported QOL for primary caregivers (mothers and fathers), using a multidimensional HRQOL instrument. It was hypothesized that maternal depression would be negatively correlated with maternal reported HRQOL, but that paternal depression would not be correlated with paternal reported HRQOL. Methods Data were from parents of children aged 4–5 years (n = 4983) involved in the Longitudinal Study of Australian Children. A questionnaire assessing parental depression (Kessler‐6) and proxy reported HRQOL (Pediatric Quality of Life Inventory) was completed by the primary caregiver. Results For maternal primary caregivers, maternal depression was negatively correlated with all domains of maternal proxy reports of HRQOL (r = ?0.24 to r = ?0.36). For paternal primary caregivers, there was no relationship between paternal depression and paternal proxy reports of HRQOL. Multiple regression analyses demonstrated that maternal depression was a significant predictor of total HRQOL, accounting for 12% of the variance. For paternal mental health, depression did not predict parent‐proxy reported total HRQOL. Conclusion These results highlight the importance of assessing maternal mental health when measuring proxy reported QOL. Further research is needed in this area to examine the relationship between parental depression and proxy reported HRQOL (including both mothers and fathers, where possible), as well as child self‐reported HRQOL.     

Quality of life measurement in paediatric and adolescent populations with HIV: a review of the literature

Purpose   To review the quality and utility of currently available self-report generic quality of life (QOL) and health-related quality of life (HRQOL) measures for use with children and adolescents with human immunodeficiency virus and/or acquired immunodeficiency syndrome (HIV/AIDS).
Methods   Literature searches were conducted to identify QOL and HRQOL measures developed for, adapted for, or otherwise used with paediatric and adolescent populations with HIV/AIDS. The quality of measures (i.e. item generation techniques, instrument properties including reliability, validity and responsiveness) were compared and critically evaluated.
Results   Nineteen QOL/HRQOL measures were identified. Item content was generated from the respondent (adult) population in only eight (42%) measures. Seventeen (90%) measures reported internal reliability in the accepted range between 0.70 and 0.90 and four (21%) reported reproducibility statistics in this range. Although validity was reported for 19 (100%) measures, only six (32%) showed evidence for three or more properties, with construct validity being the most commonly reported aspect. The authors of eight (42%) measures reported evidence for responsiveness.
Conclusions   While almost all measures reviewed demonstrated adequate psychometric properties, only one-third demonstrated all aspects of validity, and less than half demonstrated responsiveness. None included paediatric or adolescent populations with HIV/AIDS in their development, neglecting to obtain input from target respondents in item generation to determine what health-related and daily functioning factors are of importance to them. Despite noted limitations, the AUQUEI or the SWED-QUAL appear the best currently available generic measure, and the MQOL-HIV the preferred disease-specific measure, at least for use with older adolescents/young adults.     

Development of the Assistance to Participate Scale (APS) for children's play and leisure activities

Aim   This paper describes the development and psychometric evaluation of the Assistance to Participate Scale (APS). The APS measures the assistance that a school-aged child with a disability requires to participate in play and leisure activities from the primary carer's perspective.
Method   Mixed methodology using an instrument design model was used to complete two studies. First, a qualitative research design was used to generate items and scoring criteria for the APS. Second, a quantitative study evaluated the instrument using data collected from 152 mothers with children aged 5–18 years. Statistical analysis assessed the underlying structure, internal consistency and construct validity of the APS.
Results   Exploratory factor analysis revealed two correlated components, reflecting home-based and community-based play activities. Both subscales and the total APS scale showed good internal consistency. The APS correlated as predicted with individual domains and overall scores for other validated measures (Pediatric Evaluation of Disability Inventory caregiver scales and Pediatric Quality of Life Inventory) with correlations ranging from rho = 0.42 to rho = 0.77. The APS was able to discriminate between groups of children based on type of schooling (regular or segregated), need for equipment/assistive devices, frequency of lifting and disability.
Conclusions   The APS provides professionals with a brief psychometrically sound tool that measures the amount of caregiver assistance provided to a child with a disability to participate in play and recreation. The APS may be used as an outcome measure and to evaluate and predict the amount and type of additional assistance families need to facilitate their child's participation in an important aspect of the child's daily life and development: play and recreation.     

Factors affecting health-related quality of life in women with recurrent breast cancer in Korea

PURPOSE: The purpose was to determine the effects of recurrent breast cancer on health-related quality of life (HRQOL). METHODS: We administered the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-BR23, McGill Quality of Life Questionnaire (MQOL), Beck Depression Inventory (BDI), and Brief Fatigue Inventory (BFI) to 152 women experiencing recurrence 1 year after being diagnosed with stage I to III breast cancer. We classified recurrent women as post-, ongoing-, and non-treatment group and performed multivariate-adjusted analyses in HRQOL comparisons with data available from disease-free survivors and general population. RESULTS: Groups not completing treatment were more symptomatic and had poorer functioning in HRQOL than the post-treatment group. Compared to the general population, the post-treatment group showed worse scores concerning role, cognitive, and social functioning, fatigue, and financial difficulties. The post-treatment group showed identical scores to disease-free survivors in most HRQOL domains; however, they reported less fatigue and depression than the disease-free group. Higher overall QOL was related to absence of comorbidity, completing treatment, being involved in decision making, no problems before surgery, and good overall medical care. CONCLUSION: Treatment completed, most degraded aspects of HRQOL in recurrent breast cancer women can return to levels observed in disease-free survivors.     

Assessment of Fatigue in Pediatric Patients With Short Stature Utilizing the PedsQL™ Multidimensional Fatigue Scale

The standardized multidimensional assessment of fatigue has not been previously conducted in pediatric patients with short stature. Consequently, the objective of this exploratory study was to assess fatigue in a heterogeneous sample of pediatric patients with short stature utilizing the Pediatric Quality of Life Inventory? (PedsQL?) Multidimensional Fatigue Scale. The 18-item PedsQL Multidimensional Fatigue Scale (general fatigue, sleep/rest fatigue, and cognitive fatigue domains) and the 23-item PedsQL 4.0 Generic Core Scales (physical, emotional, social, and school functioning) were completed by 29 pediatric patients with a physician diagnosis of short stature and 31 parents from a hospital-based pediatric endocrinology clinic. Pediatric patients with short stature experienced more fatigue and impaired generic health-related quality of life (HRQOL) than healthy children, demonstrating comparable fatigue to pediatric patients receiving cancer treatment. Cognitive fatigue and school functioning were reported by both pediatric patients and their parents as most impaired. The results demonstrate the relative severity of fatigue symptoms and impaired HRQOL in pediatric patients with short stature, indicating the potential clinical utility of the standardized multidimensional assessment of fatigue and HRQOL in these patients on a routine basis.     

The responsiveness of the uterine fibroid symptom and health-related quality of life questionnaire (UFS-QOL)

Background

Pediatric health-related quality of life (HRQOL) has emerged as an important health outcome in clinical trials and healthcare research, for which HRQOL assessment instruments have played an important role. However, these instruments are not available in all countries or all languages. The Pediatric Quality of Life Inventory? (PedsQL?) Family Impact Module is a multidimensional instrument developed to assess the impact of chronic medical conditions on the HRQOL of parents and family functioning. The objective of the present study was to evaluate the psychometric properties of the PedsQL? Family Impact Module cross-culturally adapted for use in Brazil.

Methods

The PedsQL? Family Impact Module was administered to 95 parents/guardians of children with cancer in active therapy from 2 to 18 years of age of both genders. Subjects were recruited by means of convenience samples from the Pediatric Hematology/Oncology Centers at two public hospitals. The 'in-patient' sample was defined as individuals who were hospitalized for the administration of chemotherapy. The 'out-patient' sample was defined as individuals who were receiving chemotherapy and were not hospitalized.

Results

Test-retest reliability exhibited correlation values ranging from 0.81 to 0.96 for all subscales. Internal consistency reliability was demonstrated for the PedsQL? Family Impact Module: Total Scale Score (α = 0.89), Parent Health-Related Quality of Life Summary Score (α = 0.83) and Family Summary Score (α = 0.73). The Total Impact Score for the in-patient and out-patient samples was 67.60 and 56.43, respectively (p < 0.01). The construct validity demonstrated that the PedsQL? Family Impact Module proved capable of distinguishing between families whose children/adolescents were hospitalized and families of children/adolescents who are being taken care of at home.

Conclusion

The Brazilian version of the PedsQL? Family Impact Module was considered reliable and valid for assessing the impact of a chronic pediatric health condition on the HRQOL of parents and family functioning. The instrument should be field tested on other chronic pediatric illnesses.     

Assessment of health related quality of life among school children with cancer in Alexandria

In recent years, the necessity of measuring health related quality of life (HRQOL) among children with cancer has been stressed. The aim of the present work was to assess the HRQOL in terms of physical, emotional and social functioning, to identify some predictors of QOL and to describe the scholastic achievement and nutritional status among school children with cancer in Alexandria. A cross-sectional study of 215 students with cancer who attended the oncology school health insurance clinic of Sporting Student's Hospital in Alexandria governorate within a period of one month (June 2005) was conducted. Every child was subjected to the Pediatric Oncology Quality Of Life scale to assess the quality of life with cancer. Anthropometric measurements including weight and height were measured for each child and BMI was calculated. Review of records of each child was done to take the last heamoglobin level. Lymphoma was the most common tumour (34.9%), followed by leukemia (24.2%), brain tumour (13.0%), osteosarcoma (7.9%), and Wilm's tumour (7%). About one third of the sample (36.7%) reported poor QOL which was more evident in the physical domain (54.4%), as compared to 34.4% in emotional domain and 26% in the social domain. Sex (p<0.05), age (p<0.05), complications (p<0.01), place of treatment (p<0.05), place of diagnosis (p<0.05) and treatment (p<0.05) were all significantly associated with QOL. However after adjustment for other variables, poor QOL was more likely among students of younger age, students with complications, and students whose diagnosis was done at the student hospital. About two thirds of the sample (68.5 %) reported poor scholastic achievement, 25.1% were underweight and 87.4% were anemic. Conclusion and recommendations: HRQOL measurement should be done as a routine for all children with cancer in order to identify specific therapies that require modifications in management. More efforts are needed to improve the health care in the student's hospital, especially for young children with cancer.     

Quality of life among tuberculosis (TB), TB retreatment and/or TB-HIV co-infected primary public health care patients in three districts in South Africa

Background

The concept Health related Quality of life (HRQOL) is increasingly recognized as an important health outcome measure in clinical and research fields. The present study attempted to evaluate the psychometric properties of the Sinhala version of the Pediatric Quality of Life Inventory? 4.0 (PedsQL? 4.0) Generic Core Scales among adolescents in Sri Lanka.

Methods

The original US PedsQL? was translated into Sinhala and conceptually validated according to international guidelines. A cross-sectional study was conducted among 142 healthy school going adolescents (12-14 years), their parents (n?=?120) and a group of adolescents with asthma who attended asthma clinics (n?=?115). Reliability was assessed using Cronbach??s alpha and validity by examining scale structure, exploring inter-scale correlations and comparing across known groups (healthy vs. chronically ill).

Results

The PedsQL? Sinhala version was found to be acceptable with minimal missing responses. All scales demonstrated satisfactory reliability. Cronbach??s alpha for the total scale scores was 0.85 for adolescent self-report while for the parent proxy-report for the healthy group it was 0.86. No floor effects were observed. Ceiling effects were noticed in self-report and parent proxy-report for the healthy group. Overall results of the multi trait scaling analysis confirmed the scale structure with 74% item-convergent validity, 88% item-discriminant validity and an overall scaling success of 72%. Moderate to high correlations were shown among the domains of teen self-report (Spearman rho?=?.37-.54) and between teen self-report and parent proxy-reports (Spearman rho?=?.41-.57). The PedsQL? tool was able to discriminate between the quality of life in healthy adolescents and adolescents with asthma.

Conclusion

The findings support the reliability and validity of the Sinhala version of the PedsQL? 4.0 Generic Core Scales as a generic instrument to measure HRQOL among early adolescents in Sri Lanka in a population setting.     

MGB4 Relationship Between Quality of Life, Disease Severity, and Physician Visits in Managed Care Patients with Atopic Dermatitis

The relationship between disease severity, quality of life (QOL), and resource use in patients with atopic dermatitis (AD) has not been well explored in a managed care population. As the overall lifetime incidence of AD is 15–20%, this represents a substantial burden to the healthcare system.
OBJECTIVE: To investigate how severity of illness assessed via chart review relates to patient-assessed severity, QOL, and number of physician encounters.
METHODS: Questionnaires regarding AD severity (e.g., mild, moderate, severe) were mailed to 400 participants identified from the claims database. Adults assessed their QOL using the Dermatology Life Quality Index (DLQI) and the Short Form 36(SF-36), while children used the Children's Dermatology Life Quality Index (CDLQI). The number of physician visits for AD over the previous 12 month period were determined from a claims database. Data were analyzed using Pearson correlation coefficients.
RESULTS: Results of the interim analysis in 150 respondents (64 adults, 86 children) indicate that patient assessed severity had a stronger correlation with DLQI (r = 0.43, p = 0.0004) and CDLQI (r = 0.42, p = 0.0011) than did retrospectively assessed severity (r = 0.39, p = 0.0015 [DLQI]; and r = 0.10, p = 0.44 [CDLQI]). Among the eight domains reported in the SF-36, the DLQI showed the strongest correlation with the mental health domain (r =−0.57, p = 0.0001). Visit counts were significantly correlated with self-assessed severity for adults (r = 0.40) and children (r = 0.32).
CONCLUSIONS: A weaker correlation for QOL and physician visits was observed with retrospectively assessed severity than with patient-assessed severity. Self assessed severity of illness correlated moderately well with QOL and number of physician encounters.     

Reduced Quality of Life in Very Overweight Mexican American Adolescents

Quality of life (Pediatric Quality of Life Inventory^™, PedsQL^™) was assessed for 175 Mexican American adolescents with measured height and weight used to determine body mass index (BMI) percentile/weight classification. Main effects for weight classification were detected using One-way ANOVAs (p < .05 for total, physical, and psychosocial), with the heaviest adolescents demonstrating the lowest ratings.     

Health-related quality of life of school- age children with rheumatic Fever

Background: Rheumatic fever (RF) is a major public health problem and it is an important cause of acquired cardiovascular disease in childhood and adolescence. The goal of effective management of rheumatic fever is to allow children with RF to function with minimal restrictions and enjoy a good quality of life(QOL) throughout their lives. The aim of this study was to identify the health-related quality of life of school- age children with rheumatic fever. Materials and Methods: A convenient sample of 100 school-age children with rheumatic fever and their mothers were selected from outpatient clinic and inpatient pediatric cardiac departments of EL-Shatby Children University Hospital, Alexandria, Egypt. Data was collected from children in the previously mentioned settings who fulfil the following criteria, the children's age ranged from 8 to 12 years & free from any associated disease. Two tools were used in Clinical Data of Rheumatic School-Age Children Questionnaire that was developed by the researcher and Pediatric Quality of Life Inventory scale (Peds QL). Results: The majority (78.3%) of school-age children with rheumatic fever had a neutral HRQOL and less than a quarter of them had high HRQOL. Only small percent (8.7%) of studied subjects had poor HRQOL. Children's parents' reports confirmed such results, where there were a significant positive correlations between children reports and their parents reports in the majority of studied items of HRQOL regarding rheumatic fever. Conclusion and Recommendations: Health education program for school-age children who had rheumatic fever and their parents towards the different measures of high HRQOL is recommended to help those children to improve their quality of life.     

The value of the PedsQLTM in assessing quality of life in survivors of childhood cancer

AIMS: To determine differences in ratings of quality of life (QOL) depending on respondent (mother or child) and implications for the validity of measures of QOL, and interpretation of scores. METHOD: Forty-five survivors of acute lymphoblastic leukaemia (ALL) and 23 survivors of central nervous system (CNS) tumours and their mothers completed a generic measure of QOL: the Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0; Varni et al., 2001). RESULTS: Although correlations between mother and survivor ratings were largely moderate to good, further analyses showed that mothers reported QOL to be worse than survivors. Both mothers and survivors rated physical health worse than psychological health, and survivors of a CNS tumour had poorer QOL than survivors of ALL. Although survivors of ALL reported reasonably good physical health, their psychosocial health was more adversely affected. CONCLUSIONS: Implications for further use of the PedsQL 4.0 in the clinical or research context are discussed. Incidental findings highlight some limitations of the PedsQL 4.0 for work with this population.     

Feasibility, reliability and validity of the Thai version of the Pediatric Quality of Life Inventory 3.0 cerebral palsy module

Background

Quality of Life (QOL) and Health-related Quality of Life (HRQOL) are now considered as necessary outcome measures for children with cerebral palsy (CP). Various reliable and valid condition-specific HRQOL tools are available for these children. One of these is Pediatric Quality of Life Inventory (PedsQL) 3.0 CP module which has been widely used and was translated to many languages. As no Thai version is available, the authors have completed this translation.

Purpose

This study then aimed to investigate psychometric properties of the newly translated Thai PedsQL 3.0 CP module and to establish parent confidence in their ratings in the translated tool.

Methods

Translation of the PedsQL 3.0 CP module was performed based on linguistic translation guidelines. Then, the psychometric properties of the Thai version were established. PedsQL 3.0 CP module was completed by children with CP and their parents or caregivers twice with 2–4 weeks.

Results

Respondents were 97 parents or caregivers and 54 children. Minimal missing data were found. Acceptable internal consistency was supported except for Movement and Balance Scale (self-report). Intraclass correlation coefficients for parent proxy and self-report were good to excellent (0.684–0.950).

Conclusions

The feasibility, reliability and validity of the translated tool were supported.     

The influence of diet and/or exercise and parental compliance on health-related quality of life in obese children

Recent findings of a direct association of obesity and impaired health-related quality of life (HRQOL) in children suggest a need for early weight-management interventions that address psychosocial issues and lifestyle. Our aim was to compare the effects of exercise, diet, or diet + exercise on HRQOL in obese children. We hypothesized that HRQOL will improve as a result of the weight-loss intervention and will be correlated with the amount of weight loss achieved by each of the intervention groups. A total of 162 children aged 6 to 11 years with a body mass index (BMI) exceeding the 95th percentile were randomly allocated to a 12-week regimens of diet, exercise, or diet + exercise. Weight, height, and percent fat mass were measured, and parents completed the Pediatric Quality of Life Inventory (PedsQL) 4.0 at baseline and at the end of the intervention. The reductions in BMI were significantly greater in the diet and diet + exercise groups than in the exercise group. Pediatric Quality of Life Inventory scores improved significantly, with no differences among the groups. A greater reduction in BMI occurred in children whose parents completed the PedsQL at baseline (n = 105) than in children whose parents did not (n = 15) (−1.8 ± 1.3 vs −1.0 ± 1.5; P = .048) and in children whose parents completed the PedsQL at the end of the intervention (n = 73) than in children whose parents did not (n = 47) (−2.0 ± 1.3 vs −1.3 ± 1.3; P = .013). Weight-management programs that promote a healthy eating and physical activity can serve as an effective tool to improve the low HRQOL of obese children. Parental compliance is an important factor and may be assessed by the parents' cooperativeness in completing questionnaires.     

Psychometric properties of the Sinhala version of the PedsQL

ABSTRACT: BACKGROUND: The concept Health related Quality of life (HRQOL) is increasingly recognized as an important health outcome measure in clinical and research fields. The present study attempted to evaluate the psychometric properties of the Sinhala version of the Pediatric Quality of Life Inventory[trade mark sign] 4.0 (PedsQL[trade mark sign] 4.0) Generic Core Scales among adolescents in Sri Lanka. METHODS: The original US PedsQL[trade mark sign] was translated into Sinhala and conceptually validated according to international guidelines. A cross-sectional study was conducted among 142 healthy school going adolescents (12-14 years), their parents (n = 120) and a group of adolescents with asthma who attended asthma clinics (n = 115). Reliability was assessed using Cronbach's alpha and validity by examining scale structure, exploring inter-scale correlations and comparing across known groups (healthy vs. chronically ill). RESULTS: The PedsQL [trade mark sign] Sinhala version was found to be acceptable with minimal missing responses. All scales demonstrated satisfactory reliability. Cronbach's alpha for the total scale scores was 0.85 for adolescent self-report while for the parent proxy-report for the healthy group it was 0.86. No floor effects were observed. Ceiling effects were noticed in self-report and parent proxy-report for the healthy group. Overall results of the multi trait scaling analysis confirmed the scale structure with 74% item-convergent validity, 88% item-discriminant validity and an overall scaling success of 72%. Moderate to high correlations were shown among the domains of teen self-report (Spearman rho = .37-.54) and between teen self-report and parent proxy-reports (Spearman rho = .41-.57). The PedsQL[trade mark sign] tool was able to discriminate between the quality of life in healthy adolescents and adolescents with asthma. CONCLUSION: The findings support the reliability and validity of the Sinhala version of the PedsQL[trade mark sign] 4.0 Generic Core Scales as a generic instrument to measure HRQOL among early adolescents in Sri Lanka in a population setting.     

Quality of life and psychosocial well-being among children living with HIV at a care home in Southern India

This study was designed to evaluate the quality of life (QOL) of children living with HIV at an institutional care home in Bangalore, India. The Sneha Care Home is a unique residence that provides educational and community support with a focus on physical, nutritional, medical, and psychological care for orphans and vulnerable children. Cross-sectional health measures and interview data were collected from 97 residents including 52 boys and 45 girls between 5 and 12 years of age (mean age = 9). QOL was measured with the Pediatric Quality of Life 4.0 (PedsQL) Inventory. Caregivers perceived children to have an overall higher QOL than was self-reported by children (total score 83 vs. 78). Our findings indicated self-reported QOL decreased with age of the child, while caregiver-reported QOL increased with age, suggesting a need to ensure greater psychological support for older children. Physical measures showed the children’s clinical severity of disease remained well controlled living in this residential, values-based care home.