The effect of family-based multidisciplinary cognitive behavioral treatment on health-related quality of life in childhood obesity

Purpose

To evaluate the effect of multidisciplinary treatment on obesity and health-related quality of life (HRQOL).

Methods

Obese children were randomized to a multidisciplinary lifestyle treatment, including medical, nutritional, physical, and psychological counseling during 3?months, (n?=?40, BMI-SDS; 4.2?±?0.7, age; 13.3?±?2.0) or standard care, including an initial advice on nutrition and physical activity by the pediatrician (n?=?39, BMI-SDS; 4.3?±?0.7, age; 13.1?±?1.9). At baseline, after 3?months of treatment and at 12?months follow-up, data were collected for BMI-SDS and a European validated questionnaire for assessing HRQOL (DISABKIDS).

Results

A significantly reduced BMI-SDS was found for the intervention group after 3?months treatment (4.0?±?0.9 vs. 4.2?±?0.7, P?=?0.02) and at 12?months follow-up (3.8?±?1.1 vs. 4.2?±?0.7, P?=?0.03). HRQOL in the intervention group was significantly improved at 12?months follow-up and unchanged in the obese control group. Agreement between child and parent report was moderate (67?C85%), with parents reporting a lower HRQOL for their obese children than children themselves in both groups.

Conclusion

Multidisciplinary treatment is effective in reducing BMI-SDS and improving HRQOL after 12?months follow-up.     

The associations among economic hardship, caregiver psychological distress, disease activity, and health-related quality of life in children with juvenile idiopathic arthritis

Purpose

To examine the associations among caregiver perceived economic hardship, psychological distress, children??s disease activity, and health-related quality of life (HRQOL) in children with juvenile idiopathic arthritis (JIA).

Methods

Caregivers of 182 children with JIA (ages 2?C18) attending the rheumatology clinics at the Montreal Children??s Hospital and the British Columbia??s Children Hospital completed a series of questionnaires on perceived financial hardship, caregiver psychological distress, and children??s HRQOL at baseline, 6 and 12?months. Clinical information such as disease activity was obtained from medical charts. Statistical models were used to look at the significance of several factors of interest while controlling for possible confounders.

Results

Higher caregiver perceived economic hardship [(???=?0.03, 95% CI?=?0.005, 0.06), P?=?0.02], psychological distress [(???=?0.02, 95% CI?=?0.006, 0.03), P?=?0.004], and higher children??s disease activity [(???=?0.11, 95% CI?=?0.07, 0.15), P?Conclusions Findings suggest that caregiver financial hardship and psychological distress as well as children??s disease activity may impact children??s HRQOL. By providing psychological help to parents, offering information regarding financial resources in the community and by ensuring disease control, especially when the disease is severe, health providers may improve children??s health outcomes.     

Health-related quality of life changes associated with buprenorphine treatment for opioid dependence

Background

Few studies have described improvement in health-related quality of life (HRQOL) associated with opioid dependence treatment with buprenorphine (ODT-B).

Objective

To evaluate HRQOL changes in domain scores, physical and mental component summaries, and health utilities (HUs) associated with ODT-B using the Short Form 36 (SF-36).

Methods

We assessed HRQOL changes in a substudy of a pharmacokinetic study that compared buprenorphine oral tablet and liquid dosage formulations over 16?weeks. Individuals, aged 18?C65?years, were screened for opioid dependence. They were excluded if they would not agree to birth control or had a serious medical condition. Subjects received psychosocial counseling and weekly group therapy. The SF-36 was administered upon enrollment and at 4-week intervals. We used the SF-6D to estimate HUs. We performed intention to treat (ITT) analyses based on the last observation available for each subject. Paired t tests of each domain and HU, limited to remaining patients at each 4-week interval, were also conducted.

Results

Of 96 subjects enrolled, cumulative dropouts over time resulted in 80, 69, 59, and 44 subjects remaining at 4, 8, 12, and 16?weeks. There were no significant differences in opioid-positive urines, dropout rates, or dosage changes between formulations. In the ITT analyses, HRQOL improvements over time were bodily pain (62.1 vs. 69.1, P?=?0.017), vitality (49.8 vs. 56.5, P?=?0.001), mental health (59.9 vs. 66.0, P?=?0.001), social function (66.4 vs. 74.7, P?=?0.001), role emotional (59.4 vs. 71.9, P?=?0.003), role physical (60.9 vs. 70.6, P?=?0.005), and mental component summary (41.9 vs. 45.4, P<0.001). HU scores also improved (0.674 vs. 0.715, P?=?0.001). Results from paired t tests, with only concurrently enrolled patients, showed similar improvements from baseline to 4, 8, 12, or 16?weeks.

Conclusion

Buprenorphine, accompanied with psychosocial counseling, was associated with improved HRQOL and HUs.     

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.     

Differences in quality of life of hemodialysis patients between dialysis centers

Purpose

Hemodialysis patients undergo frequent and long visits to the clinic to receive adequate dialysis treatment, medical guidance, and support. This may affect health-related quality of life (HRQOL). Although HRQOL is a very important management aspect in hemodialysis patients, there is a paucity of information on the differences in HRQOL between centers. We set out to assess the differences in HRQOL of hemodialysis patients between dialysis centers and explore which modifiable center characteristics could explain possible differences.

Methods

This cross-sectional study evaluated 570 hemodialysis patients from 24 Dutch dialysis centers. HRQOL was measured with the Kidney Disease Quality Of Life-Short Form (KDQOL-SF).

Results

After adjustment for differences in case-mix, three HRQOL domains differed between dialysis centers: the physical composite score (PCS, P?=?0.01), quality of social interaction (P?=?0.04), and dialysis staff encouragement (P?=?0.001). These center differences had a range of 11?C21 points on a scale of 0?C100, depending on the domain. Two center characteristics showed a clinical relevant relation with patients?? HRQOL: dieticians?? fulltime-equivalent and the type of dialysis center.

Conclusion

This study showed that clinical relevant differences exist between dialysis centers in multiple HRQOL domains. This is especially remarkable as hemodialysis is a highly standardized therapy.     

Promotion of physical activity in primary care: knowledge and practice of general practitioners and physiotherapists

Aim

Being physically active has many proven health benefits and promoting physical activity to patients in primary care is an important component of public health programmes. This study examined the knowledge and practices of general practitioners and physiotherapists in the promotion of physical activity in primary care.

Subject and methods

A cross-sectional population survey was conducted in Ireland to establish participants’ knowledge of physical activity guidelines and current practice in the promotion of physical activity. A total of 342 general practitioners (response rate 65 %; n?=?543) and 89 physiotherapists (response rate 88 %; n?=?101) responded to the survey.

Results

More physiotherapists (50.5 %; n?=?45) than general practitioners (28 %; n?=?97) correctly reported the minimal physical activity guidelines (X²?=?16.56, p?<?.005, df?=?1). General practitioners reported screening physical activity opportunistically (41 %; n?=?139) and when related to a patient’s presenting complaint (37 %; n?=?126). Physiotherapists reported screening physical activity routinely (34 %; n?=?30) and when related to the presenting complaint (28 %; n?=?25). With the exception of overweight patients, general practitioners were more likely than physiotherapists to promote physical activity to patients with known cardiovascular risk factors such as hypertension (X²?=?49.65, p?<?.001, df?=?2) and hypercholesterolemia (X²?=?32.58, p?<?.001, df?=?2). Physiotherapists, however, were more likely to promote physical activity to healthy populations (X²?=?9.91; p?<?.01, df?=?2). Education and advice was the intervention most frequently used (general practitioners 76 %; n?=?258, physiotherapists 97 %; n?=?86).

Conclusion

Despite high levels of awareness of physical activity promotion amongst general practitioners and physiotherapists, there is scope to improve physical activity promotion particularly to healthy populations and ongoing challenges to incorporate evidence based interventions into routine care.     

Contracts, Vouchers, and Child Care Subsidy Stability: A Preliminary Look at Associations between Subsidy Payment Mechanism and Stability of Subsidy Receipt

Background

The federal child care subsidy program, funded through the Child Care and Development Fund (CCDF), is the nation’s largest public investment in early child care. However, little is known about whether and how subsidy payment mechanisms relate to the stability of subsidy receipt or the stability of children’s care arrangements.

Objective

This study is the first to explore whether subsidized care administered through contracts paid directly to providers is associated with greater stability of subsidy receipt than subsidized care administered through vouchers. Hypotheses predicted that contracts would confer stability in subsidy receipt, especially among families whose children received care in family child care homes.

Methods

Data were drawn from administrative files on subsidy recipients in New York City and merged with data from a phone survey of a small subsample. The analytic sample consisted of subsidy recipients who had a history of participating in the TANF cash assistance program (weighted n?=?9,087; unweighted n?=?311).

Results

Results indicate that subsidy payment mechanism was not associated with the number of interruptions in subsidy receipt. This finding held true of children in both family- and center-based care arrangements.

Conclusions

This preliminary study finds no evidence that contracted care and care purchased with a voucher are differentially associated with subsidy stability. Replication of this test with larger samples and stronger guards against selection into type of payment mechanism is needed.     

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.     

Assessment of health-related quality of life 6 years after childhood cochlear implantation

Purpose

To examine the impact of cochlear implant (CI) intervention on health-related quality of life (HRQOL) assessed by both self- and parent-reported measures.

Methods

In this national study of children implanted between ages 6 months and 5 years, HRQOL of 129 children 6-year post-CI was compared to 62 internal study (NH1) and 185 external (NH2) samples of hearing children frequency-matched to the CI group on sociodemographic variables. HRQOL ratings of children and their parents in each group, measured using the Child Health and Illness Profile-Child Edition, were compared, and their associations with the Family Stress Scale were investigated.

Results

CI children reported overall and domain-specific HRQOL that was comparable to both NH1 and NH2 peers. CI parents reported worse child scores than NH1 parents in Achievement, Resilience, and Global score (p’s < 0.01) but similar or better scores than socioeconomically comparable NH2 parents. Higher family stress was negatively associated with all parent-reported HRQOL outcomes (p’s < 0.01). Parent–child correlations in HRQOL global scores trended higher in CI recipients (r = 0.50) than NH1 (r = 0.42) and NH2 (r = 0.35) controls.

Conclusions

CI recipients report HRQOL comparable to NH peers. These results, from both child and parent perspective, lend support to the effectiveness of CI intervention in mitigating the impact of early childhood deafness. Family stress was associated with worse HRQOL, underscoring a potential therapeutic target. Parent–child agreement in HRQOL scores was higher for CI families than NH families, which may reflect higher caregiver insight and involvement related to the CI intervention.     

Is family functioning and communication associated with health-related quality of life for Chinese- and Korean-American breast cancer survivors?

Purpose

This study aims to investigate direct and indirect pathways of family flexibility, social support, and family communication on health-related quality of life (HRQOL) for Chinese- and Korean-American breast cancer survivors (BCS).

Methods

A total of 157 Chinese (n = 86)- and Korean-American (n = 71) BCS were recruited from the California Cancer Surveillance Program and area hospitals in Los Angeles County. The present study was guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation.

Results

Structural equation modeling demonstrated that (1) family communication was directly associated with HRQOL for both groups; (2) family flexibility was indirectly associated with HRQOL through family communication for Korean-Americans only; (3) social support mediated the relationship between family flexibility and family communication for Chinese-Americans only; and (4) acculturation was directly related to social support for both groups. Multigroup analysis demonstrated that the structural paths were equivalent between Chinese- and Korean-American BCS, although statistical differences in baseline parameters were noted.

Conclusions

Our findings suggest that family communication impacts HRQOL among Asian-American BCS. Our results show that while there are commonalities in family characteristics among Asian-Americans, specific ethnic variations also exist. Therefore, specific cultural and familial contexts should be assessed to better inform interventions to enhance family communication strategies and improve HRQOL.     

‘It helps me make sense of the world’: the role of an art intervention for promoting health and wellbeing in primary care—perspectives of patients, health professionals and artists

Background

Art interventions are increasingly used in public health for the enhancement of patients’ health and wellbeing. The present study investigated perceived outcomes and role of an art intervention from the collective perspectives of participants (patients who took part), deliverers (artists) and referrers (general practitioners and practice nurses).

Methods

A qualitative methodology, using interviews and focus groups, allowed investigation of participants (n?=?18) perceived outcomes and role of the intervention. Participants included patients (n?=?10), artists (n?=?5), and referring health professionals (n?=?3).

Results

Themes that emerged from the analysis included perceived benefits, role and value of the intervention, and setting and referral process. Central to these themes were psychological and mental health benefits, an appreciated holistic treatment option and the merits of the intervention being situated in the surgery setting.

Conclusions

The study showed that art interventions within primary care are valuable in the promotion of public health, and in particular, patients’ mental health. Interactions between other participants and the artist were central to achieving patients’ perceived health improvement. Locating the intervention in primary care facilitated patient participation and provided health professionals with a holistic treatment alternative. There is also some evidence that participation in the intervention encourages less dependence on the health professional.     

Quality of life and psychological functioning in pediatric obesity: the role of body image dissatisfaction between girls and boys of different ages

Purpose

This study aims to explore the associations between weight status, body image dissatisfaction (BID), and psychosocial adjustment [quality of life (QOL), internalizing and externalizing problems] of normal-weight and obese youth. It aims to explore whether the associations between weight status and psychosocial adjustment are mediated by BID as well as the moderating role of youth’s age and gender on these associations.

Methods

The sample comprised 260 children and adolescents aged 8–18 years with normal weight (n = 128) and obesity (n = 132). All of the participants completed self-report instruments, including the KIDSCREEN-10, Strengths and Difficulties Questionnaire, and Collins Body Image scale.

Results

Obese youth, regardless of gender, reported poorer QOL, more internalizing/externalizing problems, and higher rates of BID compared with their normal-weight counterparts. BID mediated the relationship between weight status and QOL, but only for youth above 12-year old. The relationship between weight status and internalizing/externalizing problems was direct and independent of youth’s age and gender.

Conclusions

Pediatric obesity is associated with poorer psychosocial outcomes, which underlines the need for preventive and early interventions. An important target in psychological interventions seems to be BID, which proved to be an important mechanism linking obesity and decreased QOL among adolescents.     

Documenting an epidemic of suffering: low health-related quality of life among transgender youth

Purpose

To quantify HRQOL of TGN patients using the PedsQL 4.0 generic core scales, and to compare reported HRQOL of TGN adolescents with published data from comparison populations.

Methods

Transgender children and adolescents (N?=?142; 68% natal females) ages 6–23 years (M?=?15.9, SD?=?3.7) attending an outpatient clinic for TGN care at an academic pediatric hospital and caregivers of children and adolescents (N?=?95) completed the PedsQL 4.0 generic core scales. Scores were compared with published scores for healthy adolescents and adolescents with 10 chronic diseases.

Results

TGN youth reported significantly lower overall HRQOL (more than twice the clinically meaningful difference) compared to youth without chronic disease. Total self-reported TGN HRQOL (M(SD), 65.72(17.40)) was lower than all chronic disease comparison groups except for rheumatology and cerebral palsy. TGN youth reported physical functioning (M(SD), 75.33(22.87)) lower than or similar to chronically ill comparisons, but higher than rheumatology and cerebral palsy groups. Psychosocial functioning (M(SD), 59.87(17.83)) was lower than all comparison samples and similar to youth with cerebral palsy. Results were similar for parent proxy-reports of TGN youth HRQOL (LS means: 68.75; 95% CI 65.87–71.61 vs 66.16; 95% CI 62.87–69.45; p?=?0.12).

Conclusions

TGN youth reported low HRQOL across all domains; most were significantly lower than healthy peers or peers with chronic diseases. Clinicians should understand the magnitude of TGN youth’s low HRQOL and offer them and their caregivers resources to maximize their ability to achieve their full potential for healthy and productive lives.

     

H.U.B city steps: methods and early findings from a community-based participatory research trial to reduce blood pressure among african americans

Background

Although lifestyle interventions targeting multiple lifestyle behaviors are more effective in preventing unhealthy weight gain and chronic diseases than intervening on a single behavior, few studies have compared individual and combined effects of diet and/or exercise interventions on health-related quality of life (HRQOL). In addition, the mechanisms of how these lifestyle interventions affect HRQOL are unknown. The primary aim of this study was to examine the individual and combined effects of dietary weight loss and/or exercise interventions on HRQOL and psychosocial factors (depression, anxiety, stress, social support). The secondary aim was to investigate predictors of changes in HRQOL.

Methods

This study was a randomized controlled trial. Overweight/obese postmenopausal women were randomly assigned to 12 months of dietary weight loss (n = 118), moderate-to-vigorous aerobic exercise (225 minutes/week, n = 117), combined diet and exercise (n = 117), or control (n = 87). Demographic, health and anthropometric information, aerobic fitness, HRQOL (SF-36), stress (Perceived Stress Scale), depression [Brief Symptom Inventory (BSI)-18], anxiety (BSI-18) and social support (Medical Outcome Study Social Support Survey) were assessed at baseline and 12 months. The 12-month changes in HRQOL and psychosocial factors were compared using analysis of covariance, adjusting for baseline scores. Multiple regression was used to assess predictors of changes in HRQOL.

Results

Twelve-month changes in HRQOL and psychosocial factors differed by intervention group. The combined diet + exercise group improved 4 aspects of HRQOL (physical functioning, role-physical, vitality, and mental health), and stress (p ≤ 0.01 vs. controls). The diet group increased vitality score (p < 0.01 vs. control), while HRQOL did not change differently in the exercise group compared with controls. However, regardless of intervention group, weight loss predicted increased physical functioning, role-physical, vitality, and mental health, while increased aerobic fitness predicted improved physical functioning. Positive changes in depression, stress, and social support were independently associated with increased HRQOL, after adjusting for changes in weight and aerobic fitness.

Conclusions

A combined diet and exercise intervention has positive effects on HRQOL and psychological health, which may be greater than that from exercise or diet alone. Improvements in weight, aerobic fitness and psychosocial factors may mediate intervention effects on HRQOL.     

Health-related quality of life in mothers of children with epilepsy: 10 years after diagnosis

Purpose

Epilepsy in childhood extends far beyond seizures and affects child and parental well-being. The long-term impact of childhood-onset epilepsy on parental well-being is unknown. This study assessed health-related quality of life (HRQOL) in mothers 10 years after their child’s diagnosis of epilepsy.

Methods

Data come from the Health-Related Quality of Life in Children with Epilepsy Study, a multicenter prospective cohort study of children with newly diagnosed epilepsy. Mothers completed a mailed questionnaire at the 10-year follow-up, which included the Short-Form Health Survey (SF-12-v2) to evaluate the physical and mental health components of their HRQOL. Block-wise linear regressions identified child/epilepsy, maternal/family, and maternal psychosocial factors associated with mothers’ HRQOL.

Results

A total of 159 mothers participated in this study (46% of the sample assessed at baseline). At follow-up, 69% of youth had been seizure free for the past 5 years. Mothers scored similarly to population norms (mean: 50, SD: 10) on the mental health subscale (mean: 49.5, SD: 9.3) and significantly better on the physical health subscale (mean: 53.0, SD: 7.6). Better family resources were associated with higher (better) scores on the physical health subscale (B?=?0.20; 95% CI 0.03, 0.36). Better family functioning (B?=?0.34; 95% CI 0.06, 0.62), fewer maternal depressive symptoms (B?=?0.33; 95% CI 0.20, 0.47), and perception of less stress (B?=?0.70; 95% CI 0.52, 0.88) were associated with higher (better) scores on the mental health subscale.

Conclusion

Ten years after the diagnosis of epilepsy in children, the HRQOL of mothers was similar to reports from women in the general population. This study identified factors contributing to better maternal HRQOL and highlights the importance of family environment over epilepsy-related variables.

     

Impact of care at foster homes on the health-related quality of life of HIV-infected children and adolescents: a cross-sectional study from India

Purpose

To assess the impact of care at foster homes on the health-related quality of life (HRQOL) of children living with HIV (CLHIV), attending a referral ART Centre, and to compare their HRQOL with children living in their own homes.

Methods

A cross-sectional study was conducted in 144 CLHIV between 5 and 18 years of age, attending a referral ART Centre in South India to assess their HRQOL using the standard PedsQL? 4.0 questionnaire. Data were then analysed to compare the HRQOL of children living in foster homes to those children living in their own homes. The child report and the parent proxy-report on the child’s HRQOL were also compared to see for any differences in their perspectives.

Results

56.25% CLHIV were brought up in different foster homes. In the child’s self-report, the mean HRQOL was higher for children living in foster homes [physical score (76.54?±?12.40), psychosocial score (71.41?±?12.40) and total score (73.20?±?11.13)] when compared to children living in their own homes [physical score (75.09?±?14.76), psychosocial score (70.60?±?13.48) and total score (72.17?±?12.00)]. There was no statistically significant difference in the HRQOL between these two groups (p?>?0.05). In the parent proxy-report also, there was no statistically significant difference in the HRQOL in all the three scores. The child self-report depicted a significantly higher HRQOL in all the domains compared to the parent proxy-report (p?<?0.05).

Conclusions

HRQOL of children living in foster homes is at par with the quality of life enjoyed by children living in their own homes. Foster care manages to provide a reasonable HRQOL in CLHIV, and has become an inseparable component of quality health care delivery for these children.

     

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.