Socioeconomic determinants of health related quality of life in childhood and adolescence: results from a European study

STUDY OBJECTIVE: The objective of this study was to investigate the impact of two different socioeconomic status (SES) measures on child and adolescent self reported health related quality of life (HRQoL). The European KIDSCREEN project aims at simultaneous developing, testing, and implementing a generic HRQoL instrument. DESIGN AND SETTING: The pilot version of the questionnaire was applied in school surveys to students from 8 to 18 years of age, as well as to their parents, together with such determinants of health status as two SES indicators, the parental educational status and the number of material goods in the family (FAS, family affluence scale). PARTICIPANTS: Students from seven European countries: 754 children (39.8%; mean: 9.8 years), and 1142 adolescents (60.2 %; mean: 14.1 years), as well as their respective parents. MAIN RESULTS: In children, a higher parental educational status was found to have a significant positive impact on the KIDSCREEN dimensions: physical wellbeing, psychological wellbeing, moods and emotions, bullying and perceived financial resources. Increased risk of low HRQoL was detected for adolescents in connection with their physical wellbeing. Family wealth plays a part for children's physical wellbeing, parent relations and home life, and perceived financial resources. For adolescents, family wealth furthermore predicts HRQoL on all KIDSCREEN dimensions. CONCLUSIONS: There is evidence to suggest that exposure to low parental educational status may result in a decreased HRQoL in childhood, whereas reduced access to material (and thereby social) resources may lead to a lower HRQoL especially in adolescence.     

Socioeconomic status and health behaviour patterns through adolescence: results from a prospective cohort study in Norway

BACKGROUND: In this paper, we investigate cross-sectional and prospective relationships between various socioeconomic indicators and different health behaviours among boys and girls at ages 13-21, and whether socioeconomic status (SES) is related to changes in health behaviour over time. METHODS: The study is based on a 10-year, two-generation prospective cohort study of health and lifestyle factors among a sample of Norwegian adolescents and their parents. Data presented here were collected at the ages of 13 (baseline), 15, 18 and 21. Parental and adolescent reports of socioeconomic factors were assessed along with a number of health-enhancing and health-compromising behaviours, both as single behaviours and as part of health behaviour indices. RESULTS: Relatively few significant relationships are observed between parental occupation and adolescents' reported health behaviour when the latter is analysed as single behaviours. A significant, but weak, social gradient in health-enhancing behaviour is observed when measuring health behaviour as composite indices rather than single forms of behaviour. This is apparent both when applying parental SES variables or adolescents' own educational aspirations as proxy measures of their socioeconomic status. CONCLUSION: Future investigations of the presence of a social gradient in adolescent health behaviour should focus on composite measures of health behaviour. Further research is needed on potential mediating mechanisms behind the SES-health behaviour relationships in youth.     

Oral health-related quality of life determinants throughout adolescence: a cohort study in Brazil

Quality of Life Research - Oral health-related quality of life (OHRQoL) is a complex construct that reflects the interaction among well-being, socioeconomic, oral health status, and also contextual...     

Health-related quality of life: gender differences in childhood and adolescence

Summary. Objectives: To assess whether gender and age differences can be found in different aspects of health-related quality of life (HRQOL) of children and adolescents, and to what extent these results correspond to theoretical and empirical findings from developmental psychology. Methods: A newly developed HRQOL questionnaire was completed by 3 710 youths aged nine to 17 years in seven European countries. The “Kidscreen 52” questionnaire consists of 10 scales operationalising aspects of the physical, psychological and social dimensions of HRQOL. With the use of ANOVA and effect sizes, the influence of age and gender on aspects of HRQOL is reported. Results: Children report a very good quality of life largely independent of gender. After 12 years, HRQOL decreases in the majority of aspects. In the physical and psychological dimensions, a stronger decrease is found for females than for males. Conclusions: Children have higher HRQOL than adolescents in many aspects. With increasing age, HRQOL is frequently worse for females than for males. Examination of the individual aspects leads to a differentiation of the results with relevance for public health.

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Zusammenfassung. Gesundheitsbezogene Lebensqualit?t: Geschlechtsunterschiede in Kindheit und Jugend Fragestellung: Die Studie geht der Frage nach, in welchen Aspekten der gesundheitsbezogenen Lebensqualit?t (HRQOL) von Kindern und Jugendlichen Geschlechts- und Altersunterschiede zu finden sind und wie weit sie damit theoretischen und empirischen entwicklungspsychologischen Erkenntnissen entsprechen. Methode: Ein neu entwickelter HRQOL-Fragebogen wurde von 3 710 Kindern und Jugendlichen von neun bis 17 Jahren aus sieben europ?ischen L?ndern beantwortet. Der “Kidscreen 52”-Fragebogen besteht aus 10 Skalen, welche Aspekte der physischen, psychischen und sozialen Dimensionen der HRQOL operationalisieren. Der Einfluss von Alter und Geschlecht auf die verschiedenen HRQOL-Aspekte wird mit Hilfe von ANOVA und Effektst?rken detailliert berichtet. Ergebnisse: Kinder bis zum Alter von etwa 12 Jahren berichten weitgehend unabh?ngig vom Geschlecht über eine sehr gute Lebensqualit?t. Danach sinkt die Lebensqualit?t in der Mehrheit ihrer Aspekte. In der k?rperlichen und psychischen Dimension ist für die weiblichen Jugendlichen eine st?rkere Abnahme zu beobachten als für die m?nnlichen Jugendlichen, was bei den ?lteren Jugendlichen zu einem bedeutend weniger guten Befinden der jungen Frauen führt. Schlussfolgerung: Die HRQOL von Kindern ist in vielen Aspekten h?her als jene der Jugendlichen, mit zunehmendem Alter ist die HRQOL von weiblichen Jugendlichen h?ufig weniger gut als jene der m?nnlichen Jugendlichen. Eine Betrachtung der einzelnen Aspekte führt zu einer Differenzierung der Ergebnisse mit konkreter Relevanz für Public Health.

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Résumé. Qualité de vie en lien avec la santé: différences entre les sexes chez les enfants et les adolescents Objectifs: Analyser l’effet du genre et de l’age sur différents aspects de la qualité de vie en lien avec la santé (HRQOL). Voir dans quelle mesure ces résultats correspondent à des connaissances théoriques et empiriques issues de la psychologie développementale. Méthodes: 3 710 enfants et adolescents de neuf à 17 ans de sept pays européens ont répondu à un questionnaire indiquant la HRQOL. Cet instrument, ?Kidscreen 52?, se compose de 10 échelles qui mesurent des aspects des dimensions physiques, psychiques et sociales de la HRQOL. L’influence de l’age et du sexe sur les différents aspects de HRQOL est analysée à l’aide de ANOVA. Résultats: Les enfants rapportent une qualité de vie très bonne jusqu’à l’age de 12 ans environ, indépendamment du sexe. Ensuite la qualité de vie baisse. En ce qui concerne les aspects physiques et psychiques, une diminution plus forte est observée chez les jeunes femmes que chez les jeunes hommes. La qualité de vie est ensuite nettement moins bonne chez les jeunes femmes plus agées. Conclusion: La HRQOL des enfants est globalement meilleure que celle des adolescents. Avec l’age, la HRQOL est fréquemment moins bonne pour les jeunes femmes que pour les jeunes hommes. Il faut tenir compte de ces différents aspects pour des actions de santé publique.

     

Health-related quality of life: gender differences in childhood and adolescence

Objectives: To assess whether gender and age differences can be found in different aspects of health-related quality of life (HRQOL) of children and adolescents, and to what extent these results correspond to theoretical and empirical findings from developmental psychology. Methods: A newly developed HRQOL questionnaire was completed by 3 710 youths aged nine to 17 years in seven European countries. The “Kidscreen 52” questionnaire consists of 10 scales operationalising aspects of the physical, psychological and social dimensions of HRQOL. With the use of ANOVA and effect sizes, the influence of age and gender on aspects of HRQOL is reported.     

Distribution and determinants of patient satisfaction in oncology with a focus on health related quality of life

Background  

Cancer patients usually undergo extensive and debilitating treatments, which make quality of life (QoL) and patient satisfaction important health care assessment measures. However, very few studies have evaluated the relationship between QoL and patient satisfaction in oncology. We investigated the clinical, demographic and QoL factors associated with patient satisfaction in a large heterogeneous sample of cancer patients.     

Health related quality of life [HRQOL] in childhood and adolescence: a review of the literature and instruments adapted in Spain

The aims of this study were to systematically review the availability and characteristics of generic instruments of health-related quality of life (HRQOL) for use in childhood and adolescence published in the literature, and to revise generic or disease-specific measures adapted or developed for use in Spain. Questionnaires were selected if they had been developed specifically for use in children and/or adolescents. The data bases consulted were Medline, HealthSTAR and PsycLIT (1980-August 2001). Combinations of key words were used with no restriction on language. The main characteristics analyzed were the content and psychometric properties of the questionnaires retrieved. For instruments adapted for use in Spain, the quality of the adaptation process was also reviewed.Fifteen generic HRQOL instruments for use in children and adolescents were found. The measures were designed for the age range 4-18 years. The number and content of domains, and the number of items included in each measure varied greatly. Test-retest reliability was analyzed in half of the instruments, and all authors analyzed at least one aspect of validity. Two generic and five specific instruments have been developed or adapted in Spain. The adaptation process was generally acceptable.Sensitivity to change has been assessed only in two of the instruments analyzed (one generic and one specific). HRQOL measurement in children and adolescents is in initial stages. The next step will be to investigate the utility of these measures in clinical practice and public health.     

Socioeconomic inequalities in mental health and health-related quality of life (HRQOL) in children and adolescents from 11 European countries

Objectives

To assess the presence and magnitude of social inequalities in mental health and health-related quality of life (HRQOL) in the population aged 8–18 years in 11 European countries.

Methods

Cross-sectional surveys were carried out in representative samples of children/adolescents (8–18 years) from the participating countries of the KIDSCREEN project. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ), and HRQOL by means of the KIDSCREEN-10. Socioeconomic status (SES) was assessed using the Family Affluence Scale and parental level of education. The association between health outcomes and SES was analyzed with the regression-based relative index of inequalities (RII) and population attributable risk.

Results

A total of 16,210 parent–child pairs were included. The SDQ showed inequalities in mental health according to family level of education in all countries (RII = 1.45; 1.37–1.53). The RII for HRQOL was 2.15 (1.79–2.59) in the whole sample, with less consistent results by age and country.

Conclusions

Socioeconomic inequalities in mental health were consistently found across Europe. Future research should clarify the causes of these inequalities and define initiatives which prevent them continuing into adulthood.     

Respiratory symptoms in adults are related to impaired quality of life,regardless of asthma and COPD: results from the European community respiratory health survey

Background  

Respiratory symptoms are common in the general population, and their presence is related to Health-related quality of life (HRQoL). The objective was to describe the association of respiratory symptoms with HRQoL in subjects with and without asthma or COPD and to investigate the role of atopy, bronchial hyperresponsiveness (BHR), and lung function in HRQoL.     

Variation in Chinese population health related quality of life: Results from a EuroQol study in Beijing,China

The purpose of this study is to measure Chinese population health related quality of life (HRQoL) using European quality of life (EQ-5D) instrument, to examine the validity of EQ-5D in measuring Chinese population HRQoL, to explore the relationships between EQ-5D and other health determinants, and to display the similarities and differences of HRQoL between the Chinese population and the populations of other countries. The data used in this study includes 2994 respondents whose age are 12 years and older, which is from the 2000 Beijing Household Health Survey. Univariate and bivariate analyses have been used to examine the level of HRQoL and the relationships between HRQoL and other variables. Multi-variate analyses have been used to explore the relationships between the EQ-5D Visual Analogue Scale (VAS) and the EQ-5D five dimension indicators. There are four principal findings from this study. First, the EQ-5D instrument is a valid measure for Chinese HRQoL, but with a significant ceiling effect. Second, Pain/Discomfort and Anxiety/Depression are the major Chinese HRQoL problems and the extents of these problems differ in subgroup populations. Third, typically mean scores are lower for older age group; this is observed at lower ages in the Chinese population than in populations from developed countries. Fourth, Chinese HRQoL has strong association relationship with population socio-economic status (SES), which might imply that issues brought on by the rapid economic transition have both positive and negative impacts on Chinese HRQoL.     

Body mass index and health related quality of life in elementary school children: a pilot study

Background

Interpretation of the Hospital Anxiety and Depression Scale (HADS), commonly used to assess anxiety and depression in COPD patients, is unclear. Since its minimal important difference has never been established, our aim was to determine it using several approaches.

Methods

88 COPD patients with FEV₁ ≤ 50% predicted completed the HADS and other patient-important outcome measures before and after an inpatient respiratory rehabilitation. For the anchor-based approach we determined the correlation between the HADS and the anchors that have an established minimal important difference (Chronic Respiratory Questionnaire [CRQ] and Feeling Thermometer). If correlations were ≥ 0.5 we performed linear regression analyses to predict the minimal important difference from the anchors. As distribution-based approach we used the Effect Size approach.

Results

Based on CRQ emotional function and mastery domain as well as on total scores, the minimal important difference was 1.41 (95% CI 1.18–1.63) and 1.57 (1.37–1.76) for the HADS anxiety score and 1.68 (1.48–1.87) and 1.60 (1.38–1.82) for the HADS total score. Correlations of the HADS depression score and CRQ domain and Feeling Thermometer scores were < 0.5. Based on the Effect Size approach the MID of the HADS anxiety and depression score was 1.32 and 1.40, respectively.

Conclusion

The minimal important difference of the HADS is around 1.5 in COPD patients corresponding to a change from baseline of around 20%. It can be used for the planning and interpretation of trials.     

Selecting a measure of health related quality of life

Quality of life is becoming recognized increasingly as an important outcome measure which needs to be considered by social workers. However, there does not appear to be a clear consensus about the definition of quality of life. In addition, social workers are likely to experience difficulties choosing and applying an appropriate instrument with which to measure quality of life because of the many available instruments purporting to assess quality of life. This paper discusses the definition of health-related quality of life and explains the main measurement properties of an instrument that must be appraised when considering whether or not an instrument is appropriate. The paper will assist social workers to make an informed choice about measures of health-related quality of life.     

Drowning in childhood and adolescence: a population-based study.

We present the results of a residence-based study of drownings among Sacramento County, California children and adolescents ages 0-19 years for the years 1974-84. Children ages 1-3 had the highest drowning rates. The majority of drownings in this group, and one-third of all drownings in the study, occurred in residential swimming pools. Males ages 15-19 had a high drowning rate as well; at least 38 per cent of drownings in that age group were alcohol-associated. The implications for preventive efforts are discussed.     

Physical activity and health related quality of life

ABSTRACT: BACKGROUND: Research on the relationship between Health Related Quality of Life (HRQoL) and physical activity (PA), to date, have rarely investigated how this relationship differ across objective and subjective measures of PA. The aim of this paper is to explore the relationship between HRQoL and PA, and examines how this relationship differs across objective and subjective measures of PA, within the context of a large representative national survey from England. METHODS: Using a sample of 5,537 adults (40-60 years) from a representative national survey in England (Health Survey for England 2008), Tobit regressions with upper censoring was employed to model the association between HRQoL and objective, and subjective measures of PA controlling for potential confounders. We tested the robustness of this relationship across specific types of PA. HRQoL was assessed using the summary measure of health state utility value derived from the EuroQol-5 Dimensions (EQ-5D) whilst PA was assessed via subjective measure (questionnaire) and objective measure (accelerometer- actigraph model GT1M). The actigraph was worn (at the waist) for 7 days (during waking hours) by a randomly selected sub-sample of the HSE 2008 respondents (4,507 adults - 16 plus years), with a valid day constituting 10 hours. Analysis was conducted in 2010. RESULTS: Findings suggest that higher levels of PA are associated with better HRQoL (regression coefficient: 0.026 to 0.072). This relationship is consistent across different measures and types of PA although differences in the magnitude of HRQoL benefit associated with objective and subjective (regression coefficient: 0.047) measures of PA are noticeable, with the former measure being associated with a relatively better HRQoL (regression coefficient: 0.072). CONCLUSION: Objective measure of PA is associated with a relatively better HRQoL than subjective measure of PA. The nature of the constituents of the HRQoL gains associated with PA and the research and policy implications of our findings are discussed.     

Logistic feasibility of health related quality of life measurement in clinical practice: results of a prospective study in a large population of chronic liver patients

Background  

The objective of the present study was to provide a complete and detailed report of technical and logistical feasibility problems with the implementation of routine computerized HRQoL measurement at a busy outpatient department of Hepatology that can serve as a tool for future researchers interested in the procedure.     

Health-related quality of life in long-term survivors of acute lymphoblastic leukemia in childhood and adolescence

Quality of Life Research - Children with acute lymphoblastic leukemia (ALL), the commonest form of cancer in this age group, suffer considerable morbidity during treatment, with the majority...     

Studies of atherosclerosis determinants and precursors during childhood and adolescence

At a Meeting of Investigators on Epidemiological Studies of Atherosclerosis Determinants and Precursors, which was held in Geneva on 7-9 November 1983, representatives from 26 countries reviewed the current status of epidemiological studies in this area. Particular interest was shown in the following determinants of cardiovascular disease: blood pressure, blood lipid levels, body weight, pathological studies, and tobacco use. Working papers on each determinant were prepared, and recommendations were made on areas for research, and on the need for prevention programmes and pathological studies. This article summarizes the work of the meeting.     

Impact of health education on health-related quality of life among elderly persons: results from a community-based intervention study in rural Bangladesh

This study examines the change in health-related quality oflife (HRQoL) among (60 years) elderly persons as a result ofhealth education intervention. A community-based interventionstudy was performed in eight randomly selected villages (Intervention:n = 4; Control: n = 4) in rural Bangladesh. A total of 1135elderly persons was selected for this study. The analyses include839 participants (Intervention: n = 425; Control: n = 414) whoparticipated in both baseline and post-intervention surveys.Participants in the intervention area were further stratifiedinto compliant (n = 315) and non-compliant (n = 110) groupsbased on the reported compliance to the intervention activities.The intervention includes, for example, physical activity, adviceon healthy food intake and other aspects of management. To createan enabling environment, social awareness was provided by meansof information about the contribution of and challenges facedby elderly persons at home and the community, including informationabout elderly persons' health and health care. The interventionactivities were provided to the elderly persons, caregivers,household members and community people for 15 months. The HRQoLwas assessed using a multi-dimensional generic instrument designedfor elderly persons. Multivariate analyses revealed that inthe non-compliant group the probabilities of increased scoreswere less likely in overall HRQoL (OR 0.52, 95% CI 0.32–0.82).Among the Control group, increased scores were less likely inthe physical (OR 73, 95% CI 0.54–0.99), social (OR 0.37,95% CI 0.27–0.50), spiritual (OR 0.60, 95% CI 0.34–0.94),environment (OR 0.36, 95% CI 0.26–0.49) dimensions andoverall HRQoL (OR 0.44, 95% CI 0.32–0.59) (adjusted forage, sex, literacy, marital status and economic status). Thisstudy concludes that provision of community-based health educationintervention might be a potential public health initiative toenhance the HRQoL in old age.     

Cross-cultural differences in health-related quality of life of people with epilepsy: Findings from a European study

Purpose: To examine between-country differences in health-related quality of life (HRQOL) of adults with epilepsy across a large number of European countries. Methods: Self-completion postal questionnaire sent to large sample of adults with epilepsy, recruited from epilepsy support groups or epilepsy outpatient clinics. The questionnaire was developed in English and translated. Back-translations from each language were checked for accuracy. The questionnaire sought information on clinical and socio-demographic details, and contained a number of previously validated scales of psychosocial well-being (the SF-36, the perceived impact of epilepsy scale, and a feelings of stigma scale). Results: Controlling for socio-demographic and clinical characteristics, significant between-country differences were found in scores on the perceived impact of epilepsy scale, on seven of the eight SF-36 domains, and on the feelings of stigma scale. Respondents in Spain and the Netherlands fared consistently better, whilst those in France fared poorest, compared to those in other countries in terms of the various HRQOL measures used. Conclusion: Several possible reasons for the cross-cultural differences in HRQOL are proposed. Clearly, there is no single explanation and there may also be reasons which we have overlooked. This study emphasises the need for further comprehensive research in order that the position of people with epilepsy in different countries be more thoroughly understood in the social context.